Legislature(2001 - 2002)
05/11/2002 05:50 PM House FIN
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE FINANCE COMMITTEE
May 11, 2002
5:50 P.M.
TAPE HFC 02 - 109, Side A
TAPE HFC 02 - 109, Side B
CALL TO ORDER
Co-Chair Williams called the House Finance Committee meeting
to order at 5:50 P.M.
MEMBERS PRESENT
Representative Bill Williams, Co-Chair
Representative Eldon Mulder, Co-Chair
Representative Con Bunde, Vice-Chair
Representative Eric Croft
Representative John Davies
Representative Richard Foster
Representative John Harris
Representative Bill Hudson
Representative Ken Lancaster
Representative Carl Moses
Representative Jim Whitaker
MEMBERS ABSENT
None
ALSO PRESENT
Representative Fred Dyson; Josh Govaars, Staff, Senator Dave
Donley; Gwendolyn Hall, Staff, Senator Pete Kelly; Chip
Wagoner, Alaska Catholic Conference; William Craig, Alaska
Independent Blind, Sitka; Helen Craig, Sitka; Nancy Weller,
Division of Medical Assistance, Department of Health &
Social Services
PRESENT VIA TELECONFERENCE
Dr. Colleen Murphy, Anchorage; Dr. John Middaugh,
Epidemiology Section, Department of Health and Social
Services, Anchorage
SUMMARY
SB 180 An Act implementing pay differentials based on
geographic areas for certain state employees and
for members of the Alaska State Defense Force; and
providing for an effective date.
HCS CS SB 180 (FIN) was reported out of Committee
with a "do pass" recommendation and new fiscal
notes by Department of Administration and the
Alaska Court System.
SB 206 An Act relating to registration plates and parking
permits for persons with disabilities and to
illegal use of parking spaces for persons with
disabilities.
HCS CS SB 206 (FIN) was reported out of Committee
with a "do pass" recommendation and with zero
fiscal notes, #2 by the Department of Public
Safety and #3 by the Department of Administration.
SB 247 An Act making capital appropriations and
reappropriations, and capitalizing funds; making
appropriations under art. IX, sec. 17(c),
Constitution of the State of Alaska, from the
constitutional budget reserve fund; and providing
for an effective date.
SB 247 was HEARD and HELD in Committee for further
consideration.
SB 252 An Act renaming the Alaska Human Resource
Investment Council as the Alaska Workforce
Investment Board and relating to its membership;
repealing the termination date of the state
training and employment program; relating to
employment and training activities; and providing
for an effective date.
CS SB 252 (RLS) was SCHEDULED but had not arrived
to the Committee.
SB 359 An Act relating to organization grants for
mergers, consolidations, or unifications involving
third class boroughs.
CS SB 359 (RLS) was SCHEDULED but the House
Majority was still working on the work draft.
SB 364 An Act relating to medical services under the
state Medicaid program.
SB 364 was HEARD and HELD in Committee for further
consideration.
CS FOR SENATE BILL NO. 247(FIN)
An Act making and amending appropriations and
reappropriations; making appropriations under art. IX,
sec. 17(c), Constitution of the State of Alaska, from
the constitutional budget reserve fund; and providing
for an effective date.
Co-Chair Williams explained his intent regarding the capital
budget amendment process. He asked if there was any public
testimony. There being no one on line or present in
Committee to testify, public testimony was closed.
SB 247 was HELD in Committee for further consideration.
#SB180
CS FOR SENATE BILL NO. 180(FIN)(efd fld)
An Act implementing pay differentials based on
geographic areas for certain state employees and for
members of the Alaska State Defense Force; relating to
cost-of-living differentials for state aid to
municipalities.
Co-Chair Mulder MOVED to RESCIND previous action taken on
adopting Amendment #2. There being NO OBJECTION, the action
was rescinded.
Co-Chair Mulder MOVED to WITHDRAW Amendment #2. There being
NO OBJECTION, the amendment was withdrawn.
Co-Chair Mulder MOVED to report HCS CS SB 180 (FIN) out of
Committee with individual recommendations and with the
accompanying fiscal notes. There being NO OBJECTION, it was
so ordered.
