Legislature(2015 - 2016)BUTROVICH 205

02/24/2016 01:30 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 113 NEW DRUGS FOR THE TERMINALLY ILL TELECONFERENCED
Heard & Held
*+ SB 156 INSURANCE COVERAGE FOR CONTRACEPTIVES TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
          SB 156-INSURANCE COVERAGE FOR CONTRACEPTIVES                                                                      
                                                                                                                                
2:07:48 PM                                                                                                                    
CHAIR STEDMAN announced the consideration of SB 156.                                                                            
                                                                                                                                
2:08:02 PM                                                                                                                    
SENATOR BERTA GARDNER, Alaska State  Legislature, sponsor SB 156,                                                               
introduced the bill. She explained  that it is difficult to draft                                                               
a bill  that is  perfect and  she recognizes  that it  needs some                                                               
changes. The bill  attempts to make it easier for  people who are                                                               
using  self-administered birth  control to  get it  for a  longer                                                               
term than  currently they  can. If a  person has  insurance, they                                                               
should  be able  to  get it  for 12  months.  It is  particularly                                                               
important in  Alaska, but it  is a  part of a  national movement.                                                               
The bill does not speak to copays  or prices. It is a cost to the                                                               
patient  and to  the medical  system to  only be  allowed to  get                                                               
birth control  monthly or for  three months. She  emphasized that                                                               
the bill is not trying to change insurance policies or co-pays.                                                                 
                                                                                                                                
2:10:32 PM                                                                                                                    
KATIE  BRUGGEMAN,  Staff,  Alaska  State  Legislature,  presented                                                               
information on SB 156. She  said the bill would mandate insurance                                                               
companies  to  provide  a  12-month  supply  of  hormonal,  self-                                                               
administered  contraception at  one  time,  should the  recipient                                                               
chose that option.                                                                                                              
                                                                                                                                
She read from the sponsor statement:                                                                                            
                                                                                                                                
All across Alaska,  women working in rural areas,  in the tourism                                                               
industry, in the military, and on  the North Slope, do not always                                                               
have  ready access  to women's  health  services, thereby  posing                                                               
limitations on  their ability  to control  whether and  when they                                                               
conceive  children.   This  bill,  SB  156,   mandates  insurance                                                               
companies to pay  both private and Medicaid  claims and reimburse                                                               
health care  providers for  an initial 3  month supply  (to gauge                                                               
adverse reactions), which  is then followed by a  12 month supply                                                               
of contraceptives,  including, but not limited  to, birth control                                                               
pills  and  hormonal contraceptive  patches.  The  bill makes  no                                                               
changes to insurance  plans or coverage. The goal of  the bill is                                                               
quite narrow. If a woman is  already covered by insurance, and if                                                               
she already  receives birth control prescriptions,  she should be                                                               
able to receive a 12-month supply at one time.                                                                                  
                                                                                                                                
She pointed out  that the current version of SB  156 does include                                                               
problems that have  come to light in the past  few days, but with                                                               
the help of departments, stakeholders,  and the legislative legal                                                               
team and the  committee, the sponsor's aim is to  address them in                                                               
development of  a new version  of the  bill. She noted  that they                                                               
have  heard from  many Alaska  women who  have had  difficulty in                                                               
obtaining a consistent supply of  hormonal contraception. Some of                                                               
those  are  limited  clinic hours,  privacy  concerns,  and  long                                                               
stretches of  time spent in  remote areas.  The bill is  meant to                                                               
address a real problem for Alaskans.                                                                                            
                                                                                                                                
2:13:22 PM                                                                                                                    
MS. BRUGGEMAN shared facts about  unintended pregnancies, both in                                                               
Alaska  and  nationwide.  She said  unintended  pregnancy  has  a                                                               
profound effect  on the economic opportunities  and overall well-                                                               
being of  Alaskans statewide. According  the Centers  for Disease                                                               
Control and  Prevention, an unintended  pregnancy is  a pregnancy                                                               
that  is reported  to have  been either  unwanted (the  pregnancy                                                               
occurred when no children, or  no more children, were desired) or                                                               
mistimed   (the  pregnancy   occurred   earlier  than   desired).                                                               
Unintended pregnancy  is a  core concept that  is used  to better                                                               
understand the  fertility of populations  and the unmet  need for                                                               
contraception and family planning.                                                                                              
                                                                                                                                
Unintended    pregnancy   mainly    results   from    not   using                                                               
contraception,  or inconsistent  or  incorrect  use of  effective                                                               
contraceptive  methods. Unintended  pregnancy is  associated with                                                               
an increased risk of problems for  both the mother and baby: if a                                                               
pregnancy is  not planned before  conception, a woman may  not be                                                               
in optimal health for childbearing,  and might make poor prenatal                                                               
choices due  to a lack of  resources or a family  support system,                                                               
unaddressed  issues  with drug  and  alcohol  dependence, and  an                                                               
absence of  nutritional knowledge that might  otherwise keep both                                                               
mother and child healthy through the prenatal experience.                                                                       
                                                                                                                                
