Legislature(1997 - 1998)
04/08/1998 04:40 PM Senate FIN
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
CS FOR HOUSE BILL NO. 234(FIN) am "An Act relating to assistance for abortions under the general relief program." Co-Chair Sharp noted this was the first hearing for this bill in the Senate Finance Committee. During this meeting, the members would hear public testimony. Testimony would be limited to three minutes because the teleconference was only available until 6:30 p.m. The sponsor of the bill, Representative Terry Martin, was invited to speak to the legislation. His testimony was as follows: "The purpose of HB 234 is to change the priority of programs under the General Relief [Medical Program]. Over the past four years we have heard the Governor and his Administration complain about the Legislature's not having enough money for eyeglasses for children, for emergency dental care for senior citizens - all kinds of things." "As I looked into the issue, we find out that what's really happened is that the free abortion rate has accelerated to a pace that's unbelievable. For instance, in one year from '96 to '97 the number of free abortions have increased 116 procedures. That's way out of line. We find out that perhaps part of that reason has to do with the child enforcement services doing a better job making the fathers of children pay for their off-springs, whether they're married or not." "So it seems to be that the male partner involved in these activities are encouraging to get free abortions, it being a matter of convenience more than of need. It certainly does not have much to do with economic needs either as I'll show you later." "One of the things that really surprise me about this bill, Mr. Chairman and members of the committee, is the number of public support that has come in. Here I have petitions that I did not initiate and we divided them by communities, whether they be Fairbanks, Kenai, Juneau and so on, and I'm just amazed at the number of people that know about this bill and the reason why we've introduced it. So outside of those petitions, which have over 5,000 names on them, we have been receiving tremendous amount of POM's and I have some of them printed here. We put them in different sections of the state, whether it be Anchorage, Fairbanks, Kenai, whatever. But it shows that a lot of public interest has been generated that they do not want public monies, to the point that we are doing it now, to be used on free elective abortions and that abortions should not just be another kind of safe sex option." "This bill is intended to solve the number one problem that the Governor and the Administration has complained about and that is how General Relief money is spent." "We made this the lowest priority because even though we talk about poor people all the time not having money, things have dramatically changed in the last 25 years since legalization of abortion. Many citizens throughout this state and a large number of them receiving abortions have the money - and especially the boyfriend or the male partner has the money. We always talk about the poor lady, but basically we found out that they do not follow the requirements [unable to decipher]...by settlement by former Commissioner Ted Mala. The department does not have to check any requirements whatsoever of someone wanting an elective abortion. They're just like a free bill. I don't know where the offices are in Anchorage. They just call 'em up, get an appointment and go in and charge it to the state. The state its looks like that [undecipherable] say well all we're worried about is the major code, what type of abortions did they do. We don't want to go too personally into the person's qualifications of even being eligible for Medicaid." "So there [are] no guidelines whatsoever, but that's outside this bill. The bill is: do we want to allow all the money that we appropriate to the General Relief [Medical Program] to be used for abortions as the number one priority and then allow the Administration to constantly say this is not enough money for glasses or emergency dental service." "It's such nature all through the statistics that we've found out that, the chairman and members that - I think once we delve into what's happening as to the abortion policy of Alaska is most disturbing. For every white child that is aborted, three Native children are aborted. For every white child that is aborted five black children are aborted. That is a very, very bad policy for the state to follow. Under the guise of poor is a terrible way to solve your problem of poor people is to abort their children." "I just think that we can reverse this situation. We can make the males responsible for paying for their own deeds, their own irresponsible activities rather than just the female suffer through the abortion. Certainly the public is opposed to public funding of abortion of this nature." "Also by putting this at a lower priority than you will have more money for dental care or other services that are deemed necessary that Medicaid does not pay for." "I think I'll leave it right there at that point, Mr. Chairman so if you have anyone that has a question. I do want to say that Alaska is probably the most liberal state in the nation and abortions pay for anything. We literally have no laws restraining people under government sponsored paid abortions. Thirty-two states do not pay