Legislature(2013 - 2014)HOUSE FINANCE 519

02/25/2014 08:00 AM House FINANCE

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08:01:57 AM Start
08:02:11 AM SB49 || HB173
10:00:59 AM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
SPONSOR SUBSTITUTE FOR SENATE BILL NO. 49 am                                                                                  
     "An Act relating to women's health services and                                                                            
     defining 'medically necessary abortion' for purposes                                                                       
     of making payments under the state Medicaid program."                                                                      
HOUSE BILL NO. 173                                                                                                            
     "An Act defining 'medically necessary abortion' for                                                                        
     purposes of making payments under the state Medicaid                                                                       
8:02:11 AM                                                                                                                    
Co-Chair Stoltze discussed the agenda for the day.                                                                              
8:03:11 AM                                                                                                                    
SENATOR  JOHN  COGHILL,   SPONSOR,  introduced  himself  and                                                                    
discussed his intent related to the bill presentation.                                                                          
Senator Coghill  stated that  SB 49  would bring  clarity to                                                                    
Medicaid  payments  for  abortions.  He  detailed  that  the                                                                    
Alaska Supreme Court ruled that  the state pay for medically                                                                    
necessary   abortions,  but   a   definition  of   medically                                                                    
necessary had not been provided.  The bill was an attempt to                                                                    
define   medically   necessary,   which   would   categorize                                                                    
abortions outside  of the definition  as elective.  The bill                                                                    
addressed when  a medically necessary abortion  was required                                                                    
and  looked  to  the  physical   health  of  the  woman.  He                                                                    
communicated  that  a  presentation  would  provide  further                                                                    
REPRESENTATIVE   GABRIELLE   LEDOUX,   SPONSOR,   introduced                                                                    
herself. She relayed  that HB 173 was the  companion bill to                                                                    
SB 49.  She believed  the term medically  necessary abortion                                                                    
needed to be  defined. She did not see the  bill as pro-life                                                                    
or pro-choice,  but only as  fiscal legislation.  She stated                                                                    
that the  bill would bring  clarity to a  previously unknown                                                                    
8:06:25 AM                                                                                                                    
CHAD HUTCHINSON,  STAFF, SENATOR  JOHN COGHILL,  stated that                                                                    
SB 49 was  about bringing clarity to  the previously unknown                                                                    
term "medically necessary abortion."  The goal was to define                                                                    
the term for the purpose  of making payments under Medicaid.                                                                    
He  referred to  a bound  document titled  "SB 49  Committee                                                                    
Binder" (copy  on file).  Tabs 1  and 2  included a  copy of                                                                    
SSSB 49 am and the  sponsor statement. He clarified that the                                                                    
bill did  not attempt  to argue  a prior  Planned Parenthood                                                                    
case  from  2001  (Tab 7).  The  sponsor  acknowledged  that                                                                    
Alaska was required to  provide medically necessary services                                                                    
including  medically   necessary  abortions   to  low-income                                                                    
individuals. The  challenge was that no  definition had been                                                                    
established   to   determine  what   constituted   medically                                                                    
Mr. Hutchinson  pointed to  Tab 1 and  read the  bill title.                                                                    
Section 1 of the bill had  been amended on the Senate Floor.                                                                    
Section  2 included  the definition  for the  term medically                                                                    
necessary abortion. He read from Section 2(a):                                                                                  
     The department may not pay  for abortion services under                                                                    
     this  chapter unless  the abortion  services are  for a                                                                    
     medically necessary  abortion or the pregnancy  was the                                                                    
     result of rape  or incest. Payment may not  be made for                                                                    
     an elective abortion.                                                                                                      
Mr. Hutchinson  read from  the top of  page 2  pertaining to                                                                    
the definition of abortion:                                                                                                     
     (2) "elective  abortion" means an abortion  that is not                                                                    
     a medically necessary abortion;                                                                                            
     (3)  "medically necessary  abortion" means  that, in  a                                                                    
     physician's   objective  and   reasonable  professional                                                                    
     judgment after considering  medically relevant factors,                                                                    
     an  abortion must  be  performed to  avoid  a treat  of                                                                    
     serious risk to the life  or physical health of a woman                                                                    
     from continuation of the woman's pregnancy;                                                                                
Mr. Hutchinson relayed that the  language had been taken out                                                                    
of  the 2001  Planned Parenthood  decision and  was used  in                                                                    
various forms in the Hyde Amendment.                                                                                            
8:10:07 AM                                                                                                                    
Mr. Hutchinson continued with Section 2(4):                                                                                     
     "serious  risk   to  the   life  or   physical  health"                                                                    
     includes, but is not limited  to, a serious risk to the                                                                    
     pregnant woman of                                                                                                          
     (A) death; or                                                                                                              
     (B)  impairment  of  a major  bodily  function  because                                                                    
Mr. Hutchinson relayed that  the various medical afflictions                                                                    
listed  under  the  section had  been  verified  by  medical                                                                    
experts including  eight Alaskan doctors and  three national                                                                    
doctors.  He   noted  that  the  physical   conditions  were                                                                    
included in the 2001 Planned  Parenthood decision. He read a                                                                    
catchall provision in Section 2(4)(B)(xxii):                                                                                    
     another   physical   disorder,  physical   injury,   or                                                                    
     physical   illness,    including   a   life-endangering                                                                    
     physical  condition  caused  by  or  arising  from  the                                                                    
     pregnancy that places  the woman in danger  of death or                                                                    
     major  bodily   impairment  if   an  abortion   is  not                                                                    
Mr.  Hutchinson stated  that death  was  the foundation  the                                                                    
term  "major  bodily  impairment"  had been  included  as  a                                                                    
mandatory  extra  protection  as   stipulated  in  the  2001                                                                    
Planned  Parenthood decision.  He  addressed  Section 3  and                                                                    
relayed that  the analysis  had not  been as  substantive as                                                                    
that  of  the definition.  He  discussed  the definition  of                                                                    
medically necessary  as stated  in the bill.  The definition                                                                    
incorporated  the federal  foundation required  by the  Hyde                                                                    
Amendment. He spoke to the  importance of the Hyde Amendment                                                                    
and  noted  that it  had  been  incorporated into  Executive                                                                    
Order 13535 by President Obama  for inclusion in the federal                                                                    
Affordable Care Act  (Tab 3). He read from Section  1 of the                                                                    
executive order:                                                                                                                
     it is  necessary to  establish an  adequate enforcement                                                                    
     mechanism  to ensure  that Federal  funds are  not used                                                                    
     for  abortion  services (except  in  cases  of rape  or                                                                    
     incest,  or  when  the  life  of  the  woman  would  be                                                                    
     endangered),  consistent  with a  longstanding  Federal                                                                    
     statutory  restriction that  is commonly  known as  the                                                                    
     Hyde Amendment.                                                                                                            
Mr. Hutchinson  disputed the  claim that  there could  be no                                                                    
restrictions on  funding for abortions.  He stated  that the                                                                    
executive order limited abortion  funding to cases involving                                                                    
rape, incest,  and the  life of the  woman. He  relayed that                                                                    
the definition  in SB 49  provided more protection  than the                                                                    
federal  definition. He  read from  Hyde Amendment  language                                                                    
under Tab 4:                                                                                                                    
     Section  508 (a)  The  limitations  established in  the                                                                    
     preceding section shall not apply to an abortion                                                                           
     (1) if  the pregnancy is the  result of an act  of rape                                                                    
     or incest; or                                                                                                              
     (2) in the  case where a woman suffers  from a physical                                                                    
     disorder,   physical  injury,   or  physical   illness,                                                                    
     including a life-endangering  physical condition caused                                                                    
     by or  arising from  the pregnancy itself,  that would,                                                                    
     as certified by a physician,  place the woman in danger                                                                    
     of death unless an abortion is performed.                                                                                  
Mr.  Hutchinson emphasized  the  word  physical and  relayed                                                                    
that the focus was incorporated into the bill's definition.                                                                     
8:14:36 AM                                                                                                                    
Mr. Hutchinson pointed out that  death was the standard used                                                                    
in  the Hyde  Amendment. He  stated that  the bill  provided                                                                    
additional   protection  as   required   under  the   Alaska                                                                    
Constitution.  He reiterated  that  definitions provided  in                                                                    
the  bill  had  been   taken  from  the  Planned  Parenthood                                                                    
decision  and had  been  agreed to  by  medical experts.  He                                                                    
stated  that  the  bill made  a  clear  distinction  between                                                                    
elective  and medically  necessary procedures.  He clarified                                                                    
that Medicaid did not fund  elective procedures and stressed                                                                    
that it  should not fund  elective abortions. He  added that                                                                    
