Legislature(2013 - 2014)HOUSE FINANCE 519
02/25/2014 08:00 AM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| SB49 || HB173 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 49 | TELECONFERENCED | |
| + | HB 173 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE FINANCE COMMITTEE
February 25, 2014
8:01 a.m.
8:01:57 AM
CALL TO ORDER
Co-Chair Stoltze called the House Finance Committee meeting
to order at 8:01 a.m.
MEMBERS PRESENT
Representative Alan Austerman, Co-Chair
Representative Bill Stoltze, Co-Chair
Representative Mark Neuman, Vice-Chair
Representative Mia Costello
Representative Bryce Edgmon
Representative Les Gara
Representative David Guttenberg
Representative Lindsey Holmes
Representative Cathy Munoz
Representative Steve Thompson
Representative Tammie Wilson
MEMBERS ABSENT
None
ALSO PRESENT
Senator John Coghill, Sponsor; Representative Gabrielle
Ledoux, Sponsor; Chad Hutchinson, Staff, Senator John
Coghill; Susan Schrader, Self, Juneau; Laura Powers, Self,
Juneau; Izebella Powers, Self, Juneau; Korbyn Powers, Self,
Juneau; George Brown, Pediatrician, Juneau; Michael Pauley,
Alaska Family Council, Juneau; Melissa Engel, Self, Juneau;
Joyanne Bloom, Self, Juneau; Ann Robertson, Self, Juneau;
Allison Currey, Self, Juneau.
PRESENT VIA TELECONFERENCE
Mike Coons, Self, Palmer; Joshua Decker, Executive
Director, American Civil Liberties Union of Alaska; Kine
McClintock, Self, Anchorage; Lynn Escola, Self, Petersburg;
Jessica Cler, Public Affairs Manager, Planned Parenthood
Votes Northwest, Anchorage; Theda Pittman, Self, Anchorage;
Robin Summers, Policy Director, National Family Planning
and Reproduction Association, Washington D.C.; Jan Carolyn
Hardy, Self, Anchorage; Amy Bollenbach, Self, Homer; Jean
Bramer, Obstetrician, Fairbanks.
SUMMARY
HB 173 RESTRICT MEDICAID PAYMENT FOR ABORTIONS
HB 173 was HEARD and HELD in committee for
further consideration.
SSSB 49(FIN)
MEDICAID PAYMENT FOR ABORTIONS; TERMS
SSSB 49(FIN) was HEARD and HELD in committee for
further consideration.
SPONSOR SUBSTITUTE FOR SENATE BILL NO. 49 am
"An Act relating to women's health services and
defining 'medically necessary abortion' for purposes
of making payments under the state Medicaid program."
HOUSE BILL NO. 173
"An Act defining 'medically necessary abortion' for
purposes of making payments under the state Medicaid
program."
8:02:11 AM
Co-Chair Stoltze discussed the agenda for the day.
8:03:11 AM
SENATOR JOHN COGHILL, SPONSOR, introduced himself and
discussed his intent related to the bill presentation.
Senator Coghill stated that SB 49 would bring clarity to
Medicaid payments for abortions. He detailed that the
Alaska Supreme Court ruled that the state pay for medically
necessary abortions, but a definition of medically
necessary had not been provided. The bill was an attempt to
define medically necessary, which would categorize
abortions outside of the definition as elective. The bill
addressed when a medically necessary abortion was required
and looked to the physical health of the woman. He
communicated that a presentation would provide further
detail.
REPRESENTATIVE GABRIELLE LEDOUX, SPONSOR, introduced
herself. She relayed that HB 173 was the companion bill to
SB 49. She believed the term medically necessary abortion
needed to be defined. She did not see the bill as pro-life
or pro-choice, but only as fiscal legislation. She stated
that the bill would bring clarity to a previously unknown
term.
8:06:25 AM
CHAD HUTCHINSON, STAFF, SENATOR JOHN COGHILL, stated that
SB 49 was about bringing clarity to the previously unknown
term "medically necessary abortion." The goal was to define
the term for the purpose of making payments under Medicaid.
He referred to a bound document titled "SB 49 Committee
Binder" (copy on file). Tabs 1 and 2 included a copy of
SSSB 49 am and the sponsor statement. He clarified that the
bill did not attempt to argue a prior Planned Parenthood
case from 2001 (Tab 7). The sponsor acknowledged that
Alaska was required to provide medically necessary services
including medically necessary abortions to low-income
individuals. The challenge was that no definition had been
established to determine what constituted medically
necessary.
Mr. Hutchinson pointed to Tab 1 and read the bill title.
Section 1 of the bill had been amended on the Senate Floor.
Section 2 included the definition for the term medically
necessary abortion. He read from Section 2(a):
The department may not pay for abortion services under
this chapter unless the abortion services are for a
medically necessary abortion or the pregnancy was the
result of rape or incest. Payment may not be made for
an elective abortion.
Mr. Hutchinson read from the top of page 2 pertaining to
the definition of abortion:
(2) "elective abortion" means an abortion that is not
a medically necessary abortion;
(3) "medically necessary abortion" means that, in a
physician's objective and reasonable professional
judgment after considering medically relevant factors,
an abortion must be performed to avoid a treat of
serious risk to the life or physical health of a woman
from continuation of the woman's pregnancy;
Mr. Hutchinson relayed that the language had been taken out
of the 2001 Planned Parenthood decision and was used in
various forms in the Hyde Amendment.
8:10:07 AM
Mr. Hutchinson continued with Section 2(4):
"serious risk to the life or physical health"
includes, but is not limited to, a serious risk to the
pregnant woman of
(A) death; or
(B) impairment of a major bodily function because
of...
Mr. Hutchinson relayed that the various medical afflictions
listed under the section had been verified by medical
experts including eight Alaskan doctors and three national
doctors. He noted that the physical conditions were
included in the 2001 Planned Parenthood decision. He read a
catchall provision in Section 2(4)(B)(xxii):
another physical disorder, physical injury, or
physical illness, including a life-endangering
physical condition caused by or arising from the
pregnancy that places the woman in danger of death or
major bodily impairment if an abortion is not
performed.
