Legislature(2019 - 2020)GRUENBERG 120

03/07/2019 03:00 PM STATE AFFAIRS

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Audio Topic
03:01:31 PM Start
03:02:06 PM Confirmation Hearing(s)
03:02:15 PM Department of Administration, Commissioner
03:03:39 PM Presentation(s): Medicaid Hospitals Impact on State Health Insurance Costs
03:51:02 PM HB34
03:58:36 PM HB12
04:26:21 PM HB14
04:49:09 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentation: Medicaid Hospitals Impact on State TELECONFERENCED
Health Insurance Costs
+= HB 34 NAMING SCOTT JOHNSON MEMORIAL BRIDGE TELECONFERENCED
Moved HB 34 Out of Committee
-- Public Testimony --
+= HB 12 PROTECTIVE ORDERS TELECONFERENCED
Moved CSHB 12(STA) Out of Committee
-- Public Testimony --
+= HB 14 ASSAULT; SEX OFFENSES; SENT. AGGRAVATOR TELECONFERENCED
Moved CSHB 14(STA) Out of Committee
-- Public Testimony --
                    ALASKA STATE LEGISLATURE                                                                                  
             HOUSE STATE AFFAIRS STANDING COMMITTEE                                                                           
                         March 7, 2019                                                                                          
                           3:01 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Zack Fields, Co-Chair                                                                                            
Representative Jonathan Kreiss-Tomkins, Co-Chair                                                                                
Representative Gabrielle LeDoux                                                                                                 
Representative Andi Story                                                                                                       
Representative Adam Wool                                                                                                        
Representative Sarah Vance                                                                                                      
Representative Laddie Shaw                                                                                                      
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
CONFIRMATION HEARING(S)                                                                                                         
                                                                                                                                
Alaska Department of Administration, Commissioner                                                                             
                                                                                                                                
     Kelly Tshibaka - Anchorage                                                                                                 
                                                                                                                                
     - CONFIRMATION(S) ADVANCED                                                                                                 
                                                                                                                                
PRESENTATION(S): MEDICAID HOSPITALS IMPACT ON STATE HEALTH                                                                      
INSURANCE COSTS                                                                                                                 
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
HOUSE BILL NO. 34                                                                                                               
"An Act naming the Scott Johnson Memorial Bridge."                                                                              
                                                                                                                                
     - MOVED HB 34 OUT OF COMMITTEE                                                                                             
                                                                                                                                
HOUSE BILL NO. 12                                                                                                               
"An Act relating to protective orders."                                                                                         
                                                                                                                                
     - MOVED CSHB 12(STA) OUT OF COMMITTEE                                                                                      
                                                                                                                                
HOUSE BILL NO. 14                                                                                                               
"An Act relating to assault in the first degree; relating to sex                                                                
offenses; relating to the definition of 'dangerous instrument';                                                                 
and providing for an aggravating factor at sentencing for                                                                       
strangulation that results in unconsciousness."                                                                                 
                                                                                                                                
     - MOVED CSHB 14(STA) OUT OF COMMITTEE                                                                                      
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB  34                                                                                                                  
SHORT TITLE: NAMING SCOTT JOHNSON MEMORIAL BRIDGE                                                                               
SPONSOR(s): REPRESENTATIVE(s) TALERICO                                                                                          
                                                                                                                                
02/20/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/20/19       (H)       STA, TRA                                                                                               
02/28/19       (H)       STA AT 3:00 PM GRUENBERG 120                                                                           
02/28/19       (H)       Heard & Held                                                                                           
02/28/19       (H)       MINUTE(STA)                                                                                            
03/07/19       (H)       STA AT 3:00 PM GRUENBERG 120                                                                           
                                                                                                                                
BILL: HB  12                                                                                                                  
SHORT TITLE: PROTECTIVE ORDERS                                                                                                  
SPONSOR(s): REPRESENTATIVE(s) KOPP                                                                                              
                                                                                                                                
02/20/19       (H)       PREFILE RELEASED 1/7/19                                                                                
02/20/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/20/19       (H)       STA, JUD                                                                                               
02/28/19       (H)       STA AT 3:00 PM GRUENBERG 120                                                                           
02/28/19       (H)       Heard & Held                                                                                           
02/28/19       (H)       MINUTE(STA)                                                                                            
03/07/19       (H)       STA AT 3:00 PM GRUENBERG 120                                                                           
                                                                                                                                
BILL: HB  14                                                                                                                  
SHORT TITLE: ASSAULT; SEX OFFENSES; SENT. AGGRAVATOR                                                                            
SPONSOR(s): REPRESENTATIVE(s) LINCOLN                                                                                           
                                                                                                                                
02/20/19       (H)       PREFILE RELEASED 1/7/19                                                                                
02/20/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/20/19       (H)       STA, JUD                                                                                               
02/28/19       (H)       STA AT 3:00 PM GRUENBERG 120                                                                           
02/28/19       (H)       Heard & Held                                                                                           
02/28/19       (H)       MINUTE(STA)                                                                                            
03/07/19       (H)       STA AT 3:00 PM GRUENBERG 120                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
KELLY TSHIBAKA, Commissioner Designee                                                                                           
Department of Administration (DOA)                                                                                              
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Testified  as commissioner designee  to the                                                             
Department of Administration.                                                                                                   
                                                                                                                                
BECKY HULTBERG, President/CEO                                                                                                   
Alaska State Hospital Association (ASHA)                                                                                        
Anchorage, Alaska                                                                                                               
POSITION   STATEMENT:     Provided  a   PowerPoint  presentation,                                                             
entitled  "The  impact of  Medicaid  in  hospitals and  in  their                                                               
communities."                                                                                                                   
                                                                                                                                
PHIL HOFSTETTER, Chief Executive Officer (CEO)                                                                                  
Petersburg Medical Center (PMC)                                                                                                 
Petersburg, Alaska                                                                                                              
POSITION   STATEMENT:     Provided  a   PowerPoint  presentation,                                                             
entitled "The impact of Medicaid  at Petersburg Medical Center, a                                                               
rural critical access hospital in Petersburg."                                                                                  
                                                                                                                                
BUD JOHNSON                                                                                                                     
Tok, Alaska                                                                                                                     
POSITION STATEMENT:  Testified in support of HB 34.                                                                           
                                                                                                                                
SUE STANCLIFF                                                                                                                   
Tok, Alaska                                                                                                                     
POSITION STATEMENT:  Testified in support of HB 34.                                                                           
                                                                                                                                
DAVE STANCLIFF                                                                                                                  
Tok, Alaska                                                                                                                     
POSITION STATEMENT:  Testified in support of HB 34.                                                                           
                                                                                                                                
REPRESENTATIVE CHUCK KOPP                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Testified as the sponsor of  HB 12, Version                                                             
S.                                                                                                                              
                                                                                                                                
ROBIN MITCHELL                                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   Testified  during the  hearing  on HB  12,                                                             
Version S.                                                                                                                      
                                                                                                                                
ADAM FLETCHER                                                                                                                   
Eagle River                                                                                                                     
POSITION  STATEMENT:   Testified  during the  hearing  on HB  12,                                                             
Version S.                                                                                                                      
                                                                                                                                
TASHINA FLETCHER                                                                                                                
Eagle River                                                                                                                     
POSITION STATEMENT:  Testified during the hearing on HB 12,                                                                   
Version S.                                                                                                                      
                                                                                                                                
CHERI SMITH, Executive Director                                                                                                 
The LeeShore Center                                                                                                             
Kenai, Alaska                                                                                                                   
POSITION STATEMENT:  Testified in support of HB 12, Version S.                                                                
                                                                                                                                
TERYN BIRD                                                                                                                      
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 12, Version S.                                                                
                                                                                                                                
CHRISTINE PATE, Legal Program Director                                                                                          
Alaska Network on Domestic Violence and Sexual Assault (ANDVSA)                                                                 
Sitka, Alaska                                                                                                                   
POSITION STATEMENT:  Testified in support of HB 12, Version S.                                                                
                                                                                                                                
CARMEN LOWRY, Executive Director                                                                                                
Alaska Network on Domestic Violence and Sexual Assault (ANDVSA)                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 12, Version S.                                                                
                                                                                                                                
KEN TRUITT, Staff                                                                                                               
Representative Chuck Kopp                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during the hearing on HB                                                              
12, Version S, on behalf of Representative Kopp, prime sponsor.                                                                 
                                                                                                                                
MAGGIE HUMM, Supervising Attorney                                                                                               
Alaska Legal Services Corporation (ALSC)                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions during the hearing on HB                                                              
12, Version S.                                                                                                                  
                                                                                                                                
CHERI SMITH, Executive Director                                                                                                 
The LeeShore Center                                                                                                             
Kenai, Alaska                                                                                                                   
POSITION STATEMENT:  Testified in support of HB 14, Version E.                                                                
                                                                                                                                
SHERRY MILLER                                                                                                                   
Eagle River, Alaska                                                                                                             
POSITION STATEMENT:  Testified in support of HB 14, Version E.                                                                
                                                                                                                                
ISSAC WILLIAMS                                                                                                                  
No More Free Passes                                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 14, Version E.                                                                
                                                                                                                                
JAENELL MANCHESTER                                                                                                              
49th Rising                                                                                                                     
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 14, Version E.                                                                
                                                                                                                                
NATASHA GAMACHE                                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 14, Version E.                                                                
                                                                                                                                
DESERIE BOND                                                                                                                    
Dillingham, Alaska                                                                                                              
POSITION STATEMENT:  Testified in support of HB 14, Version E.                                                                
                                                                                                                                
DOROTHY KOLEROK                                                                                                                 
Palmer, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 14, Version E.                                                                
                                                                                                                                
CARMEN LOWRY, Executive Director                                                                                                
Alaska Network on Domestic Violence and Sexual Assault (ANDVSA)                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 14, Version E.                                                                
                                                                                                                                
REPRESENTATIVE JOHN LINCOLN                                                                                                     
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified on HB 14, Version E, as prime                                                                  
sponsor.                                                                                                                        
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:01:31 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZACK FIELDS  called the  House  State Affairs  Standing                                                             
Committee meeting to order at  3:01 p.m.  Representatives LeDoux,                                                               
Story, Shaw, Kreiss-Tomkins, and Fields  were present at the call                                                               
to order.  Representatives Wool  and Vance arrived as the meeting                                                               
was in progress.                                                                                                                
                                                                                                                                
^CONFIRMATION HEARING(S)                                                                                                        
                    CONFIRMATION HEARING(S)                                                                                 
                                                                                                                              
3:02:06 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS announced that the first order of business would                                                                
be confirmation hearings.                                                                                                       
                                                                                                                                
^Department of Administration, Commissioner                                                                                     
           Department of Administration, Commissioner                                                                       
                                                                                                                              
3:02:15 PM                                                                                                                    
                                                                                                                                
KELLY    TSHIBAKA,   Commissioner    Designee,   Department    of                                                               
Administration (DOA),  shared with the committee  that the intent                                                               
of  her opening  statement at  the [3/5/19]  House State  Affairs                                                               
Standing   Committee   (HSTA)   meeting   was   not   to   attack                                                               
Representative  Fields in  any way.   She  said, "If  my comments                                                               
were taken  in that way,  I sincerely apologize."   She continued                                                               
by saying her  intent was to address the questions  that had been                                                               
raised.                                                                                                                         
                                                                                                                                
