Legislature(1999 - 2000)

03/24/1999 01:40 PM Senate HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
      SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE                                                                    
                          March 24, 1999                                                                                        
                            1:40 p.m.                                                                                           
                                                                                                                                
MEMBERS PRESENT                                                                                                                 
                                                                                                                                
Senator Mike Miller, Chairman                                                                                                   
Senator Pete Kelly, Vice-Chairman                                                                                               
Senator Gary Wilken                                                                                                             
Senator Drue Pearce                                                                                                             
Senator Kim Elton                                                                                                               
                                                                                                                                
MEMBERS ABSENT                                                                                                                  
                                                                                                                                
All members were present                                                                                                        
                                                                                                                                
COMMITTEE CALENDAR                                                                                                              
                                                                                                                                
CS FOR SENATE BILL NO. 82(HES)                                                                                                  
"An Act requiring that the cost of contraceptives obtained by                                                                   
prescription and related health care services be included in health                                                             
insurance coverage."                                                                                                            
                                                                                                                                
     -MOVED CSSB82(HES)OUT OF COMMITTEE                                                                                         
                                                                                                                                
SENATE BILL NO. 94                                                                                                              
"An Act relating to the medical use of marijuana; and providing for                                                             
an effective date."                                                                                                             
                                                                                                                                
     -HEARD AND HELD                                                                                                            
                                                                                                                                
PREVIOUS SENATE COMMITTEE ACTION                                                                                                
                                                                                                                                
SB 82 - No previous action to report                                                                                            
                                                                                                                                
SB 94 - No previous action to report                                                                                            
                                                                                                                                
WITNESS REGISTER                                                                                                                
                                                                                                                                
                                                                                                                                
Ms. Theda Pittman                                                                                                               
PO Box 241513                                                                                                                   
Anchorage, AK  99524                                                                                                            
POSITION STATEMENT:  Supported SB 82                                                                                            
                                                                                                                                
Ms. Cathy Girard                                                                                                                
PO Box 101359                                                                                                                   
Anchorage, AK  99510                                                                                                            
POSITION STATEMENT:  Supported SB 82                                                                                            
                                                                                                                                
Ms. Mary Ross                                                                                                                   
342 W. 11th                                                                                                                     
Anchorage, AK  99501                                                                                                            
POSITION STATEMENT:  Supported SB 82                                                                                            
                                                                                                                                
Ms. Robin Smith                                                                                                                 
14100 Jarvi                                                                                                                     
Anchorage, AK  99515                                                                                                            
POSITION STATEMENT:  Supported SB 82                                                                                            
                                                                                                                                
Mr. Charles McKee                                                                                                               
PO Box 243053                                                                                                                   
Anchorage, AK  99524                                                                                                            
POSITION STATEMENT:  Commented on SB 82                                                                                         
                                                                                                                                
Mr. Scott Calder                                                                                                                
PO Box 75011                                                                                                                    
Fairbanks, AK  99707                                                                                                            
POSITION STATEMENT:  Commented on SB 82                                                                                         
                                                                                                                                
Ms. Kay Lahdenpera                                                                                                              
Alaska Nurses Association                                                                                                       
Anchorage, 99501                                                                                                                
POSITION STATEMENT:  Supported SB 82                                                                                            
                                                                                                                                
Mr. Gordon Evans                                                                                                                
Health Insurance Association of America                                                                                         
211 4th St., Suite 205                                                                                                          
Juneau, AK  99801                                                                                                               
POSITION STATEMENT:  Opposed SB 82                                                                                              
                                                                                                                                
Ms. Marianne Burke, Director                                                                                                    
Division of Insurance                                                                                                           
PO Box 110805                                                                                                                   
Juneau, AK  99811-0805                                                                                                          
POSITION STATEMENT:  Commented on SB 82                                                                                         
                                                                                                                                
Ms. Becka Braun                                                                                                                 
536 Park St. B                                                                                                                  
Juneau, AK  99801                                                                                                               
POSITION STATEMENT:  Supported SB 82                                                                                            
                                                                                                                                
Senator Loren Leman                                                                                                             
Alaska State Capitol                                                                                                            
Juneau, AK  99811-1182                                                                                                          
POSITION STATEMENT:  Presented SB 94                                                                                            
                                                                                                                                
Mr. David Finkelstein                                                                                                           
Alaskans for Medical Rights                                                                                                     
Anchorage, AK                                                                                                                   
POSITION STATEMENT:  Opposed SB 94                                                                                              
                                                                                                                                
Lt. Audie Holloway, Commander                                                                                                   
Narcotics Enforcement Division                                                                                                  
Anchorage Police Department                                                                                                     
4501 S.Bragaw                                                                                                                   
Anchorage, AK  99507                                                                                                            
POSITION STATEMENT:  Supported SB 94                                                                                            
                                                                                                                                
Mr. Richard Welch                                                                                                               
721-1/2 18th Avenue                                                                                                             
Fairbanks, AK  99701                                                                                                            
POSITION STATEMENT:  Opposed SB 94                                                                                              
                                                                                                                                