HCS CS SB 180 (FIN) was reported out of Committee with a "do
pass" recommendation and with new fiscal notes by the
Department of Administration and the Alaska Court System.
#SB206
CS FOR SENATE BILL NO. 206(TRA)
An Act relating to registration plates and parking
permits for persons with disabilities and to illegal
use of parking spaces for persons with disabilities.
JOSH GOVAARS, STAFF, SENATOR DAVE DONLEY, stated that the
committee substitute for SB 206 (TRA) would help to insure
the availability of priority parking for truly disabled
Alaskans and was intended to prevent many of the instances
of abuse that currently exist in our State's disabled
parking system. The bill would accomplish that by improving
the issuing process for disabled parking permits and
cracking down on individuals convicted of illegally parking
in disabled parking areas or convicted of misusing disabled
parking permits.
To provide better access to disabled parking spaces for the
truly disabled, the State of Washington toughened its laws
to combat widespread abuse of disabled parking placards.
Other states have also tightened up their disabled parking
laws.
Mr. Govaars noted that it is often difficult to identify
whether or not individuals who have parked an automobile in
a disabled parking space are disabled. Working closely with
the Division of Motor Vehicles (DMV), it has been determined
that their computer system indicates whether an individual
has been issued a disabled parking placard and/or license
plates. The Division was able to make the information
available to troopers and police officers when they perform
a records check on either a license plate or a person's
identification. That would allow law enforcement officials
to determine if a placard or license plate was being used
fraudulently.
Mr. Govaars added that under current law, anyone might park
in a disabled parking space as long as their vehicle has a
disabled placard or license plate. The legislation would
clearly define whom "may park" in a parking place reserved
for disabled individuals. A new provision was added
specifying that the person issued a special permit must be
occupying or operating the vehicle; or that the person
operating the vehicle was doing so for the purpose of
transporting a disabled person and that the disabled person
must actually exit or enter the vehicle.
Mr. Govaars concluded that the legislation would increase
the penalties for illegally parking in a disable parking
space and for misusing a disabled permit to park in a
disabled parking space. Under existing law, violators are
fined $100 dollars if they are convicted of either of those
offenses. Under the bill, individuals convicted of
illegally parking in a disabled parking space would be fined
$125 dollars for the first offense
Representative Croft inquired what the current requirement
was.
Mr. Govaars explained that as statute is now, if there is a
permit in the vehicle, any person has the right to use the
space. The proposed legislation guarantees that only the
person actually issued the permit is able to use the space.
To use it, the person must get in and out of the vehicle.
Representative Croft asked what was being corrected.
Mr. Govaars responded that there have been people caught in
Anchorage with someone else's permit in their car, which is
legal under current statute. The bill would change that.
Representative Hudson asked if the disabled person had to be
the driver.
Mr. Govaars responded that in order to use the spot, the
disabled has to be in the vehicle and must either enter or
exit the vehicle when it is parked.
Representative Hudson suggested that the legislation could
be "over" restrictive.
Discussion following between Mr. Govaars and Representative
Hudson regarding a particular situation with a handicapped
friend of his.
Vice-Chair Bunde noted that the legislation would be
establishing a new standard.
Representative Davies asked if consideration had been given
to how many spaces were available at each lot.
Mr. Govaars responded that federal law mandates a certain
number and size of spaces to be allocated. The persons
owning the lot decide the number of spaces.
Representative Davies understood that all the handicap
spaces were open and that the driver could remain in the car
to guarantee that the space remains available.
Mr. Govaars clarified that the legislation would not account
for people borrowing a spot, which would be considered an
inappropriate use of that spot. The disabled parking spots
are designed for those people that need to have access.
Representative Davies pointed out that there are
circumstances in which no other parking places are available
outside of those designated. He thought it was reasonable
that as long as there were spaces available and there was a
driver in the car, it should be okay to park there.
Mr. Govaars did not know how to make the legislation "fit"
into that example.
WILLIAM CRAIG, ALASKA INDEPENANT BLIND, SITKA, spoke in
favor of the bill and urged that it pass from Committee.
HELEN CRAIG, SITKA, testified in support of the legislation.
