Legislature(2003 - 2004)
04/09/2003 01:31 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE April 9, 2003 1:31 p.m. TAPE(S) 03-18, 19 MEMBERS PRESENT Senator Fred Dyson, Chair Senator Lyda Green, Vice Chair Senator Gary Wilken Senator Bettye Davis Senator Gretchen Guess MEMBERS ABSENT All members present COMMITTEE CALENDAR SENATE BILL NO. 121 "An Act relating to community schools; and providing for an effective date." MOVED SB 121 OUT OF COMMITTEE SENATE BILL NO. 30 "An Act relating to information and services available to pregnant women and other persons; and ensuring informed consent before an abortion may be performed, except in cases of medical emergency." HEARD AND HELD SENATE BILL NO. 157 "An Act relating to inpatient psychiatric services for persons who are under 21 years of age and are either eligible for medical assistance or are in the custody of the Department of Health and Social Services." MOVED CSSB 157(HES) OUT OF COMMITTEE SENATE BILL NO. 84 "An Act relating to the Alaska teacher recruitment loan repayment program; and providing for an effective date." MOVED CSSB 84(HES) OUT OF COMMITTEE SPONSOR SUBSTITUTE FOR SENATE BILL NO. 154 "An Act relating to a student loan repayment program for nurses, and amending the duties of the Board of Nursing that relate to this program; and providing for an effective date." MOVED SSSB 154 OUT OF COMMITTEE PREVIOUS ACTION SB 121 - See HESS minutes dated 4/7/03. SB 30 - See HESS minutes dated 3/17/03, 3/26/03 and 4/3/03. SB 157 - No previous action to record. SB 84 - No previous action to record. SB 154 - No previous action to record. WITNESS REGISTER Mr. Curt Ledford, Director Community Schools Sitka AK POSITION STATEMENT: Opposed SB 121. Ms. Janice DeLand Offnet - No address provided POSITION STATEMENT: Supported SB 30. Mr. Sid Heidersdorf PO Box 658 Juneau AK POSITION STATEMENT: Supported SB 30. Ms. Karleen Jackson, Deputy Commissioner Department of Health & Social Services PO Box 110601 Juneau, AK 99801-0601 POSITION STATEMENT: Supported SB 30. Ms. Linda Bowdre PO Box 1048 Delta Junction AK 99737 POSITION STATEMENT: Supported SB 30. Ms. Kari Thomas PO Box 165 Delta Junction AK 99737 POSITION STATEMENT: Supported SB 30. Ms. Roseanne Curran PO Box 42 Cordova AK 99574 POSITION STATEMENT: Supported SB 30. Ms. Karen Vosburgh PO Box 1847 Palmer AK 99645 POSITION STATEMENT: Supported SB 30. Dr. Coleen Murphy No address provided POSITION STATEMENT: Opposed SB 30. Ms. Thea Pitmann No address provided POSITION STATEMENT: Opposed SB 30. Ms. Dietrick Stitler No address provided POSITION STATEMENT: Opposed SB 30. Ms. Robin Smith No address provided POSITION STATEMENT: Opposed SB 30. Ms. Pauline Udder No address provided POSITION STATEMENT: Opposed SB 30. Mr. Bill Hogan, Director Division of Mental Health and Developmental Disabilities Department of Health & Social Services PO Box 110601 Juneau, AK 99801-0601 POSITION STATEMENT: Supported the concept of SB 157. Mr. John Duffy, Manager Mat-Su Borough 350 E. Dahlia Palmer AK 99645 POSITION STATEMENT: Supported SB 157. Ms. Catherine Rapoport, Regional Vice President Universal Health Services POSITION STATEMENT: Supported SB 157. Ms. Terry Keklak No address provided POSITION STATEMENT: Supported SB 157. Mr. Richard Rainery, Executive Director Alaska Mental Health Board 550 W 7th Ave., Suite 1820 Anchorage AK 99501 POSITION STATEMENT: Supported SB 157. Ms. Diane Barrans, Executive Director Postsecondary Education Commission Department of Education & Early Development th 801 W 10 St. Juneau, AK 99801-1894 POSITION STATEMENT: Supported SB 84. Ms. Mary Francis, Executive Director Alaska Association of School Administrators 326 4th, Suite 404 Juneau AK 99801 POSITION STATEMENT: Supported SB 84. Mr. John Alcantra, Government Relations Director National Education Association POSITION STATEMENT: Supported SB 84. Mr. Rick Urion, Director Division of Occupational Licensing Department of Community & Economic Development PO Box 110800 Juneau, AK 99811-0800 POSITION STATEMENT: Supported SB 154. Ms. Camille Soleil Alaska Nurses Association 2207 E. Tudor Rd. Ste. 34 Anchorage AK 99507 POSITION STATEMENT: Supported SB 154. Ms. Catherine Geissel Alaska Nurse Practitioner's Association Anchorage AK POSITION STATEMENT: Supported SB 154. Ms. Pat Senner, President Alaska Nurses Association 2207 E. Tudor Rd. Ste. 34 Anchorage AK 99507 POSITION STATEMENT: Supported SB 154. Ms. Deb Erickson, Deputy Director Division of Public Health Department of Health & Social Services PO Box 110601 Juneau, AK 99801-0601 POSITION STATEMENT: Supported SB 154. Ms. Angel Rick PO Box 71727 Fairbanks AK 99707 POSITION STATEMENT: Supported SB 154. ACTION NARRATIVE TAPE 03-18, SIDE A SB 121-COMMUNITY SCHOOLS CHAIR FRED DYSON called the Senate Health, Education and Social Services Standing