ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 8, 2011
3:02 p.m.
MEMBERS PRESENT
Representative Wes Keller, Chair
Representative Alan Dick, Vice Chair
Representative Bob Herron
Representative Paul Seaton
Representative Bob Miller
Representative Charisse Millett
MEMBERS ABSENT
Representative Sharon Cissna
COMMITTEE CALENDAR
HOUSE BILL NO. 1
"An Act stating a public policy that allows a person to choose
or decline any mode of securing health care services."
- HEARD & HELD
HOUSE BILL NO. 78
"An Act establishing a loan repayment program and employment
incentive program for certain health care professionals employed
in the state; and providing for an effective date."
- HEARD & HELD
PRESENTATION: ALASKA HEALTHCARE WORKFORCE PLAN
- HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 1
SHORT TITLE: POLICY FOR SECURING HEALTH CARE SERVICES
SPONSOR(s): REPRESENTATIVE(s) GATTO, LYNN
01/18/11 (H) PREFILE RELEASED 1/7/11
01/18/11 (H) READ THE FIRST TIME - REFERRALS
01/18/11 (H) HSS, JUD
03/01/11 (H) HSS AT 3:00 PM CAPITOL 106
03/01/11 (H) Scheduled But Not Heard
03/08/11 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 78
SHORT TITLE: INCENTIVES FOR CERTAIN MEDICAL PROVIDERS
SPONSOR(s): REPRESENTATIVE(s) HERRON
01/18/11 (H) PREFILE RELEASED 1/14/11
01/18/11 (H) READ THE FIRST TIME - REFERRALS
01/18/11 (H) HSS, FIN
03/08/11 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
KAREN SAWYER, Staff
Representative Carl Gatto
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 1 on behalf of the joint prime
sponsor, Representative Carl Gatto.
PAT LUBY, Advocacy Director
AARP
POSITION STATEMENT: Testified and answered questions during
discussion of HB 1.
SIGNE ANDERSON, Chief Assistant Attorney General - Statewide
Section Supervisor
Commercial/Fair Business Section
Civil Division (Anchorage)
Department of Law (DOL)
Anchorage, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
1.
LIZ CLEMENT, Staff
Representative Bob Herron
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 78 on behalf of the bill
sponsor, Representative Bob Herron.
DR. MARY LOEB, Medical Director
Sunshine Community Health Center
Talkeetna, Alaska
POSITION STATEMENT: Testified in support of HB 78.
NANCY DAVIS, Executive Director
Alaska Pharmacists Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 78.
ELIZABETH RIPLEY, Executive Director
Mat-Su Health Foundation
Wasilla, Alaska
POSITION STATEMENT: Testified in support of HB 78.
JULIE MCDONALD, Pharmacist
Prince of Wales, Alaska
POSITION STATEMENT: Testified in support of HB 78.
JIM TOWLE, Executive Director
Alaska Dental Society
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 78.
RICHARD PECK, Board President
Iliuliuk Family and Health Services, Inc.
Unalaska, Alaska
POSITION STATEMENT: Testified in support of HB 78.
SHELLEY HUGHES, Government Affairs Director
Alaska Primary Care Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 78.
RHONDA RAYE, Physical Therapist
Palmer, Alaska
POSITION STATEMENT: Testified in support of HB 78.
JUSTIN RUFFRIDGE
Pharmacist
Soldotna, Alaska
POSITION STATEMENT: Testified in support of HB 78.
KAREN PERDUE, CEO & President
Alaska State Hospital and Nursing Association
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 78 and presented
a PowerPoint on the Alaska Healthcare Workforce.
PAT CARR, Chief
Health Planning and Infrastructure
Division of Health Care Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of HB 78.
DELISA CULPEPPER, Chief Operating Officer
Alaska Mental Health Trust Authority
Department of Revenue
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 78 and presented
a PowerPoint on the Alaska Healthcare Workforce.
