Alaska Health Policy Review

Dear Reader:

Despite the fact that Alaska is one of the more diverse states in the nation in terms of ethnicity, heritage, and "race," there is no established office of health disparities, minority health, or a comparable institutional presence involving this most important topic. Moreover, nearly every other state in the nation -- a total of 46 states -- has some formal institutional entity addressing racial and ethnic minority health, and/or other health disparities.

The central issues are these: Alaskan Natives die younger than others, African Americans are more likely to have high blood pressure, low-income families are less likely to have a regular primary care physician, and so on. Health, and access to health care are unequally distributed among Alaskans, and among Americans. These are health disparities. The central questions are: Why do they occur, and how can they be addressed?

The Alaska Department of Health and Social Services received a $50,000 one-year planning grant from the United States Department of Health and Social Services Office of Minority Health to increase the overall awareness of health disparities of racial and ethnic minorities in Alaska, and to assess the feasibility of establishing an Office of Health Disparities or some comparable institutional presence.

Beginning January 2009, HSS staff have been conducting key informant interviews to assess current health disparity efforts, identify partnerships, and gather input to determine if an "office" of health disparities would fit Alaska.

Informants have been asked four questions:

1) What are some ways DHSS can better work with your agency to address minority health?

2) How do you think DHSS should approach racial and ethnic minority health disparities?

3) In your opinion, who are the key partners and players in addressing racial and ethnic minority health?

4) What are your recommendations and thoughts on the development of an Office of Minority Health? Please tell us what this office might look like (components, definition, etc.)?

Sound intriguing? Contact Patricia A. Carr, director, Alaska Office of Rural Health, Dept. of Health and Social Services, Office: (907) 465-8618. I suspect she is looking forward to hearing of your interest. Maybe she'll even send you the draft report, "Alaska Office of Minority Health Planning Project Findings to Date, March 2009."

I wonder if the new Alaska Health Care Commission will be addressing health disparities? Perhaps you will find a suggestion of an answer to that question in our frank and far-ranging interview with Dennis McMillian, which follows.

Lawrence D. Weiss PhD, MS
editor, AHPR
ldweiss@gmail.com

Interview with Dennis McMillian

Dennis McMillian is president and CEO of the Foraker Group. The Foraker Group is a unique nonprofit Alaska organization established to strengthen Alaska's nonprofits. The Foraker Group, along with the Rasmuson Foundation, unveiled a new health insurance program in October of 2008 that is designed specifically for the nonprofit sector in Alaska. In addition, McMillian facilitated the Governor's Health Care Strategies Planning Council in 2007, and has been involved with the new Alaska Health Care Commission. In this interview McMillian discusses the vision and reality of health insurance for Alaska nonprofit workers; and the goals, frustrations, and achievements of working with health policy planning groups in Alaska. This interview has been edited for clarity and length.

AHPR: The Foraker Group benefit plan went into effect on October 1, 2008. Would you please give a brief overview of what it is and the philosophy behind it?

McMillian: If you serve on a non-profit, about their biggest concern relates to attracting and retaining good employees [through] the ability to offer benefits, specifically health insurance. This is a perennial issue in the non-profit world: to have affordable health insurance, competitive health insurance for their employees. Having had now 20 some odd years experience in the non-profit sector looking at health insurance for employees, I've become a bit of an expert on what it is and what it isn't, what can be and what can't be done.

Foraker -- since it started -- had the ambition of trying to do an association health plan for non-profits. We didn't do it with the understanding that the association itself would generate lower rates, because associations don't by themselves generate lower rates -- the larger the group doesn't mean the lower the cost. What association plans do for small employers is stabilize rates so there is more predictability about what the rates will be and whether they go up or down, so you don't have one major incident in a small office setting off a huge increase in premiums.

To create an association plan in itself at best stabilizes rates, and that would be beneficial to small employers. A lot of the research that has been coming out nationally on health is what can an employer do or an association do to help mitigate rate increases, and that's all through health risk management and through helping people become better health consumers.

[At this time] the Foraker health plan is an off-the-shelf Premera product -- nothing unique. We will not be able to offer this as an association plan until we reach a critical mass of folks in the plan, and we hope to achieve that within the next eight to twelve months -- the critical mass. We will then be switched over and become a true association plan.

But in the meantime, we're the first association plan that has, as a requirement for employer participation in our plan, that they encourage health risk management programs in the workplace. That's everything from a self-assessment on your own personal health and habits, to wellness classes and other activities in the workplace that help people learn how to be healthier.

That is really the unique quality, plus one of the plans that we took off the shelf from Premera is a high deductible health savings account-related plan. There is some early evidence that when you do a health savings account plan where the health savings account is truly funded so people have the money in it, that it does help promote consumerism. People actually ask before they get a procedure or a prescription, "Is this the best?" "Can I get a better price?" "Is there a different way to do it?"

Those two things we think will [have an] impact. One of the earliest really great feedbacks we've had according to Premera and the whole Blue Cross Blue Shield Washington Alaska Premera network, [is that] we have the highest usage of health risk management of any employer or association, and we're only a few months old.

"We haven't gotten to the critical mass yet. Critical mass is when we have enough enrollees to where we're pretty confident that we're not going to have a negative selection scenario ... Because we've had so much enrollment, we're much more confident that we're going to get there faster."

AHPR: That's a good segue to my next question, which you may have partly answered. While the plan has only been in effect for a few months, does it look like you are on track for a successful, sustainable health plan for non-profits in Alaska?