for abortions. In the last two years, four states that were paying for abortions have now stopped. I've just got reports this morning that South Carolina legislation approved in the Senate stopped public funding of abortions. North Carolina did that last year and they went through their state supreme court and it was upheld. Just because a person has a constitutional right to something doesn't mean that the state will pay for it, whether it be freedom of the press or free speech or free abortions. Michigan has stopped this state funding of abortion. They never did allow elective abortions or free abortions. One other state has solved their problem with the courts and have stopped funding of abortions." "In this case here, we're not asking to stop it, we're asking that it be given a lower priority over other medical needs." Senator Adams understood Section 1 of the bill, however, he asked the representative to go over Section 2 as it had changed one or two times. Basically he wanted to know what was covered under abortions. He also wanted to know if there was a definition of physical disorder. Representative Martin spoke to the changes made to the original bill. He said the bill was amended during the House debate to allow for abortions in the case of rape, incest and when the life of the mother is in danger. This was the same as the current law. Representative Martin brought up the petition he had earlier mentioned. He offered to share it with any committee members if they were interested in reading the names of people from their community. Co-Chair Sharp moved on and began taking public testimony. He reminded speakers they would be limited to three minutes, and that he would first call on those waiting to testify via teleconference. First to be heard was PATRICIA MACK, who was linked to the meeting from Anchorage. Her testimony was as follows: "The purpose of this - It is unfair to take away the ability for the poorest women in this state to exercise their right to..." Co-Chair Sharp interrupted, asking her to state her name and any affiliation for the record. Ms. Mack began again. "My name is Patricia Mark and I'm speaking for myself." "I feel it's unfair to take away the ability for the poorest women in the state to exercise their right to choose, which is what this bill would do." "Despite what was said earlier, a lot of these women are poor and just because their boyfriends could pay for their abortion doesn't mean they will pay for an abortion. It's not so easy to say, 'honey give me some money.' A lot of these men have either abandoned these women when they found out they were pregnant and just said, 'tough luck, you're on your own.' That's reality." "If a woman can't afford an abortion, an unplanned pregnancy would place an incredible financial burden on her. And plus, pregnancy would cost the state's general relief program a lot more money than an abortion would, which will mean there is even less money for things such as speech therapy and dental services for the elderly. So you're really not going to get the results you think you are if you force these poor women to have an abortion - or I mean to have - to go through an unplanned pregnancy." Co-Chair Sharp called upon the next person in Anchorage to testify, ROBIN SMITH. Her testimony was as follows: "I am speaking on behalf of the Pro-Choice Alliance and we have about 3,500 members actively participating here in Anchorage." "I'd like to look at the consequences of this law. First of all there will be an increased number of second trimester abortions. No one likes abortions. Most people would agree the later an abortion occurs in a pregnancy, the more objectionable it becomes. With low-income women, one of the primary reasons to delay an abortion is difficulty in obtaining financing. This delay also increases the health risk to a woman having an abortion later in the pregnancy." "The negative affect on the family of an unintended pregnancy - and this is according to the Institute of Medicine's report, The Best Intention's 1995 - the mother is more likely to seek prenatal care after the first trimester or receive no prenatal care at all. She is more likely to expose the fetus to harmful substances, such as tobacco, alcohol or drugs. The child of an unwanted conception is at greater risk of having low birth weight, of dying in the first year of life and of not receiving sufficient resources for healthy development. The mother may be at greater risk of physical abuse herself and her relationship with her partner is at a greater risk of dissolution. Both mother and father may suffer economic hardship and fail to achieve their educational and career goals." "There's also a negative impact on the unwanted child. They frequently experience more mental handicaps and are twice as likely to receive psychiatric care at government's expense; are more than twice as likely as wanted children to have a juvenile delinquency record; are six times more likely to receive some form of welfare between the ages of 16 and 21; and are at increased risk of suffering abuse, neglect, abandonment and removal to foster homes or institutions." "This bill would also cause an increase in medical costs to the state as opposed to what Representative Martin said. Nationwide, when public funds are unavailable, 20 percent of Medicaid eligible women, who want to have an abortion, carry their pregnancy to