04/30/2002 03:15 PM House HES
| Audio | Topic |
|---|
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
April 30, 2002
3:15 p.m.
MEMBERS PRESENT
Representative Fred Dyson, Chair
Representative Peggy Wilson, Vice Chair
Representative John Coghill
Representative Gary Stevens
Representative Sharon Cissna
Representative Reggie Joule
MEMBERS ABSENT
Representative Vic Kohring
OTHER LEGISLATORS PRESENT
Representative Beth Kerttula
Representative Gretchen Guess
Representative Joe Hayes
COMMITTEE CALENDAR
CS FOR SENATE BILL NO. 342(HES)
"An Act relating to the long term care ombudsman."
- MOVED HCS CSSB 342(HES) OUT OF COMMITTEE
HOUSE JOINT RESOLUTION NO. 50
Supporting the participation of Taiwan in the annual summit of
the World Health Assembly.
- MOVED HJR 50 OUT OF COMMITTEE
HOUSE BILL NO. 313
"An Act requiring that the cost of contraceptives be included in
certain health care insurance coverage."
- HEARD AND HELD
PREVIOUS ACTION
BILL: SB 342
SHORT TITLE:LONG TERM CARE OMBUDSMAN
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES
Jrn-Date Jrn-Page Action
02/25/02 2300 (S) READ THE FIRST TIME -
REFERRALS
02/25/02 2300 (S) HES, FIN
03/04/02 (S) HES AT 1:30 PM BUTROVICH 205
03/04/02 (S) Heard & Held
03/04/02 (S) MINUTE(HES)
03/06/02 (S) HES AT 1:30 PM BUTROVICH 205
03/06/02 (S) Moved CS(HES) Out of
Committee
03/06/02 (S) MINUTE(HES)
03/13/02 2415 (S) HES RPT CS 5DP SAME TITLE
03/13/02 2415 (S) DP: GREEN, WILKEN, LEMAN,
DAVIS, WARD
03/13/02 2415 (S) FN1: ZERO(ADM)
03/25/02 2518 (S) FIN RPT CS(HES) 6DP 2NR
03/25/02 2518 (S) DP: KELLY, GREEN, AUSTERMAN,
WILKEN,
03/25/02 2518 (S) LEMAN, WARD; NR: DONLEY,
OLSON
03/25/02 2518 (S) FN1: ZERO(ADM)
03/25/02 (S) FIN AT 9:00 AM SENATE FINANCE
532
03/25/02 (S) Moved Out of Committee
03/25/02 (S) MINUTE(FIN)
04/03/02 2610 (S) RULES TO CALENDAR 4/3/02
04/03/02 2612 (S) READ THE SECOND TIME
04/03/02 2612 (S) HES CS ADOPTED UNAN CONSENT
04/03/02 2612 (S) ADVANCED TO THIRD READING
UNAN CONSENT
04/03/02 2612 (S) READ THE THIRD TIME CSSB
342(HES)
04/03/02 2613 (S) PASSED Y19 N- E1
04/03/02 2619 (S) TRANSMITTED TO (H)
04/03/02 2619 (S) VERSION: CSSB 342(HES)
04/03/02 (S) RLS AT 10:30 AM FAHRENKAMP
203
04/03/02 (S) MINUTE(RLS)
04/04/02 2794 (H) READ THE FIRST TIME -
REFERRALS
04/04/02 2794 (H) HES
04/30/02 (H) HES AT 3:00 PM CAPITOL 106
BILL: HJR 50
SHORT TITLE:SUPPORT TAIWAN IN WORLD HEALTH ASSEMBLY
SPONSOR(S): RLS BY REQUEST OF ECONOMIC DEVEL, TRADE, &
Jrn-Date Jrn-Page Action
04/22/02 3066 (H) READ THE FIRST TIME -
REFERRALS
04/22/02 3066 (H) HES
04/30/02 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 313
SHORT TITLE:INSURANCE COVERAGE FOR CONTRACEPTIVES
SPONSOR(S): REPRESENTATIVE(S)MURKOWSKI, GUESS, KAPSNER, CISSNA,
Jrn-Date Jrn-Page Action
01/14/02 1957 (H) PREFILE RELEASED 1/11/02
01/14/02 1957 (H) READ THE FIRST TIME -
REFERRALS
01/14/02 1957 (H) HES, L&C, FIN
01/14/02 1957 (H) REFERRED TO HES
02/22/02 2369 (H) COSPONSOR(S): CRAWFORD
03/01/02 2448 (H) JT-PRIME SPONSOR(S) REMOVED:
JAMES
03/18/02 2593 (H) JT-PRIME SPONSOR(S) REMOVED:
WILSON
04/30/02 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
JERRY BURNETT, Staff
to Senator Lyda Green
Alaska State Legislature
Capitol Building, Room 125
Juneau, Alaska 99801
POSITION STATEMENT: Presented SB 342 on behalf of Senate
Health, Education and Social Services Standing Committee,
sponsor.