Medicaid  was   required  to  perform   medically  necessary                                                                    
procedures.  He directed  attention  to statistics  included                                                                    
under  Tab  6.  He  communicated   that  at  a  minimum  the                                                                    
definition was  required to  include the  federal exceptions                                                                    
of  rape,  incest,  and life  endangerment.  The  statistics                                                                    
showed performance in other states.  Tab 7 included the 2001                                                                    
Planned Parenthood  decision court order. He  read from page                                                                    
     DHSS  [Department of  Health  and  Social Services]  is                                                                    
     constitutionally  bound to  apply  neutral criteria  in                                                                    
     allocating    health    care    benefits,    even    if                                                                    
     considerations of expense,  medical feasibility, or the                                                                    
     necessity  of particular  services otherwise  limit the                                                                    
     health care it provides to poor Alaskans.                                                                                  
Mr. Hutchinson moved  to page 16 of tab 7  and read from the                                                                    
court order conclusion:                                                                                                         
     The  State, having  undertaken to  provide health  care                                                                    
     for poor  Alaskans, must adhere to  neutral criteria in                                                                    
     distributing  that  care.  It may  not  deny  medically                                                                    
     necessary  services to  eligible  individuals based  on                                                                    
     criteria  unrelated  to  the  purposes  of  the  public                                                                    
     health care program.                                                                                                       
Senator Coghill noted that the  goal was not to discriminate                                                                    
health  care  services  and to  define  when  something  was                                                                    
medically  necessary versus  elective. He  acknowledged that                                                                    
the bill  would probably draw  litigation given its  base in                                                                    
Representative   Costello  MOVED   to  ADOPT   the  proposed                                                                    
committee  substitute  for  SSSB  49(FIN),  Work  Draft  28-                                                                    
LS0410\Y (Mischel, 4/13/13).                                                                                                    
Representative Gara  OBJECTED. He  asked for clarity  on the                                                                    
bill version before  the committee. He referred  to the bill                                                                    
that  had  passed  the Senate,  which  had  included  family                                                                    
planning language.                                                                                                              
Co-Chair  Stoltze answered  that the  version was  different                                                                    
from  the bill  passed by  the Senate;  the bill  before the                                                                    
committee reflected the original bill language.                                                                                 
Representative Gara  spoke to his  objection. The  bill that                                                                    
passed  the Senate  included a  provision  that allowed  the                                                                    
state to  participate in the women's  health Medicaid family                                                                    
planning program.  He relayed  that evidence  suggested that                                                                    
participation  in the  program  would reduce  the number  of                                                                    
unintended  pregnancies,  the  cost  of  care  for  pregnant                                                                    
women, and  the number  of abortions in  Alaska. He  did not                                                                    
want remove  a portion from  the bill that would  reduce the                                                                    
number   of   abortions   or  the   number   of   unintended                                                                    
8:20:15 AM                                                                                                                    
Senator Coghill  spoke in opposition to  the family planning                                                                    
language.  He  elaborated  that  the  language  had  been  a                                                                    
mandate to  go beyond  what was already  done by  the state.                                                                    
The  department had  provided a  list  of existing  programs                                                                    
that  included 7,500  individuals  who  had received  family                                                                    
planning services to date.  Services were currently provided                                                                    
for  contraception,   sexually  transmitted   diseases,  and                                                                    
general reproductive  health. He reiterated that  the family                                                                    
planning  language  had been  a  mandate  to go  beyond  the                                                                    
current   services   for   items  like   sterilization   and                                                                    
preconception care  that he thought  was already  done under                                                                    
pelvic  exams.  He  concluded that  the  language  had  been                                                                    
broader than he wanted.                                                                                                         
Representative  Ledoux  offered  that  the  family  planning                                                                    
component could  be considered in the  operating budget. She                                                                    
did not believe the language was appropriate for the bill.                                                                      
Representative   Gara  asked   for  verification   that  the                                                                    
Medicaid  women's health  program language  that had  passed                                                                    
the Senate was 90 percent  covered by federal funds. Senator                                                                    
Coghill  replied that  part of  the program  was 90  percent                                                                    
covered and part was covered at 50 percent.                                                                                     
A roll call vote was taken on the motion to adopt the CS.                                                                       
IN FAVOR: Munoz,    Wilson,   Edgmon,    Neuman,   Thompson,                                                                    
Costello, Stoltze, Austerman                                                                                                    
OPPOSED: Holmes, Gara, Guttenburg                                                                                               
The MOTION PASSED (3/8).                                                                                                        
8:24:44 AM                                                                                                                    
Representative Gara discussed that  the Alaska Supreme Court                                                                    
opinion  from 2001  had included  the  condition of  bipolar                                                                    
disorder  under the  definition of  medically necessary.  He                                                                    
believed  the bill  should include  the disorder  given that                                                                    
medication  for bipolar  disorder  was very  dangerous to  a                                                                    
pregnancy.  He asked for  verification that the disorder had                                                                    
been in the  2001 court opinion language and why  it had not                                                                    
been included in the bill.                                                                                                      
Senator  Coghill answered  that  thorough medical  testimony                                                                    
had convinced the sponsor that  the particular condition and                                                                    
most  psychological  conditions were  not  a  threat to  the                                                                    
health  of a  pregnant woman.  Additionally, he  referred to                                                                    
the Hyde  Amendment where physical  health was given  as the                                                                    
reason for the need of an abortion.                                                                                             
Representative  Munoz  asked  how many  medically  necessary                                                                    
abortions had  occurred in Alaska  in 2013.  Senator Coghill                                                                    
answered  that the  figure was  over 1,700.  He stated  that                                                                    
currently  all abortions  paid  under  Medicaid were  deemed                                                                    
medically necessary  due to the  broad definition;  the bill                                                                    
clarified the definition. He  corrected that 1,450 medically                                                                    
necessary  abortions  had occurred  in  2013  and 1,700  had                                                                    
occurred the year the legislation had been introduced.                                                                          
8:27:02 AM                                                                                                                    
Senator  Coghill   corrected  that   the  total   number  of                                                                    
abortions in  2013 was 1,450;  Medicaid had paid for  547 of                                                                    
the total.                                                                                                                      
Representative Guttenberg pointed  to the qualification list                                                                    
of medically  necessary conditions and observed  that one of                                                                    
the items  was "any  other physical  disorder." He  asked if                                                                    
the  language  sufficiently  covered  the  other  conditions                                                                    
listed under the bill section.                                                                                                  
Senator  Coghill  replied that  the  items  listed out  were                                                                    
based on Alaska Supreme Court testimony.                                                                                        
Representative   Guttenberg   asked    if   the   list   was                                                                    
Co-Chair Stoltze  commented that he had  never known Senator                                                                    
Coghill to promote or increase the number of abortions.                                                                         
Representative  Guttenberg  wanted  to make  sure  something                                                                    
unintentional was  not done.  Senator Coghill  answered that                                                                    
the  list  had  been  verified by  doctors  and  the  Alaska                                                                    
Supreme  Court.  He  understood  that  the  list  could  not                                                                    
include  everything, which  was the  reason it  included the                                                                    
language "any other physical disorder."                                                                                         
Representative  Guttenberg observed  that all  conditions in                                                                    
the  bill   were  physical.  He  discussed   that  increased                                                                    
information about  mental disorders was  becoming available.                                                                    
He  believed mental  disorders were  not included  under the                                                                    
bill's definition of medically necessary.                                                                                       
Senator  Coghill  replied  that  when his  office  had  gone                                                                    
through  the court  test of  neutral  criteria, the  neutral                                                                    
criteria   showed   that  psychologically   terminating   or                                                                    
carrying a  pregnancy to  term could  have equal  weight. He                                                                    
did not  feel from the  doctors' testimony that  a pregnancy                                                                    
would go beyond the physical well-being of a mother.                                                                            
8:30:39 AM                                                                                                                    
Representative  Wilson wondered  how  the  bill compared  to                                                                    
state insurance. She  wondered if there were  two classes of                                                                    
people  being created  by implementing  the  law related  to                                                                    
Medicaid but  not for other  state employees. She  wanted to                                                                    
provide accurate information to her constituents.                                                                               
Senator  Coghill  answered  that  Medicaid  was  a  mandated                                                                    
formula program  for individuals meeting  qualifications. He                                                                    
explained that  the state had  a negotiated  healthcare plan                                                                    
