Legislature(2015 - 2016)BELTZ 105 (TSBldg)
04/05/2016 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing: Alaska Gasline Development Corporation Board of Directors | |
| HB155 | |
| SB201 | |
| SB175 | |
| SB156 | |
| SB193 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 155 | TELECONFERENCED | |
| += | SB 201 | TELECONFERENCED | |
| += | SB 175 | TELECONFERENCED | |
| + | SB 156 | TELECONFERENCED | |
| + | SB 193 | TELECONFERENCED | |
| + | HB 268 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
SB 156-INSURANCE COVERAGE FOR CONTRACEPTIVES
2:38:54 PM
CHAIR COSTELLO announced the consideration of SB 156; "An Act
relating to insurance coverage for contraceptives and related
services; relating to medical assistance coverage for
contraceptives and related services; and providing for an
effective date." She noted that this is the first hearing of the
bill. [CSSB 156(HSS) was before the committee.]
SENATOR BERTA GARDNER, Alaska State Legislature, sponsor of SB
156, explained that with the exception of religious exemptions,
everyone is mandated to have health insurance and all policies
include coverage for birth control. Oftentimes, insurers make
self-administered hormonal birth control available on a monthly
or three-month increment. Passage of SB 156 would mean that,
after an initial three-month usage to demonstrate that a woman
is not experiencing complications, she'd be able to request a
12-month supply if she wished to do so. All existing copays
would remain in effect. Not every woman would want an entire
year's supply.
She said the goal is narrow. An individual who is covered by
insurance can opt to get a 12-month supply of hormonal
contraception, if she wants to.
SENATOR GARDNER reported that states that have implemented this
policy have seen a cost savings in all insurance pools that are
affected by the law. Washington State has experienced a savings
of about $4 million in Medicaid savings since implementation.
The fiscal note for SB 156 shows a savings of about $1.35
million a year.
2:41:21 PM
SENATOR GARDNER said much public testimony showed numerous
problems and barriers in the ability for women to obtain a
consistent supply of birth control. They are limited by clinic
hours, privacy concerns, and long stretches of time where they
are in remote areas.
She concluded that the bill is good policy and saves the state
money and offers benefits for women who use birth control.
2:42:08 PM
CHAIR COSTELLO asked how the savings would be made.
2:42:26 PM
KATIE BRUGGEMAN, Staff, Senator Berta Gardner, Alaska State
Legislature, referred to the fiscal note for SB 156 that shows
the Department of Health and Social Services estimated a savings
of $1.35 million. Cost savings would come in two main ways, by
preventing unintended pregnancies covered by Medicaid, and
through lower costs for bulk orders negotiated by insurance
companies. Washington experienced these cost savings.
2:43:40 PM
MICHELE MICHAUD, Chief Health Official, Division of Retirement
and Benefits, Department of Administration, explained that the
division administers the Alaska Care Employee Health Plan and
Retiree Plan, and SB 156 does not impact the division directly.
The employee plan offers extensive benefits and they are working
on surrendering "grandfather status" on January 1, 2017, which
means they would offer the full suite of contraceptive benefits
that are afforded under the Affordable Care Act. As a preventive
service they would be provided without copay. She noted they
have the ability within their plan to offer an extended supply
of contraceptives in the case of travel or being otherwise
unavailable to receive them. She noted they also offer mail-
order prescriptions to rural areas.
She said she does not oppose this bill, but it does not really
apply to the division. She believes that Alaska Care benefits
are equal to or better than the provisions in the bill. She
opined that the division will not see a large decrease in
pregnancies, nor cost savings to its plan should the bill pass.
2:46:22 PM
CHAIR COSTELLO asked if the fiscal note would change in the
future as it applies to Alaska Care.
MS. MICHAUD said there would be some savings for bulk orders and
reduced dispensing fees, but they have a different population
than the Medicaid population.
2:46:59 PM
SENATOR GIESSEL asked about their mail order option and whether
local pharmacies are used.
MS. MICHAUD explained their mail orders are from a third-party
administrator in another state.
2:47:29 PM
ERIN NARUS, Pharmacy Program Manager, Division of Health Care
Services, Department of Health and Social Services, offered to
answer questions related to SB 156.
