ALASKA STATE LEGISLATURE  SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  January 23, 2019 1:30 p.m. MEMBERS PRESENT Senator David Wilson, Chair Senator John Coghill, Vice Chair Senator Gary Stevens Senator Click Bishop Senator Tom Begich MEMBERS ABSENT  All members present COMMITTEE CALENDAR  CONFIRMATION HEARING(S) Commissioner, Department of Health and Social Services Adam Crum - Anchorage - CONFIRMATION ADVANCED PREVIOUS COMMITTEE ACTION  No previous action to record WITNESS REGISTER ADAM CRUM, Commissioner Designee Department of Health and Social Services Anchorage, Alaska POSITION STATEMENT: Testified during his confirmation hearing. ALYSON CURRY, Legislative Liaison Planned Parenthood Votes Juneau, Alaska POSITION STATEMENT: Opposed the confirmation of DHSS Commissioner Designee Adam Crum. CHERYL LOVEGREEN, representing self Anchorage, Alaska POSITION STATEMENT: Opposed the confirmation of DHSS Commissioner Designee Adam Crum. JAY BUTLER, M.D., representing self Anchorage, Alaska POSITION STATEMENT: Supported the confirmation of DHSS Commissioner Designee Adam Crum. JERRY ALDERMAN, representing self Anchorage, Alaska POSITION STATEMENT: Opposed the confirmation of DHSS Commissioner Designee Adam Crum. ZHENIA C. PETERSON, representing self Anchorage, Alaska POSITION STATEMENT: Opposed the confirmation of DHSS Commissioner Designee Adam Crum. ROBIN SMITH, representing self Anchorage, Alaska POSITION STATEMENT: Opposed the confirmation of DHSS Commissioner Designee Adam Crum. JANET COLON, representing self Anchorage, Alaska POSITION STATEMENT: Opposed the confirmation of DHSS Commissioner Designee Adam Crum. ELIZABETH RIPLEY, Chief Executive Officer Mat-Su Health Foundation Wasilla, Alaska POSITION STATEMENT: Supported the confirmation of DHSS Commissioner Designee Adam Crum. MICHELLE OVERSTREET, Executive Director and Founder Mat-Su Youth Housing Wasilla, Alaska POSITION STATEMENT: Supported the confirmation of DHSS Commissioner Designee Adam Crum. ACTION NARRATIVE 1:30:12 PM CHAIR DAVID WILSON called the Senate Health and Social Services Standing Committee meeting to order at 1:30 p.m. Present at the call to order were Senators Begich, Coghill, Stevens, Bishop, and Chair Wilson. 1:31:04 PM CHAIR WILSON announced the first order of business was to elect a vice-chair. 1:31:09 PM SENATOR STEVENS moved and asked unanimous consent that Senator Coghill be elected as vice-chair. 1:31:14 PM CHAIR WILSON announced that without objection, Senator Coghill would serve as vice-chair. Without objection, it was so ordered. ^CONFIRMATION HEARING(S) CONFIRMATION HEARING(S)  Commissioner, Department of Health and Social Services  1:31:21 PM CHAIR WILSON announced the next order of business to come before the committee was the confirmation hearing of Commissioner Designee Adam Crum of the Department of Health and Social Services (DHSS). He invited Commissioner Designee Crum to testify. 1:32:17 PM ADAM CRUM, Commissioner Designee, Department of Health and Social Services, Anchorage, Alaska, said he was born and raised in Anchor Point, Alaska, as one of five siblings. For several years the family had no running water and had to collect their drinking water from a spring. He spent his youth hunting and fishing along the banks of the Anchor River. He graduated from Homer High School as valedictorian and went to Northwestern University. He joined the football team and within a year he had a full-ride scholarship. He finished by winning a leadership and spirit award voted on by his coaches and teammates. He mentioned these achievements because assuming leadership, pursuing excellence, and taking on challenge is central to who he is. After earning a bachelor's degree in psychology, he returned to Alaska. COMMISSIONER DESIGNEE CRUM said his work as a safety professional and trainer took him all over Alaska. He spent weeks at a time in villages like Kaktovik, Barrow, and Point Hope. He earned a Master of Science in Public Health from John Hopkins University Bloomberg School of Public Health. It is widely regarded as the number one public health school in the world. COMMISSIONER DESIGNEE CRUM said he studied public health toxicology, environmental and occupational health law, risk communication and public policy and epidemiology. He wrote white papers on naturally occurring asbestos in western Alaska, as well as mercury content in seafood caught in the north Pacific. He worked as a consultant and project lead for large oil and gas companies and pipeline and transportation companies. He did environmental health analysis and worked on long-term strategy and organizational development. He said he experienced what good looks like first-hand from working with these companies. He has internalized that and used it in his work