Mark Vinsel is the executive director of United Fishermen of Alaska (UFA), an umbrella association representing 37 Alaska commercial fishing organizations from fisheries throughout Alaska and its offshore waters. For many years UFA has taken a strong and active interest in health issues facing Alaska commercial fishers. For example, UFA has studied and visited a program in Massachusetts that insures the health of commercial fishers in the Northeast, UFA actively supports legislation in Alaska which would allow the Alaska Fishermen's fund to better serve the commercial fishing population, and UFA authored a fascinating study, "Alaska Fishermen's Health Care -- Challenges and Opportunities." This interview was conducted July 22, 2009, and has been minimally edited for length and clarity.

AHPR: Please tell us a little bit about United Fishermen of Alaska. For example, in general terms, who are its members?

Vinsel: United Fishermen of Alaska is an umbrella association. We currently represent 37 different commercial fishing organizations or associations from fisheries including offshore fisheries, Bering Sea, and then all of the regions that actively commercial fish throughout Alaska, although currently we don't have a Yukon group. All together I think [these Alaska fisheries] make up about 60 percent of the US domestic seafood production.

It's an extensive group -- because of that we've got a 41 member board of directors and there's also 4 at-large members that are elected by our individual fishermen members. So together we have a 41- member board and we meet twice a year and they get together. We also communicate through e-mail and occasional teleconferences, but these are people representing us. Each one is a leader in their own fishery. Some of them are on a volunteer basis, some of them are professional executive directors for groups that have those, but it's a very broad cross-section of active leadership in commercial fisheries in Alaska.

AHPR: What is the mission of United Fishermen of Alaska?

Vinsel: The UFA's mission is to promote and protect the common interest of Alaska's commercial fishing industry as a vital component of Alaska's social and economic well-being.


AHPR: Given that mission what kind of activities does UFA engage in?

Vinsel: Typically we will spend usually somewhere around a third of our budget on lobbying at both state and to some extent federal, but we also do a lot of outreach to members. We try to provide information to our members and also actually to commercial fishermen and their families, and actually anybody who's interested can sign up to our e-mail list -- we don't charge for that -- and we currently have a list of about 1,500 people that are interested in what's going on on a day-to-day basis. Not all of them can check in day-to-day but that's a big part -- keeping fishermen informed so they can be active and represent themselves in the public process. Basically as we harvest the public resource we have to be engaged in the public process, so our goal is to enable fishermen to do that, and to represent them where we can as a collective entity.

If you go back in history, I've been with the UFA since 2000, and at that point we had not yet hit bottom on very drastic and dire situations in our salmon market. Not so much a problem with the resource, which does tend to fluctuate up and down in different areas, but as a collective whole most of our fisheries are stable and in good health in stocks, but it was the markets that were very difficult. We were blind sided in the past by growth in the marketplace and competition, primarily from farmed fish and farmed salmon. We had to aggressively focus on improving our product quality to be competitive and we had to really engage in marketing. After [the UFA] salmon summit in 2001 in Petersburg we identified a bunch of priorities and ended up passing over 50 bills in the six years following that in the Alaska Legislature.

Many of these are small incremental things to either help fishermen diversify or help investment. Actually, some of the legislation helped processors get able to move to newer technology and new product forms that could compete in the marketplace. It really ranges quite broadly. In the federal arena we're always active in ensuring that Banks and Stevens legislation was reenacted. We do support the workings of our North Pacific Fishery Management Council and that system. We think it helps protect our stocks and so we are active with that. We've been working with the coalition of different fishing groups -- some from Massachusetts and then the commercial fishermen to try to advance fishermen's health care.

This I believe is the number one issue facing all fishermen nationwide. I mean every different fishery has something that might affect them locally that might not be the priority of other groups. But we find all commercial fishermen throughout the country are in a very difficult situation with health care. So that's one of our prime things to try to get in Washington, D.C. or in Alaska, but that's an issue that brings all fishermen together.

AHPR: That's interesting, what you just mentioned. Do you have a working relationship with some comparable organization in Massachusetts over the issue of health care?

Vinsel: Yes. Massachusetts is very advanced in this. I believe it was a goal somewhere over the last 10 years for Massachusetts to try to make sure that everybody in the state is insured, so for fishermen there they have what's called Massachusetts Fishing Partnership Health Plan. We visited with them in Gloucester in June. The Massachusetts Fishing Partnership is centered in Gloucester, Massachusetts, which is probably the closest thing the east coast has to Dutch Harbor. Actually their history goes back much farther, but it's fishing communities through and through.

They were able to [start up the partnership] with the help of the Legislature [and] some start-up funding -- and I believe in Massachusetts the tax structure there does fund the health care for a whole bunch of different constituencies through their own individual programs there. But they do get some state financing and they have a plan. We've worked on federal legislation [with them] that would've allowed or promoted the sort of building up of systems like that on a regional basis -- run or coordinated locally because actually our health care situation is so different with the lack of resources in Alaska compared to what Massachusetts has.

It would have to be custom-tailored, but the legislation would've provided research funding and then start-up funding for organizations to be able to collectively work with commercial fishermen to get health insurance plans.

AHPR: Is that legislation you were interested in passing here in Alaska?

