Legislature(2011 - 2012)HOUSE FINANCE 519
03/31/2011 01:30 PM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB78 | |
| HB103 | |
| HB127 || HB175 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 78 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 103 | TELECONFERENCED | |
| += | HB 127 | TELECONFERENCED | |
| += | HB 175 | TELECONFERENCED | |
HOUSE BILL NO. 78
"An Act establishing a loan repayment program and
employment incentive program for certain health care
professionals employed in the state; and providing for
an effective date."
1:38:16 PM
REPRESENTATIVE BOB HERRON, SPONSOR, explained that HB 78
had been crafted to create a support for service program to
attract medical professionals to Alaska. He stated that
Alaska was one of only four states that did not offer
incentives to keep healthcare providers in-state. Ideally,
market forces would provide the state with access to
quality care; this was not happening and was creating an
ever expanding need. The legislation was based on a 2007
proposal, assembled by a workgroup of the Alaska Primary
Care Council. He relayed that participating healthcare
providers could choose from two options: loan repayment or
a direct cash incentive. He believed that he the direct
incentive option would give Alaska the necessary edge to
lure well experienced, mid-career professionals to the
state.
Representative Herron shared that the federally funded
workforce support programs that the state currently
participated in did not support the needs unique to Alaska.
The legislation would create a string program curtailed to
Alaska and to Alaskans. He pointed out that the program
could show high return with a low amount of investment and
that similar programs, in over 46 states, had been found to
be effective.
Vice-chair Fairclough clarified that the committee was
working with the "R" version of the bill.
Representative Herron replied in the affirmative.
Representative Wilson MOVED to ADOPT proposed committee
substitute, work draft 27-LSO147\R.
Representative Edgmon OBJECTED for the purpose of
discussion.
1:42:12 PM
Representative Gara offered support for the concept of the
bill. He noted that the biggest physician shortage faced by
the state was in primary care. He understood that other
areas periodically faced shortages, but high wages
maintained the pool of specialists within the state. He
stated that if funds were limited, a priority for primary
care providers should be written into the bill.
Representative Herron agreed that the biggest shortage in
the state was affordable primary care providers. He said he
would work with the committee to improve the priority
process.
Representative Gara asked if the language prioritizing
primary care already existed in the legislation.
Representative Herron replied that prioritizing primary
care providers was his intention when crafting the
legislation.
Representative Wilson asked whether similar legislation
passed in other states had inspired the crafting of the
bill.
1:46:26 PM
LIZ CLEMENT, STAFF, REPRESENTATIVE BOB HERRON, referred the
question to members of the work group that assembled the
initial bill.
Representative Guttenberg referenced page 5 of the bill. He
wondered how the work group had established the 90 person
cap for program participants.
Vice-chair Fairclough requested clarification between the
original legislation and the R version currently before the
committee.
Representative Herron highlighted the changes. A conforming
change had been made on page 3, line 10: "lending
institution or to the eligible health care", this allowed
payment to the health care professional or the lending
institution.
Representative Edgmon REMOVED his OBJECTION. There being NO
further OBJECTION, it was so ordered.
1:50:26 PM
Vice-chair Fairclough opened public testimony
MARGARET SODEN, PRESIDENT ALASKA PHARMACISTS ASSOCIATION
(via teleconference), testified in strong support of the
legislation. She stressed that there were currently no
pharmacy schools located in Alaska, which forced students
to seek schooling out-of-state for up to six years. She
believed that providing the incentives would entice future
pharmacists to return to the state to practice.
RHONDA SCHNEIDER, NORTON SOUND HEALTH CORPORATION (via
teleconference), testified in support of HB 78. She shared
that her area of Nome, Alaska was particularly limited in
transportation because it was not on a road system. She
believed that the incentives written into the bill would
help with retention of care providers in the Nome area.
1:52:51 PM
NANCY DAVIS, EXECUTIVE DIRECTOR, ALASKA PHARMACISTS
ASSOCIATION (via teleconference), voiced support for the
legislation. She reiterated that there were no programs in
the state to recruit and retain pharmacists. She
highlighted that pharmacists were necessary for the
responsible distribution and use of prescription drugs.
IAN ERLICH, PRESIDENT AND CEO, MANIILAQ ASSOCIATION (via
teleconference), testified in support of the legislation.
He expressed curiosity concerning the employer match
written into the legislation. Felt that the shortage of
care providers was an issue that needed to be addressed to
ensure the future of quality care in Alaska.
1:55:51 PM
Representative Wilson asked how many doctors were working
in Kotzebue and how many more would be required.
Mr. Erlich responded that there were 15 full-time positions
and currently 13 of those positions were filled.
