Legislature(1997 - 1998)

01/30/1998 09:00 AM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
      SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE                   
                         January 30, 1998                                      
                            9:00 a.m.                                          
                                                                               
MEMBERS PRESENT                                                                
                                                                               
Senator Gary Wilken, Chairman                                                  
Senator Loren Leman, Vice-Chairman                                             
Senator Lyda Green                                                             
Senator Jerry Ward                                                             
Senator Johnny Ellis                                                           
                                                                               
MEMBERS ABSENT                                                                 
                                                                               
None                                                                           
                                                                               
COMMITTEE CALENDAR                                                             
                                                                               
CS FOR SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 189(JUD) am                       
"An Act relating to sale, gift, exchange, or distribution of                   
tobacco and tobacco products."                                                 
     HEARD AND HELD                                                            
                                                                               
SENATE BILL NO. 181                                                            
"An Act relating to assistance for abortions under the general                 
relief program; and relating to financial responsibility for the               
costs of abortions."                                                           
     MOVED CSSB 181 (HES) OUT OF COMMITTEE                                     
                                                                               
SENATE CONCURRENT RESOLUTION NO. 14                                            
Establishing the Alaska Task Force on Parity for Mental Health.                
     HEARD AND HELD                                                            
                                                                               
PREVIOUS SENATE COMMITTEE ACTION                                               
                                                                               
HB 189 - See HESS minutes dated 1/16/98 and 1/28/98.                           
                                                                               
SB 181 - No previous committee action.                                         
                                                                               
SCR 14 - See HESS minutes dated 4/30/97.                                       
                                                                               
WITNESS REGISTER                                                               
                                                                               
Marco Pignalberi                                                               
Staff to Representative Cowdery                                                
Alaska State Capitol                                                           
Juneau, Alaska  99801-1182                                                     
POSITION STATEMENT:  Testified for sponsor of HB 189                           
                                                                               
Anne Carpeneti                                                                 
Assistant Attorney General                                                     
Department of Law                                                              
P.O. Box 110300                                                                
Juneau, Alaska  99811-0300                                                     
POSITION STATEMENT: Commented on HB 189                                        
                                                                               
Representative Terry Martin                                                    
Alaska State Capitol                                                           
Juneau, Alaska  99801                                                          
POSITION STATEMENT:  Testified on HB 234/SB 181                                
                                                                               
Jennifer Rudinger                                                              
Alaska Civil Liberties Union                                                   
P.O. Box 201844                                                                
Anchorage, Alaska  99520                                                       
POSITION STATEMENT: Opposed to CSSB 181(HES)                                   
                                                                               
Hugh Fleischer                                                                 
1401 W 11th Avenue                                                             
Anchorage, Alaska  99501                                                       
POSITION STATEMENT:  Opposed to CSSB 181(HES)                                  
                                                                               
Jan McGillivary                                                                
Alaska Mental Health Trust Authority                                           
4050 Lake Otis #202                                                            
Anchorage, Alaska  99508                                                       
POSITION STATEMENT:  Supports SCR 14                                           
                                                                               
Pauline Utter                                                                  
P.O. Box 190908                                                                
Anchorage, Alaska  99519                                                       
POSITION STATEMENT: Opposes CSSB 181(HES)                                      
                                                                               
Robyn Smith                                                                    
14100 Jarvis                                                                   
Anchorage, Alaska  99515                                                       
POSITION STATEMENT:  Opposes CSSB 181(HES)                                     
                                                                               
Mary Elizabeth Rider                                                           
3601 C Street                                                                  
Anchorage, Alaska  99503                                                       
POSITION STATEMENT: Supports SCR 14                                            
                                                                               
Sid Heidersdorf                                                                
Alaskans for Life                                                              
Box 658                                                                        
Juneau, Alaska  99802                                                          
POSITION STATEMENT:  Supports concept of CSSB 181 (HES)                        
                                                                               
Kristen Bomengen                                                               
Attorney General's Office                                                      
Department of Law                                                              
P.O. Box 110300                                                                
Juneau, Alaska  99801-1182                                                     
POSITION STATEMENT:  Discussed legal aspects of CSSB 181(HES)                  
                                                                               
Nancy Weller                                                                   
Division of Medical Assistance                                                 
Department of Health & Social Services                                         
P.O. Box 110660                                                                
Juneau, Alaska                                                                 
POSITION STATEMENT:  Answered questions on medical payment programs            
                                                                               
Ronald Kreher                                                                  
Division of Public Assistance                                                  
Department of Health & Social Services                                         
P.O. Box 110640                                                                
Juneau, Alaska  99811                                                          
POSITION STATEMENT:  Answered questions on medical payment programs            
                                                                               
Tom Gordy                                                                      
Christian Coalition of Alaska                                                  
P.O. Box 34832                                                                 
Juneau, Alaska                                                                 
POSITION STATEMENT:  Supports CSSB 181(HES)                                    
                                                                               
