Legislature(2019 - 2020)GRUENBERG 120
03/07/2019 03:00 PM House STATE AFFAIRS
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) | |
| Commissioner, Department of Administration | |
| Presentation(s): Medicaid Hospitals Impact on State Health Insurance Costs | |
| HB34 | |
| HB12 | |
| HB14 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 34 | TELECONFERENCED | |
| += | HB 12 | TELECONFERENCED | |
| += | HB 14 | TELECONFERENCED | |
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)
Commissioner, Department of Administration
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.
^Commissioner, Department of Administration
Commissioner, Department of Administration
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 |