Legislature(1995 - 1996)
02/14/1996 09:02 AM House HES
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JOINT HOUSE & SENATE HEALTH, EDUCATION AND
SOCIAL SERVICES COMMITTEE
February 14, 1996
9:02 a.m.
HOUSE MEMBERS PRESENT
Representative Cynthia Toohey, Co-Chair
Representative Gary Davis
Representative Tom Brice
Representative Caren Robinson
HOUSE MEMBERS ABSENT
Representative Con Bunde, Co-Chair
Representative Al Vezey
Representative Norman Rokeberg
SENATE MEMBERS PRESENT
Senator Lyda Green, Chairman
Senator Loren Leman, Vice-Chairman
Senator Johnny Ellis
Senator Judy Salo
SENATE MEMBERS ABSENT
Senator Mike Miller
COMMITTEE CALENDAR
Presentation by the Alaska Native Health Board.
WITNESS REGISTER
LINCOLN BEAN, SR., Chairman
Alaska Native Health Board
1345 Rudakof Circle
Anchorage, Alaska 99508
POSITION STATEMENT: Presented the opening statement.
The following Alaska Native Health Board members presented the
Alaska Native Health Board's legislative priorities for fiscal year
1997:
Cindy Thomas, Morgan Solomon, Tim Kaganak, Anne Marie Holen, Cheryl
Edenshaw, Michael Hunt, Katherine Grosdidier
ACTION NARRATIVE
TAPE 96-9, SIDE A
Presentation by the Alaska Native Health Board
Number 003
CHAIRMAN GREEN called the Joint House & Senate Health, Education
and Social Services (HESS) Committee to order at 9:02 a.m. and
invited the Alaska Native Health Board to begin its presentation.
LINCOLN BEAN, Chairman of the Alaska Native Health Board (ANHB),
appreciated the time to present their legislative priorities. He
noted that the committee had copies of the ANHB State Legislative
Priorities for the Fiscal Year 1997 booklet. He pointed out the
ANHB has identified two health priorities this year. The first
being water and sanitation services for rural communities and the
second is the increase in state tobacco taxes. He said that the
ANHB would like to work with the committee on these issues in order
to develop plans for improvements in state policies and services.
The members of the Alaska Native Health Board attending the meeting
then introduced themselves.
Number 120
CINDY THOMAS, Coordinator of the Rural Alaska Sanitation Coalition,
acknowledged the past legislature for continuing to fund sanitation
at a level allowing work to continue at the existing $1 billion of
unmet needs. She hoped to see that same commitment next year. She
pointed out three priorities for village water and sanitation:
(1) Sustained consistent funding. Ms. Thomas pointed out
that the federal government's legislation contains
authorization language in the Department of Administration
for sustained funding at the federal level. Hopefully the
state and federal governments will continue to work in a
partnership on this in order to receive the needed levels of
funding.
(2) Resources for operations and maintenance. Ms. Thomas felt
that the Remote Maintenance Worker (RMW) program and the Rural
Utility Business Advisors should both be viewed as a capital
investment as well as a public health investment. EPA has
made a commitment of $1.1 million over the next two years, but
that requires a state match in some form.
(3) Water and sanitation services for all village health
clinics. Over 30 communities still operate without water and
sewer. There was a commitment from Alaska in the fiscal years
1993 and 1994 to provide supplemental funds to hook these
clinics to water and sewer services. That is not present in
the 1995 or 1996 budgets. There is $325,000 to start up that
program.
Ms. Thomas pointed out that the booklet contains a list of the
villages and the funding needed to meet their sanitation needs.
The total funding necessary for all those villages would be
approximately $800 million which does not include basic compliance,
new homes, or health clinics.
SENATOR LEMAN asked if a portion of the quarter million dollar
match by Alaska could be obtained through local matches. CINDY
THOMAS explained that the program requires state and local matches.