that fell under  a very different set of  rules. He deferred                                                                    
to the administration for further detail.                                                                                       
Representative Wilson wanted to  hear from the Department of                                                                    
Administration (DOA) about state health insurance.                                                                              
Co-Chair  Stoltze noted  that both  the DHSS  and DOA  would                                                                    
8:33:20 AM                                                                                                                    
AT EASE                                                                                                                         
8:34:00 AM                                                                                                                    
SUSAN SCHRADER, SELF, JUNEAU, spoke  in opposition to HB 173                                                                    
and SB 49 as amended.  She stated that the bills represented                                                                    
another  attempt by  politicians  to  intervene in  personal                                                                    
medical  decisions made  by  Alaskan  women; decisions  that                                                                    
should  be left  up to  women to  make in  consultation with                                                                    
their  family,  faith,  and physicians.  She  spoke  to  the                                                                    
complexity a  woman faced  when deciding  whether to  have a                                                                    
child,  put  the  child  up  for adoption,  or  to  have  an                                                                    
abortion. She  believed the  bills were  an effort  to limit                                                                    
access to  abortion under the  guise of clarifying  the term                                                                    
"medically  necessary."  She   stated  that  bills  defining                                                                    
personhood,  requiring  invasive  ultrasound,  or  requiring                                                                    
extended waiting periods, were  all chipping away at women's                                                                    
rights.  She  stressed  that  limiting  access  to  Medicaid                                                                    
funded  abortions was  not  likely to  limit  the number  of                                                                    
abortions;  however,  it would  limit  the  number of  safe,                                                                    
legal abortions.  She furthered  that it  may lead  women to                                                                    
seek  out  illegal  procedures.  She  pointed  to  practices                                                                    
occurring prior  to Roe  v. Wade.  She asked  legislators to                                                                    
adopt the  women's health program  under state  Medicaid for                                                                    
ready-access to  family planning  and birth control  for all                                                                    
Alaskan  women  (if the  goal  was  to make  abortion  safe,                                                                    
legal, and  rare, and  to saving  money). She  stressed that                                                                    
the program  would effectively  reduce abortions  and costs;                                                                    
however,  the CS  removed the  language from  the bill.  She                                                                    
emphasized that  family planning  worked and did  so without                                                                    
trampling  on women's  rights to  make their  own healthcare                                                                    
decisions.  She  understood  that   abortion  was  a  highly                                                                    
emotional issue, but she felt  that the most upsetting thing                                                                    
was  to   see  other   women  limiting  women's   rights  to                                                                    
8:37:20 AM                                                                                                                    
LAURA POWERS,  SELF, JUNEAU, testified in  opposition to the                                                                    
bills. She  introduced her daughters. She  communicated that                                                                    
a woman's  pregnancy decision was  complex and  personal and                                                                    
should be made in consult  with her doctor, not politicians.                                                                    
She stressed that only healthcare  providers could know what                                                                    
was medically necessary. She implored  the committee to vote                                                                    
no on  the legislation and  to implement a  Medicaid women's                                                                    
health program instead.                                                                                                         
IZEBELLA POWERS,  SELF, JUNEAU,  spoke in opposition  to the                                                                    
bill. She stressed  that women should be able  to make their                                                                    
own decisions.                                                                                                                  
KORBYN  POWERS, SELF,  JUNEAU, testified  against the  bill.                                                                    
She stated that women should  have the ability to make their                                                                    
own healthcare decisions.                                                                                                       
Ms.  Laura  Powers  encouraged the  committee  to  take  all                                                                    
Alaskan women into  consideration. She stated that  it was a                                                                    
woman's choice  to have control  of her body. She  asked the                                                                    
committee to vote no.                                                                                                           
8:39:29 AM                                                                                                                    
GEORGE  BROWN, PEDIATRICIAN,  JUNEAU, testified  against the                                                                    
bills.   He  relayed   that  he   had   been  a   practicing                                                                    
pediatrician in Alaska since 1965.  He read from a letter to                                                                    
the committee (copy on file):                                                                                                   
     These bills have several flaws.  While it addresses the                                                                    
     most  contentious  issue  of our  Republic's  political                                                                    
     history  since the  abolition  of  slavery, it  IMPOSES                                                                    
     personal values which restrict  access to legal medical                                                                    
     services, DISRESPECTS  personal choice of  women, which                                                                    
     means  sexual discrimination,  and  of most  importance                                                                    
     DENIES  the  reality of  mind  and  body connection  in                                                                    
     human health.  Neuroscience continues  to show  how our                                                                    
     brain influences physical  health and illness. Physical                                                                    
     illnesses  such  as  cancer and  trauma  injuries  like                                                                    
     domestic  violence,  child  maltreatment,  concussions,                                                                    
     and traumatic  brain injuries impose  continuing mental                                                                    
     stress and make a huge  influence on our brains. Social                                                                    
     and behavioral  disorders also  have huge  influence on                                                                    
     our brains.                                                                                                                
     Unintended  pregnancies can  produce intense  stress on                                                                    
     brains. Not uncommonly,  some intended pregnancies that                                                                    
     conclude  with healthy  newborns result  in post-partum                                                                    
     depression,  now well  recognized in  medical practice.                                                                    
     Persons who are  trying to cope with  such physical and                                                                    
     social stresses  can cope with them.  Successful coping                                                                    
     can  be  enhanced  with   family,  health,  and  social                                                                    
     supports,  which  opens   possibilities  to  other  and                                                                    
     future choices and healing.                                                                                                
     Laws which deny personal  choices about health care add                                                                    
     more  stress to  individuals.  Persons  who have  never                                                                    
     been pregnant  or who can never  become pregnant cannot                                                                    
     really  understand these  particular stresses.  Persons                                                                    
     who are or who have  been pregnant are more experienced                                                                    
     for seeking  and finding  the most  appropriate choices                                                                    
     to deal with these stresses.                                                                                               
     There is a  more positive option for all of  us in this                                                                    
     complex social dilemma.  As we try hard  to be tolerant                                                                    
     about others  values, understand the  deep complexities                                                                    
     of individual  and social behavior, and  to listen with                                                                    
     the intent to hear all  voices, we can come together to                                                                    
     accept and increase practices which  prevent as many as                                                                    
     possible future  unintended pregnancies. This is  in no                                                                    
     way simple, but  it has been done for  decades and does                                                                    
     work when practiced. It also  can redirect our energies                                                                    
     away  from   conflict  toward  cooperation.   There  is                                                                    
     certainly  much more  we  can all  do  to improve  male                                                                    
     understanding about  violence and  pregnancy prevention                                                                    
     and  to increase  their practice  of respect  and birth                                                                    
     control. I hope  you will vote against  these bills and                                                                    
     work toward preventive legislation action.                                                                                 
8:44:38 AM                                                                                                                    
Representative Costello acknowledged Dr.  Brown for his work                                                                    
making  house  calls  and his  good  reputation.  Dr.  Brown                                                                    
replied that enjoyed  his work. He noted  that children were                                                                    
born with  love, empathy,  and trust  and that  listening to                                                                    
children would help solve the problems under discussion.                                                                        
Vice-Chair Neuman  spoke from the  perspective of  a father.                                                                    
He wondered who  spoke for the life of the  unborn child and                                                                    
fetus. He  believed it  had been  implied that  a man  had a                                                                    
lesser opinion  than a  woman. He  was very  concerned about                                                                    
the lives  of unborn  children. He  wondered how  the unborn                                                                    
child  could be  protected.  He spoke  about  the option  of                                                                    
giving a  child up  for adoption. He  wondered how  to speak                                                                    
for unborn children.                                                                                                            
Dr.  Brown  replied  that  the  issue  was  not  simple.  He                                                                    
believed there  was still government  of the people,  by the                                                                    
people, and  for the people,  as long as people  continue to                                                                    
speak up  and create dialogue between  elected officials and                                                                    
themselves. He stated that more  males and more fathers were                                                                    
appreciating  the pregnancy  process, which  was a  positive                                                                    
thing.  He  emphasized  the  importance  of  prevention.  He                                                                    
discussed  the importance  of doing  everything possible  to                                                                    
increase youths  understanding about  unintended pregnancies                                                                    
and providing  increased funds  to counseling,  support, and                                                                    
family planning. He spoke about  work to prevent child abuse                                                                    
through  the  Alaska   Children's  Trust;  the  organization                                                                    
