Legislature(1999 - 2000)
02/09/2000 01:35 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE February 9, 2000 1:35 P.M. MEMBERS PRESENT Senator Mike Miller, Chairman Senator Pete Kelly, Vice-Chairman Senator Gary Wilken Senator Drue Pearce MEMBERS ABSENT Senator Kim Elton COMMITTEE CALENDAR HOUSE CONCURRENT RESOLUTION NO. 15(title am) Requesting the governor to proclaim March 2000 as Developmental Disability Awareness Month. -MOVED HCR 15 (title am) OUT OF COMMITTEE SENATE CONCURRENT RESOLUTION NO. 12 Relating to declaring March 2000 as Sobriety Awareness Month. -MOVED SCR 12 OUT OF COMMITTEE SENATE BILL NO. 204 "An Act extending the termination date of the Alaska Commission on Aging; and providing for an effective date." -MOVED SB 204 OUT OF COMMITTEE SENATE BILL NO. 198 "An Act increasing the base student allocation component of the public school funding formula; and providing for an effective date." -MOVED SB 198 OUT OF COMMITTEE CS FOR HOUSE BILL NO. 85(FIN) am "An Act relating to licensure and professional discipline of members of the teaching profession and providing for related penalties; relating to grounds for dismissal of a teacher; relating to the Professional Teaching Practices Commission; relating to limited immunity for procedures under the Educator Ethics Act; making conforming amendments; and providing for an effective date." -MOVED CSHB 85(FIN) am OUT OF COMMITTEE Presentation by Mr. Jerry Near and Mr. Gary Schwartz of the Statewide Health Care Commission PREVIOUS SENATE COMMITTEE ACTION HJR 15 - See Resources minutes dated 4/14/99, 4/19/99 and 4/23/99 and Rules Committee minutes dated 5/5/99. SCR 12 - No previous action to consider. SB 204 - See HESS minutes dated 2/2/00. SB 198 - No previous action to consider. HB 85 - See Health and Social Services minutes dated 2/2/00. WITNESS REGISTER Ms. Jennifer Strickland Aide to Speaker Brian Porter State Capitol Bldg. Juneau, AK 99811-1182 POSITION STATEMENT: Testified for the sponsor of HCR 15. Ms. Angela Moss Aide to Senator Ward State Capitol Bldg. Juneau, AK 99811-1182 POSITION STATEMENT: Testified for the sponsor of SCR 12. Ms. Rene' Gayhart, Specialist Division of Mental Health and Developmental Disabilities Department of Health and Social Services P.O. Box 110620 Juneau, AK 99811-214 POSITION STATEMENT: Supports SCR 12. Ms. Pamela Watts, Executive Director Advisory Board on Alcoholism and Drug Abuse P.O. Box 240249 Anchorage, AK 99534-0249 POSITION STATEMENT: Supports SCR 12. Mr. Ernie Turner, Director Division of Alcohol and Drug Abuse Department of Health and Social Services P.O. Box 110607 Juneau, AK 99811-0607 POSITION STATEMENT: Supports SCR 12. Mr. Eddy Jeans, School Finance Manager Department of Education 801 W 10th, Suite 200 Juneau, AK 99801-1894 POSITION STATEMENT: Supports SB 198. Mr. Carl Rose, Executive Director Association of Alaska School Boards 316 W 11th Street Juneau, AK 99801 POSITION STATEMENT: Supports SB 198. Mr. John Cyr, President National Education Association Alaska (NEA) 114 Second Street Juneau, AK 99801 POSITION STATEMENT: Supports SB 198. Ms. Sanna Green, Executive Director Professional Teaching Practices Association (PTPA) 344 3rd Street, Ste 127 Anchorage, AK 99508 POSITION STATEMENT: Supports HB 85. ACTION NARRATIVE TAPE 00-04, SIDE A Number 001 HCR 15-DEVELOPMENTAL DISABILITY AWARENESS MONTH CHAIRMAN MILLER called the Senate Health, Education and Social Services (HESS) Committee to order at 1:35 p.m. and announced HCR 15 to be up for consideration. MS. JENNIFER STRICKLAND, aide to Representative Brian Porter, said the resolution simply establishes this coming March as developmental disability awareness month. Representative Porter decided to introduce this legislation as a resolution instead of a citation to bring broader recognition to the issue. Passage of HCR 15 will give strength to the efforts of many groups, especially the Key Campaign, and promote a greater understanding of the capabilities of Alaskans with developmental disabilities and the challenges they face. This has been a tradition in Alaska for a number of years and coincides with a similar designation on the national level, as proclaimed by President Reagan in 1983. SENATOR WILKEN moved to report HCR 15 from committee with individual recommendations and its zero fiscal note. There were no objections and it was so ordered. SENATE CONCURRENT RESOLUTION NO. 12 Relating to declaring March 2000 as Sobriety Awareness Month. CHAIRMAN MILLER announced SCR 12 to be up for consideration. MS. ANGELA MOSS, aide to Senator Ward, sponsor of SCR 12, declares March 2000 as sobriety awareness month. Alcohol and drug abuse has been identified as the single most destructive health problem in Alaska. Its devastating effects have been felt within every racial, ethnic, and economic background. SCR 12 reinforces Alaskans' commitment to a clean and healthy lifestyle. CHAIRMAN MILLER announced an at-ease. He called the meeting back to order and said that a person signed up to testify on the previous bill. He said the committee would take testimony now. MS. RENE' GAYHART, Developmental Disabilities (DD) Program, Division of Mental Health and Developmental Disabilities, stated support for