Legislature(1997 - 1998)

04/29/1998 03:22 PM House L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 350 - INSURANCE COVERAGE FOR CONTRACEPTIVES                                 
Number 0185                                                                    
CHAIRMAN ROKEBERG announced the committee's next order of business             
was HB 350, "An Act requiring that the cost of contraceptives and              
related health care services be included in health insurance                   
CHAIRMAN ROKEBERG called a brief at ease at 3:41 p.m.  The                     
committee came back to order at 3:42 p.m.                                      
Number 0192                                                                    
REPRESENTATIVE ERIC CROFT came forward to present HB 350.  He                  
stated HB 350 came out of discussions he had at the end of the                 
previous session about what they could do to reduce the number of              
abortions in Alaska.  He indicated there had been discussions with             
a number of Republican legislators, many of whom were pro-life.                
Representative Croft said he wondered what they could do                       
practically, without getting into political fights, to reduce the              
numbers of abortions.  He said that led to a couple of chains of               
events.  First they analyzed that the majority of abortions come               
from unintended pregnancies.  The next question was, "Where do the             
unintended pregnancies come from?"  He noted almost all unintended             
pregnancies were the result of not using or misusing                           
contraceptives.  He said that then led them to this state, "What               
could we do to allow working families access to contraceptives."               
REPRESENTATIVE CROFT pointed out they were not talking about                   
contraceptives for kids, this is an insurance bill that you have to            
be covered under an insurance policy, this is primarily working                
families who by working have access to that insurance policy.  It              
also does not mandate any coverage for abortion.  He mentioned, to             
some extent the unfortunate fact is that abortions are currently               
covered under most insurance policies.  He said he thinks that's a             
rough financial calculus that insurance companies make now that the            
cost of an abortion is much cheaper than the cost of the full                  
delivery and pregnancy.  Representative Croft distributed a number             
of handouts.                                                                   
Number 0217                                                                    
REPRESENTATIVE CROFT concluded access to contraceptives saves                  
substantial amounts of health care money.  It's the classic                    
prevention -- an ounce of prevention being worth a pound of cure.              
He noted the statewide average of all groups in the Oregon health              
plan is approximately $20 a year which conforms closely to what the            
Health Insurance Association of America has estimated.  He said,               
"We also estimate that the average increase in per employee cost               
would be $16.20 per annum.  We've had some discussions with them,              
they think that now may be the prescription cost.  That is the                 
majority of the cost of providing contraceptives."                             
The sponsor statement read:                                                    
     Most health insurance plans do not routinely cover                        
     contraceptives.  Nationwide, only one third of health                     
     insurers cover oral contraceptives, the most popular                      
     method.  Only 15% cover diaphragms, only 18% cover IUDs                   
     and only 24% cover hormonal implants.                                     
     Coverage in Alaska is worse:  the three insurance                         
     companies which sell the most policies in this state                      
     provide no routine coverage for any type of contraceptive                 
     (unless the policy purchase pays extra for it).  Neither                  
     Blue Cross nor NYLCare (the company that insures state                    
     employees) provides contraceptive coverage in their basic                 
     While nonprescription contraceptive methods (such as                      
     condoms and spermicides) are widely available, the most                   
     effective methods (such as oral contraceptive and                         
     hormonal implants) are more costly and are obtainable                     
     only from a health care provider.  Thus, women whose                      
     health care plan does not cover contraceptives do not                     
     have access to the most effective methods.                                
     Though most insurance plans provide no contraceptive                      
     coverage they routinely cover abortions, sterilizations,                  
     and tubal ligations - all more dangerous and more                         
     expensive procedures.                                                     
     "Fewer Abortions, Fewer Orphans"                                          
     Improving private insurance coverage for contraceptive                    
     services increase access to contraception and reduce                      
     barriers to effective family planning.  It will help more                 
     women prevent unintended pregnancy and reduce demand for                  
     Increased access to contraceptive services will help                      
     families plan to bring children into healthy homes when                   
     the time is right.  Wanted children and their mothers are                 
     much less likely to become victims of abuse and neglect.                  
     Wanted children tend to succeed more easily in school and                 
     in life.                                                                  
     Please join me in this effort to strengthen Alaskan                       
     families by broadening the range of contraceptive options                 
     available to them.                                                        
Number 0256                                                                    
CHAIRMAN ROKEBERG asked how do you reconcile that with the cost if             
an individual prescription would be $25 a month.                               
REPRESENTATIVE CROFT replied you're spreading it over an entire                
CHAIRMAN ROKEBERG asked what the group is for these figures.  He               
said it has to be connected to a formula.  The chairman asked are              
these different in the Oregon plan.                                            
REPRESENTATIVE CROFT replied right.                                            
CHAIRMAN ROKEBERG stated these are different types or levels of                
care, and that's how they analyze that.                                        
REPRESENTATIVE CROFT said he believes it's a state-run plan and                
it's primarily a welfare plan so it's different categories...                  
CHAIRMAN ROKEBERG indicated these would under some type of public              
assistance or Medicaid percipients.                                            
Number 0262                                                                    
REPRESENTATIVE CROFT responded, "Right, and you can see the highest            
number is the one that focuses most on women of childbearing age.              
You would expect them to need the most (indisc.).  So it sort of               
goes from a low of one cent to a high of $2.87 per month with the              
average across a general population being $1.68, or about $20 a                
year. ... We don't know specifically what it saves.  We do know it             
save substantial amounts.  We do know that having contraceptive                
services available, and people using them properly saves health                
care money.  So what we can say for sure, is it costs individual               
people $15.00 to $20.00 a year depending on which estimate you're              
talking about.  And that there is substantial saving in the system.            