CO-CHAIR FIELDS replied,  "I want to say clearly it  was never my                                                               
intent to  question your faith, but  simply to get on  the record                                                               
that  you  can be  a  fair  administrator  at the  Department  of                                                               
Administration, including for a diverse workforce."                                                                             
                                                                                                                                
3:03:06 PM                                                                                                                    
                                                                                                                                
CO-CHAIR   KREISS-TOMKINS  moved   to  forward   the  resume   of                                                               
Commissioner Designee  Kelly Tshibaka  from the committee  to the                                                               
joint session  [of the House  and Senate] for consideration.   He                                                               
stated that doing  so does not reflect the intent  of any members                                                               
to  vote  for  or  against this  individual  during  any  further                                                               
sessions for the purposes of this confirmation.                                                                                 
                                                                                                                                
[Because the confirmation hearing on  Commissioner of DOA was not                                                               
noticed  as an  agenda item  for the  3/7/19 House  State Affairs                                                               
Standing  Committee  meeting,  the confirmation  of  Commissioner                                                               
Designee Kelly  Tshibaka was advanced  from committee  during the                                                               
3/12/19 HSTA meeting.]                                                                                                          
                                                                                                                                
3:03:27 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease at 3:03 p.m.                                                                                 
                                                                                                                                
^PRESENTATION(S):  Medicaid  Hospitals  Impact  on  State  Health                                                               
Insurance Costs                                                                                                                 
   PRESENTATION(S): Medicaid Hospitals Impact on State Health                                                               
                        Insurance Costs                                                                                     
                                                                                                                              
3:03:39 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS announced  that the next order  of business would                                                               
be  presentations  by Becky  Hultberg,  President  of the  Alaska                                                               
State  Hospital and  Nursing Home  Association (ASHNHA)  and Phil                                                               
Hofstetter, Chief  Executive Officer (CEO) of  Petersburg Medical                                                               
Center.                                                                                                                         
                                                                                                                                
3:04:20 PM                                                                                                                    
                                                                                                                                
BECKY HULTBERG, President/CEO,  Alaska State Hospital Association                                                               
(ASHA), stated  that she is  before the committee to  discuss the                                                               
difficult  choices  that  the  legislature  faces  regarding  the                                                               
Medicaid program,  which is an important  component of healthcare                                                               
services   in  Alaska   and  specifically   contributes  to   the                                                               
healthcare  infrastructure that  many Alaskans  use and  take for                                                               
granted.                                                                                                                        
                                                                                                                                
MS. HULTBERG  referred to slide  2, entitled  "Medicaid matters,"                                                               
and asked,  "Why is Medicaid important  to the state?   Why is it                                                               
important specifically in  the hospital context?"   She said that                                                               
Medicaid  covers  a large  percentage  of  hospital services;  in                                                               
other  words, it  constitutes a  large percentage  of the  "payer                                                               
mix."   She offered that  another way  to view the  importance of                                                               
Medicaid to a  hospital is to look at the  percentage of patients                                                               
coming  into a  hospital  for  specific services.    She gave  an                                                               
example using the  data reported by one Alaska  hospital in 2018:                                                               
21  percent  of  general  acute   hospital  stays  were  Medicaid                                                               
patients;  34 percent  of emergency  department (ED)  visits were                                                               
Medicaid patients;  and 60%  of visits to  the ED  for behavioral                                                               
health were  Medicaid visits.   She relayed  that the  budget put                                                               
forth by the governor [Governor  Michael J. Dunleavy] for [fiscal                                                               
year  2020  (FY  20)]  calls  for  a  reduction  in  Medicaid  of                                                               
approximately  35 percent.   She  maintained that  the impact  of                                                               
pulling that money  out of the healthcare  system is significant,                                                               
given the percentage of patients covered by Medicaid.                                                                           
                                                                                                                                
MS. HULTBERG moved on to  slide 3, entitled "Background: EMTALA,"                                                               
to point  out a foundational  principle for hospitals.   A person                                                               
can walk into an ED anywhere in  the country and be treated.  The                                                               
person does not need to demonstrate  ability to pay or prove that                                                               
he/she has the resources to pay;  it is assumed that the hospital                                                               
will  provide the  person with  care.   She  explained that  this                                                               
provision is  due to  the Emergency  Medical Treatment  and Labor                                                               
Act (EMTALA),  which requires hospitals  to accept  anyone coming                                                               
into a hospital  ED regardless of his/her ability to  pay, if the                                                               
condition can be  reasonably considered an emergency.   She added                                                               
that just  about every circumstance  could be  reasonably assumed                                                               
by a  lay person to be  an emergency.  Hospitals  have been under                                                               
this   obligation  since   the  mid-90s,   and  from   a  mission                                                               
standpoint, would abide by this principal regardless.                                                                           
                                                                                                                                
MS.  HULTBERG  turned  to  slide  4,  entitled  "EMTALA:  why  it                                                               
matters," and  stated that  it matters for  a couple  of reasons.                                                               
She asked, "What's  the government's role in  healthcare? Is this                                                               
an  appropriate   role  for   the  government   as  a   payer  in                                                               
healthcare?"   She  stated that  the reality  is that  government                                                               
already has a  significant role, because society  has decided the                                                               
public  has  a right  to  healthcare;  however, society  has  not                                                               
decided how  to pay for that  healthcare or who will  deliver it.                                                               
She offered  that there  is no  safety net,  such as  EMTALA, for                                                               
other  basic services,  such  as  food, shelter,  or  heat.   She                                                               
declared, "We have accepted that  healthcare is different.  We're                                                               
not going to let people go  untreated."  She reiterated that what                                                               
hasn't been  decided is how  to pay for  it and the  best setting                                                               
for that  care.  She  added that  during the [November  30, 2018]                                                               
earthquake [in  South Central  Alaska] all  the hospitals  in the                                                               
area stayed open.                                                                                                               
                                                                                                                                
3:09:18 PM                                                                                                                    
                                                                                                                                
MS. HULTBERG asked,  "Who pays for this service  when anybody can                                                               
go in  the ED and  not necessarily have to  pay the bills?"   She                                                               
said that  the assumption is that  hospitals pay for it,  but the                                                               
reality  is  that  everyone  pays  for  it  -  through  insurance                                                               
premiums, Medicaid dollars, Medicare, and other programs.                                                                       
                                                                                                                                
MS. HULTBERG  referred to slide 5,  entitled "Uncompensated care:                                                               
big picture," and stated that  when patients come into a hospital                                                               
with  no  source  of  payment,  it  results  in  what  is  called                                                               
"uncompensated  care."   She explained  that healthcare  does not                                                               
come without  a cost, and the  cost is great.   The definition of                                                               
uncompensated  care  is  an  overall  measure  of  hospital  care                                                               
provided for  which no payment  was received from the  patient or                                                               
insurer.   It is the  sum of the  hospital's bad debt,  which the                                                               
hospital will  have to write  off, plus the  financial assistance                                                               
the hospital  provides, that is,  voluntarily forgiving  the debt                                                               
of patients who  cannot pay.  She continued by  saying that since                                                               
2000,  hospitals   have  provided  more  than   $620  billion  in                                                               
uncompensated care in the U.S.                                                                                                  
                                                                                                                                
MS. HULTBERG  referred to slide 6,  entitled "Uncompensated care:                                                               
Alaska,"  and  pointed out  that  the  chart, entitled  "Hospital                                                               
uncompensated  care: October  2018,"  displays the  uncompensated                                                               
care for  Alaska hospitals  from 2011-2016.   She noted  that the                                                               
data  understates  the  impact  of  uncompensated  care,  because                                                               
ASHNHA does not  get data on uncompensated care from  most of the                                                               
tribal  hospitals;  they do  not  file  the  same reports.    She                                                               
pointed out  the impact of  Medicaid expansion on  hospital care:                                                               
from 2011  through 2015, uncompensated  care was  trending around                                                               
$85-95 million;  in 2016, it dropped  to $50 million; that  was a                                                               
direct result of  Medicaid expansion.  She said  that if Medicaid                                                               
expansion  was repealed  or if  the governor's  proposed Medicaid                                                               
cuts  translated  to a  one-third  reduction  in Medicaid,  large                                                               
amounts of money would be eliminated from the healthcare system.                                                                
                                                                                                                                
MS.  HULTBERG  moved  on  to  slide 7,  entitled  "Who  pays  for                                                               
uncompensated  care?"   She  said  that  when uncompensated  care                                                               
increases, hospitals  still must cover  the cost of care.   Other                                                               
payers, such as  Medicare and Medicaid, do not cover  the cost of                                                               
care.  If  the hospital is receiving 85 cents  on the dollar from                                                               
60 percent  of its patients, it  needs to make up  the difference                                                               
somewhere else.   To make  up the  difference and keep  the doors                                                               
open,  the  following   takes  place:    costs   are  shifted  to                                                               
commercial insurance, which  raises insurance premiums; community                                                               
services  are  cut  back,  such  as  services  to  the  homeless,                                                               
education programs  in schools, and subsidized  medical services;                                                               
and hospital services are cut back.                                                                                             
                                                                                                                                
MS.  HULTBERG turned  to slide  8, entitled  "Uncompensated care:                                                               
key questions," and  asked, "What would happen  if current visits                                                               
that are covered by Medicaid  turn into uncompensated care?"  She                                                               
noted  that this  could  happened either  through  the repeal  of                                                               
Medicaid expansion or just through big Medicaid cuts.                                                                           
                                                                                                                                
3:13:29 PM                                                                                                                    
                                                                                                                                
MS.  HULTBERG  addressed  the  key  questions  by  reviewing  the                                                               
answers  on  slides  9  and  10,  entitled  "Uncompensated  care:                                                               
answering the questions UC impact on patients," as follows:                                                                     
                                                                                                                                
       ? What is the impact on the patients who will lose                                                                       
     access to services?                                                                                                        
                                                                                                                                
     Potential for worsening  physical and behavioral health                                                                    
     conditions:   "multiple  new   studies  demonstrate   a                                                                    
     positive  association  between   expansion  and  health                                                                    
     outcomes"                                                                                                                  
                                                                                                                                
MS. HULTBERG relayed that when  patients lose access to services,                                                               
they often wait  to seek medical care and end  up in the hospital                                                               
ED;  therefore, in  many cases,  conditions  that were  treatable                                                               
become more costly and difficult to treat.  She continued:                                                                      
                                                                                                                                
     ?  What is  the impact  on the  community of  untreated                                                                    
     medical and behavioral health conditions?                                                                                  
                                                                                                                                
     Potential  increase in  crime: "We  find that  Medicaid                                                                    
     expansions led to  an economically meaningful reduction                                                                    
     in  the  rates  of   robbery,  aggravated  assault  and                                                                    
     larceny theft."                                                                                                            
                                                                                                                                
