05/04/2017 03:00 PM House HEALTH & SOCIAL SERVICES

          HB 234-EXTEND ALASKA HEALTH CARE COMMISSION                                                                       
                                                                                                                                
4:08:07 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the next order  of business would                                                               
be HOUSE BILL NO. 234, "An  Act extending the termination date of                                                               
the  Alaska   Health  Care  Commission;  and   providing  for  an                                                               
effective date."                                                                                                                
                                                                                                                                
4:08:34 PM                                                                                                                    
                                                                                                                                
SETH  WHITTEN,  Staff,  Representative David  Guttenberg,  Alaska                                                               
State  Legislature,   paraphrased  from  the   Sponsor  Statement                                                               
[included in  members' packets], which read  as follows [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     The   Alaska   Health   Care   Commission   was   first                                                                    
     established by Governor Palm on  December 4, 2008 under                                                                    
     Administrative  Order #246.  In  2010, the  legislature                                                                    
     passed  SB 172,  establishing  the  Alaska Health  Care                                                                    
     Commission  in Statute.  The  legislature's intent  was                                                                    
     that the Commission would be  a permanent instrument to                                                                    
     address the need  for health care reform  in our state.                                                                    
     The  Commission worked  to  identify opportunities,  as                                                                    
     well  as a  broad  set of  strategies,  to improve  the                                                                    
     quality, accessibility and  availability of health care                                                                    
     for  all citizens  of the  State. These  strategies and                                                                    
     recommendations  can  be   found  in  the  Commission's                                                                    
     reports that were issued annually from 2009-20 14.                                                                         
                                                                                                                                
     In 2015 the Commission  was defunded. Alaska's need for                                                                    
     health  care reform  remains one  of the  most critical                                                                    
     challenges we  face. At $10  billion in  total spending                                                                    
     annually25%   of which  is  administered  by the  state                                                                    
     government   health care  is  one  of Alaska's  largest                                                                    
     consumer product  industries. When this  enormous scale                                                                    
     is considered  in conjunction with  the fact  that that                                                                    
     the state  government is the  largest single  payer for                                                                    
     those  services,   there  is   a  clear  need   for  an                                                                    
     instrument that  identifies the  costs and  benefits of                                                                    
     the health  care system  and identifies  strategies for                                                                    
     ensuring sustainability  therein. Extending  the Alaska                                                                    
     Health Care  Commission will give  the state a  tool to                                                                    
     address this crucial priority.                                                                                             
                                                                                                                                
MR. WHITTEN added  that health care was a very  complex issue and                                                               
it was  changing across  the country,  "and certainly  maybe even                                                               
more so in Alaska."                                                                                                             
                                                                                                                                
4:10:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON asked  for an  explanation to  the zero-                                                               
fiscal note.  She asked if  all the Alaska Health Care Commission                                                               
reports were available on-line.                                                                                                 
                                                                                                                                
MR. WHITTEN replied that the reports were available.                                                                            
                                                                                                                                
REPRESENTATIVE JOHNSTON  said that no  matter what the  result of                                                               
the  proposed   bill,  the  already  completed   work  was  still                                                               
available on-line.                                                                                                              
                                                                                                                                
MR.  WHITTEN  replied  that these  reports  would  be  available,                                                               
although  he was  unsure  if the  Alaska  Health Care  Commission                                                               
website would be maintained after the end of the fiscal year.                                                                   
                                                                                                                                
4:11:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON   asked  if   the  Alaska   Health  Care                                                               
Authority was "mainly in response to Medicaid reform."                                                                          
                                                                                                                                
4:11:57 PM                                                                                                                    
                                                                                                                                
MR. WHITTEN  said that he was  not an expert, and  he shared that                                                               
per  Senate  Bill  74,  the  Alaska  Health  Care  Authority  was                                                               
undergoing a feasibility study, due  for completion at the end of                                                               
the  current  fiscal  year.     Contingent  on  that  study,  the                                                               
legislature would  determine what to  do with Alaska  Health Care                                                               
Authority.                                                                                                                      
                                                                                                                                