RON COWAN, Long Term Care Ombudsman
Alaska Mental Health Trust Authority
Department of Revenue
550 West Seventh Avenue, Suite 1830
Anchorage, Alaska 99501
POSITION STATEMENT: Testified in support of SB 342.
REPRESENTATIVE LESIL MCGUIRE
Alaska State Legislature
Capitol Building, Room 418
Juneau, Alaska 99801
POSITION STATEMENT: Presented HJR 50 as sponsor.
REPRESENTATIVE LISA MURKOWSKI
Alaska State Legislature
Capitol Building, Room 408
Juneau, Alaska 99801
POSITION STATEMENT: Presented HB 313 as one of the prime
sponsors.
BOB LOHR, Director
Division of Insurance
Department of Community & Economic Development
3601 C Street, Suite 1324
Anchorage, Alaska 99503-5948
POSITION STATEMENT: Testified in support of HB 313.
COLLEEN MURPHY, M.D., Obstetrician-Gynecologist
3260 Providence Drive
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 313.
EILEEN FARIAN
7010 Fairweather Drive
Anchorage, Alaska 99518
POSITION STATEMENT: Testified in support of HB 313.
ANNE HARRISON
3270 Rosie Creek Road
Fairbanks, Alaska 99709
POSITION STATEMENT: Testified in support of HB 313.
CINDY NORQUEST
12225 Ginami Street
Anchorage, Alaska 99516
POSITION STATEMENT: Testified in support of HB 313.
SHERRY JAEGER
YWCA
PO Box 90541
Anchorage, Alaska 99509
POSITION STATEMENT: Testified in support of HB 313.
PAULINE UTTER
Alaska Women's Political Caucus
13820 Jarvi Drive
Anchorage, Alaska 99515
POSITION STATEMENT: Testified in support of HB 313.
ROBIN SMITH
14100 Jarvi Drive
Anchorage, Alaska 99515
POSITION STATEMENT: Testified in support of HB 313.
KAREN PEARSON, Director
Division of Public Health
Department of Health & Social Services
PO Box 110610
Juneau, Alaska 99811-0610
POSITION STATEMENT: Testified that HB 313 is a good public
policy bill and asked the committee to support it.
KATIE CAMPBELL, Actuary Life/Health
Division of Insurance
Department of Community & Economic Development
PO Box 110805
Juneau, Alaska 99811-0805
POSITION STATEMENT: Answered questions on HB 313.
ACTION NARRATIVE
TAPE 02-38, SIDE A
Number 0001
CHAIR FRED DYSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:15 p.m.
Representatives Dyson, Wilson, Coghill, and Cissna were present
at the call to order. Representatives Stevens and Joule arrived
as the meeting was in progress.
SB 342 - LONG TERM CARE OMBUDSMAN
CHAIR DYSON announced that the first order of business would be
CS FOR SENATE BILL NO. 342(HES), "An Act relating to the long
term care ombudsman."
Number 0088
JERRY BURNETT, Staff to Senator Lyda Green, Alaska State
Legislature, chair, Senate Health, Education and Social Services
Standing Committee, sponsor, presented SB 342. He informed the
members that SB 342 was introduced at the request of the
executive director of Alaska Mental Health Trust Authority. It
was introduced to bring Alaska's law in compliance with federal
law regarding the long term care ombudsman. He gave the
following testimony:
Each state is required to have a long term care
ombudsman under the Older [Americans] Act. Alaska's
long term care ombudsman is located in the Alaska
Mental Health Trust Authority. Recently, the long
term care ombudsman resigned and was replaced. The
one that resigned cited frustration with the Alaska
statutes. It's one of his reasons [for] leaving.
[SB] 342 directs that the long term care ombudsman
visits long term care facilities and identifies
problems, rather than assuming the more passive role
of responding to complaints; provides that no long-
term care facility may deny immediate access to an
employee or volunteer.
MR. BURNETT requested that the committee adopt Version P.
Number 0206
REPRESENTATIVE WILSON made a motion to adopt the proposed House
committee substitute (HCS) for CSSB 342, version 22-LS1591\P,
Lauterbach, 4/30/02, as a work draft. There being no objection,
Version P was before the committee.
MR. BURNETT explained the changes in the proposed CS on page 3,
Section 2. The new version allows immediate access granted
between the hours of 8:00 a.m. and 8:00 p.m. under any
circumstances. Between the hours of 8:00 p.m. and 8:00 a.m.,
immediate access will be granted if there is a scheduled visit,
if there's a complaint that's being investigated, or if a
resident in the long-term care facility has requested a visit
during that time. He noted that this was worked out with
representatives of the nursing homes who were concerned about
having immediate access at all times.
MR. BURNETT explained that Version P clarified that the duties
of the long term care ombudsman are [performed by the long term
care ombudsman himself] or through a representative of the
office, which would include employees and volunteers who are
certified. There is a separation between volunteers and
employees on page 2, (b), so only the ombudsman or employees of
the office may subpoena witnesses, compel their attendance, et
cetera, and volunteers are not given all the powers of the
ombudsman.