Capt. Bill Miller                                                                                                               
Anchorage Police Department                                                                                                     
4501 S. Bragaw                                                                                                                  
Anchorage, AK  99507                                                                                                            
POSITION STATEMENT:  Supported SB 94                                                                                            
                                                                                                                                
Mr. Jay Snodderly                                                                                                               
PO Box 813                                                                                                                      
Ward Cove, AK  99928                                                                                                            
POSITION STATEMENT:  Opposed SB 94                                                                                              
                                                                                                                                
ACTION NARRATIVE                                                                                                                
                                                                                                                                
TAPE 99-14, SIDE A                                                                                                              
Number 001                                                                                                                      
                                                                                                                                
                                                                                                                                
          SB  82-INSURANCE COVERAGE FOR CONTRACEPTIVES                                                                          
                                                                                                                                
CHAIRMAN MILLER called the Senate Health, Education and Social                                                                  
Services (HESS) Committee to order at 1:40 p.m. and brought up SB
82.                                                                                                                             
                                                                                                                                
SENATOR GARY WILKEN, presented his sponsor statement on SB 82                                                                   
which requires insurance carriers to provide coverage for                                                                       
prescribed contraceptives and related health costs.  While many                                                                 
health care plans pay for surgical means of preventing pregnancy,                                                               
few pay for the routine oral contraceptive methods prescribed and                                                               
recommended by physicians.                                                                                                      
                                                                                                                                
Women spend about 68% more out-of-pocket costs for health care than                                                             
men.  One of the biggest contributors to those expenses is birth                                                                
control.  The most widely used prescription drug of women aged 15                                                               
to 54 is for birth control, yet most insurance companies do not                                                                 
include contraceptive coverage in their policies.                                                                               
                                                                                                                                
The out-of-pocket cost for oral contraceptives is about $25 per                                                                 
month while the estimated increase in insurance premiums for                                                                    
coverage for birth control is about $16 annually per enrollee,                                                                  
according to the Health Insurance Association of America.                                                                       
Requiring insurance coverage for contraceptive services not only                                                                
makes good business sense, but it also increases access to                                                                      
contraceptives and related services.                                                                                            
                                                                                                                                
In response to a person's conscientious objection to contraceptive                                                              
coverage, SB 82 states an individual health care insurance policy                                                               
or a policy issued by a qualified church-controlled organization                                                                
with a religious-based objection is exempted from this mandate.                                                                 
                                                                                                                                
Eight out of ten privately insured adults support contraceptive                                                                 
coverage.  SENATOR WILKEN concluded, SB 82 recognizes this strong                                                               
public support, and he urged the committee's support for this                                                                   
legislation.                                                                                                                    
                                                                                                                                
Number 046                                                                                                                      
                                                                                                                                
SENATOR WILKEN commented that people will point out the increased                                                               
cost of $16 for this coverage, but the cost is much more for                                                                    
unwanted pregnancies and the problems caused by unwanted                                                                        
pregnancies.  This is an investment that over time pays back, and                                                               
the cost of insurance over time will decrease because of this bill.                                                             
                                                                                                                                
On a personal note, SENATOR WILKEN related that he became involved                                                              
in this issue when his daughter, an active high school junior                                                                   
needed oral contraceptives, not for birth control but to regulate                                                               
female hormones so that she could basketball. He said, "You can                                                                 
imagine when my wife said to me, 'Gary, I think we need to put                                                                  
Karen on birth control pills' what I said... a junior in high                                                                   
school."  After the reasons were explained to him, his daughter                                                                 
went on birth control pills and is an active college basketball                                                                 
player today.  The birth control pill began as a  medicinal device                                                              
for birth control and it's evolved into a significant therapy to                                                                
control female hormones.                                                                                                        
                                                                                                                                
He referred to pages 3-4 of the committee packets containing quotes                                                             
of support from organizations, and studies speaking to the benefits                                                             
of contraceptive coverage.                                                                                                      
                                                                                                                                
SENATOR WILKEN brought up the draft CS and a draft Amendment                                                                    
Version H.  He moved that the committee adopt the CS as a working                                                               
document.  Without objection, the CS was adopted.                                                                               
                                                                                                                                
SENATOR WILKEN explained the CS, Version H, does two things.  Last                                                              
year in similar legislation the intent language addressed the                                                                   
primary purpose of contraceptives in preventing conception.  This                                                               
CS rolls that purpose, which gave a lot of people comfort, into the                                                             
legislation itself.  Secondly, the CS cleans up the bill by                                                                     
removing the definition of contraceptive device and adding the                                                                  
words "obtained by prescription" to clarify that only                                                                           
contraceptives obtained through a doctor's prescription are covered                                                             
by this insurance.                                                                                                              
                                                                                                                                
Number 107                                                                                                                      
                                                                                                                                
CHAIRMAN MILLER announced that following testimony on SB 82, many                                                               
people want to speak on SB 94, and he set a 2-minute time limit on                                                              
testimony on both bills.                                                                                                        
                                                                                                                                