MS. HULTBERG stated Alaska has  experienced an uptick in crime in                                                               
the last several years; much of  the crime has been documented to                                                               
be related to substance abuse and  addiction.  She said that when                                                               
fewer people  have access to  treatment - when  behavioral health                                                               
conditions are  not treated -  there is a potential  for increase                                                               
in crime.  She added that  there are many other community impacts                                                               
of a  less healthy population who  do not have access  to care at                                                               
the appropriate care center.  She continued:                                                                                    
                                                                                                                                
     ? What  is the impact  on the community of  a reduction                                                                    
     in hospital services?                                                                                                      
                                                                                                                                
     Patients forego  treatment or  must travel  outside the                                                                    
     community for care.                                                                                                        
                                                                                                                                
MS. HULTBERG  maintained that Alaska  now has many  services that                                                               
it didn't have decades ago;  however, with significant reductions                                                               
in Medicaid,  some of those  services will be  eliminated causing                                                               
people to have to travel south for care.                                                                                        
                                                                                                                                
REPRESENTATIVE LEDOUX asked, "What services would go away?"                                                                     
                                                                                                                                
MS. HULTBERG suggested that some  of the pediatric subspecialties                                                               
may go away, because the volume  of patients is low.  She offered                                                               
to  provide  the  committee  with   a  list  of  those  pediatric                                                               
services.   She stated  that it might  be beneficial  to identify                                                               
the services  that have  been added in  recent years  and whether                                                               
the volume of patients served supports them.  She continued:                                                                    
                                                                                                                                
     ? What  are the impacts on  individual health insurance                                                                    
     premiums?                                                                                                                  
                                                                                                                                
     According to  Alaska Legislative Research  Services, "?                                                                    
     the result  of reversing  expansion would  be increases                                                                    
     in  commercial health  insurance  premiums of  3 to  17                                                                    
     percent."                                                                                                                  
                                                                                                                                
MS. HULTBERG  gave an  example:   If 30  percent of  a hospital's                                                               
patient volume is  Medicaid, currently there is  a payment source                                                               
for  those  patients.   Without  that  payment source  for  those                                                               
patients, the hospital  would be absorbing the full  cost of that                                                               
treatment   without  any   revenue;   therefore,   it  would   be                                                               
uncompensated  care.   When  hospitals  have uncompensated  care,                                                               
they  must cost  shift to  insurance to  make up  the difference,                                                               
thus,  driving  up the  cost  of  insurance  for everyone.    She                                                               
continued:                                                                                                                      
                                                                                                                                
       What are the impacts on state and local government                                                                       
     costs?                                                                                                                     
                                                                                                                                
     According to the report cited below, "? the full-year                                                                      
     increase   on    aggregate   spending    over   current                                                                    
     projections would be $32.1 million to $181.0 million."                                                                     
                                                                                                                                
MS. HULTBERG reminded the committee  that if the funds are state,                                                               
then  they  are  general  fund  (GF)  dollars.    Medicaid  is  a                                                               
combination  of [state]  Medicaid funds  and federal  funds.   By                                                               
foregoing   federal  funds   -   through   cutting  Medicaid   or                                                               
eliminating expansion - the cost  shift becomes totally a GF cost                                                               
shift.                                                                                                                          
                                                                                                                                
MS. HULTBERG summarized by saying  that Medicaid is a significant                                                               
part of the  hospital payer mix; it is a  significant part of the                                                               
healthcare infrastructure;  and when you start  eliminating parts                                                               
of the  infrastructure, there  are consequences.   She  urged the                                                               
committee  to  clearly articulate  and  provide  context for  the                                                               
choices it makes.                                                                                                               
                                                                                                                                
3:19:37 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  FIELDS mentioned  a previous  presentation on  cost and                                                               
impacts  of  expansion  on  the  state.   He  recalled  from  the                                                               
presentation that  the data demonstrated that  Medicaid expansion                                                               
to date  has been net  revenue positive  for the State  of Alaska                                                               
because of  positive cost shifts from  fifty-fifty match programs                                                               
to ninety-ten  or even 100  percent match programs.   He declared                                                               
that  it  is a  remarkable  achievement  that the  state  brought                                                               
health insurance to 47,000 Alaskans at  zero net cost in terms of                                                               
GF, as  well as $1  billion in  federal revenue and  thousands of                                                               
jobs.   He offered  to provide  the committee  with the  study on                                                               
Medicaid cost impacts to GF.                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS  asked, "How  many Alaskans  are on  Medicaid and                                                               
what portion of that is the [Medicaid] expansion population?"                                                                   
                                                                                                                                
MS. HULTBERG  responded that  approximately 210,000  Alaskans are                                                               
on Medicaid.   She  added that  she did  not know  the percentage                                                               
covered  through  Medicaid  expansion   but  would  provide  that                                                               
information.                                                                                                                    
                                                                                                                                
CO-CHAIR  FIELDS asked  whether Medicaid  was one  of the  larger                                                               
health insurance programs in the state.                                                                                         
                                                                                                                                
MS. HULTBERG  expressed her belief  that Medicaid is  the largest                                                               
payer; the  only program that  could rival  it is Medicare.   She                                                               
maintained that  Medicare and Medicaid  are 60-70 percent  of the                                                               
revenue to  a hospital.   She stated  that the country  is moving                                                               
from commercial insurance, which used  to insure about 40 percent                                                               
of the  population, to public  insurance programs -  Medicare and                                                               
Medicaid.    She  added  that  due to  an  aging  population  the                                                               
Medicare share of patients is growing quickly in Alaska.                                                                        
                                                                                                                                
CO-CHAIR FIELDS relayed that one  of the underreported aspects of                                                               
Medicaid in  Alaska throughout the  last few years is  that there                                                               
has   been   incredible   progress  in   cost   containment   and                                                               
efficiencies.     He   credited   previous  administrations   and                                                               
bipartisan  legislative work.    He requested  that Ms.  Hultberg                                                               
speak  to  the achievement  of  lower  per  capita costs  in  the                                                               
Medicaid program.                                                                                                               
                                                                                                                                
MS. HULTBERG responded that the  state is spending about the same                                                               
in GF  dollars today as in  2015.  She said  that essentially the                                                               
program  has not  grown  from a  fiscal  standpoint, even  though                                                               
47,000  more Alaskans  have insurance  coverage.   She said  that                                                               
there are  a few reasons  for that:   One contributing  factor is                                                               
that  through the  good  work of  the  last administration,  more                                                               
federal  funds can  be claimed  for Indian  Health Service  (IHS)                                                               
beneficiaries  receiving care  outside of  the IHS  system.   The                                                               
federal matching  percentage (FMAP) for  those claims is  now 100                                                               
percent,  whereas before  it was  only  50 percent.   The  second                                                               
contributing factor is that the  Medicaid expansion match - which                                                               
started out  at 100  percent and  declined to  90 percent  - will                                                               
always  be greater  than 90  percent for  Alaska, because  of the                                                               
number of  Alaska beneficiaries under  IHS and, thus,  covered at                                                               
100  percent.   She stated  that  because of  those two  factors,                                                               
Alaska's match is about 93 percent.                                                                                             
                                                                                                                                
3:23:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SHAW  offered, "Our  best defense  as legislators,                                                               
and  especially  in  this  committee,  to  benefit  Medicaid  and                                                               
Medicare is to  visualize or give thought  to uncompensated care.                                                               
Would you agree?"                                                                                                               
                                                                                                                                
MS.  HULTBERG  reiterated  that   there  is  an  assumption  that                                                               
hospitals pay for uncompensated care,  because it is the hospital                                                               
that  treats patients  who cannot  pay; however,  the reality  is                                                               
that  everyone  pays for  uncompensated  care,  and by  foregoing                                                               
Medicaid dollars, they will pay more  for it.  If Medicaid is cut                                                               
significantly  or  if expansion  is  eliminated,  Alaska loses  a                                                               
tremendous amount  of federal dollars  in the system.   The money                                                               
will have  to come from  somewhere to support  the infrastructure                                                               
of the system or the system will change dramatically.                                                                           
                                                                                                                                
3:25:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX asked whether all hospitals have an ED.                                                                   
                                                                                                                                
MS.  HULTBERG  replied  that  under   Centers  for  Medicare  and                                                               
Medicaid Services (CMS) rules, to  be a hospital, a facility must                                                               
have an ED  staffed 24/7.  She  said that clinics do  not have to                                                               
have an ED;  the best example of that is  the clinic in Unalaska,                                                               
where the  ED is not  staffed 24 hours per  day.  She  added that                                                               
there  are challenges  for rural  hospitals;  the rural  hospital                                                               
financial model is  not working well anywhere.  She  said that at                                                               
the  national  level  and  the state  level,  there  are  ongoing                                                               
discussions about  the future  of rural  healthcare and  the need                                                               
for EDs.                                                                                                                        
                                                                                                                                
REPRESENTATIVE  STORY relayed  that  the concern  she hears  most                                                               
often  is  that  of  the   federal  payment  for  Medicaid  being                                                               
eliminated.  She  asked Ms. Hultberg to speak  to the possibility                                                               
of a reduction of the 90 percent federal match.                                                                                 
                                                                                                                                
MS.  HULTBERG  answered  that  the match  rate  is  currently  in                                                               
federal law.   She added that  she doubts that the  U.S. Congress                                                               
would  attempt  to  reduce  that   match  rate;  it  would  be  a                                                               
significant "lift"  for Congress; it's more  likely that Congress                                                               
would look for other changes.   She acknowledged that some states                                                               
have instituted  clauses in their  Medicaid statutes  calling for                                                               
some action should the match rate go below 90 percent.                                                                          
                                                                                                                                
CO-CHAIR FIELDS  offered that  Alaska has  received a  97 percent                                                               
match to date  resulting partially from the  changing ratios over                                                               
time and  from a larger  tribal population.   He recalled  from a                                                               
previous  hearing  that  Medicaid expansion  has  enabled  tribal                                                               
providers to  enroll more participants  with 100  percent federal                                                               
match, now totaling 21 percent  of the Medicaid population.  Even                                                               
at  a constant  90 percent  rate,  because the  number of  tribal                                                               
beneficiaries will  continue to increase, Alaska  will exceed the                                                               
90 percent threshold.                                                                                                           
                                                                                                                                
CO-CHAIR FIELDS asked for confirmation  that during the recession                                                               
of the  last few years and  continuing, the only sector  that has                                                               
consistently created jobs  is healthcare.  He  maintained that in                                                               
Anchorage, some of  the only development has  been dental clinics                                                               
and  other development  directly  resulting  from the  [Medicaid]                                                               
expansion  population.   He mentioned  the legislature's  role in                                                               
making budgetary  decisions associated with Medicaid  funding and                                                               
asked whether there  are infrastructure and services  that are at                                                               
risk  in  Southcentral  Alaska  -  either  in  Anchorage  or  the                                                               
Matanuska-Susitna  (Mat-Su)  -  as  a result  of  the  governor's                                                               
budget.                                                                                                                         
                                                                                                                                
