Legislature(2001 - 2002)

04/30/2002 03:15 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 313 - INSURANCE COVERAGE FOR CONTRACEPTIVES                                                                                
Number 1317                                                                                                                     
                                                                                                                                
CHAIR DYSON announced  that the final order of  business would be                                                               
HOUSE  BILL  NO.  313,  "An   Act  requiring  that  the  cost  of                                                               
contraceptives  be  included  in certain  health  care  insurance                                                               
coverage."                                                                                                                      
                                                                                                                                
REPRESENTATIVE LISA  MURKOWSKI, Alaska State Legislature,  one of                                                               
several  prime  sponsors,  presented  HB   313.    She  told  the                                                               
committee  that it  is  an  issue of  prescriptive  equity.   She                                                               
recognized that  it being  late in the  session, HB  313 probably                                                               
wouldn't move, but  she appreciated the opportunity to  get it on                                                               
the record.   She referred to a handout put  out by The Coalition                                                               
for [Prescription] Equity.   She said the handout  puts forth all                                                               
the substantial arguments  as to why Alaska  should have mandated                                                               
prescription coverage.                                                                                                          
                                                                                                                                
Number 1415                                                                                                                     
                                                                                                                                
REPRESENTATIVE MURKOWSKI  said that  first of  all, contraception                                                               
is  a  basic  health  care  need.    Contraception  is  the  only                                                               
prescription approved  by the FDA [Food  and Drug Administration]                                                               
not routinely  covered by insurers.   This is an issue  that gets                                                               
to the  heart of  talking about  prescriptive equity.   It  is an                                                               
equity issue recognizing that when  contraception is being talked                                                               
about,  there is  no prescription  contraception for  men.   Less                                                               
than 20 percent  of traditional health care plans  cover the FDA-                                                               
approved methods of contraception.                                                                                              
                                                                                                                                
Number 1475                                                                                                                     
                                                                                                                                
REPRESENTATIVE MURKOWSKI told the members  in terms of the equity                                                               
issue, statistics say that women  of childbearing age have to pay                                                               
68  percent more  in out-of-pocket  health care  costs than  men.                                                               
The bulk of  these health care costs are  related to reproductive                                                               
health care services.                                                                                                           
                                                                                                                                
REPRESENTATIVE  MURKOWSKI noted  that the  question, What  is the                                                               
cost to the employer? always comes  up.  She pointed out the fact                                                               
that covering contraceptives will actually  save money.  The cost                                                               
for covering  contraceptives for a  year is about $300,  which is                                                               
far  less than  pregnancy services.   Contraception  is not  just                                                               
intended  to  prevent  pregnancy,  but  there  are  many  medical                                                               
reasons for  prescribing birth control pills,  such as prevention                                                               
of  anemia,  osteoporosis, and  endometriosis.    Even for  those                                                               
reasons, it would  still not be covered under  the insurance plan                                                               
at  this  point.     She  told  the   committee  that  affordable                                                               
contraception  will  decrease   the  unintended  pregnancies  and                                                               
prevent abortions.                                                                                                              
                                                                                                                                
Number 1572                                                                                                                     
                                                                                                                                
REPRESENTATIVE  MURKOWSKI  referred  to statistics  that  say  42                                                               
percent of  live births in Alaska  are unintended; 85 out  of 100                                                               
women  of reproductive  age, who  are  not using  contraceptives,                                                               
will  become pregnant  in  a  year.   Each  year  in Alaska,  120                                                               
pregnancies  occur  per 1,000  women,  and  69 percent  of  these                                                               
pregnancies end in  live births and 16 percent in  abortion.  She                                                               
commented  that it  is  legitimate to  look  at contraception  if                                                               
members  are concerned  about abortion.   This  is an  issue that                                                               
causes discussion.   It was  suggested to her  that contraception                                                               
is an optional thing for women.                                                                                                 
                                                                                                                                
Number 1650                                                                                                                     
                                                                                                                                
REPRESENTATIVE MURKOWSKI referred the  committee to a footnote in                                                               
the EEOC [U.S. Equal  Employment Opportunity Commission] decision                                                               
in  the packet,  which is  a statement  from Senator  Snowe in  a                                                               
discussion or debate  about the legislation at  the federal level                                                               
for equity in prescription  insurance and contraceptive coverage.                                                               
The   senator  states:     "There   is  nothing   optional  about                                                               
contraception.   It's  a medical  necessity for  women during  30                                                               
years  of their  lifespan.    To ignore  the  health benefits  of                                                               
contraception  is  to  say  that  the alternative  of  12  to  15                                                               
pregnancies during  a woman's lifetime is  medically acceptable."                                                               
She urged the committee to think about that.                                                                                    
                                                                                                                                
