HB 25-INSURANCE COVERAGE FOR CONTRACEPTIVES  3:02:16 PM CHAIR SPOHNHOLZ announced that the first order of business would be HOUSE BILL NO. 25, "An Act relating to insurance coverage for contraceptives and related services; relating to medical assistance coverage for contraceptives and related services; and providing for an effective date." 3:03:12 PM LIZZIE KUBITZ, Staff, Representative Matt Claman, Alaska State Legislature, stated that proposed HB 25 mandated that health care insurers provide coverage for a 12-month supply of contraceptives at one time. She reported that currently, women who used prescriptive contraceptives needed to return to the pharmacy every one to three months to refill their prescriptions. She pointed to the difficulties for women who did not have access to transportation, worked multiple jobs, or lived in rural areas of the state of getting refills so often. She shared that the Centers for Disease Control and Prevention (CDC) recommended dispensing a year's supply of contraception, as missing pills was a major reason for oral contraceptive failure leading to unintended pregnancies. Greater access and availability to contraceptives reduced unintended pregnancies, with a direct cost savings to the state. She noted that hormonal contraceptives were used for reproductive health care and other medical reasons, including menstrual pain and migraines. She declared that the proposed bill sought to make prescriptive contraceptives more easily available, which made sense for Alaskan women and families. REPRESENTATIVE SULLIVAN-LEONARD asked about testimony from those who were seeking contraceptives for a full year. MS. KUBITZ replied that there were individuals ready to testify. 3:06:07 PM CHAIR SPOHNHOLZ opened public testimony. 3:06:40 PM JUDY ANDREE, League of Women Voters, stated that the League of Women Voters fully supported comprehensive affordable health care for all people, including reproductive health care, and the availability of birth control. She stated that the ability to avoid unintended pregnancies was of primary importance to a woman's health and her ability to chart her own future. She relayed that planning a pregnancy with the help of birth control could increase a woman's economic opportunities. She said that this could also lead to savings to the state, as 64 percent of pregnancies required public financing. She pointed to a letter of support [Included in members' packets]. She added that this was the time to accept birth control as an important and normal part of women's health care, and that it should be as affordable and accessible, as possible. She reiterated support of the proposed bill. 3:08:55 PM CARMEN LOWRY, Executive Director, Alaska Network on Domestic Violence and Sexual Assault, offered some background on the network, that it was comprised of 19 member programs which provided services to victims and survivors of domestic violence and sexual assault across Alaska, about 7,000 people during the previous year. She said that access for a 12-month supply of contraceptives allowed protection and a reduced risk of coercion from an abuser. She stated that it was a common tactic for an abuser to attempt to control access to birth control. She shared research which had shown that women were more vulnerable during pregnancies, hence their range of choices for leaving an abusive relationship became more limited. She stated that a 12- month supply offered a wider range of choices. She declared, as there was a disproportionate number of women experiencing domestic violence in rural areas, it was important to ensure full range access to contraceptives. She stated support for the proposed bill. 3:12:21 PM ALYSON CURREY, Planned Parenthood Votes Northwest and Hawaii, stated support for the proposed bill. She declared that every woman should have full access to the birth control method that worked best for her, without any barriers to cost or availability, regardless of insurance plan. She stated that proposed HB 25 would remove any barriers, allow women more career and education opportunities, encourage healthier pregnancies, and make them less dependent on government programs. She reported that consistent use of birth control was the best way to prevent unintended pregnancy, although, one in four women stated they had missed pills because of a lack of availability. A full year supply improved consistent use, reduced the odds of an unintended pregnancy by 30 percent and was associated with a 46 percent drop in the chance of needing an abortion. She declared that this was cost effective for both public and private insurance plans, as it lowered the costs for follow up visits, pregnancy tests, and the long term costs associated with unintended pregnancy. She declared that this was a solution that would work for women and she stated support of HB 25. 