Legislature(2013 - 2014)CAPITOL 106
03/25/2014 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB376 | |
| HCR21 | |
| HB360 | |
| SB169 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 374 | TELECONFERENCED | |
| + | SB 169 | TELECONFERENCED | |
| *+ | HB 376 | TELECONFERENCED | |
| *+ | HB 360 | TELECONFERENCED | |
| *+ | HCR 21 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 25, 2014
3:03 p.m.
MEMBERS PRESENT
Representative Pete Higgins, Chair
Representative Wes Keller, Vice Chair
Representative Benjamin Nageak
Representative Lance Pruitt
Representative Lora Reinbold
Representative Paul Seaton
Representative Geran Tarr (via teleconference)
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 376
"An Act extending the termination date of the Alaska Health Care
Commission; and providing for an effective date."
- MOVED HB 376 OUT OF COMMITTEE
HOUSE CONCURRENT RESOLUTION NO. 21
Proclaiming April 2014 as Child Abuse Prevention Month.
- MOVED HCR 21 OUT OF COMMITTEE
HOUSE BILL NO. 360
"An Act prohibiting smoking in certain locations; and providing
for an effective date."
- HEARD & HELD
COMMITTEE SUBSTITUTE FOR SENATE BILL NO. 169(FIN)
"An Act establishing in the Department of Health and Social
Services a statewide immunization program and the State Vaccine
Assessment Council; creating a vaccine assessment account;
requiring a vaccine assessment from assessable entities and
other program participants for statewide immunization purchases;
repealing the temporary child and adult immunization program;
and providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 374
"An Act establishing in the Department of Health and Social
Services a statewide immunization program and the State Vaccine
Assessment Council; creating a vaccine assessment account;
requiring a vaccine assessment from assessable entities and
other program participants for statewide immunization purchases;
repealing the temporary child and adult immunization program;
and providing for an effective date."
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 376
SHORT TITLE: EXTEND ALASKA HEALTH CARE COMMISSION
SPONSOR(s): HEALTH & SOCIAL SERVICES
03/14/14 (H) READ THE FIRST TIME - REFERRALS
03/14/14 (H) HSS, FIN
03/25/14 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HCR 21
SHORT TITLE: CHILD ABUSE PREVENTION MONTH
SPONSOR(s): TARR
02/26/14 (H) READ THE FIRST TIME - REFERRALS
02/26/14 (H) HSS
03/25/14 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 360
SHORT TITLE: REGULATION OF SMOKING
SPONSOR(s): HOLMES
02/26/14 (H) READ THE FIRST TIME - REFERRALS
02/26/14 (H) HSS, JUD
03/25/14 (H) HSS AT 3:00 PM CAPITOL 106
BILL: SB 169
SHORT TITLE: IMMUNIZATION PROGRAM; VACCINE ASSESSMENTS
SPONSOR(s): GIESSEL
02/10/14 (S) READ THE FIRST TIME - REFERRALS
02/10/14 (S) HSS
02/21/14 (S) HSS AT 1:30 PM BUTROVICH 205
02/21/14 (S) Heard & Held
02/21/14 (S) MINUTE(HSS)
02/24/14 (S) HSS RPT CS 4DP NEW TITLE
02/24/14 (S) DP: STEDMAN, MICCICHE, MEYER, ELLIS
02/24/14 (S) FIN REFERRAL ADDED AFTER HSS
02/24/14 (S) HSS AT 1:30 PM BUTROVICH 205
02/24/14 (S) Moved CSSB 169(HSS) Out of Committee
02/24/14 (S) MINUTE(HSS)
03/03/14 (S) FIN AT 5:00 PM SENATE FINANCE 532
03/03/14 (S) Scheduled But Not Heard
03/05/14 (S) FIN AT 5:00 PM SENATE FINANCE 532
03/05/14 (S) Moved CSSB 169(FIN) Out of Committee
03/05/14 (S) MINUTE(FIN)
03/07/14 (S) FIN RPT CS 5DP NEW TITLE
03/07/14 (S) DP: MEYER, KELLY, BISHOP, DUNLEAVY,
OLSON
03/21/14 (S) TRANSMITTED TO (H)
03/21/14 (S) VERSION: CSSB 169(FIN)
03/24/14 (H) READ THE FIRST TIME - REFERRALS
03/24/14 (H) HSS, FIN
03/25/14 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
THOMAS STUDLER, Staff
Representative Pete Higgins
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 376 for the sponsor of the
bill, Representative Pete Higgins.
WARD HURLBURT, M.D., Chief Medical Officer/Director
Division of Public Health
Central Office
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the discussion of
HB 376.
DEBORAH ERICKSON, Executive Director
Alaska Health Care Commission
Office of the Commissioner
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 376.
KRISTIN CURTIS
Legislative Auditor
Division of Legislative Audit
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 376.
REPRESENTATIVE LINDSEY HOLMES
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 360 as the sponsor of the
bill.
ROBERT ERVINE, Staff
Representative Lindsey Holmes
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Discussed HB 360 on behalf of the sponsor
of the bill, Representative Holmes.
JANET KINCAID, Business Owner
Palmer, Alaska
POSITION STATEMENT: Stated her support for HB 360.
CARMEN LUNDE
Kodiak Cabaret, Hotel, Restaurant, & Retailers Association
Kodiak, Alaska
POSITION STATEMENT: Testified in opposition to HB 360.
LARRY HACKENMILLER, Member
Alaska Cabaret, Hotel, Restaurant, & Retailers Association
Fairbanks, Alaska
POSITION STATEMENT: Testified during discussion of HB 360.
MARK MILITELLO, Owner
Sumo Vapor
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 360.
DANIEL LYNCH
Soldotna, Alaska
POSITION STATEMENT: Testified in opposition to HB 360.
ANGELA CARROLL, Owner
Glacier Vapors
Palmer, Alaska
POSITION STATEMENT: Testified in opposition to HB 360.
DALE FOX, President & CEO
Alaska Cabaret, Hotel, Restaurant, & Retailers Association
(CHARR)
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 360.
BETTY MACTAVISH
Kodiak, Alaska
POSITION STATEMENT: Testified in support of HB 360.
MATT WAGNER
Bad Boy Vapors Alaska, LLC
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 360.
