Legislature(1997 - 1998)
02/18/1997 03:08 PM Senate HES
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* first hearing in first committee of referral
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JOINT MEETING
HOUSE HEALTH, EDUCATION AND SOCIAL
SERVICES STANDING COMMITTEE
SENATE HEALTH, EDUCATION AND SOCIAL
SERVICES STANDING COMMITTEE
February 18, 1997
3:08 p.m.
HOUSE MEMBERS PRESENT
Representative Con Bunde, Chairman
Representative Joe Green, Vice Chairman
Representative Brian Porter
Representative Fred Dyson
Representative J. Allen Kemplen
Representative Tom Brice
HOUSE MEMBERS ABSENT
Representative Al Vezey
OTHER HOUSE MEMBERS PRESENT
Representative Reggie Joule
SENATE MEMBERS PRESENT
Senator Gary Wilken, Chairman
Senator Loren Leman, Vice Chairman
Senator Jerry Ward
SENATE MEMBERS ABSENT
Senator Johnny Ellis
Senator Lyda Green
COMMITTEE CALENDAR
ALL NATIVE HEALTH BOARD: LEGISLATIVE PRIORITIES
(* First public hearing)
PREVIOUS ACTION
No previous action to record
WITNESS REGISTER
LINCOLN BEAN, Chairman
Alaska Native Health Board;
Chairman, Southeast Alaska Regional Health Consortium
P.O. Box 318
Kake, Alaska 99830
Telephone: (907) 785-3283
POSITION STATEMENT: Provided information on Alaska Native Health
Board programs.
PAUL MANUMIK, Chairman
Yukon-Kuskokwim Health Corporation
P.O. Box 44
Sheldon Point, Alaska 99666
Telephone: (907) 498-4215
POSITION STATEMENT: Provided information on Alaska Native Health
Board programs.
ANNE WALKER, Executive Director
Alaska Native Health Board
4201 Tudor Centre Drive, Suite 105
Anchorage, Alaska 99508
Telephone: (907) 562-6006
POSITION STATEMENT: Provided information on Alaska Native Health
Board programs.
ANDREW JIMMIE, President
Tanana Chiefs Regional Council;
Member, Alaska Native Health Board
4201 Tudor Centre Drive, Suite 105
Anchorage, Alaska 99508
Telephone: (907) 562-6006
POSITION STATEMENT: Provided information on Alaska Native Health
Board programs.
LARRY IVANOFF, Chairman
Norton Sound Health Corporation;
Member, Alaska Native Health Board
4201 Tudor Centre Drive, Suite 105
Anchorage, Alaska 99508
Telephone: (907) 562-6006
POSITION STATEMENT: Provided information on Alaska Native Health
Board programs.
PAUL SHERRY, Deputy Director
Alaska Native Health Board
4201 Tudor Centre Drive, Suite 105
Anchorage, Alaska 99508
Telephone: (907) 562-6006
POSITION STATEMENT: Provided information on Alaska Native Health
Board programs.
DONALD NIELSON, Vice Chairman
Bristol Area Health Corporation;
Member, Alaska Native Health Board
4201 Tudor Centre Drive, Suite 105
Anchorage, Alaska 99508
Telephone: (907) 562-6006
POSITION STATEMENT: Provided information on Alaska Native Health
Board programs.
BEN ATORUK, Representative
Manilaq;
Member, Alaska Native Health Board
4201 Tudor Centre Drive, Suite 105
Anchorage, Alaska 99508
Telephone: (907) 562-6006
POSITION STATEMENT: Provided information on Alaska Native Health
Board programs.
ACTION NARRATIVE
TAPE 97-11, SIDE A
Number 0001
CHAIRMAN CON BUNDE called the joint meeting of the House/Senate
Health, Education and Social Services Standing Committees to order
at 3:08 p.m. Members present at the call to order were
Representatives Bunde, Green, Porter, Dyson, Kemplen and Brice and
Senators Wilken, Leman and Ward. Members absent were
Representative Vezey and Senators Green and Ellis.
ALL NATIVE HEALTH BOARD: LEGISLATIVE PRIORITIES
Number 0095
LINCOLN BEAN, Chairman, Alaska Native Health Board; and Chairman,
Southeast Alaska Regional Health Consortium, introduced the
speakers and the areas they represent.
PAUL MANUMIK, Chairman, Yukon-Kuskokwim Health Corporation,
stated that the first priority is village water and sanitation and
read the following statement into the record:
"A. Rural Village Water and Sanitation Facilities Construction.