Number 1650                                                                                                                     
                                                                                                                                
REPRESENTATIVE  MURKOWSKI   said  the  bulletin  issued   by  the                                                               
Division of  Insurance refers  to the  EEOC decision  of December                                                               
2000  that, "pursuant  to the  Pregnancy Discrimination  Act, the                                                               
federal  act,  employers may  not  discriminate  in their  health                                                               
insurance   plan    by   denying   benefits    for   prescription                                                               
contraceptives when they provide  benefits for other prescription                                                               
drugs  and devices."   The  bill before  the committee  is saying                                                               
that  if a  plan offers  a  prescription benefit,  it must  cover                                                               
contraceptives.  It  is not saying if no  prescription benefit is                                                               
provided, it now has  to be provided.  She noted  that in HB 313,                                                               
there is a religious exemption.                                                                                                 
                                                                                                                                
Number 1745                                                                                                                     
                                                                                                                                
CHAIR DYSON  asked what  happens if Alaska  is not  in conformity                                                               
with the Civil Rights Act of 1964.                                                                                              
                                                                                                                                
REPRESENTATIVE MURKOWSKI  answered that  the State  insurance for                                                               
public   employees  currently   covers  contraception,   but  the                                                               
retirement plan is not covered.   She agreed that an employer who                                                               
offers a  plan that  does not  provide for  prescriptive coverage                                                               
could be  subject to a lawsuit.   In answer to  the question, she                                                               
said she does believe the state has exposure on this issue.                                                                     
                                                                                                                                
Number 1937                                                                                                                     
                                                                                                                                
CHAIR DYSON  asked if insurance  companies are required  to cover                                                               
prescriptions for medicines that prevent an illness.                                                                            
                                                                                                                                
REPRESENTATIVE  MURKOWSKI answered  that  she  was only  familiar                                                               
with those mandates that are  currently in statute, for instance,                                                               
mammograms,  prostate  screening,   and  diabetes  coverage,  and                                                               
wasn't sure of the answer to the question.                                                                                      
                                                                                                                                
REPRESENTATIVE  MURKOWSKI,  responding  to  comments  from  Chair                                                               
Dyson, remarked that  it's not an issue  of [insurance companies]                                                               
covering   prescriptive  drugs   equally  for   men  and   women.                                                               
Representative Murkowski said the issue  is:  "should I choose to                                                               
become  pregnant, my  pregnancy is  covered; if  I choose  not to                                                               
become pregnant, my contraception should be covered."                                                                           
                                                                                                                                
CHAIR  DYSON asked  if the  morning after  pill would  be covered                                                               
under this bill.                                                                                                                
                                                                                                                                
Number 2119                                                                                                                     
                                                                                                                                
REPRESENTATIVE  MURKOWSKI answered  that  if  she understands  it                                                               
correctly, then  yes it would  be covered under  the legislation.                                                               
She reminded the committee that it  has to be an FDA-approved and                                                               
prescribed prescription.                                                                                                        
                                                                                                                                
Number 2156                                                                                                                     
                                                                                                                                
BOB  LOHR,   Director,  Division  of  Insurance,   Department  of                                                               
Community  & Economic  Development, testified  that the  division                                                               
supports this legislation.  He gave the following testimony:                                                                    
                                                                                                                                
     It  clearly  establishes  that  insurers  must  provide                                                                    
     coverage  for   contraceptives  if   prescription  drug                                                                    
     coverage is  provided.  The  recent federal  court case                                                                    
     and   the  Equal   Employment  Opportunity   Commission                                                                    
     opinion  on  coverage  of  prescription  contraceptives                                                                    
     concludes that  employers may be found  in violation of                                                                    
     the  Pregnancy  Discrimination  Act,  if  they  do  not                                                                    
     provide  coverage of  prescription contraceptives  when                                                                    
     they  provide coverage  for  other prescription  drugs.                                                                    
     The court  case and  the EEOC  opinion are  directed to                                                                    
     employers, not insurers.  Therefore,  we do not believe                                                                    
     that action by the division is mandated.                                                                                   
                                                                                                                                
     The  division recently  issued a  bulletin to  insurers                                                                    
     requesting their  assistance in informing  employers of                                                                    
     the   potential    violation   under    the   Pregnancy                                                                    
     Discrimination   Act,   if   they   fail   to   provide                                                                    
     prescription contraceptive  coverage when  they provide                                                                    
     coverage   for   other   prescription   drugs.      For                                                                    
     enforcement  purposes, a  legislation mandate,  such as                                                                    
     HB 313,  requiring   insurers  to   offer  prescription                                                                    
     contraceptive  drug   coverage,  is  preferable.     An                                                                    
     informal  survey by  the Alaska  Division of  Insurance                                                                    
        indicates that the largest insurers in the State                                                                        
        already provide prescription drug coverage as a                                                                         
     benefit option for employees.                                                                                              
                                                                                                                                
Number 2235                                                                                                                     
                                                                                                                                
CHAIR DYSON asked how much  more the insurers would charge should                                                               
the employers choose the option.                                                                                                
                                                                                                                                
