Legislature(2021 - 2022)DAVIS 106
04/20/2021 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB133 | |
| HB145 | |
| HB58 | |
| HB153 | |
| HB58 | |
| HB153 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 133 | TELECONFERENCED | |
| + | HB 145 | TELECONFERENCED | |
| += | HB 58 | TELECONFERENCED | |
| *+ | HB 153 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
HB 58-CONTRACEPTIVES COVERAGE:INSURE;MED ASSIST
4:20:54 PM
CO-CHAIR ZULKOSKY announced that the next order of business
would be HOUSE BILL NO. 58, "An Act relating to insurance
coverage for contraceptives and related services; relating to
medical assistance coverage for contraceptives and related
services; and providing for an effective date."
4:21:08 PM
The committee took an at-ease from 4:21 p.m. to 4:26 p.m.
4:26:21 PM
REPRESENTATIVE MATT CLAMAN, Alaska State Legislature, answered
questions during the hearing of HB 58, as prime sponsor. He
reminded the committee that HB 58 would make contraception more
readily available for individuals who choose to use it, but it
does not require anyone to use contraception. He said the bill
would make it easier in particular for individuals who
oftentimes have difficulty getting long-term prescriptions.
4:27:07 PM
CO-CHAIR ZULKOSKY asked Renee Gayhart to speak to the change in
the fiscal note from a cost-savings fiscal note to a zero fiscal
note.
4:27:24 PM
RENEE GAYHART, Director, Division of Health Care Services,
Department of Health and Social Services, stated that the
Division of Healthcare Services is looking at a neutral fiscal
note and a zero fiscal note for 2021. She expressed that the
division supports the policy and shared her understanding that
the program could absorb any potential costs with the change and
the disbursement to 12 months. She added that the cost would be
absorbed in the existing appropriation, and similar to other
healthcare market utilization trends. The zero fiscal note, she
said, means that the cost avoidance of previous fiscal notes is
not a guarantee. She reiterated that the division supports the
policy, and explained that it would be looking retrospectively
at claims to consider what the savings were in areas such as
labor and delivery and prenatal care. She offered clarification
that the division is looking at cost of implementation, and
would retrospectively be looking at savings.
4:28:55 PM
REPRESENTATIVE MCCARTY asked Ms. Gayhart whether there are
changes that are necessary for regulation in the fiscal note.
MS. GAYHART responded that there would be regulations in
amendment changes, but the division does not see a change in the
fiscal note with implantation of the policy changes.
4:30:00 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 1 to HB 58,
labeled 32-LS0259\A.1, Marx, 4/16/21, which read as follows:
Page 1, following line 10:
Insert a new subparagraph to read:
"(B) emergency contraception, including
over-the-counter emergency contraception, approved by
the United States Food and Drug Administration; the
insurer may not require a prescription for coverage of
over-the-counter emergency contraception under this
subparagraph;"
Reletter the following subparagraphs accordingly.
Page 6, line 23:
Delete "and"
Page 6, following line 23:
Insert a new paragraph to read:
"(2) emergency contraception, including
over-the-counter emergency contraception, approved by
the United States Food and Drug Administration; the
department may not require a prescription for coverage
of over-the-counter emergency contraception under this
paragraph; and"
Renumber the following paragraph accordingly.
CO-CHAIR ZULKOSKY objected for discussion purposes.
REPRESENTATIVE FIELDS explained that, during the House Health
and Social Services Standing Committee on April 15, 2021, he
learned that there are circumstances under which emergency
contraception, or the "morning-after pill," would not be covered
by insurance if it were to be purchased over the counter, but it
would be covered if an individual were able to obtain a doctor's
prescription. He opined that it is unreasonable that an
individual with insurance would not be able to receive insurance
coverage for a covered product simply because there are
circumstances that prevent them from getting in contact with a
doctor. He explained that Amendment 1 addresses this inequity,
and that it would allow emergency contraception to be covered by
insurance regardless of the presence of a doctor's note.
4:31:05 PM
REPRESENTATIVE KURKA expressed his concern about the use of the
term "emergency contraception." He shared his understanding
that it does not simply refer to contraception, but also to
"abortabations." He opined that one of the purposes of the
morning-after pill is to prevent implantation of an "already
created human embryo," which he understands to be ending a human
life. He said he opposes this perceived consequence.
4:31:51 PM
REPRESENTATIVE MCCARTY asked for clarification on whether there
is a window of opportunity for a physician to prescribe
emergency contraception otherwise it is not effective.
REPRESENTATIVE FIELDS responded yes, that is his understanding
as well.
REPRESENTATIVE MCCARTY asked if he understands correctly that an
individual might seek out emergency contraception in instances
of rape or domestic violence.
REPRESENTATIVE FIELDS responded yes, and expressed that those
instances are good reasons as to why insurance should cover
emergency contraception.