ACTION NARRATIVE                                                               
                                                                               
TAPE 98-6, SIDE A                                                              
Number 001                                                                     
                                                                               
CHAIRMAN WILKEN called the Senate Health, Education and Social                 
Services (HESS) Committee to order at 9:03 a.m. and recognized the             
presence of Senators Green, Leman and Ward.  He announced the                  
committee would be discussing HB 189, SB 181 and SCR 14, in that               
order.                                                                         
                                                                               
                HB 189 - RESTRICT TOBACCO SALES                                
                                                                               
MARCO PIGNALBERI, legislative aide to Representative Cowdery,                  
sponsor of the measure, explained the changes in the proposed                  
committee substitute.  Section 3 contains a simplified penalty                 
sentence in which the age and condition qualifiers were omitted.               
Section 4 was restructured for the purpose of clarification, and               
contains no substantive change, and a penalty section was added as             
Section 4(c).                                                                  
                                                                               
CHAIRMAN WILKEN noted the proposed committee substitute is a                   
cleaned up cut and paste version.                                              
                                                                               
SENATOR GREEN asked if the word "negligently" was omitted from                 
Section 1(3) because it was redundant.  MR. PIGNALBERI said that               
was correct.                                                                   
                                                                               
SENATOR GREEN asked if a person can receive a violation under this             
bill without intending to break the law.  She noted her support for            
the "knowingly" standard because that standard requires intent.                
MR. PIGNALBERI stated the bill that passed the House was based on              
the heavier penalty, but after testimony from police agencies and              
the Attorney General's Office, the standard was lowered.                       
                                                                               
SENATOR GREEN asked if the "knowingly" standard and violation                  
penalty could be maintained simultaneously.  MR. PIGNALBERI                    
deferred to Anne Carpeneti of the Department of Law to answer that             
question.                                                                      
                                                                               
Number 091                                                                     
                                                                               
ANNE CARPENETI, Department of Law, explained the "knowingly"                   
culpable mental state is problematic in this type of criminal                  
statute because a clerk could not be prosecuted unless he/she sold             
a customer tobacco products, knowing that person was under 19.  The            
knowingly standard would create a giant loophole for clerks; by not            
asking for identification of minors, they could not be prosecuted              
for selling to underaged customers.  The negligent culpable mental             
state is in current law, which is why the Department of Law                    
recommended maintaining it.                                                    
                                                                               
SENATOR GREEN said she recalled hearing about legislation during               
the past session that contained benchmarks that referred to people             
older than 19 and required identification and asked about the                  
status of that legislation.                                                    
                                                                               
MS. CARPENETI believed Senator Green was referring to a federal law            
that requires a person to ask for identification if the buyer                  
appears to be under 27 years old.  SENATOR GREEN asked if the                  
Legislature adopted similar legislation last year.  MS. CARPENETI              
believed that provision was in HB 159 which has not passed.                    
                                                                               
Number 125                                                                     
                                                                               
SENATOR LEMAN moved to adopt SCSCSSSHB 189(HES), version P, as the             
committee's working document.  There being no objection, the motion            
carried.                                                                       
                                                                               
SENATOR LEMAN moved to pass SCSCSSSHB 189(HES) from committee with             
individual recommendations.  There being no objection, the motion              
carried.                                                                       
                                                                               
        SB 181 - ABORTION COSTS: GENERAL RELIEF/PARENTS                        
                                                                               
SENATOR WARD moved to adopt CSSB 181(HES), a version identical to              
CSHB 234(FIN).  SENATOR ELLIS objected and asked for an explanation            
of the new version.                                                            
                                                                               
CHAIRMAN WILKEN asked SENATOR WARD if his motion addresses version             
L of CSHB 234(FIN).  SENATOR WARD affirmed that was correct.                   
                                                                               
SENATOR WARD explained the proposed committee substitute                       
establishes a logical priority within the funding mechanism for                
General Medical Relief Program funds.  Abortion, an elective                   
procedure, would be placed at the bottom of the list.  In his                  
opinion the bill will accomplish two things: it will provide more              
funding for eyeglasses and other services and will reduce the                  
number of elective abortion procedures.                                        
                                                                               
CHAIRMAN WILKEN noted the question on the table was whether to                 
substitute the house bill for SB 181.  SENATOR WARD said in                    
revisiting this issue, he decided the house bill is                            
straightforward, fits into a more logical state program and                    
accomplishes what he wanted to do.                                             
                                                                               
SENATOR ELLIS asked Senator Ward what his original bill did.                   
SENATOR WARD said his original bill contained various mechanisms               
for individuals, both male and female, to reimburse the General                
Medical Relief Program for elective abortions.  By placing elective            
abortions at the bottom of the priority list, the bill should                  
increase the availability of eyeglasses and dental services for                
clients, and reduce the number of abortions performed.                         
                                                                               