We can also say, I think, that the more people are allowed to plan             
their families, the fewer abortions we can expect.  So, on a                   
society level and on a cost level, I think this bill makes good                
public policy sense."                                                          
REPRESENTATIVE CROFT referred to the handout that mentions Russia's            
experience.  A long time under the Soviet Union they did not have              
access to contraceptives.  They instead used abortion as a form of             
birth control.  That led to huge rates of abortions in the former              
Soviet Union.  He said, "In the early 90's when contraceptives                 
became available, you saw a corresponding decrease in the abortion             
rate.  When people can have this access, they don't need to use                
abortion that way.  So, for cost reasons, for fairness reasons                 
because right now women pay much higher health care costs, and the             
primary reason they do is increased costs relating to family                   
planning services.  So, there's an equity argument, a cost                     
argument, as well as just letting working families plan their                  
Number 0282                                                                    
REPRESENTATIVE RYAN said he took a round number of 20,000 state                
employees, at $1.68 an employee, estimating a cost to the State of             
$403,200, yet the fiscal note is zero.                                         
CHAIRMAN ROKEBERG responded the state is a self-funded insurance               
plan and it would not be covered by an insurance mandate bill and              
that's one of the problems.                                                    
Number 0302                                                                    
REPRESENTATIVE COWDERY stated he thought this would save insurance             
companies money by reducing the number of covered births.  He asked            
"Don't you think the insurance companies might be in a better                  
position to determine what - if this is going to be.  If that was              
the case don't you - would it be reasonable to think they'd already            
been doing this in their policy."                                              
REPRESENTATIVE CROFT reiterated that it saves money.  He said he               
believes it becomes a difficult question of whether it's going to              
save the insurer money when the population keeps moving in and out.            
He indicated he may be saving the next insurance company down the              
line money when they move out of his policy.  They found, in                   
looking at a market, the HMO's (health maintenance organizations)              
do a much better job of providing this coverage because they see a             
much more stable population, they see the savings.  Alaska doesn't             
have HMO's and as he understands it there isn't much of a chance               
that we will.  So, we're still left with a fractured market where              
it's difficult for any individual insurer to see those savings.                
This in effect spreads it all out.  Because we don't have the                  
economies of scale for HMO's, he said he was worried, and worried              
that we're not going to see that.                                              
REPRESENTATIVE COWDERY stated everyone works toward the objectives             
that Representative Croft is trying to do.  He said he didn't know             
if it was the right time and asked who would get the prescription.             
REPRESENTATIVE CROFT replied most likely the woman.  Cover it                  
through your normal procedures.                                                
REPRESENTATIVE HUDSON understood that nobody has to have this and              
the person has the discretion of use.                                          
REPRESENTATIVE CROFT replied that's exactly right.                             
Number 0314                                                                    
REPRESENTATIVE HUDSON indicated that if it's against your religion             
you just don't use it.                                                         
REPRESENTATIVE CROFT responded exactly right, we are not forcing               
individuals to have contraceptive services if they don't want it               
only that they have access to it.  Secondly, if a religious group              
doesn't want a policy that includes contraceptive (indisc.--paper              
ripping) and there's an amendment to that effect.                              
REPRESENTATIVE HUDSON asked if the exclusion for religious purposes            
would be addressed on page 1, line 7.                                          
REPRESENTATIVE CROFT referred to page 1, line 8.                               
REPRESENTATIVE HUDSON remarked Representative Croft doesn't have an            
amendment, he's just suggesting that he'd be amendable to one.                 
Number 0325                                                                    
REPRESENTATIVE CROFT replied he had one drawn up and is amendable              
to it.  However, since it's not his committee he can't talk to it.             
Amendment, labeled 0-LS1297\B.2, Ford, dated 3/3/98, read:                     
     Page 1, line 8, following "society":                                      
          Insert "or a policy issued to an individual"                         
Amendment, labeled 0-LS1297\B.4, Ford, dated 4/20/98, read:                    
     Page 1, line 8, following "society":                                      
          Insert "or a qualified church-controlled                             
     organization with a religious-based objection"                            
     Page 2, line 3, following "contraceptives":                               
               (3) "qualified church-controlled organization"                  
          has the meaning given in 26 U.S.C. 3121(w)(3)"                       
Number 0327                                                                    
CHAIRMAN ROKEBERG brought the committee's attention the Attorney               
General's letter, March 11, 1998, stating state mandated befit laws            
like HB 350 many not be applied to self-funded ERISA (Employee                 
Retirement and Income Security Act) health benefit plans.  He asked            
if $25.00 a month is a good figure.                                            
REPRESENTATIVE CROFT indicated $300 a year, $25 a month, is what he            
CHAIRMAN ROKEBERG asked what other devices, or other contraceptives            
would be covered under this bill.                                              
REPRESENTATIVE CROFT stated it wasn't limited by type, it's limited            
to not ones that work as early abortions.  He mentioned various                
devices.  He further explained it's not limited by method, but only            
those methods that work to prevent fertilization of the egg, not to            
take a fertilized egg and do something with it.                                
CHAIRMAN ROKEBERG referenced the Los Angeles Times dated March 25,             
1998, pointing out Governor Wilson said he would sign the bill ...             
only if it included a conscience clause allowing employers to opt              
out of such coverage on moral or religious ground.                             
REPRESENTATIVE CROFT mentioned that office was contacted and that              
our statutes are a little different.                                           
CHAIRMAN ROKEBERG noted the committee was not being teleconferenced            
today.  He mentioned there are a number of people are not able to              
testify today because lines weren't available.                                 
Number 0354                                                                    
DR. PETER NAKAMURA, Director, Division of Public Health, Department            
of Health and Social Services came forward to testify in support of            
HB 350.  He said first of all he is getting rather tired of getting            
involved in abortion debates.  It's one series after another for               
the past two years.  One of the commonalities is that no one can               
challenge that these unwanted pregnancies lead to unwanted births              
that lead to higher instances of child abuse, higher instances of              
domestic violence, or that leads to more kids ending up in the                 
juvenile justice system.  He indicated all of these are a very high            
cost to society and to each of us.                                             
DR. NAKAMURA stated we could all agree on that none of us really               
want to see the continuation of abortions.  Contraceptive services             
would provide these unwanted pregnancies from coming about and                 
that's what this bill is about.                                                
DR. NAKAMURA noted he doesn't agree with the comment that men and              
other people have no use for this benefit.  Secondly, there isn't              
a one of us that isn't impacted by the negative outcome of these               
unwanted pregnancies and births.  He stressed that contraception is            
not a health care treatment, however, they do see prevention as a              
health care issue, such as immunizations, mammograms, those are all            
prevention activities, just like contraception is a preventive                 
health activity.                                                               
Number 0375                                                                    
DR. NAKAMURA said everyone should have a choice of the type of                 
insurance coverage they want, that's one of the things that led to             
health care reform.  He also mentioned contraceptive services are              
not expensive and are accessible.  The common response in a survey,            
generally from the women, not just the poor but the women in                   
general said, "Access to contraceptive services was the biggest                
reason for unwanted births, not that they couldn't afford it.  Some            
times it was a matter of the issue of understanding the need for               
it.  So, contraception goes into two phases, one is making sure                
that service is available and second is to make sure that they want            
DR. NAKAMURA stated that he didn't agree with the statement, "sex              
without procreation is a product of the contraceptive mentality."              