3:14:24 PM ELIZABETH FIGUS, PhD. Student, University of Alaska Fairbanks, shared that she was a fisherperson during the summers which did not allow much time to get to doctors, and she urged support of the proposed bill. She declared that it was frustrating and an unnecessary expense to alter schedules for a pre-approved prescription pick-up. She offered her belief that this bill was about streamlining prescription medication pick-ups. She pointed out the need for economic efficiency. She stated her support for HB 25. 3:16:13 PM MICHAEL PAULEY, Alaska Family Council, stated that the council was opposed to the proposed legislation, as it was essentially taking a health care mandate and grafting it into state law. He directed attention to written testimony [Included in members' packets]. He expanded on a few of those points, noting that the primary objection was for a sweeping one size fits all mandate which would require every insurance plan issued in Alaska to provide coverage for certain drugs and devices that "have the effect of causing very early abortions." He stated his organization's objections toward helping subsidize or facilitate this. He opined that the proposed bill defined prescription contraceptive as a drug or device as something which required a prescription and was approved by the U.S. Food and Drug Administration for the purpose of preventing pregnancy. He offered definitions for conception and pregnancy, which he opined were similar to those by numerous religious groups which had filed lawsuits objecting to the Patient Protection and Affordable Care Act (PPACA). He reiterated that the religious exemptions offered in the proposed bill "ranged from inadequate to non-existent." He offered the belief that it was a mistake to "peg the religious exemptions to federal statutes and regulations associated with [PPACA]" and that religious exemptions "should be spelled out in plain English." He suggested that the House Health and Social Services Standing Committee seek legal advice for interaction of the proposed bill with the existing statute, AS 25.20.025. He asked if a young woman could receive contraception and have her parent's health insurance pay for this. He asked that the committee review the broader economic impact of the proposed legislation, specifically on the effect of fertility on the long term economic well-being. He referenced the "replacement level fertility rate" which addressed the average number of children born to each woman in a society in order for the population to sustain itself. He spoke about an international "demographic crisis" in developed countries. 3:25:43 PM ARLENE BRISCOE, Vice President, Legislative Chair, Alaska Nurses Association, stated support for the proposed bill, and directed attention to a letter of support [Included in members' packets] stating the strong belief that Alaskan women and families should have an opportunity to have available, adequate birth control supplies for 12-months at a time. She declared that this would prevent unintended pregnancies which cost the state millions of dollars annually. 3:27:15 PM RUDY POGLITSH said that the proposed bill allowed abortion and not contraception, which he deemed was "the gravest of moral issues." He stated that lawmakers should not force someone's morality on someone else. He declared his opposition to HB 25. 3:28:15 PM KATIE BRUGGEMAN declared that the U.S Supreme Court, not advocacy groups, had decided that women could decide for themselves whether they wanted to bear and raise children. She shared that one reason to support the bill was that lower income women working several jobs and relying on public transportation would benefit from fewer trips to the pharmacy. She opined that there were also fewer administrative costs. She stated that the proposed bill made sense for women in the tourism and fishing industries who did not have access readily available to pharmacies. She declared that family planning was an essential component of economic opportunity for women, and that reproductive choice allowed for great access to education and career advancement. 3:29:24 PM JEANNETTE OKINCZYC stated her support of the proposed bill and said that birth control was a responsible action and that family planning should be a right. She stated that the proposed bill offered families the power to make responsible decisions. 3:31:12 PM CHAIR SPOHNHOLZ closed public testimony. REPRESENTATIVE EASTMAN asked for the division's perspective. 