MR. BURNETT explained that SB 342 gives the long term care
ombudsman guaranteed access to deal with any conflicts in
access, gives the ombudsman an active role in providing the
technical support to volunteer organizations and in protecting
the health and safety of the most vulnerable older Alaskans.
Number 0428
CHAIR DYSON asked if there have been problems.
MR. BURNETT answered that there have been reports of a problem
in getting access or cases where complaints were perhaps not
investigated in a timely manner.
CHAIR DYSON asked what the remedy is if one of the facilities
denies access according to this new law.
MR. BURNETT replied that the ombudsman has the power to
subpoena, compel attendance, et cetera. He suggested that the
long term care ombudsman or executive director of the Alaska
Mental Health Trust Authority be asked that question.
REPRESENTATIVE COGHILL pointed out to Chair Dyson page 2, lines
28 to 29, which reads, "The powers described in this subsection
shall be enforced by the superior court."
Number 0580
RON COWAN, Long Term Care Ombudsman, Alaska Mental Health Trust
Authority, Department of Revenue, testified via teleconference.
He endorsed everything Mr. Burnett indicated about the purpose
of these amendments to the existing statute. From his
experience in health care in Alaska, he noted that there have
been various points of confusion regarding the authority of the
long term care ombudsman but also the ombudsman's
responsibilities.
MR. COWAN said he believes that the proposed changes will help
clarify both of those issues. It will further delineate the
responsibilities of the office, which are to be more proactive
advocates rather than persons who respond to complaints. His
office has made an effort to respond to what it has heard from
the industry and smaller assisted living facilities. His office
has no problems with those hours from 8:00 a.m. to 8:00 p.m.
being identified for reasonable visits. He said his office
would not come in without good cause outside of those hours. He
urged the committee to support the SB 342.
REPRESENTATIVE WILSON moved to report HCS CSSB 342, version 22-
LS1591\P, Lauterbach, 4/30/02, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, HCS CSSB 342(HES) moved from the House Health,
Education and Social Services Standing Committee.
HJR 50 - SUPPORT TAIWAN IN WORLD HEALTH ASSEMBLY
CHAIR DYSON announced that the next order of business would be
HOUSE JOINT RESOLUTION NO. 50, Supporting the participation of
Taiwan in the annual summit of the World Health Assembly.
Number 0920
REPRESENTATIVE LESIL MCGUIRE, Alaska State Legislature, sponsor,
presented HJR 50. She explained that the World Health Order
(WHO) convenes a world health assembly, and this year will be in
Geneva May 14 through 22, in which participants from all over
the world have an opportunity to discuss health epidemics,
problems, AIDS [acquired immune) deficiency syndrome], and
cross-border infectious diseases. It is an opportunity to seek
solutions and get direct evidence from other countries about
what is going on. Taiwan has asked to have direct participation
as an observer in this to have that first-hand information to
take back to its people. She referred to a letter of support
that noted it's been a case of "too little, too late" as far as
health epidemics have been concerned in Taiwan.
REPRESENTATIVE MCGUIRE read through parts of the resolution for
the committee. She noted that the U.S. [House] passed a
resolution, that substantially mirrors HJR 50 in December 2001,
urging Taiwan's participation as an observer. The U.S. Senate
recently passed the same resolution March 19, 2002.
REPRESENTATIVE MCGUIRE indicated that this resolution would be a
gesture of goodwill to Taiwan for the hard work it has put into
health issues.
CHAIR DYSON asked who decides who participates.
Number 1127
REPRESENTATIVE MCGUIRE replied it is a committee of people, and
the United States happens to be one of those committees. It is
a committee of the WHO, and the U.S. is a voting member of that.
She indicated there is an argument that China considers Taiwan
part of the Republic of China, and people she has spoken with in
Taiwan are fine with that relationship. At the same time,
Taiwan has a large population that has separate epidemics,
separate information, and many times the lag time on information
from China to Taiwan is too much. She said, "That has been the
hurdle, Mr. Chairman; it's been a political issue, and really
what I'm trying to say is I don't believe this to be a political
issue. People's health is not political to me."
REPRESENTATIVE MCGUIRE reported that Taiwan has been reaching
out to people it has special relationships with. Taiwan is
Alaska's sixth largest trading partner, and they have shared a
special relationship through the years. She indicated that a
resolution from Alaska's legislature would carry some weight.
Number 1297
REPRESENTATIVE COGHILL moved to report HJR 50 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, HJR 50 was reported out of the
House Health, Education and Social Services Standing Committee.
HB 313 - INSURANCE COVERAGE FOR CONTRACEPTIVES
Number 1317
CHAIR DYSON announced that the final order of business would be
HOUSE BILL NO. 313, "An Act requiring that the cost of
contraceptives be included in certain health care insurance
coverage."
