Legislature(2023 - 2024)BELTZ 105 (TSBldg)
04/29/2024 01:30 PM Senate LABOR & COMMERCE
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s): Alaska Labor Relations Agency | |
| SB211 | |
| SB257 | |
| SB153 | |
| HB17 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 211 | TELECONFERENCED | |
| += | SB 257 | TELECONFERENCED | |
| += | SB 153 | TELECONFERENCED | |
| + | HB 17 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
HB 17-CONTRACEPTIVES COVERAGE:INSURE;MED ASSIST
3:00:34 PM
CHAIR BJORKMAN announced the consideration of CS FOR HOUSE BILL
NO. 17(HSS) am(efd fld), "An Act relating to insurance coverage
for contraceptives and related services; and relating to medical
assistance coverage for contraceptives and related services."
3:01:15 PM
REPRESENTATIVE ASHLEY CARRICK, District 35, Alaska State
Legislature, Juneau, Alaska, sponsor of HB 17, introduced
herself and gave an overview of HB 17. She said, since the mid-
1990s, 28 states have required health insurance plans regulated
by the state to provide coverage of prescription drugs and
devices to also cover prescription contraceptives. Federal law,
under a provision in the Affordable Care Act (ACA), expanded on
state policies in several ways. The ACA's contraceptive coverage
guarantee stems from the Public Health Service Act, which
requires non-grandfathered health insurance coverage and
employer sponsored group health plans to cover preventative
services without cost sharing and requires coverage of women's
preventative services as defined by the Health Resources and
Services Administration. Since the time [ACA took effect], 22
states and the District of Columbia have [through legislation]
ensured that women can receive an extended supply of a
[prescribed contraceptive] method at one time, usually a 12-
month supply, which is provided for in HB 17, rather than the
current guidelines of a one-to-three-month supply.
3:02:33 PM
REPRESENTATIVE CARRICK said HB 17 would put into Alaska statutes
language that is consistent with standards set in the federal
contraceptive coverage guarantee and HB 17 would mandate
coverage for dispensing up to 12 months of prescription
contraceptives at one time.
REPRESENTATIVE CARRICK said HB 17 was being brought forward
because Alaskans often face numerous challenges when trying to
access prescription contraceptives. She said that women,
especially those living or working in rural Alaska often cannot
take multiple trips a year to the pharmacy, not without great
cost and inconvenience. Additionally, the many women working in
high demand careers that take them away from regular providers,
such as working up on the North Slope, working in the field
doing research in our commercial fishing industry, in mining or
in other professions, makes this barrier a consistent one for
contraceptive access. A one-year supply of contraceptives will
assist many women in Alaska to balance their personal health
with work and family life. She referred to research provided to
the committee members from the Journal of Obstetrics and
Gynecology, which shows that women who are dispensed a 12-month
supply of contraceptives show a 30 percent drop in unplanned
pregnancies and a 46 percent drop in the likelihood of abortion
compared to women dispensed just a one-to-three-month supply.
3:03:57 PM
REPRESENTATIVE CARRICK said she brought HB 17 forward, not only
because it's often time consuming and deeply inconvenient to
obtain these [contraceptive] prescriptions every one to three
months, but also because she said she knew improved access to
contraceptives would mean improved health for women and better
family planning. She said, under HB 17, providers would still be
able to make decisions in consultation with their patients to
decide what type and length of prescription contraceptive to
provide. She said HB 17 would not change that relationship, or
those diagnosis decisions. However, HB 17 would remove insurance
coverage as a barrier to access. In other words, HB 17 wouldn't
change what happens in a doctor's office, it would change what
happens at the pharmacy counter.
3:04:40 PM
REPRESENTATIVE CARRICK briefly addressed the changes to the
committee substitute for HB 17, noting the bill had gone through
several changes on the House side and the Senate side.
• On the House side, in its first committee of referral,
emergency contraception, and all reference to emergency
contraception was removed from HB 17. HB 17 does not cover
Plan B or emergency contraceptives.
• On the House floor, religious exemption language was also
added - more robust religious exemption language than what
currently exists in statute.
• The religious exemption language was clarified to more
accurately reflect the intent of the sponsor of that
amendment on the floor.