SEAN DASILVA
Bad Boy Vapors Alaska, LLC
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 360.
SENATOR CATHY GIESSEL
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SB 169 as the sponsor of the
bill.
ROSALYN SINGLETON, MD
Alaska Native Tribal Health Consortium (ANTHC) Immunization
Program
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 169 and
presented a PowerPoint titled "Alaska - What have vaccines done
for you?"
JILL LEWIS, Deputy Director - Juneau
Central Office
Division of Public Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of SB 169.
ACTION NARRATIVE
3:03:58 PM
CHAIR PETE HIGGINS called the House Health and Social Services
Standing Committee meeting to order at 3:03 p.m.
Representatives Higgins, Keller, Seaton, and Reinbold were
present at the call to order. Representatives Nageak, Pruitt,
and Tarr (via teleconference) arrived as the meeting was in
progress.
HB 376-EXTEND ALASKA HEALTH CARE COMMISSION
3:04:53 PM
CHAIR HIGGINS announced that the first order of business would
be HOUSE BILL NO. 376, "An Act extending the termination date of
the Alaska Health Care Commission; and providing for an
effective date."
3:05:22 PM
THOMAS STUDLER, Staff, Representative Pete Higgins, Alaska State
Legislature, paraphrased from the sponsor statement, which read:
HB 376 extends the sunset of the Alaska Health Care
Commission until June 30, 2017. The Legislative
Auditor has concluded that the Alaska Health Care
Commission is serving the public's interest and should
continue its statutory obligation.
The legislature established the Commission under AS
18.09.010 in 2010 to recommend policies to improve
quality, affordability and access to health care, and
to identify strategies for improving the health of all
Alaskans. Seats representative of various health care
stakeholders are designated in statute, and voting
members are appointed by the Governor. Sen. Coghill
and Rep. Keller currently represent the legislature as
ex-officio members of the Commission.
The Commission's approach has been to study current
conditions of Alaska's health care market, and design
market-based strategies and policy recommendations
that enhance the consumer's role in health and health
care. The Commission submits an annual report
including policy recommendations to the Governor and
the legislature on January 15 each year. A summary of
the core strategies and policies recommended by the
Commission to-date is attached.
In its short tenure the Commission has developed a
strategic framework including a time-specific vision
with measurable objectives; conducted numerous studies
to increase knowledge and understanding of current
problems in the health care system, designed a
comprehensive body of specific, relevant and
measurable market-based policy recommendations for
improving health care cost and quality; and created a
template for and is facilitating development of an
executive branch action plan for implementing
Commission policy recommendations. The Commission has
also coordinated with and provided consultation to
private sector employer groups on health care system
concerns.
Excessive health care costs and medical inflation in
Alaska threaten the sustainability of the health care
system and create a burden on families and public and
private employers. Continuation of the Commission
would promote accountability and evaluation of public
program implementation through finalization of a state
agency plan to implement recommended policies,
increase transparency in the health care system, and
provide continuing consultation and coordination with
private sector employers in support of their health
care value improvement strategies.
The Commission has consistently proven to be efficient
and effective in its progress to develop a strategic
framework for improving statewide health care and I
ask for your support in the passage of this bill.
3:07:02 PM
WARD HURLBURT, MD, Chief Medical Officer/Director, Division of
Public Health, Central Office, Department of Health and Social
Services, said that the Alaska Health Care Commission had been
initially established by then Governor Sarah Palin by executive
order, and later established in law by the Alaska State
Legislature. The Commission was "charged with looking at health
care delivery in Alaska related to accessibility, affordability,
quality, prevention, and so on." He stated that the committee
had reviewed the various aspects of the health care delivery
system; however, the dominant focus was for the cost of health
care, and what opportunities there were to mitigate the high
cost. He reported that about 18 percent of gross domestic
product was spent for health care in the United States, almost
$3 trillion annually, whereas the rest of the industrialized
world spends about half to two-thirds of this amount in terms of
both gross domestic product and dollar equivalents. He pointed
out that Norway and Switzerland were the next most expensive
countries, spending about two thirds the amount of the U.S.,
even with longer life expectancies and lower infant mortality.
In the past twenty years, comparable health care spending by the
U.S. to Norway and Switzerland in percentage of gross domestic
product would have saved the U.S. about $15 trillion, an amount
equivalent to the current national debt. He reported that
Alaska spends about 20 - 21 percent of its gross domestic
product for health care. He relayed that the average salary of
teachers in the Anchorage School District had increased about 1
percent annually, over inflation, in the last 30 years, whereas
the cost of health care insurance had increased about 15 percent
each year above inflation. This was a challenge for the Alaska
State Legislature. He noted that the Milliman Company had
compared the charges for medical services by various payers in
Alaska with those charges in Washington, Oregon, Idaho, North
Dakota, Wyoming, and Hawaii, and that Alaska was much higher
than the other states. He said that an all payer claims data
base had been studied by another contractor, which would provide
information for health service charges and quality data for
outcomes. He noted that 12 states had this process, with 18
others considering it. He pointed out that the Health Care
Commission was working with other health care entities, both
public and private sectors. He offered as an example that the
Human Resources directors from the large for-profit companies
had included the cost of health care during discussion of
expansion plans. He noted that the Legislative Audit process
had focused on DHSS developing a health plan, and the department
had taken those policy recommendations to the Legislature and
the governor for guidelines to the formation of a health plan to
benefit Alaskans. He offered his belief that all the members of
the Health Commission believed that its work benefited the state
and its citizens. He requested a determination of value from
the Alaska State Legislature.
CHAIR HIGGINS asked if there had been implementation and savings
for the state from the recommendations of the Alaska Health Care
Commission.
DR. HURLBURT offered his belief that there were results;
however, if the Alaska State Legislature did not see those
results, he would question his own assessment. He declared that
this was a critical decision for the legislature, particularly
in light of the necessity for fiscal conservation. He opined
that, in terms of value, the response from larger employers was
that the information had helped to contain health care costs.
He said that anecdotal reports indicated that this information
was helpful in negotiating rates to ensure a level playing field
between payers and providers for fair levels of compensation to
support a health care industry which was sensitive to the
adverse effects of high costs. He compared these high costs to
a tax.
