ALASKA STATE LEGISLATURE  HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE  February 22, 2005 3:08 p.m. MEMBERS PRESENT Representative Peggy Wilson, Chair Representative Paul Seaton, Vice Chair Representative Tom Anderson Representative Vic Kohring Representative Sharon Cissna Representative Berta Gardner MEMBERS ABSENT  Representative Lesil McGuire COMMITTEE CALENDAR    HOUSE JOINT RESOLUTION NO. 10 Relating to a proposed reduction in the Federal Medical Assistance Percentage for Alaskans; and urging the United States Congress to take action to prevent the reduction. - MOVED HJR 10 OUT OF COMMITTEE ^CONFIRMATION HEARING(S) ^University of Alaska Board of Regents Carl H. Marrs - Anchorage Robert Martin - Juneau Jeff Staser - Anchorage - CONFIRMATION(S) ADVANCED ^Professional Teaching Practices Commission Karen Macklin - Sitka - CONFIRMATION(S) ADVANCED PREVIOUS COMMITTEE ACTION  BILL: HJR 10 SHORT TITLE: FEDERAL MEDICAL ASSISTANCE REDUCTION SPONSOR(S): FINANCE 02/14/05 (H) READ THE FIRST TIME - REFERRALS 02/14/05 (H) HES, FIN 02/22/05 (H) HES AT 3:00 PM CAPITOL 106 WITNESS REGISTER  SUE WRIGHT, Staff to Representative Mike Chenault Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Presented HJR 10 on behalf of the House Finance Committee, sponsor by request, which is co-chaired by Representative Chenault. JOEL GILBERTSON, Commissioner Alaska Department of Health and Social Services Juneau, Alaska POSITION STATEMENT: Presented HJR 10 and answered questions regarding HJR 10. CARL MARRS, Appointee to the University of Alaska Board of Regents Anchorage, Alaska POSITION STATEMENT: Testified as appointee to the University of Alaska Board of Regents. JEFF STASER, Appointee to the University of Alaska Board of Regents Anchorage, Alaska POSITION STATEMENT: Testified as appointee to the University of Alaska Board of Regents. ROBERT MARTIN, Appointee to the University of Alaska Board of Regents Juneau, Alaska POSITION STATEMENT: Testified as appointee to the University of Alaska Board of Regents. KAREN MACKLIN, Appointee to the Professional Teaching Practices Commission Sitka, Alaska POSITION STATEMENT: Testified as appointee to the Professional Teaching Practices Commission. ACTION NARRATIVE CHAIR PEGGY WILSON called the House Health, Education and Social Services Standing Committee meeting to order at 3:08:14 PM. Representatives Wilson, Cissna, Seaton, and Anderson were present at the call to order. Representatives Gardner and Kohring arrived as the meeting was in progress. 3:08:49 PM HJR 10-FEDERAL MEDICAL ASSISTANCE REDUCTION [Contains a brief mention of SJR 6.] CHAIR WILSON announced that the first order of business would be HOUSE JOINT RESOLUTION NO. 10, "Relating to a proposed reduction in the Federal Medical Assistance Percentage for Alaskans; and urging the United States Congress to take action to prevent the reduction." 3:09:17 PM SUE WRIGHT, Staff to Representative Mike Chenault, Alaska State Legislature, presented HJR 10 on behalf of Representative Chenault, sponsor. She explained that the proposed joint resolution was crafted to urge the U.S. Congress to take action to prevent the reduction of the Federal Medical Assistance Percentage (FMAP) for Alaskans from a 57.58 percent federal/42.42 percent state match to an even 50:50 even split on October 1, 2005. She said, "This resolution outlines the environmental and demographic reasons health care costs in Alaska are so high and substantiates that it is reasonable to maintain a rate at 57.58 percent instead of a reduction to 50 percent." 3:10:26 PM JOEL GILBERTSON, Commissioner, Alaska Department of Health and Social Services, explained that HJR 10 has a parallel in the Senate side, which is SJR 6. He said: What this gets towards is a resolution by the legislature finding a lot of cost drivers in the Alaska health care system. And also acknowledging that, absent some congressional action, on October 1, 2005, ... we will see a sizeable reduction in the federal support for our health care system in this state. ... It's quite concerning to this administration and to health care providers generally. And what this resolution expresses is an acknowledgement of this challenge and this problem, and urges Congress and the presidential administration to focus on passing legislation this session that will hold Alaska harmless and will preserve our current Medicaid match rate. 3:11:43 PM COMMISSIONER GILBERTSON continued: To give you a little background: we run this program called Medicaid ... which, for the State of Alaska, is serving almost 130,000 Alaskans. And in our FY 06 [fiscal year 2006] budget, for the first time ever, it actually creeps above $1 billion in program operations. It's a billion-dollar program, but it's not wholly financed by the state. The Medicaid program, when established in 1965, was established as a partnership between the states and the federal government to provide ... health care services to low income and needy populations. Many people become eligible because of other assistance benefits they have access to, such as being disabled