03/06/2021 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Executive Order 119 – Dhss Reorganization | |
| HB76 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 6, 2021
3:03 p.m.
MEMBERS PRESENT
Representative Liz Snyder, Co-Chair
Representative Tiffany Zulkosky, Co-Chair (via teleconference)
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
EXECUTIVE ORDER 119 DHSS REORGANIZATION
HEARD
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 AND HELD
PREVIOUS COMMITTEE ACTION
EXECUTIVE ORDER 119
DHSS REORGANIZATION
01/20/21 (S) RECEIVED IN THE SENATE
01/25/21 (S) INTRODUCED - REFERRALS
01/25/21 (S) HSS, FIN
02/18/21 (H) RECEIVED IN THE HOUSE
02/19/21 (H) INTRODUCED - REFERRALS
02/19/21 (H) HSS, FIN
03/02/21 (H) HSS
03/02/21 (H) Heard & Held
03/06/21 (H) HSS AT 3:00 PM DAVIS 106
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
03/04/21 (H) Heard & Held
03/06/21 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
MICHELE GIRAULT
Key Coalition of Alaska
Anchorage, Alaska
POSITION STATEMENT: During the hearing of Executive Order (EO)
119, provided invited testimony regarding the coalition's
questions about the reorganization proposed in the order.
RHONDA PROWELL-KITTER, Chief Financial Officer
Plan Administrator
Public Education Health Trust (PEHT)
Anchorage, Alaska
POSITION STATEMENT: During the hearing of Executive Order (EO)
119, provided invited testimony about the reorganization
proposed in the order.
ANDREW DUNMIRE, Legislative Counsel
Legislative Legal Services
Legislative Affairs Agency
Juneau, Alaska
POSITION STATEMENT: During the hearing of Executive Order 119,
answered questions relating to the legal memorandum, dated
3/5/21, that he prepared at the committee's request about the
order.
ADAM CRUM, Commissioner
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: During the hearing of Executive Order (EO)
119, answered questions about the order on behalf of the
administration.
JASON LESSARD
Anchorage, Alaska
POSITION STATEMENT: During the hearing of Executive Order (EO)
119, testified he is not necessarily opposed to the split
proposed in the EO but is opposed to the manner in which it has
played out.
KEVIN BERRY, PhD, Professor
Department of Economics" University of Alaska Anchorage (UAA)
Anchorage, Alaska
POSITION STATEMENT: During the hearing of HB 76, provided
invited testimony via a PowerPoint presentation titled "Economic
Impacts of COVID."
NILS ANDREASSEN, Executive Director
Alaska Municipal League (AML)
Juneau, Alaska
POSITION STATEMENT: During the hearing of HB 76, provided
invited testimony in support of extending the state's emergency
declaration.
KATI CAPOZZI, President & CEO
Alaska Chamber of Commerce
Anchorage, Alaska
POSITION STATEMENT: During the hearing of HB 76, provided
invited testimony in support of HB 76.
MICHELLE DEWITT, Executive Director
Bethel Community Services Foundation (BCSF)
Bethel, Alaska
POSITION STATEMENT: During the hearing of HB 76, provided
invited testimony in support of the section of the bill that
pertains to charitable gaming online.
THOMAS QUIMBY, MD, Vice President
Alaska Chapter of the American College of Emergency Physicians
Palmer, Alaska
POSITION STATEMENT: During the hearing of HB 76, provided
invited testimony in support for reinstating an emergency
disaster declaration as it relates to the COVID-19 pandemic.
ACTION NARRATIVE
3:03:35 PM
CO-CHAIR LIZ SNYDER called the House Health and Social Services
Standing Committee meeting to order at 3:03 p.m.
Representatives McCarty, Kurka, Zulkosky (via teleconference),
Spohnholz (via teleconference), Fields (via teleconference), and
Snyder were present at the call to order. Representative Prax
arrived as the meeting was in progress.
^Executive Order 119 DHSS Reorganization
Executive Order 119 DHSS Reorganization
3:05:54 PM
CO-CHAIR SNYDER announced that the first order of business would
be Executive Order (EO) 119 DHSS Reorganization.
CO-CHAIR SNYDER opened invited testimony on EO 119.
3:06:04 PM
MICHELE GIRAULT, Key Coalition of Alaska, provided invited
testimony on behalf of the board of the Key Coalition of Alaska,
a statewide group of stakeholders focusing on elevating the
voices of those experiencing intellectual and developmental
disabilities, advocating for best practice policies, and funding
allocations resulting in enhanced quality of life for some of
the most vulnerable citizens of the state. She noted that the
annual Key Campaign, where stakeholders meet with legislators to
share their priorities, was held this past week. During those
visits, she related, participants were asked opinions about EO
119, the proposed reorganization of the Department of Health and
Social Services (DHSS). She said the coalition has not come out
for or against the reorganization because it is still in
dialogue with the administration regarding the impact on the
coalition's stakeholder group. However, Ms. Girault continued,
no one has any argument that the department is huge, with many
moving parts and stakeholder groups to serve.
MS. GIRAULT stated that the coalition deeply desires to see the
Developmental Disability (DD) Shared Vision come to life in
administrative practice. The DD Shared Vision, she specified,
was put into statute [Senate Bill 174 signed into law in 2018]
so changes of leadership can't change the philosophy of support
and the lens from which decisions should be made. She related
that this Shared Vision states: "Alaskans share a vision of a
flexible system in which each person directs their own supports,
based on their strengths and abilities, toward a meaningful life
in their home, their job and their community. Our vision
includes supported families, professional staff and services
available throughout the state now and into the future."
MS. GIRAULT shared with the committee the questions that the Key
Coalition has already brought forward to the administration
regarding the [proposed] reorganization and the coalition's
desired outcomes around those questions. She stated:
Question Number 1. Help us understand how the
restructure will better serve families and individuals
and align with the Shared Vision? As a coalition our
desired outcome is to see increased flexibility in
service models, more self-directed supports, less
regulatory burdens on individuals and families, and
the waitlist of 800-plus people eradicated. We would
like to see a better partnership between the
department and those receiving disability support, and
a focus on removing barriers to meaningful lives and
community.
Question Number 2. Can you explain the split in the
department and why the 24/7 institutional side is
identified as community and family services and why DD
community supports are identified under the health
care regulatory side of the division? For coalition
members, language matters. Once Alaska entered the
Home and Community Based Waiver Program in the 1990s,
with Medicaid the source of funding rather than state
grants, the medical model has prevailed with a focus
on deficits, not on strengths. With Medicaid
expansion in our state the focus on health care costs
and outcomes has created a perception among coalition
members they are cost to be contained rather than a
citizen to be supported. We would love to see a focus
on people and cost saving measures we have brought
forward that would enhance lives to be implemented.
Question Number 3. How will you prevent disability
services from becoming strictly medically modeled
focused rather than a social service model? Again, as
I stated before, the nature of Medicaid funding
creates a deficit-based model that a person needs to
be habilitated or fixed. Our desired outcome is not
to have a funding source focusing on compliance
overshadow the needs of the person and family and help
find innovative ways through a social model lens to
support strength so people can be active participants
in the community.
Question Number 4. We have brought forward cost
saving suggestions that have not been moved forward.
Will this restructure give us more opportunity to have
dialogue and move these initiatives forward? We all
spent last week bringing forward cost saving
suggestions to legislators, all recommendations we
have brought to both current and previous
administrations. Again, our desire as a coalition of
primary stakeholders receiving support, their families
and supporters, provider agencies, and the direct
support professionals walking alongside people, is to
partner to assure the Shared Vision is the lens from
which we are all making decisions.
MS. GIRAULT concluded by relating that for those experiencing
disabilities the mantra has long been, "Nothing about me without
me." She said the coalition welcomes the continued dialogue of
how the proposed departmental reorganization will bring the DD
Shared Vision to life.
3:11:27 PM
REPRESENTATIVE PRAX said he understands the Key Coalition's
concern about any reorganization but asked whether the services
that are provided to the coalition are set up in statute.
MS. GIRAULT replied that the DD Shared Vision was put into
statute several years ago, which is really a philosophical north
star by which to make decisions. She said the funding that
funds DD services comes from Medicaid. In response to a follow-
up question, she said she was not able to cite the statute
number.
3:12:43 PM
REPRESENTATIVE SPOHNHOLZ thanked Ms. Girault for her testimony
and the Key Coalition's work, particularly its recent work to
advance the DD Shared Vision. She offered her belief that this
work could result in improving person-centered living while
eventually saving money over time if the administration were to
adopt some of the proposals advanced by the coalition. She
related that one of the concerns being heard from some folks is
that they were not substantively consulted about EO 119 prior to
its introduction. She inquired whether town hall meetings were
held with members of the Key Coalition, members of the DHSS
leadership, or anyone from the governor's office in advance of
releasing the EO.
MS. GIRAULT answered that there was no advance dialogue but
there is current dialogue. The Key Coalition has met with the
administration a couple times and the Shared Vision Legislative
Committee has a meeting next meeting next week. She offered her
belief that Alaskans for Medicaid had a meeting last week.
