03/02/2020 01:30 PM House FINANCE

HOUSE BILL NO. 159                                                                                                            
                                                                                                                                
     "An Act relating to repayment conditions for medical                                                                       
     education program participants."                                                                                           
                                                                                                                                
3:07:37 PM                                                                                                                    
                                                                                                                                
Co-Chair   Johnston  reviewed   the  testifiers   that  were                                                                    
available online.                                                                                                               
                                                                                                                                
3:08:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   JONATHAN   KREISS-TOMKINS,  BILL   SPONSOR,                                                                    
explained  that HB  159 would  increase the  repayment by  a                                                                    
WWAMI Program alumni from 50  percent to 100 percent if that                                                                    
person did  not return to  Alaska to practice  medicine once                                                                    
completing medical  school and a residency.  Currently, if a                                                                    
WWAMI participant did  not return to the  state to practice,                                                                    
they  were expected  to  pay 50  percent  of the  difference                                                                    
between the  cost of out-of-state tuition  at the University                                                                    
of Washington  Medical School and  the amount the  state was                                                                    
contributing  to  incentivize  its  young people  to  go  to                                                                    
medical school and return to practice in Alaska.                                                                                
                                                                                                                                
3:09:57 PM                                                                                                                    
                                                                                                                                
Representative Tilton asked if he  had an idea of the number                                                                    
of people who utilized the  WWAMI program who did not return                                                                    
to Alaska. She asked for the criteria for residency.                                                                            
Representative Kreiss-Tompkins deferred to his staff.                                                                           
                                                                                                                                
3:10:56 PM                                                                                                                    
                                                                                                                                
KEVIN  MCGOWAN,   STAFF,  REPRESENTATIVE   JONATHAN  KREISS-                                                                    
TOMPKINS,  reported that  about 40  percent of  students did                                                                    
not return  to the state.  Dr. Suzanne Allen from  WWAMI was                                                                    
available online.                                                                                                               
                                                                                                                                
3:11:28 PM                                                                                                                    
                                                                                                                                
DR.  SUZANNE ALLEN,  PROGRAM  DIRECTOR,  WWAMI PROGRAM  (via                                                                    
teleconference), responded that  currently between 14-15 out                                                                    
of 20  WWAMI students  each year  returned as  physicians to                                                                    
Alaska.  In looking  specifically at  Alaskans returning  to                                                                    
the  state,  the  number  might  be  slightly  lower,  12-13                                                                    
students,  as  there  were WWAMI  students  from  the  other                                                                    
participating states,  4 in all,  that end up  practicing in                                                                    
Alaska.                                                                                                                         
Mr.  McGowan responded  to the  question about  residency. A                                                                    
person must be a resident for  at least 2 years before being                                                                    
allowed into the WWAMI Program.                                                                                                 
                                                                                                                                
Representative  Tilton asked  what  would determine  whether                                                                    
someone  was practicing  in  Alaska  after completing  their                                                                    
studies.                                                                                                                        
                                                                                                                                
Mr.  McGowan replied  that  a student  must  practice for  3                                                                    
years in a rural community or  5 years in an urban community                                                                    
after completing the program to qualify.                                                                                        
                                                                                                                                
Vice-Chair Ortiz  asked whether implementing the  bill would                                                                    
change   or   dissuade   the  states    talent   pool   from                                                                    
participating.                                                                                                                  
                                                                                                                                
Representative  Kreiss-Tompkins spoke  from the  perspective                                                                    
of the legislature.  He thought the program  was stellar. He                                                                    
had several  friends who had  either gone through  the WWAMI                                                                    
program or  were currently participating  in it.  He thought                                                                    
it was important to remember  the prestige of the program as                                                                    
well.  The University  of  Washington was  one  of the  best                                                                    
medical schools  in the country  and extremely  difficult to                                                                    
get into.  He suggested  there was a  golden brick  path for                                                                    
Alaskans through  the WWAMI program for  the set-aside spots                                                                    
that  were  highly  sought  after.   He  thought  it  was  a                                                                    
consideration that weighed heavily  with many applicants. He                                                                    
thought  there  might  be  a   dissuasive  effect  for  some                                                                    
applicants.  However,  given   some  conversations  and  the                                                                    
prestigious reputation  of the University of  Washington, he                                                                    
thought it would be a relatively small factor.                                                                                  
                                                                                                                                
3:17:23 PM                                                                                                                    
                                                                                                                                
Co-Chair  Johnston  noted   that  Representative  Knopp  and                                                                    
Representative Josephson had joined the meeting.                                                                                
                                                                                                                                
Representative  Wool  asked  if scholarships  were  commonly                                                                    
given out for medical school.                                                                                                   
                                                                                                                                
Representative  Kreiss-Tompkins responded  affirmatively. He                                                                    
had friends  that had  attended medical  school and  who had                                                                    
received    merit   and    other   scholarships.    If   the                                                                    
representatives  question related  to whether WWAMI students                                                                    
could  receive other  scholarships in  addition to  in-state                                                                    
tuition through WWAMI, he was  uncertain. He deferred to Dr.                                                                    
Allen.                                                                                                                          
3:18:04 PM                                                                                                                    
                                                                                                                                