Representative Herron thought that the language referring
to priority for those who served as primary care medical
providers could appropriately be written into page 2 of the
legislation.
Vice-chair Fairclough noted that the committee had not
intended to move the bill at this hearing. She stated that
there would be further opportunity to entertain amendments
about primary care providers and have a conversation
concerning the employer match.
Representative Gara if the shortage of care providers in
Kotzebue were located primary care.
Mr. Erlich replied yes.
1:58:25 PM
EMILY HUGHES (via teleconference) shared that she was a
pre-med student who would be applying to medical school in
2012. She voiced support for HB 78. She hoped to return to
the state after completing medical school but worried about
the financial debt. She stressed that a financial incentive
to return to Alaska would be helpful when deciding where to
practice in the future.
SONIA HANDFORTH KOME, EXECUTIVE DIRECTOR, ILIULIUK FAMILY
AND HEALTH SERVICES AND PRESIDENT, ALASKA PRIMARY CARE
ASSOCIATION (via teleconference), testified in strong
support of the bill. She expressed that 15 positions in
Unalaska would be covered by the legislation; 5 of which
were currently open. One registered nurse (RN) position had
been open for over a year. She stressed that the
legislation would be extremely helpful in providing
services to the community.
ELIZABETH RIPLEY, EXECUTIVE DIRECTOR, MATSU HEALTH
FOUNDATION, WASILLA (via teleconference), spoke in support
of HB 78. She testified that that recruitment of quality
care providers in rural areas was a challenge. She stated
that keeping people out of the hospital began with chronic
disease management in the primary care setting. She stated
the legislation would make significant improvements in
reducing the rate in the growth of Medicate cost in the
state.
2:03:12 PM
MARY SULLIVAN, ALASKA PRIMARY CARE ASSOCIATION (via
teleconference), spoke in support of HB 78.
ELIZABETH SIRLES, DIRECTOR, UAA SCHOOL OF SOCIAL WORK,
ANCHORAGE (via teleconference), testified in support of the
legislation. She stressed that there were serious workforce
shortages in all of the areas listed in HB 78. She
specifically cited the possible increase in behavioral
health providers that could result by passing the bill.
KAREN PERDUE, EXECUTIVE DIRECTOR AND PRESIDENT, ALASKA
STATE HOSPITAL & NURSING HOME ASSOCIATION, voiced support
of HB 78. She stated that rural hospitals struggled to
assist communities in recruiting providers of all kinds.
She commented that there were severe shortages in the
medical field across the board and not just for primary
care providers.
Representative Guttenberg asked about the urban hospital
structure versus regional healthcare. He wondered if the
bill was indifferent to the different needs throughout the
state.
2:07:22 PM
Ms. Perdue thought that the bill had evolved to try and
target the greatest area of need. She believed that the
bill was flexible to meeting the different strategic needs
of the state.
Representative Gara spoke to the draft amendment to the
bill. He thought that the best way to move forward was to
deal with the shortage in primary care first and use any
leftover funds in the other recognized areas.
Ms. Perdue responded that the medical sites were good at
prioritizing what they needed. She was concerned there
would not be funds left over for specialty services.
SHELLEY HUGHES, ALASKA PRIMARY CARE ASSOCIATION, PALMER,
testified in support of HB 78. She stated that as a
healthcare consumer in Mat-Su it had taken her eight months
to get an internal medicine physician through an
application process. She stressed the importance of the
legislation for the future of quality healthcare in the
state. She said that clinics in Alaska were losing
candidates to other states that offer incentives to
providers.
2:11:47 PM
PAT CARR, PROGRAM MANAGER, HEALTH PLANNING AND
INFRASTRUCTURE, DIVISION OF HEALTH CARE SERVICES,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES testified in
support of the legislation.
Representative Wilson asked whether there was a model that
the working group for the bill had used as a guide.
Ms. Carr responded that the working group had done research
across the country; information had been drawn from various
states.
Representative Wilson wondered if other states had chosen
to make one care provider group a priority.
Ms. Carr responded that some repayment programs set
priority on particular types of providers, and the
definition of "primary care" differed among the programs.
Representative Guttenberg asked how many different
categories of doctor fell under the term "primary care
provider."
Ms. Carr explained that the definition depended on who you
asked, but most often the definition included categories of
physicians, dentists, behavioral health providers, and
certain types of clinical psychologists. She said that some
states added others as needed.
2:15:43 PM
Representative Gara reiterated the importance of retaining
enough primary care providers. He repeated his query as to
whether there was language in the bill to give priority to
primary care providers, or would an amendment be needed.