REPRESENTATIVE LISA MURKOWSKI, Alaska State Legislature, one of
several prime sponsors, presented HB 313. She told the
committee that it is an issue of prescriptive equity. She
recognized that it being late in the session, HB 313 probably
wouldn't move, but she appreciated the opportunity to get it on
the record. She referred to a handout put out by The Coalition
for [Prescription] Equity. She said the handout puts forth all
the substantial arguments as to why Alaska should have mandated
prescription coverage.
Number 1415
REPRESENTATIVE MURKOWSKI said that first of all, contraception
is a basic health care need. Contraception is the only
prescription approved by the FDA [Food and Drug Administration]
not routinely covered by insurers. This is an issue that gets
to the heart of talking about prescriptive equity. It is an
equity issue recognizing that when contraception is being talked
about, there is no prescription contraception for men. Less
than 20 percent of traditional health care plans cover the FDA-
approved methods of contraception.
Number 1475
REPRESENTATIVE MURKOWSKI told the members in terms of the equity
issue, statistics say that women of childbearing age have to pay
68 percent more in out-of-pocket health care costs than men.
The bulk of these health care costs are related to reproductive
health care services.
REPRESENTATIVE MURKOWSKI noted that the question, What is the
cost to the employer? always comes up. She pointed out the fact
that covering contraceptives will actually save money. The cost
for covering contraceptives for a year is about $300, which is
far less than pregnancy services. Contraception is not just
intended to prevent pregnancy, but there are many medical
reasons for prescribing birth control pills, such as prevention
of anemia, osteoporosis, and endometriosis. Even for those
reasons, it would still not be covered under the insurance plan
at this point. She told the committee that affordable
contraception will decrease the unintended pregnancies and
prevent abortions.
Number 1572
REPRESENTATIVE MURKOWSKI referred to statistics that say 42
percent of live births in Alaska are unintended; 85 out of 100
women of reproductive age, who are not using contraceptives,
will become pregnant in a year. Each year in Alaska, 120
pregnancies occur per 1,000 women, and 69 percent of these
pregnancies end in live births and 16 percent in abortion. She
commented that it is legitimate to look at contraception if
members are concerned about abortion. This is an issue that
causes discussion. It was suggested to her that contraception
is an optional thing for women.
Number 1650
REPRESENTATIVE MURKOWSKI referred the committee to a footnote in
the EEOC [U.S. Equal Employment Opportunity Commission] decision
in the packet, which is a statement from Senator Snowe in a
discussion or debate about the legislation at the federal level
for equity in prescription insurance and contraceptive coverage.
The senator states: "There is nothing optional about
contraception. It's a medical necessity for women during 30
years of their lifespan. To ignore the health benefits of
contraception is to say that the alternative of 12 to 15
pregnancies during a woman's lifetime is medically acceptable."
She urged the committee to think about that.
Number 1650
REPRESENTATIVE MURKOWSKI said the bulletin issued by the
Division of Insurance refers to the EEOC decision of December
2000 that, "pursuant to the Pregnancy Discrimination Act, the
federal act, employers may not discriminate in their health
insurance plan by denying benefits for prescription
contraceptives when they provide benefits for other prescription
drugs and devices." The bill before the committee is saying
that if a plan offers a prescription benefit, it must cover
contraceptives. It is not saying if no prescription benefit is
provided, it now has to be provided. She noted that in HB 313,
there is a religious exemption.
Number 1745
CHAIR DYSON asked what happens if Alaska is not in conformity
with the Civil Rights Act of 1964.
REPRESENTATIVE MURKOWSKI answered that the State insurance for
public employees currently covers contraception, but the
retirement plan is not covered. She agreed that an employer who
offers a plan that does not provide for prescriptive coverage
could be subject to a lawsuit. In answer to the question, she
said she does believe the state has exposure on this issue.
Number 1937
CHAIR DYSON asked if insurance companies are required to cover
prescriptions for medicines that prevent an illness.
REPRESENTATIVE MURKOWSKI answered that she was only familiar
with those mandates that are currently in statute, for instance,
mammograms, prostate screening, and diabetes coverage, and
wasn't sure of the answer to the question.
REPRESENTATIVE MURKOWSKI, responding to comments from Chair
Dyson, remarked that it's not an issue of [insurance companies]
covering prescriptive drugs equally for men and women.
Representative Murkowski said the issue is: "should I choose to
become pregnant, my pregnancy is covered; if I choose not to
become pregnant, my contraception should be covered."
CHAIR DYSON asked if the morning after pill would be covered
under this bill.
Number 2119
REPRESENTATIVE MURKOWSKI answered that if she understands it
correctly, then yes it would be covered under the legislation.
She reminded the committee that it has to be an FDA-approved and
prescribed prescription.