term. In our state that percentage could approach 40 percent due to poor access and greater travel expenses." "So, had Alaska not paid for 843 abortions last year, then a minimum of 169 births, or 20 percent, would have occurred. Alaska pays $8,617 per pregnancy. So the total cost would have exceeded $1,456,000 or an increase of $950,000 over the total of last year's abortion expenses. This does not take into account the child's eligibility for medical care for its first year or any high risk pregnancy costs." "Alaska would be increasing its medical costs and actually decreasing the monies available in the GRM." "In conclusion, HB 234 is not a cost saving bill as professed. Its negative affects will only add to our societal woes. In this era of decreasing welfare benefits - and when we are asking families to be more self-reliant - this bill is a contradiction to provide - we need to be providing support for low-income women and their family's needs." Co-Chair Sharp attempted to call on a testifier from the Fairbanks teleconference hook-up, but the connection was broken and he moved on to those people waiting to testify in person at Juneau. He invited CHRISTIAN BOMENGEN, Assistant Attorney General, Human Services Section of the Department of Law to come to the table. She introduced herself and began speaking: "I want to address the fact that this bill has the effect of cutting off abortion funding under the GRN program, except it does provide for an exception for when the life of the pregnant woman is in jeopardy, or in cases of reported cases of incest or rape. Medicaid coverage generally does require coverage under those circumstances, however under Medicaid, one is not allowed to require the rape or incest be reported." "This does not have an exception for the physical or physiological health of the mother. Thus it's limiting not only elective procedures as has been represented on occasion, but also other medically indicated procedures." "Even though it's permissible in some states to limit the availability of abortion funding under the federal constitutional test, Alaska's constitution contains explicit privacy protection that has been interpreted as providing more protection to individual liberties than the privacy rights that have been inferred under the federal constitution. Last year we saw the decision of the Valley Hospital case that more clearly articulated the fact that reproductive rights are fundamental in Alaska; that they're encompassed within our privacy provision; that they may be legally constrained only when the constrains are justified by a compelling state interest and no less restrictive needs could advance the interest." "Other states that offer exclusive privacy protection in their constitution though that recognize a higher degree of protection for those individual rights, have determined that when the state provides for any pregnancy related services it must do so in a constitutionally neutral manner. In other words, even if a state is not obligated to pay for the exercise of the constitutional rights, once it chooses to dispense funds for pregnancy related services, it has to do so in an evenhanded manner nondiscriminatory and cannot withdraw those funds simple because a woman chooses to exercise a constitutionally protected right." "This principle is also supported in Judge Tan's Superior Court decision in Planned Parenthood via Alaska, which addressed the minor's right to seek an abortion without first having to obtain parental consent. In that decision, he applied an equal protection test to the governmentally drawn distinction between a minor who chooses to seek an abortion and one who doesn't. He concluded that the government could not establish a compelling interest to justify the classification of minors in this way. Similarly, the equal protection analysis will apply to the distinction that's now being drawn between adult women who make different reproductive choices." "The state does not have a compelling state interest that would allow it to withstand the equal protection challenge." "I can refer to a number of state cases in which this principle is elaborated upon. Minnesota case addresses the question of whether the state can fund child birth related health services without funding abortion services. That's excluding the woman from receiving benefits solely because they chose to make a constitutionally protected health care decision. The court determined that the state had to provide public funds for medically necessary or therapeutic abortions. To not do so impermissibly infringed on a woman's fundamental right of privacy." "West Virginia's case, when the state government sought to - seeks to act for the common benefit such as it does when it provides medical care to the poor, has an obligation to do so again in a neutral manner." There's also Connecticut cases, Massachusetts cases. I guess if I could just take a few moments, one thing that may be helpful is to draw your attention to a case that was cited in the Minnesota case. As a parallel that applies the principle of when a government engages in a program it has to do so in a way that doesn't infringe upon the exercise of a constitutional right. Maybe we could move to a more neutral subject such as religion." Co-Chair Sharp asked Ms. Bomengen to summarize as her three- minute time limit had passed. She continued. "This is simple, the