Committee meeting to order at 1:31 p.m. All members were present. He announced SB 121 to be up for consideration. SENATOR GRETCHEN GUESS reminded the committee that Senator Wilken wanted her to find out about fees for the Anchorage community schools programs. She said last year Anchorage collected $65,000 in fees and spent approximately $700,000. She stated: Although there were some questions and we did get some faxes, I do think that Eddy Jeans' sheet was wrong, because in the accounting of community schools, multiple things go into community schools. This is just one of, I think, of five or six. So, the sheet we got was incorrect on how much money is being spent. SENATOR GARY WILKEN moved to report SB 121 from committee with individual recommendations and its attached fiscal note. SENATOR GUESS objected. MR. CURT LEDFORD, Director, Community Schools, Sitka, said although the state's portion of Sitka's overall budget is small, it's seen by the community as state support of the program. CHAIR DYSON said he supports community schools and that using unused community facilities along with community talent to provide a multitude of services is a wonderful deal. He noted: It's one of the ones the governor highlighted; I wish it wasn't so. I am willing to pass it on to the consideration of the Finance Committee and this is not the end of the track for this. CHAIR DYSON called for a roll call vote. SENATORS GREEN, WILKEN, and DYSON voted yea; SENATORS GUESS and DAVIS voted nay; and SB 121 moved from committee. SB 30-ABORTION: INFORMED CONSENT; INFORMATION CHAIR FRED DYSON announced SB 30 to be up for consideration and called an at-ease from 1:36 to 1:38 p.m. He said the Department of Health and Social Services (DHSS) and the Department of Law (DOL) provided conceptual notes about the amendments to SB 30. The first two notes concern typos. DHSS suggested that it create a website to keep the pamphlet information updated with access by agencies to update their particular information as it became available. That approach decreases the fiscal note from $120,000 to $10,000 and he had not heard a good argument against it. The DOL suggested offering immunity from prosecution to providers who distribute the pamphlet or a printout as incentive for fulfilling the requirements for getting information to the patient/client. MS. JANICE DELAND supported SB 30. She related her experience 27 years ago when a doctor told her she had to have an abortion because she was miscarrying. MR. SID HEIDERSDORF, Juneau resident, said, "This is much needed legislation to protect women from unscrupulous abortion practices." He thought that abortion counseling was a sham and that most women are not adequately informed. Many states already require informed consent of this type. He also added that the 24-hour waiting period is important because a woman needs some breathing room from the intimidating atmosphere of a clinic after getting their information. MS. KARLEEN JACKSON, Deputy Commissioner, Department of Health and Social Services, supported SB 30. DHSS is particularly excited about making the information available on its website. That would not only allow physicians to download and print out the information, but it would allow women who have access to an Internet connection to get the information as they try to figure out what to do regarding a pregnancy. The fiscal note would be much lower if the information was on a website. MS. LINDA BOWDRE, Delta Junction resident, supported SB 30 and commented that she can't understand why the state has to have a bill to require doctors to explain a very serious medical procedure to their patients. MS. KARI THOMAS, Delta Junction resident, supported SB 30 and thought the website was a great idea, except that providers need to be held accountable to make sure they give the information to the patient. MS. ROSEANNE CURRAN, Cordova resident, supported SB 30. She noted, "It just makes sense to have as many facts as possible before any type of surgery or medical procedure, especially one as life changing as an abortion." MS. KAREN VOSBURGH, Mat-Su resident, supported SB 30 saying, "It's always a good idea to have more information rather than none or less." DR. COLEEN MURPHY, OB-GYN, said she has been practicing in Alaska since 1987 and is an active abortion provider. She has undergone credentialing and review by the National Abortion Federation to provide such services. She is currently undergoing her annual board certification for the American College of OB- GYN to provide many high quality services, including menopausal care, gynecologic services, contraceptive services, abortion and others. She noted that she just paid $10,000 on a premium for malpractice coverage to practice here. She is accountable to the American Medical