Legislature(2023 - 2024)BUTROVICH 205
03/12/2024 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SCR9 | |
| SB27 | |
| SB240 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SCR 9 | TELECONFERENCED | |
| *+ | SB 27 | TELECONFERENCED | |
| += | SB 240 | TELECONFERENCED | |
SB 27-CONTRACEPTIVES COVERAGE:INSURE;MED ASSIST
4:08:51 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 27
"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."
4:09:02 PM
SENATOR LÖKI TOBIN, District I, Alaska State Legislature,
Juneau, Alaska, speaking as sponsor of SB 27, introduced
herself.
4:09:21 PM
SENATOR TOBIN emphasized that SB 27 is critical contraceptive
legislation. She cited a 2020 report by the Joint Economic
Committee of the U.S. Senate. The report highlights the
importance of access to birth control, noting its impact on
women's economic outcomes, including higher education
attainment, income, better health, reduced poverty, narrowing
the gender pay gap, and increasing labor force participation.
She pointed out that while birth control is constitutionally
protected, many women in Alaska still face barriers to access,
particularly due to pharmacy closures and vacancies in U.S.
Postal Service offices, which affect timely delivery of
contraceptives by up to 12 weeks. She expressed concern about
how extreme weather and lack of access to pharmacies further
impede the ability to obtain birth control. She highlighted the
broader societal benefits of family planning, including reduced
child poverty and improved educational outcomes for children.
She mentioned the Affordable Care Act's role in reducing out-of-
pocket costs for women by $483 million in one year and noted
that a 2014 study included in the 2020 Joint Economic Committee
Report showed that preventing unplanned pregnancies has saved
$15.2 billion in Medicaid maternity and child related costs. In
addition, there was an associated miscarriage Medicaid cost
savings of $409 million. She stated that SB 27 is essential for
expanding contraception coverage in Alaska by requiring insurers
to cover up to a 12-month supply at once. SB 27 includes
exemptions for religious employers that meet specific
requirements. SB 27 will also help ensure both public and
private healthcare insurers cover a 12-month supply of
contraceptives.
4:14:23 PM
MICHAEL MASON, Staff, Senator Löki Tobin, Alaska State
Legislature, Juneau, Alaska, Provided the sectional analysis for
SB 27.
[Original punctuation provided.]
Senate Bill 27
"Insurance Coverage for Contraceptives and Related
Services" Sectional Analysis
Version: 33-LS0241\A
Section 1 AS 21.42.427 Adds a new section that (1)
requires a health care insurer to provide coverage for
prescription contraceptives and medical services
necessary for those products or devices (including
over-the counter emergency contraception that was
obtained without a prescription); (2) requires
reimbursement to a health care provider or dispensing
entity for dispensing prescription contraceptives
intended to last for a 12-month period for subsequent
dispensing; (3) prevents an insurer from offsetting
the costs of compliance; (4) prevents an insurer from
restricting or delaying coverage for contraceptives;
(5) if the provider recommends a particular service or
FDA-approved item based on a determination of medical
necessity, the plan or issuer must cover that service
or item without cost sharing; and (6) exempts
religious employers if certain criteria are met.
Section 2 AS 29.10.200 Amends AS 29.10.200 by adding a
provision applying to home rule municipalities.
Section 3 AS 29.20.420 Amends AS 29.20 by adding a new
section clarifying that municipal health care
insurance plans that are self-insured are subject to
the requirements of sec. 1.
Section 4 AS 39.39.090(a) Clarifies that a group
health insurance policy covering employees of a
participating governmental unit is subject to the
requirements of sec. 1.
Section 5 AS 39.30.091 Clarifies that a self-insured
group medical plan covering active state employee
provided under this section is subject to the
requirements of sec. 1.
Section 6 AS 47.07.065 Requires the Department of
Health and Social Services to pay for prescription
contraceptives intended to last for a 12-month period
for subsequent dispensing for eligible recipients of
medical assistance, if prescribed to and requested by
the recipient, as well as medical services necessary
for those products or devices. The Department of
Health and Social Services must also provide coverage
for over-the-counter emergency contraception that was
obtained without a prescription.
Section 7 Uncodified Law Requires the Department of
Health to immediately amend and submit for federal
approval a state plan for medical assistance coverage
consistent with sec. 6 of this Act.
Section 8 Uncodified Law Makes sec. 6 of the Act
conditional on the approval required under sec. 7 of
the Act.
Section 9 Uncodified Law If, under sec. 8 of this Act,
sec. 6 of this Act takes effect, it takes effect on
the day after the date the United States Department of
Health and Human Services approves the state plan
amendment or determines an amendment is not necessary
4:17:47 PM
SENATOR TOBIN acknowledged that concerns raised by the Division
of Insurance exist and stated that the committee is open to
potential amendments to the legislation. She expressed the
intent to clarify any outstanding issues through these
adjustments to ensure SB 27 addresses all concerns effectively.
4:18:26 PM
CHAIR WILSON referenced SB 27, page 2, line 13 [Section 1
(2)(c)], which states, "Except as provided in (d) of this
section, a health care insurer may not offset the costs of
compliance with (a)...". He asked how SB 27 would ensure that
insurers do not pass the costs of compliance onto plan holders.
