Legislature(2021 - 2022)DAVIS 106

03/04/2021 03:00 PM House HEALTH & SOCIAL SERVICES

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Audio Topic
03:09:26 PM Start
03:10:05 PM HB76
04:51:34 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-- Invited & Public Testimony --
- Jared Kosin, Alaska State Hospital & Nursing
Home Assoc.
- Phil Hofstetter, Petersburg Medical Center
- Ellen Hodges, Dan Winkleman, & Jim Sweeney,
Yukon-Koskokwim Health Corp.
- Emily Ford, Providence Alaska
- Tom Hennessy, University of Alaska
- Cara Durr, Food Bank of Alaska
- Laurie Wolf, The Foraker Group
+ Bills Previously Heard/Scheduled TELECONFERENCED
**Streamed live on AKL.tv**
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 4, 2021                                                                                          
                           3:09 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Representative Liz Snyder, Co-Chair                                                                                             
Representative Tiffany Zulkosky, Co-Chair                                                                                       
Representative Ivy Spohnholz (via teleconference)                                                                               
Representative Zack Fields (via teleconference)                                                                                 
Representative Ken McCarty                                                                                                      
Representative Mike Prax                                                                                                        
Representative Christopher Kurka                                                                                                
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
HOUSE BILL NO. 76                                                                                                               
"An Act  extending the January  15, 2021,  governor's declaration                                                               
of a  public health disaster  emergency in response to  the novel                                                               
coronavirus   disease  (COVID-19)   pandemic;  providing   for  a                                                               
financing  plan;  making  temporary   changes  to  state  law  in                                                               
response  to  the  COVID-19  outbreak  in  the  following  areas:                                                               
occupational and  professional licensing, practice,  and billing;                                                               
telehealth;   fingerprinting   requirements   for   health   care                                                               
providers; charitable  gaming and online ticket  sales; access to                                                               
federal  stabilization funds;  wills; unfair  or deceptive  trade                                                               
practices;  and meetings  of shareholders;  and providing  for an                                                               
effective date."                                                                                                                
     - HEARD & HELD                                                                                                             
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: HB 76                                                                                                                   
SHORT TITLE: EXTENDING COVID 19 DISASTER EMERGENCY                                                                              
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
02/18/21       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/18/21       (H)       HSS, FIN                                                                                               
02/19/21       (H)       HSS REFERRAL REMOVED                                                                                   
02/19/21       (H)       BILL REPRINTED                                                                                         
02/26/21       (H)       FIN AT 1:30 PM ADAMS 519                                                                               
03/01/21       (H)       HSS REFERRAL ADDED BEFORE FIN                                                                          
03/01/21       (H)       BILL REPRINTED                                                                                         
03/02/21       (H)       HSS AT 3:00 PM BY TELECONFERENCE                                                                       
03/02/21       (H)       Heard & Held                                                                                           
03/04/21       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
WITNESS REGISTER                                                                                                              
JARED KOSIN, President/CEO                                                                                                      
Alaska State Hospital and Nursing Home Association                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 76.                                                                           
VERNE BERNER, President/CEO                                                                                                     
Alaska Native Health Board                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 76.                                                                           
PHILLIP HOFSETTER, CEO                                                                                                          
Petersburg Medical Center                                                                                                       
Petersburg, Alaska                                                                                                              
POSITION STATEMENT:  Testified in support of HB 76.                                                                           
ELLEN HODGES, MD, Chief of Staff                                                                                                
Yukon Kuskokwim Health Corporation                                                                                              
Bethel, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 76.                                                                           
JAMES SWEENEY, Vice President of Hospital Services                                                                              
Yukon Kuskokwim Health Corporation                                                                                              
Bethel, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 76.                                                                           
EMILY FORD, Government Affairs Director                                                                                         
Providence Alaska Medical Center                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 76.                                                                           
TOM HENNESSY, MD, MPH                                                                                                           
College of Health                                                                                                               
University of Alaska Anchorage                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 76.                                                                           
CARA DURR, Director of Public Engagement                                                                                        
Food Bank of Alaska                                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 76.                                                                           
LAURIE WOLF, President and CEO                                                                                                  
The Foraker Group                                                                                                               
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 76.                                                                           
SARAH SPENCER, DO,                                                                                                              
Ninilchik, Alaska                                                                                                               
POSITION STATEMENT:  Testified in  support of a renewed emergency                                                             
declaration during the hearing on HB 76.                                                                                        
DOLORES VANBOURGONDIEN, NP                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in  support of a renewed emergency                                                             
declaration during the hearing HB 76.                                                                                           
ACTION NARRATIVE                                                                                                              
3:09:26 PM                                                                                                                    
CO-CHAIR  TIFFANY ZULKOSKY  called  the House  Health and  Social                                                             
Services  Standing  Committee  meeting  to  order  at  3:09  p.m.                                                               
Representatives  Snyder,   Kurka,  Prax,  McCarty,   Fields  (via                                                               
teleconference),  Spohnholz  (via teleconference),  and  Zulkosky                                                               
were present at the call to order.                                                                                              
          HB 76-EXTENDING COVID 19 DISASTER EMERGENCY                                                                       
[Contains discussion of SB 56.]                                                                                                 
3:10:05 PM                                                                                                                    
CO-CHAIR  ZULKOSKY  announced that  the  only  order of  business                                                               
would be  HOUSE BILL NO.  76, "An  Act extending the  January 15,                                                               
2021,  governor's   declaration  of  a  public   health  disaster                                                               
emergency in  response to the  novel coronavirus  disease (COVID-                                                               
19) pandemic;  providing for a  financing plan;  making temporary                                                               
changes to state law in response  to the COVID-19 outbreak in the                                                               
following   areas:  occupational   and  professional   licensing,                                                               
practice,  and billing;  telehealth; fingerprinting  requirements                                                               
for health  care providers; charitable  gaming and  online ticket                                                               
sales; access  to federal stabilization  funds; wills;  unfair or                                                               
deceptive  trade practices;  and  meetings  of shareholders;  and                                                               
providing for an effective date."                                                                                               
3:10:16 PM                                                                                                                    
CO-CHAIR SNYDER moved to adopt  the proposed committee substitute                                                               
(CS) for HB  76, Version 32-GH1011\B, Dunmire, 3/3/21,  as a work                                                               
3:10:40 PM                                                                                                                    
CO-CHAIR  ZULKOSKY   objected  for  purpose  of   discussion  and                                                               
requested that  Co-Chair Snyder walked the  committee through the                                                               
proposed changes.                                                                                                               
3:10:52 PM                                                                                                                    
CO-CHAIR  SNYDER   informed  the  committee  that   the  proposed                                                               
committee substitute for  HB 76 ("Version B") is  similar to CSSB
56(L&C), a companion  bill in the Senate.  She  explained that it                                                               
would  add  a section  requiring  health  care administrators  to                                                               
acquire   informed  consent   before  administering   a  COVID-19                                                               
vaccine, allow individuals  to object to the  administration of a                                                               
COVID-19 vaccine  based on religious, medical,  or other grounds,                                                               
and protects  individuals from  the liability  of an  action that                                                               
does  not comply  with  the  order after  the  expiration of  the                                                               
original declaration, and before the  enactment of this one.  She                                                               
said Version  B includes legislative  findings that it is  in the                                                               