Mr. Hutchinson stated that death was the foundation the
term "major bodily impairment" had been included as a
mandatory extra protection as stipulated in the 2001
Planned Parenthood decision. He addressed Section 3 and
relayed that the analysis had not been as substantive as
that of the definition. He discussed the definition of
medically necessary as stated in the bill. The definition
incorporated the federal foundation required by the Hyde
Amendment. He spoke to the importance of the Hyde Amendment
and noted that it had been incorporated into Executive
Order 13535 by President Obama for inclusion in the federal
Affordable Care Act (Tab 3). He read from Section 1 of the
executive order:
it is necessary to establish an adequate enforcement
mechanism to ensure that Federal funds are not used
for abortion services (except in cases of rape or
incest, or when the life of the woman would be
endangered), consistent with a longstanding Federal
statutory restriction that is commonly known as the
Hyde Amendment.
Mr. Hutchinson disputed the claim that there could be no
restrictions on funding for abortions. He stated that the
executive order limited abortion funding to cases involving
rape, incest, and the life of the woman. He relayed that
the definition in SB 49 provided more protection than the
federal definition. He read from Hyde Amendment language
under Tab 4:
Section 508 (a) The limitations established in the
preceding section shall not apply to an abortion
(1) if the pregnancy is the result of an act of rape
or incest; or
(2) in the case where a woman suffers from a physical
disorder, physical injury, or physical illness,
including a life-endangering physical condition caused
by or arising from the pregnancy itself, that would,
as certified by a physician, place the woman in danger
of death unless an abortion is performed.
Mr. Hutchinson emphasized the word physical and relayed
that the focus was incorporated into the bill's definition.
8:14:36 AM
Mr. Hutchinson pointed out that death was the standard used
in the Hyde Amendment. He stated that the bill provided
additional protection as required under the Alaska
Constitution. He reiterated that definitions provided in
the bill had been taken from the Planned Parenthood
decision and had been agreed to by medical experts. He
stated that the bill made a clear distinction between
elective and medically necessary procedures. He clarified
that Medicaid did not fund elective procedures and stressed
that it should not fund elective abortions. He added that
Medicaid was required to perform medically necessary
procedures. He directed attention to statistics included
under Tab 6. He communicated that at a minimum the
definition was required to include the federal exceptions
of rape, incest, and life endangerment. The statistics
showed performance in other states. Tab 7 included the 2001
Planned Parenthood decision court order. He read from page
10:
DHSS [Department of Health and Social Services] is
constitutionally bound to apply neutral criteria in
allocating health care benefits, even if
considerations of expense, medical feasibility, or the
necessity of particular services otherwise limit the
health care it provides to poor Alaskans.
Mr. Hutchinson moved to page 16 of tab 7 and read from the
court order conclusion:
The State, having undertaken to provide health care
for poor Alaskans, must adhere to neutral criteria in
distributing that care. It may not deny medically
necessary services to eligible individuals based on
criteria unrelated to the purposes of the public
health care program.
Senator Coghill noted that the goal was not to discriminate
health care services and to define when something was
medically necessary versus elective. He acknowledged that
the bill would probably draw litigation given its base in
litigation.
Representative Costello MOVED to ADOPT the proposed
committee substitute for SSSB 49(FIN), Work Draft 28-
LS0410\Y (Mischel, 4/13/13).
Representative Gara OBJECTED. He asked for clarity on the
bill version before the committee. He referred to the bill
that had passed the Senate, which had included family
planning language.
Co-Chair Stoltze answered that the version was different
from the bill passed by the Senate; the bill before the
committee reflected the original bill language.
Representative Gara spoke to his objection. The bill that
passed the Senate included a provision that allowed the
state to participate in the women's health Medicaid family
planning program. He relayed that evidence suggested that
participation in the program would reduce the number of
unintended pregnancies, the cost of care for pregnant
women, and the number of abortions in Alaska. He did not
want remove a portion from the bill that would reduce the
number of abortions or the number of unintended
pregnancies.
8:20:15 AM
Senator Coghill spoke in opposition to the family planning
language. He elaborated that the language had been a
mandate to go beyond what was already done by the state.
The department had provided a list of existing programs
that included 7,500 individuals who had received family
planning services to date. Services were currently provided
for contraception, sexually transmitted diseases, and
general reproductive health. He reiterated that the family
planning language had been a mandate to go beyond the
current services for items like sterilization and
preconception care that he thought was already done under
pelvic exams. He concluded that the language had been
broader than he wanted.
Representative Ledoux offered that the family planning
component could be considered in the operating budget. She
did not believe the language was appropriate for the bill.
Representative Gara asked for verification that the
Medicaid women's health program language that had passed
the Senate was 90 percent covered by federal funds. Senator
Coghill replied that part of the program was 90 percent
covered and part was covered at 50 percent.
A roll call vote was taken on the motion to adopt the CS.
IN FAVOR: Munoz, Wilson, Edgmon, Neuman, Thompson,
Costello, Stoltze, Austerman
OPPOSED: Holmes, Gara, Guttenburg
The MOTION PASSED (3/8).
8:24:44 AM
Representative Gara discussed that the Alaska Supreme Court
opinion from 2001 had included the condition of bipolar
disorder under the definition of medically necessary. He
believed the bill should include the disorder given that
medication for bipolar disorder was very dangerous to a
pregnancy. He asked for verification that the disorder had
been in the 2001 court opinion language and why it had not
been included in the bill.
Senator Coghill answered that thorough medical testimony
had convinced the sponsor that the particular condition and
most psychological conditions were not a threat to the
health of a pregnant woman. Additionally, he referred to
the Hyde Amendment where physical health was given as the
reason for the need of an abortion.
Representative Munoz asked how many medically necessary
abortions had occurred in Alaska in 2013. Senator Coghill
answered that the figure was over 1,700. He stated that
currently all abortions paid under Medicaid were deemed
medically necessary due to the broad definition; the bill
clarified the definition. He corrected that 1,450 medically
necessary abortions had occurred in 2013 and 1,700 had
occurred the year the legislation had been introduced.
8:27:02 AM
Senator Coghill corrected that the total number of
abortions in 2013 was 1,450; Medicaid had paid for 547 of
the total.
Representative Guttenberg pointed to the qualification list
of medically necessary conditions and observed that one of
the items was "any other physical disorder." He asked if
the language sufficiently covered the other conditions
listed under the bill section.
