Legislature(1993 - 1994)
02/23/1994 01:40 PM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
February 23, 1994
1:40 p.m.
MEMBERS PRESENT
Senator Steve Rieger, Chairman
Senator Bert Sharp, Vice-Chairman
Senator Loren Leman
Senator Mike Miller
Senator Jim Duncan
Senator Judy Salo
MEMBERS ABSENT
Senator Johnny Ellis
COMMITTEE CALENDAR
SENATE BILL NO. 249
"An Act relating to assisted living homes; repealing references to
residential facilities for dependent adults; and providing for an
effective date."
SENATE BILL NO. 319
"An Act relating to the possession of controlled substances within
500 feet of recreation and youth centers; and permitting
municipalities to install `drug-free recreation and youth center
zone' signs."
CS FOR HOUSE BILL NO. 195(FIN)
"An Act authorizing youth courts to provide for peer adjudication
of minors who have allegedly committed violations of state or
municipal laws, and renaming the community legal assistance grant
fund and amending the purposes for which grants may be made from
that fund in order to provide financial assistance for organization
and initial operation of youth courts."
PREVIOUS SENATE COMMITTEE ACTION
SB 249 - See Health, Education & Social Services minutes dated
2/2/94, 2/4/94, and 2/16/94.
SB 319 - No previous action to record.
HB 195 - No previous action to record.
WITNESS REGISTER
Connie Sipe
Executive Director, Division of Senior Services
Department of Administration
P.O. Box 110209
Juneau, Alaska 99811-0209
POSITION STATEMENT: Reviewed SB 249.
Ken Erickson
Staff to Senator Pearce
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Reviewed SB 319.
Paula Terrel
Staff to Representative Sitton
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Reviewed HB 195.
Anne Walker, Executive Director
Alaska Native Health Board
1345 Rudakof Circle
Anchorage, Alaska
POSITION STATEMENT: Reviewed ANHB State Legislative Priorities for or
Fiscal Year 1995.
Katherine Johnson, Treasurer
Alaska Native Health Board,
Representative for South Central Foundation
1345 Rudakof Circle
Anchorage, Alaska
POSITION STATEMENT: Reviewed ANHB State Legislative Priorities for or
Fiscal Year 1995.
Paul Manumik, Member
Alaska Native Health Board
1345 Rudakof Circle
Anchorage, Alaska
POSITION STATEMENT: Present for information.
Joseph Dexter, Executive Committee Member
Alaska Native Health Board
1345 Rudakof Circle
Anchorage, Alaska
POSITION STATEMENT: Present for information.
ACTION NARRATIVE
TAPE 94-12, SIDE A
Number 006
CHAIRMAN RIEGER called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:40 p.m. He introduced SB
249 (REGULATION OF ASSISTED LIVING HOMES) as the first order of
business before the committee.
SENATOR MILLER moved to adopt the CS of SB 249, Lauterbauch 8-
GS2002\E. Hearing no objections, the CS was adopted.
CONNIE SIPE, Director of Senior Services, referred to page 25, line
29 of the CS when noting the insertion of the definition of a
"terminally ill resident." She noted that this definition is
commonly accepted and used by Medicaid.
CHAIRMAN RIEGER noted that this language was before the committee
because the CS had been adopted. There was no objection to the
language of the inserted definition.
CONNIE SIPE pointed out the new definition of "resident" on page
25, line 23 of the CS. There was no objection to this language
change. She noted that on page 24, line 14 of the CS the words "to
the resident's self, to the staff of a home, or to others;" had
been added to the definition of "imminent danger." There were no
objections to that language change.
Ms. Sipe highlighted the new sections that Lauterbauch had added.
Page 26, Section 2 and Section 3 added assisted living homes to the
list of licensed centers where it is a crime to possess weapons on
such properties. These sections also discuss the results of
misconduct of weapons on such properties. She explained that this
addition was due to the assisted living homes being licensed by
Department of Family and Youth Services.
Ms. Sipe stated that subsection (b) on page 3 intends to avoid
assisted living homes from becoming primarily nursing homes. She
mentioned that on line 11 of subsection (b), the word "only" seems
too restrictive. She suggested deleting the word "only." She
explained that the regulating agency should have more flexibility
to give waivers for rural conditions or to allow other health care.
She noted that the word "only" on line 12, page 3 addresses those
individuals trying to operate as a mini-nursing home or
rehabilitation home with no intent of long term care.