with other clients and organizations. COMMISSIONER DESIGNEE CRUM said that out of the need to influence organizational culture, he developed a repertoire of leadership courses he could facilitate. For example, one course he is certified to facilitate is based on Stephen Covey's Seven Habits of Highly Effective People. He has been a supporter of MyHouse in Mat-Su, which works with homeless youth to provide job opportunities. Another group he is involved in is JOY International, which focuses on ending sex trafficking. He is also on the advisory board of the Mat-Su Salvation Army. They talk about issues such as hungry families, drug treatment and rehabilitation, and transitional housing. When he was looking for additional resources while working with these groups, he came across the Alaska State Ombudsman May 2018 report of an investigation of the Division of Public Assistance. The report stated that since 2016, there have been hundreds of complaints about lack of communication, a backlog of applications, and delayed payments COMMISSIONER DESIGNEE CRUM called the report heartbreaking. The division was not responsive to people reaching out in their moment of need. And employees trying to do their best didn't have the tools to provide the best customer support. What was really lacking was leadership and support. He brings organizational and strategic expertise and a history of developing high-performing teams and a winning culture. He also brings compassion. He has worked with a lot of the constituent groups the department services. He brings a commitment to recognize and support the employees within the department so they can provide the best possible service. He believes he has been successful in starting down this path. In seven weeks, he has assembled an excellent team. 1:37:39 PM COMMISSIONER DESIGNEE CRUM directed attention to Deputy Commissioner Albert Wall, a military veteran who is still active in the National Guard. Mr. Wall has 20 years of experience as a behavioral health clinician and previously worked for DHSS as a budget director and director of behavioral health. The last few years he has been the CEO for the Peninsula Community Health Services. He now oversees Family, Community and Integrated Services. He has worked at DHSS and understands long-standing issues and is motivated to correct them for the benefit of all Alaskans. COMMISSIONER DESIGNEE CRUM said the Deputy Commissioner of Medicaid and Health Care Policy, Donna Steward, is uniquely suited to this role because she spent the last few years as the executive director of the Office of Rate Review. Before that she was a research analyst for the Washington state legislature and has worked at the Centers for Medicare & Medicaid Services as associate regional administrator for the Medicare side. She has vast experience working with and for federal partners. She understands the actual numbers as they stand in Alaska. COMMISSIONER DESIGNEE CRUM introduced Sana Efird. She was the deputy commissioner at the Department of Education and Early Development and has returned to DHSS as Assistant Commissioner of Finance and Management Services, a position she had been in before for four years. She has knowledge of the department, its budget, and programs. COMMISSIONER DESIGNEE CRUM noted that Tony Newman was continuing in his role as legislative liaison for DHSS and that he is incredibly responsive to legislative requests. COMMISSIONER DESIGNEE CRUM noted that the Health Care Policy Advisor, Heather Carpenter, had been chief of staff for Senator [Pete] Kelly. COMMISSIONER DESIGNEE CRUM said that in the short time that he has been in this role, he has visited as many employees as possible. His first communication was to thank everyone for their hard work and service and to remind them to always remember the good they do. DHSS is a large department with many divisions. It's a safe bet that in any week one of those divisions may make the news. He wants all employees to know that he understands and appreciates the jobs they do, and he is proud to work with them during these difficult times. 