Vinsel: Actually that would be federal legislation. We originally tried to get that language in the re-enactment of Magnuson-Stevens legislation, 2007, and that had to do with the health care paper we wrote at the time. Then in 2008 when that wasn't included in Magnuson -- actually it was only by the skin of our teeth at the very end of the session there Senator Stevens was able to get Magnuson passed, and it took a lot of late-night work in the few days leading up to Christmas 2007 for that to be done.

Anyway, the health care language was out of it but there was HR 5404 and a companion bill S 2630 -- those were the legislation in 2008 Legislature that we tried to get passed. Actually we had great momentum on those, they had a total of I believe 29 co-sponsors and no real opposition. With Senator Ted Kennedy as the champion in the Senate we had high hopes for that bill. Also Barney Frank was a champion of that, and Senator Gary from Massachusetts, and also some other representatives from Massachusetts that have influential placings in the House. The difficulty came when Senator Kennedy was stricken and not as able to actively push for these things.

Now we kind of keep our eye on this national health care debate and where different legislations are going, and we had hopes that the [the fishermen's health care language] legislation might be included in that, but currently it's not. Although, there is a potential in the Senate Health Education and Labor Committee bill [because] there is mention of fishing organizations, among other kinds of entities, that would be enabled to help as active navigators in health care for organizing and forming groups to work collectively to try to get plans. There is some hope in the current health care debate.


AHPR: Moving to the state level for a moment, have you been involved with SB 61 and Senator French's health reform bill which is based fairly strongly on the Massachusetts health reform legislation of some years ago?
 
Vinsel: Mostly due to a matter of timing, the UFA board hasn't looked at that directly, but we certainly pay attention to it. I think when we come back to the state of Alaska, in general there are a lot more people like commercial fishermen in Alaska that suffer. Primarily rural residents are very underserved, especially those who do not fall into the categories of veterans or Natives or state employees or spouses of state employees or people who have access to health insurance through other means. The method of Senator French's legislation -- to make sure that everybody has insurance coverage -- I think is very interesting to us on the UFA board. We'll be taking that up for a position coming up in the fall.

AHPR: I wonder if we could just step back for a moment to that very interesting study you did in 2007 [Alaska Fishermen's Health Care: Challenges and Opportunities]? I wanted to ask: What was the goal of that study? In other words, what were the main factors that led your organization to initiate the study?

Vinsel: Right, and that's on the UFA's web page with the tab for "Positions." I think it was just a matter of timing, not that we can ever riff on our morals with markets, prices, public relations, funding for science, funding for marketing, these kind of things. I think that back in 2007 -- that was before the fuel prices took such a drastic hit -- I think we became aware partly through the organization of the Commercial Fishermen of America. It was a fledgling organization that was just getting started then, and its whole focus as a unifying issue was on fishermen's health care.

As the organization representing Alaska and 60 percent of the nation's seafood harvest, we wanted to research the concept here in Alaska. We're always under the perception that we would probably be less well-served than fishermen even in other regions of the country just by a matter of geography. I happen to have grown up in New England so I'm kind of aware that in the area around Massachusetts and Cape Cod it's only about ten miles between communities at the most. Most communities might only be two miles between, which you tend to consider walking distance.

And there are roads, other than on islands, there are roads to and from all communities that clearly lead toward hospitals and choice of hospitals. I think a case in point is that Massachusetts Fishing Partnership ended up partnering to start their plan with Tufts Medical School or Tufts University. I think there's a number of teaching universities right in the Boston area. The center of their seafood area is also the center of medical education in the United States, if not in the world.

That's an obvious advantage while many of our fisherman don't even have a road that goes to even a clinic, although I think in general small communities are as well-served as we can expect from the population they have, [and] the fact that they can't be hubs without a road system like that.

AHPR: I wonder if you could tell us a little bit about how your study was done. In other words, where did you get the information that informed this study?

Vinsel: Yes. We always want to be doing outreach to our members -- fishermen who support us are our highest priorities -- to see what they think. So we sent out a survey to all of our individual members and I think we got back over 100 responses, which is, you know, enough for statistical validity. It's not a broad representation of commercial fishing permit holders because the vast majority of them don't also pay UFA dues. That's a highly discretionary thing. Anyone who's going to pay us $150 on a voluntary basis to support the work we do is probably more likely to be able to afford health insurance than somebody who doesn't pay that.

So we don't say that these numbers apply to everybody, although I wanted to hear what, more or less, the professional fishermen that join UFA, [what] kind of relative levels of how much insurance coverage they have, how far it is or how costly it could be for them to get to a hospital or medical treatment for things that are considered beyond local clinics, or something like that.

AHPR: So let me just get clarification on this. You're saying that you sent this survey out only to individual members, not organizational members of UFA, is that correct?

Vinsel: Correct. We did sort of want to control the amount of responses we got back because we only have an employee and a half to deal with it.

I wanted to get a gauge of access -- about our members, which are pretty spread out -- access to health care.

Actually, I was also interested in [our UFA employees], even administering a very small group of our own employees, which at the most has been four employees in our United Fishermen of Alaska group -- which we're very lucky to have. I know that things like cigarette use and age -- as well as gender, but I think a little bit less so -- but cigarette use and age are primary factors insurance companies use to set rates and project health I think, or any projected use of health care, I should say. I wanted to sort of see how those compared to the general population, and so we asked questions about that as well.