CHAIRMAN WILKEN asked if objection was maintained to adopting CSSB
181(HES).  SENATOR ELLIS maintained his objection because he felt              
a more accurate explanation of how the list of priorities works                
should be given.  SENATOR WARD said the results are exactly as he              
wanted them to turn out if CSSB 181(HES) is adopted.                           
                                                                               
A roll call vote was taken with Senators Leman, Green, Ward, and               
Wilken voting "yea," and Senator Ellis voting "nay."  CHAIRMAN                 
WILKEN noted the motion to adopt CSSB 181(HES) carried.                        
                                                                               
Number 244                                                                     
                                                                               
REPRESENTATIVE MARTIN, sponsor of HB 234, thanked Senator Ward for             
proposing the committee substitute that corresponds to work being              
done in the House.  The bill decreases many problems discussed by              
the Administration last year.  During those discussions, the                   
subject of the male who is responsible seldom arose so he                      
originally attempted to design a program in which users pay part of            
the cost of medical services provided by the government.  In the               
case of abortions, a lien would have been placed on permanent fund             
dividend checks, especially on those of the males responsible. That            
approach was eliminated because the fiscal note estimated a cost of            
$5 million.  The fiscal note for the new approach of placing                   
abortion services at the bottom of the General Medical Relief                  
Program priority list of services is $1 million.                               
                                                                               
REPRESENTATIVE MARTIN said the Administration has constantly                   
belittled the Legislature during the last three or four years for              
inadequately funding the General Medical Relief Program, thereby               
preventing children from receiving eyeglasses and seniors from                 
receiving emergency and dental services.  As he looked into the                
line item amounts, he wondered why the $2.8 million appropriation              
was used up so quickly when that amount was in addition to the 50              
percent State contribution to the Medicaid/Medicare programs.  He              
then found out that abortions provided by that program are not                 
dependent on a person's economic status.  Last year 843 free                   
abortions were provided under that program, yet there were not                 
enough funds to pay for other services.  The cost of 800 abortions             
could provide 6,000 pairs of eyeglasses. CSSB181(HES) solves the               
problem by making abortion the lowest priority use of the monies               
available.  He criticized the argument that the State has a                    
constitutional obligation to pay for abortions, and noted that                 
court decisions in New York and North Carolina have established                
that the constitutional right involved does not guarantee                      
government payment for abortions.                                              
                                                                               
Number 298                                                                     
                                                                               
SENATOR ELLIS asked Representative Martin about his statement that             
there are no income guidelines related to the Medicaid eligibility.            
REPRESENTATIVE MARTIN said that was correct; those guidelines are              
not imposed until after the person becomes a welfare recipient.  He            
said one can go to the same clinic and self-pay or get a voucher               
from the State.  SENATOR ELLIS asked how there can be no income                
guidelines associated with the Medicaid program.  REPRESENTATIVE               
MARTIN corrected himself, and said Medicaid does have guidelines,              
the General Medical Relief Program does not for abortions.  He                 
explained Medicaid will not cover free abortions unless the                    
mother's life is at risk, or the pregnancy is the result of rape or            
incest.                                                                        
                                                                               
JENNIFER RUDINGER, Executive Director of the Alaska Civil Liberties            
Union (ACLU), testified via teleconference from Anchorage.  The                
ACLU's mission is to preserve and defend the guarantees of                     
individual liberties found in the Bill of Rights and Alaska                    
Constitution.  The ACLU asks the committee to take no action on SB
181 because it is blatantly unconstitutional under Alaska's                    
Constitution.  In November, the Alaska Supreme Court decided, in               
the Valley Hospital v. Mat-Su Coalition for Choice case, that the              
right to choose to terminate a pregnancy is a fundamental right                
under the privacy clause in the Alaska Constitution.  The Board of             
Directors at Palmer Valley Hospital, a non-profit corporation which            
receives substantial public funding, voted to prohibit abortion                
services from being provided at the hospital.  The Alaska Supreme              
Court found Valley Hospital's actions in violation of a woman's                
fundamental right to an abortion and stated:                                   
                                                                               
     We are of the view that reproductive rights are fundamental               
     and that they are encompassed within the right to privacy,                
     expressed in Article 1, Section 22, of the Alaska                         
     Constitution.  These rights may be legally constrained only               
     when the constraints are justified by a compelling state                  
     interest, and no less restrictive means could advance that                
     interest.  These fundamental reproductive rights include the              
     right to an abortion.  The scope of a fundamental right to an             
     abortion that we conclude is encompassed within Article 1,                
     Section 22, is similar to that expressed in Roe v. Wade.  We              
     do not, however, adopt as Alaska constitutional law, the                  
     narrower definition of that right, promulgated in a plurality             
     opinion in Casey [ph].                                                    
                                                                               