CHAIR HIGGINS questioned whether the work of the commission was
saving the state money and providing the necessary services.
3:18:24 PM
DEBORAH ERICKSON, Executive Director, Alaska Health Care
Commission, Office of the Commissioner, Department of Health and
Social Services, addressed the $500,000 fiscal note, [Included
in members' packets] which had been proposed in the governor's
budget, as it reflected the ongoing costs for the next few
years. She explained that $335,000 was paid from the general
fund and the remaining $165,000 from federal funds to the
department. She reported that this budget supported two staff,
travel for the 14 commission members, and the occasional
facility cost to host a meeting with the private sector. She
noted that some of the budget was for professional service
contracts for special studies on which the commission did not
have expertise or capacity. She offered an example of the
actuarial study comparing pricing and reimbursement levels
between payers in Alaska, to better understand cost shifting
between private insurance and Medicaid, as well as a cost
comparison between Alaska and other states in our region. She
reported that currently there was a contract with the Institute
for Social and Economic Research (ISER) and Department of Labor
& Workforce Development to survey private sector health
insurance, concerns, and employee wellness programs. She
pointed out that there had been studies related to the impact of
the Affordable Care and Patient Protection Act, including an
employer survey to capture information regarding the actions of
Alaska employers both before and after implementation of the
individual mandate, for use as a baseline with future
assessments.
REPRESENTATIVE SEATON referred to the report on "Core Strategies
for Health Care Transformation" [Included in members' packets]
and asked how the commission reached its first goal of ensuring
that the best available evidence was used for making decisions.
MS. ERICKSON replied that a series of more specific policy
recommendations related to that strategy was an appendix to the
commission's 2013 report. She relayed that ensuring the best
available evidence was used for making decisions was the most
important, although it was more difficult to implement and had
longer term implications. She offered an example of the
learning sessions with the private medical community in order to
critically appraise medical literature for identification of
biases during reporting of studies. She said there were
additional techniques for incorporating evidence into insurance
designs, which were being discussed for employee and retiree
health plans. She noted that the commission had also presented
a specific recommendation to the Workers' Compensation Board.
REPRESENTATIVE SEATON asked that the upcoming report show the
strategy and what was being done to accomplish the strategy.
MS. ERICKSON directed attention to the recommendations by
Division of Legislative Audit, which stated that the commission
was meeting its intent, although it was necessary for an actual
plan for implementation of the strategies. She stated that
there had been meetings with the directors from state agencies
that had a lead role in health care services. She referred to
an appendix in the 2013 report that detailed the plan for each
agency to implement the recommendations by the commission.
3:26:44 PM
KRISTIN CURTIS, Legislative Auditor, Division of Legislative
Audit, Alaska State Legislature, explained that her division had
conducted a sunset audit of the commission to decide whether the
commission served the public interest and whether its
termination date should be extended. She referred to the audit
report [Included in members' packets]. She offered some
background on the commission and the expectations from the
legislature. The commission had been started by executive order
in 2008, with the legislature intending for the commission to
achieve health reforms through development of the statewide
health plan; however, the original commission did not consider
itself responsible for the development of a plan, and the new
commission, established in statute in 2010, had agreed to
continue the approach by the prior commission. The new
commission collected information from various cost studies and
developed high level policy recommendations, while establishing
general priorities which evolved into a strategic framework.
She directed attention to Appendix A of the audit report
[Included in members' packets]. She declared that the audit had
concluded that the commission was serving the interest of the
public, but improvements in the development of a state health
plan were necessary to justify its continued existence. She
stated that the legislature had intended the commission to work
in conjunction with Department of Health and Social Services
(DHSS) to create a comprehensive health plan; however, as the
commission had not collaborated with DHSS, Division of
Legislative Audit recommended only a three year extension in
order to develop a plan. The audit concluded that the
commission was active, although there was concern by the
division that the framework lacked any actionable components for
effective implementation and did not identify specific actions
to be taken, a timeframe for completion, the person responsible
for taking action, a definition for a successful outcome, or a
means to specifically monitor and measure progress. Without a
statewide health plan, the actions of the commission may not
effectively impact health care in Alaska. She recommended
coordination with the DHSS commissioner to identify the role and
responsibility of each agency and then pursue development of the
health plan. The audit also recommended improvement for the
public noticing of meetings and assurance that annual reports
include all statutorily required elements.
REPRESENTATIVE KELLER clarified that he was a member of the
commission, although he did not perceive any conflict of
interest and he had no economic connection. He acknowledged
that he was biased and very positive in general terms for the
commission. He declared that there was a challenge to keep the
health care system in Alaska from entering a crisis, and that
everyone on the commission had agreed on the necessity to cut
the costs. He opined that it would get better, as the
commission had identified significant issues, including a focus
on preventive care.
3:31:56 PM
REPRESENTATIVE SEATON referenced the plan mentioned in the audit
report, and asked if the commission agreed with the findings by
the Division of Legislative Audit to develop a specific
actionable plan as a primary goal of the commission.
REPRESENTATIVE KELLER replied that this had been the focus of
the previous commission meeting.
CHAIR HIGGINS offered his agreement that the commission had the
potential to be really beneficial to Alaska, and he recommended
that it be allowed more time.
3:33:07 PM
REPRESENTATIVE KELLER moved to report HB 376, version 28-
LS1604\A, out of committee with individual recommendations and
the accompanying fiscal notes. There being no objection, HB 376
was moved from the House Health and Social Services Standing
Committee.
3:33:40 PM
The committee took an at-ease from 3:33 p.m. to 3:35 p.m.
HCR 21-CHILD ABUSE PREVENTION MONTH
3:35:40 PM
CHAIR HIGGINS announced that the next order of business would be
HOUSE CONCURRENT RESOLUTION NO. 21, Proclaiming April 2014 as
Child Abuse Prevention Month.
3:36:13 PM
REPRESENTATIVE TARR, via teleconference, testified in support of
HCR 21, as the sponsor of the resolution. She expressed
recognition of April as Child Abuse Awareness Month, and stated
that it would help raise the profile of this and similar issues,
in order to "break the silence." She directed attention to the
numbers for child abuse incidences in the resolution, which had
been gathered from the DHSS monthly on-line reports [Included in
members' packets]. She stated that this resolution joined
others in support across the United States, and she pointed to a
chronology for the national effort toward recognition of Child
Abuse Awareness going back to 1974 [Included in members'
packets]. She expressed her desire to share this resolution
with agencies and organizations that worked on these issues, and
with legislators to share with their constituents. She offered
examples of some planned events.