And then also as far as access to health care, we did some statistical work on the location of fishing permit holders, where they claim their address is for their resident Alaska fishing permit, and compare that with health care availability. A lot of the small communities that fishermen tend to live in may have only a clinic, and most don't have a connection to a road system that would be able to get them perhaps to a full-fledged hospital or where higher medical needs could be addressed.

So we plugged in statistics about number of fishermen in a community and then referenced that with whether or not there was more than one clinic in the community, or a hospital, or what. For those who were on road systems, we estimated the distance to the nearest community with a hospital, just to gauge what was our perception, what people just generally assume, that it's a little more difficult for fishermen, [considering] where they tend to live, or rural fishermen, or any rural person, to be able to get to health care.

It was clear to us that a lot of the debate about health care -- some of it is about health insurance -- but when we say access to health care, for us it's a distance and a cost, and a time that it takes to get from point A to point B. If you're out fishing on the Bering Sea and you become sick, that's a lot more expensive than if you live in Anchorage even if you have to take a taxi cab.


AHPR: I wonder if I could get you to address some of the findings. I've pulled out brief statements about some of the key findings and I wonder if you could expand on these and tell us, for example, why they are important and what actions if any UFA might take in response. The first summarized finding is, and I quote, "Commercial fishermen are underserved, and options for health care delivery are limited." I think you just discussed that in terms of rural fishermen, especially if they're out on a boat, may have difficulty getting to any health care facility.

Vinsel: Sure, and so that in itself [involves a] cost. If emergency transportation is needed, then the time itself, as any doctor would say I'm sure, how long it takes you to get to appropriate care can really basically be a life and death determiner in some injuries or illnesses. How quickly somebody can get something looked at -- and that's not just for injuries while fishing, [but also] that can be something like you notice something growing on your body that wasn't there before. The quicker you have that looked at, [the better]. Somebody that only comes to town once a month or something like that, that's a tough decision.

AHPR: Right. I notice another finding is: "Health insurance options are difficult to find and vary by location." I'm wondering what are the facts or experiences about commercial fishermen that lead to this kind of finding. I mean especially the "vary by location" aspect.

Vinsel: That I think is really not particular to Alaska fishermen as much as it's particular to Alaska, and that's actually something I can report very favorably on at this point. In 2007, when I went online -- there's a couple of different sites that come to mind, [for example] www.healthinsurance.com or ehealthinsurance.com -- but there are sites that are look-ups for as many insurance quotes as they can get. In general the major insurers are participating in these because I'm seeing them when I do look-ups in other areas.

In 2007 when I did a look-up, I think I used either the town of Angoon or Hoonah or some town off the road system in Southeast Alaska. In general there were two providers that were offering individual plans for fishermen, or a family, or typically anybody that said they were, I think, 49 years old. That's about the average age of an Alaska commercial fishing permit holder -- not crew member mind you -- but I entered that in and a zip code and it came back with options for Blue Cross, and another one that was called Golden Rule at the time. It's since gone by the wayside. I always kind of keep up with this a little bit -- I haven't had a chance to rewrite the paper -- but now when I do this I get about ten different companies offering probably 30 or 40 different plans total.

I think in many, many cases some of the information that I found at the time about lack of options for insurance in Alaska [has changed]. I think companies have been willing to come into the Alaska market, and that is very encouraging. So that part I don't think it's the same since 2007. I think most fishermen though, will point out many of those options aren't really affordable unless they're backed up with a health savings account or something like that. The rates are still extremely high compared to many other parts of the country. But I think in general I'm seeing plenty of providers that are offering plans, it's just whether or not they're affordable to fishermen.

AHPR: While your study has a number of other findings, the last one I would like to ask you about is, and I quote, "Lack of health insurance is a significant barrier to entry for the next generation of commercial fishermen." What do you mean by that?

Vinsel: For us to continue providing seafood -- and Alaska seafood we feel is a gift to the world that we're helping deliver -- it depends on people that are able to go out there and carry out the business of commercial fishing, and there's a lot of interest in it. When young crew members are having their choices its very common for them to be able to work their way through school and use commercial fishing as a crew member to further other goals.

Now, there's always been kind of a balance, that the commercial fishing lifestyle, and career path, and income, as long as it's sustainably managed, is a viable career option [and] very desirable if you worked your way up. But for many people there will be options to work in a job that offers health care, whether or not in Alaska. It may be a state or federal employee -- I mean there's still not a whole lot of entrepreneurship in Alaska, especially in the rural communities. There are other jobs that any fishermen starting out looking forward to providing for his or her family will be comparing that [to, but] without any hope of health insurance on the horizon for commercial fishing.

For most of the people that are currently commercial fishing permit holders right now, many of them reach back to the era before Ronald Reagan when commercial fishing was covered under the Seafarer's Act, and did have a health care plan that was provided. I don't know all the background on that, but I do know that went away in the early 80s and ever since we've had this gap, and if young fishermen choose to go into other lines of work, then ultimately there won't be anyone to bring home the harvest.