MARIE DARLIN, Coordinator
AARP Capital City Task Force
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 78.
JAN HARRIS, Vice Provost
University of Alaska
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint on the Alaska
Healthcare Workforce.
ACTION NARRATIVE
3:02:47 PM
CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:02 p.m.
Representatives Keller, Miller, Dick, Herron, Seaton, and
Millett were present at the call to order.
HB 1-POLICY FOR SECURING HEALTH CARE SERVICES
3:03:20 PM
CHAIR KELLER announced that the first order of business would be
HOUSE BILL NO. 1, "An Act stating a public policy that allows a
person to choose or decline any mode of securing health care
services."
3:05:44 PM
KAREN SAWYER, Staff, Representative Carl Gatto, Alaska State
Legislature, presented HB 1 and stated:
This bill is not really about health insurance or
health care services, but it's rather about state
rights. We allege that the new federal law passed
last year, "Patient Protection and Affordable Care
Act," otherwise also known as Obamacare, infringes
upon the constitutional rights of U.S. individuals by
mandating all citizens and legal residents have
qualifying health care coverage or pay a tax penalty.
By imposing such a mandate, this law exceeds the
powers of the United States under the Constitution.
We're not challenging the authority of the federal
government, they've actually challenged our authority,
and it's up to us to defend ourselves. If we don't,
this is just the beginning of more federal take-over.
Therefore, this bill will codify as state policy that
every person in the State of Alaska is and shall
continue to be free from federal government force in
the selection of health insurance options, and that
such liberty is protected by the constitutions of the
United States and the State of Alaska. This bill also
removes the authority of any state official or
employee from enforcing any penalty which violates the
policy.
3:07:07 PM
MS. SAWYER referred to the handout, titled "HB 1-Explanation
of:" [Included in members' packets]. She stated that the
sponsor was agreeable to having this explanation included in the
bill.
CHAIR KELLER clarified that HB 1, Version A, was in front of the
committee.
MS. SAWYER, referring to the "Patient Protection and Affordable
Care Act," reported that nationwide, 40 state legislators had
"introduced legislation to limit, alter, or oppose selected
federal actions regarding this bill, including single care
provisions and mandates that would require purchase of
insurance." She asked that Alaska join the seven other states
which enacted legislation "to establish the individual's right
in their state to be free of federal government force to make
their own choice about health care." She quoted a statement by
former Supreme Court Justice Sandra Day O'Connor regarding the
federal regulation of states.
3:08:58 PM
REPRESENTATIVE SEATON offered his belief that HB 1 limited state
action, not federal action. As he did not see any naming of the
federal government, he opined that the requirement was for the
state or within the state.
MS. SAWYER replied that HB 1 would put into policy that Alaska
guaranteed for individuals to have the right to choose.
3:10:39 PM
REPRESENTATIVE SEATON, referring to an initiative for managed
care on the Kenai Peninsula, asked if HB 1 would prevent health
care by a subdivision of the state.
MS. SAWYER offered her belief that HB 1 prevented a mandate for
Alaskans to buy health care, except for those provisions listed
on page 1, line 12.
3:11:58 PM
REPRESENTATIVE MILLER asked to clarify that the bill sponsors
deemed the "Patient Protection and Affordable Care Act" as
unconstitutional. He stated that of the five court cases
regarding this, three had ruled for its constitutionality. He
pointed to the recent court ruling in Florida which directed
that portions of the federal health care act should be
implemented. He asked if HB 1 was a bit premature.
MS. SAWYER offered her understanding that the recent Florida
ruling was a 7 day stay for appeal. She declared that the
sponsors still desired that HB 1 become a state policy "that
will protect us."
3:13:55 PM
REPRESENTATIVE MILLER asked to clarify that HB 1 stated that
Alaskans are free to choose or decline any mode of obtaining
health care, but that HB 1 does not apply to health care
services that might be required by the State of Alaska.