Senator Coghill replied that the items listed out were
based on Alaska Supreme Court testimony.
Representative Guttenberg asked if the list was
restrictive.
Co-Chair Stoltze commented that he had never known Senator
Coghill to promote or increase the number of abortions.
Representative Guttenberg wanted to make sure something
unintentional was not done. Senator Coghill answered that
the list had been verified by doctors and the Alaska
Supreme Court. He understood that the list could not
include everything, which was the reason it included the
language "any other physical disorder."
Representative Guttenberg observed that all conditions in
the bill were physical. He discussed that increased
information about mental disorders was becoming available.
He believed mental disorders were not included under the
bill's definition of medically necessary.
Senator Coghill replied that when his office had gone
through the court test of neutral criteria, the neutral
criteria showed that psychologically terminating or
carrying a pregnancy to term could have equal weight. He
did not feel from the doctors' testimony that a pregnancy
would go beyond the physical well-being of a mother.
8:30:39 AM
Representative Wilson wondered how the bill compared to
state insurance. She wondered if there were two classes of
people being created by implementing the law related to
Medicaid but not for other state employees. She wanted to
provide accurate information to her constituents.
Senator Coghill answered that Medicaid was a mandated
formula program for individuals meeting qualifications. He
explained that the state had a negotiated healthcare plan
that fell under a very different set of rules. He deferred
to the administration for further detail.
Representative Wilson wanted to hear from the Department of
Administration (DOA) about state health insurance.
Co-Chair Stoltze noted that both the DHSS and DOA would
testify.
8:33:20 AM
AT EASE
8:34:00 AM
RECONVENED
SUSAN SCHRADER, SELF, JUNEAU, spoke in opposition to HB 173
and SB 49 as amended. She stated that the bills represented
another attempt by politicians to intervene in personal
medical decisions made by Alaskan women; decisions that
should be left up to women to make in consultation with
their family, faith, and physicians. She spoke to the
complexity a woman faced when deciding whether to have a
child, put the child up for adoption, or to have an
abortion. She believed the bills were an effort to limit
access to abortion under the guise of clarifying the term
"medically necessary." She stated that bills defining
personhood, requiring invasive ultrasound, or requiring
extended waiting periods, were all chipping away at women's
rights. She stressed that limiting access to Medicaid
funded abortions was not likely to limit the number of
abortions; however, it would limit the number of safe,
legal abortions. She furthered that it may lead women to
seek out illegal procedures. She pointed to practices
occurring prior to Roe v. Wade. She asked legislators to
adopt the women's health program under state Medicaid for
ready-access to family planning and birth control for all
Alaskan women (if the goal was to make abortion safe,
legal, and rare, and to saving money). She stressed that
the program would effectively reduce abortions and costs;
however, the CS removed the language from the bill. She
emphasized that family planning worked and did so without
trampling on women's rights to make their own healthcare
decisions. She understood that abortion was a highly
emotional issue, but she felt that the most upsetting thing
was to see other women limiting women's rights to
healthcare.
8:37:20 AM
LAURA POWERS, SELF, JUNEAU, testified in opposition to the
bills. She introduced her daughters. She communicated that
a woman's pregnancy decision was complex and personal and
should be made in consult with her doctor, not politicians.
She stressed that only healthcare providers could know what
was medically necessary. She implored the committee to vote
no on the legislation and to implement a Medicaid women's
health program instead.
IZEBELLA POWERS, SELF, JUNEAU, spoke in opposition to the
bill. She stressed that women should be able to make their
own decisions.
KORBYN POWERS, SELF, JUNEAU, testified against the bill.
She stated that women should have the ability to make their
own healthcare decisions.
Ms. Laura Powers encouraged the committee to take all
Alaskan women into consideration. She stated that it was a
woman's choice to have control of her body. She asked the
committee to vote no.
8:39:29 AM
GEORGE BROWN, PEDIATRICIAN, JUNEAU, testified against the
bills. He relayed that he had been a practicing
pediatrician in Alaska since 1965. He read from a letter to
the committee (copy on file):
These bills have several flaws. While it addresses the
most contentious issue of our Republic's political
history since the abolition of slavery, it IMPOSES
personal values which restrict access to legal medical
services, DISRESPECTS personal choice of women, which
means sexual discrimination, and of most importance
DENIES the reality of mind and body connection in
human health. Neuroscience continues to show how our
brain influences physical health and illness. Physical
illnesses such as cancer and trauma injuries like
domestic violence, child maltreatment, concussions,
and traumatic brain injuries impose continuing mental
stress and make a huge influence on our brains. Social
and behavioral disorders also have huge influence on
our brains.
Unintended pregnancies can produce intense stress on
brains. Not uncommonly, some intended pregnancies that
conclude with healthy newborns result in post-partum
depression, now well recognized in medical practice.
Persons who are trying to cope with such physical and
social stresses can cope with them. Successful coping
can be enhanced with family, health, and social
supports, which opens possibilities to other and
future choices and healing.
Laws which deny personal choices about health care add
more stress to individuals. Persons who have never
been pregnant or who can never become pregnant cannot
really understand these particular stresses. Persons
who are or who have been pregnant are more experienced
for seeking and finding the most appropriate choices
to deal with these stresses.
There is a more positive option for all of us in this
complex social dilemma. As we try hard to be tolerant
about others values, understand the deep complexities
of individual and social behavior, and to listen with
the intent to hear all voices, we can come together to
accept and increase practices which prevent as many as
possible future unintended pregnancies. This is in no
way simple, but it has been done for decades and does
work when practiced. It also can redirect our energies
away from conflict toward cooperation. There is
certainly much more we can all do to improve male
understanding about violence and pregnancy prevention
and to increase their practice of respect and birth
control. I hope you will vote against these bills and
work toward preventive legislation action.
8:44:38 AM
Representative Costello acknowledged Dr. Brown for his work
making house calls and his good reputation. Dr. Brown
replied that enjoyed his work. He noted that children were
born with love, empathy, and trust and that listening to
children would help solve the problems under discussion.
Vice-Chair Neuman spoke from the perspective of a father.
