Legislature(2019 - 2020)BUTROVICH 205

02/26/2020 01:30 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SJR 13 CONST. AM: PROHIBIT ABORTION/FUNDING TELECONFERENCED
Heard & Held
-Invited Testimony Followed by Public Testimony-
+ Bills Previously Heard/Scheduled: TELECONFERENCED
+= SB 173 LICENSE MOBILE INTENSIVE CARE PARAMEDICS TELECONFERENCED
Moved SB 173 Out of Committee
+= SB 134 MEDICAID COVERAGE OF LIC. COUNSELORS TELECONFERENCED
Moved SB 134 Out of Committee
                                                                                                                              
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                       February 26, 2020                                                                                        
                           1:31 p.m.                                                                                            
                                                                                                                                
                             DRAFT                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Natasha von Imhof, Vice Chair                                                                                           
Senator Cathy Giessel                                                                                                           
Senator Mike Shower                                                                                                             
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
OTHER LEGISLATORS PRESENT                                                                                                     
                                                                                                                                
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 173                                                                                                             
"An Act  relating to  mobile intensive  care paramedics;  relating                                                              
to  duties  of the  State  Medical  Board  and the  Department  of                                                              
Health  and  Social  Services;  and  providing  for  an  effective                                                              
date."                                                                                                                          
                                                                                                                                
     - MOVED SB 173 OUT OF COMMITTEE                                                                                            
                                                                                                                                
SENATE BILL NO. 134                                                                                                             
"An Act relating to medical assistance reimbursement for the                                                                    
services of licensed professional counselors; and providing for                                                                 
an effective date."                                                                                                             
                                                                                                                                
     - MOVED SB 134 OUT OF COMMITTEE                                                                                            
                                                                                                                                
SENATE JOINT RESOLUTION NO. 13                                                                                                  
Proposing an amendment to the Constitution of the State of                                                                      
Alaska relating to abortion.                                                                                                    
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 173                                                                                                                  
SHORT TITLE: LICENSE MOBILE INTENSIVE CARE PARAMEDICS                                                                           
SPONSOR(s): SENATOR(s) REVAK                                                                                                    
                                                                                                                                
02/03/20       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/03/20       (S)       HSS, L&C                                                                                               
02/17/20       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/17/20       (S)       Heard & Held                                                                                           
02/17/20       (S)       MINUTE(HSS)                                                                                            
                                                                                                                                
BILL: SB 134                                                                                                                  
SHORT TITLE: MEDICAID COVERAGE OF LIC. COUNSELORS                                                                               
SPONSOR(s): SENATOR(s) WILSON                                                                                                   
                                                                                                                                
01/21/20       (S)       PREFILE RELEASED 1/10/20                                                                               

01/21/20 (S) READ THE FIRST TIME - REFERRALS

01/21/20 (S) HSS, FIN 02/21/20 (S) HSS AT 1:30 PM BUTROVICH 205 02/21/20 (S) Heard & Held 02/21/20 (S) MINUTE(HSS) BILL: SJR 13 SHORT TITLE: CONST. AM: PROHIBIT ABORTION/FUNDING SPONSOR(s): SENATOR(s) HUGHES