and being on [Supplemental Security Income (SSI)]. But regardless of how you got on the program, there is federal support to finance that person's health care services. ... How much of your ... Medicaid program that's going to be financed by the federal government is based on a pretty rough formula that tries to calculate [if the state is rich or poor]. And this formula is called the FMAP, or the Federal Medical Assistance Percentage, and it's a really rough formula. It looks at a state's per capita income and then compares it to the national average for per capita income, and benchmark[s] states according to that continuum of incomes. The richest states are required to bear a greater burden of their Medicaid costs. The poorest states, and overwhelmingly that's always been Mississippi, ... receives the highest amount of federal support. 3:13:33 PM COMMISSIONER GILBERTSON continued: The least you can receive in federal support is 50 percent, and historically Alaska was a 50:50 state, meaning that when that claim for Medicaid went through the system ... the state [paid 50 percent of the claim and the federal government would pay 50 percent of the claim]. What that formula failed to acknowledge is that, while our per capita incomes might be incrementally higher in Alaska, our cost of delivering that care is exponentially higher. And when you start looking at the cost of living, the cost of delivering supplies, the labor costs, the construction costs, [and] the geographic challenges around transportation, ... it is very expensive to deliver health care services in this state. We spend almost $10 million a year just on Medicaid transportation for nonemergency cases, just bringing people into more urban areas to receive services.... 3:14:46 PM COMMISSIONER GILBERTSON continued: [There are] a lot of cost drivers. We're dealing with a state that, ... in land mass size, has no peer amongst other states. For these various reasons, ... Congress twice - once in 1997 and once again in 2000 - passed legislation to temporarily increase Alaska's Medicaid match rate. It was historically a 50:50 state, then U.S. Senator Frank Murkowski ... passed legislation ... to increase Alaska's Medicaid match rate to 59.8 [percent] ...; it increased the federal share by 9.8 points, and in real dollars that brought in about $100 million of additional support for our health care system for three years. When that sunset, he passed another piece of legislation to extend and to increase the subsidy .... And this time it was not set at a fixed amount; it was a formula change. The net effect was [that] it decreased our per capita income going into the formula by about 5 percent. But in real dollars, it increased our Medicaid match rate to about ... 61 percent federal. ... And that has slowly evolved down as per capita income in the State of Alaska has increased over the last couple of years. And right now, in the last year of that five-year rate adjustment, we're getting about 57.5 percent federal financing for a Medicaid claim. 3:16:27 PM What has that meant to the State of Alaska over those five years? It's meant about $300-350 million of additional federal funds that have come into our health care system through this adjustment over that time period. ... This last adjustment was a five-year adjustment for the State of Alaska; it sunsets on October 1, 2005. And ... I believe the department provided to the committee a set of charts and documents [a 6-page handout included in the committee packet, with the first page labeled, "Impact of FMAP Reduction on State Match"], ... which sort of explains what is the long term fiscal impact to the State of Alaska's health care system - absent change. And that change can be about one thing: ... legislation passed by the United States Congress to extend the adjustment, [to] hold harmless the State of Alaska, or [to] come up with some other methodology that acknowledges the high cost of delivering care in this state. 3:16:51 PM Absent that change, October 1, 2005, which ... would run for three quarters of our fiscal year of 2006, the impact would be the loss of about $53 million in federal support to the state's Medicaid program and our health care system generally. Once that's annualized in the first state fiscal year, 2007, where it runs for a full 12 months, the impact will be roughly $73 million. And what you see in the charts we provided is that over the next 10 years the loss of this federal adjustment that was passed by Congress five years ago would be almost a billion dollars - $914 million dollars over the next ten years - of support that's providing services across the state. 3:17:48 PM While this is money that comes through the state, this money does not stay within the state; this money is used to pay providers. These are the dollars that are paying for everything from wheel chairs and prosthetics, to seniors and skilled nursing care, to home and community-based services, personal care attendant services, acute care services, services for chronic disease, for children, for youth, and for the seniors of this state. These are resources that are going out right now to support infrastructure, ongoing operations and maintenance, and personal services of facilities all throughout the state. And who is hurt the most, I think, is largely rural Alaska, because rural Alaska disproportionately relies upon Medicaid as its primary source of payment ... and revenue. 