MR. LOHR replied that the figure he has heard is $1 per month.                                                                  
                                                                                                                                
CHAIR  DYSON asked  if  it  is the  employer  that exercises  the                                                               
option,  and all  the employees  in that  company are  paying the                                                               
dollar, or if  it is just the individual  employee that exercises                                                               
the option.                                                                                                                     
                                                                                                                                
MR. LOHR  said he believes it  would be the employer  making that                                                               
choice to have that type of coverage.                                                                                           
                                                                                                                                
Number 2281                                                                                                                     
                                                                                                                                
REPRESENTATIVE STEVENS  commented that his own  insurance company                                                               
would  have  been  far  better  off  providing  his  family  with                                                               
contraception than to  cover his children up to age  21.  He said                                                               
he would  think that the  insurance companies would  be delighted                                                               
and would save  money in providing contraception  instead of life                                                               
coverage.                                                                                                                       
                                                                                                                                
MR.  LOHR replied  that he  believes that  most insurers  support                                                               
this  type  of legislation.    Many  have already  exercised  the                                                               
option within  Alaska, and there is  relatively little opposition                                                               
to this  concept.  He  noted that  that is unlike  most insurance                                                               
mandates, in which there will be substantial insurer opposition.                                                                
                                                                                                                                
REPRESENTATIVE STEVENS  asked why  there would be  any additional                                                               
charge to the businessman who covers his employees.                                                                             
                                                                                                                                
MR. LOHR answered  that he isn't sure how  insurance companies do                                                               
their  internal  discounting, but  the  prescription  cost is  an                                                               
immediate  expense   and  the  long-term  savings   are  hard  to                                                               
quantify.                                                                                                                       
                                                                                                                                
Number 2337                                                                                                                     
                                                                                                                                
CHAIR DYSON  asked Mr.  Lohr for  his guess  of the  lower annual                                                               
salary of people  who have insurance through their  employer.  He                                                               
said he suspects  that people who make $15,000  per year probably                                                               
don't have group insurance, and people who make $40,000 do.                                                                     
                                                                                                                                
MR.  LOHR said  that  he  couldn't give  him  a  number, but  the                                                               
general indication is the lower  the income of the average salary                                                               
of  an employer,  the less  likely  it would  be offering  health                                                               
insurance.                                                                                                                      
                                                                                                                                
CHAIR DYSON  asked Mr. Lohr  if he  knew of any  employees making                                                               
less than $25,000 who had health insurance.                                                                                     
                                                                                                                                
MR. LOHR  replied that  he couldn't  cite a  list, but  there are                                                               
some.   Typically,  the  incidence is  lower.   There  is also  a                                                               
correlation of the size of the  employer and the ability to offer                                                               
coverage.                                                                                                                       
                                                                                                                                
TAPE 02-38, SIDE B                                                                                                              
Number 2378                                                                                                                     
                                                                                                                                
MR. LOHR  indicated that the  division believes that  the limited                                                               
benefit health  care insurance definition is  unnecessary because                                                               
the  term  "health  care insurance  plan"  already  excludes  the                                                               
benefits defined  as limited benefit  health care insurance.   He                                                               
suggested deleting  the following:   Page 2, lines 27  through 31                                                               
and page  3, lines 1 through  3; Page 2, line  2, delete "limited                                                               
benefit health care insurance or".                                                                                              
                                                                                                                                
Number 2325                                                                                                                     
                                                                                                                                
REPRESENTATIVE MURKOWSKI concurred  with that proposed amendment.                                                               
She  referred to  a  letter  from Blue  Cross  Blue Shield  which                                                               
indicates it has no opposition to HB 313.                                                                                       
                                                                                                                                
CHAIR  DYSON said  he thinks  he  heard Representative  Murkowski                                                               
infer that if  insurance companies are not offering  or making it                                                               
universally available  to the clients they're  covering, they may                                                               
be exposed to a lawsuit.  He wondered if that was correct.                                                                      
                                                                                                                                
MR.  LOHR  responded  that the  division  believes  insurers  are                                                               
providing better  customer service to employers  by advising them                                                               
of the EEOC decision.  With  this knowledge employers can make an                                                               
informed choice about [various] types of coverage.                                                                              
                                                                                                                                
CHAIR DYSON  asked if it  would be  the employers that  would get                                                               
sued.                                                                                                                           
                                                                                                                                
Number 2247                                                                                                                     
                                                                                                                                
MR.  LOHR answered  that the  employers are  the ones  "under the                                                               
gun" of the EEOC opinion; it's  not the insurance companies.  The                                                               
division's regulatory  authority extends  to insurers, so  it has                                                               
let them  know of  this opinion  in hopes  that they  will advise                                                               
employers.                                                                                                                      
                                                                                                                                
