SPONSOR SUBSTITUTE FOR SENATE BILL NO. 49 am "An Act relating to women's health services and defining 'medically necessary abortion' for purposes of making payments under the state Medicaid program." 1:46:29 PM Representative Costello discussed the bill's three fiscal notes including two indeterminate notes from Department of Health and Social Services (DHSS) and one fiscal impact note from DHSS with a cost of $55,200 in FY 15. 1:47:51 PM Representative Gara MOVED to ADOPT Amendment 1: Page 1, line 1, after "Act" insert "relating to women's health services and" Page 1, line 4, insert a new section to read: Section 1. AS 4 7.07 .030 is amended by adding a new subsection to read: (g) The department shall make available to eligible recipients a program for women's health for the purpose of providing family planning services, health screening examinations, and related services. Page 3, line 6, insert a new section to read: Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to read: WOMEN'S HEALTH PROGRAM UNDER STATE MEDICAID. The Department of Health and Social Services shall immediately prepare and submit to the United States Department of Health and Human Services, for approval in accordance with the provisions of 42. U.S.C. 1396a (Title XIX, Social Security Act), an amendment Co-Chair Stoltze OBJECTED and ruled Amendment 1 out of order. He stated that the amendment was identical to a vote that had previously taken place on the adoption of the CS [the CS previously adopted by the House Finance Committee had removed language that Amendment 1 would reinsert]. Representative Gara replied that the topic had been fully debated before the committee had all of the information about the women's health program. He believed that the amendment should be discussed given the updated information the committee had received. Vice-Chair Neuman MOVED to REPORT HCS SSSB 49(FIN) out of committee with individual recommendations and the accompanying fiscal notes. Representative Guttenberg OBJECTED. He spoke to the contentious nature of the bill topic. He remarked that a considerable portion of the bill had been removed following its passage from the Senate. He stated that if the goal was to reduce the number of abortions, the most immediate way was to prevent them from taking place. He stressed that the CS eliminated the consideration from the bill. He remarked that the constitutional issue would be played out in the Alaska courts. He believed that without a prevention component, the bill guaranteed the number of abortions would increase. He was equally bothered by the definition used in the legislation because it did not consider the health or well-being of the mother or who the responsible party would be for the unborn child. He believed that the legislation's definition treated the mother as the vessel carrying a child; that the mother had no responsibility and that government was responsible. He found it problematic that the bill did not honor a woman's decision about her own health, especially if the decision related to mental health. He believed the bill moved further away from a point where people could agree on a definition that would make things healthier for women and unborn children. He emphasized that the bill did not come near to resolving the issue. He noted that the courts had spoken on the issue; he knew no one liked making end-runs around the courts. He stated that the legislature was not getting closer to a definitive answer because it was refusing to acknowledge some of the more serious problems on the issue. 1:53:42 PM Representative Gara discussed that there were many individuals in Alaska who were pro-choice and many others who were not. However, constituents expected legislators to come together where they agreed. He stated that there was an opportunity to reduce the number of abortions by adopting a women's family planning program that would have covered 90 percent of the cost for contraception. He believed the number of abortions should be reduced through family planning. He believed it was a mistake to remove the provision from the bill. He thought the bill may increase the number of abortions and may also make them more dangerous for women who could not afford to go to a medical provider. He stated that women who had no children and were not pregnant would be covered by a women's health program. He stressed that contraception would result in fewer unintended pregnancies and fewer abortions. He believed it was a win-win for people on both sides of the pro-choice pro-life debate. He addressed former comments by a bill sponsor related to public health clinics. He discussed that many public health clinics provided some family planning services; however, women should have the right to go to their personal doctor. He did not believe there should be a law preventing women from going to their doctor when they wanted family planning services. He noted there were no public health clinics in Denali Park, Arctic Village, Barrow, Kotzebue, Togiak, Naknek, or King Salmon. He stressed that there had been an easy way for the bill to limit the number of abortions; he intended to have the discussion on the House floor. Representative Gara addressed the bill as a whole. He discussed that he was pro-choice, but that the topic of abortion made him uncomfortable. He did not like having fights in the legislature related to the divisive issue. The system created by the bill allowed middle class and wealthy woman to choose to have an abortion; however, it did not cover lower class women. He stated that a similar system had existed sometime in the past; unsafe abortions had led to the death and serious injury of mothers. He opined that states should each have a robust debate on the right to choose; he believed the right should exist. He did not believe in creating two classes of women; those who could afford a safe abortion and those who could not. 1:59:22 PM Representative Gara continued to discuss his objection to the legislation. He reiterated that the bill would increase the number of abortions for women due to a lack in family planning services and would also make abortions less safe. He did not support the legislation. Representative Munoz observed that federal law limited public funds for abortions. She noted that 547 abortions had been performed the past year. She believed it was clear that more abortions were happening than were medically necessary. She wondered why the bill's definition did not include diagnosed mental disabilities. Co-Chair Stoltze relayed his intent to allow the sponsor to provide clarity on the specific point. Representative Guttenberg remarked that the committee was in the middle of a motion and the sponsor was providing comments on the legislation. Co-Chair Stoltze explained his intent to have the sponsor address the topic as part of the committee deliberation. 