MS. THEDA PITTMAN, Anchorage, thanked Senator Wilken for                                                                        
introducing SB 82 and urged co-sponsorship and support by the                                                                   
committee members.  She stated that according to DHSS, there were                                                               
over 10,000 births in Alaska in 1995 and 41% were unintended,                                                                   
unwanted or mis-timed.  In 1995 alone there were 4,000 reasons why                                                              
this legislation is a good idea.  She suggested that two groups                                                                 
oppose this idea, the insurance companies and members of the "far-                                                              
righteous groups" that seek to control the right of a woman to make                                                             
her own decision about pregnancy.                                                                                               
                                                                                                                                
MS. CATHY GIRARD, Anchorage, expressed support for SB 82. She                                                                   
stated her medical bills over 10 years for prescription                                                                         
contraceptives and related medical exams have not been reimbursed                                                               
by her insurance plan or her husband's. She asked why Viagra, a                                                                 
sexual aid for men, is covered by both their insurance policies and                                                             
yet contraception, primarily made for and purchased  by women is                                                                
not covered by current insurance programs.                                                                                      
                                                                                                                                
MS. MARY ROSS, Nurse-Midwife representing the Chapter of the                                                                    
American College of Nurse Midwives, Anchorage, expressed support                                                                
for SB 82 as a practitioner for women's health care.  Many women up                                                             
to the age of 52 use birth control as a supportive measure during                                                               
the perimenopausal and menopausal times.                                                                                        
                                                                                                                                
MS. ROBIN SMITH, Anchorage, spoke in strong support of SB 82,                                                                   
stating insurance coverage for contraceptive care would be a good                                                               
business decision. Recently four of her employees, both male and                                                                
female, have dealt with unintended pregnancies, causing emotional                                                               
stress and negative impacts on her business including lost employee                                                             
time. increased work loads on others, re-hires and re-training.                                                                 
Small business cannot dictate special insurance coverage for                                                                    
employees, and must choose a package that does not include birth                                                                
control coverage in Alaska.  Rectifying this inequity in health                                                                 
care for women will establish a more stable work force and                                                                      
stronger, healthier families.                                                                                                   
                                                                                                                                
MR. CHARLES MCKEE, Anchorage, stated he thought it was mandatory                                                                
insurance coverage for all individuals in the state of Alaska.                                                                  
                                                                                                                                
Number 260                                                                                                                      
                                                                                                                                
MR. SCOTT CALDER, Fairbanks, referred to the language on page 2,                                                                
Section 3, line 6 "except for a policy issued to an individual or                                                               
a qualified church-controlled organization," and "qualified church-                                                             
controlled organization" on page 2, lines 15-16, defined under 26                                                               
U.S.C. 3121(w)(3).  He asked why the focus is on a religious-based                                                              
organization when 'fraternal benefit society' is not included in                                                                
this section, which he found referenced in Sec. 21.42.390.                                                                      
                                                                                                                                
MS. KAY LAHDENPERA, Public Health Nurse representing the Alaska                                                                 
Nurses Association, applauded the committee for SB 82, which  "is                                                               
terribly important to reduce unintended pregnancies."   There are                                                               
about 6 million unintended pregnancies nationally every year. Women                                                             
must have the opportunity to plan their families and get coverage                                                               
for this $25-$35 per month expense.  The National Commission to                                                                 
Prevent Infant Mortality estimates infant death could be reduced by                                                             
10%  and incidence of low birth weight babies reduced by 12% if                                                                 
pregnancies were planned.                                                                                                       
                                                                                                                                
Number 312                                                                                                                      
                                                                                                                                
MR. GORDON EVANS, representing the Health Insurance Association of                                                              
America (HIAA), a national trade association of commercial health                                                               
insurance companies, stated HIAA opposes SB 82 as presently                                                                     
written. Its provisions mandate coverage for contraceptives, which                                                              
is not considered to be basic health care treatment, and the                                                                    
consequences in the long run would be to increase the costs and                                                                 
reduce the efficiencies of managed care.  As noted previously, the                                                              
HIAA favors the preservation of a system that allows the                                                                        
prospective purchaser of health insurance free choice of which                                                                  
risks he or she wishes to cover from among the various coverages                                                                
offered by competing insurance carriers.  The HIAA also believes                                                                
that the choice of how the policy holder spends the funds available                                                             
for health insurance should be free of government decree.  Any time                                                             
government mandates certain coverage, that mandate becomes one of                                                               
the rating factors which insurance companies use in making their                                                                
underwriting decisions. Premium costs would be increased, even for                                                              
those people who have no use for or  do not want the coverage.                                                                  
                                                                                                                                
MR. EVANS continued, this mandate would apply only to small                                                                     
employer group policies and certain other group policies who                                                                    
generally can least afford a premium increase.  The mandate would                                                               
not affect Alaska's largest employers such as Carrs, BP, ARCO, or                                                               
EXXON which are self-insured and subject to federal ARISA law which                                                             
pre-empts state law.  The mandate also would not affect those with                                                              
federal insurance coverage such as the Indian Health Service.                                                                   
Technically, it wouldn't affect the state employees.                                                                            
                                                                                                                                
Senator Wilken noted a $16 cost; however, MR. EVANS felt the figure                                                             
is misleading because it covers only the cost of contraceptive                                                                  
drugs like birth control pills.  It does not include contraceptive                                                              
devices or appliances like IUDs, or the cost of related health care                                                             
services.                                                                                                                       
                                                                                                                                