best interest  of the  state to  continue having  the appropriate                                                               
tools and taking the correct  steps forward to contain the spread                                                               
of COVID-19  and distribute COVID-19  vaccines.  She  shared that                                                               
it also  includes language  from Senate Bill  241 of  the Thirty-                                                               
First  Alaska  State  Legislature   that  limits  the  governor's                                                               
appropriation authority to those  detailed in the financing plan.                                                               
It  would override  (AS) 26.23.050  and  make it  clear that  the                                                               
governor may only appropriate funds under HB 76.                                                                                
CO-CHAIR SNYDER  commented that Version  B maintains  a September                                                               
30, 2021,  expiration date.  She  opined that Alaska has  done an                                                               
excellent  job  responding  to   COVID-19,  largely  due  to  the                                                               
flexibility  and tools  from the  original disaster  declaration.                                                               
She  emphasized that  the  state needed  to  continue having  the                                                               
tools  so  it   could  continue  to  [respond   to  the  COVID-19                                                               
pandemic].  She stated that Version B would provide for that.                                                                   
3:12:45 PM                                                                                                                    
REPRESENTATIVE  MCCARTY  commented  that  Commissioner  Crum  had                                                               
previously  stated that  this legislation  was no  longer needed,                                                               
because there is no emergency.  Representative McCarty asked what                                                               
Version B is for if there is no longer a disaster.                                                                              
CO-CHAIR  ZULKOSKY  responded  that  the intention  is  to  bring                                                               
alignment from  the original  bill version to  the work  that was                                                               
done in the Senate Health  and Social Services Standing Committee                                                               
and the Senate Labor and  Commerce Standing Committee, so that HB
76 remains  companion legislation.   She explained that  later in                                                               
the meeting  the committee would  be hearing from  healthcare and                                                               
community  stakeholders  regarding  the ongoing  pandemic.    She                                                               
reminded the  committee that adoption  of Version B as  a working                                                               
document does not give commitment to passage.                                                                                   
REPRESENTATIVE  MCCARTY  asked  if   CSSB  56(L&C)  is  still  in                                                               
CO-CHAIR ZULKOSKY  responded that CSSB  56(L&C) is in  the Senate                                                               
Finance Committee.                                                                                                              
3:14:42 PM                                                                                                                    
REPRESENTATIVE  PRAX  sought  understanding on  various  spending                                                               
figures throughout the Version B.   He asked if there was a total                                                               
of $30 million in spending authorizations.                                                                                      
CO-CHAIR ZULKOSKY asked if he wanted his approximation verified.                                                                
REPRESENTATIVE PRAX replied, "No."                                                                                              
3:17:00 PM                                                                                                                    
REPRESENTATIVE    MCCARTY    commented    that    the    language                                                               
Representative Prax  read came  from the  original version  of HB
76, not from Version B.                                                                                                         
3:17:29 PM                                                                                                                    
REPRESENTATIVE PRAX expressed concern  about language on page 10,                                                               
line  9, of  Version  B, concerning  personal  objections to  the                                                               
administration  of  the  COVID-19  vaccine.     He  said  he  was                                                               
"philosophically uncomfortable with  the state permitting someone                                                               
to  do  something to  which  they  already  have  a right."    He                                                               
requested  clarification from  Legislative Legal  Services as  to                                                               
why this language was included.                                                                                                 
CO-CHAIR SNYDER  shared that [Section 11]  reflected an amendment                                                               
to  the  Senate companion  bill,  but  the committee  could  have                                                               
Legislative Legal Services follow up.                                                                                           
REPRESENTATIVE PRAX  directed attention to  page 10, line  18, of                                                               
Version B,  regarding civil  liability.   He said  the exemptions                                                               
allowed by this section made him uncomfortable.                                                                                 
CO-CHAIR   ZULKOSKY   reiterated   that  adopting   a   committee                                                               
substitute is  not the same  as passing legislation.   Any action                                                               
in adopting  a committee substitute  is solely  to adopt it  as a                                                               
working document to be amended  and considered by this committee,                                                               
she explained.                                                                                                                  
3:21:15 PM                                                                                                                    
CO-CHAIR SNYDER commented that  Representative Prax's concern was                                                               
addressed  in  the Senate  companion  legislation  in the  Senate                                                               
Health and Social Services Standing Committee.                                                                                  
3:21:29 PM                                                                                                                    
CO-CHAIR ZULKOSKY  removed her objection  to the motion  to adopt                                                               
the proposed CS for HB  76, Version 32-GH1011\B, Dunmire, 3/3/21,                                                               
as a work draft.                                                                                                                
3:22:00 PM                                                                                                                    
REPRESENTATIVE PRAX asked for procedural clarification.                                                                         
3:22:04 PM                                                                                                                    
The committee took a brief at-ease at 3:22 p.m.                                                                                 
3:22:11 PM                                                                                                                    
CO-CHAIR  ZULKOSKY asked  if there  were any  further objections.                                                               
There  being no  further  objections, Version  B  was before  the                                                               
3:22:57 PM                                                                                                                    
CO-CHAIR  ZULKOSKY announced  the  committee  would hear  invited                                                               
3:23:52 PM                                                                                                                    
JARED  KOSIN, President/CEO,  Alaska State  Hospital and  Nursing                                                               
Home Association  (ASHNHA), testified  in support of  HB 76.   He                                                               
shared  that ASHNHA  was on  record prior  to February  14, 2021,                                                               
with warnings about the impact  that could result if the disaster                                                               
declaration expired.   He said Alaska was  in "compliance limbo,"                                                               
airport  testing  had  declined,  there was  a  new  outbreak  in                                                               
Petersburg,   and    out-of-state   telehealth    providers   had                                                               
discontinued care.                                                                                                              
MR.  KOSIN  shared  that  there  have  been  numerous  compliance                                                               
questions from  Alaska's hospitals and nursing  homes, concerning                                                               
the authority to use federal  waivers for operational flexibility                                                               
without  a   state  emergency  declaration.     Without  guidance                                                               
available, ASHNA  has had to  appeal to the Centers  for Medicare                                                               
and Medicaid Services (CMS) of  the federal government for formal                                                               
guidance.   He  said  that ASHNHA  had yet  to  receive a  formal                                                               
response to  a letter sent  to CMS  on February 19,  2021, [about                                                               
the blanket waivers].   He said that documentation is  key in the                                                               
healthcare industry,  so without a  formal answer in  writing, it                                                               
remains an  open question [whether providers  are in compliance].                                                               
Mr. Kosin  concluded by arguing  that the simplest way  to remove                                                               
compliance  doubt, secure  federal  assistance,  allow access  to                                                               
out-of-state  telehealth,  and   maximize  Alaska's  geographical                                                               
advantage with airport testing is by passing HB 76.                                                                             
3:26:49 PM                                                                                                                    
REPRESENTATIVE SPOHNHOLZ  asked Mr.  Kosin to talk  about airport                                                               
testing and  why he thinks it  could be problematic to  no longer                                                               
require it.                                                                                                                     
MR.  KOSIN answered  that the  airport testing  is Alaska's  best                                                               
line of defense  given the state's geography.   He commented that                                                               
once Petersburg  stopped testing  at the airport,  it had  one of                                                               
the largest outbreaks per capita in  the country.  He argued that                                                               
considering Petersburg's geography, airport testing is critical.                                                                
3:28:44 PM                                                                                                                    
VERNE BERNER,  President/CEO, Alaska Native Health  Board, stated                                                               
that the  Alaska Native Health  Board (ANHB) is supportive  of HB