Representative Croft referenced Page 4; the phrase used
throughout, "is operated by or used for the purpose of
transporting a person with a disability". He noted that the
problem exists that Section 2 adds, "The person who has the
special permit actually exits or enters the vehicle". He
stated that language should address the concern.
Representative Croft MOVED to DELETE language on Page 4,
Lines 11 & 12, "and the person who has the special permit
actually exits or enters the vehicle".
Vice-Chair Bunde OBJECTED. He stated that the person
driving does not need the special space. The person with
the disability would not be inconvenienced if they were not
getting into or exiting the vehicle.
Representative Hudson referred to a personal situation in
which his friend remained in the car but he had parked in a
designated space in order to take care of her pharmacy needs
from that establishment. He understood that he could have
backed out and parked in another space.
Vice-Chair Bunde reiterated that if the driver is capable,
they should not use the designated handicap spot.
Representative Davies interjected that there are handicap
persons that are mobile that might only need assistance.
Vice-Chair Bunde commented that person would be driving with
handicap plates or a handicap sticker.
Discussion followed between Vice-Chair Bunde, Representative
Davies and Representative Croft regarding the handicap
plates and ticketing potential.
Representative Davies thought that "handicap" should be
clarified.
Vice-Chair Bunde pointed out that the legislation stipulates
that the handicap person must either enter or exit the
vehicle. The person does not have to do both to avoid the
ticket.
Co-Chair Mulder voiced concern with language written on Page
4 and the number of points charged for a non-moving
violation. He stated that he did not object to a fine,
however, the points affect the amount that person pays for
insurance. He reiterated that would be an inappropriate
point charge. He referenced Lines 22-31, recommending a
conceptual amendment which would double the fine and delete
language regarding the points against the person's driving
record.
Co-Chair Mulder MOVED to ADOPT that conceptual amendment.
Representative Foster MOVED to report HCS CS SB 206 (FIN)
out of Committee with individual recommendations and with
the accompanying fiscal notes. There being NO OBJECTION, it
was so ordered.
HCS CS SB 206 (FIN) was reported out of Committee with a "do
pass" recommendation and with zero fiscal notes, #2 by the
Department of Public Safety and #3 by the Department of
Administration.
CS FOR SENATE BILL NO. 252(RLS)
An Act renaming the Alaska Human Resource Investment
Council as the Alaska Workforce Investment Board and
relating to its membership; relating to repayment on
promissory notes for work-related items paid for by
grant programs; extending the termination date of the
state training and employment program; relating to
employment and training activities; and providing for
an effective date.
Co-Chair Williams noted that CS SB 252 (RLS) was SCHEDULED
but had not yet arrived into the House Finance Committee.
#SB359
CS FOR SENATE BILL NO. 359(RLS)
An Act relating to organization grants for mergers,
consolidations, or unifications involving third class
boroughs; and relating to identification by the Local
Boundary Commission of areas that meet the standards
for borough incorporation.
Co-Chair Williams stated that CS SB 359 (RLS) was SCHEDULED,
however, the House Majority was working on a committee
substitute.
SENATE BILL NO. 364
An Act relating to medical services under the state
Medicaid program.
GWENDOLYN HALL, STAFF, SENATOR PETE KELLY, noted that a
majority of Alaskans agree that it is inappropriate to use
State funds to provide elective abortions. Despite the many
efforts of the Legislature, the State has been unable to
implement the will of the people. All attempts to bring
Alaskan Medicaid funding under federal standards, which
prohibit funding abortions except for rape, incest and life
of the mother, have been thwarted by the Alaska Supreme
Court.
Ms. Hall stated that the Alaska Administrative Code defines
therapeutic abortion as:
"The termination of a pregnancy, certified
by a physician as medically necessary to
prevent the death or disability of the woman,
or to ameliorate a condition harmful to
the woman's physical or psychological health."
"Medically necessary" has proved to be too broad language,
allowing elective abortions to take cover under the umbrella
of protection. She suggested that any form of emotional
discomfort a woman may experience from pregnancy could
warrant a "medically necessary" termination. Ms. Hall noted
that SB 364 would define "medically necessary", restricting
Medicaid funded abortions to those cases that fall under the
Hyde Amendment guidelines.
