Legislature(2011 - 2012)CAPITOL 106
03/13/2012 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: State Funding for Pregnancy Termination | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 13, 2012
3:07 p.m.
MEMBERS PRESENT
Representative Wes Keller, Chair
Representative Alan Dick, Vice Chair
Representative Bob Herron
Representative Bob Miller
Representative Charisse Millett
Representative Paul Seaton
MEMBERS ABSENT
Representative Beth Kerttula
OTHER LEGISLATORS PRESENT
Representative Bob Lynn
Senator Fred Dyson
COMMITTEE CALENDAR
PRESENTATION: STATE FUNDING FOR PREGNANCY TERMINATION
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
WILLIAM STREUR, Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified during the presentation on state
funding for pregnancy termination.
REPRESENTATIVE BOB LYNN
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified during the presentation on state
funding for pregnancy termination.
KAREN LEWIS, Educational Director
Alaska Right to Life
Anchorage, Alaska
POSITION STATEMENT: Testified during the presentation on state
funding for pregnancy termination.
CANDY MILLER
(No address provided)
POSITION STATEMENT: Testified during the presentation on state
funding for pregnancy termination.
DEBBIE JOSLIN, President
Eagle Forum Alaska
Delta Junction, Alaska
POSITION STATEMENT: Testified during the presentation on state
funding for pregnancy termination.
CLOVER SIMON
Planned Parenthood of the Great Northwest
Anchorage, Alaska
POSITION STATEMENT: Testified during the presentation on state
funding for pregnancy termination.
ILONA FARR, MD
Anchorage, Alaska
POSITION STATEMENT: Testified during the presentation on state
funding for pregnancy termination.
MARGARET MULLINS
Delta Junction, Alaska
POSITION STATEMENT: Testified during the presentation on state
funding for pregnancy termination.
CHRISTINE KURKA, Chair
Fair Committee
Alaska Right to Life
40 Days For Life
Anchorage, Alaska
POSITION STATEMENT: Testified during the presentation on state
funding for pregnancy termination.
MIKE DUNLEAVY
Wasilla, Alaska
POSITION STATEMENT: Testified during the presentation on state
funding for pregnancy termination.
JENNIFER MEYER
Anchorage, Alaska
POSITION STATEMENT: Testified during the presentation on state
funding for pregnancy termination.
MIRIAM LANDAU
Anchorage, Alaska
POSITION STATEMENT: Testified during the presentation on state
funding for pregnancy termination.
MATT JOHNSON, Executive Director
Alaska Right to Life
Anchorage, Alaska
POSITION STATEMENT: Testified during the presentation on state
funding for pregnancy termination.
CHRISTOPHER KURKA, Chair
Political Committee
Alaska Right to Life
Anchorage, Alaska
POSITION STATEMENT: Testified during the presentation on state
funding for pregnancy termination.
ACTION NARRATIVE
3:07:40 PM
CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:07 p.m.
Representatives Keller, Dick, Herron, Miller, and Millett were
present at the call to order. Representative Seaton arrived as
the meeting was in progress. Also in attendance were Senator
Dyson and Representative Lynn.
^Presentation: State Funding for Pregnancy Termination
Presentation: State Funding for Pregnancy Termination
3:08:17 PM
CHAIR KELLER announced that the only order of business would be
a presentation about state funding for pregnancy termination.
He explained that the hearing "is meant to put information on
the record related to one question, that question is, should the
state use public money, tax dollars, to pay for elective
abortions, or should it not." He stated that this was not a
debate "whether abortion is good or bad. That's an ongoing
discussion that I am sure we have all been part of and will
continue." He suggested that a definitive statement of policy
could be made. He stated that the purpose of the presentation
was purely informational.