Number 191
CHAIRMAN RIEGER moved to adopt Amendment 26.
AMENDMENT 26
Page 3, line 11:
Delete "only"
Hearing no objections, Amendment 26 was adopted.
Chairman Rieger pointed out that page 6, line 22 incorporated a
previous amendment, but the change did not include the words " but
not limited to." He assumed that was not included because the
wording was implicit.
CHAIRMAN RIEGER expressed concern with the Residents' Rights
language. He was concerned that the use of the word "rights" would
require the assisted living home to expend money beyond what is in
the residential services contract. He cited examples of this
possible problem: page 11, paragraph (3); page 12, paragraph (6)
and (10). He explained that those examples seem to create an
obligation of the home that are not in the contract. He expressed
the need to have clarification on this issue.
CONNIE SIPE stated that this bill attempts to address past abuses.
She suggested adding language which clarifies that the home does
not have an obligation to provide these "rights", but that the
resident has access to these "rights." She also reiterated
Chairman Rieger's previous suggestion to change them from "rights"
to "standards" that must be present in the contract. She also
suggested adding language that would not require the facility to
expend funds or guarantee that a resident has all the benefits and
services; however, that resident would not be restricted from
receiving them.
SENATOR SALO noted that the resident must be informed of their
rights.
CONNIE SIPE explained that this Residents' Rights section was meant
to be a balance. Ms. Sipe likened this section to the Tenant
Landlord law. She recommended adding a subsection (c) or
regrouping of the paragraphs in order to alleviate Chairman
Rieger's concerns.
Number 283
SENATOR SALO stated that a generic subsection would be difficult to
add. She pointed out that there are qualifiers, such as the word
"reasonable" on line 14 of page 12 which are already present on
some of the rights. She explained that her main concern was with
upholding the residents' rights.
CHAIRMAN RIEGER explained that he did not want to create a right
without knowing what was being created. He pointed out that the
fiscal note includes state facilities which often times means that
the court will have an open checkbook. He suggested taking the
rights separately and where appropriate adding Ms. Sipe's clause.
SENATOR SALO agreed that taking the rights separately would be more
appropriate than a general clause.
CHAIRMAN RIEGER asked if after the word "resident;" on page 11,
paragraph (3) the language stating "this subsection does not create
an obligation for the assisted living home to provide these items"
would be satisfactory to the intent. CONNIE SIPE said it would
work, but pointed out that if an individual does not own the items
then it is not theirs. She agreed that in order not to create new
rights Chairman Rieger's suggested language would work.
CHAIRMAN RIEGER cited paragraphs (3), (4), (12), and (14) as rights
that needed qualifiers stating that, "these do not create an
obligation for the home to expend resources to provide the items
unless specified in the contract." He felt paragraphs (6) and (10)
were different.
SENATOR LEMAN recommended that paragraph (7) should have a
qualifier in order to be consistent. CHAIRMAN RIEGER stated that
if paragraph (7) said "possessed" money it would be the same case
as paragraph (3).
SENATOR SALO suggested eliminating the words "possess and" in
paragraph (3) which would parallel paragraph (7). CHAIRMAN RIEGER
agreed that deletion would work for paragraph (3). CONNIE SIPE
noted that "the possession of" on line 29 should also be deleted.
CONNIE SIPE asked for clarification of Chairman Rieger's concerns
with paragraph (4) of the Residents' Rights section.
CHAIRMAN RIEGER suggested adding following clause: "this
subsection does not create an obligation for the assisted living
home to provide these items or to expend resources to provide these
items" at the end of paragraphs (3), (4), (12), and (14).
SENATOR SALO referred to page 12, line 4 when recommending changing
"visits with" to "visits from." CHAIRMAN RIEGER agreed with
Senator Salo's suggestion and believed that the generic clause
would not be necessary. Chairman Rieger reconsidered and believed
that the possibility that the home would become obligated was still
present in Senator Salo's language change.
Number 401
CHAIRMAN RIEGER stated his proposed disclaimer, "this subsection
does not create an obligation for the assisted living home to
expend money to provide these items, unless provided for in the
residential services contract." This language would be inserted at
the end of paragraphs (3), (4), (7), (12), and (14). Chairman
Rieger moved to adopt this language, Amendment 27.