3:19:06 PM These challenges are real; the fiscal challenge is real. What this resolution expresses is ... a summation of the cost drivers in Alaska's health care system. The reason why the formula currently does not serve Alaska very well ... [is] that the underlying formula is fundamentally flawed; it simply does not acknowledge the high cost of delivering care in rural, remote frontier states. And through resolution, [it] urges Congress and the federal administration to pass legislation this year to fix this funding challenge and to continue the federal support for Alaska's Medicaid program as it is doing in the current year. 3:19:34 PM CHAIR WILSON asked if the fix would be temporary. 3:19:44 PM COMMISSIONER GILBERTSON answered that that's largely the discretion of the language drafters. He stated from experience that the most recent adjustment for the state was set with a five-year sunset, because that was the amount of money that was available in the budget at the time. He said he thinks there will be a lot of competing factors. He said in the grand scheme of Medicaid "this is very small." He offered his understanding that over the 10 years, Medicare/Medicaid will be spending $2.6 trillion. Notwithstanding that, he stated, "In the grand scheme of the programs themselves it's very large when you start talking about a state our size and with our population base." COMMISSIONER GILBERTSON said some states will be seeing their federal support increase next year, while others will be seeing it decrease. He explained that is due to an annual adjustment that looks at a rolling average of per capita incomes. He reported that Alaska is the most negatively affected state at a 7.5-point drop. The second-most affected state is Wyoming, with a 3-point drop. The magnitude of Alaska's drop is unprecedented. He concluded, "It's going to be a challenge to get this passed; I think it's something that Congress can do, and we're certainly working with our delegation to try and get this passed this year. But will it be sunset again? I think parts of that will be budgetary concerns that will drive that decision." 3:21:28 PM CHAIR WILSON asked if Commissioner Gilbertson thinks that the delegation needs the resolution "to give them a little bit of backup when they ask for it." 3:21:39 PM COMMISSIONER GILBERTSON responded that he thinks Alaska's delegation is keenly aware of the challenge and has been generally supportive of the state's health care system. He continued: This has been passed twice by the United States Congress; it's been passed twice by the U.S. Senate unanimously. I think it's been generally acknowledged that this is a challenge facing the state, and it is in need of additional assistance. I'm sure we're all aware ... federal employees receive a cost of living adjustment for the state. Many federal programs are adjusted. This is one that should be adjusted as well. COMMISSIONER GILBERTSON said he thinks even though the delegation is aware of [the need for adjustment], it is important for all affected parties to share their concerns with the delegation. 3:22:32 PM REPRESENTATIVE SEATON asked Commissioner Gilbertson to describe the difference between Title 21 and Title 19. 3:22:46 PM COMMISSIONER GILBERTSON explained that there is a different match rate for different populations. He directed attention to [the first page of the previously mentioned 6-page handout] and noted that [the chart at the far-right of the page, titled, "Announced FMAP*"] shows a 57.58 percent match in fiscal year 2005 (FY 05) [under Title XIX FMAP] and a 70.31 percent match the same year [under Title XXI FMAP]. He said the former reflects the general Medicaid population, while the latter reflects the enhanced federal medical assistance percentage, including the state children's programs, such as Denali Kid Care. He added, "We also were able to get that enhanced match rate for our breast and cervical cancer program, under Medicaid." He noted that there is a third category for Alaska Natives who receive services through Native operated facilities at 100 percent federal reimbursement. That is not expressed on the chart. 3:23:57 PM REPRESENTATIVE SEATON asked if the 100 percent match population would be affected by the reduction. 3:24:08 PM COMMISSIONER GILBERTSON said it's important to remember that the reduction is not felt by the provider, but is felt initially by the state. The real impact to the providers is felt the second year when the legislature, as the appropriator, has to factor into a new budget decision that "it's going to cost you $72 million in additional funding to do the same thing you were doing the previous year." The challenge created then is whether to offset that loss with the general fund or proposing program reductions, or a combination of the two. He said, "When that's converted, the providers will feel that downstream, because that could be reductions in optional services, ... rates, [and/or] ... eligibility." He reiterated that the more rural providers will be more affected by that, because they disproportionately rely upon Medicaid as one of their key sources of funding. 