4:19:10 PM
SENATOR TOBIN deferred the question.
4:19:39 PM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community & Economic Development, Juneau, Alaska,
replied that SB 27 has an indeterminate fiscal note likely for
three relatively small changes. She explained that when the
state adopted the Affordable Care Act (ACA) essential health
benefits benchmark plan it agreed on what would be presented in
the individual market. If the state strays outside of the
agreement, the Centers for Medicare and Medicaid (CMS) can ask
the state to defray the cost. The Division of Insurance
suggested changing three provisions in SB 27 that might trigger
such an action. Asking an insurer to let go of co-pays is one of
the three triggers. Therefore, the division suggests deleting
(c) and replacing it with, "except for as provided in (d)",
which should alleviate the concern of the co-pays referenced in
(c). She said the second concern is use of "over the counter"
because the ACA does not ask insurers to pay for over-the-
counter drugs on emergency contraceptives. The third possible
trigger is on page 2, lines 20 - 29 concerning medical
management techniques. The division recommends deleting (e) and
replacing it with, "the health care insurer that applies the
medical management techniques, such as step therapy or prior
authorization must provide for a simple and easy to understand
exception."
4:21:26 PM
MS. WING-HEIER expressed hope that these suggestions are not
seen as offensive and do not change the bill's intent. She noted
that while CMS could fine the state, it is not a certainty. She
emphasized that the changes do not significantly alter SB 27's
intent and offered to work with the sponsor on further ideas.
4:22:13 PM
CHAIR WILSON announced invited testimony on SB 27.
4:22:31 PM
SENATOR TOBIN acknowledged that she serves on a non-profit board
that provides operational support to Kachemak Bay Family
Planning and stated her desire to have the conflict of interest
on record.
4:22:45 PM
ROBIN HOLMES, Ph.D., representing self, Homer, Alaska, described
her work as a family medicine physician and emphasized how SB 27
will improve access to contraceptive methods. She explained that
the bill would require insurance to cover a year's supply of
birth control at once and allow patients and providers full
control over the choice of contraception without arbitrary
limits. She noted that barriers to accessing contraception,
including insurance denials and restrictions, negatively impact
her patients, 30 percent of whom miss doses due to refill
issues. She highlighted challenges faced by patients in school,
commercial fishing, or college, who struggle to get timely
refills, often relying on family members for assistance.
4:25:11 PM
DR. HOLMES discussed the challenges faced by individuals with
disabilities, whose insurance plans often deny access to certain
contraceptives, forcing them to go through ineffective stepwise
methods. She noted that patients working multiple jobs or caring
for families also struggle to get prescriptions on time. She
emphasized that contraceptive decisions should be private and
made between a patient and their healthcare provider, with
providers trained to prescribe safely and adjust quantity when
necessary. She highlighted the importance of continuous access
to birth control, particularly for medical conditions like
polycystic ovarian syndrome and endometriosis, where missing
doses can lead to serious health impacts. She added that
expanding access to a 12-month supply of contraception has
proven effective in areas outside of Alaska.
4:27:27 PM
DR. HOLMES stated that the Centers for Disease Control and
Prevention (CDC) recognized birth control as one of the top 10
health achievements of the past century, crediting it for
contributing to women's societal, educational, and economic
gains. She explained that when women have access to a full year
of birth control rather than the current one to three-month
supply in Alaska, the odds of unintended pregnancy decrease by
30 percent, and abortion rates fall by 46 percent. She
emphasized the importance of addressing loopholes in insurance
practices through state laws to reduce income- and geography-
based disparities in unintended pregnancy rates and access to
medically necessary treatments. She noted that 26 other states,
including Washington, DC, have enacted similar policies, and
Alaska must recognize the racial disparities in health outcomes,
particularly for Alaska Native and American Indian women who
face systemic and geographic barriers to accessing reproductive
health care, including contraception. Alaska has a 20 percent
Native population and should lead the charge in reducing the
barriers they face. She concluded by urging support for SB 27 to
expand access to contraception, positioning Alaska alongside
other states pursuing financially sound solutions.
4:30:14 PM
INGRID JOHNSON, representing self, Anchorage, Alaska, introduced
herself as an associate professor at the University of Alaska
Anchorage, clarifying that she holds a PhD and is a
criminologist, not a medical doctor. She said her research
focuses on victimization, particularly intimate partner and
sexual violence, and how victims seek help and services. She
emphasized her expertise in rural-urban dynamics and her role as
the principal investigator for the Alaska Victimization Survey
(AVS). She referenced a handout provided, which includes data
from the 2020 AVS and other sources, highlighting statistics
relevant to her testimony.
4:32:06 PM
MS. JOHNSON discussed the connection between birth control
access and intimate partner abuse, noting that requiring regular
trips to pharmacies or medical providers disproportionately
impacts those in abusive relationships and their risk for
homicide victimization. She shared that 48.3 percent of Alaskan
women have had controlling partners, which makes it difficult to
regularly seek medical care. These controlling behaviors can
include monitoring their activities, restricting access to
money, and reproductive control, complicating efforts to obtain
contraception. She emphasized that this figure is a
representative, weighted estimate from a randomized sample of
Alaskan women.