AMENDMENT 27
Page 12, at the end of paragraphs (3), (4), (7), (12), and (14):
Insert " this subsection does not create an obligation for the
assisted living home to expend money to provide these items,
unless provided for in the residential services contract "
SENATOR SALO objected. After a hand vote, Amendment 27 was
adopted.
CHAIRMAN RIEGER recommended that paragraph (6) should have a
qualifier. After the word "from" the following clause ", at the
resident's own expense unless provided for in the residential
services contract," should be inserted. Chairman Rieger moved to
adopt this language insertion, Amendment 28.
AMENDMENT 28
Page 12, line 8, after "from":
Insert " , at the resident's own expense unless provided for in
the residential services contract,"
SENATOR SALO clarified the clause with an example. She stated that
a home could have a van to carry residents to activities, but the
home would not be required to provide a van. CHAIRMAN RIEGER
agreed with that example.
Hearing no objections, Amendment 28 was adopted.
CONNIE SIPE said that paragraph (10) could be put into programmatic
standards. She emphasized that the crucial part of paragraph (10)
is the resident's right to go outdoors. Having a "reasonable
opportunity" must remain. She explained that without this right,
arguably homes could lock residents inside.
CHAIRMAN RIEGER asked why there is a comma after "week" on line 15,
page 12; does a "reasonable opportunity" only apply to exercise but
not outdoors. CONNIE SIPE suggested deleting "to exercise at least
several times a week, and" in paragraph (10). SENATOR SALO asked
Ms. Sipe how that would read.
SENATOR SALO suggested deleting "at least several times a week,"
from paragraph (10).
CHAIRMAN RIEGER moved to adopt Amendment 29.
AMENDMENT 29
Page 12, line 14:
Delete "at least several times a week,"
Hearing no objections, Amendment 29 was adopted.
SENATOR SHARP suggested adding, "subject to the consent of the
resident," after "home" on page 13, line 25. He was concerned that
"shall" mandates that the resident must allow the advocates in the
home. CONNIE SIPE explained that on page 23, the definition of an
advocate requires that in order to be an advocate one must be
designated by the federal or state statute, like the long term care
Ombudsman and the Alaska Advocacy Services program.
Number 507
SENATOR SHARP asked if Veteran's Services Officers would meet the
definition of an advocate. CONNIE SIPE said yes and asserted that
any individual would have to be official.
SENATOR SHARP explained that the "shall" aspect would infringe on
the residents privacy. He did not want anyone to be routed to
individual resident's rooms; it should be subject to the resident's
consent. CONNIE SIPE asked if there could still be group meetings
which the residents could choose to attend or not. SENATOR SHARP
said yes.
CHAIRMAN RIEGER moved to adopt Amendment 30.
AMENDMENT 30
Page 13, line 24, after "home":
Insert " , subject to the consent of the resident, "
Hearing no objections, Amendment 30 was adopted.
CONNIE SIPE referred to page 14, line 26 when noting that at
present, that sentence implies that there may be other times when
the home could physically restrain residents. She suggested
changing the sentence to read: "An assisted living home may not
physically restrain a resident unless the resident's own actions
presents an imminent danger to the resident or others, in which
instance," and leave the remainder of the sentence in tact. This
change would basically clarify the standard of imminent danger.
SENATOR LEMAN asked if subsection (b) on page 14 imposed a burden
on other services that may not be intended. He questioned the
necessity to report to the listed personnel during short limited
instances of restraint.
CONNIE SIPE pointed out that the assisted living home has to have
a written policy that would have to be approved by the licensing
agency. Each instance will be different depending on the size and
location of the home. She said that the licensing agency would
determine what was appropriate in the different facilities.
SENATOR LEMAN asked if current practice is to always report
physical restraint to emergency personnel even if it is a one or
two minute incident. CONNIE SIPE pointed out that the last
sentence in subsection (b) addresses that issue. If the restraint
is short term then the physical restraint could stop as well as the
reporting of it, but there must be a procedure for ongoing
restraint. She explained that these homes are not correctional
facilities and if they physically restrain residents, professional
help should be present.
SENATOR SALO agreed with Senator Leman's interpretation of the
language in subsection (b). She believed that there would be
instances that would waste the time of the listed personnel due to
the lack of physical restraint standards regarding reporting.
CONNIE SIPE stated that someone more familiar with restraint
protocols would be able to answer Senator Leman and Senator Salo's
concerns with subsection (b).