Number 2225                                                                                                                     
                                                                                                                                
CHAIR DYSON  asked what the  effect of the  law would be  if this                                                               
bill passes.   He wondered if  the division would be  putting any                                                               
employers in jail.                                                                                                              
                                                                                                                                
MR. LOHR responded no, he said  he doesn't believe that this bill                                                               
would  give  the division  any  authority  over employers.    Its                                                               
authority extends  to Title  21, which  regulates the  conduct of                                                               
insurance companies, agents, brokers, et cetera.                                                                                
                                                                                                                                
CHAIR DYSON asked what would be the effect of this law.                                                                         
                                                                                                                                
Number 2200                                                                                                                     
                                                                                                                                
MR.  LOHR  answered  that  the  law  would  require  prescriptive                                                               
equity, and  therefore would require  that if an  insurer chooses                                                               
to offer prescription benefits,  those benefits would be required                                                               
to include  contraceptives approved by  the FDA.  If  the insurer                                                               
elects not to  offer prescription coverage, that's fine.   But if                                                               
they don't include contraception,  the division would enforce the                                                               
mandate  under  law  to  say,  because  you've  chosen  to  offer                                                               
prescription drug  benefits, you  must provide  them on  an even-                                                               
handed basis  with respect to  approved contraceptives.   If they                                                               
don't,  the division  has a  range of  enforcement options  which                                                               
include  fines  to  ultimately  removal  of  the  certificate  of                                                               
authority to operate in the state.                                                                                              
                                                                                                                                
CHAIR DYSON  commented that putting  this in law would  just give                                                               
the division  a better  way of getting  employers informed  to do                                                               
what they  ought to be doing  anyway to serve the  clients and to                                                               
protect themselves from lawsuits.                                                                                               
                                                                                                                                
MR. LOHR  said that is  correct with  respect to employers.   The                                                               
division doesn't  go there in terms  of its authority.   It isn't                                                               
trying to  boot strap any kind  of authority here.   The division                                                               
is  trying to  make sure  that employers  are following  whatever                                                               
mandates are legislatively approved.                                                                                            
                                                                                                                                
Number 2109                                                                                                                     
                                                                                                                                
COLLEEN  MURPHY, M.D.,  Obstetrician-Gynecologist, testified  via                                                               
teleconference.   She expressed strong  support for HB 313.   She                                                               
said it  makes medical sense,  social sense, and  economic sense.                                                               
As a small  business employer who now  purchases health insurance                                                               
for  her employees,  she  has  to have  policies  that make  this                                                               
available.   It  is difficult  for the  Division of  Insurance to                                                               
remind employers  to buy  insurance that  is consistent  with the                                                               
EEO  process,  and it  is  very  difficult  for the  division  to                                                               
enforce this.   By  passing this  legislation, it  actually gives                                                               
the  Division of  Insurance some  teeth  to follow  the plans  it                                                               
regulates in  the state.   She encouraged  the committee  to pass                                                               
this bill on  so that women can get the  prescriptions they need,                                                               
so  that unintended  pregnancy will  decrease in  the state  with                                                               
effective FDA-approved  forms of contraception, and  that it will                                                               
show  that women  are  cared  about and  are  no longer  sexually                                                               
discriminated against.                                                                                                          
                                                                                                                                
CHAIR DYSON  asked Dr. Murphy  if oral contraception  costs about                                                               
$300 a year.                                                                                                                    
                                                                                                                                
DR.  MURPHY  answered that  depends.    She explained  that  drug                                                               
companies can  charge more for  new drugs, but there  are generic                                                               
drugs  available  for  several  dollars per  pack.    If  doctors                                                               
prescribe  the  older drugs,  they  can  use cheaper  pills  with                                                               
comparable effects.   The newer pills that  have third generation                                                               
progesterone tend to be more  expensive.  If someone uses generic                                                               
drugs, the cost would be under $100 per year.                                                                                   
                                                                                                                                
Number 2009                                                                                                                     
                                                                                                                                
CHAIR DYSON commented that it seems  to him that everyone who has                                                               
a  good  enough  job  with  health  insurance  could  afford  the                                                               
prescription contraceptive.                                                                                                     
                                                                                                                                
DR.  MURPHY answered  that she  doesn't  think it  is a  question                                                               
about  the affordability  of different  forms of  family planning                                                               
that are  FDA approved.   She informed  the committee  that there                                                               
are many  different forms someone  could consider using.   An IUD                                                               
[intra-uterine device] costs about $400,  and to have it inserted                                                               
costs $300 to  $400, which is a large amount  of money for people                                                               
to pay  out of pocket.   There are newer monthly  injections that                                                               
cost about  $50 per month.   There are new patches  coming out, a                                                               
ring to put inside the  vagina, and oral contraceptive pills; all                                                               
these things  cost different  amounts of money.   She  noted that                                                               
the bottom line is the EEO issue.   In order to be fair to women,                                                               
they  should  be able  to  get  prescriptive contraception  as  a                                                               
primary health care need.                                                                                                       
                                                                                                                                