CHAIR HIGGINS expressed his support for the proposed resolution.
3:40:25 PM
REPRESENTATIVE KELLER moved to report HCR 21, Version 28-
LS1522\U, out of committee with individual recommendations and
the accompanying zero fiscal notes. There being no objection,
HCR 21 was moved from the House Health and Social Services
Standing Committee.
3:41:00 PM
The committee took a brief at-ease.
HB 360-REGULATION OF SMOKING
3:42:22 PM
CHAIR HIGGINS announced that the next order of business would be
HOUSE BILL NO. 360, "An Act prohibiting smoking in certain
locations; and providing for an effective date."
REPRESENTATIVE KELLER moved to adopt the proposed committee
substitute (CS) CSHB 360, labeled 28-LS1336\U, Strasbaugh,
3/21/14, as the working draft. There being no objection, it was
so ordered.
3:42:39 PM
REPRESENTATIVE LINDSEY HOLMES, Alaska State Legislature,
declared that the proposed bill was also called "the take it
outside bill." She explained that it was designed to protect
people in their own workplaces from having to breathe second
hand smoke. She stated that there was now more knowledge about
the effects from second hand smoke and she offered anecdotes
about past experiences with second hand smoke. She reported
that second hand smoke killed an estimated 50,000 Americans
every year from lung cancer and heart disease, and the Surgeon
General had reported that even brief exposure to second hand
smoke could have immediate adverse effects on the cardio-
vascular system. This same report estimated that second hand
smoke caused about $5.6 billion in loss productivity annually.
An analysis from the Institute of Medicine in 2009 concluded
that smoke free workplace laws helped reduce heart attacks from
6 - 47 percent. She noted that stroke had also been added to
the list as caused by exposure to second hand smoke. She said
that approximately half of the jobs in Alaska were covered by
smoke free workplace laws. She reported that more than 400
businesses in Alaska had signed resolutions supporting a state
wide smoke free indoor workplace law [Included in members'
packets], noting that the Alaska Supreme Court had recently
recognized that the government did have a legitimate interest in
protecting citizens from "the well-established dangers of second
hand tobacco smoke." She reported that more than 30 other
states already had similar laws.
CHAIR HIGGINS asked if the decision by work places to be smoke
free was voluntary.
REPRESENTATIVE HOLMES replied that some were voluntary, although
many were in areas of the state that had local, smoke free work
place laws. She pointed out that, in many unincorporated areas,
local government did not have the power to impose these
ordinances.
CHAIR HIGGINS asked how the proposed bill would be enforced.
REPRESENTATIVE HOLMES replied that "it's fairly well self-
policing" and there had been very little need for enforcement.
3:47:37 PM
ROBERT ERVINE, Staff, Representative Lindsey Holmes, Alaska
State Legislature, explained that smoking laws in Alaska were
under the purview of Department of Environmental Conservation
(DEC) although a goal of the proposed bill was to shift this to
Department of Health and Social Services (DHSS). This would
allow an employee to make a complaint if there was a violation.
He referred to the Sectional Summary [Included in members'
packets]. He explained that Section 1, paragraph (1), created
new smoking laws to prohibit smoking in, among others, enclosed
areas within places of employment, public places, schools, and
transportation facilities. Describing paragraph (2), he stated
that it applied to, among others, outdoor arenas, stadiums, and
areas of public schools. Moving on to subsection (b), he listed
the three exemptions to include private clubs, private
residences except hotels or motels, and vessels engaged in
commercial or sport fishing activities. The next section, AS
18.35.331, required employers, owners, and operators to post no
smoking signs within places or vehicles where smoking was
prohibited.
REPRESENTATIVE SEATON asked for identification of the referenced
page and line.
REPRESENTATIVE KELLER stated that this was on page 3, line 3.
MR. ERVINE directed attention to page 3, line 23, which required
the commissioner of DHSS to develop and maintain procedures for
processing reports of violations. He observed that it would be
necessary for further clarification that this was not "a gotcha
task force as enforcement." He moved on to page 3, line 31
through page 4, line 13, which established the fine amounts for
violations. He noted that, although these regulations did not
fall under the purview of DHSS, DEC did not have enforcement
capabilities for the current smoking law either. This would
shift the enforcement to DHSS, and "hopefully give them some
measure of teeth to enforce this."
REPRESENTATIVE SEATON directed attention to page 3, line 6, and
asked about a task force.
MR. ERVINE stated that a task force was not being established.
REPRESENTATIVE HOLMES said that the goal was for clarification
that the intent for the proposed bill was not to be "a sting
operation," or a "big enforcement effort." She offered that her
intent was for this to be "complaint driven only, and fairly
limited in scope," and not for "a big enforcement effort."
CHAIR HIGGINS said that the proposed bill would be held over.
MR. ERVINE directed attention back to AS 18.35.344(c) through
(e), page 3, line 31 through page 4, line 13, which allowed
peace officers, or an employee designated by the commissioner,
to issue citations for violations of the new law. These
violations could be reported by a person observing the
violation. He stated that it went on to discuss ticketing and
bail for violations.
3:54:47 PM
MR. ERVINE directed attention to AS 18.35.351, page 5, lines 30
- 31, and page 6, lines 1 - 9, which required the Commissioner
of DHSS "to administer and enforce the provisions of the new law
and adopt regulations as needed." He referred to AS 18.35.356,
page 6, lines 10 - 19, which required the [DHSS] commissioner to
provide ongoing access to the public about the law, including an
electronically published brochure explaining the new
requirements for employers, property owners, property operators,
and the public. He said this was an important component of the
proposed bill, as it focused on public education and not
enforcement.
MR. ERVINE moved on to AS 18.35.357, page 6, lines 20 - 27,
noting that this was an important protection for employees from
retaliation by an employer. He said that AS 18.35.359, page 6,
lines 28 - 31, and page 7, line 1, established that a
municipality may adopt and enforce local laws that were more
stringent that the proposed bill. He explained that AS
18.35.366, page 7, lines 3 - 31 and page 8, lines 1 - 14, were
the definitions provided for business, commissioner, department,
e-cigarette, employee, employer, enclosed area, health care
facility, private club, place of employment, public place, and
smoking.