McMillian: Absolutely. We are now, with over 300 employee lives covered -- most of these are mini shops, little itty bitty shops, three or four employee kind of places -- so the Premera folks at our consultant broker are astounded at how many we've had sign up so far. We knew that January of '09 would be big enrollment date because a lot of non-profits do their benefits either January 1 or July 1. July 1 is a bigger date than January 1 so we're really kind of playing toward that date but we're farther along than thought we would be at this point.

We haven't gotten to the critical mass yet. Critical mass is when we have enough enrollees to where we're pretty confident that we're not going to have a negative selection scenario and again, we don't know when that's going to happen. Premera had told us that they really had anticipated it would take 18 months -- so that would be a year from May basically -- before we got to the place where we would be there. Because we've had so much enrollment, we're much more confident that we're going to get there faster.

Another thing that we've been able to do is we have right now two different plans off the shelf at Premera: one is a $1,500 deductible health savings account and the other is an indemnity plan [with] a $2,500 deductible. That's all we started with because we really wanted to keep it simple. But what we've learned is that the employers really like this high deductible health savings account plan, but at $1,500 deductible that is just too expensive for many of the smaller non-profits.

So we're getting ready to announce in the next few weeks a higher deductible -- we don't know what that's going to be -- health savings account plan. A lot of these groups that had interest in the beginning that have backed out because of cost, we're hoping to get back in the door.

AHPR: I heard you talk one time in the past when you were rolling this plan out, and if I recall correctly you said that the critical mass was 1,200 or 1,500 bodies.

McMillian: That was just a guesstimate of what we were thinking at the time. It would be great if we get to that level but it's not a hard number. It's really a discussion between Premera and us when we get enough enrolled and we can look at those groups, and say this is a pretty diverse, good representation of employees and organizations. That number is arbitrary, I guess is what I'm saying, and there are other factors that will play in more than just a gross number.

We know that there are a number of organizations that are not sure we'll ever get to whatever that arbitrary number was that we said at the beginning. In the beginning we said 1,500, but what we didn't do a good job at the beginning was saying that that really was an arbitrary number. If we get to 1500, great, but we don't have to get to that number in order to create the plan. Premera has already told us that failure is not an option. They're going to make this happen and we're going to make it happen but we're not there yet. We're getting closer.

AHPR: And July hasn't happened yet.

McMillian: And July hasn't happened, and quite frankly, we've gone up a third since January and January was a big, big month. But the first month, of course, we didn't have any action because non-profits to buy insurance have to bid it, they have to get the quote, they have to go to their board.

We didn't even have any action until late November, early December but what's been encouraging to us is we've been getting some additional groups after January -- and some large groups. We got a number of employers with, you know, 20, 30, 50 employees that have either come on already or are right now going through the double jumps [?] and trying to decide. Again the brokers that sell insurance are all very, they're very supportive, they're telling me not to be nervous and that everything is fine.

AHPR: This is a question perhaps unlike ones that you would usually get asked about this: Do you see any role for the Foraker Group benefit plan in the ongoing discussion of health reform at the state level? For example, might it be integrated or rolled into Senator French's SB 61, based on the Massachusetts model. The short title of his bill is Mandatory Universal Health Insurance or as Senator French prefers to call it, "Health Insurance for all Alaskans."

McMillian: Since the beginning, knowing Senator French's leadership and interest on this, we've kept him in the loop of what we're doing. We've kept people in the state Department of Health and Social Services, and of course, the [Division] of Insurance knows what we're doing. They're all watching with great interest.

We've also been working on a national basis with consultants out of Robert Wood Johnson Foundation and with Academy Health. It's a big think tank about health reform in America. They all know what we're doing. They've all been advising us about what to do and what not to do.

Whether it's Senator French's bill or any other reform that happens, I'm convinced that this mix between personal responsibility and coverage is the new paradigm. It's the new way to start thinking about health coverage. I'm convinced that what we're going through with health insurance in America today is what we went through with retirement plans 25 years ago when everybody moved from defined benefit to defined contribution -- or a lot of people did -- not the PERS and TERS but outside of that.

The reason that small employers had to move from defined benefit to defined contribution retirement plans was the critical mass. There was not enough people in those smaller organizations to really fund a defined benefit plan. The cost would have been prohibitive. It would have been a benefit that would have gone away totally.

Instead of going away totally, these new things, the 401K's, came up and I think that health savings accounts, while they still need to be adjusted and there is a definite role for employers to contribute to these plans -- which some employers haven't done -- that these plans are the ones that will end up being more affordable for individuals if we have to pay for it ourselves, or for employers to help.

We're hoping that with this experiment that we've been able to do with Rasmuson Foundation support -- incentivizing individuals' contributions in health savings and employer contributions in health savings -- that this might be a model that would be very useful in the state of Alaska.

Just think if we get to a mandatory coverage or something less than mandatory but where more people would be covered and the state were to use some of its resources and encourage individuals with their Permanent Fund Dividend to fund their health savings accounts in Alaska -- some sort of public-private sector and personal responsibility -- Alaska might be able to pull something off a lot better than other states.

Why couldn't we have some of the tools with health risk management for every individual in the state of Alaska, where anybody could go online and do a health assessment and get some sort of coaching if they had issues?

"I mean we're not going to have the same kind of health insurance in the future that we've had for the past 40 years. It's going to change; we just don't know what it's going to look like ... But at some point, what we've all become familiar with is going to change in this country and it's going to happen sooner than later."

AHPR: I wasn't aware of the national attention that you are generating. That sounds very interesting.

McMillian: Again, thanks to Rasmuson Foundation, early on they required that for it to move ahead that it built money into its budget for assessing what we're doing. Part of assessing what we're doing is to talk to people that deal with these things on a national basis and get feedback.

