JOINT MEETING HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE February 18, 1997 3:08 p.m. HOUSE MEMBERS PRESENT Representative Con Bunde, Chairman Representative Joe Green, Vice Chairman Representative Brian Porter Representative Fred Dyson Representative J. Allen Kemplen Representative Tom Brice HOUSE MEMBERS ABSENT Representative Al Vezey OTHER HOUSE MEMBERS PRESENT Representative Reggie Joule SENATE MEMBERS PRESENT Senator Gary Wilken, Chairman Senator Loren Leman, Vice Chairman Senator Jerry Ward SENATE MEMBERS ABSENT Senator Johnny Ellis Senator Lyda Green COMMITTEE CALENDAR ALL NATIVE HEALTH BOARD: LEGISLATIVE PRIORITIES (* First public hearing) PREVIOUS ACTION No previous action to record WITNESS REGISTER LINCOLN BEAN, Chairman Alaska Native Health Board; Chairman, Southeast Alaska Regional Health Consortium P.O. Box 318 Kake, Alaska 99830 Telephone: (907) 785-3283 POSITION STATEMENT: Provided information on Alaska Native Health Board programs. PAUL MANUMIK, Chairman Yukon-Kuskokwim Health Corporation P.O. Box 44 Sheldon Point, Alaska 99666 Telephone: (907) 498-4215 POSITION STATEMENT: Provided information on Alaska Native Health Board programs. ANNE WALKER, Executive Director Alaska Native Health Board 4201 Tudor Centre Drive, Suite 105 Anchorage, Alaska 99508 Telephone: (907) 562-6006 POSITION STATEMENT: Provided information on Alaska Native Health Board programs. ANDREW JIMMIE, President Tanana Chiefs Regional Council; Member, Alaska Native Health Board 4201 Tudor Centre Drive, Suite 105 Anchorage, Alaska 99508 Telephone: (907) 562-6006 POSITION STATEMENT: Provided information on Alaska Native Health Board programs. LARRY IVANOFF, Chairman Norton Sound Health Corporation; Member, Alaska Native Health Board 4201 Tudor Centre Drive, Suite 105 Anchorage, Alaska 99508 Telephone: (907) 562-6006 POSITION STATEMENT: Provided information on Alaska Native Health Board programs. PAUL SHERRY, Deputy Director Alaska Native Health Board 4201 Tudor Centre Drive, Suite 105 Anchorage, Alaska 99508 Telephone: (907) 562-6006 POSITION STATEMENT: Provided information on Alaska Native Health Board programs. DONALD NIELSON, Vice Chairman Bristol Area Health Corporation; Member, Alaska Native Health Board 4201 Tudor Centre Drive, Suite 105 Anchorage, Alaska 99508 Telephone: (907) 562-6006 POSITION STATEMENT: Provided information on Alaska Native Health Board programs. BEN ATORUK, Representative Manilaq; Member, Alaska Native Health Board 4201 Tudor Centre Drive, Suite 105 Anchorage, Alaska 99508 Telephone: (907) 562-6006 POSITION STATEMENT: Provided information on Alaska Native Health Board programs. ACTION NARRATIVE TAPE 97-11, SIDE A Number 0001 CHAIRMAN CON BUNDE called the joint meeting of the House/Senate Health, Education and Social Services Standing Committees to order at 3:08 p.m. Members present at the call to order were Representatives Bunde, Green, Porter, Dyson, Kemplen and Brice and Senators Wilken, Leman and Ward. Members absent were Representative Vezey and Senators Green and Ellis. ALL NATIVE HEALTH BOARD: LEGISLATIVE PRIORITIES Number 0095 LINCOLN BEAN, Chairman, Alaska Native Health Board; and Chairman, Southeast Alaska Regional Health Consortium, introduced the speakers and the areas they represent. PAUL MANUMIK, Chairman, Yukon-Kuskokwim Health Corporation, stated that the first priority is village water and sanitation and read the following statement into the record: "A. Rural Village Water and Sanitation Facilities Construction. "The Alaska Native Health Board has consistently considered safe drinking water and adequate sanitation to be one of its highest working priorities. Sustained commitments from both federal and state sources are necessary to eliminate public health problems resulting from poor sanitation conditions in rural Alaska villages. The Indian Health Service estimates that total cost of constructing piped water and sewer services in all rural communities at nearly $1 billion. "The Alaska Native Health Board has worked aggressively with the federal government to increase appropriations for rural Alaska water and sanitation through the Indian Health Service, the Environmental Protection Agency, the Department of Agriculture and the Department of Housing and Urban Development. "Previous legislatures have demonstrated their commitment to providing state contributions through appropriations for community water and sanitation facility construction: FY1993, $24 million, FY1994, $26.5 million, FY1995, $21.7 million, FY1996, $21.5 million, FY1997,$19.3 million. The Alaska Native Health Board acknowledges these contributions. "Over the past year, the Alaska Native Health Board and our Rural Alaska Sanitation Coalition have participated in the deliberations of the Governor's Council on Rural Sanitation. "The Alaska Native Health Board urges the Alaska State legislature to adopt the recommendation of the Governor's Council on Rural Sanitation, and