3:25:05 PM COMMISSIONER GILBERTSON continued as follows: When the claim is submitted by our provider, we pay that provider. We then turn to our federal sister agency - Centers for Medicare/Medicaid Services - and we submit proof of that payment, and then we claim it and request payment back from the federal government for their share of that claim. 3:25:39 PM REPRESENTATIVE SEATON reiterated that he wants to know whether the population with the 100 percent match would be unaffected by the reduction and would still remain at 100 percent. 3:25:52 PM COMMISSIONER GILBERTSON answered yes. He noted that's a sizeable claim volume in the system. He added, "So, the numbers that you're seeing, in terms of impact, to some extent [are] actually more drastic, because it's that impact over a smaller percentage of the overall Medicaid slice." 3:26:14 PM CHAIR WILSON asked if many services will have to be cut "if this doesn't happen." 3:26:29 PM COMMISSIONER GILBERTSON responded that the governor's budget for FY 06 assumes that the President and Congress will pass and sign legislation this year that will hold harmless Alaska and not implement this reduction. If there is no change in law by October 1, 2005, the administration will submit "a supplemental" to the legislature in FY 06 to offset the loss in federal funds. It will be up to the legislature to decide at that time whether to fully fund the supplemental request or not to and instead propose changes to the program, "or some other reduction." 3:27:36 PM CHAIR WILSON asked, "What happens if the legislature didn't okay that? How would all this get paid then if it's past tense?" 3:27:56 PM COMMISSIONER GILBERTSON said there is an acknowledged challenge if the hold harmless provision is not passed by Congress. If it is six-seven months into a fiscal year and the legislature chooses not to fund the entire amount of the supplemental, that would put tremendous pressure upon the agency to reduce expenditures in the remaining months of the fiscal year "to bring in line expenditures with authorization." He offered an example. 3:29:39 PM REPRESENTATIVE SEATON moved to report HJR 10 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HJR 10 was reported from the House Health, Education and Social Services Standing Committee. 3:29:47 PM ^CONFIRMATION HEARING(S) ^University of Alaska Board of Regents 3:30:14 PM CHAIR WILSON announced the next order of business would be the confirmation hearing for appointees to the University of Alaska Board of Regents. 3:30:59 PM CARL MARRS, Appointee to the University of Alaska Board of Regents, told the committee that he was born and raised in Seldovia, Alaska, went to school in Kodiak, Alaska, joined the Marine Corps, and worked as a commercial fisherman. Beginning September 1973, he worked for Cook Inlet Region, Incorporated (CIRI) in a lot of different capacities, including as president and CEO for the last eight years until his retirement from CIRI at the end of [2004]. 3:31:47 PM MR. MARRS, in response to a question from Chair Wilson, confirmed that he is a new appointee. Furthermore, he shared the reasons for his interest in the position. He said education has always been a top priority. Even during his time with CIRI he spent a lot of time on programs for children and helped fund the CIRI Foundation for Education, which presently has an endowment of approximately $48 million. He revealed that he has served for the past five years on the Alaska Pacific University Board. He said he thinks he can be helpful to the university in philanthropic ways. He mentioned his concerns regarding fisheries, artic research, and research in general and stated that he thinks the university can be one of the finest in the world in terms of research and he would like to help mold it that way. 3:32:55 PM REPRESENTATIVE CISSNA noted that the University of Alaska, Anchorage has "the applied health ... for the state ... for all of the large medical facilities," and there is a desperate need for advanced degrees to be given on that campus "because of its large applied health presence." She mentioned expansion of alternative health. She indicated that [the university] could be the hub of "distance delivery center." She asked Mr. Marrs if he has considered those issues and would address them. 3:34:12 PM MR. MARRS stated that he's spent an inordinate amount of time working with and helping set up the SouthCentral Foundation, which is "the health arm for Cook Inlet region in Central Alaska." He said there has been an explosive growth in health care in the Anchorage area. Both [the University of Alaska Anchorage (UAA)] and [Alaska Pacific University (APU)] play a key role in that. He said APU has focused on health administrative programs and has a Masters program in that area, while UAA is focusing on research and nursing. He said he thinks there is so much more that the university could do, but it all equates to trying to get the funding to make it happen. He said he thinks it's an area that he has some knowledge in, by virtue of his work getting the SouthCentral Foundation set up and headed in the right direction, and also because of working with the federal government to get federal dollars to help those issues. 