worked  with Father's  Community Café  to discuss  pregnancy                                                                    
and  associated responsibilities  of becoming  a father.  He                                                                    
stressed that the  work was about changing  the paradigm. He                                                                    
discussed the  importance of working together,  listening to                                                                    
each other, and cooperation.                                                                                                    
8:49:00 AM                                                                                                                    
Vice-Chair Neuman  believed the opinion of  a medical doctor                                                                    
was important.  He spoke about  changing his  own children's                                                                    
diapers. He  wondered how to  measure the life and  voice of                                                                    
an unborn child.                                                                                                                
Co-Chair  Stoltze relayed  his  intent  to continue  hearing                                                                    
public testimony.                                                                                                               
Representative  Gara  referred  to   a  court  opinion  that                                                                    
included bipolar  disorder on  a list  of items  that should                                                                    
qualify for  Medicaid coverage  for abortions.  He discussed                                                                    
that  the  drug used  to  treat  bipolar disorder  had  been                                                                    
dangerous  to  a  pregnancy.  He  wondered  about  potential                                                                    
dangers and if the information remained current.                                                                                
Dr. Brown answered  that there were a  number of potentially                                                                    
dangerous drugs. He noted that  one of the real problems was                                                                    
that  people with  bipolar disorder  or  those under  stress                                                                    
frequently  used  many  other drugs  including  alcohol.  He                                                                    
stated that working  to help eliminate drug  and alcohol use                                                                    
was far  better than trying  to tell  a woman she  should or                                                                    
should not have  an abortion. Ultimately out  of respect for                                                                    
the  belief in  individual  liberty, he  believed  it was  a                                                                    
woman's right to make her  own decision. He believed support                                                                    
around the  decision was needed. He  stressed the importance                                                                    
of prevention.                                                                                                                  
Representative  Gara had  been told  that a  Medicaid family                                                                    
planning  program could  reduce the  number of  abortions by                                                                    
over 500  per year.  He wondered if  Dr. Brown  believed the                                                                    
adoption  of   the  program  would  reduce   the  number  of                                                                    
abortions in Alaska.                                                                                                            
Dr.  Brown  believed the  adoption  of  the Medicaid  family                                                                    
planning program  would reduce  the number of  abortions. He                                                                    
strongly urged  the committee to implement  the program that                                                                    
provided  services to  youths who  were far  more likely  to                                                                    
have unintended  pregnancies. The program would  not prevent                                                                    
all abortions, but it was a very worthwhile investment.                                                                         
8:52:58 AM                                                                                                                    
Representative  Munoz had  been advised  by the  Division of                                                                    
Public Health Nursing  that no one was  denied service based                                                                    
on  ability to  pay.  She asked  whether  services would  be                                                                    
expanded to  cover more individuals  if the  family planning                                                                    
proposal was added to the bill.                                                                                                 
Dr.  Brown replied  that many  people eligible  for Medicaid                                                                    
and  Medicare did  not use  the services  because they  were                                                                    
ashamed of being poor. Likewise,  there were many people who                                                                    
could utilize  public health  services, but  did not  due to                                                                    
the  same reason.  He believed  Denali  KidCare was  helpful                                                                    
because it gave lower-income  individuals access to services                                                                    
with  the  broader  population   without  making  them  feel                                                                    
ostracized. He stated  that if access was  made friendly and                                                                    
open  to  everyone,  individuals  would be  more  likely  to                                                                    
participate. He  acknowledged that it would  cost money, but                                                                    
the  investment would  reduce costs  associated with  jails,                                                                    
courts, and other in the long-term.                                                                                             
Vice-Chair   Neuman   stated   that  the   financial   costs                                                                    
associated with taking a healthy  baby to full term were not                                                                    
that high.  He wondered how  much it  would cost to  carry a                                                                    
baby to  term and to offer  it for adoption compared  to the                                                                    
cost of abortion.                                                                                                               
Dr. Brown  could not provide  a financial figure.  He stated                                                                    
that  in  the  short-term   an  abortion  would  cost  less;                                                                    
however,  he  believed  it  was  a  tragedy  and  should  be                                                                    
prevented  if  possible.  He   stressed  the  importance  of                                                                    
investing in  supports to provide assistance  and counseling                                                                    
to  pregnant women.  He stated  that investing  the supports                                                                    
that  would help  a mother  deal with  mental stress  was as                                                                    
medically important as anything  physical. He noted that the                                                                    
services  were costly,  but would  save money  in the  long-                                                                    
term. He  believed if  people kept  fighting over  the issue                                                                    
the  problem  would  not  be  solved  and  the  state  would                                                                    
continue to pay for services related to drugs and other.                                                                        
8:57:05 AM                                                                                                                    
MICHAEL  PAULEY, ALASKA  FAMILY  COUNCIL,  JUNEAU, spoke  in                                                                    
strong  support of  SB 49.  He regretted  that the  bill had                                                                    
been cast  as a  question about  when a  person was  able to                                                                    
have  an abortion.  He believed  the bill  was really  about                                                                    
Medicaid funding.  He referred to  a 2004 study by  the Alan                                                                    
Guttmacher Institute of 1,209  abortion patients at 11 large                                                                    
providers. He  stated that the  study participants  had been                                                                    
asked about  the primary reason  for an abortion;  4 percent                                                                    
had  communicated that  a physical  health  problem was  the                                                                    
most important  reason for the  abortion; 12  percent stated                                                                    
that  health  was a  factor.  He  spoke about  applying  the                                                                    
numbers to  Alaska; in 2013  the Bureau of  Vital Statistics                                                                    
reported that 1,450 abortions had  been performed in Alaska,                                                                    
547 or 37.7 percent of which  had been paid for by Medicaid.                                                                    
He stated that the number  had held consistent over time. He                                                                    
noted that  public funds paid  for the abortions.  He stated                                                                    
that if the numbers were  consistent with the national study                                                                    
related  to  the  number of  medically  required  abortions,                                                                    
Medicaid would  pay for  58 to 175  abortions per  year. The                                                                    
council  believed  that   doctors  performing  abortions  in                                                                    
Alaska were  submitting claims for  abortions that  were not                                                                    
medically  necessary.  He  believed   SB  49  articulated  a                                                                    
reliable,   medically   neutral  definition   of   medically                                                                    
necessary  abortion,  which  made  good  policy  and  fiscal                                                                    
sense. He opined  that the bill had nothing to  do with pro-                                                                    
life  versus pro-choice;  it was  about meeting  the state's                                                                    
obligations to  pay for  medically necessary  abortions, but                                                                    
not elective abortions.                                                                                                         
9:01:42 AM                                                                                                                    
Representative  Wilson referred  to prior  testimony related                                                                    
to the  national study's  percentage of  medically necessary                                                                    
abortions. She asked  if the state was  paying for abortions                                                                    
that were  not medically necessary because  doctors were not                                                                    
asking the  right questions. She  noted that her  office had                                                                    
been  told that  no one  was asking  the questions.  She was                                                                    
trying to  determine whether the doctors  were not currently                                                                    
asking the questions or whether  the definition was specific                                                                    
Mr.  Pauley  believed that  the  current  system afforded  a                                                                    
significant amount of discretion  to the physician. He noted                                                                    
that  the physicians  were getting  compensated with  public                                                                    
dollars for  performing abortions. He opined  that the issue                                                                    
was shrouded  in ideology. He noted  that Planned Parenthood                                                                    
provided  the  majority  of  abortions   in  the  state.  He                                                                    
believed Planned  Parenthood took the view  that an abortion                                                                    
was  medically necessary  if a  patient did  not want  to be                                                                    
pregnant.  His opinion  was based  on testimony  and Planned                                                                    
Parenthood litigation. He had  been disturbed the prior year                                                                    
when a Planned Parenthood  representative had testified that                                                                    
she did  not have  a definition  for elective  abortions. He                                                                    
stressed that  the U.S. Supreme  Court decision  on abortion                                                                    
funding   had  repeatedly   made  the   distinction  between                                                                    
elective and medically necessary.  He believed SB 49 offered                                                                    
the needed precision and clarification of language.                                                                             
9:04:58 AM                                                                                                                    
Representative  Guttenberg  asked  about  dialog  between  a                                                                    
woman  and  a  doctor  regarding the  decision  to  have  an                                                                    
abortion.  He  believed  Mr.  Pauley  was  insinuating  that                                                                    
virtually no  conversation occurred  between the  two people                                                                    