He wondered who spoke for the life of the unborn child and
fetus. He believed it had been implied that a man had a
lesser opinion than a woman. He was very concerned about
the lives of unborn children. He wondered how the unborn
child could be protected. He spoke about the option of
giving a child up for adoption. He wondered how to speak
for unborn children.
Dr. Brown replied that the issue was not simple. He
believed there was still government of the people, by the
people, and for the people, as long as people continue to
speak up and create dialogue between elected officials and
themselves. He stated that more males and more fathers were
appreciating the pregnancy process, which was a positive
thing. He emphasized the importance of prevention. He
discussed the importance of doing everything possible to
increase youths understanding about unintended pregnancies
and providing increased funds to counseling, support, and
family planning. He spoke about work to prevent child abuse
through the Alaska Children's Trust; the organization
worked with Father's Community Café to discuss pregnancy
and associated responsibilities of becoming a father. He
stressed that the work was about changing the paradigm. He
discussed the importance of working together, listening to
each other, and cooperation.
8:49:00 AM
Vice-Chair Neuman believed the opinion of a medical doctor
was important. He spoke about changing his own children's
diapers. He wondered how to measure the life and voice of
an unborn child.
Co-Chair Stoltze relayed his intent to continue hearing
public testimony.
Representative Gara referred to a court opinion that
included bipolar disorder on a list of items that should
qualify for Medicaid coverage for abortions. He discussed
that the drug used to treat bipolar disorder had been
dangerous to a pregnancy. He wondered about potential
dangers and if the information remained current.
Dr. Brown answered that there were a number of potentially
dangerous drugs. He noted that one of the real problems was
that people with bipolar disorder or those under stress
frequently used many other drugs including alcohol. He
stated that working to help eliminate drug and alcohol use
was far better than trying to tell a woman she should or
should not have an abortion. Ultimately out of respect for
the belief in individual liberty, he believed it was a
woman's right to make her own decision. He believed support
around the decision was needed. He stressed the importance
of prevention.
Representative Gara had been told that a Medicaid family
planning program could reduce the number of abortions by
over 500 per year. He wondered if Dr. Brown believed the
adoption of the program would reduce the number of
abortions in Alaska.
Dr. Brown believed the adoption of the Medicaid family
planning program would reduce the number of abortions. He
strongly urged the committee to implement the program that
provided services to youths who were far more likely to
have unintended pregnancies. The program would not prevent
all abortions, but it was a very worthwhile investment.
8:52:58 AM
Representative Munoz had been advised by the Division of
Public Health Nursing that no one was denied service based
on ability to pay. She asked whether services would be
expanded to cover more individuals if the family planning
proposal was added to the bill.
Dr. Brown replied that many people eligible for Medicaid
and Medicare did not use the services because they were
ashamed of being poor. Likewise, there were many people who
could utilize public health services, but did not due to
the same reason. He believed Denali KidCare was helpful
because it gave lower-income individuals access to services
with the broader population without making them feel
ostracized. He stated that if access was made friendly and
open to everyone, individuals would be more likely to
participate. He acknowledged that it would cost money, but
the investment would reduce costs associated with jails,
courts, and other in the long-term.
Vice-Chair Neuman stated that the financial costs
associated with taking a healthy baby to full term were not
that high. He wondered how much it would cost to carry a
baby to term and to offer it for adoption compared to the
cost of abortion.
Dr. Brown could not provide a financial figure. He stated
that in the short-term an abortion would cost less;
however, he believed it was a tragedy and should be
prevented if possible. He stressed the importance of
investing in supports to provide assistance and counseling
to pregnant women. He stated that investing the supports
that would help a mother deal with mental stress was as
medically important as anything physical. He noted that the
services were costly, but would save money in the long-
term. He believed if people kept fighting over the issue
the problem would not be solved and the state would
continue to pay for services related to drugs and other.
8:57:05 AM
MICHAEL PAULEY, ALASKA FAMILY COUNCIL, JUNEAU, spoke in
strong support of SB 49. He regretted that the bill had
been cast as a question about when a person was able to
have an abortion. He believed the bill was really about
Medicaid funding. He referred to a 2004 study by the Alan
Guttmacher Institute of 1,209 abortion patients at 11 large
providers. He stated that the study participants had been
asked about the primary reason for an abortion; 4 percent
had communicated that a physical health problem was the
most important reason for the abortion; 12 percent stated
that health was a factor. He spoke about applying the
numbers to Alaska; in 2013 the Bureau of Vital Statistics
reported that 1,450 abortions had been performed in Alaska,
547 or 37.7 percent of which had been paid for by Medicaid.
He stated that the number had held consistent over time. He
noted that public funds paid for the abortions. He stated
that if the numbers were consistent with the national study
related to the number of medically required abortions,
Medicaid would pay for 58 to 175 abortions per year. The
council believed that doctors performing abortions in
Alaska were submitting claims for abortions that were not
medically necessary. He believed SB 49 articulated a
reliable, medically neutral definition of medically
necessary abortion, which made good policy and fiscal
sense. He opined that the bill had nothing to do with pro-
life versus pro-choice; it was about meeting the state's
obligations to pay for medically necessary abortions, but
not elective abortions.
9:01:42 AM
Representative Wilson referred to prior testimony related
to the national study's percentage of medically necessary
abortions. She asked if the state was paying for abortions
that were not medically necessary because doctors were not
asking the right questions. She noted that her office had
been told that no one was asking the questions. She was
trying to determine whether the doctors were not currently
asking the questions or whether the definition was specific
enough.
Mr. Pauley believed that the current system afforded a
significant amount of discretion to the physician. He noted
that the physicians were getting compensated with public
dollars for performing abortions. He opined that the issue
was shrouded in ideology. He noted that Planned Parenthood
provided the majority of abortions in the state. He
believed Planned Parenthood took the view that an abortion
was medically necessary if a patient did not want to be
pregnant. His opinion was based on testimony and Planned
Parenthood litigation. He had been disturbed the prior year
when a Planned Parenthood representative had testified that
she did not have a definition for elective abortions. He
stressed that the U.S. Supreme Court decision on abortion
funding had repeatedly made the distinction between
elective and medically necessary. He believed SB 49 offered
the needed precision and clarification of language.
9:04:58 AM
Representative Guttenberg asked about dialog between a
woman and a doctor regarding the decision to have an
abortion. He believed Mr. Pauley was insinuating that
virtually no conversation occurred between the two people
about the decision to have an abortion.
