Legislature(2015 - 2016)BELTZ 105 (TSBldg)

04/05/2016 01:30 PM LABOR & COMMERCE

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Audio Topic
01:36:07 PM Start
01:37:12 PM Confirmation Hearing: Alaska Gasline Development Corporation Board of Directors
01:49:30 PM HB155
01:58:09 PM SB201
02:02:05 PM SB175
02:38:54 PM SB156
03:19:51 PM SB193
03:27:22 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Consideration of Governor's Appointee: TELECONFERENCED
Alaska Gasline Development Corporation Board of
Moved SCS CSHB 155(L&C) Out of Committee
Moved SB 201 Out of Committee
Moved CSSB 175(L&C) Out of Committee
Heard & Held
Heard & Held
Scheduled but Not Heard
+ Bills Previously Heard/Scheduled TELECONFERENCED
-- Public Testimony --
          SB 156-INSURANCE COVERAGE FOR CONTRACEPTIVES                                                                      
2:38:54 PM                                                                                                                    
CHAIR COSTELLO  announced the  consideration of  SB 156;  "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." She noted that this  is the first hearing of the                                                               
bill. [CSSB 156(HSS) was before the committee.]                                                                                 
SENATOR BERTA  GARDNER, Alaska State  Legislature, sponsor  of SB
156, explained  that with the exception  of religious exemptions,                                                               
everyone is  mandated to have  health insurance and  all policies                                                               
include  coverage for  birth control.  Oftentimes, insurers  make                                                               
self-administered hormonal  birth control available on  a monthly                                                               
or  three-month increment.  Passage of  SB 156  would mean  that,                                                               
after an  initial three-month usage  to demonstrate that  a woman                                                               
is not  experiencing complications,  she'd be  able to  request a                                                               
12-month  supply if  she wished  to  do so.  All existing  copays                                                               
would  remain in  effect. Not  every woman  would want  an entire                                                               
year's supply.                                                                                                                  
She said  the goal  is narrow.  An individual  who is  covered by                                                               
insurance  can  opt   to  get  a  12-month   supply  of  hormonal                                                               
contraception, if she wants to.                                                                                                 
SENATOR GARDNER  reported that states that  have implemented this                                                               
policy have seen  a cost savings in all insurance  pools that are                                                               
affected by the  law. Washington State has  experienced a savings                                                               
of  about $4  million in  Medicaid savings  since implementation.                                                               
The  fiscal note  for  SB  156 shows  a  savings  of about  $1.35                                                               
million a year.                                                                                                                 
2:41:21 PM                                                                                                                    
SENATOR  GARDNER  said  much  public  testimony  showed  numerous                                                               
problems  and barriers  in  the  ability for  women  to obtain  a                                                               
consistent supply  of birth control.  They are limited  by clinic                                                               
hours, privacy  concerns, and long  stretches of time  where they                                                               
are in remote areas.                                                                                                            
She concluded  that the bill is  good policy and saves  the state                                                               
money and offers benefits for women who use birth control.                                                                      
2:42:08 PM                                                                                                                    
CHAIR COSTELLO asked how the savings would be made.                                                                             
2:42:26 PM                                                                                                                    
KATIE  BRUGGEMAN,  Staff,  Senator Berta  Gardner,  Alaska  State                                                               
Legislature, referred  to the fiscal  note for SB 156  that shows                                                               
the Department of Health and  Social Services estimated a savings                                                               
of $1.35  million. Cost savings would  come in two main  ways, by                                                               
preventing  unintended  pregnancies   covered  by  Medicaid,  and                                                               
through  lower  costs for  bulk  orders  negotiated by  insurance                                                               
companies. Washington experienced these cost savings.                                                                           
2:43:40 PM                                                                                                                    
MICHELE MICHAUD,  Chief Health  Official, Division  of Retirement                                                               
and Benefits,  Department of  Administration, explained  that the                                                               
division  administers the  Alaska Care  Employee Health  Plan and                                                               
Retiree Plan, and  SB 156 does not impact  the division directly.                                                               
The employee plan offers extensive  benefits and they are working                                                               
on surrendering  "grandfather status"  on January 1,  2017, which                                                               
means they would  offer the full suite  of contraceptive benefits                                                               
that are afforded under the  Affordable Care Act. As a preventive                                                               
service  they would  be provided  without copay.  She noted  they                                                               
have the  ability within their  plan to offer an  extended supply                                                               