Association's code of ethics for providing appropriate informed consent and she is held to a preexisting statute, AS 05.09.555, which discusses informed consent for all surgical and invasive medical procedures. She concluded by saying this bill is unnecessary and meddles with private discussions between a patient and a doctor. She said this would place obstructions to health care, as many women in Alaska have to travel from remote places to get abortion services; requiring a 24-hour wait only raises the cost of the care. CHAIR DYSON appreciated her mentioning that the Legislature is putting the language now in the Alaska Administrative Code about informed consent into statute. DR. MURPHY interrupted to say that she had just done a vaginal hysterectomy on a Jehovah's Witness who didn't want blood products. She suggested if the Legislature is going to specifically include abortion in statute, it should put all procedures, like that one, in as well. CHAIR DYSON replied the difference is that the human rights issue makes abortion different from other surgical procedures. He said he might agree that the 24-hour waiting period is an unfortunate choice and asked whether doctors still inject laminaria and then wait for a couple of hours as a procedure. DR. MURPHY replied that the National Abortion Federation does not recommend the use of cervical dilatation. She explained that the moment a foreign body is put in the cervix, basically, the abortion starts. The informed consent for people who use laminaria actually states that the minute laminaria is used, the abortion starts. CHAIR DYSON asked the standard length of time a patient stays for observation after the procedure. DR. MURPHY replied that the majority of patients are immediately observed for excessive blood loss. She explained that there are two different types of abortions now available - medical and surgical. The medical procedure involves giving a patient medicine. The patient can then safely deliver at home as an abortion. That procedure is growing in usage. The surgical procedure is done in the office and the patient is observed for signs of blood loss for approximately a half to one hour afterwards. She also said that more and more non-obstetrician gynecologists are getting trained in the use of medical abortion so they can offer it, if they haven't been surgically trained. She pointed out, "So, more and more women are actually doing this at home and it's going to be really hard for you to regulate that." CHAIR DYSON said he appreciated her information. He asked if a patient who flies in from rural Alaska would be able to fly home on the same day. DR. MURPHY replied if it's a surgical procedure, patients can generally fly home the same day. If they have to wait 24-hours and are using a laminaria procedure, they can return home 48 hours later. She noted that Medicaid pays for a minority of the abortions done in her office because most women pay for them out of pocket to avoid creating a paper trail. MS. THEA PITMANN, Anchorage resident, opposed SB 30, but was not opposed to trying to reduce the number of abortions that take place. She said the bad thing about this bill is that it addresses the issue after a woman is pregnant, instead of providing opportunities to prevent unwanted pregnancies in the first place. She urged the committee to do more research on this issue. MS. DIETRICH STITLER, Anchorage resident, opposed SB 30. She related how she was diagnosed with hemophilia at the age of 14 and it is medically dangerous for her to carry a pregnancy to term because a loss of blood during delivery could potentially be fatal. She didn't think the government should have a place in any pregnancy decision she might have to make. Her biggest concern is with their definition of medical necessity. She might not fall under that section, because having an abortion at the very moment would probably not be a life saving measure or an emergency situation. Her doctor would probably say that a delay in abortion could create a serious risk or that there is a significant chance that a delay may create a serious risk. She said this bill would add costs for additional office visits and create a waiting period that could increase the risk of complication. MS. ROBIN SMITH opposed SB 30. She said it is far more than an informed consent bill. The 24-hour waiting period makes it totally biased against rural women by increasing the cost of whatever stay they have to make in the city. Abortions cost more than $500 and one of the main reasons second trimester abortions occur is that women are trying to get funds together to pay for them. She pointed out the parental consent requirement has already been struck down by Alaska courts (although it is now in the Supreme Court, but she thought it would be struck down