MS. RUDINGER commented the State will be required to show a                    
compelling state interest for singling out these specific services             
for de-funding.  While the government need not create a medical                
assistance program in the first place, once it has done so it must             
proceed with neutrality in regard to the exercise of a                         
constitutional right.  She urged committee members to vote against             
SCSSB181(HES).                                                                 
                                                                               
HUGH FLEISCHER, testifying on his own behalf, concurred with the               
previous speaker's comments regarding the constitutional problems              
with the bill.  He challenged the sponsor of this legislation to               
produce the name of one child who did not receive eyeglasses                   
through the General Medical Relief Program last year because                   
abortions took priority.  He believed that rationale is bogus and              
said it will be most unfortunate to have to spend State time and               
money on litigation over this bill if it becomes law.                          
                                                                               
Number 389                                                                     
                                                                               
SENATOR WARD said he could not produce the name of a child who                 
couldn't receive eyeglasses last year, but said his subject is                 
about saving the life of an unborn child.                                      
                                                                               
PAULINE UTTER, representing the Abortion Rights Project, asked the             
committee to take no action on this legislation because it is a                
back door way to remove a woman's constitutional right to choose,              
which was eloquently restated in the Valley Hospital case.  Also,              
if passed, this bill will clog up the Court System.                            
                                                                               
ROBYN SMITH testified in opposition to CSSB 181(HES) for the                   
following reasons.   Although no one likes the concept of abortion,            
all agree that the later an abortion occurs within a pregnancy, the            
more difficult it is. One of the most common reasons abortions                 
occur after the first trimester is because it is difficult to                  
obtain funding.  When abortions are delayed until the second                   
trimester, the mother's health is at risk.  When an unintended                 
pregnancy occurs, the mother is more likely to seek prenatal care              
after the first trimester, or to not obtain care at all, creating              
a high risk pregnancy.  Those mothers are more likely to expose the            
fetus to harmful substances, and the child is more likely to have              
a low birth rate.  She read statements from the Institute of                   
Medicine report, entitled The Best Intentions, which details the               
health and social consequences of unwanted pregnancies.  She stated            
if a woman needs public funds to have an abortion, she will need               
public funds for a delivery, and often those deliveries are                    
complicated because of poor prenatal care.  Ms. Smith said the                 
State is trying to get people off welfare but is not providing an              
adequate support system.                                                       
                                                                               
Number 465                                                                     
                                                                               
CHAIRMAN WILKEN read a correction, provided by Representative                  
Martin to his testimony, on the point of financial qualifications              
for free abortions.  Women under 18, living at home, do not need to            
have their parents' or guardians' income considered to qualify and             
in a medical emergency, a woman may apply for qualification after              
the fact.                                                                      
                                                                               
SID HEIDERSDORF, representing Alaskans for Life, made the following            
comments.  Alaskans for Life supports any efforts to reduce,                   
restrict, or eliminate state involvement in the abortion business.             
The present policy of paying for abortions for women on welfare is             
terribly misguided.  So many people find this procedure repugnant,             
it seems the State would remain neutral on the issue.  He expressed            
concern that bureaucrats might be able to work around the                      
requirements of SB 181, and continue to consider abortions a                   
priority procedure.  This issue is controversial because it is a               
life and death issue, and therefore deserves special consideration             
in terms of the State coming down on the side of promoting life,               
not death.  Abortion proponents always discuss the issue without               
mentioning the life of the child, which is like discussing slavery             
without mentioning the plight of the slave.                                    
                                                                               
MR. HEIDERSDORF said the argument that paying for abortions will               
save money over the long term is poor policy and is based on the               
premise that it is better for some babies to live than others.  On             
the issue of abuse, abortion leads to abuse because it breaks down             
the social taboo against harming the defenseless.  He felt it is an            
insult to say that the poor are more likely to harm their children             
because they are poor.  Mr. Heidersdorf concluded by saying that               
State policy should help both the mother and child.                            
                                                                               
SENATOR ELLIS asked Mr. Heidersdorf if he had any suggestions for              
changes to the bill.  MR. HEIDERSDORF said he did not.                         
                                                                               
KRISTEN BOMENGEN, Assistant Attorney General, focused her comments             
on the legal and constitutional issues presented by CSSB 181(HES).             
This bill has the effect of eliminating all abortion funding except            
in situations when the life of the woman is at risk.  The Alaska               
Constitution provides greater privacy protection than is generally             
construed under the federal constitution.  That extra protection               
makes it less useful to focus on court decisions made in states                
which rely on a federal interpretation of privacy rights, such as              
North Carolina, and more useful to focus on states that offer                  
greater privacy protection, such as Massachusetts, West Virginia,              
Connecticut and Minnesota.  In those states, courts that have                  
addressed cases involving abortion funding have generally decided              
that when the state decides to offer pregnancy related services, it            
must do so in a constitutionally-neutral manner that does not                  
infringe on the constitutional rights of the citizens.  While                  
states are not obligated to pay for the exercise of a                          
constitutional right as such, once it chooses to dispense funds, it            
must do so in a non-discriminatory manner.                                     
                                                                               