3:36:20 PM REPRESENTATIVE SEATON said he is pleased to see someone from his district nominated for this position. He said there are basically three concentrated campuses, in Fairbanks (UAF), Anchorage (UAA), and Juneau (UAS), as well as the dispersed regional campuses. He asked Mr. Marrs to share his evaluation of those systems and whether he has strong support for the rural campuses across the state or would like to concentrate the elements into the three main campuses. 3:37:10 PM MR. MARRS said he needs to learn more about those campuses, but said he thinks they bring value to the university system. He suggested that with today's technology there ought to be some cost efficiencies built in to the system. He stated his belief that having a campus in areas that have populations is necessary for education. He mentioned timber, fishing, and tourism. He said the university ought to be able to help communities in those areas through research to make the state a better place in which to work and live. He said he thinks the university has the capability and the technology to "make those kind of things happen." He noted, "We're one of the only universities in the country that has a ... super computer." 3:39:05 PM REPRESENTATIVE ANDERSON thanked Mr. Marrs for his service to the state, in terms of his philanthropy and business and private sector experience. He said he thinks that will "complement your public sector analysis as you help ... secure funding for the university." He added, "I think we'll have a really good advocate in Carl." 3:40:14 PM REPRESENTATIVE SEATON moved to advance the confirmation of Carl Marrs to the joint session of the House and Senate. There being no objection, the confirmation of Carl Marrs to the position of Board of Regents was advanced. 3:40:46 PM JEFF STASER, Appointee to the University of Alaska Board of Regents, noted that his grandfather was in the Sixth Alaska Territorial Legislature and his parents met at the University of Alaska Fairbanks campus. He related that he enlisted, attended West Point Academy, and served a military career, ending up in Washington D.C. as the assistant director of civil works for the corps of engineers. After that, he was asked to join Senator Ted Stevens' staff from 1994-1999. In 1999, the senator asked him to serve in Alaska as the federal co-chair of the Denali Commission. Mr. Staser noted that, while working for Senator Stevens, he was the associate staff from the senator's office on the Senate Commerce Subcommittee for Science and Technology. Since coming back to the state, he has worked at the University of Alaska, Anchorage (UAA) as the Business School advisory board member and Engineering School advisory board member, as well as serving on the statewide [Experimental Program to Stimulate Competitive Research (EPSCoR)]. Mr. Staser said he is deeply rooted in the state and university system and sees "some wonderful, unfolding opportunities to engage [the] university with federal help with some of the issues that are looming large right here in front of us in the very near future." 3:43:14 PM REPRESENTATIVE CISSNA noted that she is a student and meets with many students who have expressed concern about the lack of advanced degree programs in advanced health fields. The result is that those students don't have the incentive to stay at the university and go Outside more often than not. She indicated that there is not much opportunity to work in health institutions right next to the university. She says this is a problem that needs to be addressed. She said, "The concentrated health center there does offer an opportunity that appears to me not being taken advantage of. Have you thought of any way to deal with that?" 3:45:05 PM MR. STASER replied that the more he learns about the university, the more he realizes how much at risk that institution is for losing its accreditation and capacity to do research and development. He said it's difficult to recruit Ph.D.s to come to Alaska with their families, and without those Ph.D. instructors, the university not only loses out on research opportunities, but the classroom suffers. He suggested that if the university cannot import instructors with Ph.D.s, it ought to "grow" its own. He offered further details. 3:46:29 PM MR. STASER said the multiple-disciplinary aspects of a full- fledged Ph.D. program are huge. He said the boards he is involved with have been working hard to get programs on the campuses that promote having graduate level programs, so that people can get degrees and stay in Alaska. 