Legislature(2013 - 2014)HOUSE FINANCE 519

02/27/2014 01:30 PM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Recessed to a Call of the Chair on 2/28/14 --
Heard & Held
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved HCS SSSB 49(FIN) Out of Committee
SPONSOR SUBSTITUTE FOR SENATE BILL NO. 49 am                                                                                  
     "An Act relating to women's health services and                                                                            
     defining 'medically necessary abortion' for purposes                                                                       
     of making payments under the state Medicaid program."                                                                      
1:46:29 PM                                                                                                                    
Representative  Costello discussed  the bill's  three fiscal                                                                    
notes including  two indeterminate notes from  Department of                                                                    
Health  and Social  Services (DHSS)  and  one fiscal  impact                                                                    
note from DHSS with a cost of $55,200 in FY 15.                                                                                 
1:47:51 PM                                                                                                                    
Representative Gara MOVED to ADOPT Amendment 1:                                                                                 
     Page 1, line 1, after "Act" insert "relating to                                                                            
     women's health services and"                                                                                               
     Page 1, line 4, insert a new section to read:                                                                              
          Section 1. AS  4 7.07 .030 is amended  by adding a                                                                    
          new subsection to read:                                                                                               
          (g)  The   department  shall  make   available  to                                                                    
          eligible recipients  a program for  women's health                                                                    
          for  the  purpose  of  providing  family  planning                                                                    
          services,   health  screening   examinations,  and                                                                    
          related services.                                                                                                     
     Page 3, line 6, insert a new section to read:                                                                              
          Sec. 3. The uncodified law  of the State of Alaska                                                                    
          is amended by adding a new section to read:                                                                           
               WOMEN'S HEALTH PROGRAM UNDER STATE MEDICAID.                                                                     
          The  Department  of  Health  and  Social  Services                                                                    
          shall  immediately  prepare   and  submit  to  the                                                                    
          United  States  Department  of  Health  and  Human                                                                    
          Services,  for  approval  in accordance  with  the                                                                    
          provisions of 42. U.S.C.  1396a (Title XIX, Social                                                                    
          Security Act), an amendment                                                                                           
Co-Chair  Stoltze  OBJECTED and  ruled  Amendment  1 out  of                                                                    
order. He stated that the  amendment was identical to a vote                                                                    
that had  previously taken place  on the adoption of  the CS                                                                    
[the CS  previously adopted by  the House  Finance Committee                                                                    
had removed language that Amendment 1 would reinsert].                                                                          
Representative Gara  replied that  the topic had  been fully                                                                    
debated  before the  committee had  all  of the  information                                                                    
about  the  women's health  program.  He  believed that  the                                                                    
amendment should be discussed  given the updated information                                                                    
the committee had received.                                                                                                     
Vice-Chair Neuman  MOVED to REPORT  HCS SSSB 49(FIN)  out of                                                                    
committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal notes.                                                                                                      
Representative   Guttenberg  OBJECTED.   He  spoke   to  the                                                                    
contentious nature  of the  bill topic.  He remarked  that a                                                                    
considerable portion of the bill  had been removed following                                                                    
its passage from the Senate. He  stated that if the goal was                                                                    
to reduce  the number of  abortions, the most  immediate way                                                                    
was to prevent them from  taking place. He stressed that the                                                                    
CS eliminated  the consideration from the  bill. He remarked                                                                    
that the  constitutional issue  would be  played out  in the                                                                    
Alaska  courts.  He  believed   that  without  a  prevention                                                                    
component,  the  bill  guaranteed the  number  of  abortions                                                                    
would increase.  He was equally  bothered by  the definition                                                                    
used  in the  legislation because  it did  not consider  the                                                                    
health or  well-being of the  mother or who  the responsible                                                                    
party would  be for the  unborn child. He believed  that the                                                                    
legislation's definition  treated the  mother as  the vessel                                                                    
carrying a child; that the  mother had no responsibility and                                                                    
that  government was  responsible. He  found it  problematic                                                                    
that the  bill did  not honor a  woman's decision  about her                                                                    
own  health, especially  if the  decision related  to mental                                                                    
health.  He believed  the  bill moved  further  away from  a                                                                    