MS. SAWYER concurred, and she directed attention to the handout,
"HB 1-Explanation of:"
REPRESENTATIVE MILLER opined that HB 1 stated that "the federal
government can't mandate anything, but the state still retains
its ability to do so."
MS. SAWYER concurred.
3:14:50 PM
REPRESENTATIVE HERRON asked how HB 1 addressed the problem of
uninsured people going to hospital emergency rooms.
MS. SAWYER replied that HB 1 did not address any provisions for
health care service. She offered her belief that HB 1 was
"about just the federal government telling the states, the
individuals of our state, that they have to do something, or be
taxed." She stated that her limited understanding of the
"Patient Protection and Affordable Care Act" was that there
would "still be a significant number of individuals who will
still not have health care." She opined that many more people
would be added to Medicaid.
3:16:23 PM
REPRESENTATIVE HERRON, reading from HB 1, summarized that Alaska
was creating "a policy of the State of Alaska that [a person
has] the right to choose or decline any mode of obtaining health
care services without penalty or threat of penalty." Offering
an assumption for the passage of HB 1, he inquired to the
efficacy for the passage of a policy to stop any chosen federal
law or mandate to which some people disagree.
MS. SAWYER replied that HB 1 could set an important precedent
for future federal mandates. She declared that Alaska was an
important state to the federal government.
3:17:43 PM
REPRESENTATIVE MILLETT asked how many states had passed similar
legislation.
MS. SAWYER replied that seven states had similar legislation.
REPRESENTATIVE MILLETT asked about any anticipated federal
response.
MS. SAWYER offered her belief that the federal government "was
just waiting to see what's going to happen." She opined that
even with passage of the Patient Protection and Affordable Care
Act, there was no enforcement to non-compliance. She declared
that President Obama had relaxed some of his provisions,
allowing states to offer alternative choices.
3:19:54 PM
REPRESENTATIVE MILLETT asked to clarify that greater opposition
to the federal health care act would lead to removal of the more
stringent requirements.
MS. SAWYER offered her belief that a majority of the country was
opposed to the mandate, and that would make a difference.
3:21:02 PM
REPRESENTATIVE MILLER asked whether there was a state
requirement for vaccines to children attending public school.
MS. SAWYER offered her belief that it was a requirement, and, in
response to Representative Miller, she relayed that the vaccines
would still be required. She emphasized the importance of the
list on the handout.
3:21:45 PM
REPRESENTATIVE MILLER, referencing the vaccines, asked if there
were any health mandates that came from federal legislation.
MS. SAWYER replied that she would look into it.
3:22:24 PM
REPRESENTATIVE MILLER, referring to the mandatory vaccine for
smallpox in 1969, opined that HB 1 would allow him to now
decline anything similar.
MS. SAWYER, referring to (9) of the handout, said that the
committee could include something to cover this.
3:23:30 PM
REPRESENTATIVE MILLER offered his belief that vaccines for any
naturally occurring diseases, listing HIV, tuberculosis, polio,
malaria, or dengue fever, would not be mandatory under HB 1.
MS. SAWYER opined that vaccinations were not mandatory for
Alaskans.
REPRESENTATIVE MILLER agreed, stating that HB 1 would enforce
that, no matter whether public health was threatened.
3:24:37 PM
MS. SAWYER declared that even knowingly having a disease still
did not mandate a vaccination.
REPRESENTATIVE MILLER, directing attention to page 2, line 3,
suggested the addition of prevention.
3:25:14 PM
CHAIR KELLER opened public testimony.
3:26:17 PM
PAT LUBY, Advocacy Director, AARP, declared that "many well
meaning people have completely opposite positions on the federal
health care reform bill, especially the individual mandate." He
pointed out that people had declined health insurance for many
years. He noted that many others, including older people,
wanted health insurance but could not secure it. He stated that
19 percent of Alaskans between 50 and 64 were uninsured. He
reported that the uninsured ended up in the emergency room,
which was paid for by those who had insurance. He estimated
that every Alaskan family spent $1900 annually toward people
without insurance. He emphasized that the State of Alaska, and
private employers who provided insurance, among others, paid for
the uninsured, as the costs were shifted to those with coverage.