01/21/20 (S) READ THE FIRST TIME - REFERRALS

01/21/20 (S) HSS, JUD, FIN 02/26/20 (S) HSS AT 1:30 PM BUTROVICH 205 WITNESS REGISTER DAVE WALLACE, Chief Executive Officer Mat-Su Regional Medical Center Palmer, Alaska POSITION STATEMENT: Supported SB 134. ELIZABETH RIPLEY, Chief Executive Officer Mat-Su Health Foundation Wasilla, Alaska POSITION STATEMENT: Supported 134. JARED KOSIN, President and Chief Executive Officer Alaska State Hospital and Nursing Home Association Anchorage, Alaska POSITION STATEMENT: Supported SB 134. SENATOR SHELLY HUGHES Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Resolution sponsor. LISA HART, Staff Senator Hughes Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Presented an overview and sectional of SJR 13 on behalf of the resolution sponsor. SENATOR KATRINA JACKSON, representing self Louisiana State Legislature Baton Rouge, Louisiana POSITION STATEMENT: Supported SJR 13. DONNA HARRISON, M.D., Executive Director American Association of Pro-Life Obstetricians and Gynecologists Eau Claire, Michigan POSITION STATEMENT: Supported SJR 13. TERRISA BUKOVINAC, representing self San Francisco, California POSITION STATEMENT: Supported SJR 13. LISA GENTEMANN, representing self Eagle River, Alaska POSITION STATEMENT: Supported SJR 13. LOREN LEMAN, representing self Anchorage, Alaska POSITION STATEMENT: Supported SJR 13. ROBIN SMITH, representing self Anchorage, Alaska POSITION STATEMENT: Opposed SJR 13. CAROLINE MALSEED, Reverend Church of the Holy Trinity Juneau, Alaska POSITION STATEMENT: Opposed SJR 13. ROBB ARNOLD, representing self Juneau, Alaska POSITION STATEMENT: Supported SJR 13. SARAH HENNEMANN, M.D., representing self Palmer, Alaska POSITION STATEMENT: Supported SJR 13. WINDY PERKINS, representing self Anchorage, Alaska POSITION STATEMENT: Supported SJR 13. MOIRA PYHALA, representing self Soldotna, Alaska POSITION STATEMENT: Opposed SJR 13. JONATHAN FISHER, representing self Juneau, Alaska POSITION STATEMENT: Supported SJR 13. LUANN MCVEY, representing self Juneau, Alaska POSITION STATEMENT: Opposed SJR 13. ACTION NARRATIVE 1:31:47 PM CHAIR DAVID WILSON called the Senate Health and Social Services Standing Committee meeting to order at 1:31 p.m. Present at the call to order were Senators Giessel, von Imhof, Begich, Shower, and Chair Wilson. SB 173-LICENSE MOBILE INTENSIVE CARE PARAMEDICS 1:32:12 PM CHAIR WILSON announced the consideration of SB 173. He noted the committee had heard an overview on February 17, took public testimony, and received an updated fiscal note from the Department of Health and Social Services (DHSS). He solicited a motion. 1:32:47 PM SENATOR VON IMHOF moved SB 173, version 31-LS1365\M, from committee with individual recommendations and updated fiscal notes. 1:33:01 PM Without objection, SB 173 moved from committee. 1:33:11 PM At ease SB 134-MEDICAID COVERAGE OF LIC. COUNSELORS 1:33:16 PM CHAIR WILSON announced the consideration of SB 134. He noted that he was a sponsor and that on February 21 the committee had heard an overview of the bill and took public testimony. He called on invited testimony. 1:35:16 PM DAVE WALLACE, Chief Executive Officer, Mat-Su Regional Medical Center, Palmer, Alaska, said that Mat-Su Regional is a 125-bed acute care hospital in the fastest growing service area in Alaska. He mentioned its size because a year ago it was a 74-bed hospital. It did a 35-bed med-surge expansion and then last month, added a 16-bed behavioral health unit. The Medicaid coverage for licensed professional counselors is important because it is part of the continuum of care for behavioral health. The lack of behavioral health services in Mat-Su and throughout the state is an issue of concern. Mat-Su Regional would like to have care provided at the most appropriate level. If more counselors are able to be paid to see Medicaid patients with behavioral health needs, it will keep the patients from going to a higher, more expensive level of care, which for Mat- Su Regional means overutilization of its emergency department. This will be better for everyone. The patients will receive treatment in an environment that is exclusively meant for their needs. It will relieve stress on the already overtaxed emergency department, and it will save the state money. MR. WALLACE said that Mat-Su Regional is working with the Mat-Su Health Foundation to reduce the overuse of the emergency department through approaches like the High Utilizer Mat-Su project, HUMS. HUMS targets patients that have used the emergency department at least five or more times in a year. Sixty-eight percent of these patients are Medicaid recipients. The majority, if not all, are suffering from a primary or secondary diagnosis related to behavioral health. His counterparts with the foundation have testified that they are saving money through this program. MR. WALLACE said the number of patients served is relatively small, but a small number of patients overutilizing the emergency department is too much. Mat-Su regional estimates that over a million dollars has been saved by reducing the number of ER visits related to this population. If there were more counselors to see behavioral health patients in the community, there would be savings to the state in Medicaid services. Mat-Su Reginal has had a counselor on staff for five years who works in a primary care clinic and has been waiting to see Medicaid patients. Sixty percent of the population that comes to the emergency department has a behavioral health diagnosis and would benefit from counseling. Without this important payment mechanism, she cannot see Medicaid patients. SB 134 adds an important piece to the continuum of care. 1:39:12 PM ELIZABETH RIPLEY, Chief Executive Officer, Mat-Su Health Foundation, Wasilla, Alaska, said SB 134 is crucial because it will help address an important health issue facing Mat-Su residents every day, mental health and substance use disorders. Licensed professional counselors are key behavioral health providers for these issues. Mat-Su residents said these are prominent issues in the last three community needs assessments conducted by the foundation. In the first one conducted in 2013, residents and professionals said that the top five health challenges are alcohol and substance abuse, children experiencing trauma and violence, depression and suicide, domestic violence and sexual assault, and lack of access to behavioral health care. These issues can all be helped by residents seeking counseling. SB 134 would expand the workforce that could provide that counseling to residents who have Medicaid. Mat-Su school nurses say they see waiting lists of four to eight months for children and families with Medicaid to see counselors. Mat-Su has skilled and trained licensed professional counselors in communities across Mat-Su that could see these children and others, but they aren't because they cannot be paid for their services. MS. RIPLEY said the prevalence of mental health and substance use disorders and crises is increasing in Mat-Su and statewide. The average annual growth rate for visits to the Mat-Su Regional emergency department by patients with behavioral health diagnoses grew 20 percent from 2015 to 2017 due to the opioid epidemic and lack of treatment access. As Dave Wallace just shared, the hospital now has an inpatient unit up and running. Previously, the hospital provided no behavioral health care treatment. Passage of SB 134 could bring the appropriate level of care to people who need