76.  She explained that ANHB  is a statewide voice for the Alaska                                                               
Tribal Health System (ATHS).   She shared that Alaska Natives are                                                               
over-represented in  Alaska's hospitalizations and deaths  due to                                                               
COVID-19.   As of  March 3, 2021,  hospitalizations were  at 26.9                                                               
percent,  and deaths  were at  37.1 percent  for Alaska  Natives.                                                               
She  stated that  rural communities  were at  continued risk  for                                                               
COVID-19  due  to  factors such  as  crowded,  multi-generational                                                               
homes,  a lack  of running  water and  sanitation infrastructure,                                                               
and distance from  advanced medical care that  often requires air                                                               
travel to reach hospitals.                                                                                                      
MS. BERNER said the public  health emergency declaration has been                                                               
critical   in   ANHB's   response  to   protect   Alaska   Native                                                               
communities.  Since the beginning  of the public health emergency                                                               
declaration, there has been a  303 percent increase in telehealth                                                               
related  Medicaid  services   statewide,  keeping  providers  and                                                               
patients safe.   She  noted that  the majority  of this  has been                                                               
delivered through  ATHS.   This has  included expanded  access to                                                               
behavioral health  services via  telehealth, which  has increased                                                               
by 400 percent.   She also shared that access  via telehealth has                                                               
reduced the  number of  missed and  no-show appointments  for all                                                               
MS.  BERNER stated  that travel  mandates had  helped reduce  the                                                               
spread of COVID-19  in rural Alaska dramatically  during the 2020                                                               
fishing season.   She argued  that these types of  supports would                                                               
still be  needed as the next  fishing season arrived.   She noted                                                               
that the  public health emergency declaration  provided for swift                                                               
action during  the crisis, which  Alaska was  still experiencing,                                                               
and  provided the  needed time  for the  legislative process  for                                                               
other  initiatives.    Further,  declaration  allowed  for  rapid                                                               
procurement and hiring for the  vaccine distribution plan and for                                                               
enabling  mass vaccine  clinics.   She  reiterated  that it  also                                                               
helped  with telehealth  and other  forms of  healthcare delivery                                                               
and maximized  Alaska's workforce  by allowing for  expedited and                                                               
courtesy licensing.                                                                                                             
3:32:19 PM                                                                                                                    
MS.  BERNER  spoke about  airport  testing,  noting that  it  has                                                               
protected rural communities and has  help slow new variants.  She                                                               
highlighted  that the  public health  emergency also  allowed the                                                               
National  Guard  to assist  with  testing,  contact tracing,  and                                                               
administration of the  vaccines.  She pointed out  that the state                                                               
disaster  declaration  allowed  the   governor  to  allocate  and                                                               
redistribute   food,  water,   fuel,   clothing,  medicine,   and                                                               
MS. BERNER said that since  the disaster declaration expired, the                                                               
state's  largest drive-through  testing site  closed, communities                                                               
had missed vaccine  distribution due to the inability  to use the                                                               
National  Guard,  and there  had  been  an increase  in  COVID-19                                                               
cases.   She closed her  testimony with ANHB's strong  support of                                                               
HB 76.                                                                                                                          
3:33:59 PM                                                                                                                    
REPRESENTATIVE  PRAX  asked  Ms. Brener  whether  the  telehealth                                                               
providers used were from in-state or out-of-state.                                                                              
MS. BERNER  replied that ATHS  has a  well-established telehealth                                                               
program that has  been developed over several decades.   She said                                                               
ATHS  was able  to  expand  and utilize  the  program during  the                                                               
pandemic, with use in some  communities increasing as much as 400                                                               
percent.    She  said  she  would get  information  back  to  the                                                               
committee regarding whether providers were from in-state or out-                                                                
REPRESENTATIVE  PRAX asked  if all  village airports  had testing                                                               
MS. BERNER  answered that she  did not  know if all  airports had                                                               
testing  sites,  but  tribal  health  organizations  in  the  hub                                                               
communities had put forward testing  sites.  She pointed out that                                                               
without  the public  health emergency  declaration in  place, the                                                               
testing is  not mandated.   The mandated health testing  had been                                                               
successful   in  capturing   positive  cases   of  COVID-16   and                                                               
protecting the communities out in rural Alaska.                                                                                 
REPRESENTATIVE PRAX  commented that  some rural  communities have                                                               
health powers  and have been  imposing their own  restrictions on                                                               
travel.   He  asked  if that  was  still the  case  now that  the                                                               
emergency declaration had expired.                                                                                              
MS. BERNER answered that each  of these communities are sovereign                                                               
and may  self-determine the  level to which  they are  willing to                                                               
open to  travelers.   However, she  argued that  some communities                                                               
are  second-class  and  do  not  have  the  same  authorities  to                                                               
exercise those measures.                                                                                                        
3:38:08 PM                                                                                                                    
REPRESENTATIVE MCCARTY  asked if  the telehealth  and teletherapy                                                               
that she suggested needed to  continue was just because of COVID-                                                               
19 or was something ANHB desired throughout the state.                                                                          
MS. BERNER  said ANHB  is looking for  ways to  extend telehealth                                                               
authorities and  flexibilities that have  been put in  place with                                                               
the disaster  declarations.   She said this  would allow  ANHB to                                                               
maximize its current resources until new statutes are in place.                                                                 
REPRESENTATIVE  MCCARTY  asked  if  Ms. Brener  was  saying  that                                                               
expanded telehealth would be desired  and beneficial to the state                                                               
regardless of the COVID-19 emergency.                                                                                           
MS. BERNER responded  yes, ANHB has definitely  seen the benefits                                                               
of telehealth in Alaska, particularly  in rural communities.  She                                                               
explained that over 80 percent  of ANHB's communities are off the                                                               
road system,  accessible only via  airplane or boat.   Telehealth                                                               
has allowed  for earlier medical interventions  to address health                                                               
conditions  before the  patient requires  higher levels  of care,                                                               
she  stated.   She  concluded  that in  general  there have  been                                                               
benefits which are being realized across the nation.                                                                            
REPRESENTATIVE MCCARTY  commented that  Ms. Brener  had mentioned                                                               
an  increase in  COVID-19 cases.   He  asked if  she had  data to                                                               
support that statement.                                                                                                         
MS. BERNER  said yes, ANHB does,  but it had been  accessing that                                                               
data  through  the dashboard  on  the  Department of  Health  and                                                               
Social  Services (DHSS)  webpage.   She commented  that there  is                                                               
additional data through ATHS that she could follow up with.                                                                     
3:42:03 PM                                                                                                                    
PHILLIP  HOFSETTER, CEO,  Petersburg  Medical Center,  introduced                                                               
himself and  stated that he  supports HB 76.   He stated  that on                                                               
February 6, 2021, he submitted  a letter of support for companion                                                               
bill  SB 56  to the  Senate Health  and Social  Services Standing                                                               
Committee.   He  said the  letter  had cited  key provisions  the                                                               
Petersburg  Medical Center  healthcare facility  would lose  when                                                               
the emergency declaration expired.                                                                                              
MR. HOFSETTER  referred to a  graph he  sent to the  House Health                                                               
and Social Services Standing Committee.   He shared that one week                                                               
after the  disaster declaration expired, Petersburg,  Alaska, had                                                               
over 60 cases in 7 days; more  than they had seen the entire year                                                               
prior.  Leading up to  the expiration of disaster declaration, he                                                               
observed  a noticeable  behavioral  difference  in the  community                                                               