4:12:44 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  reported that the  Alaska Health  Care Authority                                                               
was  not under  the purview  of Department  of Health  and Social                                                               
Services,  but  under  the Department  of  Administration  as  it                                                               
related  to the  role  of the  department as  an  employer.   She                                                               
explained that  there was a  review to determine  the possibility                                                               
of consolidating  the various health  care plans and  health care                                                               
coverage  paid for  by the  state.   She stated  that it  was not                                                               
related to the Alaska Health Care Commission.                                                                                   
                                                                                                                                
4:13:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO  asked  about  the sunset  audit  which  had                                                               
recommended to not extend the  Alaska Health Care Commission.  He                                                               
asked about  the benefits for maintaining  the commission, noting                                                               
that there would be an expense  to the legislature, even as there                                                               
was a zero-fiscal note.                                                                                                         
                                                                                                                                
4:14:12 PM                                                                                                                    
                                                                                                                                
MR. WHITTEN  replied that  the commission  had been  inactive and                                                               
not  funded since  2015.    He explained  that  an  audit by  the                                                               
Legislative Budget  and Audit  Committee reviewed  the commission                                                               
to determine whether  it was meeting its legislative  intent.  He                                                               
reported  that the  committee had  suggested that  the commission                                                               
needed  to  do  more.    The committee  had  reported  after  the                                                               
previous sunset  audit for  the commission  that although  it had                                                               
identified some  issues and  determined some  recommendations, as                                                               
well as created  some useful data, the commission  needed to move                                                               
toward  implementation.     He  relayed  that   there  were  some                                                               
differences of  opinion on the  committee for whether it  was the                                                               
job  of the  commission to  implement a  health care  plan.   The                                                               
statute   stated    that   the   commission   was    to   provide                                                               
recommendations  for and  foster the  development of  a statewide                                                               
plan  to  address  quality, accessibility,  and  availability  of                                                               
health care for all citizens of the state.                                                                                      
                                                                                                                                
4:15:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO  offered his opinion after  reading the audit                                                               
that it  was development of  a plan  and not implementation  of a                                                               
plan that the  commission was tasked in statute.   He stated that                                                               
to date,  as a plan  had not  been developed, the  commission had                                                               
not   been   meeting   its    legislative   intent,   hence   the                                                               
recommendation for the sunset.                                                                                                  
                                                                                                                                
4:16:27 PM                                                                                                                    
                                                                                                                                
MR.  WHITTEN offered  his understanding  that  Chapter 18  stated                                                               
that    the   commission    was    responsible   for    providing                                                               
recommendations for  and fostering  development of  the statewide                                                               
plan.    He  reported  that  his review  of  the  transcripts  of                                                               
meetings prior to the de-funding  had revealed that conversations                                                               
with  the Legislative  Budget and  Audit  Committee declared  the                                                               
need  to   move  away  from   recommendations  and   move  toward                                                               
implementation.   He offered  his belief  that testimony  by Kris                                                               
Curtis to  the Legislative Budget  and Audit  Committee indicated                                                               
that  "they [the  commission] weren't  doing enough  to implement                                                               
the plan.  That feedback had  been provided to the commission and                                                               
that while  there was some  momentum building at that  point, the                                                               
point which they were de-funded in  2015, ... put all that on the                                                               
back burner."                                                                                                                   
                                                                                                                                
4:18:07 PM                                                                                                                    
                                                                                                                                
KRISTIN CURTIS, Legislative  Auditor, Legislative Audit Division,                                                               
Alaska  State Legislature,  reported that  the recommendation  in                                                               
the  sunset  audit findings  had  been  due  to  the lack  of  an                                                               
actionable plan,  and she  offered her  belief that  although the                                                               
commission  had created  a framework,  this framework  lacked the                                                               
actionable  components  to  effectively  impact  health  care  in                                                               
Alaska because  it did  not go  far enough  to explain  how these                                                               
high  level  recommendations  and  framework  were  going  to  be                                                               
implemented.  She  suggested that this may  have caused confusion                                                               
regarding  the use  of  "implementation."   She  opined that  the                                                               
framework was not a plan, and  hence, did not meet the purpose of                                                               
the statute.                                                                                                                    
                                                                                                                                
