Legislature(2009 - 2010)BUTROVICH 205
02/03/2010 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| United Way, 211 Project | |
| Alaska Health Care Commission Report | |
| SB172 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 172 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
JOINT MEETING
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 3, 2010
1:33 p.m.
MEMBERS PRESENT
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Senator Bettye Davis, Chair
Senator Joe Paskvan, Vice Chair
Senator Johnny Ellis
Senator Joe Thomas
Senator Fred Dyson
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Representative Wes Keller, Co-Chair
Representative Tammie T. Wilson, Vice Chair
Representative Sharon Cissna
MEMBERS ABSENT
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
All members present
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Representative Bob Herron, Co-Chair
Representative Bob Lynn
Representative Paul Seaton
Representative Lindsey Holmes
COMMITTEE CALENDAR
Presentation: United Way, 211 Project; Alaska Health Care
Commission Report
SENATE BILL NO. 172
"An Act establishing the Alaska Health Care Commission in the
Department of Health and Social Services; and providing for an
effective date."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 172
SHORT TITLE: ALASKA HEALTH CARE COMMISSION
SPONSOR(s): SENATOR(s) OLSON
03/27/09 (S) READ THE FIRST TIME - REFERRALS
03/27/09 (S) HSS, FIN
04/17/09 (S) HSS AT 1:30 PM BUTROVICH 205
04/17/09 (S) Scheduled But Not Heard
04/18/09 (S) HSS AT 10:00 AM BUTROVICH 205
04/18/09 (S) -- MEETING CANCELED --
02/03/10 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
SUE BROGAN and KAREN BITZER
Alaska 2-1-1
Anchorage, AK
POSITION STATEMENT: Presented information about Alaska 2-1-1.
WARD HURLBURT M.D., MPH, Chief Medical Officer
Department of Health and Social Services
Division of Public Health
Chairman, Alaska Health Care Commission
Anchorage, AK
POSITION STATEMENT: Presented information regarding the work of
the Alaska Health Care Commission. Supported SB 172.
DEBORAH ERICKSON, Executive Director
Alaska Health Care Commission
Anchorage, AK
POSITION STATEMENT: Presented the Alaska Health Care Commission
2009 Report. Supported SB 172.
ELLEN ADLAM, Board Member
Peninsula Community Health Services
Soldotna, AK
POSITION STATEMENT: Supported SB 172.
DR. LARRY STINSON, representing himself
Anchorage, AK
POSITION STATEMENT: Supported SB 172.
BEVERLY SMITH
Christian Science Committee on Publication for the state of
Alaska
Juneau, AK
POSITION STATEMENT: Supported SB 172.
RYAN SMITH, CEO
Central Peninsula Hospital and Heritage Place
Soldotna, AK
POSITION STATEMENT: Supported SB 172.
J. KATE BURKHART, Executive Director
Alaska Mental Health Board and the Advisory Board on Alcoholism
and Drug Abuse
Anchorage, AK
POSITION STATEMENT: Supported SB 172 as long as the commission
includes representation for behavioral health.
PAT LUBY, Advocacy Director for AARP
Anchorage, AK
POSITION STATEMENT: Supported SB 172.
SHELLY HUGHES, Government Affairs Director
Alaska Primary Care Association
Anchorage, AK
POSITION STATEMENT: Supported SB 172.
ACTION NARRATIVE
1:33:39 PM
CHAIR BETTYE DAVIS called the joint meeting of the Senate and
House Health and Social Services Standing Committees to order at
1:33 p.m. Present at the call to order were Senators Dyson,
Ellis, Olson, Paskvan and Davis; Representatives Wilson and
Keller.
^United Way, 211 Project
1:34:51 PM
CHAIR DAVIS announced a presentation on the Alaska 2-1-1
Project.
SUE BROGAN and KAREN BITZER, Alaska 2-1-1, Anchorage, Alaska,
said hundreds of people call every day for essential human
services information such as training for employment, the hours
of operation of a food pantry, help for an aging parent,
information on addiction prevention programs, and affordable
housing options. Alaska 2-1-1 was launched in 2007; it has
answered 25,000 calls and made 27,586 referrals since that time.
