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.]