Legislature(1997 - 1998)
04/25/1997 01:06 PM House JUD
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 234 - ABORTIONS UNDER GENERAL RELIEF PROGRAM CHAIRMAN GREEN announced the final item of business was House Bill No. 234, "An Act relating to assistance for abortions under the general relief program; and relating to financial responsibility for the costs of abortions." Two people had testified during that morning's hearing. Number 0236 REPRESENTATIVE TERRY MARTIN, sponsor of HB 234, offered a more detailed background for the bill than presented that morning. He said over the years, people have been offended by the public's paying for elective services, especially abortions. Although there is perhaps less stigma to abortions than previously, people do not feel they should pay for someone's elective procedure. REPRESENTATIVE MARTIN said Alaska's laws have been supported by the federal government, which says a male is responsible for a child out of wedlock at least until the age of 18. He asked: If males are to be responsible for a child who is born, why should they not be responsible for an abortion, especially when it competes against other medical needs of our society? Representative Martin stated, "... and in the House, it was about $500,000 we analyze on abortions that in many cases could be paid for by the male." Number 0443 REPRESENTATIVE MARTIN indicated the legislature had never taken direct action to pay for abortion; it has been an interpretation by the attorney general and the Department of Health and Social Services. The idea was that when there was a shortage of federal Medicaid money, the state would pick it up under the general relief medical program. A number of years ago, a department head had decided to use that money for abortions. Representative Martin said that offended many people. While some proposed dropping medical relief money as a complement to Medicaid funds, he said that is not an answer. Currently, senior citizens are denied emergency medical and dental services while elective abortions are covered. He believes that is a poor way to run a medical assistance program. REPRESENTATIVE MARTIN referred to an amendment by Representative Rokeberg that was not formally before the committee. He expressed support for it, saying when he first read it, he had been confused; however, after discussion, he believes it is right on target, as it makes a rapist or person convicted of incest responsible for paying for an abortion. Representative Martin stated that he opposes abortion, period, and is more opposed to state money being used for elective abortions. Even more offensive is when a person has been convicted of rape or incest and the state pays the bill. He said the permanent fund dividend is tapped for many purposes and Representative Rokeberg's amendment is "very rational." Number 0680 REPRESENTATIVE MARTIN advised that he disagreed with a second amendment proposed by Representative Rokeberg. Not yet formally before the committee, that amendment makes the parent or legal guardian of a minor liable for the cost of an abortion. REPRESENTATIVE MARTIN recalled that ten years before, he and other legislators had received phone calls from a mother who was outraged when she received a medical bill for her daughter's abortion; prior to that, she had no idea it had occurred. Expecting confidentiality, the daughter had gone through the public health system. He stated, "So, we did work it out that they would stop charging parents for abortions, especially when they weren't even consulted or involved." REPRESENTATIVE MARTIN said this second amendment touches on the same thing. Because of the confidentiality issue, he believes it is a conflict of interest to introduce legislation making the parent responsible. He discussed personal experience working with kids in boys' clubs and past attitudes towards out-of-wedlock pregnancy. REPRESENTATIVE MARTIN briefly addressed the fiscal note, which he acknowledged is high at $5.5 million. He said he disagreed with "the other half" because Medicaid money cannot be used for abortions. If anyone pays for it, it should be the male. He expressed disappointment that no representative from the Department of Law was present to address legal aspects. Number 0845 REPRESENTATIVE JAMES asked what the cost of an abortion usually is. REPRESENTATIVE MARTIN believes abortions cost between $300 and $600. He advised that especially in Southeast Alaska, the public health service flies women to Tacoma, Washington, to use a clinic there; it is a same-day operation and the travel cost is in addition to the abortion. Number 0886 REPRESENTATIVE JAMES recalled that the legislature had passed a bill the previous year relating to identifying the father in the case of a birth. REPRESENTATIVE MARTIN agreed. He stated, "And that's where this comes from. We're using the same law, Chapter 47, that allows for that on the federal and state ...." Number 0911 REPRESENTATIVE JAMES commented that two people make a pregnancy and therefore both should be responsible to decide whether to keep the child and to pay for it. She noted that it is possible to determine paternity for a living child and asked: What do you do with an aborted fetus if the alleged father denies paternity? REPRESENTATIVE MARTIN replied that DNA could still be taken from an aborted fetus, to his knowledge. REPRESENTATIVE