about the decision to have an abortion.                                                                                         
Mr.  Pauley  deferred  the question  to  doctors  preforming                                                                    
abortions.  He   did  not   believe  that   most  physicians                                                                    
performing  abortions in  Alaska  felt  that counseling  was                                                                    
within  their   purview.  He  stated  that   the  physicians                                                                    
believed  that abortion  was a  constitutional right  and as                                                                    
long as  the informed  consent law  was followed  the doctor                                                                    
would provide the procedure without question.                                                                                   
Representative  Guttenberg referred  to  a personal  medical                                                                    
experience and  stressed that  he did  not know  any doctors                                                                    
who did not counsel their patients.                                                                                             
Representative  Gara communicated  that  the term  medically                                                                    
necessary abortion  had been defined  in a prior  legal case                                                                    
between the state and other  parties. He believed Mr. Pauley                                                                    
thought  there  were   doctors  calling  elective  abortions                                                                    
medically  necessary.  He  disagreed; however,  if  it  were                                                                    
true, he wondered why doctors  would follow the law under SB
49 if they were not currently following the law.                                                                                
Mr. Pauley  believed the outcome would  be different because                                                                    
of the list of medical  conditions included in the bill that                                                                    
fell    under    the   medically    necessary    definition.                                                                    
Additionally,  the bill  included a  catchall provision  for                                                                    
conditions that  it did not  specifically list.  He expected                                                                    
the department to  begin to ask tough questions  if the bill                                                                    
passed and  547 abortions  performed fell under  the "other"                                                                    
category in the future.                                                                                                         
9:09:02 AM                                                                                                                    
MELISSA ENGEL, SELF, JUNEAU, testified  in opposition to the                                                                    
bills. She  spoke from her  perspective as a  Christian. She                                                                    
believed  that God  had created  humans with  amazing bodies                                                                    
and that humans were connected  to their physical and mental                                                                    
bodies in ways that no one  else could ever be. She stressed                                                                    
that  each person  knows  what  is best  for  them and  when                                                                    
unsure  has  the ability  to  consult  with trusted  medical                                                                    
doctors.  She  urged the committee to oppose  the bills. She                                                                    
stressed  that  women  knew  what was  best  for  their  own                                                                    
bodies. When a  woman was unsure, she  consulted her medical                                                                    
doctor,  not government  officials; each  woman was  created                                                                    
differently  and had  various  reasons for  deciding upon  a                                                                    
medical choice.  She asked the  committee what  would happen                                                                    
if  the  reason  did  not  fit  within  the  bill's  defined                                                                    
parameters  of  medically  necessary.  She  emphasized  that                                                                    
women's health was  not a political matter to  be decided on                                                                    
by legislators. She thanked the committee for its time.                                                                         
9:11:44 AM                                                                                                                    
MIKE  COONS, SELF,  PALMER  (via  teleconference), spoke  in                                                                    
favor of the legislation. He  stated that all physicians had                                                                    
a physician's  desk reference and  knew if medication  was a                                                                    
threat to pregnancy. He referred  to prior testimony related                                                                    
to drug  and alcohol abuse  and stated that  substance abuse                                                                    
caused many  self-induced abortions. He did  not believe the                                                                    
issue  was   about  elective   abortions,  but   about  what                                                                    
constituted  medically necessary  based  on medically  sound                                                                    
knowledge. He stated that elective  abortions were not to be                                                                    
paid for with state money under federal and state law.                                                                          
9:13:10 AM                                                                                                                    
JOSHUA DECKER, EXECUTIVE  DIRECTOR, AMERICAN CIVIL LIBERTIES                                                                    
UNION  OF ALASKA  (via  teleconference),  spoke against  the                                                                    
bills.   He  stated   that  the   bills  posed   substantial                                                                    
constitutional  challenges. He  pointed to  a separation  of                                                                    
powers concern  and explained that  once the  Alaska Supreme                                                                    
Court  had stated  the contours  of  a constitutional  right                                                                    
such  as the  right for  low-income women  to have  Medicaid                                                                    
funded abortions, the  legislature was not able  to alter or                                                                    
narrow the right (which both  of the bills attempted to do).                                                                    
He   communicated   that   the  bills   were   substantively                                                                    
unconstitutional. He  spoke to earlier testimony  related to                                                                    
the omission of bipolar  disorder from the bill's definition                                                                    
of medically necessary, which in  the Alaska Supreme Court's                                                                    
opinion was a constitutionally  mandated reason to allow for                                                                    
Medicaid funded  abortions. Additionally, the bills  were of                                                                    
concern because  they "cherry pick  out" the  term medically                                                                    
necessary  in  the abortion  context  and  defined it  in  a                                                                    
narrow  and  restrictive  way;  whereas  the  term  was  not                                                                    
defined  elsewhere in  Medicaid documents.  The organization                                                                    
believed  that  if  the  bills were  enacted  into  law  and                                                                    
subject  to constitutional  challenge that  the court  would                                                                    
"look askance" at the cherry picking definition.                                                                                
Mr. Decker  addressed the cost  of the bills. He  noted that                                                                    
the bills'  fiscal notes were zero,  but abortion litigation                                                                    
was  not  new  to  Alaska.  He shared  that  the  state  had                                                                    
repeatedly  attempted   to  unconstitutionally   restrict  a                                                                    
woman's right  to reproductive choice  and had  spent nearly                                                                    
$1  million  defending  the unconstitutional  attempts.  The                                                                    
organization  believed the  state would  likely have  to pay                                                                    
hundreds of thousands of dollars  in attorney fees and costs                                                                    
to  the potential  plaintiffs if  the issue  was subject  to                                                                    
legal  challenge. He  urged the  committee to  not pass  the                                                                    
9:16:27 AM                                                                                                                    
KINE  MCCLINTOCK,  SELF,   ANCHORAGE  (via  teleconference),                                                                    
urged the  committee to  vote against the  bills. She  was a                                                                    
life-long Alaskan and was currently  working on pursuing her                                                                    
master's in  public health. She  had spent  significant time                                                                    
studying  the effects  of  policies  that either  restricted                                                                    
access to  abortion or made contraceptives  more accessible.                                                                    
She stated that the  latter approach could decrease abortion                                                                    
rates  and provided  women and  families with  the necessary                                                                    
tools  to lead  healthy and  fulfilling lives.  She detailed                                                                    
that research showed  that restrictions such as  the ones in                                                                    
SB 49 were ineffective at  decreasing the need for abortion.                                                                    
She  asked  the  legislature  to  make  contraceptives  more                                                                    
accessible to  low-income women  if the  goal was  to reduce                                                                    
the number of abortions. She  stated that the definitions in                                                                    
the bill  denied low-income women medically  necessary care,                                                                    
which  effectively   created  two  classes  of   women.  She                                                                    
believed  it  was  unethical  to   make  a  safe  and  legal                                                                    
procedure unavailable  to some women. She  strongly believed                                                                    
that it  was the state's  obligation to care for  all people                                                                    
and to  provide them  with equal  protection under  the law.                                                                    
She was disheartened that the  legislature was spending time                                                                    
on  SB  49, which  she  believed  was dangerous  to  women's                                                                    
health.  She  stressed  that  deciding  what  constitutes  a                                                                    
medically  necessary abortion  was  a  medical decision  and                                                                    
should  be left  to physicians,  not politicians.  She asked                                                                    
the committee to oppose the legislation.                                                                                        
Representative   Gara  thanked   Ms.   McClintock  for   her                                                                    
9:19:16 AM                                                                                                                    
LYNN  ESCOLA, SELF,  PETERSBURG (via  teleconference), spoke                                                                    
in  opposition   to  SB  49.   She  stated  that   the  bill                                                                    
established  a  "Chinese  menu"   for  determining  who  can                                                                    
receive an abortion under Medicaid.  She pointed out that no                                                                    
mental and  emotional illnesses regardless of  severity were                                                                    
included  under the  bill's  definition.  Also missing  were                                                                    
cases of  malformed fetus. She  stressed that  the omissions                                                                    
were incredibly  inhumane and  represented very  poor public                                                                    
policy. She stated that legislators  were attempting to dole                                                                    
out healthcare  according to their  own judgment  of medical                                                                    
necessity. She  believed the  bill was  not needed  and that                                                                    
deciding what constituted medically  necessary could be left                                                                    
to  physicians.  She  believed  the  bill  was  prompted  to                                                                    
withhold   medical  care   from   some   Alaskan  women   by                                                                    
withholding payment.  She wanted  the government to  pay for                                                                    
medical  care  for  poor  women,  including  abortions.  She                                                                    
referred to  an Alaska Supreme  Court ruling that  the state                                                                    
was required to  provide equal protection under  the law for                                                                    
