MISC-20260507-1030

Will the House please come to order?

Will members please indicate their presence by voting?

Will the clerk please tally the board? 40 Members present. With 40 members present, we have a quorum present too. To conduct business. Mr.

Majority Leader. Mr. Speaker, there are no previous excused absences today. Leading the invocation this morning is Douglas K. Mertz of Juno Friends Meeting. Will members please rise.

With respect for all religious beliefs of all persons, I ask you to join in the following prayer. We thank you for everyone gathered here now. We know that you know each of us by name. Fill us with your spirit, inspire our hearts today. Fill this meeting with your presence and your wisdom.

Amen.

Representative Moore, will you please lead us in the Pledge of Allegiance? I pledge allegiance to the flag of the United States of America and to the republic for which it stands. Of the United States of America, and to the Republic for which it stands, one nation under God, indivisible, with liberty and justice for all.

Representative Story. Thank you, Mr. Speaker. I move and ask unanimous consent that the prayer be spread across the journal. Hearing no objection, the prayer will be spread across the journal. Will the clerk please certify the journal for the previous legislative days?

I certify as to the correctness of the journal for the 107th legislative day. Mr. Majority Leader. Mr. Speaker, I move and ask unanimous consent that the journal of the previous days be approved as certified by the chief clerk. Hearing no objection, the journal stands approved.

Are there guests for introduction this morning?

Seeing no guests be introduced. Madam Clerk, are there any messages from the governor? I have no messages from the governor this morning, Mr. Speaker. Are there any messages from the other body?

Messages dated May 6th stating the Senate has passed and is returning the following: House Bill number 48, Civil Legal Services Fund. The Senate has passed and is transmitting the following for consideration: committee substitute for Senate Bill number 200, Resources, amended. By the Senate Resources Committee entitled An Act Relating to Municipal Assessments of Farm or Agricultural Land and Providing for an Effective Date. Community and Regional Affairs. I have no further messages from the other body.

Are there any communications? Department of Public Safety Edward Byrne Memorial Justice Assistance Grant Application FY 2025. I have no further communications. Are there any reports of standing committees? In accordance with AS3905080, the Finance Committee held a hearing on the following board, State Assessment Review Board appointee, Jana Weltson.

Signing the report, Representatives Jimmy, Tomaszewski, Hannon, Allard, Stapp, Moore, Bynum, and co-chairs Schraggy, Foster, and Josephson.

The State Affairs Committee considered House Bill 218, Tanana Valley State Forest, recommends it be replaced with committee substitute for House Bill 218, State Affairs, with the same title. Attached one previously published zero fiscal note. Signing the report, do pass, Representatives McCabe and St. Clair. No recommendation, Holland, Hemmschulte, and Chair Carrick. The bill has a further referral to the Resources Committee.

The Labor and Commerce Committee considered committee substitute for Senate Bill Number 21, Finance, Alaska Work and Save Program. Recommends it be replaced with House Committee Substitute for Committee Substitute for Senate Bill 21, Labor and Commerce, with a new title forthcoming. Attached one indeterminate— previously published indeterminate fiscal note and one new fiscal note. Signing the report do pass: Representatives Freer and co-chairs Hall and Fields. No recommendation.

Colon, Carrick, Sadler. Amend. D. Nelson. The bill has a further referral to the Finance Committee, and I have no further reports of standing committees. Are there any reports of special committees?

There are no reports of special committees this morning, Mr. Speaker. Are there any citations or resolutions for introduction? There's a special order citation calendar and House Concurrent Resolution number 18 by the House Labor and Commerce Committee. Suspending Rules 24C, 35, 41B, and 42E, Uniform Rules of the Alaska State Legislature, concerning Senate Bill Number 21, establishing the Alaska Work and Save Program in the Department of Revenue. I have no further citations or resolutions for introduction.

Mr. Majority Leader. Mr. Speaker, I move and ask unanimous consent that notice and publication requirements be waived and the citations on the first special order citation calendar be made a special order of business. Without objection. Mr.

Majority Leader. Mr. Speaker, I move and ask unanimous consent that the House approve the citations on the first special order citation calendar. Hearing no objection, the first special order citation calendar is approved. Madam Clerk, are there any bills for an introduction? House Bill number 390 by the House Rules Committee by request of the Governor entitled an act relating to elections, relating to voters, relating to voting, relating to voter registration, relating to election administration, Relating to campaign contributions, relating to write-in candidates for president and vice president,.

United States relating to the crimes of unlawful interference with voting in the first degree, unlawful interference with an election, and election official misconduct relating to voter registration on permanent fund dividend applications relating to the duties of the Commissioner of Revenue and providing for an effective date attached as a letter in one fiscal note. State Affairs, Judiciary, and Finance Committees.

House Bill number 391 by the House Rules Committee by request of the governor, entitled An Act Extending the Governor's October 9, 2025 Declaration of a Disaster Emergency in Response to the 2025 West Coast Storm and Providing for an Effective Date, attached as a letter and 10 fiscal note. Community Regional Affairs and Finance Committees. I have no further bills for introduction.