MS.  HULTBERG  replied  that  like  any  other  business  sector,                                                               
healthcare relies on  a stable business climate in  order to make                                                               
investments.  She acknowledged  that Alaska's healthcare industry                                                               
has   made  a   great   number  of   investments  in   healthcare                                                               
infrastructure over 20  years: however, there are  still areas of                                                               
need.    She  cited  that  one area  is  behavioral  health;  the                                                               
industry   is  experiencing   a  crisis   involving  the   Alaska                                                               
Psychiatric  Institute  (API)  and  the  [overflow]  of  behavior                                                               
health patients  in the EDs.   She stated that part  of the long-                                                               
term  solution  to that  problem  is  more inpatient  psychiatric                                                               
beds.                                                                                                                           
                                                                                                                                
3:31:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SHAW asked for  confirmation of his understanding:                                                               
Alaska is receiving  $9 in federal benefits to every  $1 in state                                                               
cost for the  Medicaid expansion population, and  the governor is                                                               
considering cutting a portion of the $1.                                                                                        
                                                                                                                                
CO-CHAIR FIELDS  replied that it  is a complicated question.   He                                                               
said that he  asked for a Legislative Legal  Services analysis on                                                               
the  following   question:    Could  the   governor  unilaterally                                                               
withdraw  from Medicaid  expansion?   Legislative Legal  Services                                                               
said, "No"; when you have  large unallocated cuts, they are going                                                               
to be spread  across populations; therefore, the  losses would be                                                               
on various match rates for different populations.                                                                               
                                                                                                                                
MS.  HULTBERG explained  that she  has intentionally  referred to                                                               
the  impacts as  being  associated with  [Medicaid] expansion  or                                                               
being associated  with budget cuts;  the two result  in different                                                               
effects but have the same outcome  from a dollar standpoint.  The                                                               
governor  has  not  stated  that  he  will  eliminate  expansion;                                                               
however, he  has not  committed to retaining  it.   She expressed                                                               
her belief that it remains  an open question.  Medicaid expansion                                                               
does provide close to 93 cents  for every 7 cents of state money.                                                               
One uncertainty for  the healthcare system is not  knowing if the                                                               
governor will retain Medicaid expansion.   The second uncertainty                                                               
is the magnitude  of the budget reduction; it is  close to a one-                                                               
third reduction in  the overall Medicaid budget.   She maintained                                                               
that it is difficult for those  in healthcare to "pencil out" how                                                               
that reduction  could be  enacted without  significant disruption                                                               
to services and  to populations.  She said that  $225 million [of                                                               
the  state's   Medicaid  budget],  which  matches   another  $465                                                               
million,  is  essentially  unallocated; therefore,  there  is  no                                                               
current plan for how those [budget]  cuts would be enacted.  This                                                               
creates a tremendous climate of  uncertainty, because there is no                                                               
clarity on how those cuts would  be implemented and whether it is                                                               
even possible to  implement them in a short period  of time.  She                                                               
asserted  that  implementing  them  in  a  short  period  is  not                                                               
possible because of  the requirement for approval from  CMS.  She                                                               
concluded  that the  unallocated nature  [of the  funds] and  the                                                               
size  of  the  cuts  is   of  tremendous  concern  to  healthcare                                                               
providers.                                                                                                                      
                                                                                                                                
CO-CHAIR  FIELDS expressed  his understanding  that the  cuts are                                                               
impossible to  make because they  either violate  basic statutory                                                               
requirements or  up to  70,000 Alaskans  would lose  their health                                                               
insurance  plans -  one-third  of the  Medicaid  population.   He                                                               
maintained, "Either is  crazy; somewhere in the  middle is crazy;                                                               
and the administration, because  they have conducted no analysis,                                                               
can't actually tell us where we are on that spectrum."                                                                          
                                                                                                                                
MS. HULTBERG added that when  the budget was proposed, the Office                                                               
of  Management   &  Budget  (OBM)  mentioned   for  consideration                                                               
"provider rate  cuts."  It  cited Alaska Medicaid rates  as being                                                               
the highest  in the nation.   She stated  that the claim  is only                                                               
partially  true  because  the  full  picture  of  rates  was  not                                                               
considered.    She explained  that  Alaska's  hospital rates  are                                                               
higher,  because it  pays 95  percent  of the  cost of  services,                                                               
whereas most states pay about 70  percent.  Also, Alaska has made                                                               
some  intentional  decisions to  have  higher  Medicaid rates  to                                                               
promote  healthcare infrastructure  outside  of  Anchorage.   She                                                               
maintained that hospitals outside  of Anchorage are not typically                                                               
"high  margin"; Fairbanks  Memorial Hospital  has an  [operating]                                                               
margin of  less than three  percent; Petersburg  Medical Center's                                                               
margin is about one percent; Juneau  has no margin except under a                                                               
federal program that could be  sunsetting in 2020.  She concluded                                                               
that if rate cuts are used as  a strategy to get to $700 million,                                                               
it  would not  make much  sense  unless the  expectation is  that                                                               
there  be  very  little   healthcare  infrastructure  outside  of                                                               
Anchorage.    She said,  "I'm  not  suggesting that's  the  plan,                                                               
because ...  we don't really  know what it  is.  I'm  just saying                                                               
when you  start trying to  draw connections to what's  been said,                                                               
it's difficult to get to that number."                                                                                          
                                                                                                                                
3:36:47 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  FIELDS  maintained that  it  is  hard to  imagine  wide                                                               
swaths of  the state not  having hospitals; however,  hundreds of                                                               
hospitals  have   closed  in  areas  of   rural  America  lacking                                                               
[Medicaid] expansion.                                                                                                           
                                                                                                                                
MS.  HULTBERG concurred  that a  significant number  of hospitals                                                               
have closed  since 2010 - about  90 hospitals - and  the majority                                                               
are  in  the southeast  part  of  the  U.S.  where there  was  no                                                               
Medicaid expansion.  She maintained  that Alaska's problem is not                                                               
unique;  rural hospitals  across  the country  are struggling  to                                                               
stay open  due to a lack  of economic viability.   She emphasized                                                               
that there is  value in having healthcare in rural  America.  She                                                               
posed the  question facing the country  and the state:   "How are                                                               
we going to  change the model to make it  more sustainable in the                                                               
long-term fiscally and to make  sure that we are providing access                                                               
in  rural communities?"   She  mentioned that  some of  the rural                                                               
communities  subsidize their  hospitals  through  taxes, such  as                                                               
South Peninsula  Hospital (in  Homer).   She reiterated  that the                                                               
rural  hospitals  are  increasingly  at  risk  and  their  future                                                               
viability  is of  great  concern.   The  hospitals perform  great                                                               
work, are  connected to their  communities, know  their patients,                                                               
take good care of them,  help them manage their chronic diseases,                                                               
and  provide   tremendous  value.     She  maintained   that  the                                                               
[healthcare] financing model doesn't recognize that value.                                                                      
                                                                                                                                
CO-CHAIR FIELDS  stated that the legislators  have seen proposals                                                               
to eliminate  "optional" Medicaid services,  such as dental.   He                                                               
asked,  "What  are  the  impacts  of  eliminating  such  optional                                                               
services and does  it actually just cost us more  in the end when                                                               
we don't treat basic medical needs like dental?"                                                                                
                                                                                                                                
MS.  HULTBERG  responded that  there  is  much variability  among                                                               
Medicaid programs, both levels of  service and payment.  She said                                                               
that  for  a state  to  have  a  Medicaid program,  CMS  requires                                                               
certain services.  In addition, there  is a list of services that                                                               
are optional.   She offered that  some of those services  are not                                                               
truly  optional.   She maintained  that even  though the  federal                                                               
government requires  hospitals to provide  ED care, it is  on the                                                               
optional  services list.   Also,  on the  list is  pharmacy care,                                                               
behavioral health, and many other  services.  She added that some                                                               
of these  optional services are  essential health  benefits under                                                               
the Affordable Care Act (ACA), therefore, cannot be excluded.                                                                   
                                                                                                                                
3:40:08 PM                                                                                                                    
                                                                                                                                
PHIL  HOFSTETTER,  Chief   Executive  Officer  (CEO),  Petersburg                                                               
Medical Center  (PMC), relayed that through  his presentation, he                                                               
will attempt  to demonstrate  the impact of  Medicaid on  a small                                                               
critical  care hospital.   He  mentioned that  Petersburg is  100                                                               
miles south  of Juneau;  it is on  a small island;  and it  has a                                                               
population  of about  3,200.   He  stated that  Petersburg has  a                                                               
critical access  hospital with 15  long-term care beds,  12 acute                                                               
care  beds, an  ED, a  primary care  clinic, and  some outpatient                                                               
services.                                                                                                                       
                                                                                                                                
MR.  HOFSTETTER referred  to slide  2 and  relayed the  following                                                               
bullet points [original punctuation provided]:                                                                                  
                                                                                                                                
     ?  Petersburg   Medical  Center  (PMC)   has  delivered                                                                    
     healthcare to the community since 1917.                                                                                    
                                                                                                                                
     ?  PMC  operates  efficiently and  independently  as  a                                                                    
     component of  the Borough with tight  operating margins                                                                    
     of less than 1%.                                                                                                           
                                                                                                                                
     ? Over 95%  of our employees live in  the community and                                                                    
     a  large number  were  born and  raised in  Petersburg.                                                                    
     Employee turnover  rate is less  than 10%  yet salaries                                                                    
     are at the 10th percentile.                                                                                                
                                                                                                                                
     ?  47%  of  Petersburg  Medical  Center's  $15M  annual                                                                    
     budget goes toward employees.                                                                                              
                                                                                                                                
MR. HOFSTETTER continued by discussing  the pie chart on slide 3,                                                               
which  illustrates  the  utilization  of services  at  PMC.    He                                                               
pointed  out  that  90  percent of  utilization  is  through  the                                                               
primary care  clinic, which demonstrates  the continuity  of care                                                               
at  PMC.   There  are three  long-time physicians  at  PMC.   The                                                               
Monday through  Saturday clinics  are available to  patients that                                                               
schedule  appointments.   He  maintained  that  the clinics  help                                                               
manage  patient care  without accessing  the ED,  which helps  to                                                               
keep costs  down.   Visits to the  ED constitute  unmanaged care;                                                               
conditions become  worse and may  require acute care  or transfer                                                               
to another  hospital by medical evacuation  (medevac); therefore,                                                               
costs increase.  He pointed out  on the chart that utilization of                                                               
services through the ED is on the low side of 7 percent.                                                                        
                                                                                                                                
MR. HOFSTETTER  moved on to  slide 4  and relayed that  the payer                                                               
mix for PMC  is one-third Medicaid, one-third  Medicare, and one-                                                               
third commercial;  about 40  percent of  its overall  annual cash                                                               
collections  comes   from  Medicaid.     He  stated   that  PMC's                                                               
uncompensated care  after Medicaid expansion took  place declined                                                               
about 31 percent - about #394,000 - since 2015.                                                                                 
                                                                                                                                
MR.  HOFSTETTER referred  to the  line graphs  on slide  5, which                                                               
demonstrate  an upward  trend in  compensated care  from 2014  to                                                               
2018  and a  downward trend  in uncompensated  care from  2014 to                                                               
2018.                                                                                                                           
                                                                                                                                
MR. HOFSTETTER  reviewed the bullets  on slide 6 to  describe the                                                               
health impacts [associated with Medicaid expansion] as follows:                                                                 
                                                                                                                                