with  increased  public  and  private  social  activity,  reduced                                                               
masking, and bypassed airport testing.                                                                                          
MR.  HOFSETTER   said  after   mounting  response   efforts,  the                                                               
Petersburg Medical  Center (PMC) spent over  $250,000 towards the                                                               
outbreak alone.   He  shared that schools  had moved  online, and                                                               
businesses closed.  He stated that  at that time there had been 4                                                               
inpatient  admissions,  11  patients  were being  seen  by  home-                                                               
health, and  the medical center  had used 14  monoclonal antibody                                                               
treatments  and  had  tested  over  700 people.    Prior  to  the                                                               
outbreak, Petersburg only had two days of school closure.                                                                       
MR. HOFSETTER  argued that as  an island community,  the mandates                                                               
for testing  and intra and interstate  travel prevented community                                                               
spread.   He stated that testing  travelers is the first  line of                                                               
defense  for  his community,  and  an  emergency declaration  was                                                               
still  needed  to stem  further  outbreaks  from occurring.    He                                                               
opined  that  it  was  much  too soon  and  a  wasted  effort  to                                                               
downgrade the pandemic.                                                                                                         
3:45:15 PM                                                                                                                    
REPRESENTATIVE  KURKA asked  for clarification  on the  number of                                                               
MR.   HOFSETTER  responded   that  there   were  four   inpatient                                                               
admissions.   In  response  to follow  up  questions, he  related                                                               
there are [a limited number]  of COVID-19 beds, which differ from                                                               
traditional hospital beds.   He explained that there  is one room                                                               
allocated for  COVID-19 treatment, a negative  pressure room, but                                                               
the four hospitalizations did not occur  at once.  He stated that                                                               
the  medical center  is  limited  in how  it  can treat  COVID-19                                                               
CO-CHAIR ZULKOSKY  offered her understanding that  Petersburg had                                                               
the   resources  to   treat  one   inpatient  COVID-19   positive                                                               
individual.   She said beyond  that, the hospital staff  would be                                                               
working in "not-ideal" healthcare standards.                                                                                    
MR. HOFSETTER  clarified that the  Petersburg Medical  Center has                                                               
12  inpatient beds.    He  explained that  bed  capacity did  not                                                               
dictate the  level of treatment  or care.   He said  the hospital                                                               
has one  dedicated room with  safeguards in place for  a COVID-19                                                               
patient.   Those  rooms can  be extended  as needed,  however, he                                                               
explained,  the biggest  limiting factor  is staffing.   He  said                                                               
that COVID-19 patients take twice  the staffing and time as other                                                               
admissions.   He  shared  that  the room  itself  is  not a  good                                                               
picture of the breadth of how  patients are taken care of, and if                                                               
there were more  than two or three admissions,  the patient would                                                               
need to be medevacked out.                                                                                                      
3:48:46 PM                                                                                                                    
REPRESENTATIVE SPOHNHOLZ  asked Mr.  Hofsetter to discuss  how no                                                               
longer  requiring   people  to   get  tested  has   impacted  the                                                               
Petersburg community, so individuals who  don't live on an island                                                               
could better understand what the testing means.                                                                                 
MR. HOFSETTER  answered by providing  an anecdote about  his wife                                                               
who worked in the airport testing  tent.  He shared that his wife                                                               
observed  that people  now  bypass  the test  because  it is  not                                                               
mandated  by the  state.   He clarified  that even  though it  is                                                               
locally mandated  by the city,  it isn't  enforced.  He  said the                                                               
lack  of  state  enforcement  has  had  a  behavioral  effect  on                                                               
travelers, which  has extended out  into the community.   He said                                                               
the  lack of  compliance [coincided  with the  expiration of  the                                                               
disaster declaration].                                                                                                          
REPRESENTATIVE SPOHNHOLZ  asked whether  the perceived  change in                                                               
people's behavior in  the community when they heard  there was no                                                               
longer a public health emergency resulted in the school closure.                                                                
MR.  HOFSETTER  commented  that  the  hospital  worked  with  the                                                               
Division of  Public Health to  backtrack the sequence  of events.                                                               
He  shared  that travelers  with  COVID-19  bypassed the  testing                                                               
tents.   He said there was  an increase in social  activity, both                                                               
private and public,  that had a spreading factor.   He emphasized                                                               
that  once  the  expiration  occurred, the  lax  behavior  became                                                               
obvious.   The  infected  people  then went  to  bars and  events                                                               
within the  community, he stated,  on sequential days,  which had                                                               
an effect in daycare and schools.  He explained that once COVID-                                                                
19 gets  into a  congregate setting  there is  no way  to prevent                                                               
spread without closing down the vector or moving online.                                                                        
REPRESENTATIVE  SPOHNHOLZ commented  that  she is  sorry to  hear                                                               
about the school and Mr. Hofsetter's frustrations.                                                                              
3:53:11 PM                                                                                                                    
REPRESENTATIVE  MCCARTY noted  that  during  the emergency  order                                                               
many communities expanded their  COVID-19 response abilities.  He                                                               
asked if  there was always  only one bed available  in Petersburg                                                               
for that  purpose, or if  there had  been several beds  that were                                                               
now downsized since the emergency order had expired.                                                                            
MR. HOFSETTER responded that he  didn't feel the bed capacity was                                                               
the primary  issue, and the  hospital was able to  allocate rooms                                                               
as needed.   He shared that  the home health program  has enabled                                                               
patients to  be discharged  into home  health and  these patients                                                               
have   been  managed   by  supplying   oxygen,  checking   oxygen                                                               
saturation, and determining  when and if patients  needed to come                                                               
in for treatment.                                                                                                               
REPRESENTATIVE  MCCARTY asked  if schools  had been  closed since                                                               
the COVID-19  case count had  increased in Petersburg or  if that                                                               
had been during the time of the emergency.                                                                                      
MR. HOFSETTER  answered that he  was trying to explain  that when                                                               
the expiration  of the  emergency disaster  declaration happened,                                                               
[Petersburg lost] the protections that  kept its schools open and                                                               
kept people safe,  [which] involved testing as the  first line of                                                               
defense.   He  said  without the  testing, Petersburg's  defenses                                                               
crumbled.  He  said it was how COVID-19 was  detected and how the                                                               
city  had infected  persons isolate.  Without detection  COVID-19                                                               
just spreads  and there is no  way to stop it  other than closing                                                               
down  schools  and  [performing  mass]  testing,  isolating,  and                                                               
quarantining,  which  is  difficult   and  time  consuming.    He                                                               
summarized  his point  that once  the mandate  fell, there  was a                                                               
correlation with  behavior and with the  city's frontline defense                                                               
of  testing crumbling;  and once  a few  [undetected] cases  came                                                               
into the community, there was an exponential effect.                                                                            
REPRESENTATIVE  MCCARTY  offered   his  understanding  that  with                                                               
freedom  of   behavior,  there  was  more   mobility  within  the                                                               
community, and  that there was  an increase in numbers  of people                                                               
that  contracted COVID-19,  and this  affected the  schools.   He                                                               
said he did  not understand the demographics of  the numbers, and                                                               
whether  the  information was  anecdotal,  or  whether there  was                                                               
another testing mechanism.                                                                                                      
MR.  HOFSETTER  answered  that   the  anecdotal  aspect  was  the                                                               
behavioral  observation;  the objectivity  is  the  testing.   He                                                               
explained that  now the  hospital was  testing the  community and                                                               
symptomatic  patients.   He  noted  that  the Petersburg  Medical                                                               
Center  was also  assisting public  health with  contact tracing,                                                               
which was in turn assisting  with testing, follow-up testing, and                                                               
