02/10/1998 03:04 PM House HES
| Audio | Topic |
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+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL
SERVICES STANDING COMMITTEE
February 10, 1998
3:04 p.m.
MEMBERS PRESENT
Representative Con Bunde, Chairman
Representative Joe Green, Vice Chairman
Representative Al Vezey
Representative Brian Porter
Representative Fred Dyson
Representative J. Allen Kemplen
Representative Tom Brice
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
* HOUSE BILL NO. 353
"An Act relating to adoption by reference in regulations; and
providing for an effective date."
- HEARD AND HELD
* HOUSE BILL NO. 350
"An Act requiring that the cost of contraceptives and related
health care services be included in health insurance coverage."
- HEARD AND HELD
* HOUSE BILL NO. 344
"An Act relating to paternity establishment and child support;
relating to the crimes of criminal nonsupport and aiding the
nonpayment of child support; and amending Rule 37(b)(2)(D), Alaska
Rules of Civil Procedure; and providing for an effective date."
- HEARD AND HELD
(* First public hearing)
PREVIOUS ACTION
BILL: HB 353
SHORT TITLE: REFER IN HSS REGS TO OTHER DOCUMENTS
SPONSOR(S): REPRESENTATIVES(S) KELLY, Dyson
Jrn-Date Jrn-Page Action
01/26/98 2138 (H) READ THE FIRST TIME - REFERRAL(S)
01/26/98 2138 (H) HES
02/10/98 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 350
SHORT TITLE: INSURANCE COVERAGE FOR CONTRACEPTIVES
SPONSOR(S): REPRESENTATIVES(S) CROFT, Phillips, Bunde, Green,
James, Berkowitz, Davies, Elton
Jrn-Date Jrn-Page Action
01/26/98 2133 (H) READ THE FIRST TIME - REFERRAL(S)
01/26/98 2133 (H) HES, L&C
02/04/98 2223 (H) COSPONSOR(S): ELTON
02/10/98 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 344
SHORT TITLE: PATERNITY/CHILD SUPPORT/NONSUPPORT CRIMES
SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR
Jrn-Date Jrn-Page Action
01/23/98 2114 (H) READ THE FIRST TIME - REFERRAL(S)
01/23/98 2115 (H) HES, JUDICIARY, FINANCE
01/23/98 2115 (H) INDETERMINATE FISCAL NOTE (ADM)
01/23/98 2115 (H) 3 ZERO FNS (2-ADM, REV)
01/23/98 2115 (H) GOVERNOR'S TRANSMITTAL LETTER
02/10/98 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
REPRESENTATIVE PETE KELLY
Alaska State Legislature
Capitol Building, Room 411
Juneau, Alaska 99801-1182
Telephone: (907) 465-2327
POSITION STATEMENT: Testified as sponsor of HB 353.
JONATHAN SHERWOOD, Program Officer
Division of Medical Assistance
Department of Health & Social Services
P.O. Box 110660
Juneau, Alaska 99811-0660
Telephone: (907) 465-3355
POSITION STATEMENT: Testified on HB 353.
RAY GILLESPIE, Lobbyist
Charter North Hospital
9478 Riverbend Court
Juneau, Alaska 99801
Telephone: (907) 463-3375
POSITION STATEMENT: Testified on HB 353.
REPRESENTATIVE ERIC CROFT
Alaska State Legislature
Capitol Building, Room 430
Juneau, Alaska 99801-1182
Telephone: (907) 465-2116
POSITION STATEMENT: Testified as sponsor of HB 350.
GORDON EVANS, Lobbyist
Health Insurance Association of America
211 4th Street, Suite 305
Juneau, Alaska 99801
Telephone: (907) 586-3201
POSITION STATEMENT: Testified in opposition to HB 350.
KAREN PEARSON, Deputy Director
Division of Public Health
Department of Health & Social Services
P.O. Box 110610
Juneau, Alaska 99811-0610
Telephone: (907) 465-3090
POSITION STATEMENT: Testified on HB 350.
LAUREE HUGONIN, Director
Alaska Network on Domestic Violence and Sexual Assault
130 Seward Street, Room 501
Juneau, Alaska 99801
Telephone: (907) 586-3650
POSITION STATEMENT: Testified in favor of HB 350.
SID HEIDERSDORF
P.O. Box 020658
Juneau, Alaska 99802
Telephone: (907) 789-9858
POSITION STATEMENT: Testified in opposition to HB 350.
BARBARA J. MIKLOS, Director
Child Support Enforcement Division
Department of Revenue
550 West 7th Avenue
Anchorage, Alaska 99501
Telephone: (907) 269-6800
POSITION STATEMENT: Testified in favor of HB 344.
PHIL PETRIE, Operations Manager
Child Support Enforcement Division
550 West 7th Avenue
Anchorage, Alaska 99501
Telephone: (907) 269-6803
POSITION STATEMENT: Answered questions on HB 344.
JIM NORDLUND, Director
Division of Public Assistance
Department of Health & Social Services
P.O. Box 1106420
Juneau, Alaska 99811-0640
Telephone: (907) 465-3347
POSITION STATEMENT: Testified in support of HB 344.
ACTION NARRATIVE
TAPE 98-5, SIDE A
Number 0009
CHAIRMAN CON BUNDE called the House Health, Education and Social
Services Standing Committee meeting to order at 3:04 p.m. Members
present at the call to order were Representatives Bunde, Green,
Porter and Dyson. Representative Kemplen arrived at 3:05 p.m.;
Representative Brice arrived at 3:12 p.m.; and Representative Vezey
arrived at 3:44 p.m. Chairman Bunde announced the committee would
be hearing House Bill 353, House Bill 350 and House Bill 344.
CHAIRMAN BUNDE welcomed students from Valdez, Akiak and Akiachak
who were participating in the Close-Up Program.
HB 353 - REFER IN HSS REGS TO OTHER DOCUMENTS
Number 0124
CHAIRMAN BUNDE announced the first order of business was HB 353,
"An Act relating to adoption by reference in regulations; and
providing for an effective date." He asked Representative Kelly to
present House Bill 353.
