Legislature(2017 - 2018)CAPITOL 106
03/17/2017 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HJR14 | |
| HB132 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 79 | TELECONFERENCED | |
| += | HB 132 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| *+ | HJR 14 | TELECONFERENCED | |
HJR 14-FCC: INCREASE RURAL HEALTH CARE BUDGET
3:19:49 PM
CHAIR KITO announced that the first order of business would be
HOUSE JOINT RESOLUTION NO. 14, Urging the Federal Communications
Commission to increase the Rural Health Care Program budget
sufficiently to adjust for inflation, advances in technology and
the services available with increased broadband, and the
increase in demand for broadband-based services and provide for
any unused funds to be carried forward to future funding years,
ensuring that rural communities in the state continue to have
access to affordable broadband telehealth services.
3:20:25 PM
TIM CLARK, Staff, Representative Bryce Edgmon, Alaska State
Legislature, advised that during the last few years, rural
Alaska has made great strides in long-distance delivery of
healthcare via telemedicine. These broadband services expand
locally available treatment options for an increasing number of
maladies, including substance abuse treatment; and the service
accelerates diagnosis, treatment, and assists Alaskans in
avoiding expensive travel for care. Except, he explained, these
broadband services are about to hit a roadblock because the
existence of such services depends upon support from the Federal
Communications Commission (FCC) Rural Health Care Universal
Services Support Program. The budget for this program has been
capped at the same level since its establishment in 1997, and
the $400 million budget has been enough to meet demand.
Although, he noted, after two decades of advances in technology,
increases in demand, and the effects of inflation, the FCC now
expects that in 2017 the demand may exceed the budget cap for
the first time. This resolution urges the FCC to increase the
Rural Health Care Universal Services Support budget sufficiently
to adjust for inflation, keep with advances in technology, the
services available with increased broadband, and meet the
increase in demand for broadband based services in Alaska.
Additionally, he explained, the resolution encourages the FCC to
index the program budget for inflation, and allow any unused
funds to be carried forward to future funding years, thereby
allowing healthcare providers to continue improving access to
care in rural Alaska.
3:23:16 PM
REPRESENTATIVE SULLIVAN-LEONARD asked whether there is a state
match on this item for telehealth for the rural areas.
MR. CLARK responded no, and he said it is entirely funded
through Universal Services Support program charges.
3:23:53 PM
JENNIFER HARRISON, Chief Executive Officer, Eastern Aleutian
Tribes, advised that this is a complicated program as far as
submitting an application and getting bids from local
telecommunications firms, and it is quite expensive. The amount
of money that the Eastern Aleutian Tribes receives to get
internet for its eight clinics along the Aleutian Islands is
substantial. Without this funding, she offered, the Eastern
Aleutian Tribes would be looking at possibly closing clinics, so
the funding is important. She stressed that travel costs to the
Aleutian Islands are approximately $1,000 round trip, therefore,
every trip patients do not take saves a substantial amount of
money. Also, she explained, not all patients have access to
travel assistance provided by Medicaid or the Alaska Tribal
Health Compact, and in the event this program was removed, the
higher levels of care would not be available to these
individuals and would dramatically decrease their quality of
health. The Eastern Aleutian Tribes support HJR 14, she
emphasized.
3:25:39 PM
COLIN UNDERWOOD, Manag
Communications, offered support for the legislation and noted
that the nationwide healthcare industry, particularly in Alaska,
has seen a revolution in the manner in which healthcare is
provided. He pointed out that many federal laws have been
enacted to incentivize the digital transformation of healthcare,
and while that is "wonderful," no attention is made to this
program that supports the vital backbone infrastructure
necessary to deliver that digital telehealth network, he said.
This resolution voices support to the FCC by pointing out the
importance of also funding this program. He remarked that while
the federal government continues to incentivize and provide
requirements modernizing moving to a digital platform, it is
also important to continue programs that have been in existence
for nearly 20 years unmodified.
3:26:55 PM
REPRESENTATIVE BIRCH referred to distance delivery for
education, healthcare, and asked whether there is a point where
"you've got enough bandwidth" in a community.