of  contraceptives  in the  case  of  travel or  being  otherwise                                                               
unavailable  to receive  them. She  noted they  also offer  mail-                                                               
order prescriptions to rural areas.                                                                                             
She said  she does not oppose  this bill, but it  does not really                                                               
apply to  the division.  She believes  that Alaska  Care benefits                                                               
are  equal to  or better  than the  provisions in  the bill.  She                                                               
opined  that  the division  will  not  see  a large  decrease  in                                                               
pregnancies, nor cost savings to its plan should the bill pass.                                                                 
2:46:22 PM                                                                                                                    
CHAIR  COSTELLO asked  if the  fiscal  note would  change in  the                                                               
future as it applies to Alaska Care.                                                                                            
MS. MICHAUD said there would be  some savings for bulk orders and                                                               
reduced  dispensing fees,  but they  have a  different population                                                               
than the Medicaid population.                                                                                                   
2:46:59 PM                                                                                                                    
SENATOR GIESSEL asked  about their mail order  option and whether                                                               
local pharmacies are used.                                                                                                      
MS. MICHAUD  explained their mail  orders are from  a third-party                                                               
administrator in another state.                                                                                                 
2:47:29 PM                                                                                                                    
ERIN  NARUS, Pharmacy  Program Manager,  Division of  Health Care                                                               
Services, Department  of Health  and Social Services,  offered to                                                               
answer questions related to SB 156.                                                                                             
SENATOR  GIESSEL  said the  bill  covers  more than  prescription                                                               
contraceptives. She  read the  list on page  1, lines  10-12, and                                                               
asked if it expands Medicaid benefits.                                                                                          
MS.  NARUS said  those items  are  under a  different section  of                                                               
commercial pay insurance.  The Medicaid section of  SB 156 begins                                                               
on page 3, line 5.                                                                                                              
SENATOR  GIESSEL  asked  if   some  prescriptions  are  dispensed                                                               
without  copay.  She  asked  if  that is  the  standard  for  all                                                               
prescriptions under Medicaid.                                                                                                   
MS. NARUS said  there are copays for certain  drugs. She provided                                                               
2:50:31 PM                                                                                                                    
SENATOR GIESSEL commented that it would absolve the beneficiary                                                                 
of a copay.                                                                                                                     
MS. NARUS said yes.                                                                                                             
2:51:18 PM                                                                                                                    
CHRISTINE NIEMI, Member, League of Women Voters-Alaska,                                                                         
testified in support of SB 156. She read the following prepared                                                                 
     At  the  national level,  the  League  of Women  Voters                                                                    
     supports primary care for all,  care that includes pre-                                                                    
     natal  and reproductive  health.  When  women have  the                                                                    
     consistent  ability to  plan  their pregnancies,  their                                                                    
     families benefit through  greater financial well-being,                                                                    
     healthier   living   conditions,  healthier   children,                                                                    
     greater  opportunities,  and  a  myriad  of  additional                                                                    
     benefits.  While  improving  the quality  of  life  for                                                                    
     families, the  ability to avoid  unintended pregnancies                                                                    
     also   reduces  the   cost   for   state  and   federal                                                                    
     In  2010, according  to the  Guttmacher Institute,  the                                                                    
     State  of Alaska  spent nearly  $43  million on  health                                                                    
     costs  related  to  unintended pregnancies,  while  the                                                                    
     federal government  added another  $71 million  for the                                                                    
     total cost of $114  million. Guttmacher reports that 48                                                                    
     percent  of  all pregnancies  in  Alaska  in 2010  were                                                                    
     unplanned   and  64   percent  of   Alaska's  unplanned                                                                    
     pregnancies were publicly  funded, representing the $43                                                                    
     million cost.                                                                                                              
     In addition,  the cost benefits of  supporting women in                                                                    