This brings us to consideration of the daily calendar. Madam Clerk, please read the first item on today's calendar. House Bill Number 1 by Representatives McCabe, Underwood, Johnson, Rauscher, Moore, Tilton, Tomaszewski, Prox, Calombe, Ruffridge, Elam, Bynum, Stutes, Vance, St. Clair, D. Nelson, Costello, Foster, G. Nelson, and Schwonke, entitled an Act Relating to Species as Legal legal tender in the state and relating to borough and city sales and use taxes on specie.

The State Affairs Committee considered the bill, recommends it be replaced with committee substitute for House Bill 1, State Affairs, with the same title. Attached to new zero fiscal notes. Signing the report: do pass. Representatives Vance, McCabe, Moore, Holland, Hemmschute, and Chair Carrick. No recommendation.

Story. The Finance Committee considered the bill, recommends it be replaced with committee substitute for House Bill 1, State Affairs, with the same title, attached to new zero fiscal notes. Signing the report: do pass, Representatives Tomaszewski, Stapp, Moore, Bynum, Co-Chair Foster. Do not pass: Jimmy. No recommendation: Galvin, Hannon, and Co-Chairs Schraggy and Josephson.

There is one committee substitute. Mr. Majority Leader. Mr. Speaker, I move and ask unanimous consent that the State Affairs Committee substitute for House Bill 1 be adopted in lieu of the original bill.

Hearing no objection, the State Affairs Committee substitute has been adopted. Madam Clerk, are there any amendments? I have no amendments, Mr. Speaker. Mr. Majority Leader.

Mr. Speaker, I move and ask unanimous consent that the State Affairs Committee substitute for House Bill 1 be considered engrossed, advanced to third reading, and placed on final passage.

Representative Johnson. Thank you, Mr. Speaker. I would like to ask the maker of the— I mean, the sponsor to speak to the committee's changes. Representative Johnson, might I advise that if we could ask the sponsor to do that, we're about to move the bill into third reading. If the sponsor might do that during his introductory comments.

So the objection has been removed. Madam Clerk, would you please read the bill title for the third and final time? Committee substitute for House Bill Number 1, State Affairs, by the House State Affairs Committee, entitled An Act Relating to Specie as Legal Tender in the State and Relating to Borough and City Sales and Use Taxes on Specie. Representative McCabe.

Thank you, Mr. Speaker. I appreciate this opportunity again to offer this bill. HB 1 recognizes gold and silver specie as legal tender in Alaska and stops boroughs and cities from taxing the sale or exchange of legal tender such as specie. The acceptance stays voluntary. It doesn't have to be accepted by a merchant, doesn't have to be offered by a person.

The dollar stays the unit of account. Nobody is forced to do anything with Mr. Speaker, Thomas Sowell once wrote that inflation is the most universal tax of all. He called it a way to take people's wealth without ever holding a vote. We don't have anything to do with that on this floor, Mr. Speaker. It's a tax without our input.

That's not a metaphor. The dollar has lost 20%, roughly a quarter of its purchasing power since 2020. Every family in Big Lake feels the impact. Every family trying to save for a house paid a tax and nobody knows anything about it.

HB 1 does not fix federal monetary policy. We can't. But we can't stop punishing Alaskans who try to protect themselves from it by storing portable value somewhere. Right now, in some boroughs, an Alaskan who buys a 1-ounce gold coin to set aside for future inflation for retirement, they pay a sales tax on that gold coin, even though it technically, via our Constitution, should be money. He is taxed on converting one form of money to another.

That's the state taking a cut, or the borough or city taking a cut, for the act of savings. HB 1 would end that uniformly in every borough and home rule city in Alaska.

Sol also said there are no solutions, only trade-offs. So let me be honest about the trade-off here. Boroughs do lose, or cities that have taxing authority would lose a sliver of money, sliver of sales tax revenue on a category of transaction that is already small and largely structured to avoid the tax anyway. What they give up on the front end, they save on the back end. Anyone who sets specie aside as a hedge against savings, or a savings cushion, or an inflation cushion, will eventually spend that money.

They convert it. They remodel a kitchen. They help a kid with a down payment. They cover a medical bill they've had to incur, one that they did not see coming. That money flows back into the economy then.

Often exactly when it is needed most. During a downturn, possibly when other spending dries up, when the price of gas has so depleted your spending, um, or depleted your savings that now you need to dip into it. If you've been saving gold specie for years, you have a hedge, Mr. Speaker. Specie in a safe today is fuel for Main Street tomorrow. In exchange for that small sliver of a non-term or of a near-term give, Alaskans get a clear uniform rule and the constitutional medium of exchange named in Article 1, Section 10.

This would then be treated as legal tender, and frankly, it already is. Some will say it's symbolic. I do not believe this is true. The tax exemption has real teeth. For anyone actually using it.

It will encourage savings, Mr. Speaker. It won't cost that much to do so. Some say it creates a parallel currency. It does not. The bill is very explicit in this means.

No merchant has to accept specie. No Alaskan has to use it. It's an option, not a mandate.

Thomas Sowell spent 60 years writing about the gap between what governments promise money will do and what money actually does. HB 1 is a small, sober step that closes a piece of that gap at the state level. It costs the treasury nothing. It aligns Alaska with the plain text of the Constitution. It joins what most other states have done.

46 States are considering this or have already accepted it, Mr. Speaker. The legislation has been thoroughly vetted over 6 years. This body passed this policy last session as HB 3, and this version returns a clearer, stronger, and more refined more refined bill, frankly due to the amendments that created the committee substitute. So some of those amendments had protections in them for consumer protection amendments. There was at least one amendment that changed the oversight of this from Finance Committee to the LB&A Committee.