3:11:03 PM
CHAIR KELLER, referring to the letter from the Department of
Health and Social Services [Included in members' handout],
reported that the state had spent $546,000 on abortion related
services during the last [calendar] year. He declared that this
money was spent despite the declaration in House Bill 108, page
23, lines 15 - 20, which he read, as follows:
no money in this appropriation [Medicaid services] may
be expended for an abortion that is not mandatory
service under AS 47.07.030(a). The money appropriated
for Health and Social Services may be expended only
for mandatory services under Title 19 of the Social
Security Act and for optional services offered by the
state under the plan for medical assistance that has
been approved by the U.S. Department of Health and
Human Services.
CHAIR KELLER asked for Commissioner Streur [Department of Health
and Social Services (DHSS)] to explain why this money was spent
despite the intent language written in House Bill 108.
3:12:38 PM
CHAIR KELLER explained that he had researched back to 1971 on
the question of public money being spent for abortion. He
expressed his desire to review the topic "with thought and not
debate passion and confusion" in order to get the information on
the record so the legislature could address the issue. He
offered his belief that there were conflicting decrees from the
Alaska Supreme Court and the Alaska State Legislature.
3:14:21 PM
WILLIAM STREUR, Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), agreed that
this was an important issue, and as he wanted to be perfectly
clear, he read from a prepared statement [original punctuation
included]:
There may not be an issue facing the Department that
has drawn more of my attention than this particular
one.
The federal Hyde Amendment is a rider to the annual
Labor/Health and Human Services (HHS)/Education
appropriations bill which prevents Medicaid and any
other programs under these departments from funding
abortions, except in limited cases. It is named after
Rep. Henry J. Hyde (R-IL) who, as a freshman
legislator, first offered the amendment. Various
amendments over the years since 1977 have clarified
those limited cases to generally include rape or
incest and when following through with the pregnancy
threatens the life of the pregnant woman.
In 2001, the Alaska State Supreme Court established
that the State could not selectively deny payment for
medically necessary care to Medicaid-eligible women
because the threat to their health arises from
pregnancy. The court reasoned that the state is
required to use neutral criteria when it places
restrictions on medical care, concluding that
regulations that prohibited payment for medically
necessary abortions were based on criteria that were
unrelated to Medicaid's program purpose of granting
uniform and high quality medical care to all needy
persons in the state. The court specifically
determined that the differential treatment that is
created by regulations that deny payment for medically
necessary abortions fails and equal protection
analysis. A Superior Court decision in 1999 ruled that
7 AAC 43.140 limited when and how the state could pay
for medically necessary abortions and the court said
the criteria in the regulation was not neutral and
therefore violated the Equal Protection clause. That
is a quick snapshot of how we got to here. With that
decision, we are one with a dozen other states under
court order to publically fund medically necessary
abortions under broader criteria than Hyde.
So, what options do we have to minimize our exposure
in paying for elective abortions that do not meet the
court's criteria of being "medically necessary"?
One effort may be to impose a definition of medical
necessity, either specific to abortions or for
Medicaid services as a whole. Under the old General
Relief Medical (GRM) program, which paid for abortions
for two decades until the program was defunded in
1998, a therapeutic abortion had to be "certified by a
physician as medically necessary to prevent the death
or disability of the woman, or to ameliorate a
condition harmful to the woman's physical or
psychological health." The GRM standard was perceived
by many as not materially restricting access to state-
funded abortions. Some believe the current system does
not adequately ensure some Medicaid services,
including abortion services, are not conclusively
supported by strong medical necessity criteria.
It has been suggested that statute may be able to
define medical necessity and that any services be
measured against that criteria. While one can place a
definition of medical necessity in statute or
regulation, it bears little weight as the ultimate
decision for the necessity for care rests with the
physician and his or her determination that an
abortion is necessary due to rape or incest or the
woman was in danger of death due to physical disorder,
physical injury or physical illness. OR, in Alaska's
case; the abortion is not elective and was
necessitated because the pregnancy endangered the
health of the woman, Medicaid must pay some or all of
the costs. The caution still remains that we had a
regulation before and it was challenged and we lost.