It is a free, confidential service available statewide from 8:30
to 5:00 Monday through Friday, even in those areas that do not
have a 911 dialing option. Referrals are made from a robust
database that currently has 875 provider sites and 1978
programs; data is updated on an ongoing basis as new resource
information becomes available. The database is searchable on the
Alaska 2-1-1 website at and has had 53,880 web searches so far.
This is an easy way for individuals to search for information or
referral services.
MS. BROGAN continued; the Alaska 2-1-1 project is in a unique
position to play a role in disaster response. They are co-
located in the emergency operations center in Anchorage and have
already supported two local responses: providing health
information when Mount Redoubt was erupting, and assisting the
H1N1 immunization effort in Anchorage.
She said Alaska 2-1-1 is connected to a national system that has
answered nearly 14 million calls since 2008. It is built on a
platform similar to other 2-1-1 systems and could be asked to
answer calls from other states or roll its phones to another
state if needed. She noted that the "Calling for 2-1-1 Act of
2009" is making its way through congress supported by Senator
Murkowski, Senator Begich, and Representative Young.
While Alaska 2-1-1 is not a direct service provider, Ms. Brogan
said, the data it collects has already influenced some very
positive change in the state. Recently the data collected was
used in a successful presentation to a major foundation in
Alaska, which resulted in hundreds of thousands of dollars of
unrestricted new money being distributed for use to address
emergency food and shelter needs. She suggested that the state
could increase efficiency and save money if all of the referral
services it supports were integrated into Alaska 2-1-1 as the
sole source for health and human service referrals.
MS. BROGAN said they have worked very hard during the past year
to secure agreements with many state departments to require that
their grantees keep up-to-date information in the Alaska 2-1-1
database; partnerships with Public Safety, Workforce
Development, Homeland Security, and others flourish. She asked
that the legislators include Alaska 2-1-1 in their newsletters
and provide a link to the service on their websites.
In conclusion, Ms. Brogan stated that Alaska 2-1-1 helps
Alaskans connect to the health and human services they need. If
the Calling for 2-1-1 Act passes, Alaska 2-1-1 will need the
state's commitment so it can access federal matching grant
funds. She said they welcome feedback to help them improve the
system and invited the committee to celebrate 2-1-1 Day with
them on February 11, 2010.
1:40:30 PM
CHAIR DAVIS commended Ms. Brogan and Ms. Bitzer for their work
on the 2-1-1 program and assured them that the legislators will
include information about it in their newsletters and mention it
at their upcoming constituent meetings.
1:41:23 PM
KAREN BITZER, Director for Alaska 2-1-1, Anchorage, Alaska, said
she is available for questions.
^Alaska Health Care Commission Report
1:41:43 PM
CHAIR DAVIS announced a report by members of the Alaska
Healthcare Commission.
WARD HURLBURT M.D., MPH, Chief Medical Officer, Department of
Health and Social Services, Division of Public Health; Chairman,
Alaska Health Care Commission, Anchorage, Alaska, introduced the
members of the commission: Ryan Smith, Soldotna, representing
the Alaska State Hospital and Nursing Home Association(ASHNHA);
Wayne Stevens, Juneau representing the Chamber of Commerce;
Larry Stinson MD, Palmer; Senator Donald Olson; Representative
Wes Keller; Commissioner Linda Hall, with the Alaska Insurance
Commission; Deb Erickson, Executive Director, Alaska Health Care
Commission; Valerie Davidson, representing the Alaska Native
Tribal Health Consortium (ANTHC); Jeff Davis, Alaska health
insurance industry representative; Keith Campbell, a health care
consumer.
DR. HURLBURT said the commission was chartered by Governor Palin
on December 4, 2008 and started work in February 2009. It has
had four formal meetings and several telephonic meetings.
1:45:38 PM
Senator Thomas and Representative Cissna joined the meeting.