1:40:43 PM COMMISSIONER DESIGNEE CRUM said he has three top priorities for DHSS. • Number one is addressing the overall budget issue. DHSS has one of the largest budgets in government. They must do what they can to reduce duplicative efforts, gain efficiencies, and leverage community partners. • The second priority is to work on the Alaska Psychiatric Institute (API). It has a longstanding number of issues. As the state's residential psychiatric treatment hospital, API plays a critical role in the continuum of care for behavioral health. For far too long API has not received its due attention. This administration committed to putting API on the correct course, to provide better patient outcomes, and to ensure a safe environment for patients and staff. • The third priority is to reduce the backlog of applications at Division of Public Assistance (DPA) so these people can be responded to and heard. The new DPA leader is working on new processes and the support levels to address and correct this issue. COMMISSIONER DESIGNEE CRUM said another key item is addressing IT solutions. It can reduce the burden from front line employees and allow them to do their jobs better and faster. The department is constantly looking at ways to gain efficiencies while keeping an eye on superior customer service. He said he is committed to the department, the people it serves, and the people he works with. He concluded by saying, "Our mission is to promote and protect the health and well-being of all Alaskans. That is what I am committed to do. I am humbled that Governor Dunleavy has asked me to perform this role and I am honored to be before the committee today." 1:42:23 PM SENATOR STEVENS said the governor in the State of the State address last night spoke of the importance of cracking down on crime, but he also mentioned the opioid crisis, which falls under Commissioner Designee Crum's jurisdiction. He asked what can be done about that. COMMISSIONER DESIGNEE CRUM said the White House yesterday continued the public health emergency for the opioid crisis. The department will work with the federal delegation to see what that means as far as resources and tools. Andy Jones is continuing in the director position for the Office of Substance Misuse and Addiction Prevention (OSMAP). He works with public safety, law, and corrections, and also reaches out to the public to help set up task forces. The intent is to bring a high level of awareness and support to this issue. 1:44:03 PM CHAIR WILSON said last year the legislature approved additional staffing to handle some of the backlog related to Medicaid applications. He as was sufficient to take care of the backlog of unprocessed applications. COMMISSIONER DESIGNEE CRUM said he has not had that conversation with budget. There are open positions at the Division of Public Assistance (DPA) but part of the new director's priority is to reduce that burden. 1:45:11 PM SENATOR COGHILL commented on the Medicaid budget and the fact that it is one of the big budgetary drivers. He asked the commissioner to tell the committee what he had learned in the last seven weeks to help make this more sustainable. COMMISSIONER DESIGNEE CRUM replied that Medicaid is 70 percent of DHSS's overall budget and his team will work with federal partners to see what they can do with the overall plan, perhaps with waivers. Stakeholders will be brought to the table with providers to work together on this issue. He said the goal is to run as clean a business model as possible so legislators don't get hit with a bill at the end of session for the previous year. SENATOR COGHILL said he will ponder what the legislature can do to address the issue of trapping people in the Medicaid world. That is that someone on Medicaid who gets a raise may find their medical bills are more than the raise. He also cited the example of someone with a child covered by Denali KidCare who had to turn down a promotion in the Air National Guard to not lose eligibility and have to pay about $3,500 a month. This person had to turn down a promotion or quit his job. He said that's a clear example of how people get trapped in a system that is meant to give them a hand up. He expressed hope that the commissioner would help legislators understand CMS rules and what the department's health care plan can and cannot do under the waiver system. COMMISSIONER DESIGNEE CRUM said that is an issue he has addressed with his team. He believes there should be a step-wise function so people can take help when they need it, but also progress and improve their lot in life. The department will look for models that work and perhaps ask for statutory change. They will also look at the federal side for rules they can adjust. SENATOR COGHILL expressed appreciation for the response. 