And there was one amendment that into the committee substitute that clarified the idea that if you are selling or buying specie as a collectible— so in other words, say that you, you have a 1-ounce gold coin that is somehow cast to be a commemorative. The intrinsic value of the 1-ounce gold coin would be about $5,000 or $5,200 right now, but it might sell for $6,000 because it is a commemorative, or it might be a numismatic. The value above the intrinsic value of the gold and the collectible part of it is taxable. That's what the committee substitute did, and that's what the refinements did from, from the folks that put in amendments. And I really appreciate them making this a stronger bill.

So, Mr. Speaker, with that, I'll sit down and listen for questions, and I ask for a yes vote. Thank you. Representative Carrick. Thank you, Mr. Speaker. I wish to rise in support of House Bill 1, and as the sponsor of the bill, just discussed.

There were some changes that have been made between this bill and prior versions of this bill in past legislatures and even from its original version at the beginning of this legislature. For one thing, our committee work focused on ensuring that we preserve the maximum latitude for municipalities to collect revenue and continue their current revenue systems while also providing the flexibility and the mechanism for.

Alaskans to legally engage in using this— I like to call it bartering behavior because gold and silver specie kind of falls into its own category— with participating retailers. So we're providing the greatest latitude for that to take place while also preserving maximum ability for boroughs and municipalities to collect revenue. Specifically, we have included provisions that say that the non-value-of-the-metal portions of a transaction, such as dealer premiums or services and other parts of that transaction, are taxable. It's just the value of that specie itself that's not taxable. And that's different from the original versions of this bill where no portion of that transaction was taxable.

Additionally, we've clarified that the state and local governments are not compelled to accept specie for payment of taxes, fees, or other obligations. In other words, you still— if you want to participate in gold and silver specie in the market for that, you do still need to pay all of your state and local taxes and other fees with traditional cash-based transactions. So we've narrowed this bill so that— and provided clarity so that we are allowing the opportunity for use of specie with participating retailers while making sure that this is not an open door to carte blanche, have individuals in Alaska paying their taxes and fees or even their groceries at non-participating stores with specie. And then additionally, as the sponsor of the bill mentioned, this bill provides for Legislative Budget and Audit to have a slightly increased scope on their study. Not only will they be studying the use of specie in Alaska, they will also be studying consumer protections ways to strengthen those, and market behaviors.

So we've included that to get an additional sense as this new market continues to take off, um, of what that consumer behavior looks like and provide those protections. And Mr. Speaker, ultimately, I believe House Bill 1 is extremely important because Alaskans are already engaging in these practices. As I said, right now it sort of functions like bartering. What people are not allowed to do right now is legally use tender at their— at a retailer that wants to participate in that. So this allows retailers to accept that if they want to participate in it.

It does not prevent any individual from coming into those retailers and paying for purchases with traditional cash or credit card. It just allows them, if they want to, the option to accept this payment, and for folks, if they want to, the option to use this as a form of payment. And I expect that gold and silver specie will be a particular interest to a lot of Alaskans because of our long history of gold and silver production. And so as that market again continues to potentially take off, we're just providing, um, a mechanism for people to use it in the way they currently do that is legal, that is safe, and we're providing additional supports for that. So I rise in strong support of House Bill 1.

Thank you, Mr. Speaker. Additional debates or discussion? On House Bill 1. Not seeing any. Any wrap-up comments?

I'm not seeing any of those either. Are you ready for the question? The question being, shall committee substitute for House Bill 1, State Affairs, pass the House? Members may proceed to vote.

Will the clerk please lock the roll? Does any member wish to change his or her vote? Will the clerk please announce the vote? 40 Ayes, 0 nays. With a vote of 40 ayes to 0 nays, House Bill 1 has passed the body.

I believe we do not have an effective date on that. So, Madam Clerk, Will you please, uh, brief it ease.

Will the House please come back to order. Madam Clerk, will you please read the next item on today's calendar?

Committee substitute for Senate Bill number 89, 2D, Labor and Commerce, by the Senate Labor and Commerce Committee, entitled An Act Relating to Physician Assistants, Relating to Collaborative Agreements Between Physicians and Physician Assistants, Relating to the Practice of Medicine, Relating to Health Care Providers, and Relating to Provisions Regarding Physician Assistants in Contracts Between Certain Health Care Providers and Health Care Insurers.

The Health and Social Services Committee considered the bill, recommends it be replaced with House Committee Substitute for Senate Bill 89, Health and Social Service— Committee Substitute for Senate Bill Number 89, Health and Social Services, with the same title. Attached 1 new zero fiscal note. Signing the report do pass: Representatives Prox, Fields, Gray, Mears, Schwanke, and Chair Mena. The Labor and Commerce Committee considered the bill, recommends it be replaced with House Committee Substitute for Committee Substitute for Senate Bill 89, 89, Health and Social Services, with the same title, attached 1 previously published 0 fiscal note. Signing the report, do pass, Representatives Freer, Carrick, and co-chairs Fields and Hall.