Along  with these  health concerns,  unintended  pregnancy is  an                                                               
economic  issue  for  Alaskan  families, as  well  as  the  state                                                               
Department of Health and Social  Services. Nationally, 51% of all                                                               
US  births in  2010 were  paid  for by  public insurance  through                                                               
Medicaid,  the Children's  Health Insurance  Program (CHIP),  and                                                               
the  Indian Health  Service. Public  insurance programs  paid for                                                               
68% of the 1.5 million  unplanned births that year, compared with                                                               
38% of  planned births. Two  million births were  publicly funded                                                               
in  2010; of  those, about  half were  unplanned. Alaska  data is                                                               
consistent with national trends.                                                                                                
                                                                                                                                
Nationally, a  publicly funded birth  in 2010 cost an  average of                                                               
$12,770  in prenatal  care, labor  and delivery,  postpartum care                                                               
and  12  months of  infant  care;  when  60  months of  care  are                                                               
included,  the cost  per birth  increases to  $20,716. Government                                                               
expenditures   on  the   births,   abortions,  and   miscarriages                                                               
resulting  from unintended  pregnancies nationwide  totaled $21.0                                                               
billion in 2010;  that amounts to 51% of the  $40.8 billion spent                                                               
for  all publicly  funded  pregnancies that  year.  To put  these                                                               
figures  into  perspective,  in   2010,  the  federal  and  state                                                               
governments  together  spent an  average  of  $336 on  unintended                                                               
pregnancies for every women aged 15 - 44 in the country.                                                                        
                                                                                                                                
In  Alaska,  where health  care  sometimes  costs more  than  30%                                                               
higher than  national averages  and Medicaid  spending is  one of                                                               
the primary cost drivers of  the state budget, these costs become                                                               
even  more  problematic.  Amid   an  unprecedented  state  budget                                                               
deficit, and  the fact that  most Alaskan women  cherish economic                                                               
and  professional freedoms,  now  is the  time  to allow  greater                                                               
access  to family  planning options.  SB 156  will help  us reach                                                               
that goal.                                                                                                                      
                                                                                                                                
2:16:53 PM                                                                                                                    
MS.  BRUGGEMAN  noted  that  concerns   by  opponents  are  being                                                               
considered. She concluded  that the sponsor believes  in the core                                                               
concept of  the bill and the  positive impact that it  might make                                                               
in the lives of Alaskan families.                                                                                               
                                                                                                                                
2:17:32 PM                                                                                                                    
CHAIR STEDMAN noted it is the first hearing of the bill.                                                                        
                                                                                                                                
SENATOR STOLTZE asked who is opposed to the bill.                                                                               
                                                                                                                                
MS. BRUGGEMAN  said Dr.  Carolyn Brown  was opposed  to over-the-                                                               
counter  contraceptives, which  will  be removed  from the  bill.                                                               
Also,  the National  Federation  of  Independent Business  (NFIB)                                                               
voiced concern about costs to  small business, which will also be                                                               
removed from  the bill.  The sponsor intends  to keep  the co-pay                                                               
requirements  the   employee  is   responsible  for.   NFIB  also                                                               
discussed  a hypothetical  situation  of an  employee starting  a                                                               
job,  working for  a month  and  receiving a  12-month supply  of                                                               
contraceptives, and then quitting.                                                                                              
                                                                                                                                
2:19:53 PM                                                                                                                    
SENATOR STOLTZE inquired if the  Division of Insurance is opposed                                                               
to the mandate.                                                                                                                 
                                                                                                                                
2:20:37 PM                                                                                                                    
CHAIR STEDMAN opened public testimony.                                                                                          
                                                                                                                                
2:21:09 PM                                                                                                                    
LORI WING-HEIER,  Director, Division of Insurance,  Department of                                                               
Commerce, Community  and Economic Development  (DCCED), testified                                                               
on SB  156. She said DCCED  has been working with  the sponsor on                                                               
the bill  and several issues have  been resolved. The bill  is in                                                               
process and a new version will  be out soon. She talked about the                                                               
issue of mandates under the ACA.                                                                                                
                                                                                                                                
SENATOR STOLTZE commented on mandates.                                                                                          
                                                                                                                                
MS. WING-HEIER  said the majority  of the  bill is under  the ACA                                                               
already. The issues of co-pay  and deductible were concerns, have                                                               
been considered, and  would address the costs borne  by the state                                                               
as a mandate.                                                                                                                   
                                                                                                                                