help when a problem first starts instead of after it develops into a crisis. Mat-Su Regional is inundated by residents in crisis with behavioral health problems. In 2016, 3,443 residents were seen in the emergency department with a primary behavioral health diagnosis. Those 3,443 people had 8,400 visits, and 46 percent were on Medicaid. The top diagnoses were suicidal ideation and self-harm, alcohol- related disorders, delirium, dementia, and cognitive disorders. MS. RIPLEY said the costs for those visits was $43.8 million dollars in facility charges alone. This does not include the costs associated with law enforcement or emergency transportation. The average charge per visit was $5,216 and the average cost per patient was $12,725. Clearly, the emergency department is the least cost effective place to treat behavioral health problems. If intervention can be provided early with a system that provides more immediate access to a behavioral health provider for all residents, the state would save a ton in pain and suffering as well as money. An individual session for Medicaid is $75 while an average charge for a behavioral health visit to the emergency department is $4,370. Granted, an individual needs more than one visit to prevent a crisis, but even 10 visits would save $3,600. 1:44:22 PM MS. RIPLEY said that access, however, remains a problem. Very few primary care practices employ behavioral health providers. She knows of two primary care practices in Mat-Su, outside of federally qualified health centers, that employ a behavioral health clinician and there are many primary care practices. One reason there is so little integration of behavioral health into these practices is that those providers cannot bill Medicaid. Another reason was a shortage of psychiatrists to supervise behavioral health providers, but with the passage of SB 169 in 2018 that allows behavioral health care providers to be supervised by any physician, that barrier has been overcome. She thanked Senator Giessel for sponsoring SB 169. MS. RIPLEY said the next step is have more behavioral health providers who can bill Medicaid, thus making the inclusion of behavioral health services sustainable in physician offices. This bill, combined with SB 105, which allowed Medicaid billing for marriage and family counselors that passed last session, will do just that. A number of pieces are falling into place to provide more upstream intervention for behavioral health care. MS. RIPLEY noted that Mr. Wallace had referenced HUMS. The foundation started HUMS as a way to provide care coordination and access to community supports for high utilizers, defined as residents who had five or more visits in the emergency system in a year and who were, for whatever reason, unable to independently access consistent and appropriate care and support in the community. Mr. Wallace mentioned the dramatic cost savings of more than one million dollars a year. The foundation is entering the third year of the project. It also has alleviated significant trauma for not just the patients, but for the health care providers and family who often suffer trauma along with the patients. "The current director of the HUMS program, Dr. Quimby, told me that when he took over for Dr. Zink, who is now the chief medical officer for the state of Alaska, he took it over as a favor to her and he really didn't believe this was going to work. And he said, 'I'm a believer now. I'll talk about it to anybody.' In fact, he said, 'I like coming to work more now because the patients I'm serving actually get help,'" she said. MS. RIPLEY said that if people had access to care and support before their needs become a crisis and they came to the emergency department, there would be far less need for a program like HUMS. The project has had more than $2.168 million in cost savings. The project does have a third party evaluator who is tracking progress and the need for course correction. In 2018, $347,288 in emergency room charges was saved with the top three utilizers alone. That same year seven patients did not use the emergency department at all after enrollment in HUMS. The age of the superutilizers ranges from 16 to 82. Seventy-two percent had Medicaid coverage. Besides the data and cost savings, she wanted to share the human piece of the impact of HUMS. Dr. Quimby told this story at the annual meeting of the health foundation of a young adult who had had 17 visits to the emergency department in the previous year before enrolling in HUMS. He was not managing his diabetes and had a long history of substance use disorder. Most of his emergency visits led to inpatient admission in the intensive care unit. The client had a long history of IV drug use, was noncompliant with primary care appointments, and his outlook was poor. The hospital staff believed this young man was going to die. HUMS was told the client had little to no interest in improving his situation. The HUMS team built a rapport with the client and he did want to change. This client is now sober and his diabetes managed. He is working full time and has a great relationship with his primary care provider. He has years to live to make a positive difference. 1:50:47 PM JARED KOSIN, President and Chief Executive Officer, Alaska State Hospital and Nursing Home Association, Anchorage, Alaska, said this bill is good policy. People talk constantly about how to lower the cost of care. This is how to do it, invest in the continuum of care at the community level, where it is a lot cheaper, and reserve those higher level, more expensive settings for people who actually need it. He was talking to a CEO of a facility yesterday, and the CEO said this bill is a test and if this bill fails, he would know whether anyone cares about the behavioral health crisis. This is a very practical step forward. 1:51:46 PM CHAIR WILSON solicited a motion. 1:52:01 PM SENATOR VON IMHOF moved SB 134, version 31-LS1261\A, from committee with individual recommendations and attached fiscal notes. 1:52:17 PM There being no objection, the motion passed. 1:52:19 PM At ease. SJR 13-CONST. AM: PROHIBIT ABORTION/FUNDING 1:54:45 PM CHAIR WILSON announced the consideration of SJR 13. He noted that the committee would hear an overview from the sponsor and take invited and public testimony. He urged people to email their testimony to [shss@akleg.gov]. He called SJR 13 sponsor Senator Hughes and her staff to the table. 