There is 1 House committee substitute. Mr. Majority Leader. Mr. Speaker, I move and ask unanimous consent that the House Health and Social Services Committee substitute for committee substitute for Senate Bill 89, 2nd Labor and Commerce, be adopted in lieu of the original bill.

There's an objection. For purposes of explanation. Yeah, thank you, Mr. Speaker. I'd like to adopt— I would like to object to the adoption of the CS for Senate Bill 89 and request a summary of changes. Thank you, Mr. Speaker.

Representative St. Clair. Thank you, Mr. Speaker. Very few changes from the— actually, there's only one. In Health and Social Services, the bill text was amended to remove reference to hours of documentation conforming with the existing structure of the bill, and you can find this on page 4, line 22 through 24. Thank you, Mr. Speaker.

The objection has been removed, and seeing no additional objection, the Health and Social Services Committee substitute has been adopted.

Madam Clerk, are there any amendments? Amendment number 1 by Representative Gray, beginning page 1, line 1. Representative Gray, Amendment 1 will not be offered at this time. Amendment number 1 will not be offered. Madam Clerk, I have no further amendments, Mr. Speaker.

Mr. Majority Leader, I move and ask unanimous consent that the House Committee Substitute for Committee Substitute for Senate Bill 89, Health and Social Services, be considered engrossed, advanced to third reading, and placed on final passage. Referees.

Will the House please come back to order. Mr. Majority Leader, you had made a motion. There was no objection to it, so I'm considering the bill to be in third reading. Madam Clerk, could you You read the title for the third, final time.

House Committee Substitute for Committee Substitute for Senate Bill Number 89, Health and Social Services, by the House Health and Social Services Committee, entitled An Act Relating to Physician Assistants, Relating to Collaborative Agreements Between Physicians and Physician Assistants, Relating to the Practice of Medicine, Relating to Health Care Providers, and Relating to Provisions Regarding Physician Assistants and contracts between certain healthcare providers and healthcare insurers. Representative St. Clair. Thank you, Mr. Speaker. As many of you know, and I've said it many times on this floor, my daughter is a PA, and I actually asked to go ahead and carry this SB 89 on the House floor.

We hear that we need healthcare workers, qualified medical professionals all over the state. Whether it be in villages or it be in rural areas, urban, everywhere. We need more healthcare professionals. It'll reduce the wait times and cost for accessing medical care. PAs work across all of rural Alaska and allow people to access care in their home communities, reducing travel costs.

As we know, Medicaid travel costs are on the increase. It increases the capacity of our medical systems in itself. Senate Bill 89 reduces the bureaucracy burden that is currently on the physician assistants and their employees. Senate Bill 89 uses our current facilities licensing structure and allows PAs to provide medical care to the fullest extent of their licensure. Now, what this does is collaborative practice, uh, collaborative practice agreements where an MD, a doctor, and a PA enter into an agreement, and that is basically their oversight.

Collaborative practice agreements are not necessarily required if working at the Department of Health license— at a Department of Health licensed health facility. PAs no longer need that collaborative agreement. I'm not going to say how much they charge the PAs for that. If a PA is working outside of the Department of Health licensed facility, they still can be within a collaborative agreement structure. This reduces— brings— brings— reduces the unnecessary regulation on the profession.

There are no changes to it. You still have to go to school, you still have to get certified, you have to pass a certification test and get licensed in the state of Alaska. Senate Bill 89 is an elegant compromise struck through years of of conversations with stakeholders. The Alaskan approach initially used a model legislation structure. This created uniquely Alaskan solutions to meet our needs based on our diversity and landmass, and is the right step forward for our state.

I welcome any questions or comments, and we'll follow up at the end. Any debates or discussion? On Senate Bill 89, Representative Gray. Thank you, Mr. Speaker. I rise in strong support of Senate Bill 89.

Uh, this bill has evolved over time. Uh, it's had multiple, uh, changes over the years. This version that you have in front of you is supported by the Alaska State Medical Association. It modernized Alaska's PA statute so the law better reflects the way PAs actually practice in our state. As the only physician assistant in the body, I feel like I have to speak about the bill a little bit and speak about, about what PAs do.

So our profession was founded in 1965 at Duke University. It was a mechanism for medics from the Vietnam War who had been basically doing surgery on the battlefield to have a way to use the skills that they had learned in war in order to have a job. They were coming back and they, they couldn't use what they've learned. So that was how this profession started. I myself went to Baylor College of Medicine in Houston.

That is a medical school. The difference between like an MD's education and a PA's education, as I say, I went to medical school and stopped with the master's degree. My first year of school was with the medical students. We did everything together including gross anatomy, meaning that we we dissected a human body. And then my second, my last 18 months of school, I was with the third and fourth year medical students, doing my clinical rotations with the medical students.

The trade-off for me having that accelerated pathway towards getting to my profession is that I make less money, and there's a collaborative agreement for the rest of my life. But I was in my mid-30s when I decided to go back to school, and I was willing to make that sacrifice. The way I framed it in my own head is I didn't care so much about the title and the money. I wanted to do this job. What this bill in front of us does is modernizes the way physician assistants have been working in Alaska for decades, and that is providing care in our most remote areas particularly, but also in our urban areas, and, um, filling gaps that are ever-present because it is hard for Alaska to recruit medical providers.

I think one thing I'll just end with is that when I, one of my professors in PA school gave a lecture on my last week of school, and it was about the type of care that we provide. We're often called mid-level providers. And what he said is no one goes to see their,.