Mr. Pauley deferred the question to doctors preforming
abortions. He did not believe that most physicians
performing abortions in Alaska felt that counseling was
within their purview. He stated that the physicians
believed that abortion was a constitutional right and as
long as the informed consent law was followed the doctor
would provide the procedure without question.
Representative Guttenberg referred to a personal medical
experience and stressed that he did not know any doctors
who did not counsel their patients.
Representative Gara communicated that the term medically
necessary abortion had been defined in a prior legal case
between the state and other parties. He believed Mr. Pauley
thought there were doctors calling elective abortions
medically necessary. He disagreed; however, if it were
true, he wondered why doctors would follow the law under SB
49 if they were not currently following the law.
Mr. Pauley believed the outcome would be different because
of the list of medical conditions included in the bill that
fell under the medically necessary definition.
Additionally, the bill included a catchall provision for
conditions that it did not specifically list. He expected
the department to begin to ask tough questions if the bill
passed and 547 abortions performed fell under the "other"
category in the future.
9:09:02 AM
MELISSA ENGEL, SELF, JUNEAU, testified in opposition to the
bills. She spoke from her perspective as a Christian. She
believed that God had created humans with amazing bodies
and that humans were connected to their physical and mental
bodies in ways that no one else could ever be. She stressed
that each person knows what is best for them and when
unsure has the ability to consult with trusted medical
doctors. She urged the committee to oppose the bills. She
stressed that women knew what was best for their own
bodies. When a woman was unsure, she consulted her medical
doctor, not government officials; each woman was created
differently and had various reasons for deciding upon a
medical choice. She asked the committee what would happen
if the reason did not fit within the bill's defined
parameters of medically necessary. She emphasized that
women's health was not a political matter to be decided on
by legislators. She thanked the committee for its time.
9:11:44 AM
MIKE COONS, SELF, PALMER (via teleconference), spoke in
favor of the legislation. He stated that all physicians had
a physician's desk reference and knew if medication was a
threat to pregnancy. He referred to prior testimony related
to drug and alcohol abuse and stated that substance abuse
caused many self-induced abortions. He did not believe the
issue was about elective abortions, but about what
constituted medically necessary based on medically sound
knowledge. He stated that elective abortions were not to be
paid for with state money under federal and state law.
9:13:10 AM
JOSHUA DECKER, EXECUTIVE DIRECTOR, AMERICAN CIVIL LIBERTIES
UNION OF ALASKA (via teleconference), spoke against the
bills. He stated that the bills posed substantial
constitutional challenges. He pointed to a separation of
powers concern and explained that once the Alaska Supreme
Court had stated the contours of a constitutional right
such as the right for low-income women to have Medicaid
funded abortions, the legislature was not able to alter or
narrow the right (which both of the bills attempted to do).
He communicated that the bills were substantively
unconstitutional. He spoke to earlier testimony related to
the omission of bipolar disorder from the bill's definition
of medically necessary, which in the Alaska Supreme Court's
opinion was a constitutionally mandated reason to allow for
Medicaid funded abortions. Additionally, the bills were of
concern because they "cherry pick out" the term medically
necessary in the abortion context and defined it in a
narrow and restrictive way; whereas the term was not
defined elsewhere in Medicaid documents. The organization
believed that if the bills were enacted into law and
subject to constitutional challenge that the court would
"look askance" at the cherry picking definition.
Mr. Decker addressed the cost of the bills. He noted that
the bills' fiscal notes were zero, but abortion litigation
was not new to Alaska. He shared that the state had
repeatedly attempted to unconstitutionally restrict a
woman's right to reproductive choice and had spent nearly
$1 million defending the unconstitutional attempts. The
organization believed the state would likely have to pay
hundreds of thousands of dollars in attorney fees and costs
to the potential plaintiffs if the issue was subject to
legal challenge. He urged the committee to not pass the
bills.
9:16:27 AM
KINE MCCLINTOCK, SELF, ANCHORAGE (via teleconference),
urged the committee to vote against the bills. She was a
life-long Alaskan and was currently working on pursuing her
master's in public health. She had spent significant time
studying the effects of policies that either restricted
access to abortion or made contraceptives more accessible.
She stated that the latter approach could decrease abortion
rates and provided women and families with the necessary
tools to lead healthy and fulfilling lives. She detailed
that research showed that restrictions such as the ones in
SB 49 were ineffective at decreasing the need for abortion.
She asked the legislature to make contraceptives more
accessible to low-income women if the goal was to reduce
the number of abortions. She stated that the definitions in
the bill denied low-income women medically necessary care,
which effectively created two classes of women. She
believed it was unethical to make a safe and legal
procedure unavailable to some women. She strongly believed
that it was the state's obligation to care for all people
and to provide them with equal protection under the law.
She was disheartened that the legislature was spending time
on SB 49, which she believed was dangerous to women's
health. She stressed that deciding what constitutes a
medically necessary abortion was a medical decision and
should be left to physicians, not politicians. She asked
the committee to oppose the legislation.
Representative Gara thanked Ms. McClintock for her
testimony.
9:19:16 AM
LYNN ESCOLA, SELF, PETERSBURG (via teleconference), spoke
in opposition to SB 49. She stated that the bill
established a "Chinese menu" for determining who can
receive an abortion under Medicaid. She pointed out that no
mental and emotional illnesses regardless of severity were
included under the bill's definition. Also missing were
cases of malformed fetus. She stressed that the omissions
were incredibly inhumane and represented very poor public
policy. She stated that legislators were attempting to dole
out healthcare according to their own judgment of medical
necessity. She believed the bill was not needed and that
deciding what constituted medically necessary could be left
to physicians. She believed the bill was prompted to
withhold medical care from some Alaskan women by
withholding payment. She wanted the government to pay for
medical care for poor women, including abortions. She
referred to an Alaska Supreme Court ruling that the state
was required to provide equal protection under the law for
all pregnancy decisions. She stated if the state paid for a
woman to remain pregnant it should pay for a woman to not
remain pregnant. She pointed out that remaining pregnant
cost the public much more than an abortion. She stated that
SB 49 represented excess government regulation, it hurt
individual Alaskans who would be denied healthcare, and it
would result in the increased expenditure of public funds.
