Alaska Legislature: Senate Labor & Commerce, 3/27/26, 1:30pm

I'd like to call this meeting of the Senate Labor and Commerce Committee to order.

The time is now 1.34 p.m. We are in belt room 105.

Today is Friday,

March 27,

2026.

Members present are Senator Gray Jackson,

Senator Merrick,

Senator Dunbar, and Senator yon't.

Let the record reflect that we have a quorum to conduct business.

I myself am also here.

Welcome everyone.

Senate Labor and Commerce,

please join me in welcoming our recording secretary,

Carrie Tupo, and LAO moderator,

Doug Bridges. Please turn off or silence your cell phones.

We have two items on our agenda today.

First up is Senate Bill 124, nurse licensure,

multi-state compact.

Following that will be Senate Joint Resolution 28,

supporting J-1 and H-1B visa programs.

First,

we will take up Senate Bill 124. We have opening remarks on the bill from

Commissioner Heidi Hedberg and Deputy Commissioner Anna Latham.

Welcome to Senate Labor and Commerce.

Please join us at the table.

State your names and affiliations for the record and begin your presentation of the bill.

all right for the record my name is Anna Latham I'm the deputy commissioner at the Department of Commerce Community and Economic Development

Thank you, Mr.

Chairman and the Senate Labor and Commerce Committee for hearing SB 124 this afternoon.

This has been the department's top legislative priority for the past three years.

The math is really simple.

We graduate about 350 licensed nurses each year in Alaska.

At the same time, we face a shortage of around 1,100 nurses across our state.

The reality is that we're already losing ground,

and we want to remove barriers that keep qualified people from practicing.

were there needed most.

And you might ask why joining the NLC is important to the Department of Commerce.

For those of you that have been on the committee for a while,

you might recall that the corporation's business and professional licensure division had some severe challenges with staffing and license turnaround during and after the pandemic.

Under Commissioner Sandy and Director Rob's leadership,

licensing times have improved and currently it takes just a week for a nurse license to be issued if the application is complete when it's submitted.

Director Rob and her team are consistently chipping away at modernizing the licensing process with the goal of having everything online through the My Alaska app.

Right now we have all professional license renewals available online and about half of our initial applications.

The nurse licensure program is one of the largest programs that CBPL administers.

Joining the NLC will remove much of the administrative burden and free up existing staff to focus on process improvements across all business,

corporate,

and professional licenses.

In this legislature,

clearly understands the value of compacts and has demonstrated that through the eight compacting bills that are under consideration this year.

And the 33rd legislative legislature also passed two compacting bills quite recently.

The NLC is not a new concept.

It's the longest standing professional licensure compact.

It has a proven framework for mobility,

efficiency,

and workforce stability.

44 jurisdictions are already in the NLC and six states have pending NLC legislation.

So I urge this committee to move SB 124 forward to strengthen Alaska's health care workforce and ensure that Alaskans have access to the care they deserve.

And there's been an increased interest in health care compacts with the Department of Health's engagement in the Rural Health Care Transformation Project.

And I'm pleased that Commissioner Hedberg is here to speak about the critical role that the NLC plays in the Rural Health Care Transformation Project.

Good afternoon, and for the record,

my name is Heidi Hedberg,

Commissioner for the Department of Health.

The Alaskan Department of Health is in support of this bill because it's both a workforce solution for Alaska and a critical component of the rural health transformation program. Last year, Congress passed H.R.1, creating the Rural Health Transformation Program,

and it's to strengthen Alaska's health care system by improving access,

stabilizing providers,

and advancing.

and care delivery systems,

particularly in our rural communities.

Alaska received the second highest award in the nation. That award was $272 million for the first year.

If you look at per capita,

it was the highest in the nation.

This was a highly and is a highly competitive grant.

As part of our application, we made commitments to implementing several key policies identified by the Centers for Medicaid and Medicare Services,

also known as CMS,

that represent five professional licensing compacts. The Nurse Compact licensure before you today is one of them.

If Alaska does not implement these compact licenses by the end of the calendar year 2027,

there is risk of losing a portion of the rural health transformation funding.

The exact amount is not known.

I want to be clear,

I don't want Alaska to lose any funding with this critical investment into our health care system.

This funding really represents a once-in-a-generational opportunity to strengthen our healthcare system and improve health outcomes for Alaskans. That said, our support for the Nurse Compact licensure does go beyond this grant.

Alaska faces ongoing challenges in recruitment and retention of nurses. During the pandemic,

I saw firsthand when I was the director of...

of public health leading through the pandemic, how licensing delays impacted our ability to bring in needed staff when hospitals were under strain.

That compact could have helped remove those barriers by allowing qualified nurses to practice in Alaska more quickly while maintaining the authority to regulate and discipline.

It's also important to know that Alaska would be joining the majority of states.

The compact is well established,

widely adopted,

and strongly supported by Alaskans nursing communities.

The bottom line is very simple.

We need more nurses in Alaska and we need to make it easier for them to come here and stay here.

And this legislation will help us do that while also protecting a significant federal investment in our healthcare system.

Thank you.

Senator Gray Jackson has a question.

Thank you, Mr. Chairman,

and thank you both for your presentations.

And I heard you say that the exact amount is unknown if we don't move forward with this.

But I had heard, and I don't do rumors,

but I'd heard that it's about a million each year.

Through the Chair,

Senator,

that's a great question.

I think everyone has heard many presentations on the rural health transformation and their takeaway has been some degree or trying to calculate their own math.

Simply stated,

because this is a competitive grant,

the states are ranked annually based off of the progress of the commitments in their application. So every year they will be looking at.

at the work that was completed if we followed through on those commitments.

If we did not, we will have a clawback of funding and then it will impact the future funding.

But because it's constantly changing every year,

we don't know that exact amount.

Thank you. Thank you, Mr.

Chairman.

Are there any other questions for the Commissioner or Deputy Commissioner?

Senator Yunt?

Thank you, Mr. Chairman, and thank you both for the presentation so far. Earlier you had mentioned we need to - we're graduating about 350 nursing students annually in Alaska, did I understand that correctly? And we're about eleven hundred short statewide, give or take, right?

Senator Yunt, through the chair, we need - our shortage is around I think thirteen hundred to be approximate.

Do you know how many nurses we have total in Alaska, just so I can kind of try to figure out the percentage of the shortage?

The director of CBPL will have that information. I'd rather, I know she's quoted it earlier to me today. So she'll have that. Senator Yannick.