     ?  Compensated care  (Medicaid)  patients  are 4  times                                                                    
     more likely to come to primary clinic.                                                                                     
                                                                                                                                
     ? Uncompensated  care patients are less  likely to come                                                                    
     in to primary care clinic (4 times less).                                                                                  
                                                                                                                                
MR. HOFSTETTER reiterated that  uncompensated care patients don't                                                               
utilize PMC  much at  all unless  under emergency  conditions; it                                                               
constitutes  unmanaged care;  patients  are usually  in a  crisis                                                               
state;  they may  be  admitted, transferred  to  a tertiary  care                                                               
facility, or medevaced out.  He continued:                                                                                      
                                                                                                                                
     ?  Opioid and  substance  abuse are  managed more  with                                                                    
     compensated care.  Suboxone program reduces  charges by                                                                    
     1/3 compared to patients not in suboxone treatment.                                                                        
                                                                                                                                
     ? During 2014 and  2015, 83% of uncompensated inpatient                                                                    
     stays were  attributable to mental health  disorders or                                                                    
     substance abuse.  100% of the  charges for  these stays                                                                    
     were written off to bad debt.                                                                                              
                                                                                                                                
MR. HOFSTETTER added that because  compensated care patients come                                                               
into the  clinic more, their  care is  managed more, and  many of                                                               
the indirect  health issues related  to substance abuse  is being                                                               
managed more; therefore, overall health is better.                                                                              
                                                                                                                                
3:46:50 PM                                                                                                                    
                                                                                                                                
MR.  HOFSTETTER  emphasized  that  the  uncertainty  [surrounding                                                               
Medicaid funding and expansion] makes  him nervous.  He turned to                                                               
slide  7  and  reviewed  the bullets  describing  the  healthcare                                                               
impacts as follows:                                                                                                             
                                                                                                                                
      ? Each 1% overall reduction in Medicaid would equal                                                                       
     $50,000.                                                                                                                   
                                                                                                                                
       Uncovered patients would present at a higher level                                                                       
     to ER.                                                                                                                     
                                                                                                                                
     ?   Unmanaged  care   would  increase   overall  costs.                                                                    
     Unmanaged patients  more frequently present to  ER, are                                                                    
     admitted to  Acute care, or  are medevaced  to tertiary                                                                    
     care.                                                                                                                      
                                                                                                                                
    ?   Uninsured/undersinsured    [sic]   patients   would                                                                     
     increase uncompensated care.                                                                                               
                                                                                                                                
                                                                                                                                
MR.  HOFSTETTER referred  to  slide 8  and  reviewed the  bullets                                                               
related to community impacts as follows:                                                                                        
                                                                                                                                
     ? Low operating margins                                                                                                    
                                                                                                                                
     ? Reduction in services.                                                                                                   
                                                                                                                                
     ? Workforce reductions.                                                                                                    
                                                                                                                                
     ? Negative economic impact to community.                                                                                   
                                                                                                                                
     ? PMC is an at-risk facility.                                                                                              
                                                                                                                                
3:48:14 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  FIELDS suggested  that  since PMC  is  operated by  the                                                               
Borough  of Petersburg,  if it  loses money,  the costs  would be                                                               
passed  on  to  local  taxpayers   or  there  would  be  dramatic                                                               
reductions in services.                                                                                                         
                                                                                                                                
MR. HOFSTETTER replied affirmatively.   He said that historically                                                               
there  has been  very  few  times when  the  borough  has had  to                                                               
subsidize care at PMC.                                                                                                          
                                                                                                                                
CO-CHAIR  FIELDS complimented  the  quality of  data presented  -                                                               
demonstrating  the relationship  between  Medicaid expansion  and                                                               
expanding availability of treatment.   He asked Mr. Hofstetter to                                                               
expand  on what  he has  seen in  the community  in terms  of the                                                               
greater availability  of substance abuse treatment  post Medicaid                                                               
expansion.                                                                                                                      
                                                                                                                                
MR.  HOFSTETTER  answered that  he  has  shown  the data  to  his                                                               
physicians,  who   maintained  that  the  positive   effects  [of                                                               
Medicaid expansion] are even greater  than the data demonstrates.                                                               
Since  substance  abuse   medications  are  extremely  expensive,                                                               
patients cannot  receive treatment without the  medications being                                                               
reimbursed.     Physicians  have   seen  not   only  improvements                                                               
regarding medication  assisted treatment,  but in other  areas as                                                               
well.  He asserted that  when patients are on medication assisted                                                               
treatment in  the treatment program,  they do not present  to the                                                               
ED and  the charges  overall for the  patient are  one-third less                                                               
than  when  they are  off  treatment.    He emphasized  that  the                                                               
reduction  in costs  are dramatic,  which  speaks to  compensated                                                               
coverage and managed healthcare.                                                                                                
                                                                                                                                
3:50:54 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease at 3:51 p.m.                                                                                 
                                                                                                                                
CO-CHAIR FIELDS passed the gavel to CO-CHAIR KREISS-TOMKINS.                                                                    
                                                                                                                                
          HB  34-NAMING SCOTT JOHNSON MEMORIAL BRIDGE                                                                       
                                                                                                                                
3:51:02 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KREISS-TOMKINS   announced  that  the  next   order  of                                                               
business would  be HOUSE BILL  NO. 34,  "An Act naming  the Scott                                                               
Johnson Memorial Bridge."                                                                                                       
                                                                                                                                
3:51:59 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KREISS-TOMKINS  opened   public  testimony  during  the                                                               
hearing on HB 34.                                                                                                               
                                                                                                                                
3:52:11 PM                                                                                                                    
                                                                                                                                
BUD  JOHNSON,  as  the  father  of  Scott  Johnson,  thanked  the                                                               
community for its  support for HB 34.  He  mentioned that the Tok                                                               
River  has always  been special  to  his family;  he floated  the                                                               
river and hunted with Scott as a youngster.                                                                                     
                                                                                                                                
3:53:05 PM                                                                                                                    
                                                                                                                                
SUE  STANCLIFF testified  that  she supports  the  naming of  the                                                               
bridge after  Scott.  She  stated that  she had the  privilege of                                                               
working  with Scott  in  the Department  of  Public Safety  (DPS)                                                               
under [former]  Commissioner [Joe]  Masters; Scott was  a special                                                               
human being and an exceptional trooper.                                                                                         
                                                                                                                                
3:54:37 PM                                                                                                                    
                                                                                                                                
DAVE STANCLIFF  testified that the  bridge over the Tok  River is                                                               
an appropriate site  to honor and remember Scott  Johnson.  Scott                                                               
crossed the river many times in  his life, and floated and boated                                                               
the river as  well.  Mr. Stancliff maintained that  the Tok River                                                               
is synonymous with Scott's community;  he spent many of his young                                                               
years there.  He said that  a bridge spans an otherwise difficult                                                               
feature  to cross  or pass  through and  Scotts life  was one  of                                                               
crossing many  challenges, cultures, and settings.   He continued                                                               
by saying that Scott was rural  but learned to thrive in an urban                                                               
environment; he  was Caucasian but  learned to  love, appreciate,                                                               
and respect the ways of  his Athabascan neighbors and friends; he                                                               
worked well with all people of  all ages; and he also learned how                                                               
to  work,  train,  and  admire   his  canine  companions  in  law                                                               
enforcement.   Scott knew  the dangers of  his career  choice but                                                               
spanned  that danger  with emotion  and courage.   He  maintained                                                               
that Scott has  been an inspiration to all young  people who grow                                                               
up in  a tiny  rural Alaska  community and  wonder if  the larger                                                               
world has a place  for them.  The bridge bearing  his name in his                                                               
beloved Tok is both fitting and  truly a positive public act.  He                                                               
said  that  Scott  believed  in   bridges  and  his  life  was  a                                                               
continuing example  of how he  built them.   Many years  from now                                                               
someone pausing  on the bridge  over the Tok River  will probably                                                               
ask who Scott  Johnson was; perhaps they will ask  someone in the                                                               
community or search  the internet for the name  and remark "Wow!"                                                               
Mr. Stancliff maintained that because  of Scott's dedication, his                                                               
incredible contributions to life will  live on, and the community                                                               
that so  loved him will  smile and nod  each time they  cross the                                                               
bridge.                                                                                                                         
                                                                                                                                
3:57:31 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KREISS-TOMKINS closed public testimony.                                                                                
                                                                                                                                
3:57:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SHAW moved  to report HB 34 out  of committee with                                                               
individual recommendations and zero fiscal  note.  There being no                                                               
objection,  HB  34 was  reported  from  the House  State  Affairs                                                               
Standing Committee.                                                                                                             
                                                                                                                                
                    HB  12-PROTECTIVE ORDERS                                                                                
                                                                                                                                
3:58:36 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KREISS-TOMKINS   announced  that  the  next   order  of                                                               
business  would  be  HOUSE  BILL  NO. 12,  "An  Act  relating  to                                                               
protective orders."                                                                                                             
                                                                                                                                
3:58:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CHUCK  KOPP,  Alaska State  Legislature,  as  the                                                               
sponsor of  HB 12,  reminded the committee  that HB  12 addresses                                                               
the  August 2018  Whalen  v. Whalen  ("Whalen")  decision by  the                                                               
Alaska  Supreme Court,  which stated  that  it was  not clear  in                                                               
statute  that  long-term  protective   orders  can  be  extended,                                                               
renewed,  or  otherwise  reauthorized, unless  there  is  another                                                               
crime of  domestic violence perpetrated  against the victim.   He                                                               
said  that  the  proposed  legislation   would  make  the  needed                                                               
statutory changes.                                                                                                              
                                                                                                                                
3:59:36 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KREISS-TOMKINS opened public testimony on HB 12.                                                                       
                                                                                                                                
4:00:00 PM                                                                                                                    
                                                                                                                                
ROBIN  MITCHELL  testified that  Judge  Jennifer  Wells made  her                                                               
homeless for  two years;  the judge  denied Ms.  Mitchell medical                                                               
and  dental care  causing her  to  have three  surgeries and  six                                                               
weeks of daily  intravenous therapy (IV); she is  still facing at                                                               
least  two  more surgeries.    She  stated  that she  was  denied                                                               
employment  because of  what she  considered to  be a  fraudulent                                                               
domestic  violence  restraining  order (DVRO)  against  her;  the                                                               
judge allowed  an attorney to misappropriate  $32,000 of $110,000                                                               
(indisc.) from his client, while admitting no domestic violence.                                                                
                                                                                                                                
MS. MITCHELL cited another domestic  violence case involving that                                                               
same  judge, which  cost the  City of  Kenai $35,000  due to  the                                                               
judge's  abuse of  a  women in  DVRO.   She  maintained that  the                                                               
system  has no  protection  for falsely  accused  victims of  the                                                               
court system.   She acknowledged  that people need  protection in                                                               
domestic violence  and stalking; however, there  is no protection                                                               
or  standardized meaning  of the  preponderance of  the evidence.                                                               
She relayed that  she started going to Anchorage  almost daily to                                                               
watch the  DVRO court and  maintained that Alaska has  some great                                                               
judges.                                                                                                                         
                                                                                                                                