4:34:18 PM
MS. JOHNSON noted that almost one in five Alaskan women, or 18.8
percent, have experienced reproductive control in their
lifetime, underscoring the importance of easy access to
contraceptives to reduce unintended pregnancies. She explained
that the Alaska Victimization Survey (AVS) uses two measures for
reproductive control: partners attempting to get women pregnant
against their will or trying to prevent them from using birth
control, and partners refusing to use a condom when requested.
This reproductive control affects one in five women in Alaska,
illustrating the significance of this issue.
4:35:00 PM
MS. JOHNSON referred to the third bullet point in her handout,
explaining that it is not a generalizable estimate but comes
from a large sample of about 13,000 women who participated in
the Alaska Victimization Survey (AVS). This sample includes data
from the 2010, 2015, and 2020 statewide surveys, along with
regional surveys conducted between 2011 and 2015. While not
generalizable, it closely represents the population. The data
shows that 18 percent of Alaskan women have experienced sexual
assault by an intimate partner. She highlighted that separate
reports provide generalizable rates of sexual assault for adult
Alaskan women. She said one fifth of adult Alaskan women
experience sexual assault by an intimate partner and emphasized
that this underscores the importance of access to birth control
in abusive relationships.
4:36:15 PM
MS. JOHNSON stated that the last bullet point, with two sub-
bullet points, comes from non-Alaska Victimization Survey (AVS)
data sources, which are cited in her handout. She explained that
pregnancy increases the risk of violent victimization for women,
especially those in abusive relationships. Qualitative research
shows that abusive partners sometimes intentionally try to
impregnate their partners to prevent them from leaving.
Additionally, extensive research indicates that pregnancy raises
a woman's risk of homicide, a critical concern in Alaska, where
the rate of women killed by men is nearly double the national
average.
4:37:03 PM
SENATOR DUNBAR highlighted how the connection between extended
contraceptive coverage and violence prevention is an important
point often overlooked when discussing bills like SB 27. He
acknowledged that this concept resonates with policymakers
familiar with the issue. He noted that her testimony was
particularly timely, referencing that many people in the
building were wearing purple in recognition of Ashley Johnson-
Barr Day, which focuses on violence against children, as well as
sexual violence and violence against women. He emphasized that
her testimony demonstrated a concrete action that could help
address these issues and expressed his gratitude.
4:38:10 PM
CHAIR WILSON opened public testimony on SB 27.
4:38:39 PM
MAUREEN O'HANLON, representing self, Sitka, Alaska, testified in
support of SB 27. She said the SB 27 matters to her because her
quality of life depends on access to birth control pills. She
explained that she has endometriosis, a painful condition with
no cure, and that birth control pills help manage its symptoms
and progression. She highlighted the inconvenience of only
receiving a one- to three-month supply, especially for those in
Alaska who work seasonal jobs or live in remote areas. She
emphasized that birth control has no overdose risk or street
value and urged elected officials to support SB 27 for her
health and safety.
4:39:52 PM
OLIVIA LYNN, representing self, Fairbanks, Alaska, testified in
support of SB 27. She stated that birth control is essential for
her to remain competitive in her job as a single, childless
union journeyman electrician. She explained that without it, her
work performance would suffer due to endometriosis, but with
birth control, she can manage these symptoms every three months
and schedule time off without negative consequences. It is not
possible to overdose on birth control so there is no street
value. She emphasized that all Alaskans deserve the opportunity
to be more competitive in their careers and improve their
standard of living. Consistent access to birth control is key to
ensuring this opportunity for everyone.
4:41:06 PM
NANCY SCHEETZ-FREYMILLER, representing self, Anchorage, Alaska,
testified in support of SB 27. She said she is retired but
served on the Council of Domestic Violence and Sexual Assault
and has been involved with other women's issues for many years.
She expressed gratitude to the committee for addressing the
topic and supporting women's full participation in Alaska's
economy and society. She acknowledged the challenges of creating
equal access for all Alaskans and felt that earlier testimony
addressed solutions to the issues raised. She emphasized that,
while SB 27 may seem small, it has the potential to make a
significant impact on Alaska's future.
4:42:29 PM
At ease
4:42:34 PM
CHAIR WILSON reconvened the meeting.
4:42:58 PM
CHAIR WILSON closed public testimony on SB 27.
4:43:09 PM
SENATOR GIESSEL noted that SB 27 was offered more than a year
ago. She expressed appreciation for Senator Tobin's efforts in
bringing it forward.
4:43:23 PM
SENATOR TOBIN shared that during her time in the Peace Corps,
she had access to 12 months of birth control, though she didn't
fully grasp the complications she might face if she had
unintentionally become pregnant. When she and her husband
decided to have a child, she was grateful to be near a major
medical facility, which she credits for her being here today.
4:44:03 PM
CHAIR WILSON held SB 27 in committee.