In 2010, the DOL researched the 13 states under court
order to fund abortions beyond the reasons permitted
under Hyde (rape, incest or life endangerment) and
those state definitions of "medically necessary" in
the context of Medicaid funded abortions and other
health care services. The research did not show any
states that apply a narrower or stricter definition of
"medically necessary" to Medicaid funded abortions in
comparison to other Medicaid funded services. In the
case of six states the definitions are quite broad and
provide physicians with wide latitude to use their
professional judgment on the necessity.
Alaska Medicaid may have some opportunity to define
medical necessity or to require physicians to certify
that an abortion is medically necessary and not an
elective procedure. We have played with both and
continue to attempt to seize what might have been an
opportunity afforded by the Supreme Court to do so.
We have designed and are finalizing the efficacy of a
medical certification completed and signed by a
physician performing an abortion for which federal or
state funding is requested. That signed certification
must affirm the abortion is the result or rape or
incest or condition that places the woman in danger of
death of death unless an abortion is performed, OR, in
the case of request for state funding only, the
abortion is performed due to the health of the woman
being endangered by the pregnancy.
This issue is both perplexing and challenging as we
move forward with Medicaid funded healthcare and the
proposed Medicaid expansion. To address this issue we
need to enlist the assistance of our tribal partners
and the medical community, as well as the State
Legislature. I am bound under the Alaska Supreme
Court's Constitutional determination that I must
protect a woman's right to a medically necessary
abortion and ask for your indulgence to not place us
in an, even more difficult situation, by legislating a
prohibition to not provide that access.
Thank you for your consideration and allowing me the
time to discuss this issue. I am happy to answer any
questions you may have or discuss further my testimony
today.
3:23:30 PM
CHAIR KELLER, in reference to the aforementioned letter from
DHSS, asked for a definition of abortion related services, and
asked if this included "pro-life counseling."
3:24:27 PM
COMMISSIONER STREUR, in response, explained that the presenting
symptom dictated whether a billing was for services under
abortion related counseling. He affirmed that "pro-life
counseling" could also be included.
3:24:56 PM
REPRESENTATIVE BOB LYNN, Alaska State Legislature, asked if the
"abortionist" decided what was medically necessary, and he
questioned whether this would be a conflict of interest.
COMMISSIONER STREUR, pointing out that the provider was a
physician, confirmed that the physician did make this decision.
He offered his belief that the Hippocratic Oath would preclude
the relatively small fee that the physician would receive for
performing an abortion. He declared his faith in mankind.
3:26:09 PM
REPRESENTATIVE MILLETT confirmed that this was "an emotional
issue to both men and women, it's a tough issue to talk about,
it's a tough issue to legislate." She asked if the medical
certification that Commissioner Streur had referenced would be
issued by the State of Alaska and would certify that the
abortion had been done for reasons under the federal definition
of medically necessary abortions. She asked what the penalty
was for not completing the medical certification or for
perjuring the medical certification. She asked how it would be
determined that either of these had occurred.
3:27:10 PM
COMMISSIONER STREUR, in response, said that the proposed
certification form was still going through numerous reviews. He
reported that it would contain two certification boxes, one box
for the aforementioned Hyde Amendment, and the second
certification box for state funding only; and, it would declare
that the services were medically necessary for the psychological
or physical health of the mother. He clarified that the
physician would choose which box to check, and the certification
was subject to review. He pointed out that, without a
certification, there would not be any payment.
3:28:08 PM
REPRESENTATIVE MILLETT asked for the definition of psychological
damage to the mother.
COMMISSIONER STREUR replied that this related to a medication
regimen whereby the medication could cause harm to the fetus or
the mother. He offered to research and to provide a broader
definition.
3:29:01 PM
REPRESENTATIVE MILLETT asked if the psychological component was
only considered when the mother was on medication for
psychological issues.
COMMISSIONER STREUR replied that he would research that
question.
3:29:37 PM
REPRESENTATIVE HERRON asked what would happen if the legislature
decided not to provide funding.