3:14:14 PM
CO-CHAIR ZULKOSKY thanked Ms. Girault for her testimony. She
noted the committee has heard from DHSS that the reduction in
the waitlist in the Division of Public Assistance has positioned
the agency well for such a significant reorganization. She
requested Ms. Girault to speak to any sort of waitlist that the
coalition faces regarding providing support services to
Alaskans. She further requested Ms. Girault to speak to the
potential impacts for coalition stakeholders were there to be
waitlist issues forthcoming.
MS. GIRAULT replied there are a couple different avenues for
potential waiting in terms of qualification for services. She
explained that a person with a disability must qualify for, be
determined, to have a developmental disability. Then, getting
on Medicaid is another qualification and the Division of Public
Assistance (DPA) is one of those hoops to jump through. To get
waivered services is another waitlist, she continued, so
sometimes when talking about waitlist it can be confusing about
what people are waiting for, what are they getting qualified
for. For example, a person with Down's Syndrome gets a
determination of having Down's Syndrome and needs support and
qualifies for Medicaid and Social Security; then he or she still
goes on a potential waitlist for actual community supports,
which is the home and community-based waiver.
CO-CHAIR ZULKOSKY requested Ms. Girault to speak to the waitlist
for Alaskans who are trying to get identified for services and
who are on a waitlist for home and community-based care, and
what the projected dates for being eligible for services has
been and could potentially be under a reorganization.
MS. GIRAULT responded she doesn't know that she can speak to
that unless there are cost saving measures because the waitlist
is somewhat of a cost containment for the state. She said the
Intellectual and Developmental Disabilities (IDD) Waiver is the
one waiver that has a waitlist so a person can potentially
qualify for services. To provide an example, she related that a
Key Coalition member's daughter has Down's Syndrome and is
living with her family. The daughter was put on that waitlist
at the age of 2, is now 20, and is still on a waitlist for that
full IDD waiver. Ms. Girault stated she can't speak to how a
reorganization could impact that unless there was a considerable
cost savings that then was reallocated toward that waitlist.
CO-CHAIR ZULKOSKY stated the department has suggested that it is
looking at a reduction of roughly 129-139 positions in the
[Division] of Public Assistance because there is no longer a
significant waitlist, as there had been, for determining
eligibility. She asked whether Ms. Girault knows how that might
impact Alaskans waiting for services through the Key Coalition.
MS. GIRAULT took off her "Key Coalition hat" and spoke from her
personal involvement as a guardian for two people who experience
disabilities. She explained that when going through DPA, going
through Social Security Income (SSI), many hoops must be jumped
through and there is lots of back-and-forth communication. So,
coalition members, or parents and guardians' members, have some
fear about a reduction in access to good communication and good
problem solving for people who must have that financial aspect
of eligibility to move forward. It has been very challenging
during COVID with Social Security and DPA, she added, so there
is fear that workforce reduction would exacerbate those issues.
3:18:41 PM
RHONDA PROWELL-KITTER, Chief Financial Officer, Plan
Administrator, Public Education Health Trust (PEHT), provided
invited testimony on behalf of PEHT, a not-for-profit
governmental trust organization that provides health insurance
benefits for public education employees in Alaska such as school
boards, teachers, and support staff. She stated that PEHT
supports finding innovative methods to keep health care costs
low while providing local choice, local control, and low-cost
health insurance options for its members. She said PEHT
supports nearly 17,000 Alaska residents who are dedicated to the
education of Alaskan children.
MS. PROWELL-KITTER stated that PEHT greatly appreciates the
efforts of DHSS and the State of Alaska to find cost savings and
opportunities to improve outcomes for Alaskans. The recognized
need to support the overwhelmed and understaffed Office of
Children's Services (OCS) is more important than ever in this
pandemic. She encouraged DHSS to take a measured, thoughtful
approach in considering this restructuring and consult the many
stakeholders across Alaska. She related that foster families
and caseworkers have expressed concern about changes without
input, changes during the pandemic, and no clear understanding
of how their monumental needs will be met.
MS. PROWELL-KITTER noted PEHT is a small organization accustomed
to finding cost savings through innovative practices and
operating with minimal administrative cost. She said PEHT is
concerned that splitting the department and separating staff who
are accustomed to working closely together could increase
administrative work and create communication challenges between
those divisions. Health and community services are often highly
interrelated, she pointed out, as recognized by the growing
emphasis on wraparound services for addressing issues from
substance abuse to disability support and even end-of-life care.
MS. PROWELL-KITTER said DHSS performs many vital services and
houses divisions that rely on close communications, such as the
offices of Children's Services and Public Assistance, which
would be separated by this division. The concern is that this
division would complicate and delay access to needed services.
She stressed that, to be meaningful, a change of this magnitude
requires utilizing a thoughtful and comprehensive approach. She
urged that there be engagement with all impacted stakeholders to
ensure their needs are met, their mission supported, and their
voices heard throughout the process.
3:21:54 PM
REPRESENTATIVE MCCARTY asked whether PEHT is taking a stance on
EO 19 or is waiting to see the outcome.
MS. PROWELL-KITTER replied that PEHT's position is that the
stakeholders, many of whom are PEHT members, are overtaxed and
overburdened with the current COVID situation, the ZOOM
classroom schedules, and the class students that they have who
are in the foster care system. The guardians ad litem and the
caseworkers are all shrugging their shoulders with their hands
in the air saying, "We don't know." So, she said, PEHT's
concern is that they have not been engaged thoughtfully in this
process at this time.
3:22:45 PM
REPRESENTATIVE PRAX requested clarification about the name of
Ms. Prowell-Kitter's organization as he thought PEHT had to do
with the educational professionals' health benefit system. He
asked whether PEHT is doing something with DHSS.
MS. PROWELL-KITTER responded that PEHT's members who are being
impacted by this are expressing that they don't know what steps
will be taken. These members do interact directly with DHSS,
she explained, and they have interactions with the children who
are in the foster care system. It's already complex at this
time, she related, and they are worried that their concerns have
not been heard thoughtfully in this area.
REPRESENTATIVE PRAX offered his understanding that it's PEHT's
members as individuals who are being affected, not necessarily
members of the health trust as members of the trust.
MS. PROWELL-KITTER answered correct. She explained that the
trust's members are often foster care families themselves. They
are reaching out to the trust in need for employee assistance
and member assistance programs to assist them through the mental
health challenges that exist inside the foster care system.
They are highly concerned about additional disruptions that
would be occurring, she stated, and would like an opportunity to
have a voice.
3:24:43 PM
REPRESENTATIVE MCCARTY noted Ms. Prowell-Kitter spoke in general
about the concerns. He asked whether she has any specific
pieces that she would like to share with the committee about
what she is hearing from foster parents or services.
MS. PROWELL-KITTER replied that the number one issue she is
hearing from trust members is about the [proposed] separating of
the offices of Children's Services and Public Assistance and how
that coordination would impact their homes as foster care
families, as well as any new foster children coming into the
system and possibly into their home. The second issue is the
[proposed] separating of two different finance departments
between the two divisions and whether, if one division is
lacking funds, they will be unable to access funds that are
designed to assist all children in the foster care system.
REPRESENTATIVE MCCARTY requested a specific example of the
concern that one group of foster children will be able to get
services while another group will not.
MS. PROWELL-KITTER responded the concern is access to the public
assistance if there is an enrollment in Medicaid and that when
getting children into the foster care system their birth parents
have access to the services needed for substance abuse so the
family can be reunified. She said the concern is having the two
different departments as opposed to them working side-by-side.
REPRESENTATIVE MCCARTY, regarding family reunification, inquired
whether he is correct in understanding that Ms. Prowell-Kitter
is saying that if there were a split the kids would be in one
area of services that the state is overseeing but the parents
would be in a different realm, and that that would cause a
conflict because there could be a potential lack of continuity
of care and things will get challenged.
MS. PROWELL-KITTER answered, "The concern being that an
individual needing to work closely with the Office of Children's
Services and with the Office of Public Assistance, if they're
not funneling under the same department any longer that there
would be ... potentially delays in communication."
REPRESENTATIVE MCCARTY stated he knows OCS and is familiar with
the process there. He said there seems to be several entities
that are involved in the services to help Alaska's children, one
of which is the courts, which is a whole different entity from
OCS and yet they do work together in realms. He stated he isn't
diminishing PEHT's concern but is trying to understand how a
different department division, three different types, will
affect Alaska's children.
MS. PROWELL-KITTER replied that the information coming to her,
the individuals who are seeking this access to PEHT's members
assistance program, is the uncertainty of how this division will
impact. She said their fear is that it is going to add
additional red tape in an already complicated system. It is
certainly known, she continued, that the courts are overwhelmed
with the amount of OCS cases that are coming before the judges
and lengthy times in the scheduling of appointments is being
seen. The concern is the lack of understanding, she added, "Is
this going to improve that operation or the fear that the
separation is going to complicate an already complex area?"
REPRESENTATIVE MCCARTY stated that that is a good question.
3:29:12 PM
CO-CHAIR SNYDER announced that the committee has received a
memorandum from Legislative Legal and Research Services
regarding the legality of EO 119 [dated 3/5/21, from Andrew
Dunmire]. She read from page 1, fourth sentence in paragraph 2,
of the memorandum which states, "some sections of the executive
order impermissibly make substantive changes to existing law,"
and stated that this impedes on the legislature's authority.
She noted Mr. Dunmire is online and invited committee members to
ask questions of him.
