Legislature(2017 - 2018)SENATE FINANCE 532
03/26/2018 09:00 AM FINANCE
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SENATE BILL NO. 198 "An Act relating to a study of the effectiveness and cost of providing long-acting reversible contraception to women with substance abuse disorders." 10:13:32 AM SENATOR PETE KELLY, SPONSOR, introduced the legislation. He remarked that good people had spent time and effort to correct social ills like sexual assault, addiction, suicide, and alcoholism that were issues of despair. He remarked that he had created Empowering Hope, and felt that the meetings were very effective. He shared that the group probably could not fix all of Alaska's ills. He stated that the group narrowed its focus to fetal alcohol spectrum disorder (FASD). He stated that there was decision not to have efforts to manage the problem, rather focusing on eradicating the problem. He clarified that FASD was part of the Empowering Hope legislation. He noted that he had funding the Empowering Hope mission through his legislative office by hiring Ryan Ray as executive director. He stated that Empowering Hope was moved to the Institute of Circumpolar Health. He remarked that there were various collaborations, and shared that there were approaches that had been implementation. 10:22:22 AM HEATHER CARPENTER, STAFF, SENATOR PETE KELLY, discussed the Sectional Analysis (copy on file): Section 1: (A) Directs the University of Alaska Anchorage Center for Alcohol and Addiction Studies to conduct a study to evaluate the effectiveness of providing long-acting reversible contraception (LARC) to women with substance abuse disorders who are at high risk for unintended pregnancies that may result in prenatal drug or alcohol exposure. The study shall be done in collaboration with hospitals and health care providers in Alaska who treat women with substance abuse disorders and: (1) Establish an advisory council to assist with designing and implementing the study, (2) Evaluate best practices for treating women and children when there is a high risk of neonatal abstinence syndrome (NAS) or fetal alcohol spectrum disorders (FASD), (3) Facilitate a network for sharing of best practices, (4) Identify women and children to participate in the study on a voluntary basis, (5) Provide LARC to participants who are at a high risk for unintended pregnancies that may result in prenatal drug or alcohol exposure, (6) Evaluate the cost and effectiveness of providing LARC to reduce the occurrence of NAS and FASD, (7) Develop a cohort of women and children who can be evaluated in later studies regarding NAS and FASD, (8) Provide a data driven framework to establish a comprehensive strategy for using LARC to reduce NAS and FASD in Alaska. (B) Directs the University to complete two interim reports by June 30 of 2019 and 2020 and a final report by June 30, 2021. (C) Provides definitions for "fetal alcohol spectrum disorder," "long-acting reversible contraception," and "neonatal abstinence syndrome." Section 2: Repeals Section 1 on June 30, 2021, which coincides with the date of the final report on the project 10:25:17 AM Senator Olson wondered where in the state the studies would be conducted. He shared that the issues discussed often occurred in rural Alaska. Senator Kelly deferred to Mr. Ray. JEFF JESSE, DEAN, COLLEGE OF HEALTH, UNIVERSITY OF ALASKA, ANCHORAGE (via teleconference), discussed the bill. He stressed that the abuse of alcohol and drugs had severe consequences to Alaskans, especially to the unborn and the consequences of that effect over their lifetime. He remarked that fetal alcohol spectrum disorder was a problem for many years in the state. He noted that over 120 children were diagnosed every year. He remarked that the number did not include the many children who were affected by alcohol exposure, but their symptoms did not rise to the level of diagnosis. He remarked that there was also the advent of the opioid crisis, which resulted in a 500 percent in neonatal abstinence syndrome over the recent decade. He remarked that those were critical human and financial issues for the state. He stressed that there was an importance for financial investment in the university to ensure that there was the capacity for assistance in addressing major policy, by providing objective data to have the best information available to make the best decision. 10:31:50 AM TREVOR STORRS, EXECUTIVE DIRECTOR, ALASKA CHILDRENS TRUST, ANCHORAGE (via teleconference), testified in support of the bill. He stated that there was a project to help reduce child abuse, so Alaska was able to identify key social determinants, which included unplanned and unwanted pregnancies. He shared that the Center for Disease Control (CDC) reported in 2006 that 49 percent of pregnancies were unintended. He stated that 4 of 5 pregnancies for women ages 19 and younger were unintended. He stressed that under the age of 15, 98 percent of those pregnancies were unplanned. He shared that births from unplanned pregnancies were associated with adverse maternal and child health outcomes. 