2:23:47 PM                                                                                                                    
AL TAMAGNI, Leadership Chair,  National Federation of Independent                                                               
Business (NFIB),  testified in  opposition to  several provisions                                                               
in  SB 156.  He  opined  that small  employers  are  going to  be                                                               
affected. The biggest question is  why small business is the only                                                               
one that has to pay.                                                                                                            
                                                                                                                                
2:26:08 PM                                                                                                                    
DIANA KRISTELLER, Nurse Midwife, testified  in support of SB 156.                                                               
She  believed women  should have  access  to 12  months of  birth                                                               
control.  She pointed  out that  women are  on birth  control for                                                               
reasons other  than birth control.  The pharmacy  currently fills                                                               
three  months' supply  at a  time, which  is a  burden to  women.                                                               
There   are  limits   in  place   for  cost   overruns  regarding                                                               
prescriptions.  She  stressed  that  unintended  pregnancies  are                                                               
frequent and real occurrences.                                                                                                  
                                                                                                                                
2:29:01 PM                                                                                                                    
AMMIE TREWHLY,  representing herself, testified in  support of SB
156. She said she is a  nurse educator who works with young women                                                               
in the School of Nursing at  UAA. She stated the bill will reduce                                                               
many hurdles for women.                                                                                                         
                                                                                                                                
2:30:27 PM                                                                                                                    
ROBIN  SMITH, representing  herself, testified  in support  of SB
156. She spoke  as a small business owner who  did not agree with                                                               
NFIB's concerns because small businesses  are covered by ACA. She                                                               
shared  situations where  women find  it difficult  to get  birth                                                               
control pills  monthly. She  referred to  the Center  for Disease                                                               
Control regarding birth control  distribution. Dispensing for one                                                               
year would decrease  the unintended birth rate by  30 percent. It                                                               
would also reduce costs. She urged  the committee to look at this                                                               
as a way to empower people.                                                                                                     
                                                                                                                                
2:34:39 PM                                                                                                                    
CATRIONA REYNOLDS,  Clinic Manager, Kachemak Bay  Family Planning                                                               
Clinic, testified  in support of  SB 156. She  shared information                                                               
about the  struggles of obtaining  birth control in  rural areas.                                                               
She said many  of her clients are  on Medicaid and some  are on a                                                               
sliding  scale for  which  the clinic  has  been distributing  12                                                               
months' worth  for some time. She  shared a study for  the Oregon                                                               
Health Authority regarding pill distribution.                                                                                   
                                                                                                                                
2:39:25 PM                                                                                                                    
KEN LANDFIELD,  representing himself, testified in  support of SB
156. He  said the bill  could prevent  the need for  abortion and                                                               
unwanted pregnancies.                                                                                                           
                                                                                                                                
2:40:38 PM                                                                                                                    
JUDY  ANDREE,  Member,  League  of  Women  Voters,  testified  in                                                               
support of SB 156. She  said birth control contributes to healthy                                                               
families, healthy  babies, less unintended pregnancies  and saves                                                               
costs. The  bill would decrease  financial dependence  helping to                                                               
encourage  planned pregnancies,  and  save  money. She  concluded                                                               
that  it makes  sense for  the  government to  do all  it can  to                                                               
increase family health and financial stability and save money.                                                                  
                                                                                                                                
2:43:07 PM                                                                                                                    
MAXINE DOOGAN, Member, Community  United for Safety, testified in                                                               
support of SB  156. She says her organization  deals with current                                                               
and former sex  workers, sex trafficking victims,  and allies. It                                                               
works toward seeking protection for  all people in the sex trade.                                                               
Expanding access to  women's health care is in  the best interest                                                               
to all Alaskans.                                                                                                                
                                                                                                                                
2:44:13 PM                                                                                                                    
SAMANTHA SAVAGE,  representing herself,  testified in  support of                                                               
SB  156.  She   shared  a  personal  story   and  concluded  that                                                               
increasing access to contraception is good.                                                                                     
                                                                                                                                
2:45:21 PM                                                                                                                    
TERRA  BURNS, representing  herself, testified  in support  of SB
156. She  shared her  experience living in  rural Alaska  and the                                                               
difficulty in obtaining birth control.                                                                                          
                                                                                                                                
2:46:33 PM                                                                                                                    
ROBYN STEVENS,  representing herself, testified in  support of SB
156. She shared  a personal story of difficulty  in getting birth                                                               
control only every  25 days. She said she will  have to take time                                                               
off from work in order to get birth control.                                                                                    
                                                                                                                                
2:47:48 PM                                                                                                                    
ALICIA NORTON,  representing herself, testified in  support of SB
156. She shared  stories about two friends who did  not have time                                                               
to  get birth  control and  had  to drop  out of  school to  have                                                               
children.                                                                                                                       
                                                                                                                                