1:46:52 PM
DEBORAH ERICKSON, Executive Director, Alaska Health Care
Commission, Anchorage, Alaska, visited the history of formal
attempts over the past 20 years to address problems surrounding
access and affordability of health care in Alaska. She said
Governor Cowper created The Governor's Interim Health Care
Commission in 1987, which came out with a report in 1988. In
1991 the Alaska legislature created the Health Resources and
Access Taskforce that came out with a series of recommendations.
One result was the Alaska Comprehensive Health Insurance
Association (ACHIA), which was created in 1992 for high-risk
individuals who have been denied health coverage by private
insurers due to a pre-existing medical condition. A private
group formed in 2003 by Commonwealth North came out with a
report focused on improving access and delivery of primary care.
In 2007, Governor Palin established the Alaska Health Care
Strategies Planning Council, which met for about six months and
came out with recommendations for improving health care delivery
in the state.
1:49:15 PM
MS. ERICKSON directed the committee members' attention to a
graph on slide 3 that was taken from the Health Resources and
Access Task Force 1993 Report. It shows a projected increase in
health care expenditures from $1.6 billion in 1991 to $5.5
billion by 2003. That figure is now estimated to be over $6
billion, and the state Medicaid budget General Fund expenditures
are approaching $500 million.
MS. ERICKSON explained that Governor Palin established the
current Alaska Health Care Commission specifically to foster
development of a statewide health care plan to improve
affordability and access to health care. It was required to
submit a report to the Governor and the Legislature on or before
January 15, 2010 regarding the commission's recommendations and
activities.
MS. ERICKSON observed that health care is generally quite a bit
higher in the United States than in other countries. That
impacts workers' and families' ability to afford health care, as
insurance premiums are rising much more quickly than income. The
commission found evidence that costs for care in Alaska are even
higher than elsewhere in the United States. Alaska has the
highest annual Medicaid expenditure per enrollee in the country.
It is also ranked first in the nation for the cost of workers'
compensation premiums; that is significant because those high
premiums are driven in part by medical costs. Medical costs make
up 72 percent of workers' compensation benefit claims in Alaska;
the national average is 58 percent. The average medical cost in
Alaska is $40,000 per injury, compared to the national average
of $26,000. The average cost per hospital stay in this state is
nearly twice the national average. She added that the Consumer
Price Index (CPI) for Anchorage, specifically for medical care,
doubled between 1991 and 2005.
1:55:06 PM
MS. ERICKSON said the commission really didn't have the time or
resources during its first year to gather all of the information
it needed to study the issue of pricing, but examples from
Alaska's Medicaid fee schedules indicate that Alaska's fees are
two to three times higher than the fees paid by Washington's
Medicaid program.
She reported that the commission was particularly interested in
the role individual behaviors play in determining health and
health care services. Forty percent of the determinants of
health are driven by individual behaviors, as opposed to just 10
percent by access to quality health care. Nationwide, 70 percent
of deaths are caused by chronic diseases, most of which are
preventable, and 75 percent of all health care expenditures are
costs related to chronic disease. The graph on slide 15
illustrates that two thirds of the increase in health care
expenditures over the past 20 years is due to the increase in
chronic disease. Research indicates that if the prevalence of
chronic disease in the population had remained the same over the
past 20 years, this country would have saved $200 billion in
health care costs.
She thanked Mark Foster, an economist for the ISER Institute for
Social and Economic Research, for the equation on slide 16. It
shows that overall costs are driven by price, times utilization.
1:59:24 PM
MS. ERICKSON highlighted the issues identified by the commission
and included in its report:
- Costs are unaffordably high and continue to climb.
- The system is fragmented.
- Financing and payment mechanisms are very complex.
- Many Alaskans lack access to health insurance.
- Some Alaskans are on Medicare or have private insurance but
can't find a physician.
- There are high vacancy rates in many of the health care job
categories.
- Levels and variations in the quality of care are not well
understood.
- Both consumers and providers are frustrated.
- The system as designed is not sustainable.