HCR 15. HCR 15 is important because it recognizes nearly 12,000 Alaskans with DD and their need for life-long supports to be fully included in the community where they live. The Division welcomes the advocacy consumers, the Key Campaign, and the Key coalition branch of the DD Program. They also support the efforts of service provider agencies, families, and the Governor's Council on Disabilities and Special Education to ensure that more Alaskans with DD are able to participate in and contribute to community life. The programs in her division accomplish the important goals of integration and inclusion in one's community. Recognition of March as developmental disabilities awareness month will demonstrate the power of community that is exemplified by people with disabilities. CHAIRMAN MILLER apologized for missing her testimony when the bill was before them. He then returned to SCR 12. Number 465 MS. PAMELA WATTS, Executive Director, Advisory Board on Alcoholism and Drug Abuse, stated support for SCR 12. She said March has been proclaimed DD awareness month since 1995 in recognition and appreciation of the example set by citizens who believe in and support a life of sobriety. Alcoholism and drug abuse has had a negative impact on our society, but most unfortunately on our families and communities. Our high national ranking in child abuse and neglect is significantly impacted by alcohol and drug abuse. The cost to Alaska in terms of human and financial resources is staggering. This resolution reflects the mission, strategies, and goals of the Advisory Board's state plan for alcohol and drug abuse services. The Board strongly supports individual, organizational, community, and statewide efforts toward prevention and intervention of alcohol and drug abuse problems. The Board recognizes the efforts of those who lead the way. They appreciate the leadership of the Legislature in paving the way for continued reenforcement of the improved quality of life for all Alaskans. Number 585 MR. ERNIE TURNER, Director, Division on Alcohol and Drug Abuse, stated support for SCR 12. He fully endorsed the previous testimony. SENATOR WILKEN moved to pass SCR 12 out of committee with individual recommendations. There were no objections and it was so ordered. SB 204-EXTEND ALASKA COMMISSION ON AGING CHAIRMAN MILLER announced SB 204 to be up for consideration and announced that the committee had already held a public hearing on this legislation. SENATOR KELLY asked for a fiscal note. CHAIRMAN MILLER noted that it has a zero fiscal note. There being no one else wishing to testify, SENATOR WILKEN moved to pass SB 204 from committee with individual recommendations and its attached fiscal note. There were no objections and it was so ordered. SB 198-INCREASE BASE ALLOCATION FOR EDUCATION CHAIRMAN MILLER announced SB 198 to be up for consideration. SENATOR WILKEN, sponsor of SB 198, said the State of Alaska's education funding formula is based on a specific dollar amount per student. Currently, the base student allocation is $3,940. SB 198 increases this allocation by $50, making the base allocation $3,990. In FY01, the foundation program, which funds K-12 Alaska public schools, will require approximately $19 million less in state aid than the amount authorized in FY00. Several key factors contribute to this drop in state aide while continuing to fund the foundation formula. One is a decline in projected student enrollment which is projected to be about .8 percent; another is a required increase in the local effort per the formula (an increase, depending on where you live, of around 2-5 percent); another is an increase in assessed values across the state; and last, an increase in the deductible impact aid, known as PL 874 money (an increase of $11 million or 15 percent over last year). SB 198 keeps a portion of these savings within K-12 education and provides a modest increase in school funding equally across the state. He encouraged their support. MR. EDDY JEANS, School Finance Manager, Department of Education (DOE), said the Governor has introduced SB 244 which would direct an increase in funding through the quality schools grant component of the foundation program. Specifically, it targets the money to improve student performance. The Department of Education prepared a fiscal note for SB 198 and the $50 increase in the base student allocation equals $10,489,300. He emphasized that he feels strongly that new dollars in the foundation program need to be targeted to improve student performance. He offered to answer any questions at this time. Number 908 MR. JOHN CYR, President, National Education Association - Alaska, stated support for SB 198. NEAA believes the need for more money for schools is critical. It believes the foundation formula needs to be increased. NEAA is also concerned about teacher salaries. More and more young professionals are leaving the state because they can't make a living here. For instance, his son-in-law is moving away with his two grandchildren. He has been teaching in Homer for the last three years but cannot make an adequate living. The same thing is happening to other folks, too; and it's a shame to see it happen. The State needs to