3:29:54 PM
REPRESENTATIVE SPOHNHOLZ observed that Mr. Dunmire's memorandum
of findings and analysis of EO 119 is lengthy. She requested
Mr. Dunmire to highlight the categories of concerns identified
in the memo, particularly the ones around potential creation of
law or changing of law that are done in EO 19 that the committee
should be considering.
3:30:53 PM
ANDREW DUNMIRE, Legislative Counsel, Legal Services, Division of
Legal and Research Services, Legislative Affairs Agency, replied
that Legal Services believes a number of provisions in EO 19
create substantive law. He said Section 2 of the EO, for
example, would change how and when nurses can pronounce deceased
people as dead. Currently, nurses can do so at the Alaska
Pioneers' Home and the Alaska Veterans' Home, and this law would
prevent them from doing that, and the position of Legal Services
is that that is substantive. He stated that Legal Services
thinks several other parts of the executive order are
substantive. He also noted that Legal Services has highlighted
a couple other problems, things that might just be tracking
errors. For example, he pointed out that Sections 142-145 give
instructions to the revisor to replace DHSS with Department of
Health in some instances and Department of Family and Community
Services in others, and there are a couple duplicates. He said
these might be drafting errors or grammatical errors, but
nonetheless they are in the executive order.
REPRESENTATIVE SPOHNHOLZ observed from the memo that EO 119
would add new members to boards; for example, there would be two
commissioners where currently there is one. She requested Mr.
Dunmire to describe how that is a policy change and what would
be the concerns associated with that.
MR. DUNMIRE confirmed there are a few boards that would increase
in membership from the executive order. For example, he said
Sections 3-4 of the EO would [create new board positions] on the
Controlled Substances Advisory Committee and the Criminal
Justice Information Advisory Board and both these boards would
go from an odd number [nine] to an even number [ten] of members,
which has policy implications that the legislature can consider.
Section 11 of the EO has another example of this in that a
member is added to the Council on Domestic Violence and Sexual
Assault by naming the commissioners of both new departments to
the council, which would result in the council going from an odd
number of members (nine) to an even number (ten).
REPRESENTATIVE SPOHNHOLZ opined that that is important because
many of these boards have been crafted with an odd number and
with very specific membership in order to have geographic and
expertise balance, as well as balance between the administration
and members of the community and the legislature and in some
cases members of local government. She observed it isn't just
the Criminal Justice Information Advisory Board, the Controlled
Substances Advisory Committee, and the Council on Domestic
Violence and Sexual Assault, but also the Alaska State Emergency
Response Commission, and that is just a few of the changes Mr.
Dunmire has identified in the memo. There are many very
specific changes, she continued, and it looks like a lot of work
needs to be done on this to ensure that all the policy options
are considered. She pointed out that executive orders cannot be
amended, which creates policy problems as well as concerns with
being able to advance this order at all. This executive order
has substantive problems, and the committee doesn't have a means
to make a change to it. She said she has a lot of concerns.
3:35:20 PM
REPRESENTATIVE KURKA offered his understanding that generally
the membership of boards and commissions is often appointed by
the governor and then approved by the legislature. He said he
recognizes that these new positions on the boards would give
more weight to the administration and asked whether Mr. Dunmire
is suggesting that these new memberships would not be voted on
or confirmed by the legislature.
MR. DUNMIRE responded that these are board positions that are
defined by statute. For example, he said that for the Criminal
Justice Information Advisory Board there is currently a
provision in statute that declares the commissioner of the
Department of Health and Social Services is on that board.
REPRESENTATIVE KURKA said it seems to him that the legislature
would be voting to confirm or not confirm these new
commissioners, so the legislature would still have a say or
authority in that.
MR. DUNMIRE answered that Representative Kurka is correct. He
said if the EO becomes effective then the two departments would
both be principal departments of law and there is nothing in the
order that changes the appointment or nomination process.
REPRESENTATIVE KURKA drew attention to page 1, paragraph 2, of
the memo that references Article III, sec. 23 of the Alaska
Constitution and the governor's authority to reorganize
executive departments. He related that Article III, sec. 23,
states "where these changes require the force of law they shall
be set forth in executive orders." He said the legislature then
has 60 days to potentially reject this. It seems clear in the
constitution, he opined, that [the governor] has that authority
to change the law in an executive order for the purpose of
splitting up [DHSS] and then the legislature can decide if it
doesn't want that. He asked where the line is with having those
changes in the law to allow for the reorganization and where it
is going beyond that to make substantive policy differences.
MR. DUNMIRE replied that that is a question with a lot of grey
area. For example, he said he thinks the change to nursing law
in Section 2 is clearly a substantive change because it changes
the statute and changes the duties that nurses at the Pioneers'
Home would have given to them by law. On the other end of the
scales are provisions in EO 119 that take existing statutes and
move them into a new title or a new chapter without making any
changes whatsoever; he said he doesn't think there is any
argument to be made that that could be considered a substantive
change to the law because it's merely a reorganization of the
way that the statutes are numbered. In between those two
extremes, he continued, is a lot of middle ground that he tried
to document in the memo.
3:40:54 PM
CO-CHAIR SNYDER requested Mr. Dunmire to explain how adding
another member changes the balance of power in the boards and
how that becomes problematic in the context of what is being
called substantive changes.
MR. DUNMIRE responded that, respectfully, he thinks that might
be a policy consideration for the legislature. He said he
thinks it's up to the legislature as a body to determine how
these boards are composed, for example, whether they have an odd
number or even number of members. He explained he merely
pointed out that change in the memo to bring that to the
committee's attention, but he doesn't feel equipped to answer
the question as to how it would change the dynamics.
CO-CHAIR SNYDER stated that the responsibility lies at the
legislature.
CO-CHAIR SNYDER drew attention to page 2 of the memo regarding
Section 15 of EO 119. She requested Mr. Dunmire to clarify and
explain which services these changes would affect.
MR. DUNMIRE answered that Section 15 amends AS 25.27.125(b) and
that references an account that is salvaged by 37.05.142, he
believes. In this case, he explained, these are receipts that
come in from the "Child Support Services agency." Currently the
statute says that the legislature may use the money in the fund
to make appropriations to the Department of Health and Social
Services, but Section 15 of EO 119 would delete the reference of
Department of Health and Social Services and leave the statutory
citation that's in there. It's unclear what effect that might
have on how the government functions, he advised, but a cleaner
way to have done it might have been to leave the Department of
Health and Social Services references and replace it to a
reference that says Department of Family and Community Services
and Department of Health to keep it the same as what it is now.
CO-CHAIR SNYDER stated she is hearing that this would create
some significant uncertainty in how these appropriations would
be directed.
MR. DUNMIRE replied he thinks there is a possibility that that
could happen. But, he continued, the citations remain in that
statute, and it just takes out the name of the department that
[the funds] must be appropriated to. So, he advised, it's
difficult to predict what effect that might have.
CO-CHAIR SNYDER brought attention to page 2 of the memo
regarding Section 30 of EO 119, which would make changes to the
DHSS commissioner's current statutory authority to establish a
schedule of fees for the services found in AS 44.29.020(a)(1),
(8), and (14). She asked Mr. Dunmire to explain who currently
has authority for (a)(17). She further noted that Section 30
also removes several other areas of authority and asked what
would be affected.
MR. DUNMIRE responded that currently under AS 44.29.020(a)(1-7)
it is the commissioner of the Department of Health and Social
Services who has that authority. Regarding the other areas of
authority that would be removed by Section 30 and what would be
affected, he said "the statute sections that are referenced in
this bill section are amended by bill Section 36." He explained
that Section 36 gives the Department of Family and Community
Services authority to regulate what is currently (a)(7), (a)(8),
and (a)(2), and the others would go to the Department of Health.
3:46:44 PM
REPRESENTATIVE MCCARTY remarked that he has lots of questions
about Section 30. He asked what the implications are of the
commissioner being able to charge fees, establish fees, and not
being able to establish fees, for services or whatever codes
need to be fee driven. He further asked what the concern is
there and what the big change is that will happen to take away
that authority.
MR. DUNMIRE answered that currently this statute does not give
the commissioner of the Department of Health and Social Services
the authority to create fee schedules for AS 44.29.020(a)(2-6).
He said that includes preventative medical services, public
health nursing services, nutrition services, health education,
and laboratories. But, he continued, Section 30 of EO 119 would
give the commissioner of [the Department of] Health the
authority to establish fees for those services.
REPRESENTATIVE MCCARTY offered his understanding that Mr.
Dunmire is saying that currently the commissioner is not able to
establish these fees for services that are had in the state. He
inquired whether that implies that [the state] is not able to
collect revenue for such things, and if this happens, this will
then resolve that.
MR. DUNMIRE replied he will have to do more research and get
back to the committee, but at this moment he can say that the
current statute does not grant the commissioner that authority,
but it would after EO 119.
3:49:17 PM
CO-CHAIR SNYDER stated the committee is hearing that Section 30
would make substantive changes in the commissioner's powers.
3:49:41 PM
CO-CHAIR ZULKOSKY said she is hoping to zero in on Mr. Dunmire's
conclusion, understanding that there are some substantive
examples that have been provided within the memo about risk of
substantive law that would be established through the proposed
executive order. She posed a scenario in which the legislature
does not act, and Executive Order 119 moves forward in its
current manner. She asked whether it is Mr. Dunmire's legal
opinion that in this scenario the legislature could ultimately
be ceding its appropriations or legislative authority to
establish new laws in the state of Alaska.