1:55:40 PM SENATOR SHELLY HUGHES, Alaska State Legislature, Juneau, Alaska, expressed her gratitude to Senator Wilson for hearing the resolution and noted that it had been awhile since this topic has been on the docket. She read the longer title for the resolution, "Proposing an amendment to the Constitution of the State of Alaska relating to abortion" and pointed out that it does not specifically prohibit abortion. SJR 13 proposes amendment to the state constitution by adding a new section that would provide clarity regarding Article 1, which pertains to the right to privacy and the right to equal protection and Alaska's ability to set public policy related to abortion. SENATOR HUGHES noted that that the U.S. Supreme Court declared in 1973 with Roe v. Wade and reaffirmed in 1992 with Planned Parenthood v. Casey that there is an alleged federal constitutional right to abortion. However, the federal courts have held that states can still legislate related issues in a number of ways, for example, by banning the use of public funds for abortions, requiring a parent to consent for an abortion for a minor, and even by disallowing certain procedures, such as partial birth abortion or late-term abortion. In Minnesota, both parents must be informed before a minor can have an abortion. In Illinois, one parent must be informed. Thirty-seven states, including blue states, have laws requiring parental notification, and 21 of those require parental consent. Additionally, 21 states prohibit partial birth abortion, and three have laws that apply to postviability, the ability to survive outside of the womb. SENATOR HUGHES said that blue states such as California, Washington, Minnesota, Illinois, Michigan, Pennsylvania, Massachusetts and more prohibit abortion after the baby in the womb is 24-weeks old. Gray states are competitively split between left and right, Democrat vs. Republican, according to Gallup, and three gray states, Texas, Nebraska, and North Carolina, prohibit abortion when a baby is more than 18- to 22- weeks old. Another three gray states have recently passed heartbeat bills, prohibiting the abortion of babies at 6 to 8 weeks. SENATOR HUGHES said that Alaska is unable to have any provisions in law related to abortion because of its present constitution. She is there today asking for help to fix the constitution, so that some of the same parameters that even blue and gray states have made could be allowed to stand if it is the will of the people, as shown either through their elected legislators or through the voter initiative process. In the past, legislation and ballot initiatives similar to the laws she just discussed have passed in the state, but in Alaska they have been struck down by the Alaska Supreme Court. SENATOR HUGHES said these laws have been subject to a series of decisions asserting the existence of a state constitutional right to abortion that protects abortion even more broadly than the U.S. Constitution. As a result, numerous laws that would be completely permissible under the federal constitution and that exist in other states have been struck down by Alaska's courts. SENATOR HUGHES said that SJR 13 simply would allow Alaska to be on par with other states. It would permit the decisions that Alaskans make on issues regarding the parents of minors, unborn babies, and public funding of abortion to stand. The state has seen a pattern too long of obstruction by the state's supreme courts in the lawful business of the legislature. The bill is not designed to answer the question of what a woman may legally do or not do. This bill is not designed to tell the legislature it may not fund abortion in the future. This bill is designed to keep the courts from adding something to the state constitution that its framers never envisioned. Because the right to privacy has been the court's default to knock down abortion-related laws in Alaska, she would like to point out that decades ago, when the legislature in this building passed a resolution to put the right to privacy on the ballot and when Alaskans agreed with that amendment at the ballot box in 1972, it had nothing to do with abortion. 2:01:19 PM SENATOR HUGHES quoted from Alaska's Constitution: A Citizen Guide by Legislative Affairs, "The right to privacy was prompted by fear of the potential for misuse of computerized information systems, which were then in their infancies." In the 1970s, the Department of Public Safety was developing the Alaska Justice Information System, a computerized database of the criminal history of individuals. Fearful that such a system was the precursor of a Big Brother, government information bureaucracy, legislators responded with a constitutional amendment on the right to privacy. SENATOR HUGHES said this history of the adoption of the right to privacy is an important perspective to have as the committee considers this resolution because that right to privacy was not at all related to abortion. This bill is about protecting the separation of powers. Judge Andrew Kleinfeld in Fairbanks in the case Compassion in Dying v. the State of Washington in 1995 made this powerful and poignant statement, "That a question is important does not imply that it is constitutional. The founding father did not establish the United States as a democratic republic so that elected officials would decide trivia while all great questions would be decided by the judiciary." This bill is about "we the people," what parameters and what laws the people want. It is about common sense. Even though she personally wants the most vulnerable Alaskans, unborn babies, protected, and abortion to be abolished, and these precious Alaskan children to be cared for and cherished by loving parents and families, and even though she as a sponsor believes that one day Americans will look back at abortion on the same way they look at slavery, a barbaric act that has no place in civil society, this constitutional amendment will simply allow Alaskans to decide what kind of policy they want in Alaska regarding abortion. 2:04:39 PM LISA HART, Staff, Senator Hughes, Alaska State Legislature, Juneau, Alaska, said that she would share some maps showing the gray states. Her objective with the page of maps is to show that actions are being taken across the United States. In 2019, conservative state legislators raced to enact an unprecedented wave of bans for some, most, or all abortions. At the end of the year, 25 new abortion bans had been signed into law, primarily in the South and Midwest. Along with this new strategy, legislators also continued their efforts to adopt other types of abortion restrictions. State-level policy developments to ban or restrict abortion are an important backdrop as the U.S. Supreme Court considers a Louisiana law to require abortion providers to have admitting privileges at a local hospital. She noted the committee would be hearing from Louisiana State Senator Katrina Jackson. MS. HART said that her point is that action is being taken by states to take this matter to the legislative, the law-making body of government, as opposed to it being decided by judicial review. 2:07:14 PM SENATOR BEGICH said that Ms. Hart is couching this legislation in terms of politics. Her map shows Alaska listed as a solid Republican state. He asked if that is the best way to frame this issue. In Alaska, the difference between the top two candidates in Alaska's last gubernatorial race was less than five percent. The prior governor was nonpartisan and supported by the Democratic Party. The U.S. senator from 2008 to 2014 was also a Democrat. He asked if that is the right way to present this argument, as partisan and as an argument about party, and is that helpful to the cause of this process. SENATOR HUGHES said that she would respond and would take the blame or the credit. She is not trying to introduce partisan politics, but the point is to make it clear that a spectrum of states has decided to put parameters around abortion. Alaska is unable to. Alaska is likely to be a gray state for 2020. It doesn't matter where anyone falls along the political spectrum, but there have been parameters set in various states. It is not to pit anyone against another. Senator Katrina Jackson is an African-American and a Democrat from Louisiana. She led this in her state. For Senator Hughes, this is not partisan. It is about the babies. 