Legislature(2025 - 2026)BUTROVICH 205

05/06/2025 03:30 PM Senate HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HJR 9 EXTEND AFFORDABLE CARE ACT TAX CREDITS TELECONFERENCED
Heard & Held
-- Invited & Public Testimony --
+= SB 178 EXPAND EARLY INTERVENTION SERVICES TELECONFERENCED
Moved SB 178 Out of Committee
Bills Previously Heard/Scheduled
         HJR  9-EXTEND AFFORDABLE CARE ACT TAX CREDITS                                                                      
                                                                                                                                
4:12:19 PM                                                                                                                    
CHAIR DUNBAR  announced the consideration  of CS FOR  HOUSE JOINT                                                               
RESOLUTION  NO.  9(HSS)  Urging the  United  States  Congress  to                                                               
extend enhanced  tax credits for health  insurance premiums under                                                               
the Affordable Care Act.                                                                                                        
                                                                                                                                
4:12:44 PM                                                                                                                    
MAKAYLA  WILSON,  Staff,  Representative Genevieve  Mina,  Alaska                                                               
State Legislature, introduced HJR 9 on behalf of the sponsor.                                                                   
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     HJR 9 - SHSS                                                                                                           
     House Joint  Resolution 9 urges Congress  to extend the                                                                    
     Affordable  Care  Act   enhanced  Premium  Tax  Credits                                                                    
     (PTCs), which expires at the end of this year.                                                                             
                                                                                                                                
4:13:04 PM                                                                                                                    
MS. WILSON continued with the introduction of HJR 9:                                                                            
                                                                                                                                
     Over  15 years  ago, small  business owners  and people                                                                    
     working  multiple  jobs  struggled to  find  affordable                                                                    
     health insurance.                                                                                                          
                                                                                                                                
     Since the  ACA passed  in 2010, the  Alaska Marketplace                                                                    
     made  health  care   affordable,  reducing  uninsurance                                                                    
     rates.  Premium tax  credits have  always been  part of                                                                    
     the marketplace,  which are  federal tax  credits based                                                                    
     on income and household size that reduce net premiums.                                                                     
                                                                                                                                
     Over 80 percent of  Alaskans on the marketplace qualify                                                                    
     for                                                                                                                        
                                                                                                                                
4:13:32 PM                                                                                                                    
SENATOR TOBIN and SENATOR GIESSEL arrived at the meeting.                                                                       
                                                                                                                                
MS. WILSON continued the introduction of HJR 9:                                                                                 
                                                                                                                                
     subsidies but, those who don't  are largely the middle-                                                                    
     class  and   entrepreneurial  Alaskans  that   pay  the                                                                    
     highest in health care premiums in the state.                                                                              
                                                                                                                                
     During the COVID-19  pandemic, Congress passed enhanced                                                                    
     Affordable Care  Act (ACA) premium tax  credits (PTCs),                                                                    
     making  the  marketplace  more  affordable  for  22,180                                                                    
     Alaskans. Enhanced PTCs lowered  caps on premiums, made                                                                    
     plans   more  affordable   for  Alaskans   getting  off                                                                    
     Medicaid, and extended credits  for people with incomes                                                                    
     above 400  percent ($78,200). Savings of  an average of                                                                    
     $690  per person  annually. Self-employed  Alaskans and                                                                    
     small  business  owners  are  major  beneficiaries.  28                                                                    
      percent of marketplace enrollees nationwide are self-                                                                     
     employed.                                                                                                                  
                                                                                                                                
     However, enhanced PTCs are set  to expire by the end of                                                                    
     2025.  51  percent  of  those  who  would  lose  credit                                                                    
     eligibility  are  aged  5064,   not  yet  eligible  for                                                                    
     Medicare.  Without  extending enhanced  PTCs,  premiums                                                                    
     will  increase  on  the marketplace.  Overall  loss  to                                                                    
     Alaskans would be more than  $287 million in annual tax                                                                    
     subsidies.                                                                                                                 
                                                                                                                                
     From the Division of Insurance:                                                                                            
     A single  50 year old  making $32,918/yr would  see his                                                                    
     premiums  jump  from  $27/mo to  $129/mo  -  more  than                                                                    
     QUADRUPLE what he's paying this year.                                                                                      
                                                                                                                                
     Family of 4 paying $667/mo would pay $3,333/mo (5 X)                                                                       
                                                                                                                                
     More estimates.                                                                                                            
                                                                                                                                
