Legislature(2009 - 2010)CAPITOL 17
04/14/2010 08:30 AM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB172 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 172 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 14, 2010
8:38 a.m.
MEMBERS PRESENT
Representative Bob Herron, Co-Chair
Representative Wes Keller, Co-Chair
Representative Tammie Wilson, Vice Chair
Representative Bob Lynn
Representative Sharon Cissna
Representative Lindsey Holmes
MEMBERS ABSENT
Representative Paul Seaton
COMMITTEE CALENDAR
CS FOR SENATE BILL NO. 172(FIN) am
"An Act establishing the Alaska Health Care Commission in the
Department of Health and Social Services; and providing for an
effective date."
- MOVED HCS CSSB 172(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: SB 172
SHORT TITLE: ALASKA HEALTH CARE COMMISSION
SPONSOR(s): SENATOR(s) OLSON
03/27/09 (S) READ THE FIRST TIME - REFERRALS
03/27/09 (S) HSS, FIN
04/17/09 (S) HSS AT 1:30 PM BUTROVICH 205
04/17/09 (S) Scheduled But Not Heard
04/18/09 (S) HSS AT 10:00 AM BUTROVICH 205
04/18/09 (S) Bills Previously Heard/Scheduled
02/03/10 (S) HSS AT 1:30 PM BUTROVICH 205
02/03/10 (S) Heard & Held
02/03/10 (S) MINUTE(HSS)
03/10/10 (S) HSS AT 1:30 PM BELTZ 105 (TSBldg)
03/10/10 (S) Heard & Held
03/10/10 (S) MINUTE(HSS)
03/17/10 (S) HSS AT 1:30 PM BUTROVICH 205
03/17/10 (S) Moved CSSB 172(HSS) Out of Committee
03/17/10 (S) MINUTE(HSS)
03/18/10 (S) HSS RPT CS 3DP 1NR SAME TITLE
03/18/10 (S) DP: DAVIS, ELLIS, PASKVAN
03/18/10 (S) NR: DYSON
04/07/10 (S) FIN AT 9:00 AM SENATE FINANCE 532
04/07/10 (S) Heard & Held
04/07/10 (S) MINUTE(FIN)
WITNESS REGISTER
DENISE LICCIOLI, Staff
Senator Donny Olson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SB 172, on behalf of the prime
sponsor.
WARD B. HURLBURT, M.D.
Director and Chief Medical Officer
Division of Public Health (DPS)
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during the
discussion of SB 172.
WILDA LAUGHLIN, Special Assistant
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during the
discussion of SB 172.
WAYNE STEPHENS, President and CEO
Alaska State Chamber Of Commerce;
Member; Alaska Health Care Commission
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 172.
MR. BRIAN SAYLOR, Ph.D., Retired
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 172.
DEB ERICKSON, Executive Director
Alaska Health Care Commission (AHCC)
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during the
discussion of SB 172.
LIZ CLEMENT, Staff
Representative Bob Herron
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during the
discussion of SB 172.
JILL LEWIS, Deputy Director - Juneau
Division of Public Health (DPS)
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the discussion of
SB 172.
ACTION NARRATIVE
8:38:36 AM
CO-CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 8:38 a.m.
Representatives Keller, Herron, Cissna, Lynn, T. Wilson, and
Holmes were present at the call to order.
8:39:34 AM
CO-CHAIR KELLER announced that the first order of business would
be CS FOR SENATE BILL NO. 172(FIN) am, "An Act establishing the
Alaska Health Care Commission in the Department of Health and
Social Services; and providing for an effective date."
8:39:49 AM
DENISE LICCIOLI, Staff to Senator Donny Olson, Alaska State
Legislature, paraphrased from the sponsor statement, which read
as follows [original punctuation provided]:
Alaska is currently facing serious healthcare cost,
access and quality issues. Between 1991 and 2005,
health care expenditures in our state more than
tripled from $1.6 billion to $5.3 billion. Costs are
expected to double again by 2013 to over $10 billion.