HIAA would not be opposed to a mandate to offer coverage for                                                                    
contraceptives and related health care services.  As a result,                                                                  
policy holders - employers and their employees - would be able to                                                               
choose whether to spend additional funds on this type of coverage.                                                              
They, and not the insured population in general, would pay the cost                                                             
of that coverage.  Substituting the word "offer" for the word                                                                   
"provide" on page 1, line 10 of original draft would make the                                                                   
coverage sought as a mandated offering.  MR. EVANS suggested this                                                               
would accomplish the purposes of the bill's proponents.                                                                         
                                                                                                                                
Referring to the adopted draft CS, HIAA opposes favoring a specific                                                             
group, as in the language "a qualified church-controlled                                                                        
organization" because it gives persons of one religion a preference                                                             
over other groups who also may not want the coverage but will have                                                              
to take and pay for it. MR. EVANS said it should be an "all or                                                                  
nothing bill."                                                                                                                  
                                                                                                                                
Number 371                                                                                                                      
                                                                                                                                
SENATOR ELTON asked if Mr. Evans' testimony that emphasized the                                                                 
cost that will be spread to all policy holders, disputes the                                                                    
sponsor's claim that the contraceptive health coverage would save                                                               
money by not incurring additional medical expenses with unwanted                                                                
pregnancies or problem pregnancies.                                                                                             
                                                                                                                                
MR. EVANS replied that is the HIAA position.                                                                                    
                                                                                                                                
SENATOR WILKEN responded that in the testimony in U.S. Congress on                                                              
the recently passed Equity in Prescription Insurance and                                                                        
Contraceptive Coverage Act, the president of the organization said                                                              
"we oppose mandates but we're not going to spend a dime fighting                                                                
this."                                                                                                                          
                                                                                                                                
He continued, noting for the record that the total dollars spent                                                                
per employee is $17.12 on all contraceptive devices including oral,                                                             
diaphragms, cervical caps, injectables, implants and IUDs.  Of that                                                             
figure, $16.13 or almost 95% is spent on oral contraceptives.                                                                   
                                                                                                                                
MR. EVANS countered that the memo provided to him last session by                                                               
Senator Ellis stated oral contraceptives cost on average $25 per                                                                
month.                                                                                                                          
                                                                                                                                
Number 400                                                                                                                      
                                                                                                                                
MS. BECKA BRAUN expressed support for SB 82.  She described it as                                                               
a "win/win" proposition because it would reduce the number of                                                                   
unintended pregnancies. According to several studies, half of                                                                   
unintended pregnancies end in abortion in this country.  Those who                                                              
support choice and those who oppose abortion can all agree that                                                                 
reducing the number of abortions is a good thing, and making                                                                    
contraceptives more widely available is one very smart way to do                                                                
that.  Studies show that as the availability of contraceptives                                                                  
increases, the number of legal and illegal abortions decreases.                                                                 
Those unintended pregnancies that go to full term have costly                                                                   
effects for society and for the state.                                                                                          
                                                                                                                                
There's a much higher pregnancy rate with cheap contraceptives,                                                                 
such as condom failure.  These are the methods most affordable to                                                               
women.  It doesn't make sense to exclude contraception, the only                                                                
FDA-approved prescription drug regularly  excluded by insurers.                                                                 
It's not included on the list of "basic health care" but MS. BRAUN                                                              
said she's not sure what basic health care entails, when Viagra is                                                              
covered.  Insurer costs should not rise by more than 1% under this                                                              
proposed mandate.  She urged the committee's support of SB 82.                                                                  
                                                                                                                                
SENATOR WILKEN moved the draft Amendment Version H.1 by Ford 3/24.                                                              
The text follows.                                                                                                               
                                                                                                                                
Page 2, lines 6-7:                                                                                                              
     Delete "for a policy issued to an individual or a qualified                                                                
church-controlled organization with a religious-based objection"                                                                
     Insert "as provided in (b) of this section"                                                                                
                                                                                                                                
Page 2, following line 11:                                                                                                      
     Insert a new subsection to read:                                                                                           
          "(b) This section does not apply to a policy                                                                          
               (1) issued to an individual;                                                                                     
               (2) issued to a qualified church-controlled                                                                      
     organization with a religious-based objection                                                                              
     to contraceptives; or                                                                                                      
               (3) that does not provide coverage for drugs                                                                     
     obtained by prescription."                                                                                                 
                                                                                                                                
Reletter the following subsection accordingly.                                                                                  
                                                                                                                                
                                                                                                                                
SENATOR WILKEN explained that it inserts a provision that if a                                                                  
policy is in place by an employer that does not offer coverage for                                                              
prescription drugs, this legislation would not impose upon the                                                                  
employer the requirement that they now offer prescription coverage.                                                             
If they did have prescription coverage, contraceptive prescription                                                              
coverage would be included.                                                                                                     
                                                                                                                                
Number 446                                                                                                                      
                                                                                                                                
SENATOR ELTON objected to adopting the amendment for the purpose of                                                             
discussion.  He pointed out on line 8 of the amendment, it provides                                                             
that this section does not apply to a policy "issued to an                                                                      
individual." The previous language has been removed that said                                                                   
"issued to an individual with a religious objection."  He asked if                                                              
this means that only insurance policies that are group insurance                                                                
policies would now be affected.                                                                                                 
                                                                                                                                
