Legislature(2021 - 2022)BUTROVICH 205
02/17/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) | |
| SB184 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | SB 184 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 17, 2022
1:32 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Shelley Hughes, Vice Chair
Senator Mia Costello
Senator Lora Reinbold
Senator Tom Begich
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CONFIRMATION HEARING(S):
State Medical Board
Matt Heilala Anchorage
David Wilson Palmer
- CONFIRMATIONS ADVANCED
SENATE BILL NO. 184
"An Act relating to Alaska Native settlement trusts and
eligibility for adult public assistance, senior benefits, and
the Alaska Pioneers' Home."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 184
SHORT TITLE: SETTLEMENT TRUSTS & BENEFITS ELIGIBILITY
SPONSOR(s): SENATOR(s) BEGICH
02/08/22 (S) READ THE FIRST TIME - REFERRALS
02/08/22 (S) HSS, FIN
02/17/22 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
MATT HEILALA, Appointee
State Medical Board
Department of Commerce, Community and Economic Development
Anchorage, Alaska
POSITION STATEMENT: Testified as the governor's appointee to the
State Medical Board.
DAVID WILSON, Appointee
State Medical Board
Department of Commerce, Community and Economic Development
Palmer, Alaska
POSITION STATEMENT: Testified as the governor's appointee to the
State Medical Board.
ED MARTIN, representing self
Kenai, Alaska
POSITION STATEMENT: Testified with concerns on governor
appointee Mr. David Wilson to the State Medical Board.
SENATOR TOM BEGICH
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of SB 184.
LOKI TOBIN, Staff
Senator Tom Begich
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented a sectional analysis on SB 184.
SHAWNDA O'BRIAN, Director
Division of Public Assistance
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions on SB 184.
ACTION NARRATIVE
1:32:49 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:32 p.m. Present at the
call to order were Senators Reinbold, Hughes, Begich, Costello
and Chair Wilson.
^CONFIRMATION HEARING(S)
CONFIRMATION HEARING(S)
State Medical Board
1:33:29 PM
CHAIR WILSON announced the consideration of governor appointees
to the State Medical Board, Dr. Matt Heilala and Mr. David
Wilson.
1:34:05 PM
MATT HEILALA, Appointee, State Medical Board, Department of
Commerce, Community and Economic Development (DCCED), Anchorage,
Alaska, stated he was originally from Soldotna. He was asked by
Governor Dunleavy to sit in one of the physician seats on the
medical board, which he considers an honor. He said he has
practiced in Anchorage as a podiatric physician for 25 years. He
has been involved in the medical community in Southcentral,
Alaska. It is a unique time to serve, and he would be the first
foot and ankle doctor and surgeon to serve on the board.
1:35:47 PM
SENATOR REINBOLD said she was pleased that he would be the first
from his area to serve on the board. It is an especially
important time to serve on the board due to COVID 19. She
requested he answer the following questions:
• What is your position on patient advocacy?
• What is your opinion on non-discrimination against COVID 19
vaccination status in healthcare?
• What is your opinion on the patient-to-doctor relationship of
being able to prescribe off-label medication?
SENATOR REINBOLD opined that it is wrong for a pharmacist to
decline to fill a prescription, such as Ivermectin.
1:37:07 PM
DR. HEILALA replied that it is critically important to advocate
for oneself or to have an advocate, whether experiencing
inpatient or outpatient care. Patients should have a say
regarding which staff members provide them treatment during
inpatient care.
He opined that hospital formularies pertaining to COVID 19
treatments could be convoluted. Hospital formulary decisions
must be left to the medical staff and governing bodies of the
hospital. However, the hospital should not interfere with what
the physicians and families feel is their best treatment choice.
He stated that his approach would be to defer to physicians,
families, and patients rather than be overridden with strict
top-down rules.
SENATOR REINBOLD said many people across the nation and in
Alaska have said the COVID 19 vaccine has been pushed so
rigorously that they are not being allowed to receive medical
treatments because of their vaccine status. She created a bill
to address nondiscrimination against people that choose not to
accept the COVID 19 vaccination.
1:40:14 PM
DR. HEILALA stated that he could not imagine a rationale for
basing eligibility on vaccination status. He recalled hearing of
an organ transplant issue centered on vaccination status but
could not speak to its appropriateness. He was aware of the
politicization concerning whether unvaccinated people deserve
attention from physicians. He stated his belief that to deny
service based on behavioral choice is a slippery slope. People's
behaviors, such as obesity, smoking, drinking, and other
activities, largely dictate their health. He said he would stand
firm against the concept of parsing care out based on people
behavioral choices. Getting vaccinated is a choice.
