Legislature(2017 - 2018)HOUSE FINANCE 519
04/17/2017 01:30 PM FINANCE
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HOUSE BILL NO. 25 "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." 3:31:21 PM REPRESENTATIVE MATT CLAMAN, SPONSOR, read a prepared statement: Good afternoon members of the Committee, for the record, my name is Matt Claman, and I am the State Representative for House District 21 in West Anchorage. First off, I would like to thank you all for hearing House Bill 25 this afternoon. All across Alaska, women do not always have ready access to women's health services. Women living and working in rural areas, the tourism industry, the military, and on the North Slope face additional barriers, geographical and otherwise, to obtaining greater access to family planning options. Currently, women who use hormonal contraceptives must return to the pharmacy every month to three months to refill their prescriptions. House Bill 25 requires health insurers to offer consumers the option to receive a 12-month supply of hormonal contraception at a time. The women in my family support House Bill 25, and that tells me a lot. They support it not only because it is often time consuming and inconvenient to obtain a prescription contraceptive every 3 months or, in some cases, every month, but they support it because they know that improved access to contraceptives means huge reductions in unintended pregnancies. Unintended pregnancy has a profound effect on the overall well-being of Alaskan families. Unintended pregnancy is associated with adverse maternal and child health outcomes. Along with health concerns, unintended pregnancy is a dramatic cost driver to public health programs. I believe, and I hope the members of the committee will agree, that with Alaska's financial challenges, we should look for ways to reduce costs in the short-term and long-term, and this bill does exactly that. House Bill 25 makes sense for Alaskan women and families. With that, I will turn it over to my staff, Lizzie Kubitz, to explain the details of the bill. LIZZIE KUBITZ, STAFF, REPRESENTATIVE MATT CLAMAN, read from a prepared statement: Thank you members of the committee, for the record, my name is Lizzie Kubitz and I am staff to Representative Claman. Thank you all for hearing House Bill 25 today. House Bill 25 would require health insurance companies to, at the request of the consumer, provide coverage for a 12-month supply of contraceptives at one time and provide reimbursement to a health care provider or dispensing entity. In the bill, prescriptive contraceptives include hormonal contraceptives, namely oral contraceptives, commonly known as "the pill." Section 1 of the bill lays this out. Section 1 also gives health care insurers the ability to enact reasonable cost containment measures. In subsection (d), cost containment is defined as incentivizing the use of generic or lower cost medications or the use of health care providers or pharmacies that offer services or prescriptions at a lower rate. The inclusion of this language gives insurers the ability to steer towards generics as a cost containment strategy-a provision that the Department of Administration has advocated for as it could substantially reduce their costs in covering a 12- month supply of birth control. However, subsection (e) states if the covered therapeutically equivalent version of a prescription contraceptive is not available or is considered medically inadvisable by the health care provider of the insured, a health care provider shall provide coverage without cost sharing for an alternative therapeutically equivalent version of the prescription contraceptive that is prescribed for the insured. The inclusion of this language makes it clear that even though insurers will be allowed to steer towards generics, if a particular generic or brand is determined medically inappropriate by the health care provider, then the insurer must accommodate the insured. 3:35:55 PM Ms. Kubitz continued to read a prepared statement: Finally, Section 1 also includes a religious exemption, so health plans sponsored by certain exempt religious employers are not subject to the requirements of Section 1. Section 2 amends AS 39.30.090(a), which relates to policies of group insurance covering state employees- by adding a new subsection (13) to capture group health insurance policies covering employees of a participating governmental unit. Section 3 amends AS 39.30.091, which relates to self- insurance and excess loss insurance-by adding language to capture a self-insured group medical plan covering active state employees. Sections 2 and 3 clarify that the requirements of Section 1 apply to active state employees. I will note for the record that Michele Michaud from the Department of Administration is present to answer questions relating to Title 39. Section 4 directs the Department of Health and Social Services to cover the 12-month supply of prescription contraceptives for eligible recipients of medical assistance. Section 