2:01:39 PM
MS. ERICKSON said the commission's strategic plan laid out a
five-year planning framework that started with developing a
vision of the ideal health care delivery system for Alaska; it
calls for accurately identifying the problems with the current
system, building a foundation for reform, designing the elements
that will move it forward, measuring progress along the way, and
engaging the public and stakeholders in the process. The
commission came up with 31 specific recommendations around the
priority issues it had identified; included with the policy
recommendations was a directive to the governor and the
legislature. Tables on pages 63 through 68 of the Alaska Health
Care Commission 2009 Report lay out a suggested action plan for
the recommendations. The commission also included a 2010 work
plan with the hope that there will be a health care commission
continuing this work.
She stressed that this commission believes the health care
delivery system focuses too much on providing sick care and not
enough on improving health status. Alaska needs a system that
maximizes the dollars spent, is sustainable, and satisfies both
consumers and providers. She read quickly through the vision,
reform goals, and values on slide 20.
2:04:03 PM
At the commission's first meeting in February of 2009, the group
defined the following priorities for their first year:
- Consumers' Role In Health Care - This is related to healthy
lifestyles and the importance of primary care.
- Statewide Leadership - They realized immediately that one
year is not enough to conduct a thorough analysis and develop
a comprehensive understanding of the problems with the current
system or to formulate strategies to address them; they
recommend that the state establish a permanent body in
statute. She pointed out that no recommendations were made
regarding improving access to health insurance because so much
work is being done at the national level.
- Health Care Workforce - Recognizing that there are a lot of
health care workforce issues, they pinpointed physician supply
for their attention.
- Health Information Technology - They identified the
importance of developments in the move toward electronic
health records and the health-information exchange as a
priority.
- Medicare Access Problem - The problems Medicare enrollees,
especially those in urban areas of Alaska, experience in
accessing primary care and finding a physician who will take
new Medicare patients, was the final issue targeted for study
the first year.
MS. ERICKSON said the pyramid chart on slide 22 reveals that the
first four priorities come together neatly for an overall health
care transformation strategy. She emphasized the group's concern
that the fifth element, Medicare access, might be the "canary in
the coal mine," an early indication that Alaska's health care
system is beginning to fail.
2:08:14 PM
She said the 31 recommendations she referenced earlier cut
across the five priority areas. Slides 25-28 provide key high-
level recommendations associated with each priority area.
MS. ERICKSON asked if any members of the committee have had a
chance to look at the bills coming out of both the U.S. House
and the U.S. Senate and underscored that there is no one agency
in the state that is responsible for looking at health care
overall and understanding the impact of federal proposals on
Alaska's families and businesses. One of the committee's
recommendations is that the state develop the infrastructure and
capacity to analyze and respond to the impacts of national
reform efforts.
She stated that building the health care workforce has to be an
ongoing priority for the legislature and the governor on health
care reform and on economic development agendas. Children should
be exposed to health care as a workforce opportunity as early as
preschool and should get the educational foundation in math and
science they will need if they choose to pursue it. The state
also needs to build on the innovation and adaptation that has
made Alaska a global leader in creative approaches to delivering
health care, like the community health aide program and the
dental health aide program that were developed in the tribal
health system for rural and remote communities.
2:11:06 PM
MS. ERICKSON said a lot is going on in the area of planning for
workforce development by organizations such as the Workforce
Investment Board, the Mental Health Trust and the Department of
Health and Social Services. While the commission acknowledged
those individual efforts, it recommended that a single entity be
designated to coordinate and oversee them in order to avoid
duplication. The series of recommendations specific to
increasing the supply of primary-care physicians includes:
establishing educational loan repayment programs, implementing
more Graduate Medical Education (GME) residency programs, and
expanding the Washington, Wyoming, Alaska, Montana, Idaho
(WWAMI) medical school program.
2:13:10 PM
She moved on to slide 27 and some general groupings of
recommendations for deploying health care information technology
including the importance of privacy and security and the
appropriate role for government in supporting the adoption and
utilization of electronic health records and the development of
the health information exchange. The commission also looked at
telemedicine, another area where Alaska is a leader; it
recommended that the state improve telecommunications
infrastructure and make more resources available for
telemedicine services.
