Legislature(1999 - 2000)
03/24/1999 01:40 PM Senate HES
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SB 82-INSURANCE COVERAGE FOR CONTRACEPTIVES
CHAIRMAN MILLER called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:40 p.m. and brought up SB
82.
SENATOR GARY WILKEN, presented his sponsor statement on SB 82
which requires insurance carriers to provide coverage for
prescribed contraceptives and related health costs. While many
health care plans pay for surgical means of preventing pregnancy,
few pay for the routine oral contraceptive methods prescribed and
recommended by physicians.
Women spend about 68% more out-of-pocket costs for health care than
men. One of the biggest contributors to those expenses is birth
control. The most widely used prescription drug of women aged 15
to 54 is for birth control, yet most insurance companies do not
include contraceptive coverage in their policies.
The out-of-pocket cost for oral contraceptives is about $25 per
month while the estimated increase in insurance premiums for
coverage for birth control is about $16 annually per enrollee,
according to the Health Insurance Association of America.
Requiring insurance coverage for contraceptive services not only
makes good business sense, but it also increases access to
contraceptives and related services.
In response to a person's conscientious objection to contraceptive
coverage, SB 82 states an individual health care insurance policy
or a policy issued by a qualified church-controlled organization
with a religious-based objection is exempted from this mandate.
Eight out of ten privately insured adults support contraceptive
coverage. SENATOR WILKEN concluded, SB 82 recognizes this strong
public support, and he urged the committee's support for this
legislation.
Number 046
SENATOR WILKEN commented that people will point out the increased
cost of $16 for this coverage, but the cost is much more for
unwanted pregnancies and the problems caused by unwanted
pregnancies. This is an investment that over time pays back, and
the cost of insurance over time will decrease because of this bill.
On a personal note, SENATOR WILKEN related that he became involved
in this issue when his daughter, an active high school junior
needed oral contraceptives, not for birth control but to regulate
female hormones so that she could basketball. He said, "You can
imagine when my wife said to me, 'Gary, I think we need to put
Karen on birth control pills' what I said... a junior in high
school." After the reasons were explained to him, his daughter
went on birth control pills and is an active college basketball
player today. The birth control pill began as a medicinal device
for birth control and it's evolved into a significant therapy to
control female hormones.
He referred to pages 3-4 of the committee packets containing quotes
of support from organizations, and studies speaking to the benefits
of contraceptive coverage.
SENATOR WILKEN brought up the draft CS and a draft Amendment
Version H. He moved that the committee adopt the CS as a working
document. Without objection, the CS was adopted.
SENATOR WILKEN explained the CS, Version H, does two things. Last
year in similar legislation the intent language addressed the
primary purpose of contraceptives in preventing conception. This
CS rolls that purpose, which gave a lot of people comfort, into the
legislation itself. Secondly, the CS cleans up the bill by
removing the definition of contraceptive device and adding the
words "obtained by prescription" to clarify that only
contraceptives obtained through a doctor's prescription are covered
by this insurance.
Number 107
CHAIRMAN MILLER announced that following testimony on SB 82, many
people want to speak on SB 94, and he set a 2-minute time limit on
testimony on both bills.
MS. THEDA PITTMAN, Anchorage, thanked Senator Wilken for
introducing SB 82 and urged co-sponsorship and support by the
committee members. She stated that according to DHSS, there were
over 10,000 births in Alaska in 1995 and 41% were unintended,
unwanted or mis-timed. In 1995 alone there were 4,000 reasons why
this legislation is a good idea. She suggested that two groups
oppose this idea, the insurance companies and members of the "far-
righteous groups" that seek to control the right of a woman to make
her own decision about pregnancy.
MS. CATHY GIRARD, Anchorage, expressed support for SB 82. She
stated her medical bills over 10 years for prescription
contraceptives and related medical exams have not been reimbursed
by her insurance plan or her husband's. She asked why Viagra, a
sexual aid for men, is covered by both their insurance policies and
yet contraception, primarily made for and purchased by women is
not covered by current insurance programs.
MS. MARY ROSS, Nurse-Midwife representing the Chapter of the
American College of Nurse Midwives, Anchorage, expressed support
for SB 82 as a practitioner for women's health care. Many women up
to the age of 52 use birth control as a supportive measure during
the perimenopausal and menopausal times.
MS. ROBIN SMITH, Anchorage, spoke in strong support of SB 82,
stating insurance coverage for contraceptive care would be a good
business decision. Recently four of her employees, both male and
female, have dealt with unintended pregnancies, causing emotional
stress and negative impacts on her business including lost employee
time. increased work loads on others, re-hires and re-training.
Small business cannot dictate special insurance coverage for
employees, and must choose a package that does not include birth
control coverage in Alaska. Rectifying this inequity in health
care for women will establish a more stable work force and
stronger, healthier families.
MR. CHARLES MCKEE, Anchorage, stated he thought it was mandatory
insurance coverage for all individuals in the state of Alaska.