making  certain  people  were quarantining  and  isolating.    He                                                               
explained that  once [COVID-19]  is spread  in the  community, it                                                               
goes everywhere.  He offered that  Petersburg has age ranges of 1                                                               
year  old  all  the  way  up  to  83  years  old  [having  tested                                                               
positive].   He  explained  this is  why the  schools  had to  be                                                               
closed until the COVID-19 infectious period ran its course.                                                                     
3:59:15 PM                                                                                                                    
CO-CHAIR  ZULKOSKY asked  Mr. Hofsetter  to summarize  the public                                                               
health  risk  within  his  community  of  the  virus  that  poses                                                               
unforeseen impacts on an individual  who contracts it.  She asked                                                               
where  he would  suggest  that Petersburg,  the  region, and  the                                                               
state  are in  terms of  the risk  posed by  the pandemic  on the                                                               
hospital system.                                                                                                                
MR. HOFSETTER  shared that  Petersburg was very  proud to  have a                                                               
good  portion of  its  community vaccinated.    He explained  the                                                               
vaccines  have  prevented transmission  and  pointed  out on  his                                                               
graph  that only  two people  who had  been vaccinated  were then                                                               
infected with COVID-19  during the Petersburg outbreak.   He said                                                               
he  supported  vaccination and  testing,  which  he didn't  think                                                               
could be  done without mandates.   He opined it was  too early to                                                               
let the disaster declaration expire.                                                                                            
4:00:58 PM                                                                                                                    
ELLEN  HODGES,  MD,  Chief  of   Staff,  Yukon  Kuskokwim  Health                                                               
Corporation, expressed  her support for  HB 76.  She  shared that                                                               
the  Yukon Kuskokwim  (Y-K) Delta  region's  COVID-19 case  rates                                                               
were  the highest  in the  state until  recently, and  for a  few                                                               
weeks, the highest in the nation.   While she attested that there                                                               
are many  stories that she  could tell about the  desperate fight                                                               
against the  outbreak, she divulged  that the  most heartbreaking                                                               
ones  are those  of  her holding  the hands  of  people dying  of                                                               
COVID-19 because  their families couldn't be  there or explaining                                                               
to families  that they  must hastily bury  their loved  ones with                                                               
out the  usual comfort  of cultural  tradition, meant  to support                                                               
grieving  families because  of the  risk of  holding funerals  in                                                               
villages ravaged by  COVID-19.  She emphasized her  hope to never                                                               
have to have those conversations in the future.                                                                                 
DR.  HODGES asserted  that while  case rates  were dropping,  the                                                               
pandemic was  far from over, and  shared that the Y-K  Delta lost                                                               
two more  elders the past  weekend.  She  said the Y-K  Delta has                                                               
had young people  die or have their lives  permanently altered by                                                               
COVID-19.   She  stated  that  many patients  have  been sent  to                                                               
intensive care units, and the  Yukon Kuskokwim Health Corporation                                                               
(YKHC) has seen  many people die.  She explained  the Y-K Delta's                                                               
rural population lives in  crowded, multi-generational homes, and                                                               
that  many of  the communities  do not  have access  to water  or                                                               
sewer,  which  is   a  known  risk  factor  for   the  spread  of                                                               
respiratory infections.                                                                                                         
DR.  HODGES  observed that  with  the  expiration of  the  public                                                               
health emergency  declaration, many Alaskans seemed  to feel like                                                               
the pandemic was over, but  she countered that there were ongoing                                                               
outbreaks  in  12 of  the  region's  46  villages, and  YKHC  was                                                               
diagnosing  new cases  every day.   She  said the  impact of  the                                                               
emergency declaration in  the Y-K Delta region  was immense, with                                                               
improved  access to  telehealth,  flexibility  to deliver  needed                                                               
care and testing,  the ability to require  testing and quarantine                                                               
for  people arriving  in  the region's  airports,  and access  to                                                               
funding  to  care for  patients.    She  asserted that  with  the                                                               
presence of variants in the  state, she was highly concerned that                                                               
she would lose  ground in the desperate fight  against the deadly                                                               
disease.    She  cautioned  that cases  grow  exponentially,  not                                                               
linearly,  with  the  increased   infectious  rates  of  the  new                                                               
variants  being  possibly  50 percent  higher  than  the  current                                                               
circulating  virus, communities  would  be  even more  devastated                                                               
than they already  are.  She concluded that support  is needed in                                                               
order  to  continue  vaccination   efforts  and  the  broad-based                                                               
testing strategy.                                                                                                               
4:04:07 PM                                                                                                                    
JAMES  SWEENEY,  Vice  President   of  Hospital  Services,  Yukon                                                               
Kuskokwim Health Corporation, testified in  support of HB 76.  He                                                               
explained the tools the YKHC was  using to manage not only COVID-                                                               
19, but  healthcare in general.   He recounted that early  in the                                                               
pandemic the Y-K  Delta region lost much of its  air access, both                                                               
by Raven  Air shutting  down, and by  the restrictions  in travel                                                               
that were put in place.   He shared that telehealth became a real                                                               
tool for the YKHC to use, and  it was rapidly set up and expanded                                                               
to  the  villages.   He  explained  that  YKHC has  about  30,000                                                               
individuals  in  its  service  area,   many  of  whom  depend  on                                                               
telehealth  and  remote  services  to  receive  healthcare.    He                                                               
remarked  that  COVID-19 is  important,  but  when people  cannot                                                               
address regular  healthcare, things  get worse.   So,  he stated,                                                               
telehealth  helped  YKHC  to maintain  patients'  health  and  to                                                               
understand before a patient gets very  bad.  In order to do this,                                                               
he  insisted,  this  program  must be  maintained,  which  is  an                                                               
important piece of HB 76.                                                                                                       
4:05:41 PM                                                                                                                    
REPRESENTATIVE  PRAX  asked for  context  on  which are  the  hub                                                               
communities in the Y-K district.                                                                                                
DR. HODGES answered that Bethel is the main hub community.                                                                      
REPRESENTATIVE  PRAX  asked if  the  communities  have their  own                                                               
health powers, as far as imposing their own restrictions.                                                                       
DR.  HODGES  answered that  many  of  the  villages do  have  the                                                               
ability as tribal entities to  set their own health restrictions.                                                               
She explained that Bethel is a second-class city [and does not].                                                                
REPRESENTATIVE  PRAX offered  his  understanding  that there  are                                                               
several dozen  small communities that  are spread out a  long way                                                               
from each other.                                                                                                                
DR. HODGES specified that there are 46 villages.                                                                                
4:07:15 PM                                                                                                                    
REPRESENTATIVE MCCARTY  asked how many  villages self-quarantined                                                               
and didn't want travelers.                                                                                                      
DR.  HODGES  answered that  every  village  had some  version  of                                                               
restrictions or recommendations  for people coming in.   She said                                                               
it varied  greatly from some  that required pre-approval  to even                                                               
book a ticket, to villages that just had recommendations.                                                                       
REPRESENTATIVE MCCARTY  asked regarding telehealth, how  YKHC was                                                               
able to  reach the villages or  if there was already  some degree                                                               
of medical support assistance.                                                                                                  
DR.  HODGES answered  that  the villages  are  staffed mostly  by                                                               
community health  aides, who can  provide basic medical  care and                                                               
can communicate  with the providers  in Bethal  or in one  of the                                                               
five regional sub-clinics.   She explained that  once air service                                                               
became  limited,  YKHC  had  to heavily  rely  on  telehealth  to                                                               
provide basic  services for the villages.   She said that  as the                                                               