"The Alaska Native Health Board has consistently considered safe
drinking water and adequate sanitation to be one of its highest
working priorities. Sustained commitments from both federal and
state sources are necessary to eliminate public health problems
resulting from poor sanitation conditions in rural Alaska villages.
The Indian Health Service estimates that total cost of constructing
piped water and sewer services in all rural communities at nearly
$1 billion.
"The Alaska Native Health Board has worked aggressively with the
federal government to increase appropriations for rural Alaska
water and sanitation through the Indian Health Service, the
Environmental Protection Agency, the Department of Agriculture and
the Department of Housing and Urban Development.
"Previous legislatures have demonstrated their commitment to
providing state contributions through appropriations for community
water and sanitation facility construction: FY1993, $24 million,
FY1994, $26.5 million, FY1995, $21.7 million, FY1996, $21.5
million, FY1997,$19.3 million. The Alaska Native Health Board
acknowledges these contributions.
"Over the past year, the Alaska Native Health Board and our Rural
Alaska Sanitation Coalition have participated in the deliberations
of the Governor's Council on Rural Sanitation.
"The Alaska Native Health Board urges the Alaska State legislature
to adopt the recommendation of the Governor's Council on Rural
Sanitation, and appropriate $25 million to the ADEC (Alaska
Department of Environmental Conservation) Village Safe Water
program for rural water and sanitation project construction in the
FY1998 capital budget.
"B. Rural Water and Sanitation Facility Operations and Maintenance.
"Lack of operations and maintenance resources for proper management
of sanitation facilities in rural Alaska is a critical issue that
must be addressed."
Number 0476
MR. MANUMIK stressed that rural sanitation is needed because it is
affecting the health of the villages.
Number 0525
SENATOR LOREN LEMAN, referred to the recommendation that the
legislature appropriate $25 million and stated that is consistent
with what the legislature has been doing in years past with a
federal government match of $25 million to $30 million. He asked
if the federal government match was going to be continued.
Number 0592
ANNE WALKER, Executive Director, Alaska Native Health Board,
responded that the board is pursuing the federal government's
match. She stated that the board was successful in having
appropriations language added to the clean water bill in order to
eliminate having to ask for money each year. She stated that both
Senators in the congressional delegation will be requesting upwards
to $30 million this year.
Number 0639
SENATOR LEMAN stated that it is likely that the legislature will be
able to participate in this as part of the capital expenditures if
there is something to match. He stated that with the legislature's
limited capital budget we are almost totally focusing on matches.
Number 0668
MS. WALKER stated that in the booklet, provided to the committee,
"Alaska Native Health Board State Legislative Priorities - Fiscal
Year 1998", under the section of water and sanitation there is a
request for a match from the Environmental Protection Agency.
Number 0682
ANDREW JIMMIE, President, Tanana Chiefs Regional Council; and
Member, Alaska Native Health Board, stated that the Alaska Native
Health Board strongly urges the Alaska State Legislature to
appropriate sufficient funds in the FY1998 operating budget to the
Department of Environmental Conservation for the support of 12
remote maintenance worker positions. He stated that this is
important to villages, without these positions the villages do not
have the trained people or the money to train people to fix the
problems that occur. He continued that there needs to be
sufficient funds for the Department of Community and Regional
Affairs to increase the number of rural utility business advisors,
for the development of utility management materials and for
development of "plain English water quality regulations." He
stated that the Alaska Native Health Board urges the legislature to
approve the recommendation of the Governor's Council on Rural
Sanitation and provide a $500,000 match in the FY1998 capital
budget to support the Alaska Native Health Board Operation and
Maintenance Support Demonstration Project. He stated the money
goes directly to the villages to help maintain their systems.
Number 0945
LARRY IVANOFF, Chairman, Norton Sound Health Corporation; and
Member, Alaska Native Health Board, stated that he would address
the water and sanitation services for all village health clinics.
He read the following statement into the record: "The Alaska
Native Health Board's vision is that by the year 2002 every village
health clinic in rural Alaska will have piped water and sewage
disposal. The state of Alaska has shared the commitment and in
FY1993 and FY1994, appropriated $500,000 each year for the hook-up
of village clinics to community sanitation systems. No funds were
appropriated in the FY1995 and FY1996 capital budget.
"$325,000 was appropriated in the FY1997 capital budget. These
funds have been obligated through a project agreement with the
Indian Health Service to fund clinic hook-ups in seven villages
(Manakotak, South Naknek, Koyukuk, Rampart, Healy Lake, Venetie and
Newtok). Some of these will be connected in the summer 1997;
others are in the planning design stage.