     A  single parent  earning  $40,000/year  would go  from                                                                    
     paying  $18/month to  $130/month...SEVEN TIMES  as much                                                                    
     as what she pays this year.                                                                                                
                                                                                                                                
     A  family of  four earning  $60,000/year would  go from                                                                    
     paying $28/month to $189/month...6.7x AS MUCH                                                                              
                                                                                                                                
4:15:14 PM                                                                                                                    
MS. WILSON continued with the introduction of HJR 9:                                                                            
                                                                                                                                
     Expiration would also  destabilize our health insurance                                                                    
     risk pools.  Jeopardizes Alaska's  reinsurance program,                                                                    
     which was  developed in  2017 response  to skyrocketing                                                                    
     premiums and  has successfully lowered premiums  on the                                                                    
     marketplace. But reinsurance  depends on stable premium                                                                    
     levels.                                                                                                                    
                                                                                                                                
     In  2017,  when  Alaska  faced  skyrocketing  premiums,                                                                    
     Alaska Division of  Insurance Director Lori Wing-Heier,                                                                    
     implemented   the   reinsurance    program   in   2017,                                                                  
     controlling  premium increases  from  42  percent to  7                                                                    
     percent  after its  implementation    leading 18  other                                                                    
     states to follow  suit, and has sent  the state roughly                                                                    
     $700 million in federal funds.                                                                                             
                                                                                                                                
     Health care costs cripple  small business, our economy,                                                                    
     and  entrepreneurship.  While  we are  facing  a  tough                                                                    
     fiscal situation,  enhanced PTCs costs no  money to the                                                                    
     State  of Alaska  budget, but  saves health  care costs                                                                    
     for Alaskans  because the ACA  helps people get  off of                                                                    
     Medicaid.                                                                                                                  
                                                                                                                                
     HJR  9 is  integral for  controlling health  care costs                                                                    
     with  no cost  to the  State budget,  and strengthening                                                                    
     our economy.                                                                                                               
                                                                                                                                
     Extension of enhanced PTCS is supported by:                                                                                
                                                                                                                                
     Alaska Children's Trust                                                                                                    
     Alaska Hospital and Healthcare Association                                                                                 
     Alaska Native Tribal Health Consortium                                                                                     
     Anna Brawley                                                                                                               
      Alaska Chapter, National Association of Benefits and                                                                      
     Insurance Professionals                                                                                                    
     Protect Our Care                                                                                                           
     Mat-Su Reentry Coalition                                                                                                   
     Alaska Native Health Board                                                                                                 
     Juneau Reentry Coalition                                                                                                   
     Anchorage Chamber of Commerce                                                                                              
                                                                                                                                
     Without  the  tax  credits, some  Alaskans  could  face                                                                    
     premiums   equivalent  to   or  exceeding   a  mortgage                                                                    
     payment. Entrepreneurs  may have to forego  their small                                                                    
     businesses  to find  a job  with health  insurance. Our                                                                    
     health  care  and  economy  should  not  go  backwards.                                                                    
     Please support HJR 9.                                                                                                      
                                                                                                                                
4:16:52 PM                                                                                                                    
CHAIR DUNBAR announced invited testimony on HJR 9.                                                                              
                                                                                                                                
4:17:10 PM                                                                                                                    
AMBER  LEE,  Owner,  Amber  Lee  Strategies,  Anchorage,  Alaska,                                                               
testified by  invitation on HJR 9.   She shared that  eight years                                                               
ago, during a  routine exam, she was diagnosed  with melanoma and                                                               
multiple  leiomyomas, markers  of  Hereditary Leiomyomatosis  and                                                               
Renal Cell Carcinoma (HLRCC), a  rare genetic syndrome associated                                                               
with a highly fatal form of  kidney cancer. She said at the time,                                                               
she  was the  COO of  a  digital advertising  agency with  health                                                               
insurance,  though soon  after lost  both her  job and  insurance                                                               
coverage when  the company lost  a major client,  coinciding with                                                               
an  early-stage   breast  cancer  diagnosis.   Alaska's  Medicaid                                                               
expansion  provided  critical  coverage   for  her  and  her  two                                                               
children,  and later  the  Affordable Care  Act  allowed them  to                                                               
obtain  affordable  marketplace  insurance when  they  started  a                                                               
consulting  business, despite  preexisting  conditions. She  said                                                               
living in  Alaska, where  health care  costs are  extremely high,                                                               
they  have faced  substantial  out-of-pocket expenses,  including                                                               
over  $75,000 in  one  year. Extended  premium  tax credits  have                                                               
helped  make coverage  manageable, however  without congressional                                                               
renewal,  premiums are  expected to  double. She  emphasized that                                                               
affordable ACA  coverage is essential for  small business owners,                                                               
economic  diversification  in  Alaska,   and  urges  support  for                                                               
extending these tax credits.                                                                                                    
                                                                                                                                