appropriate $25 million to the ADEC (Alaska Department of Environmental Conservation) Village Safe Water program for rural water and sanitation project construction in the FY1998 capital budget. "B. Rural Water and Sanitation Facility Operations and Maintenance. "Lack of operations and maintenance resources for proper management of sanitation facilities in rural Alaska is a critical issue that must be addressed." Number 0476 MR. MANUMIK stressed that rural sanitation is needed because it is affecting the health of the villages. Number 0525 SENATOR LOREN LEMAN, referred to the recommendation that the legislature appropriate $25 million and stated that is consistent with what the legislature has been doing in years past with a federal government match of $25 million to $30 million. He asked if the federal government match was going to be continued. Number 0592 ANNE WALKER, Executive Director, Alaska Native Health Board, responded that the board is pursuing the federal government's match. She stated that the board was successful in having appropriations language added to the clean water bill in order to eliminate having to ask for money each year. She stated that both Senators in the congressional delegation will be requesting upwards to $30 million this year. Number 0639 SENATOR LEMAN stated that it is likely that the legislature will be able to participate in this as part of the capital expenditures if there is something to match. He stated that with the legislature's limited capital budget we are almost totally focusing on matches. Number 0668 MS. WALKER stated that in the booklet, provided to the committee, "Alaska Native Health Board State Legislative Priorities - Fiscal Year 1998", under the section of water and sanitation there is a request for a match from the Environmental Protection Agency. Number 0682 ANDREW JIMMIE, President, Tanana Chiefs Regional Council; and Member, Alaska Native Health Board, stated that the Alaska Native Health Board strongly urges the Alaska State Legislature to appropriate sufficient funds in the FY1998 operating budget to the Department of Environmental Conservation for the support of 12 remote maintenance worker positions. He stated that this is important to villages, without these positions the villages do not have the trained people or the money to train people to fix the problems that occur. He continued that there needs to be sufficient funds for the Department of Community and Regional Affairs to increase the number of rural utility business advisors, for the development of utility management materials and for development of "plain English water quality regulations." He stated that the Alaska Native Health Board urges the legislature to approve the recommendation of the Governor's Council on Rural Sanitation and provide a $500,000 match in the FY1998 capital budget to support the Alaska Native Health Board Operation and Maintenance Support Demonstration Project. He stated the money goes directly to the villages to help maintain their systems. Number 0945 LARRY IVANOFF, Chairman, Norton Sound Health Corporation; and Member, Alaska Native Health Board, stated that he would address the water and sanitation services for all village health clinics. He read the following statement into the record: "The Alaska Native Health Board's vision is that by the year 2002 every village health clinic in rural Alaska will have piped water and sewage disposal. The state of Alaska has shared the commitment and in FY1993 and FY1994, appropriated $500,000 each year for the hook-up of village clinics to community sanitation systems. No funds were appropriated in the FY1995 and FY1996 capital budget. "$325,000 was appropriated in the FY1997 capital budget. These funds have been obligated through a project agreement with the Indian Health Service to fund clinic hook-ups in seven villages (Manakotak, South Naknek, Koyukuk, Rampart, Healy Lake, Venetie and Newtok). Some of these will be connected in the summer 1997; others are in the planning design stage. "However, at least twenty five more villages, excuse me, let's make that twenty six because Bristol Bay just told me to add Clarks Point on the list of villages... The average cost of hook-ups is approximately $50,000 per community for a total unmet need of approximately $1.2 million. "The Alaska Native Health Board urges the Alaska State Legislature to appropriate a minimum of $325,000 in the FY1998 capital budget to the Alaska Department of Environmental Conservation to ensure that additional village health clinics are connected to water and sanitation systems." Number 1045 MR. BEAN stated that last year he addressed the Alaska Federation of Natives on the tobacco tax and the Alaska Native Health Board was the first advocate to present this proposal to the legislature. He stated that Alaska has one of the highest smoking prevalence rates in the United States as tobacco kills more Alaskans than AIDS, aircraft crashes, alcohol, falls, firearms and motor vehicle crashes. He continued that 20 percent of all deaths in Alaska between 1992 and 1994 were due to smoking. He asserted that a great concern of the board is the tobacco use by Alaskan youths. 