example I want to state. The court in Minnesota examined a South Carolina decision state rule that said that the - the decision said that the state could not operate its unemployment security program in a manner that infringed on the constitutionally protected right to exercise an individual's religion. In this case, a man was a Seventh Day Adventist who had refused a job that required him to work on Saturdays. The court decided there that the state could not condition its availability of those benefits on whether he chose to exercise his constitutionally protected rights." That concluded Ms. Bomengen's testimony. Senator Parnell asked for a copy of her speech. The teleconference hook-up was reestablished with Fairbanks and Co-Chair Sharp called upon RONNIE ROSENBERG to testify. She spoke as follows: "I'm representing the Arctic Alliance For People, which is a consortium of 43 non-profit social service agencies. We oppose any attempt to cut the general relief program. I'm not going to get into a long dialog plus or minus abortions. However, I will tell you that we service many, many individuals who are recipients of the General Relief Medical Program. We would implore you to find the funding somehow to fund this program in its entirety so we do not have to pit people with hearing disabilities against people who need prosthetics against people who need emergency dental care." "Many of our clients are people who would otherwise fall between the cracks. Many of them are people who are awaiting SSI determination. I do volunteer SSI appeals. I'm an attorney and I do volunteer SSI appeals and up here it can be three years until we get a written decision. Meanwhile people with seizure disorders and other kinds of medical needs, without General Relief Medical, they would have absolutely no way of receiving medical care and of course their medical conditions would worsen and they would end up in the emergency room at a higher rate of pay." "So however you can fund General Relief Medical, I would ask you all to find the will to fund it in its entirety. It is very, very necessary for people who are living on less than $300 a month. And that is basically what I wanted to say on this bill." There were no questions or comments of Ms. Rosenberg. Co- Chair Sharp resumed calling on people in Juneau to testify. NANCY WALLER from the Division of Medical Assistance, Department of Health and Social Services came to the table. Her testimony was as follows: "I would like to address the fiscal note for this bill. I prepared a fiscal note that's dated 1/23/98 for the CS HB 234 (FIN). Representative Hanley replaced my fiscal note in the House Finance Committee with his own fiscal note assuming that a small number of women would carry their children to term." "I did a lot of research and discovered a study that was conduced in the state of Texas in the two years following the eliminate state funding for abortions there. The Center for Disease Control reports on this study that in those two years they found that 35 and 40 percent of the low-income women ended up carrying their children to term. In the fiscal note that I have is based on the 35 percent of the women currently receiving abortions, carrying their babies to term and becoming eligible for the Medicaid programs for themselves and their children. We believe that a higher percentage is applicable in Alaska because the cost of health care in Alaska is much higher here than it is in the lower 48. You can get an abortion in Seattle for about $250. It costs about $600 for our program, largely because of transportation related costs. Those people have to fly to a different community." Senator Parnell asked how, if her fiscal note reflected the costs of children who were going to be born rather than aborted, why that would have any bearing on the transportation costs to Seattle for an abortion. Ms. Waller replied she felt the higher percentage of women who would carry their children to term and therefore become eligible for Medicaid was applicable in Alaska because of the cost of receiving the abortion procedure in the state. It was not available in many communities; people had to fly to different communities. Senator Parnell wanted to know if her argument for the fiscal note increase was be because of the additional children born who would be eligible for Medicaid. Ms. Waller said based on the study that was her belief. She felt the 35 percent birth increase was more defensible than the 20 percent inserted in the House Finance Committee's fiscal version of the fiscal note. Senator Parnell questioned if the lack of availability of abortion services didn't come into play, would the division's version of the fiscal note talk about the cost of providing health care for children who would be in the Medicaid system. Ms. Waller argued that a higher percentage of birth and higher health care costs for the children who would automatically be eligible for Medicaid during their first year of life. Senator Adams noted that his bill packet didn't have a copy of the fiscal note drafted by the Division of Medical Assistance. He only had the fiscal note written by the House Finance Committee. He expressed a desire for all members to have a copy of the earlier version for consideration and comparison. Senator Parnell countered that the only fiscal note the committee should be looking at was the one that traveled with the