All levels of government - state, local, and federal -
are affected, and Alaska's economy cannot sustain this
inflationary growth. The purpose of SB 172 is to
establish in statute the Alaska Health Care Commission
to address the need for health care reform in our
state. This issue is complex and broad in scope, and
cannot be dealt with adequately unless we have a
permanent body to plan and follow through for long
range comprehensive health care reform.
The two most recent groups to work on the issue of
health care reform in Alaska, the Alaska Health Care
Roundtable (2005) and the Alaska Health Care
Strategies Planning Council (2007), both recommended
that a permanent body be established to address the
problem of health care reform. The Roundtable (which
met for 2 years) and the Planning Council (which met
for 6 months) recognized that the problem is too great
to be effectively addressed through a short-term, ad-
hoc body.
The Alaska Health Care Commission would be established
in the Department of Health And Social Services, and
would consist of a ten member body including public
officials and private citizens. Representatives from
both the executive and legislative branches of state
government are included, as well as citizens
representing the private business sector, the health
care community, and consumers. Three members are to be
ex officio appointees from the legislature and the
governor's office. The composition and small size
would enable efficient and effective teamwork and
decision-making, while bring a balance of viewpoints
and perspectives.
The commission would provide its recommendations and
support the development of a statewide plan to address
the quality, accessibility, and availability of health
care for all citizens of the State. A plan for reform
will be based on education, sustainability, management
efficiency, health care effectiveness, private-public
partnerships, research, personal responsibility and
individual choice.
Alaska's need for healthcare reform is pressing and
must be dealt with thoroughly and efficiently, with a
long range view towards meaningful and lasting change.
The Alaska Health Care Commission would play an
important role in this process, and it is essential
that we make it a permanent component of the
Department of Health and Social Services, so that
present as well as future issues with Alaska's
healthcare systems can be better anticipated,
understood and addressed.
8:44:47 AM
MS. LICCIOLI concluded by stating that the problem is pressing
and health care reform must address present and future issues.
The Alaska Health Care Commission would play an important role
in that process.
8:45:28 AM
CO-CHAIR KELLER referred to page 3, line 23, and pointed out
that "insurance" was added after "care" which would need to be
amended in the bill.
8:46:19 AM
REPRESENTATIVE HOLMES referred to language in paragraph (F),
which read, "one member who represents the health care industry
in the state."
MS. LICCIOLI explained that "care" was removed and "insurance"
was added by an amendment so the language currently reads
"health insurance industry."
8:46:55 AM
REPRESENTATIVE HOLMES stated she generally supports the bill.
She recalled a sunset provision applies to the Alaska Health
Care Commission (AHCC) and asked if it was the sponsor's
intention to have the commission to serve indefinitely, but the
purpose of the sunset provision is to provide a periodic review
of the commission.
8:47:35 AM
MS. LICCIOLI referred to page 7, line 31, to the June 30, 2014
sunset provision.
REPRESENTATIVE HOLMES asked if the sponsor's intent was to
reauthorize the AHCC or if it would be a short-term commission.
MS. LICCIOLI answered that the prime sponsor, Senator Olson,
does not necessarily want to direct the legislature in this
matter. He recognizes the task of implementing health care
reform is a complex issue and acknowledged the legislature could
choose to extend the commission. However, the sponsor also
recognizes that it is possible that the AHCC could be finished
with its work by 2014. Additionally, it is possible that some
additional changes may be needed. Thus, the prime sponsor
wanted a shorter sunset date to allow the legislature time to
review and determine the outcome based on events as they unfold.
8:49:06 AM
REPRESENTATIVE HOLMES pointed out that the proposed AHCC has
staggered three-year terms, which indicates it may be an ongoing
commission, which she said she did not have any objection to but
noted the staggered dates tend to indicate the role may be
longer.
MS. LICCIOLI surmised that the prime sponsor would be surprised
if work was completed at end of sunset date, which is why the
terms are staggered terms. However, given the adoption of
health care reform at the national level, it may take time for
policy impacts to trickle down to Alaska. The current language
would provide the legislature the opportunity to review the
progress.
8:50:42 AM
REPRESENTATIVE HOLMES referred to page 2, line 3, which she said
would give the department the ability to develop, adopt, and
implement a statewide health plan based on the recommendations
of the proposed Alaska Health Care Commission (AHCC). She asked
what the legislature's role would be and if the AHCC would make
recommendations and the department would implement them or if
further legislative review would be required.