Talking to some of these folks who've been working with state reform and looking at these different insurance models and hearing what's good about them and hearing what's bad about them and hearing what we can do to mitigate what's bad about them, has been very helpful with the design of what we're doing. Groups like Academy Health are watching what we're doing, I think to inform some of their discussions with the states that have done broader reform because they're intrigued. They're trying to learn from us and we're trying to learn from them -- "Is any of this going to work or is it not going to work."

But there's a sea change that has to happen with the public, and that's going back to this issue of the way retirement used to be and the way it is for many people in America, and health insurance is at that place. I mean we're not going to have the same kind of health insurance in the future that we've had for the past 40 years. It's going to change; we just don't know what it's going to look like. A lot of it is going to depend on whether governments mandate everybody be insured like they are with car insurance or it's going to be something less than that.

But at some point, what we've all become familiar with is going to change in this country and it's going to happen sooner than later. Nobody really has what that looks like now except that it probably won't be like Canada or the plan in Great Britain. It'll be some sort of hybrid of the private scenario, at least that's what I keep hearing.

AHPR: I'd like to completely switch gears now, into the other high profile health-related activity that you are involved with. You were the facilitator of Governor Palin's Alaska Health Care Strategies Planning Council, which met for several months in 2007. In retrospect, how would you characterize the concept, the process, and the final outcome of that effort?

McMillian: The concept happened because -- from what I could tell -- the governor, being new in office, had gone to her leadership team, her commissioners, and basically asked for things that could be done in the first few days of the administration that might have a strong impact. My understanding is the commissioner [of Health and Social Services] said that having some strategies around health care reform would be appropriate and good for the state, and the governor said, "Fine," and very quickly pulled together a group of individuals to serve on the health strategies council.

Everyone that was asked to be on the council had some experience in health care from different perspectives so they were [almost] all subject matter experts. Many of them had been engaged in public process before. Most had not really been involved in any kind of public process and many had never even served on boards of organizations. So they were all very motivated to do it.

They came from incredibly diverse ideologies around politics and this issue. The governor's mandate to the group was to look at what had already been done -- so to look at the health policy round table and to look at some of what other states had done and to look at all the research that had been done in this state around health and health care and not to do any new studies but to become familiar with all the old studies and agree on a few short term and long term strategies that could come from what they learned.

That sounds simple enough except when you quantified looking at all the studies that had been done, it was significant. It was a four-foot high stack of paper. We had a group of incredibly busy people that were tasked with -- over a six-month period, meeting for 24 hours face to face and a little bit more through web communication and in a very exposed position being on television and recorded the whole time -- discussing what they had learned, try to agree, develop a consensus about what was good and what wasn't good. They did listen to some subject matter experts but very few because again, it was not about doing new research, it was more about taking what had already been done.

In all honesty -- and I've said this publicly and privately -- it was a very painful process to try to get these people to come to consensus and to have sufficient communication with each other to develop consensus and move ahead. I think most of the people on the health strategies council were frustrated with the process. I think when they really looked at the magnitude of what we were trying to do, it was incredibly ambitious to try to do what we did. That was all the bad news.

The good news is that a year and a half since the discussion -- I look at the report and I look at the recommendations that came out of the report -- I think they did an incredible job of coming to consensus and coming up with some especially low hanging fruit for the governor and the Legislature to look at.

One of the strongest recommendations was that this was a very useful exercise, but this was way more complex than 24 hours was going to suffice, so one of their strongest recommendations was the development of a permanent health commission in the state of Alaska, which is now almost done and one has been named.

Another was to increase SCHIP [Denali KidCare health insurance for children from low-income families]. That was low hanging fruit. It was one of the very last things that they did and probably created more last minute angst than anything else. But the consensus was: Yes, this is almost a no-brainer, and the majority moved ahead with SCHIP.

And there are other things, like trying to provide a web portal with more robust information about health and health services in Alaska that Dr. Butler [chief medical officer for the state of Alaska] is now working on, and talking about ways of increasing personal responsibility, improving the health of all Alaskans, providing more information to Alaskans about health and health care.

In hindsight, the result was much better than what we thought was going to come out during the process and even immediately after the process. And when you go back -- and this is credit to the round table that Commonwealth North had done before -- it was a lot of the same recommendations that were there and it's a lot of the same recommendations that have been around.

When the new health commission met, I think that was one of their big observations at the first meeting is that regardless of who is in the room, and what their process was like, the recommendations that are coming out have a theme, there are some similarities.

I think that having also been involved to some extent with Commonwealth North's [process] -- much different people in the room and a much longer time to really do study and debate -- yet, what they came up with was very similar to what this very different group of people looking at a lot of the same information came up with.

There's some wisdom in that, that if you look at enough of the data and you agree on what is relevant and is maybe the best available data, that perceptions tend to go away and people come up a little bit more with what reality is. I think that's what happened.

"The new health commission really is much more around recommending policy. It is continuing to advise the governor, advise the Department of Health and Social Services, advise the Legislature on health policy issues but it also could, in my understanding it could, recommend additional research or try to get more information if necessary."

AHPR: You sort of anticipated my next question. You have some familiarity with the governor's new Alaska Health Care Commission, established December of last year by Administrative Order 246. How does the concept or goal of this commission, the new one, compare or differ from the preceding 2007 planning council?

McMillian: I did go to their very first meeting to give them a summary of what the health strategy council had done but that was a 20-minute presentation: here's what it was, the task. The health strategies council was to look at all the studies and to recommend short-term and long-term strategies. In reality, we did do short-term, to some extent long-term strategies, but not enough robust planning came out of health strategy council. It was much more of a summary document.