5 directs the Department of Health and Social Services to amend and submit for federal approval a state plan for medical assistance coverage consistent with Section 4. Section 6 is a conditional effect of Section 4 of the bill, and Sections 7 and 8 pertain to effective dates. One major premise behind House Bill 25 is that when women have greater access and availability to contraceptives, unintended pregnancies are reduced. Reductions in unintended pregnancies have a direct cost savings to the state, which is reflected in the fiscal notes from the Department of Health and Social Services. And I will note for the record that Margaret Brodie from the Department is online and available to answer questions about the department fiscal notes. According to a study, which I believe is in your bill packets, in 2010, 48% of all pregnancies in Alaska were unintended. Additionally, the study estimates that 64.3% of the unintended pregnancies in 2010 were publicly funded. As a State, Alaska spent $113.7 million on unintended pregnancies. Of that, $70.8 million was paid for by the federal government and $42.9 million was paid by the state. An additional study, included in your packet, looks at 84,000 women in California who were given various supplies-1 month, 3 months, and yearlong-of oral contraceptives . The researchers of that study observed a 30% reduction in the odds of conceiving an unintended pregnancy when given the yearlong supply of oral contraceptives. That study also showed that over the course of the year, California's family planning program paid $99 more annually for women who received 3 cycles, and $44 more for women who received one cycle, than it did for women who received a yearlong supply all at once. This was mostly due to the costs of associated visits and the higher use of pregnancy tests among women who received fewer cycles. Women who received 3 cycles were almost twice as likely as women who received the 12-month supply to visit a clinic to get a pregnancy test. It is important to note that this bill does not change who is eligible for coverage. What the bill does is allow women, who already receive coverage for prescription contraceptives, to receive, if she so chooses, 12 months of that prescription at one time. I wanted to take a moment to address some concerns we have received from the Alaska National Federation of Independent Business (NFIB) and America's Health Insurance Plan (AHIP). The NFIB has brought forward concerns about whether this bill would apply to the state employee programs. We have addressed that concern with the inclusion of language found in Sections 2 and 3 of the bill. An additional concern from the NFIB is the cost burden of supplying 12 months of contraception at one time. In response to that concern, multiple studies over the past two decades have found that contraceptive coverage does not raise insurance premiums and that employers providing such coverage can, in fact, save money by avoiding costs associated with unintended pregnancy. The average commercial insurer payment for all maternal and newborn care ranges from $18,000 to $28,000. The average hormonal birth control costs range from $100 to $600 a year. By preventing just one unintended pregnancy, an insurer can save a minimum of $17,000. That is enough savings to pay for 29 additional years of contraception. AHIP also brought forward concerns. Their initial concern is that a 12-month supply of contraceptives could compromise patient safety, due to potential decreased visits to a prescribing physician, and efficacy, due to potential improper storage of a 12-month supply of birth control. To address the concern of safety-research shows that birth control pills can be safely prescribed based on a careful review of your medical history and blood pressure measurement. For most women, no further exams are necessary. A Centers for Disease Control and World Health Organization study in 2013 recommended dispensing a year's supply of contraception and advising women to return at any time to discuss side effects, other problems, or changing the method being used, but that no routine follow-up is required. 3:41:21 PM To address the concern of efficacy-according to the Centers for Disease Control and Prevention, oral contraceptives have a shelf life of three to five years, depending on the manufacturer. This timeframe can be diminished depending on things like temperature and moisture, but we trust that women who would opt for a 12-month supply (women who are regular users of hormonal contraception) know how to properly store their medication. Additional concerns from AHIP include waste, fraud, and abuse. To address the concern of waste-in the study included in your bill packets, researchers in California found that women who were dispensed a yearlong supply on average "wasted" about one cycle of prescription contraceptives. Wasting one cycle of pills is fairly insignificant in comparison to the cost savings, such as fewer total clinician and pharmacy visits, the