SENATOR WILKEN replied he put it in at the request of Blue Cross.                                                               
He admitted he did not know why that change was made.                                                                           
                                                                                                                                
CHAIRMAN MILLER followed up, asking if this language just deals                                                                 
with those companies that do not offer the coverage, that being the                                                             
original understanding of the amendment.                                                                                        
                                                                                                                                
SENATOR ELTON replied, and CHAIRMAN MILLER agreed, that this                                                                    
section outlines the exceptions. This broadens the exception that                                                               
had formerly applied to an individual, now including any policy                                                                 
written to an individual.                                                                                                       
                                                                                                                                
SENATOR WILKEN stated his staff told him that language was in last                                                              
year's bill.                                                                                                                    
                                                                                                                                
MR. EVANS said the way he reads the draft CS with the draft                                                                     
amendment, this bill would exempt individual policies; it would                                                                 
exempt policies issued to church-controlled organizations; and it                                                               
would exempt any group policies that do not provide coverage for                                                                
drugs obtained by prescription. On the other hand, the CS on page                                                               
2, line 5-6 says "except for a policy issued to an individual or a                                                              
qualified church-controlled organization with a religious-based                                                                 
objection."                                                                                                                     
                                                                                                                                
CHAIRMAN MILLER followed up, asking if the language is because an                                                               
individual who decides he doesn't want this coverage may be                                                                     
mandated by law to take the coverage anyway.                                                                                    
                                                                                                                                
MS. MARIANNE BURKE, Director of the Division of Insurance, stated                                                               
Chairman Miller is correct.  Individual policies are individually                                                               
underwritten, and (Chairman Miller) would probably not want a                                                                   
policy that covered oral contraceptives.                                                                                        
                                                                                                                                
CHAIRMAN MILLER asked for objection to adopting the amendment.                                                                  
Hearing none, the amendment was adopted.  He asked the sponsor if                                                               
the bill covers contraceptives prior to conception but not after                                                                
conception, such as the RU 486 drug. He said that question will                                                                 
come up on the Senate floor.                                                                                                    
                                                                                                                                
SENATOR WILKEN replied post-conception prescriptions are not part                                                               
of this legislation.  The intent language from last year's bill was                                                             
incorporated into the CS on page 2, lines 1-2 and states "insurance                                                             
providers not be required to cover the cost of prescriptive drugs                                                               
necessary to cause the rejection of a fertilized ovum."  The intent                                                             
of the bill addresses pre-conception.                                                                                           
                                                                                                                                
Number 505                                                                                                                      
                                                                                                                                
SENATOR KELLY stated "that may be the bill's intent, but with our                                                               
Judiciary, I'm sure somebody's going to take the right to privacy                                                               
clause of the Constitution and require that you include RU 486 or                                                               
something like that...I think you'll probably find that there will                                                              
be a lawsuit on that."                                                                                                          
                                                                                                                                
He said he's not a big fan of the bill, and he doesn't feel the                                                                 
Legislature has any business telling insurance companies that they                                                              
have to do this. Contraceptives are widely available, and this asks                                                             
insurance companies to cover those who choose more expensive                                                                    
methods than condoms. It doesn't require legislation.  It                                                                       
encourages people to go toward oral contraceptives which have no                                                                
value in prevention of sexually-transmitted diseases (STDs).  He                                                                
asked, would there be unintended health consequences as a result of                                                             
this?  Are we putting a burden on private industry?  Those are his                                                              
biggest objections to this bill.                                                                                                
                                                                                                                                
SENATOR WILKEN said he appreciated Senator Kelly's comments. He                                                                 
doesn't have data on STDs.  He wants to see mandated coverage                                                                   
happen sooner because the cost of insurance will go down.  It's an                                                              
issue of equity and of money.  Some women can't afford the                                                                      
contraception they need, and he suggested that those are the                                                                    
pregnancies that should be most controlled.  While there is a                                                                   
rackful of inexpensive male contraceptives available, there is not                                                              
a rack of female contraceptives, and this limits a couple's ability                                                             
to plan and time their childbearing.  This legislation is a tool                                                                
that could benefit society.                                                                                                     
                                                                                                                                
SENATOR WILKEN said he cannot understand why it's taken so long to                                                              
get us to where we are today.  It's an investment in lowering                                                                   
costs, and an investment in society, and it gives us more options                                                               
to plan our lives.  If the industry doesn't want to do it, then                                                                 
this bill will encourage them to do it, and he said he's pleased to                                                             
do that.                                                                                                                        
                                                                                                                                
Number 540                                                                                                                      
                                                                                                                                
CHAIRMAN MILLER said that, like Senator Kelly, he's not necessarily                                                             
a big fan of the bill, but he is willing to be democratic and let                                                               
the will of the committee prevail. He asked for a motion.                                                                       
                                                                                                                                
SENATOR ELTON expressed appreciation for the work of the sponsor to                                                             
bring the legislation this far, and said he looks forward to it                                                                 
being on the Floor.                                                                                                             
                                                                                                                                