She's next on our lineup.

Okay.

Okay, I'll hold some more - I'll hold some questions for a bit then,

Yeah.

thank you.

Any further questions for Commissioner Hedberg or Deputy Commissioner Latham?

Seeing and hearing none. Ladies, thank you very much for being with us here today.

Up next is the illustrious director of the corp

from DCCED.

Sylvan Robb. Director Robb, welcome back to Senate Labor and Commerce.

Thank you, Mr. Chair.

Chair.

Good afternoon, fellow members of the Senate Labor and Commerce Committee. For the record, I'm Sylvan Robb, Director of the Division of Corporations, Business and Professional Licensing.

Thank you so much for hearing the nurse licensure compact this afternoon.

I realize the committee has been talking a lot about compacts recently,

and all of which are important and will benefit the state,

the relevant professionals and the Alaskans they care for.

However, I do want to note from a licensing standpoint and based on vacancy rates for the profession in the state,

the Nurse Licensure Compact or NLC is the most important of the compacts for us to pass,

and that's why this bill is the department's top priority.

And Mr.

Chair, would you like me to just proceed or answer Senator Young's question?

I have that information in the slide shortly.

Yes, that would be great.

Thank you.

Um so on slide two you can see the structure of the N_L_C_ Since everyone is more familiar with compacts at this point, we're not going to start at the beginning explaining what they are in general.

The N_L_C_ covers registered nurses and licensed practical nurses. To give you a sense of the scope of this, in fiscal year 2025 we had just over twenty six thousand R_N_s and just under a thousand L_P_N_s.

We do want to be clear that the compact simply offers another pathway to legally practice in Alaska. If Alaska joins,

no one has to participate in the compact if they choose not to.

This creates options,

but is definitely not mandatory.

For being the first and longest standing professional licensure compact,

it is very elegantly designed and a simple structure. It is the same structure as the Social Work compact you have been discussing in HB110.

If an RN or LPN lives in a compact state and meets the licensure requirements in the compact,

they can obtain a multi-state license from their home state.

Using that multi-state license,

they can practice in any of the 43 compact jurisdictions.

If a nurse moves from one compact state to another compact state,

they have 60 days to obtain a multi-state license from their new home state.

If a nurse moves from a compact state to a non-compact state,

they must obtain a license in each state for which they wish to practice.

If a nurse only wants to practice in Alaska,

they have the option to keep or apply for a single state Alaska license.

Every Alaska employer will be able to easily verify if a nurse is actively licensed to practice in Alaska through the national online quick confirm license verification offered through Nursys, uh which specifies which state or states a nurse holds a license in and whether it's a single state or multi-state license. All states, whether they've joined the compact or not, currently participate in this national database.

So here on slide three you can see the requirements for getting a multi-state license through the NLC compared to the current requirements to obtain an Alaska license.

You can see that the compact and Alaska have the same requirements when it comes to education,

exam,

the requirement for a fingerprint-based background check,

and the requirement for English proficiency if someone's education wasn't taught in English.

Beginning with item seven on this chart,

you can see that the compact has higher standards. It does not allow anyone with a felony conviction,

anyone with a misdemeanor conviction related to nursing,

or anyone currently enrolled in an alternative to discipline program.

These are usually programs used for an individual with a substance misuse disorder. This is how we have confidence that nurses practicing

In Alaska,

using a multi-state license are safe and will not lower the standard of care in Alaska.

These are squeaky clean nurses,

if you will.

And just to be clear,

the option to obtain a single state Alaska license is not going away.

Anyone who either does not qualify for a multi-state license or does not want a multi-state license can continue to get a single state license.

This is adding options,

not removing them.

When applying for a single state license,

items seven through ten on the chart are considered on a case-by-case basis by the Alaska Board of Nursing,

which may choose to allow someone to obtain an Alaska license with those items in their background,

and that process will continue to be an option for people.

For other compacts, we've had a concern about professionals working under a multi-state license or a compact privilege not having the cultural awareness our Alaska-based professionals have.

If this concern transfers to nurses,

it's important to note that Alaska does not have any such training requirement for Alaska nurses currently.

If such a requirement exists for cultural training or cultural competency,

it's at the employer's discretion.

Before we leave that slide,

I'm wondering about

background checks and safeguards and you mentioned your confidence level in the compact licensed nurses

Recently in my community, we had a rather horrific situation with a nurse who was a traveling contract nurse who wound up having some very severe mental health issues and had some problems at work, was reported to the police.

She continued to spiral and then wound up brutally murdering her landlord,

stabbing him over 70 times.

many times.

So could you tell us more about kind of the safety of licensees for traveling nurses and how like how we can ensure that folks who who come here that if they are if they are okay when they start how do we continue through that process?

It's just I think many people are alarmed that

This this gal was reported at work to have issues and then the cops came and maybe this is a like a law enforcement problem

Yeah.

How can we be sure that things like that don't happen with licensing is there anything we can do to help

Yeah,

thank you for that question,

Mr.

Chair.

To the chair, I'm familiar with the case you're referring to.

Certainly, it's worth pointing out that we are not currently in the compact,

and so the individual in question had obtained an Alaska license through our current process.

Nurses are required to renew their licenses every two years in the period of time between when they obtain a license or when they...

They last renewed and the next time they renewed,

unless we receive a complaint,

we don't have a lot of interaction with them.

Certainly, it's obviously extremely unfortunate that no one in that individual's life or at her workplace recognized the magnitude of the issue she was struggling with and was able to get her the assistance she might have needed. But it feels more like a law enforcement problem than a.

a nurse licensure problem.

Thank you.

Moving on to slide four,

you can see part of the reason it takes time to implement a compact after the legislation passes.

This is because one of the most important pieces is ensuring all member states can share information about nurses in their state.

Being a member of the compact will improve our communication with other states because all member states participate in a coordinated information system with information on licensure.

And all member states have to promptly report license action or a significant investigation,

denial of licensure, or a nurse in an alternative to discipline program.

In discussions on other compacts, concerns have been raised about the inability to sort of tweak the terms of the compact as we see fit.

But we'd like to point out that all states being required to adopt the exact same language and terms into their statutes is a good thing.

This is how we can trust the compacts.

If everyone was able to tweak around the edges,

we wouldn't be sure that all the other states were holding nurses to the same requirements.

requirements and standards, quickly investigating complaints against their nurses and immediately reporting disciplinary actions.