That is a tragedy. It could be very tragic for fishing communities that don't have a lot of other economic options. Also, in my opinion and I think the opinion of nutritionists, that seafood we bring to market -- which we think is the world's best and the highest quality and the highest purity -- we don't have to worry about what's going into it at some industrial-size kind of operation. I mean it's the best food in the world so we want to continue it so we think its very important topic to tackle for that reason as well.

AHPR: Thanks very much. That's an interesting discussion. I'm assuming from what you're saying that United Fishermen of Alaska does not provide some group health insurance plan for members?

Vinsel: No, although if you go way back in history at one point we did, but we do not currently. Actually we've not found any health insurance provider who's willing to offer a plan to a membership-based organization other than employees. Basically they all stipulate that it be an employee/employer relationship, which doesn't exist in the fishing industry. Also we're aware [that] the Alaska Foraker Group is moving forward with what we've been told by them was the first such health insurance group plan that is based on an association membership rather than an employer-based [membership]. So we watch that with great interest. Actually, we may well get on that plan -- Fishermen of Alaska employees -- but anyways we keep an eye on that and we think that could potentially be a model for Alaska fishing associations' members.

Although, we don't want to always set our sights on something that would be restricted to our own membership. Really, commercial fishermen that are independent and not participating are also important for us to be serving, to be taking care of.

AHPR: Yes. Just as an aside, out in one remote site with commercial fishing I understand that there's a clinic that has a pre-payment plan, at least with some of the fish processors out there. Is that kind of plan of interest to you, or do you know anything about that?

Vinsel: No, I don't know about it but it sounds very interesting to me. And I don't want to show my ignorance too much but is it the case that the processor pays up front, and instead of an insurance policy they're basically buying service, and then all of their employees can go? They don't need the individual plan, and all that stuff?


AHPR: Well, I don't have the details on it. I just have heard a number of times that that a clinic out there has some kind of agreements with the fish processors. I believe it is a prepaid plan but I am not familiar with the agreement. Here at the Alaska Center for Public Policy we're the publishers of the Alaska Health Policy Review, and we're very interested in this question of prepaid plans, specifically prepaid plans for small clinics and health centers because as you were implying they're scattered all over Alaska.  The cost of health insurance is quite high so a lot of people can't afford it and a lot of businesses are dropping it. Maybe people could afford $100 or $120 a month for a list of services that they could get at any time -- primary care services at any time from a small clinic or health center.

Vinsel: You know what that sounds brilliant to me, and [there are] a few reasons why. In general right now, if you follow the money, the patient or the public pays a health insurance company, and then they pay a doctor, so the person's relationship with the doctor is not direct. And health insurance companies are not only in many cases a for-profit company unlike some countries like Switzerland I hear, so they're in a goal to make a profit, and there's also some administrative overhead in there.

If the relationship was directly between the patient/public and the health care provider, then the clinic, if they have the financial means to do this, can spread the cost among all fishermen and do it more like a subscription basis where -- although there's always little problems here and I'm sure the details are way, way more complicated than it seems on face value to me -- but that sounds like as long as you have the right individual and they actually are connected to whoever paid for it if its not them as an individual, then you don't have somebody who's getting paid in my health care dollar. I object to the fact that there are people whose day-to-day job doesn't add anything to my health care including many people's [whose] job it is to look at my claim and say, "Well this is not covered" or even if they do say, "this is covered," they're still not adding any value to the transaction.

That seems to me like a viable economic model if the financing could be worked out. Basically the hospital or clinic would need to be able to pay the staff that they're going to need to have, [and] they need to be certain that if everyone was in there it's probably more efficient than health insurance in that small microcosm community there.

AHPR: These are some of the very ideas that we're exploring ourselves right now, those kinds of issues. Your positive reaction is pretty interesting and hopeful in that regard.

Vinsel: Yeah, I just made a note. Our next board meeting won't be until November, although I'm sure we'll have some teleconferences when people get back from the busy summer. But I just slipped a note about that one into what we call the "bucket" for the next meeting. We definitely will be discussing that model. That sounds like a great option, and there's a lot of fishing going on out there and we all know how far [remote fishing villages are] from other kinds of facilities.

AHPR: Yes. Let me just say as an aside that one of the obstacles here in Alaska appears to be a unique law that makes it extremely difficult for organizations to directly contract with providers. That's something we need to look into further. But that appears to be an issue here in Alaska that doesn't exist elsewhere. So that would have to be addressed as part of the whole package.

Moving right along to specific legislation, I'd like to move to HB 207, which was introduced by representative Harris in late March of this year. The title reads in part and I quote, "An act increasing the allowances for injury, disability, or heart attack, payable from the Fishermen's Fund." I understand that United Fishermen of Alaska supports this bill. Why is that?

Vinsel: The fishermen's fund has been set up all the way back since actually right around the anniversary of statehood I believe, 1959, because fishermen don't have employee to employer relationships. [Consequently,] we are not within the [Alaska Workers' Compensation] pool and system. This is a separate program that was put in place basically to address injuries that happen while people are commercial fishing -- fishermen and crew out on boats.