Dr.  Allen   responded  that  Alaska  WWAMI   students  were                                                                    
eligible   to   receive   scholarships.  There   were   some                                                                    
scholarships  specific to  Alaska WWAMI  students and  other                                                                    
general  scholarships. She  elaborated  that WWAMI  students                                                                    
received  scholarships, federal  grants, and  loans to  help                                                                    
with tuition  and living  expenses during  their 4  years of                                                                    
medical school.                                                                                                                 
                                                                                                                                
3:18:37 PM                                                                                                                    
                                                                                                                                
Representative Wool asked if the  scholarships were based on                                                                    
need or academic performance.                                                                                                   
                                                                                                                                
Dr. Allen did not have the breakdown but both applied.                                                                          
                                                                                                                                
Representative  Wool   suggested  that  if  a   student  was                                                                    
accepted  and  was  weighing  more   than  one  option,  the                                                                    
scholarship   payback  percentage   might  influence   their                                                                    
decision.                                                                                                                       
                                                                                                                                
Representative  Kreiss-Tompkins  agreed  that  there  was  a                                                                    
possibility  of behavior  changes  with the  passage of  the                                                                    
bill.  However, it  was difficult  to  assign a  correlating                                                                    
fiscal impact. The legislation would  have a negative fiscal                                                                    
impact on  the budget which  was part  of the reason  he had                                                                    
pursued the  bill. The  impact would  be about  $600,000 per                                                                    
year  but,  the  figure  assumed   no  behavior  change.  He                                                                    
indicated that  if the passage of  the bill proved to  be an                                                                    
incentive  for WWAMI  participants  to return  to Alaska  to                                                                    
practice medicine,  the negative  fiscal impact of  the bill                                                                    
could  be eroded.  The fiscal  impact could  be $500,000  or                                                                    
$400,000 per year. He thought  it was difficult to determine                                                                    
what  behavior  changes  might  occur as  a  result  of  the                                                                    
legislation. He argued that it  could be positive for Alaska                                                                    
if  a  greater  percentage  of WWAMI  alumni  came  back  to                                                                    
practice  medicine in  the  state. He  thought  it would  be                                                                    
unreasonable to  think there would  be zero  behavior change                                                                    
on the front  end, as he thought it  would rebalance medical                                                                    
school  applicants   decisions.  Depending  on  a  financial                                                                    
package and the overall tuition  of a school would influence                                                                    
a students  decision. He suggested  students would be making                                                                    
a slightly  different choice  with the  passage of  the bill                                                                    
than without.                                                                                                                   
                                                                                                                                
3:22:32 PM                                                                                                                    
                                                                                                                                
Representative  Wool  supposed  that   if  the  program  was                                                                    
completely successful,  all 20  students would come  back to                                                                    
the  state and  the state  would  have to  reimburse all  of                                                                    
them. It  would cost  Alaska more money  but, it  would have                                                                    
more practicing physicians.                                                                                                     
                                                                                                                                
Representative   Kreiss-Tompkins  responded   that  if   100                                                                    
percent  of  alumni returned,  it  would  be beneficial  for                                                                    
Alaska. He was unsure of the fiscal crossover point.                                                                            
                                                                                                                                
Co-Chair  Johnston  directed Representative  Kreiss-Tompkins                                                                    
to  review  the  sectional analysis  which  she  anticipated                                                                    
would be brief.                                                                                                                 
                                                                                                                                
Mr. McGowan  reviewed the sectional  analysis. Section  1 of                                                                    
the bill amended AS.14.43.51(a)  and increased the repayment                                                                    
from 50  percent to 100  percent plus interest  for students                                                                    
that did not  return to the state upon  completing the WWAMI                                                                    
Program. Section 2  of the bill specified  an effective date                                                                    
which applied  to students who  entered the agreement  on or                                                                    
after the effective date of the act.                                                                                            
                                                                                                                                
3:25:11 PM                                                                                                                    
                                                                                                                                
Representative  Kreiss-Tompkins offered  that the  bill came                                                                    
about in order to make  a structural change to take pressure                                                                    
off of the  budget in the long term. At  one point the WWAMI                                                                    
Program  was  slated for  a  gubernatorial  veto. It  was  a                                                                    
compromise in  response to  a conversation  he had  had with                                                                    
the governors   chief of staff. The  compromised allowed for                                                                    
the placement of  the WWAMI Program into  a stable long-term                                                                    
place. He  wanted to  provide context to  the origin  of the                                                                    
bill.                                                                                                                           
                                                                                                                                
Co-Chair Johnston set the bill aside.                                                                                           
                                                                                                                                
HB  159  was  HEARD  and   HELD  in  committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
3:26:45 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
3:28:33 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
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