DR. HEILALA said it had not been a precedent in the US to
require FDA approval to prescribe medication. He stated he had
seen statistics where 70-80 percent of medications written in
specific timeframes were non-FDA approved. Many drugs do not go
through the FDA approval process, which is very laborious, time-
intensive, and costly. Yet, standard of care has dictated that
many of these medications are the preferred treatment. He
questioned whether pharmacists, especially those working for
chain store pharmacies, were pressured by top-down corporate
policy. Also, it is a unique time where people are facing
anxiety and pressure from all directions. Therefore, patience
with each other is needed. There was some blowback to the
pharmacies that participated in overriding prescriptions written
by physicians. He viewed it as a problem that pharmacists were
taking it upon themselves to say that patients could not receive
readily available, very cheap, and largely very safe medications
for the treatments they disagreed with.
1:43:50 PM
SENATOR REINBOLD stated that many people believe their loved
ones died due to the lack of early intervention and product
accessibility. Many doctors she spoke with experienced this. She
found it outrageous that even her pharmacist in Eagle River
denied filling prescriptions. She reiterated Mr. Heilala's
answers to her questions and asked if she had understood
correctly.
DR. HEILALA responded that, in general, that was correct, but
there can always be exceptions.
1:44:53 PM
SENATOR BEGICH stated that people are free to choose their
pharmacists and physicians. It is a personal choice based on
whether you like how they practice. Pharmacists are
professionals in business for themselves with degrees and
certifications. He asked whether pharmacists should be forced to
fill prescriptions that go against their personal opinion and
medical knowledge.
1:46:22 PM
DR. HEILALA replied that the question would need to be applied
broadly under current circumstances. As a functioning but
unconfirmed board member, he has learned that it is critically
important to stay within the board's purview. He stated he is
unsure whether the situation described would be under the
board's purview. As a practicing surgeon, he has been confronted
with pharmacists having much more say in doctors' prescribing
practices due primarily to the opioid crisis. It can be
frustrating to be challenged by a pharmacist, but concern
surrounding opioid abuse makes questioning prescriptions
understandable. Physicians would be more likely to push back if
challenged on other types of medications since a pharmacist does
not know the patient's treatment plan. If a physician meets the
general criteria of safety and the medicine is not scarce, he
prefers physicians to maintain the freedom to prescribe. He said
he would be open-minded if a situation met critical thresholds
like the opioid epidemic.
1:49:35 PM
SENATOR BEGICH said he agreed with a dialog approach to conflict
resolution. He also agreed, and thought it noteworthy to the
committee, that the question asked was not within the medical
board's purview. The focus of the board is disciplinary
processes and actions. He asked if Mr. Heilala was comfortable
applying statutes and regulations to potential violations and
whether he had been involved in conducting any inquiries.
DR. HEILALA replied that it is a learning process, but he is
comfortable in the role. With assistance from investigators, he
believes he is well suited for the position.
1:50:46 PM
SENATOR COSTELLO stated her belief that appointees should heed
the board's purview, the seat being filled, applicable statutes,
and not personal criteria. She noted and thanked him for his
community service, particularly for serving on the Life Alaska
Donor Services board. She opined that when a person goes to the
doctor, they are a patient; when they take a prescription to the
pharmacy, they are a customer. She said she has never understood
the concept of a pharmacist having prescriptive authority or the
ability to second guess a doctor's prescription. The doctor has
the degree, does the examination, and confers with the patient
to make a private decision. She asked if he sees Alaskans as
customers when they go to the pharmacy.
1:52:31 PM
DR. HEILALA replied that it is relatively new for pharmacists to
be involved and believes it is because of the lack of checks and
balances associated with the opioid crisis. Traditionally
pharmacists have been seen as professionals that provide
guidance but respect physicians' prescribed orders, except in
rare instances where conflicts or mistakes are realized.
Neighborhood pharmacists had relationships with customers and
offered advice. He declared that his persistent viewpoint is
that the physician makes the medical decisions and develops a
treatment plan, and it is expected that the pharmacist helps
facilitate the treatment plan.
1:54:12 PM
SENATOR REINBOLD confirmed his position on her previous
questions and those of Senator Costello. She stated that about
35 percent of prescription drugs are off-label, not including
scheduled drugs. She commented that it sounded like he disagreed
with pharmacists superseding a physician's prescription even
when a drug is off-label, such as Ivermectin. She stated that
the National Institutes of Health approved Ivermectin for use in
treating COVID, and she agrees with others who feel their loved
ones did not need to die.