MR. ERVINE referred to page 8, lines 15 - 16, which repealed the
listed existing statutes.
CHAIR HIGGINS asked about the authority to issue citations.
MR. ERVINE replied that the proposed bill would designate that
authority.
REPRESENTATIVE KELLER asked for clarification that the person
issuing the citation had to see the offense committed.
MR. ERVINE referred to page 4, lines 21 - 23.
REPRESENTATIVE KELLER asked if the criteria for a citation were
for the complainant to witness the offense.
MR. ERVINE replied that either a peace officer or the designated
department person could issue the citation.
REPRESENTATIVE KELLER asked for more clarification.
REPRESENTATIVE HOLMES offered her understanding that the peace
officer must witness the offense, but that the designated
department person did not have to witness it.
3:59:14 PM
REPRESENTATIVE PRUITT, asking for clarification that a person
designated by the commissioner could issue a citation without
having to see the offense, announced that this "could be opening
ourselves up" and declared "that's a slippery slope."
MR. ERVINE explained that the intention was for the
commissioner, or the designated person, to follow up on a report
with a letter, instead of an actual citation. He offered to
provide clarification in the proposed bill.
REPRESENTATIVE PRUITT stated his recognition for an
indeterminate fiscal note, as it "could be huge if you're
talking about having enough people out there for all the little
situations."
REPRESENTATIVE HOLMES said that this was not the intent for the
proposed bill, and they would continue to work for
clarification.
REPRESENTATIVE SEATON referred to page 4, lines 16 - 17, and
stated that a violation of AS 18.35.301 had to be committed in
the presence of the officer, although a citation could be issued
for a violation of AS 18.35.331 or AS 18.35.357 that did not
occur in the presence of the officer.
REPRESENTATIVE SEATON, referring to page 5, line 27, asked for
clarification and the intent that a commissioner may bring civil
action to enjoin a violation of these statutes.
REPRESENTATIVE HOLMES replied that this would be a result of
non-compliance with the law.
REPRESENTATIVE SEATON asked if this could result from a $100
violation in Superior Court.
REPRESENTATIVE HOLMES explained that enjoining the action was
similar to a temporary restraining order after non-compliance to
repeated complaints.
MR. ERVINE pointed out that the fines and the injunction
sections were modeled from existing law. He discussed Section
3, page 8, lines 17 - 20, which was uncodified law and clarified
that the new provisions of the bill applied to violations or
failure to comply that occur on or after the effective date.
Section 4, page 8, lines 21 - 26, was uncodified law and
permitted Department of Health and Social Services to adopt
regulations to implement Section 1 of the proposed bill. He
noted that any regulations could not take effect before the
effective date. He concluded with Sections 5 and 6, page 8,
lines 27 and 28, which set the effective date of October 1, 2014
for the bill, although Section 4 would take effect immediately.
4:05:32 PM
MR. ERVINE paraphrased from the Summary of Changes [Included in
members' packets] and stated that there was a slight
modification of the bill title. He directed attention to page
1, line 8, and said that the proposed areas for prohibiting
smoking had been split to just include enclosed areas, with page
2, line 15, now including enclosed areas and the grounds. On
page 2, line 1, "health care facility" was deleted from the list
in subsection (a)(1)(D). On page 2, lines 11 - 12, a new
subparagraph (H) specified that smoking was only allowed in
vehicles driven by an owner/operator, and not in any vehicle
used as a place of employment. On page 3, line 1, "or adult"
was inserted after "children" to clarify that the exemption was
for private residences, and did not include a location where
adult care was provided on a fee for service basis. Moving on
to page 3, lines 13 - 17, he described that subsections (b) and
(c) were combined and rewritten to place responsibility for
posting signage that smoking was prohibited on the person in
charge of the building. On page 3, lines 21 - 22, subsection
(d) was rewritten to require the Department of Health and Social
Services to provide the required signs in this section. On page
3, AS 18.35.331, subsection (f) was deleted, and on page 6, line
29, "or a political subdivision of the state" was deleted.
Finally, on page 7, lines 9 - 12, the definition of "e-
cigarette" was amended to include a broader range of e-cigarette
products that produce a vapor for inhalation, even though this
vapor may not be nicotine, but could contain other harmful
toxins.
4:08:47 PM
The committee took an at-ease from 4:08 p.m. to 4:10 p.m.
4:10:23 PM
CHAIR HIGGINS said that the proposed bill would be held over,
and he opened public testimony.
4:11:22 PM
JANET KINCAID, Business Owner, reported that there was a no
smoking ordinance in Palmer with almost universal support and
that it had been very good for business and health.
CARMEN LUNDE, Kodiak Cabaret, Hotel, Restaurant, & Retailers
Association (CHARR), stated that government intervention needed
to stop. She declared that the proposed bill was targeted at
bars, as there was no longer smoking in the other places
described in the proposed bill. She said that Kodiak used
common sense for its smoking issues and allowed a free choice
for individuals. She opined that no government at any level
should have the right to dictate how a business owner chooses to
run their business. She declared that citizens should have the
right to make their own choices.
LARRY HACKENMILLER, member, Alaska Cabaret, Hotel, Restaurant, &
Retailers Association, stated that the Fairbanks City Council
had decided that there was sufficient choice and had decided not
to implement any widespread ban. He declared that the
statistics for death from second hand smoke had not changed
since initial testimonies, and he opined that this would have
declined as there were now fewer smokers. He questioned the
hazards included with smoking. He said that there was not any
science to support harm from e-cigarettes. He compared the
toxins, chemicals, and carcinogens emitted from e-cigarettes
with those from candles, declaring them to be similar. He
pointed out that candles were not included in the proposed bill.