Medical provider looking for middle care. They want the best care, and PAs need to be providing the very best care. Our notes are going to be reviewed in a way that a doctor's won't. Our diagnoses and our, um, uh, treatment plans and the prescriptions that we write are going to be reviewed in a way that other medical providers won't. We must be providing the very best care all all the time.

And I believe that PAs in Alaska have been doing this for decades. I, I can't not mention that one of the big advocates of this bill for a decade has been former Senator Shelley Hughes, whose husband was one of the first PAs in Alaska. And I urge a yes vote. Thank you, Mr. Speaker. Representative Allard.

Uh, thank you, Mr. Speaker. If you don't mind, if I can ask the body's indulgence so I can read from my notes. Permission granted. Thank you, Mr. Speaker. So this bill has some positives and it also has some negatives.

The pros is it expands access to healthcare with less strings attached. The cons, there's less strings attached. Current law requires a doctor to collaborate and be responsible for verifying a PA is highly qualified. This bill eliminates the oversight. This bill also locks into place wording about basic qualifications to practice.

Outstanding is a Supreme Court decision allowing or not allowing not advanced practice clinicians, including nurse practitioners and PAs, to provide medication within their scope for abortions. This is happening now and has been since a temporary ruling in 2021. Based on this reason, I will be voting no on CSSB House Bill or Senate Bill 89, and I yield the floor back. Thank you, Mr. Speaker. Further discussion?

Representative Tomaszewski.

Thank you, Mr. Speaker. I rise with strong support of this, uh, legislation. And, um, uh, my son just graduated as a PA, uh, just a few days ago. And so I know that's an important part of, uh, the healthcare system. And I think we should be all looking at ways we can improve healthcare in Alaska, even as far as go, that we should also be including nurses in that.

So thank you, Mr. Speaker. Representative Ruffridge.

Well, thank you, Mr. Speaker. I rise in support of SB 89, and this is really, I think, a good example of how we use our efforts during the times where we're not here for the good of when we are here. There was a lot of work that was done on this bill, particularly after the 33rd legislative session did not see this bill get to the finish line. And I applaud all of the physician assistants and the physicians who met over the interim to discuss how can we get something that moves both the physician assistants into a space where they feel like they have some autonomy and some ability to do some of the work that they are able to do, that the representative from UMed was able to to put forward for us to know how much work that the physician's assistants do and how much training that they have. And I think this is a good example of how physicians in our state have the ability to direct and guide care in a way that says exactly what the representative from U Med said.

We want the best care for everybody, but we have a limited number of physicians in the state. How can we maximize the access to primary care and other services that we really desperately need here. And I think this bill goes a long ways to doing that, and, uh, I will be in support. So thank you. Representative McCabe.

Thank you, Mr. Speaker. I'd like to address this a little bit differently. In my district, there is a little town called Healy. Of course, there's Denali, McKinley Park, there's villages up there, Cantwell. That have no medical care, zero medical care.

They might have a traveling doctor, usually not, it's usually a traveling PA that comes up there once in a while to provide them with care. If there is any small chance that we can attract the representative from Fairbanks Sun to come open a clinic in Healy, I'm all for that, or any other PA that would be interested to come up there. Sometimes the doctors are, have a higher level of practice and they're in hospitals and they're needed in urban areas. If we can get and attract some PAs into a rural area such as Healy or up north there, I just have to be in support of this. So I appreciate it.

Thank you, Mr. Speaker. Additional debate or discussion? Not seeing. Representative Gray. Thank you, Mr. Speaker.

I rise to a conflict of interest as this bill directly benefits my profession. There's an objection. Representative Gray, you will be required to vote. In wrap-up, Representative St. Griffidis.

House, please come back to order and wrap up. Representative St. Clair. Thank you, Mr. Speaker. I appreciate all the comments, and it's It's not perfect. We still have things we need to work out, but it's a start.

We need PAs, and I ask for your vote. Yes vote, green button. Thank you. Are you ready for the question? The question being, shall House Committee Substitute for Senate Bill 89, Health and Social Services, pass the House?

Members may proceed to vote.

Will the clerk please lock the roll?

Does any member wish to change his or her vote?

Will the clerk please announce the votes? 38 Yeas, 2 nays. With a vote of 38 yeas to 2 nays, Senate Bill 89 has passed the body. Mr. Majority Leader.

Mr. Speaker, I move and ask unanimous consent that the roll call vote on the passage of the bill be considered the roll call vote on the effective date clause. Hearing no objection, the effective date— I'll brief at ease.

Will the House please come back to order. Madam Clerk. Senate Bill 272 by the Senate Health and Social Services Committee entitled an Act Relating to the Electronic Health Information Exchange System and Providing for an Effective Date.

The Health and Social Services Committee considered the bill, recommends it be replaced with House Committee Substitute substitute for Senate Bill number 272, Health and Social Services, with the same title. Attached: one previously published zero fiscal note. Signing the report: do pass. Representatives Gray, Fields, and Chair Mena. No recommendation: Prox, Schwanke, and Ruffridge.

There is one House committee substitute. Mr. Majority Leader. Mr. Speaker, I move and ask unanimous consent that the House Health and Social Services Committee substitute for Senate Bill 272 be adopted in lieu of the original bill.