costs associated with pregnancy, and so on. Overall, House Bill 25 would have huge advantages for Alaskan women. From eliminating the inconvenience of refilling their prescription every 1 or 3 months at a time, to the real inability for some Alaskan women to make it to the clinic, hospital, or pharmacy to refill that prescription at all. Fisherwomen sometimes spend 3 to 4 months out on a boat at one time. Women who are attending college often have busy schedules balancing school and a job. Women in rural Alaska often have trouble making it to the clinic or hospital due to lack of transportation and limited operating hours. This bill ensures the freedom for Alaskan women to make decisions about their health and their futures. Ms. Kubitz offered to answer any committee questions. 3:43:50 PM Representative Wilson asked for the definition of unintended pregnancy. Ms. Kubitz replied that the pregnancy was not planned or desired by the individual. Representative Wilson countered that it was necessary to know which definition applied - unplanned or undesired. She spoke to concern about the fiscal note. She spoke to statistics and the distinction between unplanned and unwanted. She believed that not all unplanned pregnancies were unwanted. Co-Chair Seaton asked Representative Wilson for clarification. He provided the scenario where a woman misses taking the pill due to a one month or three month prescription and wondered what distinction she inquired about. Representative Wilson referred to analysis in the fiscal note and expected savings regarding the number of unintended pregnancies due to the twelve month prescription. She deduced that the "whole premise behind the savings in the fiscal notes" was based on unintended pregnancies. She relayed from personal experience that it was not a problem to obtain contraceptives for an extended period. She believed the distinction between unplanned and "unwanted" was germane to the fiscal notes. 3:46:13 PM Ms. Kubitz replied that the statistics only applied to the rates of unintended pregnancies. She cited the study ["Increased Contraceptive Supply linked to Fewer Unintended Pregnancies" University of California San Francisco (copy on file)] statistics that reported a 30 percent reduction in the odds of a pregnancy and a 46 percent decrease in the odds of an abortion for women given a one-year supply of birth control. She noted that the "whole point" of the bill was for women to receive the entire supply of the contraceptive prescription for a 12-month period. She stated that if women had access they were more likely to use it which limited the chance of pregnancy. Representative Wilson reiterated her belief that women had access to contraceptives. She asked whether the bill made contraceptives available for men as well. Representative Claman replied that "sadly" hormonal prescription contraceptives were not available for men. Representative Wilson opined that condoms could be provided for men. She remarked that women must remember to take the pill on a scheduled basis or they risk pregnancy. The issue did not apply to condom use. She believed the legislation placed the burden and fault on women. Ms. Kubitz discerned that adding condoms would erode the cost savings in the fiscal note. The cost savings in the fiscal note was predicated on the amount of unintended pregnancies avoided when women were prescribed a twelve month supply of contraceptives. Representative Wilson wondered whether current statute prohibited a twelve month prescription. MARGARET BRODIE, DIRECTOR, DIVISION OF HEALTH CARE SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, responded that currently all prescriptions were available for the maximum of 90 days. Representative Wilson asked where she could find the provision in statute. Ms. Brodie was uncertain and offered to provide the information later. Representative Wilson referred to Page 1, line 11 of the bill concerning voluntary sterilization procedures and wondered whether the provision applied to both men and women. Ms. Kubitz thought the provision applied to both sexes. She stated that the provision was added to ensure sterilization was a covered service. Ms. Brodie conveyed that sterilization was covered for both sexes. 3:52:24 PM Representative Neuman understood that contraceptive pills were also used for other purposes such as migraines. He inquired whether other uses were covered. Ms. Kubitz answered in the affirmative. Representative Neuman asked Representative Claman about facts in the sponsor statement. He referred to the $42.9 million cost to the state for unintended pregnancies and asked for a breakdown of costs. Ms. Kubitz reported that the number was based on a study included in members bill packets from the Guttmacher Institute titled, "State Facts About Unintended Pregnancy" (copy on file). She informed the committee that the data was from 2010 and was the most recent available. In Alaska, the state and federal governments spent $113.7 million for unintended pregnancies broken down to $70.8 million or 52 percent was spent by the federal government and $42.9 million was spent by the state. Co-Chair Seaton verified that the cost savings resulted in the avoidance of the unintended pregnancies. Ms. Kubitz nodded affirmatively. Representative Neuman maintained that he wanted a better understanding of the costs associated with the savings. Ms. Kubitz deferred to Ms. Brodie to clarify the numbers. 