4:19:53 PM                                                                                                                    
TREVOR  STORRS, President  and  Chief  Executive Officer,  Alaska                                                               
Children's Trust,  Anchorage, Alaska, testified by  invitation on                                                               
HJR  9. He  stated that  Alaska Children's  Trust (ACT)  supports                                                               
policies that expand  access to health care  for children, youth,                                                               
and families. ACT backs HJR  9 urging Congress to extend enhanced                                                               
ACA premium  tax credits. The  Affordable Care  Act significantly                                                               
reduced the number of uninsured  Alaskans, including thousands of                                                               
families  with  children,  and enhanced  tax  credits  have  made                                                               
health  insurance   more  affordable  and  accessible.   He  said                                                               
maintaining  these  credits  is critical  to  ensuring  continued                                                               
coverage,  promoting   health  and  well-being,   and  supporting                                                               
economic stability for thousands of Alaska's families.                                                                          
                                                                                                                                
4:21:20 PM                                                                                                                    
CHAIR DUNBAR opened public testimony on HJR 9.                                                                                  
                                                                                                                                
4:21:51 PM                                                                                                                    
LORETTA GREGORY,  representing self,  Kake, Alaska,  testified in                                                               
support of  HJR 9. She argued  that health care is  a basic need,                                                               
not a  privilege, and described how  underfunded and overextended                                                               
tribal and  Indian Health  Service systems  force long  waits and                                                               
costly travel  for specialty  care. The  Affordable Care  Act and                                                               
premium  tax credits  have expanded  access  to local  providers,                                                               
prescriptions,  and emergency  care without  overwhelming medical                                                               
bills, while allowing  clinics to reinvest in  services. She said                                                               
letting  these  tax  credits  expire  would  increase  costs  for                                                               
families and further strain the federal health system.                                                                          
                                                                                                                                
4:24:00 PM                                                                                                                    
MEGAN  LINGLE, representing  self, Juneau,  Alaska, testified  in                                                               
support of HJR 9. She  emphasized that affordable health coverage                                                               
is  vital  for families,  noting  that  while she  currently  has                                                               
employer  sponsored insurance,  job loss  or medical  emergencies                                                               
could quickly  jeopardize coverage. She  said, in that  case, the                                                               
Affordable  Care  Act (ACA)  and  premium  tax credits  would  be                                                               
essential to remain insured, as  Indian Health Service and tribal                                                               
clinics  alone  cannot  meet all  specialty  and  emergency  care                                                               
needs. The ACA  provides flexible coverage when  families need it                                                               
most. It  supports tribal health  systems by allowing  clinics to                                                               
be reimbursed  and reinvest  in care.  She concluded  that health                                                               
care  should  not  depend  on   location  or  sudden  changes  in                                                               
employment.                                                                                                                     
                                                                                                                                
4:25:39 PM                                                                                                                    
KAY  RILEY,  representing  self,  Juneau,  Alaska,  testified  in                                                               
support of HJR 9. She explained  that the Affordable Care Act has                                                               
made it possible to receive  life-changing treatment for multiple                                                               
sclerosis  despite a  preexisting  condition, allowing  a her  to                                                               
remain mobile through medication  she could not otherwise afford.                                                               
She noted  that enhanced  ACA tax  credits have  lowered premiums                                                               
for  more than  23,000  Alaska families,  small business  owners,                                                               
self-employed  individuals, and  hourly  workers. Allowing  these                                                               
credits  to  expire  would   make  coverage  unaffordable,  force                                                               
families  to  choose  between  medical   care  and  basic  needs,                                                               
increase strain on state and  emergency services, and destabilize                                                               
the individual insurance  market. She urged support for  HJR 9 as                                                               
a  bipartisan step  to keep  health care  accessible and  protect                                                               
Alaskans.                                                                                                                       
                                                                                                                                
4:27:25 PM                                                                                                                    
CHAIR DUNBAR closed public on HJR 9.                                                                                            
                                                                                                                                