MR. DUNMIRE replied he thinks there is a risk if Executive Order
119 goes into law that there would be a lawsuit. He said there
is certainly the potential for somebody with an actual interest
in the changed law or a public interest litigant to bring a
case. One argument that would be made by a plaintiff in that
situation in court, he posited, would be that the governor has
usurped the legislature's power by enacting statutes via an
executive order. Predicting how that would play out is not
something he feels comfortable doing, he continued, but he can
tell the legislature that he thinks there certainly is a
substantial litigation risk if this executive order becomes law.
CO-CHAIR ZULKOSKY recalled that the committee has heard
overwhelmingly in testimony about the disproportionality in the
child welfare system, as well as about the challenges and
impacts with Medicaid and guardians ad litem. She asked whether
Mr. Dunmire has a sense of the implication to Alaskans utilizing
services through the department if there were a lawsuit.
MR. DUNMIRE requested clarification as to whether Co-Chair
Zulkosky is asking if a lawsuit would impact the services
received by citizens of Alaska.
CO-CHAIR ZULKOSKY replied yes.
MR. DUNMIRE responded that he doesn't have an answer.
3:53:07 PM
REPRESENTATIVE FIELDS drew attention to Section 17 of EO 119,
lines 18-19, and related that the executive order would remove
state and federal receipt authority from the Department of
Health regarding foster care youth and places this receipt
authority on the Department of Family and Community Services.
He said his understanding is that OCS would still have children
in custody in the Division of Behavioral Health, specifically
youth in therapeutic foster homes. He inquired whether that is
going to present a problem for the Department of Health trying
to receive federal dollars that pay for these foster youth if
receipt authority is deleted. He further inquired whether the
administration has articulated how to address that issue.
MR. DUNMIRE replied he isn't able to answer the question. He
said the executive order would give both the new departments,
the Department of Health and the Department of Family and
Community Services, authority over the receipts, but he is
unable to say anything beyond that.
3:54:29 PM
REPRESENTATIVE PRAX inquired whether it would be appropriate to
have the [DHSS] commissioner address some of these questions.
CO-CHAIR SNYDER confirmed the commissioner is online if
Representative Prax would like to pose a question.
REPRESENTATIVE PRAX requested Commissioner Crum to address the
concerns that have been raised by Legal Services as far as the
substantive changes. He noted he has not read through the legal
opinion but that making these changes made sense to him when
reading through the executive order.
3:55:24 PM
ADAM CRUM, Commissioner, Department of Health and Social
Services (DHSS), requested clarification on the question being
asked.
REPRESENTATIVE PRAX referenced the concerns expressed by Mr.
Dunmire of Legal Services about changing board makeup and
authority to collect fees and authority for federal receipts.
He asked what the administration's thoughts were at the time of
drafting Executive Order 119.
3:55:57 PM
COMMISSIONER CRUM, regarding board makeup, responded that not
all the board seats have voting rights to each of the members,
particularly a commissioner that is directed to sit on them. He
said that normally the commissioner's role is to represent the
administration and provide information to the board members and
the public. Regarding the ability to collect fees, Commissioner
Crum stated:
Office of Children's Services would need the receipt
authority to collect those items because items that
are under their care or the custody of OCS. Division
of Behavioral Health does not have children in
custody, they are a program manager, and they help
provide services and so they connect in resources that
way. Whereas OCS, if that is the case, they would be
the individuals there in charge of those children
connecting them to youth because they've got Medicaid
eligibility technicians on staff at OCS.
REPRESENTATIVE PRAX asked whether it is correct to think about
this as: "It isn't so much that the commissioner was setting
fees, somebody is setting fees at this point. But just one
department is collecting them currently, whereas another
department would be collecting them in the future."
COMMISSIONER CRUM replied yes. "These are authorities that
exist right now," he stated, "things that are being collected
and/or fees, and they're being pointed to the department that
houses the division that performs those services and/or that
work."
REPRESENTATIVE PRAX, regarding the concerns about services
raised by various testifiers, surmised the department would be
required to maintain the services if the services are provided
by statutes. He further surmised it would just be a different
way of providing [the services].
COMMISSIONER CRUM answered that absolutely the services DHSS
provides as a department will be maintained. He continued:
There is no disruption of the services, the programs,
or the payment structures that people receive, whether
they be providers or beneficiaries. Those services
will continue to be maintained. The current divisions
that provide those services will continue to do so,
they'll just be doing it under a different banner of a
department, and that has been the primary work when
we're reaching out to the stakeholder groups is
letting them know and explaining that. Whereas we
have been quite successful over the last week with
various townhalls assuaging their concerns about the
services and the work they do will be able to continue
to go on.
3:58:35 PM
REPRESENTATIVE SPOHNHOLZ opined that changing the balance of
boards, which are often very carefully crafted, is a substantive
change in law given that each one of those boards has
essentially been passed in individual laws and carefully crafted
compromises over time. Sometimes commissioners are voting
members, sometimes they're not, she noted. Adding another
member and changing it from an odd to an even board composition
with an additional administrative representative is a
significant change and ordinarily would be an individual bill in
and of itself.
REPRESENTATIVE SPOHNHOLZ addressed the Legal Services memo by
Mr. Dunmire. She observed that beginning on page 3 regarding
Section 62 of the EO, the memo describes that the authority to
the new Department of Family and Community Services to adopt
regulations is broader than what is currently in statute. She
further observed that on page 5 regarding Section 130 of the EO,
the memo describes the apparent removal of any reference to
"crisis stabilization" in statute. She requested Mr. Dunmire to
speak to these.
MR. DUNMIRE responded that Section 2 creates Chapter 6 in Title
47, which are the duties of the Department of Family and
Community Services. The language that is put in this section
comes from 47.05.010, he said, but differs. He related that the
current language in the statute tasks DHSS with administering
and regulating [adult] public assistance, the temporary cash
assistance program, and a few other programs. There are
explicit lists in the statute, he continued, that are replaced
in the new statute with the term "applicable assistance
programs." He said it appears to also give DFCS a broader
mandate to apply regulations by telling DFCS that it can do so
as necessary for the conduct of its business. He further
pointed out that there is a paragraph in AS 47.05.010, program
5, that currently declares that DHSS shall: "cooperate with the
federal government in matters of mutual concern pertaining to
adult public assistance, the Alaska temporary assistance
program, and other forms of public assistance." But, he said,
EO 119 would keep that within Health, while other public
assistance programs are transferred to DFCS.
REPRESENTATIVE SPOHNHOLZ reiterated her observation regarding
Section 130 and the removal of reference to "crisis
stabilization center," which she thinks the legislature recently
put into law. She asked whether it is created in another
section of the EO.
MR. DUNMIRE answered that Section 130 is the repealer section of
EO 119. He said this section repeals AS 47.32.900(5), which
defines "crisis stabilization center." He stated he was unable
to find any reason that that is repealed in this EO, and he
suspects that it might be a drafting error.
REPRESENTATIVE SPOHNHOLZ remarked that it is a substantial
drafting error.
4:02:52 PM
REPRESENTATIVE KURKA addressed Section 30 and the question of
reassigning of the authority to set fee schedules. He recalled
the commissioner stating that they would continue to reassign
these fees going to their appropriate place. He asked who or
what, such as the legislature, has the authority currently to
set those fee schedules.
MR. DUNMIRE replied he doesn't know who schedules those fees but
offered to get back to the committee with an answer.
4:04:02 PM
REPRESENTATIVE MCCARTY concurred with the question being asked
about Section 130 especially since [legislators] have been
looking at the Crisis Now program in the state. He said he
doesn't understand why the removal of "crisis stabilization
center" and whether it was or was not intentional. Regarding
the topic of fees, he said he is hearing there is a struggle to
be able to charge for some services, the Alaska Psychiatric
Institute (API) being an example. He asked whether shifting
things around for availing fee structures would solve these
challenges.
COMMISSIONER CRUM responded that regarding the API issue, those
would be billable services at normal rates for services and
would either go towards insurance or back towards Medicaid.
Regarding fees, he said fee schedules are generally in
regulation and there is a public notice process to change. Many
of the fees to the department that it administers are through a
regulatory process with substantive public input.
REPRESENTATIVE MCCARTY asked whether there is a situation that
services are unable to be charged and this would bring some
resolve to that.
COMMISSIONER CRUM answered yes, there are different services
that could possibly get billed. Those must be adapted, he said,
and go through the requisite process for the department to look
at.
REPRESENTATIVE MCCARTY inquired whether the current structure is
not allowing the ability to do that, but the EO would provide
the structure that would allow doing that.
COMMISSIONER CRUM replied:
There is charge master that needed to be updated at
API in order to put attention to third party billing,
plus the opening of the Chilkat Unit will bring more
Medicaid. But the structure will allow ... kind of
the leadership and policy team focus in order to make
sure that those changes can occur because it does
require quite a bit of time and effort while
simultaneously building up the foundation of API while
getting it to a fully functioning unit ... of
structure overall.