     their  efforts  to  plan  their  pregnancies  goes  far                                                                    
     beyond the  cost of the  pregnancy itself. A  woman who                                                                    
     is able to  plan a pregnancy can  better guarantee that                                                                    
     her  health is  at optimum  levels prior  to pregnancy,                                                                    
     reducing the  risk of a difficult  pregnancy and trauma                                                                    
     to the child. Such  planning reduces the possibility of                                                                    
     increased  health  problems  for  the  child;  problems                                                                    
     which  can  follow  the child  for  years  and  require                                                                    
     increased health and education costs for the state.                                                                        
     A  planned pregnancy  increases  a  woman's ability  to                                                                    
     manage her role as an  income provider for a family and                                                                    
     allows  the family  the best  opportunity to  remain as                                                                    
     financially   independent   as   possible.   Supporting                                                                    
     affordable  contraceptives  prescribed  on  a  12-month                                                                    
     basis will undoubtedly reduce  the number of unintended                                                                    
     pregnancies  in   Alaska,  thereby   increasing  family                                                                    
     wellbeing and  reducing state costs. SB  156 can assist                                                                    
     women  and families  to plan  pregnancies  so they  are                                                                    
     ready  for  the added  responsibility  of  a child.  In                                                                    
     addition, cost to the  state for unintended pregnancies                                                                    
     can be reduced.                                                                                                            
2:54:50 PM                                                                                                                    
SENATOR GIESSEL asked if she said a  child born as a result of an                                                               
unplanned pregnancy is at a disadvantage.                                                                                       
MS. NIEMI  responded that  children who  are unplanned  often are                                                               
not able  to be cared  for by their  families as well  as planned                                                               
SENATOR  GIESSEL  responded,  "I  guess  I  would,  using  logic,                                                               
construe that you're saying that  they're better off having never                                                               
been born."                                                                                                                     
MS. NIEMI countered that she would not say it quite that way.                                                                   
SENATOR GIESSEL said, "I'm sure not."                                                                                           
2:56:02 PM                                                                                                                    
ALYSON   CURREY,   representative,   Planned   Parenthood   Votes                                                               
Northwest and Hawaii,  testified in support of SB  156. She spoke                                                               
in support of  insurance coverage for a 12-month  supply of birth                                                               
control  when prescribed  by a  healthcare provider.  She thanked                                                               
the sponsor  for her leadership  and work  on the bill.  She read                                                               
from the following prepared statement:                                                                                          
     As  an advocate  and  provider  of reproductive  health                                                                    
     care  for   all,  Planned  Parenthood  (PP)   has  long                                                                    
     supported  sincere efforts  to expand  access to  birth                                                                    
     control. We  believe that every women  should have full                                                                    
     access  to the  birth  control method  of her  choosing                                                                    
     without  barriers based  on  cost  and availability.  A                                                                    
     year's supply of birth control  at a time is a solution                                                                    
     that lowers barriers and works for women.                                                                                  
     One in  four women say  they have missed  pills because                                                                    
     they could  not get the  next pack in  time. Consistent                                                                    
     use  of  birth  control  is the  best  way  to  prevent                                                                    
     unintended  pregnancy   for  those  who   are  sexually                                                                    
     active.   Getting   a  one-year   supply   dramatically                                                                    
     improves   consistent  use.   According   to  a   study                                                                    
     published  in Obstetrics  and Gynecology,  dispensing a                                                                  
     one-year  supply   at  a  time  reduces   the  odds  of                                                                    
     experiencing an unintended pregnancy  by 30 percent and                                                                    
     is  also  associated with  a  46  percent drop  in  the                                                                    
     chance of needing  an abortion. Furthermore, dispensing                                                                    
     twelve months  of birth control would  save significant                                                                    
     money for the state and private insurance carriers.                                                                        