pandemic  expanded  and the  number  of  positive COVID-19  cases                                                               
increased, many  did not feel  safe traveling, so  telehealth was                                                               
important.  She also noted that the only way to transport COVID-                                                                
19  positive patients  was to  medivac them,  which was  one more                                                               
reason that YKHC relied heavily  on telehealth to care for COVID-                                                               
19  patients  who weren't  sick  enough  for medivac,  but  still                                                               
required care.                                                                                                                  
4:09:50 PM                                                                                                                    
CO-CHAIR  ZULKOSKY asked  for confirmation  that YKHC  had ceased                                                               
telehealth services  in the absence  of the  disaster declaration                                                               
and on what date that was effective.                                                                                            
MR. SWEENEY  responded that YKHC has  not yet ceased them  but is                                                               
considering it  now.  He  explained that telehealth  services are                                                               
important,  so they  are  trying to  maintain  them, but  without                                                               
receiving reimbursement they will be curtailed.                                                                                 
CO-CHAIR  ZULKOSKY asked  about the  strain on  medical resources                                                               
experienced at  the height [of  COVID-19 cases in the  Y-K Delta]                                                               
and the region's and the state's current risk levels.                                                                           
DR.  HODGES responded  that YKHC's  medical  system was  stressed                                                               
immensely at  the height of the  outbreak.  She said  YKHC had 10                                                               
people with COVID-19 at one  time in its hospital, which required                                                               
a  level of  care and  respiratory  support it  did not  normally                                                               
provide.   She explained  that ICU beds  in Anchorage  were "non-                                                               
existent," so  YKHC had to  medivac patients  out of state.   She                                                               
emphasized  that it  was an  incredible amount  of stress  on the                                                               
nursing staff  and respiratory staff,  and that the  pressure was                                                               
intense.    She  acknowledged,  however, that  the  pressure  had                                                               
lessened,  citing only  one hospitalized  patient [in  Bethel] at                                                               
the time of  the meeting, along with a few  patients in intensive                                                               
care in Anchorage, Alaska.  She  shared that the region still had                                                               
over 20 cases per 100,000, with 41  new cases in the past 7 days.                                                               
She said she still considered the  Y-K Delta region to be on high                                                               
alert, and  therefore needed to continue  testing and vaccination                                                               
efforts.  She said the state,  according to the DHSS website, had                                                               
many regions still in "red," where  they had not dropped below 10                                                               
cases per 100,000.                                                                                                              
CO-CHAIR ZULKOSKY asked how many  cases per 100,000 in the region                                                               
were at  the height  of the  pandemic, and  how that  compared to                                                               
numbers statewide.                                                                                                              
DR. HODGES answered close to  400 cases per 100,000 and commented                                                               
that  for many  months  the  region had  the  highest case  rates                                                               
across Alaska.   She again  mentioned that  for a few  weeks, the                                                               
region had the highest case rate in the nation.                                                                                 
CO-CHAIR ZULKOSKY referenced  Commissioner Crum's presentation on                                                               
Tuesday which  discussed a drop in  cases.  She asked  Dr. Hodges                                                               
to  discuss the  level  of  public health  risk  that remains  to                                                               
necessitate a disaster declaration.                                                                                             
DR. HODGES responded that she  thought the level of public health                                                               
risk was still  high.  She said that although  cases have dropped                                                               
considerably, 20  cases per 100,000  was still a  lot, especially                                                               
in  a region  with  a  fragile healthcare  system  that could  be                                                               
easily  overwhelmed.    She  mentioned  that  she  was  extremely                                                               
concerned  about the  variants,  which had  already  shown up  in                                                               
Alaska and were potentially more  infectious and resistant to the                                                               
vaccines.  She  asserted her concern that the  new variants could                                                               
lead to  another wave  of outbreak  in the  Y-K Delta  region and                                                               
mentioned  possible   re-infection.    She  concluded   that  the                                                               
disaster  declaration   was  needed  to  quickly   vaccinate  the                                                               
population and to prevent a new wave of cases and deaths.                                                                       
4:15:32 PM                                                                                                                    
EMILY  FORD,  Government   Affairs  Director,  Providence  Alaska                                                               
Medical Center,  testified in  support of  HB 76.   She  told the                                                               
committee members  that roughly one  year ago the  first COVID-19                                                               
patient  in  the  United  States  was  treated  at  a  Providence                                                               
Hospital in Washington  State, and in the  year since, Providence                                                               
hospitals have worked  tirelessly during the pandemic.   She said                                                               
that the promising rate of  vaccination in Alaska allows Alaskans                                                               
to look towards positive days  ahead, but she cautioned that [the                                                               
administration] cannot lose sight of  the policies that would get                                                               
the state there.                                                                                                                
MS.  FORD stated  that  the COVID-19  response  has required  the                                                               
healthcare  community   to  act   nimbly  and   creatively  while                                                               
delivering  care and  protecting vulnerable  patients.   She said                                                               
that  the  state and  federal  government  acted swiftly  at  the                                                               
beginning  of   the  pandemic  to   provide  hospitals   and  the                                                               
healthcare  community with  the tools  necessary to  deliver care                                                               
and save  lives through legislation  and a series of  waivers and                                                               
flexibility with  a response  framework that  was built  upon the                                                               
state  and   federal  disaster   declarations  and   allowed  the                                                               
Providence Alaska  Medical Center to adapt  to changing community                                                               
MS.  FORD shared  that because  of the  government response,  the                                                               
medical center was  able to make many adjustments  in response to                                                               
COVID-19.     She  explained  that  the   hospital  modified  its                                                               
ventilation  systems  in  the emergency  department  and  created                                                               
negative pressure rooms to protect  patients and caregivers.  She                                                               
said it  partnered on  alternative care  sites and  drive through                                                               
testing,  examined   supply  chain  processes,   and  [increased]                                                               
personal protective  equipment (PPE).   It also set up  a program                                                               
to safely  monitor patients at home,  thereby augmenting critical                                                               
capacity and reducing potential exposure.   She shared that these                                                               
flexibilities impacted  more than  the COVID-19  response, helped                                                               
many Alaskans  facing illness, and  allowed for help from  out of                                                               
state  providers  with  specialties  not  offered  in  the  state                                                               
through telehealth.                                                                                                             
MS.  FORD  commented  that  healthcare   is  a  highly  regulated                                                               
industry.   She discussed audits and  compliance departments. She                                                               
argued that ending  the disaster declaration shifted  the risk of                                                               
interpreting  the network  of  flexibilities  onto hospitals  and                                                               
providers.  She explained that  the regulatory structure from the                                                               
past  year  created a  high  volume  of  regulatory change  in  a                                                               
compressed  timeline.    Without the  disaster  declaration,  the                                                               
medical center faces  legal uncertainty in how  to operate during                                                               
the pandemic.   She argued  that ending the  disaster declaration                                                               
doesn't end the pandemic.                                                                                                       
4:20:08 PM                                                                                                                    
TOM HENNESSY,  MD, MPH, College  of Health, University  of Alaska                                                               
Anchorage,  testified  in support  of  HB  76 with  a  PowerPoint                                                               
presentation.   He  said that  from his  perspective as  a public                                                               
health specialist, he  was very disappointed to  see the disaster                                                               
declaration  expire.   He argued  that  the declaration  provided                                                               
many  of  the tools  that  are  needed  to  fight COVID-19.    He                                                               
acknowledged the good news about  lower case counts and increased                                                               
vaccine supplies  and the  desire to  "get back  to normal."   He                                                               