MS. ERICKSON admitted that Medicare access is really a
challenging problem and a critical one. The commission
determined that the most important thing the state can do is to
increase the supply of primary providers. It also recognized the
importance of mid-level practitioners (nurse practitioners and
physicians assistants) and of establishing a residency program
for internal medicine providers.
She said the commission recommended state support for the
federal safety-net programs, Federally Qualified Health Centers
(FQHC), and Rural Health Clinics (RHC), and the development of a
Program of All-Inclusive Care for the Elderly (PACE). PACE is a
Medicaid, Medicare waiver program that provides comprehensive,
integrated, wrap-around services for seniors who are eligible
for and need a nursing home level of care.
2:16:07 PM
MS. ERICKSON read briefly from the remaining slides on other
transformation elements. She closed by saying that the current
commission under AO 246 expires April 10, 2010, but there are
three bills pending in the legislature that would establish a
health care commission in statute: SB 172, HB 25 and HB 75.
2:18:28 PM
SENATOR PASKVAN asked Ms. Erickson to define the term "chronic
disease."
DR. HURLBURT responded that when he came to Alaska in 1961,
doctors saw mostly episodic events that they could treat and be
done with. Chronic diseases are those that people acquire and
that generally go on for life. Some are wear-and-tear conditions
like arthritis, but most are diseases of choice. Insufficient
exercise and poor diet cause diabetes and heart disease. Smoking
causes chronic lung disease. There is no magic bullet to cure
these.
REPRESENTATIVE KELLER thanked the other commissioners and the
director for their efforts and expressed his respect for their
knowledge and professionalism.
2:22:18 PM
REPRESENTATIVE CISSNA said she believes the commission has
produced a fine result and has managed to look at the system and
its problems in a new way.
2:24:51 PM
SENATOR THOMAS commented that the commission has gathered a lot
of information and knows what the problems are; he asked whether
the next steps will concentrate primarily on how to control
costs through education in the schools.
2:26:09 PM
DR. HURLBURT said that will certainly be part of it, but the
issues are broad. He pointed to the importance of doing the
right thing to encourage proper nutrition and positive lifestyle
changes. Educating kids about these things should begin before
they are in school; but school does give educators an
opportunity to reach them.
2:27:22 PM
CHAIR DAVIS called an at ease at 2:27 and called the meeting
back to order at 2:28.
SB 172-ALASKA HEALTH CARE COMMISSION
2:28:30 PM
CHAIR DAVIS announced consideration of SB 172.
2:28:47 PM
SENATOR OLSON, sponsor of SB 172, said Alaska is currently
facing serious health care cost, access, and quality issues. The
ISER report alluded to by Deborah Erickson, stated that between
1991 and 2005 health care expenditures in the state tripled,
going from $1.6 billion to $5.3 billion. These costs are
expected to double by 2013. All levels of government are
affected; what is more important is that Alaska's economy cannot
sustain this inflationary growth.
The issues involved are broad and complex; they cannot be dealt
with unless there is a permanent body to plan and follow through
with long-range comprehensive reforms. Both the Commonwealth
North Alaska Health Care Roundtable group and the Alaska Health
Care Strategies Planning Council have recommended establishment
of a permanent body to address the problems Alaska is facing.
The Health Care Commission will be established under the
Department of Health and Social Services and will consist of ten
members including public officials and private citizens. It will
provide recommendations for the development of a statewide plan
to address the quality, accessibility, and availability of
health care to all residents of the state of Alaska. Alaska's
need for health care reform is pressing and must be dealt with
thoroughly and efficiently, with a long-range view toward
meaningful and lasting change. The Alaska Health Care Commission
will play an important role in this process; it is essential
that the legislature make it a permanent component of the
Department of Health and Social Services so that present, as
well as future issues with Alaska's health care can be better
anticipated, understood, and addressed.
2:33:36 PM
ELLEN ADLAM, Board Member, Peninsula Community Health Services,
Soldotna, Alaska, said she is an X-ray technician and has been
involved for a long time with community health centers. She
agreed that health care is a big problem in this state and said
she supports SB 172, but the board would like to see a primary
care "safety net" seat established on the commission to provide
a voice for the underinsured and uninsured. Peninsula Community
Health Services is one of the three largest health systems in
the state, serving 81,000 patients. It includes 26 organizations
with 142 sites, and those sites see Medicare patients, so it is
very important that they be included. She suggested the
commission use a provider from a health center, because they
provide not only medical, but dental and behavioral health. That
seat would encompass the voice for the underinsured and the
primary provider.