If each state could tweak the compact language,

it would no longer be in agreement between all the states, but rather blind reciprocity, which wouldn't work for Alaska and could create public safety or standard of care issues.

The fact that we know all NLC states have adopted exactly what we're looking at today into their state laws

is why we can trust it.

Here on slide five,

we want to cover disciplinary authority under the NLC,

sort of addressing your question,

Mr.

Chair.

So we want to be clear we are not giving up any sovereignty because both the Alaska Board of Nursing retains the right to investigate and discipline a nurse practicing in Alaska under a multi-state license up to revoking that nurse's privilege to practice in Alaska,

regardless of which state issued their multi-state license.

This is the same authority we currently have.

It's just called action against their multi-state privilege rather than against their Alaska license.

If we did take license action,

we'd immediately report that to the shared data system I mentioned earlier,

who would ensure that the home state was aware and that all the other states would be able to see that as well,

helping improve public safety across state lines.

The compact requires the board to apply Alaska statutes and regulations to determine the appropriate action.

These laws remain fully under the legislature and board's authority.

The compact has no jurisdiction.

over Alaska's nursing laws or due process requirements.

The bottom line is that our Board of Nursing will retain full authority over nursing practice in Alaska and who can practice here.

And as a reminder,

if a nurse loses their multi-state license,

whether it was issued by Alaska or another state,

they can still opt to apply for a single state Alaska license through our standard process and have their situation evaluated by the Board of Nursing.

Moving on to slide six.

I've touched on this already,

but I really want to stress this point.

Are we handing over control of the practice of nursing to the compact?

And the answer to that is absolutely not.

Neither the Alaska Board of Nursing,

nor the administration,

nor I feel confident would the legislature be willing to allow another state or a multistate entity to dictate the practice of nursing in Alaska.

No one is interested in or willing to give up state sovereignty.

Governance. Governance of the practice of nursing in Alaska remains first and foremost with the Alaska Legislature through the statute you pass and then through the regulations that are adopted by the Alaska Board of Nursing.

And a nurse must follow the laws of the state where their patient is located.

Okay,

so that covers jurisdiction over individual nurses,

but what about the NLC itself?

Who has jurisdiction over the operation of the NLC?

And the answer is the member states do.

Every member state adopted the compact exactly as you're seeing it into their statutes.

Within those statutes, Article 7 of the compact establishes the interstate commission of nurse licensure compact administrators or the NLC commission,

which is an instrumentality of all the party states,

each of which appoints one administrator who has one vote on all NLC matters.

including the creation of rules and bylaws.

Only member states have a seat on the compact commission,

so the NLC is controlled exclusively by those member states.

This is a typical compact structure.

It is the structure of the two professional licensing compacts of which Alaska is already a member and the other seven currently before the legislature.

Also,

all of the Compact Commission meetings are public. They are required to be noticed in advance,

and they all have to follow the Administrative Procedures Act.

So it's an open process.

Here on slide seven,

let's talk about costs.

Let's start with the cost to licensees.

Alaska will set an appropriate fee for a multi-state license.

This bill includes language to set the multi-state license fee at twice the cost of a single state license.

Currently that cost is $200 for a two-year license.

The reason the fee-for-a-multi-state license was structured this way is to ensure those Alaska nurses who only want a single-state license are paying less than those with a multi-state license.

For many nurses,

a multi-state license will save them money and headaches as some nurses currently hold licenses in three or four states or even more,

and so they're paying all of those individual state licensing fees as well as dealing with the headaches of tracking different.

expiration dates,

and different requirements.

The compact itself does not charge a fee to individual nurses.

The compact does, however,

charge the state $6,000 to be a member.

You might be wondering,

wondering why there's a zero fiscal note when there's that cost.

We are confident that despite the annual assessment fee,

we will still save a lot more than we spend by joining the compact,

which will also result in lower licensing fees.

I'll get into this in more detail on slide nine.

Senator Dunbar has a question.

Thank you, Mr.

Chair.

So $6,000 annual fee.

Let's say that all 50 states were in the compact.

That's still only $300,000 a year.

What's their other revenue source?

How are they able to survive?

That would only pay for a couple of staffers.

Through the chair to Senator Dunbar,

they do receive some funding from other sources. I do believe,

Mr.

Chair,

on the line for questions, we have Nicole Lovanos.

Yes, we do.

Ms.

Lovanos, did you hear Senator Dunbar's question?

Okay, thank you so much.

I did.

And through the chair, Senator Dunbar,

the NLC Commission does have a memorandum of understanding with the National Council of State Boards of Nursing.

And under that MOU,

NCSBN does provide support for staff and services to assist the commission with its operations.

And just to follow up on the staff for the NLC,

there are three staff members for the entire Nurse Licensure Compact.

Follow-up?

Not this time, Mr. Chair. Thank you.

Thank you. Any further questions during this break in the action for Director Rob?

Please continue,

ma'am.

Thank you, Mr.

Chair.

Moving on to slide eight,

let's talk about the costs associated with not joining the NLC.

As we heard Commissioner Hedberg explain,

we will lose a sizable amount of rural health transformation funding.

There are millions associated with a failure to join.

Another cost is that we are currently incentivizing our Alaska graduates to leave Alaska and move to a compact state if they are interested in operating as a travel nurse.

In conversations with our nursing schools,

we are currently incentivizing our Alaska

They tell us that this is fairly common for new graduates.

graduates to leave Alaska and move to a compact state if they are interested in operating as a travel nurse.

People are young and don't have a lot of obligations,

and so it's a great time to travel and see the country.

And again,

the incentive to leave the state is because you can only obtain a multi-state license if you live in a compact state.

Given that we only graduate 350 of the 1,100 nurses we need every year,

this incentive for people to leave the state is not helping with that shortage.

In the same vein,

we have created a disincentive to move to or return to Alaska,

since again a nurse holding a multi-state license who moves here now must give up that multi-state license.

Finally,

we have some of the highest nurse licensure fees in the country because we process so many redundant applications as a result of not being in the compact,

which I'll talk about more on the next slide.

However,

I first want to note that AHA,

the Alaska Health Care and Hospital and Health Care Association,

has found that 25% of traveling health care professionals, and again, that's all health care professionals, not just nurses,

but 25% of those folks who come to Alaska.

up to come to Alaska permanently.

Alaska really sells itself.

We are confident that if we remove the loss of your multi-state license currently associated with becoming an Alaska resident,

more nurses will make our state their home.

