ALASKA STATE LEGISLATURE  HOUSE LABOR AND COMMERCE STANDING COMMITTEE  April 25, 2025 9:09 a.m. DRAFT MEMBERS PRESENT Representative Carolyn Hall, Co-Chair Representative Zack Fields, Co-Chair Representative Ashley Carrick Representative Robyn Niayuq Burke Representative Dan Saddler Representative Julie Coulombe Representative David Nelson MEMBERS ABSENT  All Members Present COMMITTEE CALENDAR  CONFIRMATION HEARING(S): Board of Professional Counselors Mary Elkins Anchorage Crystal Herring Anchorage Ashley Martin Anchorage Carrie-Elaine Border Anchorage - CONFIRMATION(S) HEARD Board of Public Accountancy Donovan Neal Juneau James Doughty - Anchorage - CONFIRMATION(S) HEARD State Board of Registration for Architects, Engineers, & Land Surveyors Samson Shepherd Anchorage - CONFIRMATION(S) HEARD Marijuana Control Board Lacy Wilcox Juneau - CONFIRMATION(S) HEARD Occupational Safety & Health Review Board Isaac Diboue Anchorage Ryan Sharratt Kodiak Zachary Schasteen - Unalaska - CONFIRMATION(S) HEARD Real Estate Commission Jimi Cash Fairbanks Susan Wilcox Soldotna Yolanda Logan - Anchorage - CONFIRMATION(S) HEARD State Physical Therapy & Occupational Therapy Board Victoria Daugherty Juneau Jonathan Gates - Kenai - CONFIRMATION(S) HEARD Board of Veterinary Examiners Robert Gerlach - Chugiak - CONFIRMATION(S) HEARD HOUSE BILL NO. 178 "An Act relating to medical debt and consumer credit reporting agencies; relating to discriminatory practices based on the medical debt of a person; and providing for an effective date." - HEARD & HELD HOUSE BILL NO. 193 "An Act establishing a paid parental leave program; relating to unemployment benefits; relating to the collection of child support obligations; and relating to the duties of the Department of Labor and Workforce Development." - BILL HEARING CANCELED HOUSE BILL NO. 192 "An Act relating to the payment of unemployment compensation benefits; relating to a penalty for late unemployment benefit payments; relating to inflation adjustments to unemployment benefit amounts; relating to an insured worker's availability for work; and providing for an effective date." - BILL HEARING CANCELED PREVIOUS COMMITTEE ACTION  BILL: HB 178 SHORT TITLE: MEDICAL DEBT: INFORMATION, DISCRIMINATION SPONSOR(s): REPRESENTATIVE(s) MINA 04/09/25 (H) READ THE FIRST TIME - REFERRALS 04/09/25 (H) L&C, FIN 04/25/25 (H) L&C AT 9:00 AM BARNES 124 WITNESS REGISTER DONOVAN NEAL, Appointee Board of Public Accountancy Juneau, Alaska POSITION STATEMENT: Testified as appointee to the Board of Public Accountancy. JAMES DOUGHTY, Appointee Board of Public Accountancy Anchorage, Alaska POSITION STATEMENT: Testified as an appointee to the Board of Public Accountancy. MARY ELKINS, Appointee Board of Professional Counselors Anchorage, Alaska POSITION STATEMENT: Testified as an appointee to the Board of Professional Counselors. CRYSTAL HERRING, Appointee Board of Professional Counselors Anchorage, Alaska POSITION STATEMENT: Testified as an appointee to the Board of Professional Counselors. ASHLEY MARTIN, Appointee Board of Professional Counselors Anchorage, Alaska POSITION STATEMENT: Testified as an appointee to the Board of Professional Counselors. CARRIE-ELAINE BORDER, Appointee Board of Professional Counselors Anchorage, Alaska POSITION STATEMENT: Testified as an appointee to the Board of Professional Counselors. ROBERT GERLACH, DVM, Appointee Board of Veterinary Examiners Chugiak, Alaska POSITION STATEMENT: Testified as an appointee to the Board of Veterinary Examiners. SAMSON SHEPERD, Appointee State Board of Registration for Architects, Engineers & Land Surveyors Anchorage, Alaska POSITION STATEMENT: Testified as an appointee to the State Board of Registration for Architects, Engineers & Land Surveyors. REPRESENTATIVE GENEVIEVE MINA Alaska State Legislature Juneau, Alaska POSITION STATEMENT: As prime sponsor, presented HB 178. CLARK HANSEN, Managing Director of Advocacy ALS Association Juneau, Alaska POSITION STATEMENT: Gave invited testimony on HB 178. ADAM ZARRIN, Director of State Government Affairs, Leukemia & Lymphoma Society (LLS) Sacramento, California POSITION STATEMENT: Gave invited testimony on HB 178. CLAIRE LUBKE, Economic Justice Lead Alaska Public Interest Research Group Anchorage, Alaska POSITION STATEMENT: Gave invited testimony on HB 178. LACY WILCOX, Appointee Marijuana Control Board Juneau, Alaska POSITION STATEMENT: Testified as an appointee to the Marijuana Control Board. ISAAC DIBOUE, Appointee Occupational Safety & Health Review Board Anchorage, Alaska POSITION STATEMENT: Testified as an appointee to the Occupational Safety & Health Review Board. ZACHERY SCHASTEEN, Appointee Occupational Safety & Health Review Board Unalaska, Alaska POSITION STATEMENT: Testified as an appointee to the Occupational Safety & Health Review Board. JIMI CASH, Appointee Real Estate Commission POSITION STATEMENT: Fairbanks, Alaska( Testified as an appointee to the Real Estate Commission. VICTORIA DAUGHTERY, Appointee State Physical Therapy & Occupational Therapy Board Juneau, Alaska POSITION STATEMENT: Testified as an appointee to the State Physical Therapy & Occupational Therapy Board. JONATHAN GATES, Appointee State Physical Therapy & Occupational Therapy Board