21 percent of Alaskan high school students are frequent smokers and 44 percent of Alaskan Native high school students are frequent smokers. He advised that one in three will eventually die from smoking. MR. BEAN stated that the Alaska Department of Health and Social Services estimated that tobacco use costs Alaska's economy over $96 million each year in direct medical care costs. He continued that increasing tobacco tax reduces tobacco use and asserted that the board wishes to stay with a dollar tax, nothing more or less. He predicted that lives that would be saved if this tax reduced smoking. Number 1181 MR. BEAN stated that there are a lot of arguments on where the Native community stands on the issue of selling tobacco. He asserted that the Alaska Native Health Board rejects the argument being offered that tribal governments will undermine this legislation through the establishment of tax-free smoke shops. He stated that tribal tax-exempt sales can only be made to their own tribal members. He continued that the majority of Alaskan Natives, along with the majority of Alaskans, support the proposed tax increases and are concerned about the increased rates of cancer and other diseases caused by tobacco. MR. BEAN declared that the Alaska Native Health Board joins with the American Cancer Society, the American Heart Association and the American Lung Association in encouraging this Alaska State Legislature to approve the tobacco excise tax of at least $1.00 per pack on cigarettes and up to 100 percent of the wholesale price on other tobacco products. Number 1235 CHAIRMAN BUNDE asked if the Alaska Federation of Natives has taken a position on the tobacco tax. Number 1242 MR. BEAN responded that he had alone addressed the federation as an entire body to let them know where the board stood on the issue. Number 1264 REPRESENTATIVE FRED DYSON stated that many grade-school-age children use smokeless tobacco in rural Alaska and asked if Mr. Bean found this to be true. Number 1282 MR. BEAN responded that he has heard that as well and referred the question to Ms. Walker. Number 1290 MS. WALKER stated that a group of dental assistants and hygienists conducted a study in four rural Alaskan villages, and the outcome was that 25 percent of the students in lower grades where using smokeless tobacco and by the time they reached high school, they had converted to cigarettes. She stated that the students were already addicted to tobacco by the time they reached junior high School. Number 1329 REPRESENTATIVE DYSON asked if parents were able to deal with this issue. Number 1336 MS. WALKER stated that the study did not look at how the parents interfaced with the children, it was a dental study. Number 1346 REPRESENTATIVE DYSON referred to the Alaska Native Health Board, State Legislative Priorities booklet and asked if it was a fairly inclusive list of issues that the board was concerned about. Number 1360 MR. BEAN replied yes. Number 1365 REPRESENTATIVE DYSON stated that he noticed there was nothing in the booklet regarding Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effects (FAE) and asked why that was. Number 1370 MS. WALKER referred to the page entitled Alaska Native Health Board Vision for 2002 and the statement "To be sober and drug free is a Native cultural value" and stated that it goes further than addressing children with (FAS) or (FAE). She said, "We are working very hard currently addressing that as a treatment issue but what we want to do is take it farther than that. We want to make it part of our lives." Number 1406 REPRESENTATIVE DYSON asked if child abuse was a concern of the board. Number 1414 MS. WALKER replied that it is. She stated this board's vision list was developed in 1991, two years ago the board revisited the top health priorities and child abuse is on that list and it is a concern. Number 1435 REPRESENTATIVE DYSON stated that he appreciated what the board is doing. He stated that to him those two issues are of monumental importance and what the board is talking about in the booklet is in regards to more programs and more money in the midst of epidemic problems for children. Number 1463 MS. WALKER referred Representative Dyson to the statement in the board's vision, "Each region has Native operated child protection services." She informed that the villages have been putting together programs in regards to child abuse. Number 1499 REPRESENTATIVE DYSON asked if there were any programs on incarcerating perpetrators. Number 1501 MS. WALKER responded that the board is not working on it as an issue but if it was taken up the board would endorse it. Number 1519 REPRESENTATIVE JOE GREEN asked why the