Legislature(2015 - 2016)CAPITOL 106
04/05/2016 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB345 | |
| HB334 | |
| HB315 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 345 | TELECONFERENCED | |
| += | HB 334 | TELECONFERENCED | |
| += | HB 315 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 345-INSURANCE COVERAGE FOR CONTRACEPTIVES
3:05:49 PM
CHAIR SEATON announced that the first order of business would be
HOUSE BILL NO. 345, "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."
3:06:28 PM
REPRESENTATIVE TALERICO moved to adopt the proposed committee
substitute (CS) for HB 345, labeled 29-LS1503\H, Wallace,
3/22/16, as the working document.
CHAIR SEATON objected for discussion.
3:07:24 PM
MEGAN CAVANAUGH, Staff, Representative Matt Claman, Alaska State
Legislature, shared the changes to the proposed committee
substitute, Version H. She relayed that Version H removes the
provisions that applied to over-the-counter contraceptives in
the original bill on page 1, lines 11 - 12; page 2, lines 16 -
17; and page 3, lines 18 - 19.
3:08:15 PM
REPRESENTATIVE MATT CLAMAN, Alaska State Legislature, as prime
sponsor of HB 345, paraphrased from the sponsor statement
[included in members' packets], which read as follows [original
punctuation provided]:
Unintended pregnancies have significant and negative
consequences for individual women, their families, and
society as a whole. Research links births resulting
from unintended or closely spaced pregnancy to adverse
maternal and child health outcomes and other social
and economic challenges. With Alaska's fiscal
challenges, we should look for ways to reduce costs in
the shortterm and long-term. House Bill 345 will
reduce costs associated with unintended pregnancies by
making oral contraceptives more easily available to
Alaskan women.
In 2010, 48% of all pregnancies in Alaska were
unintended. Alaska's unintended pregnancy rate in 2010
was 54 per 1,000 women aged 15-44. Of those unintended
pregnancies, 60% resulted in births, 26% resulted in
abortions, and the remainder resulted in miscarriages.
Most unintended pregnancies are associated with
significant public costs. In 2010, 64.3% of unplanned
births in Alaska were publically funded, which
resulted in a $42.9 million cost to the state.
House Bill 345 seeks to reduce the costs of unintended
pregnancies by making oral contraceptives more easily
available to Alaskan women. A research study shows
that women who were dispensed a 12-month supply of
oral contraceptives were 30% less likely to have an
unintended pregnancy than women who received a 1- or
3-month prescription. The study concluded that health
insurance programs and public health programs may
avert costly unintended pregnancies by increasing
dispensing limits on oral contraceptives to a 1-year
supply.
HB 345 requires health care insurers, including
Medicaid services, to cover 12 months of prescriptive
oral contraceptives at a time. Alaskan women often
face challenges while trying to access prescription
contraceptives. Women living in rural Alaska have less
access to healthcare services and therefore less
reliable access to prescriptive contraceptives.
Fisherwomen working on a boat for two or three months
at a time need longer supplies of prescription oral
contraceptives. This bill looks to reduce health care
costs in Alaska by preventing unintended pregnancies
and providing Alaskan women greater access to family
planning options.
3:09:19 PM
MS. CAVANAUGH clarified that the recently distributed fiscal
note reflected the original version and not the proposed
committee substitute, Version H. She explained that,
additionally, a fiscal note was written for the Senate companion
bill, SB 156, and reflected a $1.3 million cost savings for the
state.
CHAIR SEATON pointed out that the fiscal note for SB 156 was
located in the committee packets.
MS. CAVANAUGH reported that the proposed bill mandated that
health care insurers provide coverage for a prescriptive
contraceptive up to 12 months at one time. She defined
prescriptive contraceptives as self-administered, hormonal
contraceptives, namely oral contraceptives that do not require
insertion or other types of administration by a medical
professional. She said this was explained in Section 1 of the
proposed bill, which contained a religious exemption as well as
a definition for health care insurer, which included a self-
insured employer, such as the State of Alaska. She moved on to
explain that Section 2 of the proposed bill directed the
Department of Health and Social Services to cover the 12 month
supply of prescription contraceptives for eligible recipients of
medical assistance. Section 3 of the proposed bill allowed for
the 12 month supply of prescription contraceptives to be made
available to Medicaid recipients, and Section 4 of the proposed
bill related to the effective date.