BUNDE questioned whether the fiscal note included that testing. He concurred with Representative James in holding fathers responsible. He mentioned an Alaskan man who had bragged about fathering 19 children with 11 different women; he suggested there should be higher penalties than taking a permanent fund dividend. He also noted that current law says convicted felons do not receive dividends. He asked for confirmation of that. REPRESENTATIVE MARTIN said when he and Representative Rokeberg had discussed it, it was possible the dividend was already covered; however, they had wanted to be explicit. He mentioned that there is a special account for victims of crime. REPRESENTATIVE BUNDE, acknowledging that the amendments were not officially before the committee, named the longer amendment "Amendment 1" and the shorter one "Amendment 2." He asked whether Representative Martin would support an amendment that made the parents liable when they had given consent for the abortion. REPRESENTATIVE MARTIN replied, "I would be flexible there, because ... I think that in a case like this here -- in most cases, and maybe I'm now reminded on the old law where we want to keep it confidential from the parents. And so now that we've got the judicial bypass, I still feel uncomfortable in the confidentiality. If a parent were to go ahead, there's nothing wrong with that at all, for the parent to -- and perhaps they may not even want their daughter to get involved in the government aspect of it but just quietly and cheaper do it through private sources." Number 1160 REPRESENTATIVE BUNDE said his point was that if someone could not afford the abortion but her parents gave consent, should the parents not be financially responsible? REPRESENTATIVE MARTIN commented that on a given day, the children of the most wholesome parents could do something out of character. In a case like this, where the child makes money including permanent fund dividends, perhaps this would curtail activity. REPRESENTATIVE ROKEBERG asked: Given the bill that the legislature is about to pass regarding consent, would that impact this bill as written? And is there not a need to require confidentiality between the mother and father of the unborn child? Number 1380 REPRESENTATIVE MARTIN replied that the mother and father would usually know each other. He said in Chapter 47, which relates to when the child is born, the mother-to-be is responsible for disclosing who the father is at the time of birth. He said through Representative Bettye Davis's law, passed four years ago, that seemed to work. REPRESENTATIVE PORTER said that is voluntary, not required. REPRESENTATIVE MARTIN concurred. REPRESENTATIVE ROKEBERG commented that when there is an abortion, there is no birth. He was uncertain how that body of law related to this. He believes confidentiality should be maintained regarding the father as well as the mother's parents. He said apparently Representative Martin does not agree with his theory that there is either a constitutional or legal requirement to maintain confidentiality as it relates to the father. He noted that from earlier testimony, many times the father is unknown. Number 1487 REPRESENTATIVE BERKOWITZ asked: What would happen if the woman did not want to release the father's name? REPRESENTATIVE MARTIN likened it to child support enforcement. Only when applying for Medicaid does it becomes a problem; he did not know the rationale. If a mother keeps the child, he did not know at what point the state would deny Medicaid or other welfare. He said it is predicated on federal law and asked, "If it's okay under federal law to disclose who the father is, and now state law has been upheld, then why not for the abortion? And the confidentiality is right there within the department." Number 1562 REPRESENTATIVE BERKOWITZ asked whether Representative Martin envisioned a situation where the state would compel the woman to disclose the identity of the father. REPRESENTATIVE MARTIN said he did not put it beyond the state to compel anything; it has gone way out of bounds for many things, not only for childbirth or abortion. He said we can always imagine government getting out of control, which is why we have legislators to adjust it. Number 1598 REPRESENTATIVE JAMES commented that this is an area about which she has long been concerned. She believes there is equal responsibility, except in the case of rape or incest. She had supported trying to identify the father at the time of birth, which she believes is when the father is most vulnerable. She was not taking a position on this bill until seeing the other consequences. However, she supports the concept of the man paying at least half of the cost. She specified she was willing to divide it in half, as a joint responsibility. REPRESENTATIVE MARTIN thanked Representative James and said that is his sentiment as well. CHAIRMAN GREEN advised that they would lose their quorum shortly. He suggested taking testimony immediately and addressing the two amendments later. NANCY WELLER, Medical Assistance Administrator, Division of Medical Assistance, Department of Health and Social Services, came forward to testify. Referring to Section 3 of the bill, she said it eliminates the ability of the department to fund abortions for low- income women by placing abortions and related services first on the priority list in AS 