Number 1949                                                                                                                     
                                                                                                                                
CHAIR DYSON  said he appreciated  the equity issue.   He wondered                                                               
if there are  other times when insurance companies  are forced to                                                               
pay for prescriptions that prevent a condition.                                                                                 
                                                                                                                                
DR. MURPHY  replied yes.   For example,  there is a  monthly shot                                                               
for  rheumatic  heart  disease  so  bacteria  won't  get  in  the                                                               
bloodstream.    She  noted  there are  all  sorts  of  preventive                                                               
medications.  She reminded the  members that it is cost effective                                                               
to prevent problems.  She said,  "An ounce of prevention is worth                                                               
a pound of cure."                                                                                                               
                                                                                                                                
Number 1909                                                                                                                     
                                                                                                                                
CHAIR DYSON asked Dr. Murphy about the morning after pills.                                                                     
                                                                                                                                
DR. MURPHY replied that morning after  pills are a backup form of                                                               
birth control.                                                                                                                  
                                                                                                                                
CHAIR DYSON  said as he  understands it, the morning  after pills                                                               
act after fertilization but before implantation.                                                                                
                                                                                                                                
DR. MURPHY told him  that is not true.  There have  been a lot of                                                               
theories  around the  mechanism  of action  for contraception  in                                                               
general.    Most of  the  hormonal  contraceptives work  at  many                                                               
different  levels.   The  progesterone is  known  to thicken  the                                                               
cervical  mucus so  that  sperm  cannot get  out  of the  vagina.                                                               
Progesterone also changes  the lining of the uterus  and makes it                                                               
thinner.   The hormones  can also affect  tubal motility  so that                                                               
sperm and eggs  are not normally transported and  meet each other                                                               
in the middle.   The estrogen and progesterone are  also known to                                                               
affect the  development of  egg and ovulation.   The  only proven                                                               
mechanism of action  for emergency contraception is  the delay in                                                               
ovulation.      Basically,   when   a   woman   takes   emergency                                                               
contraception, it slows down the  development of a developing egg                                                               
so that it is  not released within the next 72  hours, so in that                                                               
time, the sperm dies before it can reach the egg.                                                                               
                                                                                                                                
CHAIR DYSON  asked what  the earliest  is that  fertilization can                                                               
take place.                                                                                                                     
                                                                                                                                
Number 1856                                                                                                                     
                                                                                                                                
DR.  MURPHY  answered   that  the  egg  can   be  fertilized  for                                                               
approximately 24 hours  after its been released.   She noted that                                                               
studies  have  shown  that  it  takes  hours  for  the  sperm  to                                                               
transport itself into  the tubes, but contractions  in the uterus                                                               
help the sperm out.  She  explained that sperm have been observed                                                               
in  the  fallopian  tube  within  minutes  of  having  successful                                                               
intercourse with  normal cervical mucus.   If there is  a healthy                                                               
egg  sitting  in   the  tube,  it  can   happen  within  minutes.                                                               
Emergency contraception  is not 100  percent effective.   It will                                                               
not necessarily  prevent a pregnancy that  is already developing.                                                               
If emergency  contraception was an abortifacient,  it would cause                                                               
a higher  rate of  miscarriage and potentially  a higher  rate of                                                               
malformation, neither of which occurs.                                                                                          
                                                                                                                                
CHAIR  DYSON  expressed  concern  that  this  legislation  covers                                                               
abortifacients  in  the  emergency contraception  and  asked  Dr.                                                               
Murphy to comment on that.                                                                                                      
                                                                                                                                
DR.  MURPHY   said  she  thought   he  was   confusing  emergency                                                               
contraception pill with RU486 which  is also known as Mifeprex or                                                               
Mifepristone  produced by  Danco Laboratories.   This  is a  drug                                                               
that's  an anti-progesterone  which  can also  be  used in  other                                                               
female health  conditions, such  as endometriosis,  fibroids, and                                                               
breast  cancer.    It  is  a drug  that  can  stop  a  pregnancy.                                                               
Emergency  contraception does  not  interfere  with a  successful                                                               
pregnancy.                                                                                                                      
                                                                                                                                
Number 1631                                                                                                                     
                                                                                                                                
REPRESENTATIVE  STEVENS   asked  Dr.  Murphy  for   some  written                                                               
information on the morning after pill.                                                                                          
                                                                                                                                
DR. MURPHY referred  him to a website for this  information.  The                                                               
address is http://www.akemergencycontraception.org.                                                                             
                                                                                                                                