• Technical changes were added at the request of the
Department of Health and the Division of Insurance to
ensure that HB 17 would be neutral and would not generate
any fiscal note.
• Effective dates were adjusted to be appropriate to the HB
17.
REPRESENTATIVE CARRICK noted the presence of individuals to
answer questions from the committee and an invited testifier
online for the Committee's consideration.
3:06:28 PM
CHAIR BJORKMAN announced invited testimony on HB 17.
3:06:47 PM
ROBIN HOLMES, M.D., Family Medicine Physician, Homer, Alaska,
said she was testifying in favor of HB 17 and HB 17 would
dramatically improve access to the full range of contraceptive
methods by requiring insurance to cover a year's supply of birth
control at one time, building on the Affordable Care Act's
contraceptive coverage mandate to ensure all people have timely
access to contraceptive care. She said HB 17 would also ensure
that patients and providers have full control over what
contraceptive method is used without arbitrary restrictions such
as prior authorizations or insurance-mandated management
techniques.
DR. HOLMES said, as a board-certified family medicine physician,
she had seen how access to contraception affected the lives of
Alaskans every day and had the privilege of supporting her
patients through the entire lifespan with evidence-based medical
care that empowered them to choose when and if to have a family,
as well as raising the family they had in the healthiest way
possible. Unfortunately, she said part of her job and advice
entailed anticipating barriers to accessing medications,
including insurance denials and restrictions on quantity. She
said it was known that one in three women missed their
contraception doses because they could not pick up a refill in
time. Barriers to contraception imposed by insurance companies
make no sense for Alaskans and cause significant economic and
physical harm to our population. She said she regularly had
patients who were in school and could not make it to the
pharmacy during the limited hours they are open to pick up
another pack of pills, or a motivated college attendee or
commercial fisher who is unable to fill enough contraception
[prescriptions] to get them through until they are back in town.
In many cases, her patients must rely on family or friends who
have their own families and work schedules to get the medication
they need. She said she often had patients with disabilities
whose insurance plans deny their access to certain
contraceptives, leaving them with no coverage for the methods
that are safest and most effective for them and forcing them to
use medications they cannot take due to their disability. She
said she had seen patients who at the height of their careers,
working multiple jobs or working while raising a family, who
could not get to the pharmacy to pick up contraceptive
prescriptions.
3:09:16 PM
DR. HOLMES said whether to use contraception or which
contraceptive method to use, is a private medical decision that
should be made by a patient in consultation with their
healthcare provider. Medical providers are extensively trained
in how to prescribe contraceptives safely and when restrictions
may be warranted. HB 17 does not supersede a doctor's judgment
if a short supply is warranted. When insurance companies force
people to use ultimate contraceptive methods, they are not
recommended for them. She said, in order to get what they
actually need, they cause inefficiencies in the systems that may
cause harm to the patient.
DR. HOLMES advocated for Alaska to have fewer barriers to
medications than other states. Even for those on the road
system, she said her patients have to travel for hours to access
prescriptions; and with contraception, even one or two days can
make a huge difference in a person's life. Outside of Alaska,
there are fewer baseline barriers to accessing birth control,
and we have seen how expanding access makes a positive
difference in other states.
3:10:15 PM
DR. HOLMES reported that the CDC named birth control one of the
top 10 public health achievements in the past century, and birth
control is widely credited for contributing to women's societal
educational and economic gains. Access to contraception allows
people to avoid unintended pregnancy, and unintended
complications. She said, when women were able to obtain a full
year of birth control on time, their odds of an unintended
pregnancy decreased by 30 percent and odds of an abortion
decreased by 40 percent versus when they were given a one-to-
three-month supply.
Dr. HOLMES concluded her testimony and said access to
contraception should be up to a provider and patient, not
insurance companies. She said birth control was incredibly safe.
She said the patients [providers] care for were smart and aware
of their needs and their goals and regarding decisions about if
and when and how they build their families. She urged the
committee to support HB 17 to allow Alaskans meaningful access
to contraception.
3:11:18 PM
CHAIR BJORKMAN held HB 17 in the Senate Labor and Commerce
Standing Committee.