A Minnesota Court recently addressed the question of whether the               
State can fund childbirth related health services without funding              
abortion related services, thus excluding some women from receiving            
benefits solely because they make constitutionally protected health            
care decisions with which the State disagrees.  The Court                      
recognized that the woman's right to choose, whether to terminate              
or continue a pregnancy without interference from the state, was               
protected.  In that case the State was required to fund any                    
medically necessary or therapeutic abortions under their Medicaid              
and General Medical Relief Programs.  The Alaska Supreme Court's               
November decision in the Valley Hospital case was based on the                 
analysis of a fundamental right.  The Department of Law does not               
believe that court will uphold this bill as constitutional.                    
                                                                               
Number 582                                                                     
                                                                               
SENATOR ELLIS asked Senator Ward if his intent is to eliminate all             
funding for abortions with this bill.  SENATOR WARD said it will               
not cut off all because federal funds will be available.  He noted             
he disagrees with the Alaska Supreme Court's decision and with Ms.             
Bomengen's analysis, and believes the Legislature has a                        
responsibility to eliminate public funding for abortions which is              
his underlying purpose.  He believes this particular bill will be              
upheld by the Alaska Supreme Court.                                            
                                                                               
TAPE 98-6, SIDE B                                                              
                                                                               
NANCY WELLER, Division of Medical Assistance, Department of Health             
and Social Services (DHSS), reviewed several items in the original             
version of HB 234 that were removed from the committee substitute.             
HB 234 required state recovery of the cost of an abortion and would            
have required DHSS to track people throughout their lives in order             
to garnish money from them, perhaps from an inheritance of from                
their own estate.  A provision requiring PFD garnishment required              
fetal tissue testing to establish paternity.  Fetal tissue testing             
can be done in Alaska, at a cost of under $1,000.  This was                    
eliminated because DHSS does not have the ability to coerce the                
father of the unborn child to come in for tissue testing to prove              
paternity.  Also the original Section 2 provided that the woman who            
signed the application for assistance was assigning the right of               
any other person who might be potentially liable for the                       
expenditures.  DHSS questioned whether it is legal to assign the               
rights of payment to another unrelated party.                                  
                                                                               
MS. WELLER said DHSS has not paid for any services above number 7              
on the existing priority list since 1986, when funding for the                 
General Medical Relief Program was substantially reduced.  There is            
some confusion over the priority listing for the General Medical               
Relief Program, which is in AS 47.25.205, and the priority list for            
the Medicaid program, which is in AS 47.07.035.  The Medicaid                  
program is what Senator Ward referred to when he spoke about dental            
services and eyeglasses.  DHSS never eliminated those services for             
children, and cannot under federal law.  In 1994, when the                     
Legislature directed DHSS, through legislative intent written in               
the budget, to eliminate the top ten services on the Medicaid                  
priority list, those services were eliminated for adults only.                 
Intent language in the bill last year added those services back;               
those regulations went into effect October 12, 1997.  Regarding                
program eligibility, services are available to those found to be               
income eligible for the Medicaid program. People can apply for                 
eligibility after the fact, and DHSS does pay unpaid medical bills             
if the applicant was income eligible.  If minors apply for services            
and state they do not want their parents to know, they are not                 
required to provide their parents' income information during the               
income eligibility process.                                                    
                                                                               
Number 531                                                                     
                                                                               
SENATOR WARD asked if, CSSB 181(HES) moves elective abortions down             
the list, more funds will be available to pay for services higher              
on the list, and if so, which items will be funded.  MS. WELLER                
answered that a recent federal Medicaid policy change eliminated               
funding for legal aliens, so a large increase in expenditures for              
the General Medical Relief Program has occurred for only the                   
covered services which include hospital stays, physician services,             
prescription drugs, and laboratory-related tests.  DHSS will be                
requesting a $1.6 million increase to continue the existing                    
coverage and will not be able to move up the list.                             
                                                                               
SENATOR WARD asked if Ms. Weller was saying DHSS will be able to               
fund more of the higher priorities under this legislation.  MS.                
WELLER said no because the General Medical Relief Program is                   
underfunded at this time.                                                      
                                                                               
SENATOR LEMAN asked if DHSS has any record of the number of women              
who have more than one abortion in one year.  MS. WELLER said DHSS             
does not have that information.  It has information on abortion                
expenditures for each of the last several years, by age and place.             
                                                                               
SENATOR ELLIS asked if DHSS keeps track of the number of abortions             
that are purely elective and those that are medical necessities.               
MS. WELLER answered DHSS does have forms sent in by doctors                    
claiming federal medicaid funds when the pregnancy is life                     
threatening to the mother but those are rare because of the                    
paperwork involved and because that defense is not necessary since             
abortions are paid for with state funds.                                       
                                                                               