WARD B. HURLBURT, M.D., Director and Chief Medical Officer,
Division of Public Health (DPS), Department of Health and Social
Services (DHSS), stated that the AHCC, as it is currently
functions, views itself as making recommendations to legislature
and to the governor to develop plans. Thus, before a health
plan would be adopted, the AHCC would work in collaboration with
the legislature and the administration. He related he is "one
of the world's largest skeptics on commissions." He said he has
been impressed with the AHCC's work thus far. He thought the
sunset provision would give the AHCC an opportunity to truly
demonstrate its worth and if it did not do so, it should not be
extended.
8:53:32 AM
REPRESENTATIVE HOLMES pointed to page 5, line 11, to the
disclosure forms required. She asked if there are any problems
with medical ethics under the required disclosure. She did not
want to set up an instance that caused a medical professional to
breach their medical ethics.
DR. HURLBURT deferred to Representative Holmes as an attorney,
but related from his own experience he did not see any problem.
8:55:01 AM
REPRESENTATIVE HOLMES referred to page 5, line 24, and asked for
the definition of enhanced market forces.
DR. HURLBURT replied that the intent would be to examine the
leverage of purchasing to ensure "that you get your money's
worth at the $6 billion that we're spending. The 18 percent of
the GDP now is just a huge amount of our national resource. We
would want to make sure the services that we get for that really
are supported by the science; that they are purchased
efficiently and effectively."
REPRESENTATIVE HOLMES reflected that this commission appeared to
be a full time job.
CO-CHAIR KELLER remarked that the challenge is "so huge." He
related that there is virtually no one in the health care
industry that is not concerned. He suggested that he has not
heard anything negative about actions taken that address the
cost in a responsible way and also increase access to quality
care. He remarked that the commissioners' passion has been
impressive.
8:57:13 AM
REPRESENTATIVE T. WILSON suggested that the department has
expertise. She referred to the fiscal note and inquired as to
whether anyone currently performing the functions could take
over as executive director rather than to hire a new person.
DR. HURLBURT responded that the executive director's position is
a full-time position. This person would serve as a public
entity to serve to react to health care reform. Additionally,
the department does not have the expertise to provide some
analyses on health care reform, such as a health care economist.
Some national analyses will be available through organizations
such as Covington & Burley and Henry J. Kaiser Family
Foundation, but the state will also need to acquire state-
specific analysis to address health care reform, which could be
provided by outside contracts, such as the University of
Alaska's Institute of Social and Economic Research (ISER).
8:59:04 AM
MS. LICCIOLI said the AHCC has "a lot of work" to accomplish.
She was unsure of their needs but she could say that at least
one full-time staff person would be necessary, given that the
other commission members are doing other work. The AHCC members
are essentially "volunteers." It is envisioned that one full-
time person would conduct research and would interact and
prepare materials so the commission members' time would be
minimized. She related that it already takes significant time
just to prepare for and attend meetings. She stated that
without a dedicated staff person the commission's work would be
hampered.
9:00:41 AM
REPRESENTATIVE T. WILSON said many issues will need to be
addressed. She suggested that perhaps a staff member could work
on the issues as opposed to hiring an executive director. She
expressed concern about adding another $500,000 to the budget.
MS. LICCIOLI related that the department and Dr. Hurlburt would
need to answer with respect to resources.
CO-CHAIR KELLER said he would like to have them available to
answer questions.
9:01:49 AM
REPRESENTATIVE CISSNA offered her belief that the commission's
work would cover every department in the state since they have
their "fingers in the health pie." All state employees are
affected since they receive pay and health insurance. Thus,
"billions of dollars are really impacted by this commission."
She indicated that data collection has been cut back so the
state cannot compare itself to a lot of other states. This
commission could offer a financial savings to the state.
"Underfunding is usually the 'kiss of death' for business", she
said. She stated that the executive director needs to be a
person "that keeps the glue in place."
