Legislature(2017 - 2018)BUTROVICH 205
03/13/2017 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB53 | |
| SB91 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 91 | TELECONFERENCED | |
| *+ | SB 53 | TELECONFERENCED | |
SB 53-INSURANCE COVERAGE FOR CONTRACEPTIVES
1:32:37 PM
CHAIR WILSON announced the consideration of SB 53.
1:32:43 PM
SENATOR BERTA GARDNER, Alaska State Legislature, Juneau, Alaska,
provided a sponsor's statement on SB 53 as follows:
SB 53 is, we believe, a cost-saving measure that will
help improve the lives of women in families. What it
does simply is it requires that health-care insurers
in the state of Alaska allow for coverage of a 12-
month supply of contraceptives, self-administered
hormonal-contraceptive patches at one time.
Some of you may be aware that prescription
contraceptives require that a woman return to her
provider or to a pharmacy for refills sometimes in one
month, sometimes in three-month increments.
Contraceptives have been used for a long time and are
known to be safe we think should be available in 12-
month increments.
Many women in Alaska don't have the ability to
consistently get to their providers for appointments
either because of work, location, or school. One-in-
four women report missing a pill because they couldn't
get the refill pack in time. Ensuring consistent
access to birth control gives individuals better
ability to control when and whether they have
children, it gives them more career and educational
opportunities and reduces the likelihood that they end
up needing government assistance. With perfect use,
hormonal birth control has a success rate of about 95
percent.
The data that we have that we are relying on comes
from 2010 that says, "In Alaska 48 percent of all
pregnancies were unintended; of those pregnancies, 60
percent resulted in birth, 26 percent in abortion, and
the remainder were miscarriages. Unintended
pregnancies have a drastic impact on the wellbeing of
Alaskan women and families, and are associated with
adverse maternal and child health outcomes, and along
with health concerns, unintended pregnancies are major
cost drivers to Alaska's public-health programs. In
2010, public-funded unintended pregnancies cost Alaska
almost $43 million.
When contraceptives are more readily available, Alaska
will see a reduction in the number of unintended
pregnancies and abortions which will ultimately result
in a cost savings to the state.
1:35:39 PM
JONATHON CHURCH, Staff, Senator Gardner, Alaska State
Legislature, Juneau, Alaska, provided supportive data on SB 53
as follows:
One of the studies in your packet followed 84,000
women in California who were given various supplies of
contraceptives: one-month supply, three months, and
one year. Researches of that study found that women
given a one-year supply saw a 30-percent reduction in
the odds of having conceived a pregnancy as well as a
46-percent reduction in the odds of having an
abortion. Had the remainder of the women in the study
been given a one-year supply, an estimated 1300
publicly funded births and 300 abortions would have
been avoided.
We have heard some concerns about the issue of pill
waste due to improper storage or possible illegal
selling. According to the CDC, oral contraceptives
have a shelf life of three to five years depending on
the manufacturer; this timeline can be diminished due
to humidity or temperature, but we believe that women
that opt for a 12-month supply of birth control and
who are regular users of oral contraceptives know how
to store their medications.
The study from California also found that women who
were dispensed the one-year supply of oral
contraceptives wasted on average one cycle. Wasting
one cycle is rather insignificant compared to the cost
of clinic and pharmacy visits as well as the cost of
unintended pregnancies. In the unlikely event that
women do start selling-off hormonal birth control,
there are already criminal statutes in place to deal
with that behavior. Senate Bill 53 would also make
birth control more readily available therefore
decreasing the need for any sort of black market.
MR. CHURCH provided a sectional analysis on SB 53 as follows:
Section 1:
Amends AS 21.42 by adding a new section, AS 21.42.427. AS
21.42.427 requires a health care insurer, in the group or
individual market, that provides coverage for prescription
contraceptives to provide reimbursement for dispensing
prescription contraceptives for a 12- month period. AS
21.42.427(b)-(g) contains other related compliances and coverage
provisions. Also provides provision for allowing for a religious
organization that is not required to provide contraceptives
under the Affordable Care Act would also be exempt from having
to provide contraceptives.
Section 2:
Amends AS 47.07.065 by adding new subsections (b)-(d), which
require the Department of Health and Social Services to pay for
prescription contraceptives intended to last for a 12-month
period for eligible recipients of medical assistance, if
prescribed to and requested by the recipient, as well as pay for
specified related services.
Section 3:
Requires the Department of Health and Social Services to amend
and submit for federal approval a state plan for medical
assistance coverage consistent with sec. 2 of this act.
Section 4:
Provides that sec. 2 of this Act takes effect only if the
provisions of sec. 2 of this Act receive federal approval.
Section 5:
Provides that if sec. 2 of the Act takes effect, it takes effect
the day after the commissioner of the Department of Health and
Social Services makes certification of federal approval under
secs. 3 and 4 of the act.
Section 6:
Except for sec. 5 of this act, provides for a January 1, 2018
effective date.
1:39:09 PM
MR. CHURCH addressed fiscal notes and an issue on coverage as
follows:
There are three-fiscal notes currently attached to the
bill. Two-fiscal notes noted from the Department of
Health and Social Services, and one zero-fiscal note
from the Division of Insurance.
One issue that came up recently is that the bill as
written would not cover the Alaska Care Plan which
covers 45 percent of state employees; this is due to
the location of the definition of health-care insurer
in Title 21. Since the Division of Insurance does not
regulate self-insured employers such as the state, we
would need to place the definition outside of Title 21
and at that time the Division of Administration will
have a fiscal note associated with the bill, but we do
not know what the fiscal impact will be at this time.