MS. MITCHELL requested that the committee  not rush HB 12 and add                                                               
some protections for victims.                                                                                                   
                                                                                                                                
4:03:36 PM                                                                                                                    
                                                                                                                                
ADAM  FLETCHER testified  that there  are legitimate  protections                                                               
put in place  by judges and magistrates for  victims; however, it                                                               
is  his  belief  that  restraining   order  abuse  is  not  being                                                               
recognized or  addressed.  He offered  that countless individuals                                                               
are becoming  the real  victims through  an abusive  process; the                                                               
current  statutes  do not  offer  recourse  against the  original                                                               
petitioners  who have  illegally obtained  false statements.   He                                                               
maintained  that he  is  one  of these  victims  - with  multiple                                                               
restraining orders  against him through false  information.  When                                                               
he takes  evidence to court  that would defend his  position, the                                                               
petitions are either withdrawn or  dismissed, but the prejudicial                                                               
effect  is  already  there.     He  asserted  that  this  happens                                                               
repeatedly.   He expressed the  need in the  proposed legislation                                                               
to  protect people,  like himself,  who are  being abused  by the                                                               
process.   He maintained that  if HB  12 is "pushed  through" too                                                               
quickly,  there will  be greater  abuse by  individuals who  take                                                               
advantage of the system.                                                                                                        
                                                                                                                                
4:06:15 PM                                                                                                                    
                                                                                                                                
TASHINA  FLETCHER testified  that  HB 12  would  infringe on  the                                                               
rights of children to have access  to both parents.  She has seen                                                               
the judicial process be corrected in  a way that has infringed on                                                               
those rights;  allowing a parent  to maintain control  of custody                                                               
based on an  unsubstantiated allegation is unfair.   She asserted                                                               
that a higher  level of scrutiny should be applied;  it becomes a                                                               
quasi-criminal  matter   that  needs   to  be  addressed.     She                                                               
maintained that  protective orders have  been used to  withhold a                                                               
child from a  parent; it is unfair; and  the proposed legislation                                                               
needs  to address  this  matter fully,  because  it infringes  on                                                               
one's constitutional rights.                                                                                                    
                                                                                                                                
4:07:32 PM                                                                                                                    
                                                                                                                                
CHERI SMITH,  Executive Director, The LeeShore  Center, testified                                                               
that  her  agency  provides   emergency  shelter,  advocacy,  and                                                               
support  to  victims of  domestic  violence  and sexual  assault.                                                               
Many of the victims receiving  services from the center also seek                                                               
help through  the court system  by filing for  protective orders.                                                               
Last year  the center  assisted 64  victims in  court procedures.                                                               
She stated that she cannot  express strongly enough how important                                                               
it is for a  victim to be allowed to file  for a protective order                                                               
extension for  the same incident  if needed.  She  explained that                                                               
often  when a  victim secures  a protective  order, the  violence                                                               
escalates,  and the  order  can be  violated  by the  perpetrator                                                               
multiple  times.   The  victim  has good  cause  to fear  ongoing                                                               
violence because the perpetrator often  continues to pose a great                                                               
risk to the victim.  She  asserted that arrests for violations of                                                               
an order  do not  always occur.   She gave the  example:   if the                                                               
perpetrator is  ordered to  stay 500 feet  away from  the victim,                                                               
the perpetrator  will stay 510  feet away  from the victim.   She                                                               
maintained  that  such  actions  continue to  cause  fear  on  an                                                               
ongoing basis up to and after  expiration of the order.  A victim                                                               
should not  have to  wait for another  violent incident  to occur                                                               
after a  protective order has  expired to be safe  from violence.                                                               
She expressed her belief that  HB 12 would better protect victims                                                               
of domestic violence, sexual assault, and stalking.                                                                             
                                                                                                                                
4:09:33 PM                                                                                                                    
                                                                                                                                
TERYN  BIRD testified  that  she is  an  attorney who  represents                                                               
victims  of domestic  violence, sexual  assault, and  stalking in                                                               
protective order and  family law matters.  She  asserted that the                                                               
Whalen decision  issued by the Alaska  Supreme Court interpreting                                                               
protective order  statutes has had  a devastating effect  on men,                                                               
women,  and  children in  the  Interior  seeking protection  from                                                               
extremely  lethal perpetrators  of domestic  violence and  sexual                                                               
assault.  She said that a victim,  who has not been a victim of a                                                               
new crime, could formerly seek  protection through re-issuance of                                                               
a protective order in the  Fourth Judicial District in Fairbanks.                                                               
That remedy  has been removed,  leaving victims of  egregious and                                                               
lethal crimes  without protection  unless re-victimized in  a way                                                               
that is recognized as a crime by the State of Alaska.                                                                           
                                                                                                                                
MS. BIRD maintained that the  gap left in protecting victims must                                                               
be remedied by legislative action for  a variety of reasons.  She                                                               
mentioned two  primary reasons:     1) protective  orders prevent                                                               
perpetrator escalation, which  has been shown to  lead to further                                                               
harm, serious  injury, or death;  and 2)  one year is  not enough                                                               
time for  every perpetrator of  domestic violence to  either cool                                                               
down enough to  move on or to rehabilitate.   She stated that she                                                               
has  countless  clients who  have  been  impacted by  the  Whalen                                                               
decision.   She  described the  case  of a  client, who  suffered                                                               
direct harm:   The client, her 10-year-old son,  and her 14-year-                                                               
old daughter all  had protective orders against  her ex-husband -                                                               
the children's father  - due to physical assault,  and sexual and                                                               
physical abuse of the children.   In January 2019, the protective                                                               
order expired.   Because  their perpetrator  had not  committed a                                                               
new crime, they were left  exposed.  The perpetrator was incensed                                                               
over   an  ongoing   custody  case   and  began   to  send   them                                                               
correspondence.    While  not threatening  a  crime  of  domestic                                                               
violence,  he often  alluded to  such by  attaching music  videos                                                               
containing  content  of  murders   over  unrequited  love.    The                                                               
children  received  messages  about  their  father  appearing  in                                                               
places that  they frequented and experienced  the constant threat                                                               
of being easily  accessed and harmed.  Each of  the children were                                                               
victims of  serious crimes; they  were provided a  brief reprieve                                                               
and the opportunity to heal  during the time the protective order                                                               
was  in  place.   Because  of  the  Whalen  case, they  were  re-                                                               
victimized  and   denied  the   opportunity  to  heal   and  feel                                                               
protected.                                                                                                                      
                                                                                                                                
4:12:28 PM                                                                                                                    
                                                                                                                                
CHRISTINE  PATE,  Legal  Program   Director,  Alaska  Network  on                                                               
Domestic Violence  and Sexual Assault (ANDVSA),  paraphrased from                                                               
her   written   statement   as  follows   [original   punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     Thank  you Chairs  and Members  of the  Committee.   My                                                                    
     name  is Christine  Pate  and I  am  the Legal  Program                                                                    
     Director  for  ANDVSA.    In  this  capacity  I  run  a                                                                    
     statewide  legal  services  program  for  survivors  of                                                                    
     domestic  violence, sexual  assault  and  stalking.   I                                                                    
     also providing training to the  advocates at our member                                                                    
     programs  around that  state that  go into  court daily                                                                    
     with survivors on civil protection orders.                                                                                 
                                                                                                                                
     Domestic  violence,  sexual  assault and  stalking  are                                                                    
     often part of  a pattern of behavior  that can escalate                                                                    
     over time and  separation is often the  time of highest                                                                    
     lethality for  survivors.   Because of  this, survivors                                                                    
     often  need  protection from  abuse  for  more than  12                                                                    
     months yet that is all  that they can get under current                                                                    
     Alaska law.                                                                                                                
                                                                                                                                
     Historically,    courts    interpreted   the    current                                                                    
     protection  order  statutes  differently:   some  found                                                                    
     that  the  statutes  allowed  discretion  to  grant  an                                                                    
     extension of  a long  term order or  grant a  new order                                                                    
     based on  prior found acts of  violence, others didn't.                                                                    
     For  example, in  Fairbanks,  courts routinely  granted                                                                    
     new  orders based  on past  violence or  extended them.                                                                    
     In Anchorage  and SE Alaska,  some courts did  and some                                                                    
     didn't.  This  led to confusion for  survivors and lack                                                                    
     of predictability  for them  at a  time when  they were                                                                    
     making  difficult   decisions  to  end  the   cycle  of                                                                    
     violence that they had experienced.                                                                                        
                                                                                                                                
     In Whalen  v. Whalen,  the Alaska  Supreme Court,  in a                                                                    
     divided 3/2  opinion, ended  this confusion  by stating                                                                    
     that  the  current  protection  order  statute  doesn't                                                                    
     allow  for  extension  or  new  orders  based  on  past                                                                    
     domestic violence, sexual assault or stalking.                                                                             
                                                                                                                                
     The court  was clear  in its decision  that it  "is the                                                                    
     legislature's  role to  establish Alaska's  policy with                                                                    
     respect   to  domestic   violence  protective   orders,                                                                    
     including  the time  limits for  protective orders  and                                                                    
     the availability of extension or renewal.                                                                                  
                                                                                                                                
     We  appreciate   Representative's  Kopp's   efforts  to                                                                    
     establish  policy  now that  makes  it  clear that  new                                                                    
     protection orders  can be granted based  on prior found                                                                    
     DV,  SA  or stalking  and  that  the court  can  extend                                                                    
     already issued protection orders.                                                                                          
                                                                                                                                
     As a  civil legal  provider for  survivors    have seen                                                                    
     devastating effect that the Whalen  decision has had on                                                                    
     survivors    we have heard from  numerous survivors who                                                                    
     need protection  after histories of terrible  abuse but                                                                    
     are unable to get it.                                                                                                      
                                                                                                                                
     For example: a  sexual assault victim lives  in a small                                                                    
     town in  Alaska and  gets a  SA protection  order after                                                                    
     the  assault.  The  survivor  reports   the  SA  and  a                                                                    
     criminal investigation  begins but the DA  doesn't have                                                                    
     enough  evidence   to  prosecute  the  case   beyond  a                                                                    
     reasonable doubt  and the  charges are  dismissed after                                                                    
     five months.   The survivor  now has one more  month of                                                                    
     protection  and  cannot  get further  protection  under                                                                    
     current  law  and  has  to see  her  assailant  in  the                                                                    
     grocery store, school or library.                                                                                          
                                                                                                                                
     Or  a survivor  who  has endured  a  history of  lethal                                                                    
     domestic  violence in  the  past  including biting  and                                                                    
     strangulation gets a 12 month  order.  After that order                                                                    
     expires there  is an escalation of  concerning behavior                                                                    
     including excessive drinking,  violent outbursts around                                                                    
     children, and other limit pushing    behaviors that the                                                                    
     survivor,  who best  understands the  meaning of  these                                                                    
     behaviors,  sees as  red flags  -  has to  wait like  a                                                                    
     sitting duck  until there is  a crime  of DV for  a new                                                                    
     order.                                                                                                                     
                                                                                                                                