Number 1520                                                                                                                     
                                                                                                                                
EILEEN  FARIAN testified  via teleconference  on her  own behalf.                                                               
She told the  committee that she was irritated  when she refilled                                                               
her prescription  and discovered  that for  no reason,  all birth                                                               
control had increased a significant  amount, and her prescription                                                               
had  increased $4.    She  uses [birth  control  pills] for  many                                                               
medical reasons,  but it is not  covered.  She stated  that it is                                                               
not covered  by all  state unions.   The GGU  [General Government                                                               
Unit]  does not  cover birth  control and  hasn't as  far as  she                                                               
knows.  She said she believes  that birth control is a preventive                                                               
item.     Insurance  covers  other  preventive   things  such  as                                                               
hepatitis C shots,  immunizations, and flu shots.   She expressed                                                               
frustration about things that insurance doesn't cover.                                                                          
                                                                                                                                
Number 1396                                                                                                                     
                                                                                                                                
REPRESENTATIVE  WILSON asked  Ms. Farian  how much  she pays  per                                                               
month.                                                                                                                          
                                                                                                                                
MS. FARIAN  answered that in  the past she  has paid from  $20 to                                                               
$35; currently, she pays $25 for a generic prescription.                                                                        
                                                                                                                                
Number 1368                                                                                                                     
                                                                                                                                
ANNE  HARRISON  testified  via  teleconference.    She  expressed                                                               
support for HB 313.  She noted  that the numbers give a clear and                                                               
convincing  case  for the  passage  of  this prescriptive  equity                                                               
bill.   It  must get  out of  committee and  onto an  affirmative                                                               
vote.  She  told the committee that she has  a 37-year history as                                                               
a nurse  and nurse practitioner working  with women.  She  is now                                                               
retired and  can schedule  her still-busy  schedule to  justify a                                                               
bill critical  to reproductive  health.   She told  the committee                                                               
that  women's   health,  and  ultimately  the   health  of  their                                                               
children,  is  absolutely dependent  on  the  ability to  control                                                               
their  fertility.    They  should not  have  to  pay  inequitable                                                               
amounts  relative to  men for  their contraception  because their                                                               
insurance companies do  not pay for contraception.   This refusal                                                               
of  some  insurance companies  to  cover  contraception makes  no                                                               
sense  financially  or  from  a health  care  perspective.    She                                                               
reminded the  committee that  contraception can  prevent untimely                                                               
pregnancies  and   therefore  abortion.    She   emphasized  that                                                               
contraception is not  abortion.  She urged the  committee to pass                                                               
HB 313.                                                                                                                         
                                                                                                                                
Number 1156                                                                                                                     
                                                                                                                                
CINDY  NORQUEST  testified  via teleconference.    She  told  the                                                               
members that she  was astounded that this is even  an issue.  She                                                               
said that she  is a Catholic, a Republican,  and a businesswoman.                                                               
She explained that one of her  reasons she is a Republican is her                                                               
intolerance for  government telling citizens and  businesses what                                                               
to do.  But,  sometimes that has to be done, she  said.  It makes                                                               
good  sense  to  make  decisions that  are  tough  decisions  but                                                               
address the issues of equity and  fairness.  That is what this is                                                               
all  about.    Both  the  Civil  Rights  Act  and  the  Pregnancy                                                               
Discrimination Act were  passed as a result of  the greater good.                                                               
No  one   wanted  to  admit  that   discrimination  existed,  and                                                               
legislation was necessary  to correct the issue, she  noted.  The                                                               
bottom  line is  that  women  and people  of  color were  treated                                                               
unfairly.   Neither  act  mandated  preferential treatment,  just                                                               
equal, and that's what is being asked for today.                                                                                
                                                                                                                                
MS. NORQUEST pointed out that the  numbers do not show that women                                                               
are treated equally  when it comes to health care  issues.  Women                                                               
are paying 68 percent more  than men on out-of-pocket health care                                                               
costs.   She explained that  she is very familiar  with insurance                                                               
plans  since she  used to  manage the  benefit plan  for National                                                               
Bank  of Alaska.    She  stated that  women  do  not get  treated                                                               
equally.   She noted  that this does  save money  for businesses.                                                               
The Washington Business Group on  Health found that not providing                                                               
contraceptive  coverage would  cost  employers 15  to 17  percent                                                               
more.                                                                                                                           
                                                                                                                                
Number 1055                                                                                                                     
                                                                                                                                
MS. NORQUEST addressed some questions  asked earlier.  Responding                                                               
to a question about how low  people's income was before they were                                                               
eligible for health insurance, she  reported that Wells Fargo has                                                               
employees  making as  little as  $16,500  a year  who do  receive                                                               
health insurance.   Wells Fargo  stepped up  to the plate  in the                                                               
1990s and said it was an EEO  employer, and it was going to treat                                                               
its women fairly  and equally, so it covered  contraception.  She                                                               
said the ramifications about not  passing or passing this are not                                                               
from a legal  standpoint, but from what is right  and in the best                                                               
interest of the public.   She expressed disappointment about some                                                               
condescending  comments and  for  taking time  off  from work  to                                                               
testify on  something that really is  a "no brainer."   She urged                                                               
the committee to pass HB 313.                                                                                                   
                                                                                                                                