SENATOR ELLIS asked if DHSS keeps no information on abortion                   
procedures performed for medically necessary reasons.  MS. WELLER              
said that was correct.                                                         
                                                                               
SENATOR WARD commented that the original intent of this bill was to            
garnish the father's permanent fund dividend, to cover the cost of             
the abortion.                                                                  
                                                                               
Number 458                                                                     
                                                                               
RON KREHER, Division of Public Assistance, discussed the impact                
this bill will have on other public assistance programs.  Regarding            
eligibility for general relief medical in particular, this is a                
safety net program intended to serve the poor in the State of                  
Alaska.  The financial eligibility criteria are so low that truly              
only the indigent receive assistance.  An individual's monthly                 
income cannot exceed $300, and maximum resource limit is $500.                 
Based on the Division of Medical Assistance's projection of 295                
individuals who would remain on Medicaid if they were not able to              
terminate an unwanted pregnancy, the Division of Public Assistance             
has estimated that approximately 166 of those individuals would                
become dependent upon temporary assistance benefits.  The Division             
of Public Assistance has projected a cost of $720,000 in ATAP                  
benefits to cover those families.  That estimate does not factor in            
other supportive services that will be needed, such as child care              
and transportation.                                                            
                                                                               
TOM GORDY, Executive Director of the Christian Coalition of Alaska,            
testified in support of CSSB 181(HES).  He noted his wife, who                 
works at an optometrist's office, had to turn away two people this             
year who needed eyeglasses for their children because they could               
not pay.  One of those people called the Governor's Office, whose              
staff called the optometrist for a week to get him to provide the              
glasses for free.  Mr. Gordy said on the same day the children were            
turned down, three abortions were performed, so three to five                  
people lost.  If this bill had been enacted, those three to five               
would have been better off.  This bill sets a priority and helps               
those who genuinely need help, not those who elect to have a                   
problem.  This bill is moderate; many proponents of the right to               
choose do not believe abortions should be government funded.                   
Regarding the right to privacy argument and the need for the state             
to prove a compelling interest in de-funding abortion procedures,              
Mr. Gordy said people have a right to prosthetic devices, but they             
cannot get them because the State does not have the money.  He did             
not believe the Alaska Supreme Court will decide against this bill             
if it is enacted.                                                              
                                                                               
SENATOR LEMAN stated this bill is common ground that most people               
believe makes sense.  He asked Mr. Gordy if he agreed.  MR. GORDY              
said statistics he recently read showed the majority of the people             
in this country do not support public funding of abortion; only                
those to the extreme left support it.                                          
                                                                               
SENATOR ELLIS asked Mr. Gordy to elaborate on his last comment                 
about the extreme left.  MR. GORDY said this bill deals primarily              
with elective abortion.  He said his eyesight deteriorated rapidly             
between the ages of 19 and 20, but that is not a problem he chose              
to have, whereas a person who chooses to have sex when they can't              
afford to have a baby or an abortion cannot afford to have sex.  He            
believes all children are a gift from God, and people choose to see            
the pregnancy as a problem.                                                    
                                                                               
SENATOR ELLIS asked if the problem he referred to is the pregnancy             
or the decision.  MR. GORDY answered the problem is whether one                
views the pregnancy as a problem or as a need.                                 
                                                                               
SENATOR WARD moved CSSB 181(HES) out of committee with individual              
recommendations and its accompanying fiscal notes.  SENATOR ELLIS              
objected.  The motion carried with Senators Green, Ward, Wilken and            
Leman voting "yea," and Senator Ellis voting "nay."                            
The committee took a brief at ease.                                            
                                                                               
          SCR 14 - PARITY FOR MENTAL HEALTH TASK FORCE                         
                                                                               
CHAIRMAN WILKEN announced this issue was considered last session,              
and then reviewed by a steering committee of participating                     
organizations.  The steering committee's recommendations were                  
incorporated into CSSCR 14(HES), version F.                                    
                                                                               
SENATOR LEMAN moved to adopt CSSCR 14(HES), version F, as the                  
working document of the committee.  The motion carried with no                 
objection.  There being no discussion, the committee took                      
testimony.                                                                     
                                                                               
WALTER MAJOROS, Executive Director of the Alaska Mental Health                 
Board, stated the Alaska Mental Health Board brought forth this                
legislation in partnership with the Building Bridges Campaign for              
mental health consumers.  He reviewed the changes in the committee             
substitute as follows.                                                         
                                                                               
The first change is to the representation on the task force and who            
is responsible for the appointments.  Senator Ward's concerns were             
addressed and the task force will have broad representation. The               
legislation states that there will be no expenditure of state funds            
to support the task force; the Alaska Mental Health Trust Authority            
has pre-funded the task force in the amount of $50,000.  The                   
purpose of the resolution is to create the task force to study the             
issue of parity; not to introduce parity legislation.                          
                                                                               