REPRESENTATIVE FRED DYSON explained that Senator Kelly has
attempted to narrow down the definition of what is medically
necessary for emotional and psychological problems. SB 364
makes a clear provision that the woman must, in order to
maintain emotional and psychological stability, take a
powerful drug, which would not endanger the child, and
currently is allowed. The bill would "tighten" up that
language.
He pointed out that in 1998, when the Legislature tightened
up the language on "medical necessity", the number of State
funded abortions dramatically decreased. That court case
was overturned and it now appears that more abortion cases
are being paid with State dollars.
Representative Dyson advised that all polls in Alaska
indicate that the public is not interested in using public
money to fund abortions.
Representative Davies asked the definition of "medical
necessity" used in the State of Michigan.
Ms. Hall read the list of complications listed in that
report:
· Shock
· Uterine Perforation
· Cervical Laceration
· Hemorrhage
· Allergic Response
· Death
· Infection
· Retained Products
· Other complications
Representative J. Davies pointed out that no psychological
sections had been added.
Ms. Hall acknowledged that was true.
Representative Whitaker asked for clarification that the
bill would not restrict the Supreme Court decision Roe
versus Wade and the woman's right for an abortion. He noted
that the legislation only restricts what the State will pay
for.
Representative Dyson agreed.
DR. COLEEN MURPHY, (TESTIFIED VIA TELECONFERENCE),
PHYSICIAN, ANCHORAGE, testified in opposition to the
proposed bill stating that it is important that Alaska not
compare itself to Michigan. The Alaska State Constitution
has a greater right to privacy than Michigan State one does.
Dr. Murphy stated that previous testimony indicates how lay
people confuse indications for incomplete abortions. There
is a difference between evacuating a uterus for a uterine
preparation and an incomplete product of conception. It is
important to understand those distinctions. At present
time, legislators are attempting to provide what they
determine a "clear" provision of what constitutes "medical
necessity" for termination of a pregnancy.
Dr. Murphy noted that she is a practicing medical doctor,
who currently provides reproductive health services to women
in need. The language of the bill is not clear. She
commented that the bill attempts to meddle in the
relationship between a doctor and their patient, a
relationship which should remain private.
Dr. Murphy explained that when she talks with women about
their pregnancies, she requests an informed consent about
that pregnancy. Each woman signs certain conditions that
are acceptable.
Dr. Murphy provided hypothetical pregnancy situations
questioning if they were considered appropriate for
consideration of "medical necessity". She acknowledged that
she personally could not make that determination for any
woman and that ultimately that must be their choice. It
should be a very private discussion.
Dr. Murphy voiced concern that when a woman is depressed
that they should be medicated during their pregnancy. She
reminded members of the Committee that Andrea Yates
experienced multiple signs of depression throughout her
pregnancy preceding the murder all her children. She warned
members that the patient's doctor should make the ultimate
choice regarding medication.
Dr. Murphy stressed that pregnancies, where the woman wants
a termination, are high-risk pregnancies. Right now the
State Medicaid program costs $450 dollars for a State
termination of pregnancy. If those pregnancies go on to
full term, basically, the State would be paying out $75
dollars for every prenatal visit and $1500 dollars for the
delivery services. She emphasized that if the State wants
to save money, give women what they want and do not judge
them for their choice. She reiterated that women should be
able to decide for themselves.
TAPE HFC 02 - 109, Side B
Representative Croft asked if defects of the fetus would fit
into the definition.
Dr. Murphy advised that some of the highest risk medical
conditions for women are associated with a 50% mortality
rate. She addressed primary pulmonary hypertension
conditions associated with up to a 50% mortality rate. She
pointed out that nothing is 100% guaranteed. Doctors can
access good pictures of what the fetus looks like but the
ultimate outcome cannot be determined until birth.
Dr. Murphy commented that the legislation gives doctors too
much credit about their ability to predict outcomes. She
stressed, ultimately the decision is a private choice
whether a woman wants to continue a pregnancy associated
with long term disabilities. Those costs are usually
shifted from the family to the State.