     A  study  from  the  University  of  California  -  San                                                                    
     Francisco, found  that insurance plans that  dispense a                                                                    
     one-year  supply of  birth control  lower their  direct                                                                    
     costs on follow up visits  and pregnancy tests, as well                                                                    
     as  long-term pregnancy  management. Women  on Medicaid                                                                    
     would  also   experience  lower  rates   of  unintended                                                                    
     pregnancies and save the state money.                                                                                      
     We believe  that a woman's  consistent access  to birth                                                                    
     control  should not  depend on  her insurance  carrier,                                                                    
     and we continue  to be committed to  working with other                                                                    
     stakeholders  to create  the best  possible legislation                                                                    
     for all  parties in  order to  help reduce  barriers to                                                                    
     contraceptives, prevent unintended  pregnancy, and save                                                                    
     the state additional money.                                                                                                
2:58:27 PM                                                                                                                    
CHAIR COSTELLO  asked about the  correlation between the  lack of                                                               
birth control  and unplanned pregnancies.  She inquired  how that                                                               
data is collected.                                                                                                              
MS. CURREY offered to provide follow up information.                                                                            
SENATOR  GIESSEL  noted  the  bill  sounds  benign,  but  entails                                                               
volunteer sterilization procedures.                                                                                             
MS.  CURREY said  she  believes  that language  was  in the  bill                                                               
because the procedure is included in the Affordable Care Act.                                                                   
3:00:33 PM                                                                                                                    
ELIZABETH FIGUS,  representing herself,  testified in  support of                                                               
SB 156.  She spoke of  her work as a  captain of an  Alaska trawl                                                               
tender. She  urged support of the  bill in order to  help make it                                                               
possible for  Alaska women to  receive contraceptives  for twelve                                                               
months at  a time.  She noted  that so  many residents  of Alaska                                                               
spend a  significant portions  of the  year in  remote locations,                                                               
herself  included.   She  spoke   of  the  barriers   to  getting                                                               
contraceptives during this time. She  believes the bill will save                                                               
individual women  money and time and  avoid unwanted pregnancies.                                                               
She clarified  that this  bill is  a fiscally  responsible choice                                                               
for women's health.                                                                                                             
She pointed  out that the  bill does  not focus on  children that                                                               
are   unplanned,  but   on  women   who  are   legally  receiving                                                               
contraception  and whether  or not  they  can receive  it for  12                                                               
3:02:27 PM                                                                                                                    
SAMANTHA SAVAGE,  representing herself,  testified in  support of                                                               
SB  156. She  stated that  Alaska women  face more  barriers when                                                               
trying  to  access  all  medications   due  to  geographical  and                                                               
occupational  and  financial  reasons.  She  related  a  personal                                                               
experience of difficulty in trying  to obtain oral contraceptives                                                               
while going to school and working.                                                                                              
3:03:46 PM                                                                                                                    
ROBIN  SMITH, representing  herself, testified  in support  of SB
156. She  said it's inconvenient to  get just 30 pills  at a time                                                               
and there are  a lot of reasons other than  unwanted pregnancy to                                                               
be  on birth  control. She  gave  examples of  other reasons  for                                                               
being on  birth control including ovarian  cancer and endometrial                                                               
3:07:40 PM                                                                                                                    
KENNI PSENAK-LINDEN,  representing herself, testified  in support                                                               
of SB 156. She shared her  personal story of being diagnosed with                                                               
endometriosis and  the difficulty  of only having  a prescription                                                               
for 30  days at a  time. She  attributed the ability  to graduate                                                               
from  college to  the ability  to have  access to  hormonal birth                                                               
3:09:42 PM                                                                                                                    
DAN  NELSON,  Director  of Pharmacy,  Tanana  Chiefs  Conference,                                                               
testified  in support  of  SB 156.  It will  save  the state  and                                                               