COMMISSIONER STREUR confirmed that this "was the horns of my
dilemma," as he was under orders of the supreme court to ensure
that the services were not only provided, but also paid. He
relayed that the issue of payment was an annual problem when the
funding was eliminated from the department budget. He
established that "it's a tough and thorny issue, and it's the
issue that I ask that I not be put into, but I'm there."
REPRESENTATIVE HERRON asked what action the commissioner chose
when he was put into this dilemma.
COMMISSIONER STREUR confirmed that he would continue to make the
services available and to pay for them, although he would also
continue his attempt to clarify what was a medical necessity.
He affirmed that he worked with the provider community to "move
toward a level of comfort that the abortions that we are
performing are indeed medically necessary."
3:31:39 PM
REPRESENTATIVE HERRON asked if there was a distinction between
abortion related and abortion preventive services.
COMMISSIONER STREUR stipulated that abortion services needed "to
help the pregnant female come to a decision about the choices
before them." He emphasized that women were given the best
advice possible by ensuring that the best advice was available.
He stated that he did not make a distinction between abortion
related and abortion preventive services.
REPRESENTATIVE HERRON offered his belief that it was more than
semantics. He opined that people live up to expectations, and
he suggested changing the phrase to abortion preventive
services, which the state would pay. He declared that this
would engender expectation for abortion preventive services.
3:34:32 PM
CHAIR KELLER, declaring this to be an "unholy stalemate,"
recounted that six commissioners over the past 10 years had this
same dilemma. He asked if there were any current regulations to
better serve the legislative purpose as outlined in the intent
language of the bill.
COMMISSIONER STREUR, directing attention to the physician form
certifying medical necessity, endorsed that this would be in
regulation. He opined that any attempt to define medical
necessity was "a mighty thorny road to go down," and he
questioned whether this was mandating, legislating, or
regulating the practice of medicine. He declared that his
professional experience in health care had determined that this
was not a good course of action. He suggested a partnership
with the physician community for adherence to the rules of the
Hyde Amendment and the supreme court.
3:36:32 PM
CHAIR KELLER offered his belief that most other states were
closer to the CMS (Centers for Medicare and Medicaid Services)
guidelines on abortion, which he read:
If the pregnancy is a result of an act of rape or
incest, or ... if a woman suffers from a physical
disorder, a physical injury, or physical illness,
including a life endangering physical condition caused
or arising from the pregnancy itself, that would, as
certified by a physician, place the woman in danger of
death unless an abortion is performed.
CHAIR KELLER shared that this CMS standard went on to list the
specific examples. He shared a story of a doctor's definition
for medically necessary, which was "medically necessary is
necessary if I say so. I decide if an abortion is necessary or
not based on what the patient wants." He opined that these
different standards necessitated exploration for a tightening of
the definition "without stepping unduly on the toes of the
physicians."
3:39:09 PM
REPRESENTATIVE DICK suggested a tightening of the language, so
that "people of both sides of the argument would have peace with
it." He offered a second suggestion, that by adding abortion
services to Pick, Click and Give, "this whole problem would go
away." He likened the violation of physical rape to an ethical
and moral violation "of having to participate in our state
funding abortions."
3:42:22 PM
CHAIR KELLER asked if the category "abortion related services"
included transportation.
COMMISSIONER STREUR said that it did not.
3:42:59 PM
REPRESENTATIVE MILLETT asked for the locations in Alaska where
abortions were performed.
COMMISSIONER STREUR replied that the majority were performed in
the Anchorage area, with a smaller number in Fairbanks and, he
added, "quite a few in Seattle."
3:43:37 PM
REPRESENTATIVE MILLETT asked for a cost estimate of
transportation to a clinic performing state funded abortions.
She asked if the State of Alaska paid for this transportation.
COMMISSIONER STREUR explained that some cases involved a
Medicaid recipient arranging their own transportation and
arriving at the office of a physician, and other cases included
transportation paid by state funding. He declared that each
case of abortion related services was reviewed in order to
determine whether transportation for that individual had
occurred during that same time period. He affirmed that he
would research the costs.