SENATOR BEGICH asked him to verify that the bill simply extends
the time period for contraceptives.
MR. CHURCH answered correct, 12 months instead of monthly or 3-
month visits.
SENATOR BEGICH assumed that the negative-fiscal notes are due to
data in the bill's report that the bill should lead to a drop in
unintended pregnancies and unintended abortions.
MR. CHURCH concurred with Senator Begich.
SENATOR GIESSEL noted that the bill contained more than
contraceptives and asked for an elaboration.
MR. CHURCH replied that the first portion of the bill addresses
the coverage for contraceptives that is required by the
Affordable Care Act and puts the requirements in statute, so the
coverage continues if changes occur.
SENATOR GIESSEL stated that she thought the bill strictly
addressed prescriptive contraceptives.
MR. CHURCH replied as follows:
Ultimately with the current requirements these are
already required by the federal government so there
would be no, I would say, practical change minus the
ability to prescribe the hormonal birth controls
beyond the one or three months.
1:42:26 PM
SENATOR VON IMHOF quoted section 1 in SB 53, lines 12-14 as
follows:
Provide coverage for prescription contraceptives;
voluntary sterilization procedures; and consultations,
examinations, procedures, and medical services that
are necessary to prescribe, dispense, insert, deliver,
distribute, administer, or remove the drugs, devices,
and other products or services provided under this
paragraph.
She asked if voluntary sterilization procedures were already in
the bill or being added in a new section.
MR. CHURCH explained that voluntary sterilization procedures
would be added to state statute. He assumed that the procedure
was covered by the Affordable Care Act. He noted that Megan
Wallace with Legislative Legal was available to speak more
accurately to the bill.
SENATOR VON IMHOF asked to confirm that the bill is not
necessarily about just adding 12 months of contraceptives. She
opined that voluntary sterilization gets into surgery and is
very expensive.
SENATOR GARDNER noted that the bill's intention is not to
increase coverage, but to simply say for the hormonal
contraceptives that people should be able to get them in a 12-
month supply.
SENATOR VON IMHOF asked to confirm that SB 53 is saying that
voluntary sterilization is included.
SENATOR GARDNER reiterated that her intention is for the 12-
month supply and asked that the bill's drafter address the
committee.
1:44:42 PM
At ease.
1:45:40 PM
CHAIR WILSON called the committee back to order.
SENATOR VON IMHOF repeated her inquiry regarding voluntary
sterilization procedures versus the sponsor's intent of just
covering 12 months of oral contraceptives.
1:46:15 PM
MEGAN WALLACE, Attorney, Legislative Affairs Agency, Alaska
State Legislature, Juneau, Alaska, addressed bill-drafting
questions regarding SB 53 as follows:
Section 1 starting on page 1, line 9, requires that
any insurance plan offered in the state have to
provide coverage for a, b and c, which is prescription
contraceptives, the voluntary sterilization
procedures, and the consultation, examination,
procedures, and medical services that are necessary
for those services; in addition to that, the bill
requires that a health-care insurer reimburse for 12
months of birth control.
Yes, the bill does two things: it requires the
sterilization and consultation and procedures and
other services necessary to have birth control or
other contraceptives prescribed and those procedures
necessary to carry out those prescriptions covered and
then in addition requires essentially a 12-month
supply of contraceptives where requested.
SENATOR VON IMHOF asked to clarify if the verbiage being added
is new or is already covered by the Alaska Care Plan.
MS. WALLACE replied as follows:
I cannot speak to what the plan already covers, I
don't possess that information, so that would be a
question for the administration in terms of whether
they can confirm that these coverages are already
available under this specific plan. All I can advise
is that the bill requires that all health-insurance
plans provide the coverage in both item-1 on page 1,
[lines 10-14], and then item-2 which is on page 2,
line 2-6; it requires both 1 and 2 being included in
all plans offered in the state if this bill becomes
law.
1:48:58 PM
SENATOR MICCICHE noted that AS 21.42.420 has coverage for
prescription drugs and asked why a separate section under AS
21.42.420 was not considered that simply says, "Birth control
pills and hormonal contraceptive patches will be extended for
360 days versus the 90 days that is currently allowed under the
section." He asked why an entire subsection was created that
included other services.
MS. WALLACE replied as follows:
The bill does more than provide prescription drug
coverage, so it was essentially a drafting decision to
set this requirement out in their own subsection
because as I was just articulating the bill requires
coverage for certain procedures, consultations,
examinations, and then in addition to that there's
restrictions on the coverage provided under this
section that don't apply to the prescription drug
coverage under AS 21.42.420.
SENATOR GARDNER specified as follows:
Our intent is not to add any new coverage as not to
change co-pays, but simply to have prescription,
hormonal, self-administered contraceptives to be
available at a 12-month plan and why it was drafted
differently I don't know. I should know, but I don't.
SENATOR BEGICH asked Ms. Wallace why the bill was drafted in a
way that was not what the sponsor of the legislation requested.
1:51:44 PM
MS. WALLACE replied as follows:
I was directed to draft the bill that is in front of
us and if there was a miss communication between our
office and Senator Gardner, the sponsor, I'd be happy
to provide her with a new version that clarified that
intent, but essentially it was my understanding that
we provided the bill that was requested.
SENATOR BEGICH asked Senator Gardner if the bill does what she
intended it to do.
SENATOR GARDNER replied apparently not and conceded that the
bill goes further.
1:52:40 PM
CHAIR WILSON announced that the committee will hear public
testimony.
1:52:57 PM
At ease.
1:54:52 PM
CHAIR WILSON called the committee back to order. He announced
that SB 53 will be held awaiting a committee substitute (CS).