The new health commission really is much more around recommending policy. It is continuing to advise the governor, advise the Department of Health and Social Services, advise the Legislature on health policy issues but it also could, in my understanding it could, recommend additional research or try to get more information if necessary. I was only at their first meeting for about an hour and my understanding is after that there was a lot of discussion about advocating and whether they would be advocates for policy. I don't think that they've come to total consensus around that.

It is being staffed by Deb Erickson, who is a long time state employee [and] in my experience with Deb, very knowledgeable about a lot of this stuff, and it is being chaired by Dr. Butler, who I also have a lot of confidence in as a leader. [He] is somebody who really helps people to come to consensus.

It's a smaller group. I would say the big difference is everybody in the smaller group has a lot more experience in public process so some of the things about how does the group work as a group, how does it come up with decisions is going to be easier with this commission.

It's being staffed by the state, and it's being led by the state. Karleen Jackson [former commissioner of Health and Social Services] was the official chair of the health strategy council as commissioner, [but] I really did facilitate what was going on. This one I think is going to be more facilitated by Jay Butler and by Deb Erickson.

AHPR: How do you anticipate the process of the Alaska Health Care Commission will compare or differ with the previous Alaska Health Care Strategies Planning Council, in terms of the process? You said, for example, that the process had been very frustrating in the earlier months.

McMillian: It was frustrating mainly because of the time allotted and the massive amount of data to go through, assimilate, and develop consensus around. This one's ongoing. It's kind of forever. Their job is not necessarily to review studies and recommend strategies from a few studies. It really is to talk about what could be done to change the paradigm around health care in Alaska.

I would see them studying specific issues -- prioritizing issues -- whether it's public education, or more public health, or increasing the WWAMI [a regional medical school in which Alaska participates] seats, or whatever the issue would be, they're going to study that issue a lot more and dig into more than the health strategies council was able to do. Then [they will] come up with recommended policy or options for policy that would then go to the governor, or the commissioner, or to [the] Legislature, or to all three.

I'm really seeing them more as taking some of the recommendations from the health strategy council, from the round table, from some of the studies, and determining which of these are the biggest priorities for the state to change the way it's done, and then zeroing in on it and making it happen. That's the big change. I really think it's a much more tactical and not just a planning group.

"They didn't always agree, but it didn't get into any rancor at all, and people seemed to be reasonable and listening to each other and really focused on what would be best for the state of Alaska, which bodes well for it. I mean if that's the way they're going to be able to continue, that's going to be great."

AHPR: They did meet for a number of hours over a period of two days and I'm wondering, even though you were only there for an hour, I wonder if you have a sense -- perhaps by talking with other people who were there -- if you have a sense of what may have happened in this first round of meetings and what the time table might be for new meetings and reports.

McMillian: I do know that the meeting lasted for about a day and a half, and a lot of this meeting besides just general information, was organizational -- trying to get their heads around what their job could entail, and how it would be staffed. While Dr. Butler had tapped Deborah Erickson to be the staff leader of the group, that needed to be reaffirmed by the committee, which it was. [In addition] the commission spent a lot of time getting to know each other.

My understanding is they each talked about what their interests in health were and how they saw them moving ahead, so it was a lot of what normally should be happening with a brand new group: bonding, team building, seeing how people interface with each other, and that's what they did.

My understanding is that they were all there except for one of the commissioners, and that at the end of the meeting they all left as friends. They didn't always agree, but it didn't get into any rancor at all, and people seemed to be reasonable and listening to each other and really focused on what would be best for the state of Alaska, which bodes well for it. I mean if that's the way they're going to be able to continue, that's going to be great.

They did already select one subcommittee to review something, and I'm not even remembering for sure what that was now, but they've done it and they sent the report back and they collectively made a decision. My understanding is that they were going to be meeting pretty regularly, if not monthly, on a pretty regular schedule for a while.

AHPR: This may be too far a field but I'd like to ask it anyway. There are two bills currently in the legislative hopper: HB 25 and HB 75. They both propose to create different long-term commissions. These bills would establish a commission resembling the current one. I'm not sure if you've been following those bills but if so, how would you characterize the differences between those bills and the current commission?

McMillian: I haven't been following the bills so it's hard for me to even comment about how this would change. I've read both of them but right now I'm blanking on which one's which.

AHPR: I think they both propose to create a larger commission.

McMillian: I would suggest that size of boards and commissions is always a big debate when organizations start. There are those that say smaller is better and others who say if you don't have larger, you don't have enough different viewpoints for healthy discourse.

I think it's the right conversation to have about how big and how small something should be and how people are selected, but I don't personally think that legislating that kind of stuff makes much sense. I totally get that legislators want to legislate and establish policy but I would think picking a number and keeping it consistent is the biggest issue.

It is hard on one hand to get great diversity and dissent -- actually, healthy dissent is a good thing on boards and commissions -- in a very small group. Having a very large group adds layers of complexity about how you keep them in a room and keep them working together as a larger group. There are really good arguments compelling on both sides about larger or smaller.

I don't personally have a dog in that hunt. I would have a dog in the hunt that if people think it's going to be better because it's larger or just as a larger they're wrong, and if people think it's going to be better just as a smaller, they're wrong. That's the wrong question. You can have a lot of diversity on a small commission. You can have a lot of one-voice out of a huge group. It's more how it's managed.

"Health is way more [important] than health insurance and access. It's us as people doing what we know is healthy. When we drink too much and we smoke too much and we eat too much and we don't do anything physical, we can have all the best hospitals and the best doctors in the universe and we're still going to be sick."

AHPR: Thank you. I really appreciate your observations in this interview. This is your opportunity to say whatever else you would like to say that the readers of Alaska Health Policy Review might appreciate, might learn from.