He stated that, as 95 percent of restaurants in Fairbanks were
non-smoking by choice, the proposed bill was not necessary and
only "makes criminals out of people" and "beefs up the
government payroll beyond what's necessary and it doesn't
address [the] real issue." He referenced the building code
requirement for air exchanges, which did not mention second hand
smoke, and he said "well, this bull about, well, the employee's
safety, it's a matter of preference and an employee may not like
the smell of smoke or whatever, but it's still.. again, when
they keep telling you that we have a right to smoke free air,
well, that's true, but you also have a right to smoke filled
air. Those rights exist for everybody." He declared that, as
the discussion was for second hand smoke, he had not found any
research that "shows a miniscule exposure" was a health issue.
4:17:09 PM
MARK MILITELLO, owner, Sumo Vapor, said that, although he was a
non-smoker, he did not agree with a comparison of cigarettes to
e-cigarettes. He said he had not yet been shown that anyone had
died from exposure to e-cigarettes. He offered his belief that
e-cigarettes should be compared to the nicotine patch or
nicotine gum. He stated that he was the owner of an electronic
cigarette store, and he opined that e-cigarettes should not be
included in the proposed bill.
DANIEL LYNCH said that he had been a smoker for forty years,
although he recognized that it was "a bad habit." He stated
that "a few do-gooders want to make me a criminal for having a
bad legal habit." He pointed out that he voluntarily paid
substantial taxes on his cigarette purchases. He stated that
cigarette smoke was healthier than tailpipe exhaust. He relayed
that all of his previous employers had the freedom to make and
enforce their own policies on work place activities, including
smoking, and that these policies worked well.
ANGELA CARROLL, Owner, Glacier Vapors, said that she was an
owner of a vapor e-cigarette shop, and that she was opposed to
the language including electronic cigarettes in the proposed
bill. She offered her belief that a business owner should make
the decision to allow vaping or smoking in their establishment.
She stated that e-cigarettes should not be included with
cigarettes. She reported that she had been a smoker for 37
years, and that e-cigarettes had dramatically lowered her
nicotine intake. She offered her belief that the proposed bill
would close down most e-cigarette stores. She pointed to
studies which indicated that vaping was far less harmful than
cigarettes, and she asked for an educated vote on the proposed
bill, and an exclusion of e-cigarettes in the language of the
proposed bill.
4:24:41 PM
DALE FOX, President & CEO, Alaska Cabaret, Hotel, Restaurant, &
Retailers Association (CHARR), declared that the "ban on smoking
is a ban on bars." He said that almost every place on the list
was already excluded from smoking, and that most communities
offered a number of choices for bars and businesses to visit.
He said that CHARR members were really frightened, as
significant losses of revenue were reported after a smoking ban.
His observations were that smoking bans had led to a 30 percent
decrease in revenue. He stated that there should be a freedom
of choice for smoking or non-smoking. He said that many CHARR
members were angry, as local votes had allowed the maintenance
of both smoking and non-smoking establishments. He stated that,
if legislators believed in smaller government and the right of
self-determination by local government, there would not be
support of the proposed bill.
BETTY MACTAVISH commended the committee for considering the
proposed bill. She reported that only half of Alaskan workers
were protected by smoke free workplace laws, and that one non-
smoker died from second hand smoke for every nine smokers "who
died from their addiction." Her extended exposure to second
hand smoke had resulted in her diagnosis as "having the lungs of
a smoker." She stated that the science was clear that exposure
to tobacco smoke kills. She addressed e-cigarettes and second
hand aerosol, and stated that this was not harmless water vapor,
as stated by the tobacco industry. She noted that research had
just begun for the health effects of e-cigarettes. She reported
that second hand e-cigarette aerosol contained nicotine and
ultra-fine particles, concentrated at levels higher than in
conventional tobacco cigarette smoke, which exacerbated
respiratory ailments. She listed some of the compounds and
metals known to be in second hand e-cigarette aerosol, including
chromium, nickel, tin, benzene, acetone, and glycerol. She
shared that three other states had already protected their
workers from second hand aerosol exposure from e-cigarettes in
the work place by passing strong work place laws.
4:29:13 PM
CHAIR HIGGINS stated that public testimony would be kept open.
4:29:32 PM
The committee took a brief at-ease.
4:30:47 PM
MATT WAGNER, Bad Boy Vapors Alaska, LLC, stated his opposition
to the proposed bill. He expressed his agreement for consistent
regulation of smoking in Alaska and the detrimental health
effects to both users and those in proximity to second hand
smoke. He stated, however, that inclusion of e-cigarettes in
the proposed bill was a mistake. He declared "smoking is not
vaping and vaping is not smoking." He explained that there was
not any combustion from use of e-cigarettes, and therefore,
there were no dangerous by-products. He directed attention to
studies which indicated that the second hand effects of vaping
were extremely negligible. He shared his excitement for the
success of people who had "quit smoking paper cigarettes with
the help of electronic cigarettes." He declared that these e-
cigarettes were an effective alternative, and that they did not
put anyone at risk for inhaling the toxic by-products of
smoking. He declared opposition to the proposed bill, as it
would no longer be possible to demonstrate the benefits of
vaping.
SEAN DASILVA, Bad Boy Vapors Alaska, LLC, shared that the
aforementioned technical research had been from a study
conducted almost six years prior, when the industry was still
extremely primitive. He acknowledged that the e-cigarettes and
the "e-juice" were then coming from China, and that there had
not been any regulation. He stated expectations for the FDA to
regulate and certify the "e-juice." He pointed to two studies
that reported no meaningful risk from second hand vapor. He
asked that the committee gather all the facts to better
understand that policy in HB 360 for e-cigarettes was mis-
guided.
[HB 360 was held over]
4:34:14 PM
The committee took a brief at-ease.
SB 169-IMMUNIZATION PROGRAM; VACCINE ASSESSMENTS
4:35:14 PM
CHAIR HIGGINS announced that the next order of business would be
CS FOR SENATE BILL NO. 169(FIN), "An Act establishing in the
Department of Health and Social Services a statewide
immunization program and the State Vaccine Assessment Council;
creating a vaccine assessment account; requiring a vaccine
assessment from assessable entities and other program
participants for statewide immunization purchases; repealing the
temporary child and adult immunization program; and providing
for an effective date."