Dr. Murphy discussed the number of uninsured people that
live in the State of Alaska. Many of those uninsured people
qualify for the State Medicaid Program for their pregnancy
care. She added that she was disturbed that there is a
partial solution for some of the unwanted pregnancies, the
prescription equity bill. She stated that bill should have
been addressed with the legislation before the Committee.
There are women that do not receive contraception options
through their current insurance provider. She noted that
contraception works and prevents unintended pregnancies.
Dr. Murphy mentioned that the rate of termination of
pregnancies in Alaska is lower than most other states.
There are tremendous access issues compared to other states.
The most recent statistic in Alaska is that 16% of
pregnancies result in termination as compared to 34% in all
other states. The epidemic in this State is uninsured women
seeking reproductive health.
Vice-Chair Bunde commented that medicine is more of an art
than it is a science. He claimed there is a "public policy
issue" regarding women that use abortion for birth control.
He questioned how often that occurs.
Dr. Murphy replied that there is national data regarding
that concern with 50% of women using a contraceptive
technique and 50% not using a contraceptive. Despite
efforts to have reliable contraceptive devices, there will
continue to be contraceptive failures. One out of two women
that come in for a termination of pregnancy have used
contraceptives. The other 50% of women, who did not use
contraceptives, have an opportunity to prevent the pregnancy
by using "Emergency Contraception". Most women are very
responsible. She challenged that the Committee provide a
companion bill, which legislates the sexual behavior of men.
Vice-Chair Bunde asked if out of 100 performed abortions,
would 25 of those result from accidents using birth control.
Dr. Murphy spoke to the elective abortion. Invariably every
woman contemplates the risk factors involved with her
pregnancy. There is nothing elective about those risks.
Abortion is not a procedure that most women want to under
go. They would prefer to avoid it.
DR. JOHN MIDDAUGH, (TESTIFIED VIA TELECONFERENCE),
EPIDEMIOLOGY SECTION, DEPARTMENT OF HEALTH AND SOCIAL
SERVICES, spoke in opposition to SB 364.
Dr. Middaugh explained that the legislation has language
problems with regard to the physician and patient
relationship. The absence of a fair understanding and the
meaning of the language, physicians would have great
problems meeting the certification required by the
legislation. The terms "serious, adverse, physical
conditions" could seriously aggravate the physical health.
That language would need to be interpreted to enforce the
statute.
The language also has problems in the areas of psychological
illness that require medication. He pointed out that there
are many serious psychological illnesses that are not
treated by medication. Because of the wording, women who
have a serious mental problem would not be eligible for
funding. Dr. Middaugh proposed to delete "would" and insert
"could" or "might". Rarely, if ever, can physicians make a
prediction to 100% accuracy. By requiring a standard of
"would", implies a certainty that almost could never be met.
Dr. Middaugh pointed out that the bill omits coverage in all
instances in which a pregnant woman bearing an infant with
horrible congenital malformations, even if they are known to
be incompatible with the mother's life.
Dr. Middaugh reiterated that there is no epidemic of
abortions in Alaska. He pointed out that Alaska ranks #33
of all the states for the number of average abortions. The
State's policy does not pay for elective procedures.
In summary, Dr. Middaugh urged that the bill not be passed
and offered to answer questions of the Committee.
Vice-Chair Bunde asked if the statistic for Alaska's rate
was based on per capita or total numbers performed.
Dr. Middaugh replied that the rate was based on the number
of abortions for 1000 women between the ages of 15-44 years.
In 1997, the national rate was 22 women per thousand and in
Alaska that rate was 12 per thousand.
Vice-Chair Bunde inquired the difference in comparison
between Michigan and Alaska.
Dr. Middaugh responded that the numbers quoted for Michigan
were based on Michigan State law that was restrictive and
enabling payment only for saving the life of a woman. He
advised that law has been held unconstitutional. Using
those figures today would be inaccurate.
Representative Hudson asked about Dr. Middaugh's
recommendation on Page 2 replacing "would" with "could" or
"might".
Dr. Middaugh advised that "would" implies that you know that
something is going to happen with 100% certainty; however,
medicine is always about probability. The physicians can
only inform patients of probable outcomes.
Vice-Chair Bunde asked if it would be medically more
accurate to say "would more likely".