1:51:38 PM SENATOR BEGICH mentioned the governor's desire for state spending to match resources estimated to be $3.2 billion and the DHSS budget that is one of the largest in the state. He asked how to mesh recognition and support to employees on one hand and substantial budget cuts on the other. He said today in the Finance Committee, Donna Arduin, the Director of the Office of Management and Budget, said each department had to prioritize areas that would be supported and what could be eliminated. He asked what was at the bottom of the list for DHSS that would potentially be eliminated in this administration. COMMISSIONER DESIGNEE CRUM said people in his department have noticed that they can save quite a bit of money by taking care of how the dollars are spent. This includes things like making sure processes are clean and preventing overpayments. That's the first step. SENATOR BEGICH referenced a meeting in his office when the commissioner mentioned that all options were on table. He asked what options would be on Table A and whether he was looking at privatization of the Alaska Psychiatric Institute (API). COMMISSIONER DESIGNEE CRUM responded that all options truly are on the table. If API is privatized, the level of care would need to meet all the requirements. DHSS will be a mission-driven organization. Each division and every subgroup will work to accomplish what is in its mission. SENATOR BEGICH asked his perception of the mission of DHSS and what he believes his constitutional obligation is to uphold that mission. COMMISSIONER DESIGNEE CRUM answered that the mission is to promote and protect the health and well-being of Alaskans. He said the plan is to identify and work with the neediest groups. There will be cuts and the department will need to gain efficiencies, but they are committed to work with stakeholder groups looking at available resources to make sure the rug is not pulled out from underneath people. CHAIR WILSON requested he send the DHSS priority list to the committee when the budget is released on February 13 so legislators can take that into consideration in future legislation. 1:57:11 PM SENATOR BISHOP asked whether he played offense or defense. COMMISSIONER DESIGNEE CRUM answered both; in high school he was a linebacker and in college an offensive lineman. SENATOR BISHOP responded that he asked because the state is always playing defense in the health care world and he wonders when a leader will take the offense and promote healthy living, similar to John F. Kennedy's health and physical fitness challenge. He asked the commissioner if he and his team or the governor had any ideas to promote something like that. He related that he spent eight days in Iceland and was astounded by the lifestyle, their physical fitness, and how they promote physical education for both people in school and the private sector. He reiterated that the state should get on the offense. COMMISSIONER DESIGNEE CRUM agreed that getting on the offense is a critical aspect to changing the path of the future. He noted that his public health background is on the preventative side. He said the idea is to work on innovative measures to save money by spending money on the front end. He acknowledged that specific projects have not been targeted but it is an ongoing conversation as the full team comes together. That. SENATOR BEGICH pointed out that federally, 7 million fewer people are insured and that burden falls on emergency rooms and hospitals. The smallest hospitals in Alaska suffered because they didn't get their Medicaid reimbursement in a timely manner and, if the state reduces Medicaid, will eventually have to deal with the expense of those additional emergency services. He asked the commissioner if he was considering a block grant waiver proposal coming from the current presidential administration because that raises some concern. He referenced the statement that DHSS plans to identify and work with the neediest groups and noted all people in Alaska have a constitutional right to abortion and family planning services, which the state does compensate through Medicaid for the neediest citizens. He asked if the state will continue doing that. COMMISSIONER DESIGNEE CRUM said the department has ongoing negotiations for a 1115 [Medicaid] waiver, which is their ability to work with federal partners to tailor an Alaska- specific solution that is cost-neutral or a cost-savings for the state while also providing better services. He asked Senator Begich to repeat the second question, which he did. COMMISSIONER DESIGNEE CRUM said he will follow the law. He added, "As it stands now, Alaska law and the federal law maintains we have to do that." SENATOR BISHOP asked for assurance that he was committed to improving the mental health assets in the state. He also reminded the commissioner that in their earlier meeting he cautioned that for every action there is a reaction. Senator Bishop asked him think about that and weigh the change when he does any cost-benefit analysis and due diligence. COMMISSIONER DESIGNEE CRUM answered that he and the governor are committed to working on the behavioral health situation in Alaska. He visited Fairbanks Memorial Hospital recently in recognition of the state partnering with the hospital to expand psychiatric beds in the emergency room. He said the department is trying to find innovative solutions around the state to address behavioral health. He is excited that Deputy Commissioner Wall has a background in this. He said the department will work with community partners and have had many conversations with possible different funding sources to leverage local as much as possible. SENATOR BISHOP asked if the several acting directors in the department were placeholders during the recruiting process. COMMISSIONER DESIGNEE CRUM replied that that the Public Health director is now full time and recruitment is ongoing for the directors of Senior and Disabilities Services director and Behavioral Health. 