McMillian: I think all Americans have begun to blur the difference between access to health care, health care, and health. While in my own opinion, everybody being able to go to the doc if they want to go to the doc, if they need meds, get meds -- that's just who I am, I believe that's a God-given right.

[I believe] that too many people in our society think that it's having health insurance or having access to a good clinic or doc or hospitals, is what's going to make them healthy, and they've forgotten to eat their vegetables and to do a little bit of exercise. Health is way more [important] than health insurance and access.

It's us as people doing what we know is healthy. When we drink too much and we smoke too much and we eat too much and we don't do anything physical, we can have all the best hospitals and the best doctors in the universe and we're still going to be sick.

Talk about modern culture, the movie, Wall-E, the cartoon, really hits the nail on the head about my vision of the way Americans are right now. We're overweight, we push a button to do things, and we've forgotten how to live as human beings.

My family has a long history of heart disease, and even if I hadn't had as much fried chicken as a kid as I did, I'm going to have a higher risk of having some sort of heart disease because my dad did and my grandparents did and their grandparents. It goes back.

But knowing that, I'd be remiss if I wasn't trying to exercise every day and eat the right way and do things to mitigate that. There is no hospital in the world that's going to be able to help me do that. I have to do that.

But there are people, regardless of how healthy they live, who are going to be in an accident, or they're going to have this genetic defect and there's not anything they can do about that risk. But what they can do is limit the risk: wearing a helmet when they ride their bicycle or ski or whatever.

That's what I think scares me the most about any kind of mandatory coverage or any kind of government solution is we're pretty good at saying, "Yeah, you've got to do this or you've got to do that." But when it comes to personal behavior, we're reluctant to say, "You're too fat." Or we're reluctant to say, "You really do need to stop smoking."

We do have the highest taxes, or some of the highest taxes on tobacco in the country, and it has helped reduce smoking in Alaska. That's an example of how we've actually legislated in a good way to help people become healthier, but there's still a lot of angst and anger about, "It's my body, I want to be able to do what I want to do with my body."

I would agree with that except when you do something with your body that is going to put you at risk and you also haven't got the financial resources to take care of what you're doing to your self to where it's going to come back to me as a taxpayer to support you because of your bad choices, then that's an issue.

I know this is a very hard conversation and I think we're just on the verge of figuring out how to do that without sounding hard-hearted or condescending or self-righteous because it's none of those things.

It really is like [banning] smoking in public places. Thirty years ago that wouldn't have been even thought about and yet we've done it. I think there's other ones like that still to wrestle with and figure out what is the right balance between personal choice and for the greater good of everybody.

AHPR: I want to thank you for the interview and thank you especially for discussing such a difficult issue.

Back to top

Please Respect Our Copyright

Alaska Health Policy Review is sent to individual and group subscribers for their exclusive use. Please contact us for information regarding significant discounts for multiple subscriptions within a single organization. Distributing copies of the Alaska Health Policy Review is prohibited under copyright restrictions without written permission from the editor; however, we encourage the use of a few sentences from an issue for reviews and other "Fair Use."

We appreciate your referral of colleagues to akhealthpolicy.org in order to obtain a sample copy. The Alaska Center for Public Policy holds the copyright for Alaska Health Policy Review. Your respect for our copyright allows us to continue to provide this service to you.

For all related matters, please contact the editor, Lawrence D. Weiss, health.policy.review@gmail.com.

Alaska Health Policy Calendar

This calendar of health policy-related legislative meetings is current as of March 25, 2009 at 2 PM. Please visit the Alaska State Legislature's list of committee hearings for the most current listings, as they are subject to change.

March 27, Friday, Noon
What: House and Senate Joint Legislative Health Caucus
Where: Location TBA
Other Information: Week of the Uninsured

March 27, Friday, 1:15 PM
What: SB 133 Electronic Health Info Exchange System
Where: Senate Health and Social Services Standing Committee, Butrovich 205
Other Information: Teleconferenced

March 27, Friday, 1:30 PM
What: HB 35 Notice and Consent for Minor's Abortion
Where: House finance Standing Committee, House Finance 519
Other Information: Teleconferenced

March 31, Tuesday, Noon
What: Exposure to Violence and a Child's Developing Brain
Where: Butrovich 205
Other Information: Teleconferenced

March 31, Tuesday, Noon
What: House and Senate Children's Caucus
Where: Butrovich 205, Juneau
Other Information: Joint with legislative health caucus; Exposure to violence and a child's developing brain; teleconferenced

Back to top

Bill Watch: Bills on the Move

Bill Watch: Drugs

HB 17 PROHIBIT TOBACCO USE UNTIL AGE 21
Sponsor: Representative Crawford
Committee(s) and date of last action: Read and referred to (H) L&C, 01/20/09
Description: This bill requests to change the legal age from 19 to 21 for the purchase, sale, exchange, and possession of tobacco. Specifically, it requests that any statute listing the legal age as 19 for the above activities be amended to the age of 21.

SB 52 SALVIA DIVINORUM AS A CONTROLLED SUBSTANCE
Sponsor: Senator Therriault
Committee(s) and date of last action: 03/18/09 (S) Referred to Finance
Description: Salvia divinorum and Salvinorin A are compounds of a plant used for medicinal purposes and with hallucinogenic properties. There has been an increase in its use, and has the potential for misuse and abuse. This bill requests that it be listed as a controlled substance.

Back to top

Bill Watch: Education

HB 58 EDUC LOAN REPAYMENT PROGRAM
Sponsors: Representatives Thomas, Wilson, Millett, Harris
Committee(s) and date of last action: Scheduled hearing in (H) EDC, 03/018/09, CANCELED
Description: This bill requests that general funds be set aside for incentive use to recruit individuals in occupations facing a shortage. Dentists and licensed practical nurses are among the occupations listed that would have access to these funds and incentive programs. Allocation of these funds is grouped by geographical location, with more funding available to professionals who are employed in rural areas of the state. A minimum of one year of employment is required for eligibility, and the amount of funding increases incrementally with the number of years of employment.