2:37:43 PM
DR. LARRY STINSON, representing himself, Anchorage, Alaska, said
he supports SB 172 and recognizes that the there needs to be a
balance between representation and the number of people on a
committees in order to get things done. This bill creates a
manageable group; it also keeps any one entity from having a
majority vote that might dominate the outcome.
2:39:18 PM
DEBORAH ERICKSON, Executive Director, Alaska Health Care
Commission, Anchorage, Alaska, said this particular bill mirrors
very closely Administrative Order 246, which established the
current commission and includes a transition clause that will
automatically appoint the members of the current commission to
the new one if SB 172 passes in its current form. She added that
the commission's work during its first year really laid the
groundwork and will be a good jumping-off point if this bill
passes.
2:42:12 PM
WARD HURLBURT M.D., MPH, Chief Medical Officer, Division of
Public Health, Department of Health and Social Services (DHSS);
Chairman, Alaska Health Care Commission, Anchorage, Alaska, said
the commission under this bill should provide significant
continuity; the membership reflects excellent professional and
geographic diversity and has achieved momentum that will
continue under SB 172.
As was previously discussed, he said, the commission's major
focus will be on health care costs, which now represent about 18
percent of the U.S. gross national product; Alaska is spending
about $6 billion per year. The American Health Insurance Plans
Association announced today that the expectation nationally is
for commercial health insurance premiums to go up more than 10
percent in 2010, as compared to a 1.4 percent increase in wages.
He said Medicaid is a huge chunk of the governor's supplemental
request to the legislature for funding, and ventured to say that
every department, in every state in the country, has to make
control of Medicaid costs almost their top priority.
DR. HURLBURT shared that he is a cynic with regard to
commissions, but thinks the members on this commission have
worked well together and that making it permanent is the right
step.
2:47:08 PM
BEVERLY SMITH, Christian Science Committee on Publication for
the state of Alaska, Juneau, Alaska, said one of her roles is to
ensure the legislature has accurate information concerning
spiritual healing as practiced in Christian Science, so this
cost-effective and reliable form of care is not overlooked or
restricted in the state's health care reform efforts. With
regard to SB 172, she requested that access to spiritual care
for the treatment and cure of disease be given appropriate
consideration during discussions of the development of a
statewide health plan. To facilitate this discussion, she
recommended that the bill mandate one of the duties of the
commission be to recommend the extent to which and under what
circumstances access to spiritual care should be addressed in a
comprehensive statewide health care policy. Because health care
reform discussions at the state and federal levels have raised
issues that could impact the insurance coverage for spiritual
care, it is important that these issues be discussed so as not
to create unintended results that could limit the coverage for
spiritual care.
She said she noticed the bill does not mandate insurance
coverage for all Alaskans, but asks the commission to develop a
strategy that encourages acquisition of health insurance and
that increases the number of insurance options available for
health care services. If Alaskans pay health insurance premiums,
they should be able to be reimbursed for the health care they
choose, whether that is medical care or spiritual treatment.
MS. SMITH referred to page 2 of her memorandum to the committee,
dated February 3, 2010, which cites a number of state and
federal programs that offer benefits for spiritual care. She
pointed out that Alaska does allow spiritual treatment under the
state employees' health insurance plans. Christian Science care
can also be deducted under medical expenses from federal income
tax.
She closed by saying that she hopes the commission will preserve
the insurance coverage for spiritual care that Alaska residents
now enjoy and recommend that it be expanded to include religious
non-medical nursing services. If the commission were directed in
statute to include spiritual care in its discussions of reform,
it would prevent such access from being overlooked or minimized.
2:51:34 PM
MS. SMITH thanked the committee and the sponsor for their work
on health care reform and respectfully requested that this
commission have the responsibility for discussing and
recommending how access to spiritual treatment and care can be
part of the overall health care plan in Alaska.