provide the basic infrastructure that schools require. Alaska schools need help all over, not just in the quality schools initiative. He urged committee members to pass the bill. Number 1021 MR. CARL ROSE, Executive Director, Association of Alaska School Boards, stated support for SB 198 and made the following comments. The quality of life in Alaska and across the U.S. will be directly proportionate to the quality of the education we provide the young people today. The issue is one of quality and he agrees with the Department of Education that we need to pay strict attention to that. There is a system in place right now and quality initiatives have been introduced that will require additional money. We don't have the option of stopping what we do right now and focus strictly on the quality of improvements. We have to continue providing the services they do right now and, in many cases, schools are doing a good job. Their needs are tremendous and the way the foundation is set up ... we have a strong economy in Alaska and it's reflected in our property values. It calls for more local contributions as a result of declining enrollment and the additional impact aid money. The actual money to public education will be less than what was appropriated last year and the question is not that we have fewer needs today; we have more needs. They support the quality initiatives. He understands the Governor's position, but he is perplexed by the comment that dollars won't be siphoned off or redirected to salaries, maintenance and administration. Students have to be housed somewhere, which is maintenance. Our students have to be taught and that is largely salaries for our teachers. These schools have to be administered; that's not the responsibility of professionals in the class room. They are under tremendous mandates; schools have to be administered to provide the public with some level of accountability. He concluded by saying that schools have great needs and this should get us part of the way there. There is some merit to the Governor's proposal. We are $19 million short and he wanted to do everything he could to get those dollars into our schools, because they need the money. SENATOR WILKEN moved to report SB 198 out of committee with individual recommendations with the attached fiscal note. There were no objections and it was so ordered. HB 85-TEACHERS'LICENSES, DISCIPLINE & ETHICS MS. SANNA GREEN, Deputy Director, Professional Teaching Practices Commission (PTPC), said the purpose of the bill is essentially to consolidate statutes in a single place and add some new provisions. In order to make things consistent, the word "certification" has been changed to "license." The rest of the bill gives the PTPC the authority to do some of the things it has been doing in practice. She said one of the new sections is a compilation of the grounds for denial of applications. The PTPC would like reciprocal discipline in Alaska for an educator who has been disciplined in another jurisdiction. To do that now, the PTPC has to go through the whole hearing process. Notification is available through the national clearinghouse, but the PTPC has to go through a hearing process. This change would speed things up. The PTPC would like to expand the waiting period from one to five years for reinstatement, because one year is not sufficient. It wants to add that misrepresentation of a material fact on an employment application is grounds for discipline. Right now the PTPC can discipline if a fact is misrepresented on an application for certification, but they want to include misrepresentation on an application to a school district. The PTPC would like the authority to put conditions on teaching licenses. The PTPC wants the authority to impose a civil fine against a person who is regulated by state law but does not hold a license. The main people covered by that provision would be teachers in higher education who are under their jurisdiction by statute but have no license. There are hardly any disciplinary sanctions the PTPC can impose on that group. The PTPC would like the ability to impose a civil fine of up to $5,000 (although that amount is limited in the proposed legislation). The bill also contains a provision that a person's license is suspended or revoked from employment as a member of the teaching profession even if the position does not require a license. There is a case where it revoked the certificate of a superintendent and then the school district wished to rehire him back in the same position as a noncertificated employee. It would also like to strengthen the provisions of confidentiality of minors. The PTPC would like a provision to provide immunity from liability for persons who participate in good faith in their proceedings. They have this now, but it is a little restrictive. They would like to mandate that a person who accepts a job that requires a certificate and doesn't have one could be charged with a class B misdemeanor if they don't petition to get one. This has happened, because the person can just say they have applied for the certificate when they are hired for 90 days (while presumably the Department is going through the process of getting them