Number 0157
REPRESENTATIVE PETE KELLY, Alaska State Legislature, Sponsor,
explained that currently the Department of Health & Social Services
is required to adopt regulation standards changes, or standardized
codes. Each time the standardized codes change, the Administrative
Procedures Act requires the department to promulgate regulations.
This legislation changes that process, so it could be done by
reference. The intent of the legislation is to save time for the
department by eliminating the cumbersome regulation process each
time the standardized codes are changed by the federal government.
He introduced Jon Sherwood from the Department of Health & Social
Services, who was available to answer questions.
Number 0244
JONATHAN SHERWOOD, Program Officer, Division of Medical Assistance,
Department of Health & Social Services, said the department tries
to use the industry standards in terms of billing codes when people
submit claims that are to be paid by Medicaid. The codes are
updated at all times of the year and a new book is published every
year. The regulations process, however, is not particularly speedy
and in order to incorporate the standards into the department's
regulations, the department needs to make a regulations change
every time the book is updated. He explained that it's very
cumbersome and time consuming for the department, and burdensome
for the providers. The codes are used because they are industry
standards.
Number 0351
CHAIRMAN BUNDE referred to the zero fiscal note and said if the
proposed process is as efficient as it sounds, there should
actually be a savings.
MR. SHERWOOD explained that currently most of these regulation
changes are bundled with other regulation changes, so he doesn't
expect it will reduce the department's regulations process, but it
will allow the department to get the changes in the books and on
record in a timely fashion so the providers know what information
the department is using.
Number 0397
REPRESENTATIVE JOE GREEN asked if the department is required to
follow the codes and had there ever been changes the department
didn't agree with.
MR. SHERWOOD responded the department is not absolutely required to
follow these standards, but from a practical standpoint it's what
is used. If the department used anything different, there would
be a risk of losing providers willing to participate in the
Medicaid programs.
Number 0448
REPRESENTATIVE KELLY noted that Mr. Chenoweth from the Legislation
& Regulations Section of the Department of Law had recently advised
that the first portion of the bill probably would be more
appropriate in Title 44 IN the Administrative Procedures Act.
CHAIRMAN BUNDE suggested Representative Kelly draft a committee
substitute which would be adopted by the committee.
Number 0503
RAY GILLESPIE, Lobbyist, Charter North Hospital, testified that
Kathy Cronen, Administrator of Charter North Hospital had reviewed
HB 353 and asked Mr. Gillespie to convey her endorsement for this
legislation. It will have the effect of simplifying and
streamlining the process for Charter North Hospital.
Number 0535
CHAIRMAN BUNDE closed public testimony. He noted that HB 353 would
be heard again on Thursday at which time the committee would be
addressing a committee substitute.
HB 350 - INSURANCE COVERAGE FOR CONTRACEPTIVES
Number 0573
CHAIRMAN BUNDE announced the next item on the committee calendar
was HB 350, "An Act requiring that the cost of contraceptives and
related health care services be included in health insurance
coverage." He invited Representative Croft to present his bill.
Number 0656
REPRESENTATIVE ERIC CROFT, Alaska State Legislature, testified as
the sponsor of HB 350. He began his presentation with a slide show
and explained this legislation was the result of discussions with
a number of pro-choice and pro-life people on how to reduce the
number of abortions. He then began to look at where most of the
elective abortions come from; i.e., what types of pregnancies. He
learned the vast majority of elective abortions come from
unintended pregnancies. This information led to the question of
what is the best public policy initiative to reduce unintended
pregnancies. The result was HB 350.
Number 0735
REPRESENTATIVE CROFT directed the committee's attention to the
sponsor statement and letter of intent which simply makes clear
this legislation does not mandate abortion; it speaks to
contraception. He noted that it's unclear technologically how some
devices work in terms of whether they are primarily an early
abortion or a late contraception.
Number 0774
REPRESENTATIVE CROFT displayed a slide with information from a 1987
U.S. Department of Health study which indicated that of the 43
percent of intended pregnancies resulting in live births, an almost
negligible amount resulted in abortions. In absolute numbers, of
unintended pregnancies, about half ended in abortion. A review of
how insurance companies cover these indicated that almost all
insurance policies, without any mandate of any kind, cover
abortion, probably for fiscal reasons. When an insurance company
has a policyholder who is pregnant, the cost of having an abortion
is much less than the cost of bringing that child to term.
CHAIRMAN BUNDE mentioned that concerns had been expressed to him
about the very high level of teen pregnancies in Alaska. He asked
if Representative Croft had statistics for Alaska.
REPRESENTATIVE CROFT explained that he had 1994 information for
Alaska, as well as various studies across the nation, but the
information was for different years, so it really doesn't match.
Number 0927
REPRESENTATIVE CROFT displayed information which reflected that of
the 57 percent of unintended pregnancies, 81 percent were teens 15
to 19 years of age and 75 percent were women at or below the
poverty level. He said the issue is that people who most need to
plan families are having the least success.
REPRESENTATIVE CROFT next displayed information specific to Alaska.
Data from a federally required Pregnancy Risk Assessment Monitoring
System (PRAMS) indicates that 41 percent of births were unintended
pregnancies and 90 percent of women who had an unintended pregnancy
were not using, or were improperly using, a birth control method.
His chain of reasoning is that if the vast majority - statistically
all - of the elective abortions are based on unintended pregnancies
and 90 percent of the unintended pregnancies come from improper use
of or lack of access to birth control, how can we increase the
availability of birth control?
Number 1025
CHAIRMAN BUNDE said in his opinion, there was a difference between
not using a birth control method and a lack of access to birth
control.
REPRESENTATIVE CROFT agreed with Chairman Bunde and added that is
the most difficult number to come up with. He has good numbers
that show fairly conclusively that the overall health costs are
much cheaper when a family has access to and uses a contraceptive
method. It becomes difficult to decide how much of this is cost
and how much is attributed to other reasons. He believed that a
common sense conclusion can be reached that at least some aspect of
it is the cost. Other studies have shown that women have
significantly higher health care costs which is mostly due to their
paying for the non-insurance of some of these costs.