Moving on to slide nine.

As promised,

let's talk about why we are so confident that joining the NLC will result in savings for our division and therefore lower licensing fees for our nurses.

Licensing fees are statutorily set to be an amount that covers the cost of regulating the occupation.

The annual cost to regulate nurses over the last five years has been in excess of $3 million annually.

That cost is so high because the team that processes nurse license applications is almost triple the size of our next largest team.

It is comprised of 13 people, including eight licensing examiners.

The cost of a single licensing examiner, too,

is $113,000 annually.

If we join the NLC,

we will no longer process applications for nurses that hold multi-state licenses in other states,

which are basically redundant for us to process since another state has already confirmed those nurses meet standards higher than Alaska's.

If we have fewer applications to process,

we don't need as many examiners.

We'd reassign existing examiners to other programs that have room to improve processing times.

And we would shrink staff by eliminating examiner positions as they became vacant if they were no longer needed for other programs.

So even though the annual cost will be $6,000,

we know we will actually save money by joining the NLC if even just one examiner is reassigned,

hence the zero fiscal note.

Additionally,

no state has reported an increase in investigation costs as a result of joining the NLC.

This is primarily because multi-state nurses have to remain squeaky clean in order to retain their multi-state privileges.

Here on slide 10,

while there has been limited but vocal opposition to the NLC,

there is overwhelming support for Alaska to join.

First and foremost,

there is substantial support by those most impacted,

Alaska's nurses.

We surveyed all Alaska nurses in the late fall of 2023,

and 92% of nurses were in favor of joining the NLC.

Among nurses who live in Alaska,

the results were 89% in support of joining the NLC,

and 85% among union nurses.

We conducted the same survey in 2019 and got the same results. 92% want to see Alaska join the NLC.

As you know,

there is a lot of legislation introduced regarding professional licensing.

We have seen more public engagement on the NLC than any other bill in the last decade.

The Board of Nursing has been copied on 99 letters of support from individuals and 12 from entities submitted to the legislature so far in the 34th legislature prior to this week, and that was without the bill having been scheduled.

We don't know how many more letters may have come in since the hearing was scheduled.

In the 33rd legislature,

the board was copied on even more.

more letters of support from individuals and organizations.

Though we didn't want to overwhelm the committee,

we have lists of all the individuals and organizations that copied us on letters of support and opposition or that were posted on BASIS since NLC legislation was first introduced in 2020.

So if any committee member would like to see those lists, please let us know and we're happy to share.

Slide 11 shows the Coalition of Support for the NLC from the interim between the 32nd and 33rd Legislature. Since that time more organizations have expressed support,

including the Alaska Commission on Aging and the State Medical Board.

Obviously, we're not going to read through all of these,

but I do hope you will to see the breadth of support.

A few to highlight include tribal organizations like the Alaska Native Medical Center, the Alaska Native Tribal Health Consortium,

Bristol Bay Area Health Consortium,

Manilic Health Center,

Norton Sound Health Consortium, Southeast Alaska Regional Health Consortium, and the Yukon Kuskokwim Health Corporation,

plus associations of health care providers, including the Alaska Native

Alaska State Medical Association,

Tribal Health Center.

the Emergency Nurses Association,

the Alaska Behavioral Health Association,

the Alaska Primary Care Association,

and every single hospital in Alaska.

But it's not just health care associations like the APRN Alliance who you'll hear from in a few minutes who are supportive.

It also includes the AARP,

Chambers of Commerce,

the Alaska Municipal League,

Schools of Nursing,

the Department of Defense and the United States Department of Commerce.

I'll stop now,

but I really do want to emphasize the depth of support for the NLC statewide.

Moving on to slide 12.

So why is there so much support for the NLC?

While this is ultimately a licensing issue,

access to health care is a quality of life issue.

Heck, it's even sort of a life issue if you need health care and you can't get it because of a lack of providers.

You can see the numbers on the slide. It's taking nearly five months to fill a vacant hospital RN position and more than six months to fill one in a long-term care facility.

While we don't have statistics on it, we know recruitment times are similar,

if not worse,

for other facilities like health care clinics,

especially in our remote communities.

Passing the NLC is important because our situation is only projected to get worse.

We're projected to have the worst nursing shortage in the country by 2030,

while seven compact states are projected to have a surplus of nurses.

If we join the NLC and make it easier for nurses to come up and give Alaska a try,

this helps us.

Alaska sells itself and it's a great place to live.

Joining the NLC will give us access to more squeaky clean nurses.

More than 80% of the country is part of the compact,

so nurses are less willing to jump through additional hoops to come here.

It will allow nurses to more easily try Alaska and fall in love with it.

It will remove the incentive we've created to not become an Alaska resident.

It helps military families, and nursing is one of the top ten military spouse professions.

It will lower licensing costs for nurses.

It will make it easier for our health care facilities and clinics to recruit nurses,

and it will prevent us from losing any of our rural health transformation funds by failing to join something that has been working for 43 U.S. jurisdictions and has been around for 25 years.

Finally,

on slide 13,

here's a map of the NLC jurisdictions.

This is not a red state or a blue state issue.

As this map shows,

you can see Texas,

Florida,

Wyoming,

Idaho are all members of the NLC.

And you can also see Washington,

Massachusetts,

Rhode Island,

Connecticut are also members of the NLC.

And with that, Mr.

Chair,

I am happy to go through a brief sectional, answer any questions, or move on to our invited testifiers, as you wish.

Thank you. Are there any questions from committee members?

Senator Dunbar.

Thank you, mr.

Chair. Uh I think you said th did you say we were number one in the nation for a nursing sh shortage or one of the top for nursing shortage?

Through the chair to Senator Dunbar, we have the largest and we are projected to continue there.

Can you

Can you give me a s can you send us a citation to that list? I'd like to know where that comes from and sort of, you know, the rank order of all the states and in that list.

Through the chair Senator Dunbar, certainly. Off the top of my head I believe the citation for that is RN.org.

Um

Anything?

Senator Young.

Oh, yeah,

thank you through the chair to Director Sylvan Rubb.

A couple of quick questions. Earlier there were some numbers thrown out there.

So we got about 26,000 RNs in Alaska,

and you're figuring about 1,300 or so a year are leaving the, you know, the profession.

That's 5%. I assume that's an average of a 20-year career.

People retire, they move, whatever it may be.