stated that  the Center for  Disease Control (CDC) just  issued a                                                               
warning that lowering the nation's  guard could result in a surge                                                               
of cases, undoing months of progress.                                                                                           
DR. HENNESSY directed  attention to slide 2, a  graph of national                                                               
COVID-19 trends.  He explained that  the red line showed the rate                                                               
of COVID-19 cases nationally.  He  observed that there has been a                                                               
downward trend  since January 9,  2021, nationwide.   He directed                                                               
attention to  slide 3 and indicated  that circled in red  was the                                                               
drop  off in  cases which  had since  leveled off.   He  moved to                                                               
slide 4 and  explained that the likely reasons  for this leveling                                                               
off  were decreased  vigilance on  the  part of  the public,  not                                                               
following through  in public health recommendations,  and the new                                                               
DR. HENNESSY presented slide 5,  which showed the rates in Alaska                                                               
during  the pandemic.   He  pointed out  that although  rates had                                                               
declined  substantially  since  the  end  of  December,  Alaska's                                                               
numbers had stabilized and flattened in  the high "red zone."  He                                                               
said  that was  the  state picture.  He moved  to  slide 6  which                                                               
showed four  regions of concern  with increasing  COVID-19 rates.                                                               
He  pointed out  the increase  in  case rates  in Fairbanks,  the                                                               
Matanuska-Susitna area,  the northern  area of  Southeast Alaska,                                                               
which includes  Petersburg, and the Southeast  region where there                                                               
was  an outbreak  in Ketchikan.   He  said this  showed that  the                                                               
epidemic  was  not  over  in  Alaska,  as  there  were  continued                                                               
increased surges in cases.                                                                                                      
4:24:26 PM                                                                                                                    
DR. HENNESSY  moved to slide 7  and opined that it  was important                                                               
to think about emergency declarations  in.  He directed attention                                                               
to a  graph that showed  the infection  waves from the  2009 H1N1                                                               
swine flu.   He  pointed out  that case  rates declined  once the                                                               
vaccine was  administered, and that it  took half a year  for the                                                               
public  emergency to  end after  case rates  dropped.   He shared                                                               
this  was because  public  health officials  knew  the virus  was                                                               
better capable of  spreading during summer months.   He said this                                                               
was the  type of caution  he felt  that Alaska should  exhibit at                                                               
this time.                                                                                                                      
DR.  HENNESSY presented  slide 8  which showed  the graph  of the                                                               
United  States  COVID-19 case  rates  with  three distinct  waves                                                               
highlighted, showing transmission in  the spring, the summer, and                                                               
a  late winter  peak.   He said  the virus  was not  seasonal and                                                               
could  be transmitted  any  time; therefore,  it  wasn't safe  to                                                               
assume it would go away because of declining rates.                                                                             
DR. HENESSY  presented slide 9,  which read as  follows [original                                                               
punctuation provided]:                                                                                                          
     What did we lose when the Emergency lapsed?                                                                                
     - Required traveler testing at airports                                                                                    
      ? Decreased participation in voluntary program                                                                            
       ? Increases chances of introducing virus variants                                                                        
     into Alaska                                                                                                                
     - Flexibility and speed in response                                                                                        
       ? Contracting, purchasing, alternative cares sites                                                                       
     for testing, vaccination, treatment                                                                                        
      ? Medical licensing and reciprocity                                                                                       
      ? Telehealth from providers outside of Alaska                                                                             
      - Official recognition of urgency and concern about                                                                       
     COVID epidemic                                                                                                             
     ? Sends signal that "All is well" to Alaskans when we                                                                      
        need continued vigilance ? Most Alaskans are not                                                                        
     vaccinated or immune                                                                                                       
     ? Likely to result in people lowering their guard and                                                                      
     increased case counts                                                                                                      
DR. HENNESSY  elaborated on a  few points and mentioned  that the                                                               
virus only enters Alaska through  airports, so without testing it                                                               
can't be caught or contained.                                                                                                   
4:28:49 PM                                                                                                                    
DR.  HENNESSY concluded  by  stating  that it  was  too soon  for                                                               
Alaska to let down its guard and pack away its tools.                                                                           
CO-CHAIR ZULKOSKY  referred to the  four regions on slide  6 with                                                               
rising  case counts.   She  asked  what the  boundaries of  those                                                               
regions were.                                                                                                                   
DR.  HENNESSY responded  that those  were  the behavioral  health                                                               
regions defined  by the State  of Alaska  in order not  to single                                                               
out any one community, thus protecting privacy.                                                                                 
4:29:46 PM                                                                                                                    
CARA DURR,  Director of Public  Engagement, Food Bank  of Alaska,                                                               
testified  in support  of  HB  76.   She  informed the  committee                                                               
members  she would  be  speaking  to the  potential  loss of  the                                                               
Supplemental  Nutrition   Assistance  Program   (SNAP)  emergency                                                               
allotments (EAs).   She stated that failure to  extend the public                                                               
health disaster declaration or  something comparable would result                                                               
in  the  loss  of  EAs,   which  provide  critical,  100  percent                                                               
federally funded benefit boosts to individuals in need.                                                                         
MS. DURR  stated that  hunger during  the pandemic  has increased                                                               
dramatically.    She  cited estimates  that  food  insecurity  in                                                               
Alaska  had increased  30 percent  in 2020;  looking at  children                                                               
specifically,  this  rate  is  44   percent,  she  shared.    She                                                               
explained that areas  in the state with  food insecurity continue                                                               
to  see increased  need.    She further  stated  that areas  that                                                               
tended  to have  low rates  of food  insecurity experienced  huge                                                               
increases.   She remarked that  Skagway had seen an  estimated 72                                                               
percent increase in child food insecurity during the pandemic.                                                                  
MS. DURR said that in order  to meet these needs, food banks have                                                               
had to  distribute more  food than  ever before.   She  said that                                                               
last month was Food Bank  of Alaska's biggest weekly distribution                                                               
ever at its Anchorage drive-through  sight, and the SNAP outreach                                                               
team's busiest months  ever were December, 2020,  and January and                                                               
February, 2021.   She shared  that partner associations  had also                                                               
seen  higher  numbers.   She  explained  that SNAP  benefits  are                                                               
calculated  based  on  household  size,  income,  and  geographic                                                               
region, and  EAs supplement existing  SNAP benefits  by providing                                                               
all individuals and  families with the maximum  benefit for their                                                               
household size.  She related that  EAs are worth about $8 million                                                               
each  month to  the  State  of Alaska,  equivalent  to about  2.2                                                               
million meals  each month.   She pointed out that  these benefits                                                               
have  a broad  economic impact  and help  regenerate more  wealth                                                               
within communities where the money  is spent.  She concluded that                                                               
EA benefits are  essential to Alaska's hunger response  and HB 76                                                               
provides a clear path forward to continuing them.                                                                               
4:34:21 PM                                                                                                                    
LAURIE  WOLF, President  and  CEO, The  Foraker  Group, spoke  in                                                               
support of  HB 76.   She stated  while there may  be hope  on the                                                               
horizon,  Alaska  is not  there  yet.    She likened  ending  the                                                               
declaration to  stopping a penicillin  regiment three  days early                                                               
because the  patient is starting  to feel better.   She explained                                                               