REPRESENTATIVE CROFT stated besides numbers, there are many
societal benefits to families having families when they can take
care of them. Statistically, unplanned children have a much harder
time in life. That doesn't apply to every family, of course, but
statistically, unplanned children have higher levels of abuse and
poverty and there are greater social costs.
Number 1136
REPRESENTATIVE CROFT referred to statistics from the April 1995
edition of the American Journal of Public Health which he believed
attributed to the conclusions reached by insurance companies that
it is much cheaper for an induced abortion than it is to carry the
child to term. The information reflects that an induced abortion
costs $416 while a term pregnancy cost $8,619. The information
does not address the continuing health care obligation after the
child is born. Condensing all those factors, a Department of
Health study showed that family planning or allowing people to do
this sort of planning, shows about a 4 to 1 ratio of savings.
Number 1188
REPRESENTATIVE CROFT referred again to a study from the Journal of
Public Health, which showed over a five-year period, the known
failure rates of the various different methods of contraception,
the cost of the method itself, and the cost to the insurance
company of the unintended pregnancy. He pointed out the difference
in cost between the oral contraceptive method and no method. In
reference to Chairman Bunde's question, he said this is using or
not using, and there's a significant, about 7 to 1, financial
savings for the insurer. The question then becomes, "How many
would use even if they had to pay for it?" Based on a statistical
analysis of whether it is cheaper to provide contraceptives or to
not from a health care basis, it's clearly cheaper to provide them.
Number 1247
REPRESENTATIVE CROFT displayed Alaska statistics which indicated
that of 10,222 births in Alaska in 1995, 55 percent of Medicaid-
funded births were unintended. Medicaid does cover contraceptive
use, so it can be concluded that providing contraceptives is not a
complete panacea; that is, without education or the willingness to
use and use correctly, simply providing contraceptives is not going
to cure everything. He drew a correlation between the previously
mentioned nationwide study which showed that about 75 percent of
births for people under the poverty level were unintended and the
55 percent of Alaska Medicaid-funded unintended births.
Number 1305
CHAIRMAN BUNDE pointed out that no method of contraceptive is 100
percent effective and even with access to contraception, there will
be unintended pregnancies.
REPRESENTATIVE CROFT next discussed the cost of Medicaid-funded
births in Alaska. The prenatal care and follow-up care based on
1993 data, and the first year of life care based on 1995 data,
indicate about a $10,000 cost from prenatal care through the birth
and the first year of life compared to a cost of about $300 a year
for oral contraceptives. He directed the committee's attention to
some of the additional yearly costs to the state of Alaska for an
unintended pregnancy of a Medicaid-eligible woman.
REPRESENTATIVE CROFT reiterated that it is not a panacea but the
starting point of effective child abuse prevention is pregnancy
planning. He discussed the consequences, statistically speaking,
of an unplanned pregnancy in terms of the social costs; e.g., more
likely to drop out of school, more encounters with the criminal
justice system, and to becoming teen parents. One of the
consequences listed that was particularly disturbing to him was the
abortion rate in the United States is two to four times higher than
other countries.
Number 1463
REPRESENTATIVE FRED DYSON said based on information he had seen,
there is no correlation between whether a child was intended or
unintended and child abuse; however, there may be on the neglect
side. He said he'd be interested in seeing Representative Croft's
data on that issue.
REPRESENTATIVE CROFT responded he would be happy to furnish that
information to Representative Dyson. He continued his discussion
with the state of health plan coverage for contraceptives. He
pointed out that 97 percent of health plans cover prescription
drugs, but 49 percent fail to cover contraceptives, and only 15
percent cover all five reversible methods. Many of the policies
don't include contraceptives even if it's prescribed for a medical
condition other than birth control. He said that besides the
expected long-term financial savings societally, and the expected
social benefits by families having more ability to control and
choose when they have families, there is also an equity issue. He
quoted from an article, "Women's Health Insurance Cost and
Experiences 1994" in the Women's Research and Education Institute,
"On average, women of childbearing age pay more for their health
care than their male counterparts. Women between the ages of 15
and 44 pay 68 percent more in out-of-pocket medical costs, with
reproductive health services accounting for much of the
difference."
Number 1619
REPRESENTATIVE CROFT reiterated there are more uncovered medical
expenses for women. It's a team effort to create the child and it
should be a team effort to take care of the child. Unfortunately,
it's not a team effort in paying for it or paying for the planning.
In contrast, most insurance policies offer full coverage for drugs
and devices for men.
Number 1659
REPRESENTATIVE CROFT said in summary, there is a dramatic
difference in the abortion rates and the social statistical future
between intended and unintended pregnancies. Insurance coverage is
currently not covering the family planning option and it is known
that family planning saves money. The goal is that all pregnancies
will be intended and that people will only have families when it's
a family decision.
CHAIRMAN BUNDE thanked Representative Croft for his presentation
and inquired if there were questions of the sponsor.
Number 1718
REPRESENTATIVE BRIAN PORTER presumed that some insurance companies
were not providing coverage for contraceptives and asked
Representative Croft if he could explain why.
REPRESENTATIVE CROFT said insurance companies have cost concerns.
It's a matter of some guesswork as to the savings as well as how
much it would cost insurance companies to provide this service. He
contends that it might save the insurance companies money in the
long run. It is interesting to note that Health Maintenance
Organizations (HMOs) cover contraceptives at a much higher rate.
He thought the reason may be that HMOs see a whole community and
the whole community cost and those people are less likely to move
from carrier to carrier. An HMO can see the cost on a more global
level. Representative Croft said to his knowledge, there is no
Alaska insurance carrier providing this coverage as a part of their
regular package. Some carriers provide it as options; but it's
generally not available.
Number 1774
CHAIRMAN BUNDE noted that contraception is a concern or prohibition
in some religions and asked if Representative Croft had received
any feedback about public funds being used for a form of behavior
which may be in conflict with religious feelings.