SENATOR WILKEN moved to report CSSB 82(HES) out of committee with                                                               
individual recommendations and indeterminate fiscal note.                                                                       
                                                                                                                                
CHAIRMAN MILLER asked for objection.  Senator Kelly objected and                                                                
the roll was called, with Senators Wilken, Peace and Elton voting                                                               
"yea," and Senators Kelly and Miller voting "nay."  CSSB 82(HES)                                                                
passed out on a 3-2 motion.                                                                                                     
                                                                                                                                
                SB  94-MEDICAL USE OF MARIJUANA                                                                                 
                                                                                                                                
Number 576                                                                                                                      
                                                                                                                                
CHAIRMAN MILLER brought up SB 94, relating to the medical use of                                                                
marijuana initiative.  He stated that SB 94 is a very controversial                                                             
bill that raises emotions on both sides of the issue, but he                                                                    
believed a fair discussion could take place about policies and                                                                  
which direction the state should be heading.  He cautioned, "be                                                                 
forewarned, I will not tolerate anybody in the audience raising the                                                             
personal motives of anybody in the State Senate."  He would not                                                                 
tolerate anybody questioning the motives or attacking a senator                                                                 
personally. "We may attack their legislation, that's fair game, but                                                             
not them personally."  He warned that he would rule anybody out of                                                              
order who does that.                                                                                                            
                                                                                                                                
TAPE 99-14, SIDE B                                                                                                              
Number 588                                                                                                                      
                                                                                                                                
CHAIRMAN MILLER repeated that SB 94 would not move out today                                                                    
because of the number of people waiting to testify and the                                                                      
committee having to adjourn and vacate the room by 3:00.  He was                                                                
unsure when the next hearing on SB 94 would take place.  He set a                                                               
2-minute time limit on all speakers except the bill's sponsor,                                                                  
Senator Leman,  and former state Representative David Finkelstein,                                                              
representing Alaskans for Medical Rights, the sponsor of the                                                                    
initiative.                                                                                                                     
                                                                                                                                
SENATOR LOREN LEMAN, expressed appreciation for the committee's                                                                 
willingness to hear the bill. SB 94 addresses an issue that is                                                                  
timely and needs to be debated.  It proposes several amendments to                                                              
the medical marijuana initiative that was enacted last November.                                                                
The amendments are designed to close loopholes in the initiative                                                                
and ensure that it works as intended and as advertised. The bill                                                                
was drafted with input from Attorneys General in the Department of                                                              
Law, and the Department of Public Safety. A draft CS for the                                                                    
committee's consideration is from the Department of Health & Social                                                             
Services and youth counselors from around the state, and law                                                                    
enforcement personnel from Anchorage and other communities.  These                                                              
people told him they had trouble with the initiative as it is                                                                   
worded and it would cause them trouble enforcing the drug laws of                                                               
Alaska. The initiative can't be repealed but it can be amended to                                                               
work as intended.                                                                                                               
                                                                                                                                
SENATOR LEMAN continued, his aim is to ensure that marijuana is                                                                 
legally available only for valid medical reasons as defined and                                                                 
intended in the initiative, and not for recreational use.  The                                                                  
people voted to recriminalize the recreational use of marijuana                                                                 
when Ballot Measure 2 was approved in 1990.  Sponsors of Ballot                                                                 
Measure 8 in the 1998 official election pamphlet described their                                                                
proposal as designed to help terminally ill patients and others                                                                 
suffering from debilitating medical conditions.  Marijuana would                                                                
still be illegal for non-medical use, and Ballot Measure 8 would                                                                
provide full protection against abuse of the new law.                                                                           
Unfortunately, SENATOR LEMAN said, close study of the initiative by                                                             
legal experts and those who work in law enforcement revealed there                                                              
is plenty or room for abuse of the new law.  "It is rife with legal                                                             
loopholes, ill-defined terms and vague language."  These are well                                                               
outlined in the bill's sectional analysis and he wouldn't discuss                                                               
them in detail today.                                                                                                           
                                                                                                                                
SENATOR LEMAN said he believes the Legislature, as public                                                                       
officials, must respect and honor the views of voters.  In this                                                                 
case of marijuana policy, however, there are two ballot initiatives                                                             
to consider.  On one hand, the 1990 initiative affirmed that                                                                    
possession, use or distribution is a criminal act, punishable by                                                                
imprisonment of up to 90 days and fines up to $1,000.  These are                                                                
not trivial punishments and reveal how seriously the voters take                                                                
the problem of drug abuse, particularly among the youth. On the                                                                 
other hand, Ballot Measure 8 from last year proposed to allow                                                                   
unlimited marijuana use for valid medical purposes. Because the                                                                 
latter initiative does not repeal the earlier ballot measure, the                                                               
Legislature's job is to make both measures work together.  SB 94 is                                                             
designed to reconcile the provisions of both initiatives, which                                                                 
both represent the majority will of Alaskan voters.                                                                             
                                                                                                                                