3:47:08 PM REPRESENTATIVE SEATON said he thinks Mr. Staser's involvement in nonprofit organizations is beneficial. He restated the question he asked of Mr. Marrs regarding the main campuses and regional sites. 3:47:57 PM MR. STASER responded that as he travels around the state, he has seen many rural communities and regional hubs. He said, "We're all working in the connected world through the Internet. I think one of our greatest natural resources is the untapped mental capacity of our rural folks." He opined that if people are not given access to education, "they'll never figure out how to pay for and sustain their families and their communities." He said the main universities and the regional areas are all one economic engine, connected more so than ever. He continued: We're at a threshold. We either recognize how to tap into our ability to innovate, our ability to think, our ability to work together, or we don't. And if we can't do it effectively in a sustainable basis, who's going to do it for us? I mean, shame on us if we don't figure out how to get the optimum mix of access to high ..., good ..., and sustainable education, so that we can afford the university that we've got. I think we can get there, but it's going to take an awful lot of teamwork - a lot of realization that we're all in this together, and we may have to read just some of the opportunities versus constraints that we're working with. One of the things I've learned already through the university is how complex our university system is, and ... we need to take a look at that. 3:50:15 PM REPRESENTATIVE SEATON expressed that many are concerned that funding will be concentrated at the main campuses and drained from the regional campuses. He indicated that he doesn't want total reliance on a connection to the rural centers through the Internet. 3:51:01 PM MR. STASER said he agrees. He said a person can't get a good education "just through the Internet." He stated the importance of lab work and hands-on experience. He concluded, "There's a lot of things that could be done better in our rural communities with the proper balance of resources and access." 3:51:42 PM REPRESENTATIVE SEATON moved to advance the confirmation of Jeff Staser to the joint session of the House and Senate. There being no objection, the confirmation of Jeff Staser to the position of Board of Regents was advanced. 3:52:18 PM ROBERT MARTIN, Appointee to the University of Alaska Board of Regents, told the committee that he was born and raised in the rural village of Kake and graduated high school in Juneau. He attended a technical school in Kansas run by the Bureau of Indian Affairs, and worked several years for the Federal Aviation Administration (FAA) as a radar technician. He attended the University of Alaska Fairbanks (UAF), graduating in 1969, at which point he served in the U.S. Army. During his service in the Army, he helped build the road to Prudhoe Bay for the Alaska Pipeline. Since then he has worked primarily in the electric utility and road building industries, primarily with the then Department of Highways [currently the Department of Transportation & Public Facilities]. Currently, he is working as the regional transportation engineer for the Bureau of Indian Affairs, with responsibility for transportation needs throughout rural Alaska. 3:53:59 PM MR. MARTIN stated he is interested in serving on the board for a number of reasons. First, after receiving an excellent engineering education from UAF, he said, serving on the Alaska Board of Regents would be a way to repay the university system for that education. Second, he said a huge benefit is having "served my career in Alaska with people I went to school with." He offered further details. 3:55:09 PM MR. MARTIN described rural Alaska as an untapped workhorse. Currently, he said, the state is facing a labor shortage so severe that within a few years, it will become overwhelming if nothing is done. He said rural residents have a problem adapting to an urban lifestyle while going to school, but offered his belief that rural citizens and those who need to hire new engineers or business majors - for example - could help each other. 3:56:13 PM MR. MARTIN said he was fortunate to have grown up in a family with a grandfather and uncle who both graduated from college. The former was a territorial legislator and the latter served his career as a certified public accountant (CPA). He added, "That's not something that's available to most rural kids. So, they grow up without someone that ... would ... be good at things that they value. That sort of leaves out many of the teachers, because the teachers aren't skilled at the things that are valued in the Bush." He indicated that [by serving on the Alaska Board of Regents] he could be a role model for the children in rural Alaska. CHAIR WILSON agreed that having a family member with a college education can have a big impact on a person's life. 3:58:01 PM REPRESENTATIVE CISSNA noted that the top employer in Alaska is in the field of health care. She said it's a profession in which people can work within a variety of job ranges. She stressed the importance of having a health component at every university, and asked Mr. Martin if he has given the matter thought. 