MR. UNDERWOOD responded that the FCC published an updated
national broadband plan in 2010 that included a study showing
that for any community health center, the minimum recommended
bandwidth was 10 megabits symmetrical, which means 10 megs
downloaded as well as 10 megs uploaded to provide basic
healthcare services. Unfortunately, he said, Alaskans do not
have the luxury of many healthcare specialists in these remote
locations and many critical access hospitals and community
health centers based in Anchorage or elsewhere around the state,
provide some of that specialty care. He explained that will
doing so will; increase broadband demands "from that base level
right there," including video conferencing, real time telehealth
services, and those types of opportunities. Additionally, he
pointed out, technology has increased in the healthcare space
now with x-rays and digital imagining for example, and the
quality has quadrupled which also increases file sizes. He
offered a scenario of a patient in an emergent situation who may
require a 64 slice CT scan, wherein a few years ago that scan
may have been 8 slices, but the result is now a much better
picture and diagnosis. The FCC has some minimum guidelines, he
said, and the rest is driven by technology demands in providing
the best care possible in Alaska.
3:29:45 PM
REPRESENTATIVE BIRCH referred to 10 megabits symmetrical, and
commented that it did not sound like much and asked whether it
was sufficient for a healthcare center.
MR. UNDERWOOD clarified that that is the amount the FCC deemed a
minimum standard, however most community health centers are
looking to move to 50 megabytes. He related that the hospitals
Alaska Communications is serving today are looking at hundreds
of megabytes, with one customer closer to a gigabyte in
connectivity because there is a tremendous demand for broadband
services to deliver these high-quality healthcare services.
3:30:46 PM
REPRESENTATIVE BIRCH referred to his initial question and asked
how much bandwidth is enough because he was trying to get a
sense of a $400 million cap and what it provides to the extent
it is an allocation or request. He asked Mr. Underwood's sense
of the education requirement, whether that was a competing
interest for the Universal Services support funds and how many
people were drawing on the fund. He assumed, he said, that it
was a share of whatever people pay every month on their phone
bill, but asked whether there are other competing interests in
Alaska and other communities.
MR. UNDERWOOD answered that the universal service Schools and
Libraries program (E-Rate) budget nationwide is $3.9 billion and
it was increased again this year. That program, he explained,
has been able to adjust every year for inflation, and "We are
asking now for the same consideration for the healthcare
program." As to competition, he advised that the funds are
separate in that healthcare and education are not competing for
the same dollars, but are being pulled out of the same Universal
Services fund bucket.
3:32:34 PM
REPRESENTATIVE BIRCH asked the size of the Universal Services
fund bucket upon which all are collectively drawing.
MR. UNDERWOOD said he would have to get back to Representative
Birch.
REPRESENTATIVE BIRCH said, "We are paying a bit of that, aren't
we?"
MR. UNDERWOOD agreed, and he said every month funds come out of
an individual's telephone bill which reads: "USS Universal
Services" or something similar, and that charge goes into that
nationwide bucket, he said.
REPRESENTATIVE BIRCH surmised that this resolution is attempting
to obtain a larger share for Alaska's rural communities.
MR. UNDERWOOD agreed, and he said Alaska uses the largest
percentage of the program given its geographic size, diversity,
and how each of the communities are spread out. He explained
that there are unused funds in the Universal Services program
and this resolution asks to reallocate some of those unused
funds to this program in order to match the demands the federal
government put on healthcare providers. Wherein, he offered,
the federal government requires that "You must transform to
digital healthcare and you must integrate with electronic health
records." This resolution, he reiterated, simply asks that the
FCC recognize those federal requirements and helps support these
healthcare providers to continue providing the best healthcare
possible, he said.
3:34:07 PM
REPRESENTATIVE BIRCH asked whether anything other than
healthcare and education was fed by the Universal Services Fund
that comes to Alaska.
MR. UNDERWOOD replied that there are two other programs, the
rural healthcare program, and E-rate, a life line program and
subsidy for low income families for mobile or landline dial tone
service, as well as the High Cost or Connect America Fund which
is typically geared toward certain telecom providers to help
build out in high cost areas.