4:07:00 PM
CO-CHAIR SNYDER stated the committee is hearing that [EO 119] is
going to create a significant change and that some of it is
substantive and impermissible. It raises a lot of questions
that still need to be answered, she said, especially how it
relates to impact to the quality of care that Alaskans will
receive in the essential services being provided. While this
change may be warranted in the future, she continued, these
things need be done through a public and transparent process
with the opportunity to ask questions. She noted committee
members still have questions pertaining to the legal memo, and
the committee still hasn't seen some documents that it requested
last week, including information on the 139 positions that will
be cut and the addition of new upper administrative positions.
Co-Chair Snyder further noted the committee is looking for some
details on the stakeholder engagement that it has heard is
occurring, as well as a detailed plan on the bifurcating of
Alaska's largest department. She pointed out that the deadline
to act on EO 119 is in 15 days on 3/21/21 and added that the
timeline is what the focus is on and how quickly this change
would happen.
[CO-CHAIR SNYDER closed invited testimony.]
4:09:02 PM
CO-CHAIR SNYDER opened public testimony.
4:09:20 PM
JASON LESSARD stated he is testifying on behalf of himself but
the roles he has had in his community are relevant to his
perspective. He said he is the executive director of the
National Alliance on Mental Illness (NAMI) Anchorage, serves on
several boards and commissions relating to mental health, and
most notably is a member of the governing body at API.
MR. LESSARD testified he is not necessarily opposed to the split
proposed in the executive order but is vehemently opposed to the
manner in which it has played out. He asked that the
legislature slow the roll on this and require the due diligence
this kind of change to this particular department warrants. He
said that at some point DHSS touches just about every Alaskan's
life, most notably the most vulnerable.
MR. LESSARD stated that this could be a good idea and, if so, it
will continue to be a good idea in six months or a year.
Perhaps it would be an even a better idea if tempered by actual
stakeholder engagement, which this executive order has glaringly
and offensively lacked as seen by looking at all the concerns
raised by stakeholders in testimony. He stressed that this is
happening too fast and without an understanding of the impacts.
Given the pandemic, the EO being 106 pages, and the 60-day time
bomb before the EO becomes law, he charged that it feels more
akin to a hostage negotiation than to proactive and earnest
engagement. He related that in January [2021] the API governing
body requested an update on the split from DHSS but that the
35,000-foot elevator pitch allowed to the governing body was
hardly engagement. He asked why would the department not engage
API or the Anchorage Department of Health and [Social] Services
earlier in the executive order drop?
MR. LESSARD reminded the committee that this same administration
rushed headlong down the road to privatize API without doing its
homework. In reviewing that plan, the conclusions reached by
the API governing body did not match the assumptions of the
department. He said he is worried that things are proceeding in
a similar vein regarding EO 119. Change needs to be anchored in
proactive engagement and evidence, he emphasized, not just
driven by ideology and assumption. He urged the department to
show [the public] how this will help Alaskans with better
outcomes and to take the time to prove that it's a good idea.
4:12:47 PM
CO-CHAIR SNYDER stated that public testimony on EO 119 would be
continued on 3/9/21.
[EO 119 was held over.]
HB 76-EXTENDING COVID 19 DISASTER EMERGENCY
4:13:02 PM
CO-CHAIR SNYDER announced that the final 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." [Before the committee was the proposed
committee substitute (CS) for HB 76, Version 32-GH1011\B,
Dunmire, 3/3/21 ("Version B"), adopted as a work draft on
3/4/21.]
CO-CHAIR SNYDER opened invited testimony on HB 76, Version B.
4:13:23 PM
KEVIN BERRY, PhD, Professor, Department of Economics" University
of Alaska Anchorage (UAA), provided his invited testimony via a
PowerPoint presentation titled "Economic Impacts of COVID." He
began with slide 2, "Takeaways," and noted these takeaways fit
with what is becoming the consensus of the research literature
around pandemic events and economic growth. He said the first
takeaway is that COVID-19 is an unprecedented shock to the
economy. Simultaneously there is a health shock as well as a
negative impact on people's ability to live prosperous good
lives through the negative impacts of the pandemic on the
economy. The second takeaway, he stated, is that the economic
shock cannot end until COVID-19 is dealt with. For as long as
the infectious disease persists the shock to the economy will
continue as well. Masking, social distancing, and vaccination
drive down case numbers, helping the economy. He continued with
the third takeaway which is that policies that speed the end of
the pandemic and allow safe economic activity are pro-business,
pro-economic growth, pro-Alaska, and pro-U.S. These policies
include masks, social distancing, and even travel screening.
DR. BERRY spoke to slide 3, "Impact of Declaration Expiration."
He said some of the main impacts of the expiration of the
emergency declaration include the ability to require pretravel
testing rather than suggesting it. A large body of literature
indicates that requiring things leads to higher compliance than
does suggesting that people do things. He specified that the
expiration also potentially impacts the flexibility and the
speed in response as the ability is lost to have things like
emergency orders, other restrictions, and the ability to lift
different regulations in response to needs of business. He
credited Commissioner Crum and the administration for possibly
solving the problem of the $8 million in Supplemental Nutrition
Assistance Program (SNAP) funding that is at risk. Mr. Berry
stated that another impact of the expiration of the declaration
is the uncertainty for the healthcare sector. He stressed that
the most important impact of the expiration is the clear
communication of the risk of COVID-19 and that most Alaskans are
still susceptible to the disease, and therefore the possibility
of a third wave that could lead to the need for more blanket
restrictions that can slow the economy.
DR. BERRY noted that the graph on slide 4, "Total Employment in
Total Nonfarm," depicts the total employment in nonfarm sectors
in Alaska statewide [for the years 2018, 2019, and 2020]. He
further noted that the four graphs on slide 5 depict the total
employment in accommodation, food services and drinking, leisure
and hospitality, and retail trade in Anchorage [for 2018, 2019,
and 2020]. He said slides 4 and 5 highlight that there is a
large impact to employment in Alaska, particularly focused in
things that are thought of as the tourism sector, but these also
provide services to Alaskans. So, he continued, the pain of the
recession is not equal across everyone. He further noted that
in Alaska the job losses are also focused on those who are
between the ages 35 and 45, and between 25 and 35, particularly
amongst lower income workers, mostly in these sectors where
people are working face-to-face high-risk jobs in restaurants,
bars, and other locations.
4:17:20 PM
DR. BERRY displayed slide 6, "Total Employment in Health Care,"
and pointed out that the pain is felt everywhere. He related
that the employment level in the health care sectors is down to
that of 2018 following a steep drop early in the pandemic.
DR. BERRY moved to slide 7, "COVID-19 is the problem," and
discussed the driver of this trouble. He drew attention to the
two studies cited on the slide, one by Cronin and Evans, and the
other by Goolsbee and Syverson. He explained that both studies
basically make the point that when talking about the difference
between economic shutdowns and voluntary avoidance behavior,
voluntary stay at home behavior seems to explain a large
majority of the economic consequences of shutdown orders. This
means that even when the orders are lifted these sorts of
slowdowns remain, they are driven by the risk of the disease,
not by the orders themselves. He allowed it is a bit difficult
to look at shelter in place orders given Alaska hasn't been
under one for quite some time now and Anchorage, which has had
three different shutdowns, is not currently under one. People
are responding to the risk of the disease, and so long as the
disease persists economic malaise and less economic activity
will be seen. He advised that to heal the economy and be open
for business, COVID-19 must be dealt with first and the
administration needs the necessary tools to do so.
DR. BERRY turned to slide 8, "Reopening has limited effects,"
and related that the graphs are from an event study done by
Chetty et al. He said this study compared reopening in New
Mexico and Colorado, two relatively similar states. Colorado
opened first. He reported that there was roughly no difference
between the two states in consumer spending or employment,
although there was a relatively large difference in the number
of businesses open. This suggests that reopening early did not
help with economic activity, he continued, it simply meant that
businesses were open but didn't have an increase in customers.
So, he stated, some portion in the economic damage is due to
people avoiding getting sick and trying to protect themselves.
DR. BERRY explained that slide 9, "People respond to COVID
risk," summarizes the idea behind these previous studies. He
said this is an idea that is older than himself and older than
the studies he has pointed to. He related that the literature
itself got kicked off in about 2010 by a study done by Eli
Fenichel at the Yale School of Forestry that suggests that
basically the course of diseases and pandemics are often
influenced by self-protective behavior. He said a lot of the
economic cost of infectious disease comes from people trying to
avoid getting sick, whether to do the right thing for their
community, to protect their at-risk family members, protect
themselves, or because they've been told it's an at-risk
situation and they are doing their best to respond. So, to
mitigate the economic cost of the disease, which includes the
harmed human health and the economic harm, Mr. Berry advised
that the spread of the virus and voluntary avoidance behavior
must both be reduced by making it safer. Lockdowns and other
mandates need to be avoided and, for this, things like testing
matter as does the ability to identify variants and stop new
outbreaks by detecting people when they are coming into the
state. He said giving people good information about the risk in
their community is important. These resources for groups like
the Department of Health and Social Services (DHSS) and others
are vital. Mr. Berry pointed out that there is cost to people
staying home. For instance, if it is decided to depend solely
on self-protective behavior, it will come at the cost of lower
economic activity, decreased academic achievement from having
schools closed, and increased calls to domestic violence and
sexual assault organizations. So, allowing the pandemic to
continue has monetary cost to the economy as well as social ill
costs, he added. Targeted policies and resources for the state
government to reduce the risk of the disease will reduce the
social and economic ills and open the economy safely.