4:19:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  stated that she had  watched the                                                               
Alaska Health  Care Commission  since its  inception, as  she had                                                               
been  working in  the governor's  office.   She  reported that  a                                                               
clear   plan   was   never  developed   as   requested   by   the                                                               
administrative order, which she deemed  to be "problematic."  She                                                               
explained that she did not discount  the work which had been done                                                               
by  this  commission,  although she  had  concerns  that  another                                                               
extension  of  the  commission   would  continue  with  the  same                                                               
results.   She asked if  it would  be beneficial to  consider new                                                               
legislation to clearly  identify the direction for  a health care                                                               
commission,   as   opposed   to   continuing  the   use   of   an                                                               
administrative  order   which,  she  opined,  has   "caused  some                                                               
difficulty."                                                                                                                    
                                                                                                                                
MS.  CURTIS shared  that there  was ambiguous  statutory language                                                               
and added that  more clarity for direction from  the Alaska State                                                               
Legislature  would   be  helpful  to  ensure   that  all  parties                                                               
understood the expectations moving forward.                                                                                     
                                                                                                                                
4:20:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  suggested that the  House Health                                                               
and  Social  Services  Standing   Committee  could  look  at  new                                                               
legislation  in moving  forward,  instead of  following the  same                                                               
path as previously.                                                                                                             
                                                                                                                                
4:21:26 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ, reflecting  on an  earlier discussion  with the                                                               
sponsor of the bill, offered  her observation that the mandate of                                                               
the Alaska  Health Care Commission  was not  always implementable                                                               
and  that there  was some  tension for  its implementation.   She                                                               
suggested  that two  bosses with  two  different instructions  is                                                               
"almost always gonna end up with  a sub-par product."  She shared                                                               
that the  bill sponsor would like  to see the commission  stay on                                                               
the  books and  move  forward.   She reported  that  it had  been                                                               
agreed to  work on a  proposed revision  to narrow the  scope and                                                               
ensure that the commission was  serviceable in the current health                                                               
care environment.   She opined that the use  of an administrative                                                               
order and  then a statute created  more than eight years  ago was                                                               
no longer practical.                                                                                                            
                                                                                                                                
4:23:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR asked  how this would work  as the commission                                                               
was due to expire on June 30, 2017.                                                                                             
                                                                                                                                
4:23:47 PM                                                                                                                    
                                                                                                                                
MS. CURTIS  explained that although the  commission would sunset,                                                               
the board  had a one-year  wind down administrative period.   She                                                               
reported that this had occurred with other sunsets.                                                                             
                                                                                                                                
4:24:18 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ asked  if this would mitigate the need  for a new                                                               
sunset audit.                                                                                                                   
                                                                                                                                
4:24:25 PM                                                                                                                    
                                                                                                                                
MS. CURTIS expressed her agreement if  a bill was passed prior to                                                               
July 1, 2018.                                                                                                                   
                                                                                                                                
4:24:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO  asked what  activities the  commission would                                                               
be responsible for during this  upcoming sunset period.  He asked                                                               
if the staff  would have identified duties to  perform until this                                                               
was addressed.                                                                                                                  
                                                                                                                                
4:25:04 PM                                                                                                                    
                                                                                                                                
MS. CURTIS offered her belief  that currently there was no staff,                                                               
no  funding, and  no committee.   She  offered her  understanding                                                               
that  there was  an intent  to keep  the law  on the  books, even                                                               
though the members' terms had expired.                                                                                          
                                                                                                                                
4:25:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO  asked if the  commission were allowed  to go                                                               
into  sunset, would  the  statute remain  for  a possible  future                                                               
authorization.                                                                                                                  
                                                                                                                                
4:26:22 PM                                                                                                                    
                                                                                                                                
MS.  CURTIS  offered her  understanding  that  the statute  would                                                               
stay, and she suggested to ask Legislative Legal Services.                                                                      
                                                                                                                                
4:26:43 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ  said  that  there  would  be  a  follow-up  for                                                               
clarification to these questions.                                                                                               
                                                                                                                                
[HB 234 was held over.]