TAPE 94-12, SIDE B
Number 591
CHAIRMAN RIEGER recommended that this issue be discussed further at
another hearing. He also noted that paragraphs (17) and (18) on
page 12 should have qualifiers. He suggested holding SB 249 until
Monday.
Chairman Rieger stated that Amendment 28 should precede paragraphs
(17), (18), and (6) on page 12.
CONNIE SIPE suggested deleting all of subsection (b) on page 14
except the first sentence, in order to address Senator Leman and
Senator Salo's concerns regarding physical restraint. The
reporting aspect would be dealt with through the individual home
working out their own procedure that would have to meet appropriate
protocol standards on restraint.
SENATOR SALO explained that the last sentence of subsection (b)
should be retained in order to address the termination of the
physical restraint when it is no longer necessary.
CHAIRMAN RIEGER held SB 249 until Monday. He requested that Mr.
Williams be present at the next meeting to discuss the fiscal note.
Number 561
CHAIRMAN RIEGER introduced SB 319 (DRUG FREE RECREATION AND YOUTH
CENTERS) as the next order of business before the committee.
KEN ERICKSON, Staff to Senator Pearce, read Senator Pearce's
sponsor statement.
SENATOR LEMAN asked if the reference to associated buildings
applies to municipal constructions. KEN ERICKSON pointed out that
Section 5 provides the definition of a "recreation or youth
center." Mr. Erickson said yes those would be included.
SENATOR SALO asked if a controlled substance included alcohol and
tobacco. KEN ERICKSON did not believe that alcohol or tobacco were
included in the laundry list in the statutes.
SENATOR SALO explained that the drug free zones around schools
clearly did include alcohol and tobacco. She asked if they also
used the language "controlled substance" and if they were changing
the same part of the statute. KEN ERICKSON stated that youth
centers are added to those currently listed in statutes.
SENATOR SALO noted that lay people would interpret "controlled
substances" to include alcohol and tobacco. She explained that
preventing the use of alcohol and tobacco in school during school
hours was not a problem; but when the facilities are used by
adults, problems with this drug free zone occur. She expressed
concern that if this language does include alcohol and tobacco
there would be numerous problems since this legislation speaks to
many adult used facilities.
CHAIRMAN RIEGER noted that SB 319 refers to schedules which
classify controlled substances. SENATOR SALO emphasized the need
to definitely know if "controlled substance" includes alcohol and
tobacco because this could be a felony.
KEN ERICKSON reviewed the statutes and did not see alcohol and
tobacco listed.
SENATOR LEMAN moved that SB 319 be passed out of committee with
individual recommendations. Hearing no objection, it was so
ordered.
Number 485
CHAIRMAN RIEGER introduced HB 195 (AUTHORIZING YOUTH COURTS) as the he
next order of business before the committee.
PAULA TERREL, Staff to Representative Sitton, gave an overview of
the sponsor statement. She pointed out that this youth court
program is modeled after the Anchorage program which has been
successful. She stated that Representative Sitton wanted to use
this legislation in order to help the kids without throwing them in
jail. HB 195 establishes the authority to establish the Youth
Court as a diversionary program and sets up a grant program. She
noted that in the Anchorage program, participation of the community
was shown to be essential to the programs success. HB 195 allows
flexibility to rural and urban communities to establish programs
based upon their specific needs. She noted that HB 195 allows the
Youth Court to subpoena witnesses. She expressed the support of HB
195 from the Anchorage youths who have participated in the program.
SENATOR SHARP asked if the subpoenas would be an added cost that is
not done through the Division of Family and Youth Services (DFYS).
PAULA TERREL said there would not be any extra cost for the
administration of the program. This is done through FYS not the
court system.
CHAIRMAN RIEGER asked what page 3, line 8 means; "may secure
jurisdiction over a juvenile." PAULA TERREL explained that
Juvenile Intake, of the Department of Health and Social Services
(DHSS), can refer a minor who has committed a misdemeanor to the
jurisdiction of the Youth Court. The parents of the minor, the
minor, and the Juvenile Intake officer must all approve of the
minor being sent to Youth Court. She clarified that Alaska Statute
18 refers to DHSS.
CHAIRMAN RIEGER asked if the authority is delegated by the statute
or from the court due to this statute enabling the court to have
the authority. PAULA TERREL stated that originally this was
purview of the court, but now it has shifted to Juvenile Intake of
DHSS. She noted the need for some clean up language in the
statutes. Basically the court system is not involved at all.