He said he thinks that was a very inappropriate and out of place               
CHAIRMAN ROKEBERG asked Doctor Nakamura if he had any idea of how              
many Alaskans are uninsured.                                                   
DR. NAKAMURA replied he could probably provide that information.               
CHAIRMAN ROKEBERG asked, "Do you figure, excluding the Native                  
population, approximately 70 to 80 thousand people, about 14 to 15             
percent ring a bell with you."                                                 
DR. NAKAMURA replied no, he could not honestly respond to that.                
But would be happy to find that answer.                                        
CHAIRMAN ROKEBERG indicated this committee has been searching for              
these answers for years.  He asked, would a figure of (indisc.--               
coughing) not to exceed 33 thousand people covered by individual               
insurance policies ring a bell with you in any way.                            
DR. NAKAMURA replied he has not looked into this, but could.                   
CHAIRMAN ROKEBERG asked Doctor. Nakamura to explain his comment                
that everybody should have their own type of health insurance.                 
Number 0405                                                                    
DR. NAKAMURA reiterated that every individual should choose the                
type of health insurance they have.  He said that was a comment                
made by an individual who testified earlier on this bill.  Doctor              
Nakamura explained his comment was that that's one of the issues               
that led to the health care reform that we've been experiencing.               
That those who are young and healthy, who are able to access health            
insurance policies at a very low premium...                                    
TAPE 98-54, SIDE B                                                             
Number 0001                                                                    
DR. NAKAMURA continued, "...some of these contraceptive services.              
CHAIRMAN ROKEBERG asked, "Are you not aware that the most fertile              
portion of our population, the younger portion are the ones that               
usually are more prone to opt out of obtaining health insurance if             
they have that ability, I mean that's a known fact.  Were you aware            
of that?"                                                                      
DR. NAKAMURA indicated his impression is that HB 350 refers to                 
those who are insured.                                                         
CHAIRMAN ROKEBERG commented that the fact is that the people are               
more prone - that could be there to help spread the risks aren't               
there to help pay for it either.  He agreed that they should be and            
then they end up relying on the state or charity, or themselves to             
take care of it.                                                               
DR. NAKAMURA stressed that if there is anything that we can do to              
bring about a lower number of unwanted births, that's what he would            
like to see happen.                                                            
CHAIRMAN ROKEBERG said he couldn't agree with him more.                        
CHAIRMAN ROKEBERG thanked Doctor Nakamura and announced Angela                 
Salerno was next to testify.                                                   
Number 0019                                                                    
ANGELA SALERNO, Executive Director, National Association of Social             
Workers of Alaska (NASW), came forward to testify in support of HB
350.  She said NASW thinks this bill will have three outcomes: We              
are going to prevent unwanted pregnancy and abortion; we're going              
to promote basic primary and preventive gynecological health care              
for women; and we are going to see health care cost savings for the            
consumer and third-party payers.  Ms. Salerno mentioned she is pro-            
choice and that they are very weary of skirmishing around this                 
issue because they are not going to agree on it and that's why                 
prevention is the way that they want to go.                                    
MS. SALERNO pointed out some misconceptions about this bill.  She              
said it's false to think that contraception promotes abortion.                 
Reference was made to the Netherlands where they have widespread               
availability of contraception and have the lowest abortion rate in             
the world.  Latin-American countries where there are religious                 
proscriptions against abortion, where contraception is not                     
available -- some countries such as Peru have twice the abortion               
rate compared to the United States, so again that's a                          
Number 0040                                                                    
MS. SALERNO addressed basic primary preventative health care.  She             
reported half the pregnancies in Alaska are unwanted, mistimed, or             
unplanned.  She stressed that Alaskan women don't have great access            
to the most effective forms of birth control, 60 percent of health             
insurance providers exclude coverage for contraceptive drugs even              
though contraceptives are the most widely used drug for women                  
between the ages of 18 and 44.                                                 
MS. SALERNO referred to an article in the Journal of the American              
Medical Association that reported on an Institute of Medicine                  
report which called contraceptions largely an unmet need in                    
America.  They recommended that a full range of contraceptive                  
products be made available to consumers and they further urged that            
third-party payers cover contraceptive services.  They also clearly            
stated that costs will reap benefits, in overall better health for             
women and their families and in the management of overall sexual               
MS. SALERNO added that overall health care cost savings was                    
discussed at length.  She said prevention is the future of                     
providing health care in this country, we see that in the rise of              
the HMO which has a much better track record at offering preventive            
services.  In fact, 84 percent of the HMO's around the country                 
currently cover oral contraceptives.  Ms. Salerno, stated, "Our                
private fees for service providers operate in an almost antiquated             
medically-necessary mode, and I'm sure you'll hear more about that             
today.  What we have are insurance companies, 90 percent of which              
cover surgical sterilization, 67 percent cover abortion, but 50                
percent cover no contraceptive services of any sort.  Again, that's            
in the fee for service, what we're used to - at least here in                  
Alaska.  Providing, as HMO's do, contraceptive service has the                 
potential to lower health care costs for all."  Ms. Salerno                    
reiterated that NASW thinks this is good social policy, it's going             
to prevent unwanted pregnancy and abortion, it's going to promote              
the overall health of women and their families, and it has the                 
potential to lower health care costs to consumers and insurance                
Number 0076                                                                    
REPRESENTATIVE HUDSON indicated Ms. Salerno deals with many of the             
people who have unplanned children and stated he knows many of                 
these are unemployed.  Representative Hudson asked, "I'm wondering             
how we get to them this prevention because isn't that really the               
target group that we really need to come to."                                  
MS. SALERNO said she assumes he is referring to folks of very low              
REPRESENTATIVE HUDSON replied yes.                                             
MS. SALERNO said some programs are helping them today.  She                    
explained Title X funds come to us from the federal government, and            
in Anchorage there are some city funds that cover that group.  Ms.             
Salerno added that she thinks the provision of contraceptive care              
to all segments of society is crucial to the goal of preventing                
unwanted pregnancies.                                                          
REPRESENTATIVE HUDSON asked if she thinks they are covered.                    