9:04:10 AM
DR. HURLBURT agreed with Representative Cissna's comments. He
said the need for the commission has become more acute with the
passage of federal health care reform. Health care impacts
everyone. He stated that the department does need resources to
keep the commission ongoing. Resources were not provided the
first year the AHCC operated. Thus, it has been an "unfunded
mandate." He suggested that his division needs to be involved
in preventative health and needs to be held accountable. He
speculated that on a day-to-day basis the AHCC will be working
on "medical care cost issues" since the bill charges the
commission to develop a strategy for improving the health of all
residents of the state to encourage personal responsibility for
disease prevention, healthy living, and acquisition of health
insurance.
9:06:11 AM
MS. LICCIOLI said that the fiscal note shares the cost with the
federal government so other federal programs will be billed
since the programs will benefit from the commission's work. The
full fiscal impact will not come from general fund (GF),
although more than half the cost is GF funding.
REPRESENTATIVE T. WILSON referred to the fiscal note funding
that indicates $500,000 from the general fund (GF).
WILDA LAUGHLIN, Special Assistant, Office of the Commissioner,
Department of Health and Social Services (DHSS), explained the
fiscal note was updated on April 13, 2010 to show federal
receipts of $165,000 and GF match of $335,000. The fiscal note
also reflects the additional person to reflect the additional
commission membership, which totals 13 members.
9:08:55 AM
WAYNE STEPHENS, President and CEO, Alaska State Chamber Of
Commerce, stated he has served on the Alaska Health Care
Commission (AHCC) for the past year. He expressed support for
the AHCC. He noted the increase in health care costs and
premiums has created a significant burden on businesses and
employers. The health care personnel workforce shortage has
reduced access for seniors and other Alaskans. Alaska's health
care system needs adjustments and there are not any quick fixes.
The best first step is to address pressing health care issues is
to permanently establish the AHCC, comprised of experts and
representatives of key stakeholders in the state. The AHCC will
make recommendations to the legislature to realign and redesign
the system. The temporary AHCC, established by executive order,
expired this year but began to consider relevant issues
including coverage, cost, access, quality, work force, health
information technology, primary care safety net, cost
transparency, prevention, personal responsibility, but the short
timeframe is inadequate to address the complex issues to the
degree needed. The Alaska State Chamber of Commerce supports
the establishment in statute of the AHCC to recommend
comprehensive statewide health and health care policy to the
governor and legislature that will result in a health care
system that provides quality and affordable access to Alaskans.
9:11:16 AM
REPRESENTATIVE T. WILSON asked how many members serve on the
AHCC.
MR. STEPHENS replied seven plus the three ex-officio members.
9:11:42 AM
MR. BRIAN SAYLOR, Ph.D., Retired, stated he retired from the
University of Alaska Anchorage (UAA) and has previously served
as the deputy commissioner, Department of Health and Social
Services (DHSS) and as the director, Alaska Psychiatric
Institute. He spoke in support of SB 172 and in recognition of
the complexity of the health care system. One element that he
thought would warrant additional attention and would strengthen
the bill is the extent to which the public health enterprise can
reduce costs and improve people's health by reducing the demand
for services. He stated that the element is suggested in the
bill but should be made very explicit. He commented that
Representative Cissna has a copy of an amendment he prepared
that would address this issue. He stated that demand reduction
that comes as a direct result of preventive activities of public
health, which go beyond individual responsibility and are more
consistent with Article 7, of the Alaska State Constitution that
argues we promote and protect the public health. Those things
have been shown repeatedly to have a marked effect to reduce the
demand for medical care. He explained that the bill currently
focuses more on the delivery of health services to reduce costs.
His strong recommendation is public health be explicitly noted
in the bill. He offered his belief that this would add a
welcome additional element to the study of our health care
system. Currently, the health care system consists of health
care services delivery rather than one that addresses overall
health. He thought the addition of public health would "go a
long way to correct that."
9:14:29 AM
REPRESENTATIVE CISSNA thanked Dr. Saylor. She recalled a prior
study that suggested cost reductions could be achieved by
providing care at the point a person develops a chronic disease,
to help them to get better and stop the growth of disease. She
asked whether such a study could be made available to the
legislature and newly-convened commission.