percentage of Native high school smokers is more than double that of non-Native high school smokers. Number 1534 MS. WALKER suggested that it could be a result of earlier addiction, Native children are generally getting addicted at a much earlier age. Number 1549 REPRESENTATIVE GREEN stated that it has been suggested that kids are smoking and getting into trouble because of a "boredom syndrome", a lack of chores and duties required of today's youth and asked if that is also the cause in the villages. Number 1578 MS. WALKER stated that she could not generalize that to be true but provided that in her own family there appears to be an effect of the "boredom syndrome" as attention is directed towards television, peer pressure, and things that are not required to support the family structure, such as chores. Number 1605 REPRESENTATIVE GREEN stated that when his children where in high school there was a cyclic attitude towards smoking, it was cool and then it wasn't cool. He stated that education, in regards to the effects of smoking did have an influence. He asked if this is the same in the villages and if the 44 percent statistic is the high. Number 1629 MS. WALKER responded that the percentage has been increasing. She stated that the leading cause of death for Alaska Native women is lung cancer which is directly related to smoking. She stated that the factors could be lack of education or peer pressure that are causing the Native high schoolers to smoke at rates that she has never seen before. Number 1693 REPRESENTATIVE GREEN stated that it has been said, if there was $1 tax on cigarettes it would not make a difference because it costs $10 to go to the movies. He advised the peer pressure, idle time and the availability of money are factors that cause kids to smoke. Number 1741 MS. WALKER stated that if a child is already addicted the chances are the child will do anything to get cigarettes, but if one is a junior high school student on an allowance and the choice is to either go to the movies, buy a new compact disc or buy cigarettes that have increased in price, the chance is that the child will buy the other things first. REPRESENTATIVE GREEN announced his joy to Ms. Walker's remark. Number 1767 SENATOR GARY WILKEN thanked both Mr. Green and Ms. Walker for their work on the tobacco tax. He stated that a woman from the Alaska Native Health Board testified on the Senate side as to the board's serious position in regards to the tobacco tax. Number 1775 CHAIRMAN BUNDE stated that in the hearings on the tobacco tax, representatives from the tobacco industry testified that a tax was a cruel thing to do to poor people, particularly the rural and Native people because they have less disposable income, creating an unfair victimization. He asked for Ms. Walker's response. Number 1822 MS. WALKER replied that if poor people want to play the victim role when it comes to buying tobacco or any other drug that they are addicted to, they will. She stated that this argument is meant to raise the emotions of those people who are making decisions on whether to tax a product that will stop young people from accessing it easily and cheaply. She stated that she did not think it was a good argument. Number 1858 MR. BEAN stated that he also wanted to acknowledge that there are some kids who are focusing on the positive and on health care issues in order to improve their lives. Number 1890 REPRESENTATIVE DYSON stated that he has heard two different studies in relation to AIDS; one said there are 60 cases of HIV positive people in Alaska and the other indicated 480 cases. He asked what the board's understanding was. MS. WALKER stated that she did not know the answer to that as AIDS is not a reportable disease in Alaska. Number 1901 PAUL SHERRY, Deputy Director, Alaska Native Health Board, stated that he did not have the exact number but believed it is in the 350 to 400 range of confirmed tested HIV positive cases in Alaska. He stated that Alaska Natives fall in to 16 percent of those cases. He stated that it is a cumulative measure of those people since the start of the count and about half of those people have since died. He noted that since it is not a reportable disease it is clear that there are more HIV positive residents than that number indicates. Number 1963 REPRESENTATIVE GREEN stated that it is a little less then one per thousand residents and asked how it compares to other fairly rural states. Number 1975 MR. SHERRY replied that Alaska is a low prevalent state. He stated that the Alaska Native Health Board has spent six years in HIV prevention because of the desire to keep Alaska a low prevalent state. He continued that it is an escalating rate and it is not a situation that is going to taper off or go away. Number 2012 REPRESENTATIVE DYSON asked if Mr. Sherry has identified the predominant means of transmission of the disease in rural Alaska. Number 2020 MR. SHERRY replied that