10:37:11 AM PATRICK REINHART, EXECUTIVE DIRECTOR, GOVERNORS COUNCIL ON DISABILITIES, ANCHORAGE (via teleconference), spoke in support of the bill. He remarked that the council had a large FASD work group that included individuals from around the state, which included a prevention subcommittee. He stated that there was a submitted letter of support in the packet. 10:38:22 AM ART DELAUNE, GOVERNORS COUNCIL ON DISABILITIES, FAIRBANKS (via teleconference), spoke in support of the bill. He echoed Mr. Rienhart's comments. He shared that he was the parent of two men who were exposed to alcohol in the womb. He stressed that he was very aware of the consequences of unintended pregnancies of women who had addictions. He shared that one of his sons had siblings who were all alcohol-exposed and in state custody. He shared that he was involved in consequences for women who were finding homes for children who were exposed to alcohol. He understood that there was a stigma attached to mothers of children with FASD. He shared that the mothers felt guilty and were judged by others. He stressed the no women would intentionally expose their children to the lifelong disability. He stressed that the addictions impaired judgment and resulted in poor decisions. 10:42:11 AM ALYSON CURREY, LEGISLATIVE LIAISON, PLANNED PARENTHOOD VOTES, JUNEAU, addressed some concerns with the bill. She shared that Planned Parenthood, in 2016, provided long- acting reversible contraception (LARC) to more than 1000 patients in Alaska. She strongly support efforts to address barriers to access to the full range of birth control methods. She supported efforts to evaluate best practices for treatment, and facilitate the efforts. She shared that there was a history of coercion around provider-controlled contraceptive methods such as LARC. She share that because of the history and potential for ongoing coercion, nobody should be directed toward any particular method solely because it was cost effective or more effective at preventing pregnancy, which may not be a woman's primary goal when using contraception. She felt that women with substance use disorders were just as deserving of the right to make their own reproductive health decisions. She felt that the state should ensure that every person receives complete, unbiased information on the full range of birth control methods. She stated that she submitted written comments. Co-Chair MacKinnon wondered whether Ms. Currey was in opposition to the bill, or whether there was a request for amendments. Ms. Currey replied that she was asking for amendments. 10:45:51 AM Senator Micciche wondered whether the eight pieces of the study in Section 1 were understood. Ms. Currey replied in the affirmative. She stressed that her concerns were not related to that section. She remarked that the legislation did not clarify the need for collaboration with experts, contraception, and family planning. Senator Micciche looked at item 3, which related to facilitating a network for sharing of best practices. He appreciated the discussion outside of the bill. Ms. Currey responded that there was a desire to be aware of the concerns and use a reproductive justice approach when working with women with substance use disorders. She hoped that the women would not be pushed toward one method, without information on the full range of birth control methods. 10:48:59 AM MARY NANUWAK, SELF, BETHEL (via teleconference), felt that the contraceptive studies have been controversial. She felt that the studies were often biased. She remarked that FASD was preventable. She considered Bethel a "third world country." She stressed that individuals should be given informed consent to make their own decisions. She felt that Senator Giessel should not be considered the medical authority. She shared that there were many native people who did not speak English, which could be complicated. She stressed that she did not like the attitudes of some professionals, because it caused confusion. Co-Chair MacKinnon CLOSED public testimony. 10:52:47 AM RYAN RAY, HEALTH POLICY FELLOW, UNIVERSITY OF ALASKA, shared that he had been involved in the Empowering Hope mission since the beginning. He shared that he was integral in conducting the pregnancy test dispenser study. Senator Olson wondered where the concentration of the study would be conducted. He noted that some of the issues were concentrated in rural Alaska, where women did not have access to information and contraception. Mr. Ray replied that the goal was to develop a network of hospitals and birthing centers to ensure that those in rural Alaska were not left out of the study. He stated that the primary partnership was with the Alaska Regional NEST Program, which had taken the lead in addressing NAS. He stated that other hospitals would be partnering with the study. Co-Chair MacKinnon stated that the fiscal note would be updated. Co-Chair MacKinnon announced that the public hearing for the operating budget is cancelled. Senator Micciche looked forward to hearing from the public once the committee had received the budget. SB 198 was HEARD and HELD in committee for further consideration.