REPRESENTATIVE MILLETT asked when the proposed medical
certification would be available for public comment. She asked
if the certification would be mandatory for participation by all
physicians, was there an "opt out," or was it only required for
state funding.
COMMISSIONER STREUR confirmed that the medical certification was
only required for state payment through Medicaid.
REPRESENTATIVE MILLETT asked if abortions provided in Seattle
would require medical certification.
COMMISSIONER STREUR explained that any abortion paid by Medicaid
would require medical certification for payment.
3:46:22 PM
REPRESENTATIVE DICK clarified that abortion was legal but that
the question was whether the State of Alaska would pay for the
procedure.
3:47:10 PM
COMMISSIONER STREUR emphasized that there was not a choice of
payment by the State of Alaska. He stated that the Alaska
Supreme Court had established that the State of Alaska could not
"selectively deny payment for medically necessary care to a
Medicaid-eligible recipient because the threat to their health
arises from pregnancy."
REPRESENTATIVE DICK offered his belief that there was
"tremendous wiggle room" in the definition for medically
necessary, and he suggested that the committee tighten up the
definition.
3:48:00 PM
CHAIR KELLER offered his belief that the Alaska Supreme Court
justices had endorsed an opportunity for the definition of an
"elective abortion." He declared that the definition would be
tested if the legislature "is to press on with trying to define
this once and for all." He reiterated that this hearing was to
gather information for whether the state should pay for elective
abortions. He requested that all testifiers be respectful and
precise.
3:49:20 PM
KAREN LEWIS, Educational Director, Alaska Right to Life,
declared that she spoke for herself and others who were morally
opposed to tax payer funding for elective abortions. She opined
that 50 percent of the population "considered themselves to be
pro-life." She expressed her support for the suggestion by
Representative Dick to "let those who embrace abortion pay for
those who want one."
3:51:02 PM
CANDY MILLER offered her belief that privatization was the
solution, and that "no government should be paying for abortion
or pregnancy, adoption, all of those." She suggested a stop to
the enablement by the government, that private organizations
could facilitate adoptions. She asked if the state paid for
contraceptives and abortions for foster children; and, how much
federal money was paid for abortions.
REPRESENTATIVE MILLETT asked if there was funding for the state
program for adoption.
COMMISSIONER STREUR replied that the Office of Children's
Services offered subsidies to encourage adoptions.
3:55:50 PM
DEBBIE JOSLIN, President, Eagle Forum Alaska, stated that she
represented herself, and directing attention to the inherent
rights section of the Alaska State Constitution, she said "that
all persons have a natural right to life, liberty, and the
pursuit of happiness." She opined that assistance in ending a
life was not living up to the constitution. She said she would
direct her comments to "medically necessary." She shared
stories of her own abortion and of her diagnosis for trisomy 13
during a subsequent pregnancy. She disagreed with payment of
abortions for "mental illness" and suggested that adoption was
an alternative. She offered her belief that payment for
"medically necessary" abortions was a cover. She urged the
committee to stop government payment for abortions. She
referred to Planned Parenthood as "a business, it is an abortion
business. It is not about helping women or healing women, it's
a business and they make a good deal of money." She opined that
it was wrong for Planned Parenthood to receive state or federal
funding for abortions.
4:03:00 PM
CLOVER SIMON, Planned Parenthood of the Great Northwest,
endorsed that Alaskans valued independence and privacy, and she
opined that "many Alaskans believe that the government should
not interfere in a decision between a woman, her doctor, her
family, and her faith when she's deciding what to do with an
unintended pregnancy." She declared this to be a value for the
daily operation of Planned Parenthood. She relayed that the
Alaska Supreme Court had already decided that pregnancy care and
other medically necessary procedures, including abortion when
medically necessary, would be covered by Medicaid. She offered
her belief that any attempt to legislate what was or was not
medically necessary was "a grey and sticky ground." She
expressed her agreement with Ms. Joslin that a definition of
medically necessary could vary between women, reiterating that
it was a decision for each individual woman and her doctor.