REPRESENTATIVE CROFT responded he had not had any of those
discussions. He was of the opinion there was a distinction between
mandating something and offering it as an option. He noted that
currently, contraceptive services are provided under Medicaid.
This would not be public money, but private money. Also, it's
distinguishable from some of the recent cases in that this
legislation does not mandate that any particular doctor or hospital
provide it if they don't want to. It simply means that it would be
a covered care; a person might have to look around to find it in
the community, but it would be an insured cost.
Number 1828
REPRESENTATIVE DYSON said his immediate concern with this
legislation was the propriety of a state requiring a private
company to add a line to its business that it chooses not to. He
likened that to the state telling Fred Meyers they have to start
selling cars and asked Representative Croft to comment.
REPRESENTATIVE CROFT said that at some time in the development of
cars, the installation of seat belts were mandated and each state
then mandated the use of them. He believed mandating the
installation of seat belts could be viewed as an interference in a
car manufacturer's freedom to sell cars without them. It made good
social sense; it was not a huge burden on the design; and it was
made available for everyone to use for preventive measures which
would have great societal benefits. He commented that he has been
talking with the insurance industry about whether contraceptive
services would be a substantial cost. The industry doesn't view it
as a huge cost, but the concern is more so with being told what to
do. The discussions have included how the insurance companies
assess and whether it's proper to put a mandate on a stream of
factors looked at. Representative Croft said, "I think we fit
under even their definitions of when it's appropriate -- what you
should look at before putting a mandate on the insurance industry."
In his opinion, this is an appropriate protective device which may
have a cost savings, or a small cost, but the societal health
implications that sometimes go unseen by the industry, make it
justified.
Number 1933
REPRESENTATIVE DYSON asked what factors were used in the evaluation
by the insurance companies.
REPRESENTATIVE CROFT noted that would be discussed in-depth in the
House Labor and Commerce Committee, but some of the factors
discussed were how large the cost would be for each of the payers,
what other procedures might it supplant, how available is it, is
this a need that is being unmet, how great are the costs to society
of it being unmet, et cetera.
REPRESENTATIVE DYSON said, "My sense is that insurance companies
are in business to make money. Aside from sounding good in their
publicity brochures, why the heck do they think -- why should we
think they really care about what's best for society."
REPRESENTATIVE CROFT responded, "... I think that's largely right.
I don't know that I want every particular company pursuing their
view of public policy - and probably don't if I'm an investor. I'd
like them to see that profit motive. And to some extent, it's our
goal to guide that, put fence posts on it. And as long as we're
not shutting them in, closing down business, or unnecessarily
restricting it, if we're directing it the way we want it to go,
that's better than other types of interference."
Number 2027
REPRESENTATIVE J. ALLEN KEMPLEN asked if Representative Croft had
determined if other states had passed similar legislation or would
the result in Alaska be on the cutting edge.
REPRESENTATIVE CROFT responded that it had been introduced, but not
passed yet, on the federal level; Washington had passed legislation
passed out of the House but not the Senate; and California passed
legislation, but Governor Wilson vetoed it, with the stipulation
that if changes were made, he might pass it. Alaska would be on
the cutting edge, but other states are actively considering similar
legislation.
CHAIRMAN BUNDE noted that a number of people wished to testify. He
asked Gordon Evans to come forward to present his testimony.
Number 2078
GORDON EVANS, Lobbyist, Health Insurance Association of America,
(HIAA), testified the Health Insurance Association of America is a
trade association of commercial health insurance companies who
provide health insurance for approximately 55 million Americans.
The HIAA opposes HB 350 for a number of reasons, not the least of
which is that the provisions mandate a specific coverage of
something that is not basic health care treatment; the consequence
of which in the long run would be to increase the costs and reduce
the efficiencies of managed care. The HIAA favors the preservation
of a system which allows the prospective purchaser of health
insurance free choice of which risks that individual wishes to
cover from among the various coverages offered by competing
insurance carriers. The HIAA also believes that the choice of how
the policyholder spends what funds are available for health
insurance should be free of government decree and continues to
oppose the proliferation of benefits through a government mandate.
The coverage mandated by HB 350 is generally considered to be
elective services. If the coverage for contraceptive services is
mandated, it will affect both individual and group policies and
premium costs will be increased even for people who have no use for
or do not want the coverage.
Number 2134
MR. EVANS commented that he was not aware that most health
insurance plans "routinely cover abortions, sterilization and tubal
ligations." Like vasectomies, these are generally considered to be
elective services. As written, this bill could have a much wider
application than he believed was intended. In addition to major
medical insurance policies, it could include Medicare Supplement
insurance policies, long-term care insurance, specific service
policies such as dental or disability income, and hospital
policies.
MR. EVANS said according to his research, only one state has
enacted contraceptive coverage into law; that being Virginia.
California's legislation was carried over to this year; the
legislation died in Connecticut and Oregon; Hawaii carried over two
bills; and Illinois, Massachusetts and New York have bills pending.
Number 2192
REPRESENTATIVE PORTER asked if Mr. Evans was aware of any cost
analysis being done between the two options.
MR. EVANS was not aware of any, but said he would get back to the
committee.
Number 2202
REPRESENTATIVE KEMPLEN noted the sponsor had presented significant
data documenting the cost to society of not providing
contraceptives to the citizenry. He was of the impression it would
be in the best interest of society to seek to minimize these costs.
Since he has been in the legislature, he has routinely heard about
reducing costs and doing things more efficiently and effectively.
Based on the sponsor's statements, this proposed legislation
achieves that purpose. It does present a more cost effective
approach to the use of resources in our society. He asked Mr.
Evans for his comments.
MR. EVANS said there have been numerous attempts in this state and
in the country on a whole, to bring in "socialized medicine" and
the country has not accepted the idea of having society pay for
health care for everyone. The only state that has come close to
that is Washington State, which ended up repealing most of what was
passed.