Objection. There is an objection for purposes of discussing the differences in the committee substitute that's before the body.

A brief dees.

Will the House please come back to order. Representative Mena. Thank you, Mr. Speaker. There was one amendment that was added in the House Health and Social Services Committee to align the bill with the House companion. This amendment pertains to the annual report of the HIE, and this amendment includes more details included in that annual report for the HIE specific to rates of participation, number of health records exchanged, uh, and gaps and obstacles for providers to participate in the health information exchange.

The objection has been removed. Not hearing additional objection, the committee substitute has been adopted.

Mr.— Madam Clerk. Amendment number 1 by Representative Schwanke, beginning page 5, line 18. Representative Schwanke. I move amendment number 1. There's an objection.

Representative Schwanke. I move amendment number 1 to amendment number 1.

I did hear an objection out there, I believe.

So with an objection registered, Representative Schwanke, would you address amendment number 1 to amendment number 1? I believe it's being handed out. Okay, let's take it at ease until we get the amendment handed out.

Will the House please come back to order? I believe we have Amendment Number 1 to Amendment Number 1. On members' desks. Representative Schwanke. Thank you, Mr. Speaker.

My apologies, everybody. Amendment number 1 to amendment number 1 is page 1, line 4 of the amendment. The word "to" is supposed to be "from," and I missed it when it came back from legal. It very specifically references patient records originating from a certain provider. That's what my original amendment pertains to.

So I hope that we can adopt Amendment 1 to Amendment 1. I move my objection. The objection has been removed. Not hearing further objection, Amendment 1 to Amendment 1 has been adopted. Representative Schwonke.

Thank you, Mr. Speaker. Amendment number 1, as amended, is written very specifically because I had originally asked in our committee that we change this entire health information exchange system from an opt-out system to an opt-in system, and we did not get that change in. So this particular amendment is a little different approach. This one actually allows for an avenue for Alaskans to maintain some control over their personal health medical records and health-related data that they may not want shared. This particular amendment allows for patients to restrict or to reauthorize access to any of their specific health records at any time.

This is actually a very common provision in health information exchanges in other states. States.

As an example, New York, believe it or not, is actually one of the most patient-friendly states out there when it comes to information exchanges. There are some requirements in their statutes that require explicit consent for providers to access their records. Patients consent per provider or organization. They can also limit their access at any time. New York also allows for an emergency authorization, which is something someday maybe we should add to our current exchange.

California is also a very strong opt-in state.

They have broad affirmative consent policies written in to allow very specifically for people to hold hold private some of their most personal information. Consider genetic information, reproductive information, mental health information. Florida is also a very strong opt-in state. They typically require patient authorization to search and access any records. So I ask that we consider that today in offering Alaskans some opportunity to have control over their personal data and not have it be explicitly within a public database that's always available at all times.

Thank you.

Brief it is.

ទ្ទ្ទ្.

Will the House please come back to order.

To the bill sponsor, I will turn next to Representative Mina on amendment Amendment number 1 is amended. Thank you, Mr. Speaker. I seen an opposition of amendment number 1. We just spoke briefly with, uh, the Department of Health, and my understanding is that with amendment number 1, if you create this provision to be able to opt out for our particular provider, the system right now for the health information exchange is not designed for that. So this would add a fiscal note to the bill.

Right now this bill has a zero fiscal note. Additionally, if you want to not be able to have your information be shared with another provider, you could opt out of the Health Information Exchange, and then if you decide to change your mind, you could opt back in in a different scenario. This would create an information gap, which makes it a little bit wary if you are in an emergency situation where a provider might need to access your medical records, but you are opted out of the HIE. But there is a way to allow the patient to have their choice in participating in the HIE while it's still ensuring that they have their security protections that are in the bill.

Representative Prox.

Well, how about that? I'm ambivalent about this amendment because Alaska has in Article 1, Section 22, a very strong right to privacy. And so a couple hours ago I was, uh, thinking, nope, this causes a lot of complications for the system, but nevertheless we do have the right to privacy in our Constitution. So I think I'm going to exercise my right to change my mind, and I will be in favor of this amendment. Thank you.

Representative Gray. Thank you, Mr. Speaker. I rise in opposition to the amendment, and the reason why is, as somebody who has accessed exchanges, when you leave your emergency medical record or your electronic medical record and go to another medical record, you have to break the glass. You have to acknowledge that you as the medical provider are breaking this glass, are entering another system because you are providing medical care for a person, a specific person. When somebody's on this health exchange, people aren't randomly accessing your information.

They're only accessing one patient's information because they need it to provide medical care in that moment. If you are randomly accessing somebody's medical information when you don't need it, you're breaking the law as it currently exists. So, really— I worry about, uh, creating a system in which a lot of people, uh, opt out thinking that they're protecting their privacy by opting out, and then they are brought to an emergency room unconscious, and those folks taking care of that person cannot access any of their medical information. They cannot provide the highest level of care. You want folks who are treating you when you are unconscious, brought to the ER, to have as much information as possible.

And that's what the purpose of health information exchange is, is that you access it. So again, just to repeat, it is against the law for a medical provider to access your medical record without a medical need. That's the law today. Thank you. Representative Bynum.