all pregnancy decisions. She stated  if the state paid for a                                                                    
woman to  remain pregnant it should  pay for a woman  to not                                                                    
remain  pregnant. She  pointed out  that remaining  pregnant                                                                    
cost the public much more  than an abortion. She stated that                                                                    
SB  49 represented  excess  government  regulation, it  hurt                                                                    
individual Alaskans  who would be denied  healthcare, and it                                                                    
would result  in the increased expenditure  of public funds.                                                                    
She opined  that it  was hard to  see any  legitimate public                                                                    
interest being  served by  the bill. She  added that  if the                                                                    
law passed it  would likely be found  unlawful. She stressed                                                                    
that the  bill was  wasting the  legislature's time  and the                                                                    
public's money.  She was offended  that the  bill victimized                                                                    
poor  women,  especially young  and  rural  poor women  with                                                                    
limited options.  She stated that  the bill  would constrain                                                                    
poor   women  to   producing   babies   for  the   childless                                                                    
middleclass seeking to  adopt. She was repulsed  by the idea                                                                    
of  the  government's  hands compelling  a  pregnancy  as  a                                                                    
commodity. She  stated that the  bill would result  in death                                                                    
from back alley or self-induced abortions or from suicide.                                                                      
Co-Chair  Stoltze asked  for  clarification  about the  term                                                                    
Chinese menu. Ms. Escola replied that it was a metaphor.                                                                        
9:23:03 AM                                                                                                                    
JESSICA  CLER, PUBLIC  AFFAIRS  MANAGER, PLANNED  PARENTHOOD                                                                    
VOTES  NORTHWEST,  ANCHORAGE   (via  teleconference),  spoke                                                                    
against  the   bills.  She  shared  that   the  organization                                                                    
operated  five  health centers  in  Alaska  and in  2012  it                                                                    
served  nearly 12,000  people in  the state  with lifesaving                                                                    
and   cost   saving    reproductive   healthcare   including                                                                    
contraception,  cancer and  disease  screenings, exams,  and                                                                    
abortions. The  agency was  proud to be  a provider  of safe                                                                    
and  legal  abortions,  but  its  efforts  were  focused  on                                                                    
providing   the  resources   people  need   to  plan   their                                                                    
pregnancies.  The planning  reduced unintended  pregnancies,                                                                    
abortions, and  cost to the  state for  unintended pregnancy                                                                    
care.  She  stressed  that every  woman  and  every  woman's                                                                    
health  was different;  only a  trained health  professional                                                                    
should decide what was medically  necessary for a woman. She                                                                    
added that  the healthcare  decision should  not be  made by                                                                    
Ms. Cler  stated that  the bills were  a blatant  attempt to                                                                    
put  government into  low-income  Alaskan women's  pregnancy                                                                    
decisions,  which was  not  right, not  fair,  and not  good                                                                    
healthcare. She  pointed to  the unconstitutionality  of the                                                                    
legislation;  in 2002  the  Alaska  Supreme Court  specified                                                                    
that  the Medicaid  program could  not discriminate  against                                                                    
women  who have  an abortion.  She  noted that  a judge  had                                                                    
already enjoined  a DHSS rule  that was almost  identical to                                                                    
the bills.  She stressed that  there was no reason  to waste                                                                    
legislative time, energy,  and money while the  court was in                                                                    
the process  of deciding  the issue.  She stressed  that the                                                                    
bills  would  cost  money.  She  advised  that  if  reducing                                                                    
abortions and  saving money was  the legislature's  goal, it                                                                    
should get  rid of  the bills and  enact a  Medicaid women's                                                                    
health  program to  get contraceptives  to more  women whose                                                                    
pregnancies would  otherwise be paid  for by the  state. The                                                                    
savings  would be  approximately  $9  million annually.  She                                                                    
addressed the  sponsor's stated  reason for  the legislation                                                                    
pertaining to  state savings. She emphasized  that the bills                                                                    
would not save money and  would cost money in continuing law                                                                    
suits.  She respectfully  urged  the committee  to not  move                                                                    
forward with the bills.                                                                                                         
9:26:05 AM                                                                                                                    
THEDA PITTMAN,  SELF, ANCHORAGE (via  teleconference), spoke                                                                    
in  opposition to  the  legislation.  She believed  everyone                                                                    
agreed  in the  goal of  reducing the  number of  abortions;                                                                    
however,  there was  disagreement in  the way  to accomplish                                                                    
the goal and about whether public  funds should be used if a                                                                    
pregnant  girl or  woman was  on Medicaid.  She stated  that                                                                    
public officials were vocalizing  serious warnings about the                                                                    
need to  be much  more careful  about spending  state funds.                                                                    
She  relayed that  the  bills had  already  wasted time  and                                                                    
money. She continued  that in spite of a  current court case                                                                    
challenging regulation  language, the  sponsor of SB  49 had                                                                    
pressed  forward  because  statute  held  more  weight  than                                                                    
regulation. She  noted that the  sponsor had  identified the                                                                    
issue as fiscally conservative. She  opined that if the goal                                                                    
was  to behave  in a  fiscally conservative  way, the  bills                                                                    
should  be tabled  until the  court decision  was made.  She                                                                    
stated  that the  bills would  be unnecessary  if the  court                                                                    
upheld the regulations; if the  regulations were struck down                                                                    
as unconstitutional  the decision would need  to be analyzed                                                                    
to  determine  guidance  the decision  provided  as  to  how                                                                    
broadly  the term  medically  necessary  abortion should  be                                                                    
construed.  She  stated that  the  bills  would need  to  be                                                                    
redrafted  all over  again. She  asked the  committee to  be                                                                    
fiscally prudent  and to  wait until  additional information                                                                    
was available.                                                                                                                  
9:28:37 AM                                                                                                                    
ROBIN  SUMMERS, POLICY  DIRECTOR,  NATIONAL FAMILY  PLANNING                                                                    
AND   REPRODUCTION   ASSOCIATION,   WASHINGTON   D.C.   (via                                                                    
teleconference),  briefly  described the  organization.  She                                                                    
thanked Representative Holmes for  the invitation to testify                                                                    
on Medicaid family planning [the  amendment had been removed                                                                    
from the bills].  She read from prepared  testimony (copy on                                                                    
     For two  decades states have broadened  eligibility for                                                                    
     their  Medicaid  programs  to provide  family  planning                                                                    
     services  and  supplies  to  individuals  who  are  not                                                                    
     otherwise eligible  for Medicaid. Today 30  states have                                                                    
     chosen to  expand eligibility  for family  planning; 12                                                                    
     of  those have  done  so through  what's  known as  the                                                                    
     State  Plan Amendment  (SPA). Medicaid  family planning                                                                    
     SPAs provide  a broad range of  family planning-related                                                                    
     services,  including the  full  range of  contraceptive                                                                    
     methods, pap  tests, and other  associated examinations                                                                    
     and laboratory  tests. A  Medicaid family  planning SPA                                                                    
     does not cover abortion.                                                                                                   
Ms. Summers  addressed the  idea that  some of  the services                                                                    
were  already provided  through  the  Medicaid program.  She                                                                    
communicated  that  a  family  planning  SPA  would  not  be                                                                    
duplicative  of  the   coverage  Alaska  currently  provided                                                                    
through its Medicaid program.                                                                                                   
     Today, a single mother  with one child (working parent,                                                                    
     household of 2)  is eligible for Medicaid  if she earns                                                                    
     less than  $2,111 per  month. However,  eligibility for                                                                    
     that same single mother with  one child, if she becomes                                                                    
     pregnant,  goes  up  to $4,124  per  month  during  her                                                                    
     pregnancy. A  childless adult is  not eligible  at all,                                                                    
     unless she has a  qualifying condition (e.g. disabled).                                                                    
     A  Medicaid family  planning SPA  would provide  family                                                                    
     planning  services  to  childless adults  who  are  not                                                                    
     otherwise eligible  for Medicaid,  as well as  to those                                                                    
     single  mothers  with  incomes that  fall  in  the  gap                                                                    
     between $2,111 and pregnancy eligibility.                                                                                  
Ms. Summers detailed that  Medicaid family planning programs                                                                    
like the SPA under  consideration saved states money; nearly                                                                    
$6.00  saved  for every  $1.00  spent.  Expanding access  to                                                                    
contraception  and  increasing  the use  of  more  effective                                                                    
contraceptive methods  are essential to  reducing unintended                                                                    
pregnancy. She read from a prepared statement:                                                                                  
     The  Brookings  Institution   estimates  that  Medicaid                                                                    
     family  planning  expansion   programs  save  taxpayers                                                                    
     $1.32   billion   annually.   Births   resulting   from                                                                    
     unintended pregnancy  cost US tax  payers approximately                                                                    
     $12.5 billion annually.                                                                                                    
Ms. Summers relayed that in  Alaska in 2010 there were 3,000                                                                    