How many do we have coming up right now? What is the delay when somebody comes to Alaska?

And bear with me, I have professional licenses and CUs I have to do every year too, but it's not for this. So this is, it's not my area of expertise, which is why I'm asking.

But if somebody comes here as a nurse from another state,

what is the timeline to obtain a license in Alaska?

Because don't all nurses, I believe, take the same test nationally?

It's the same one, I'm going to say this.

This incorrectly, but it's like INCLEX or something, right?

Um yes, through the chair to Senator Yonta, um I'm very impressed you have the the name of the exam correct, um and it is a national exam that nurses take. So currently um the time as Deputy Commissioner Latham mentioned to obtain a uh nurse licence um from the time we get a complete application is just about a week. Um but some of the issue Senator is that

But for anyone who is used to living in a compact state,

they are used to no cost,

no delay,

no paperwork that they need to need to put up with. So it does create a barrier,

even though right now processing times are are good.

Follow-up, Mr. Chairman?

Yes.

Thank you. And I certainly see the convenience of that in states possibly like Oregon,

Idaho as an example where,

you know, I see.

You could drive to another state, possibly even work in a state you don't live in and be there in the same amount of time as it drives to, you know, takes a drive from Nevada to Anchorage.

We're a little bit different,

we're unique in the sense that we're separated from most.

Do you know the average salary for an Alaskan nurse and an average salary for the United States for an RN?

Through the chair to Senator Yant, I do not have that information.

Mr. Chair,

I don't know if Ms.

Lovanos might know that information.

If not,

you can get it to me the next time I hear the bill or whatever.

I guess.

I don't know.

I think the other day we were told I think 22.9% give or take of Alaska's workforce right now currently lives out of state and they come here for rotational work.

I know in a lot of our remote locations rotational work is an option.

It's a little bit worrisome to me,

I won't lie,

in regard to making it easier for people to snowbird, I guess you could say, or live here half the time, work here half the time and then take their money to where they're going to live.

where they're at. But um I'll continue to do homework on it. So thank you.

Uh through the chair to Senator Young. Um I would just say that you know we do

feel like the best opportunity to create a warm and welcoming climate for nurses and attract them to the state is not to,

and I know this isn't what you were suggesting,

but to sort of hold them hostage by making it harder for them to go elsewhere to practice.

Additionally,

we really like our odds. There are 2.4 million RNs and LPNs who have a compact license.

We have twenty seven thousand Alaska licensed RNs and LPNs. So it gives us quite a few people to to choose from and to attract.

Senator Dunbar.

I I'm sorry if you said this before, but there's twenty seven thousand licensed. How many of them currently live out of state? And then how many folks are licensed or have

the sort of qualifications to be licensed but aren't not have left the profession for other reasons aren't practicing anymore whether it's work conditions or pay benefits here in Alaska do you have those numbers?

Through the chair to Senator Dunbar, to your second question about how many people have left the profession,

that's not a question we can answer because we don't track.

People can renew their license,

but just because they didn't doesn't mean that they're maybe not just taking a break while they have other life circumstances that are preventing them from working or that they're not still practicing nursing but in a different location.

as to your first question, I apologize.

Twenty seven thousand nurses licensed. How many of them live in Alaska?

Yeah,

Through the chair to Senator Dunbar, and thank you for that prompt. We have mailing addresses for nurses, but we do not know where they live, and so

Can you give me an approximate? Is it half? Is it a third? What percentage of those folks live out of state?

I don't know. May I

No.

Um

Uh

If you could get back

may I call

to the committee

Yeah.

In writing on that one,

that'd be most excellent.

Um yes,

thank you Mr.

Chair. My Deputy Director has amazing recall, so I thought she might be a lifeline.

Thank you.

Um well, to the other point,

let me see let me see if I can rephrase the question.

27,000 active licenses in Alaska.

Are you saying you you can't track who is and is not working in the state? So someone could have a license and not be working, but you you wouldn't be able to track that?

Through the Chair to Senator Dunbar, that's correct.

We don't keep track of where nurses work or if they're working. We don't do that for any of our professions,

with the exception of realtors where we need to know which broker they work for.

And so would the Department of Labor have that? Is there, do you know, does any other, you know, part of the state have that kind of data?

Through the church of Senator Dunbar, we were looking for some information about that and did not find it on Department of Labor's website,

which I certainly don't want to speak for them and couldn't say that it's not there and we just didn't manage to find the right page to click on.

Follow up.

Mr.

Chair. So

Chair.

Senator Dunbar.

have you had a chance to you know I think we've all met with a number of nurses. There's a lot of nurses that come to this building. There's twenty seven thousand of them, although I think um

Significantly fewer that live in Alaska,

but a lot of them come to our offices and talk to us about a variety of issues.

And one of the things that's been expressed to me is there are many thousands of licensed nurses that live in Alaska that are licensed to practice here that don't because they feel that the whether it's the nurses to patient ratio or the pay and benefits or the safety.

or other things the working conditions have deteriorated to the point where they've just left the profession so in other words there the nurses are here but we have a shortage because they don't want to work in this profession anymore which I can really identify with as an attorney that doesn't work in corporate law

But do you have have you ever spoken with nurses that indicate that's the case?

Has the Department of Health, I guess this is not a department of health, but you know you said this is your the top top priority for the department. Have there been efforts to get those nurses to return to active practice in the profession?

Through the chair to Senator Dunbar,

working conditions are obvious.

usually an issue between an employee and their employer.

Additionally,

not, we would be pretty far out of our lane in that part looking at that.

I will say I feel like frequently the discussion gets very focused on hospital nurses,

and it is worth remembering that, you know, 47% of nurses, and this is national data,

but 47% of nurses work in other locations, you know, so there are nurses who work in long-term care facilities,

assisted living facilities at our deep.

our D_O_C_ facilities who are school nurses um who work at the public health facilities, pioneer homes, et cetera. Um so it is helpful to sometimes remember that uh the scope of locations where nurses work um is more expansive than just hospitals. And I don't mean to suggest you were not thinking of that, but it's always worth remembering.

Follow up, Mr.

So the nursing shortage that you've referred to, where is it most acute

Chair.

in those categories you just described?

Through the chair to Senator Dunbar,

that's probably a question that would be better asked maybe to the Hospital and Health Care Association,

and we can certainly reach out to them.

You know, I can say some of the figures that we cited in our presentation,

it is taking, you know, just under five months to hire an RN for a hospital, and it is taking in excess of six months to hire people for long-term care facilities. So I think that is certainly.