SENATOR GIESSEL said the bill covers more than prescription
contraceptives. She read the list on page 1, lines 10-12, and
asked if it expands Medicaid benefits.
MS. NARUS said those items are under a different section of
commercial pay insurance. The Medicaid section of SB 156 begins
on page 3, line 5.
SENATOR GIESSEL asked if some prescriptions are dispensed
without copay. She asked if that is the standard for all
prescriptions under Medicaid.
MS. NARUS said there are copays for certain drugs. She provided
examples.
2:50:31 PM
SENATOR GIESSEL commented that it would absolve the beneficiary
of a copay.
MS. NARUS said yes.
2:51:18 PM
CHRISTINE NIEMI, Member, League of Women Voters-Alaska,
testified in support of SB 156. She read the following prepared
statement:
At the national level, the League of Women Voters
supports primary care for all, care that includes pre-
natal and reproductive health. When women have the
consistent ability to plan their pregnancies, their
families benefit through greater financial well-being,
healthier living conditions, healthier children,
greater opportunities, and a myriad of additional
benefits. While improving the quality of life for
families, the ability to avoid unintended pregnancies
also reduces the cost for state and federal
governments.
In 2010, according to the Guttmacher Institute, the
State of Alaska spent nearly $43 million on health
costs related to unintended pregnancies, while the
federal government added another $71 million for the
total cost of $114 million. Guttmacher reports that 48
percent of all pregnancies in Alaska in 2010 were
unplanned and 64 percent of Alaska's unplanned
pregnancies were publicly funded, representing the $43
million cost.
In addition, the cost benefits of supporting women in
their efforts to plan their pregnancies goes far
beyond the cost of the pregnancy itself. A woman who
is able to plan a pregnancy can better guarantee that
her health is at optimum levels prior to pregnancy,
reducing the risk of a difficult pregnancy and trauma
to the child. Such planning reduces the possibility of
increased health problems for the child; problems
which can follow the child for years and require
increased health and education costs for the state.
A planned pregnancy increases a woman's ability to
manage her role as an income provider for a family and
allows the family the best opportunity to remain as
financially independent as possible. Supporting
affordable contraceptives prescribed on a 12-month
basis will undoubtedly reduce the number of unintended
pregnancies in Alaska, thereby increasing family
wellbeing and reducing state costs. SB 156 can assist
women and families to plan pregnancies so they are
ready for the added responsibility of a child. In
addition, cost to the state for unintended pregnancies
can be reduced.
2:54:50 PM
SENATOR GIESSEL asked if she said a child born as a result of an
unplanned pregnancy is at a disadvantage.
MS. NIEMI responded that children who are unplanned often are
not able to be cared for by their families as well as planned
pregnancies.
SENATOR GIESSEL responded, "I guess I would, using logic,
construe that you're saying that they're better off having never
been born."
MS. NIEMI countered that she would not say it quite that way.
SENATOR GIESSEL said, "I'm sure not."
2:56:02 PM
ALYSON CURREY, representative, Planned Parenthood Votes
Northwest and Hawaii, testified in support of SB 156. She spoke
in support of insurance coverage for a 12-month supply of birth
control when prescribed by a healthcare provider. She thanked
the sponsor for her leadership and work on the bill. She read
from the following prepared statement:
As an advocate and provider of reproductive health
care for all, Planned Parenthood (PP) has long
supported sincere efforts to expand access to birth
control. We believe that every women should have full
access to the birth control method of her choosing
without barriers based on cost and availability. A
year's supply of birth control at a time is a solution
that lowers barriers and works for women.
One in four women say they have missed pills because
they could not get the next pack in time. Consistent
use of birth control is the best way to prevent
unintended pregnancy for those who are sexually
active. Getting a one-year supply dramatically
improves consistent use. According to a study
published in Obstetrics and Gynecology, dispensing a
one-year supply at a time reduces the odds of
experiencing an unintended pregnancy by 30 percent and
is also associated with a 46 percent drop in the
chance of needing an abortion. Furthermore, dispensing
twelve months of birth control would save significant
money for the state and private insurance carriers.
A study from the University of California - San
Francisco, found that insurance plans that dispense a
one-year supply of birth control lower their direct
costs on follow up visits and pregnancy tests, as well
as long-term pregnancy management. Women on Medicaid
would also experience lower rates of unintended
pregnancies and save the state money.