Anchorage, Alaska POSITION STATEMENT: Testified as an appointee to the State Physical & Occupational Therapy Board. YOLANDA LOGAN, Appointee Real Estate Commission Anchorage, Alaska POSITION STATEMENT: Testified as an appointee to the Real Estate Commission. RYAN SHARRAT, Appointee Occupational Safety & Health Review Board Anchorage, Alaska POSITION STATEMENT: Testified as an appointee to the Occupational Safety & Health Review Board. ACTION NARRATIVE 9:09:33 AM CO-CHAIR CAROLYN HALL called the House Labor and Commerce Standing Committee meeting to order at 9:09 a.m. Representatives Saddler, Nelson, Carrick, Burke, Coulombe, and Hall were present at the call to order. Representative Fields arrived as the meeting was in progress. ^CONFIRMATION HEARING(S): Board of Professional Counselors CONFIRMATION HEARING(S): Board of Professional Counselors    ^Board of Public Accountancy Board of Public Accountancy    ^State Board of Registration for Architects, Engineers & Land Surveyors State Board of Registration for Architects, Engineers & Land  Surveyors    ^Board of Veterinary Examiners Board of Veterinary Examiners  [Contains discussion of HB 121 and SB 54.] 9:10:57 AM CO-CHAIR HALL announced that the first order of business would be confirmation hearings on the governor's appointees to various boards. 9:11:20 AM DONOVAN NEAL, Appointee, Board of Public Accountancy, testified as appointee to the Board of Public Accountancy. He began his testimony by stating he has been a licensed Certified Public Accountant (CPA) for 25 years, noting that he has spent 10 years in public accounting and another 15 years "in industry." He further stated that he has participated on a few non-profit boards, which were notated on his resume that had been provided to the committee members. He welcomed questions from the committee. 9:12:30 AM REPRESENTATIVE SADDLER asked what APICDA stood for, referring to Mr. Neal's resume. MR. NEAL explained that it stood for Aleutian Pribilof Island Community Development Association, which was a non-profit community development quota (CDQ) group that is focused on the Bering Sea region. REPRESENTATIVE SADDLER, referring to HB 121, asked Mr. Neal's opinion on the proposed legislation. MR. NEAL explained that, at one point in the public accounting area, there were a lot of candidates and a lot of competition for jobs. He stated that, in recent years, its been more difficult to attract qualified candidates to the CPA profession. He noted that HB 121 was a part of a nationwide movement in efforts to reduce the additional requirement to attract more applicants to the CPA profession. 9:14:29 AM REPRESENTATIVE COULOMBE asked what issues Mr. Neal foresees that would need to be addressed by the Board of Public Accountancy. MR. NEAL noted that the board meets four times annually, and oversees a number of things, including applications for new accountancy, regulation changes, and alternative pathways to CPA licensure. He stated that the board also looks at application renewals. 9:16:27 AM JAMES DOUGHTY, Appointee, Board of Public Accountancy, He stated that he started in public accounting in 2006 after receiving his bachelor's in accounting from the University of Alaska Anchorage (UAA). He stated that he became a CPA in 2009. He noted that he has worked for corporations, government clients, non-profits organizations, et cetera. He stated that he looked forward to tackling various issues as a member of the board, noting that the proposed changing credit requirements for CPA was the primary reason that he applied for the board. He stated that he would like to see the proposed changing credit requirements pass the legislature, noting that there was a nationwide shortage of CPAs. 9:17:37 AM REPRESENTATIVE SADDLER asked whether Mr. Doughty found the disclosure requirements for his application to the board onerous. MR. DOUGHTY replied that he found the application process easy. 9:18:04 AM REPRESENTATIVE CARRICK asked for clarification whether his application was for appointment or re-appointment. MR. DOUGHTY clarified that this was his initial application. 9:18:45 AM MARY ELKINS, Appointee, Board of Professional Counselors, testified as an appointee to the Board of Professional Counselors. She stated that she had applied to the board to ensure that Alaska's counseling regulations reflect the work "on the ground." 9:19:22 AM REPRESENTATIVE SADDLER asked whether this was a re-appointment. MS. ELKINS explained that she was appointed in June [2025]. REPRESENTATIVE SADDLER asked what issues she saw facing the mental health industry in Alaska. MS. ELKINS replied that the industry was changing significantly, particularly with the advent of artificial intelligence (AI). She asserted that there was a great need for increased access to mental healthcare, reporting that there are underserved clients through Medicaid. She further asserted that private health insurance plans are challenging, noting that, while mental health care should be a weekly or twice weekly appointment, many private health insurance plans offer coverage capping at a few times a year. 9:21:28 AM REPRESENTATIVE CARRICK asked for the term length on the Board of Professional Counselors. MS. ELKINS stated