4:04:46 PM
REPRESENTATIVE MILLETT asked for the Planned Parenthood
definition for when a life begins.
MS. SIMON replied that Planned Parenthood did not "take a stance
on when life begins. We leave that decision up to the woman,
and her physician, and her family, and her faith." She declared
that Planned Parenthood was not interested in making that
decision for women, as it was a personal decision.
4:05:27 PM
REPRESENTATIVE DICK offered his belief that pregnancy was an
issue for both a man and a woman. He declared:
If a woman chooses to carry the child, then the man is
totally responsible for the child; yet if the woman
chooses not to carry the child, all of a sudden it's
her individual personal choice as to whether she's
gonna carry that child or not. So, there's a double
standard there that really troubles me. I don't think
it's really her pregnancy because it's their pregnancy
and, if anything, that decision to have an abortion
should be made not only by the woman, but the man who
was also involved and who also will live with the
decision whether that child should enter life or not
be able to enter life.
4:06:40 PM
MS. SIMON confirmed that Planned Parenthood counseled for
everyone involved in the pregnancy to be included with the
decision making. She summarized the Planned Parenthood
education programs, which included discussions of healthy
relationships and the importance of communication about birth
control and unintended pregnancy in sexual relationships.
REPRESENTATIVE DICK declared that double standards had always
bothered him, and "if I thought that a man's signature was
required in order for a woman to have an abortion, I'd have a
little more peace about it."
4:08:33 PM
CHAIR KELLER asked if there was any conflict of interest for
Planned Parenthood with any profit to be made from abortion
services.
4:08:48 PM
MS. SIMON emphasized that Planned Parenthood had no "interest in
profiting off of abortion services." She disclosed that the
revenue versus the cost as a provider of prevention services was
not profit generating. She stated: "we're a medical provider.
We provide lots of services, most of them are prevention
services." She offered her belief that there was not a conflict
of interest.
4:09:31 PM
REPRESENTATIVE MILLETT asked for the profit margin at Planned
Parenthood.
MS. SIMON replied that Planned Parenthood of the Great Northwest
did not make a profit for the last year.
4:09:57 PM
MS. SIMON, in response to Representative Lynn, stated that the
definition for a medically necessary area should be made between
a patient and a physician, not by the legislature. In response
to a second question from Representative Lynn, she affirmed that
"doctors have different opinions about what is or isn't
medically necessary, and that's why it's really important that
the patient is involved in that decision making process."
4:11:37 PM
ILONA FARR, MD, declared that she was a pro-life physician. She
expressed her belief that most abortions are elective, "because
people don't want the consequences of what their action is,
essentially." She reported her "difficulty as a physician, as a
person in the State of Alaska, having my tax dollars pay for
abortion." She declared the importance to each of the
following: parental involvement while women were minors,
involvement of the father of the child, and ultra sounds for
full knowledge. She opined that the State of Alaska should
"stay out of this and not to fund abortions."
CHAIR KELLER asked if the legislature should write the
definition for medically necessary, even without any medical
background. He asked Dr. Farr if she would help write this
definition.
DR. FARR offered her belief that guidelines were necessary for
physician discretion, and she offered her support and that of
other physician colleagues, some of whom provided abortion
services, in order to "get the language correct with this
legislation."
4:16:11 PM
MARGARET MULLINS said that this is "basic to right to life,
which I know is not the issue here." She offered a personal
story about the right to life. She asked to clarify whether 600
abortions had been paid by Medicaid in Alaska.
CHAIR KELLER replied that the $546,000 had been spent on 901
individuals for abortion related services. He offered his
belief that at least 600 abortions had been paid by Medicaid in
Alaska.
MS. MULLINS reflected on her personal experiences with good and
evil, and power. She discussed definitions for adulthood, and
the development of the brain. She declared that funding for
abortions "makes a nation an abomination" and she urged the
legislature not to fund "abortions with tax payer's dollars."
