03/09/2017 03:00 PM House HEALTH & SOCIAL SERVICES

          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.