"However, at least twenty five more villages, excuse me, let's make
that twenty six because Bristol Bay just told me to add Clarks
Point on the list of villages... The average cost of hook-ups is
approximately $50,000 per community for a total unmet need of
approximately $1.2 million.
"The Alaska Native Health Board urges the Alaska State Legislature
to appropriate a minimum of $325,000 in the FY1998 capital budget
to the Alaska Department of Environmental Conservation to ensure
that additional village health clinics are connected to water and
sanitation systems."
Number 1045
MR. BEAN stated that last year he addressed the Alaska Federation
of Natives on the tobacco tax and the Alaska Native Health Board
was the first advocate to present this proposal to the legislature.
He stated that Alaska has one of the highest smoking prevalence
rates in the United States as tobacco kills more Alaskans than
AIDS, aircraft crashes, alcohol, falls, firearms and motor vehicle
crashes. He continued that 20 percent of all deaths in Alaska
between 1992 and 1994 were due to smoking. He asserted that a
great concern of the board is the tobacco use by Alaskan youths.
21 percent of Alaskan high school students are frequent smokers and
44 percent of Alaskan Native high school students are frequent
smokers. He advised that one in three will eventually die from
smoking.
MR. BEAN stated that the Alaska Department of Health and Social
Services estimated that tobacco use costs Alaska's economy over $96
million each year in direct medical care costs. He continued that
increasing tobacco tax reduces tobacco use and asserted that the
board wishes to stay with a dollar tax, nothing more or less.
He predicted that lives that would be saved if this tax reduced
smoking.
Number 1181
MR. BEAN stated that there are a lot of arguments on where the
Native community stands on the issue of selling tobacco. He
asserted that the Alaska Native Health Board rejects the argument
being offered that tribal governments will undermine this
legislation through the establishment of tax-free smoke shops. He
stated that tribal tax-exempt sales can only be made to their own
tribal members. He continued that the majority of Alaskan Natives,
along with the majority of Alaskans, support the proposed tax
increases and are concerned about the increased rates of cancer and
other diseases caused by tobacco.
MR. BEAN declared that the Alaska Native Health Board joins with
the American Cancer Society, the American Heart Association and the
American Lung Association in encouraging this Alaska State
Legislature to approve the tobacco excise tax of at least $1.00 per
pack on cigarettes and up to 100 percent of the wholesale price on
other tobacco products.
Number 1235
CHAIRMAN BUNDE asked if the Alaska Federation of Natives has taken
a position on the tobacco tax.
Number 1242
MR. BEAN responded that he had alone addressed the federation as an
entire body to let them know where the board stood on the issue.
Number 1264
REPRESENTATIVE FRED DYSON stated that many grade-school-age
children use smokeless tobacco in rural Alaska and asked if Mr.
Bean found this to be true.
Number 1282
MR. BEAN responded that he has heard that as well and referred the
question to Ms. Walker.
Number 1290
MS. WALKER stated that a group of dental assistants and hygienists
conducted a study in four rural Alaskan villages, and the outcome
was that 25 percent of the students in lower grades where using
smokeless tobacco and by the time they reached high school, they
had converted to cigarettes. She stated that the students were
already addicted to tobacco by the time they reached junior high
School.
Number 1329
REPRESENTATIVE DYSON asked if parents were able to deal with this
issue.
Number 1336
MS. WALKER stated that the study did not look at how the parents
interfaced with the children, it was a dental study.
Number 1346
REPRESENTATIVE DYSON referred to the Alaska Native Health Board,
State Legislative Priorities booklet and asked if it was a fairly
inclusive list of issues that the board was concerned about.
Number 1360
MR. BEAN replied yes.
Number 1365
REPRESENTATIVE DYSON stated that he noticed there was nothing in
the booklet regarding Fetal Alcohol Syndrome (FAS) or Fetal Alcohol
Effects (FAE) and asked why that was.
Number 1370
MS. WALKER referred to the page entitled Alaska Native Health Board
Vision for 2002 and the statement "To be sober and drug free is a
Native cultural value" and stated that it goes further than
addressing children with (FAS) or (FAE). She said, "We are working
very hard currently addressing that as a treatment issue but what
we want to do is take it farther than that. We want to make it
part of our lives."
Number 1406
REPRESENTATIVE DYSON asked if child abuse was a concern of the
board.
Number 1414
MS. WALKER replied that it is. She stated this board's vision list
was developed in 1991, two years ago the board revisited the top
health priorities and child abuse is on that list and it is a
concern.