MS. SALERNO replied this bill will not help anyone who is not                  
working and does not have insurance.  This is actually going to his            
a narrower group of folks.  This bill is going to affect and help              
our families, especially as more and more folks move from welfare              
to work as is our social policy today.  She said she thinks it                 
behooves us to assist them to make sure that they are successful in            
staying off welfare.  This will help.                                          
Number 0095                                                                    
REPRESENTATIVE RYAN indicated this bill is trying to establish it              
as a first step in the door of a social policy than to actually                
benefit a large group.                                                         
MS. SALERNO commented that she is not sure what he is asking.  She             
added that it is a change in social and almost economic policy.                
She further explained that we're asking a private industry to jump             
on board here.  It is something different that we're not used to               
doing in a lot of cases, it's a huge industry, and it's a missing              
part of a comprehensive system with health care for folks.                     
MS. SALERNO mentioned that maybe she is narrowing this down too                
much.  She said she believes that there will be quite a few people             
in Alaska that will be helped by this bill.  Folks who are living              
paycheck to paycheck, who have as large a family as they can handle            
without busting the budget, and maybe it's a quite larger group                
than we'd expect.                                                              
CHAIRMAN ROKEBERG asked does the State provide contraceptives under            
the Medicaid program.                                                          
MS. SALERNO replied yes the State provides, through Medicaid,                  
contraceptive services to eligible participants.                               
CHAIRMAN ROKEBERG expressed a concern about Ms. Salerno's statement            
that the cost will reap benefits because there is health care cost             
savings.  He indicated that he hasn't seen evidence to that.                   
MS. SALERNO pointed out that she was quoting from an Institute of              
Medicine report which referred to an even broader issue than just              
reducing pregnancies.                                                          
Number 0135                                                                    
GORDON EVANS, Lobbyist, Health Insurance Association of America                
(HIA), appeared before the committee in opposition to HB 350.  He              
said the Health Insurance Association of America is a national                 
trade association of commercial health insurance companies                     
providing health insurance for approximately 55 million Americans.             
MR. EVANS stated, "Health Insurance Association of America opposed             
HB 350 and we also oppose the companion bill SB 260 for a number of            
reasons and not the least of which is that its provisions mandate              
a specific coverage of something that's really not considered to be            
basic health care treatment which is what health insurance policies            
are supposed to cover.  And the consequence of which in the long               
run would be to increase the costs and reduce the efficiencies of              
managed care.  As I've noted on previous occasions, HIA favors the             
preservation of a system that allows the prospective purchaser of              
health insurance pre-choice of which risk he or she wishes to cover            
from the various coverages offered by competing insurance carriers.            
You heard Doctor Nakamura object to that."                                     
MR. EVANS continued, "Health Insurance Association of America also             
believes that the choice of how their policy holders spend what                
funds are available for health care and health insurance, we feel              
they should be free of government decree and we continue to oppose             
the proliferation of benefits through government mandates.  The                
proponents of HB 350 argue that mandating coverage of                          
contraceptives and related health care services will serve several             
purposes.  First they say it will increase access to contraception             
and we don't doubt that for one minute.  Secondly it would reduce              
barriers to effective family planning and to be honest with you I              
didn't realize family planning was considered to be health care                
treatment.  Third it would help more women prevent unintended                  
pregnancies, and again that may be true but again that's also not              
really health care treatment.  And finally it would reduce demand              
for abortions.  And I assume that if you take the previous three               
purposes that I mentioned, that would be the case.  But Mr.                    
Chairman, the services for which this coverage is sought, and it               
would be mandated, is actually to be considered to be elective                 
Number 0156                                                                    
MR. EVANS explained that any time the government requires or                   
mandates certain coverage, that mandate becomes one of the rating              
factors that insurance companies use in making their underwriting              
decisions.  If the coverage sought by HB 350 is mandated, the                  
premium costs will be increased, even for those people who have no             
use for it or don't want the coverage.  For example, if this                   
legislation passes and coverage for contraceptive services are                 
mandated, this mandate would apply only to small employer group                
policies and certain other group policies, generally those who can             
least afford the increased premiums.  The mandate would not affect             
Alaska's largest employers such as the State, although the State               
generally follows mandates.  Mr. Evans reiterated mandated benefits            
are costly and those costs will be passed along to policyholders.              
He indicated HIA would not be opposed to a mandate to offer                    
coverage for contraceptives in related health care services.  As a             
result of a mandated offering individual policyholders as well as              
employers and their employees in the affected group policies would             
be able to choose whether they want to spend additional funds on               
the particular coverage.  In other words, those who want to avoid              
unwanted pregnancies by the use of contraceptive devices may do so,            
but they, and not the insured population in general will pay the               
cost of the insurance coverage.                                                
MR. EVANS suggested substituting the word "offer" of the word                  
"provide" on line 9 of page 1 would make this coverage sought a                
mandated offering.  He said he believed it would accomplish at                 
least part of the bill's proponents.  Mr. Evans pointed out the                
proponents of this bill used a memorandum by a California lobbyist             
regarding a 1996 bill which required health insurers to provide                
coverage for contraceptives if they included prescription drug                 
benefits in their plan.  The comment that was made that the cost               
would be approximately $1.35 per month per employee is misleading              
because the California legislation covered only the cost of                    
contraceptive drugs such as birth control pills and it did not                 
include costs of contraceptive devices, appliances, or the cost of             
related health care services.  So those are not included in the                
price that has been used by the proponents in the other body to say            
that the cost would be only $1.35 per month per employee.                      
Number 0196                                                                    
REPRESENTATIVE RYAN asked, does that include gynecological                     
MR. EVANS replied yes.                                                         
REPRESENTATIVE RYAN asked isn't a service like that under normal               
policy allow for pap-smears - gynecological...                                 
MR. EVANS replied certain other services are.  He indicated he                 
didn't know what all related health care services would be.                    
REPRESENTATIVE RYAN stated that he believed birth control would be             
incidental to a normal examination and that he just wanted to                  
clarify that.                                                                  
REPRESENTATIVE HUDSON asked Mr. Evans if the companies that he                 
represents routinely offer contraceptive services and things of                
this nature.                                                                   
MR. EVANS responded, in individual policies, if the individual                 
asked for it.  It's considered into the amount of what the premium             
is going to be, but it's not generally offered by most of the                  
companies that he represents.                                                  
REPRESENTATIVE HUDSON asked if it is offered or provided by the                
state in its self-insured package.                                             
MR. EVANS replied no, not to his knowledge.                                    