4:23:43 PM
CHRISTINE KURKA, Chair, Fair Committee, Alaska Right to Life, 40
Days For Life, reflected that a duty of government was to
protect life, and it was not an appropriate use of state funds
for abortion services. She affirmed that it was different in
the event that it was medically necessary to save a life. She
offered her belief that 51 percent of Americans were opposed to
public funding of abortions. She shared a story of a woman who
had an abortion. She opined that a consideration for
legislation needed to be "in favor of life."
4:28:27 PM
MIKE DUNLEAVY offered his belief that a primary role of the
state should be security of its citizens, and that state dollars
should not be used "for the termination of its citizens, the
termination of life of its citizens."
4:29:17 PM
JENNIFER MEYER shared that she had worked in health care for
more than a decade and declared "abortion is something that
nobody likes it. Nobody wants to be put in a position where
that has to be a decision that's made, from the patient side or
from the care provider side." She suggested that the committee
work harder on prevention, health education, information, and
easier access for contraception. She offered her belief, that
although it would not solve everything, it would "make a
significant dent in the abortion rates." Reflecting on the high
teen birth rate statistics in the United States as opposed to
many other developed countries, she suggested a study on how
other countries had kept a low teen birth rate. She reiterated
the need for an investment in prevention.
4:31:59 PM
MIRIAM LANDAU offered her belief that our culture allowed
conversation about "how terrible abortion is," but made it
difficult to discuss that "women are in control of our own
destiny." She opined that the decision for abortion should be
made by a woman, her doctor, her faith, her family and her
partner. She specified that this discussion should be about low
income Alaskan women who did not have access to health care.
She suggested that, instead of a discussion for limiting access
to a legal medical procedure, there should be discussion to
increase funding for family planning to people with incomes up
to 175 percent of the federal poverty level. She encouraged the
committee to consider family planning as the best way to reduce
unplanned pregnancies.
4:34:22 PM
MATT JOHNSON, Executive Director, Alaska Right to Life,
directing his questions to Commissioner Streur, asked how many
abortions were paid through Denali Kid Care or Medicaid which
were under the parameters of the Hyde Amendment exceptions of
"rape, incest, and the life of the mother." He also asked what
the Department of Health and Social Services deliberative
process was to determine whether to follow the directives of the
legislature if there was a conflict with the judiciary.
4:36:20 PM
COMMISSIONER STREUR, in response to Mr. Johnson's first
question, stated that no abortions were claimed "under Hyde last
year." He replied that he would have to research the previous
years for that information. In response to the second question,
he stated that he worked for the executive branch, and his boss
was the governor.
4:36:59 PM
CHAIR KELLER asked Mr. Johnson why he questioned the Hyde
Amendment payment.
MR. JOHNSON replied that it was his understanding that the FMAP
(Federal Medical Assistance Percentage) would pay for any
abortions that were not covered under the parameters of the Hyde
Amendment.
4:37:35 PM
COMMISSIONER STREUR explained that FMAP would pay for 50 percent
of any abortions performed under the parameters of the Hyde
Amendment. He noted that any abortions performed outside those
parameters, were paid with 100 percent of general funds.
4:38:00 PM
MR. JOHNSON asked to receive the information for the number of
abortions which had been paid for under the parameters of the
Hyde Amendment. Expressing his agreement with the earlier
analysis by Representative Dick, he opined that the medical
necessity language was amorphous, "basically whatever the health
care provider or the mother decides it is." He offered his
belief that the legislature should better define the language.
COMMISSIONER STREUR, in response to Mr. Johnson, said that the
supreme court had determined that abortion was included with
pregnancy related services, and that the legislature had the
option to not cover pregnancy related services.
4:40:29 PM
MR. JOHNSON stated:
In Planned Parenthood One, the court argued that it is
a violation of equal protection to pay for pre-natal
services and not pay for abortion services and they
argued it upon an argument that they called equal
footing. I just want to point out, for the record,
that the court artificially divided women into two
classes that, I believe, were not necessary. I
believe it's a piece of sophistry. The two classes
were those who choose to have abortions and those who
chose to carry their child to term. I would submit
that that is the class of two choices, not a class of
two kinds of persons. On its face, it seems to me
like it's preposterous to claim that there's even a
remote equivalent between covering a service, in this
case pre-natal care, that covers medical procedures
for all women potentially, and all women definitely
who go through a natural birthing process, and one
that intrudes upon and pre-empts nature.
