Gov. Sarah Palin's health care proposal for this year's Legislature may have a better chance than last year's did, but it's not because of what's in the plan. It's what Palin left out.
Palin is abandoning her proposal to repeal the state's Certificate of Need regulations. Instead, she'll try negotiations to modify the process to work better. That's won praise from hospitals, which support CON, but a legislative opponent of CON says he stands ready to introduce repeal legislation if the negotiations fail.
Bartlett Regional Hospital's Shawn Morrow praised Palin's change of position, as did Rod Betit of the Alaska State Hospital and Nursing Home Association.
Certificates of Need, which are intended to prevent unnecessary and costly duplication among medical service providers, are seen by hospitals, especially small ones, as crucial to their survival.
Palin will instead look at changes to CON regulations that may be able to eliminate some of the controversy and lawsuits around them, which Betit called "a better way to go than repeal."
Critics of CON, however, say the regulations prevent competition that could drive down costs for consumers.
At a press conference announcing her health care agenda, Palin said she had not changed her views on CON.
"I'll be supporting efforts to invite more competition in our larger markets," she said. "More competition can result in more accessibility and affordability of health care."
Morrow said he thought Palin's more measured approach this year could succeed.
"It's nice that we're talking about ways to collaborate and communicate and find a plan that hopefully reduces litigation in CON without repealing it," he said.
Rep. Bob Lynn, R-Anchorage, backed Palin's unsuccessful attempt to repeal CON last year. He said he won't be introducing repeal legislation again, but is ready if the negotiations don't produce adequate improvements.
"I might even put my bill in again - and I've got the bill ready to go," he said.
The centerpiece of Palin's health care proposal is a new Alaska Health Care Commission, which will develop a statewide plan to address the quality, accessibility and availability of health care for all Alaskans.
Palin has already created the commission by executive order, but other parts of her proposal need legislative approval, including increasing the income eligibility for Denali KidCare to 200 percent of Alaska's federal poverty level.
Palin acknowledged that her proposal might stir some criticism in the Legislature, but that it would likely make 1,300 more children and 225 more pregnant women eligible for health coverage.
"We've all heard stories of abuses of the system there," she said, but said they'd try to find ways to prevent abuses to get more people covered.
"That means more working families will have health coverage," she said.
Lynn praised Palin for her efforts to expand availability to more people.
"Governor Palin has a heart for the health care needs of the state," Lynn said.
Palin's plan also calls for continued support for ending tobacco use, preventing obesity and increasing exercise, including daily physical education in schools.
New spending proposals include $250,000 for early screening and diagnosis of autism, $800,000 to increase the number of students in Head Start, and $2 million to the Department of Education to implement a pilot pre-school program.
Palin called her plan "a call for action," but said government programs were not the entire solution, and that individual responsibility for health care is also important.
Rep. Sharon Cissna, D-Anchorage, and co-chairwoman of the Legislative Health Caucus, said she supported the idea of a health care commission. She was concerned about the make up of Palin's commission, however.
"The governor had very heavy administrative control," she said. "These kinds of things work best if they are semi-independent so you can bring in all the stakeholders," she said.
A bill introduced by Sen. Bettye Davis, D-Anchorage, that would have increased the number of people eligible for Denali KidCare passed the Senate but died in the House last session. Cissna said she thought that with Palin's support it could pass this time.
Cissna said the Legislature may pass legislation establishing in law the commission Palin created by executive order. That would both allow legislators to change the commission's members, and ensure it lives on past Palin's term as governor.
Betit said he hoped that separating the controversial CON issues and other topics, such as establishment of the health care commission, will be beneficial.
"Having the commission and the CON repeal in the same bill caused so much discussion that neither one went anywhere" last year, Betit said.