Number 260
MR. SCOTT CALDER, Fairbanks, referred to the language on page 2,
Section 3, line 6 "except for a policy issued to an individual or
a qualified church-controlled organization," and "qualified church-
controlled organization" on page 2, lines 15-16, defined under 26
U.S.C. 3121(w)(3). He asked why the focus is on a religious-based
organization when 'fraternal benefit society' is not included in
this section, which he found referenced in Sec. 21.42.390.
MS. KAY LAHDENPERA, Public Health Nurse representing the Alaska
Nurses Association, applauded the committee for SB 82, which "is
terribly important to reduce unintended pregnancies." There are
about 6 million unintended pregnancies nationally every year. Women
must have the opportunity to plan their families and get coverage
for this $25-$35 per month expense. The National Commission to
Prevent Infant Mortality estimates infant death could be reduced by
10% and incidence of low birth weight babies reduced by 12% if
pregnancies were planned.
Number 312
MR. GORDON EVANS, representing the Health Insurance Association of
America (HIAA), a national trade association of commercial health
insurance companies, stated HIAA opposes SB 82 as presently
written. Its provisions mandate coverage for contraceptives, which
is not considered to be basic health care treatment, and the
consequences in the long run would be to increase the costs and
reduce the efficiencies of managed care. As noted previously, the
HIAA favors the preservation of a system that allows the
prospective purchaser of health insurance free choice of which
risks he or she wishes to cover from among the various coverages
offered by competing insurance carriers. The HIAA also believes
that the choice of how the policy holder spends the funds available
for health insurance should be free of government decree. Any time
government mandates certain coverage, that mandate becomes one of
the rating factors which insurance companies use in making their
underwriting decisions. Premium costs would be increased, even for
those people who have no use for or do not want the coverage.
MR. EVANS continued, this mandate would apply only to small
employer group policies and certain other group policies who
generally can least afford a premium increase. The mandate would
not affect Alaska's largest employers such as Carrs, BP, ARCO, or
EXXON which are self-insured and subject to federal ARISA law which
pre-empts state law. The mandate also would not affect those with
federal insurance coverage such as the Indian Health Service.
Technically, it wouldn't affect the state employees.
Senator Wilken noted a $16 cost; however, MR. EVANS felt the figure
is misleading because it covers only the cost of contraceptive
drugs like birth control pills. It does not include contraceptive
devices or appliances like IUDs, or the cost of related health care
services.
HIAA would not be opposed to a mandate to offer coverage for
contraceptives and related health care services. As a result,
policy holders - employers and their employees - would be able to
choose whether to spend additional funds on this type of coverage.
They, and not the insured population in general, would pay the cost
of that coverage. Substituting the word "offer" for the word
"provide" on page 1, line 10 of original draft would make the
coverage sought as a mandated offering. MR. EVANS suggested this
would accomplish the purposes of the bill's proponents.
Referring to the adopted draft CS, HIAA opposes favoring a specific
group, as in the language "a qualified church-controlled
organization" because it gives persons of one religion a preference
over other groups who also may not want the coverage but will have
to take and pay for it. MR. EVANS said it should be an "all or
nothing bill."
Number 371
SENATOR ELTON asked if Mr. Evans' testimony that emphasized the
cost that will be spread to all policy holders, disputes the
sponsor's claim that the contraceptive health coverage would save
money by not incurring additional medical expenses with unwanted
pregnancies or problem pregnancies.
MR. EVANS replied that is the HIAA position.
SENATOR WILKEN responded that in the testimony in U.S. Congress on
the recently passed Equity in Prescription Insurance and
Contraceptive Coverage Act, the president of the organization said
"we oppose mandates but we're not going to spend a dime fighting
this."
He continued, noting for the record that the total dollars spent
per employee is $17.12 on all contraceptive devices including oral,
diaphragms, cervical caps, injectables, implants and IUDs. Of that
figure, $16.13 or almost 95% is spent on oral contraceptives.
MR. EVANS countered that the memo provided to him last session by
Senator Ellis stated oral contraceptives cost on average $25 per
month.
Number 400
MS. BECKA BRAUN expressed support for SB 82. She described it as
a "win/win" proposition because it would reduce the number of
unintended pregnancies. According to several studies, half of
unintended pregnancies end in abortion in this country. Those who
support choice and those who oppose abortion can all agree that
reducing the number of abortions is a good thing, and making
contraceptives more widely available is one very smart way to do
that. Studies show that as the availability of contraceptives
increases, the number of legal and illegal abortions decreases.
Those unintended pregnancies that go to full term have costly
effects for society and for the state.
There's a much higher pregnancy rate with cheap contraceptives,
such as condom failure. These are the methods most affordable to
women. It doesn't make sense to exclude contraception, the only
FDA-approved prescription drug regularly excluded by insurers.
It's not included on the list of "basic health care" but MS. BRAUN
said she's not sure what basic health care entails, when Viagra is
covered. Insurer costs should not rise by more than 1% under this
proposed mandate. She urged the committee's support of SB 82.
SENATOR WILKEN moved the draft Amendment Version H.1 by Ford 3/24.
The text follows.