DR. BERRY pointed to the graph on slide 10, "Passenger Volumes
at Ted Stevens International Airport." He said he gathered this
data from Kevin Sullivan who scraped TSA data through roughly
June 2020, and he personally scraped the rest of the data from
Freedom of Information Act (FOIA) documents in 2020 and 2021 to
look at passenger volumes through this airport as sort of a
measure of the number of visitors to Alaska. He said two things
can be seen in the graph of the first four months of passenger
traffic over the last four years. The years 2018 and 2019 see a
consistent pattern in the number of visitors to the state. The
year 2020 sees a discreet drop-off around the timing of the
first case deemed confirmed in Alaska, the announcement of the
emergency order, the announcement of various shutdown orders,
and other things happening. So, Mr. Berry stated, it's hard to
blame the declining passenger traffic solely on the emergency
order. He further stated that in 2021 passenger volumes remain
lower. The data is unavailable post expiration of the emergency
order, he continued, but anecdotally it's unlikely Alaska will
see a dramatic increase in passenger load. What is being seen
is that people are making a choice to avoid traveling and avoid
coming to Alaska because of the risk of COVID-19. He pointed to
a study by Yan et al., published in "Nature Scientific Reports,"
that found people are making this risk tradeoff. He said the
best thing that can be done to heal the economy is to reduce the
prevalence of the disease.
4:24:18 PM
REPRESENTATIVE MCCARTY inquired whether the graphs on slide 5
representing employment in accommodation, food services and
drinking, leisure and hospitality, and retail trade are for
Anchorage only or for the state.
DR. BERRY replied that those graphs are focused on Anchorage.
REPRESENTATIVE MCCARTY drew attention to slide 7, "COVID-19 is
the problem." He asked if, while doing economic indicators, Dr.
Berry is seeing a standard deviation of a delay in knowing the
changes, and whether that delay is days or weeks. For example,
he said, things have been opened in Anchorage and restaurants
are filling up. He asked how long before that economic outcome
will be seen.
DR. BERRY confirmed there is potentially a delay. He explained
that potentially people are going to make calculations about the
risk that they face. Regarding the travel restrictions that he
previously mentioned, he said the requirement to be tested is a
signal to people coming to Alaska that the state is still taking
COVID-19 seriously. So, removing that potentially could make
people believe it's riskier to come here, although it's a burden
to travelers and could also disincentivize people. If talking
about a delay in people gaining new information as they change
their travel plans, he stated it is entirely possible it will
take a week or two to see the effect of policy. The problem is
that it's unlikely something new will be seen, he continued, so
people are still fairly educated on the risk of COVID-19 and
that is not significantly changing.
4:27:23 PM
REPRESENTATIVE MCCARTY addressed slide 10, "Passenger Volumes at
Ted Stevens International Airport." He inquired whether the
lower passenger numbers for 2021 could be attributed to Alaska
Airlines not allowing the planes to be filled and the Al-Can
Highway is closed.
DR. BERRY allowed it's possible that other things are impacting
this. He said this gets back to the main point that Alaska
Airlines is imposing these restrictions in response to COVID-19
and COVID-19 risk and is doing this above and beyond what the
state suggests as the company's response to try to make
passengers feel safe. He stated that one of the best
communication strategies he's seen so far is coming from the
governor reminding people that Alaska is open but also safe to
visit. By giving the governor additional resources to fight the
pandemic and make it safer to visit Alaska by speeding
vaccinations travel to Alaska can be encouraged by reducing
those risks and making people feel safer on fuller flights.
4:28:31 PM
REPRESENTATIVE KURKA shared that he and his wife own small
businesses in the Matanuska-Susitna (Mat-Su) Valley that serve
other small businesses "in terms of ... the accounting world,"
so they are in many networks. He stated that much of Dr.
Berry's presentation "doesn't pass the smell test." He allowed
there is some truth to the point that COVID-19 has brought on
fear and therefore less people going out and doing consumer
activities. But, he said, it wasn't COVID-19 that shut down
businesses it was the government. He asked whether Dr. Berry
has done a comparison of economic prosperity between businesses
in Anchorage where there has been continued shutdowns and those
in the Mat-Su, particularly restaurants. He related that he is
hearing about and seeing successful generationally owned
restaurants in Anchorage being shut down permanently but hasn't
seen that happening in the Mat-Su.
DR. BERRY responded that his presentation cites two nationwide
studies that compare, sort of, county to county based on the
timing of shutdown orders and other restrictions. He stated
that the Cronin and Evans study and the Goolsbee and Syverson
study, as well as others, demonstrate that the bulk of reduction
in traffic seems to be explained by the local case counts and
risk of COVID-19, not necessarily the timing of shutdowns.
Anecdotes are individual data points, he added, and it's often
better to look at the total dataset as widely as possible.
There is also the potential that many of the businesses in the
Mat-Su are relatively close and a lot of people commute between
the Mat-Su and Anchorage, so it can be hard to disentangle what
is happening between those two locations. He said it would be a
worthwhile study that he'd be happy to look at.
DR. BERRY continued his answer and explained that the nationwide
studies cited in his presentation might, for instance, look at
one county in Iowa and a county across the border in Illinois
where one faces a shutdown order, and the other doesn't. He
doesn't mean this to also sound like shutdown orders have no
impact at all, he said, it's just that they are also
simultaneously often occurring around the same time that COVID
cases are increasing. For instance, he continued, the Anchorage
shutdowns occurred in August when the summer wave was happening
and again in December when the second wave was happening, so
they are also timed to the highest risk periods to COVID-19. He
allowed Representative Kurka raises a valuable point that there
are some folks who are making risk calculations where they are
willing to participate in the economy regardless of local case
counts and what is going on but advised that what's overall
happening in the economy depends on everybody's choices. There
is some subset of the population that is very responsive to
risk, so mandates that are not lockdowns - like mask mandates
and testing - help encourage those people to feel safe and
return to their typical economic behavior. Dr. Berry agreed
that some businesses in the Mat-Su are potentially doing well
and said that could also be because some of the people in
Anchorage were making the risk calculation that they are
unafraid of COVID, or have decided that their family is unlikely
to be impacted, or they don't know anybody who is high risk, or
they have miscalculated their own risk, and may be driving to
the Mat-Su and increasing business there as well. So, it's
unclear if that is a strategy that is possible for the entire
state at once.
4:33:05 PM
NILS ANDREASSEN, Executive Director, Alaska Municipal League
(AML), noted AML's membership is comprised of Alaska's cities
and boroughs. He pointed out that in considering the extension
of the state's emergency declaration, it is three weeks past the
declaration's expiration. That's important, he said, because
it's reflective of the overall process that local governments
have experienced. He continued:
Over the course of the last year the experience that
local governments have had can best be described as
frustrating. For every state action or inaction 165
local councils, assemblies, have wrestled with what to
do in response or in place of. That's required
thousands of local elected officials and more than 100
administrators to become public health experts,
incident commanders, and targets. Together they have
dealt with hundreds of state and federal actions that
provide guidance without clarity, direction without
data, and an emergency declaration that hasn't been
firmly in place since November. That means since
October and every 30 days thereafter, our members in
AML have reached out to the governor and to
legislators to renew the declaration to ensure that
Alaska's communities have the resources they need to
respond to this pandemic. Alaska's local governments
have managed through this process and continue to do
so. This means that they have diverted a large amount
of their attention to disaster response and
management, to responding to the needs of their
residents and businesses, and to fill the gap where
the state was enacting at the local level.
The governor has been clear throughout, placing
emphasis on local control of COVID mitigation. This
has come up most prominently with respect to business
closures or limitations or requirements for face
coverings. So, let's be clear, those had nothing to
do with the state's emergency declaration and
everything to do with the transfer of responsibility
from the state to the local level to make decisions
that helped contribute to flattening the curve and
protecting our healthcare capacity. In a lot of ways
local leaders have borne the brunt of the public
backlash of these mitigation measures, but it's also
true that the public may conflate the disaster
declaration with these actions.
The loss of the declaration means that local
governments have been scrambling to fill holes created
in its absence. Many declarations were tied to the
state's and have either been renewed or now expired.
Many have had to reconsider their own travel,
quarantine, and testing restrictions when the state's
[restrictions] went from mandatory to optional. Many
are in the midst of operating testing or vaccination
clinics with questions about available resources,
training, and authorities. Some are now racing to
address spikes in cases. Many are looking at an
uncertain future, new strains, variants, supporting of
vulnerable residents, preparing for an economic
rebound, and preparing for the lack thereof.
Ultimately, it's this uncertainty that ends up most
challenging.
A state government that is responsive and capable at
the very least assists local governments in
stabilizing their current operating environment. In
fact, the emergency declaration just makes government
work better when it's needed most. That means that
while we, state and local officials charged with
public welfare, continue to try and respond to the
public health needs of our communities and to take
necessary actions that support economic recovery, the
declaration remains just a tool at our disposal. The
Alaska Disaster Act, which within HB 76 I believe is
just Sections 2 and 3, allows the state to allocate,
distribute, and manage scarce resources, including
vaccine and testing supplies, much of this in
cooperation with and at the request of local
governments; allows it to suspend regulations that may
prevent or impede the provision of health services or
COVID response, including many that businesses and
organizations have depended on to ensure continued
operations; allows DMVA [Department of Military and
Veterans Affairs] and DHSS [Department of Health and
Social Services] to work together within unified
command structure, which has met weekly or bi-weekly
with our members; and allows the state to coordinate
with FEMA [Federal Emergency Management Agency] on
non-congregate shelters, which is also intersected
with municipal assets.