He pointed out that proposed HB 1 would continue the practice of
cost shifting.
3:28:33 PM
MR. LUBY relayed the story of an accident to a 54 year old with
no health insurance. He defined cost shifting as the payment
for these incidences by those who did have health insurance. He
declared that HB 1 had nothing to do with freedom of choice, it
had to do with cost shifting. He established that the Patient
Protection and Affordable Care Act would subsidize those who
could not afford health insurance. He affirmed that HB 1 would
continue cost shifting to those who did have insurance.
3:30:06 PM
CHAIR KELLER asked which was more important, choice or paying
your own way. He offered his belief that it was unprecedented
for any government to declare that it was mandatory to buy a
commodity or a service.
MR. LUBY compared the federal health care act to social
security, and stated that it provided for retirement or
disability. He noted that it was mandatory, and it ensured that
the public would not have to provide for an individual. He
indicated that this was the basis for the Patient Protection and
Affordable Care Act.
3:31:56 PM
REPRESENTATIVE SEATON asked to clarify that if an individual
declined health insurance, they would be responsible for any
costs incurred.
MR. LUBY replied that the Supreme Court had ruled that an
individual had to be treated; however, the cost would be paid by
those with insurance.
3:33:13 PM
REPRESENTATIVE SEATON, pointing to line 10, referred to "without
penalty or threat of penalty," and asked if this could include
personal liability as an individual consequence.
MR. LUBY determined that the only exclusion within the Patient
Protection and Affordable Care Act was to decline the purchase
of insurance for religious reasons. He explained the sliding
scale for payment of basic health coverage, and confirmed that
there was a tax penalty for failure to purchase health
insurance. He declared that even the payment of a tax penalty
would still require hospital payment by someone else.
3:35:27 PM
REPRESENTATIVE SEATON declared that proposed HB 1 concerned
itself with a policy of the state, and not with the Patient
Protection and Affordable Care Act. He questioned whether HB 1
removed personal liability for an individual who refused health
insurance. He asked Mr. Luby if inclusion of personal liability
would address some of the AARP concerns.
MR. LUBY opined that the health exchange would offer many
choices, and that some individuals would choose to pay the
penalty and pay for their own health care costs.
3:38:09 PM
REPRESENTATIVE HERRON asked if proposed HB 1 would affect
federal law. He questioned whether a lawsuit would be a
substitute for the bill.
3:38:39 PM
SIGNE ANDERSON, Chief Assistant Attorney General - Statewide
Section Supervisor, Commercial/Fair Business Section, Civil
Division (Anchorage), Department of Law (DOL), replied that the
state was already a party to a lawsuit challenging the Patient
Protection and Affordable Care Act. She offered her belief that
proposed HB 1 was a policy statement in support of the lawsuit.
3:39:00 PM
REPRESENTATIVE SEATON, referring to page 1, line 9, asked if
"decline any mode of obtaining health care services without
penalty or threat of penalty" could be amended to ensure
personal liability for the costs associated with health care
service.
MS. ANDERSON replied that HB 1 could be amended. She stated
that the definition of "penalty" only included a fine, tax,
surcharge fee, or similar. She declared that all ambiguity
could be removed with an amendment.
3:40:25 PM
CHAIR KELLER closed public testimony.
3:40:49 PM
CHAIR KELLER commented that HB 1 "is so easy to understand" if
individuals take responsibility for paying for their own health
care.
[HB 1 was held over.]
HB 78-INCENTIVES FOR CERTAIN MEDICAL PROVIDERS
3:41:45 PM
CHAIR KELLER announced that the next order of business would be
HOUSE BILL NO. 78, "An Act establishing a loan repayment program
and employment incentive program for certain health care
professionals employed in the state; and providing for an
effective date."