47.25.205. Since 1986, due to budget reductions relating to the general relief medical program, the department has not had sufficient financial resources to fund the first seven items on the existing list. MS. WELLER advised that the accompanying fiscal note, which she had prepared, assumes that 80 percent of the number of women currently receiving abortions would bear the children, with both mothers and children having medical costs paid for by the state through the Medicaid program. MS. WELLER said other sections of the bill, related to financial responsibility and garnishment of permanent fund dividend checks to recoup the costs of abortion, would not come into effect because Section 3 eliminates the ability of the department to fund abortions. MS. WELLER advised that the department also has a number of administrative problems with sections relating to garnishment of the permanent fund dividends and tracking the recipients' estates. She explained, "We do not track people's estates and go after their estates in order to recoup costs. We would not have the ability to force a putative father to come in for DNA testing in order to determine whether they would be the father of the unborn child. Fetal DNA testing can be done by a laboratory in the state; it would cost $975 plus transportation for the parties; we would have to set up an administrative procedure for getting the fetal tissue from the facilities. Many abortions are done outside of the state, so it would be a significant administrative `adventure' dealing with setting up these procedures." Number 1857 CHAIRMAN GREEN asked, "You said that we're funding many abortions now that are done outside the state?" MS. WELLER said yes, particularly in Southeast Alaska, from which women go to Seattle. CHAIRMAN GREEN asked what the relative cost would be for someone to go to Seattle rather than have it done in Juneau. MS. WELLER said she believes people in Southeast Alaska go south because there are no facilities in Juneau. She explained that there are many different medical procedures, some related to miscarriages and other "birthing disasters." The range of payments for these procedures is $365 to $900. When the department pays for services out of state, they pay the Medicaid rate for the state where the service is provided; those rates are significantly less than the fee schedule in Alaska. CHAIRMAN GREEN asked whether the department pays for transportation. MS. WELLER said yes. Last year, they paid for 737 abortions at a cost of $487,000, of which $300,000 was directly related to the abortions. The remainder was related to transportation and other services. Number 1940 CHAIRMAN GREEN suggested that averaged $500 each. He asked about the assumption that 80 percent of the women now receiving abortions would deliver instead. He also asked whether most abortions paid for by the state are for lower-income people. MS. WELLER said the state only pays for low-income people. REPRESENTATIVE ROKEBERG asked whether Ms. Weller was indicating that 80 percent of Medicaid-covered women have abortions. MS. WELLER replied, "No, I'm saying that in preparing the fiscal note for the bill, the way I came up with this cost is that I was assuming that of the people who receive an abortion every year, 80 percent of those people would not have an abortion through their own means or some other means and would become Medicaid-eligible, and that the Medicaid program would pay for the costs of the birth and for the child, because children receive automatic Medicaid eligibility for the first year of life when their mother is on Medicaid." CHAIRMAN GREEN asked for approximately how many births or abortions the state would expect difficulty in trying to find a father who is not voluntarily assuming responsibility. MS. WELLER explained that for Medicaid and public assistance programs, they operate under federal rules that require the woman to identify the father of the child in order to receive public assistance, cash assistance or Medicaid. However, there are exceptions, such as when a woman fears for her life or there is abuse. CHAIRMAN GREEN asked whether that is for a small percentage. MS. WELLER said although she would assume that, she did not know. CHAIRMAN GREEN suggested finding the father really is not the major problem in most cases. Number 2085 MS. WELLER responded, "I don't know what percentage would be in disagreement, because ... when someone applies for cash assistance, the state has an obligation to go and get a child support order. Child support enforcement is required to issue an administrative order for child support for the children whose mothers are receiving assistance, and then the state and the federal government share the child support funds that are collected on behalf of the children that are on assistance, in order to recoup the amount of money that we're paying for assistance." CHAIRMAN GREEN stated his understanding that it is a requirement to determine the father. MS. WELLER affirmed that it is a requirement, which is there because the state obtains a child support order against the father who is not supporting a child on assistance. The department had never tried to recoup funds for abortions. REPRESENTATIVE ROKEBERG asked whether exceptions to the required identification of the father are examined on a case-by-case basis. He further asked whether there is a statutory