Number 412
SENATOR LEMAN asked what case can be referred to the Youth Court.
PAULA TERREL explained that DHSS would not refer nor would the
Youth Court accept severe felony cases such as murder. HB 195
would not conflict with the juvenile waiver bill.
CHAIRMAN RIEGER stated that Senator Leman's concern could be
addressed by inserting language on page 2, line 23 that would
specify that the case be a misdemeanor and the class of felony the
Youth Court would accept. PAULA TERREL expressed concern that such
an amendment should not hamper the Anchorage Youth Court and the
tasks it is already doing.
CHAIRMAN RIEGER asked if the Anchorage model would be included if
HB 195 passes. PAULA TERREL said yes.
SENATOR LEMAN said that knowing there is some protection sets his
mind at ease. He believed that having his concern on the record is
sufficient at this point.
SENATOR SALO moved to pass CSHB 195 (FIN) out of committee with
individual recommendations. Hearing no objections, it was so
ordered.
CHAIRMAN RIEGER invited the Alaska Native Health Board (ANHB) to
come forward to give their presentation.
ANNE WALKER, Executive Director of ANHB; KATHY JOHNSON, Treasurer
and Representative for South Central Foundation of the ANHB; JOSEPH
DEXTER, Chairman of the Nordan Sound Health Corporation Board of
Directors and Executive Committee member of ANHB; and Paul Manumik,
ANHB member introduced themselves to the committee.
Number 355
ANNE WALKER explained that the ANHB represents 93,000 Alaska
natives on health care issues. ANHB is the standing health
committee of the Alaska Federation of Natives. She stated that
ANHB supports SB 284 and SB 259. She explained that mandatory
health education in the schools is needed; she urged a senate
companion to HB 320.
Ms. Walker expressed support for an anti-tobacco program. She
pointed out that the committee could help by supporting the
Governor's proposed increase in tobacco tax. She stated that ANHB
supports a $1, as opposed to the Governor's 42 cents, per pack
cigarette tax. The increased tax would prevent easy access to
tobacco for children. Ms. Walker stated ANHB support of SB 235.
Number 311
KATHY JOHNSON referred to the ANHB briefing paper on "Home and
Community Based Services" when noting that in 1993 federal waivers
allowed Medicaid funds to be used to provide home and community
based services in Alaska; however, Medicaid limitations have
delayed the implementation of these new authorities. The ANHB
realizes that home and community based care will decrease the need
for institutional services in the long term. This will result in
dramatic cost savings for the state. She urged the legislature to
provide the medical assistance funding necessary to enhance these
services. She stated that the ANHB supports SB 249 and HB 377.
Ms. Johnson read the ANHB briefing paper on "Health Promotion and
Disease Prevention" which gave many statistics that illustrate that
almost one-third of all Native deaths are due to suicides,
homicides, and unintentional injuries. She noted that many people
are giving up smoking; however, they are turning to chewing. This
is related to the increase in heart disease and stroke. She said
that health prevention and information are ways to combat such
problems.
Ms. Johnson noted that the South Central Foundation has opened one
of the first FAS treatment facilities in the country. Indian
Health Services (IHS) supplies the majority of the funding. She
said that additional help was needed. She stated support for
funding of physicians assistant training programs. ANHB supports
SB 231, HB 341 for reimbursement of services for physicians
assistants in rural Alaska. She noted that physicians assistants
are often economical.
Ms. Johnson stated support for funding of mental health and
substance abuse services. She emphasized that it is essential to
continue efforts to resolve the Mental Health Lands Trust so that
state funding remains intact for services currently provided. She
expressed concern with the provision of adequate resources to
reduce dependency on the Alaska Psychiatric Institute by allowing
rural hospitals to provide inpatient psychiatric services without
financial risk. She noted that Fairbanks was experimenting with
this. She acknowledged the need to have an Alaska Psychiatric
Institute (API); however, it does not seem to be the most effective
means of care for rural people or people in Juneau. In conclusion,
she stated that the problems that had been discussed were relevant
to urban and rural Natives.
Number 195
CHAIRMAN RIEGER asked how many beds would be needed at the API.
KATHY JOHNSON could not answer with the exact number. ANNE WALKER
stated that the number of beds at an API would be proportional to
the number of designated psychiatric beds funded in other hospitals
in the state. Ms. Walker noted that the choice would be between
funding and locating all beds at API or less beds at API and
operational funding be given to other hospitals for designated
psychiatric beds. This would shift psychiatric beds from a
centralized location to other hospitals.