DR. SAYLOR pointed out that extensive literature on the impact
of health promotion and disease reduction, not only among
corporations, where the return on investment is astonishing, but
in the public, in general. He thought that the commission would
add attention to public health infrastructure. He said he would
be happy to help in any way he can to provide additional
information.
9:16:42 AM
DEB ERICKSON, Executive Director, Alaska Health Care Commission
(AHCC), explained that the workload has substantially increased
with passage of the federal health care laws. She recalled an
overview on the legislation, which added over a thousand pages
of federal law. She offered her belief that the law will
fundamentally change the method of delivery for health care in
Alaska. The AHCC has been working to more effectively and
efficiently organize funding and delivery of health care in
Alaska. She related the AHCC will work to understand the new
federal law. She understood an amendment may be considered.
She offered her view that a strong delivery system must rest on
a foundation of prevention and a strong public health system.
As duties are added, it could potentially "water down" the
AHCC's mission. She reiterated Dr. Hurlburt's comments that the
Department of Health and Social Services (DHSS) does not have
the expertise it needs without obtaining additional resources.
Her position was created as essentially a non-permanent fully
exempt position that is not in the budget. She suggested that
if the fiscal note were to be "stripped" that her position would
likely disappear. Prior to taking this position, she worked for
about 25 years with the DHSS. Thus, speaking from experience if
the bill passed without funding the DHSS would not be able to
acquire necessary expertise through consultants. She speculated
that if that were to happen, the level of work product would
suffer. She speculated that might translate into the commission
issuing a staff report and holding several "teleconferenced"
commission meetings. She brought up two things to note.
Supporting the executive director position created budget issues
for the department. The AHCC developed a detailed public
communication and engagement strategy that could not be
implemented due to a lack of resources. Thus, the commission
was not able to engage or interact with the public to a greater
extent and was less transparent than it could have been if it
had been funded.
9:23:02 AM
CO-CHAIR KELLER stated the AHCC, which he had the privilege of
serving on, was established by an executive order that also gave
the commission the authority to hire an executive director. He
asked to place on the record that he has profound respect and
appreciation for Ms. Erickson's work. He said the commission
would not have been successful without her. He said, "I've
become one of your greatest fans."
9:24:14 AM
CO-CHAIR KELLER closed public testimony on SB 172.
9:24:24 AM
REPRESENTATIVE CISSNA moved to adopt Amendment 1, labeled 26-
LS0790\CA.1, which read as follows:
Page 6, line 4:
Delete "and"
Page 6, line 6, following "services":
Insert ";
(G) determines the resources needed by
local and state governments to protect the public
health; and
(H) assesses the effect of improved health
status on the cost of health care"
CO-CHAIR KELLER objected for purpose of discussion.
9:25:17 AM
REPRESENTATIVE CISSNA explained that proposed Amendment 1 would
add two paragraphs to the services and duties of the commission.
She stated that it follows the discussion of personal
responsibility and preventative medicine. She stated that the
constitution looks at primary prevention and determining the
resources needed by local and state governments. She suggested
that proposed Amendment 1 should state "promote and protect"
since those terms are in Alaska's constitution. She offered her
belief that state government should put its efforts into keeping
people healthy. Currently, people often enter the health care
system when they are Medicare eligible and go to the emergency
room for treatment, which is the most expensive provider. Thus,
people enter the most expensive part of the system, become
Medicaid eligible, and continually are treated for illness or
disease. This becomes a "huge driver" of the "huge debt" in the
state and absorbs the department's resources. She advocated for
Alaska to review the needs and assess the effect of improved
health status to ensure money is spent in the most cost
effective manner rather than waiting until sick people are
eligible for Medicare before their problems emerge. She further
advocated striving for a healthier population. This language
provides a different focus and a more refined way of viewing
health care that "builds health."
9:30:58 AM
REPRESENTATIVE HOLMES offered her support for proposed Amendment
1. She agreed that prevention is not clearly spelled out and
the need for prevention, such as for immunizations, anti-
obesity, and life style changes and should be in the purview of
the AHCC.