2:52:10 PM
RYAN SMITH, CEO, Central Peninsula Hospital and Heritage Place,
Soldotna, Alaska, and a member of the Alaska Health Care
Commission, thanked the committee and others for their support
for health care reform and expressed strong support for SB 172.
2:53:53 PM
J. KATE BURKHART, Executive Director, Alaska Mental Health Board
and the Advisory Board on Alcoholism and Drug Abuse, Anchorage,
Alaska, said both boards were created by statute, with statutory
duties that include providing advice and advocacy on issues
related to mental health and substance abuse to the executive
and legislative branches.
She prefaced her testimony by saying that the information and
positions she expresses today are those of the boards and not of
the governor's office or the Department of Health and Social
Services. On behalf of both boards, she extended their
appreciation to the Alaska Health Care Commission for the work
it has done and stated that they support the continuation of a
health care commission in whatever form that takes, as long as
it includes representation of the Behavioral Health system.
MS. BURKHART enumerated three reasons that having the
perspective and representation of an active, licensed,
behavioral health professional on the commission is very
important:
1. The state of Alaska invests a substantial amount of money
in the behavioral health system. As Ms. Erickson stated, the
current health system is very fragmented, and to create a
commission that doesn't include representation of a major
health care system will not help to resolve that fragmentation
problem.
2. The issue of co-morbidity when working with populations
that experience a mental health disorder is significant.
Often, people with serious mental illness live 25 years less
than others who do not have a mental illness. Given the
commission's focus on chronic diseases, representation from
the behavioral health field seems appropriate.
3. What is contemplated here is system change. The
commission's report says that the system as it is now is not
sustainable. If the legislature is going to address a
comprehensive system change, all of its health systems should
be represented.
In response to concerns that the commission could become too
large and unwieldy, she suggested AS 18.09.020(1)(e) seems to
contemplate that the health care provider who is not affiliated
with ASHNHA is a primary health care provider. She said she
thinks it is possible to have a seat for a primary care provider
from Alaska's federally qualified health centers and the
providers who serve indigent populations, and another for a
behavioral health professional. She pointed out that there are
movements afoot to integrate primary care and behavioral health.
Examples include Peninsula Community Health and South Central
Foundation.
2:58:42 PM
PAT LUBY, Advocacy Director for AARP, Anchorage, Alaska, said
they are in full support of SB 172. He praised the members of
the Alaska Health Care Commission for the great work they have
done on some targeted issues and for their ability to work
collaboratively for the good of all Alaskans, despite different
backgrounds or political affiliations.
2:59:54 PM
SHELLY HUGHES, Government Affairs Director, Alaska Primary Care
Association, Anchorage, Alaska, said part of reason Governor
Palin and Governor Parnell established the current commission
was due to a report by Commonwealth North, Alaska Health Care
Roundtable Group, titled "Alaska Primary Health Care
Opportunities and Challenges;" She pointed to the words "Primary
Care" and said that primary care is the gateway to health care
and includes behavioral health, dental, and medical care.
Without a designated seat for primary care, she is concerned
that the commission will be missing expertise and input that may
be helpful in working out a statewide plan. She agreed with
previous speakers that the commission could get "two for the
price of one" because, if the legislature adds a primary care
safety-net seat, it will also be getting expertise on the
uninsured problem in this state.
She emphasized that the three largest health systems in the
state are the hospitals, tribal health, and the community health
centers. The first two of these are designated in the bill; the
primary care safety-net or community health centers are not in
the bill. The one provider seat may or may not be a primary care
provider but is a specialist at this time. She encouraged the
committee to consider adding a primary care provider seat. While
she understands the need to keep the commission compact, she
believes this is a key component and something very integral to
working on a statewide plan.
She mentioned that the state Chamber of Commerce passed a
position for this session in agreement with the establishment of
the health care commission, including a seat for primary care.
[SB 172 was held in committee.]
3:02:38 PM
There being no further business to come before the committee,
Chair Davis adjourned the meeting at 3:02 p.m.
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