Number 2294
REPRESENTATIVE KEMPLEN said he was somewhat confused by Mr. Evans'
response in that he didn't understand how this legislation, which
only requires that contraceptives and related health care services
be included in health insurance coverage with existing health
insurance, moves in the direction of "socialized medicine" for
everyone. He was of the opinion this proposed legislation makes
contraceptives and related health care services a legitimate item
to be covered by health insurance.
MR. EVANS replied that any time a service is mandated, the cost of
the insurance policy will increase, whether it's a group policy or
individual policy. A mandated offering on the other hand, is
where individuals have the option of selecting the coverage, and
paying for it, if they choose the coverage. The biggest insurer in
the state ...
TAPE 98-5, SIDE B
Number 0001
MR. EVANS ... of Alaska, is self-insured, and if this coverage is
mandated, the state's costs will definitely increase.
CHAIRMAN BUNDE thanked Mr. Evans for his comments and asked Karen
Pearson to come forward to present her testimony.
Number 0022
KAREN PEARSON, Deputy Director, Division of Public Health,
Department of Health & Social Services, testified the division's
interest is always access to care and providing information to
committee members to assist in deliberations. She provided a
handout to committee members on Alaska demographic, birth,
pregnancy intendedness and contraceptive access/cost information.
She said most of the data is from 1995, which is the most current.
Number 0063
CHAIRMAN BUNDE commented that over a period of time he has heard
reports that Alaska has one of the highest teen pregnancy rates in
the United States, if not in the world, and in fact, has been
compared with Third World countries in teen pregnancy rates. He
asked Ms. Pearson if those statements were accurate.
MS. PEARSON responded that Alaska is not at the top, but in the top
one-third of the United States. If those statistics are broken
down by population, the young Native girls have one of the highest
rates in the world; it's about double the national average.
Number 0101
REPRESENTATIVE KEMPLEN asked if the department had any data which
showed where a particular type service had been mandated and had
resulted in a lower cost?
MS. PEARSON couldn't respond at this time, but offered to get back
to the committee.
Number 0123
REPRESENTATIVE VEZEY asked if the Alaska Native Health Service
provided birth control?
MS. PEARSON replied that federal funding is available.
REPRESENTATIVE VEZEY asked through what agency was it available?
MS. PEARSON responded through the various delivery systems.
REPRESENTATIVE VEZEY observed that Alaska's population of Native
teenage females has the highest rate of teenage pregnancies and yet
they have access to federally-funded birth control.
MS. PEARSON replied that finance isn't the only access issue; there
has to be a provider on-site to fill prescription contraceptives.
She didn't know what role some of those barriers may play in the
utilization versus just the funding.
REPRESENTATIVE VEZEY confirmed that Ms. Pearson was saying that
it's not just the cost of health care, but it's the availability
of service, as well.
MS. PEARSON explained that cost is just one of several barriers,
and availability of service could be a barrier for certain
populations.
REPRESENTATIVE VEZEY asked if funding was a problem for the Alaska
Native teenage female population.
MS. PEARSON said it would depend on where they lived. Access
issues would be different for young Native women in a more urban
area than it would be in a remote rural area.
Number 0215
CHAIRMAN BUNDE thanked Ms. Pearson for her testimony and called on
Lauree Hugonin to present her comments.
Number 0231
LAUREE HUGONIN, Director, Alaska Network on Domestic Violence and
Sexual Assault, testified the Network has about 20 member programs
of which 13 have joined together to participate in a health
insurance program administered by the Network. There are 184
employees, along with spouses and children, participating in the
program and NYLCARE is the health insurer. She testified in favor
of HB 350 stating that most of the employees are women who are
employed and would like to take advantage of having contraceptives
covered with their health insurance program. The Network has been
looking for several years to find a way to provide that benefit,
but has been unsuccessful. She pointed out that employees are
willing to pay an increased cost to have the benefit because they
perceive the increased cost to be less than what is being paid out-
of-pocket currently.
Number 0283
MS. HUGONIN surmised that insurance companies will not absorb the
increased cost; it will be passed on to the consumer. She
reiterated the willingness of participating members to absorb the
increased cost. Lastly, she pointed out that contraceptives are
not only used to prevent pregnancy; sometimes there are other
medical reasons women need to take contraceptives.
MS. HUGONIN concluded that there are employers across the state who
have employees who would very much appreciate having this benefit
covered.
Number 0312
REPRESENTATIVE VEZEY inquired if Ms. Hugonin was talking about
employees or clients.
MS. HUGONIN replied employees.
REPRESENTATIVE VEZEY wanted to know why the Network, as an
employer, didn't offer this benefit to employees. The Network
could pay the cost of this benefit out of the operating budget.
Speaking as an employer, Representative Vezey said he didn't need
the permission from anyone, including the Internal Revenue Service,
to give his employees a benefit.
MS. HUGONIN responded that it would probably be cost prohibitive
because the programs wouldn't be able to pick up the cost. Having
it through health insurance, even though it may increase the
premium, would be a way for more employees to take advantage.
Number 0381
SID HEIDERSDORF testified in opposition to HB 350. He said
presumably the driving force behind this legislation is limiting
and reducing unwanted pregnancies, especially teen pregnancies. He
had several reasons for opposing this legislation. First, it is
just one more example of government making demands on private
enterprise. It is his opinion that insurance companies have the
right to decide what kind of coverage to provide in health plans.
The insurance company should have the freedom to negotiate with
clients and not have specific coverage mandated by the state;
especially something like contraceptives.
Number 0443
MR. HEIDERSDORF said that some of his comments may seem foreign to
many individuals, but he believes that it is time to come to grips
with the harmful effects in the sexually permissive society today
and one of the cornerstones is the availability of contraceptives.
He discussed the social consequences including increased sexual
activity, fornication, adultery, divorce, teen pregnancy, sexually
transmitted diseases, abortion, et cetera. The one aspect of
contraceptive use he wanted to address was its relationship to
abortion. The conventional wisdom is that contraceptives will
reduce unwanted pregnancies and therefore, by extension, will
reduce abortion. It's a seductively simple argument which sounds
very logical; however, in the real world he believes it is false.