MS. CAVANAUGH stated that a major premise behind the proposed
bill was that offering women greater access and availability to
contraceptives reduced unintended pregnancies. This reduction
in unintended pregnancies had a direct cost savings to the
state, which was reflected in the provided fiscal note, which
was drafted to the Senate version. She directed attention to
the study [included in members' packets], which reported that,
in 2010, 48 percent of pregnancies, about 8,000 pregnancies in
Alaska, were unintended. She pointed out that the study had
used the Centers for Disease Control and Prevention definition
of an unintended pregnancy to mean either "mistimed, or the
woman did not want to become pregnant at that time." She added
that the study estimated that 3,000, or 64.3 percent of the
unplanned pregnancies in 2010, were publicly funded. She
reported that Alaska had spent almost $113 million on unintended
pregnancies, that 70.8 percent was federally funded, while 42.9
percent was funded by the state. She relayed that these costs
also had impacts on programs down the line, including foster
care, and on the child's overall well-being. She shared that an
additional study [included in members' packets] reviewed 84,000
women in California provided with varying amounts of oral
contraceptives, and that those researchers observed a 30 percent
reduction in the odds of pregnancy when given a year-long supply
of oral contraceptives. Also reported in this study, the
California family planning program paid $99 more annually for
women who received three cycles of oral contraceptives and $44
more annually for women who received one cycle of oral
contraceptives than it did for women who received the 12-month
supply all at once. She shared that the additional costs were a
result of pregnancy tests and associated visits. She noted that
the proposed bill did not change who was eligible for coverage
or what kind of prescriptions were being covered, the bill only
allowed that women who currently received coverage for
prescription contraceptives could receive the prescription for
12 months at one time, if they choose. She shared that there
had been concerns expressed from the Small Business Association
for whether the bill would apply to self-insured entities. She
stated that the sponsor would continue to work with the group to
address these concerns. She pointed out that an important
inclusion to the proposed bill was for the definition of a
health care insurer to include a self-insured entity, which did
help to address some of the concerns. She declared that
proposed HB 345 would offer "huge advantages for Alaskan women,
from eliminating the inconvenience of refilling the prescription
every one or three months at a time to the real inability for
some Alaskan women to make it to the clinic, hospital, or
pharmacy to refill that prescription at all." She listed the
difficulties that many women faced in refilling prescriptions.
3:14:50 PM
REPRESENTATIVE TARR pointed out that the fiscal note showed a
$1.3 million savings annually.
3:15:11 PM
CHAIR SEATON opened public testimony on HB 345.
3:15:24 PM
DIANA GREENE FOSTER, Researcher, University of California, San
Francisco, explained that she was working on research for the
State of California to evaluate and analyze the impact of year-
long supplies for oral contraceptives. She shared that her
research indicated that the benefits included a cost savings of
almost $100 annually per person. She reported that there were
fewer clinic visits and fewer pregnancy tests. She relayed that
a second study linked family planning dispensing to claims for
pregnancies, births, and abortions. The findings were that
women who received a one year supply were less likely to have
either a birth or an abortion in the subsequent year. She
stated that oral contraceptives were the most commonly used
reversible method of contraception in the United States, and
that most unintended pregnancies and most abortions occurred to
women using contraceptives inconsistently. She reported that
one in five women in abortion clinics reported that they had
unprotected sex because they ran out of birth control. She
allowed that this change would offer a higher potential for
women to avert unintended pregnancies.
3:17:50 PM
CHAIR SEATON noted that a synopsis of her research is included
in members' packets.
3:18:27 PM
KENNI PSENAK LINDEN shared that, as a college student, she had
been diagnosed with Stage 4 endometriosis and had been
prescribed hormonal birth control to allow for the future
possibility to have children. She reported on the difficulty of
maintaining consistent use of birth control while being only
allowed a one-month prescription, and stated that having a 12-
month supply readily available "would have been a huge relief
and would have given me much needed peace of mind about my
health and my ability to choose what was best for me in
consultation with my doctor." She asked that the proposed bill
address access to birth control by dependents. She relayed the
health difficulties of endometriosis, and shared that the
prescriptions for hormonal birth control allowed her to continue
with and graduate from college. She declared support for the
proposed bill.