MR. JOHNSON assessed that any legislative relevance was to be
determined by the legislature. He offered his opinion that the
logic of the decision by the supreme court, "inexorably leads us
back to the first question I asked ... it seems to me the logic
of the courts, if it were carried to its conclusion, would lead
us to the place where the state would perforce be required to
pay for any medical choice any patient wanted to make." He
voiced his objection for "the activism of the Alaska State court
system." He declared that this was "fundamentally undemocratic.
The courts have moved to circumvent the will of the electorate,
as expressed in the legislature and in the executive branch, and
in addition to the federal laws that are in place." He declared
a desire to register his protest.
4:43:35 PM
REPRESENTATIVE DICK conveyed:
Just for the record, the fact that a committee
member's eyes are closed may mean that that committee
member is napping, but it also might mean that that
committee member is deeply contemplative.
CHAIR KELLER asked Representative Dick if the camera had caught
him sleeping.
4:44:21 PM
CHRISTOPHER KURKA, Chair, Political Committee, Alaska Right to
Life, declaring that he was speaking for himself, reminded the
House Health and Social Services Standing Committee and
Commissioner Streur that "we have a state constitution, and
every member of the legislature, including the courts and the
governor, have an oath to uphold that document." He directed
attention to Article 9, Section 13, [Alaska State Constitution]
and read: "no money shall be withdrawn from the treasury except
in accordance with the appropriations made by law. No
obligation for the payment of money shall be incurred except as
authorized by law. Unobligated appropriations outstanding at
the end of the period of time specified by law shall be void."
He expressed that the legislature and the governor should be
more concerned that the courts have usurped the delegation of
power. He stated:
The courts, as far as I can tell, have no place in
deciding what we do and do not spend money on. That
is the prerogative of the legislature and the
governor. The court doesn't make law; they merely
interpret law that is written by the legislature. If
the legislature decides it does not want to fund
abortions, it is not the prerogative of the court to
tell the legislature well we think that's a violation
of whatever contrivance they want to come up with at
the time.
MR. KURKA offered his belief that "if we as a people and as a
legislature and the governor think that it is entirely up to the
court to interpret everything that the constitution has to say,
then the other branches of the government become meaningless in
their actual authority." He expressed that "there are no checks
and balances under that system." He further prescribed that
"each person who has an oath to uphold the constitution has then
some semblance of responsibility to interpret that for
themselves using plain English of the constitution. It's not
rocket science, and it's pretty clear to me that the legislature
is the one who control the purse strings."
4:47:11 PM
CHAIR KELLER, in response, acknowledged:
That's one that personally outrages me. To me, it's
very clear that it's the legislative job to
appropriate and when we have a supreme court case that
says we will appropriate, especially in light of the
fact that we keep saying no you won't, on a very
unlegal level, that the whole big picture just seems
like it is a fundamental question that is being
challenged in this whole process. We have a
constitution that's very different. We've got the
privacy and we've got the equal access issues that we
have case law around, and we're looking for a way
forward to challenge it, and I'm not sure what that
will be, but I got some ideas.
4:47:42 PM
COMMISSIONER STREUR emphasized that he had taken an oath "to
defend and uphold the Constitution of the United States against
all enemies foreign and domestic" although there were things
with which he did not always agree. He shared that he had taken
a similar oath "to support the people of the great State of
Alaska." He offered his belief that he took that role "fully as
conscientiously" as the oath he had taken to uphold the U.S.
Constitution. He affirmed that this was a difficult situation,
and he requested that everyone work together for a solution. He
declared "I do believe in providing the best care that we can
for the people of the great State of Alaska and I will continue
to do that as long as you let me."
4:49:50 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:49 p.m.
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