that she thought it was a two- or three-year term. REPRESENTATIVE CARRICK noted that Ms. Elkins' resume was very robust, seeming to serve in a lot of positions simultaneously in the last decade. She asked how the Board of Professional Counselors would fit into Ms. Elkins' life. MS. ELKINS acknowledged that she was very busy but stated that she did not find it difficult to juggle many roles. She noted that her roles were concurrent, stating that she was the CEO of her business, and that she additionally started a community behavioral health clinic. MS. ELKINS, in response to a follow-up question from Representative Carrick, identified "providing guidance and supervision" to help individuals become "fantastic counselors" as her number one role. 9:24:37 AM REPRESENTATIVE SADDLER asked Ms. Elkins opinion on the integration of behavioral health providers in public school and further asked her to identify any regulations in need of change with regards to behavioral health services in Alaska. MS. ELKINS opined that the present of behavioral health professionals in schools was very important. She identified the COVID-19 pandemic as very impactful on children, noting that access to mental health professionals would be very helpful. She stated that behavioral health services needed to be expanded. She noted that she would like to see private insurances cover what is typically covered under Medicaid. 9:27:16 AM CRYSTAL HERRING, Appointee, Board of Professional Counselors, testified as an appointee to the Board of Professional Counselors. She stated that she was originally from Mississippi, and she has lived in Alaska for the past 24 years. She stated that she had been in the counseling profession for about 28 years, and that she had been a licensed professional counselor (LPC) in Alaska since 2013. She identified keeping up with current practices and making regulatory changes as needed as goals in the name of serving her community. 9:28:35 AM REPRESENTATIVE SADDLER asked what challenges Ms. Herring saw in the mental health industry. MS. HERRING replied that she agreed with Ms. Elkins on the regulation of AI technology, noting that AI had a large impact on the mental health field as it was heavily unregulated and there was a lot of concern about confidentiality. REPRESENTATIVE SADDLER asked whether Ms. Herring's appointment was a re-appointment. MS. HERRING replied that her appointment was new and that she had never served on a board. 9:31:26 AM ASHLEY MARTIN, Appointee, Board of Professional Counselors, She stated that she has been in the behavioral health field for the past 17 years, noting that she received her LPC in 2019. She reported that past experience included work in both inpatient and outpatient substance use treatment programs, and a mental health crisis recovery center. She stated that, through her current position as a behavioral health officer at Catholic Social Services, she helps homeless individuals and individuals who reside at shelters. She emphasized the importance of qualify supervision for individuals working towards their LPCs and stated that she hoped to be a part of "retaining quality counselors for my community." 9:32:50 AM REPRESENTATIVE SADDLER asked what Ms. Martin saw as the biggest issues facing the behavioral health industry. MS. MARTIN replied that lack of counselors was a problem in Alaska. She offered her agreement with previous appointees on changing technologies and the potential impacts on the mental health profession. She additionally spoke to barriers to access, such as lack of transportation in rural areas, as an issue. MS. MARTIN, in response to a follow-up question from Representative Saddler, stressed the importance of allowing licenses to transfer upon relocation to Alaska. 9:35:11 AM REPRESENTATIVE CARRICK asked what the board was doing to communicate with and address regional issues in Alaska, noting that every appointee to the Board of Professional Counselors was located in Anchorage, Alaska. MS. MARTIN emphasized access to supervision in their region while earning their license. She noted that new graduates in rural areas may not have a licensed supervisor in their area. 9:37:51 AM CARRIE-ELAINE BORDER, Appointee, Board of Professional Counselors, testified as an appointee to the Board of Professional Counselors. She stated that she has 14 years of experience in the mental health field, with 7 years of experience as a supervisory LPC. She further stated that she had 16 years of experience with medical billing, noting that she was a Medicare and Medicaid billing specialist prior to becoming a counselor. She said that she had a bachelor's in teaching. She stated that she had helped with the legislative efforts to create an Associate Counselor license type, a new license that allows counselors to practice under supervision as a step towards LPC. 9:40:02 AM REPRESENTATIVE SADDLER appreciated Ms. Borders technical experience and history with medical billing. He asked what policy changes the legislature should consider to prevent mental health crises. MS. BORDER answered that LPCs needed more accountability and noted that the renewal process was simplistic and did not provide for actual accountability. MS. BORDER further stating that blending Medicaid services with healthcare services to classify what kind of services are being provided, the cost of actual services, and to whom. She specified that it was important to identify who had the greatest need for mental healthcare and quantify the effectiveness of care. 9:44:29 AM CO-CHAIR HALL asked what accountability looks like for LPCs. MS. BORDER replied that accountability means "showing that you have done what you said you would do." CO-CHAIR HALL queried the mechanisms by which accountability could be taken. MS. BORDER responded that technology could be used to show progress, and additional paperwork that could be sent to the Board of Professional Counselors to prove supervision. 