Thank you, Mr. Speaker. I rise for a question. For the sponsor of the amendment, my understanding, Mr. Speaker, is that when I go in and receive care, that I am already required to sign disclosures. And in those disclosures, it would clearly outline that my information is going to be stored in a medical record of some kind, and that that paperwork with this law would provide an opt-out option.

The question really is, is by me signing that disclosure document, am I not then giving my consent for the medical record? Thank you. Representative Sadler. Thank you, Mr. Speaker. I rise in support of this amendment.

Whenever possible in my professional and personal life, I try to respect individuals' right to privacy and to control their own data. I'm that guy at the doctor's office who actually reads the clipboard and stuff, reads page 5 and asks questions about it before I initial it. Privacy is important. I will acknowledge that the medical system, any large system, would love to have universal data available at all times to all participants for any purpose, but that is not the right of the Borg. We have individual rights to control our information.

Privacy is part of individual autonomy and we bear responsibility for the possible consequences that the record does not contain everything your providers might want to know if they treat you when you're unconscious. They still have an obligation to treat you, they might not have all the information they'd like, but the patient is sovereign, the patient is not, the meat is the person deciding what happens. And as to whether it would be against the law to access this data for any illegitimate purpose, the Alaska, the ASPIN system, the State Public Safety Information Network, which provides a database available for criminal purposes, crime prevention has been breached for nefarious purposes. And so that's why it's important to be vigilant at all times, in all places, for individual privacy. I think this amendment addresses that and advances it, and so I will support it.

Representative Elam. Thank you, Mr. Speaker. Um, I rise with sort of mixed feelings about this particular amendment. Philosophically, I support it, and I believe that the maker of the amendment is actually bringing it about in a way that many of us actually would really prefer to support. But I don't mean to speak for anybody else's intentions.

Myself personally, I have a bit of knowledge into the HIE system. And so I do support— I won't be able to support the amendment, Because the reality is, is that the opt-out option is at the point of care. And much like what was brought about by my colleague from the U Med area is that there is, in federal statute and in state statute, the requirement for minimum necessary access. And that's taken at the user level whenever you're doing account provisioning, within the system. And so the entire purpose of an HIE is to share data.

And so you, if you don't want your data shared, you need to opt out at the point of care. And so the complications that this brings is actually on the back end of how many of the benefits will be impacted from a Medicare, Medicaid, VA,.

Private insurance, all of those areas. So very strongly support in people's privacy, but the point where they should opt out is at the point of care. So unfortunately, I won't be able to support this, but philosophically I do. Thank you. Representative Colon.

Thank you, Mr. Speaker. There's been a lot of talk about how important this system is for healthcare providers to exchange information, be able to provide the best care. But I would like to point to something something in the bill. Permission to read?

[FOREIGN LANGUAGE] So at the bottom of page 4, this allows access to this information to facilitate payment for services received by a patient who is the subject of the information. So this isn't just your healthcare records. They can also access this in order to pursue you to pay bills. So it's even more important to protect and give patients all the options— opting in, opting out— of what they want to share.

In wrap-up, Representative Schwanke. Thank you, Mr. Speaker. A question for everybody: how in the world did we survive before the internet? Clearly. There are a couple questions.

I want to thank everybody for a good discussion and debate here, but I'm afraid that the comments that were made actually prove the point that I'm trying to make with this amendment.

The Department of Health says that this system that we contract with is not designed for what I'm asking. That is why I am bringing an amendment, because it was not designed so that we had privacy for our data.

There was a question, disclosures at provider.

I have a handout on your desk. I hope everybody had a chance to look through it because this is exactly the problem that we face right now. You do not get to opt out of this system at the provider. This is exactly the problem. The opt-out mechanism is at the actual system level.

You have to go to Health eConnect, which I'm going to guess that most of us have never heard of. I didn't know about it until we started discussing this, this bill, this issue. This is the provider that the state contracts with to provide our— not just statewide, but West Coast-wide and Boston. It's a national HIE. They built this system a number of years ago, but it does not provide for our privacy.

We are opted in. Our data goes into this big public digital asset. The minute that we step into a provider's office and sign their traditional consent forms, our data is already in there.

All we are trying to do here is to say, if at any point you visited a provider and there was some sensitive information pertaining to your visit that you may not want to share, maybe with your primary provider, or your chiropractor or your dentist or whomever, you have the opportunity to restrict access to those records. That is a really important opportunity for us to retain privacy for our own records. It states it very clearly in the Alaska Constitution.

I'm not going to go back over some of the details that I said at the very beginning, but, um, this is an opportunity for us to offer Alaskans right to privacy without completely restricting access to data that might actually help when we walk through the ER. I get it. Providers, especially in the ER, they want to have all possible health information available to them. But Mr. Speaker, it doesn't belong to them. That information belongs to us, each and every one of us.

And if there's information we don't want to share, then we should not have to share it.

I hope to see the green button on the amendment. Thank you. Are you ready for the question? The question being, shall Amendment No. 1 As amended pass the House?

Members may proceed to vote.

Will the clerk please lock the roll? Does any member wish to change his or her vote? Will the clerk please announce the vote? 17 Yeas, 23 nays. With a vote of 17 yeas to 23 nays, Amendment Number 1 has failed to pass.

Madam Clerk. Amendment Number 2 by Representative Schwanke, beginning page 5, line 8. Representative Schwanke. I will not be offering this amendment, thank you. Amendment Number 2 will not be offered.