CHAIRMAN ROKEBERG noted for the record that Representative Brice is            
REPRESENTATIVE COWDERY asked if this becomes a mandate, what's to              
stop requiring plastic surgery or facelifts.                                   
Number 0218                                                                    
MR. EVANS replied that's exactly why they are opposed to mandating             
benefits.  He reiterated that they don't oppose mandating offering             
of benefits.                                                                   
REPRESENTATIVE COWDERY asked Mr. Evans if this passes would he                 
assume there would be an increased cost of premiums.                           
MR. EVANS responded, yes.                                                      
REPRESENTATIVE RYAN noted that as a mandate there would be an                  
increase, but if there was an offer(indisc.).                                  
MR. EVANS interjected as an offer it wouldn't be increased to the              
general insured population, only to those who chose to take it.                
REPRESENTATIVE HUDSON asked Mr. Evans wouldn't his companies see               
some offsetting reductions in costs that result from the cost of               
abortions or the additional insurance cost for unwanted children or            
maybe children with fetal alcohol syndrome.  He mentioned that he              
is trying to look for the balance point in this whole situation.               
MR. EVANS stated that is a difficult situation.  He noted the                  
insurance industry has not taken that view.  He said he has                    
personally wondered why the insurance industry hasn't worked more              
toward preventive maintenance than just afterward maintenance.                 
Number 0247                                                                    
CHAIRMAN ROKEBERG asked for a brief at ease.  [Time not indicated].            
TAPE 98-55, SIDE A                                                             
Number 0001                                                                    
CHAIRMAN ROKEBERG called the meeting back to order.  [Time not                 
indicated].  He asked, "Does the cost to provide childbirth and                
pregnancy service cost more than contraceptives, and are pregnated             
services mandated in State law."                                               
MR. EVANS indicated he didn't follow him.                                      
CHAIRMAN ROKEBERG remarked there's two questions there actually.               
MR. EVANS asked for the first question.                                        
CHAIRMAN ROKEBERG asked, "What were the costs to provide childbirth            
and pregnancy service - is that more costly than contraceptives, or            
do you have a handle on it."                                                   
MR. EVANS replied he has no handle on it, but since childbirth is              
covered under the State policy, and so forth...                                
CHAIRMAN ROKEBERG asked if most of his clients offer pregnancy                 
service coverage.                                                              
MR. EVANS said he believes the majority of them do.                            
CHAIRMAN ROKEBERG asked if his clients would estimate what the cost            
would be for the contraceptive services.                                       
MR. EVANS said he requested that, but does not have that                       
Number 0018                                                                    
CHAIRMAN ROKEBERG asked is the 48-hour pregnancy service, PSA                  
(Prostate Specific Antigen) and mammogram strict mandates.                     
MR. EVANS replied they're mandates.                                            
CHAIRMAN ROKEBERG asked if there has been other legislation that               
requires offerings.                                                            
MR. EVANS explained that there were several offerings in the past.             
He referred to a bill by Representative Brice which hasn't had a               
REPRESENTATIVE TOM BRICE commented that it's only an offering and              
not a mandate.                                                                 
MR. EVANS said he believes there was one on genetics but that bill             
didn't pass.                                                                   
CHAIRMAN ROKEBERG mentioned that it's currently federal law.                   
Number 0028                                                                    
REPRESENTATIVE GENE KUBINA said he assumes all insurance policies              
handle pregnancies, the actual delivery, and then if there's a                 
problem with the child, this could cost an insurance company                   
hundreds of thousands of dollars.                                              
MR. EVANS responded that he is probably correct.                               
REPRESENTATIVE KUBINA asked if this was put into effect, and it                
saved one of those from happening it could pay for a full year's               
worth of contraceptives.                                                       
MR. EVANS replied he doesn't know because that's an underwriting.              
He mentioned it's obviously the younger population that will make              
the most use of this particular service.                                       
REPRESENTATIVE KUBINA mentioned what he has seen, one-pound babies,            
fetal alcohol syndrome.  He said the cost to the insurance company             
has to be astronomical for that and, if you could not have one of              
those expenses - just once a year, this would be a tremendous                  
CHAIRMAN ROKEBERG asked Mr. Evans if childbirth and pregnancy                  
services are currently mandated for health insurance.                          
MR. EVANS said he didn't believe it's mandated.                                
CHAIRMAN ROKEBERG asked, then why are they offered - because the               
market wants them.                                                             
MR. EVANS replied that may be one thing, but also is as far as the             
State and some of the other big group plans is probably part of the            
bargaining that they've bargained for, and they pay for it then.               
Number 0062                                                                    
CHAIRMAN ROKEBERG asked, don't some underwriters offer the                     
pregnancy writer as an addition to their policy, and some don't -              
particularly for people who aren't in the fertility ages.                      
MR. EVANS said he can't answer that question.                                  
CHAIRMAN ROKEBERG stated he thinks they do.  So, the market bears              
whether they desire that.  He said it could be a different menu                
item on a menu for example in a group plan.                                    
MR. EVANS replied, "I would assume that was..."                                
CHAIRMAN ROKEBERG interjected if you chose to have that menu item,             
then you would pay a higher premium, wouldn't you?                             
MR. EVANS replied yes, when it's done as part of the...                        
CHAIRMAN ROKEBERG interjected, it's just like the offering, if you             
offer it, then you can choose it.                                              
REPRESENTATIVE KUBINA said he would like to see that be the case.              
He mentioned that he has never head of a health insurance policy               
that can handle pregnancies.                                                   
CHAIRMAN ROKEBERG said no, it's not mandated in law.  He indicated             
a lot of group plans have menu selections.                                     
Number 0073                                                                    
MR. EVANS mentioned when he worked for Governor Egan in 1964, the              
state health plan at that point did not cover pregnancies.  In 1965            
it was changed by the Legislature.                                             
CHAIRMAN ROKEBERG stated, "...I've received some letters (indisc.--            
noise) physicians saying that one reason we should use the allow -             
the mandate for all contraceptives is because of the estrogen                  
therapy benefits for the oral contraceptives.  Now is it or is it              
not true that other pharmaceuticals would be available in                      
replacement from the specific oral contraceptives?  Or in other                
words, are there estrogen therapies available so you wouldn't have             
to take the oral contraceptive is the question?  A technical                   
question, I'm not sure you can answer it but I think the committee             
would like to have a - I'm sure the sponsor would like to know the             
answer to that question.  Because it seems to me, is that an excuse            
to allow for oral contraceptives or aren't there other substitute              
or alternate therapies available for those particular uses is the              
MR. EVANS indicated he would try to get that information.                      