2:01:57 PM Senator Coghill replied that the Alaska Mental Health Trust Authority talked about the need for commitment. The sponsor felt that the bill language left the issue well within the purview of a doctor. He stated that if a mental condition created a question [about the safety of a pregnancy] the doctor would have every right to make the decision. Representative Wilson spoke to her question from the prior day. She pointed to occurrences in 2012 and who paid for the service; she listed Medicaid, cash, insurance, and other. She did not know if the "other" category was the possibility for women to have the procedure who did not have insurance or Medicaid. She stated that if the "other" was another group taking care of women who did not qualify under other insurance then the question became who paid for the procedure. She was concerned about not knowing what the other was. She was hoping to have the question answered before it went to the House floor. She was bothered by the difference between items that were paid for by state insurance compared to Medicaid; she noted that state insurance paid only for medically necessary abortions. She stated that if a person did not qualify for a procedure under state insurance they were on their own to determine how to pay for it. She remarked on a definition used by private insurance that appeared to work given that there had been no legal suits. She was concerned that the state may get sued in the future because regulations already existed. She wondered why the state did not use the proven method used by other insurances versus going in the direction the bill went. She stressed that the state would get sued under the current method. She continued that if the state lost on the definition it cost money and meant the legislature would be required to discuss the issue again. She stressed that the term medically necessary was used for all medical procedures. She believed the issue should not have been made a "women's issue." She was willing to let the bill out of committee, but reiterated her hope for answers prior to hearing it on the House floor. 2:06:41 PM Co-Chair Austerman stated that he had always been pro- choice. He acknowledged the efforts of the sponsors to create a definition. He recognized that the debate was not about pro-choice or pro-life. His concern was about pro- life efforts to cumulatively move towards the pro-life goal. He believed any movement down a cumulative path to stop pro-choice created a long-term problem. He opposed the legislation. Representative Holmes was disappointed that the bill did not include a family planning program. She believed that working to avoid unwanted pregnancies was the area that everyone came together on. She urged the sponsors and committee members to include family planning. She spoke to the underlying language of the bill. She understood that the topic pertained to funding and was not about pro-life or pro-choice. The discussion related to who paid and under what circumstances. She pointed to the list included in the bill. She did not want to continue debating the issue, but did not know if the nail had been hit on the head. She believed the definition equated to the legislature telling a doctor what was and was not medically necessary. She agreed that under current laws Medicaid was only supposed to pay for medically necessary abortions; she was okay with that, but was uncomfortable with the list. 2:10:00 PM Representative Costello commented on the family planning portion that would not move forward with the legislation. She believed there was a place for a discussion about family planning, but she did not believe the language belonged in the current bill. She noted that adoption was not mentioned in the bill; she hoped that adoption would be discussed when family planning was addressed at some point. She shared personal information related to adoption. Representative Edgmon had hoped to be given the opportunity to vote on the family planning element. He discussed the cause and effect relationship of family planning services related to cost savings. He highlighted the lack of facilities in his rural district. He believed that in the current social environment (where there was an increased need for Village Public Safety Officers) there were many things occurring that family planning would enhance. He believed the objective supported by all was fewer unwanted pregnancies and abortions. He stated that without the family planning element it was difficult for him to support the legislation. He respected the sponsor, but he could not support the legislation. Vice-Chair Neuman spoke for the life of an unborn child. He believed the definition represented a good effort to find a scope of what medically necessary abortion meant. He believed there were some issues related to family planning that needed to be addressed. He supported bringing babies to full term so they could be adopted into families. He addressed Representative Wilson's concern related to private insurance. He thought insurance companies may choose to pay for an abortion even if a procedure was not medically necessary if it may save the insurance company money. He supported the bill and believed it was necessary to include descriptive language in statute. 2:14:49 PM Representative Costello MOVED to RESCIND previous motion on the fiscal notes. There being NO OBJECTION, it was so ordered. She moved two indeterminate and one fiscal impact fiscal notes from the Department of Health and Social Services. A roll call vote was taken on the motion to report the bill from committee. IN FAVOR: Costello, Neuman, Thompson, Munoz, Wilson, Stoltze OPPOSED: Guttenberg, Gara, Holmes, Edgmon, Austerman The MOTION PASSED (6/5). There being NO further OBJECTION, HCS SSSB 49(FIN) was REPORTED out of committee with "no recommendation" and with two indeterminate fiscal notes and one fiscal impact note from the Department of Health and Social Services. 2:16:19 PM AT EASE 2:24:47 PM RECONVENED