licensed). Number 1605 SENATOR WILKEN asked if the PTPC supports the legislation unanimously. MS. GREEN replied that it does. SENATOR WILKEN added that the Department of Education is in full support also. CHAIRMAN MILLER said he thought this was a worthy piece of legislation, but it bothers him when state agencies do something and then ask for the authority to do it later; this is the reverse of the way things should be done. SENATOR KELLY moved to pass HB 85 from committee with individual recommendations and the attached zero fiscal note. There were no objections and it was so ordered. Number 1693 CHAIRMAN MILLER announced that was all the legislation the committee would take up today, but they would now receive a presentation from Mr. Jerry Near and Gary Schwartz with the Health Care Commission. MR. GARY SCHWARTZ, member of the Community Care Foundation Board of Directors, said their purpose is to conduct intensive study and public hearings regarding the establishment of a self-funded state health care delivery organization. It's not a government organization; it could be public, private, coop, or 501(C)(3) type of organization. It could offer and administer a basic health benefit plan available to all Alaskans. He said the bill they prepared is modeled after the Long-term Care Task Force that they have all supported. The Statewide Health Care Commission, after about a year's work, had recommendations for the legislature on appropriate and affordable health services for Alaskans to be covered in a statewide plan. The projected health insurance premium costs could be approximately 30% lower than what we are now seeing. He asked the legislature to encourage the creation of a health care market more directly driven by consumers and health care providers responsive to the needs of Alaskans. Under the statewide health care delivery system envisioned, Alaskans would be able to have a choice of their physicians from a panel of providers who meet participation criteria and want to provide health care to Alaskans. The physicians' panels would provide a full continuum of medically necessary services for the enrolled population. The Alaska Health Care Delivery System does not need to be overhauled; we need to fine tune the existing system. We have excellent physicians and hospitals in Alaska who, they believe, are committed to providing high quality, accessible, and cost effect services. They need support and encouragement from Alaskans to improve efficiencies in delivering health and medical care - a basic standard program that provides medically necessary services throughout Alaska covering physician services, institutional or in- patient care, emergency care, out patient procedures, preventive services, and prescription to create the proper marketing climate for improvements in provider productivity and efficiency. In addition to addressing a statewide health plan, they envision the Commission recommending health care efficiencies and the elimination of unnecessary services. The ultimate goal is to ensure that every Alaskan has access to affordable and appropriate health care services. The Alaska Health Plan should become the obvious choice for health care financing by virtue of its affordability, quality of services, superior health outcomes and demonstrated commitment to excellence. MR. SCHWARTZ said that there are limited numbers of health insurance companies competing in the Alaska market which seriously impacts the cost availability of coverage and patient access to quality medical care. There are between 80,000 to 100,000 uninsured Alaskans who cannot afford health insurance premiums. He understands that they run a good 35 - 40% more than they do in the lower 48. If we had our own program, we could probably reduce those costs by at least 30%. He said they are concerned that about 40% of our health and hospital services are provided out-of-state in spite of the fact that we have excellent physicians and hospitals in the state. We bypass our own resources. They thought that an Alaska plan for Alaskans and by Alaskans would address that issue. They would also like to see the administration of private and public health insurance claims done here in Alaska. There is no reason why you can't process claims, determine eligibility, and provide an administrative service right here in Alaska. The Commission would like to see the state form a partnership with the health insurance company, but they have to meet a certain criteria. They have to use Alaskans, provide jobs and keep those resources and people here. There really is no means for Alaskans to compare existing health insurance plans and the relative costs of operation, medical, and hospital services, as well as administrative efficiency. They believe the Commission in its public hearings could address these issues as well. SENATOR WILKEN asked what was different about their proposal compared to what the situation is today. Number 2116 MR. JERRY NEAR answered that it would be an Alaskan citizen-owned system. SENATOR WILKEN asked if it would compete with Aetna and the rest. MR. SCHWARTZ answered that it certainly could compete with the other insurance companies, or they could become a