Number 0112                                                                    
MARIANNE BURKE, Director, Division of Insurance Department of                  
Commerce & Economic Development, appeared before the committee.                
She said there seems to be some misunderstandings about state                  
mandates and whom they cover.  In the opinion of the assistant                 
attorney general who represents and provides technical support to              
the division any self-insured governmental entity, whether it's the            
state, a municipality or a rural city, or whatever, that has not               
requested and received a waiver from the federal government is                 
subject to all state mandates.  Non-governmental entities that are             
self-insured, and there subject to Employee Retirement Income                  
Security Act (ERISA), are not subject to state mandates - Ms. Burke            
said she wanted to clarify that.  Unless the State of Alaska health            
plan requests and receives a waiver from the federal government in             
the opinion of our assistant attorney general, they are subject to             
state mandates.                                                                
CHAIRMAN ROKEBERG indicated this bill would cover the state,                   
municipality and every other political subdivision.                            
MS. BURKE responded that unless they have requested and received               
that waiver.  She added that she wanted to clarify that on the                 
CHAIRMAN ROKEBERG remarked, major-major difference.                            
REPRESENTATIVE RYAN stated, the fiscal note will go up half a                  
million bucks.                                                                 
REPRESENTATIVE CROFT noted that's the first he's heard of that.  He            
stated, "We had a number of attorney general's opinions that it is             
not covered, and I know there is a lot of internal discussion on               
it, but we have a zero fiscal note from..."                                    
CHAIRMAN ROKEBERG interjected that there's been misunderstandings              
in this committee about that.                                                  
Number 0132                                                                    
REPRESENTATIVE KUBINA said, "I'm not sure that other places are                
covered, it does have a fiscal impact because the employees are                
certainly all the bargaining ones are having to pick up the cost               
over and above a certain level anyway.  So if this adds that cost              
over and above there's no fiscal note to the State on it."                     
MS. BURKE agreed.                                                              
REPRESENTATIVE KUBINA pointed out the only one that would cover                
would be the non-bargaining unit which is very small.                          
CHAIRMAN ROKEBERG remarked that depends on what the future                     
contracts are.                                                                 
MS. BURKE said it was her understanding that, since it would be an             
additional cost, that cost would be borne by the employees.                    
REPRESENTATIVE HUDSON asked if that opinion would affect the offer             
as the same as (indisc.--coughing).                                            
MS. BURKE stated, "It is our understanding that an offer is a form             
of a mandate, and that you mandating an offer be made.  It does not            
mean, however, that they have to have it.  It is a choice."                    
Number 0150                                                                    
REPRESENTATIVE CROFT explained we're mandating that employers offer            
it to their employees, and the employees have the choice.  He said,            
"And I think that's the appropriate line to draw on this - the way             
the bill is.  If you simply mandate that the employer may have the             
option of taking it or not, I as an employee still don't - I don't             
have any way to access that.  It's then my employer's decision, not            
mine to get it (indisc.)..."                                                   
REPRESENTATIVE HUDSON interjected, "I guess there's no required                
REPRESENTATIVE CROFT agreed.  He said, "If you mean by that,                   
mandate that the employer offer it to their employees, then that's             
the appropriate, in my opinion.  And I have a March 11 memorandum              
from Signe Anderson in the Attorney General's Office saying it's               
not.  I think though, Representative Kubina's point is well taken,             
even if it seems to be a legal disagreement about whether it does              
affect the State of Alaska, or require us to get an exemption from             
it, but even if it did, it would not change the fiscal note."                  
CHAIRMAN ROKEBERG asked Ms. Burke for a copy of the opinion of the             
Insurance Omnibus Act that we carried last year because it's                   
different that what we've been operating under.                                
MS. BURKE indicated that she would provide that opinion to the                 
committee.  She noted that the regulations under Health Insurance              
Portability and Accountability Act (HIPAA) are still being                     
promulgated.  For the record, Signe Anderson is the assistant                  
general who is of the opinion that waiver must be requested.                   
CHAIRMAN ROKEBERG said, "And when was that opinion - is the issue              
of the opinion letter or what is (indisc.)"                                    
Number 0171                                                                    
MS. BURKE replied, "No, she informed us and I failed an obligation             
just to bring it to you.  We're going to - the Division of                     
Insurance is going to ask for a formal opinion because we want to              
know specifically based, and again it's got to be at a point in                
time because the feds. are putting out regulations as fast as we               
turn around.  But at least at a point in time this is the federal              
read.  But I again want to stress the fact that any governmental               
entity can request this waiver and it is anecdotal but I understand            
it is not difficult at all to get that waiver.  They're not being              
turned down."                                                                  
CHAIRMAN ROKEBERG said he didn't think that particular issue should            
affect this bill.  He asked Representative Croft if he agreed.                 
REPRESENTATIVE CROFT agreed.                                                   
CHAIRMAN ROKEBERG referred to a letter from Bob Labbe, Director,               
Alaska Division of Medical Assistance, Department of Health and                
Social Services, April 3.  He indicated the 33,135 estimate may be             
high cite for individual policies in the state.  This is from a                
study that the Administration is using on your uninsured children,             
the EBRI (Employee Benefits Research Institute) study.                         
MS. BURKE stated that she is not familiar with the study, but that             
number sounds reasonable.                                                      
CHAIRMAN ROKEBERG noted the EBRI study in 1996 estimates 81,000                
non-elderly Alaskans have no health care coverage.  Of those,                  
10,000 of the uninsured may be Alaska Natives that would be covered            
under the Indian Health Service for health care services.  He said             
we're looking at approximately 14 to 15 percent of the people in               
the state that has no insurance coverage.  We also have the                    
population that would be Medicaid eligible that would be covered by            
the state, approximately 30,000 to 32,000 have individual coverage.            
The Chairman said it's the best guesstimate you can have based on              
this same study which he thinks is high.  He also mentioned the                
group plans, the governmental, self-insurers, and political                    
subdivisions.  He indicated it's still a guess because the State               
doesn't have adequate statistics on this.  He asked how many                   
people, excluding the political will be covered by this bill.                  
MS. BURKE responded, anything she gives would be a pure guess.                 
