Legislature(2015 - 2016)BUTROVICH 205
02/24/2016 01:30 PM HEALTH & SOCIAL SERVICES
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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.