or regulatory provision for those exceptions. MS. WELLER answered that it is a federal law, with specific criteria. If the woman can assert that there is danger to her life or her children because of some abusive situation, that exception applies; she is not required to prove it. REPRESENTATIVE ROKEBERG requested that Ms. Weller provide the committee with those references. He restated his desire that the legislation not breach that confidentiality. Number 2185 MS. WELLER emphasized that Section 3 would eliminate the ability of the department to pay for abortions, so that the other sections in the bill related to responsibility and garnishment of the permanent fund dividend would become moot. REPRESENTATIVE ROKEBERG suggested that the definitions of abortion under Section 7, found on page 4, would allow them to perform some procedures. MS. WELLER responded, "We are allowed under the Medicaid program, using state and federal funds, to pay for abortion services as a result of rape, incest or danger to the life of the mother." She said they could claim federal funds, under the Medicaid program, to pay for abortions in only those circumstances. Under the general relief medical program, the funding is used to pay for elective abortions. MS. WELLER stated, "And as you heard this morning, ... we are operating under consent decrees since 1993 with the ACLU that we would not, in enforcing the GRM abortion regulations, require proving that there was a threat to the woman's life or that she had a psychological problem with the pregnancy in order for her to get the funding for the pregnancy." Ms. Weller offered to make a copy of that consent decree available to the committee. CHAIRMAN GREEN asked whether that was a public record. MS. WELLER said yes. Number 2259 REPRESENTATIVE MARTIN said he was glad to hear that they could perhaps save 590 lives, out of the 730 lost through abortion. He said there was not enough money for other needed medical services. He asked: If it would make the individual responsible for paying for abortions, wouldn't that free up more money for the dental care needed for seniors, as well as eyeglasses? He noted that approximately $500,000 was involved. MS. WELLER noted that they are different programs. REPRESENTATIVE ROKEBERG asked whether there are any requirements that the department look to the parents or legal guardians for reimbursement for these procedures. He asked whether an unemancipated minor could request a Medicaid reimbursement for an abortion, even though her parents would not be eligible for Medicaid. MS. WELLER explained, "A minor can come to the Division of Public Assistance because she is pregnant and apply for assistance to pay for an abortion procedure and claim that ... they want their information to be confidential; they have not told their parents. And so, in those circumstances, we would not request information on the parents' financial information in determining the eligibility of the minor, because we would be invading ... their confidentiality in order to do that." REPRESENTATIVE ROKEBERG asked: What if she did not request confidentiality? MS. WELLER replied that if the applicant were a minor, she would have to supply financial information from her parents. REPRESENTATIVE ROKEBERG asked whether the state would seek reimbursement from the parents at that time. MS. WELLER answered that if the family was low-income, the young woman could qualify for Medicaid assistance. However, if the family was over-income because of the parents' income, she would be ineligible. REPRESENTATIVE ROKEBERG asked whether that was for the initial grant. He also asked whether the division would look into that prior to allowing the procedure. MS. WELLER explained that a person had to be found eligible prior to that. The two criteria are that she must be financially eligible and pregnant. Number 2409 REPRESENTATIVE BUNDE said if the parental consent bill passed, then when a minor asked for financial assistance for an abortion, there would have to be either judicial bypass or parental consent if the mother-to-be was under 16 years of age. "So, that takes care of the confidentiality problem that currently exists," he added. MS. WELLER replied, "It could impact the confidentiality, yes. They have to have parental consent." She reiterated that Section 3 of this bill would prevent the department from paying for abortion procedures altogether. TAPE 97-65, SIDE B Number 0006 PETER NAKAMURA, MD, MPH, Director, Division of Public Health, Department of Health and Social Services, came forward to testify. He specified he was speaking on the bill just from a health perspective. DR. NAKAMURA stated, "We've got a lot to learn from history. Before access to this procedure was available - and by access, we're talking about financial access, we're talking about legal access and we're talking about medical access - we had a period of time where we had hospitals dedicated to doing nothing more than taking care of the complications of illegal back-alley abortion procedures, self-induced abortions. Once we had legal access, and once we had medical access, we began to bring these numbers down to the point now where doing an abortion of any type is much safer than a normal delivery." DR. NAKAMURA emphasized that financial access is highly significant. They are talking about a vulnerable population of women who