Dr. Middaugh recommended using "could" or "might". Using
"would more likely" would eliminate the eligibility of women
who should have a therapeutic and indicative procedure.
Those women would fall outside that category.
Vice-Chair Bunde commented that "could" was far too
permissive and agreed that "would" allows little. He
inquired if there was any middle ground.
Dr. Middaugh pointed out that for three years,
Representative Rokeberg attempted to define "medical
necessity" in the patient's bill of rights and in those
efforts, he was unable to do so. All the efforts lead to
additional problems and basically do not take into account
the unique circumstances and problems that happen in the
practice of medicine. Dr. Middaugh reiterated that there
are not a large number of abortions occurring in Alaska, and
that in fact there is a high bar related to limiting
procedures to those that are medically needed. He noted
that information should only be decided between a physician
and a patient.
WILLIAM CRAIG, ALASKA INDEPENDENT BLIND, SITKA, spoke in
support of the legislation. He commented on various
individuals that have had developmental disabilities that
went on to become important people in society.
HELEN CRAIG, SITKA, commented that sexual abuse and rape
would be reasons for a woman to be able to have an abortion.
She admitted that babies are priceless and the ultimately
the decision should be left to the woman and her higher
power and the doctor. Ms. Craig stated that the decision
comes down to moral choices.
CHIP WAGONER, ALASKA CATHOLIC CONFERENCE, JUNEAU, stated
that there is nothing in the bill that interferes between
the doctor and the patient's relationship. The
communication between the physician and the patient will
continue just as before, and the decisions made between the
doctor and the patient will continue just as before. The
only difference is that if the bill passes, State Medicaid
funds would no longer be used to pay for the abortion
procedure.
Mr. Wagoner continued, the reason that the statute is needed
is because there is no other medical procedure paid for by
Medicaid funds for purely elective reasons. He stressed
that the issue was the payment.
He added that an additional issue is the language of "would"
verses "could". Using "would" modifies the word "aggregate"
and would be dangerous. To change "would" to "could" would
basically gut the bill because everything "could" be an
opportunity. He emphasized that if "would" was not used in
the bill, there would be no reason for the legislation.
There is an additional safeguard in the bill. It was
impossible to write the bill to take into consideration
every circumstances; that is why there are regulations and
that is why the bill authorizes the Department of Health &
Social Services to adopt regulations. He recommended that
the Department should have a review process to determine
medically necessary cases.
Mr. Wagoner spoke to the "uncomplicated" legal abortions,
which were performed that were unnecessary. He addressed
the unwanted pregnancies. Diagnosis codes should be closely
scrutinized. State funds should be used outside of the
State determined necessity and that Medicaid funds should
not be used for those abortions. Mr. Wagoner noted that the
Alaska Catholic Conference strongly supports the bill.
NANCY WELLER, DIVISION OF MEDICAL ASSISTANCE, DEPARTMENT OF
HEALTH AND SOCIAL SERVICES, offered to answer questions of
the Committee regarding the bill. Ms. Weller distributed a
handout: "Complications of Pregnancy, Childbirth, and the
Puerperium". (Copy on File).
She stated that the list of diagnostic codes for abortion
procedures are very specific and do not correlate to those
suggested by previous testimony. The diagnosis codes used,
determine if there are complications to the woman and/or the
baby. Ms. Weller offered to answer questions of the
Committee.
Vice-Chair Bunde asked about the code, which addresses the
psychological problems of the mother.
Ms. Weller replied that the codes do not indicate why the
abortion is performed, but rather indicate what type of
abortion it is such as a spontaneous abortion or
miscarriage.
Representative Croft asked if "complicated" meant that the
medical procedure was complicated by some other thing and
not a justification of why it needed to be done.
Ms. Weller agreed that was correct.
Representative Hudson referenced the court case definition
previously referenced and asked if the language "medically
necessary" was essential.
Ms. Weller explained that the Division was following the
court order under the language that the Court put forth.
She noted that she could not judge from the fiscal note what
physicians might do in reaction to the court order. She did
not know how the current regulations were being interpreted.
SB 364 was HELD in Committee for further consideration.
ADJOURNMENT
The meeting was adjourned at 7:17 P.M.
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