4:27:32 PM                                                                                                                    
SENATOR  HUGHES  explained  that   premium  tax  credits  can  be                                                               
confusingly named,  however they function like  other tax credits                                                               
by providing financial assistance. In  this case, the premium tax                                                               
credit  helps  offset  health  insurance  premiums  based  on  an                                                               
individual's income,  making coverage more affordable.  She asked                                                               
for  clarification  on the  status  of  this issue  in  Congress,                                                               
including whether  it is being  considered as part of  the Budget                                                               
Reconciliation Act,  and where Congress  stands overall,  as well                                                               
as the position of our congressional delegation on the matter.                                                                  
                                                                                                                                
4:28:30 PM                                                                                                                    
MS. WILSON deferred the question to Ms. Wing-Hier.                                                                              
                                                                                                                                
4:28:45 PM                                                                                                                    
LORI WING-HEIER,  Director, Division of Insurance,  Department of                                                               
Commerce,  Community, and  Economic Development,  Juneau, Alaska,                                                               
answered  questions on  HJR 9.  She answered  that she  is unsure                                                               
whether  the enhanced  premium tax  credits are  included in  the                                                               
Budget Reconciliation  Act and  notes they  are currently  set to                                                               
expire on December 31, 2025.  She said there is active discussion                                                               
in Washington,  DC about these  credits. She stated  that despite                                                               
confusing  terminology it  is  her belief  that  the credits  are                                                               
important and should be renewed.                                                                                                
                                                                                                                                
4:29:33 PM                                                                                                                    
SENATOR HUGHES  asked for confirmation  from Ms.  Wing-Heier that                                                               
Congress  appears inclined  to extend  the  enhanced premium  tax                                                               
credits, though  it is  unclear whether  this will  occur through                                                               
the Budget Reconciliation Act.                                                                                                  
                                                                                                                                
MS.  WING-HEIER replied  that  she cannot  speak  for members  of                                                               
Congress.  She said  there  is concern  and  active interest,  as                                                               
lawmakers  have  reached out  for  information  and data  on  how                                                               
extending or ending  the tax credits would affect  Alaska and its                                                               
reinsurance program.                                                                                                            
                                                                                                                                
4:30:23 PM                                                                                                                    
SENATOR  HUGHES asked  how expiration  of the  tax credits  would                                                               
affect  Alaska beyond  higher premiums  for many  individuals and                                                               
their families. She asked for  more information on impacts to the                                                               
reinsurance program and any broader consequences for the state.                                                                 
                                                                                                                                
MS.  WING-HEIER  replied  that since  the  enhanced  premium  tax                                                               
credits were  implemented, about  $75 million was  passed through                                                               
to Alaska's  reinsurance program. She  said with the  credits set                                                               
to expire, the  state will have sufficient funding  for 2026, and                                                               
by  2027,  the  program's  $140  million limit  may  need  to  be                                                               
reduced.  Currently,  roughly  $120 million  comes  from  federal                                                               
funds, supplemented  by the $75  million in tax  credits, leaving                                                               
about $25 million  for 2026. She stated that she  doesn't have an                                                               
idea  of how  to  replace  the expired  funds  and the  program's                                                               
limits will need reevaluation.                                                                                                  
                                                                                                                                
4:31:56 PM                                                                                                                    
SENATOR HUGHES  asked for an estimate  of the annual cost  to the                                                               
state if the enhanced premium tax credits are not renewed.                                                                      
                                                                                                                                
MS.   WING-HEIER  replied   that  the   state  cannot   fund  the                                                               
reinsurance program if the tax  credits expire, as doing so would                                                               
be  unaffordable  and  reduce benefits  to  consumers.  She  said                                                               
premiums would  rise, and  the program's limit  would need  to be                                                               
lowered, though they may explore other federal options.                                                                         
                                                                                                                                
4:32:44 PM                                                                                                                    
CHAIR  DUNBAR emphasized  that Alaska's  reinsurance program  has                                                               
been  highly effective  in controlling  premiums, and  losing its                                                               
funding would be undesirable.                                                                                                   
                                                                                                                                
4:33:23 PM                                                                                                                    
CHAIR DUNBAR held HJR 9 in committee.                                                                                           

Document Name Date/Time Subjects
HJR 9 Version I 3.28.25.pdf SHSS 5/6/2025 3:30:00 PM
HJR 9
HJR 9 Fiscal Note.pdf SHSS 5/6/2025 3:30:00 PM
HJR 9
Supporting Document DOI 03.21.25.pdf SHSS 5/6/2025 3:30:00 PM
HJR 9
HJR 9 Sponsor Statement Version N.pdf SHSS 5/6/2025 3:30:00 PM
HJR 9
HJR 9 LOS as of 04.28.25.pdf SHSS 5/6/2025 3:30:00 PM
HJR 9