partner. The point is they are really trying to lower the cost of medical care and would like to get a basic benefit program available to all Alaskans at their option. It's intolerable when you have 80,000 to 100,000 uninsureds. A fourth of those are children and nobody is really addressing that. SENATOR WILKEN asked who pays for the 75,000 people who are presently uninsured. MR. NEAR answered that a part of it could be having a health insurance plan that is not as expensive as they are now. When they testified yesterday in the House HESS Committee there was an avalanche of people responding to their ideas, like the Denali Kid Program, a participatory program with federal funds. This program is going to grow and next year there will be the need for more support than there is this year. When health insurance is getting to be $600-$700 per month, a lot of employees are not covering their families. Unless they can do something about the cause, they will have a fix-it program that will continue to grow. MR. NEAR pointed out that the World Health Organization has identified key elements to achieve better health: peace, shelter, education, decent income, and stable economy, sustainable resources, social justice, and equity. They don't even mention the intervention of our health care system that we currently pay a lot of money for. Further, they say that a society that spends so much in health care may be reducing health because they end up neglecting other key elements. Alaska needs to become more self sufficient. The Organization also winnowed through all the elements to figure out what other elements relate to the health of a nation and it got down to economics. Unless you have a decent job at a decent wage that is sustainable, it's going to be more of what we've got. MR. NEAR said you don't really have to work with a partner, but ramping up our citizen owned system is fairly expensive and demands quite a bit of talent, hardware, and expertise. He noted that the Anchorage school system, which is close to being the second largest employer in the state, is having discussions about their current program. Overall, the state spends close to $3 billion and if we could manufacture a 10% savings on those amounts, that's significant. They request that the legislature look seriously at their proposal. TAPE 00-04, SIDE B Number 2361 SENATOR KELLY said it seems like the goals of increasing health care and driving down the cost are mutually exclusive. He asked if they have any idea of how that would work. MR. SCHWARTZ said yes; that last year Representative Gary Davis provided a business plan on how that would happen. They received letters from both the House and the Senate encouraging them to go forward. They laid out one model based on what the large and small business coalitions are doing by forming group purchasing capability, working directly with providers whether they are physicians or hospitals. His experience in the Twin Cities with a large business coalition was that they were able to reduce the cost of health care by about 14% and providing care to about 485,000 people. It was getting doctors, patients, and purchasers together and reaching some common understanding of what the basics were going to be, how they would be communicated, and how they were going to demonstrate quality and outcomes. They worked with the providers and negotiated an equitable reimbursement system which was competitive. He did not mean that just Minneapolis and St. Paul were the model; this has been done in a number of areas in the private sector. They feel that by reducing premium costs, more demand would be generated, but you're improving, and with preventive services, you're actually improving health care. As a result, they can save 20-30 percent. People will be able to buy coverage again. Some of the small margin, the profit, can help subsidize the uninsured. Number 2361 MR. NEAR said there is a lot of activity in forming associations for grouping so that you get a greater mass of participation. The whole theory of insurance is to share the risk; the more participants, the per individual risk goes down. The optimal size for a group seems to be 500,000-1,000,000 enrollees. Alaska fits in that scenario. If you get more than that, it doesn't improve much. He reiterated that the state had done a lot of studies on moose, caribou, and fish; the amount of money involved in those entities nowhere compares to what we're spending on health care. He thought it merited a good close look by the legislature. SENATOR KELLY asked if their model would have price controls attached to it. MR. SCHWARTZ answered that he didn't want to have mandates; he wanted insurance companies to stay and compete. He thought the Commission could develop a very affordable plan that would lower the insurance premiums of other companies that want to stay in this market. He would be shocked if they had to impose price controls. Also, they are not out to "gore" the provider with this either. A number of physicians in Fairbanks are looking for ways to improve administrative efficiencies and provide better care. Everyone thanked each other for their efforts. CHAIRMAN MILLER adjourned the meeting at 2:40 p.m.