Page 2, lines 6-7:
Delete "for a policy issued to an individual or a qualified
church-controlled organization with a religious-based objection"
Insert "as provided in (b) of this section"
Page 2, following line 11:
Insert a new subsection to read:
"(b) This section does not apply to a policy
(1) issued to an individual;
(2) issued to a qualified church-controlled
organization with a religious-based objection
to contraceptives; or
(3) that does not provide coverage for drugs
obtained by prescription."
Reletter the following subsection accordingly.
SENATOR WILKEN explained that it inserts a provision that if a
policy is in place by an employer that does not offer coverage for
prescription drugs, this legislation would not impose upon the
employer the requirement that they now offer prescription coverage.
If they did have prescription coverage, contraceptive prescription
coverage would be included.
Number 446
SENATOR ELTON objected to adopting the amendment for the purpose of
discussion. He pointed out on line 8 of the amendment, it provides
that this section does not apply to a policy "issued to an
individual." The previous language has been removed that said
"issued to an individual with a religious objection." He asked if
this means that only insurance policies that are group insurance
policies would now be affected.
SENATOR WILKEN replied he put it in at the request of Blue Cross.
He admitted he did not know why that change was made.
CHAIRMAN MILLER followed up, asking if this language just deals
with those companies that do not offer the coverage, that being the
original understanding of the amendment.
SENATOR ELTON replied, and CHAIRMAN MILLER agreed, that this
section outlines the exceptions. This broadens the exception that
had formerly applied to an individual, now including any policy
written to an individual.
SENATOR WILKEN stated his staff told him that language was in last
year's bill.
MR. EVANS said the way he reads the draft CS with the draft
amendment, this bill would exempt individual policies; it would
exempt policies issued to church-controlled organizations; and it
would exempt any group policies that do not provide coverage for
drugs obtained by prescription. On the other hand, the CS on page
2, line 5-6 says "except for a policy issued to an individual or a
qualified church-controlled organization with a religious-based
objection."
CHAIRMAN MILLER followed up, asking if the language is because an
individual who decides he doesn't want this coverage may be
mandated by law to take the coverage anyway.
MS. MARIANNE BURKE, Director of the Division of Insurance, stated
Chairman Miller is correct. Individual policies are individually
underwritten, and (Chairman Miller) would probably not want a
policy that covered oral contraceptives.
CHAIRMAN MILLER asked for objection to adopting the amendment.
Hearing none, the amendment was adopted. He asked the sponsor if
the bill covers contraceptives prior to conception but not after
conception, such as the RU 486 drug. He said that question will
come up on the Senate floor.
SENATOR WILKEN replied post-conception prescriptions are not part
of this legislation. The intent language from last year's bill was
incorporated into the CS on page 2, lines 1-2 and states "insurance
providers not be required to cover the cost of prescriptive drugs
necessary to cause the rejection of a fertilized ovum." The intent
of the bill addresses pre-conception.
Number 505
SENATOR KELLY stated "that may be the bill's intent, but with our
Judiciary, I'm sure somebody's going to take the right to privacy
clause of the Constitution and require that you include RU 486 or
something like that...I think you'll probably find that there will
be a lawsuit on that."
He said he's not a big fan of the bill, and he doesn't feel the
Legislature has any business telling insurance companies that they
have to do this. Contraceptives are widely available, and this asks
insurance companies to cover those who choose more expensive
methods than condoms. It doesn't require legislation. It
encourages people to go toward oral contraceptives which have no
value in prevention of sexually-transmitted diseases (STDs). He
asked, would there be unintended health consequences as a result of
this? Are we putting a burden on private industry? Those are his
biggest objections to this bill.
SENATOR WILKEN said he appreciated Senator Kelly's comments. He
doesn't have data on STDs. He wants to see mandated coverage
happen sooner because the cost of insurance will go down. It's an
issue of equity and of money. Some women can't afford the
contraception they need, and he suggested that those are the
pregnancies that should be most controlled. While there is a
rackful of inexpensive male contraceptives available, there is not
a rack of female contraceptives, and this limits a couple's ability
to plan and time their childbearing. This legislation is a tool
that could benefit society.
SENATOR WILKEN said he cannot understand why it's taken so long to
get us to where we are today. It's an investment in lowering
costs, and an investment in society, and it gives us more options
to plan our lives. If the industry doesn't want to do it, then
this bill will encourage them to do it, and he said he's pleased to
do that.
Number 540
CHAIRMAN MILLER said that, like Senator Kelly, he's not necessarily
a big fan of the bill, but he is willing to be democratic and let
the will of the committee prevail. He asked for a motion.
SENATOR ELTON expressed appreciation for the work of the sponsor to
bring the legislation this far, and said he looks forward to it
being on the Floor.
SENATOR WILKEN moved to report CSSB 82(HES) out of committee with
individual recommendations and indeterminate fiscal note.
CHAIRMAN MILLER asked for objection. Senator Kelly objected and
the roll was called, with Senators Wilken, Peace and Elton voting
"yea," and Senators Kelly and Miller voting "nay." CSSB 82(HES)
passed out on a 3-2 motion.
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