Mr. Heidersdorf provided quotes from co-developers of the birth
control pill and a former medical director of the International
Planned Parenthood Federation.
Number 0543
MR. HEIDERSDORF stated there has been unlimited availability of
contraceptives for many years and things have spiraled downward.
With respect to teenage pregnancies, the argument has been the need
for better, more explicit and earlier sex education during the
school years. The results have been a breakdown in normal sexual
inhibitions of children and more sexual encounters. As people were
having more sexual encounters, more contraceptive failures, or
nonuse of a contraceptive, the result was more abortions. While he
didn't have statistics to substantiate this, he spoke with
certainty that with the availability of contraceptives during the
last 20-30 years, there has been a drastic increase in teen
pregnancies and many unwanted pregnancies.
MR. HEIDERSDORF maintained there is a contraceptive/abortion
connection on many levels. First, confusion exists with many of
the things called contraceptives; they are not contraceptives in
the real sense of the term, but abortifacients. Clearly, the
interuterine device (IUD) is an abortifacient, as are many pills.
The effect occurs after conception but before implantation of the
fertilized egg. In addition, there are also categories of chemical
contraceptives which no one really understands how they work.
There are true contraceptives which do not permit ovulation or some
other method where the sperm and the egg cannot join.
MR. HEIDERSDORF views contraception and abortion as vastly
different. With contraception, it's keeping the egg and the sperm
separate; there is no human being. However, once conception takes
place, there is a human being and it is early abortion if that's
the effect of the "contraceptive."
Number 0713
MR. HEIDERSDORF said there's also a certain contraceptive mentality
which has made abortion more possible: Sex without procreation;
sexual freedom with responsibility; the widespread use of
contraceptives has crystallized the concept that babies are a
burden; and when pregnancy occurs, abortion is the logical solution
to the problem.
Number 0729
MR. HEIDERSDORF concluded that the widespread availability of
contraceptives has led to more sexual promiscuity and all the
harmful effects that have gone with it. Certainly, insurance
companies should not be required to pay for something which he
views as part of the problem, not part of the solution.
Number 0776
REPRESENTATIVE KEMPLEN referred to the statement that
contraceptives lead to sexual promiscuousness and asked Mr.
Heidersdorf if he had researched the social policies and sexual
permissiveness in the European countries.
MR. HEIDERSDORF indicated he had not. The information he presented
was based on what he has seen transpire over the years and talking
with his children. He assumed that if contraceptives are
available, it more or less allows an individual to have sex without
responsibility, which increases permissiveness.
Number 0828
REPRESENTATIVE KEMPLEN suggested that would be important data to
examine because the European countries do have social policies that
provide contraceptives more widely without having sexual
permissiveness running rampant through communities. In his
opinion, the media and Madison Avenue, and the constant barrage of
advertisements that use sex to sell products are more relevant to
America.
MR. HEIDERSDORF agreed that what children see on television
certainly has an influence.
Number 0877
CHAIRMAN BUNDE asked if there was further public testimony.
Hearing none, he announced that HB 350 would be held in committee
for further deliberation.
HB 344 - PATERNITY/CHILD SUPPORT/NONSUPPORT CRIMES
Number 899
CHAIRMAN BUNDE announced the next bill to be heard was HB 344, "An
Act relating to paternity establishment and child support; relating
to the crimes of criminal nonsupport and aiding the nonpayment of
child support; and amending Rule 37(b)(2)(D), Alaska Rules of Civil
Procedure; and providing for an effective date." He asked Barbara
Miklos to come forward to discuss HB 344.
Number 0934
BARBARA J. MIKLOS, Director, Child Support Enforcement Division
(CSED), Department of Revenue, testified the Governor requested
that HB 344 be introduced on behalf of the Child Support
Enforcement Division. She explained that in 1996, Congress passed
the Personal Responsibility and Work Opportunity Reconciliation
Act, which from here on she would refer to as welfare reform
legislation. This legislation changed welfare as it was known,
from an ongoing, long-term potential for the rest of someone's life
to a temporary program. In making these sweeping changes, Congress
realized that in order for this to happen in people's lives,
additional tools and resources were necessary in order to survive
without public assistance payments. Congress changed many
programs, but one program that was changed dramatically was the
child support program. The intent was to give child support
agencies more tools, more opportunities, and more ways to work
efficiently in collecting support; therefore, help people who are
on welfare get off of welfare, and to help people who are not on
welfare, stay off of welfare.
Number 1000
MS. MIKLOS said that some of these major changes were passed in
legislation last year, Senate Bill 154. There were major
provisions in that legislation, some of which the legislature felt,
and rightfully so, could be postponed to this year. House Bill 344
takes care of those provisions that were left out last year as well
as things that have been amended by Congress. While the
legislation is complex, it contains nothing that isn't required in
welfare reform legislation. According to Congress, if these
provisions are not passed, the state of Alaska is at risk of losing
nearly $70 million.
Number 1061
MS. MIKLOS highlighted some of items contained in HB 344.
Currently, there is existing legislation for large employers to
report new hires to the Child Support Enforcement Division.
Welfare reform requires that all employers report all new hires
within 20 days to the division. Along with that, the sanctions
have been reduced dramatically and it is the intent of Congress and
CSED to work with employers as much as possible and to make the
process as easy as possible.
Number 1089
MS. MIKLOS continued that another provision is the requirement of
some type of sanction that involves recreational licenses, which
was a controversial issue last year. The division compromised so
that it would only be used as a sanction in the case where someone
has been criminally charged with a crime involving child support or
is in contempt of court.
Number 1124
MS. MIKLOS said another provision is that social security numbers
are mandated for child support purposes on applications for
driver's licenses and hunting licenses. These were both technical
amendments to welfare reform that weren't in existence last year.
Other provisions are to give child support liens from other states
the same standing as Alaskan liens; give courts authority to hold
a person in contempt for failing to honor an administrative child
support subpoena; amend the definition of support order; allow the
entry of default judgments in administrative paternity cases;
permit child support agencies of other states to make electronic
requests for high volume enforcement assistance; clarify which
state law an employer must follow when served with an interstate
income withholding order; provide a method for Alaska's Child
Support Enforcement Division to help a child support obligor's
children receive health care coverage; repeal the sunset provision;
and two technical changes required in order to be consistent with
the Uniform Interstate Family Support Act.