Number 0860                                                                                                                     
                                                                                                                                
SHERRY JAEGER testified via teleconference  on behalf of the YWCA                                                               
[Young  Women's Christian  Association].   She expressed  support                                                               
for HB 313.  She told  the committee that this bill addresses the                                                               
current  inequities involved  in  women's health  care plans  and                                                               
would require  fairness in the  workplace.  It has  the potential                                                               
to affect 140,000 women of childbearing  age in Alaska.  It would                                                               
eliminate  gender  discrimination  under  Title 7  of  the  Civil                                                               
Rights  Act of  1964 and  would address  the disparity  requiring                                                               
women to  spend nearly 70  percent more than men  on prescription                                                               
drug expenses.   She  pointed out that  contraception is  a basic                                                               
health  care  issue  for  women and  a  critical  contributor  to                                                               
improved maternal and child health.   This bill is not asking for                                                               
preferential  treatment;  it's  asking  for  equitable  treatment                                                               
within  the context  of an  existing  drug prescription  benefit.                                                               
The  adoption of  HB 313  would  ensure fairness  and equity  for                                                               
women in  the workplace,  and it would  not burden  the insurance                                                               
providers.   It would ensure full  coverage for women for  all of                                                               
their  reproductive  health care  needs,  and  finally, it  would                                                               
ensure that  Alaska would not  be violating the Civil  Rights Act                                                               
of 1964.  She urged the committee to move HB 313.                                                                               
                                                                                                                                
Number 0758                                                                                                                     
                                                                                                                                
PAULINE  UTTER, Alaska  Women's Political  Caucus, testified  via                                                               
teleconference.   She told  the committee that  the caucus  had a                                                               
booth at  a women's show  in Anchorage and circulated  a petition                                                               
that said if Viagra is funded,  why isn't birth control.  She was                                                               
astounded by the  number of people who signed on.   She suggested                                                               
that  the  legislature  should   have  the  wherewithal  to  pass                                                               
legislation  that is  in  the  best interest  for  women in  this                                                               
state.   She  urged  the committee  to  pass HB  313  out of  the                                                               
committee.                                                                                                                      
                                                                                                                                
Number 0700                                                                                                                     
                                                                                                                                
ROBIN SMITH  testified via teleconference.   She noted  that some                                                               
people's   religious  beliefs   run   counter  to   the  use   of                                                               
contraceptives or emergency contraception.   She pointed out that                                                               
there  are  many instances  in  which  health insurance  provides                                                               
coverage  that  conflicts   with  individual  religious  beliefs.                                                               
Christian Scientists  do not believe in  medical treatment except                                                               
for  dental and  vision  care.   But  most  people expect  health                                                               
insurance to  be available.   Jehovah's Witnesses do  not believe                                                               
in  blood  transfusions.    She  said  she  can't  imagine  blood                                                               
transfusions not  being covered by  health insurance.   The Roman                                                               
Catholic  Church opposes  tubal ligations  and vasectomies.   The                                                               
majority  of   health  insurance   companies  provide   for  this                                                               
permanent form  of contraception.   Providence  Hospital's health                                                               
insurance  covers birth  control pills  for its  employees.   She                                                               
said  she is  sure that  Pope John  Paul does  not approve.   She                                                               
noted that  there is  a wide variety  of people's  belief systems                                                               
and how  they impact what  people do regarding their  health care                                                               
treatment.                                                                                                                      
                                                                                                                                
MS. SMITH  reminded the  members that  women can  become pregnant                                                               
for more  than 30 years  of their lives.   Since most  women only                                                               
want  two or  three children,  they  spend the  vast majority  of                                                               
their  reproductive years  preventing  pregnancy.   Contraception                                                               
also  aids women  in facing  the children  they have;  therefore,                                                               
ensuring the  health of the mother  and the health of  the infant                                                               
that may be born.  She concluded:                                                                                               
                                                                                                                                
     You are here to enable  working women to have equal and                                                                    
     fair treatment  under the  law.  You  are here,  and if                                                                    
     you pass  this bill, you will  be preventing unintended                                                                    
     pregnancy, and  as a result, preventing  abortion.  You                                                                    
     are   not   forcing  anyone   to   use   any  form   of                                                                    
     contraception.   You  are  simply  ensuring that  women                                                                    
     have what  [they] need for basic  health care coverage.                                                                    
     Please  pass this  prescription  fairness  bill out  of                                                                    
     committee.  Please make this bill law.                                                                                     
                                                                                                                                