The communities are expected to match dollar for dollar, $1
million, which is not reflected in the booklet. The state is also
expected to match the $1 million in cash or kind. The total
program would then be $3 million.
Number 199
REPRESENTATIVE TOOHEY inquired as to where the funding would
normally be received regarding the care and maintenance of the
projects. CINDY THOMAS said that it had historically come from RMW
through over the shoulder training. There is also water plant
operator training through the village safe water program. Indian
Health Services also contributes a small portion of their funding
for training. Ms. Thomas noted that training in the areas of
management of the system, the collection of fees and maintenance of
the stock and supplies is also necessary. Currently, there is no
funding for that training.
MORGAN SOLOMON, ANHB member, stated that rural water and sanitation
is an important issue and has been since statehood. He was happy
that the Knowles' Administration recognized the need for sound
water and sanitation in rural areas. There is a $1 billion program
for rural water and sanitation. Mr. Solomon emphasized that water
and sanitation is a must due to the environmental impact poor
sanitation creates. He reiterated the need for a commitment from
everyone - the House, the Senate, the Administration - to improve
water and sanitation in Alaska.
MR. SOLOMON pointed out that not long ago the North Slope Borough
utilized its bonding capabilities to fund water and sewer for
Barrow which still continues today and will eventually include all
the North Slope villages. The Nenana and the central regions need
the same program that the North Slope Borough now enjoys. He
acknowledged that oil money is diminishing. He discussed his
wonderful experience in receiving running water. Honeybuckets
should only be in museums. The youth of this state are its most
important asset and they should grow up in clean environments.
There are lots of problems associated with unsanitary surroundings
one of which is hepatitis.
Number 294
REPRESENTATIVE TOOHEY pointed out that the booklet notes the
following contributions to rural water and sanitation by the
corresponding legislatures: FY1993-$24 million, FY1994-$26.5
million, FY1995-$21.7 million, FY1996-$21.5 million. She applauded
Mr. Solomon's efforts.
SENATOR LEMAN expressed concern with the cost of delivering these
projects in rural Alaska. He was convinced that the current system
practically ensures that the highest cost project is done. How can
a quality product be delivered at a cheaper cost?
MORGAN SOLOMON believed that arctic condition type facilities
should continue. Such facilities mechanically maintain themselves.
Feasibility studies should be utilized in order to avoid cost
overruns.
Number 323
In response to Senator Leman, MORGAN SOLOMON said that the project
in Wainwright has worked well. The project is no longer a
demonstration project. Water and sewer will come on-line this year
under Phase I. Phase II is scheduled to begin in March.
SENATOR SALO inquired as to the year Mr. Solomon received his
toilet. MORGAN SOLOMON said that he received his toilet about six
years ago.
TIM KAGANAK, ANHB member, said that the issues remain the same.
The biggest need in rural Alaska is water and sewer. He informed
the committee that these projects are done in phases, often the
second year is not funded and the project is frozen.
Number 370
MR. KAGANAK informed the committee that in his area there are 58
clinics in the villages. These clinics need to be clean. He
emphasized that some of the clinics have honeybuckets and do not
have running water. This lack of sanitation should not be present
in any health clinic. Mr. Kaganak said that clean water and
sanitation could be achieved if everyone worked together. He
emphasized that many legislators have constituents that do not have
running water. Furthermore, the tuberculosis outbreak remains.
Number 398
ANNE MARIE HOLEN, Manager of the Tobacco Control Program at ANHB,
expressed frustration with the way the tobacco tax has become
politicized in regards to dealing with the fiscal gap. As members
of the HESS committees, Ms. Holen hoped the tobacco tax would be
viewed as a public health benefit. A major tobacco tax increase
would be justified even without a fiscal gap. The revenues
generated, the over $40 million per year, could be seen as a bonus.
Ms. Holen stated that the real benefit of the tax is in the
significant reduction of nicotine addiction, especially among
Alaska's youth, and tobacco related death and disease in Alaska.