Definitely somewhere where we're seeing, you know, taking a very long time to recruit folks,

but I don't try to hire nurses,

so I'm probably not best suited to answer that question.

Okay, thank you. Thank you, Mr. Chair.

Chair.

That's all for now.

Senator Junt.

Yeah,

thank you to the chair.

So earlier it was mentioned we graduate our universities about 350 nurses a year.

I'm just thinking about all the kids that I coach. There's quite a few that...

go to college out of state and and I know one that just came home with an RN degree very talented young lady she actually applied at a lot of different places in Anchorage in the valley there was a ton of work in remote Alaska she considered going remote but it took quite a while to even get on in one of the local hospitals because they're all staffed up is this always is there a bigger

I guess, how many nurses did, two questions.

One,

how many did we license, say, last year in total,

or 350 that graduated here, I assume, most of them, and then how many maybe came back from universities out of state, like the kid I'm thinking about,

and then also, do you have any sort of numbers based on staffing shortages compared to like local or, you know.

Maine cities in Alaska compared to rural.

A two-part question,

Yeah.

sorry about that.

Yeah,

through the chair to Senator Yount.

Again,

that's not information that we have about we don't require people to tell us. There are different pathways to licensure for someone who recently graduated or has never been licensed somewhere else versus somebody who holds a license elsewhere.

So that's information we could provide,

but whether someone is a recent graduate.

or is interested in coming back to Alaska,

it's not information we need nor we're entitled to,

so it's not data that we have.

The figures cited the number of days to get people hired are averages for all of the hospitals in the state who are part of AHA.

I don't know off the top of my head if their report breaks it down further sort of into rural and urban hospitals,

but quite honestly it's great to hear that at the moment hospitals in South Central are finding as many nurses as they need.

And again, do you know approximately how many licenses or nurses we licensed in total last year for the whole state?

That way I could just kind of try to figure out the difference between the three fifty and and maybe

Yeah, through the chair to Senator Yount. I'm not sure I'm grasping the essence of your question. So we had just over 26,000 licensed RNs, just under 1,000 licensed LPNs, and then about 1,600 APRNs, the advanced practice registered nurses,

and 2,828 certified nurse assistants in fiscal year 25.

But I feel like maybe that's not actually what you were trying to ask.

I'll rephrase it. So how many did we license in Alaska for the first time in Alaska last year out of those 27, 28, possibly 30,000?

Give me

First

more.

time to Alaska licenses.

That could be graduates from our university programs. It could be incoming graduates that are coming back that, you know, left for college.

It could be even an experienced nurse that lived in Arizona for 10 years and moved here. Just how many did we license total last year in Alaska?

License

Yeah,

for the first time.

Through the chair to Senator Yount,

about 3,500 RNs and, yeah,

3,500.

Yeah.

That was a lot more than I thought, but okay.

I thought, but okay.

Nursing is our biggest program.

We have 112,000 professional licenses and 32,000 of those are nurses.

Okay, just so I make sure I got this, 3,500 approximately were first time licensees in Alaska in the last 12 months, give or take.

Through the chair to Senator Young, that is correct.

Thank you.

Anything further for Director Rob?

Seeing, hearing none, we will move now to invited testifiers.

First up is Danette Schloder,

Chair of the Alaska Board of Nursing.

Ms.

Schloder, please state your name and affiliation for the record and begin your testimony.

Good afternoon Chair Bjorkman and members of the Senate Labor and Commerce Committee. Thank you for the opportunity today to testify today and hearing the nurse license compact.

And I apologize,

I don't have much of a voice.

My name is Jeanette Schlater. I'm a second-generation Alaskan, University of Alaska School of Nursing graduate.

I hold five healthcare degrees, including a doctorate in nursing practice.

With over 31 years of obstetrical nursing,

I currently serve as a perinatal clinical specialist at Providence Alaska Children's Hospital,

focusing on improving health outcomes for women and newborns.

I currently serve as the chair of the Alaska Board of Nursing and have for the last seven years.

I'm here to express the board's strong and unanimous support for the Alaska adoption of the nursing compact or MLC,

a position we've held consistently since 2019.

First and foremost, as Director Rob mentioned,

Alaska Nurses overwhelmingly support joining the NLC.

The board surveyed all actively licensed RN and LPNs in 2023 statewide.

With more than 4,500 nurses responded,

92% of the respondents said they wanted Alaska to join the compact.

This high level of support is consistent across all groups,

nurses who live here and nurses who practice in multiple states,

union and non-union nurses alike.

It's been consistent across time too.

We did the same survey in 2019 and got the same results as the most recent version.

Our nurses are telling us loud and clear that they want this policy changed.

Our board is strongly supportive of the NLC for many reasons, including the critical nursing shortage our state is experiencing,

which is worsening each year.

Hospitals report vacancy rates over 20% for RNs and even higher vacancy rates in long-term care.

AHA's 2025 health care workforce analysis report confirms that filling a single RN vacancy takes 118 to 167 days.

That's months during which Alaskans wait longer for care or go without it.

To make better for projections showing Alaska will have the largest nursing deficit in the country by 2030,

while other states will have a surplus of nurses.

We simply cannot meet our needs without removing unnecessary licensure barriers.

Our board and the division have worked really hard to improve the processing times to ensure the time it takes to get a license is not a barrier for nurse recruitment,

yet high vacancy rates and lengthy recruitment times remain for our hospitals and healthcare facilities.

We recognize that there's a nursing shortage nationally,

but we're one of the few toughest states to get to geographically.

And when and we're one of the few states that require nurses to submit extra paperwork and pay extra fees to be licensed here,

we are making it unnecessarily difficult for our health care providers to recruit nurses they need and we're losing new graduates to other states.

The NLC is not experimental or untested. It's the oldest and most well-founded professional licensing compact in the United States.

It's been in place for 25 years and 43 other jurisdictions have joined and not a single one has ever withdrawn.

From a licensing perspective,

which is within the board's purview,

the NLC has more stringent eligibility requirements than our current Alaska license.

Nurses with

felony convictions,

relevant misdemeanors, active discipline,

or participation in an alternative discipline program cannot hold a multi-state license.

National data shows that the nurse with multi-state license actually has lower discipline rates than single-state licensees.

Simply put,

the NLC strengthens, not weakens, patient protections.