again). MS. SMITH also pointed out that this bill requires the facility to be state and federally approved and at this point the only facility that fits that description is Valley hospital. Most abortions are now conducted in a doctor's office. MS. PAULINE UDDER opposed SB 30 saying they should not place any more impediments in front of women who, according to our Supreme Court, still have the right to choose. She related how her 43- year old friend will have to fly to Seattle to get an abortion if it turns out that she is carrying a Downs-syndrome fetus. TAPE 03-18, SIDE B CHAIR DYSON thanked all participants for their testimony and set SB 30 aside. SB 157-INPATIENT PSYCHIATRIC SERVICES CHAIR FRED DYSON announced SB 157 to be up for consideration. SENATOR LYDA GREEN, sponsor, said SB 157 addresses instate and out-of-state psychiatric facilities, and is particularly directed toward the children of the state who are either on Medicaid or in state custody and must leave Alaska to receive services. This bill requires that those children be placed instate for psychiatric care as long as a suitable place can be found. SENATOR GRETCHEN GUESS asked if the terms "appropriately address" and "unavailable" are strong enough words to use to decide if the clinical diagnosis can be addressed in the state. SENATOR GREEN replied that she thought they provide a moveable target for each individual that would require a very personal evaluation. CHAIR DYSON said he supports this bill, but it seems that the department would never send someone out of state if an instate facility was available and that the bill might be superfluous. He asked what the bill changes. SENATOR GREEN explained that currently the department cannot disallow a person from choosing the facility to which he or she wishes to go, particularly if the person is receiving health care through the Denali Kid Care program. A little over 200 individuals have been placed in outside facilities with no review by a state entity. This bill would require that instate services be exhausted before they are sent outside. It would also encourage groups to either add on to a current facility, like a juvenile psychiatric facility, or do some other form of instate upgrading. MR. BILL HOGAN, Director, Division of Mental Health and Developmental Disabilities, DHSS, supported the concept of SB 157, which affirms the current process the department uses to ensure that instate options are explored before a child is placed out of state. They feel the bill supports and enhances the monitoring of those children once they are placed out of state to determine if they are ready to come back and, if they are, that there is an instate option available. It supports the department's view that children should be served in Alaska, in their own community and as close as possible to their own family. CHAIR DYSON asked why these instate services evolved in the past and whether this piece of legislation removed some of those impediments. MR. HOGAN replied he understands that on occasion, instate options are available and for some reason they are not being taken advantage of at the time. Another issue is whether or not adequate funding is available to build instate capacity. MR. JOHN DUFFY, Manager, Mat-Su Borough, supported SB 157 for all the reasons stated. He said the state is presently sending 350 children out of state. SB 157 will save the state large amounts of money as instate treatment is much less expensive and improves the chances of success in allowing children to be closer to their family support networks. In addition, SB 157 will bring jobs back to Alaska and reduces the risk for additional private sector investment in residential treatment centers by assuring that the state will consider use of them before sending children out of state. CHAIR DYSON asked if he anticipates that a state facility might be started or enhanced in the Mat-Su Valley. MR. DUFFY replied that the borough has been approached by at least two firms that are interested in constructing such facilities out there. MS. KATHY CRONIN RAPOPORT, Regional Vice President, Universal Health Services, supported SB 157. She said she is also responsible for the Universal Health Care facilities in Utah. She concurred that there are over 350 children in residential psychiatric treatment centers in the Lower 48. Northstar Hospital is their inpatient acute care hospital and has 58 patients. Four of them are pending discharge in the next few days. All four are children on Alaska State Medicaid who are being referred to treatment centers outside the state on the recommendation of their caseworker and the outside placement committee. This is happening while Northstar has nine available residential treatment beds. She continued: Referring these kids to treatment