bill. If the committee decided to draft a new version, they could debate past versions at that time. Co-Chair Sharp called upon DR. PETER NAKAMURA, Director of the Division of Public Health, Department of Health and Social Services. He spoke as follows: "Mr. Chairman, members of the committee, I'll take just a few seconds of my three minutes to again promote Public Health Week to you all and encourage our parents [watching the proceedings] on TV to get their children immunized. They're not doing a good job now and we'd like to do better." I'd like to use the rest of my three minutes just to state that on all the abortion bills that I've been testifying on, we've run into significant controversy because of the reasons for people participating in the debate are all different. We're not all in it for the same reason. Some are in it for moral and religious reasons. Some are in it for economic reasons. Frankly, I'm coming from one perspective and that's health. As a director of Public Health, I feel that we need to comment on the health implications of such a bill." "There's no question - and I challenge anyone to debate me, on this that we'll have more unwanted children born in Alaska. We'll have more children who will be subject to child abuse. We already have 15,000 cases reported a year of child abuse and neglect. We can expect a significant number of these kids to end up in that situation." "We're going to have more domestic violence. We have studies showing that unwed parents of unwanted children are subject to greater degrees of violence. In Alaska we're one of the leaders in that area." "We're going to find that there will be a larger number of kids in the state who didn't get the opportunity to get the education and pursue a career because they had to dedicate their life at a very early age to be a mother. Something that they were not ready for at this point." "So I guess basically the bottom line is that the costs to the State Of Alaska in terms of medical and health related problems would be very significantly increased by such a bill." "One other comment I'd like to make about the bill itself, is that it gives exceptions for a number of conditions: if the mother's life is at risk or if the lady who's pregnant was raped or if there's incest. But nowhere does it make an allowance for a mental problem. There are individuals who are pregnant and who suffer significant mental distress that could result in further medical and physical complications. These people are not addressed. They are excluded." Co-Chair Sharp asked how the doctor would control the level of mental distress. Was he talking about a previous mental disorder, he wondered? Dr. Nakamura replied it could be a previous mental disorder or it could be brought on by the present state of pregnancy. Co-Chair Sharp indicated that was what he was afraid of. Dr. Nakamura stressed there was always concern about potential suicide or self-induced medical problems such as self-induced abortions on these individuals who didn't have the ability to handle it because of their mental distress. Co-Chair Sharp reopened the topic on immunization admitting that it wasn't the focus of this meeting, but noting the public health director had mentioned it twice to the committee during the day. He asked why the immunization rates had deteriorated so much since he was a child and didn't have a choice. He had been immunized before being released from the hospital. Why wasn't that done now, he questioned. Dr. Nakamura answered saying the number of vaccines increased significantly. The number of shots when up from about 10 to 18 to complete a series. He added that the population had doubled since 1980. Therefore, he concluded there were more children, more vaccines and more diseases to protect them from, while there had been no increase in resources to meet the need. Dr. Nakamura talked of another reason for the decline in immunizations, which was due to the success in reducing outbreaks of the diseases. Because of this, parents were getting complacent and not having their children immunized in a timely manner, he disclosed. He quoted statistics of expected cases of various diseased were the immunizations not received. Co-Chair Sharp asked if it were mandatory for children to be current on their shots before they would be allowed to enter school. Dr. Nakamura told him it was, but the problem was the need to protect children before they reached the age of three. Senator Phillips questioned if there was a religious exemption to the requirement. Dr. Nakamura affirmed there was. Dr. Nakamura thanked the committee for allowing him to speak further on the issue. Co-Chair Sharp called on the next witness, LIZ DODD, President of the Alaska Civil Liberties Union. Her testimony was as follows: "First point, I wanted to respond to the sponsor's statement that this what the people want. I believe the last time this exact proposal was before the voters in the state, they voted to keep the funding in place. I'd also like to respond to a statement that Alaska Natives are receiving GRM abortions at the rate of three to one of white people. I think what that means to me is that if this passes, that Native population would be three times more discriminated against by virtue of being denied the access that they're entitled to." "The ACLU - I've talked to the lawyer who handled this case when the Hickel Administration