2:04:49 PM SENATOR COGHILL commented that although DHSS is under a court order to pay for abortions, that doesn't mean DHSS can't educate people about alternatives. He encouraged other ways of communicating with people in those circumstances. SENATOR COGHILL highlighted the sustained high turnover and vacancy rates at the Office of Children's Services (OCS). He said OCS has to work with people who are experiencing the worst circumstances of their lives but doesn't seem to be able to show them out of the dysfunction. He said it is commendable that some kids are saved but many times families are intimidated inappropriately. He asked who is tasked to work in that arena and what new ideas can be expected. COMMISSIONER DESIGNEE CRUM said discussions about children are very sensitive and emotional. Everyone wants to provide the best service, care and protection for children whether it is inside the family or not. It is a delicate balance that the staff at OCS has to manage. Natalie Norberg is the full-time director. DHSS is working on creative solutions to deal with the vacancy rates. Internal talks are ongoing about how to encourage people to apply, keep their caseloads low, and keep their morale up so they don't leave. The department is also working on an internal communication bank to help families to see OCS as a resource, not the person coming to take their kids away. SENATOR COGHILL urged him to let legislators know if he sees places where the state statutes could be improved. 2:09:11 PM CHAIR WILSON opened public testimony. 2:09:30 PM ALYSON CURRY, Legislative Liaison, Planned Parenthood Votes, Juneau, Alaska, said Planned Parenthood opposes the confirmation of Adam Crum due to his lack of experience delivering health and social services. Instead of appointing someone who understands health policy, Governor Dunleavy has appointed someone whose ideology lines up with his own. When Mr. Crum ran for state senate in 2016, he ran on a platform of cutting government programs and restricting a woman's constitutional right to make decisions about her own body. Alaska needs somebody who will implement proven and effective strategies for improving public health and decreasing health disparities across communities. The state has some of the highest rates of suicide, domestic violence, sexual assault, and sexually transmitted infections in the nation. The state needs a commissioner with the necessary experience to tackle these challenges and advance bold solutions to improve the health of all Alaskans across the state, especially for historically marginalized communities that are more likely to lack access to critical health care and social services. Anti-reproductive health and small-government ideologies are not good substitutes for policy expertise and experience. 2:11:44 PM CHERYL LOVEGREEN, representing self, Anchorage, Alaska, said she was concerned for two reasons: Mr. Crum's lack of experience and his possible bias. He has no experience as a manager within the department or in leading a large department like DHSS. He does not have the best skill set for this appointment. He said he is not a health care policy guy. He was endorsed by an anti-choice group in a recent campaign. She questioned how he will support the rights of women and teens who need comprehensive health care and information, including family planning and abortion. Alaska has a public health crisis in opioid use, unintended teen pregnancies, mental health, and other issues. The state needs health care professionals who already know how to turn these things around. 