3:31:46 PM ANNA LATHAM, Deputy Director, Juneau Office, Division of Insurance, Department of Commerce, Community & Economic Development, replied that the Division of Insurance had prepared a zero-fiscal note for the proposed bill, and that the administration's stance was officially neutral. She relayed that this legislation would be processed to ensure that it adhered to Alaska statute before approval by the division. MS. LATHAM, in response to Representative Eastman, said that self-funded plans under ERISA [Employee Retirement Income Security Act of 1974] could take this into account and any group health or individual market plans would require legislative action prior to the change. REPRESENTATIVE EASTMAN asked what changes would need to be made for this to be done voluntarily. MS. LATHAM replied that it would need to be driven by a change in Alaska statute. REPRESENTATIVE EASTMAN asked what, in statute, would keep this from being changed if it was desired. MS. LATHAM offered her belief that nothing in statute would prevent this from an insurance standpoint, although there could be another prescribing requirement or other issues. CHAIR SPOHNHOLZ suggested that the bill sponsor could offer additional information. MS. KUBITZ in response to Representative Eastman, said that the proposed bill was not a mandate to insurance companies, however it allowed for an option to the consumers. The proposed bill would be a mandate to make it available, as it was currently the "culture of the insurers" to only offer shorter supplies. REPRESENTATIVE EASTMAN questioned the financially beneficial aspect as insurance companies were not currently offering it, when they usually acted in their own economic best interest. REPRESENTATIVE MATT CLAMAN, Alaska State Legislature, offered his belief that it would be necessary to ask the insurance companies. MS. KUBITZ cited a letter in opposition, and added that there was a general "push back" to any mandates to insurers. REPRESENTATIVE EASTMAN asked if any insurance companies had taken this step. MS. KUBITZ said that although a number of states had implemented this mandate, she was not aware of any insurance companies offering this on their own. REPRESENTATIVE EASTMAN asked about a response to the concerns for claims that this was a mandate for early abortions. MS. KUBITZ replied that emergency contraceptive pills were covered under contraceptives, and that the proposed bill was offering a safe and effective means of preventing pregnancy. She declared that emergency contraceptive pills did not terminate or interrupt an established pregnancy, hence they did not cause an abortion. She declared that the only connection to abortion was the potential to prevent the need. REPRESENTATIVE EASTMAN asked for her definition to pregnancy. MS. KUBITZ offered her understanding that emergency contraceptive pills prevented ovulation, and not the termination of an established pregnancy. CHAIR SPOHNHOLZ pointed out that these were already available on the market and that the proposed bill did not specifically address them. She stated that this was a different issue, the proposed bill was for an extension to the availability of contraception. REPRESENTATIVE JOHNSTON asked why this 12-month supply was not being offered for other prescription drugs with similar benefits to the patient. MS. KUBITZ replied that there were a number of maintenance medications available, including birth control, high blood pressure, and heart disease, and prescribers could write prescriptions for a 90 day supply with three refills. She opined that control of the dispensation was a choice of the insurance companies, which was different for different insurance companies. REPRESENTATIVE JOHNSTON asked about an extension of this mandate to include other drugs, citing that "it's not broad enough" as a possible problem with the legislation. REPRESENTATIVE CLAMAN reminded that there had been discussion in a previous meeting for "a number of medications that are prescribed up to 12-month supply." He offered his understanding that there were other medications dispensed for more than 90 days, citing some of the mail-in prescription programs, although he was unsure of the details for specific medications. REPRESENTATIVE EASTMAN asked if anything prevented the dispensation of contraception medication through the mail. MS. KUBITZ replied that there were mail order programs through some insurers for a 90-day supply. She pointed out that the proposed bill allowed for all of the prescription to be mailed in bulk at one time. She offered her belief that women would like access to more than what was currently available. REPRESENTATIVE EASTMAN opined that a year was a long period of time, and that it was possible for some loss of the pills. He asked about any associated cost and impact on the insurers. REPRESENTATIVE CLAMAN offered his belief that the risk of losing prescriptions did not depend on the length of the supply, and that there was not a significant impact to the actuarial world. MS. KUBITZ added that the fiscal note labeled OMB 2077 provided by the Department of Health and Social Services [Included in members' packets] did take into account the potential loss of supply. 3:46:01 PM CHAIR SPOHNHOLZ stated that the bill would be held over.