9:31:47 AM
CO-CHAIR KELLER thought the comments were good comments. He
objected to Amendment 1 since it is already included in SB 172.
He referred to page 5, line 19-31, which outlines the duties of
the commission. He read subsection (a)(2)(A), "encourages
personal responsibility for disease prevention, healthy living,
and acquisition of health insurance;." He expressed concern
with paragraph (H) to "assessing the effect of improved health
status..." He stated that the state wants to encourage
prevention for healthy living, which the AHCC supports and while
Amendment 1 is not harmful, that specificity might cause
confusion.
9:33:43 AM
REPRESENTATIVE CISSNA said that state spends more money on
getting people familiar with Medicaid than on the effort to
break learned habits, some through expensive advertising. The
private sector has its rights but the state's role is to help
people break habits.
CO-CHAIR KELLER maintained his objection. He felt the issue is
already covered.
CO-CHAIR KELLER reopened public testimony on SB 172.
9:35:20 AM
MS. ERICKSON referred to proposed Amendment 1. She opined that
she agreed that paragraph (H) is already addressed in the
current duties on page 5, in subparagraph (A),(B), and on page 6
in subparagraph (C), which she reviewed. The one thing that
subparagraph (H) addresses that may not be recognized by a
further AHCC or is not reflected in the duties outlined in SB
172, is the role of local and state government for public
health.
CO-CHAIR KELLER asked whether the language in subparagraph (G)
would create a burden for the AHCC.
MS. ERICKSON responded that under the current fiscal note, the
AHCC would not have resources to address subparagraph (G), but
she imagined the commission could address in more general terms
the role of local and state governments with respect to public
health. She remarked that the task is huge that this language
would add one more duty for AHCC to prioritize.
9:38:44 AM
REPRESENTATIVE T. WILSON asked for the bill sponsor's comment.
MS. LICCIOLI reported she discussed a previous version of the
amendment with Senator Olson. She said he believes that
proposed Amendment 1 would not be harmful, but that the current
duties are already covered in the bill. She said he expressed
slight concern with the language "resources needed by local
government" since numerous local governments exist in Alaska and
the resource needs vary between local governments. She
suggested that it may be better to list "what we want to
accomplish" and allow the local and state governments to
identify the resources.
REPRESENTATIVE T. WILSON commented that the commission could
always add these requirements at a later date.
9:40:33 AM
MS. LICCIOLI said she thought the sponsor would agree. She
restated that he did not think the proposed Amendment 1 was
harmful, but believes the commission already is working to
accomplish the tasks.
9:40:55 AM
CO-CHAIR KELLER reclosed public testimony on SB 172.
9:41:05 AM
REPRESENTATIVE CISSNA offered her strong support for proposed
Amendment 1. She explained that she has been a legislator for
12 years. She has observed illnesses and health problems move
from adult problems to problems that increasingly affect youth.
She expressed concern that the majority of Alaska's youth have
developed poor habits that will translate to a diminished
quality of life as adults. She said, "That's really frightening
to me." She said that the legislature must think differently if
it wants to solve the problems. She pointed out that she has
visited 60 communities and has found that local governments are
accessible. She offered that having a commission ask questions
and having communities know that someone will listen "would be a
huge thing."
9:43:42 AM
CO-CHAIR KELLER maintained his objection.
9:44:03 AM
A roll call vote was taken. Representatives Cissna and Holmes
voted in favor of Amendment 1. Representatives T. Wilson, Lynn,
Keller voted against it. Therefore, Amendment 1 failed by a
vote of 3-2.
9:44:54 AM
CO-CHAIR KELLER opened public testimony on SB 172.
LIZ CLEMENT, Staff to Representative Bob Herron, Alaska State
Legislature, related that the amendment that the sponsor would
have offered is one that may be offered by Representative T.
Wilson and not Amendment 1, which failed.
CO-CHAIR KELLER closed public testimony on SB 172.
9:45:59 AM
REPRESENTATIVE T. WILSON moved Conceptual Amendment 2 [labeled
Amendment #1], which read [original punctuation provided]:
Amend/replace Sec.18/09.040 with:
"The commission may appoint an executive director, who
may not be a member of the commission, and who shall
be current staff of the department. All commission
research and supplemental work shall be accomplished
with department resources and collaboration between
commission members."
