Members of the Alaska House of Representatives have been working on several health care initiatives during the 2022 legislative session. In this conversation, Rep. Mike Prax (R-North Pole) and Rep. Zack Fields (D-Anchorage) discuss their health policy priorities with State of Reform.
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Gov. Mike Dunleavy issued an executive order to restructure the Department Health and Social Services into two departments at the beginning of the 2022 legislative session. The executive order divides the department into the Department of Health and the Department of Family and Community Services. Prax said the split should lead to some opportunities that will make Alaskans happy.
“We’re probably going to be able to reduce spending on health care,” Prax said. “It’s such a big department now that we’re adding more money for administration. Right now, the whole department is so busy they don’t have the time to devote to asking the bigger questions, and seeing how one service affects another. Is there duplication?”
Fields said the department’s split may have been the most controversial part of the House’s legislative session.
“I don’t think the notion of dividing it was controversial; just the pace and nature of stakeholder engagement,” Fields said. “I would’ve pushed it out for another year of stakeholder engagement.”
Fields said the goal will be to implement the department’s division without disruption to services, or financial hiccups.
“Hopefully, it’s a smooth process where you’ve got multiple strands of federal funding, making sure it’s not disrupted,” Fields said. “I hope the team is successful in navigating it.”
Fields and Prax also discussed Alaska’s health care workforce shortage. There are not enough health care workers to fill the demand for services in Alaska, and job vacancies in the industry are increasing. The industry had a projected job growth rate of 7.6 percent over the next 10 years, with a projected 5,000 new jobs, which was more than any other sector. Employers frequently have to recruit workers from other states to fill positions, and non-residents fill 11.3 percent of the state’s health care jobs. Twenty-one percent of the state’s key hospital and nursing home positions are vacant.
Prax said Fairbanks Memorial Hospital is having trouble recruiting workers, but a new apprenticeship program there that trains people for licensed practical nurse, certified nursing assistant, and other certifications could help with that.
“There aren’t enough people making it through nursing school, so they’re trying to start their own training program,” Prax said. “If someone wants to be involved in the health care industry, there will be something close to an apprenticeship program for them.”
Fields said there is no question the state needs more resources in the nursing industry.
“We’ll need more programs like that apprenticeship program,” Fields said. “I think where we should be going is employee-driven programs where people are paid a living wage with training. We need to also align that with college credit. [The Alaska Primary Care Association] (APCA) is a model in how to do that. We need to support APCA, and [the Alaska State Hospital and Nursing Home Association] as long-term workforce solutions.”
A primary focus for lawmakers, specifically related to mental health care, has been on establishing Crisis Now, a program for health crisis mitigation that connects people with resources at the onset of a crisis, their recovery, and follow-up care, Prax said. The program can serve as an alternative to having people sent to jail or detention centers at the onset of a mental health crisis.
“They’re trying to set up a program where people can get less intensive care,” Prax said. “It will be some longer-term care to help people stabilize their situation in an environment less formal and expensive than a hospital, and more appropriate than a jail. That should work better than what we’ve got going now. The government has, through the regulatory process, been providing for an emergency license or short-term license so [Crisis Now] can go to work while their state application is being processed. I think that will help, in particular, with mental health.”
Prax also expects to see more patients utilizing telehealth services moving forward.
“Telehealth will become more permanent,” Prax said. “I think that will reduce the cost of health care quite a bit.”
The legislative process has also given lawmakers a chance to focus on correcting some fiscal practices, Fields said.
“When you live through years of austerity, cuts add up over time,” Fields said. “We reversed some of those cuts and got back to baseline level funding. We funded our Medicaid allocations. In previous years, we acted like that wasn’t necessary.”