SENATOR LEMAN stated he believes the constitution's provision for                                                               
voter-initiated ballot measures is a great freedom, giving citizens                                                             
a direct voice in crafting laws under which we live.  However, the                                                              
crafters of Alaska's constitution recognized one potential                                                                      
shortcoming of ballot initiatives.  Unlike legislative measures,                                                                
voter initiatives are not subjected to scrutiny or the amendment                                                                
process before their final presentation to the voters. Accordingly,                                                             
the crafters included in the constitution a provision allowing the                                                              
Legislature to make needed amendments to approved ballot                                                                        
initiatives.  This authority is found in Article XI, Section 6.                                                                 
The Legislature has exercised this authority in the past, and in                                                                
response to legal challenges the Alaska Supreme Court has upheld                                                                
the Legislature's authority to do so. SENATOR LEMAN cited 1975                                                                  
Warren v. Boucher in which the Alaska Supreme Court described why                                                               
the constitution grants this power to the Legislature. He said,                                                                 
clearly, the Legislature has the authority, acting on behalf of the                                                             
people, to pass amendments but not to repeal the initiative.                                                                    
                                                                                                                                
The constitution which grants the Legislature the authority to                                                                  
amend initiatives was ratified by the people.  The voter approval                                                               
of Ballot Measure 2 in 1990 is no less valuable a measure of public                                                             
opinion than the passage of Ballot 8 in 1998.  He hoped these facts                                                             
would put to rest "venomous rhetoric about defying the will of the                                                              
people," stating the greatest service the Legislature can provide                                                               
the public is to have an intelligent, informed and civil debate on                                                              
the merits of the legislation.                                                                                                  
                                                                                                                                
The key elements of SB 94 clarify the standards the physician would                                                             
use and that registration would be required.  Law enforcement could                                                             
access the information for purposes of an investigation, but it                                                                 
would not be a public document.  It further restricts the use and                                                               
display of medical marijuana  to the doctor's office or the home of                                                             
the patient or primary care giver.  It defines primary care giver                                                               
as someone over 21 who hasn't been convicted of a felony under                                                                  
Alaska's controlled substance laws. The law enforcement people will                                                             
discuss why these elements of the bill are important to them in                                                                 
enforcing the drug laws of Alaska.                                                                                              
                                                                                                                                
                                                                                                                                
SENATOR LEMAN concluded that his intent in introducing this bill is                                                             
to lay a very important topic on the table. He has met with David                                                               
Finkelstein and staff in the Department of Law, Department of                                                                   
Public Safety, Department of Health & Social Services, the lobbyist                                                             
opposing this effort, and the Governor's Office. He said he intends                                                             
to work cooperatively to accomplish legislative objectives that                                                                 
allow enforcement of the drug laws of Alaska.                                                                                   
                                                                                                                                
Number 437                                                                                                                      
                                                                                                                                
MR. DAVID FINKELSTEIN, representing Alaskans for Medical Rights,                                                                
encouraged people who can't testify today to leave a short                                                                      
statement at the LIOs to give to the committee.  He asserted the                                                                
provisions of SB 94 are overwhelming, and a complete re-write of                                                                
the initiative. He said it took him over five hours to read and                                                                 
understand the bill, cross-referencing it with the existing law.                                                                
There are over 40 major amendments to the existing law, which can                                                               
be counted in the sponsor's sectional analysis, not including                                                                   
additional technical and conforming amendments.                                                                                 
                                                                                                                                
As he could not address these 40 amendments in the time available,                                                              
MR. FINKELSTEIN talked about the two categories they fall into.                                                                 
First,  minor amendments based on misinterpretations of the law or                                                              
based on interpretation questions, or correcting citations. He                                                                  
stated any of these changes that are necessary can be accomplished                                                              
either through the current regulation process, with the comment                                                                 
period open through Friday, March 26; or in the Revisor's Bill.  He                                                             
said some of the amendments just aren't necessary.                                                                              
                                                                                                                                
The second category are provisions that would eliminate otherwise                                                               
qualified patients from the initiative.  For example, no patients                                                               
would be covered except those with cancer, glaucoma or AIDS, and                                                                
then only where it causes them "severe and chronic pain and                                                                     
nausea." It doesn't say "severe or chronic..."  It is his                                                                       
experience with about one hundred patients who use medical                                                                      
marijuana that most of them would be excluded by just this                                                                      
provision alone.  Another provision requires doctors to make a                                                                  
finding that there are no other legal treatments that can be                                                                    
tolerated by the patient that are as effective.  There will always                                                              
be other drugs that are effective, but many of those are dangerous                                                              
or have side effects and, he said, no doctor would be willing to                                                                
make an analytic finding like this when they can prescribe other                                                                
narcotics and drugs with no findings whatsoever.                                                                                
                                                                                                                                
"The sponsor's apparent fear is that many doctors will get carried                                                              
away recommending medical marijuana."  In his view it is not very                                                               
likely.  Only licensed doctors can make the recommendation.  Under                                                              
existing statute AS 08.64.101 doctors can be investigated, and if                                                               
necessary, even lose their license.                                                                                             
                                                                                                                                
SB 94 eliminates the protection patients receive under the                                                                      
initiative and replaces it with an affirmative defense.  This                                                                   
places the burden of proof with the patient to prove their case.                                                                
Even a patient with ID card, complying with the law and possessing                                                              
less than an ounce would still have to demonstrate that the entire                                                              
amount in their possession was intended for their own medical use.                                                              
He asked how a patient can prove that.                                                                                          
                                                                                                                                