She opined that it was hard to see any legitimate public
interest being served by the bill. She added that if the
law passed it would likely be found unlawful. She stressed
that the bill was wasting the legislature's time and the
public's money. She was offended that the bill victimized
poor women, especially young and rural poor women with
limited options. She stated that the bill would constrain
poor women to producing babies for the childless
middleclass seeking to adopt. She was repulsed by the idea
of the government's hands compelling a pregnancy as a
commodity. She stated that the bill would result in death
from back alley or self-induced abortions or from suicide.
Co-Chair Stoltze asked for clarification about the term
Chinese menu. Ms. Escola replied that it was a metaphor.
9:23:03 AM
JESSICA CLER, PUBLIC AFFAIRS MANAGER, PLANNED PARENTHOOD
VOTES NORTHWEST, ANCHORAGE (via teleconference), spoke
against the bills. She shared that the organization
operated five health centers in Alaska and in 2012 it
served nearly 12,000 people in the state with lifesaving
and cost saving reproductive healthcare including
contraception, cancer and disease screenings, exams, and
abortions. The agency was proud to be a provider of safe
and legal abortions, but its efforts were focused on
providing the resources people need to plan their
pregnancies. The planning reduced unintended pregnancies,
abortions, and cost to the state for unintended pregnancy
care. She stressed that every woman and every woman's
health was different; only a trained health professional
should decide what was medically necessary for a woman. She
added that the healthcare decision should not be made by
politicians.
Ms. Cler stated that the bills were a blatant attempt to
put government into low-income Alaskan women's pregnancy
decisions, which was not right, not fair, and not good
healthcare. She pointed to the unconstitutionality of the
legislation; in 2002 the Alaska Supreme Court specified
that the Medicaid program could not discriminate against
women who have an abortion. She noted that a judge had
already enjoined a DHSS rule that was almost identical to
the bills. She stressed that there was no reason to waste
legislative time, energy, and money while the court was in
the process of deciding the issue. She stressed that the
bills would cost money. She advised that if reducing
abortions and saving money was the legislature's goal, it
should get rid of the bills and enact a Medicaid women's
health program to get contraceptives to more women whose
pregnancies would otherwise be paid for by the state. The
savings would be approximately $9 million annually. She
addressed the sponsor's stated reason for the legislation
pertaining to state savings. She emphasized that the bills
would not save money and would cost money in continuing law
suits. She respectfully urged the committee to not move
forward with the bills.
9:26:05 AM
THEDA PITTMAN, SELF, ANCHORAGE (via teleconference), spoke
in opposition to the legislation. She believed everyone
agreed in the goal of reducing the number of abortions;
however, there was disagreement in the way to accomplish
the goal and about whether public funds should be used if a
pregnant girl or woman was on Medicaid. She stated that
public officials were vocalizing serious warnings about the
need to be much more careful about spending state funds.
She relayed that the bills had already wasted time and
money. She continued that in spite of a current court case
challenging regulation language, the sponsor of SB 49 had
pressed forward because statute held more weight than
regulation. She noted that the sponsor had identified the
issue as fiscally conservative. She opined that if the goal
was to behave in a fiscally conservative way, the bills
should be tabled until the court decision was made. She
stated that the bills would be unnecessary if the court
upheld the regulations; if the regulations were struck down
as unconstitutional the decision would need to be analyzed
to determine guidance the decision provided as to how
broadly the term medically necessary abortion should be
construed. She stated that the bills would need to be
redrafted all over again. She asked the committee to be
fiscally prudent and to wait until additional information
was available.
9:28:37 AM
ROBIN SUMMERS, POLICY DIRECTOR, NATIONAL FAMILY PLANNING
AND REPRODUCTION ASSOCIATION, WASHINGTON D.C. (via
teleconference), briefly described the organization. She
thanked Representative Holmes for the invitation to testify
on Medicaid family planning [the amendment had been removed
from the bills]. She read from prepared testimony (copy on
file):
For two decades states have broadened eligibility for
their Medicaid programs to provide family planning
services and supplies to individuals who are not
otherwise eligible for Medicaid. Today 30 states have
chosen to expand eligibility for family planning; 12
of those have done so through what's known as the
State Plan Amendment (SPA). Medicaid family planning
SPAs provide a broad range of family planning-related
services, including the full range of contraceptive
methods, pap tests, and other associated examinations
and laboratory tests. A Medicaid family planning SPA
does not cover abortion.
Ms. Summers addressed the idea that some of the services
were already provided through the Medicaid program. She
communicated that a family planning SPA would not be
duplicative of the coverage Alaska currently provided
through its Medicaid program.
Today, a single mother with one child (working parent,
household of 2) is eligible for Medicaid if she earns
less than $2,111 per month. However, eligibility for
that same single mother with one child, if she becomes
pregnant, goes up to $4,124 per month during her
pregnancy. A childless adult is not eligible at all,
unless she has a qualifying condition (e.g. disabled).
A Medicaid family planning SPA would provide family
planning services to childless adults who are not
otherwise eligible for Medicaid, as well as to those
single mothers with incomes that fall in the gap
between $2,111 and pregnancy eligibility.
Ms. Summers detailed that Medicaid family planning programs
like the SPA under consideration saved states money; nearly
$6.00 saved for every $1.00 spent. Expanding access to
contraception and increasing the use of more effective
contraceptive methods are essential to reducing unintended
pregnancy. She read from a prepared statement:
The Brookings Institution estimates that Medicaid
family planning expansion programs save taxpayers
$1.32 billion annually. Births resulting from
unintended pregnancy cost US tax payers approximately
$12.5 billion annually.
Ms. Summers relayed that in Alaska in 2010 there were 3,000
publicly funded births resulting from unintended
pregnancies representing more than one-quarter of all
births in the state and more than half of the state's
Medicaid funded births. The births from unintended
pregnancies cost a total of $71 million; $34 million of the
total had been paid for by the state. She stated that a
Medicaid family planning SPA would improve public health
while saving taxpayer dollars. She strongly urged the
committee to adopt the family planning program.