2:09:34 PM MS. HART gave the sectional analysis: Section 1 Article I, Constitution of the State of Alaska, Page 1, Lines 3-7 Amends the Constitution of the State of Alaska by adding a new section, Section 26. Abortion. The amendment states that in order to protect human life, nothing in this constitution may be construed to secure or protect a right to an abortion or require the State to fund an abortion. Section 2 Article I, Constitution of the State of Alaska, Page 1, Lines 8-10 Adds that the amendment proposed by this resolution shall be placed before the voters of the state at the next general election in conformity with art. XIII, sec. 1, Constitution of the State of Alaska, and the election laws of the state. SENATOR BEGICH asked Senator Hughes if there is anything in law to prohibit anyone from choosing not to have an abortion. SENATOR HUGHES replied that she did not believe so. The Department of Law was available on the phone to answer any questions regarding legality. SENATOR BEGICH asked if there is any law in the state that compels a person to have an abortion or does a person have the ability to choose to take a child to term. SENATOR HUGHES responded that a person is free at this point. The baby doesn't have a choice, but to focus on what is before the committee, it is not a piece of legislation that takes away choice at this point. The legislation allows this body and the voter initiative process to decide what policy the state wants. The state is still subject to what has been decided at the federal level, even though she doesn't agree with what has been decided at the federal level. She believes that just as a woman wants a choice, the very tiniest, littlest women, the baby girls in a womb, deserve a choice to live, but this is about the state's ability to maximize what it can under federal law, which it is unable to do at this time. SENATOR BEGICH clarified that it removes the coverage of Alaska's right to privacy in issues regarding abortion. SENATOR HUGHES answered that is correct. SENATOR BEGICH pointed out that in issues regarding abortion, it potentially removes one gender from that coverage. He asked if there some level of unfairness in removing one gender from the coverage of right to privacy when it comes to this issue. He recognizes her concern for those who have not yet been born, but he is talking specifically about the gender that is specifically affected by removal of this coverage of the right to privacy. SENATOR HUGHES replied that two genders are involved, baby boys and girls. She prefers sticking to what the bill does rather than have a philosophical debate. She would be willing to have that debate offline, unless it is the wish of the chair. CHAIR WILSON answered that many people wanted to testify. He repeated the email address, shss@akleg.gov, to send testimony to. He moved on to invited testimony. 2:14:56 PM SENATOR KATRINA JACKSON, representing self, Louisiana State Legislature, Baton Rouge, Louisiana, said that Louisiana has legislated in a few areas where Alaska also has legislated, but the difference is that in Alaska, the court system struck down most of the laws. She believes, and the U.S. Supreme Court believed when it passed Roe v. Wade, that each state legislature has an interest in regulating abortions and protecting the health and safety of their constituencies. Louisiana has parental consent laws and as she understands it, some of Alaska's laws regarding parental consent have been struck down. SENATOR JACKSON said she had the same legislation that passed in Louisiana last year and will go to a vote of the people this year. She is alarmed when she sees courts able to strike down legislation. She is preparing to file legislation regarding human trafficking and what abortion facilities will have to report because of new studies. In Shreveport, a clinic an hour and a half from her hometown, women were being brought from Texas and human trafficked. This was only discovered because of a statute regarding parental consent and the people who came in alleging to be parents. Although the records are private, when the Louisiana Department of Health receives so many complaints, it can research them with a very private investigation between the department and the clinic. That was triggered by the parental consent laws. When states cannot pass things like parental consent laws, which go way outside of the right to abortion, states are put in a box and cannot protect vulnerable young girls who are unwillingly taken to an abortion clinic. To her, the most glaring thing was that the Alaska legislature had passed a parental consent law that was overturned by the state's supreme court. She is prolife, but she is also a practicing attorney. She always promised that she would not offer an unconstitutional law. Some situations, for the sake of human decency, like the health care industry, bear regulation and abortion is one of those industries that need regulation. She is seeing that without these constitutional amendments, some states are never able to regulate abortion facilities and clinics and their health standards. SENATOR JACKSON said she is encouraging state legislators to look at this as protecting their ability to take a vote when needed to regulate abortion facilities and to regulate human trafficking and other things that come up that relate to that. It is a simple truth. All legislators do it in other areas of health care. Legislators' hands should not be tied when there is a valid state interest in the health and safety of their constituents in regulating this area. The U.S. Supreme Court didn't think so, but alarming enough, in Alaska and other states, courts are ruling against passed legislation even when there is a compelling state interest. Even if someone is not prolife, health standards need regulation. Without a constitutional amendment, some states cannot regulate in that area. That goes far beyond whether a woman has the right to abortion. It goes into so many other areas of law. 2:21:33 PM DONNA HARRISON, M.D., Executive Director, American Association of Pro-Life Obstetricians and Gynecologists, Eau Claire, Michigan, said that her organization represents over 4,000 reproductive health professionals throughout the United States. They practice in accordance with the Hippocratic oath. Hippocratic medical professionals have vowed to do no harm to their patients and certainly not to intentionally kill them. They recognize both the pregnant mother and the human being in her womb as their patients. The committee will hear testimony that elective abortion is necessary to a woman's reproductive health. But this is not true. Eighty-five percent of ob-gyns do not perform abortions as part of their professional practice, even though they are all trained to be able to separate a mother and her fetus at any gestational age. This is because elective abortion is not necessary for women's reproductive health. The purpose of an elective abortion is to produce a dead baby for social, not medical reasons. That was made explicitly clear by the testimony of the abortion providers at the partial birth abortion hearings before the U.S. Supreme Court. Abortion providers testified that the reason they kill the unborn human being during the partial birth abortion process is because they were paid to perform an abortion, not a delivery. This distinction is critically important to understand. If an ob-gyn needs to separate the mother and her unborn human being in the womb in order to save her life or the life of her baby, and the baby is at the point of being able to survive outside of the womb, then the ob-gyn will do a delivery