Number 2156
BOB LOHR, Director, Division of Insurance, Department of
Community & Economic Development, testified that the division
supports this legislation. He gave the following testimony:
It clearly establishes that insurers must provide
coverage for contraceptives if prescription drug
coverage is provided. The recent federal court case
and the Equal Employment Opportunity Commission
opinion on coverage of prescription contraceptives
concludes that employers may be found in violation of
the Pregnancy Discrimination Act, if they do not
provide coverage of prescription contraceptives when
they provide coverage for other prescription drugs.
The court case and the EEOC opinion are directed to
employers, not insurers. Therefore, we do not believe
that action by the division is mandated.
The division recently issued a bulletin to insurers
requesting their assistance in informing employers of
the potential violation under the Pregnancy
Discrimination Act, if they fail to provide
prescription contraceptive coverage when they provide
coverage for other prescription drugs. For
enforcement purposes, a legislation mandate, such as
HB 313, requiring insurers to offer prescription
contraceptive drug coverage, is preferable. An
informal survey by the Alaska Division of Insurance
indicates that the largest insurers in the State
already provide prescription drug coverage as a
benefit option for employees.
Number 2235
CHAIR DYSON asked how much more the insurers would charge should
the employers choose the option.
MR. LOHR replied that the figure he has heard is $1 per month.
CHAIR DYSON asked if it is the employer that exercises the
option, and all the employees in that company are paying the
dollar, or if it is just the individual employee that exercises
the option.
MR. LOHR said he believes it would be the employer making that
choice to have that type of coverage.
Number 2281
REPRESENTATIVE STEVENS commented that his own insurance company
would have been far better off providing his family with
contraception than to cover his children up to age 21. He said
he would think that the insurance companies would be delighted
and would save money in providing contraception instead of life
coverage.
MR. LOHR replied that he believes that most insurers support
this type of legislation. Many have already exercised the
option within Alaska, and there is relatively little opposition
to this concept. He noted that that is unlike most insurance
mandates, in which there will be substantial insurer opposition.
REPRESENTATIVE STEVENS asked why there would be any additional
charge to the businessman who covers his employees.
MR. LOHR answered that he isn't sure how insurance companies do
their internal discounting, but the prescription cost is an
immediate expense and the long-term savings are hard to
quantify.
Number 2337
CHAIR DYSON asked Mr. Lohr for his guess of the lower annual
salary of people who have insurance through their employer. He
said he suspects that people who make $15,000 per year probably
don't have group insurance, and people who make $40,000 do.
MR. LOHR said that he couldn't give him a number, but the
general indication is the lower the income of the average salary
of an employer, the less likely it would be offering health
insurance.
CHAIR DYSON asked Mr. Lohr if he knew of any employees making
less than $25,000 who had health insurance.
MR. LOHR replied that he couldn't cite a list, but there are
some. Typically, the incidence is lower. There is also a
correlation of the size of the employer and the ability to offer
coverage.
TAPE 02-38, SIDE B
Number 2378
MR. LOHR indicated that the division believes that the limited
benefit health care insurance definition is unnecessary because
the term "health care insurance plan" already excludes the
benefits defined as limited benefit health care insurance. He
suggested deleting the following: Page 2, lines 27 through 31
and page 3, lines 1 through 3; Page 2, line 2, delete "limited
benefit health care insurance or".
Number 2325
REPRESENTATIVE MURKOWSKI concurred with that proposed amendment.
She referred to a letter from Blue Cross Blue Shield which
indicates it has no opposition to HB 313.
CHAIR DYSON said he thinks he heard Representative Murkowski
infer that if insurance companies are not offering or making it
universally available to the clients they're covering, they may
be exposed to a lawsuit. He wondered if that was correct.
MR. LOHR responded that the division believes insurers are
providing better customer service to employers by advising them
of the EEOC decision. With this knowledge employers can make an
informed choice about [various] types of coverage.
CHAIR DYSON asked if it would be the employers that would get
sued.
Number 2247
MR. LOHR answered that the employers are the ones "under the
gun" of the EEOC opinion; it's not the insurance companies. The
division's regulatory authority extends to insurers, so it has
let them know of this opinion in hopes that they will advise
employers.
Number 2225
CHAIR DYSON asked what the effect of the law would be if this
bill passes. He wondered if the division would be putting any
employers in jail.
MR. LOHR responded no, he said he doesn't believe that this bill
would give the division any authority over employers. Its
authority extends to Title 21, which regulates the conduct of
insurance companies, agents, brokers, et cetera.
CHAIR DYSON asked what would be the effect of this law.
Number 2200
MR. LOHR answered that the law would require prescriptive
equity, and therefore would require that if an insurer chooses
to offer prescription benefits, those benefits would be required
to include contraceptives approved by the FDA. If the insurer
elects not to offer prescription coverage, that's fine. But if
they don't include contraception, the division would enforce the
mandate under law to say, because you've chosen to offer
prescription drug benefits, you must provide them on an even-
handed basis with respect to approved contraceptives. If they
don't, the division has a range of enforcement options which
include fines to ultimately removal of the certificate of
authority to operate in the state.