point where  people could agree  on a definition  that would                                                                    
make  things healthier  for women  and  unborn children.  He                                                                    
emphasized that the bill did  not come near to resolving the                                                                    
issue. He noted that the courts  had spoken on the issue; he                                                                    
knew  no one  liked making  end-runs around  the courts.  He                                                                    
stated  that the  legislature was  not getting  closer to  a                                                                    
definitive  answer because  it was  refusing to  acknowledge                                                                    
some of the more serious problems on the issue.                                                                                 
1:53:42 PM                                                                                                                    
Representative   Gara  discussed   that   there  were   many                                                                    
individuals in  Alaska who were  pro-choice and  many others                                                                    
who were not. However,  constituents expected legislators to                                                                    
come together  where they agreed.  He stated that  there was                                                                    
an  opportunity  to  reduce   the  number  of  abortions  by                                                                    
adopting a  women's family planning program  that would have                                                                    
covered  90  percent  of  the  cost  for  contraception.  He                                                                    
believed the  number of abortions should  be reduced through                                                                    
family planning. He believed it  was a mistake to remove the                                                                    
provision from  the bill. He  thought the bill  may increase                                                                    
the  number  of  abortions  and  may  also  make  them  more                                                                    
dangerous for women who could not  afford to go to a medical                                                                    
provider. He stated that women  who had no children and were                                                                    
not pregnant would  be covered by a  women's health program.                                                                    
He  stressed  that  contraception   would  result  in  fewer                                                                    
unintended pregnancies  and fewer abortions. He  believed it                                                                    
was a  win-win for  people on both  sides of  the pro-choice                                                                    
pro-life  debate. He  addressed  former comments  by a  bill                                                                    
sponsor related to public health  clinics. He discussed that                                                                    
many  public health  clinics provided  some family  planning                                                                    
services;  however, women  should have  the right  to go  to                                                                    
their personal doctor. He did  not believe there should be a                                                                    
law preventing  women from going  to their doctor  when they                                                                    
wanted  family planning  services.  He noted  there were  no                                                                    
public  health  clinics  in  Denali  Park,  Arctic  Village,                                                                    
Barrow,  Kotzebue,  Togiak,  Naknek,   or  King  Salmon.  He                                                                    
stressed that  there had been  an easy  way for the  bill to                                                                    
limit  the number  of  abortions; he  intended  to have  the                                                                    
discussion on the House floor.                                                                                                  
Representative  Gara  addressed  the  bill as  a  whole.  He                                                                    
discussed  that he  was pro-choice,  but that  the topic  of                                                                    
abortion  made him  uncomfortable.  He did  not like  having                                                                    
fights  in the  legislature related  to the  divisive issue.                                                                    
The  system created  by the  bill allowed  middle class  and                                                                    
wealthy woman  to choose  to have  an abortion;  however, it                                                                    
did not  cover lower class  women. He stated that  a similar                                                                    
system had  existed sometime in  the past;  unsafe abortions                                                                    
had  led to  the death  and  serious injury  of mothers.  He                                                                    
opined that states  should each have a robust  debate on the                                                                    
right to choose; he believed  the right should exist. He did                                                                    
not  believe in  creating two  classes of  women; those  who                                                                    
could afford a safe abortion and those who could not.                                                                           
1:59:22 PM                                                                                                                    
Representative Gara  continued to  discuss his  objection to                                                                    
the legislation. He reiterated  that the bill would increase                                                                    
the number  of abortions for women  due to a lack  in family                                                                    
planning services  and would also make  abortions less safe.                                                                    
He did not support the legislation.                                                                                             
Representative  Munoz  observed  that  federal  law  limited                                                                    
public  funds for  abortions. She  noted that  547 abortions                                                                    
had been performed the past  year. She believed it was clear                                                                    
that  more  abortions  were happening  than  were  medically                                                                    
necessary. She  wondered why the  bill's definition  did not                                                                    
include diagnosed mental disabilities.                                                                                          
Co-Chair Stoltze relayed his intent  to allow the sponsor to                                                                    