9:46:26 AM ROBERT GERLACH, DVM, Appointee, Board of Veterinary Examiners, testified as an appointee to the Board of Veterinary Examiners. He stated that, after receiving his veterinary degree from the University of Pennsylvania, he practiced in Delaware, Pennsylvania, and Maryland, primarily on dairy cattle. He stated that he moved to Anchorage, where he worked in private practices for 13 years. He stated that he had a background in physiology and toxicology and began working for the State of Alaska to study contaminants in fisheries in Alaska. He stated that he had previously served as the Alaska State Veterinarian and had worked with the Board of Veterinary Examiners in the past and was encouraged by the former chair to apply for a position on the board. 9:50:00 AM REPRESENTATIVE SADDLER asked whether his appointment was a re- appointment. DR. GERLACH stated that this would be his initial appointment. REPRESENTATIVE SADDLER asked Dr. Gerlach to comment on Alaska's readiness to deal with pathogenic diseases of mammalian or avian origin. DR. GERLACH stated that, due to the challenges of remote operations around Alaska, his approach to addressing pathogenic diseases and outbreaks was highly collaborative with both state and federal entities the United States Department of Agriculture (USDA), the U.S. Department of Interior (DOI), the U.S. Fish and Wildlife Service (USFWS) and the Department of Fish & Game (ADF&G). He stated that, as the State Veterinarian, he and others performed an extensive evaluation of bird flu in both wild and domestic avian populations in Alaska. He further explained that his office trained wildlife biologists and technicians in the appropriate collection of samples, which avoided travel delays. DR. GERLACH, in response to a follow-up question from Representative Saddler, offered his belief that the state was in good shape to respond to disease outbreaks, and highlighted the importance of collaboration between state and federal entities. REPRESENTATIVE SADDLER asked for Dr. Gerlach's opinion on the proposed Department of Agriculture. DR. GERLACH stated that the Office of the State Veterinarian was very small, with three staff members, and relies on the laboratory in the Department of Environment Conservation (DEC) to provide a number of services for sample processing and analysis. He stated that the State Veterinary Office also relies on individuals in DEC and the Food Safety & Sanitation [Program] to response to outbreaks in agricultural and dairy products. He stated that these collaborations allow the State Veterinary Office to provide "a wide variety of services with efficient use of resources." He said that the State Veterinarian position was very integrated within DEC. He noted that moving the position to a new location [with the creation of the Department of Agriculture] could mean a possible expansion of staff and it could also provide challenges with regard to laboratory support and sample handling. 9:55:28 AM CO-CHAIR HALL thanked Dr. Gerlach for his testimony. 9:56:06 AM SAMSON SHEPERD, Appointee, State Board of Registration for Architects, Engineers & Land Surveyors, testified as appointee to the State Board of Registration for Architects, Engineers & Land Surveyors. He offered his education and work background. He said he is a small business owner and expressed excitement about the opportunity to serve the board. 9:56:50 AM REPRESENTATIVE SADDLER spoke to an effort in legislature [SB 54] to add interior designers to the board. MR. SHEPERD stated that he did not have any comment on that piece of legislation. REPRESENTATIVE SADDLER asked what issues Mr. Sheperd saw with the board. MR. SHEPERD noted that there appeared to be a lack of appointees to the board. 