KATHY JOHNSON commented on the needs of the patient. When someone
from rural Alaska is sent to API, they often do not seem to find
there way back to rural Alaska. She stated that 60 percent of the
people Brother Francis' shelter encounters are mentally ill. She
indicated that such information supports having community based
programs for adequate care.
SENATOR SALO noted that HB 320 which deals with school health
education has a Senate companion sponsored by Senator Ellis,
SB 314. She explained that part of addressing health issues,
especially for teenagers, would begin with them having access and
the ability to deal with their own health issues. Two major
obstacles for teenagers when they are attempting to take
responsibility for their own health issues are transportation and
access. She suggested locating health clinics and social service
agencies near schools to eliminate the transportation and
communication problems.
KATHY JOHNSON noted that the South Central Foundation along with
the Indian Health Service want to locate satellite clinics in
communities with the highest native populations for better access
to care for all clients. SENATOR SALO reiterated that also placing
them near schools would create an even better situation.
Number 097
SENATOR LEMAN asked what type of non-emergency services could be
provided to a minor without parental consent, especially if these
clinics are near schools. KATHY JOHNSON stated that ANHB is
referring to family clinics. Ms. Johnson did not have an answer.
SENATOR SALO said that the permission could be gotten.
CHAIRMAN RIEGER asked where the Indian Health Services would fit in
under SB 284 since they stated support from ANHB for the bill.
ANNE WALKER pointed out that they had questions about the language,
particularly the definition and visual picture of the market based
single payer system. She noted that under SB 284, the health
corporation would allow waivers for federally funded health
programs. She expressed their opposition to lumping the Indian
Health Services into any single payer program. The federal
government has a trust responsibility to Alaska Natives who
currently enjoy a government to government relationship. She cited
health care services from the federal government as one of the
benefits of this government to government relationship. She stated
support of SB 284 except for the pursuit of the waiver for IHS.
CHAIRMAN RIEGER asked if an exemption of IHS would be support for
SB 284 for everyone except those people who can go to IHS.
ANNE WALKER said no. She noted that the native hospitals are 50
percent funded by IHS with the remainder coming from private
insurance companies and state Medicaid and Medicare programs. She
asserted that they are a major player in SB 284. Since the IHS
does not have a complete comprehensive benefit package, often they
provide less than 50 percent of the funding, they do not provide
long term care, and they provide minimal substance abuse services.
KATHY JOHNSON explained that the Anchorage Health Corporation
accepts third party payments which go back into the pool to provide
care for those who cannot pay for care.
TAPE 94-13, SIDE A
Number 004
ANNE WALKER noted that the unique situation of delivering health
services in Alaska is often not understood by others. She
supported Alaska passing a health care reform bill before the
federal government imposes their plan.
CHAIRMAN RIEGER asked if Ms. Walker's support for SB 284 was due to
their support for Alaska working and acting on health care reform
or support for the single payer concept.
ANNE WALKER noted that they had worked on the Health Resources and
Access Task Force and the group that merged the two bills into SB
284. She stated that they support Alaska passing a health care
reform bill and involving the state government in how private
providers and insurance companies work in the health care system.
She noted that Alaska currently has many health care systems that
often clash. She said that they support components of SB 284,
including the single payer system. She emphasized that they oppose
pursuit of a waiver to merge IHS into the single payer system. The
single payer system would be at odds with their current government
to government relationship.
SENATOR SALO said that as she understood, the Clinton plan would
merge the IHS system as well as others. ANNE WALKER said no. The
IHS system would be kept separate and would be enhanced to meet the
comprehensive health care benefit package that the nation will
have.
SENATOR SALO asked why it would be kept separate.
Number 065
ANNE WALKER explained that historically and throughout national
law, Indian people have given up much, such as land and fishing
rights to name a few. In return the federal government states in
law that they will provide health care services through a trust
relationship for the Indian people as a sovereign nation. She
noted that the proposed merger in a state or national plan would
end the direct government to government relationship as well as the
federal trust. That is the major reason to keep IHS separate from
any national or state plan. She reiterated that they are a player
in state health reform because 50 percent of their funds would be
effected.
CHAIRMAN RIEGER thanked the representatives of the Alaska Native
Health Board for their patience and their presentation. There
being no further business before the committee, the meeting was
adjourned at 3:12 p.m.
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