9:31:52 AM
JAN CAROLYN HARDY, SELF, ANCHORAGE (via teleconference),
urged the committee to vote against the bills. She stated
that medically necessary was not in the purview of
government and the legal process. She stressed that the
decisions were for women and their doctors. The Alaska
Supreme Court ruled that the decision a woman makes
concerning her own body and whether to carry or terminate a
pregnancy is to be given equal protection under the law.
The passage of the bills would result in increased spending
on litigation related to the unconstitutionality of the
issue. She stated that Alaska was working with
unprecedented deficits resulting from corporation
mentality. She asked if Alaskans needed to bear another
unnecessary financial burden in order to forward partisan
positions that did nothing to improve the quality of life
for all citizens. She questioned if more money needed to be
wasted on court costs when many of the state's citizens
lacked basic family planning services.
Ms. Hardy spoke to the byproducts of unintended pregnancy
including homelessness, hunger, poverty, and malnutrition.
She stated that 50 percent of unintended pregnancies
occurred in the population served by Medicaid. She
communicated that the only safe and economic strategy to
prevent unintended pregnancy was to institute a Medicaid
women's health program. The program offered supplements and
healthcare for women choosing to carry a baby to full-term;
it offered contraceptive services for women choosing not to
have children. She urged the committee to vote against the
bills and asked it to implement a Medicaid women's health
program. She relayed that 90 percent of the program's cost
was covered by the federal government, with 10 percent
covered by the state. In addition to keeping federal
dollars in Alaska, the program would defray a significant
burden to the Denali KidCare service, which would save
millions of dollars. She thanked the committee for its
time.
9:34:45 AM
JOYANNE BLOOM, SELF, JUNEAU, testified against the bills.
She spoke to the financial impacts of the legislation. She
believed the zero fiscal notes attached to the bill were
misleading. She pointed out that the DHSS commissioner had
relayed that the bill would cost close to $1 million in
litigation. She had also heard from the sponsor that he
expected the issue would go to litigation. She believed
there were many better ways to spend $1 million.
9:36:10 AM
ANN ROBERTSON, SELF, JUNEAU, spoke strongly against the
legislation. She stated that the definition of medically
necessary abortions should be determined only be doctors;
the decision was not the purview of the legislature. She
believed the bills constituted broad government overreach,
which she understood many committee members were opposed
to. She urged the committee to vote against the
legislation.
9:37:05 AM
AMY BOLLENBACH, SELF, HOMER (via teleconference), spoke
against SB 49. She pointed out that the bills would cost
the state a significant amount of money. She noted that it
cost less to pay for an abortion than it did to pay the
healthcare of children born to women who were not ready to
be parents. She mentioned her work as a university
psychology teacher. She pointed to the connection between
mental and physical health and discussed that if someone
was mentally ill it impacted physical health and vice
versa. She stated that it was impossible to list all of the
different medical reasons a woman may need an abortion. She
asked the committee to vote against SB 49 because it was
not helpful to the health of women in Alaska.
9:39:18 AM
JEAN BRAMER, OBSTETRICIAN, FAIRBANKS (via teleconference),
testified in favor of the legislation. She stated that
medical necessity was defined every day. She stated that
many strict definitions of the term existed and much
research and literature could explain it. She continued
that there were few instances when pregnancies would be
recommended for termination based on health issues. She
stated that the number of abortions deemed medically
necessary were not close to existing definitions of medical
necessity. She stated that approximately 40 percent of
abortions were deemed necessary compared to literature
showing that approximately 4 percent fell under the
medically necessary category. She communicated that
research showed that there were very few pregnancies that
should be terminated due to the health of a mother. She
stated that most of the abortions were terminated based on
the desire to not continue a pregnancy. She furthered that
SB 49 did not limit resources for women to choose to
exercise their legal right of termination. She did not
believe the state's tax dollars needed to fund elective
abortions. She did not believe the issue had to do with
pro-life or pro-choice. She opined that it was a funding
issue and that the terms were well defined in the bill. She
supported the legislation in order to continue healthcare
provided to Alaskans and to make the best use of tax
dollars by allowing appropriate definitions to be made. She
did not support a "carte blanche" to anyone choosing to
terminate a pregnancy.
Representative Wilson asked whether doctors were following
the current law related to medical necessity. Dr. Bramer
did not believe doctors could be following the current law.
She noted that the number of abortions deemed medically
necessary by doctors [in Alaska] was much higher than the
research figures. She had one or two instances when the
option could have been considered but the patients had
chosen to continue with their pregnancies. She did not
believe it was realistic that 40 percent of the patients
could be having abortions out of medical necessity.
Representative Wilson asked Dr. Bramer if she believed that
the bill would be effective. Dr. Bramer replied in the
affirmative. She believed a statement of medical necessity
could be interpreted in various ways; however, there were
very few instances when elective surgeries were paid for by
insurance. She believed the bill represented a continuation
of medical practices in the "normal medical world." She
pointed out that the bill provided a strict guideline for
what constituted medically necessary. She stated that the
bill did not limit anyone's access to abortions. She
believed the bill was excellent.
9:44:15 AM
Representative Gara pointed to Dr. Bramer's testimony that
doctors were currently providing elective abortions under
the medically necessary category. He disagreed, but
wondered why doctors would start complying with the law in
the future if they were not complying with existing law.
Dr. Bramer replied that the bills would provide stricter
guidelines. She believed a loose guideline provided doctors
with the opportunity to deem elective abortions as
medically necessary. She stated that with a strict
definition doctors would either be committing fraudulent
activity by designating elective abortions as medically
necessary or they would have to realize the abortions would
not get funded by Medicaid. She believed many physicians
were currently providing elective abortions under the
medically necessary category.
Representative Munoz wondered if Dr. Bramer believed that a
diagnosed mental disability should be listed in the bill as
a medically necessary reason for an abortion. Dr. Bramer
replied in the negative. She relayed that she had taken
care of many women with mental disorders through
pregnancies.
9:46:30 AM
Co-Chair Stoltze wanted to hear from Alaska Mental Health
Trust Authority (AMHTA) related to the issues.
Representative Holmes wondered if the health of a fetus was
considered in the legislation. She thought it was cruel and
unusual if a woman was forced to continue a pregnancy if
the fetus would not survive. Dr. Bramer answered that the
discovery of an unviable fetus was typically found in the
second trimester. She explained that the issue typically
went through an ethics committee and an opinion was
received from two physicians at different practices. Once
agreement had been made that the fetus was nonviable, the
patient would have the option to terminate the pregnancy.