4:33:28 PM
REPRESENTATIVE CLAMAN noted that Dr. Tina Tomsen is available
for questions, and she may be able to offer a medical
perspective on the suggestions made by Representative Kurka.
4:33:44 PM
TINA TOMSEN, MD, shared that she retired at the end of 2020
after practicing medicine in obstetrics and gynecology for 34
years. She said that there is an older form of emergency
contraception called Plan B, which is approved for over-the-
counter administration and is available for purchase. If a
doctor were to write a prescription for a patient for Plan B and
that patient were to take it to a pharmacy, she explained, that
pharmacy would direct the patient to purchase Plan B over the
counter. She said that the patient would not need to get Plan B
from the pharmacists. However, there is a newer form of
emergency contraception that works over a longer period of time
and has a higher effectiveness rate, she said, and that form
does require a prescription, and a patient would have to get it
filled at a pharmacy. An example of a situation that might
arise, she continued, is that a patient might need emergency
contraception on a Friday night and there might be something
that makes the patient's physician unavailable, such as a long
weekend, which might necessitate that the patient purchase Plan
B out of pocket rather than the newer form of emergency
contraception with a prescription. She ensured the committee
that both forms of emergency contraception are effective, and
not considered by the American College of Obstetricians and
Gynecologists (ACOG), based on science, to be abortibations.
4:35:39 PM
REPRESENTATIVE SPOHNHOLZ expressed her support for the proposed
amendment. She shared her understanding that Amendment 1 would
correct an oversight that didn't get remedied as new medications
became available. She expressed support for efforts to increase
access to better medication, and divulged that, as someone who
has personally used emergency contraception, she views it as a
"common sense" measure.
4:36:20 PM
REPRESENTATIVE KURKA asked Dr. Tomsen whether the emergency
contraception she described that requires a prescription
prevents implantation once the embryo is formed.
DR. TOMSEN answered that she is not a physiologist and that is
not her area of expertise, but shared her understanding that the
position of ACOG is that none of the hormonal contraception
available, including emergency contraception, qualifies as
abortibations. She said that contraception makes implantation
more difficult, but also interrupts the quality of ovulation.
CO-CHAIR ZULKOSKY removed her objection to the motion to adopt
Amendment 1.
4:37:33 PM
REPRESENTATIVE KURKA objected.
4:37:35 PM
REPRESENTATIVE FIELDS stated that he looks to the will of
committee members as to whether the committee would like to
adopt Amendment 1 or if it would prefer that he withdraw it. He
said that he understands that there are some tradeoffs and is
interested in the opinions of committee members.
4:37:54 PM
The committee took an at-ease from 4:37 p.m. to 4:38 p.m.
4:38:14 PM
A roll call vote was taken. Representatives Spohnholz, Fields,
McCarty, Zulkosky, and Snyder voted in favor of Amendment 1 to
HB 58. Representatives Prax and Kurka voted against it.
Therefore, Amendment 1 was adopted by a vote of 5-2.
4:39:03 PM
REPRESENTATIVE KURKA moved to adopt Amendment 2 to HB 58,
labeled 32-LS0259\A.2, Marx, 4/17/21, which read as follows:
Page 3, line 5:
Delete "a religious"
Insert "an"
Page 3, line 7:
Delete "religious" in both places.
Page 3, lines 8 - 9:
Delete "and is an organization that meets the
criteria set out in 26 U.S.C. 6033(a)(3)(A)(i) or
(iii) (Internal Revenue Code of 1986), as amended"
Insert "on religious grounds"
REPRESENTATIVE FIELDS objected.
REPRESENTATIVE SPOHNHOLZ objected.
REPRESENTATIVE KURKA explained that proposed Amendment 2 spoke
to a perceived error in constitutional provisions. He shared
his understanding that the bill limits the religious exception
for non-profit organizations that identify as religious, and not
for religious people that are business owners. He cited Supreme
Court case Burwell v. Hobby Lobby Stores, Inc., and stated that
the court's ruling in favor of Hobby Lobby showed that the
"conscious rights of Americans" is not limited to non-profits,
but also includes individual business owners. He opined that HB
58 would violate Supreme Court precedent, and that proposed
Amendment 2 would protect the conscious rights of individuals.
4:40:13 PM
REPRESENTATIVE SPOHNHOLZ spoke to her objection by noting that
her understanding of the proposed amendment would essentially
"gut" the bill, which intends to expand the insurance coverage
for contraception. She expressed that expert testimony has
indicated that providing contraception reduces unintended
pregnancy, which, in Alaska and nationwide, makes up 50 percent
of all pregnancies. She continued by stating that it has been
shown that reducing unintended pregnancy reduces child abuse and
neglect, as well as the need for abortions. She said the
underlying bill should remain intact, and therefore she will
continue to oppose proposed Amendment 2.
REPRESENTATIVE FIELDS asked whether Director Lori Wing-Heier
could speak to the bill language, and whether it might cause
problems with respect to insurance exemptions to religious
organizations.