CHAIRMAN ROKEBERG said he would guess 20 to 30 percent of the                  
people of the state would be covered by this, excluding this new               
Number 0212                                                                    
MS. BURKE responded, "We know that the largest employers, excluding            
the state and federal government in this state are self-insured.               
We could put a reasonable number on the people who are covered by              
Indian Health Service.  We have a number for people who are on                 
Medicaid.  We can back into a number on that basis but the Division            
of Insurance does not have access to that data.  I can tell you                
that the 33,000 number makes sense in that Blue Cross has testified            
that their 13,000 or so policies is about 40 percent of the                    
individual policies and if you work the math on that..."                       
CHAIRMAN ROKEBERG interjected (indisc.) that's probably over 50                
now, and that was for 1997 too, that was not for this year.                    
MS. BURKE reiterated 33,000 would be a reasonable number.                      
CHAIRMAN ROKEBERG asked. "If we went to the offerings versus                   
providing (indisc.--laughter) insurance industry can handle that up            
MS. BURKE replied we do have mandates for offerings and we have                
mandates for coverage.  He said she is sure they can handle either             
REPRESENTATIVE BRICE asked does the Administration support this                
MS. BURKE said she doesn't have an opinion from the Administration.            
REPRESENTATIVE BRICE asked when did this new information come to               
MS. BURKE responded that it was about two weeks ago when they were             
reviewing regulations.  Up until that time it had been the opinion             
that governmental entities that are specifically excluded by ERISA             
that applied to state mandates because of the HIPPA legislation and            
the requirement on the basis of the federal government, for                    
governmental entities to request waivers, that is what has brought             
this to the forefront.                                                         
CHAIRMAN ROKEBERG asked Ms. Burke if she believes if this bill were            
to pass in its present form - a mandate, would increase costs to               
individuals as a small group of people in the state.                           
Number 0245                                                                    
MS. BURKE said she does not believe that it would increase the cost            
on individual policies because those are individually rated.  On               
the group policies, there is no question there would be savings.               
She added that, from an actuarial point of view she said she                   
couldn't address that.                                                         
CHAIRMAN ROKEBERG remarked that there has been no testimony that               
there would be a savings from the insurance industry.                          
MS. BURKE commented that she doesn't have empirical evidence.                  
CHAIRMAN ROKEBERG asked if the increase menu selection goes up                 
wouldn't the premium go up.                                                    
MS. BURKE explained that would be the option of the individual, if             
they chose.                                                                    
CHAIRMAN ROKEBERG commented if there is a mandate they wouldn't                
have a choice.  He said, "An empty nester would have to pay the                
spread in the group of individuals under like say the blue, that               
his premium would have to be increased.  Is that correct?"                     
MS. BURKE replied, "The individual can elect a catastrophic policy             
that would be so high it wouldn't cover it."  She added that is                
correct unless there is an actuarial determination of savings.                 
Number 0262                                                                    
REPRESENTATIVE HUDSON asked wouldn't there also be a potential                 
offset or reduced cost because of other associated costs, for                  
example, a child that wasn't wanted that had to be covered by                  
MS. BURKE replied that is true.  She added that's why she said                 
unless we have actuarial determination.                                        
REPRESENTATIVE KUBINA reiterated that it depends on what the                   
actuarial comes up with on this savings, how much is saved by not              
having that pregnancy.                                                         
CHAIRMAN ROKEBERG remarked the committee hasn't seen empirical                 
evidence of actuarial studies, if they were there they'd be on our             
REPRESENTATIVE RYAN said, from the testimony, it seems difficult to            
try to get the basis for an actuarial study on something that you              
can't show the decreases in but the increase would be an actual                
REPRESENTATIVE KUBINA disagreed with that statement.                           
CHAIRMAN ROKEBERG closed the public hearing on HB 350.  He noted               
any concerns that he has had with this legislation has to do with              
the cost, its impact and the availability of insurance for                     
individuals in small groups.  He noted it has absolutely nothing to            
do with contraception, family planning and those types of issues.              
Number 0296                                                                    
REPRESENTATIVE HUDSON asked the Chairman if he would accept a                  
motion to adopt proposed Amendment LS1297\B.4, Ford, 4/20/98.                  
     Page 1, line 8, following "society":                                      
     Insert:  or a qualified church-controlled organization with a             
     religious-based objection                                                 
     Page 2, line 3, following "contraceptives":                               
     Insert:  (3) "qualified church-controlled organization" has               
     the meaning given in 26 U.S.C. 3121(w)(3)                                 
REPRESENTATIVE CROFT said he has no objection to it.  He noted he              
would have included it in the original bill, except it hadn't                  
occurred to him until he received more information.                            
CHAIRMAN ROKEBERG referred to an article by Governor Pete Wilson,              
Los Angeles Times, ["Contraceptive Mandate for Insurers Vetoed,"               
February 12, 1998].  He asked Representative Croft if this                     
amendment was equivalent to it to the best of his knowledge.                   
REPRESENTATIVE CROFT replied to the best of his knowledge it is.               
That was the intent of the amendment.                                          
TOM ATKINSON, Researcher to Representative Croft, Alaska State                 
Legislature, informed the committee he was provided a copy of the              
amendment by Representative Bob Hertzberg that was prepared to                 
satisfy Governor Wilson.                                                       
Number 0311                                                                    
REPRESENTATIVE HUDSON made a motion to adopt proposed Amendment                
LS1297\B.4, Ford, 4/20/98.  Hearing no objections Amendment B.4 was            
CHAIRMAN ROKEBERG said, "Next there's a question about offer versus            
provide, do you have any opinion on that Representative Croft."                
REPRESENTATIVE CROFT replied that it all depends on what we mean by            
it.  As long as we mean that the employer must offer its employees             
this option, that's all right.  He said he thinks if we just do it             
as you've got to offer as an insurance company to employers whether            
you want this or not, that's nothing more than is happening now.               
He stated that, in his opinion would gut the bill.  So, it needs to            
be from his perspective as an employee that he has this option some            
how, not simply the writers of the policy.  It depends on what we              
mean by offer, if we mean the employee still have this option then             
that makes sense.                                                              
REPRESENTATIVE KUBINA asked if he was referring to line 9.                     
CHAIRMAN ROKEBERG replied yes, delete "provide" and insert "offer".            
REPRESENTATIVE KUBINA indicated that doesn't do what the sponsor of            
this legislation intended.  He said he thinks this would do what               
"Gordon" asked for, which means okay do you want this let us know              
and we'll add it and you're going to pay the full cost, it will be             
$300 a year and not $2.00 a month spread across a wider group.                 