without financial means would have no access, despite the legal possibility and medical safety. He concluded by expressing concern about HB 234 because it decreases that very important financial access. REPRESENTATIVE BUNDE asked whether this might result in lawsuits to overturn the law or court pressure to increase funding. DR. NAKAMURA replied that he could not begin to speculate. However, he hoped something would happen to allow additional funds to come forward, to make sure that these highly vulnerable women do have access. CHAIRMAN GREEN asked why a court would require a voluntary surgery. Number 0117 REPRESENTATIVE BUNDE said as he understands current federal law, because abortion is legal, the state must provide it for people who cannot afford it; at least, that is Alaska's attorney general's interpretation. Because of abortion's placement on the priority list, funding was cut off de facto. He asked whether the courts would say the legislation was flawed or require the state to put enough money in or rearrange priorities so that the money goes far enough down the list to include abortion. REPRESENTATIVE MARTIN commented that many states do not provide for abortions. He suggested that information could be obtained from a right-to-life organization. CHAIRMAN GREEN said, then, it is not federally mandated. He asked whether Representative Bunde's concern was that Alaska statute may have to be revised or that this may be in conflict. REPRESENTATIVE BUNDE noted that Alaska's attorney general has said the state must provide access to all, even those who cannot afford it. He himself believes people should be able to pay for services they want, and he opposes elective surgery of any kind being state- funded. However, if the state supreme court says the state must provide access, including financial support if necessary, then the portion of the bill that lists abortion below the cut-off level would deny access. The bill may be unconstitutional. He suggested more far-fetched would be that the court would say the legislature must put more money into the Department of Health and Services budget so that the money goes far enough to reach that level. CHAIRMAN GREEN asked whether there were more questions for Dr. Nakamura and then called upon Deborah Behr. Number 0265 DEBORAH BEHR, Assistant Attorney General, Legislation and Regulations Section, Civil Division (Juneau), Department of Law, came forward to testify. She specified that although she was a regulations attorney, she had in the past advised the Medicaid and general relief medical programs. She was also counsel when then- Governor Hickel was preparing his abortion regulations and had done considerable research in this area. MS. BEHR noted that this is a highly complex area of law and that answers differ in various states. When the federal Medicaid program first began, Medicaid funding for abortions was fairly wide-open. However, the U.S. Congress cut that back so it was only covered in cases of rape and incest, with occasional coverage when the life of the mother was in danger. MS. BEHR explained, "It's usually done by a rider on the appropriation bills in Congress." There had been major lawsuits all over the U.S. regarding whether Congress could discriminate against poor people. The U.S. Supreme Court determined that this was a benefit, that Congress can decide what level of benefit to fund and that it was fine under federal law. MS. BEHR advised that there had been a second wave of case decisions in states having a constitutional right to privacy. Noting that the case decisions in this area were different, she offered to provide case cites later. MS. BEHR explained that generally, decisions in states with a constitutional right of privacy, as Alaska has, deemed that the state does not have to fund any service. However, if it chooses to fund a service and enters into a zone of what they call `privacy,' it must do so with neutrality. For example, if the state funds pregnancy services, it must fund the other side of the coin, which is abortion services. MS. BEHR advised that there were decisions in Connecticut and a couple of other states that she could provide if requested. MS. BEHR recounted that when she was assisting then-Governor Hickel in drafting regulations, she was looking at options. She said, "And one of the things that most of the states in those areas said, at minimum, you've got to cover therapeutic abortions." She noted that this bill does not cover therapeutic abortions; it only takes into account the possible death of the mother. "So it truly does not address those kinds of cases," she added. MR. BEHR said at the time they put out the regulations, they knew they were into a gray area in the state of Alaska, which had no case decisions in this area. "The regulations came out, and we were in court within hours," she said. She noted that legislative counsel looked at those. Ms. Behr has memos in her files from 1992 that essentially say the regulations put in by then-Governor Hickel were unconstitutional. She stated, "And I would suggest strongly that you have your own counsel look at this bill and see if her conclusion has changed, ... based on those decisions." Ms. Behr asked whether she could provide further information. Number 0373 CHAIRMAN GREEN asked about the case cites Ms. Behr had offered to obtain. MS. BEHR stated, "Yes, I can speak