There is a reason that the Alaska Disaster Act is in
place to allow the state to act quickly and
efficiently in response to a disaster. It's that
easy. Any delay to this simply erodes the partnership
that's in place between the state and local
governments, between the state and its healthcare
providers, and ultimately between the state and the
business community. If we want to be open for
business, local governments need a state whose
emergency powers are fully employed on behalf of
exactly that. Anything less places extreme pressure
on local officials, slows Alaska's economic rebound,
and places Alaskans' lives at risk.
Chair and committee members, what's perhaps most
disheartening is that I know my testimony today may
not result in a desired or quick outcome. Not because
of your action, but it's part of the situation where
we're behind in responding to this continuing disaster
and I've joined colleagues from all sectors in
advocating for the Disaster Declaration's extension.
At this point it isn't just COVID fatigue that I
struggle with, but it's having this conversation about
whether there is to be, or not, a disaster declaration
placed when we continue to need exactly that.
4:39:01 PM
KATI CAPOZZI, President & CEO, Alaska Chamber of Commerce, noted
the chamber was founded in 1953 and its mission is to advocate
for a healthy business environment in Alaska. She said the
chamber has over 700 members and represents businesses of all
sizes and histories from across the state. She expressed the
chamber's support for passage of HB 76.
MS. CAPOZZI said Alaska's businesses have suffered immensely
over the course of the COVID-19 pandemic, and one year into this
public health and economic crisis many are struggling to keep
their doors open. The business community has endured and is
beginning to see light at the end of the tunnel and is plotting
a course for recovery, she continued. Economic recovery,
however, hinges on (indisc.) COVID-19. The true economic impact
of the COVID-19 pandemic to Alaska is yet to be determined,
especially considering recent policy actions (indisc.) control
that effectively shut down the largest portion of Alaska's
tourism season for at least another season.
MS. CAPOZZI related that there is concrete data on job losses.
She specified that [according to the] Department of Labor there
were 44,000 fewer jobs during peak employment months in 2020
than there were in 2019. Virtually every industry in Alaska was
negatively impacted, she said, some far more significantly than
others. The oil and gas and hospitality industries were hardest
hit, each ending 2020 with nearly 30 percent fewer employees in
their workforce than the year prior.
MS. CAPOZZI stated it's never been clearer that healthy people
are the foundation of a healthy economy. Addressing public
health concerns contributes to Alaska's ability to recover, she
pointed out. While Alaska has had lower case counts and
hospitalizations and leads the nation in vaccinations per
capita, she stressed it's important to keep the tools in place
to allow for this positive trend. From the business community's
perspective, she continued, providing the state with the
appropriate authorities and tools to continue COVID-19 response
and recovery does not represent more restrictions and burdensome
mandates but quite the opposite.
MS. CAPOZZI noted that before the Emergency Declaration expired
in February the chamber had expressed concern that any lapse in
the state's ability to receive and expend healthcare resources
would immediately impede the progress made and add unacceptable
uncertainty to the state's collective recovery, from both health
and economic perspectives. She advised that without some of the
regulatory flexibility provisions provided within HB 76,
operations throughout the state and across many industries,
particularly the healthcare industry, are forced to do their
best to comply with confusing and unclear guidance. This
unnecessarily adds increased uncertainty to the business
community, she added.
MS. CAPOZZI concluded by emphasizing the need for action and
reiterating that the chamber supports passage of HB 76 or any
legislation that provides the state authority to effectively
address ongoing COVID-19 response and recovery efforts. She
stressed that Alaska's economic health is depending on it.
4:42:13 PM
REPRESENTATIVE MCCARTY stated he would like to see data showing
the differentiation between areas and businesses. He said COVID
is a real thing. He related that he has heard some businesses
have adapted and done well, some have adapted and stayed in
business, and some were not allowed to adapt and had to close
their doors. But, he added, he is also hearing the "Stockholm
Syndrome" where some businesses want to stay the way it's been
with COVID and not go back to the way it was before COVID. He
asked whether Ms. Capozzi has also been hearing that.
MS. CAPOZZI requested clarification regarding businesses wanting
to stay the way it is with COVID.
REPRESENTATIVE MCCARTY asked whether Ms. Capozzi is familiar
with the Stockholm Syndrome.
MS. CAPOZZI responded yes.
REPRESENTATIVE MCCARTY related that some restaurants were given
the privilege of drive-through pickup of alcohol, but now will
have to go back to the old way of doing things. He said
restaurants have done great in adapting and want to be able to
continue those adaptations. He inquired whether Ms. Capozzi has
heard of other examples about businesses wanting to stay under
the COVID structures that they've adapted.
MS. CAPOZZI answered that there have been some regulatory
rollbacks or pauses which allowed businesses to innovate and
adapt, and thrive in some cases, and the alcohol pickup is
certainly one of them. She pointed out that another small, but
important, piece that the Senate is currently considering is the
ability for nonprofits to hold their board meetings virtually,
which is important for all nonprofits and something the chamber
hopes to see permanently changed moving forward. She said she
has heard anecdotally of opportunities that have become
available throughout COVID and mostly have to do with businesses
that innovated and pivoted virtually overnight to be able to
thrive in this environment.
REPRESENTATIVE MCCARTY requested Ms. Capozzi to provide the
committee with information regarding the aforementioned.
MS. CAPOZZI agreed to do so.
4:45:59 PM
MICHELLE DEWITT, Executive Director, Bethel Community Services
Foundation (BCSF), noted BCSF is the entity designated by
statute that sponsors the Kuskokwim Ice Classic, a small and
highly localized ice classic, as opposed to the Nenana Ice
Classic with which people tend to be familiar. She stated the
foundation operates a very similar fundraising contest, visible
primarily in the Yukon-Kuskokwim (YK) Delta Region, where
customers guess the month, day, and time of breakup. The
foundation dedicates the net revenue to nonprofit organizations
that provide services in the community, most of which are youth
groups.
MS. DEWITT recounted that in pre-COVID times youth groups would
sell tickets in stores to earn money for their club or group.
But last year at the time ticket sales were about to begin BCSF
began to grasp the devastation of the pandemic. Realizing
tickets could not be safely sold in person, she said the
foundation pivoted to a phone sales strategy, which resulted in
a logistics nightmare for this fundraiser. She explained that
Ice Classic staff and the volunteer groups tried to staff the
phones, but the phones were easily and quickly overwhelmed at
peak times. The process relied on a very slow routine of taking
down the customer's name, contact information, their guess, and
details about which nonprofit group they wanted to support with
their purchase. The guess, she specified, must be 100 percent
accurate, and must be verified with the caller. With volunteers
receiving the information, the accurate recording of the guess
was out of the customer's hands and into a volunteer's hands.
But, she noted, this transaction didn't stop there.
MS. DEWITT explained that volunteers work remotely from their
homes for COVID-19 safety, with phones forwarded to different
people every few hours. Folks working the phones wrote guesses
as quickly as they could on the forms, she related, and then the
forms then had to be transferred to actual Ice Classic guesses.
All the guesses in the forms now located at homes of volunteers
throughout town had to be retrieved and physically sorted in
chronological order. After all this, as a method of validating
accuracy again, guesses are entered into a spreadsheet, she
further explained. So again, a volunteer had to receive a call
and complete a form, transfer the data to a ticket, sort the
ticket into the entire pool of tickets in chronological order,
and then enter guesses into a database. This was four layers of
work 6,000 times over. A reduction in sales of more than 20
percent was seen, she reported. Normally, between 7,500 and
10,000 guesses are received, but with the phone-only approach
about 6,000 were logged.
MS. DEWITT stated that now, in 2021, the foundation is about to
go into a similar position. A vaccine is here, many COVID-19
safety precautions and adaptations have been embraced, and the
foundation is moving into an era of decreasing members, she
said. But it's not yet safe or appropriate to return to in-
person sales for this sort of fundraiser. So, BCSF is staring
down this potentially cumbersome process and the language in the
bill offers substantial relief. She asked the committee to
support this language, which will allow this fundraiser and
undoubtedly many others around the state to continue in a safe
way online in the pandemic.
MS. DEWITT emphasized that the true benefit of this [proposed]
adaptation will be reaped by the groups the foundation serves,
which most recently included a youth dance company, the group
that offers swim passes and free swim lessons at the fitness
center, the pet rescue nonprofit, the student council, and the
local youth group Teens Acting Against Violence. She said that
groups like these have had nearly all their venues for raising
funds disappear in this year of COVID. An online adaptation
will provide them with the ability to raise funds for their
programs by using technology, she stated in conclusion.
4:50:07 PM
CO-CHAIR ZULKOSKY requested Ms. Dewitt to talk about why having
an online adaptation is worthwhile moving into 2021, and the
importance of being able to do this online versus phones.
MS. DEWITT replied that the online adaptation allows for
increased efficiencies with the fundraiser. By phone, she said,
it is a four-step process repeated over and over literally
thousands of times. Online keeps everyone safe, reduces the
significant stress, and keeps the accuracy in the hands of the
customer who can submit his or her own guess and not have to
rely on somebody at the receiving end to write down the guess
accurately. It is a huge benefit for the customer as well as
for the volunteers on the receiving end in terms of efficiency.