that science and doctors wouldn't  support that action because of                                                               
the unnecessary  risk.  She  argued that  no one is  untouched by                                                               
the pandemic  and said, "While we  are all in the  same ocean, we                                                               
are  not in  the same  boat."   She  said The  Foraker Group  was                                                               
hearing  from  non-profit  organizations around  the  state  that                                                               
needed more  certainty in  order to meet  the essential  needs of                                                               
Alaskans.   She emphasized the  need for wide-spread  testing for                                                               
Alaskans and  mandatory testing  of travelers  into the  state to                                                               
protect the economy  the Alaskan people.  She  also expressed the                                                               
need for accessible vaccinations  to be delivered efficiently and                                                               
equitably  statewide,  for the  ability  to  provide direct  care                                                               
through  telehealth, and  to safeguard  Alaska's food-safety  net                                                               
through SNAP.                                                                                                                   
MS. WOLF argued that all these  issues must remain a top priority                                                               
for  Alaska in  order  to  focus on  the  intersection of  public                                                               
health and the  economy.  She acknowledged that  some issues were                                                               
being  addressed by  individual  legislation in  both bodies  but                                                               
contended that  taking each action  one by one puts  all Alaskans                                                               
at  risk   unnecessarily  and  burdens  the   non-profits,  local                                                               
governments, and  the state,  which are  all responsible  for the                                                               
safety and care of every Alaskan.   She emphasized that the state                                                               
did  not have  weeks or  months to  respond to  the unprecedented                                                               
public health  and subsequent economic  crisis and  insisted that                                                               
the urgency of an immediate solution remained paramount.                                                                        
MS.  WOLF  encouraged the  committee  members  to reinstitute  an                                                               
emergency declaration  of at least 90  days to meet the  needs of                                                               
non-profits and  communities.  She  explained that 90  days would                                                               
allow  for   a  bridge  for  service,   continuity,  and  greater                                                               
stability to the state's safety  net to help Alaskans impacted by                                                               
the crisis.  She suggested  that this bridge would give lawmakers                                                               
time  to  codify  the  additional  longer-term  relief  that  was                                                               
sought.     Additionally,  she  felt   the  bridge   would  allow                                                               
understanding for  which regulations  would be  useful in  a non-                                                               
pandemic world, such  as access to telehealth  and flexibility in                                                               
remote work.  She summarized  her testimony saying that in short,                                                               
extending the disaster declaration  is essential in responding to                                                               
the  pandemic  and  in  establishing  a  foundation  for  a  long                                                               
4:39:27 PM                                                                                                                    
CO-CHAIR ZULKOSKY informed the committee  members that she wished                                                               
to  move to  public testimony  after limited  questioning of  the                                                               
invited testifiers.                                                                                                             
REPRESENTATIVE   MCCARTY  asked   if  there   would  be   further                                                               
discussion outside of committee with testifiers.                                                                                
CO-CHAIR  ZULKOSKY  clarified  that   her  office  could  provide                                                               
contact information  for the testifiers  if he wished  to connect                                                               
with them after the committee adjourned.                                                                                        
4:40:57 PM                                                                                                                    
CHAIR  ZULKOSKY  commented  that   the  end  of  Dr.  Hennessey's                                                               
presentation  was  about what  Alaska  loses  without a  disaster                                                               
declaration.   She  asked  him how  quickly  the downward  trends                                                               
could change with the introduction of new variants.                                                                             
DR.  HENNESSEY answered  that he  had  not done  any modeling  on                                                               
that, but the  CDC has on a  national level.  He said  that a lot                                                               
of the  factors have to do  with how quickly the  population gets                                                               
vaccinated, and  at what  rate transmission  is occurring  in the                                                               
community.  He  explained that there is little data  in Alaska to                                                               
help inform such  a discussion, but the State  of Alaska Division                                                               
of  Public Health  just  came up  with a  report  on variants  of                                                               
concern, but it was too early to say.                                                                                           
CO-CHAIR ZULKOSKY thanked the testifiers.                                                                                       
4:43:27 PM                                                                                                                    
CO-CHAIR ZULKOSKY opened public testimony on HB 76.                                                                             
4:43:46 PM                                                                                                                    
SARAH SPENCER,  DO, told the  committee that she is  an addiction                                                               
medication specialist.   She informed  the committee  that during                                                               
the pandemic,  the U.S.  had seen  the worst  year ever  for drug                                                               
overdose  deaths.     She  commented  that   there  is  effective                                                               
treatment  for  opioid  use disorder,  and  that  medication  for                                                               
addiction  treatment  can  reduce  mortality  rates  by  over  80                                                               
percent.  She said the spike  in deaths was likely related to the                                                               
difficulty of accessing treatment during  times of COVID-19.  She                                                               
said providers were  able to start patients  on treatment without                                                               
meeting them in person first,  but only during the state mandated                                                               
declaration,  and if  providers  were to  follow current  federal                                                               
regulations, it  would be  in violation of  state statutes.   She                                                               
argued  that without  telemedicine  access for  people in  remote                                                               
areas,  addiction  is   disproportionately  affecting  people  in                                                               
poverty.    She  summarized  that quarantine  and  remote  access                                                               
issues  limit access  for many  to treatment,  and she  hopes the                                                               
emergency declaration is extended so she can treat patients.                                                                    
4:47:58 PM                                                                                                                    
DOLORES  VANBOURGONDIEN,  NP,  said she  treats  substance  abuse                                                               
disorders.  She said since  the beginning of the pandemic, nearly                                                               
300  Alaskans  have  lost  their  lives due  to  COVID-19.    She                                                               
expressed fear that  many Alaskans would die in  the aftermath of                                                               
the  pandemic  from  substance  abuse disorder.    She  said  the                                                               
pandemic  has resulted  in  increased  substance abuse  disorders                                                               
because  of factors  like isolation,  depression,  job loss,  and                                                               
uncertainty.  She  said CDC reported an  acceleration of overdose                                                               
deaths,  with nearly  81,000 overdose  deaths  through May  2020.                                                               
She said Alaska reported more  overdoses during the pandemic than                                                               
each  of  the  two  previous  years.    She  said  the  emergency                                                               
declaration allowed  providers to meet patients  where they were,                                                               
waiving the requirements for an  in-person, face-to-face exam for                                                               
the  initial encounter.   She  said this  allowed access  to life                                                               
saving medications.   She  said the  expiration of  the emergency                                                               
declaration order means  that those who are  most vulnerable will                                                               
be denied access to life  saving medications when they are needed                                                               
most.  She requested the extension of the declaration.                                                                          
4:50:30 PM                                                                                                                    
CO-CHAIR  ZULKOSKY  stated that  the  committee  would return  to                                                               
public testimony on Saturday, March 6, 2021.                                                                                    
CO-CHAIR ZULKOSKY announced that HB 76 was held over.                                                                           
4:51:34 PM                                                                                                                    
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 4:52 p.m.                                                                                                          

Document Name Date/Time Subjects
HB 76 Transmittal Letter.pdf HHSS 3/4/2021 3:00:00 PM
HB 76
HB 76 Sectional Analysis Version 32 GH1011 A.pdf HHSS 3/4/2021 3:00:00 PM
HB 76
HB 76 Version 32 GH 1011 A.pdf HHSS 3/4/2021 3:00:00 PM
HB 76
HB 76 AK ACEP Letter of Support HHSS.pdf HHSS 3/4/2021 3:00:00 PM
HB 76
HB0076-1-2-021821-CED-N.pdf HHSS 3/4/2021 3:00:00 PM
HHSS 3/6/2021 3:00:00 PM
HB 76
HB0076-2-2-021821-DHS-N.pdf HHSS 3/4/2021 3:00:00 PM
HHSS 3/6/2021 3:00:00 PM
HB 76
HB0076-3-2-021821-DPS-N.pdf HHSS 3/4/2021 3:00:00 PM
HHSS 3/6/2021 3:00:00 PM
HB 76
HB0076-4-2-021821-MVA-Y.pdf HHSS 3/4/2021 3:00:00 PM
HHSS 3/6/2021 3:00:00 PM
HB 76
HB76 AEMA Letter of Support to HHSS.pdf HHSS 3/4/2021 3:00:00 PM
HB 76
Petersburg Data.pdf HHSS 3/4/2021 3:00:00 PM
HB 76
Hennessy HSS Presentation March 4.pdf HHSS 3/4/2021 3:00:00 PM
HB 76
HB 76(HSS)-DOR-TAX-02-10-21.pdf HHSS 3/4/2021 3:00:00 PM
HHSS 3/6/2021 3:00:00 PM
HB 76
CSHB76 32-GH1011B.pdf HHSS 3/4/2021 3:00:00 PM
HHSS 3/6/2021 3:00:00 PM
HB 76