3:57:10 PM Ms. Brodie relayed that the cost savings to the Medicaid program was $1.355 million that represented the cost of 420 unintended pregnancies for the cost of delivery, medical services, and prenatal doctor visits. Representative Neuman was "trying to add validity" to the statements provided. Representative Grenn quoted the following from the Guttmacher Institute document: In 2010, 3000 or 64.3% of unplanned births in Alaska were publically funded… Representative Grenn calculated from the $43 million figure that the cost was roughly $14.3 thousand per unintended pregnancy. He deduced that the amount was approximate to the cost per delivery from his personal experience. He deemed that the facts provided in the sponsor statement were accurate. He thought that complicated births were factored into the calculations. Ms. Brodie answered in the affirmative. Co-Chair Seaton wondered whether the fiscal note reflected the cost of the contraceptives or savings from avoided births. Ms. Brodie explained that the fiscal note reflected the savings from unintended pregnancies. The state currently paid for the cost of the contraceptives four times a year along with dispensing fees each time therefore; no additional funding for the contraceptives were necessary. She added that the costs for contraceptives would likely decrease due to fewer dispensing fees. Representative Grenn suggested that the intent of the bill was to provide access. He wondered whether the intent of HB 25 was providing access or cost savings. Representative Claman responded that the intent was both, a cost savings to the state and better access. 4:02:02 PM Representative Kawasaki agreed with the underlying bill. He had personally obtained a 90-day prescription for the legislative session and had to go to Fred Meyer to have it refilled. He wondered whether a physician typically prescribed for twelve months or did length of prescriptions correspond with refills. Ms. Kubitz understood that length of prescription was dependent on what the insurance companies covered. Representative Kawasaki wondered whether there might be some situations where a physician would not want to prescribe a 12-month prescription for birth control. Ms. Kubitz responded that the purpose of the bill allowed a woman to opt for a 12-month prescription but ultimately the decision belonged to the doctor. Representative Kawasaki inquired whether the choice was ultimately up to the patient if the 12-month prescription was advisable. Ms. Kubitz responded that a twelve month supply was an option rather than mandatory. Representative Guttenberg relayed information from personal experience about the difficulty of obtaining the refills for his personal prescriptions that was prescribed every 30 and 90 days. He suggested that the way pharmaceuticals were prescribed was part of the inherent problem of escalating costs. He thought that the way drugs were prescribed by statute was burdensome and expensive for the state. He remarked that Alaska was doing health care by statute. He asked for clarification. Ms. Brodie responded that prescribing had to be addressed in statute so the insurance company would know coverage was possible for the entire period of time. 4:07:44 PM Vice-Chair Gara appreciated and supported the bill. Representative Wilson asked whether Alaska Care prohibited a woman from receiving a 12-month prescription for contraceptives. MICHELE MICHAUD, CHIEF HEALTH OFFICIAL, DIVISION OF RETIREMENTS AND BENEFITS, DEPARTMENT OF ADMINISTRATION, replied that currently the plan allowed for 90 days but the plan administrator who was the Commissioner of the Department of Administration could change the amount of coverage. Representative Wilson asked whether a contraceptive prescription could be extended before the 90 day period ran out through a phone call. Ms. Michaud responded in the affirmative and added that Alaska Care allowed for vacation overrides. Representative Wilson asked whether any type of contraceptive coverage was available for men. Ms. Michaud responded in the negative and elucidated that condoms were not covered under the plan. Representative Wilson asked whether she was aware of other provider's practices regarding contraceptive extensions. Ms. Michaud responded that she was uncertain of how other providers handled the situation. She assumed other insurers had similar provisions. Representative Wilson requested more information identifying the problem and wondered what the bill was "trying to fix." Representative Guttenberg asked for a definition of a vacation override. Ms. Michaud explained that the