procedure designed to maximize the chances of survival of both the mother and her unborn child. That is what an ob-gyn is trained to do. In contrast, an abortion done after a baby is capable of surviving outside of the womb is done to guarantee that the human being in the womb does not survive the separation procedure. She described the various partial birth abortion procedures. Occasionally, babies survive the feticide procedure and the induction. A baby who survives an induction abortion is called a "failed abortion." The separation from the mother did not fail to occur. What failed to occur was that the baby failed to die. DR. HARRISON said that it is true that rarely, the separation of the mother and the unborn human being in her womb must be performed before a baby is capable of surviving outside in order to save the mother's life. A Hippocratic ob-gyn would perform that delivery in a way to maximize the chances of the mother's survival and if possible, provide the family with the dignity of an intact body of their child to give them the opportunity to grieve their loss. This separation procedure is not the same as an elective abortion. Elective abortions are by definition not medical care. They do not cure any disease. Pregnancy is a natural condition that is limited in duration to nine months at the most. Disruption of that natural process carries serious risks for the mother. Some short-term risks are major hemorrhage, infection, anesthesia complications, damage to the mother's womb, and death. Long-term health risks include significantly increased risk of preterm birth in subsequent pregnancies, increased risk of breast cancer if a woman aborts before she ever brings a pregnancy past 32 weeks of gestation, and an increased risk of suicide, drug abuse, and major depression. These are certainly public health considerations that the state of Alaska has reason to be able to regulate, but under the current situation, the court does not allow for reasonable regulation in the interests of the mother's health and the life of the fetus. It is reasonable for the legislature to pass SJR 13 for the sake of the mother's health and to regulate in the interest of the unborn child. 2:27:20 PM TERRISA BUKOVINAC, representing self, San Francisco, California, said she is an atheist, liberal, feminist, vegan, an LGBTQIA ally, registered Democrat, and founder and executive director of Pro-Life San Francisco, a millennial-lead organization dedicated to resisting the influence of abortion in their community. As a full-time activist, she has seen similar bills across the nation. She has asked legislators across the nation why it is so controversial to declare that there is no right to abortion when they are not calling for its criminalization but keeping the door open for regulation. She has gotten the same answer over and over--there are people who want to use this legislation as a way to ban all abortions. Of course, there are those who want to ban all abortions. There are those who want to ban all birth control. There are people who think sex before marriage should be a crime. As a secularist, she understands that. But she is begging the committee to consider that hundreds and thousands of research projects rely on fetal tissue. They may think what is wrong with that. If there is going to be abortion, then at least the remains should go to curing diseases, etc. She gets that. But many of these projects require a monthly supply of multiple, late-term pristine fetuses between the ages of 18 and 24 weeks from elective abortions. Fetuses born after 24 weeks have a high likelihood of survival if given medical care. The only two methods are a fully-live dismemberment procedure or a medical induction. A medical induction, according to the Society of Family Planning, produces a born-alive infant up to half of the time. Most Democrats do not support that. MS. BUKOVINAC said that their constituents want the leadership of legislators on this issue, but many have been stigmatized and shamed into silence. The vast majority of people are not trying to ban all abortions. They are trying to ensure that it is regulated and they want there to be fewer of them. In the face of unrelenting pressure of the powerful abortion lobby, the will of the majority must be asserted loudly. Abortion up until birth is not a right. The people cannot protect viable, unborn babies from an industry that seeks to profit from their demise without the legislators' support for SJR 13. 2:32:07 PM CHAIR WILSON noted that over 100 people had signed up to testify and urged people to email written testimony. He opened public testimony. 2:32:31 PM LISA GENTEMANN, representing self, Eagle River, Alaska, said the state must defend and protect and speak up for the safety and rights of the unborn until they are able to defend themselves. Everyone was given the inalienable right to life by their creator, as stated in the Declaration of Independence. The government was implemented to secure rights. The declaration states that if part of the government does not secure people's rights, they have a duty to overthrow the government. Since the judicial branch does not follow the Declaration of Independence and has taken the inalienable right to life away, the people must "take it upon ourselves in sacred honor" and declare judges "as unfit to rule in a free nation and remove them from power and instead institute officials who will defend the right to life" for the public good. She asked the committee to support true governmental leaders, such as Senator Hughes, and lead the state in the right direction, in striving to protect all Alaskans through SJR 13. 2:34:48 PM LOREN LEMAN, representing self, Anchorage, Alaska, noted that he had served in the legislature for 14 years and as lieutenant governor for four years. SJR 13 is a necessary step to restore to elected officials and the people of Alaska the ability to set policy on abortion. Sadly, that authority has been usurped for more than two decades by a series of unfortunate court decisions. In 1979, he sponsored SB 24 to allow Alaskans to enforce the law already on the books for parental consent for abortions for minors. When Alaska legalized abortion in 1970, the law included a provision requiring parental consent before an abortion, but an attorney general's opinion said that was unenforceable. His bill had a judicial bypass to allow a young girl to go to the court to get permission instead of from parents. This was done in full compliance with the U.S. Supreme Court. At the time, the U.S. Supreme Court had issued a 9-0 decision that said don't send the court any more cases like this, it had already approved parental right statutes with these provisions. His legislation passed with a supermajority that could override a veto from then Governor Knowles. Planned Parenthood sued and it went to court, which ruled against the statute. Justice Dana Fabe wrote that only a parental notification law would be acceptable. He gathered the signatures for a citizen initiative and that became law and was in effect for several years. [Mr. Leman was unable to finish his testimony in the allotted time.] 2:38:17 PM ROBIN SMITH, representing self, Anchorage, Alaska, said that in 1973, Alaska was the third state to establish the right of a woman to have an abortion. This happened before Roe v. Wade was heard in the Supreme Court. Women and churches from across the state worked to get the law passed. They did so because women died from having illegal abortions. Few Americans remember how bad it was before Roe v. Wade. According to the Guttmacher Institute, 25 percent of women will have an abortion before they are 45. Fifty-nine percent of women who have abortions are already mothers. Making abortion illegal forces it underground and makes it unsafe. The best way to prevent abortion is to offer comprehensive sex education to all teens, free access to contraception, and a 12-month supply at a time instead of one month only. None of this is available in Alaska, yet Alaska has one of the highest rates of rape and sexual assault in the country. Contraception and fewer unintended pregnancies play a larger role in lower abortion numbers the past few years than abortion restrictions. 