We have so many regulations regarding the revenue impact for increased investigation,

but licensing fees in Alaska are set to match the cost of the operating program.

If fewer applications come in, fewer examiners are needed.

Other states have not seen a fee increase tied to the NLC and because multi-state licenses need such high standards,

states report minimal investigation costs related to those nurses.

Finally,

I want to declare Alaska retains full state sovereignty under the NLC.

Nurses practicing here,

regardless of their home state,

must follow Alaska laws and regulations that are set by the legislature and Alaska Board of Nursing.

The NLC does not give authority to any national organization,

including the National Council of State Boards of Nursing.

Every state, including Alaska,

has an equal voice in rulemaking.

Please trust me that the Alaska Board of Nursing would never support joining the NLC otherwise.

Additionally, from my perspective as a working registered nurse,

I strongly believe that Alaska needs to join the NLC to increase the number of qualified nursing faculty in Alaska.

My experience illustrates this need.

I have taught Alaska students enrolled in an accelerated baccalaureate.

The Black Awareness Program page of Montana,

where nurses complete their didactic coursework online and fulfill their clinical rotations in Alaska.

To serve as a nursing faculty member for these programs,

I am required to hold licenses in multiple states, including Washington,

Montana,

and Alaska.

This situation is far from unique. I've met many nurses whose Alaska-based roles require licensure in several states.

The process of securing and maintaining multiple licenses is both costly and time-consuming.

By joining the NLC and allowing nurses to obtain a multi-state license,

Alaska would significantly reduce licensing costs and administrative burden for nurses who practice across state lines.

This change would not only support current nurses, but faculty and make Alaska a more attractive destination for nursing professionals,

ultimately benefiting our healthcare workforce and patient care statewide.

In closing,

joining the Nursing Compact is one of the most powerful tools available to address Alaska's workforce crisis,

improving access to care,

lowering healthcare costs.

supporting our hospitals and clinics and strengthening safety standards.

More importantly,

it is what Alaska nurses want and what Alaska patients need.

On behalf of the Alaska Board of Nursing, I respectfully urge you to pass this legislation.

Thank you for your time and consideration,

and I'm happy to answer any questions.

Thank you very much, Ms.

Schlater.

Any questions from committee members?

Senator Dunbar.

Thank you, Mr.

Chair.

Thank you, Ms.

Slater, for being here.

Other folks have suggested that another way to improve our recruitment and retention and to improve safety as well is to have safe staffing ratios where you couldn't have more than a certain number of patients assigned to certain nurses.

Is that something that the Board of Nurses would also support or has?

Investigated

Through the chair,

Through the chair, Senator Dunbar,

the Alaska Board of Nursing has not heard that issue during our meetings and currently we don't have any regulations that address that issue.

Follow up, Mr.

Chair.

Yep, but also we will be taking up that issue at a later time.

Talk about the bill.

That'd be good.

Yeah,

I think they're interrelated or they're going to be.

So, yeah,

I think that I guess I would just say, Ms.

Schlater, that I hope the Board of Nursing does take that up and discusses it.

I think it's going to become a more active discussion. We've seen it become a more active discussion in other states.

Thank you, Mr.

Chair.

Thank you again for being here, Ms. Schlater.

Thank you. A reminder to all people testifying as well,

sometimes the audio can get pretty garbled, so if you could please make sure that you're not on speakerphone and you just pick up the handset best you can, that'll improve the audio quality quite a bit.

Up next is Ms. Teresa Lyons.

Trees Lions,

are you available?

Okay,

up next is Katie Capozzi.

Chair Bierkman and members of the Senate Labor and Commerce Committee,

thank you for the opportunity to testify today. For the record,

my name is Katie Capozzi and I proudly serve as the President and CEO of the Alaska Chamber.

I testify today in support of Senate Bill 124.

The Alaska Chamber is the state's largest statewide business advocacy organization.

Our mission is to promote a healthy business environment in Alaska.

The chamber has more than 700 members and represents businesses of all sizes and industries from across the state, representing 58,000 Alaskan workers and $4.6 billion in annual wages. The chamber has a formal policy position to support joining the multi-state nurse licensure compact,

commonly referred to as the NLC.

Our membership voted on and adopted this position in 2022.

The business community recognized then,

as we do now,

that to have a healthy economy,

we need a healthy workforce.

And a key component of having a healthy workforce means we need health care professionals here in Alaska to take care of Alaskans.

Alaska's projected to have the highest nurse vacancies in the United States by 2030,

as you heard earlier,

with over 5,000 openings.

The health care system in Alaska is struggling to keep up with demand for nurses,

which requires filling over 1,100 positions annually.

We simply don't have enough nurses coming online each year to even come close to meeting the demand.

For example, in 2024,

The University of Alaska system graduated 222 nurses.

The NLC will increase the pool of qualified candidates to fill critical vacancies at a time when we need it most.

The NLC is a straightforward and common sense tool that we should add to our toolbox for workforce recruitment.

And this isn't just the opinion of the Alaska Chamber.

We asked Alaskans in our 2024 annual public opinion survey if they would support Alaska joining the NLC.

An astounding 86% responded with support. And notably...

Those who identified as working in the healthcare sector responded with 84% support.

And I have a copy of that slide and that data that I'm happy to offer for the record.

As you know, there are currently 41 states and two territories that participate in the compact,

and it's the chamber's hope that Alaska becomes the 42nd state.

Thank you for the opportunity to testify today.

Thank you very much, Ms.

Capozzi. Are there any questions for committee members?

Up next is Ms.

Shannon Davenport.

Ms. Davenport, please state your name and affiliation for the record and begin your testimony.

Thank you, Mr.

Thank you, Mr. Chair and members of the committee.

Can you hear me okay?

Yes, ma'am.

Okay.

So my name is Shannon Davenport and I am from Anchorage, Alaska.

So.

I am here today as the president of the Alaska Nurses Association,

representing 1,742 union strong nurses,

along with other members of nursing associations.

I'm currently working as a mental health nurse at Providence Alaska Medical Center.

Thank you for the opportunity to speak today with you regarding the Nurse Licensure Compact and why we stand in strong opposition to Senate Bill 124.

I have worked in health care for more than 20 years.

I've been caring for Alaskans from all walks of life.

I've been with patients in their moments of greatest joy and deepest sorrow.

Through it all, I have never regretted my decision to become a nurse until now.

The Nurse Licensure Compact is not the solution to Alaska's health care crisis.

It is a distraction from the real problems facing our system.