CHAIR DYSON commented that putting this in law would just give
the division a better way of getting employers informed to do
what they ought to be doing anyway to serve the clients and to
protect themselves from lawsuits.
MR. LOHR said that is correct with respect to employers. The
division doesn't go there in terms of its authority. It isn't
trying to boot strap any kind of authority here. The division
is trying to make sure that employers are following whatever
mandates are legislatively approved.
Number 2109
COLLEEN MURPHY, M.D., Obstetrician-Gynecologist, testified via
teleconference. She expressed strong support for HB 313. She
said it makes medical sense, social sense, and economic sense.
As a small business employer who now purchases health insurance
for her employees, she has to have policies that make this
available. It is difficult for the Division of Insurance to
remind employers to buy insurance that is consistent with the
EEO process, and it is very difficult for the division to
enforce this. By passing this legislation, it actually gives
the Division of Insurance some teeth to follow the plans it
regulates in the state. She encouraged the committee to pass
this bill on so that women can get the prescriptions they need,
so that unintended pregnancy will decrease in the state with
effective FDA-approved forms of contraception, and that it will
show that women are cared about and are no longer sexually
discriminated against.
CHAIR DYSON asked Dr. Murphy if oral contraception costs about
$300 a year.
DR. MURPHY answered that depends. She explained that drug
companies can charge more for new drugs, but there are generic
drugs available for several dollars per pack. If doctors
prescribe the older drugs, they can use cheaper pills with
comparable effects. The newer pills that have third generation
progesterone tend to be more expensive. If someone uses generic
drugs, the cost would be under $100 per year.
Number 2009
CHAIR DYSON commented that it seems to him that everyone who has
a good enough job with health insurance could afford the
prescription contraceptive.
DR. MURPHY answered that she doesn't think it is a question
about the affordability of different forms of family planning
that are FDA approved. She informed the committee that there
are many different forms someone could consider using. An IUD
[intra-uterine device] costs about $400, and to have it inserted
costs $300 to $400, which is a large amount of money for people
to pay out of pocket. There are newer monthly injections that
cost about $50 per month. There are new patches coming out, a
ring to put inside the vagina, and oral contraceptive pills; all
these things cost different amounts of money. She noted that
the bottom line is the EEO issue. In order to be fair to women,
they should be able to get prescriptive contraception as a
primary health care need.
Number 1949
CHAIR DYSON said he appreciated the equity issue. He wondered
if there are other times when insurance companies are forced to
pay for prescriptions that prevent a condition.
DR. MURPHY replied yes. For example, there is a monthly shot
for rheumatic heart disease so bacteria won't get in the
bloodstream. She noted there are all sorts of preventive
medications. She reminded the members that it is cost effective
to prevent problems. She said, "An ounce of prevention is worth
a pound of cure."
Number 1909
CHAIR DYSON asked Dr. Murphy about the morning after pills.
DR. MURPHY replied that morning after pills are a backup form of
birth control.
CHAIR DYSON said as he understands it, the morning after pills
act after fertilization but before implantation.
DR. MURPHY told him that is not true. There have been a lot of
theories around the mechanism of action for contraception in
general. Most of the hormonal contraceptives work at many
different levels. The progesterone is known to thicken the
cervical mucus so that sperm cannot get out of the vagina.
Progesterone also changes the lining of the uterus and makes it
thinner. The hormones can also affect tubal motility so that
sperm and eggs are not normally transported and meet each other
in the middle. The estrogen and progesterone are also known to
affect the development of egg and ovulation. The only proven
mechanism of action for emergency contraception is the delay in
ovulation. Basically, when a woman takes emergency
contraception, it slows down the development of a developing egg
so that it is not released within the next 72 hours, so in that
time, the sperm dies before it can reach the egg.
CHAIR DYSON asked what the earliest is that fertilization can
take place.
Number 1856
DR. MURPHY answered that the egg can be fertilized for
approximately 24 hours after its been released. She noted that
studies have shown that it takes hours for the sperm to
transport itself into the tubes, but contractions in the uterus
help the sperm out. She explained that sperm have been observed
in the fallopian tube within minutes of having successful
intercourse with normal cervical mucus. If there is a healthy
egg sitting in the tube, it can happen within minutes.
Emergency contraception is not 100 percent effective. It will
not necessarily prevent a pregnancy that is already developing.
If emergency contraception was an abortifacient, it would cause
a higher rate of miscarriage and potentially a higher rate of
malformation, neither of which occurs.
CHAIR DYSON expressed concern that this legislation covers
abortifacients in the emergency contraception and asked Dr.
Murphy to comment on that.
DR. MURPHY said she thought he was confusing emergency
contraception pill with RU486 which is also known as Mifeprex or
Mifepristone produced by Danco Laboratories. This is a drug
that's an anti-progesterone which can also be used in other
female health conditions, such as endometriosis, fibroids, and
breast cancer. It is a drug that can stop a pregnancy.
Emergency contraception does not interfere with a successful
pregnancy.