publicly   funded    births   resulting    from   unintended                                                                    
pregnancies  representing  more   than  one-quarter  of  all                                                                    
births  in the  state  and  more than  half  of the  state's                                                                    
Medicaid   funded  births.   The   births  from   unintended                                                                    
pregnancies cost a total of  $71 million; $34 million of the                                                                    
total had  been paid  for by  the state.  She stated  that a                                                                    
Medicaid  family planning  SPA would  improve public  health                                                                    
while  saving  taxpayer  dollars.  She  strongly  urged  the                                                                    
committee to adopt the family planning program.                                                                                 
9:31:52 AM                                                                                                                    
JAN  CAROLYN HARDY,  SELF,  ANCHORAGE (via  teleconference),                                                                    
urged the  committee to vote  against the bills.  She stated                                                                    
that  medically   necessary  was  not  in   the  purview  of                                                                    
government  and the  legal process.  She  stressed that  the                                                                    
decisions  were  for women  and  their  doctors. The  Alaska                                                                    
Supreme  Court  ruled  that  the   decision  a  woman  makes                                                                    
concerning her own body and  whether to carry or terminate a                                                                    
pregnancy is  to be  given equal  protection under  the law.                                                                    
The passage of the bills  would result in increased spending                                                                    
on  litigation related  to  the  unconstitutionality of  the                                                                    
issue.   She   stated   that   Alaska   was   working   with                                                                    
unprecedented    deficits    resulting   from    corporation                                                                    
mentality.  She asked  if Alaskans  needed  to bear  another                                                                    
unnecessary financial  burden in  order to  forward partisan                                                                    
positions that  did nothing to  improve the quality  of life                                                                    
for all citizens. She questioned  if more money needed to be                                                                    
wasted  on court  costs when  many of  the state's  citizens                                                                    
lacked basic family planning services.                                                                                          
Ms. Hardy  spoke to the  byproducts of  unintended pregnancy                                                                    
including homelessness,  hunger, poverty,  and malnutrition.                                                                    
She  stated  that  50   percent  of  unintended  pregnancies                                                                    
occurred  in   the  population   served  by   Medicaid.  She                                                                    
communicated  that the  only safe  and economic  strategy to                                                                    
prevent  unintended pregnancy  was to  institute a  Medicaid                                                                    
women's health program. The  program offered supplements and                                                                    
healthcare for women choosing to  carry a baby to full-term;                                                                    
it offered contraceptive services  for women choosing not to                                                                    
have children. She  urged the committee to  vote against the                                                                    
bills and  asked it to  implement a Medicaid  women's health                                                                    
program. She relayed  that 90 percent of  the program's cost                                                                    
was  covered  by the  federal  government,  with 10  percent                                                                    
covered  by  the  state.  In  addition  to  keeping  federal                                                                    
dollars in  Alaska, the program  would defray  a significant                                                                    
burden  to  the Denali  KidCare  service,  which would  save                                                                    
millions  of  dollars. She  thanked  the  committee for  its                                                                    
9:34:45 AM                                                                                                                    
JOYANNE BLOOM,  SELF, JUNEAU,  testified against  the bills.                                                                    
She spoke to  the financial impacts of  the legislation. She                                                                    
believed the  zero fiscal  notes attached  to the  bill were                                                                    
misleading. She  pointed out that the  DHSS commissioner had                                                                    
relayed  that the  bill would  cost close  to $1  million in                                                                    
litigation.  She had  also heard  from the  sponsor that  he                                                                    
expected  the issue  would go  to  litigation. She  believed                                                                    
there were many better ways to spend $1 million.                                                                                
9:36:10 AM                                                                                                                    
ANN  ROBERTSON, SELF,  JUNEAU,  spoke  strongly against  the                                                                    
legislation.  She stated  that the  definition of  medically                                                                    
necessary abortions  should be  determined only  be doctors;                                                                    
the decision  was not  the purview  of the  legislature. She                                                                    
believed the  bills constituted broad  government overreach,                                                                    
which  she understood  many committee  members were  opposed                                                                    
to.   She  urged   the  committee   to   vote  against   the                                                                    
9:37:05 AM                                                                                                                    
AMY  BOLLENBACH,  SELF,  HOMER (via  teleconference),  spoke                                                                    
against SB  49. She  pointed out that  the bills  would cost                                                                    
the state a  significant amount of money. She  noted that it                                                                    
cost less  to pay  for an  abortion than it  did to  pay the                                                                    
healthcare of children  born to women who were  not ready to                                                                    
be  parents.   She  mentioned  her  work   as  a  university                                                                    
psychology teacher.   She pointed to  the connection between                                                                    
mental  and physical  health and  discussed that  if someone                                                                    
was  mentally  ill  it impacted  physical  health  and  vice                                                                    
versa. She stated that it was  impossible to list all of the                                                                    
different medical reasons a woman  may need an abortion. She                                                                    
asked the  committee to  vote against SB  49 because  it was                                                                    
not helpful to the health of women in Alaska.                                                                                   
9:39:18 AM                                                                                                                    
JEAN BRAMER,  OBSTETRICIAN, FAIRBANKS  (via teleconference),                                                                    
testified  in  favor of  the  legislation.  She stated  that                                                                    
medical  necessity was  defined every  day. She  stated that                                                                    
many  strict  definitions  of  the  term  existed  and  much                                                                    
research  and literature  could  explain  it. She  continued                                                                    
that  there were  few instances  when  pregnancies would  be                                                                    
recommended  for termination  based  on  health issues.  She                                                                    
stated  that  the  number   of  abortions  deemed  medically                                                                    
necessary were not close to  existing definitions of medical                                                                    
necessity.  She  stated  that approximately  40  percent  of                                                                    
abortions  were  deemed  necessary  compared  to  literature                                                                    
showing  that   approximately  4  percent  fell   under  the                                                                    
medically   necessary   category.  She   communicated   that                                                                    
research showed  that there were  very few  pregnancies that                                                                    
should  be terminated  due to  the health  of a  mother. She                                                                    
stated that most  of the abortions were  terminated based on                                                                    
the desire to  not continue a pregnancy.  She furthered that                                                                    
SB  49  did not  limit  resources  for  women to  choose  to                                                                    
exercise  their  legal right  of  termination.  She did  not                                                                    
believe  the state's  tax dollars  needed  to fund  elective                                                                    
abortions.  She did  not believe  the issue  had to  do with                                                                    
pro-life or  pro-choice. She  opined that  it was  a funding                                                                    
issue and that the terms were  well defined in the bill. She                                                                    
supported the  legislation in  order to  continue healthcare                                                                    
provided  to  Alaskans and  to  make  the  best use  of  tax                                                                    
dollars by allowing appropriate  definitions to be made. She                                                                    
did  not support  a "carte  blanche" to  anyone choosing  to                                                                    
terminate a pregnancy.                                                                                                          
Representative Wilson  asked whether doctors  were following                                                                    
the  current law  related to  medical necessity.  Dr. Bramer                                                                    
did not believe doctors could  be following the current law.                                                                    
She  noted that  the  number of  abortions deemed  medically                                                                    
necessary by  doctors [in Alaska]  was much higher  than the                                                                    
research  figures. She  had one  or two  instances when  the                                                                    
option  could  have been  considered  but  the patients  had                                                                    
chosen  to  continue with  their  pregnancies.  She did  not                                                                    
believe it  was realistic  that 40  percent of  the patients                                                                    
could be having abortions out of medical necessity.                                                                             
Representative Wilson asked Dr.  Bramer if she believed that                                                                    
the  bill would  be  effective. Dr.  Bramer  replied in  the                                                                    
affirmative. She  believed a statement of  medical necessity                                                                    
could be  interpreted in various  ways; however,  there were                                                                    
very few instances when elective  surgeries were paid for by                                                                    
insurance. She believed the  bill represented a continuation                                                                    
of  medical practices  in the  "normal  medical world."  She                                                                    
pointed out  that the bill  provided a strict  guideline for                                                                    
what constituted  medically necessary.  She stated  that the                                                                    
bill  did  not  limit  anyone's  access  to  abortions.  She                                                                    
believed the bill was excellent.                                                                                                
9:44:15 AM                                                                                                                    
Representative Gara  pointed to Dr. Bramer's  testimony that                                                                    
doctors  were currently  providing elective  abortions under                                                                    
the   medically  necessary   category.  He   disagreed,  but                                                                    
wondered why doctors  would start complying with  the law in                                                                    
the future if they were not complying with existing law.                                                                        
Dr.  Bramer replied  that the  bills would  provide stricter                                                                    
guidelines. She believed a  loose guideline provided doctors                                                                    