Fishermen pay $50 from their permit to it, and crewmembers pay $23.50, and that goes into a fund that is sort of for the first line of treatment with the intention to help bandage people up from injuries. It was started way back in 1959. It had a cap of $2,500, and through taking our eye off the ball and also I believe under the Seafarer's Act or the [Merchant] Mariner's Act up until 1980, there was other coverage involved, but that $2,500 limit had never been increased. And so you can imagine that that doesn't go very far on the health care. Basically $2,500 doesn't go very far, it hardly even gets you in the door in the emergency room. If you have any thing more than about a sprained wrist or something, it's going to not cover the bill.

Now the way that this has been dealt with in general, the Fisherman's Fund has been funded adequately for the number of claims that it has incurred, so the fund has been building up cash or building up surplus. They have a committee that arbitrates [appeals]. People have been encouraged that if your claim is higher than $2,500 to just appeal it. I'm under the impression that the committee is favorably inclined for as long as they have the funds to be able to do that, when they can verify that it was definitely a fishing injury.

But that's a difficult hurdle because you're giving more treatment to people who actually know to ask for the appeal. If somebody just gets a check for $2,500 and eats the rest of their claim just because they didn't have to know that, that's not really fair treatment. And again, this is where most of the UFA members are pretty informed about these things, but we've got fishermen out there that aren't able to keep up with things like that. So it makes sense to increase the limit there.

This was just in a conversation among UFA board members -- a general conversation about health care -- we were talking about that and somebody just asked. Actually, nobody in the room knew how long it had been that $2,500 was the limit. When we found out it was all the way since 1959, that's really out of date given health care costs. We didn't have any opposition on the bill and it was pretty much able to move through on the House side although it made it through Finance in the few days of the Legislature and didn't make it through rules for a full vote on the floor. But we think it's just a very short time in the next session, until that vote on the floor. We will be making sure that happens as best we can. And then try to get this done in the Senate.

AHPR: And if I understand correctly, most if not all those funds that pay claims for the Fishermen's fund are actually generated by fees and other payments that the members make, not the state.

Vinsel: Correct. It's funded by all commercial fishing permit holders, and crewmembers pay through their licenses. Their licenses for the permit holder actually includes the $50 that goes directly to the Fisherman's fund. The crew's license system is funded through Department of Fish and Game, or those that have licenses are issued through Fish and Game, and, of the crewmember's license fee, $23.50 goes to it.

So it's never been part of the general fund, and actually I think for the integrity of the fund and the way it works, its pretty important that it remain a dedicated fund, not subject to allocation to other uses. I think as long as we keep it a fairly closed system, we should be able to in due time to figure out what the balance point should be between how much money goes into it, and that $10,000 limit, what we're shooting for on this bill.

In the committee hearing on the bill that's the conversation that came up, well if $2,500 [is worth so little now compared to 1959], why not make it $20,000 or something like that? But it would remain to be seen what these numbers would need to be as to both on the input that fishermen pay on their permit, and then the output. I believe that members of the committee itself felt that $10,000 was something they thought would allow the fund to still be self-funding. There's also fishermen that are willing to pay more than the $50 on their permit if it went directly to this also. But this $10,000 is kind of like a starting point. When something's been [the same] so long, you don't really have the numbers on what it would be if you changed this part of the equation or that part.

AHPR: Right. Just as an observation, it seems to me that the Fisherman's Fund, as something like worker's compensation, has considerably fewer benefits than the regular worker's compensation that employers pay for employees.

Vinsel: Yes, that $2,500 limit is certainly a difference.

AHPR: And, you know, just to make it clear to the readers, commercial fishermen, like the crew on a boat, are not "employees."

Vinsel: Correct. There are even special IRS publications and forms for fishing crew income. Most commercial fishermen, for their own insurance, are required to have a contract with their crewmembers. I guess it's different than an employment relationship [because] the crewmembers are also to some extent taking a risk in the venture of fishing in that they're quite often paid as a percentage of the catch. So, if you had things that are specific deductions, [they] sometimes don't make sense in commercial fishing, because you could certainly have trips in which you don't make any money.


AHPR: Is there anything else you would like to say to the readers of Alaska Health Policy Review about any aspect of this issue?

Vinsel: Well, I have a feeling that, as in many things, Alaska may continue to suffer if we don't learn a way to grow and retain our own. We don't have a med school, and its been explained to me that we could never have a med school because we don't have the population base to sort of provide the training that med schools have to train for a group of people. They need to see a variety of people and we just wouldn't have the population base. Well, I think that we should not take that as an answer.

I think that the one thing Alaska could offer to the world is perhaps a med school that would teach people how to serve underserved communities -- remote and rural. I think the concept of everybody going to the hospital or the doctor's for a check-up in Alaska [is] difficult. I think of the kind of missions that the flying doctors I was familiar with in California [accomplished]. I think we have to think this with an open mind and come up with our solutions, because our problems are not the same as for everywhere else.

Yet, what we learn here is this great benefit to many other parts of the world. We have to be creative and not take our small size and our great distance as simple impediments. We have to try to work with these and come up with creative solutions and solve these problems for Alaskans. If we can solve this problem for rural Alaskans and provide access to health care through innovation, that would be a benefit to fishermen. That would be the best way to handle it.