DR. HEILALA replied that he did not know the details of the
argument against Ivermectin and mentioned that hospitals have
reasons for not offering certain medications in-house. Generally
speaking, he agreed that she understood him correctly. He is not
inclined to interfere with the credentials of staff physicians
caring for patients.
1:56:30 PM
SENATOR REINBOLD stated she was in pharmaceuticals and
understands the difficulty of getting medications onto hospital
formularies. However, she acknowledged her belief in patient
advocacy; if a patient needs a type of medication, they should
have access to it. She mentioned that her physician sister had
experienced great success healing COVID patients with Ivermectin
and hydroxychloroquine. She asked if he would agree to not
politically target physicians based on prescribing non-CDC
approved medications. She opined that boards should not be
political weapons.
1:57:21 PM
DR. HEILALA stated that is correct. He replied that targeting
physicians, patients, and facilities is counterproductive. He
knows her sister as a peer in the community and respects her
sister's position even though he remains neutral on the efficacy
of the treatment.
1:58:08 PM
CHAIR WILSON opened public testimony.
1:58:13 PM
[Chair Wilson treated the public testimony for Dr. Matt Heilala
as closed.]
1:59:12 PM
DAVID WILSON, Appointee, State Medical Board, Department of
Commerce, Community and Economic Development (DCCED), Palmer,
Alaska, stated he is applying for the vacant public position on
the State Medical Board as an initial appointment. He said he
moved to Kodiak in 1987. He is a 737 Captain for Alaska Airlines
with 30 years of flying experience. He served in supervisory
roles and all aspects of flight operations. He also worked with
several state departments and established procedures for safe
flight in and out of Juneau during inclement weather. He serves
as the Anchorage chair for the professional standards board. His
interest in serving on the State Medical Board stems from his
interactions with medical professionals while flying for Kodiak-
based Pen Air to rural parts of Alaska. He appreciates the care
his father received when living with dementia. He desired to
give back to the medical community by serving on the board.
2:03:07 PM
SENATOR REINBOLD stated her three questions were the same as
those asked of the other appointees.
2:04:22 PM
MR. WILSON stated that his wife's physician is Senator
Reinbold's sister. He said he wrote a letter defending Dr.
Farr's treatment of COVID. As for patient advocacy, he was his
father's advocate for several years. Many cases support the need
for advocacy. People's thought processes can be altered by the
medication received in the hospital, making it essential to have
a family member present. Finally, he agreed that people are
customers of the pharmacy because medical history is shared with
doctors, not pharmacists.
2:07:27 PM
SENATOR REINBOLD stated that his answers were excellent. She is
worried about collusion between big pharmaceutical companies and
other corporations, like Alaska Airlines and Pizer. She opined
that the companies treat mandates like statutes and would
discriminate based on vaccination status.
CHAIR WILSON interjected that questions should be relevant to
the appointee's position on the board.
SENATOR REINBOLD asked whether Mr. Wilson agreed that the
legislature should establish statutes and would he honor
statutes as a member of the board.
MR. WILSON provided his understanding that the State Medical
Board uses statutes created by the legislative body to make
policies that are consistent with the letter and intent of the
statutes.
2:09:12 PM
CHAIR WILSON opened public testimony.
ED MARTIN, representing self, Kenai, Alaska, stated he is 67
years old and has been an Alaskan resident for 56 years. He
noted that Mr. Wilson is from the private sector, but most of
his credentials are blocked out on his resume. He would
appreciate an opportunity to speak with the appointee on the
phone since he would be governing the medical professionals in
Alaska. He stated that he is not willing to see a physician
about his heart condition because he was refused the use of
hydroxychloroquine and Ivermectin. An opportunity to speak with
members of the medical board would be appreciated.
CHAIR WILSON asked if he had any input on whether he would like
to see Mr. Wilson appointed to the State Medical Board.
MR. MARTIN said that the committee had not asked questions
pertinent enough to his concerns to be able to ask questions. He
opined that doctors do not observe his right to privacy.
2:08:51 PM
CHAIR WILSON stated that appointee information is protected
until confirmation. He said public questions and concerns could
be addressed to state representatives or the State Medical
Board. Contact information can be found on the state's website.
2:13:27 PM
SENATOR HUGHES stated that in accordance with AS 39.05.080, the
Senate Health and Social Services Standing Committee reviewed
the following and recommends the appointments be forwarded to a
joint session for consideration:
State Medical Board
Matt Heilala Anchorage
David Wilson Palmer
SENATOR HUGHES reminded members that signing the reports
regarding appointments to boards and commissions in no way
reflects individual members' approval or disapproval of the
appointees; the nominations are merely forwarded to the
legislature for confirmation or rejection.