centers outside the state has devastating long-term impacts on the children, their families, and ultimately on our state. Mental health treatment should be provided close to home where we can have good coordination for follow-up care with the residential treatment provider and the outpatient provider who will see the patient after discharge. Most importantly, treatment should involve the family. Family treatment is a critical element of children's mental health treatment. Their treatment in the local community is good for the children, their family, and it increases their chances for long-term success... MS. RAPOPORT agreed that bringing children home for treatment will encourage providers in the state to expand existing residential facilities and services and will encourage new providers to enter the market. MS. TERRY KEKLAK said she would answer questions. CHAIR DYSON asked her how much out-of-state placement costs per day. MS. KEKLAK replied that she didn't have any specifics, but most out-of-state rates are in the $325 per day or lower range. She knew of one child who had a rate of $600 per day, based on additional medical needs. SENATOR DAVIS asked her to comment on why children are placed out-of-state. MS. KEKLAK replied that for a service to be paid by the Medicaid program, an interdisciplinary team is required to review the placement and make a recommendation regarding what is in the best interest of the child. They look at whether existing state services are appropriate for that child. With Medicaid, the child travels to the closest available facility that is found to meet their medical needs. All inpatient stays are authorized by an outside contractor who is looking at all the criteria before an out-of-state admission would be approved for payment. SENATOR DAVIS asked if the available instate facility can be turned down in lieu of outside placement and still be covered. MS. KEKLAK replied no. SENATOR GUESS asked if they use the same process for state custody children. MS. KEKLAK replied that those children have a placement committee in addition to the Medicaid requirements. MR. RICHARD RAINERY, Executive Director, Alaska Mental Health Board, stated that the amendment is in concert with the Board's philosophy that the community should be involved with the mental health system. SENATOR GREEN moved to adopt Amendment 1. 23-LS0179\D.1 Lauterbach 12/1/04 A M E N D M E N T OFFERED IN THE SENATE BY SENATOR GREEN TO: SB 157 Page 2, following line 12: Insert a new subsection to read: "(c) When determining whether to authorize admission of a person under 21 years of age to a psychiatric hospital facility or residential psychiatric treatment center, either located within the state or outside the state, the department shall include in its consideration the recommendations of a person selected by the Alaska Mental Health Board established by AS 47.30.661 who is selected for this duty by the board on the basis of being knowledgeable about the availability of beds in the state for inpatient psychiatric services for persons under 21 years of age. The board may not select an employee of the department for this duty." Page 3, following line 10: Insert a new subsection to read: "(m) When determining whether to authorize admission of a person under 21 years of age to a psychiatric hospital facility or residential psychiatric treatment center, either located within the state or outside the state, the department shall include in its consideration the recommendations of a person selected by the Alaska Mental Health Board established by AS 47.30.661 who is selected for this duty by the board on the basis of being knowledgeable about the availability of beds in the state for inpatient psychiatric services for persons under 21 years of age. The board may not select an employee of the department for this duty." There were no objections and it was adopted. MR. RAINERY pointed out that one of the reasons the state doesn't have facilities like this is because sending kids out- of-state is a relatively recent phenomenon and, also, the number of children being sent is no longer a question. SENATOR GUESS moved to pass CSSB 157(HES) from committee with individual recommendations and zero fiscal note. There were no objections and it was so ordered. SB 84-TEACHER LOAN REPAYMENT PROGRAM CHAIR FRED DYSON announced SB 84 to be up for consideration. SENATOR GARY STEVENS, sponsor, said the teacher shortage will be even more of a problem with passage of the federal No Child Left Behind laws. SB 84 will set up the Alaska teacher recruitment loan repayment program, which is designed to help school districts recruit and retain teachers. It includes repayment of education loans when the teachers are hired by Alaskan public elementary or secondary schools. It limits