4:51:50 PM
THOMAS QUIMBY, MD, Vice President, Alaska Chapter of the
American College of Emergency Physicians, noted he is a full-
time practicing emergency physician. He said that to date
Alaska has weathered the COVID-19 pandemic relatively well and
there are indicators that the pandemic is winding down. The
number of vaccines administered thus far in Alaska is
encouraging and is seen as a critical step towards achieving a
degree of herd immunity. The chapter is optimistic about the
future, he added, and is hoping for a return to a semblance of
normality soon.
DR. QUIMBY cautioned that, despite the many positive indicators,
there remains considerable vulnerability to additional surges.
He noted that currently there are worrisome case counts in
Petersburg and the Mat-Su Valley. Repeatedly, a resurgence in
cases has been seen throughout the country and globe when
mitigation measures are relaxed. Even though vaccine rates
increase daily and there is thought to be a degree of naturally
acquired immunity, he said the data does not suggest that the
population has yet reached a degree of immunity that would
guarantee invulnerability to future surges. He related that his
hospital continues to see COVID related complaints as an average
of 30-40 percent of its daily emergency department volume. As
well, he advised, the threat of new, more infectious variants
remains to be fully understood.
DR. QUIMBY stated that there are significant practical concerns
with the lapse of the emergency disaster declaration. Broadly,
he explained, the declaration provides important flexibility in
resources for rapidly responding to the dynamics of the
pandemic. The situation can change rapidly, he pointed out.
For example, within a recent two-day period his hospital went
from zero COVID patients to thirteen, a significant and
concerning increase for a hospital with just sixteen intensive
care unit (ICU) beds. Specifically, he further explained, there
is concern about loss of access to a variety of federal
(indisc.) waivers, with many potential implications. This may
affect alternative care sites and there is much uncertainty now
regarding the legality of existing sites and whether they can
continue to operate. The Lake Otis Testing Center has shut
down, he continued. It is known that testing is a critical
component of managing the pandemic to take intermediate steps
before healthcare systems become completely overwhelmed
necessitating shutdowns. He said the Alaska Chapter is
concerned about other existing sites and whether they can
continue to operate. With the lapse of the declaration,
patients have lost access to tele-health providers due to
concerns about liability.
DR. QUIMBY stated that his organization believes a bill to
permanently allow non-Alaska state license tele-health providers
is the wrong answer. He specified that an emergency order
extending access temporarily allows Alaska to craft a more
nuanced permanent bill that can serve Alaskans in the future.
He further noted that travel related testing has been severely
curtailed. He pointed out that this has been an important tool
for many rural communities with limited healthcare services to
prevent outbreaks. He advised that mandatory airport testing
will help protect Alaskans, should be in place until vaccination
is more widespread, and allows for detection control of COVID-19
variant strains.
DR. QUIMBY further related that some [case management] facility
regulations have also been waived in the meantime that allow
placement for personal protective equipment (PPE) supplies,
temporary walls and barriers, and other modifications to
facilities necessitated by COVID related protocols. He stressed
that the Alaska Chapter has concerns for potential misuse of
accessing supplies from the state and national stockpiles, which
include PPE such as masks, gloves, gowns, and powered air
purifying respirators (PAPRs); and essential medical equipment
such as ventilators, high-flow nasal canula devices, and testing
supplies. He shared that at one point during the November
[2020] surge his hospital was down to only one or two high-flow
nasal canula devices available, none were available on the
commercial market. His hospital was able to quickly get 15 from
the state but it's uncertain whether his hospital would be able
to do that in the future. He pointed out that during much of
the pandemic these items have been unreliably available on the
private market and the ability to get them quickly from the
state has made all the difference during surges.
DR. QUIMBY advised that there is also increased complexity and
difficulty with a variety of procurement issues, such as lengthy
standardized contract processes that prohibit rapid hiring for
vaccine distribution, testing, and delivery of health care as
needed. He stated there is concern for communications between
agencies and facilities given the loss of the Incident Command
System (ICS). Also, he said, potential messaging to the public
of the need for personal caution and responsibility in
protecting the community has been reduced. This would be a
great mistake, Dr. Quimby counseled, especially with the rapidly
improving situation. To date, countless examples of large
surges have been seen when communities, states, and countries
have relaxed mitigation measures, such as physical distancing,
indoor gathering, and masking, prior to widespread vaccination.
These surges invariably tax the healthcare system's capacity
which necessitates shutdowns that have many negative
consequences such as harming the economy, restricting liberties,
and affecting mental health.
DR. QUIMBY allowed there are many promising indicators that the
end of the pandemic draws near but cautioned that "we are not
there yet." While dropping case counts is very encouraging and
the desire to send the public positive messaging is appreciated,
he continued, failure to extend the emergency declaration has
many negative consequences for those working in healthcare and
still very much involved in managing the pandemic. He related
that, most of all, repeal of the declaration has created
considerable confusion and created uncertainty in addition to
loss of access to important tools for combatting the pandemic.
He pointed out that, overall, there is no apparent financial or
other significant negative consequences to continuing the
declaration for the immediate future. He further noted that
alternative solutions through patchwork legislation thus far did
not thoroughly address the issues created by repeal of the
declaration and had many potential unintended consequences. He
said the Alaska Chapter of the American College of Emergency
Physicians therefore respectfully requests that the committee
renew the disaster declaration.
4:58:47 PM
REPRESENTATIVE MCCARTY, regarding the recent COVID surge in the
Mat-Su Valley mentioned by Dr. Quimby, inquired about the
severity of these COVID cases compared to the past.
DR. QUIMBY replied that current cases are not looking like the
November surge. He said cases rapidly climbed several weeks ago
and have started to drop off some. Part of his concern is that
a significant outbreak among younger and healthier people is
being seen. There was a school outbreak and many of those
people are showing up in the emergency department, but they
aren't requiring hospitalization consistent with what has been
seen other places. The concern, he stated, is that if this
spills over into the more vulnerable population another large
surge could be seen. He said it is manageable at this time but
could change very quickly as mentioned in his testimony.
5:00:03 PM
CO-CHAIR SNYDER opened public testimony on Version B, the
proposed CS for HB 76, then closed it after ascertaining no one
from the public wished to testify. She said public testimony
would be reopened at the bill's next hearing on 3/9/21.
CO-CHAIR SNYDER announced that HB 76 was held over.
5:01:47 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Committee meeting was adjourned at
5:02 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| EO 119, Legislative Legal Memo, 3.6.2021.pdf |
HHSS 3/6/2021 3:00:00 PM |
EO 119 |
| HB 76; Invited Testimony, Prof. Berry - UAA Econ, 3.6.2021.pptx |
HHSS 3/6/2021 3:00:00 PM |
HB 76 |
| HB 76 Sectional Analysis Version 32 GH1011 A.pdf |
HHSS 3/2/2021 3:00:00 PM HHSS 3/6/2021 3:00:00 PM |
HB 76 |
| HB 76 Transmittal Letter.pdf |
HHSS 3/2/2021 3:00:00 PM HHSS 3/6/2021 3:00:00 PM |
HB 76 |
| HB 76 Version 32 GH 1011 A.pdf |
HHSS 3/2/2021 3:00:00 PM HHSS 3/6/2021 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 |
| 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 |
| HSCR - EO 119.pdf |
HHSS 3/6/2021 3:00:00 PM |
EO 119 |
| ASHNHA Letter of Support for HB 76 (Final).pdf |
HHSS 3/6/2021 3:00:00 PM |
HB 76 |
| Facing Foster Care Alaska HSS Testimony on EO 119.pdf |
HHSS 3/6/2021 3:00:00 PM |
EO 119 |
| FFC Alaska - Preventing Early Departures Among the Child Welfare Workforce.pdf |
HHSS 3/6/2021 3:00:00 PM |
EO 119 |
| HSCR - EO 119.pdf |
HHSS 3/6/2021 3:00:00 PM |
EO 119 |
| LAW HOUSE HSS memo.final 2.25.21.pdf |
HHSS 3/6/2021 3:00:00 PM |
EO 119 |
| ANHB to Commissioner Crum re. DHSS Reorganization - Final.pdf |
HHSS 3/6/2021 3:00:00 PM |
EO 119 |
| Alaska Healthcare Transformation Letter - EO 119.pdf |
HHSS 3/6/2021 3:00:00 PM |
EO 119 |
| DHSS_Law EO 119 Sectional Analysis.pdf |
HHSS 3/6/2021 3:00:00 PM |
EO 119 |
| EO 119 FULL.pdf |
HHSS 3/6/2021 3:00:00 PM |
EO 119 |
| FFC Alaska - 2020 HB 151 Report to the Legislature.pdf |
HHSS 3/6/2021 3:00:00 PM |
|
| FFC Alaska - Caseload briefing paper Multi-page NCWWI.pdf |
HHSS 3/6/2021 3:00:00 PM |
EO 119 |
| FFC Alaska - NCWWI Caseload-Workload 2011 One Pager.pdf |
HHSS 3/6/2021 3:00:00 PM |
EO 119 |
| House HSS Response - EO 119 - Cover Letter and Attachments.pdf |
HHSS 3/6/2021 3:00:00 PM |
EO 119 |