Legislature(2015 - 2016)BELTZ 105 (TSBldg)
04/05/2016 01:30 PM LABOR & COMMERCE
Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
Download Mp3. <- Right click and save file as
Download Video part 1. <- Right click and save file as
|Confirmation Hearing: Alaska Gasline Development Corporation Board of Directors|
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
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 examples. 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 statement: 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 governments. 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 pregnancies. 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 months. 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 cancer. 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 control. 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.