2:13:51 PM
At ease.
SB 184-SETTLEMENT TRUSTS & BENEFITS ELIGIBILITY
2:15:37 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 184 "An Act relating to Alaska
Native settlement trusts and eligibility for adult public
assistance, senior benefits, and the Alaska Pioneers' Home."
2:16:02 PM
SENATOR TOM BEGICH, Alaska State Legislature, Juneau, Alaska,
speaking as sponsor, stated SB 184 is simple legislation based
on a constituent's hardship. He read the following:
It is often that we receive personal accounts from our
residents and constituents, sharing their hardships or
experiences. Often, we work to address these issues
and in some cases, we introduce legislation to rectify
and error or unintended consequence of the application
of law. In this case, we received a request from our
congressional delegation, specifically Congressional
Aide Kellie Cordelia, to address an issue that may
affect only a handful of folks but has a
disproportioned effect on these individuals.
SB 184 is a bill to address how benefits or
distributions from a settlement trust like ANCSA
affects an Alaska Native or their descendant's
eligibility for other state and federal services.
Part of the settlement includes distributions or
benefits to 1971 enrolled tribal members, compensating
them for their portion of historic land ownership and
in recognition that financial resources may be needed
to preserve indigenous cultures and ensure Alaska
Natives and their descendants are able to contribute
to live in indigenous communities.
Distributions or benefits from ANCSA settlements are
meant to compensate Alaska Natives and their
descendants for indigenous land claims and are
separate from other benefits an individual may receive
due to disability or age. Unfortunately, the law as it
currently is written does not guarantee an Alaska
Native can and will receive their rightful
distribution as well as other benefits available to
all Alaskans due to qualifying circumstances.
Senate Bill 184 seeks by statute to exclude certain
payments to aged or disabled Alaska Natives or their
descendants from being used to determine eligibility
for adult public assistance, senior benefits, and the
Alaska Pioneers' Home. A similar bill, S.2524,
introduced on July 28, 2021, to exclude interest or
distributions from a Settlement Trust for an Alaska
Native or descendant of an Alaska Native who is aged,
blind, or disabled from eligibility for certain
programs (like Medicaid) is currently being considered
in the United States Congress, introduced by Senator
Murkowski and co-sponsored by Senator Sullivan.
2:21:19 PM
LOKI TOBIN, Staff, Senator Tom Begich, Alaska State Legislature,
Juneau, Alaska, read the sectional analysis for SB 184:
Section 1. Amends AS 47.25.435, pertaining to Adult
Public Assistance, to exclude any interest or
distribution from a settlement trust made to an Alaska
Native or their descendant who is aged, blind, or
disabled as defined by 42 U.S.C. 1382c(a)(1).
Section 2. Inserts a new subsection under AS
47.45.302, pertaining to Senior Benefits Payment
Program, to exclude from calculations of household
income any interest or distribution from a settlement
trust made to an Alaska Native or their descendant who
is aged, blind, or disabled as defined by 42 U.S.C.
1382c(a)(1).
Section 3. Amends AS 47.55.020, pertaining to Alaska
Pioneers' Home and Alaska Veterans' Home, by inserted
a new subsection to exclude any interest or
distribution from a settlement trust to an Alaska
Native or their descendant who is aged, blind, or
disabled as defined by 42 U.S.C. 1382c(a)(1).
2:23:29 PM
SENATOR REINBOLD said she would like a sustainable long-term
program without loopholes. She asked that definitions for aged
and disabled be provided as they pertain to SB 184.
MS. TOBIN stated that the code for a person aged, blind and
disabled is approximately four pages long. It is a comprehensive
definition within US code. She will send a copy to committee
members.
SENATOR REINBOLD stated that if the definition is more
complicated than providing an age limit, it is important to read
the code since it is central to SB 184.
SENATOR BEGICH reiterated that the code is complex for the
precise reason of not letting someone slip through an open door.
The committee will receive the definitions given in the Federal
code, which are relatively clear.
2:24:55 PM
SENATOR REINBOLD stated she has been working with an Americans
with Disabilities Act (ADA) lawyer and learned there are
thousands of ways to be disabled. She opined that there would
never be a sustainable program if a grand door were left open
for everyone to slip through. She understands how being blind
would qualify individuals for assistance. It is critical to
define disabled and aged to keep Medicaid from becoming diluted
and unsustainable.
2:25:39 PM
SENATOR BEGICH said he would provide a copy of Senator
Murkowski's bill S. 2524 to the committee along with Section
1614(a) of the Social Security Act since it is mentioned in S.
2524 on page 2, lines 9-11.