According to research, taxation is the single most powerful weapon
in reducing tobacco use. The tobacco tax increase would keep
youths off of drugs, reduce the leading cause of death in Alaska,
reduce the economic impact of tobacco use ($300 million a year per
the Section of Epidemiology), generate money, while enjoying
support across all political spectrums. Ms. Holen informed
everyone that last month a Robert Wood Johnson Foundation Survey
reported that 74 percent of Alaskans support a $1 per pack increase
in the cigarette tax. This is a nonpartisan issue.
MS. HOLEN commented that tobacco use is not merely a Native problem
in Alaska. Rates of the use among white Alaskans is also higher
than the national average. She noted that non-smokers face the
effects of exposure to second-hand smoke, the burden of high health
care costs, and the heart ache of seeing others struggling with
nicotine addiction and disease caused by tobacco use. Tobacco use
in Alaska kills more Alaskans than airplane crashes, automobile
crashes, alcohol, and firearms combined. The Legislature has a
responsibility, which is specified in Alaska's Constitution, to
take meaningful action to address the epidemic of tobacco related
death and disease in Alaska.
Number 440
SENATOR LEMAN asked Ms. Holen to estimate the ratio of the cost of
tobacco use in terms of health care versus the revenue derived from
its use. Based on 1991 data, ANNE MARIE HOLEN said that for every
$1 raised in tobacco tax revenues $7 worth of detrimental impact on
the economy resulted. That detrimental impact is health care
costs, lost work time, or lost productivity.
REPRESENTATIVE ROBINSON asked Ms. Holen if she had discussed the
notion of placing a portion of the revenue generated from the
tobacco tax in the Children's Trust to be utilized for prevention.
ANNE MARIE HOLEN did not know how that would be done legislatively,
but would support the concept. Ms. Holen mentioned that in other
states that have raised tobacco taxes and appropriated money for
tobacco control programs, the impact of the tax increase is
magnified.
CHERYL EDENSHAW, ANHB member, reiterated that the ANHB has been a
long time supporter of the tobacco tax increase. She expressed
concern with Alaska's high rate of smoking in Alaska in comparison
to the rest of the United States. She informed the committee that
one in five deaths in Alaska is caused by tobacco which is more
than those killed by AIDS, airplane crashes, automobile accidents,
fires, falls, and firearms all combined. The Alaska Native rate of
smoking is higher than that for all races combined. Alaska's
Native population comprises 16.5 percent of the entire state's
population and accounts for 23.2 percent of Alaska's smoking
related deaths. Ms. Edenshaw acknowledged that a tobacco tax would
not eliminate the use of tobacco, but the benefits far outweigh the
harm. A tax increase is one of the most effective methods to
reduce tobacco consumption, death, and disease. The ANHB urges the
committee to support the passage of SB 234 and HB 442 as
recommended by the Long-Range Financial Planning Commission and
Governor Knowles.
Number 483
MICHAEL HUNT, Yukon-Kuskokim Health Corporation board member,
discussed his travel experiences in which he has seen many youth
using tobacco as well as deaths of the elderly tobacco users. He
informed the committee that he quit smoking 28 years ago and
believed that he had extended his life 10 to 15 years. He feels
healthy. This tobacco tax could cut tobacco use by one-third. Mr.
Hunt also supported SB 234 and HB 442. In conclusion, he urged the
committee's support of the tobacco tax in order to strive for
better health for all Alaskans.
KATHERINE GROSDIDIER, Executive Director for South Central
Foundation, explained that it is a nonprofit arm of the Cook Inlet
Region. The foundation serves the Anchorage Native population and
represents them on the ANHB. She passed out information regarding
the Anchorage Native Primary Health Care Center which should be
added to the committee packet. The new Alaska Native Medical
Center was planned in the early 1980s. The Anchorage population
has grown and the need for primary care services has doubled. When
the new Alaska Native Medical Center opens in 1997, the center will
contain fewer primary care rooms than needed.