AHPR: Thank you very much for taking the time to do this interview.

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Michael Monagle is program coordinator for the Alaska Fishermen's Fund, which is located in the Division of Workers' Compensation. The Fishermen's Fund is a unique type of program nationally, a public sector health insurance program for 43,000 Alaska commercial fishers. It was established to assist commercial fishers who were injured or became ill as a result of commercial fishing activities. In this interview, Monagle discusses how the program operates, who benefits from it, what the main injuries and illnesses are, the financial stability of the program, and its future prospects. This interview was conducted June 30, 2009, and has been minimally edited for length and clarity.

AHPR: You are program coordinator for the Fishermen's Fund. Would you please tell us a bit about your history? For example, how long have you been in this position, and have you ever been involved in commercial fishing?

Monagle: I'm a program coordinator for the Division of Workers' Comp. The Fishermen's Fund is one of the programs I supervise, and there are a couple of others. I've been with the division since 1998, and I kicked myself in the pants for never having gotten my limited entry permit back in the day when they first came out with them. But I'm not, by trade or education, a commercial fisherman.

AHPR: Would you please describe, in general terms, what the Fishermen's Fund is?

Monagle: The fund actually predates statehood. It was developed under territorial law. Under the state scheme, commercial fishermen are actually excluded from coverage under the Workers' Comp Act. They're not eligible to receive benefits if they're hurt or injured while commercial fishing. So this fund came into existence in the 1950s, I think around '57. It was established to assist commercial fishermen who were injured while commercial fishing. It is a fund that pays for medical benefits only. Unlike workers' comp, it does not pay disability benefits or benefits for lost wages.

AHPR: How is the program funded?

Monagle: The revenues for the program come from two sources: they come from Fish and Game, and they come from the Limited Entry Commission. There is a percentage of each crewmember's license -- if you are a person and you help, or assist a commercial fisherman by crewing on his vessel, you have to possess a valid crewmember's license. A percentage of that license cost, the actual statute says 39 percent, but it's actually capped at a certain level -- I think it's $60 -- ... come[s] into the fund. Over on the limited entry side, for each permit that's renewed or purchased, again, a percentage of that permit fee up to a maximum of $60, goes into the Fishermen's Fund. So those two are our funding sources.

AHPR: And does a commercial fisher have any discretion over whether or not they want to pay into the fund, or want to be part of it?

Monagle: They do not. The fee that they pay to Fish and Game and Limited Entry Commission are transferred by those agencies into the fund. So, by virtue of having those required licenses and permits, they are participants in the fund.


AHPR: I want to go back to something you said earlier. Why is it that commercial fishers are not part of the regular workers' comp system? Why do they have a separate system?

Monagle: You know I'm not really sure why they were not included in the workers' comp program. I could venture a guess. Obviously, back in the 1950s, I assume that there were probably a lot of commercial fishermen involved. Perhaps the safety and some of the other issues -- it could be that the industry was lobbied not to include them. It is a unique program in that there is not another state that has a similar program. We are unique out there with a fund like this.

AHPR: Roughly, how much money is handed out in benefits, for example in the most recent year?

Monagle: I think for fiscal year '08, which would have [ended] June of 2008, we paid out just under a $1 million in benefits, about $850,000. For that same period of time we took in about $1.1 million. In addition to benefits that are paid, we have administrative costs [including] part of my salary, and then we have two full-time technicians that are actually processing the claims as they come in. Our actual total operating costs last year were about $33,000 more than our operating revenue. So we've actually, in the past four years, operated in the red.

One of the things that have been discussed is the ability to increase revenues at some point in time. Right now, there's $11.5 million in the fund, so we are certainly not in any immediate danger. But, having deficits for the last four years, at some point down the road, I'll take a look at a possible increase in revenue sources. Which might very well come from an increase in the fees or permits source from Fish and Game or Limited Entry Commission.

AHPR: How many commercial fishers fall under the program's protection? I looked in the annual report for workers' compensation, and I wasn't really able to find anything that singled out the Fishermen's Fund.

Monagle: No, I don't think we actually included that in those comp annual reports. I have a separate report that I prepare each year for the council. I can tell you the exact number of limited entry permits and the number of licenses that are issued, which is the basis for our funding.

AHPR: And that would give you a nose count?

Monagle: It would. So, for example -- and this is based on calendar year 2008 -- there were 20,270 Fish and Game crewmember licenses issued, and there were 22,477 individual permit holders. So the combination would be about 42,747 persons that would be eligible for benefits under the Fishermen's Fund.

AHPR: Okay, thank you. And, do you have some idea of how many incidents are compensated each year?

Monagle: It varies. Historically it's been quite a bit higher than it has been in recent years. For FY08, we had 766 claims filed. Twenty years ago, 1988, there were 2,500 claims filed, so the number of claims each year has been slowly diminishing. Of course there are fewer people commercial fishing, and there is more emphasis on workplace safety, so those are factors that combine. But although the number of claims is declining, our average cost per claim is increasing. Obviously that is due to the rising cost of health care. Back in 1988 the average claim was $298 a claim. In fiscal year '08, it was almost $1,100 a claim.

AHPR: And talking about claims, are there some injuries or illnesses that are particularly common due to commercial fishing?