tried to pass regulations removing GRM funding in 1992. The ACLU sued the state. They settled with us and the regulations were never implemented. I've talked to the lawyer who handled that case. She assures me that this law is patently unconstitutional under the Valley Hospital case. I just want to make a point that even if all of the constitutional amendments that seek to quote, overturn the Valley Hospital case are passed by this Legislature, those changes to the constitution will not reach the fundamental decision in that case that the woman has a fundamental right to an abortion. The state can't interfere with it. I won't go on and on about that, just ask you to take a look at the letter I sent today that talks about how defunding for poor women interferes with their ability to exercise their constitutional rights." "I'll ask you not to pass the bill out of committee for the simple reason that it won't stand, that it's unlawful. It's a political measure not a good piece of legislation. I hope do the right thing there." Senator Phillips commented that the best argument was the vote in 1992. Co-Chair Sharp called upon BETH KERTULLA to testify next. She introduced herself as an attorney representing herself and continued as follows: "The legislation would potentially deny poor women the choice to have an abortion, but would allow them the choice to carry a pregnancy to term. I believe this would be a denial of equal protection and that our courts would overrule it, and it's an unfortunate step backward." That concluded Ms. Kertulla's testimony and Co-Chair Sharp called CAREN ROBINSON. She spoke representing the Alaska Women's Lobby and said the following: "Most of you know the Alaska Women's Lobby has a supportive membership of at least 1,000 within the state. Kinda feel like we're here as de ja vue and not under any illusion that what we have to say today is going to change any of your minds. But I guess I do believe it's really important to remind everyone that this bill is harmful to women's health and unfairly discriminates against poor women who chooses to exercise her constitutional rights." "Low income women have often have difficult time raising the money to pay an abortion and according to one study, they need an average of twice as much time to raise the necessary funds than do middle or upper-income women. Also according to an American Medical study..." Tape #120 Side B, 5:25 p.m. "...federal funding restrictions that deter or delay women from seeking early abortions make it more likely that women will continue a potential health threatening pregnancy to term or undergo abortion procedures that would endanger their health." "Mr. Chairman, the funding for abortions under general relief programs should be handled like all other pregnancy related services and not singled out just because some of us object to this particular medical procedure." "The bottom line, no matter what you may believe philosophically about abortions and funding priorities, as a practical matter, this bill will lead to unwanted pregnancies, children having children and more back alley and self-induced abortions. That is a great step backward and we believe that fact alone is good enough reason to leave this bill behind. I wish that Senator Pearce was here again to day because I just really hope that you guys will please pull off the shelf, three-a-day children having children and please look at the recommendation within that report and continue to work with us in trying to find ways to help people have planned pregnancies and do what we can to stop children from having children." Senator Parnell understood her argument, but emphasized this bill would put abortion and related services and supplies in a place on the Medicaid priority list, where if funding was cut on the Medicaid funding list, it would be the first item to go. Why should elective abortions be treated as more important on a priority list than hearing aids for seniors, eyeglasses for children etc., he asked. Ms. Robinson responded that funding for abortion procedures belonged in the same place on the priority list as every other pregnancy related services. She gave herself as an example and said that if she were pregnant and decided to carry her baby to term, she should be in the same priority position than if she were to make the decision to terminate the pregnancy. Subjecting abortion procedures to a different standard was what her organization objected. Senator Parnell noted that eyeglasses and optometrist services were already in a different standard than prosthetic devices on the priority list. He questioned why abortions should be treated different. He felt they were all very personal medical choices. Ms. Robinson repeated her argument that all pregnancy related medical services should be categorized the same. She took the opportunity to go on record supporting the position of the Arctic Alliance. She felt more importantly, anyone in need of any type of medical care should receive that care. This concluded public testimony for this bill. Co-Chair Sharp held the bill until the full committee could be present to deliberate. Senator Parnell requested a brief recess at 5:33 p.m. The committee resumed less than a minute later. Co-Chair Sharp announced the next scheduled committee meeting to be Wednesday, April 15 at 9:00 a.m.
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