Number 535
MS. GROSDIDIER explained that the foundation proposes to open a
38,000 square foot primary care facility which would be located in
front of the new hospital. She passed around diagrams illustrating
the position of the primary care facility and its layout. The
facility would provide an additional 60 rooms in order to meet the
needs of the increasing population of Anchorage. The facility
would have 140 full-time employees which is a $60 million payroll
per year. She pointed out that the facility would have two floors
which would house primary care clinics, family medicine,
pediatrics, and mental health. This facility would provide
statewide services to the Anchorage population. More than 200
tribes support this project as well as the Alaska Native Health
Care and Indian Health Service system. She informed the committee
that lease payments have been secured through private and federal
funding; operation funds are provided. Currently, money is
accumulating for this project through South Central Foundation's
third party revenues. She said that the foundation is looking for
a state match for a federal match of $875,000. The total need is
$1.75 million for medical equipment and voice data communication.
She emphasized that the new facility's plan and methodology was
wonderful for the 1980s, but the growing population of the 1990s
which increased the space needed for the primary care was
overlooked.
Number 563
REPRESENTATIVE TOOHEY said that this was the first she had heard of
this facility. She was appalled at this need and the
shortsightedness that has created this need. Where did the funding
come from for the new hospital? KATHERINE GROSDIDIER replied that
it all came from federal funds. REPRESENTATIVE TOOHEY inquired as
to the federal government's position on this new construction.
KATHERINE GROSDIDIER explained that the foundation is meeting with
a congressional delegation which reported that if there is a state
match, the federal government would be amenable to giving the
$875,000. That would be half of the match for the medical
equipment and the data voice communication. The federal government
would provide the funding for the building.
In response to Representative Robinson, KATHERINE GROSDIDIER stated
that currently, there is no funding in the Governor's capital
budget for this.
SENATOR SALO commented that was her first time hearing of the need
for the primary care facility. The hospital looks huge now.
KATHERINE GROSDIDIER agreed that this a surprise to everyone, but
the need is a result of the methodology used in the early 1980s.
The facility is a solution developed by the South Central
Foundation who was informed of the problem by Indian Health
Services about two years ago. Ms. Grosdidier pointed out that
little administrative space was used in order to maximize the
number of primary care exam rooms.
TAPE 96-9, SIDE B
MS. GROSDIDIER discussed the waiting problems in the new hospital.
Clinicians need two exam rooms; putting one patient in an exam room
while seeing another patient is more efficient.
Number 585
REPRESENTATIVE TOOHEY asked if the notion behind this was to bring
everyone to Anchorage. Will the health center treat people
statewide? Why is this collecting everyone; what happened to the
hospitals in Bethel and Nome?
KATHERINE GROSDIDIER explained that Bethel and Nome's hospitals
will continue to operate for their constituents. The Alaska Native
Medical Center is a statewide referral hospital which offers out-
patient services. The South Central Foundation operates many of
the primary care services which is why the foundation is involved.
The out-patient services that provide services statewide will be
moved to this new clinic and would continue to provide statewide
services.
REPRESENTATIVE TOOHEY expressed concern with the decrease in
available funds nationwide due to the increasing population. Why
would everyone be brought to Anchorage, increase travel costs, in
lieu of health care money?
KATHERINE GROSDIDIER explained that the current user population in
the Anchorage area is over 100,000 patient visits; the statewide
referral system accounts for 25 to 35 percent. Ms. Grosdidier
explained that people receive out-patient care in the Bethel area,
but if they visit Anchorage and need an out-patient service then
they come to the hospital. Only those visiting or requiring in-
patient services would utilize the Anchorage hospital, otherwise,
their own regional hospitals are used for out-patient services.
Currently, more than 70 to 80 percent of the out-patient users are
Anchorage based Native people.
CHAIRMAN GREEN thanked everyone for their presentation. There
being no further business before the joint committee, the joint
meeting was adjourned at 10:49 a.m.
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