MR. MAJOROS made the following comments about the issue of parity.             
Congress passed the Mental Health Parity Act of 1996, which is a               
step in the direction of equalizing mental health care coverage                
with physical health care coverage.   Currently 90 percent of                  
insurance coverage offers a higher level of benefits for physical              
health coverage than for mental health coverage.  The federal                  
legislation equalizes lifetime and annual benefits only.  It does              
not obligate employers to provide mental health coverage and                   
contains no rules regarding deductibles, co-payments or out of                 
pocket limits.  Because of these limitations, 15 states have passed            
mental health parity legislation and 25 others have introduced                 
legislation in the past year.  Because of this activity many new               
studies have been conducted.  Those studies are reporting either               
no, or a nominal, increase in cost.  The Rand Study showed that                
equalizing annual limits is costing $1.00 per person per year.                 
Comprehensive coverage is costing $7.00 per year per person.  Most             
states are finding there is no need for differential treatment of              
people with mental illnesses versus people with physical illnesses.            
The basic belief is that mental illnesses are treatable brain                  
disorders in a cost-effective manner, and in many cases are treated            
with a better success rate than physical illnesses.  He asked                  
committee members to support the resolution.                                   
                                                                               
SENATOR LEMAN referred to the section of the resolution that                   
contains the cost of mental health disorders to the American                   
economy, and asked if any figures are available specific to Alaska.            
MR. MAJOROS said he believes the state would reflect the national              
trend.                                                                         
                                                                               
SENATOR LEMAN thought the number might be in the tens to hundreds              
of millions for Alaska.  MR. MAJOROS stated some people with mental            
illnesses are unable to leave medicaid coverage to take jobs in the            
private sector because if they do so, they lose mental health                  
coverage for medications.  Private insurance coverage often does               
not cover those medications.  SENATOR LEMAN asked that an estimate             
be calculated for Alaska.  MR. MAJOROS said he would attempt to do             
so.                                                                            
                                                                               
SENATOR GREEN asked if Alaska complies with the federal legislation            
he referred to.  MR. MAJOROS answered that legislation just became             
effective January 1,1998, so no track record of compliance has been            
established yet.  In order for an organization to request an                   
exemption, it must demonstrate six months of providing the                     
coverage.                                                                      
                                                                               
CHAIRMAN WILKEN noted he passed out the synopsis of the federal                
legislation to committee members.                                              
                                                                               
SENATOR GREEN asked if a large corporation that provides coverage              
for its employees is able to opt out if it can show an increase in             
costs.  MR. MAJOROS explained there are many ways an organization              
can opt out under the federal legislation.  Businesses with 50 or              
less employees can choose to not carry mental health coverage.                 
Businesses with more than 50 employees can get an exemption if they            
can demonstrate that their costs increased by greater than one                 
percent.                                                                       
                                                                               
SENATOR GREEN questioned whether the consequences of the                       
possibility of many businesses opting out of the program completely            
has been reviewed.  MR. MAJOROS replied that Senator Green's                   
concern demonstrates the need to take a look at how the federal                
legislation may impact Alaska and how to best respond to that                  
legislation.                                                                   
                                                                               
SENATOR GREEN said she is very fearful that the task force will                
begin to mandate mental health coverage if a large number of                   
businesses opt out.  The Legislature has mandated insurance                    
coverage of three or four procedures since she has been in office,             
and she believes establishing a piecemeal approach to national                 
health insurance is wrong.  MR. MAJOROS pointed out that he worked             
directly with Senator Ward regarding the composition of the task               
force and who will be appointed by the Legislature.  He believes               
that composition reflects a balanced and consensus-building                    
approach.                                                                      
                                                                               
SENATOR WARD confirmed that he did work with Mr. Majoros on that               
provision of SCR 14 but he agreed with Senator Green's concern.                
MR. MAJOROS responded this resolution establishes a task force to              
study the issue.  If the task force came to that conclusion, it                
would bring that information to the Legislature for its                        
consideration.                                                                 
                                                                               
SENATOR GREEN noted the clause that states that a simple majority              
of the members of the task force constitute a quorum for the                   
transaction of business, and all actions of the task force shall               
require the affirmative vote of a majority of the members present,             
requires only four votes to create a majority.  She asked if this              
language is typical for task force business.  MR. MAJOROS answered             
that the Steering Council took standard boiler plate language for              
task force construction and its decision making process.                       
                                                                               
CHAIRMAN WILKEN stated the resolution will be held in committee and            
that question can be answered before the next hearing.                         
                                                                               
SENATOR WARD said it was his understanding that task force members             
can participate via telephone and teleconference.  MR. MAJOROS said            
nothing in the resolution prevents it.  CHAIRMAN WILKEN said staff             
will follow up on that concern also.                                           
                                                                               