federal government  millions of dollars. Patients  in rural areas                                                               
will avoid  the difficulty  and inconvenience  of running  out of                                                               
contraceptive medication.                                                                                                       
3:11:45 PM                                                                                                                    
SHEELA  TALLMAN, Senior  Manager of  Legislative Policy,  Premera                                                               
Blue Cross, testified about implementation  concerns with SB 156.                                                               
She said it  is unclear whether the coverage  provision imposes a                                                               
new mandate on  health care plans. She  encouraged careful review                                                               
of  the  bill. The  bill  would  also  impact private  and  group                                                               
grandfathered health  care plans.  This could be  as high  as 3-4                                                               
percent  of premium,  so they  are  asking for  an exception  for                                                               
grandfathered plans.                                                                                                            
She  discussed an  amendment  they submitted  to  the sponsor  to                                                               
ensure that  the insured is receiving  a supply not to  exceed 12                                                               
months total. Finally,  they are requesting an  effective date of                                                               
January 1, 2018, because it  isn't feasible to make these changes                                                               
before then.                                                                                                                    
3:14:54 PM                                                                                                                    
MOLLY GRAY,  Executive Director, Alaska  Pharmacists Association,                                                               
testified in  support of SB  156. She suggested changing  the 90-                                                               
day  requirement  for  the  first  filling  of  the  prescription                                                               
because  it  would  create insurance  issues.  She  thought  that                                                               
section had been removed from the  House version of the bill. She                                                               
concluded  that  the  bill aligns  with  the  Alaska  Pharmacists                                                               
Association mission.                                                                                                            
3:16:15 PM                                                                                                                    
CATRIONA REYNOLDS, Manager, Kachemak  Bay Family Planning Clinic,                                                               
testified in support  of SB 156. She noted  she submitted written                                                               
testimony. She  noted that  Medicaid currently  has no  copay for                                                               
contraceptives. She highlighted that many  women only use 21 days                                                               
of a 30 day supply so 17 packs  could be needed for one year. She                                                               
provided anecdotes of  clients who do not have  insurance and how                                                               
they are able to receive birth control for 12 months.                                                                           
3:18:32 PM                                                                                                                    
DIRK  WHITE,  Pharmacist  and  past president  of  the  Board  of                                                               
Pharmacy, stated support for SB 156.                                                                                            
3:19:19 PM                                                                                                                    
CHAIR COSTELLO  stated she would  keep public testimony  open and                                                               
hold SB 156 in committee.                                                                                                       

Document Name Date/Time Subjects
SCS HB 155 (L&C) - Ver. P.pdf SL&C 4/5/2016 1:30:00 PM
HB 155
SB 175 - Opposition Letter - CVS Health.PDF SL&C 4/5/2016 1:30:00 PM
SB 175
SB 175 - Explanation of changes from W to H.pdf SL&C 4/5/2016 1:30:00 PM
SB 175
SB 175 - Sectional Analysis vsn H.pdf SL&C 4/5/2016 1:30:00 PM
SB 175
SB 175 vsn H.pdf SL&C 4/5/2016 1:30:00 PM
SB 175
SB 156.PDF SL&C 4/5/2016 1:30:00 PM
SB 156
SB 156 - Sponsor Statement.pdf SL&C 4/5/2016 1:30:00 PM
SB 156
SB 156 - Sectional Analysis.pdf SL&C 4/5/2016 1:30:00 PM
SB 156
SB 156 - Fiscal Note - DHSS 1.pdf SL&C 4/5/2016 1:30:00 PM
SB 156
SB 156 - Fiscal Note - DHSS 2.pdf SL&C 4/5/2016 1:30:00 PM
SB 156
SB 156 - Fiscal Note - DCCED Insurance.pdf SL&C 4/5/2016 1:30:00 PM
SB 156
SB 156 - Opposition Letter - NFIB 2016.02.18.PDF SL&C 4/5/2016 1:30:00 PM
SB 156
SB 156 - Opposition Letter - NFIB 2016.04.01.PDF SL&C 4/5/2016 1:30:00 PM
SB 156
SB 156 - Background - CDC Unintended Pregnancy.pdf SL&C 4/5/2016 1:30:00 PM
SB 156
SB 156 - Background - American Journal of Public Health Article.pdf SL&C 4/5/2016 1:30:00 PM
SB 156
SB 156 - Background - ADN Commentary.pdf SL&C 4/5/2016 1:30:00 PM
SB 156
SB 156 - Background - Examiner Article Unintended Pregnancy.pdf SL&C 4/5/2016 1:30:00 PM
SB 156
SB 156 - Background - Guttmacher Alaska Unintended Pregnancy Stats.pdf SL&C 4/5/2016 1:30:00 PM
SB 156
SB 156 - Background - Guttmacher Public Costs of UP.pdf SL&C 4/5/2016 1:30:00 PM
SB 156
SB 193.PDF SL&C 4/5/2016 1:30:00 PM
SB 193
SB 193 - Sponsor Statement.pdf SL&C 4/5/2016 1:30:00 PM
SB 193
SB 193 - Fiscal Note.pdf SL&C 4/5/2016 1:30:00 PM
SB 193
SB 193 - Leg Research Report on Regulation Sb277 3-5-10.pdf SL&C 4/5/2016 1:30:00 PM
SB 193
SB 277
SB 193 - Letter of Support- AIPPA 3-4-16.pdf SL&C 4/5/2016 1:30:00 PM
SB 193
SB 193 - Letter of Support APT LOS 3-11-16.pdf SL&C 4/5/2016 1:30:00 PM
SB 193
SB 193 - Letter of Support- CIRI 3-4-16.pdf SL&C 4/5/2016 1:30:00 PM
SB 193
SB 193 - Supporting Document letter APA 2-29-16.pdf SL&C 4/5/2016 1:30:00 PM
SB 193
SB 193 - Supporting Documents Letter CIRI Response to APA letter 3-19-10.pdf SL&C 4/5/2016 1:30:00 PM
SB 193
HB 268.pdf SL&C 4/5/2016 1:30:00 PM
HB 268
HB 268 - Transmittal Letter.pdf SL&C 4/5/2016 1:30:00 PM
HB 268
HB 268 - Sectional Analysis.pdf SL&C 4/5/2016 1:30:00 PM
HB 268
HB 268 - Fiscal Note.PDF SL&C 4/5/2016 1:30:00 PM
HB 268
HB 268 - Supporting Documents.pdf SL&C 4/5/2016 1:30:00 PM
HB 268
Gasline Development- Merrick #1.pdf SL&C 4/5/2016 1:30:00 PM
Alaska Gasline Development Corporation Factsheet.pdf SL&C 4/5/2016 1:30:00 PM
1 - Alaska Gasline Development Corporation Roster.pdf SL&C 4/5/2016 1:30:00 PM