2:40:47 PM CAROLINE MALSEED, Reverend, Church of the Holy Trinity, Juneau, Alaska, said a lot of talk about restrictions to access to abortion is based on religious thinking, so she wanted to speak on the teachings of her church, the Episcopal Church. The Episcopal Church opposes abortion as a means of birth control or family planning. At the same time, since 1967, the church has maintained its "unequivocal opposition to any legislation on the part of the national or state government, which would abridge or deny the right of individuals to reach informed decisions about the termination of pregnancy and to enact upon them." The church in 2018 called for women's reproductive health and women's reproductive health procedures to be treated like all other medical procedures. The church continues to advocate that legislating abortions will not address the root of the problem. Any proposed legislation must take special care to see that the individual conscience is respected. Termination of pregnancies existed in Biblical times, but there are no Biblical prescription against it. Jesus said nothing about the termination of pregnancies. Enforced pregnancy is a violation of international law and is considered a war crime. Laws against abortion do not prevent them but result in unregulated and illegal abortions and death by hemorrhage or sepsis and the risk of suicide by desperate, isolated women. 2:44:08 PM ROBB ARNOLD, representing self, Juneau, Alaska, said that according to the U.S. Constitution, people have been endowed by their creator with certain inalienable rights, life, liberty, and the pursuit of happiness. It does not specify born or unborn, but each person has these rights. Personhood starts at conception. The state should not impede on those rights and use appropriations to violate the U.S. Constitution. The state of Alaska should not pay for those procedures and it should uphold the U.S. Constitution, honoring each citizen's right to life, liberty, and the pursuit of happiness. 2:45:52 PM SARAH HENNEMANN, M.D., representing self, Palmer, Alaska, said that as a family medicine physician, she has a unique window into the life of patients. Her patients are burdened with the weight of many difficult situations. She comes homes every day carrying a little bit of their pain, sadness, and anxiety. As her own children were becoming teenagers, she was grateful that the state was taking a stand to protect minors from being in a situation where they were supposed to undergo a medical procedure without their parents' awareness. As a physician, she understands that teens have adult bodies, but the frontal lobes of their brains are not completely formed until the mid20s, so parents have a vital role in directing the paths that teenagers take. The American Academy of Pediatrics has said that parents understand the unique needs of their children and should be the decision makers for their children's health care. She was proud of her fellow voters for understanding that parents should be at the very least aware that an abortion was performed on a family member. She had a teen patient who almost died due to delayed medical care because her parents didn't know that she had had an abortion. 2:48:48 PM WINDY PERKINS, representing self, Anchorage, Alaska, said that the topic was not necessarily debating abortion but trying to take some of the out-of-control power away from courts. She wanted to reiterate the importance of protecting minors. Ultimately, the end goal is to eradicate abortions, but with baby steps. This is a no-brainer amendment. What the courts have done is out of control. The times are changing. She is one voice of a new generation that sees that killing unborn children is indeed murder. They are survivors of Roe v. Wade. When judges can decide whatever they want, the system is out of control and laws must be changed. 2:51:45 PM MOIRA PYHALA, representing self, Soldotna, Alaska, said she is a lifelong Alaskan who was born and raised on the Kenai Peninsula. She knows the challenges many individuals have to go through to access their own health care decisions. Alaska, and specifically the Kenai Peninsula, has many unsolved community health concerns. One is that Alaska has the highest rate of sexual assault in the nation. She is one survivor of many of sexual assault in Alaska. She is grateful that the assault did not result in pregnancy. Others in her area have not been as fortunate and have had forced births or unwanted pregnancies. She cannot physically and emotionally imagine how her life would have been altered if she had become pregnant without access to abortion at 15. She would not have continued her education and graduated from the University of Alaska Anchorage and become a community organizer. SJR 13 does not end abortion. It just supports ending safe and legal abortion. The last thing her community and state need is young individuals like herself dying because they are victims of assault who cannot access their constitutional right to abortion. JONATHAN FISHER, representing self, Juneau, Alaska, said he has three babies. During his wife's pregnancies, every time he came into the room the babies in her womb would get excited because they would hear his voice. Not only is there life in the womb, but there is cognitive life. They have memories and know about their environment. These lives need to be protected. The fact that he has to fund abortions is completely wrong. Abortion is pure evil. He doesn't get a choice, he has to help fund this choice with his taxes. 2:56:05 PM LUANN MCVEY, representing self, Juneau, Alaska, said the she is a retired teacher. She values human life. It is important to bring a child into an environment where she is wanted, cherished, and cared for. It is also important for a mother to be cherished and cared for and have the choice of conception. When a woman conceives, it is her body, her choice, her right to bring that life into the world. If she is unable to properly care for a child, or for whatever reason, it is her body, her choice to remove the cells within her uterus. Controlling one's body and health is a human right that should be protected in statute. She cannot imagine that this kind of legislation would be considered if men conceived. It is wrong for the state to force women to bring children into world. 2:57:37 PM CHAIR WILSON observed that over 100 people were waiting to testify and that testimony would continue at a later date. He urged people to send testimony to shss@akleg.gov. He held the resolution in committee. 2:58:41 PM There being no further business to come before the committee, Chair Wilson adjourned the Senate Health and Social Services Standing Committee at 2:58 p.m.