Number 1631
REPRESENTATIVE STEVENS asked Dr. Murphy for some written
information on the morning after pill.
DR. MURPHY referred him to a website for this information. The
address is http://www.akemergencycontraception.org.
Number 1520
EILEEN FARIAN testified via teleconference on her own behalf.
She told the committee that she was irritated when she refilled
her prescription and discovered that for no reason, all birth
control had increased a significant amount, and her prescription
had increased $4. She uses [birth control pills] for many
medical reasons, but it is not covered. She stated that it is
not covered by all state unions. The GGU [General Government
Unit] does not cover birth control and hasn't as far as she
knows. She said she believes that birth control is a preventive
item. Insurance covers other preventive things such as
hepatitis C shots, immunizations, and flu shots. She expressed
frustration about things that insurance doesn't cover.
Number 1396
REPRESENTATIVE WILSON asked Ms. Farian how much she pays per
month.
MS. FARIAN answered that in the past she has paid from $20 to
$35; currently, she pays $25 for a generic prescription.
Number 1368
ANNE HARRISON testified via teleconference. She expressed
support for HB 313. She noted that the numbers give a clear and
convincing case for the passage of this prescriptive equity
bill. It must get out of committee and onto an affirmative
vote. She told the committee that she has a 37-year history as
a nurse and nurse practitioner working with women. She is now
retired and can schedule her still-busy schedule to justify a
bill critical to reproductive health. She told the committee
that women's health, and ultimately the health of their
children, is absolutely dependent on the ability to control
their fertility. They should not have to pay inequitable
amounts relative to men for their contraception because their
insurance companies do not pay for contraception. This refusal
of some insurance companies to cover contraception makes no
sense financially or from a health care perspective. She
reminded the committee that contraception can prevent untimely
pregnancies and therefore abortion. She emphasized that
contraception is not abortion. She urged the committee to pass
HB 313.
Number 1156
CINDY NORQUEST testified via teleconference. She told the
members that she was astounded that this is even an issue. She
said that she is a Catholic, a Republican, and a businesswoman.
She explained that one of her reasons she is a Republican is her
intolerance for government telling citizens and businesses what
to do. But, sometimes that has to be done, she said. It makes
good sense to make decisions that are tough decisions but
address the issues of equity and fairness. That is what this is
all about. Both the Civil Rights Act and the Pregnancy
Discrimination Act were passed as a result of the greater good.
No one wanted to admit that discrimination existed, and
legislation was necessary to correct the issue, she noted. The
bottom line is that women and people of color were treated
unfairly. Neither act mandated preferential treatment, just
equal, and that's what is being asked for today.
MS. NORQUEST pointed out that the numbers do not show that women
are treated equally when it comes to health care issues. Women
are paying 68 percent more than men on out-of-pocket health care
costs. She explained that she is very familiar with insurance
plans since she used to manage the benefit plan for National
Bank of Alaska. She stated that women do not get treated
equally. She noted that this does save money for businesses.
The Washington Business Group on Health found that not providing
contraceptive coverage would cost employers 15 to 17 percent
more.
Number 1055
MS. NORQUEST addressed some questions asked earlier. Responding
to a question about how low people's income was before they were
eligible for health insurance, she reported that Wells Fargo has
employees making as little as $16,500 a year who do receive
health insurance. Wells Fargo stepped up to the plate in the
1990s and said it was an EEO employer, and it was going to treat
its women fairly and equally, so it covered contraception. She
said the ramifications about not passing or passing this are not
from a legal standpoint, but from what is right and in the best
interest of the public. She expressed disappointment about some
condescending comments and for taking time off from work to
testify on something that really is a "no brainer." She urged
the committee to pass HB 313.
Number 0860
SHERRY JAEGER testified via teleconference on behalf of the YWCA
[Young Women's Christian Association]. She expressed support
for HB 313. She told the committee that this bill addresses the
current inequities involved in women's health care plans and
would require fairness in the workplace. It has the potential
to affect 140,000 women of childbearing age in Alaska. It would
eliminate gender discrimination under Title 7 of the Civil
Rights Act of 1964 and would address the disparity requiring
women to spend nearly 70 percent more than men on prescription
drug expenses. She pointed out that contraception is a basic
health care issue for women and a critical contributor to
improved maternal and child health. This bill is not asking for
preferential treatment; it's asking for equitable treatment
within the context of an existing drug prescription benefit.
The adoption of HB 313 would ensure fairness and equity for
women in the workplace, and it would not burden the insurance
providers. It would ensure full coverage for women for all of
their reproductive health care needs, and finally, it would
ensure that Alaska would not be violating the Civil Rights Act
of 1964. She urged the committee to move HB 313.
Number 0758
PAULINE UTTER, Alaska Women's Political Caucus, testified via
teleconference. She told the committee that the caucus had a
booth at a women's show in Anchorage and circulated a petition
that said if Viagra is funded, why isn't birth control. She was
astounded by the number of people who signed on. She suggested
that the legislature should have the wherewithal to pass
legislation that is in the best interest for women in this
state. She urged the committee to pass HB 313 out of the
committee.