REPRESENTATIVE BIRCH asked how many dollars were involved
because the rural communities probably have needs in all four of
the areas being discussed. He asked how many dollars the
coordinated programs add up to for Alaska, presuming the
components were healthcare, education, life line, and Connect
America.
MR. UNDERWOOD opined that for the 2015 fund year for healthcare
and E-Rate, the State of Alaska received approximately $100
million for rural healthcare subsidies, and the E-Rate program
was closer to $80 million. As far as the other two programs, he
said he was unaware of the amount of money brought into the
state. Although, he commented, it may be important to note that
the education and healthcare entities in communities serve as
the "anchor tenant" and provide a lot of the backbone
connectivity into those communities. That connectivity, he
explained, could later provide additional services and without
healthcare and education there was not the business case to
build a lot of the infrastructure out there.
3:37:10 PM
JON ZASADA, Director, Policy Integration, Alaska Primary Care
Association (APCA), advised that the Alaska Primary Care
Association (APCA) supports the work of Alaska's federally
qualified community health centers. He offered that 25 of its
29 members benefit from the Rural Health Care Program (RHC) and
receive almost $38 million per year in subsidies for internet
service. Passage of this resolution would assist Alaska's
federal delegation in its negotiations in raising the cap,
modernizing this program, and instituting an inflation-proofing
component so this does not happen in the future, he said. The
APCA members are fearful that if the cap is not raised and pro-
rated billing is implemented, many will move from paying roughly
$500 per month, to $5 or $10,000 per month for internet
services. Clearly, he commented, that would negatively affect
their sustainability and ability to serve patients. Reverting
back to low bandwidth or undedicated internet service is not a
possibility for providers who use the service to operate their
[audio difficulties] based electronic health records to support
telemedicine and have images reviewed by specialists far away,
he stressed. The APCA would appreciate the support of this
resolution.
3:39:39 PM
CHAIR KITO opened public testimony on HJR 14.
3:39:53 PM
VERNE BOERNER, President/CEO, Alaska Native Health Board,
advised that the Alaska Native Health Board is the statewide
voice on Alaska Native Health issues, it is a 28-member
organization representing tribes from [audio difficulties]
organizations carrying out health services on behalf of the 229
federally recognized tribes in Alaska and over 158,000 Alaska
Native people. Additionally, she said, the Alaska Native Health
System serves as a critical component of the Alaska Public
Health System by providing care and services to thousands of
non-Alaska Native people and Alaskan veterans. She expressed
that this resolution helps to improve access to telehealth,
thereby improving quality of life by reducing travel costs,
intervening earlier at a lower cost and with greater success.
The January 28, 2016 Broadband Progress Report showed
significant improvements by digital divide from the FCC
persists, she said. The report stated that the benchmark speeds
of 25 megabits per second per downloads, and 3 megabits per
second uploads remains a problem, and that the divide in rural
Alaska is quite extreme. The February 15, 2015 report showed
that 81 percent of rural areas do not have access to that
minimum benchmark of 25 megabits per second for download and 3
megabits for upload, and this program is crucial in protecting
early access to care in rural communities.
3:42:34 PM
CHAIR KITO advised that public testimony would be left open for
HJR 14.
[HJR 14 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| CSHB132 (TRA) Fiscal Note-DOA-DMV 3.10.17.pdf |
HL&C 3/17/2017 3:15:00 PM |
HB 132 |
| HB132 Supporting Documents - Letters of Support 3.17.17.pdf |
HL&C 3/17/2017 3:15:00 PM |
HB 132 |
| HB132 Supporting Documents - Mercatus Farren TNC Preemption Testimony 3.17.17.pdf |
HL&C 3/17/2017 3:15:00 PM |
HB 132 |
| HB132 Supporting Documents - Letters of Opposition 3.17.17.pdf |
HL&C 3/17/2017 3:15:00 PM |
HB 132 |
| HB132 Supporting Documents Index 3.17.17.pdf |
HL&C 3/17/2017 3:15:00 PM |
HB 132 |