the lifetime financial award to $10,000 for an individual teacher. The funding would come from the dividend, which would normally be returned to the state through the Commission on Postsecondary Education. The intent is that the program would operate when the funds are available and if no funding is appropriated by the Legislature, then no money would be spent. If an individual leaves a teaching position, they would not receive the loan repayment that would be made at the end of the school year. SENATOR STEVENS explained that the proposed amendment is from the Alaska Postsecondary Commission and clarifies some of the language and expands the scope of funding sources to include federal funds and other receipts. He said he didn't know of anyone who was against this bill. SENATOR GRETCHEN GUESS asked if this program could be used by professionals in other shortage areas, like speech pathologists who don't have teaching certificates. SENATOR STEVENS replied that it's meant for certificated teachers in elementary or high school. SENATOR GUESS asked if they are only going to repay loans in areas of shortage or is this for all teachers. SENATOR STEVENS replied that the specifics would be developed by the Postsecondary Commission. His intent is that it's for any position. SENATOR GARY WILKEN said he had some reservations with this bill, as well as SB 154. He understands the financial burden of going to school, but he was concerned that this is slippery slope legislation. He came to the Legislature just as the student loan program was starting to dig itself out of the problems of the 80s and 90s when it was a give-away program. The program is now robust and has brought money back to the state. They have brought back about $5 million for the fourth year in a row. SENATOR STEVENS shared his concerns, but said this would not make the fund any less healthy than it is now, but it would simply reduce the dividend that the state receives. Every year the Legislature would have to fund the program. MS. DIANE BARRANS, Executive Director, Alaska Commission on Postsecondary Education, explained the amendments and noted that the sponsor was very proactive on getting the commission's input on this bill. One of the amendments insures that the criteria is efficient to administer and does not require costly activity. The second amendment is on page 3, line 14, after "AS 14.42.295" to insert "or any federal or other funds", the objective being to capture any funding that is available for a program of this kind. The others are technical changes. SENATOR WILKEN moved to adopt Amendment 1. There were no objections and it was so ordered. MS. BARRANS responded to Senator Wilken's concerns saying that this bill, rather than requiring additional funds to be expended from the Student Loan Corporation to pay benefits under this program, it would simply be an earmarking in statute that when the dividend is calculated and goes back to the state, the Legislature would use those funds to endow the fund from which benefits are paid. SENATOR WILKEN said that the fiscal note shows 807 new hires would participate in the program each year. MS. BARRAN responded that was correct and added that a recent study of openings each year showed about 1,600 teacher vacancies and about half of those are estimated to be new teachers who would still have educational debt. They did not build in any growth estimate and the details of the payments would have to be worked out in regulation. How I would recommend that it be structured is that when someone agrees to participate in this program, we identify what their total debt is at that time. We actually set aside the amount of funds that we would need to pay to meet its obligation to this participant so we would essentially encumber funds on their behalf. What I don't want to be in the position of doing is telling someone there is going to be a benefit for them and then not have the funds available. I don't' want to come back to the legislature...One of the things I see the commission being charged with is to monitor the amount in the fund and to monitor the amount that's been obligated to current participants and only enroll new participants when funding is available. SENATOR WILKEN said that was where his concern lay - if one year they needed all of the $5 million of the dividend, they would not fund that particular year. There would be a clamor to continue the funding over and above the $5 million. He asked if they were funding at the $500,000 level, would she prorate that through the debt or through the number of participants. MS. BARRANS replied that she could see either scenario occurring depending on a number of variables. The amount of controls put in place will affect whether or not that can occur. Her objective would be for it not to