it is his understanding that it is the same conditions that apply anywhere else; unsafe sex and needle exchange. Number 2029 REPRESENTATIVE DYSON asked "but not amongst the homosexual community, like it is in ... Number 2033 MR. SHERRY replied "As much as any where else." Number 2044 DONALD NIELSON, Vice Chairman, Bristol Area Health Corporation; and Member, Alaska Native Health Board, stated that he would talk about Title 47 reimbursement issue. He stated that the underlying problem of Title 47 is that is an unfunded mandate from the legislature to the local governments. He stated that the financial support is mainly through grants for public safety services. He referred to the Alaska Native Health Board's report for examples of what the unfunded mandate has created. He stated that one aspect is local governments trying to not accept the liabilities that come with the program and at the same time creating financial hardship for the hospitals and clinics that need to administer the health screening. He referred to the villages' Safety Officers Program and stated that Title 47 applies to every community, equally across the state; unfortunately every community does not have a hospital or a clinic with certified health providers. These communities have health aides, who are not qualified to screen. He advised that the liability is that the state contractors could be responsible for any deaths that may occur due to alcohol. He questioned if a tax to increase funding for the communities is the answer. He stated that there needs to be a collective effort to ease the financial burden on those that have to provide the care. Number 2181 REPRESENTATIVE BUNDE stated that the legislature is aware of unfunded mandates. Number 2190 REPRESENTATIVE BRIAN PORTER stated that it is indirectly a federal mandate that the legislature is stuck with as well. Number 2195 MR. NIELSON suggested that maybe there would be a way to solve the problem if everyone worked together. Number 2206 BEN ATORUK, Representative, Manilaq; and Member, Alaska Native Health Board, said that the Alaska Native Health Board is endorsing the construction of the Alaska Public Health Laboratory in Anchorage. Number 2252 CHAIRMAN BUNDE stated that the committee had heard that bill and passed it on. He felt hopeful that it would come to pass. Number 2254 MR. BEAN thanked that committee for hearing the board's statement and stated that the board represents 100,000 people across the state of Alaska. Number 2275 REPRESENTATIVE TOM BRICE asked for some information regarding the board's vision statement that "Cities and villages have the ability to support elderly, disabled, mentally ill and terminally ill patients." He also asked if the board thinks appropriate funds have been taken from the closing of the Harborview Center in Valdez and put into the communities in order for the communities to provide those services. Number 2308 MS. WALKER replied that when the board issued that priority the major focus was "the project choice" which opened an avenue to people so that they did not have to become institutionalized. She stated that in the past rural Alaskans who where unable to care for themselves were sent away. She continued that the question is whether the state of Alaska will be committed in its appropriations in changing the way the mental health delivery system is being managed. Whether there will be a centralized institution or an adequately funded community mental health centers, for short term treatment. 97-11, SIDE B Number 0001 MS. WALKER cited an example concerning Bartlett Regional Hospital. Number 0012 REPRESENTATIVE BRICE replied that there was quite a bit of argument on whether the state would pay the amount of money that Bartlett Regional Hospital was requesting. He stated that the state has been less than appropriate in getting the money out. He continued that his concern is with the support that is available in the rural villages to provide early intervention programs for infants with severe developmental disabilities so that they can grow up to live much more independently. He asked what the board was doing in this area. Number 0054 MS. WALKER replied that the major rural hub communities have a community mental health system with workers who identify the children who could benefit from treatment. She pointed out that she was not sure if the program was adequately funded or not. She questioned if the new Mental Health Trust Land's money will provide enough of an increase in funds to support a good infrastructure for a community mental health system. Number 0090 CHAIRMAN BUNDE encouraged Ms. Walker to discuss the tobacco tax issue with the Alaska Federation of Natives and asked for them to voice an opinion on the issue. He thanked the board for this briefing. ADJOURNMENT Number 0130 CHAIRMAN BUNDE adjourned the joint meeting of the House/Senate Health, Education and Social Services Committees at 4:00 p.m.