She stated that the occurrence was fairly infrequent; she
recalled that she had three patients in the situation
during her 18 years of practice.
Representative Holmes would take the issue up with the
sponsor.
Co-Chair Stoltze appreciated the testimony from the
physicians.
ALLISON CURREY, SELF, JUNEAU, spoke in opposition to the
bills. She agreed with many points made by others opposing
the bills. She spoke in support of increased access to
family planning services through a Medicaid women's health
program. She addressed supporting testimony that the bills
were only about clarifying definitions, not restricting
access to abortion. She stressed that legal abortion meant
very little to a woman who could not pay for one. She
believed the bills were discriminatory because they
violated the constitutional equal protection clause that
protects the freedom and privacy of low-income women to
make their own healthcare decisions. She thanked the
committee for its time.
Co-Chair Stoltze CLOSED public testimony.
9:51:17 AM
Senator Coghill replied that the crux of the issue in the
legislation was related to Medicaid payment. He stated that
Medicaid was an entitlement provided to poor people in
Alaska. He believed that Medicaid should be available when
there was a need. He communicated that the bill did not
restrict a woman's choice [to have an abortion]. He
believed it brought responsibility to the choice. He
acknowledged that the area was highly litigated. He noted
that Planned Parenthood had no answer when he had asked
what constituted an elective abortion. He believed Planned
Parenthood viewed any wanted abortion as required. He
stated that any other elective procedure would be provided
under Medicaid if it was for health reasons. He
acknowledged that he had a larger issue with the topic, but
he had worked to keep the bill narrowly focused. He stated
that a court decision had brought up psychological
conditions. As the chairman of the House Judiciary
Committee, he had brought eight or nine medical
professionals (pro and con) to testify extensively on the
legal technical and ethical issues. He had determined that
under neutral criteria (was healthcare available under both
circumstances) the answer had been that there was no
compelling reason to include it [psychological conditions]
in the case of abortions. He remarked that the Alaska
Supreme Court had not had the testimony that the
legislature had heard. He agreed to speak with AMHTA on the
subject as well, but believed it had been well vetted.
Senator Coghill stated that Planned Parenthood and the ACLU
pushed for abortions in almost any case. He was not
surprised that the entities had to both continually be
challenged on three legal and practical levels including
policy, how to deal with the issue in good standard medical
terms, and how to answer technical legal arguments. He
shared that he frequently disagreed with the courts on
policy and philosophy. He believed in the rule of law and
detailed that the bill attempted to bring clarity to the
issue. He agreed that litigation costs existed; however, he
found it difficult to believe that promoting abortions over
taking care of children would be cheaper. He stated that
there was an expense no matter what. He communicated that
he had worked hard to help children in need of aid,
individuals with Fetal Alcohol Syndrome, and women in need;
service for people in need cost approximately $3.2 billion
in state and federal funds. He believed the willingness of
Alaskans to help people was difficult to challenge. He
stated that the equal protection argument was about whether
equitable care was provided; he believed the answer was
yes. He acknowledged that the issue was emotional and that
the well-being and rights of a mother were to be respected.
He discussed that the issue of payment was difficult; the
bill aimed to bring clarity.
9:57:31 AM
Representative Ledoux appreciated the committee's time. She
pointed to heartfelt testimony, but noted that most of the
opposing testimony related to a woman's right to choose an
abortion. She stated that the bill was unrelated to that
right. She stressed that the bill only pertained to who
paid for abortions.
Senator Coghill added that he had asked DHSS to clarify
what was currently covered under family planning services
in Alaska. There were currently 39 items covered under
family planning. He relayed that under diagnostic general
reproductive health there were eight items including
cervical cancer, female reproductive cancer, male
reproductive, pap smear tests, urinary, and vaginal
discharge; there were 11 other items under diagnostic
sexually transmitted infections. The contraception category
included birth control pills, cervical caps, diaphragms,
etc. He stated that there were 16 different variations of
family planning currently used in the state. Other cancer
screening and prevention covered under Medicaid included
mammograms, pap smears, and colonoscopies. He detailed that
most of the items were covered at the 90 percent area and
many were covered at the 50 percent area. Preconception
gynecologic exams were also covered. He believed the
requirement under current law was significant. He stated
that Denali KidCare provided services in 18 different
areas.
Co-Chair Stoltze relayed that DHSS and DOA would address
the committee related to the bills. He noted that the issue
would be discussed further at the afternoon meeting.
HB 173 was HEARD and HELD in committee for further
consideration.
SSSB 49(FIN) was HEARD and HELD in committee for further
consideration.
ADJOURNMENT
10:00:59 AM
The meeting was adjourned at 10:00 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 173 Letters of Support.PDF |
HFIN 2/25/2014 8:00:00 AM |
HB 173 |
| HB 173 Sectional Analysis.PDF |
HFIN 2/25/2014 8:00:00 AM |
HB 173 |
| HB 173 Sponsor Statement.PDF |
HFIN 2/25/2014 8:00:00 AM |
HB 173 |
| HB 173 Supporting Document Legal Memo.PDF |
HFIN 2/25/2014 8:00:00 AM |
HB 173 |
| SB 49 - 2013 Induced Termination of Pregnancy Statistics.pdf |
HFIN 2/25/2014 8:00:00 AM |
SB 49 |
| SB 49 - Explanation of Changes.pdf |
HFIN 2/25/2014 8:00:00 AM |
SB 49 |
| SB 49 - Sectional Analysis.pdf |
HFIN 2/25/2014 8:00:00 AM |
SB 49 |
| SB 49 - Sponsor Statement.pdf |
HFIN 2/25/2014 8:00:00 AM |
SB 49 |
| SB 49 NEW FISCAL NOTES-DHSS 2.24.14.pdf |
HFIN 2/25/2014 8:00:00 AM |
SB 49 |
| SB 49 & HB 173. ACLU Review. 2014.02.24.pdf |
HFIN 2/25/2014 8:00:00 AM |
HB 173 SB 49 |
| SB 49 Public Testimony Dr. Brown.pdf |
HFIN 2/25/2014 8:00:00 AM |
SB 49 |