3:20:23 PM
ROBIN SMITH stated that this was a good bill, and there was no
reason not to pass it as it offered cost savings. She declared
that this was a preventative care bill, as it prevented
unintended and unwanted births and abortions. She listed 10
reasons why a doctor might prescribe birth control pills, other
than to prevent pregnancy: protection against ovarian and
endometrial cancer; prevention of ovarian cysts; prevent and
treat endometriosis; prevent anemia; avoid migraines associated
with menstrual periods; treat PMS; treat acne, and excess hair
growth; and balance hormone deficiency. She declared that, as
it was beneficial for women to have access to birth control
pills, there were not any negatives associated with the proposed
bill.
3:23:58 PM
CATRIONA REYNOLDS, Clinic Manager, Kachemak Bay Family Planning
Clinic, pointed out that she had sent in two pages of facts and
data. She stated that consistent access to birth control should
not be dependent on an insurance carrier. She listed the
benefits for supplying 12 months of birth control protection,
which included consistent use.
3:26:32 PM
STEVEN SAMUELSON stated his support of the proposed bill, noting
that people should not be hindered by legislation in pursuit of
health, especially when discussed with a doctor. He pointed out
that many women were working in the field and did not have
immediate access to refills. He declared "people like sex, so
why not have them be prepared." He reiterated his support of HB
345.
3:28:48 PM
ELIZABETH FIGUS reported that during the summer fishing season
she did not have time to visit a doctor. She allowed that,
although some medical issues were unavoidable, it was "silly"
and "unnecessary" not to pre-approve a birth control
prescription. She declared that the proposed bill would save
money and time for individual women, and would save the costs
for unplanned pregnancies. She pointed out that, as
contraception was already legal, it was only necessary to make
the system be more fiscally efficient. She stated her support
for proposed HB 345.
3:30:53 PM
CHRISTINE NIEMI, The League of Women Voters - Alaska,
paraphrased from a prepared statement [included in members'
packets], which read as follows [original punctuation provided]:
The League of Women Voters of Alaska strongly supports
HB 345 (companion to SB 156), a bill related to
insurance coverage for contraceptives and other
services that reduce the risk of unintended
pregnancies. At the national level, the League of
Women Voters of the United States supports primary
care for all, care that includes "prenatal and
reproductive health." When women have the consistent
ability to plan their pregnancies, their families
benefit through greater financial well-being,
healthier living conditions, healthier children,
greater opportunities, and a myriad of additional
benefits. While improving the quality of life for
families, the ability to avoid unintended pregnancies
also reduces costs for state and federal governments.
In 2010 according to the Guttmacher Institute, the
State of Alaska spent nearly $43 million on health
costs related to unintended pregnancies while the
federal government added another $71 million for a
total cost of $114 million. Guttmacher reports that
48% of all pregnancies in Alaska in 2010 were
unplanned and 64% of Alaska's unplanned pregnancies
were publicly funded, representing the $43 million
cost. In addition, the cost benefits of supporting
women in their efforts to plan their pregnancies goes
far beyond the cost of the pregnancy itself. A woman
who is able to plan a pregnancy can better guarantee
that her health is at optimum level prior to
pregnancy, reducing the risk of a difficult pregnancy
and trauma to the child. Such planning reduces the
possibility of increased health problems for the
child, problems which can follow the child for years
and require increased health and education costs for
the State. A planned pregnancy increases a woman's
ability to manage her role as income provider for a
family and allows that family the best opportunity to
remain as financially independent as possible.
Supporting affordable contraceptives prescribed on a
12-month basis will undoubtedly reduce the number of
unintended pregnancies in Alaska, thereby increasing
family wellbeing and reducing State costs. 2 HB 345
can assist women and families to plan pregnancies so
they are ready for the added responsibility of a
child. In addition, costs to the State for unintended
pregnancies can be reduced. This is a win-win bill
that deserves consideration by the Legislature
especially as it struggles with the budget crisis.
Thank you for your consideration.