Unsafe working conditions,

dangerously high patient-to-nurse ratios,

chronic understaffing, and burnout that too often leads to broken spirits and moral injury among nurses.

These conditions do not just harm nurses.

They jeopardize patient safety by increasing the risk of falls,

infections,

workplace violence,

and even higher mortality rates.

We're told there's a nursing shortage,

but I would argue that the nurses are still here.

Many have been driven.

away from the bedside,

not because they stopped caring,

but because the system made it impossible to provide the care patients deserve.

Labeling this as burnout oversimplifies the pain we experience.

What we face is moral injury,

the emotional and ethical toll of being unable to meet our professional and moral obligations in an unsafe system.

The nurse licensure compact would not fix these issues.

Instead, it would undermine state oversight,

divert licensing fees out of Alaska,

and make it harder to ensure that nurses practicing here meet the high standards Alaskans have come to expect.

We risk losing track of who is providing care,

what disciplinary actions they may have faced elsewhere,

and whether their training aligns with our state's expectations for a safe and competent practice.

I ask you to think of your own families,

your neighbors and your communities when you consider this bill.

What is a human life worth?

As a nurse, I'm more than a number on a spreadsheet.

I'm an advocate for my patients,

their families and the health of our communities.

I will be there in their darkest moments,

holding your hand,

fighting for your safety and celebrating each small victory until you return home to your loved ones.

Just as I hope to return home to mine.

I thank you, Mr.

Chair and members of the committee for your time and for listening to my testimony today.

Thank you very much, Ms.

Davenport. Are there any questions from committee members seeing and hearing?

Seeing and hearing none, we'll go next to Ms.

None.

We'll go next to Ms. Vicki Berg.

Ms.

Berg,

please state your name and affiliation and begin your presentation.

Thank you.

My name is Vicki Bird.

I am a registered nurse and I am the CEO of the Montana Nurses Association.

Cherry Walkman and members of the Senate Labor and Commerce Committee,

thank you for this opportunity to speak.

I am here on behalf of the Montana Nurses Association to share our state's experience with the nurse licensure compact and its unintended consequences, many of which are highly relevant to Alaska.

Like Alaska,

Montana is a rural state with significant workforce challenges.

From our experience,

the NLC does not ensure adequate oversight of who is practicing within the state.

Neither the compact nor participating states consistently track nurses working under compact licenses. As a result, we have seen nurses working in Montana.

for extended periods of time, sometimes hundreds and even thousands of days without obtaining their new required home state Montana license.

This reflects a serious gap in accountability and enforcement.

In a state like Alaska where geography already makes oversight more difficult,

this concern may be even more significant.

There are also financial impacts.

pandemic.

Montana loses licensure revenue that supports our Board of Nursing, while the cost of investigations and discipline still falls on Montana nurses through their licensing fees.

In our state,

a license costs just $100 every two years, a minimal cost to ensure accountability and public protection. At the same time, large travel nurse and telehealth agencies

These stand to benefit the most.

The compact allows them to deploy nurses across multiple states under a single license,

increasing corporate profits while states lose oversight and revenue.

This primarily serves a small subset of the nursing workforce rather than supporting the majority of nurses who provide direct patient care in acute care,

hospital,

and clinic settings.

Most importantly, the NLC does not solve staffing shortages.

It does not create a pool of new nurses or improve retention.

For rural states like Montana and Alaska,

the real solution is investing in the nurses who live and work in your communities through competitive wages,

strong support systems,

and enforceable safe staffing guidelines and recommendations.

Because recruiting,

then retaining those nurses is what truly strengthens access to care and community health.

Finally, there is widespread misunderstanding surrounding the Compact.

Nurses cannot simply hold one license and practice anywhere indefinitely. When they move or relocate, they must by law obtain a new home state license.

This confusion contributes to ongoing compliance issues. In closing,

Montana's experience shows that the NLC...

reduces oversight,

shifts costs onto in-state nurses,

and does not solve the workforce shortages.

We have been a part of the compact since 2015.

And with that said, if the NLC truly fixed staffing issues,

Montana would be one of the best staffed states in the country.

This is simply not the reality.

I urge you to carefully consider

whether these trade-offs align with Alaska's needs and deposit moving forward until these challenges are addressed.

Thank you, Mr.

Chair and members of the committee.

Thank you very much, Ms. Bird.

I would note,

as many of us are staring at a map where Montana is not highlighted as a compact state,

however,

quick Google search in your own words here show that you are,

so maybe we'll hear from the department as to why that is. Has there been some kind of change in status recently or vacillation in regards to Montana being a compact state?

I'm sorry,

Mr.

Chair,

members of the committee,

did you say Montana is not a compact state?

We're staring at a map here from our Department of Commerce,

Community,

and Economic Development folks that does not have Montana showed as a compact state.

We have been a compact state since 2015 and then in 2017 adopted the enhanced licensure compact.

So we in fact have.

Okay. Thank you for that clarification.

You bet.

All right.

All right, let's see.

Up next,

Mr.

Bob Severson,

Here, Bjorklund.

Dear New Yorkman members of the committee,

thank you for the opportunity to speak today.

My name is Bob Seibert and I'm the chair of the Alaska Commission on Aging and I'm here to express strong support for Alaska joining the Nursing Licensee Compact.

Alaska is facing one of the most severe nursing shortages in the country.

Hospitals, long-term care facilities,

tribal health organizations,

and rural clinics are struggling to fill critical positions.

In some communities, losing even one nurse can mean delayed care,

reduced services, or closure of essential programs.

The NLC is the fastest, most cost-effective tool to expand our workforce.

No other state faces the same combination of isolation,

weather barriers,

and limited local training and capacity.

The NLC would allow qualified nurses to begin work immediately.

We also saw during COVID how difficult it was to bring nurses quickly during an emergency,

you know, if you would solve that problem,

to give Alaska instant access to national pools of licensed vetted nurses.

Importantly, the Compact strengthens patient safety. It requires fingerprinting, background checks,

and real-time sharing of disciplinary actions across these and other states.

Today, Alaska only sees those actions after a nurse applies.

Under NLC,

they would see them immediately.

43 states have already joined the compact.

Remaining outside the NLC puts Alaska at a competitive disadvantage.

Nurses increasingly choose compact states because they offer mobility and faster employment.

We must remove barriers, not create them.

For rural Alaska and tribal health systems,

this is not a convenience,

it's a lifeline.