vacation override was variable and was based on the individual's circumstances and needs. She elaborated that the override had to be requested each time it was necessary, even if work travel was routine and overrides were needed for each 90-day prescription. Vice-Chair Gara also mentioned problems when getting his personal prescriptions refilled. He wondered whether a person's doctor had to be contacted when a contraceptive prescription needed to be refilled. Ms. Kubitz responded that it depended on whether refills were part of the prescription. She reminded the committee that the point of the bill was access to a twelve month supply all at once. She pointed out that other circumstances interfered with women getting to a pharmacy and/or obtaining refills every 90 days. 4:13:41 PM Representative Pruitt asked what percentage of insurance plans were separate from Alaska Care in the state. Ms. Kubitz responded that the bill encompassed Alaska Care, Medicaid recipients, and private health insurers. She did not know actual percentages. Representative Pruitt asserted that the state was unable to regulate all private insurers. He wondered what percentage of private insurances the bill affected. Representative Claman responded that the bill applied to private sector insurers and underwriters who covered employees in the state. ANNA LATHAM DEPUTY DIRECTOR, INSURANCE DIVISION, DEPARTMENT OF COMMERCE COMMUNITY AND ECONOMIC DEVELOPEMNT, replied that roughly 50 percent of the plans were captured under the bill. She detailed that the Employee Retirement Income Security Act (ERISA) plans and the self-insured were exempt but large and small group plans and State of Alaska plans were covered under the legislation. Representative Pruitt asked that if Alaska Care and Medicaid recipients were carved out what percentage of covered plans were left. He felt the legislation's mandate affected small "mom and pop" companies. 4:17:30 PM SARAH BAILEY INSURANCE SPECIALIST III - INSURANCE DIVISION, DEPARTMENT OF COMMERCE, responded that the division regulated approximately 20 percent of the health care market in Alaska including, individual, small and large employer. Representative Pruitt asked whether there was anything that prevented private insurers from implementing the twelve month contraceptive coverage. Ms. Bailey responded in the negative. Representative Pruitt determined that the bill mandated 12- month contraceptive coverage to 20 percent of the insurance market in the state. He wondered whether his statement was accurate. Ms. Latham answered in the affirmative. Representative Pruitt asked about the religious exemption in the bill. He read the following [page 3, lines 1 through 10]: the state a health care insurance plan in the group market 1 to a religious employer is exempt from the requirements of this section with respect to the health care insurance plan of the religious employer if the religious employer opposes the coverage required under this section and is an (1) organization that meets the criteria set out in 26 U.S.C. 6033(a)(3)(A)(i) or (iii) (Internal Revenue Code of 1986), as amended; or (2) eligible organization that has self-certified in the form and manner specified by the United States Secretary of Labor or has provided notice to the United States Secretary of Health and Human Services, under the requirements set out in 45 C.F.R. 147.131(b)(1) - (3). Representative Pruitt commented that there were employers that had legitimate religious concerns. He wondered what protections the legislation provided to employers with religious affiliations. Ms. Latham responded that based on her assessment religious groups were exempt. Ms. Kubitz pointed out that the bill was tailored to match provisions in the Affordable Care Act (ACA) regarding religious employers and organizations exemptions. She believed that the 12-month contraceptive mandate did not apply to the religiously exempt group. Representative Pruitt remarked that ACA could be repealed. He asked whether religious entities would be able to maintain their exemptions. Ms. Latham responded that if the ACA was repealed so would the contraception mandate and religious organizations and would "probably need an exemption." Representative Pruitt suggested that the bill created a mandate regardless of the ACA. He disagreed and asserted that HB 25 was based on the ACA as a guideline to some of the provisions in the bill. Representative Claman was unsure how a court would handle the situation. He predicted that the department and courts would provide exceptions. The intent in the bill provided for religious exemptions and he thought that a court would interpret the exemption to apply even if the ACA was repealed or altered. 