CHAIRMAN ROKEBERG asked what's wrong with that.                                
REPRESENTATIVE KUBINA replied the insurance company is going to add            
a 20 percent profit onto that and people will end up paying more.              
CHAIRMAN ROKEBERG asked where's the equity of the empty nest you're            
paying for a fertility-aged person.                                            
REPRESENTATIVE KUBINA stated it's no different from the empty                  
nester paying for a cancer patient when they don't have cancer.                
REPRESENTATIVE CROFT reiterated putting "offer" for "provide" on               
line 9 guts the bill.  He noted he didn't know that was the                    
specific change they were talking about.  If you just say offer,               
the bill does very little.                                                     
Number 0334                                                                    
REPRESENTATIVE RYAN indicated by mandating this we're telling an               
employer you pick it up and the cost of goods and services goes up,            
not only for the empty nester but everyone else.  He said he                   
believes that is stepping a little farther than a negotiation and              
a contractual basis or (indisc.).  We're telling everybody what                
they're going to pay for it and he has a problem with that.                    
Representative Ryan said, "If it's going to cost $300 a year, and              
I'm going to tell this guy, you've got 100 people working for you,             
$300 a year, you're going to going to provide that.  Where do I get            
off spending somebody else's money like that?"                                 
REPRESENTATIVE CROFT said there's an appropriate distinction                   
between individual policies where it's simply -- and now I can make            
that decision on my own, exempting an individual policy.  Where you            
have a group, and you can spread those costs, we're going to save              
long-term money and we're going to save health costs for society.              
It has a positive benefit as requiring coverage of mammograms.  It             
is a form of preventive medicine that we want individual employees             
to have that option.  He said in any group, he believes it makes               
sense for all the reasons that were discussed.                                 
REPRESENTATIVE RYAN mentioned that if we can show, by joining                  
groups that we can save money, and by making this affordable -                 
collectively doing this, he said he could support that.  But if                
we're mandating employer cost, he noted he has difficulty with                 
increasing anybody's cost of doing business.                                   
REPRESENTATIVE KUBINA indicated they're missing this side of the               
equation.  He said maybe this is where they disagree in that if an             
insurance company by offering this is able to say from paying the              
huge expense of having major problem births then they actually                 
could save money by this.  He said, "I wish I had an actuarial                 
study that would be able to show that to you.  And I'm not sure you            
could do it until maybe you've done it for the state for five                  
REPRESENTATIVE BRICE asked if there is an amendment pending.                   
CHAIRMAN ROKEBERG replied no, we're just talking about whether we              
should do that one.                                                            
REPRESENTATIVE RYAN suggested researching populations in the Lower             
48, similar to Alaska's, where actuarial studies have been done and            
then perhaps come up with a model.  He reiterated that it's not                
known what the savings is going to be.                                         
Number 0383                                                                    
CHAIRMAN ROKEBERG stated this currently is NOW's (National                     
Organization of Women) issues, they're beating the drums all over              
the country.  He mentioned a Boston Globe reporter said, "Virginia             
has become the first state to pass this legislation, California is             
in the wings - the governor vetoed it, and Alaska and Connecticut              
is likely to follow."                                                          
REPRESENTATIVE KUBINA said, "My last point is we did have testimony            
though that did (indisc.) in other countries.  Where, if you                   
couldn't say that there was a cost-savings, you certainly saw that             
there were reductions in abortions and (indisc.) issues.  So, at               
least there's one correlation there that something bad is going                
down and I don't know how we say it, but there's certainly a cost              
in those abortions."                                                           
CHAIRMAN ROKEBERG asked Representative Croft why didn't he try to              
be more specific in the listing of oral contraceptives, what was               
the intent.                                                                    
Number 0397                                                                    
REPRESENTATIVE CROFT replied, "Intent, to given the options that               
worked for them, and the intent to make it last more than a couple             
years, if there's a new contraceptive device, appliance or drug                
that comes out."                                                               
TAPE 98-55, SIDE B                                                             
Number 0001                                                                    
REPRESENTATIVE CROFT continued, "A statistical analysis, taking                
known failure rates for these, known costs, known costs of birth,              
it was statistical evidence that contraception clearly saves money.            
And it was the opinion of those that published statistical analysis            
that the people who were going to save the money are the third-                
party payers.  So I'm at some what of a loss of what type of                   
experiment we have to do to satisfy -- we all think it does, it                
makes sense that it saves money, there's a statistical analysis                
that saves money, we could look at other countries - and it saves              
money.  We know that HMO's, who have more of a long-term population            
to look at do it much more and that gives some indications it saves            
money.  So, we could search for the miracle, absolute study on                 
this, but we have a lot of evidence that it saves money, and I just            
believe it will.  I'm disappointed that we don't have                          
teleconference today because one of the people that was going                  
testify was a representative of the Teamster's Union that handles              
their health plan and they do this.  When I asked her, 'Well does              
it save you any money,' even though she knew she was talking to a              
representative she started laughing on the phone.  It was, 'Of                 
course it does.  Don't you think it does?'  Again, though, they are            
positive it does, they continue because it does.  But when I said,             
'Where's the numbers,' - 'Well, I know but I don't know how many               
didn't come in the next year, but it just makes sense doesn't it,              
Representative Croft?'  And I guess that's where I leave the                   
committee, it just makes sense doesn't it?"                                    
CHAIRMAN ROKEBERG commented that these are areas of science not                
art, there is clearly empirical evidence if in fact this works and             
we haven't seen it, but that's not the case here.                              
CHAIRMAN ROKEBERG referred to Amendment LS1297\B.2, Ford, 3/3/98.              
He said one of his great concerns is the direct impact on the                  
individuals who can't spread the cost over a group.  He added that             
there's no group to spread it over.                                            
     Page 1, line 8, following "society"                                       
     Insert:  or a policy issued to an individual                              
REPRESENTATIVE KUBINA made a motion to move proposed Amendment B.2.            
There being no objections, Amendment B.2 was adopted.                          
Number 0035                                                                    
REPRESENTATIVE KUBINA made a motion to move HB 350 as amended with             
individual recommendations and attached zero fiscal note.  There               
being no objections, CSHB 350(L&C) moved from the House Labor and              
Commerce Standing Committee.                                                   

Document Name Date/Time Subjects