CO-CHAIR KELLER objected for the purpose of discussion.
9:46:15 AM
REPRESENTATIVE T. WILSON expressed concern with the initial
fiscal note that added an executive director. She said she was
even more concerned with the subsequent fiscal note that added
two positions. She re-read proposed Conceptual Amendment 2 and
gave the rationale for the amendment. She stated that this
amendment would allow the commission the flexibility to
determine its staffing needs and workload. She said she changed
the language to "may appoint" and the commission can determine
their needs. The commission will utilize the expertise of the
department and maximize existing department resources. She
maintained her concern about "adding more people." She offered
her belief that this commission is a "good thing." She
reiterated her concern that the fiscal note indicated the
commission would hire someone at $134,000 and a second person at
$58,000, which is her source of objection.
9:48:04 AM
CO-CHAIR KELLER maintained his objection. He said that much of
the commission's cost is paid for by the federal government.
CO-CHAIR KELLER opened public testimony on SB 172.
9:48:50 AM
The committee took an at-ease from 9:48 a.m. to 9:50 a.m.
9:50:05 AM
CO-CHAIR KELLER asked about the language in proposed Conceptual
Amendment 2, to the second "shall". He suggested the language
read "may".
REPRESENTATIVE T. WILSON agreed to the change to proposed
Conceptual Amendment 2. She recalled a question was raised
whether a person could be hired if the person currently filling
the position resigned. She answered that the position currently
exists and if the executive director resigned the department
could fill the position. She agreed that "may" also provides
the department with more flexibility.
9:51:13 AM
CO-CHAIR KELLER asked for clarification on whether proposed
Conceptual Amendment 2, would replace AS 18.09.040 in its
entirety.
Representative T. Wilson answered yes.
CO-CHAIR KELLER asked whether Representative T. Wilson intended
that the "commission shall establish the duties of the executive
director." He said he did not see the language in Conceptual
Amendment 2.
REPRESENTATIVE HOLMES suggested just replacing the first
sentence.
9:52:14 AM
CO-CHAIR KELLER opened public testimony. He clarified that
Conceptual Amendment 2 would delete the first sentence on page
4, line 20-21, which read, "The commission shall employ an
executive director, who may not be a member of the commission."
Conceptual Amendment 2 would replace sentence one with the
following: "The commission may appoint an executive director,
who may not be a member of the commission and who may be current
staff of the department. All commission research and
supplemental work shall be accomplished with department
resources and collaboration between commission members."
REPRESENTATIVE T. WILSON agreed.
MS. LICCIOLI, stated that from her experience in the
administration, that the existing position is a non-permanent
position since the department did not have funding at the time
the commission was established. Thus, the executive director
position will "go away." She recalled Representative T. Wilson
mentioning the department "has a position." However, the
position will only be temporary and without approval of an
additional position, the department would need to reassign an
existing position.
REPRESENTATIVE T. WILSON offered her belief that changing the
wording from "shall" to "may" would allow the position to become
permanent. She said that Conceptual Amendment 2 does not force
the department to hire an executive director.
9:55:29 AM
CO-CHAIR KELLER referred to page 4, line 20-22. He related that
after the first sentence, following "member of the commission"
that Conceptual Amendment 2 would be inserted, which he read:
The commission may appoint an executive director, who
may not be a member of the commission and who may be
current staff of the department. All commission
research and supplemental work shall be accomplished
with department resources and collaboration between
commission members."
CO-CHAIR KELLER asked whether the department approves of the
language in proposed Conceptual Amendment 2, noting the short
notice.
MS. LAUGHLIN replied that she could not answer and deferred to
Dr. Hurlburt.
CO-CHAIR KELLER asked for the impact of proposed Conceptual
Amendment 2 on the fiscal note.