occur. Since the board is given some latitude to set the criteria for the program, they might define critical shortage areas and target the money to those areas. SENATOR WILKEN asked her if she saw any problems with trying this for five years. MS. BARRANS answered that was more of a political question than a financial question and, if it was structured correctly at the outset, they would not be in a financial hole in terms of being obligated to pay benefits. SENATOR WILKEN complimented Ms. Barrans on running a great show. MS. MARY FRANCIS, Executive Director, Alaska Association of School Administrators, supported SB 84. TAPE 03-19, SIDE A MS. FRANCIS said that last year only about 300 educators came in to look for Alaskan jobs. MR. JOHN ALCANTRA, Government Relations Director, National Education Association, supported SB 84 for all the reasons stated previously. SENATOR WILKEN moved to report SB 84 from committee with individual recommendations and attached fiscal note. There were no objections and it was so ordered. SB 154-NURSE EDUC LOAN REPAYMENT PROGRAM CHAIR FRED DYSON announced SB 154 to be up for consideration. SENATOR HOLLIS FRENCH, sponsor, said that a main question for him was to whom to make the loans available. Just making them available to Alaskans wouldn't produce enough nurses to fill the gap. We're thousands and thousands of nurses behind where we need to be and so we realized as we worked our way through the problem and got familiarized with it is we had to not only make it available to Alaskans going to Alaskan nursing schools, but make it available to any person who wanted to come here and become a nurse. The next thing he thought about was the length of the repayment period. Part of the reason they came up with paying someone back for five years is by letting them work in the Alaskan economy for that long, they would come to know and love the state and stay. The available funding is capped at $10,000 because that is about what it would cost to go to an Alaskan nursing school. To the slippery slope issue he responded that most programs have those problems and you just have to draw the line somewhere. SENATOR GARY WILKEN said his comments on the prior bill apply to this one as well. MR. RICK URION, Director, Occupational Licensing, said the administration hadn't taken a position on this bill, "But, it is an exceptionally good idea." He said the Board of Nursing is a good place for it to be and pointed out that the cost of the board is born by the nurses. But, the cost of this program is probably outside of that purview and the legislature might want to find funding for the program other than from the licensees, themselves. MS. CAMILLE SOLEIL, Alaska Nursing Association, said she appreciated their support of this bill. MS. CATHERINE GEISSEL, Alaska Nurse Practitioner's Association, supported SB 154. She said it is in the best interests of Alaska's public safety to increase the number of nurses positions that are currently being filled by unlicensed personnel who make mistakes. MS. PAT SENNER, President, Alaska Nurses Association, supported SB 154. She showed them a graph indicating that the average age of a nurse in this state is 45 to 46, with 72 percent of them being over the age of 40. The graph should not be a bell curve. Most hospital nurses have to retire in their 50s, because they can no longer do the heavy work required of them. It is estimated that in the next 5 to 10 years, 50 percent of the nursing workforce will leave. The School of Nursing is doubling their number of graduates by 2006. Part of the funding for that, $2.25 million, came from the private sector and the other part from the university. This bill is encouraging the individual to consider a nursing career and to stay in it. MS. DEB ERICKSON, Deputy Director, Division of Public Health, supported SB 154 for all of the stated reasons. She added that Alaska's senior population is expected to triple by 2025 and an aging population has attendant increases in chronic diseases and other health problems, which will add to the demand side of this problem. The nursing shortage affects quality of care, access to health care and cost of health care. "This program will provide a financial incentive for recruitment and retention of nurses that will benefit all Alaskans." MS. ANGELA RICK, nursing student, asked if money was coming from the federal program. SENATOR FRENCH explained that they wrote the bill so that it could some day receive money from that source, but it's not anticipated they would get it at this point. MS. RICK said she supported this bill. SENATOR WILKEN moved to pass SB 154 from committee with individual recommendations and attached fiscal note. There were no objections and it was so ordered. CHAIR DYSON adjourned the meeting at 3:23 p.m.