4:41:35 PM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community & Economic Development (DCCED), said that
Representative Kurka is not wrong to bring up Amendment 2. She
shared that DCCED did some research and found that the
administration of former U.S. President Donald Trump had a rule
that allowed employers to decide to not provide contraceptive
care. This was upheld in July of 2020 by the Supreme Court, she
said, which means that employers can decide to not provide
contraception in policy. The policies in Alaska today all write
for the Affordable Care Act (ACA) and do provide contraceptive
care. If an employer were to ask an insurance company to not
provide contraception within a policy, then the division working
with the insurer would be required to allow that. However, if
the employer did not bring this objection to providing
contraception to an insurer, the plan would automatically
include it.
REPRESENTATIVE FIELDS asked Ms. Wing-Heier, if HB 58 were to
pass and an employer were to approach the division [to remove
contraceptive care from the employer's insurance policy],
whether that would insure compliance with case law and the
previous administrative decision.
MS. WING-HEIER answered yes, the employer would have to ask the
division to allow for a plan without contraceptive care.
4:43:35 PM
REPRESENTATIVE MCCARTY asked Ms. Wing-Heier whether there is
"discrimination" in other policies in which a company or
provider can determine the items that are covered under a
policy.
MS. WING-HEIER answered that, under the ACA which a benchmark
that health plans must meet, there are 10 essential health
benefits. Mandates were then added to these health benefits by
the states, such as mammograms in the state of Alaska, she
explained. The benchmarks of the essential health benefits
allow for contraception, she said, but the issue is that
employers can now decide to not provide contraceptive care. She
reiterated that this is something the division has to allow,
even though the ACA has defined contraception as one of the 10
essential health benefits.
REPRESENTATIVE MCCARTY shared his understanding that, as a
health care professional, if a patient were to come in to his
place of work with a limited policy due to the patient's
employer's allowances, it would be important to clarify the
specifics of the plan because another patient could come in with
a plan that does not have the same restrictions. He said that
he experiences that type of discrimination with insurance
companies often in his practice. He asked for clarification on
whether his understanding is correct.
MS. WING-HEIER responded that she would not determine it as
discrimination, but there definitely would be a difference in
plans. She noted that these differences exist in plans now with
differing deductibles and co-pays. Whether the plan provides
for contraception would just be another element to check when
verifying insurance information, she said.
REPRESENTATIVE MCCARTY asked for clarification on whether this
would be out of the ordinary, as it seems to exist already based
on her comments.
MS. WING-HEIER answered yes.
4:45:57 PM
REPRESENTATIVE PRAX asked Ms. Wing-Heier whether the insurance
company would then have to offer a completely separate plan for
those who may object to contraceptive coverage, or whether that
would be dealt with on an individual level.
MS. WING-HEIER answered that it would be dependent on each
employer. For example, if one employer determined that it wants
to provide contraceptive care and another employer does not,
these two plans would be different.
REPRESENTATIVE PRAX asked for clarification on whether the plans
would necessarily be pre-approved by the division.
MS. WING-HEIER responded yes, the division will approve all
plans, including those that do not include contraceptive care.
She explained that determination is part of what the division
does on a regular basis, which involves determining whether
filings are compliant with state law and offer consumer
protections
4:47:19 PM
REPRESENTATIVE FIELDS commented that, if the committee were to
reject proposed Amendment 2, it seems to him that the division
already has an effective plan for complying with federal law,
and for that reason he said he doesn't see the need for the
amendment.
4:47:47 PM
REPRESENTATIVE KURKA asked Ms. Wing-Heir for clarification that,
currently, there isn't an option for an employer to "check a
box" to determine the inclusion of contraceptive care, but it
instead defaults to being included in a policy. He asked
whether an employer would have to request an exemption that is
not listed.
MS. WING-HEIER responded that there is no question on the
application that asks whether employers would like to cover
contraceptive care.
REPRESENTATIVE KURKA commented that he still sees the importance
in the proposed amendment. He shared his understanding that the
oath to uphold the constitution goes beyond the Supreme Court
decision. He said that he has been surprised to hear insistence
that whatever the Supreme Court says is law.
4:49:14 PM
A roll call vote was taken. Representatives McCarty, Prax, and
Kurka voted in favor of Amendment 2 to HB 58. Representatives
Spohnholz, Fields, Zulkosky, and Snyder voted against it.
Therefore, Amendment 2 failed to be adopted by a vote of 3-4.
4:49:58 PM
CO-CHAIR SNYDER moved to report HB 58, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes.
REPRESENTATIVE KURKA objected.
4:50:38 PM
A roll call vote was taken. Representatives Fields, McCarty,
Prax, Spohnholz, Zulkosky, and Snyder voted in favor of moving
HB 58, as amended, out of committee with individual
recommendations and the accompanying fiscal notes.
Representative Kurka voted against it. Therefore, CSHB 58(HSS)
was reported out of the House Health and Social Services
Standing Committee by a vote of 6-1.