9:57:19 AM
JILL LEWIS, Deputy Director - Juneau, Division of Public Health
(DPS), Department of Health and Social Services (DHSS), reported
the status of the current executive director position. She
explained that at the time the commission was created the
request for funding for an executive director was made in the
budget process and not the enabling legislation. The position
was not appropriated. Thus, the position does not technically
exist and the DPS is absorbing the cost for the unbudgeted
position. To remedy this issue, the legislature needs to
appropriate the money for the position and add the position in
the fiscal note. She reiterated that the DPS currently absorbs
the cost.
9:59:20 AM
REPRESENTATIVE HOLMES advised that the first sentence of
proposed Conceptual Amendment 2 would give discretion to the
department. She suggested that the second sentence may cause
confusion on whether the position could be reauthorized.
CO-CHAIR KELLER agreed that restricting the research and
supplemental work to department resources was problematic since
the commission may wish to use private industry for some
research.
REPRESENTATIVE T. WILSON surmised that the department had
budgeted funds for outside research so it probably has a means
to use consultants.
10:01:25 AM
CO-CHAIR KELLER clarified that this refers to the commission,
not the department. Thus, the AHCC may wish to draw in
additional sources.
REPRESENTATIVE HOLMES agreed. She commented that it was not
likely the intention, but the proposed language would hamper the
commission in accepting federal funding or private funding
resources.
REPRESENTATIVE T. WILSON interjected that "collaboration between
commission members" would provide flexibility. She asked why
the second staff was requested.
MS. LEWIS responded that the executive director of the AHCC has
been asked to be the lead of the inter-departmental team, which
will dramatically increase the workload. The position would be
an ongoing position.
REPRESENTATIVE T. WILSON asked whether this position is outside
the scope of board.
MS. LEWIS said it was not, since it is within the charter of the
Alaska Health Care Commission.
10:04:06 AM
REPRESENTATIVE CISSNA remarked the funding is coming from the
division that does preventative work, which means fewer people
will be available to do the work. She said it is important to
keep the DPS budget intact. She offered her belief that it will
save enormous amounts of money if the AHCC can do its work.
REPRESENTATIVE T. WILSON said she wanted to ensure that the
department's talents are utilized and the intent is not to
"short fund anybody or to say it's not important, but is to make
sure we're utilizing the people in the best way that we can."
She said she just wants to ensure that the state is not
complicating the matter with a board and more staff involved.
She agreed that having the commission in place is "great." She
did not want to stand in the way.
10:06:42 AM
CO-CHAIR KELLER asked whether Dr. Hurlburt would like to comment
on proposed Conceptual Amendment 2.
DR. HURLBURT expressed concerned to keep the costs as low as
possible and still "get the job done." He related that the
federal health care reform will provide some analyses. However,
what is lacking in expertise and resources is the health
economic analysis. The commission will need to contract for
that expertise and analysis. Thus, funding will be needed to
provide expertise on some of the Alaska specific aspects of
health care reform. The AHCC brought in Dr. Donald Pathman,
University of North Carolina, as a consultant. He is an expert
on loan repayments and incentives, to assist Alaska to bring
providers into the state. He related that the state of
Wisconsin established an agency to respond to health care
reform. He remarked that the department envisions the job of
responding to the federal health care reform will be a huge job.
The department hopes that using the AHCC will bring efficiencies
to work with the intra-state government departmental group. He
concluded that the DPH is trying to be sensitive to the concerns
that have been expressed.
10:09:32 AM
REPRESENTATIVE T. WILSON wanted to clarify that this is not a
new concept that the department contracts out for expertise.
She said she did not have a problem dropping the second
sentence. She reiterated that issues currently arise in which
the department obtains expertise.
10:10:05 AM
CO-CHAIR KELLER explained that proposed Conceptual Amendment 2
would replace the first sentence of AS 18.09.040 with the
language, "The commission may employ an executive director, who
may not be a member of the commission, and who may be current
staff of the department."
CO-CHAIR KELLER removed his objection.
CO-CHAIR KELLER closed public testimony on SB 172.
10:11:02 AM
REPRESENTATIVE HOLMES moved to report CSSB 172(Fin) am, as
amended, out of committee with individual recommendations and
the accompanying fiscal notes.
There being no objection, HCS CSSB 172(HSS) was reported from
the Health and Social Services Standing Committee.
10:11:46 AM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 10:11 a.m.
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