9:58:30 AM ADJOURNMENT  CO-CHAIR HALL recessed the House Labor and Commerce Standing Committee meeting to 3:15 p.m. 3:42:22 PM CO-CHAIR CAROLYN HALL called the House Labor and Commerce Standing Committee back to order at 3:42 p.m. Members present at the call back to order were Representatives Saddler, Fields, Carrick, Coulombe, Burke, and Hall. HB 178-MEDICAL DEBT: INFORMATION, DISCRIMINATION  3:42:30 PM CO-CHAIR HALL announced that the next order of business would be HOUSE BILL NO. 178, "An Act relating to medical debt and consumer credit reporting agencies; relating to discriminatory practices based on the medical debt of a person; and providing for an effective date." 3:42:50 PM REPRESENTATIVE GENEVIEVE MINA, Alaska State Legislature, as prime sponsor, presented HB 178. She gave the sponsor statement [included in the committee file], which read as follows [original punctuation provided]: No one is immune to the possibility of a costly medical bill from an unforeseen sickness, out-of- network care, or billing errors. Navigating the bureaucracy of the American health care industry can financially upend a household living paycheck-to- paycheck. Approximately 41% of American adults have some form of medical debt. In 2021, 14% of Alaskans had medical debt in collections, with a median amount of approximately $1,500 (twice the national average). A working Alaskan who lacks sufficient emergency savings and cannot pay a medical bill could have their debt sent to collections, lowering their credit score and creating insurmountable financial consequences. Low credit scores specifically entrench low-income individuals into a vicious cycle of poverty by creating barriers to economic mobility and making loans, housing, and employment more difficult to obtain. Since medical debt is rarely chosen and difficult to avoid, it should not be used a predictor of financial trustworthiness. Medical debt is an unreliable indicator of default and other types of payment behavior. Moreover, when medical debt is removed from credit reporting, credit scores increase by an average of 20 points. In January 2025, the federal Consumer Protection Finance Bureau (CFPB) issued a ruling to ban the inclusion of medical debt on credit reports, but implementation has been delayed to June, and its future is uncertain. HB 178 would ban the reporting of medical debt on credit reports in state statute, emulating the CFPB rule. It would prohibit the furnishing of medical debt to credit reporting companies and prevent them from displaying any medical debt information in the first place. Furthermore, this bill bans landlords and employers from using medical debt as eligibility criteria for considering tenants and employe[es]. With wages failing to keep up with inflation and rising living costs, credit is essential for low- income households to pay their bills. HB 178 improves the self-sufficiency of Alaskans by ensuring that illness or disability do not impact access to credit and economic opportunity. REPRESENTATIVE MINA moved to a PowerPoint presentation [included in the committee file], titled "Medical Debt: 178," and gave a background on credit scores, shown on the second slide, which read [original punctuation provided]: ? Forms of credit evaluation have existed since the early 1800s --mostly through subjective means (like word-of-mouth) and discriminatory means (such as gender, age, marital status, ethnic background). ? Attempts to nationally standardize credit scores only manifested after the Equal Credit Opportunity Act of 1974,which required equitable opportunity to credit regardless of race, religion, and other aforementioned factors. ? In 1989, the FICO score(formerly called Fair, Isaac, and Company) became the model for creditworthiness to assess financial reliability. FICO scores puts certain percentage weights on payment history, amounts owed, length of credit history, new credit, debts in collections (including medical debt!), and credit mix in an attempt to be objective. ? Today, 90% of top lenders use the FICO model to assess eligibility ? Today, 60% of employers use credit reports to evaluate job candidates (despite a lack of evidence that credit history correlates to performance or fraud) 1 ? Utility and cell phone companies are also complicit in using credit reports to make sales and pricing decisions ? FICO scores also determine housing opportunities, be it in rental or mortgage scenarios REPRESENTATIVE MINA gave an overview of criticisms in recent years of credit reporting, shown on the third slide, which read [original punctuation provided]: ? Rising costs and stagnant incomes mean greater reliance on credit; at the same time, the FICO scoring model has faced increased scrutiny and suspicion. The FICO model, like all models, is inherently imperfect. It also furthers economic divide and entrenches folks in cycles of poverty. ? Those who acquire lower credit score become subject to: i. Crippling interest rates (then have to be relegated to payday loans, etc.) ii. Higher down payments iii. Difficulty securing rentals and affordable mortgages iv. Denied employment opportunities, etc. entrenching folks in cycles of poverty. v. Higher insurance premiums vi. Higher utility costs ? Nationally, the score difference between white and non-white areas is near 80 points, which can cost families up to $100 more a month for a conventional mortgage. ? The FICO model unduly punishes student loan holders for their debt ? Furthermore, credit scoring can skew unreliable, with individuals having debts reported they did not incur. Research suggests that more than 20 million Americans could have material errors on their credit reports. REPRESENTATIVE MINA moved to the fourth slide and gave a history of medical debt reporting in the United States, which read as follows [original punctuation provided]: ? Occasionally, hospitals report to credit agencies directly. Most of the time, the health care industry sells their debt off to the debt collector, who then