2:13:33 PM JAY BUTLER, M.D., representing self, Anchorage, Alaska, identified himself as the former Chief Medical Officer for DHSS and for a brief time, the commissioner. He said he first met Mr. Crum when he learned he would replace him as the commissioner. He worked with him for a week and found him to be a man of integrity who cares about welfare of the state and its people. He understands organizational structure and function and population-based approaches to improving health. DR. BUTLER noted that Mr. Crum is a fast learner. He joined in their phone calls when DHSS activated its emergency operation center after the Anchorage earthquake [on November 30, 2018]. On his first day as commissioner he faced two internal emergencies with a cool head. He said Mr. Crum is the right person for the job. 2:15:58 PM JERRY ALDERMAN, representing self, Anchorage, Alaska, said Mr. Crum has an impressive resume and is a smart guy, but he has no background for this job. He's never worked in health care or social services. He has not managed a government agency. Mr. Alderman said he doesn't like it when politicians, especially males, start talking about what his daughter can and cannot do with her body. 2:17:20 PM ZHENIA C. PETERSON, representing self, Anchorage, Alaska, said she wanted to echo what other people have said. Mr. Crum does not have the knowledge or experience to run something as big as DHSS. He's never worked in a health-related field or had a background in health policy. His statements about reducing the size of government should be a concern to the committee. She worries that his initiatives would cause many people to lose jobs and would cut funding to health care services that many Alaskans rely on. His connection to right-to-life groups and past statements about women receiving basic health care services make her worry about her constitutional rights being taken away. 2:18:47 PM ROBIN SMITH, representing self, Anchorage, Alaska, said Mr. Crum is unqualified for the position of commissioner of DHSS, one of most difficult management jobs in the state. When he ran for the legislature in 2016, he described himself as a business owner, truck driver, and carpenter. His resume states that he managed 75 people and handled multimillion contracts. That is a far cry from managing a department of over 3,000 people and a budget the size of DHSS's. His degree from John Hopkins School of Public Health is in occupational and environmental hygiene. The John Hopkins description of the degree does not mention the medical field. He has never worked in a medical arena. Alaska has the most expensive care in America, which makes it the most expensive care in the world. No one has been able to successfully reduce the cost in Alaska. It is an extremely complex issue that should be addressed by the smartest and most qualified person available. She said she is deeply disturbed by the nomination because it shows a lack of respect for real health care professionals. She would not trust him to implement policies for women and families because he has identified himself as pro-life. She said she fears he will work against women. 2:22:17 PM JANET COLON, representing self, Anchorage, Alaska, said that during Mr. Crum's campaign two years ago for state senate, he proudly advertised that he was against a women's right to make decisions about her own body. As a nurse with 20 years of public health experience, this is a grave concern. She said she has observed women trying to get money to come in from rural Alaska to get health care in Anchorage. She has seen increased rates of sexually transmitted diseases among teens. As a sexual assault nurse, she's seen increased sexual violence against women. The state needs an unbiased commissioner who cares about the health of all women in Alaska. 2:24:00 PM ELIZABETH RIPLEY, Chief Executive Officer, Mat-Su Health Foundation, Wasilla, Alaska, said she met Adam Crum at the Mat- Su Business Alliance, where he and his business, Northern Industrial Training, have won many awards and helped the Mat-Su economy. He has been an active donor and supporter of MyHouse, a local nonprofit addressing youth homelessness. He sees the complexity of health and social issues like homelessness. He has a heart for this work. He has a master's in public health and many of the challenges DHSS faces can be improved by maximizing the public health model on both the prevention and intervention side of things. As commissioner he wants DHSS to be more strategic and efficient and effective at meeting its top goals and objectives. DHSS needs someone with the business acumen and budgetary skills, management knowledge, workforce development expertise, and the communication and emotional intelligence to pull this off. He has these skills and experiences. She said she looks forward to partnering with Mr. Crum to deliver more value for the state's health and social services dollars. 