CHAIR KELLER offered an analogy for HB 78 to that of investing
in new tires for an old car that has everything wrong. He
offered his belief that the destiny of the Patient Protection
and Affordable Care Act was still in the court system, and that
the costs of the health care system were no longer supportable.
He opined that a government subsidy for loans, as proposed by HB
78, was not a solution.
3:43:29 PM
REPRESENTATIVE HERRON expressed his appreciation for the
opportunity to hear testimony regarding incentives for medical
providers and for the "possible passage of this bill through the
House."
3:44:25 PM
LIZ CLEMENT, Staff, Representative Bob Herron, Alaska State
Legislature, directed attention to the latest proposed committee
substitute.
3:44:51 PM
REPRESENTATIVE DICK moved to adopt the proposed Committee
Substitute (CS) for HB 78, 27-LS0147\I, Mischel, 3/2/11, as the
working document. There being no objection, Version I was
before the committee.
3:45:10 PM
MS. CLEMENT emphasized the challenges to the health care
workforce in rural and urban areas. She explained that proposed
HB 78 offered incentives to attract certain medical providers to
Alaska. She reported that 46 states had sponsored "support for
service programs" and that many states had found these to be
extremely beneficial for immediate alleviation of workforce
shortages. She confirmed that research had indicated that loan
repayment and incentive programs, similar to proposed HB 78, had
been among the most effective methods for recruitment and
retention of quality health care providers. She pointed out
that medical providers could receive either loan repayment
assistance or direct cash incentives. She pointed out that few
states offered a direct cash incentive, which could attract
recent graduates as well as experienced mid-career medical
professionals.
3:47:22 PM
MS. CLEMENT announced that the program would be administered by
Department of Health and Social Services (DHSS) and allow for 90
participants each year, from 10 approved health care
professions, which included dentists, pharmacists, nurse
practitioners, and physical therapists. She reported that the
various levels of loan repayment or financial incentive would be
determined by community location and profession. She noted that
these determinations would be in statute and monitored by DHSS.
She pointed to the numerous letters of support [Included in
members' packets].
3:48:59 PM
REPRESENTATIVE MILLETT asked for the definition to "a very hard-
to-fill position."
MS. CLEMENT explained that these would be designated by DHSS,
based, in part, by the time necessary to recruit a provider for
that position.
3:50:37 PM
REPRESENTATIVE MILLETT asked if this would be determined by the
DHSS commissioner.
MS. CLEMENT agreed.
3:51:06 PM
CHAIR KELLER suggested that a question to be asked would be for
the determination of the criteria.
3:51:35 PM
CHAIR KELLER opened public testimony.
3:51:49 PM
DR. MARY LOEB, Medical Director, Sunshine Community Health
Center, testified to the difficulty in filling key medical
positions. She detailed that it was 18 months to recruit a
dentist, 24 months to recruit a behavioral health specialist,
and another 18 months to recruit for numerous provider
positions. She stated that this would offer needed support for
recruitment of qualified personnel.
3:54:02 PM
NANCY DAVIS, Executive Director, Alaska Pharmacists Association,
informed the committee that there were no public programs in
Alaska to actively recruit and retain pharmacists. She reported
that Alaska was one of only four states without a pharmacy
school, so recruitment was the only method to obtain the
necessary pharmacists. She testified that the 250 association
members were in support of HB 78.