4:24:41 PM Representative Pruitt remembered that years ago a previous proposed constitutional amendment meant to protect the Permanent Fund Dividend referenced an existing statute. A legal opinion regarding the amendment determined that attaching it to existing statute that was possible to alter was tenuous. He believed that the same argument applied to the religious exemption provision in HB 25. Representative Claman thought that the number of hypothetical arguments were limitless and maintained that he answered the question to the best of his ability. Vice-Chair Gara recommended adding a date to the statues that referenced the ACA provisions and noted that there was precedent for that type of clarification. He exemplified the language, "as existed on January 1, 2017" and suggested that the language could be added later by amending HB 25. Representative Claman agreed to examine the issue. Co-Chair Seaton surmised that Section 1 contained the language, "the health care insurer that offers" and interpreted that if the ACA was repealed the provisions would not apply. If the insurer no longer offered contraceptive coverage due to the repeal the statute no longer applied to those insurers. He thought that the scenario was "frustrating." Healthcare was driving much of the budget and economy of the state. He believed that the discussion should focus on passing bills that help control costs and improve efficiency in the health care system. 4:28:32 PM Representative Wilson shared her concern that Alaska Care and Medicaid could change the policy on its own and if so, why it wasn't changed. She wondered if the legislation would force a doctor to prescribe a 12 month prescription. She stated that some doctors wanted to see patients every three months. Ms. Kubitz replied that the bill did not place a mandate on the doctors. Most doctors who prescribed contraceptives would not think that numerous checkups were necessary. Representative Wilson inquired whether any insurance company could provide information regarding the necessity of the legislation and what if anything prevented them from covering a 12 month supply of contraceptives. Vice-Chair Gara was given the gavel to temporarily chair the meeting. Vice-Chair Gara OPENED Public Testimony. ALYSON CURREY LEGISLATIVE LIAISON, PLANNED PARENTHOOD VOTES NORTHWEST AND HAWAII, read a prepared statement: Thank you, Mr. Chair and members of the committee for the opportunity to testify today. My name is Alyson Currey. I am a resident of Juneau and I represent Planned Parenthood Votes Northwest & Hawaii. Planned Parenthood has provided birth control and other high-quality health care across the nation for more than 100 years and we strongly support HB 25. In Alaska, we currently serve more than 7,700 patients, which includes providing birth control to nearly 3,000 women. There are many different kinds of birth control, and no one method will work for every person at every stage of their life. Women who are not satisfied with their contraceptive method, are less likely to use it consistently. Therefore, every person should have full access to the birth control method that works best for them, without barriers based on cost and regardless of their insurance plan, in order to increase consistent use. House Bill 25 would remove such barriers. Family planning is a basic economic issue for women and families. Unintended pregnancies put women at greater risk of homelessness, family hunger, poor birth outcomes, and long-term dependence on publicly funded programs. Family planning also creates costs savings for public and private insurance plans. Allowing women to access a full range of FDA-approved contraceptives and providing a year's supply of birth control instead of limiting dispensing to one or three cycles lowers direct costs on follow-up visits, pregnancy tests, and long-term costs associated with unintended pregnancies. Eight other states have passed legislation similar to HB 25, including Washington, Virginia and California. In an analysis of California's bill, the California Health Benefits Review Program found that the reduction in unintended pregnancies and doctor visits would result in about $42.8 million in savings for the state in its first year of existence. AK's cost- savings analysis of HB 25 shows a higher savings per capita. By taking steps to decrease unintended pregnancies, the state will decrease its long-term social service spending and save money. Please support comprehensive birth control access for all women and vote yes on HB 25. 4:35:23 PM ELIZABETH FIGUS, SELF, SITKA, spoke in favor of HB 25. She shared that she was a doctoral student at the University of Alaska in Fairbanks and Juneau resident and in the summer months she skippered a troll fishery tender. She felt that the bill was a "no brainer" in a state where so many people worked in remote locations seasonally. She spoke about the unnecessary expense and difficulty in finding any time for doctor's appointments or pharmacy visits during her busy fishing season. She believed the bill was only about streamlining prescription pick-ups. She was certain that the committee "understood the importance of economic efficiency for all Alaska residents." She urged members to vote "yes" on the bill. 4:37:04 PM ELIZABETH EILERS, SELF, JUNEAU, spoke in favor of HB 25. She stated that "politicians cannot grow the economy and simultaneously limit access to birth control" and thought that the "state's economic health and women's reproductive health were linked." She indicated that she paid a high amount for birth control and believed that created numerous challenges to access. She spoke of the high costs of all types of birth control in out-of-pocket expenses. She thought meaningful access to a variety of methods was "critical" and a women's right. She maintained that without insurance coverage the cost of birth control was unattainable. She urged members to support HB 25 and "not leave women behind." 