Legislature(1997 - 1998)
01/30/1998 09:00 AM Senate HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
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 |
|---|