2:26:02 PM
SENATOR COSTELLO referred to SB 184, Section 3, page 2, line 12,
that addressed AS 47.55.020, Alaska Pioneer Homes. She asked
whether any thought was given to the hold harmless provisions
also being applied to non-Pioneer Homes.
MS. TOBIN stated that in alignment with requests made by Senator
Murkowski, state-funded programs were excluded, and the purview
of the legislation was not extended.
2:26:54 PM
SENATOR COSTELLO asked if SB 184 only applies to individuals in
pioneer homes with all other home and living environments
excluded.
SENATOR BEGICH stated that a separate mention was made for
Pioneer Homes because of a unique relationship shared with the
state. Pioneer Homes have a tiered benefit system, so SB 184
would keep a resident from being knocked into a higher tier. SB
184 would keep any aged, blind, or disabled individual living in
a home from being made Medicaid ineligible due to the historic
payments they receive based on the Alaska Native Claims
Settlement Act (ANCSA) of 1971.
2:29:30 PM
CHAIR WILSON asked for an estimate on how many Alaskans SB 184
would affect.
2:29:43 PM
SHAWNDA O'BRIAN, Director, Division of Public Assistance,
Department of Health and Social Services (DHSS), Juneau, Alaska,
replied that the Department of Health and Social Services (DHSS)
does not have that data available. Eligibility is determined at
the point of application or recertification, and the information
needed to provide an estimate is not currently collected. A way
to extract an estimate from the information available is being
investigated.
2:30:24 PM
SENATOR HUGHES stated her belief that the number of people SB
184 may affect could impact Medicaid because it includes people
over the age of 65, not just the blind and disabled. She
expressed concerned that Medicaid expansion could crowd out the
elderly and truly vulnerable. She requested an estimate and
suggested working with the Department of Labor and Statistics.
2:32:09 PM
SENATOR BEGICH stated that Senator Murkowski's office and DHSS
were asked to estimate the number of people the bill would
assist. He opined that the number of qualified people would be
few.
SENATOR HUGHES stated that the bill has federal bi-partisan
support and asked if there is an estimated timeline for it to
pass in Congress.
SENATOR BEGICH stated it is difficult to know when or if a
congressional bill will pass. However, it was reported by
Senator Joe Manchin as having moved through committee without
amendment on February 10, indicating that it would be on the
fast track for passage.
2:34:26 PM
SENATOR HUGHES asked if SB 184 must pass at the state level for
aged, blind, or disabled Alaska Natives to take advantage of its
passing at the federal level.
SENATOR BEGICH stated his belief that based on correspondence
with Senator Murkowski, SB 184 would need to pass at the local
level to take advantage of the federal change.
CHAIR WILSON said he would also need to know the number of
people SB 184 would affect. There is a huge difference between
ten people and thousands of people.
SENATOR BEGICH agreed that it is important to have an estimate
to determine whether Alaska can afford it. He stated he would
work to provide the committee with an estimate.
2:36:08 PM
SENATOR HUGHES commented that she would be okay with the
estimate being in the thousands if Medicaid expansion were
rolled back because Alaskans should take care of the elderly.
2:36:35 PM
CHAIR WILSON opened public testimony on SB 184; he found none
and closed public testimony.
2:36:50 PM
CHAIR WILSON held SB 184 in committee.
2:37:33 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 2:37: p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 20220214 SB 184 v. A Sectional Analysis.pdf |
SHSS 2/17/2022 1:30:00 PM |
SB 184 |
| 20220214 SB 184 v. A Sponsor Statement.pdf |
SHSS 2/17/2022 1:30:00 PM |
SB 184 |
| 20220214 SB 184 v. A Supporting Document - Constituent Request.pdf |
SHSS 2/17/2022 1:30:00 PM |
SB 184 |
| 20220214 SB 184 v. A Supporting Document - Federal Legislation.pdf |
SHSS 2/17/2022 1:30:00 PM |
SB 184 |
| SB 184 FN Senior Benifits 2.11.22.pdf |
SHSS 2/17/2022 1:30:00 PM |
SB 184 |
| SB 184 FN DPA 2.11.22.pdf |
SHSS 2/17/2022 1:30:00 PM |
SB 184 |
| Matt Heilala Board Application.pdf |
SHSS 2/17/2022 1:30:00 PM |
Confirmations |
| Matt Heilala CV.pdf |
SHSS 2/17/2022 1:30:00 PM |
Confirmations |
| David J Wilson Resume.pdf |
SHSS 2/17/2022 1:30:00 PM |
Confirmations |
| David J Wilson Board Application.pdf |
SHSS 2/17/2022 1:30:00 PM |
Confirmations |