HB 234-EXTEND ALASKA HEALTH CARE COMMISSION  4:08:07 PM CHAIR SPOHNHOLZ announced that the next order of business would be HOUSE BILL NO. 234, "An Act extending the termination date of the Alaska Health Care Commission; and providing for an effective date." 4:08:34 PM SETH WHITTEN, Staff, Representative David Guttenberg, Alaska State Legislature, paraphrased from the Sponsor Statement [included in members' packets], which read as follows [original punctuation provided]: The Alaska Health Care Commission was first established by Governor Palm on December 4, 2008 under Administrative Order #246. In 2010, the legislature passed SB 172, establishing the Alaska Health Care Commission in Statute. The legislature's intent was that the Commission would be a permanent instrument to address the need for health care reform in our state. The Commission worked to identify opportunities, as well as a broad set of strategies, to improve the quality, accessibility and availability of health care for all citizens of the State. These strategies and recommendations can be found in the Commission's reports that were issued annually from 2009-20 14. In 2015 the Commission was defunded. Alaska's need for health care reform remains one of the most critical challenges we face. At $10 billion in total spending annually25% of which is administered by the state government health care is one of Alaska's largest consumer product industries. When this enormous scale is considered in conjunction with the fact that that the state government is the largest single payer for those services, there is a clear need for an instrument that identifies the costs and benefits of the health care system and identifies strategies for ensuring sustainability therein. Extending the Alaska Health Care Commission will give the state a tool to address this crucial priority. MR. WHITTEN added that health care was a very complex issue and it was changing across the country, "and certainly maybe even more so in Alaska." 4:10:28 PM REPRESENTATIVE JOHNSTON asked for an explanation to the zero- fiscal note. She asked if all the Alaska Health Care Commission reports were available on-line. MR. WHITTEN replied that the reports were available. REPRESENTATIVE JOHNSTON said that no matter what the result of the proposed bill, the already completed work was still available on-line. MR. WHITTEN replied that these reports would be available, although he was unsure if the Alaska Health Care Commission website would be maintained after the end of the fiscal year. 4:11:40 PM REPRESENTATIVE JOHNSTON asked if the Alaska Health Care Authority was "mainly in response to Medicaid reform." 4:11:57 PM MR. WHITTEN said that he was not an expert, and he shared that per Senate Bill 74, the Alaska Health Care Authority was undergoing a feasibility study, due for completion at the end of the current fiscal year. Contingent on that study, the legislature would determine what to do with Alaska Health Care Authority. 4:12:44 PM CHAIR SPOHNHOLZ reported that the Alaska Health Care Authority was not under the purview of Department of Health and Social Services, but under the Department of Administration as it related to the role of the department as an employer. She explained that there was a review to determine the possibility of consolidating the various health care plans and health care coverage paid for by the state. She stated that it was not related to the Alaska Health Care Commission. 4:13:35 PM REPRESENTATIVE KITO asked about the sunset audit which had recommended to not extend the Alaska Health Care Commission. He asked about the benefits for maintaining the commission, noting that there would be an expense to the legislature, even as there was a zero-fiscal note. 4:14:12 PM MR. WHITTEN replied that the commission had been inactive and not funded since 2015. He explained that an audit by the Legislative Budget and Audit Committee reviewed the commission to determine whether it was meeting its legislative intent. He reported that the committee had suggested that the commission needed to do more. The committee had reported after the previous sunset audit for the commission that although it had identified some issues and determined some recommendations, as well as created some useful data, the commission needed to move toward implementation. He relayed that there were some differences of opinion on the committee for whether it was the job of the commission to implement a health care plan. The statute stated that the commission was to provide recommendations for and foster the development of a statewide plan to address quality, accessibility, and availability of health care for all citizens of the state. 4:15:55 PM REPRESENTATIVE KITO offered his opinion after reading the audit that it was development of a plan and not implementation of a plan that the commission was tasked in statute. He stated that to date, as a plan had not been developed, the commission had not been meeting its legislative intent, hence the recommendation for the sunset. 