Legislature(2021 - 2022)DAVIS 106
03/04/2021 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB76 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 76 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
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
draft.
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
process.
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
committee.
3:22:57 PM
CO-CHAIR ZULKOSKY announced the committee would hear invited
testimony.
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
services.
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
supplies.
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-
of-state.
REPRESENTATIVE PRAX asked if all village airports had testing
services.
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
hospitalizations.
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
patients.
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
needs.
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
variants.
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
recovery.
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
ADJOURNMENT
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 |