3:55:18 PM
ELIZABETH RIPLEY, Executive Director, Mat-Su Health Foundation,
explained that the Mat-Su Health Foundation was a non-profit
organization, which invested into grants to improve the health
and wellness of Alaskans living in Mat-Su. She detailed that
one of the four strategies to reach the goal of becoming the
healthiest borough in Alaska was to reduce the barriers to
health care access, which included a lack of health care
professionals. She directed attention to her letter detailing
the recruitment experience and offering support for proposed HB
78 [Included in members' packets]. She acknowledged that all
recruits reviewed opportunities before making a decision, as
competition was quite robust. She pointed out that culture,
climate, geography, and lack of amenities all combined to make
recruitment even more difficult. She identified these as
significant difficulties for recruitment in rural clinics and
community health centers. She opined that the work force had
numerous options throughout the United States, as 47 states had
loan repayment programs. She stressed the necessity for a
quality health care work force in the primary care settings in
order to keep people out of costly acute care. She declared
that an investment in loan repayment and direct incentive
programs was a solid investment with a healthy return. She
offered support of proposed HB 78.
4:00:26 PM
MS. RIPLEY, in response to Chair Keller, said that the direct
incentive programs were highly successful in other states.
4:01:24 PM
REPRESENTATIVE SEATON, referring to page 3, line 22 of Version
I, asked if the loan repayment differential between urban and
rural health care professionals was adequate.
MS. RIPLEY replied that although she was not specifically
addressing the payment differential, it was adequate, but that
urban hospitals had other tools to assist in recruitment.
4:03:17 PM
JULIE MCDONALD, Pharmacist, shared her story of pharmacy school,
and her consequent work history, and she reported that her
student loans exceeded $200,000. She declared that costs were a
major factor and that proposed HB 78 would be a powerful
incentive to bring people here.
4:08:10 PM
JIM TOWLE, Executive Director, Alaska Dental Society, shared a
story of an inquiry from a person interested in dentistry in
Alaska, but burdened with student loans, who expressed that
incentives would influence her decision. He stated that these
inquiries were not uncommon. He stressed that proposed HB 78
was a valuable incentive for recruitment.
4:09:49 PM
REPRESENTATIVE SEATON asked if the loan repayment differential
for urban and rural health care professionals was adequate.
MR. TOWLE agreed that it was adequate.
4:10:23 PM
RICHARD PECK, Board President, Iliuliuk Family and Health
Services, Inc., stated that proposed HB 78 was necessary to
attract and retain medical providers. He offered the support of
the board for HB 78.
4:11:40 PM
SHELLEY HUGHES, Government Affairs Director, Alaska Primary Care
Association, shared that she had been a member of the
stakeholders working group in 2008 looking for a solution. She
emphasized that this strategy was "the best bang for the buck."
She reported that nationally there was a shortage of physicians
and Alaska was getting hit hard. She reported that it was
expensive and difficult to recruit and retain, and even more so
in rural areas. She relayed that the physician vacancy in
tribal positions was over 28 percent, and the vacancy rate for
other medical provider positions was over 35 percent. She
stated that the medical directors from the Community Health
Centers had relayed that applicants always inquired about
incentive and loan repayment programs. She stated that the
turnover rate for medical professionals was about three years.
She remarked that the incentive and loan repayments would also
complement the "grow our own" program, as Alaskans would return
to Alaska. She compared the average loan debt to that of a
mortgage. She pointed out that proposed HB 78 targeted people
who were ready to work and, as there was not any pay until there
was service, the return was 100 percent. She asked the
committee to consider the costs of no action, as rural health
care clinics generated revenue and were "economic engines." She
opined that Medicaid costs would increase without additional
medical providers in the bush. She pointed out that proposed HB
78 included a financial match so that the health care industry
also had "skin in the game." She also noted that the Alaska
Health Care Commission had recommended loan repayment and
incentives as a strategy for increasing the medical workforce in
Alaska. She directed attention to the wide spread support from
all the medical industry sectors.
4:18:11 PM
RHONDA RAYE, Physical Therapist, pointed out that there was not
a physical therapy program in Alaska. She commented that a loan
repayment program was a big incentive when searching for jobs.
She spoke in support of HB 78.
4:20:29 PM
REPRESENTATIVE HERRON asked if the financial incentive was
enough to compete with other states, and he asked for a
comparison with Alaska.
MS. HUGHES, in response, said that the amounts were competitive,
and she offered to report back with actual comparative numbers.