Monagle: We do break it down into a statistical review of the area of the body that is injured. The most common is finger injuries. You're in a moving boat and you're dealing with hooks and sharp objects. [Finger injuries would be] followed by lower back, hand, and knee injuries.

AHPR: Moving on a little bit to the structure of the program, what is the Fishermen's Fund Advisory and Appeals Council? What does it do, and how are people appointed or selected onto that?

Monagle: It is a council, which is appointed by the governor. There are many boards and commissions and councils up in state government. A person could go to the governor's web page, and they have an ongoing roster of the various boards and commissions, including instructions on how to apply. Basically, it is just a letter of interest, an application that a person submits to be considered for the position. The governor's office has staff that vets out the applicants.

By statute we have five seats on the council representing the state. Starting with the council down in Southeast Alaska, Wrangell, which would be Southeast. And then our second district is Northern Southeast. Our third district is the Gulf; our fourth district is Western Alaska and then district five is Northern Alaska. We have one vacancy right now, an empty seat on the north district. The other four seats are filled by individuals who are all commercial fishermen.

In essence, the council advises the division on operations. We typically meet twice a year. We usually rotate back and forth between Anchorage and Juneau. Although we certainly could meet more frequently, it's just, as I said, these guys are commercial fishermen, [so] it's not always easy for them to take time away from their jobs or fisheries. So, we try to keep it down to twice a year.

And probably the most important function that they serve is that they are an appeal body. As the administrator, if we deny someone's claim for benefits, they can appeal our decision to the council for review. That appeal process also includes claims above the administrator's statutory authority, which is currently $2,500.

It's also interesting that the $2,500 statutory limit is the same today as it was in 1957. Obviously, $2,500 went a lot further then than it does now. So it's not difficult anymore to have a claim that's going to exceed the $2,500 limit. But that's one of the functions they do at our two semi-annual meetings is to review appeals of the administrator's decision, which include requests for benefits over 2,500 dollars.

AHPR: You're right, that seems very low. Are grants of funds above that made on any regular basis?

Monagle: They are. We refer to those as "extension requests," because it's a request for an extension of benefits. There is no limit on what the council may approve. So the council has complete discretion to approve whatever amount they feel compelled to approve. I think this last year we had one that the benefits being sought were over $200,000. I think that the council approved about $180,000 of that bill. That was a case where a guy had caught his arm in a winch, and had literally torn his arm off. So, there was a lot of, as you could guess, surgical emergency treatment, including getting the person down south where he could be treated, and that kind of thing.


AHPR: In general terms, how do the benefits of the Fishermen's Fund differ from the larger workers' compensation program?

Monagle: Under the workers' comp system, a person is entitled to medical treatment and disability benefits. There are also death benefits under the workers' comp system. Under the Fishermen's Fund, it's limited to medical treatments. So, if a person is injured and unable to work, we don't compensate for missed wages, nor does the fund pay any death benefits. So if a person dies in the course of commercial fishing, and we all know that that happens every year, the fund does not pay out benefits.  

The fund is a source of benefits to commercial fishermen, but it's a secondary payer, so if a person has private health insurance we pay after the primary. People can have supplemental coverage and we pick up the balance. Commercial fishermen often are also, under federal law, eligible to receive benefits under the Jones Act coverage, particularly if a person is crewing on a commercial fishing vessel. But that's a private right of action. So if a crewmember is on a vessel and he's injured and he wants to bring an action against a vessel owner, he can claim under federal law -- which is referred to as "maintenance and cure" -- basically medical treatment and disability benefits.

There are those cases where the fund coordinates with the benefits that a person might receive from the vessel owner's insurance, to make sure that the injured fisherman is taken care of.

AHPR: So does that require the crew person to actually sue the owner of the vessel?

Monagle: Yes, to get a claim under the Jones Act, yes it would. A lot of vessel owners won't carry a type of insurance, protection and indemnity insurance, which protects their vessel against these types of Jones Act suits. And so they may not end up actually bringing a suit in court, they may just file a claim against the vessel owner's insurance policy. But the vessel owners are not required under state law to carry insurance on their vessel. So we do run into those situations where the vessel owner does, in fact, not have insurance and it may be that, particularly if a person [is] going to be missing a substantial amount of work or being unable to work, that he might very well bring a Jones Act claim against the vessel owner.

AHPR: When you pay out, not the Jones Act but your program pays out money for medical claims, does the injured person have to come up with co-payments or deductibles in order to use it?

Monagle: There is no set co-payment set out in statute. In fact there is a case law, an opinion by the attorney general's office that says that we can't require a deductible or co-payment under the program because the statute itself says that the commercial fisherman is entitled to a statutory benefit. In practice, if they're asking for benefits in excess of the statutory limit, then the council has discretion on whether they decide to pay someone's claim in full, or in part. And that is based on a number of factors that the council can consider: the person's ability to pay, the person's direct connection to fishing itself. In other words, you know, if I strain my back it can be a combination of the actual incident, but it also can be having done that type of work for 25 or 30 years. And, you know, that as we age, that has an impact as well.

Obviously, in the case I mentioned before, where a person tangled his arm in a power winch, that was a direct result of commercial fishing. So there are factors like that that the council can consider in determining whether or not it's going to pay above the statutory limit, the whole claim, or the claim in part.  