with  the   opportunity  to   deem  elective   abortions  as                                                                    
medically  necessary.   She  stated   that  with   a  strict                                                                    
definition  doctors would  either  be committing  fraudulent                                                                    
activity  by  designating  elective abortions  as  medically                                                                    
necessary or they would have  to realize the abortions would                                                                    
not  get funded  by Medicaid.  She believed  many physicians                                                                    
were  currently  providing   elective  abortions  under  the                                                                    
medically necessary category.                                                                                                   
Representative Munoz wondered if  Dr. Bramer believed that a                                                                    
diagnosed mental disability should be  listed in the bill as                                                                    
a  medically necessary  reason for  an abortion.  Dr. Bramer                                                                    
replied  in the  negative. She  relayed that  she had  taken                                                                    
care   of  many   women   with   mental  disorders   through                                                                    
9:46:30 AM                                                                                                                    
Co-Chair Stoltze  wanted to hear  from Alaska  Mental Health                                                                    
Trust Authority (AMHTA) related to the issues.                                                                                  
Representative Holmes wondered if the  health of a fetus was                                                                    
considered in the legislation. She  thought it was cruel and                                                                    
unusual if  a woman  was forced to  continue a  pregnancy if                                                                    
the fetus  would not survive.  Dr. Bramer answered  that the                                                                    
discovery of  an unviable fetus  was typically found  in the                                                                    
second  trimester. She  explained that  the issue  typically                                                                    
went  through  an  ethics  committee   and  an  opinion  was                                                                    
received from  two physicians  at different  practices. Once                                                                    
agreement had  been made that  the fetus was  nonviable, the                                                                    
patient would  have the option  to terminate  the pregnancy.                                                                    
She stated  that the occurrence  was fairly  infrequent; she                                                                    
recalled  that  she  had three  patients  in  the  situation                                                                    
during her 18 years of practice.                                                                                                
Representative  Holmes  would take  the  issue  up with  the                                                                    
Co-Chair   Stoltze  appreciated   the  testimony   from  the                                                                    
ALLISON  CURREY, SELF,  JUNEAU, spoke  in opposition  to the                                                                    
bills. She agreed  with many points made  by others opposing                                                                    
the  bills. She  spoke  in support  of  increased access  to                                                                    
family planning  services through a Medicaid  women's health                                                                    
program. She  addressed supporting testimony that  the bills                                                                    
were  only  about  clarifying definitions,  not  restricting                                                                    
access to  abortion. She stressed that  legal abortion meant                                                                    
very  little to  a  woman who  could not  pay  for one.  She                                                                    
believed   the  bills   were  discriminatory   because  they                                                                    
violated  the constitutional  equal  protection clause  that                                                                    
protects  the freedom  and privacy  of  low-income women  to                                                                    
make  their  own  healthcare   decisions.  She  thanked  the                                                                    
committee for its time.                                                                                                         
Co-Chair Stoltze CLOSED public testimony.                                                                                       
9:51:17 AM                                                                                                                    
Senator Coghill  replied that the  crux of the issue  in the                                                                    
legislation was related to Medicaid  payment. He stated that                                                                    
Medicaid  was  an entitlement  provided  to  poor people  in                                                                    
Alaska. He  believed that Medicaid should  be available when                                                                    
there  was a  need. He  communicated that  the bill  did not                                                                    
restrict  a  woman's  choice  [to   have  an  abortion].  He                                                                    
believed  it  brought  responsibility   to  the  choice.  He                                                                    
acknowledged that  the area was  highly litigated.  He noted                                                                    
that  Planned Parenthood  had no  answer when  he had  asked                                                                    
what constituted  an elective abortion. He  believed Planned                                                                    
Parenthood  viewed  any  wanted  abortion  as  required.  He                                                                    
stated that  any other elective procedure  would be provided                                                                    
under   Medicaid  if   it  was   for   health  reasons.   He                                                                    
acknowledged that he had a  larger issue with the topic, but                                                                    
he had worked  to keep the bill narrowly  focused. He stated                                                                    
that  a   court  decision   had  brought   up  psychological                                                                    
conditions.  As   the  chairman   of  the   House  Judiciary                                                                    
Committee,   he   had   brought  eight   or   nine   medical                                                                    
professionals (pro  and con) to  testify extensively  on the                                                                    
legal technical  and ethical issues. He  had determined that                                                                    
under neutral criteria (was  healthcare available under both                                                                    
circumstances)  the  answer  had  been  that  there  was  no                                                                    
compelling reason  to include it  [psychological conditions]                                                                    
in  the  case of  abortions.  He  remarked that  the  Alaska                                                                    
Supreme   Court  had   not  had   the  testimony   that  the                                                                    
legislature had heard. He agreed  to speak with AMHTA on the                                                                    
subject as well, but believed it had been well vetted.                                                                          
Senator Coghill stated that Planned  Parenthood and the ACLU                                                                    
pushed  for  abortions  in  almost  any  case.  He  was  not                                                                    
surprised  that  the entities  had  to  both continually  be                                                                    
challenged  on three  legal and  practical levels  including                                                                    
policy, how to deal with  the issue in good standard medical                                                                    
terms,  and  how to  answer  technical  legal arguments.  He                                                                    
shared  that  he frequently  disagreed  with  the courts  on                                                                    
policy and  philosophy. He believed  in the rule of  law and                                                                    
detailed that  the bill  attempted to  bring clarity  to the                                                                    
issue. He agreed that litigation  costs existed; however, he                                                                    
found it difficult to believe  that promoting abortions over                                                                    
taking care  of children  would be  cheaper. He  stated that                                                                    
there was  an expense no  matter what. He  communicated that                                                                    
he  had  worked  hard  to  help children  in  need  of  aid,                                                                    
individuals with Fetal Alcohol  Syndrome, and women in need;                                                                    
service for  people in need cost  approximately $3.2 billion                                                                    
in state and  federal funds. He believed  the willingness of                                                                    
Alaskans  to  help people  was  difficult  to challenge.  He                                                                    
stated that the equal  protection argument was about whether                                                                    
equitable  care was  provided; he  believed  the answer  was                                                                    
yes. He acknowledged  that the issue was  emotional and that                                                                    
the well-being and rights of  a mother were to be respected.                                                                    
He discussed  that the issue  of payment was  difficult; the                                                                    
bill aimed to bring clarity.                                                                                                    
9:57:31 AM                                                                                                                    
Representative Ledoux appreciated  the committee's time. She                                                                    
pointed to heartfelt  testimony, but noted that  most of the                                                                    
opposing testimony related  to a woman's right  to choose an                                                                    
abortion. She  stated that  the bill  was unrelated  to that                                                                    
right.  She stressed  that the  bill only  pertained to  who                                                                    
paid for abortions.                                                                                                             
Senator  Coghill added  that he  had asked  DHSS to  clarify                                                                    
what was  currently covered  under family  planning services                                                                    
in  Alaska.  There were  currently  39  items covered  under                                                                    
family planning.  He relayed  that under  diagnostic general                                                                    
reproductive  health   there  were  eight   items  including                                                                    
cervical   cancer,   female    reproductive   cancer,   male                                                                    
reproductive,   pap  smear   tests,  urinary,   and  vaginal                                                                    
discharge;  there  were  11  other  items  under  diagnostic                                                                    
sexually transmitted infections.  The contraception category                                                                    
included  birth control  pills,  cervical caps,  diaphragms,                                                                    
etc. He  stated that there  were 16 different  variations of                                                                    
family planning  currently used in  the state.  Other cancer                                                                    
screening  and prevention  covered  under Medicaid  included                                                                    
mammograms, pap smears, and  colonoscopies. He detailed that                                                                    
most of  the items were covered  at the 90 percent  area and                                                                    
many  were covered  at the  50  percent area.  Preconception                                                                    
gynecologic  exams  were  also   covered.  He  believed  the                                                                    
requirement  under current  law was  significant. He  stated                                                                    
that  Denali  KidCare  provided  services  in  18  different                                                                    
Co-Chair Stoltze relayed that DHSS and DOA would address                                                                        
the committee related to the bills. He noted that the issue                                                                     
would be discussed further at the afternoon meeting.                                                                            
HB 173 was HEARD and HELD in committee for further                                                                              
SSSB 49(FIN) was HEARD and HELD in committee for further                                                                        

Document Name Date/Time Subjects
HB 173 Letters of Support.PDF HFIN 2/25/2014 8:00:00 AM
HB 173
HB 173 Sectional Analysis.PDF HFIN 2/25/2014 8:00:00 AM
HB 173
HB 173 Sponsor Statement.PDF HFIN 2/25/2014 8:00:00 AM
HB 173
HB 173 Supporting Document Legal Memo.PDF HFIN 2/25/2014 8:00:00 AM
HB 173
SB 49 - 2013 Induced Termination of Pregnancy Statistics.pdf HFIN 2/25/2014 8:00:00 AM
SB 49
SB 49 - Explanation of Changes.pdf HFIN 2/25/2014 8:00:00 AM
SB 49
SB 49 - Sectional Analysis.pdf HFIN 2/25/2014 8:00:00 AM
SB 49
SB 49 - Sponsor Statement.pdf HFIN 2/25/2014 8:00:00 AM
SB 49
SB 49 NEW FISCAL NOTES-DHSS 2.24.14.pdf HFIN 2/25/2014 8:00:00 AM
SB 49
SB 49 & HB 173. ACLU Review. 2014.02.24.pdf HFIN 2/25/2014 8:00:00 AM
HB 173
SB 49
SB 49 Public Testimony Dr. Brown.pdf HFIN 2/25/2014 8:00:00 AM
SB 49