She pointed to the importance of hiring experienced
professionals in rural locations.
4:22:11 PM
REPRESENTATIVE HERRON asked to confirm that "a very hard to fill
position" was not designated solely to rural areas.
MS. HUGHES replied that it was based on the length of the
vacancy and the difficulty for hiring. She offered her belief
that this would tend toward smaller, more remote locations.
4:23:39 PM
JUSTIN RUFFRIDGE, Pharmacist, reported that there was little
opportunity for loan repayment from the State of Alaska,
especially as there was not a pharmacy school in the state. He
stated his support of HB 78. He offered his belief that HB 78
was a necessary component in order for Alaska to be competitive
with other states.
4:24:56 PM
KAREN PERDUE, CEO & President, Alaska State Hospital and Nursing
Association, reported on the medical work force shortages in
Alaska, noting that some professions in the urban areas were
doing well. She relayed that hiring was cyclical in Alaska, and
she opined that the hiring situation would worsen with shortages
in both rural and urban areas. She pointed to specialist areas
which were very difficult to fill. She offered her belief that
proposed HB 78 would offer much greater help to smaller clinics
and community health centers than to hospitals. She stated that
health care was defined by the providers and the service to the
patients. In reference to an earlier analogy by Chair Keller,
she suggested that HB 78 was a replacement for the motor, not
the tires.
4:29:03 PM
CHAIR KELLER asked if HB 78 offered an appropriate incentive.
MS. PERDUE replied that the bill was a good start.
4:30:04 PM
PAT CARR, Chief, Health Planning and Infrastructure, Division of
Health Care Services, Department of Health and Social Services,
stated that HHSS had been following HB 78.
4:30:45 PM
CHAIR KELLER asked what the determinater of success would be in
5 years.
MS. CARR replied that an evaluation for measures of success
would include increased access to care, with increased
providers. She referenced HB 78 and detailed that, among
others, the number of applicants, the enrollees, the
geographical area, the length of vacancies, the employment
patterns, and the enrollment of professionals would be included
in the evaluation process. She pointed to other surveys,
including the Behavioral Risk Factor Survey, which could also be
used in evaluation. She summarized that a tracking tool to
determine the dispersal of the funding and to measure any
decrease in length of job vacancies would be necessary for the
evaluation.
4:34:22 PM
CHAIR KELLER asked if criteria needed to be developed for the
selection of applicants.
MS. CARR replied that the criteria were not yet available. She
directed attention to a current HHSS repayment program which
would act as a model, and noted that the advisory group would
also make suggestions.
4:35:38 PM
REPRESENTATIVE HERRON, referring to Version I, pointed to page
2, line [17], and stated concern with "a lifetime maximum period
of 12 years." He asked for a better definition of "hard to
fill," and if any of these professions would be eligible for
hire with the State of Alaska.
MS. CARR, reflecting on discussions about "a lifetime maximum
period of 12 years," stated that support for retention should be
extended to people returning to school for continued education.
She stated that the time frame was still under advisement. In
response to Representative Herron, she said that "hard to fill"
could either be defined in statute or be added as a program
regulation for the discretion of the advisory committee or the
commissioner.
4:38:50 PM
REPRESENTATIVE HERRON asked if a recipient of the incentives or
loan repayments in HB 78 could work for the State of Alaska.
MS. CARR replied that this had not yet been defined. She noted
that some of the professional categories referenced in the bill
were employed by the state, and that the state also had
difficulty with recruitment of certain health care providers.
4:39:37 PM
REPRESENTATIVE SEATON, referring to the lifetime maximum period
of 12 years, asked about any limitations.
MS. CARR offered her belief that the bill did not preclude an
individual from staying in the same position for the entire
time. She pointed out that, within the 12 year period, there
were periods of application renewal.
4:41:16 PM
REPRESENTATIVE SEATON reflected that the program had a 90 person
enrollment maximum, but that there was not a priority for any
new entrants.