     Survivors  who have  endured terrible  histories of  DV                                                                    
     including strangulation,  sexual assault  and stabbing,                                                                    
     are  currently  forced  to  make  impossible  strategic                                                                    
     decisions as  to when to  apply for a  protection order                                                                    
     so  as  to  maximize  their  safety.   If  there  is  a                                                                    
     criminal case,  should they wait until  it is resolved?                                                                    
     What  if  the  criminal   contact  provisions  are  not                                                                    
     comprehensive  enough? If  there is  no criminal  case,                                                                    
     should  they wait  until they  file  for divorce  since                                                                    
     that could be  a dangerous point or should  they get it                                                                    
     at the  time of immediate separation  because they feel                                                                    
     unsafe now?                                                                                                                
                                                                                                                                
     When will  they best use  the 12 months of  safety that                                                                    
     current Alaska law allows for?                                                                                             
                                                                                                                                
     These  aren't the  types  of  decisions that  survivors                                                                    
     should have to make for themselves and their families.                                                                     
     Protection  orders, to  be effective,  must respond  to                                                                    
     the  cyclical  nature  of crimes  of  intimate  partner                                                                    
     violence.    Please  approve this  bill so  that courts                                                                  
     have  discretion to  continue  protection for  victims,                                                                  
     after 6 or 12 months, if safety demands it.                                                                                
                                                                                                                                
MS. PATE expressed her belief that  Alaska is one of the very few                                                               
states  that  does not  allow  for  an  extension or  renewal  of                                                               
protection orders; forty-eight other states do.                                                                                 
                                                                                                                                
CO-CHAIR FIELDS  suggested that the  duration of the order  is an                                                               
additional  issue  and outside  the  Whalen  problem.   He  asked                                                               
whether the  legislature should consider extending  the length of                                                               
protective orders in future legislation.                                                                                        
                                                                                                                                
MS.  PATE  agreed that  doing  so  could  be  a good  remedy  for                                                               
survivors.                                                                                                                      
                                                                                                                                
CO-CHAIR KREISS-TOMKINS  asked for  a recommended length  of time                                                               
for a protective order.                                                                                                         
                                                                                                                                
MS. PATE responded that she did  not wish to speculate but wanted                                                               
to do additional  research.  She suggested that  a varying length                                                               
might  be appropriate  in different  situations.   She maintained                                                               
that  HB 12  would be  helpful because  if one  year is  not long                                                               
enough,  the policy  change would  give the  court discretion  to                                                               
look at the totality of  the circumstances and decide whether the                                                               
survivor needs more protection.                                                                                                 
                                                                                                                                
4:18:40 PM                                                                                                                    
                                                                                                                                
CARMEN  LOWRY, Executive  Director,  Alaska  Network on  Domestic                                                               
Violence and  Sexual Assault (ANDVSA),  testified that  the issue                                                               
addressed by  HB 12 has  been discussed extensively  among ANDVSA                                                               
member organizations, and all are in support.                                                                                   
                                                                                                                                
CO-CHAIR FIELDS  asked whether Ms.  Lowry agreed  that protective                                                               
order time periods should be lengthened.                                                                                        
                                                                                                                                
MS.  LOWRY answered  affirmatively and  added that  the situation                                                               
must be considered  to determine the appropriate  length of time.                                                               
She relayed  that it would  be helpful  to know the  reasons that                                                               
other  states  have  longer  term  protective  orders  than  does                                                               
Alaska.                                                                                                                         
                                                                                                                                
4:20:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VANCE referred  to testimony regarding restraining                                                               
order  abuse and  asked,  "What  recourse is  there,  if any,  if                                                               
someone  feels that  they  have  been wrongly  accused  ... if  a                                                               
protective order  has been  wrongly placed on  them."   She asked                                                               
whether there is due process for those individuals.                                                                             
                                                                                                                                
MS. LOWRY responded that she did not have that information.                                                                     
                                                                                                                                
4:21:13 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KREISS-TOMKINS closed public testimony on HB 12.                                                                       
                                                                                                                                
4:21:26 PM                                                                                                                    
                                                                                                                                
KEN  TRUITT,  Staff,  REPRESENTATIVE  CHUCK  KOPP,  Alaska  State                                                               
Legislature,  replied  that  he  did  not  have  the  answer  and                                                               
deferred  to the  representative from  the Alaska  Legal Services                                                               
Corporation (ALSC).                                                                                                             
                                                                                                                                
4:22:02 PM                                                                                                                    
                                                                                                                                
MAGGIE   HUMM,  Supervising   Attorney,  Alaska   Legal  Services                                                               
Corporation (ALSC),  testified that ALSC is  the largest provider                                                               
of  civil   legal  services  to  victims   of  domestic  violence                                                               
statewide;  it  serves  approximately  800  victims  of  domestic                                                               
violence  and  their children  every  year.    She asked  if  the                                                               
question was,  What protectives are  in place for  respondents in                                                               
domestic violence protective order cases?                                                                                       
                                                                                                                                
REPRESENTATIVE VANCE  reiterated her  question:   Is there  a due                                                               
process for an  individual named in a protective  order for which                                                               
the individual feels he/she has been wrongly accused?                                                                           
                                                                                                                                
MS. HUMM replied that there  are several protections available to                                                               
a respondent in  protective order proceedings.   The law requires                                                               
that  respondents   receive  notice   of  the   protective  order                                                               
proceedings; and they have an  opportunity to be heard in respect                                                               
to the allegations  being made.  She added  that respondents must                                                               
be notified  10 days prior  to the  hearing; they may  attend the                                                               
hearing, present their own testimony,  and present witnesses.  If                                                               
the  protective order  is issued  against them,  they can  file a                                                               
motion  for reconsideration  or file  an appeal.   She  said that                                                               
under the proposed legislation, in  the case of someone wanting a                                                               
protective  order  extension,  there are  again  protections  for                                                               
notice  and  opportunity to  be  heard  built into  the  proposed                                                               
legislation;  the  order  will  not  simply  be  granted  at  the                                                               
petitioner's request.                                                                                                           
                                                                                                                                
4:24:28 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KREISS-TOMKINS   cited  a  sentence  from   the  Whalen                                                               
decision, included in the committee packet, which read:                                                                         
                                                                                                                                
     Even  if   amici  are  correct  that   the  legislature                                                                    
     believed in  2004 that domestic violence  victims could                                                                    
     receive a  new protective  order without showing  a new                                                                    
     incident of domestic violence, we  will not rewrite the                                                                    
     law to conform  to a mistaken view of the  law that the                                                                    
     legislature had when it amended the statute.                                                                               
                                                                                                                                
CO-CHAIR KREISS-TOMKINS offered that  the statement expresses the                                                               
importance  of paying  attention to  detail in  legislative work;                                                               
the courts won't provide cover.                                                                                                 
                                                                                                                                
4:25:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STORY  moved to report  CS for HB 12,  Version 31-                                                               
LS0103\S, out  of committee  with individual  recommendations and                                                               
the zero  fiscal notes.   There being no objection,  CSHB 12(STA)                                                               
was reported from the House State Affairs Standing Committee.                                                                   
                                                                                                                                
         HB  14-ASSAULT; SEX OFFENSES; SENT. AGGRAVATOR                                                                     
                                                                                                                              
4:26:21 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KREISS-TOMKINS  announced  that   the  final  order  of                                                               
business would be HOUSE BILL NO.  14, "An Act relating to assault                                                               
in the  first degree; relating  to sex offenses; relating  to the                                                               
definition  of  'dangerous  instrument';  and  providing  for  an                                                               
aggravating factor  at sentencing for strangulation  that results                                                               
in unconsciousness."                                                                                                            
                                                                                                                                
4:26:49 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KREISS-TOMKINS opened public testimony on HB 14.                                                                       
                                                                                                                                
4:27:00 PM                                                                                                                    
                                                                                                                                
CHERI SMITH,  Executive Director, The LeeShore  Center, testified                                                               
that through  her 25 years  of working  in the field  of domestic                                                               
violence  and sexual  assault, she  knows the  devastating impact                                                               
that the  violence addressed in  the proposed legislation  has on                                                               
victims.   She  relayed  that  research reveals  that  in a  high                                                               
percent  of strangulation  cases,  there has  been  a history  of                                                               
domestic violence;  it is  the most lethal  and ultimate  form of                                                               
control  over a  victim.   It  takes only  5-10  seconds to  lose                                                               
consciousness with only  11 pounds of pressure  being applied; it                                                               
takes  20  pounds of  pressure  to  open a  can  of  soda.   Once                                                               
unconscious, a death  can occur in under two minutes;  in over 50                                                               
percent  of  the  cases,  there  will  be  no  external  physical                                                               
evidence of it.   She said that for every  10 victims of domestic                                                               
violence or  sexual assault  who come into  the center,  at least                                                               
half have  been strangled.   She maintained  that HB 14  would be                                                               
critical   for   victim   safety  and   for   holding   offenders                                                               
accountable.                                                                                                                    
                                                                                                                                
4:28:55 PM                                                                                                                    
                                                                                                                                
SHERRY MILLER testified that  making strangulation a first-degree                                                               
assault  is not  enough; it  should have  an automatic  charge of                                                               
attempted murder.   She related the story of  her daughter, Linda                                                               
Bower:   At age 19, Linda  was in a manipulative  and controlling                                                               
relationship with her boyfriend, David  Thomas.  He strangled her                                                               
to  death on  September 10,  2014.   He  is now  serving time  in                                                               
prison for second  degree murder and will be  eligible for parole                                                               
in  a  few  short  years.    She said  that  Mr.  Thomas  had  an                                                               
extensive, extremely violent past and  had strangled to the point                                                               
of  unconsciousness  one other  female  while  living in  Montana                                                               
several years prior to her daughter's death.                                                                                    
                                                                                                                                
MS.  MILLER declared  that no  parent should  have to  endure the                                                               
pain that  she lives  with each  day.   She expressed  her belief                                                               
that  Alaska is  extremely  soft on  crime.   She  said that  she                                                               
experienced  firsthand a  complete  and total  disregard for  the                                                               
value of her  daughter's life and the life sentence  that she and                                                               
her family  now face at the  expense of Mr. Thomas,  who received                                                               
the best  opportunity for  a lighter sentence.   She  is offering                                                               
her testimony to  put a "name" with the  terrifying statistics of                                                               
teen  dating violence,  domestic  violence,  and sexual  assault.                                                               
She emphasized,  "It is time  to put aside all  political agendas                                                               
and hold  each and  every one of  these criminals  accountable to                                                               
the highest  extent of the law."   She offered that  offenders of                                                               
this type are not remorseful; they  hold no regard or respect for                                                               
the dignity of  human life.  She beseeched  the committee members                                                               
to consider  the sentence they  would want  to see placed  on the                                                               
offender if  this happened to  their loved ones.   She maintained                                                               
that HB 14 is  a step in the right direction,  but she asked, "Is                                                               
it enough?"   She asked  the committee to consider  Alaska safety                                                               
as a top  priority and to put  Alaska on the map as  a state that                                                               
criminals fear.                                                                                                                 
                                                                                                                                