SB 18 POSTSECONDARY MEDICAL AND OTHER EDUC PROG
Sponsors: Senators Wielecheowski, Thomas, Ellis
Committee(s) and date of last action: Referred to (S) FIN on 03/16/09
Description: This bill proposes to raise the number of new students enrolled in medical education through the WWAMI program from 20 to 24 by 2010, and from 24 to 30 by 2012.

Back to top

Bill Watch: General Health Policy

ensures that the confidentiality of individually indentifying health information of a patient is secure and protected;
improves health care quality, reduces medical errors, increases the efficiency of care, and advances the delivery of appropriate, evidence-based health care services;
promotes wellness, disease prevention, and management of chronic illnesses by increasing the availability and transparency of information related to the health care needs of an individual for the benefit of the individual;
ensures that appropriate information needed to make medical decisions is available in a usable form at the time and in the location that the medical service is provided;
produces greater value for health care expenditures by reducing health care costs that result from inefficiency, medical errors, inappropriate care, and incomplete information;
promotes a more effective marketplace, greater competition, greater systems analysis, increased choice, enhanced quality, and improved outcomes in health care services; and
improves the coordination of information and the provision of health care services through an effective infrastructure for the secure and authorized exchange and use of health care information.

SB 139 INCENTIVES FOR CERTAIN MEDICAL PROVIDERS
Sponsors: Senators Olson, Wielechowski, Meyer, Davis
Committee(s) and date of last action: 03/25/09 (S) HSS at 1:30 PM Butrovich 205
Description: "An Act establishing a loan repayment program and employment incentive program for certain health care professionals employed in the state; and providing for an effective date."

SCR 1 BRAIN INJURY AWARENESS MONTH: MARCH 2009
Sponsor: Senator McGuire
Committee(s) and date of last action: Transmitted to the governor on 03/11/09
Description: This bill proposes that the month of March be "Brain Injury Awareness Month," effective for 2009.

Back to top

Bill Watch: Medical Assistance and Health Insurance

HB 61 MEDICAL ASSISTANCE COVERAGE
Sponsors: Representatives Cissna and Gruenberg
Committee(s) and date of last action: Read and referred to (H) HSS, 01/20/09
Description: This bill requests many changes to medical assistance eligibility for Alaskans. Among the changes are 1) disabled persons: increasing the eligibility for those in a family whose income does not exceed 250% of the official poverty level for Alaska; 2) individuals under the age of 19: increasing the family income eligibility from 175% to 200% of the federal poverty level for Alaska; 3) pregnant women: increasing the family income eligibility from 175% to 200% of the federal poverty level for Alaska.

HB 62 MEDICAL ASSISTANCE ELIGIBILITY/PREMIUMS
Sponsors: Representative Hawker
Committee(s) and date of last action: Read and referred to (H) HSS, 01/20/09
Description: This bill, also known as the "Denali Kid Care Accountability Act," amends a previous Alaska Statute on medical assistance eligibility requirements. Specifically, it adds sections requiring recipients of medical assistance in families whose income is between 175 and 250 of the federal poverty level to pay premiums, on a sliding scale, for medical assistance. The Department of Health and Human Services is required to set the premium at no less than 2% of the recipient's income, and establish a system of collecting premiums from recipients. This bill requests that these changes go into effect following the approved revisions and funding to make these changes.

HB 87 MED BENEFITS OF DISABLED PEACE OFFICERS
Sponsors: Representatives Millett, Dahlstrom, Gardner, Gara, Kerttula, Kawasaki
Committee(s) and date of last action: Heard and held in (H) L&C, 02/02/09
Description: This bill proposes waiving payment of premiums for major medical insurance for disabled peace officers who have at least 20 years of credited service as peace officers of the public.

HB 118 MEDICAL ASSISTANCE ELIGIBILITY
Sponsor: Representative Gara
Committee(s) and date of last action: Referred to (H) HSS, 02/25/09
Description: "An Act expanding, and relating to advertising about, medical assistance coverage for eligible children and pregnant women; relating to the poverty guideline and cost sharing for certain recipients of medical assistance; having the short title of the 'No Child Left Uninsured Act'; and providing for an effective date."

HCR 9 HOME HEALTH AIDES FOR SENIORS
Sponsors: Representatives Cissna and Gruenberg
Committee(s) and date of last action: Introduced and referred to (H) HSS, 02/25/09
Description: This bill promotes the expansion of home health services to older Alaskans and adults with disabilities by requesting that the governor direct the Department of Health and Social Services to apply to the federal government for additional waivers under the home and community-based waiver program to better serve older Alaskans and adults with disabilities through a federally reimbursable service either as a separate service or as a service that may be combined with other waivers.

SB 10 MEDICAID/INS FOR CANCER CLINICAL TRIALS
Sponsor: Senator Davis
Committee(s) and date of last action: Read and referred to (S) FIN, 3/13/09
Description: This bill requests that a health insurance company be required to provide coverage for any medical expenses incurred during the course of participation in an approved clinical trial.

SB 11 DEPENDENT HEALTH INSURANCE; AGE LIMIT
Sponsor: Senator Davis
Committee(s) and date of last action: 03/20/09 (S) Referred to Labor & Commerce
Description: This bill requests that among health insurance policies covering dependents of enrollees, the defined age for "dependent child" be raised from 23 to 26 years of age.