MS. CARR, in response to Representative Seaton, said that this
was not specified in the bill.
4:42:35 PM
REPRESENTATIVE SEATON pondered whether the intent for the
incentive program was to have someone receive payment for 12
years, if others were applying for the program.
MS. CLEMENT, in response to Representative Seaton, said that
more changes to HB 78 were forthcoming.
4:44:34 PM
DELISA CULPEPPER, Chief Operating Officer, Alaska Mental Health
Trust Authority, Department of Revenue, said that the Alaska
Mental Health Trust Authority supported long term loan repayment
and direct incentives and that these were important factors for
workforce strategies.
4:46:03 PM
MARIE DARLIN, Coordinator, AARP Capital City Task Force,
directed attention to its letter of support for HB 78 [Included
in members' packets]. She stated that HB 78 was important to
increase the number of health care providers for seniors. She
pointed out that proper medical care would allow seniors to
remain in Alaska, and she noted that seniors provided an
economic input of more than $1.5 billion to Alaska.
4:47:14 PM
CHAIR KELLER closed public testimony.
[HB 78 was held over.]
^PRESENTATION: Alaska Healthcare Workforce Plan
PRESENTATION: Alaska Healthcare Workforce Plan
4:48:11 PM
MS. CULPEPPER introduced a PowerPoint entitled "Alaska's Health
Workforce. [Included in members' packets]
MS. PERDUE, pointing to slide 1, "Health Care-One of the Biggest
Players Alaska's Labor Market," said that there were about 80
professions with 26,000 jobs in health care in Alaska. She said
that the Alaska Health Workforce Coalition came together to set
priorities for commonality of purpose. She noted that health
care comprised 9 percent of the workforce and that half of these
jobs were in hospitals and nursing homes. She opined that there
would be growth in all health care areas, especially in
outpatient home health areas.
4:50:19 PM
MS. PERDUE moved on to slide 2, "Health Care - The Number One
Job Generator In The 2001-08 period," and pointed to the
addition of 7400 health care jobs during that time period. She
noted that it was economically better for Alaska if the jobs
were filled by Alaskans. She turned to slide 3, "Continued
Growth is Expected," and shared that the Department of Labor &
Workforce Development had forecast for continued growth. She
pointed to slide 4, "Demographic Pressures," and shared that
Alaska's senior population was the fastest growing in the
nation. She reported that the new federal health reform could
potentially add 64,000 Alaskans to the health rolls. She
speculated that, should the health reform not be implemented,
there would still be workforce shortages.
4:52:26 PM
JAN HARRIS, Vice Provost, University of Alaska, directed
attention to slide 6, "Plan Development," and reflected that the
Alaska Health Workforce Coalition had met with many
stakeholders, reviewed the data, and submitted the Alaska Health
Workforce Plan, which was approved by the Alaska Workforce
Investment Board in May, 2010. She pointed to slide 7, "Health
Care Workforce Plan Overview," which was a schematic of the
plan. She referred to slide 8, "Initial Priority Occupations,"
which listed 15 selected occupational groups. She moved on to
slide 9, "Alaska's Health Care Workforce Plan," which projected
the action plans to attain the strategic priorities.
4:54:20 PM
MS. CULPEPPER shared slide 10, "What Will It Take To Resolve
These Issues?" and stated that it required investment from the
state, the federal government, and the health care industry.
She spoke about the support for medical residency development,
and for the University of Alaska to recruit and retain new
staff. She directed attention to the Area Health Education
Center (AHEC), a workforce development system that would also
receive funding. She reported that implementation of the plan
would be ongoing for prioritizing, strategizing, and
implementing.
4:57:03 PM
MS. CULPEPPER emphasized that this would always be an industry
partnership. She reported that more details would be
forthcoming for strategic priorities. She reminded the
committee that health care reform was the top growth industry.
4:59:08 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:59 p.m.