4:31:19 PM                                                                                                                    
                                                                                                                                
ISSAC  WILLIAMS,   No  More  Free  Passes,   testified  that  his                                                               
organization  was founded  after  the Justin  Schneider case,  in                                                               
which  Mr. Schneider  strangled a  young  woman to  the point  of                                                               
unconsciousness and ejaculated  on her but received  no jail time                                                               
for  it.     He   stated  that   his  organization   worked  with                                                               
Representative  Lincoln on  the proposed  legislation to  fix the                                                               
loophole that allowed  Mr. Schneider to receive no  sentence.  He                                                               
maintained that  HB 14 would  go along way towards  repairing the                                                               
public trust  in the  criminal justice system;  it would  fix the                                                               
policy that  allows someone to  commit such a horrific  crime and                                                               
escape jail time.  He  added that a non-fatal strangulation often                                                               
happens  before  an  escalation,  which   can  lead  to  a  fatal                                                               
incident;  it is  important to  escalate the  penalties in  these                                                               
cases.   He offered that HB  14 would send a  strong message that                                                               
these types of actions are  not acceptable; strangling someone to                                                               
the point of unconsciousness  demonstrates reckless disregard; it                                                               
is deserving of  a much longer sentence than a  zero- to two-year                                                               
sentence.                                                                                                                       
                                                                                                                                
4:33:31 PM                                                                                                                    
                                                                                                                                
JAENELL  MANCHESTER, 49th  Rising, paraphrased  from her  written                                                               
testimony as follows [original punctuation provided]:                                                                           
                                                                                                                                
     49th Rising  is a non-partisan organization  working to                                                                    
     make Alaska as safe as  it is beautiful. Alaska has the                                                                    
     highest  rate   of  reported  sexual  assault   in  the                                                                    
     country. We have  all heard this before.  We have heard                                                                    
     it so many times that  this startling fact has lost its                                                                    
     power. Yet,  we just  need to look  at our  friends, or                                                                    
     sometimes in a mirror, to  see the ocean of pain behind                                                                    
     this reality.  According to UAA's Justice  Center, 1 in                                                                    
     3  Alaskan women  has  experienced  sexual violence  in                                                                    
     their lifetime. Based on  our firsthand experiences, we                                                                    
     know that even those numbers are underestimates.                                                                           
                                                                                                                                
     49th Rising  endorses H.B.  14 as  this bill  will help                                                                    
     address deficiencies  in the current  legislation, such                                                                    
     as  with  regards  to strangulation.  Strangulation  is                                                                    
     often associated with sexual  and domestic violence and                                                                    
     is a  form power  and control  which has  a devastating                                                                    
     physical  and mental  impact on  victims. In  fact, one                                                                    
     study found that women who  had been strangled by their                                                                    
     partners  were 7-times  more likely  to  be victims  of                                                                    
     attempted  homicide  (Journal  of  Emergency  Medicine,                                                                    
     2008). Strangulation  blocks the flow of  oxygen to the                                                                    
     brain, and  while victims may  seem unharmed,  they may                                                                    
     have  internal  injuries  and may  die  days  or  weeks                                                                    
     later.  Because of  the psychological  trauma resulting                                                                    
     from strangulation, victims may also attempt suicide.                                                                      
                                                                                                                                
     H.B.  14  also closes  some  loopholes  in the  current                                                                    
     legislation  with  regards  to  non-consensual  contact                                                                    
     with ejaculate matter. As  illustrated by the Schneider                                                                    
     case, it is imperative for  the safety of Alaskans that                                                                    
     this  loophole  be  closed. Non-consensual  contact  is                                                                    
     traumatizing,  even more  so when  it is  unpunished by                                                                    
     legislation.                                                                                                               
                                                                                                                                
4:35:41 PM                                                                                                                    
                                                                                                                                
NATASHA  GAMACHE  testified  that  that  she  agrees  with  prior                                                               
testimony   suggesting   that  sentencing   recommendations   for                                                               
strangulation in the proposed legislation  should be more severe.                                                               
She  said  that  as  a  victim of  sexual  assault  and  domestic                                                               
violence,  she  feels that  given  the  statistics, cited  it  is                                                               
imperative to  do more  to protect  domestic violence  and sexual                                                               
assault victims  in Alaska.   She maintained that doing  so would                                                               
demonstrate to women  and children that Alaska  honors and values                                                               
them and  wants to protect  them; women  of Alaska are  worthy of                                                               
the protection.                                                                                                                 
                                                                                                                                
4:37:52 PM                                                                                                                    
                                                                                                                                
DESERIE BOND  testified that  she supports  the bill  because she                                                               
feels  it  is  important  to hold  perpetrators  accountable,  to                                                               
demonstrate that  survivors are being  heard, and to  ensure that                                                               
charges will  be made  against perpetrators  so that  healing can                                                               
begin for  the victims.   She  stated that she  is a  survivor of                                                               
strangulation;  no charges  were ever  made; she  suffered broken                                                               
cartilage in  her voice box.   She expressed that even  though it                                                               
occurred four years ago, she  still suffers.  She maintained that                                                               
this type of violence should not be tolerated.                                                                                  
                                                                                                                                
4:39:21 PM                                                                                                                    
                                                                                                                                
DOROTHY  KOLEROK   testified  that  she  worked   with  men  from                                                               
different  countries out  on a  tug and  barge in  remote Alaska;                                                               
they   had  access   to   pharmaceuticals   without  a   doctor's                                                               
prescription.  She  stated that she was drugged and  at the mercy                                                               
of the men; to this day she  doesn't know the drug; when she woke                                                               
up her  throat was extremely  damaged; and there were  no charges                                                               
filed.   She  expressed that  reporting the  incident to  the two                                                               
authorities  was worse  than  the offense  itself;  she is  still                                                               
jaded; and she  believes that healing would have  been easier had                                                               
she not reported it.                                                                                                            
                                                                                                                                
4:43:30 PM                                                                                                                    
                                                                                                                                
CARMEN  LOWRY, Executive  Director,  Alaska  Network on  Domestic                                                               
Violence and Sexual Assault  (ANDVSA), expressed her appreciation                                                               
to the  committee for taking  public testimony and  providing the                                                               
opportunity for people to tell their  stories.  She noted the two                                                               
critical elements of  the proposed legislation:   1) noticing and                                                               
recognizing the  extreme nature  and lethality  of strangulation;                                                               
and 2)  expanding sex crimes  to include ejaculation on  a person                                                               
without consent, which  also allows for someone  convicted of the                                                               
crime to register as a sex offender.                                                                                            
                                                                                                                                
4:45:29 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KREISS-TOMKINS closed public testimony on HB 14.                                                                       
                                                                                                                                
4:45:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHN LINCOLN,  Alaska State Legislature, expressed                                                               
that  he  was deeply  moved  by  the  testimony and  thanked  the                                                               
testifiers for coming forward.  He  stated that he was very sorry                                                               
those things  happened to the  women who testified; and  that the                                                               
gratitude  expressed  to them  for  telling  their stories  seems                                                               
inadequate.  He emphasized the  importance of taking some sort of                                                               
action that  fits the experience  of these women and  that brings                                                               
justice to them.                                                                                                                
                                                                                                                                
CO-CHAIR   FIELDS   thanked   Representative  Lincoln   for   the                                                               
introduction of HB 14.                                                                                                          
                                                                                                                                
REPRESENTATIVE  STORY thanked  the  women  who testified,  shared                                                               
their stories, and advocated for a safer Alaska.                                                                                
                                                                                                                                
4:47:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VANCE  moved to report  CS for HB 14,  Version 31-                                                               
LS0182\E, out  of committee  with individual  recommendations and                                                               
zero fiscal  notes.  There  being no objection, CSHB  14(STA) was                                                               
reported from the House State Affairs Standing Committee.                                                                       
                                                                                                                                
4:49:09 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
State Affairs  Standing Committee  meeting was adjourned  at 4:49                                                               
p.m.                                                                                                                            

Document Name Date/Time Subjects
Presentation on Uncompensated Care by Becky Hultberg 3.7.19.pdf HSTA 3/7/2019 3:00:00 PM
Presentation on the Impact of Medicaid at Petersburg Medical Center by Phillip Hofstetter 3.7.19.pdf HSTA 3/7/2019 3:00:00 PM
HB34 ver A 2.28.19.PDF HSTA 2/28/2019 3:00:00 PM
HSTA 3/7/2019 3:00:00 PM
HB 34
HB34 Sponsor Statement 2.28.19.pdf HSTA 2/28/2019 3:00:00 PM
HSTA 3/7/2019 3:00:00 PM
HB 34
HB34 Supporting Document-Scott Johnson Memorial Scholarship Biography 2.28.19.pdf HSTA 2/28/2019 3:00:00 PM
HSTA 3/7/2019 3:00:00 PM
HB 34
HB34 Fiscal Note DOT-NRHA 2.28.19.pdf HSTA 2/28/2019 3:00:00 PM
HSTA 3/7/2019 3:00:00 PM
HB 34
HB34 Supporting Document - Petition of Support 3.6.19.pdf HSTA 3/7/2019 3:00:00 PM
HB 34
HB 34 Supporting Document - Petition of Support No. 2 3.7.19.pdf HSTA 3/7/2019 3:00:00 PM
HB 34
HB12 CS ver S 2.28.19.pdf HSTA 2/28/2019 3:00:00 PM
HSTA 3/7/2019 3:00:00 PM
HB 12
HB12 Fiscal Note DPS-DET 2.28.19.pdf HSTA 2/28/2019 3:00:00 PM
HSTA 3/7/2019 3:00:00 PM
HB 12
HB12 Fiscal Note DPS-CJISP 2.28.19.pdf HSTA 2/28/2019 3:00:00 PM
HSTA 3/7/2019 3:00:00 PM
HB 12
HB12 Additional Document CPO Statute and Duration of Order 2.28.19.pdf HSTA 2/28/2019 3:00:00 PM
HSTA 3/7/2019 3:00:00 PM
HB 12
HB12 Additional Document - Whalen v Whalen 2018 2.28.19.pdf HSTA 2/28/2019 3:00:00 PM
HSTA 3/7/2019 3:00:00 PM
HB 12
HB12 ver U 2.28.19.PDF HSTA 2/28/2019 3:00:00 PM
HSTA 3/7/2019 3:00:00 PM
HB 12
HB12 Sectional 2.28.19.pdf HSTA 2/28/2019 3:00:00 PM
HSTA 3/7/2019 3:00:00 PM
HB 12
HB12 Supporting Document- ALSC Letter 2.28.19.pdf HSTA 2/28/2019 3:00:00 PM
HSTA 3/7/2019 3:00:00 PM
HB 12
HB12 Sponsor Statement 2.28.19.pdf HSTA 2/28/2019 3:00:00 PM
HSTA 3/7/2019 3:00:00 PM
HB 12
HB12 Supporting Document - APOA Letter 2.28.19.pdf HSTA 2/28/2019 3:00:00 PM
HSTA 3/7/2019 3:00:00 PM
HB 12
HB12 CS amendment ver U.3 3.7.19.pdf HSTA 3/7/2019 3:00:00 PM
HB 12
HB34 Scott Johnson Memorial Bridge Spouse Testimony 2.28.19.pdf HSTA 3/7/2019 3:00:00 PM
HB 34
HB034 Supporting Document - Letter of Support 3.7.19.pdf HSTA 3/7/2019 3:00:00 PM
HB 34