with your counsel later and help you on it. It's a difficult area of the law; it really is." CHAIRMAN GREEN said as he understood it, the state had no obligation in this area. However, if it chose to act, there was an obligation to cover both sides of the coin. MS. BEHR said yes, that is the basic problem of the question with a constitutional right of privacy. She noted that at least one constitutional amendment was proposed to try to stop state funding for abortions but did not pass the electorate. "So I'm fairly certain that this type of bill would not pass constitutional muster in this state," she advised. Number 0412 REPRESENTATIVE MARTIN referred to a case in 1982, which he said was brought before the people but did not pass. He asked: Even though Ms. Behr says the state has a responsibility to finance abortions, are they limited as to the source of the revenue? MS. BEHR said she was confused. She stated that the Division of Medical Assistance cannot fund any abortion without an appropriation. "So, in that way, the state of Alaska has to fund abortions, because it has to be done through an appropriation process," she added. REPRESENTATIVE MARTIN asked: "And if we are appropriating money from the parent, from the father who is responsible for the pregnancy, what's wrong with that?" MS. BEHR noted that she had been a child support attorney. She stated, "And it's very difficult establishing paternity of a child. It's very difficult, once you establish paternity of a child, doing collection of it. Oftentimes, the amount of money that you're talking about, in the case of an abortion, is the cost of collection, the cost of court action and the costs of DNA [testing]. I'm not sure that they'd necessarily net out." Number 0462 CHAIRMAN GREEN asked about the difficulty of determining who the father is. MS. BEHR said given that people applying for general relief medical assistance are low-income, it is a better than 50/50 chance that litigation would be required to establish paternity. At very early stages, it perhaps could be done through DNA testing, without necessarily going through a whole court process. Although a man could admit to paternity, he certainly did not have to. CHAIRMAN GREEN said earlier testimony indicated they could determine who the father was. MS. BEHR explained that when a woman applies for public assistance, she has to name a person, whether she is right or wrong. She noted that in some cases, the woman is unsure and there must be DNA testing of several people to determine paternity. REPRESENTATIVE MARTIN said with child support enforcement, there has been much more success than anticipated. He said all the fears being brought up now were brought up earlier about "forcing the poor woman to disclose who the father was." He suggested the cost involved in finding out who the father is has diminished significantly. He said as to collection, Alaskans receive permanent fund dividends and it is easy to put a lien against that check. CHAIRMAN GREEN said, "If they can prove that that's the father." REPRESENTATIVE MARTIN concurred. He restated that collection is minor. He said one important reason why the child support enforcement law is working well is that the state has an incentive. Last year, the federal government gave the state a $2.1-million incentive because of the success rate in finding the fathers. He commented, "You can't say that 80 percent of the kids will be welfare cases when they're having such good success now in finding who the fathers are and make them -- take them off of welfare." Number 0638 CARLA TIMPONE, Lobbyist for the Alaska Women's Lobby, came forward to testify. The Alaska Women's Lobby is unequivocally opposed to any piece of legislation that limits a woman's right to access a safe and legal abortion. In addition, they have specific concerns about HB 234. MS. TIMPONE noted that under the bill, a woman applying for general relief medical (GRM) assistance to pay for an abortion must name the putative father, unless the department determines that she has good cause not to do so. The definition of `good cause' as outlined by Representative Rokeberg's amendment includes rape or incest. Ms. Timpone stated, "Quite frankly, the Women's Lobby would like to see that definition not just be limited to rape or incest but to be left the way the language is currently in the bill, because we feel it's broader. There are many women who are victims of domestic violence who find themselves in life- threatening situations. And we would not like them to be excluded from the `good cause' definition by limiting it to rape or incest." MS. TIMPONE continued, "The woman then has to assign to the department the right of recovery to the funds to pay for this service. We're concerned - and we don't think that it's outside the realm of possibility that this could happen - that a woman will name a putative father, of course he won't be found, because that is far and away most often the case, the woman's PFD ...." CHAIRMAN GREEN interjected with a question: "You say far and away; is that because the person has gone or that this is a fictitious name or ....? MS. TIMPONE replied, "I would say either." Acknowledging that she is not a medical expert, she said she assumes fetal tissue would have to be used for paternity tests, which would occur after the abortion. That would be unlike paternity establishment