2:26:06 PM MICHELLE OVERSTREET, Executive Director and Founder, Mat-Su Youth Housing, Wasilla, Alaska, said Mr. Crum has been an advisor to MyHouse for the past eight years. He has supported a public health office in their building that specializes in reproductive health. He has supported MyHouse's goal of providing reproductive health services to homeless youth. He has never opposed any kind of services to the youth they serve. There are many assumptions about how he will behave as commissioner. He is a man of integrity with a huge heart with a passionate desire to make Alaska better. He is an expert on budget and fiscal management. He has given her advice on directing a nonprofit. He helped a MyHouse employee with a small child strategize because her increasing compensation disqualified her for Medicaid services. Mr. Crum demonstrated not just compassion, but knowledge and creative thinking about how to use the Medicaid expansion with a step-down system for people in the same situation as their client. To not appoint him would be a real shame and a detriment to the state, she said. SENATOR BEGICH asked whether there was any limit to the services in MyHouse's reproductive health clinic. MS. OVERSTREET said there were limits to the onsite clinic, but they are partnered with a local provider. The local provider can coordinate everything from educational sessions to abortion services provided elsewhere. 2:30:07 PM CHAIR WILSON closed public testimony and asked Mr. Crum if he wanted to address his qualifications. COMMISSIONER DESIGNEE CRUM said he does not come from a public health policy background, but DHSS needs someone who can look to long-term strategy and understand what to do, because difficult times are ahead. DHSS needs someone at the helm who can take care of things and he has put together a fantastic team to guide him through the process. 2:31:15 PM SENATOR STEVENS asked what strategies he employed to deal with homeless youth and if that would be his responsibility as commissioner. COMMISSIONER DESIGNEE CRUM replied that for whatever reason many homeless youth throughout Alaska have coalesced in the Mat-Su Borough. There are massive tent cities. The idea was to find a community solution to give the teens resources they need, such as substance abuse counseling. The model is hand up not handout. The teens must understand they have to work as part of the process. He said it will not be part of his purview as commissioner to do that, but the administration wants to ensure that all Alaskans have these opportunities to move ahead. SENATOR BISHOP said he has the utmost respect for Dr. Butler. Many do not know that DHSS is part of the state's emergency response team and Mr. Crum is very familiar with how to execute emergency response. He pointed out that Mr. Crum said that he would adhere to the law and implement the law. SENATOR BISHOP said his philosophy is that if everyone around him is thinking the same thing, then someone is not thinking. He asked Mr. Crum to respond to that. COMMISSIONER DESIGNEE CRUM said that during meetings, people volunteer to play devil's advocate. His management style is to encourage diverse thoughts to ensure the team puts out the most and the best solutions. SENATOR BEGICH asked, considering the public testimony, whether he is confident that he can put political ideology aside and focus DHSS's goals on the best scientific evidence available. COMMISSIONER DESIGNEE CRUM responded absolutely. He has a degree from a school that is one of the best in the world that is science-based. SENATOR COGHILL said some of the questions revolved around reproduction rights and abortion. That is the legislature's job to answer those. He said he has seen commissioners come and go with a bias either way. It is not big issue if he follows the law, but Mr. Crum will deal with public health issues such as disease management and things that create hunger for bad things, whether drugs or alcohol. He asked if he had anything to share about his vision regarding public health. COMMISSIONER DESIGNEE CRUM replied that the phrase social determinants [of health] are buzz words heard a lot now. Preventative measures of behavioral health issues are key aspects of addressing public health. The department is going to be more proactive and work across departments. COMMISSIONER DESIGNEE CRUM concluded by stating he is an Alaskan first and foremost. His family is here and he wants to stay in this state, which is why he wanted to take this role. 2:38:44 PM CHAIR WILSON stated that in accordance with AS 39.05.080, the Senate Health and Social Services Standing Committee reviewed the following and recommends the appointment be forwarded to a joint session for consideration: Commissioner, Department of Health and Social Services Adam Crum - Anchorage Signing the reports regarding appointments to boards and commissions in no way reflects individual members' approval or disapproval of the appointees; the nominations are merely forwarded to the full legislature for confirmation or rejection. 2:39:15 PM At ease 2:40:53 PM CHAIR WILSON reconvened the meeting. 2:41:15 PM There being no further business to come before the committee, Chair Wilson adjourned the Senate Health and Social Services Standing Committee at 2:41 p.m.