Document Name Date/Time Subjects
SJR13 Bill Text ver. A 1.21.20.PDF SHSS 2/26/2020 1:30:00 PM
SJR 13
SJR13 Sponsor Statement 2.24.20.pdf SHSS 2/26/2020 1:30:00 PM
SJR 13
SJR 13 Sectional Analysis 2.24.20.pdf SHSS 2/26/2020 1:30:00 PM
SJR 13
SJR 13 NPR - Early Abortion Bans- Which States Have Passed Them (Full article) 2.24.20.pdf SHSS 2/26/2020 1:30:00 PM
SJR 13
SJR 13 Public Input 2.24.20.pdf SHSS 2/26/2020 1:30:00 PM
SJR 13
SJR 13 FN Gov Div of Elections 2.23.20.pdf SHSS 2/26/2020 1:30:00 PM
SJR 13
SB 173 Letters of Support 2.14.20.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Fact Sheet Feb 2020.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SL&C 3/12/2020 1:30:00 PM
SB 173
SB 173 Sectional Analysis.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SL&C 3/17/2020 1:30:00 PM
SB 173
SB 173 Sponsor Statement.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SL&C 3/17/2020 1:30:00 PM
SB 173
SB 173 Letters of Support 2.14.20.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Fiscal Note DCCED CBPL 2.10.20.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SL&C 3/17/2020 1:30:00 PM
SB 173
SB 173 - DCCED_DHSS_Medical Oversight Table 2.21.20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Fiscal Note DHSS Public Health 2.19.20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Investigative Process Overview_v.2 DCCED and HSS 2.23.20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 DCCED_CBPL_Complaint_Investigation_Flowchart 2.20.20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 DHSS EMS Investigation Process 12_20_19.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 DCCED_CBPL_Investigative_Process 2.20.20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB173 DHSS EMS Office audit process 2-20-20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Excerpt State Medical Board minutes_Feb2020_part1 2.25.20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Excerp State Medical Board minutes_Feb2020_part2 2.23.20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Letter of Support - Roy Browning Fire Chief Central Emergency Services.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB173 DHSS EMS Office audit process 2-20-20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173