OPINION: This Alaska government program not only works, it’s wildly successful

I’ve become numb to dysfunction in state government from budget cuts and staff shortages. The food stamp debacle and the recent Medicaid renewals are cases in point.

Given that, it’s a delight to find a state program that not only works but exceeds all expectations.

I’m speaking of SHARP, aka Supporting Health Care through Loan Repayment, a program that recruits and helps retain heath care professionals for medical providers. It’s operated by the state Division of Public Health with support from the Alaska Mental Health Trust Authority. It has been growing for 15 years and has been highly successful. The trust authority and the Division of Public Health, with help from the Rasmuson Foundation and the federal Health Resources and Service Administration, or HRSA, founded the program in 2008 and 2009.

Robert Sewell, recently retired from the state public health division, and Eric Boyer at the mental health trust authority, have been key players, with Sewell having been around from the start.

Here’s the background: We heard a lot about shortages of nurses during the pandemic, and those still exist. However, we’ve been short of most kinds of medical providers for years, particularly family care physicians, dentists, psychiatrists, counselors and others. We now have a crisis in mental health, particularly among young people, and we’re desperately short of behavioral health counselors.

With Alaska’s population aging, the shortage of skilled staff to help in chronic care, for senior citizens and the disabled, along with mental and behavioral health, are now major concerns.

SHARP has helped in all of these areas — more than 625 two- and three-year service contracts have been issued to health practitioners in the last 15 years. The program is growing fast, with a 56% increase, from 172 participants to 269, in new medical professional contracts active during the year, according to the Division of Public Health.

This doesn’t cost the state general fund a dime. Thus far, health care employers have footed most of the bill, with some support from federal funds and foundations.

Here’s how it works: The concept is “Support for Service,” which means a new medical school graduate packing huge college loans can get those paid, often by an employer, in return for signing on to work for two to three years.

Nothing new in this. The military has been doing it for years.

What’s different about SHARP, however, is that a federal tax law passed years ago allows the college loan payoffs to be free of federal income tax, with the provision that a state agency administers the loan contracts with employers. This is one of the roles the state Division of Health plays.

A variation of this is an incentive program for older, experienced care providers to stay in the workforce. Getting college debt paid tax-free is a big deal. And direct incentive can also have real impact.

The program evolved in two ways. Initially it was all federally sponsored, but with the requirement that professionals work in underserved communities, which in Alaska means mostly rural. Federal government support continues at about $1 million per year, with the same requirement for the underserved.

However, after its initial start in 2010, the Legislature moved to expand SHARP statewide — urban and rural — in 2012, and expanded the types of providers aided. This was with state general funds supplementing federal money, and it was approved unanimously in both the state House and Senate.

When the state appropriation ran out the program was changed so that funds could come from employer contributions or any other source. This was in a bipartisan bill pushed through the Legislature by Sen. David Wilson, R-Wasilla, and former Rep. Ivy Spohnholz, D-Anchorage, when she was in the Legislature. Part of that bill also made SHARP permanent, exempting it from periodic “sunset” reviews by the Legislature to extend authorization.

SHARP now covers a broad range of health practitioners, including behavioral health, drug and alcohol treatment and counseling as well direct-care workers who are increasingly important as the population ages. The program is important in funding mental health workers and counselors, including at the state’s Alaska Psychiatric Institute, and a range of health occupations in the state prison system.

Alaska Native tribal health consortiums are big users of the SHARP program. Thirty service contracts have recently been written for workers in the Yukon-Kuskokwim Health Corp. in Bethel, as have others in regional tribal health organizations in Nome, Kotzebue and Utqiagvik, which draw on the program.

The growth of this program is impressive, but it just scratches the surface of the total need, as most in health care know. In theory, however, there’s nothing stopping a rapid expansion of SHARP — although the ability of employers to fund the payments could be a short-term constraint. No matter. We need to find ways to do this.

But the good news that that we’ve proven SHARP works. It’s no longer a pilot or demonstration program. It is now a permanent fixture in state law. It also has been shown to have broad, bipartisan support in the Legislature. In this age, that’s refreshing.

Tim Bradner is the editor of the Alaska Legislative Digest and Alaska Economic Report.

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