Ms. Carr responded that needs assessments would indicate
that primary care should be a priority in the state. She
thought the needs criteria allowed for analysis and
priority setting. She believed that because a
prioritization scheme had been used to draft the
legislation, some priority language should be in the bill
already.
MARIE DARLIN, ALASKA ASSOCIATION OF RETIRED PERSONS, spoke
in support of HB 78. She offered that most significant
factor related to retaining the states retired population
was availability of quality health care.
2:20:02 PM
DELISA CULPEPPER, CHIEF OPERATING OFFICER, ALASKA MENTAL
HEALTH TRUST AUTHORITY, testified in support of the bill.
She explained that the trust had been involved in loan
repayment programs for the last four years. She stressed
that there were serious behavioral healthcare provider
shortages in the state; close to half the applicants for
loan repayment were for those positions, including clinical
and social workers. She noted that the trust had many
beneficiaries who were also in need of primary care.
Representative Gara asked whether the loan repayment and
financial assistance in the bill applied specifically to
medical providers working for a non-profit clinic.
Ms. Culpepper said she was not sure. She believed that the
current program pertained to non-profit entities because it
was tied to federal money that was designated for public
and tribal clinics.
Representative Gara requested further information
concerning the question. He informed the committee that he
had no present intention of offering an amendment.
2:23:29 PM
KATE BURKHART, EXECUTIVE DIRECTOR, ALASKA MENTAL HEALTH
BOARD AND ADVISORY BOARD ON ALCOHOL AND DRUG ABUSE, spoke
in support of HB 78. She argued that the vacancy rate and
workforce shortage for behavioral health providers was
equally to that of primary care providers. She felt that an
amendment that created a statutory priority for primary
care providers would be unfair. She hoped that any
amendment would embrace a broad definition of primary care
to include behavioral healthcare providers. She pointed out
that there was an advisory body referenced in the bill that
would provide recommendations for oversight and evaluation
of the program. The advisory body would be composed of
individuals with expertise in hiring and retention of
healthcare professionals; she believed this would keep
priorities relevant without creating a statutory priority
for one kind of provider.
Representative Guttenberg asked if a subspecialty or
additional training was necessary for a behavioral health
specialist to practice using telemedicine.
Ms. Burkhart understood that it would depend on the type of
behavioral health provider. Alaska was more reliant on the
telemedicine system than many others and the system was not
a regular part of formal training.
2:27:09 PM
DENISE DANIELLO, ALASKA COMMISSION ON AGING, voiced support
of HB 78. She noted that Alaska was first in the nation in
the growth of its elder population. She stated that the
number of health care professional preparing to retire
would contribute to the shortage of healthcare workers in
the state. The commission had recently conducted a survey
which had identified healthcare as the number one concern
for seniors in the state. The survey had revealed that 31
percent of the seniors questioned had experienced problems
finding a primary care provider in the community in which
they lived. One part of the problem had been finding a
provider that would accept Medicare reimbursement, but 10
percent had noted that they could not find a doctor because
there were not enough in the community.
Ms. Daniello continued that the issue was most common in
Anchorage, where one out of four seniors had indicated a
problem accessing primary care. She reported that many open
ended comments from the seniors surveyed had warned that
seniors were prepared to leave the state in order to find a
primary care doctor.
DAVID MORGAN, SOUTHCENTRAL FOUNDATION, testified in support
of the bill. He believed that, in his 30 year experience
with healthcare in Alaska, the legislation would be
effective. He relayed that most states already had similar
programs and that Alaska should become competitive in the
field. He understood that the bill did not require a person
to work for a non-profit to benefit from the incentives.
2:32:53 PM
JOAN DIAMOND, SELF, ANCHORAGE (via teleconference)
testified in support of HB 78. She shared that she had a
daughter who was finishing her masters in the mental health
field and who hoped to return to Alaska.
JEFF LEPAGE, PRESIDENT OF THE ALASKA CHAPTER OF THE
AMERICAN PHYSICAL THERAPY ASSOCIATION testified in support
of HB 78. He stated that physical therapists in Alaska were
in support of the legislation.
Vice-chair Fairclough closed public testimony.
Representative Herron responded to an earlier question by
Representative Gara. Any organization that provided
healthcare services could benefit from the bill, however,
the "underserved" of the state were to be considered first.
Representative Gara felt that it would be unnecessary for
the committee to amend the legislation.
Representative Edgmon discussed the composition of the
advisory board on page 2 of the bill. He suggested that
rural Alaska should be specifically considered when
creating the board.
2:37:18 PM
Vice-chair Fairclough requested that the committee review
the fiscal notes.
HB 78 was HEARD and HELD in committee for further
consideration.