Number 0700
ROBIN SMITH testified via teleconference. She noted that some
people's religious beliefs run counter to the use of
contraceptives or emergency contraception. She pointed out that
there are many instances in which health insurance provides
coverage that conflicts with individual religious beliefs.
Christian Scientists do not believe in medical treatment except
for dental and vision care. But most people expect health
insurance to be available. Jehovah's Witnesses do not believe
in blood transfusions. She said she can't imagine blood
transfusions not being covered by health insurance. The Roman
Catholic Church opposes tubal ligations and vasectomies. The
majority of health insurance companies provide for this
permanent form of contraception. Providence Hospital's health
insurance covers birth control pills for its employees. She
said she is sure that Pope John Paul does not approve. She
noted that there is a wide variety of people's belief systems
and how they impact what people do regarding their health care
treatment.
MS. SMITH reminded the members that women can become pregnant
for more than 30 years of their lives. Since most women only
want two or three children, they spend the vast majority of
their reproductive years preventing pregnancy. Contraception
also aids women in facing the children they have; therefore,
ensuring the health of the mother and the health of the infant
that may be born. She concluded:
You are here to enable working women to have equal and
fair treatment under the law. You are here, and if
you pass this bill, you will be preventing unintended
pregnancy, and as a result, preventing abortion. You
are not forcing anyone to use any form of
contraception. You are simply ensuring that women
have what [they] need for basic health care coverage.
Please pass this prescription fairness bill out of
committee. Please make this bill law.
Number 0523
KAREN PEARSON, Director, Division of Public Health, Department
of Health & Social Services (DHSS), testified that this is a
good public policy bill. She told the committee that making
sure that every child is wanted is an important part of public
health and is aided by a contraceptive equity bill such as
HB 313. She explained that the statistic of 42 percent of
unintended births in Alaska means there are about 4200 children
born every year in Alaska to parents who didn't intend to have
that child at that time. That doesn't make an unwanted child.
That's a much smaller percent. She recognized that unintended
children are very often welcomed, but for parents to have the
ability to plan for this is very important. The equity piece is
that there are no categorical prescriptions put aside other than
contraceptives. Since only women can get pregnant, it is very
much a gender issue.
MS. PEARSON referred to Chair Dyson's question about someone's
salary and insurance. She told him that the Department of
Labor, other departments, and the DHSS have done an employers'
survey related to insurance, and those results will be coming
out soon. She remembered being surprised when she saw the first
raw information that showed it wasn't necessarily all the big
employers who provide insurance and all the small employers who
don't. There is real diversity in terms of who does and who
doesn't provide coverage in Alaska and the income levels of the
people who then receive that. She said she will make that
information available to the committee next month.
Number 0372
CHAIR DYSON commented that he didn't hear any testimony today
saying that if this becomes law, women will have contraception
that they didn't have before. It sounds to him that if the oral
contraceptives can be had for $100 a year, it's really not an
economic issue; it's an equity issue according to most of the
testimony.
MS. PEARSON said he was probably right but shared something that
may change that. She mentioned that people are aware that
family planning services are provided through the Division of
Public Health, and the price increases for oral contraceptives
over the past 12 months has been absolutely amazing. The
wholesale rate that the department buys them at has increased
from 100 to 300 percent. She commented that what's going on in
the pricing and charges is disturbing. She agreed that the real
issue is equity, but with the huge increases in prices, it's
also a growing economic issue. Passage of this bill guarantees
that equity for women in pharmaceutical coverage, and she asked
the committee to support this.
Number 0192
CHAIR DYSON said [HB 313] doesn't require religious employers to
carry it. He wondered who decides what's a religious employer.
Number 0120
KATIE CAMPBELL, Actuary Life/Health, Division of Insurance,
Department of Community & Economic Development, explained that a
religious employer is defined in the law as an employer with a
primary purpose of instilling religious principles. The
Division of Insurance would be the one to enforce this
provision.
TAPE 02-39, SIDE A
Number 0001
CHAIR DYSON asked about protecting the anonymity of a minor
child getting contraception on the parents' insurance.
Number 0126
MR. PEARSON answered that as she understands it, that's not a
violation of the privacy. It would be a violation if the
provider shared with the parent, "I saw your son or daughter and
provided this service." She commented that she believes certain
young people choose to use public family planning services
rather than choosing to go to their family physician and use
their parents' insurance for coverage of that service.
Number 0178
CHAIR DYSON referred to page 2, lines 12 through 14, and said
the copayment, "you could have it, but it had to be the same for
all prescription in the same category."
MS. PEARSON agreed that was correct. There couldn't be a copay
of $5 for all drugs, except contraceptives would have a copay of
$50. That would not be acceptable.
[HB 313 was held over.]
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:53 p.m.
| Document Name | Date/Time | Subjects |
|---|