2:49:02 PM                                                                                                                    
ALYSON  CURREY,  Member,   Planned  Parenthood  Votes  Northwest,                                                               
testified in support of SB  156. She said Planned Parenthood (PP)                                                               
has  long supported  sincere efforts  to expand  access to  birth                                                               
control. For  100 years PP  has provided birth control  and other                                                               
high quality  health care across  the nation. Every  woman should                                                               
have access to the method of  birth control of her choice without                                                               
barrier to  cost. The bill  would build  on the gains  women have                                                               
made over the past 50 years.  She pointed out that the bill would                                                               
reduce  unintended  pregnancy by  30  percent  and produce  a  46                                                               
percent drop in the chance  of needing an abortion. She concluded                                                               
that it  is a  common sense  bill that  would lower  barriers and                                                               
save the state money.                                                                                                           
                                                                                                                                
2:50:56 PM                                                                                                                    
ELIZABTHE FIGUS,  representing herself,  testified in  support of                                                               
SB  156. She  said  in the  summer she  captains  a trawl  tender                                                               
vessel based out  of Sitka and cannot  get to a place  to pick up                                                               
pre-approved birth control. She said  so many residents in Alaska                                                               
spend significant portions  of the year in  remote locations. She                                                               
concluded  that SB  156 is  the fiscally  responsible choice  for                                                               
women's healthcare in Alaska.                                                                                                   
                                                                                                                                
CHAIR STEDMAN asked if there were any final comments.                                                                           
                                                                                                                                
MS. BRUGGEMAN thanked the committee.                                                                                            
                                                                                                                                
CHAIR STEDMAN held SB 156 in committee.                                                                                         
                                                                                                                                

Document Name Date/Time Subjects
SB 156.pdf SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 Sponsor Statement.pdf SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 sectional analysis.pdf SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 Guttmacher_Alaska Stats.pdf SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 Guttmacher - general.pdf SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 CDC_Unintended Pregnancy.pdf SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 American Journal of Public Health.pdf SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 Medicaid Family planning Eligibility Expansion - Guttmacher.pdf SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 ADN commentary.PDF SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 Military rates.pdf SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 Letter of support - League of Women Voters.PDF SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 Letter of Opposition NFIB.PDF SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 issue-brief-private-insurance-coverage-of-contraception.pdf SHSS 2/24/2016 1:30:00 PM
SB 156
SB 113 Sponsor Statement.pdf SHSS 2/24/2016 1:30:00 PM
SB 113
SB113 ver H.pdf SHSS 2/24/2016 1:30:00 PM
SB 113
SB 113 ver H Sectional Analysis.pdf SHSS 2/24/2016 1:30:00 PM
SB 113
SB 113 Supporting Document - NCSL State Laws & Legislation Report 3-31-15.pdf SHSS 2/24/2016 1:30:00 PM
SB 113
SB 113 - updated NCSL Legislative Map 1-4-16.pdf SHSS 2/24/2016 1:30:00 PM
SB 113
SB 113 Supporting Document - Goldwater Institute Fact Sheet.pdf SHSS 2/24/2016 1:30:00 PM
SB 113
SB 113 Supporting Document - Goldwater Institute Patient Stories.pdf SHSS 2/24/2016 1:30:00 PM
SB 113
SB 113 Supporting Document - Goldwater Institute Policy Report Summary - 2-11-14.pdf SHSS 2/24/2016 1:30:00 PM
SB 113
SB 113 Supporting Document - FDA Drug Review Process.pdf SHSS 2/24/2016 1:30:00 PM
SB 113
SB 156 Washington House Passes 12-Month Supplies of Birth Control.pdf SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 Side Effects_Hormonal Contraception.pdf SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 Letter of Conern Carolyn Brown.PDF SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 Letter of Support APRN.pdf SHSS 2/24/2016 1:30:00 PM
SB 156
SB 156 fiscalNote.pdf SHSS 2/24/2016 1:30:00 PM
SB 156
SB 113 Supporting Document - Letter of Support 10th Amendment Center 2-9-16.pdf SHSS 2/24/2016 1:30:00 PM
SB 113
SB 113 Supporting Document - Letter of Support Dixie Hood 1-30-16.pdf SHSS 2/24/2016 1:30:00 PM
SB 113
SB 113 Supporting Document - Letter of Support Dr. Huang 2-1-16.pdf SHSS 2/24/2016 1:30:00 PM
SB 113
SB 113 Supporting Document - Letter of Support Dr. Urata 2-1-16.pdf SHSS 2/24/2016 1:30:00 PM
SB 113
SB 113 Supporting Document - Clinical Trials in Alaska.pdf SHSS 2/24/2016 1:30:00 PM
SB 113
SB 113 Supporting Document - Goldwater Institute Policy Report - 2-11-14.pdf SHSS 2/24/2016 1:30:00 PM
SB 113