SB 13 MEDICAL ASSISTANCE ELIGIBILITY
Sponsor: Senator Davis
Committee(s) and date of last action: Heard for the second time in (S) FIN and referred to (S) RLS, 03/11/09
Description: This bill requests that the family income eligibility requirements for medical assistance among children and pregnant women be raised from 175% to 200% of the federal poverty level, effective immediately.

SB 32 MEDICAID: HOME/COMMUNITY BASED SERVICES
Sponsor: Senator Ellis
Committee(s) and date of last action: Heard and held in (S) FIN, 03/11/09
Description: This bill requests an amendment to a previous statute outlining medical assistance among health facilities, adding medical assistance eligibility for home and community-based services.

SB 38 PHARMACY BENEFITS MANAGERS; MANAGED CARE
Sponsor: Senator Elton
Committee(s) and date of last action: Read and referred to (S) HSS, 01/21/09
Description: This bill proposes to change language in a previous statute, amending "managed care entity" to "health care insurer."

SB 61 MANDATORY UNIVERSAL HEALTH INSURANCE
Sponsors: Senators French, Ellis
Committee(s) and date of last action: Referred to (S) L&C on 03/16/09
Description: This bill proposes the establishment of the Alaska Health Care Program (AKCP), a program given the task of ensuring that all Alaskans have access to affordable health care insurance covering all essential services. The AKCP will be monitored and managed by an Alaskan Health Care Board of 13 members, 12 of which are to be appointed by the governor. Similar to SB 160 (25th legislative session), this bill includes

A framework for personal choice: This bill facilitates a relationship between health insurance providers and individuals, and doesn't assume that a one size fits all solution will meet the health care needs of all Alaskans.
A unique voucher system: By pooling money from all stakeholders, a sliding scale voucher system will ensure that every Alaskan can take personal responsibility for acquiring health insurance coverage. The system will also make it easy for multiple entities to contribute towards a health plan for an individual.
A health care clearinghouse: The clearinghouse will disseminate information about quality health care products, assisting Alaskans who are utilizing vouchers under the Alaska health care plan.
The Alaska health care fund: This fund will receive contributions from individuals, businesses and government to ensure that all interested parties contribute to the health of Alaskans

If passed, this bill is to take effect by January 1, 2010.

SB 65 MEDICAID FOR ADULT DENTAL SERVICES
Sponsors: Senators Davis and Ellis
Committee(s) and date of last action: Heard and Held in (S) HSS, 02/02/09
Description: This bill is "An Act repealing the repeal of preventative and restorative adult dental services reimbursement under Medicaid; providing for an effective date by repealing the effective date of sec. 3, ch. 52, SLA 2006; and providing for an effective date."

SB 79 MED BENEFITS DISABLED PEACE OFFICERS
Sponsors: Senators McGuire, Paskvan
Committee(s) and date of last action: Referred to (S) FIN, 03/05/09
Description: This bill proposes waiving payment of premiums for major medical insurance for disabled peace officers who have at least 20 years of credited service as peace officers of the public.

SB 82 MEDICAID FOR ADULT DENTAL SERVICES
Sponsors: Rules by request of the governor
Committee(s) and date of last action: Referred to (S) HSS Finance, 02/04/09
Description: This bill is "An Act providing for an effective date by delaying the effective date of the change of coverage of adult dental services under Medicaid; and providing for an effective date."

SB 87 MEDICAL ASSISTANCE ELIBILITY
Sponsor: Senator Wielochowski
Committee(s) and date of last action: Heard and held in (S) FIN, 02/25/09
Description: This bill proposes an additional eligibility category for Medicaid services. Specifically, it adds children, pregnant women, and other specified individuals in families with incomes between 200% and 300% of the federal poverty level. Additionally, individuals in this income category would be required to pay a yearly premium for medical assistance. The premiums would be determined by a sliding scale based on annual income. The range for premiums would be set at no less than $240 per year and no more than $1200 per year.

SB 155 MEDICAL ASSIST FOR COGNITIVE DISABILITIES
Sponsor: Senator McGuire
Committee(s) and date of last action: 03/18/09 (S) Referred to Health & Social Services
Description: "The department shall establish in regulation a system for setting medical assistance reimbursement rates based on the functional level of care needed by an eligible recipient with a diagnosed cognitive disability, regardless of the recipient's need for medical or personal care support. The system must address eligible recipients' needs for appropriate assessment, rehabilitation, case management, ongoing support and respite or companion services, regardless of whether the services are provided in a health care facility or under a home and community-based waiver granted under 13 AS 47.07.045."

Back to top

Bill Watch: Mental Health

HB 52 POST-TRIAL JUROR COUNSELING
Sponsor: Representative Kerttula
Committee(s) and date of last action: Read and referred to (H) JUD, 01/20/09
Description: This bill proposes to make available up to 10 hours of psychological counseling for any juror serving in a criminal trial where graphic images or content are presented.

HB 83 APPROP: MENTAL HEALTH BUDGET
Sponsor: Rules by request of the governor
Committee(s) and date of last action: 03/26/09 (S) FIN at 9:00 AM Senate Finance 532
Description: This bill outlines the specific appropriations for each component of the state's mental health program.

SB 21 MENTAL HEALTH CARE INSURANCE BENEFIT
Sponsor: Senators Davis and Ellis
Committee(s) and date of last action: Read and referred to (S) HSS, 01/21/09
Description: This bill proposes to implement parity in the types of medical services covered under existing health insurance plans. Specifically, it proposes that health care insurance policies be prohibited from denying coverage or discriminating health care services related to mental health, alcoholism or substance abuse; that there be no difference in coverage between physical and mental health coverage; and that these changes take effect no later than July 1, 2009.