used by the Child Support Enforcement Division of the Department of Revenue, which is usually a blood test because it involves two living people. MS. TIMPONE said like the Child Support Enforcement Division, that also assumes the Division of Public Assistance would have at its disposal a team of employees whose only job is to locate absent parents. However, she does not believe the latter agency has that. MS. TIMPONE explained, "We've heard testimony that when a woman - a single woman - comes in to apply for public assistance, she must give them the name of the father. And that is absolutely true. However, that pretty much ends the responsibility of the Division of Public Assistance. They get the name, they pass it on to Child Support Enforcement and Child Support Enforcement picks it up from there." MS. TIMPONE continued, "At least the way I read the bill, that is not going to be the case here. ... Because the bill does not say that anybody else is responsible, I'm assuming that the Division of Public Assistance, Department of Health and Social Services, would be responsible for doing that location. And I am not sure that they have staff that do that or even qualify to do that." MS. TIMPONE continued, "So, the woman has to assign her right of recovery to the department. If the father cannot be found and/or made to pay, then the woman's PFD is garnished. What happens, then, if the father is located? The woman can't recover a portion of what was taken from her, financially, to pay for the procedure, because she has assigned her right of recovery to the department. ... It doesn't say that that assignment is null and void once, and if, he is found. So, in other words, a woman's PFD is garnished to pay for the entire amount of the procedure. Dad suddenly turns up or she finds him. She is prohibited from seeking half the cost of the procedure, because she has assigned her right of recovery to the Department of Health and Social Services." CHAIRMAN GREEN asked why that would preclude the woman from getting back half from the father. MS. TIMPONE replied, "Because she has assigned the right of recovery of the payment to the department." CHAIRMAN GREEN said, "For the permanent fund dividend. So, she gives that up and then they find me, why can't I repay her?" MS. TIMPONE answered, "You could voluntarily. But if you don't choose to voluntarily, she has no legal recourse to try to get it, because she has assigned her right of recovery to the Department of Health and Social Services. So, we have a concern about that." MS. TIMPONE continued, "We also have some concerns about the nature of singling out this particular procedure because it is an elective procedure, or, in any case, that's how it has been characterized. I believe that there is a possibility that there are other circumstances under which treatment is paid for under GRM for people who suffer a medical condition or an injury as a result of a situation over which they had control. For instance, if a homeless alcoholic falls asleep on the curbside and is run over by the garbage truck and requires medical treatment as a result of his choice to drink himself into stupefaction, I might have some problems with the state's paying for treatment of that person." MS. TIMPONE continued, "I think that we start to go down a slippery slope when we start to prohibit some medical procedures because we have moral or religious problems with that particular kind of procedure, because there's a wide spectrum of procedures that different ones of us could have moral or religious problems with. Someone who is GRM-eligible ... steals a bike, takes a ride without a helmet, suffers a head injury. Is the state obligated to treat that person? Some of us might have a problem with that. So, we have a concern in that regard." MS. TIMPONE continued, "And while I understand that what the sponsor is trying to get to, and don't disagree at all, is an equality of responsibility, I think, then, we also have to address equality of class, for lack of a better word. The bill is not a referendum or a statement on abortion. It's a statement on who we feel deserves to have one. It's okay to have an abortion if you can afford to pay for it out of your pocket; it's not okay to have an abortion if the state has to pay for it. I think we begin to get into a whole other set of issues there that relate primarily to class, and we certainly have some concern with that as well." Number 1005 CHAIRMAN GREEN suggested there is a class distinction anyway, regarding insurance, for example, that pays for a private room or does not. MS. TIMPONE replied, "Well, to a degree. You're still receiving the medical service. You may just be receiving it in nicer surroundings." CHAIRMAN GREEN referred to Ms. Timpone's discussion of an inebriate that gets run over by a truck and questioned her willingness to provide one service over the other. MS. TIMPONE clarified that if the state pays in one case, she believes it should pay in the other. CHAIRMAN GREEN suggested the reverse may be true: If it does not pay in one case, perhaps it should not pay in the other. MS. TIMPONE emphasized that there should be equality. CHAIRMAN GREEN asked whether there were questions, then requested that Ms. Timpone answer future questions from committee members. (HB 234 was held over.)
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