reports to the credit agencies. ? March 2023:Experian, Transunion, and Equifax removed reporting medical debt <$500. ? January 2025: The Consumer Financial Protection Bureau (CFPB) finalized rules to: ? Stop credit reporting companies from sharing medical debts with lender ? Prohibit lenders from making lending decisions based on existing medical debt i. The CFPB has estimated by removing medical  debt, scores would raise an average of 20 points  ii. The CFPB also estimated that this would lead  to the approval about 22,000 mortgages  ? The January rules were supposed to take into effect in March, but the current administration has pushed it until June. ? The Executive Branch may try to retract the ruling via Executive Order ? Simultaneously, Congress is trying to quash the rule under the Congressional Review Act through House Joint Resolution 74 and Senate Joint Resolution 36. H.R.J. 74 is expected to pass the house. REPRESENTATIVE MINA gave a summary of medical debt in Alaska, shown on the fifth slide, which read [original punctuation provided]: ? Nationally, most people 72 percent, according to one estimate attribute their medical debt to bills from acute care, such as a single hospital stay or treatment for an accident.13Nearly 30 percent of adults who owe medical debt owe it entirely for hospital bills.14 ? Based on national polling from the Kaiser Family Foundation, an estimated 40% of Alaskans have some form of medical debt, including those in collections 1 ? In 2021, 14.1% of Alaskan residents had medical debt that went to collections,according to data compiled by the institute in August 2021 2 ? The median debt in collections was $1,533, nearly double the national average of $870 ? 17% of Alaskans have a debt in collections ? In 2020, medical debt represented nearly half of Alaskans with debt in collections REPRESENTATIVE MINA moved briefly to the sixth slide, drawing committee members' attention to a pie chart representative of the percentage of individuals in Alaska with medical debt in collections [14 percent] and not in collections [86 percent]. REPRESENTATIVE MINA gave an overview of policies implemented by other states regarding medical debt credit reporting, shown on the seventh slide, which read as follows [original punctuation provided]: BANNED MEDICAL DEBT CREDIT REPORTING: ? California ? Connecticut ? New Jersey ? Virginia ? Illinois ? Rhode Island ? Minnesota OTHER MEDICAL DEBT PROTECTIONS NATIONWIDE: ? Florida and Virginia now bar medical debt collection lawsuits unless they're initiated within three years of the debt ? Delaware prohibits creditors from foreclosing on patients' homes to collect on unpaid medical bills ? New Jersey recently appropriated $10 million to cancel up to a $1 billion in medical debt REPRESENTATIVE MINA moved to the eighth slide and gave an overview of HB 178, which read [original punctuation provided]: ? HB 178 prohibits debt collectors and other entities from furnishing information to credit reporting agencies ? HB 178 prohibits credit reporting agencies from reporting medical debt ? HB 178 prohibits landlords or employers from asking about medical debt and/or using it as a qualifying factor ? If a debt collector violates this rule, the debt is rendered null and void REPRESENTATIVE MINA gave a summary of the impacts of medical debt in collections, shown on the tenth slide, which read [original punctuation provided]: ? Anyone can get hit with a surprise medical bill from an unforeseen sickness out-of-network care, or billing errors. Righting the bureaucracy of the American health care industry can upend a household living paycheck-to-paycheck. ? Since medical debt is rarely chosen and difficult to avoid, it should not be used a predictor of financial trustworthiness. ? Low credit scores specifically entrench low-income individuals into a vicious cycle of poverty by creating barriers to economic mobility and making loans, housing, and employment more difficult to obtain. ? When a bad credit report makes life more expensive, and makes it hardest to earn the means by which one can pay for those expenses (i.e. jobs), it forces some consumers to take on more debt on worse debts which makes life more expensive, reinforcing the cycle of poverty. ? Furthermore, medical debt has been proven to be an  unreliable indicator of defaulting, or financial  reliability. (In general, debts types do not reflect other payment behaviors.) REPRESENTATIVE MINA concluded by asserting that HB 178 would help Alaskans to be self-sufficient and ensure factors outside their control will not impede their ability to be "economically mobile." CO-CHAIR HALL announced the committee would hear invited testimony. 