provide clarity on the specific point.                                                                                          
Representative  Guttenberg remarked  that the  committee was                                                                    
in  the middle  of a  motion and  the sponsor  was providing                                                                    
comments on the legislation.                                                                                                    
Co-Chair Stoltze  explained his  intent to have  the sponsor                                                                    
address the topic as part of the committee deliberation.                                                                        
2:01:57 PM                                                                                                                    
Senator Coghill replied that the  Alaska Mental Health Trust                                                                    
Authority talked about the need  for commitment. The sponsor                                                                    
felt that the  bill language left the issue  well within the                                                                    
purview of  a doctor. He  stated that if a  mental condition                                                                    
created a  question [about  the safety  of a  pregnancy] the                                                                    
doctor would have every right to make the decision.                                                                             
Representative Wilson  spoke to her question  from the prior                                                                    
day. She  pointed to  occurrences in 2012  and who  paid for                                                                    
the  service;  she  listed Medicaid,  cash,  insurance,  and                                                                    
other.  She did  not know  if the  "other" category  was the                                                                    
possibility  for women  to have  the procedure  who did  not                                                                    
have insurance or  Medicaid. She stated that  if the "other"                                                                    
was another group  taking care of women who  did not qualify                                                                    
under other insurance then the  question became who paid for                                                                    
the procedure. She was concerned  about not knowing what the                                                                    
other  was. She  was hoping  to have  the question  answered                                                                    
before it went  to the House floor. She was  bothered by the                                                                    
difference  between  items  that  were  paid  for  by  state                                                                    
insurance  compared  to  Medicaid;   she  noted  that  state                                                                    
insurance paid  only for medically necessary  abortions. She                                                                    
stated  that if  a person  did not  qualify for  a procedure                                                                    
under state  insurance they were  on their own  to determine                                                                    
how to  pay for  it. She  remarked on  a definition  used by                                                                    
private  insurance that  appeared to  work given  that there                                                                    
had been  no legal suits.  She was concerned that  the state                                                                    
may  get  sued in  the  future  because regulations  already                                                                    
existed. She wondered  why the state did not  use the proven                                                                    
method  used  by  other  insurances   versus  going  in  the                                                                    
direction the bill  went. She stressed that  the state would                                                                    
get sued  under the  current method.  She continued  that if                                                                    
the state  lost on  the definition it  cost money  and meant                                                                    
the  legislature  would be  required  to  discuss the  issue                                                                    
again. She  stressed that the  term medically  necessary was                                                                    
used  for all  medical  procedures. She  believed the  issue                                                                    
should  not  have  been  made a  "women's  issue."  She  was                                                                    
willing to  let the  bill out  of committee,  but reiterated                                                                    
her  hope for  answers  prior  to hearing  it  on the  House                                                                    
2:06:41 PM                                                                                                                    
Co-Chair  Austerman  stated that  he  had  always been  pro-                                                                    
choice.  He  acknowledged the  efforts  of  the sponsors  to                                                                    
create a definition.  He recognized that the  debate was not                                                                    
about  pro-choice or  pro-life. His  concern was  about pro-                                                                    
life  efforts  to  cumulatively move  towards  the  pro-life                                                                    
goal. He  believed any  movement down  a cumulative  path to                                                                    
stop pro-choice created a long-term  problem. He opposed the                                                                    
Representative  Holmes was  disappointed that  the bill  did                                                                    
not  include a  family planning  program. She  believed that                                                                    
working  to avoid  unwanted pregnancies  was  the area  that                                                                    
everyone  came  together  on. She  urged  the  sponsors  and                                                                    
committee members  to include family planning.  She spoke to                                                                    
the  underlying language  of the  bill. She  understood that                                                                    
the topic  pertained to funding  and was not  about pro-life                                                                    
or pro-choice. The discussion related  to who paid and under                                                                    
what circumstances. She pointed to  the list included in the                                                                    
bill. She did  not want to continue debating  the issue, but                                                                    
did  not know  if the  nail had  been hit  on the  head. She                                                                    
believed the  definition equated to the  legislature telling                                                                    
a  doctor what  was  and was  not  medically necessary.  She                                                                    