3:59:59 PM MR. MARTIN admitted that health care is not a matter he has spent much time thinking about. Notwithstanding that, he said that as the Baby Boomers age, the demand on the health care system increases. He noted that many of the health care professionals and technicians go out of state to get their education, and he indicated that that is an issue that could be addressed. He reported that at the last [University of Alaska Board of Regents] meeting, the board approved the addition of an x-ray technician program in the University of Alaska Southeast (UAS). 4:01:44 PM CHAIR WILSON stated that by 2010 Alaska will need 4,000 new registered nurses (RNs). Two years ago, the university graduated only 200 RNs. She predicted that, within five years, there will be the beginning of a crisis in health care. She said the problem is nationwide. 4:03:00 PM REPRESENTATIVE SEATON said Mr. Martin covered the importance of rural campuses in his remarks. He told Mr. Martin that he also graduated in 1969 from UAF. 4:03:29 PM REPRESENTATIVE GARDNER moved to advance the confirmation of Robert Martin to the joint session of the House and Senate. There being no objection, the confirmation of Robert Martin to the position of Board of Regents was advanced. ^Professional Teaching Practices Commission 4:04:01 PM CHAIR WILSON announced that the final order of business would be the confirmation hearing for an appointee to the Professional Teaching Practices Commission. 4:04:36 PM KAREN MACKLIN, Appointee to the Professional Teaching Practices Commission (PTPC), told the committee that she came with her family to Alaska in 1967 as a senior in high school. After graduating from high school, she spent several years working in the private sector and owned businesses in the Anchorage and Girdwood area. She received her BEd in [Elementary] Education from the University of Alaska, Anchorage (UAA) in 1985. She said she has taught both regular and special education, pre- school to college level, for approximately 20 years - 14 of those years in Alaska. She noted that she holds a Masters of Special Education from UAA. Ms. Macklin said she has been active in NEA-Alaska and its local chapters, and has been involved with her local school districts in a variety of capacities. 4:05:50 PM MS. MACKLIN stated her biggest reason for wanting to participate with PTPC is: "I like the idea that we have the ability to police our own profession; that we have the responsibility to uphold the [professionalism] of educators." She said she thinks the ethics that have been outlined in the Alaska Code are important. Ms. Macklin said she is confident that she holds the respect of her colleagues. She said in Sitka there has been a new awareness of what the PTPC does and what the ethics actually mean. She said she is interested in learning more, including the legal vocabulary and processes used by the commission. She stated that she has enjoyed the sessions in which she has participated and has found the team to be professional and open to discussion on tough issues regarding certification of teachers. She revealed, "It's my first somewhat political arena ... to be involved in, and I've been enjoying it so far." 4:07:25 PM MS. MACKLIN reminded Representative Wilson that she had met her last year when she brought a group of students in for "transition fair" from Sitka. She offered further details. 4:08:40 PM REPRESENTATIVE GARDNER noted that Ms. Macklin had been involved in [fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders (FASD)] coursework and said she's sure Ms. Macklin is aware that "it's a huge problem for this state." She asked if Ms. Macklin has any suggestions for things that should be done in Alaska for FAS/FASD children that are not currently being done. 4:09:18 PM MS. MACKLIN responded that she would like to say there is an easy answer to prevent FAS and [fetal alcohol effects (FAE)]. She mentioned that there is a related clinic in Sitka, but it is difficult to get a diagnosis, because the mother doesn't always want to admit that she was drinking or abusing substances during her pregnancy. Notwithstanding that, she stated she thinks a lot of the symptoms of FAS/FAE can be worked with whether or not the student "has that label." She said the state offers education on the subject and she can't think of anything else that can be done but offer more education. 4:11:03 PM REPRESENTATIVE SEATON moved to advance the confirmation of Karen Macklin to the joint session of the House and Senate. There being no objection, the confirmation of Karen Macklin to the position of the Professional Teaching Practices Commission was advanced. ADJOURNMENT  There being no further business before the committee, the House Health, Education and Social Services Standing Committee meeting was adjourned at 4:12:30 PM.