4:16:27 PM MR. WHITTEN offered his understanding that Chapter 18 stated that the commission was responsible for providing recommendations for and fostering development of the statewide plan. He reported that his review of the transcripts of meetings prior to the de-funding had revealed that conversations with the Legislative Budget and Audit Committee declared the need to move away from recommendations and move toward implementation. He offered his belief that testimony by Kris Curtis to the Legislative Budget and Audit Committee indicated that "they [the commission] weren't doing enough to implement the plan. That feedback had been provided to the commission and that while there was some momentum building at that point, the point which they were de-funded in 2015, ... put all that on the back burner." 4:18:07 PM KRISTIN CURTIS, Legislative Auditor, Legislative Audit Division, Alaska State Legislature, reported that the recommendation in the sunset audit findings had been due to the lack of an actionable plan, and she offered her belief that although the commission had created a framework, this framework lacked the actionable components to effectively impact health care in Alaska because it did not go far enough to explain how these high level recommendations and framework were going to be implemented. She suggested that this may have caused confusion regarding the use of "implementation." She opined that the framework was not a plan, and hence, did not meet the purpose of the statute. 4:19:01 PM REPRESENTATIVE SULLIVAN-LEONARD stated that she had watched the Alaska Health Care Commission since its inception, as she had been working in the governor's office. She reported that a clear plan was never developed as requested by the administrative order, which she deemed to be "problematic." She explained that she did not discount the work which had been done by this commission, although she had concerns that another extension of the commission would continue with the same results. She asked if it would be beneficial to consider new legislation to clearly identify the direction for a health care commission, as opposed to continuing the use of an administrative order which, she opined, has "caused some difficulty." MS. CURTIS shared that there was ambiguous statutory language and added that more clarity for direction from the Alaska State Legislature would be helpful to ensure that all parties understood the expectations moving forward. 4:20:57 PM REPRESENTATIVE SULLIVAN-LEONARD suggested that the House Health and Social Services Standing Committee could look at new legislation in moving forward, instead of following the same path as previously. 4:21:26 PM CHAIR SPOHNHOLZ, reflecting on an earlier discussion with the sponsor of the bill, offered her observation that the mandate of the Alaska Health Care Commission was not always implementable and that there was some tension for its implementation. She suggested that two bosses with two different instructions is "almost always gonna end up with a sub-par product." She shared that the bill sponsor would like to see the commission stay on the books and move forward. She reported that it had been agreed to work on a proposed revision to narrow the scope and ensure that the commission was serviceable in the current health care environment. She opined that the use of an administrative order and then a statute created more than eight years ago was no longer practical. 4:23:19 PM REPRESENTATIVE TARR asked how this would work as the commission was due to expire on June 30, 2017. 4:23:47 PM MS. CURTIS explained that although the commission would sunset, the board had a one-year wind down administrative period. She reported that this had occurred with other sunsets. 4:24:18 PM CHAIR SPOHNHOLZ asked if this would mitigate the need for a new sunset audit. 4:24:25 PM MS. CURTIS expressed her agreement if a bill was passed prior to July 1, 2018. 4:24:36 PM REPRESENTATIVE KITO asked what activities the commission would be responsible for during this upcoming sunset period. He asked if the staff would have identified duties to perform until this was addressed. 4:25:04 PM MS. CURTIS offered her belief that currently there was no staff, no funding, and no committee. She offered her understanding that there was an intent to keep the law on the books, even though the members' terms had expired. 4:25:46 PM REPRESENTATIVE KITO asked if the commission were allowed to go into sunset, would the statute remain for a possible future authorization. 4:26:22 PM MS. CURTIS offered her understanding that the statute would stay, and she suggested to ask Legislative Legal Services. 4:26:43 PM CHAIR SPOHNHOLZ said that there would be a follow-up for clarification to these questions. [HB 234 was held over.]