3:32:36 PM
ALYSON CURREY, Planned Parenthood of the Great Northwest and the
Hawaiian Islands, stated support for insurance coverage for a 12
month supply of birth control when supplied by a health care
provider. She added that 1 in 4 women said they had missed
pills because of not being able to get them in time. She
reported that a one year supply dramatically improved consistent
use, lowered unintended pregnancies, and hence, reduced
abortions.
3:34:10 PM
SAMANTHA SAVAGE stated her support for HB 345 and she
paraphrased from a prepared statement [included in members'
packets], which read as follows [original punctuation provided]:
I am writing today to encourage you to support SB 156.
For many many women oral contraception is their method
of choice for various personal medical reasons.
Alaskan women face more barriers trying to access all
medications due to geographic and occupational reasons
(women who live and work in rural communities or on
fishing vessels for example). Speaking from my own
life as someone who left the Mat-Su Valley to attend
school in Fairbanks, trying to get my prescription
refilled was an incredible burden as I could only have
it refilled on a month by month basis. Having the
ability to have 12 months of birth control covered by
an insurance plan and Medicaid at one time saves in
costs related to doctors visits to the women seeking
medication, and it saves money related to unintended
pregnancy. I urge your support of this bill that would
have a positive impact on the lives of many Alaskan
women.
3:35:36 PM
CAITLIN HEDBERG urged support of the proposed bill. She shared
that she is a professional woman, and that she often traveled
for work. She noted that it was a burden having to re-supply
birth control, reporting that missing a pill or starting a new
cycle because of an interruption to access wreaks havoc on the
human body. She had experienced an unintended pregnancy due to
a lack of access for birth control. She pointed out that her
insurance would only allow a one month supply at a time. She
concluded that the proposed bill was the fiscally responsible
choice for the state and for the women of the state.
3:38:49 PM
MAXINE DOOGAN, Community United for Safety and Protection,
reported that she represented current and former sex workers in
Alaska, sex trafficking victims, and their allies. She declared
support for HB 345 as it expanded access to health care.
3:39:33 PM
CHAIR SEATON closed public testimony on HB 345 after
ascertaining no one further wished to testify.
3:39:41 PM
REPRESENTATIVE WOOL stated that he supported the proposed bill
as it "totally makes sense." He asked if this was an insurance
bill, and whether it had been previously possible for a 12 month
prescription for birth control pills.
MS. CAVANAUGH replied that currently women could not get a 12
month supply of oral contraceptives at one time, as it was
usually limited to one or three month supplies.
REPRESENTATIVE WOOL mused that the current state of insurance
regulations would not cover the payments for more than three
months.
3:41:32 PM
MARGARET BRODIE, Director, Director's Office, Division of Health
Care Services, Department of Health and Social Services,
explained that a Medicaid prescription was on a month-by-month
basis, with those individuals under 18 years of age able to get
a 3 month prescription. In response to Chair Seaton, she said
that the proposed bill would change the situation for a 12 month
prescription, but that it would be necessary to ensure that the
individual was eligible for all 12 months, and if not, the
department would have to reimburse the federal government for
its share of the prescription that the individual was not
eligible.
MS. BRODIE, in response to Chair Seaton, replied that private
insurance, dependent on the plan, was for either a one month or
a three month prescription.
REPRESENTATIVE WOOL directed attention to the benefit savings in
the analysis of the fiscal note, and asked about the difference
between the 9 percent failure rate and the 7 percent failure
rate, resulting in 120 unintended pregnancies. He questioned
whether all of the unintended pregnancies had resulted in
childbirth.
MS. BRODIE expressed her agreement that the 120 pregnancies
would not all result in live birth, and she offered her belief
that this had been taken into consideration in the calculations.
3:45:14 PM
CHAIR SEATON said that HB 345 would be held over.
3:45:45 PM
REPRESENTATIVE TARR declared that this problem with access had
been long standing. She pointed out that young families had not
testified, noting that they were very challenged with the
demands of parenthood and working. She opined that the proposed
bill would be very beneficial to young families.
3:46:58 PM
CHAIR SEATON removed his objection to the proposed committee
substitute. There being no further objection, Version H was
adopted as the working draft.
[HB 345 was held over.]