agreed that  under current laws  Medicaid was  only supposed                                                                    
to pay for medically necessary  abortions; she was okay with                                                                    
that, but was uncomfortable with the list.                                                                                      
2:10:00 PM                                                                                                                    
Representative  Costello commented  on  the family  planning                                                                    
portion that  would not move  forward with  the legislation.                                                                    
She  believed  there was  a  place  for a  discussion  about                                                                    
family  planning,  but  she did  not  believe  the  language                                                                    
belonged in  the current bill.  She noted that  adoption was                                                                    
not mentioned in the bill;  she hoped that adoption would be                                                                    
discussed when family planning was  addressed at some point.                                                                    
She shared personal information related to adoption.                                                                            
Representative Edgmon had hoped  to be given the opportunity                                                                    
to vote  on the  family planning  element. He  discussed the                                                                    
cause and  effect relationship  of family  planning services                                                                    
related  to  cost  savings.  He   highlighted  the  lack  of                                                                    
facilities in  his rural district.  He believed that  in the                                                                    
current  social environment  (where there  was an  increased                                                                    
need  for Village  Public Safety  Officers) there  were many                                                                    
things  occurring that  family  planning  would enhance.  He                                                                    
believed the  objective supported by all  was fewer unwanted                                                                    
pregnancies  and  abortions.  He  stated  that  without  the                                                                    
family planning element it was  difficult for him to support                                                                    
the legislation. He respected the  sponsor, but he could not                                                                    
support the legislation.                                                                                                        
Vice-Chair Neuman spoke for the  life of an unborn child. He                                                                    
believed the definition represented a  good effort to find a                                                                    
scope  of  what  medically   necessary  abortion  meant.  He                                                                    
believed there  were some issues related  to family planning                                                                    
that needed  to be  addressed. He supported  bringing babies                                                                    
to  full term  so they  could be  adopted into  families. He                                                                    
addressed   Representative  Wilson's   concern  related   to                                                                    
private  insurance.  He   thought  insurance  companies  may                                                                    
choose to  pay for an abortion  even if a procedure  was not                                                                    
medically  necessary if  it may  save the  insurance company                                                                    
money. He supported  the bill and believed  it was necessary                                                                    
to include descriptive language in statute.                                                                                     
2:14:49 PM                                                                                                                    
Representative Costello MOVED to  RESCIND previous motion on                                                                    
the  fiscal  notes. There  being  NO  OBJECTION, it  was  so                                                                    
ordered.  She moved two  indeterminate and one fiscal impact                                                                    
fiscal  notes  from  the Department  of  Health  and  Social                                                                    
A roll call vote was taken  on the motion to report the bill                                                                    
from committee.                                                                                                                 
IN FAVOR: Costello,   Neuman,   Thompson,   Munoz,   Wilson,                                                                    
OPPOSED: Guttenberg, Gara, Holmes, Edgmon, Austerman                                                                            
The MOTION PASSED (6/5).                                                                                                        
There  being  NO further  OBJECTION,  HCS  SSSB 49(FIN)  was                                                                    
REPORTED out of committee  with "no recommendation" and with                                                                    
two indeterminate  fiscal notes  and one fiscal  impact note                                                                    
from the Department of Health and Social Services.                                                                              
2:16:19 PM                                                                                                                    
AT EASE                                                                                                                         
2:24:47 PM                                                                                                                    

Document Name Date/Time Subjects
HB 306 Sectional Analysis- Legal.pdf HFIN 2/27/2014 1:30:00 PM
HB 306
HB 306 Sponsor Statement.pdf HFIN 2/27/2014 1:30:00 PM
HRLS 4/13/2014 2:00:00 PM
HB 306
Indirect Expenditures Report - Legislative Research.pdf HFIN 2/27/2014 1:30:00 PM
HB 306
Alaskan-Seafood-Processing-Effluent-Guidelines-Notice-of-Data-Availability-Factsheet.pdf HFIN 2/27/2014 1:30:00 PM
HB 204
DOR 2013 Annual Report Page 19.pdf HFIN 2/27/2014 1:30:00 PM
HB 204
HB 204 Summary of Ocean Beauty Testimony.pdf HFIN 2/27/2014 1:30:00 PM
HB 204
HB 204 Support product development tax credit 2.5.14.pdf HFIN 2/27/2014 1:30:00 PM
HB 204
SPD Overview for HFISH.pdf HFIN 2/27/2014 1:30:00 PM
HB 204
HB 204 Sponsor Statement HFIN Committee.pdf HFIN 2/27/2014 1:30:00 PM
HB 204
SSHB204-SPDC qualified vs non qualified equipment.pdf HFIN 2/27/2014 1:30:00 PM
HB 204
Letter of Support HB 204 021714.pdf HFIN 2/27/2014 1:30:00 PM
HB 204
HB 240 Support.pdf HFIN 2/27/2014 1:30:00 PM
HB 240
HB 204 Support - LCF.pdf HFIN 2/27/2014 1:30:00 PM
HB 204
HB 204 Presentation HFIN.pdf HFIN 2/27/2014 1:30:00 PM
HB 204
HB 204 CS WORKDRAFT P version.pdf HFIN 2/27/2014 1:30:00 PM
HB 204
SB 49 - DHSS Support Document.pdf HFIN 2/27/2014 1:30:00 PM
SB 49
HB 306 NEW FISCAL NOTES.pdf HFIN 2/27/2014 1:30:00 PM
HB 306
HJR 10 - Version C - HFIN CS.pdf HFIN 2/27/2014 1:30:00 PM
HJR 10
DOR HB 204 data on Fishery Business Tax Credits 2004-2014.pdf HFIN 2/27/2014 1:30:00 PM
HB 204