Number 0523                                                                                                                     
                                                                                                                                
KAREN PEARSON,  Director, Division  of Public  Health, Department                                                               
of  Health &  Social Services  (DHSS), testified  that this  is a                                                               
good  public policy  bill.   She told  the committee  that making                                                               
sure that  every child is wanted  is an important part  of public                                                               
health  and is  aided  by  a contraceptive  equity  bill such  as                                                               
HB 313.   She  explained  that  the statistic  of  42 percent  of                                                               
unintended births in  Alaska means there are  about 4200 children                                                               
born every  year in Alaska to  parents who didn't intend  to have                                                               
that child  at that time.   That doesn't make an  unwanted child.                                                               
That's a  much smaller percent.   She recognized  that unintended                                                               
children are  very often  welcomed, but for  parents to  have the                                                               
ability to plan for this is  very important.  The equity piece is                                                               
that there are no categorical  prescriptions put aside other than                                                               
contraceptives.   Since only women  can get pregnant, it  is very                                                               
much a gender issue.                                                                                                            
                                                                                                                                
MS. PEARSON  referred to Chair  Dyson's question  about someone's                                                               
salary  and insurance.    She  told him  that  the Department  of                                                               
Labor, other  departments, and the  DHSS have done  an employers'                                                               
survey related  to insurance,  and those  results will  be coming                                                               
out soon.  She remembered being  surprised when she saw the first                                                               
raw information  that showed  it wasn't  necessarily all  the big                                                               
employers who provide  insurance and all the  small employers who                                                               
don't.   There is  real diversity  in terms of  who does  and who                                                               
doesn't provide coverage  in Alaska and the income  levels of the                                                               
people  who then  receive  that.   She said  she  will make  that                                                               
information available to the committee next month.                                                                              
                                                                                                                                
Number 0372                                                                                                                     
                                                                                                                                
CHAIR DYSON  commented that  he didn't  hear any  testimony today                                                               
saying that  if this becomes  law, women will  have contraception                                                               
that they didn't have before.  It  sounds to him that if the oral                                                               
contraceptives can  be had for  $100 a  year, it's really  not an                                                               
economic issue;  it's an  equity issue according  to most  of the                                                               
testimony.                                                                                                                      
                                                                                                                                
MS. PEARSON said he was  probably right but shared something that                                                               
may  change that.    She  mentioned that  people  are aware  that                                                               
family  planning services  are provided  through the  Division of                                                               
Public Health,  and the price  increases for  oral contraceptives                                                               
over  the  past 12  months  has  been  absolutely amazing.    The                                                               
wholesale rate  that the  department buys  them at  has increased                                                               
from 100 to  300 percent.  She commented that  what's going on in                                                               
the pricing and charges is disturbing.   She agreed that the real                                                               
issue  is equity,  but with  the huge  increases in  prices, it's                                                               
also a growing  economic issue.  Passage of  this bill guarantees                                                               
that equity for  women in pharmaceutical coverage,  and she asked                                                               
the committee to support this.                                                                                                  
                                                                                                                                
Number 0192                                                                                                                     
                                                                                                                                
CHAIR DYSON said [HB 313]  doesn't require religious employers to                                                               
carry it.  He wondered who decides what's a religious employer.                                                                 
                                                                                                                                
Number 0120                                                                                                                     
                                                                                                                                
KATIE  CAMPBELL,  Actuary  Life/Health,  Division  of  Insurance,                                                               
Department of Community & Economic  Development, explained that a                                                               
religious employer  is defined in the  law as an employer  with a                                                               
primary  purpose   of  instilling  religious  principles.     The                                                               
Division  of  Insurance   would  be  the  one   to  enforce  this                                                               
provision.                                                                                                                      
                                                                                                                                
TAPE 02-39, SIDE A                                                                                                              
Number 0001                                                                                                                     
                                                                                                                                
CHAIR  DYSON asked  about  protecting the  anonymity  of a  minor                                                               
child getting contraception on the parents' insurance.                                                                          
                                                                                                                                
Number 0126                                                                                                                     
                                                                                                                                
MR. PEARSON  answered that  as she understands  it, that's  not a                                                               
violation  of the  privacy.    It would  be  a  violation if  the                                                               
provider shared with the parent, "I  saw your son or daughter and                                                               
provided this service."  She  commented that she believes certain                                                               
young  people  choose  to use  public  family  planning  services                                                               
rather  than choosing  to go  to their  family physician  and use                                                               
their parents' insurance for coverage of that service.                                                                          
                                                                                                                                
Number 0178                                                                                                                     
                                                                                                                                
CHAIR DYSON referred to page 2, lines 12 through 14, and said                                                                   
the copayment, "you could have it, but it had to be the same for                                                                
all prescription in the same category."                                                                                         
                                                                                                                                
MS. PEARSON agreed that was correct.  There couldn't be a copay                                                                 
of $5 for all drugs, except contraceptives would have a copay of                                                                
$50.  That would not be acceptable.                                                                                             
                                                                                                                                
[HB 313 was held over.]                                                                                                         

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