AHPR: Do the injured fishers get to pick their own health care providers?

Monagle: Yes, yes they do.

AHPR: Now, moving along to just some other type of questions. I noticed that there is, on your web site, there is a special form to be filled out for carpal tunnel claims. Why is that?

Monagle: At the direction of the council several years ago, they asked the fund to come up with a particular type of form because of the high number of carpal tunnel claims that we were seeing. Repetitive use injuries, as I said before, of the five top types of injuries, fingers, hands, and wrists are in that top five. Again, not surprising, considering the amount of handwork that commercial fishermen do, working with pulling nets and lines and setting hooks and setting bait and all those kinds of things that they do. So the form was developed just to ensure that we're doing a thorough review of each carpal tunnel claim that comes in.

AHPR: Is commercial health insurance involved in any way in your program?

Monagle: Only to the degree that if someone has a primary health coverage, that we require that they submit their claim to the primary health coverage first. And then they actually have to submit a copy of their explanation of benefits, filing with their primary insurer before we pick up the unpaid balance of what their primary health coverage covered, or did not cover.


AHPR: Moving along to the more political side of these issues, during the last session HB 207 and its companion bill, Senate Bill 163, were submitted into the legislative hopper. HB 207 is titled, "An act increasing the allowances for injury, disability, or heart attack, payable from the Fishermen's Fund." To the best of your knowledge, why were these bills submitted, and what is their status now?

Monagle: Both bills, with the House and Senate side, are working their way through committee. They were introduced a little later in the session, a couple months into the session, and are now, with their 90-day limit, I think that the sponsors said quite up front, that it was not likely that they would pass last year. But the sponsor was working with United Fishermen of Alaska, primarily, as the body [that] sought to get this introduced -- it was because the $2,500 benefit that was established in the 1950s had not changed. Using U.S. Department of Labor cost of living adjustments, we [determined] that $17,500, last year's money, [would] equal that same beneficiary power that $2,500 had back in 1955.

So, the increase in the statutory benefit gives the administrator, myself, and our two technicians the ability to pay benefits up to $10,000 without having to make the claimant wait several months before the next council meeting to approve the dollar amount -- which is what happened previously whenever the claim went over that $2,500. So it'll result in fewer of these extension requests having to go to council. And we'll speed up our ability to [award benefits] in a timely manner. I haven't heard any testimony or opposition on either bill.

AHPR: I'd like to ask you one more question. Do you have any last comments you would care to make to the Alaska Health Policy Review readership?

Monagle: One of the things that we, I guess, struggle with is awareness of the program. We do have information that's handed out with the permits, now, through CFEC, [Commercial Fisheries Entry Commission]. We were advertising in publications, we were spending about $6,000 a year in various trade magazines, publishing. We've cut back on that a bit, but that's the main thing. A lot of these, particularly the crewmembers, are young folks -- college kids that come up, work the summer, and a lot of times are not aware of our program.

So particularly health providers -- that's where we're spending a lot of time now -- making sure that we get claim packets, posters, and that kind of thing out to the providers in the markets that are treating these injuries. [We are doing that] just to make sure that they're aware of our program and the benefits that we offer.

AHPR: And, one last thing I just thought of, if I may. It sounds to me like your potential claimants number about 50,000. Now, 50,000 is a very large number in Alaska. I'm surprised that you have not been approached; well maybe you have been, by the commercial insurance industry to come up with some sort of deal where they could use private health insurance to insure these people rather than through your program. Has that been an issue, or are you aware of anything like that?

Monagle: I'm a little bit on shaky ground here, but there was federal legislation to reauthorize the Magnuson Act several years ago, and I think Senator Stevens was working with industry to come up with their ability to form self-insurance groups. Commercial fishermen would be able to come together to form self-insurance groups to acquire health care coverage in the market. I'm not sure what happened to that particular legislation. I think it was something that United Fishermen of Alaska was following. I've had a couple of conversations with some of their representatives, so it was an item that they were lobbying for, and I think continue to lobby for.

AHPR: I want to thank you very much for giving us this information.

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The agenda for the next meeting of the Alaska Health Care Commission, which will be held in Anchorage on Tuesday, August 25, and Wednesday, August 26, is now available on the commission's website at: http://hss.state.ak.us/healthcommission. The agenda is posted on the Commission Meetings page - click on the meeting dates to access it. Meeting handouts will be available on the website by Monday, August 24.

This meeting is open to the public. It will be held in Room 106 of the Gorsuch Commons, 3700 Sharon Gagnon Lane (UAA Student Housing - just off Elmore between Tudor and Providence Drive). The parking lot is on the south side of the building, and is accessed by turning west on the first road to the south of Sharon Gagnon Lane. Please note that this is a paid parking lot (you will be ticketed if you park without paying).

Individuals interested in listening to the meeting who are not able to attend in person may dial-in to the teleconference line: 1-800-315-6338, Passcode: 2474#  Public comment will be taken on Wednesday, August 26, between 1:00 p.m. and 3:00 p.m.

[Source: Excerpt from electronic communication from Deborah Erickson, August 16 2009]

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