Madam Clerk, are there additional amendments? I have no further amendments, Mr. Speaker. Mr. Majority Leader.

Mr. Speaker, I move and ask unanimous consent that the House Committee Substitute for Senate Bill 72, Health and Social Services, be considered engrossed, advanced to third reading, and placed on final passage. Hearing no objection, so ordered. Madam Clerk, please read the title for the third and final time. House Committee Substitute for Senate Bill 272, Health and Social Services, by the Health and Social Services Committee entitled an Act Relating to the Electronic Health Information Exchange System and Providing for an Effective Date. Representative Mina.

Thank you, Mr. Speaker. I rise in support of Senate Bill 272, uh, which is brought forth by my companion in the other chamber. I carried the House companion for the committee bill. What this bill does is help modernize the way that our health information exchange shares data and ensures patient privacy protections. Currently, back in, excuse me, back in the late 2000s, the federal government passed a law to help create these health information exchanges across many different states.

Alaska passed a law in response to that to create a health information exchange. And the HIE helps share medical records with different providers. And this is particularly important in regards to the examples that were brought up on the amendment debate, where if you're in an ER situation and you're unconscious, you want to make sure that that provider has access to your medical information. I also want to emphasize that this HIE is not a public database, in that providers have to access the system when they're providing the care to you. This bill is now an update to the HIE since, uh, there are improvements to be made between the entity that is in charge of the Health Information Exchange, which is currently Healthy Connect, to ensure that there's clarity between the responsibilities of the Department of Health in our state and the entity that is in charge of the HIE.

It also adds a behavioral health provider to the governing body that oversees the HIE. I want to acknowledge that there are strong privacy protections that respect the choice of a patient within this bill. If you don't want your data to be part of the HIE, you can opt out of the system. Most states that have an HIE have an opt-out system. In the few states that do, such as New York, we've seen a decrease in the participation of patients within that HIE that make the data less useful for a provider to be able to utilize the HIE effectively.

And that results in worse care, in the ER, etc. And finally, uh, also just in regards to a mention on the, uh, the payment, uh, what this bill does is also make it easier for the different departments within our state to be able to utilize this data to help see if an individual might be eligible for other benefits such as Medicaid, etc. So I urge support for this bill. Thank you.

Not seeing any debate or discussion or need for wrap-up comments. Are you ready for the question? The question before the body is: Shall House Committee Substitute for Senate Bill 272, Health and Social Services, pass the House? Members may proceed to vote.

Will the clerk please lock the roll?

Does any member wish to change his or her vote?

Will the clerk please announce the vote?

34 Yeas, 6 nays. With a vote of 34 yeas to 6 nays, Senate Bill 272 has passed the body. Mr. Majority Leader. Mr. Speaker, I move and ask unanimous consent that the roll call vote on the passage of the bill be considered the roll call vote on the effective date clause.

Hearing no objection, the effective date clause has been adopted. At this time, I'm holding HGR 28 to the next day's calendar. Madam Clerk, please read the next item on today's calendar. [SPEAKING FRENCH] There are no further items on today's calendar.

Mr. Speaker, this brings us to unfinished business. Mr. Majority Leader. Mr. Speaker, I move and ask unanimous consent that Representative David Nelson be excused from a call of the House on Friday, May 8th at 12 noon to Sunday, May 10th at 10 PM.

Hearing no objection, the member is excused on the dates and times indicated by the Majority Leader. Minority Leader Johnson.

To order, Mr. Majority Leader. Yes, Mr. Speaker, to correct the excusal, I move and ask unanimous consent that Representative Garrett Nelson be excused from the call of the House on Friday, May 8th at 12 noon to Sunday, May 10th at 10 PM. Hearing no objection, so ordered. This takes us into committee announcements.

Are there any committee announcements?

Are there any other announcements?

We are in special orders. Are there any special orders today? Representative Schragi. Mr. Speaker, on a reminder. Representative Schragi.

Just a quick reminder to members of the body, Mother's Day is coming up. Now is the time to send your card if you want it to get there on time. Thank you, Mr. Speaker.

Representative Vance.

On the topic of National Day of Prayer. Representative Vance. Thank you, Mr. Speaker. Uh, today is the National Day of Prayer where thousands of, uh, Americans will gather at noon to lift up our nation in prayer and we traditionally have a gathering on across the street over at the William H. Seward statue, and I want to thank everyone who volunteered to lead in prayer today. When we were not able to adjourn at noon along with the other chamber, I asked my staff to ask the other pastors and people who had gathered to continue on in prayer without us, and so They have reported that people did volunteer and step up and pray, and they had a lovely event outside.

So no need to rush out there thinking that we're late. That's the beauty of the power of communities coming together, is that it doesn't rely on any one particular person because we all have an open heaven. So I want to thank everyone who participates, and you still have your flyers that are listed out where people can pray in unity over the different areas of influence. And so I just want to say thank you to everyone who continues to make that happen and pray for our nation in its 250th year.

Mr. Majority Leader. Mr. Speaker, I move and ask unanimous consent that the House stand at adjournment until Friday, May 8th at 10:30 AM. There being no objection, the House will stand adjournment until Friday, May 8th at 10:30 AM. 10:30 AM.