3:51:33 PM CLARK HANSEN, Managing Director of Advocacy, ALS Association, began his invited testimony on HB 178, by introducing himself as an advocate for patients with amyotrophic lateral sclerosis (ALS). He emphasized his support for HB 178, which he said would address the critical issues of medical debt and its impact on the lives of Alaskans. He said he has witnessed firsthand the financial burdens that medical expenses can impose. He described ALS as a progressive, neurodegenerative disease that requires extensive medical care, including frequent doctor visits and, in the case of Alaskans, travel to the Lower 48 states for care. Beyond that, the disease requires specialized equipment and, sometimes, around-the-clock care. These necessary treatments and care, averaging between $150,000 to $200,000 per year per patient, often lead to significant medical debt, which can have a devastating effect on patients lives beyond their health. MR. HANSEN continued his testimony, indicating the key reasons the association supports the proposed legislation is because it would: make it unlawful for an employer to discriminate against based on medical debt; make it illegal for property owners to refuse to lease or rent to individuals due to their medical debt; and prohibit the inclusion of medical debt in credit reports. He added that a fair credit rating can effect a person's ability to access necessary resources. He advised that HB 178 would increase access to employment and housing, thereby leading ASL patients to greater access to employment and housing opportunities, allowing them to live with dignity and independence. They would be allowed to live without the added stress of financial discrimination. 3:55:58 PM ADAM ZARRIN, Director of State Government Affairs, Leukemia & Lymphoma Society (LLS), gave invited testimony on HB 178. He identified curing blood cancer and supporting friends and family of those diagnosed as the society's mission. He explained that a patient diagnosed with acute leukemia typically spends an estimated $500,000 after the first year of diagnosis, noting that healthcare costs are rising. He further stated that four out of ten patients opt to delay or skip treatment due to high costs. He stated that patients that do start treatment often dip into savings or take out loans, and reported that 42 percent of patients, two years after diagnosis, will have depleted their lifesavings. He asserted that medical debt is fundamentally different from all kinds of debts, noting that no one chooses to get sick. He stated that medical debt is often fraught with all kinds of billing errors with charges that should have been covered by insurance. He stated that life-saving treatment can significantly impact an individuals financial and emotional health. He asserted that blood cancer "should have no bearing" on an individual's credit worthiness or their ability to find housing or appointment. He asserted that HB 178 would help patients stabilize their lives and pay off their debt. He offered his support for HB 178. In response to a question, he clarified that represented the western regions of LLS. 3:58:42 PM CLAIRE LUBKE, Alaska Public Interest Research Group (AKPIRG), Economic Justice Lead, She began her invited testimony by stating that AKPIRG was the only non-profit consumer advocacy organization in Alaska. She stated that credit scores carry important information. She reported that medical debt is not a good indicator of a person's credit worthiness and echoed the former speaker in stating that no person chooses to get sick and medical billing if often fraught with errors. She stated that, since 2022, there has been a 50 percent increase in the cost of premiums through the government. 4:02:03 PM REPRESENTATIVE CARRICK asked how medical debt is different from loan debt. MS. LUBKE said that she would follow up with the committee members in writing. 4:03:50 PM REPRESENTATIVE SADDLER asked if any debt was a predictor of someone's likelihood to default on loans and asked if it was "fair" to a mortgage lender to not report medical debt on a loan application. MS. LUBKE answered that the purpose of a FICO calculation was an assessment of a person's ability to pay back their debt. She said that her previous testimony answered Representative Saddler's second question. 4:07:25 PM REPRESENTATIVE CARRICK asked if states have any control over what can and cannot be considered in a person's loan application. She asked for confirmation as to whether or not debt incurred in a state other than Alaska could appear on a loan application. REPRESENTATIVE MINA answered that she was not sure of an answer to Representative Carrick's question. MR. HANSEN, in response to Representative Carrick's second question, said yes. 4:10:34 PM REPRESENTATIVE COULOMBE asked for an example of how medical debt might affect employment, noting that she has hired many people and has never checked for medical debt. MR. HANSON offered his understanding that many employers took into account a prospective employee's outstanding debt. REPRESENTATIVE COULOMBE noted that medical debt would affect someone's ability to make payments of any kind and asked for confirmation that the proposed legislation would prohibit reporting of all medical debt. REPRESENTATIVE MINA stated that the proposed legislation would prohibit the reporting of any medical debt to an employer. 4:16:30 PM REPRESENTATIVE SADDLER suggested that two credit scores could be provided, one with medical debt and one without medical debt. REPRESENTAIVE MINA stated that the intention of the proposed bill was that medical debt is not the best indicator of whether someone has had reliable payment history in other matters. 