Number 1241
CHAIRMAN BUNDE commented the committee heard a bill last week
dealing with uniform child custody interstate. He asked if these
bills are interrelated or redundant in any case.
MS. MIKLOS responded the two bills are similar, but deal with
different topics. Some of the provisions have the same intent
which is to make things uniform throughout the states.
REPRESENTATIVE DYSON said Ms. Miklos had indicated that some of the
provisions kick in if a person is guilty of a criminal child
support case separate from contempt of court.
MS. MIKLOS replied it could be either.
REPRESENTATIVE DYSON said he understood the contempt of court, but
inquired what the other crime would be.
MS. MIKLOS responded there are two crimes related directly to child
support; one is criminal nonsupport, and the second is aiding and
abetting in the nonpayment of child support.
REPRESENTATIVE KEMPLEN referred to page 2, lines 25-26 and asked if
this had been examined to determine how it relates to the right to
privacy clause in the Alaska Constitution.
MS. MIKLOS said it was a controversial issue that was researched
last year, and research is continuing. She commented that Dan
Branch from the Department of Law was present and could speak to
the research done last year with respect to social security numbers
being required for occupational licenses and other items already
passed. It is the division's position that it doesn't affect the
privacy right.
Number 1391
CHAIRMAN BUNDE noted that would be useful information for the
committee.
MS. MIKLOS indicated the division would furnish something in
writing to the committee.
Number 1421
REPRESENTATIVE VEZEY recalled that a few years ago there were
reporting requirements placed on hiring halls and he inquired if
that was being amended.
PHIL PETRIE, Operations Manager, Child Support Enforcement
Division, confirmed that about five years ago, Alaska was one of
the test states that implemented a grant program paid for by the
federal government, which implemented the current statute. He said
this is the same statute, but it's being repealed and re-enacted
with additional provisions. That program was in operation for
three years, and on the basis of that program in the other states,
the federal government concluded it was a valuable tool, as did
Alaska.
Number 1475
REPRESENTATIVE VEZEY asked Mr. Petrie to explain those
requirements.
MR. PETRIE explained the original bill passed by the legislature
required that any employer designated by the division was required
to report. Not all employers were required, but the division chose
employers in a graduated fashion. First were employers that had
the most employees with the largest number of child support cases,
and then over a three year period, additional employers were added
until there were approximately 300 employers. There had to be 20
or more employees or the individual had to work more than 360 hours
during the year, so temporary and fast turnover employees were not
covered in the original bill. There was a provision that employers
could withhold $1 for each person reported. The division worked
with employers and allowed employers as much freedom as possible on
how to report; e.g., fax, tapes or diskettes. The division used a
standard computer protocol to input the information into the
system. A child support enforcement employee matched the
information against cases, and if there was a match, the employer
was entered into the system and a withholding order was issued. If
there was no match, the information was immediately destroyed and
dropped from the system until reported by a new employer.
MR. PETRIE said all of those provisions are contained in HB 344,
but expanded to include every employer and it eliminates the
temporary nature. Another key piece is that it requires CSED to
forward everyone reported to a national new hire database, which
the federal government will link up to a national case registry.
An example of how that works is if an individual leaves Alaska and
goes to work in Louisiana, Louisiana will report to the national
level, the national level will compare that to the case registry,
discover there's a case in Alaska, and send that information back
to Alaska. Within about 10-14 days, Alaska will know who the
employer is in Louisiana and be able to issue a withholding order.
Number 1615
REPRESENTATIVE VEZEY inquired if HB 344 becomes law, would every
employer be required to report every new hire to CSED.
MS. MIKLOS confirmed that.
REPRESENTATIVE VEZEY asked how frequently the employer would need
to report.
MS. MIKLOS replied within 20 days of hire or rehire.
Number 1638
REPRESENTATIVE VEZEY referred to the situation where an employer
rehires the same individual within 2 weeks, 6 months or 1 year and
asked if that person would be considered a new hire.
MR. PETRIE responded that technically a 2-week lapse would require
a rehire report, but he was more comfortable deferring that
question to legal counsel.
Number 1682
REPRESENTATIVE VEZEY asked for an explanation on how the process
works in hiring halls.
MR. PETRIE commented there hadn't been a lot of reports from hiring
halls under the previous program because the union hiring halls
were primarily dispatch locations. Of those hiring halls
designated by CSED, only permanent employees were targeted because
those employees fell under the 360-hour provision. Under HB 344,
hiring halls will be required to report information for permanent
employees through any of the methods available; e.g., fax,
electronic filing, telephone, or just sending a copy of the W-4
form; however, for dispatch employees, hiring halls will be
required to provide the name of the person and to whom they are
being dispatched.
CHAIRMAN BUNDE observed that CSED had submitted a zero fiscal note,
and yet it appeared the division's workload would significantly
increase.
MS. MIKLOS indicated that much of the work would be done
electronically. In addition to the one designated staff person,
the division has requested additional staff in the Governor's
budget; however, if the request is not granted, existing staff will
be used.
Number 1808
REPRESENTATIVE VEZEY inquired if Ms. Miklos was inferring the
division's efficiency in handling data is such that the amount of
data could double, triple, or quadruple without any additional
cost.
MS. MIKLOS noted that a Request for Proposal (RFP) will be issued
shortly using a capital appropriation received from the legislature
last year. It is anticipated the majority of this workload, which
is expected to increase especially with small employers sending in
W-4s, will be handled electronically and through the computers.
REPRESENTATIVE VEZEY assumed the capital appropriation was for
additional hardware and software, not additional staff.
MS. MIKLOS responded there is no additional staff tied to this
legislation.
REPRESENTATIVE VEZEY inquired if the division had pursued the
possibility of outsourcing the handling of the data. He was aware
of a number of major data processing firms performing this
function.