4:38:58 PM ALICA CARGILL, POLICY SPECIALIST, ALASKA NETWORK ON DOMESTIC VIOLENCE AND SEXUAL ASSAULT, supported the legislation. She spoke to "contraceptive coercion," access, and equity. She relayed that in FY16 her agency served over 6,300 women and was "heavily invested in reproductive health, access, and equity." She explained that "power and control was the overall basis of domestic violence and sexual assault." She stated that "a victim's autonomy was fundamental in both preventing and responding to violent acts. One critical element of this autonomy was access to both affordable and consistent reproductive healthcare." She felt that the bill enabled a women's autonomy. She explained that contraceptive coercion was when an abuser controlled a woman's ability to contraceptive access and use. She explained that the bill expanded coverage for long-acting reversible contraceptives such as intrauterine devices and implants and assisted the woman living as safely as possible in the short-term. She felt that unintended pregnancies could occur without the long-acting reversible contraceptives. She noted the correlation between unintended pregnancies and domestic violence that imposed "an even greater vulnerability for the victim." She added that the bill increased women's access in underserved rural populations. 4:41:25 PM Representative Wilson asked whether she was concerned because the bill only applied to insurers who already covered contraceptives and some might choose to halt coverage due to increased costs related to the bill. She wondered if she was concerned with the possibility of less coverage. Ms. Cargill responded that she had not considered the scenario and would like to do further research. She guessed that her agency would still support the bill. Representative Wilson was concerned about any unintended consequences. 4:42:53 PM PAMELA SAMASH SELF, RIGHT TO LIFE, NENANA, opposed HB 25. She expressed concern over the discussion regarding cost savings from unintended pregnancies in rural populations and equated it to a discussion about "rural population control." She talked about doctors wanting to have routine follow-ups as a way to prevent serious side effects. She believed that unintended pregnancies were called "miracles." She said children were the "future" and not "dollar signs." She restated her opposition to HB 25. She did not believe in giving women 12 months of birth control and did not want to pay for emergency contraceptives. 4:45:56 PM PAIGE HOGSON, SELF, ANCHORAGE, spoke in support of HB 25. She offered that a lot of research existed that supported the benefits of the legislation; for women, their families, cost saving for the state, and society. She related that the access delayed child bearing until planned. She thought Alaska needed to be proactive. She urged members to support the bill. 4:47:04 PM ROBIN SMITH, SELF, ANCHORAGE, indicated that she was driving and would prefer to testify the following morning. Vice-Chair Gara agreed to the request. 4:47:38 PM JUSTINE WEBB, SELF, FAIRBANKS, spoke in favor of HB 25 She shared that she was a social work student at the University of Alaska in Fairbanks and grew up in Sitka. She relayed from personal experience the issues and difficulties regarding her limited access to contraceptives receiving only a 30 day supply at a time. She had missed classes and experienced other inconveniences accessing contraception. She conveyed that she was not able to refill her prescription with only 2 days of pills left. She could not imagine the added difficulties of accessing birth control in remote areas of the state in light of her experiences living in urban areas. She asked members to support the legislation. 4:50:04 PM VHEMIA PETERSON, SELF, ANCHORAGE, supported the legislation. She relayed that she graduated from the University of Alaska in Anchorage and currently worked two jobs and volunteered and participated in the community. She felt that her access to a long term supply of birth control contributed to her success. She noted the high sexual assault and abuse rate for women as well as a wide wage gap between men and women. She urged members to support the bill. 4:51:38 PM Vice-Chair Gara indicated the meeting would recess until April 18, 2017 at 9:45 a.m. He relayed the agenda for the afternoon meeting. ^RECESSED UNTIL TUESDAY, APRIL 18, 2017 AT 9:45 A.M.