JAN MCGILLIVARY, Chief Executive Officer of the Alaska Mental                  
Health Association (AMHA), and coordinating agency leader for the              
Building Bridges Campaign for Mental Health, gave the following                
testimony.  The issue of mental health parity is not new to those              
who work in the field.  Two efforts to champion parity by AMHA have            
failed in recent years.  The issue has been studied extensively by             
the National Mental Health Association, the National Alliance for              
the Mentally Ill, the Bazelon Law Center and the National Institute            
of Mental Health.  She hoped the committee will advance the bill so            
this issue can be studied in earnest and produce an up-to-date                 
report.  Numerous recent reports make the statement that the                   
increased costs to the employer in regard to insurance benefits is             
generally less than one percent.  Also when mental health coverage             
is on par with physical health coverage, after a five to ten year              
period, the industry perceives an overall decline in the use of the            
mental health benefit overall.                                                 
                                                                               
SENATOR GREEN remarked that when she was on the Governor's Council,            
the federal definition of "developmentally disabled" changed.  She             
asked if the state has a definition of the scope and types of                  
illnesses that would be covered and whether that includes those who            
have developed mental illnesses as the result of alcohol and                   
substance abuse.  MS. MCGILLIVARY answered that over the year                  
during the Alaska Mental Health Association's Lands Trust                      
litigation, this question was on the front burner.  Judge Green                
finally answered the question when she defined the beneficiary                 
group for the Trust Authority.  She said when she thinks of mental             
health parity, she is thinking of people who experience major                  
mental illnesses, and alcoholics with psychosis qualify under that             
definition.                                                                    
                                                                               
SENATOR GREEN asked if it would detract from this resolution to                
include limiting language.  MS. MCGILLIVARY did not know.                      
                                                                               
Number 047                                                                     
                                                                               
MARY ELIZABETH RIDER, a planner for the Mental Health Trust                    
Authority, stated last summer, when the Trust was making its budget            
recommendations for fiscal year 99, the Mental Health board brought            
up the concept of a task force.  The Trust is interested in                    
supporting a study conducted by a diverse task force of the type               
proposed, to help make decisions about the best way to finance                 
mental health services.  She offered to take questions back to the             
Trust members from the committee.                                              
                                                                               
BOB IRVINE, the Chief Executive Officer of Lifequest, the community            
mental health center in the Mat-Su Borough, testified in support of            
SCR 14.  Throughout his career with the mentally ill he has found              
that population has has been stigmatized by the work force and                 
insurance industry.   When behavioral health and physical health               
are integrated, an overall savings occurs on total health care                 
costs.  The artificial boundary between body and mind is                       
disappearing and people are realizing they need to be treated                  
together.  In terms of the cost of mental illness to the State of              
Alaska, the Alaska Mental Health Association has been in a                     
leadership position with the depression awareness treatment                    
campaign for many years.  If established, the task force could                 
answer that question.  The cost of depression alone is enormous                
when one factors in the number of lost work days, the amount of                
lost work productivity, and the effect on family members.                      
                                                                               
TAPE 98-7, SIDE A                                                              
                                                                               
DON DAPCEVICH, Executive Director of the State Advisory Board on               
Alcoholism and Drug Abuse, made the following statements.  The                 
Board supports the formation of this task force, although it has               
not taken a position on the issue of whether parity should occur,              
and in what form.  The Board encourages the Legislature to form a              
task force to look at the issues involved.  The Board's concern is             
access to services for Alaskans, in the best way possible. The                 
insurance limitations placed on services provided for clients has              
effectively discouraged the private, for-profit market from                    
providing services in Alaska.  He imagined the Board would support             
parity, but only if it is cost-effective.                                      
                                                                               
CHAIRMAN WILKEN agreed with Mr. Dapcevich and said he couldn't                 
imagine the task force would convene and not quantify the issue.               
SENATOR GREEN suggested requiring it to do so.                                 
                                                                               
GINA MCDONALD, representing the Division of Mental Health and                  
Developmental Disabilities, DHSS, stated support for SCR 14.  The              
Division is not taking a position on parity, but believes it is                
important for the task force to study the issues of cost and equity            
and to establish and informed process for decision making.                     
                                                                               
CHAIRMAN WILKEN noted there was no more discussion or testimony on             
SCR 14, and that it was his intention to hold the legislation until            
next Wednesday to work on several changes.  He announced there                 
would be no meeting scheduled on Monday, and informed committee                
members that he and Senator Ward attended a demonstration the                  
previous day on a new machine that, through ion and microprocessor             
technology, can discover the presence of illicit drugs being                   
brought into the State.  He hoped the Legislature has the ability              
and creativity to help our communities to get more of the machines             
because they are truly a deterrent to drug trafficking.  He                    
adjourned the meeting at 10:50 a.m.                                            
                                                                               
                                                                               

Document Name Date/Time Subjects