We believe that a woman's consistent access to birth
control should not depend on her insurance carrier,
and we continue to be committed to working with other
stakeholders to create the best possible legislation
for all parties in order to help reduce barriers to
contraceptives, prevent unintended pregnancy, and save
the state additional money.
2:58:27 PM
CHAIR COSTELLO asked about the correlation between the lack of
birth control and unplanned pregnancies. She inquired how that
data is collected.
MS. CURREY offered to provide follow up information.
SENATOR GIESSEL noted the bill sounds benign, but entails
volunteer sterilization procedures.
MS. CURREY said she believes that language was in the bill
because the procedure is included in the Affordable Care Act.
3:00:33 PM
ELIZABETH FIGUS, representing herself, testified in support of
SB 156. She spoke of her work as a captain of an Alaska trawl
tender. She urged support of the bill in order to help make it
possible for Alaska women to receive contraceptives for twelve
months at a time. She noted that so many residents of Alaska
spend a significant portions of the year in remote locations,
herself included. She spoke of the barriers to getting
contraceptives during this time. She believes the bill will save
individual women money and time and avoid unwanted pregnancies.
She clarified that this bill is a fiscally responsible choice
for women's health.
She pointed out that the bill does not focus on children that
are unplanned, but on women who are legally receiving
contraception and whether or not they can receive it for 12
months.
3:02:27 PM
SAMANTHA SAVAGE, representing herself, testified in support of
SB 156. She stated that Alaska women face more barriers when
trying to access all medications due to geographical and
occupational and financial reasons. She related a personal
experience of difficulty in trying to obtain oral contraceptives
while going to school and working.
3:03:46 PM
ROBIN SMITH, representing herself, testified in support of SB
156. She said it's inconvenient to get just 30 pills at a time
and there are a lot of reasons other than unwanted pregnancy to
be on birth control. She gave examples of other reasons for
being on birth control including ovarian cancer and endometrial
cancer.
3:07:40 PM
KENNI PSENAK-LINDEN, representing herself, testified in support
of SB 156. She shared her personal story of being diagnosed with
endometriosis and the difficulty of only having a prescription
for 30 days at a time. She attributed the ability to graduate
from college to the ability to have access to hormonal birth
control.
3:09:42 PM
DAN NELSON, Director of Pharmacy, Tanana Chiefs Conference,
testified in support of SB 156. It will save the state and
federal government millions of dollars. Patients in rural areas
will avoid the difficulty and inconvenience of running out of
contraceptive medication.
3:11:45 PM
SHEELA TALLMAN, Senior Manager of Legislative Policy, Premera
Blue Cross, testified about implementation concerns with SB 156.
She said it is unclear whether the coverage provision imposes a
new mandate on health care plans. She encouraged careful review
of the bill. The bill would also impact private and group
grandfathered health care plans. This could be as high as 3-4
percent of premium, so they are asking for an exception for
grandfathered plans.
She discussed an amendment they submitted to the sponsor to
ensure that the insured is receiving a supply not to exceed 12
months total. Finally, they are requesting an effective date of
January 1, 2018, because it isn't feasible to make these changes
before then.
3:14:54 PM
MOLLY GRAY, Executive Director, Alaska Pharmacists Association,
testified in support of SB 156. She suggested changing the 90-
day requirement for the first filling of the prescription
because it would create insurance issues. She thought that
section had been removed from the House version of the bill. She
concluded that the bill aligns with the Alaska Pharmacists
Association mission.
3:16:15 PM
CATRIONA REYNOLDS, Manager, Kachemak Bay Family Planning Clinic,
testified in support of SB 156. She noted she submitted written
testimony. She noted that Medicaid currently has no copay for
contraceptives. She highlighted that many women only use 21 days
of a 30 day supply so 17 packs could be needed for one year. She
provided anecdotes of clients who do not have insurance and how
they are able to receive birth control for 12 months.
3:18:32 PM
DIRK WHITE, Pharmacist and past president of the Board of
Pharmacy, stated support for SB 156.
3:19:19 PM
CHAIR COSTELLO stated she would keep public testimony open and
hold SB 156 in committee.