4:35:38 PM
SENATOR CATHY GIESSEL, Alaska State Legislature, referred to
earlier testimony regarding HB 376, for extension of the
termination date for the Alaska Health Care Commission. She
noted that the commission reviewed the high cost of health care
in Alaska, and, as revenue was declining in the state, it was
necessary to be very attentive to the budget. She declared that
"vaccines reduce the cost of health care," and that it was a
recommendation of the Alaska Health Care Commission. She
reported that SB 169 created a private/public partnership
between the insurance companies and self-insured groups with the
State of Alaska to address vaccine costs through a state vaccine
assessment council, which would oversee a reinstatement of
universal vaccines in Alaska through the Department of Health
and Social Services (DHSS). She reflected on the concerns of
health care in Alaska by Senator Ted Stevens, and shared an
anecdote about the generous funding for vaccines he secured.
She reminded the committee about the earlier high rates of
polio, as well as Hepatitis A & B, and pointed out that, with
vaccines, these had almost been eradicated. She noted that the
last outbreak of measles in Alaska, in 2000, had been introduced
by a young unvaccinated child arriving from South Korea, which
resulted in the understanding for a need of a second measles,
mumps, and rubella vaccine. She reported that there was
currently an outbreak of chicken pox in the Kenai/Soldotna area,
which was dangerous for adult men, pregnant women, and infants.
She declared that vaccines could prevent chicken pox. She
pointed out that earlier federal funding of $4.3 million each
year to Alaska for vaccines was now only $700,000. She reported
on a bill that had been introduced in 2012 as a temporary
solution, Senate Bill 140, which had passed unanimously in both
the House and the Senate to use $4.3 million of state funding
for three years of vaccines. During this time, the DHSS had
been directed to find a funding solution other than the state,
resulting in proposed SB 169. The proposed bill would create a
council, page 2, line 19 through page [4], line 8, which would
operate under DHSS and its staff. She explained that the
council would determine assessments for the insurance companies,
and then use that money to buy low cost vaccines to be
distributed around the state. She allowed that this
public/private partnership was working in nine other states,
resulting in substantial savings. She referred to 24 letters of
support [Included in members' packets], including a letter of
support from Premera Blue Cross.
4:43:38 PM
ROSALYN SINGLETON, MD, Alaska Native Tribal Health Consortium
(ANTHC) Immunization Program, stated her support for the
proposed bill to improve access to vaccines for Alaskans,
streamline distribution, and reduce the administrative burden
for providers, and she directed attention to a PowerPoint titled
"Alaska - What have vaccines done for you." She referred to
slide 2, "Vaccination: an ounce of prevention saves a ton of
lives," which offered a brief summary of the dramatic
improvement in disease control because of universal access to
vaccines in Alaska. She moved on to slide 3, "Vaccine -
Preventable Disease Success, Alaska," and stated that Hib
meningitis, measles, and Hepatitis A outbreaks had virtually
disappeared. She pointed out that measles were most often
brought in from other countries, and in Alaska, this was only a
plane flight away. She declared that it was imperative to
maintain a high rate of vaccination in children in order to
control the disease. She discussed slide 4, "Polio," and
explained that it attacked the nervous system, causing muscle
weakness, paralysis, or death. She reported that the last case
of polio in the United States had been in 1979, although polio
was still endemic in other parts of the world and could be
brought into the country. She moved on to slide 5,
"Diphtheria," and shared an anecdote of an epidemic in Nome,
which was today highlighted by the Iditarod Race. She relayed
that diphtheria was also a disease of the past in the U.S.
because of vaccines. Discussing slide 7, Hepatitis A and B in
Alaska," she relayed that there had been almost total control of
Hepatitis A in Alaska since the vaccine. She pointed to slide
6, "Hib disease," and explained that it had decreased. She
concluded with slide 8, "Measles," and stated that Alaska had
not had measles since 2000. She emphasized that since 2009,
providers had fronted the cost of vaccine for insured patients,
while separately stocking private and state purchased vaccines.
She relayed that SB 169 would re-establish universal access to
vaccines through the self-sustaining, cost effective private-
public partnership.
REPRESENTATIVE REINBOLD opined that this was leveraging the
state's buying power to reduce the cost and increase access for
vaccines. She asked if there were any adverse reactions or
concerns for vaccinations and immunizations on a larger scale.
DR. SINGLETON replied that all vaccines could have adverse side-
effects. She stated that vaccines were the most tested and
regulated health care benefit that we have. She said there was
not any evidence for significant side effects from the newer
vaccines, as they had been extensively tested with post vaccine
testing and evaluation.
4:50:50 PM
DR. SINGLETON, in response to Representative Reinbold, stated
that there was not any link between vaccines and autism. There
had been a 1998 paper published in Britain, based on research of
12 children, claiming a link between vaccines and autism, which
had ultimately been found to be fraudulent. The paper was
disavowed by the British Medical Journal, and the data had not
been replicated in subsequent studies. She declared that this
report had sparked unwarranted concerns, and she expressed her
confidence that there was not any link between vaccines and
autism.
REPRESENTATIVE REINBOLD said that the proposed bill could have
"a long term, very positive effect on our state budget."
CHAIR HIGGINS expressed his agreement with evidence that
vaccines were good. He declared that the proposed bill raised
the question for how to pay for this. He stated his concern
with third party payers and Tricare making these payments. He
stated that he wanted to make the program work.
CHAIR HIGGINS asked for more information about the third party
payer, specifically Tricare, as the focus of the proposed bill
was for adult immunizations. He stated that federal money paid
for child immunizations. He opined that the "donut hole" was
for adult immunizations, as Medicare did not offer coverage. He
asked how the proposed program would work for adults. He stated
that only one other state included adults in vaccine coverage.
He offered his belief that Vermont most closely mirrored the
proposed bill.
4:56:14 PM
JILL LEWIS, Deputy Director - Juneau, Central Office, Division
of Public Health, Department of Health and Social Services,
expressed agreement that Vermont had included adult vaccines in
its universal program since 2009. She declared that, without
the proposed bill, when the temporary funding for vaccines was
depleted at the end of 2015, the state would not have a state
supply for all children. She clarified that the only state
supplied vaccine would be for the 50 percent of children covered
by a federal program, Vaccines for Children. She reported that
this would only include Medicaid, Alaska Native, American
Indian, and uninsured children. She stated that anyone with
private pay insurance would not receive any state supplied
vaccine, as the burden would be on the providers to purchase and
pay up front for vaccines, and then seek reimbursement from the
payers. She explained that there was no safety net program for
adults, and each payer would need to be assessed funding for its
patients. She noted that Tricare had not participated and paid
the reimbursement in other states. She reported that the
proposed bill had reviewed the programs in other states and
decided that, should Tricare not participate, then the state
would not supply the vaccine and other payers would not have to
pay, so the providers would continue to purchase the vaccine on
the open market and continue to seek reimbursement from Tricare,
as was the current practice. She said that the provider could
continue to purchase vaccines privately when there was not an
accessible payer.