Number 1435
REPRESENTATIVE DYSON stated that he appreciated what the board is
doing. He stated that to him those two issues are of monumental
importance and what the board is talking about in the booklet is in
regards to more programs and more money in the midst of epidemic
problems for children.
Number 1463
MS. WALKER referred Representative Dyson to the statement in the
board's vision, "Each region has Native operated child protection
services." She informed that the villages have been putting
together programs in regards to child abuse.
Number 1499
REPRESENTATIVE DYSON asked if there were any programs on
incarcerating perpetrators.
Number 1501
MS. WALKER responded that the board is not working on it as an
issue but if it was taken up the board would endorse it.
Number 1519
REPRESENTATIVE JOE GREEN asked why the percentage of Native high
school smokers is more than double that of non-Native high school
smokers.
Number 1534
MS. WALKER suggested that it could be a result of earlier
addiction, Native children are generally getting addicted at a much
earlier age.
Number 1549
REPRESENTATIVE GREEN stated that it has been suggested that kids
are smoking and getting into trouble because of a "boredom
syndrome", a lack of chores and duties required of today's youth
and asked if that is also the cause in the villages.
Number 1578
MS. WALKER stated that she could not generalize that to be true but
provided that in her own family there appears to be an effect of
the "boredom syndrome" as attention is directed towards television,
peer pressure, and things that are not required to support the
family structure, such as chores.
Number 1605
REPRESENTATIVE GREEN stated that when his children where in high
school there was a cyclic attitude towards smoking, it was cool and
then it wasn't cool. He stated that education, in regards to the
effects of smoking did have an influence. He asked if this is the
same in the villages and if the 44 percent statistic is the high.
Number 1629
MS. WALKER responded that the percentage has been increasing. She
stated that the leading cause of death for Alaska Native women is
lung cancer which is directly related to smoking. She stated that
the factors could be lack of education or peer pressure that are
causing the Native high schoolers to smoke at rates that she has
never seen before.
Number 1693
REPRESENTATIVE GREEN stated that it has been said, if there was $1
tax on cigarettes it would not make a difference because it costs
$10 to go to the movies. He advised the peer pressure, idle time
and the availability of money are factors that cause kids to smoke.
Number 1741
MS. WALKER stated that if a child is already addicted the chances
are the child will do anything to get cigarettes, but if one is a
junior high school student on an allowance and the choice is to
either go to the movies, buy a new compact disc or buy cigarettes
that have increased in price, the chance is that the child will buy
the other things first.
REPRESENTATIVE GREEN announced his joy to Ms. Walker's remark.
Number 1767
SENATOR GARY WILKEN thanked both Mr. Green and Ms. Walker for their
work on the tobacco tax. He stated that a woman from the Alaska
Native Health Board testified on the Senate side as to the board's
serious position in regards to the tobacco tax.
Number 1775
CHAIRMAN BUNDE stated that in the hearings on the tobacco tax,
representatives from the tobacco industry testified that a tax was
a cruel thing to do to poor people, particularly the rural and
Native people because they have less disposable income, creating an
unfair victimization. He asked for Ms. Walker's response.
Number 1822
MS. WALKER replied that if poor people want to play the victim role
when it comes to buying tobacco or any other drug that they are
addicted to, they will. She stated that this argument is meant to
raise the emotions of those people who are making decisions on
whether to tax a product that will stop young people from accessing
it easily and cheaply. She stated that she did not think it was a
good argument.
Number 1858
MR. BEAN stated that he also wanted to acknowledge that there are
some kids who are focusing on the positive and on health care
issues in order to improve their lives.
Number 1890
REPRESENTATIVE DYSON stated that he has heard two different studies
in relation to AIDS; one said there are 60 cases of HIV positive
people in Alaska and the other indicated 480 cases. He asked what
the board's understanding was.
MS. WALKER stated that she did not know the answer to that as AIDS
is not a reportable disease in Alaska.
Number 1901
PAUL SHERRY, Deputy Director, Alaska Native Health Board, stated
that he did not have the exact number but believed it is in the 350
to 400 range of confirmed tested HIV positive cases in Alaska. He
stated that Alaska Natives fall in to 16 percent of those cases.
He stated that it is a cumulative measure of those people since the
start of the count and about half of those people have since died.
He noted that since it is not a reportable disease it is clear that
there are more HIV positive residents than that number indicates.
Number 1963
REPRESENTATIVE GREEN stated that it is a little less then one per
thousand residents and asked how it compares to other fairly rural
states.