4:19:28 PM CO-CHAIR FIELDS said "we have like, 20 appointees online, we should probably go through since they're waiting for us. 4:19:40 PM REPRESENTATIVE COULOMBE said "it's really money in, money out 4:20:49 PM CO-CHAIR HALL announced that HB 178 would be held over. ^CONFIRMATION HEARING(S): Marijuana Control Board CONFIRMATION HEARING(S): Marijuana Control Board    ^Occupational Safety and Health Review Board Occupational Safety and Health Review Board    ^Real Estate Commission Real Estate Commission    ^State Board of Registration for Architects, Engineers & Land Surveyors State Board of Registration for Architects, Engineers & Land  Surveyors    ^State Physical Therapy & Occupational Therapy Board State Physical Therapy & Occupational Therapy Board    ^Board of Veterinary Examiners Board of Veterinary Examiners    4:21:00 PM CO-CHAIR HALL announced that the final order of business would be a series of confirmation hearings of appointees for various boards and commissions. 4:21:57 PM LACY WILCOX, Appointee, Marijuana Control Board, testified as an appointee to the Marijuana Control Board. She explained her history in working in public health and reviewed her qualifications to serve on the Marijuana Control Board. 4:24:39 PM REPRESENTATIVE SADDLER asked which seat Ms. Wilcox was appointed to and whether this was her initial appointment. MS. WILCOX clarified that it was her initial appointment, and it was to the public - industry seat. REPRESENTATIVE SADDLER asked whether local governments should be allowed to restrict or prohibit the sale of marijuana even if the state government allows it. MS. WILCOX noted that individuals could petition their municipal local governments to opt-out of the legality of marijuana use. 4:26:06 PM ISAAC DIBOUE, Appointee, Occupational Safety & Health Review Board, He shared his experience in working in occupational safety and reviewed his qualifications to serve on the Occupational Safety and Health Review Board (OHSRB). 4:28:21 PM ZACHERY SCHASTEEN, Appointee, Occupational Safety & Health Review Board, Testified as an appointee to the Occupational Safety & Health Review Board. He shared his experience in working in occupational safety and reviewed his qualifications to serve on the OHSRB. 4:30:38 PM JIMI CASH, Appointee, testified as an appointee to the Real Estate Commission. He stated that he was a general contractor by trade and had been a general contractor for 23 years. He stated that this would be his first appointment to any commission in the state and reviewed his qualifications to serve on the Real Estate Commission. 4:31:36 PM REPRESENTATIVE CARRICK asked Mr. Cash to speak to the value of having people from different regions on the various boards and commissions. MR. CASH responded that diversity on boards and commissions was very important, particularly with regards to real estate, noting that real estate in Interior Alaska was vastly different from real estate in Southcentral or Southeast Alaska. 4:34:26 PM REPRESENTATIVE SADDLER asked what issues Mr. Cash saw with the Real Estate Commission and asked what functions the commission had. MR. CASH stated that he was representative of the public perspective of the Real Estate Commission and said that it was a regulatory body to assist in the licensing of real estate realtors and brokers. 4:37:38 PM VICTORIA DAUGHTERY, Appointee, State Physical Therapy & Occupational Therapy Board, testified as an appointee to the State Physical Therapy & Occupational Therapy Board. She shared her history working in Alaska as an occupational therapist and reviewed her qualifications to serve on the State Physical Therapy & Occupational Therapy Board (PTOTB). 4:38:53 PM REPRESENTATIVE SADDLER asked Ms. Daughtery what her thoughts were with regard to licensing reciprocity for physical therapists in the state. MS. DAUGHTERY said that there was currently a need for more occupational and physical therapists in the state. 4:40:38 PM JONATHAN GATES, Appointee, State Physical Therapy & Occupational Therapy Board, testified as an appointee to the State Physical & Occupational Therapy Board. He shared his history working in the state and reviewed his qualifications to serve on the PTOTB. 4:42:26 PM YOLANDA LOGAN, Appointee, Real Estate Commission, testified as an appointee to the Real Estate Commission. 4:43:13 PM REPRESENTATIVE SADDLER asked Ms. Logan what issues she saw coming before the commission she wished to serve on. MS. LOGAN answered that she wanted to address the unsuredness of consumers with regard to who their broker of realtor might be. 4:44:54 PM RYAN SHARRAT, Appointee, Occupational Safety & Health Review Board, Testified as an appointee to the Occupational Safety & Health Board. He began his testimony by explaining his history in occupational health & safety and explained why he would like to serve on the board. 4:46:20 PM CO-CHAIR HALL opened public testimony on the confirmation hearings. After ascertaining that there was no one who wished to testify, she closed public testimony on the confirmation hearings. [The confirmation hearings were set aside for a later date.] 4:46:31 PM ADJOURNMENT  There being no further business before the committee, the House Labor and Commerce Standing Committee meeting was adjourned at 4:46 p.m.