REPRESENTATIVE NAGEAK asked that the vaccine for shingles be
made available for people.
REPRESENTATIVE KELLER reflected that the proposed bill was "a
big issue and lots of pitfalls in it." He requested that the
questions be answered before the bill was moved from the
committee, that any unintended consequences be addressed, and
that the costs be closely reviewed.
CHAIR HIGGINS said that [SB 169] would be held over.
5:03:15 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:03 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB169 Sponsor Statement FIN.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB0169-1-2-022414-DHS-Y.PDF |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB0169-2-2-022414-DHS-Y.PDF |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB0169-3-3-022414-DHS-Y.PDF |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB0169-4-2-022414-CED-N.PDF |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB0169-5-2-022414-ADM-Y.PDF |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB0169-6-2-030714-DHS-Y.PDF |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB0169-7-3-030714-DHS-Y.PDF |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB0169-8-2-030714-DHS-Y.PDF |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB169 Vaccines In AK short vsn (2).pptx |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB169FlowChart_7Mar2014.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB169PayerPyramid_7Mar2014.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB 169 Support Letters.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB 169 Support Emails.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB 169 Support Dr. Harvey.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB 169 Support Dr Lamm NH.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB 169 Sectional Analsis vsn I.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB 169 Historic vaccine photo.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB 169 FN Vaccine Assmt Acct.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB 169 FN Medicaid Svs.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB 169 FN Fund Capitalization.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB 169 FN Epidemiology.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB 169 FN DCCED Insurance.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB 169 FN Admin.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| 2014_03_19 WA Letter from Dr. Harvey in support of AK S B _169_FINAL.pdf |
HHSS 3/25/2014 3:00:00 PM |
|
| SB 169 FAQs vsn I.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| SB0169 Version I.PDF |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| HB0374A.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 374 |
| HB0376A.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 376 |
| HB 376 Sponsors Statement.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 376 |
| HB 360 Version A.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Sponsor Statement.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360-CA A Cancer Journal for Clinicians.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Smoke-Free Indoor Workplaces Supporters as of 3-5-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360- Borough Smoke Free Law.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360- Alaska Smoke-Free Indoor Workplaces Summary from Coalition.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360- acscan-smoke-free-laws-report-summary.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HCR21 ver U.PDF |
HHSS 3/25/2014 3:00:00 PM |
|
| HCR21 Sponsor Statement.pdf |
HHSS 3/25/2014 3:00:00 PM |
|
| HCR21 Supporting Documents-Safehorizon stats.pdf |
HHSS 3/25/2014 3:00:00 PM |
|
| HCR21 Supporting Documents-US DHHS Webpage.pdf |
HHSS 3/25/2014 3:00:00 PM |
|
| HB 360 Opposed 2.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB Opposed 3.PDF |
HHSS 3/25/2014 3:00:00 PM |
|
| HB 360 Opposed 4.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Opposed 5.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Opposed 6.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Opposed 7.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Opposed 8.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Opposed 9.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Opposed 10.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Opposed 11.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Opposed 12.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Opposed 13.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Opposed 14.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB374-DCCED-DOI-03-21-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 374 |
| HB374-DHSS-EPI-03-21-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 374 |
| HB374-DHSS-HCMS-03-21-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 374 |
| HB374-DHSS-VAA-03-21-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 374 |
| HB374-DOA-HPA-03-21-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 374 |
| HB376-DHSS-CO-03-20-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 376 |
| HB 360 Opposed 10.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB360-DEC-FSS-03-21-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB360-DHSS-CO-03-21-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB360-DOT-IASO-3-21-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB360-DOT-MVO-3-21-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB360-DOT-SEF-3-21-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB360-DOT-TMS-3-21-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB360-DOA-PUR-03-21-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Draft CS.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360-Electronic Cigarette and Secondhand Aerosol (FS-39) 2014-02-181.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360- NYT Article.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360-Electronic Cigarette and Secondhand Aerosol (FS-39) 2014-02-181.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HCR21 Supporting Document-National Timeline.pdf |
HHSS 3/25/2014 3:00:00 PM |
|
| HCR21 Supporting Document-Maltreatment Data Website.pdf |
HHSS 3/25/2014 3:00:00 PM |
|
| HCR21 Supporting Document-Dec2013 Foster Placement.pdf |
HHSS 3/25/2014 3:00:00 PM |
|
| HCR21 Supporting Document-Dec2013 Allegations Substantiated.pdf |
HHSS 3/25/2014 3:00:00 PM |
|
| HCR21 Supporting Document-Dec2013 Allegations Received.pdf |
HHSS 3/25/2014 3:00:00 PM |
|
| HB 360 Sectional Summary.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Summary of Changes 3.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 376 2013AnnualReportFINAL.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 376 |
| HB 360 Support.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360- ATCA E-Cigarette Statement for Committee Hearing 3-25-14.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Letter of Support 1.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Letter of Support 2.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Letter of Support 3.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Letter of Support 4.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 E-cig Or. Ct CA edit.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 17 sug gen.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 AMA E-Cig v tobacco.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 comment to CA similar bill.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 e- cig NY Times edit.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 E-Cig Juneau emp.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 fm pres Am Lung Assoc.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Wash Times edit.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Letter of Support 5.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 376 Resolutions 3 25 2014.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 376 |
| SB 169 Support Premera.pdf |
HHSS 3/25/2014 3:00:00 PM |
SB 169 |
| HB 376 AHCC audit rpt-2013.pdf |
HHSS 3/25/2014 3:00:00 PM |
HB 376 |
| HB 360 Technical report 3 25 2014.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |
| HB 360 Research article informa healthcare 302502014.PDF |
HHSS 3/25/2014 3:00:00 PM |
HB 360 |