Number 1975
MR. SHERRY replied that Alaska is a low prevalent state. He stated
that the Alaska Native Health Board has spent six years in HIV
prevention because of the desire to keep Alaska a low prevalent
state. He continued that it is an escalating rate and it is not a
situation that is going to taper off or go away.
Number 2012
REPRESENTATIVE DYSON asked if Mr. Sherry has identified the
predominant means of transmission of the disease in rural Alaska.
Number 2020
MR. SHERRY replied that it is his understanding that it is the same
conditions that apply anywhere else; unsafe sex and needle
exchange.
Number 2029
REPRESENTATIVE DYSON asked "but not amongst the homosexual
community, like it is in ...
Number 2033
MR. SHERRY replied "As much as any where else."
Number 2044
DONALD NIELSON, Vice Chairman, Bristol Area Health Corporation; and
Member, Alaska Native Health Board, stated that he would talk about
Title 47 reimbursement issue. He stated that the underlying
problem of Title 47 is that is an unfunded mandate from the
legislature to the local governments. He stated that the financial
support is mainly through grants for public safety services. He
referred to the Alaska Native Health Board's report for examples of
what the unfunded mandate has created. He stated that one aspect
is local governments trying to not accept the liabilities that come
with the program and at the same time creating financial hardship
for the hospitals and clinics that need to administer the health
screening. He referred to the villages' Safety Officers Program
and stated that Title 47 applies to every community, equally across
the state; unfortunately every community does not have a hospital
or a clinic with certified health providers. These communities
have health aides, who are not qualified to screen. He advised
that the liability is that the state contractors could be
responsible for any deaths that may occur due to alcohol. He
questioned if a tax to increase funding for the communities is the
answer. He stated that there needs to be a collective effort to
ease the financial burden on those that have to provide the care.
Number 2181
REPRESENTATIVE BUNDE stated that the legislature is aware of
unfunded mandates.
Number 2190
REPRESENTATIVE BRIAN PORTER stated that it is indirectly a federal
mandate that the legislature is stuck with as well.
Number 2195
MR. NIELSON suggested that maybe there would be a way to solve the
problem if everyone worked together.
Number 2206
BEN ATORUK, Representative, Manilaq; and Member, Alaska Native
Health Board, said that the Alaska Native Health Board is endorsing
the construction of the Alaska Public Health Laboratory in
Anchorage.
Number 2252
CHAIRMAN BUNDE stated that the committee had heard that bill and
passed it on. He felt hopeful that it would come to pass.
Number 2254
MR. BEAN thanked that committee for hearing the board's statement
and stated that the board represents 100,000 people across the
state of Alaska.
Number 2275
REPRESENTATIVE TOM BRICE asked for some information regarding the
board's vision statement that "Cities and villages have the ability
to support elderly, disabled, mentally ill and terminally ill
patients." He also asked if the board thinks appropriate funds
have been taken from the closing of the Harborview Center in Valdez
and put into the communities in order for the communities to
provide those services.
Number 2308
MS. WALKER replied that when the board issued that priority the
major focus was "the project choice" which opened an avenue to
people so that they did not have to become institutionalized. She
stated that in the past rural Alaskans who where unable to care for
themselves were sent away. She continued that the question is
whether the state of Alaska will be committed in its appropriations
in changing the way the mental health delivery system is being
managed. Whether there will be a centralized institution or an
adequately funded community mental health centers, for short term
treatment.
97-11, SIDE B
Number 0001
MS. WALKER cited an example concerning Bartlett Regional Hospital.
Number 0012
REPRESENTATIVE BRICE replied that there was quite a bit of argument
on whether the state would pay the amount of money that Bartlett
Regional Hospital was requesting. He stated that the state has
been less than appropriate in getting the money out. He continued
that his concern is with the support that is available in the rural
villages to provide early intervention programs for infants with
severe developmental disabilities so that they can grow up to live
much more independently. He asked what the board was doing in this
area.
Number 0054
MS. WALKER replied that the major rural hub communities have a
community mental health system with workers who identify the
children who could benefit from treatment. She pointed out that
she was not sure if the program was adequately funded or not. She
questioned if the new Mental Health Trust Land's money will
provide enough of an increase in funds to support a good
infrastructure for a community mental health system.
Number 0090
CHAIRMAN BUNDE encouraged Ms. Walker to discuss the tobacco tax
issue with the Alaska Federation of Natives and asked for them to
voice an opinion on the issue. He thanked the board for this
briefing.
ADJOURNMENT
Number 0130
CHAIRMAN BUNDE adjourned the joint meeting of the House/Senate
Health, Education and Social Services Committees at 4:00 p.m.
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