Bill Watch: State Boards and Issues

HB 25 HEALTH REFORM POLICY COMMISSION
Sponsor: Representative Hawker
Committee(s) and date of last action: Read and referred to (H) HSS, 01/20/09
Description: This bill proposes that issues related to health care and health care policy be given high priority among government officials. Specifically, it proposes the addition of a new chapter in the Alaska Statute 18, establishing the Alaska Health Reform Policy Commission, outlining the composition and duties of that commission, to be effective immediately.

HB 63 COUNCIL DOMESTIC VIOLENCE: MEMBERS, STAFF
Sponsors: Representatives Fairclough, Holmes, Coghill, and Wilson
Committee(s) and date of last action: 03/20/09 (S) Referred to Finance
Description: This bill requests that the number of members of the Council on Domestic Violence and Sexual Assault be changed from three to four, and that at least one of the four members is a representative of a rural area of the state. In addition, this bill amends the length of term for public members from two to three years of eligible service. Other changes include adding the Department of Corrections as a regular collaborator with the council.

HB 75 HEALTH COMMISSION/PLANNING
Sponsors: Representatives Cissna and Gruenberg
Committee(s) and date of last action: Read and referred to (H) HSS, 01/20/09
Description: This bill requests the establishment of the Alaska Health Commission, whose purpose is to provide policy recommendations ensuring quality, accessibility, and affordability of health care throughout the state. The commission is to have 15 members, of the following composition: one member from the Alaska Mental Health Trust Authority, one member from the University of Alaska Health Education and Training Program, one member representing the Alaska Native Tribal Health Consortium, one member from the Alaska Primary Care Association, one member from the Alaska State Hospital and Nursing Home Association, one member from the health industry, one member from the Alaska Nurses Association, two health care consumer members/advocates, and six members of the Alaska legislature. This act is to take effect by July 1, 2009.

HB 123 EXTEND SUICIDE PREVENTION COUNCIL
Sponsor: Representative Flairclough
Committee(s) and date of last action: 03/26/09 (H) STA at 8:00 AM Capitol 106
Description: This bill proposes to extend the Suicide Prevention Council to June 30, 2013, effective immediately.

SB 35 EXTEND SUICIDE PREVENTION COUNCIL
Sponsors: Senator, Davis, Ellis, Therriault
Committee(s) and date of last action: Moved out of (S) HSS and referred to (S) FIN on 02/27/09
Description: This bill amends a previous act to extend the termination of the Statewide Suicide Prevention Council from June 30, 2009 to June 30, 2013.

SB 40 EXTEND SUICIDE PREVENTION COUNCIL
Sponsor: Senator Therriault
Committee(s) and date of last action: Read and referred to (S) HSS, 01/21/09
Description: This bill is identical to SB 35.

Back to top

Bill Watch: Family Health Issues

Bill Watch: Worker's Compensation

HB 104 WORKER'S COMP. MEDICAL TREATMENT FEES
Sponsor: (H) Labor and Commerce
Committee(s) and date of last action: Transmitted to the Governor on 3/16/09
Description: This bill is "An act adjusting certain fees for treatment or services under the Alaska Workers' Compensation Act to reflect changes in the Consumer Price Index; and providing for an effective date.

SB 20 WORKER'S COMP MEDICAL/REHAB RECORDS
Sponsors: Senators French and Thomas
Committee(s) and date of last action: Read and referred to (S) L&C, 01/21/09
Description: This bill proposes that any documents containing personal and confidential information of an employee that is receiving, or has received, worker's compensation, are kept in a confidential location away from the public's view.

Back to top

Bill Watch: Bill Tracking Explanation and Acronyms

Bills listed here were selected based on a series of subjective criteria to determine whether they were "health policy-related" or not. All bills currently sitting in the Senate and House Health, Education, and Social Services committees were examined, and any that obviously dealt with non-health-related education or social services issues were eliminated. Every other House and Senate committee was then examined for health-related bills, which were included in the final list.

After determining the full set of health-related bills still in committee or pre-filed for the new session, they were divided into several general categories. This was done to facilitate finding bills that dealt with certain key health policy issues and to make overall navigation of the list easier. The remaining bills were categorized as "general" health policy related because of the wide range of subjects they covered.

The information listed for each bill includes the bill number, the short title, the primary sponsor or sponsors, the committee in which the last action on the bill took place, and the date on which the last action on the bill took place. A short summary of each bill is also included.

Abbreviations have been used for committee names. The committee names and their abbreviations are:

(H) HSS: House Health and Social Services Committee
(S) HSS: Senate Health and Social Services Committee
(H) L&C: House Labor & Commerce Committee
(S) L&C: Senate Labor & Commerce Committee
(H) EDC: House Education Committee
(S) EDC: Senate Education Committee
(H) FIN: House Finance Committee
(S) FIN: Senate Finance Committee
(H) JUD: House Judiciary Committee
(S) JUD: Senate Judiciary Committee
(H) STA: House State Affairs Committee
(S) STA: Senate State Affairs Committee
(S) RLS: Senate Rules Committee

AHPR Staff and Contributors

Lawrence D. Weiss, PhD, MS, Editor

Jacqueline Yeagle, Newsletter design and editing

Back to top

Subscribe Now to the Alaska Health Policy Review!

The Review is issued electronically, weekly during the regular legislative session and monthly the rest of the year.

A standard 12-month subscription to Alaska Health Policy Review is available for $850. Please inquire about discount rates for multiple recipients in the same organization, legislators, and small nonprofit organizations.

Don't miss an issue! Send orders, comments, and inquiries to Lawrence D. Weiss at health.policy.review@gmail.com, or call (907) 276-2277.