MS. MIKLOS replied that with the RFP, the division is hoping to
work with a data processing firm in setting up the system. The
expectation, however, is that most of it will be automatic.
Number 1901
CHAIRMAN BUNDE noted that failure to comply with federal child
support mandates may result in a significant reduction in federal
financial participation. He asked if Ms. Miklos could estimate
what the financial reduction would be.
MS. MIKLOS responded it was almost $70 million, with the bulk of it
from the Division of Public Assistance budget, and all the federal
money that goes into the Child Support Enforcement Division budget.
TAPE 98-6, SIDE A
Number 0001
JIM NORDLUND, Director, Division of Public Assistance, Department
of Health & Social Services, testified in support of HB 344. The
Division of Public Assistance will be a great beneficiary if this
legislation passes; or a victim of the federal government, if it
does not pass. The Division of Public Assistance is the primary
agency that has been charged with implementing the welfare reform
plan in Alaska. He explained that welfare reform is really about
helping families move off public assistance and being able to
support their families on their own. In this endeavor, there has
been much focus on helping people go to work. It is important,
however, not to lose sight of an equally important way of helping
families become self-sufficient, and that is making sure that both
parents responsible for bringing children into the world are also
responsible for supporting those children. House Bill 344 provides
additional tools for the Child Support Enforcement Division to
collect support payments that are owed on behalf of those children.
It also would help the Division of Public Assistance in that almost
dollar for dollar to the extent that child support payments can be
collected from the responsible parents, it will reduce the amount
of money being paid out in public assistance benefits. It's a good
thing from a budget standpoint, as well as from a public policy
standpoint, and the federal government is basically mandating the
state of Alaska to do this.
Number 0167
MR. NORDLUND referred to the penalties, and said the Division of
Public Assistance faces a potential 5 percent penalty to the
federal block grant. He explained the block grant is basically the
amount of money the state receives from the federal government,
which is the federal share of participation of paying benefits to
recipients, as well as administration of the program. In the
upcoming year, the amount of that grant will be about $65 million,
so a 5 percent penalty amounts to approximately $3 million. He
noted that any state facing that penalty is required to make up the
difference from the state general fund.
Number 0239
MR. NORDLUND concluded that if this conforming legislation is not
passed by the time Alaska resubmits the plan which allows the state
to draw down federal money, Alaska could potentially face the loss
of the entire federal block grant, or approximately $65 million.
Number 0293
REPRESENTATIVE KEMPLEN understood that Alaska's Constitution is one
of the most powerful of all the states in terms of an individual
right to privacy. He speculated that the requirement of having to
furnish a social security number when applying for a driver's
license or hunting license could be in direct conflict with the
strong right to privacy clause. He asked if the nature of the
Alaska Constitution and how this requirement comes into conflict
with the right to privacy clause had been pointed out to the
federal government, and if not, were there any plans to do so.
MR. NORDLUND deferred that question to Ms. Miklos.
Number 0474
REPRESENTATIVE KEMPLEN asked if Mr. Nordlund was aware of any state
that had not complied with these requirements and faced the
penalties.
MR. NORDLUND responded that Ms. Miklos would be the appropriate
person to answer that question.
MS. MIKLOS responded the state of Idaho has been put on notice.
CHAIRMAN BUNDE asked if there was further public testimony.
Hearing none, he asked Representative Porter to explain
Amendment 1.
REPRESENTATIVE PORTER made a motion to adopt Amendment 1, 0-
GH2007/A.1, Lauterbach, 1/29/98, which read:
Page 1, following line 10:
Insert a new bill section to read:
*Sec. 2. AS 09.10.040(a) is amended to read:
(a) A [EXCEPT AS PROVIDED IN (b) OF THIS SECTION, A]
person may not bring an action upon a judgment or decree of
a court of the United States, or of a state or territory
within the United States, and an action may not be brought
upon a sealed instrument, unless the action is commenced
within 10 years."
Renumber of following bill sections accordingly.
Page 11, following line 20:
Insert a new bill section to read:
*Sec. 30. AS 09.10.040(b) is repealed."
Renumber the following bill sections accordingly.
Renumber internal references to bill sections in accordance
with this amendment. Internal bill section references occur
in the following places:
Page 11, line 22
Page 11, line 23
Page 11, line 26
Page 11, line 27
Number 0551
CHAIRMAN BUNDE objected for discussion purposes.
REPRESENTATIVE PORTER explained the amendment fits within the title
and has basically nothing to do with the intent of the bill. He
had discussed the amendment with Ms. Miklos, and while not pleased
about it, she has no problem with the adoption of the amendment.
He explained he is offering the amendment because of a constituent,
who after paying child support for 20+ years, was sued by his ex-
spouse claiming that no payments had been paid through the entire
span of child support period. He was able to come up with
documented evidence through receipts and checks, and prove this
claim false for about 95 percent of the time involved. However, he
was not able to do so for the first few years. Representative
Porter recalled there is a presumption within the law that if
payment can't be verified, payment wasn't made. Even though the
complaint alleged that no payments had been made, which was
obviously false, one particular provision of law allows the Child
Support Enforcement Division an exception to the statute of
limitations. He explained that by deleting that provision, it
allows CSED the ability to go back probably 5 years, and maybe more
for good cause shown. He noted these kinds of cases will drop off
in terms of having any relevance because now all the payments go
through the Child Support Enforcement Division. In any case, this
will have some effect for the next 2 or 3 years.
Number 0715
CHAIRMAN BUNDE clarified that previously, child support payments
were paid directly to the recipient rather than through CSED, and
the individual making those payments was required to maintain
records for protection.
CHAIRMAN BUNDE asked if there was further discussion about
Amendment 1. Chairman Bunde withdrew his objection and Amendment 1
was adopted.
CHAIRMAN BUNDE noted this was the first hearing on HB 344 and a
number of questions had been raised, so HB 344 would be held in
committee.
ADJOURNMENT
Number 0772
CHAIRMAN BUNDE adjourned the House Health, Education and Social
Services Standing Committee at 4:46 p.m.
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