In conclusion, MR. FINKELSTEIN stated that SB 94 is not necessary                                                               
and if passed, will eliminate hope for all the patients who would                                                               
be helped under the initiative.  He offered to work with the                                                                    
sponsor during the interim to see which concerns were addressed                                                                 
through the regulation process, check whether the registration is                                                               
working as intended, and address any problems that may have arisen                                                              
under the law. He asked, on behalf of Alaskans for Medical Rights,                                                              
to be given a chance to let this initiative work.                                                                               
                                                                                                                                
Number 375                                                                                                                      
                                                                                                                                
CHAIRMAN MILLER stated Mr. Finkelstein's reputation in Juneau has                                                               
always been one for "open government and full disclosure."  He                                                                  
mentioned the talk about the expensive ad campaign floating around                                                              
the state. While acknowledging Mr. Finkelstein not legally required                                                             
to disclose the source of the the funds to his group, CHAIRMAN                                                                  
MILLER asked in the spirit of open government where those funds                                                                 
came from.                                                                                                                      
                                                                                                                                
MR. FINKELSTEIN replied that he respects and considers Senator                                                                  
Leman a worthy adversary, but Alaskans for Medical Rights which                                                                 
represents the majority of Alaskans wasn't included in any of the                                                               
deliberations on how this bill was developed.  He stated the cost                                                               
of the ad campaign was probably $4,000 to $5,000 and it came                                                                    
entirely from individuals in and outside Alaska, with no government                                                             
or PAC money involved.                                                                                                          
                                                                                                                                
SENATOR WILKEN echoed Chairman Miller's request.  He didn't know                                                                
how he stands on SB 94, but he opposed groups that try to influence                                                             
public opinion through the media. He would like to know all donors                                                              
of over $100, and asked that the information be sent to the                                                                     
committee in the interest of full disclosure.                                                                                   
                                                                                                                                
CHAIRMAN MILLER again promised that SB 94 would not move from                                                                   
committee until everyone wanting to testify had the opportunity to                                                              
do so. He apologized to those who will not have that chance today.                                                              
                                                                                                                                
Number 331                                                                                                                      
                                                                                                                                
LT. AUDIE HOLLOWAY, Narcotics Enforcement Division, Anchorage                                                                   
Police Department, spoke in support of SB 94 which gives some clear                                                             
guidelines for the police department in dealing with those people                                                               
who want to take advantage of the initiative. He said, "I can                                                                   
assure you that we will have a lot of people who will try to take                                                               
advantage of it."  He has a limited number of people working on  a                                                              
lot of drug cases.  A standardized registration and format for                                                                  
those people who are using medical marijuana and deserving of it                                                                
would help in cutting down the workload of the department.  He                                                                  
doesn't have time to investigate people with legitimate use for the                                                             
plant.  Rigorous standards should be in place.  A lot of people in                                                              
Alaska make a lot of money off the illegal use of marijuana, and he                                                             
suspects money is coming from "that area to keep it as vague as                                                                 
possible."  He reads  police reports everyday about people who are                                                              
driving and using marijuana. There needs to be a standard                                                                       
addressing that, to prevent hiding behind medical use and driving                                                               
because it's as bad as alcohol in that regard.                                                                                  
                                                                                                                                
MR. RICHARD WELCH stated he is a long-time resident of Fairbanks                                                                
and has HIV and Hepatitis C and chronic pain.  This bill would                                                                  
severely limit what his doctor can tell him he can have.  He's also                                                             
a member of the Interior HIV Care Consortium, a group that performs                                                             
needs assessments and quality assurance tasks regarding HIV care.                                                               
The consortium is sponsored by the Interior Aids Association whose                                                              
executive director could not stay, but wanted Mr. Welch to convey                                                               
that they object to any effort to change the peoples' initiative                                                                
about medical marijuana.                                                                                                        
                                                                                                                                
Number 276                                                                                                                      
                                                                                                                                
CAPT. BILL MILLER, Headquarters, Anchorage Police Department,                                                                   
stated headquarters deals with major crimes including homicides,                                                                
sexual assaults and narcotics.  His officers must have the ability                                                              
to distinguish between what is legal and what is not.  Officers                                                                 
need definitions and clear understanding.  This bill would clear up                                                             
confusion, and prevent wasting time and resources. It defines who                                                               
can prescribe the medical marijuana and who decides who can                                                                     
prescribe it.                                                                                                                   
                                                                                                                                
MR.JAY SNODDERLY, Ward Cove, stated he is opposed to anything that                                                              
would restrict the wishes of the people as expressed last November.                                                             
He admitted he does not understand the bill, so he doesn't know if                                                              
it would do that, but he's heard it both ways.                                                                                  
                                                                                                                                
CHAIRMAN MILLER stated he would hold SB 94 and take further                                                                     
testimony the next time it is brought up, and again apologized for                                                              
the time constraints.  The committee will take up bills previously                                                              
heard,  the education bills and the proposed CS for SB 73, next                                                                 
Monday, March 29.  He thanked the members for their hard work in                                                                
his absence, and adjourned at 3:01 p.m.                                                                                         

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