HOUSE BILL 234 "An Act relating to assistance for abortions under the general relief program; and relating to financial responsibility for the costs of abortions." REPRESENTATIVE TERRY MARTIN explained that HB 234 would provide a new measure of logic and consistency to the State's abortion law in two areas; first, in establishing the procedure's priority on the official list of medical procedures the State will pay for under the General Relief Medical (GRM) program; and second, by creating a mechanism by which the State can identify and hold financially responsible the would-be father. He added, it is not logical that an elective procedure such as an abortion should continue to hold a higher priority to other more essential services. HB 234 would have the State require payment from the pregnant woman, either partially or in full, for an elective abortion if it had been paid for under the General Relief Medical Program. HB 234 would require that the male responsible for the pregnancy be identified and held financially responsible for an abortion sought under the General Relief Medical Program. Currently, under Title 47, the State requires a woman seeking financial assistance from the State to identify the father or her dependent children. The State then recovers any costs it can from the father through the Child Support Enforcement Division. Representative Martin thought that it was logical that if a father of a born child should reimburse the State, so should the father of an unborn child. Representative Martin pointed out that HB 234 would represent a new bench mark in requiring accountable parties to accept the full responsibility for their actions. If we are to continue to have a policy in Alaska of publicly- funded abortion, Representative Martin stressed that the State should do all it can to collect from the responsible persons. PETER NAKAMURA, M.D., MPH, DIRECTOR, DIVISION OF PUBLIC HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, noted that the Department strongly opposes the proposed legislation. He indicated that the bill would be harmful, speaking to the historical problems during the times when there was no 3 medical access to abortion. Hospital rooms were then responsible for addressing the "back yard" results of self induced abortions. At this time, any abortion procedure is safer than a normal delivery. He asserted that to remove access to the services, would force the State back into the "dark ages". KRISTEN BOMENGEN, ASSISTANT ATTORNEY GENERAL, HUMAN SERVICES SECTION, DEPARTMENT OF LAW, spoke to the constitutional issues raised by the legislation. The effect of the bill would eliminate abortion funding which raises a constitutional inquiry. If the funding was restored to the relief medical services spectrum, it would give rise to a subsequent constitutional issue requiring that the woman reveal the name of her sexual partner in order to receive the service. Section 3 of the bill separates out abortion services from all other pregnancy related services and places it into the list of items eliminated from funding. Ms. Bomengen pointed out that to date, the Alaska State Courts have not addressed abortion issues directly. In other states which have explicate privacy protection, provide for pregnancy related services in a constitutionally neutral manner. She noted that it was the Department of Law's belief that the effect of the legislation's language would place impermissible burdens upon a woman's option to choose to terminate the pregnancy. She continued, if funding was fully restored for all general relief services, or if a constitutional challenge was required for the State to offer all pregnancy related services equally, at that time, Section 2 of the bill would be addressed. That section provides that the woman name the sexual partner in order to receive medical services from the State. The Department understands that the woman's choice not to provide the name of her sexual partner is a protected right. There are many reasons that a woman would not want to have the name released. In response to Representative Kelly's request, Ms. Bomengen explained that the male involved often needs to be sought in order to be identified. Ms. Bomengen provided some reasons why a woman would choose not to identify the male partner. Co-Chair Therriault advised that the State provides the funds for the service and has the right to recoup those costs. Ms. Bomengen agreed that the State does have the right to recoup costs as established in the bill. However, given the cost of the procedure, the State would be able to recoup their cost solely through the woman's permanent fund check. Given the 4 current value of that check, the State would have recouped costs from the woman's check. Requiring her to reveal information that she may not wish to reveal, could result in constitutional problems. Discussion followed between Representative Martin and Ms. Bomengen regarding the number of other states which pay for abortions. Ms. Bomengen agreed that all states are not constitutionally required to pay for an abortion. The State can not discourage the right to exercise a constitutional right based on religious or moral hostility. Co-Chair Therriault asked how the father's dividend check would be accessed. Ms. Bomengen stated that in most cases, the procedure would be paid for by the woman's permanent fund check. Representative Martin countered that procedure should be similar to the one used by the Child Support Enforcement Agency (CSEA) and would be done at the time of delivery. Representative Martin thought this action would provide an incentive to the Department of Health and Social Services (DHSS). Co-Chair Therriault pointed out that even though the bill recommends pursuing both the man and woman, there would be no need to go past the woman. Representative Kelly suggested that an amendment be added to the bill which would clarify that the both parents be equally responsible, whereas, if the mother chose not to identify the father, then she remain singularly responsible for payment. NANCY WELLER, DIVISION OF MEDICAL ASSISTANCE, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, stated that Section 3 of HB 234 would eliminate the Department's ability to fund abortions for low income women. Since 1986, the Department has not funded any services beyond the current number #7. She addressed the concerns of the Department. The Department would take action against the woman and collect her permanent fund dividend for the abortion costs. Of the people who apply for the Medicaid program, most recipients are eligible for Medicaid. Those who receive abortions under the General Relief Medical (GRM) program, do not have to identify the father of the child until the child is born. The person could be required, under a condition of receiving funding for an abortion, to assign the rights to their permanent fund dividend check to the State or ask them to identify the father of the unborn child. That would be costly for the Department and would require deep tissue testing. The cost for the testing in the State of Alaska is 5 $975 dollars. Many areas of the State do not do DNA testing. Also, there is no statewide authority to compel a father to comply with the testing. Ms. Weller agreed that it was a compelling idea to have the father take part in the administrative costs, although, reiterated that it is not a sound idea or financially feasible. The bill provides authority to take action on the cost of the abortion, but does not cover the administrative costs associated with establishing paternity. Representative Kelly asked the connection between federal Medicaid, Medicare and State funded abortion dollars. Ms. Weller replied that most women that receive funding for abortion through the General Relief Program (GRP) are Medicaid recipients. There is no link between federal and state dollars. Representative Martin spoke to the priorities of the services funded and suggested that by eliminating abortions would provide more funding for other emergency services. Ms. Weller advised that those are two different programs and services. The State spends about $300 thousand dollars on GRM abortions annually, whereas, the cost of adult emergency care is close to $4 million dollars. She emphasized that these are two different programs and the money can not be used for the alternate program. ANGELA SALERNO, EXECUTIVE DIRECTOR, NATIONAL ASSOCIATION OF SOCIAL WORKERS, JUNEAU, spoke in strong opposition to the proposed legislation. HB 234 would virtually eliminate the availability of abortion services for one class of individuals in the State, poor women. If the services are eliminated, there will be unintended outcomes. The options would be restricted for poor women. There are many unintended pregnancies each year. There will also be increased costs to the State with the fetal testing. And also, assuming the cost of Medicaid and welfare for those children. She stressed that when children are unwanted in a family, much more recorded child abuse and neglect exists. CARLA TIMPONE, ALASKA WOMEN'S LOBBY, JUNEAU, testified in opposition to the proposed legislation. The Lobby's concerns are specific to three areas: * Related to gender equity; * Related to class issues; and * Related to singling out one elective procedure as opposed to another. (Tape Change HFC 97-124, Side 2). Representative Kelly pointed out that the bill does not make 6 a statement about an individual's position on abortion; rather, it is only a statement about funding abortion. Co-Chair Therriault placed HB 234 in Subcommittee with Representative Kelly as Chair and with members Representative Martin and Representative J. Davies. He asked that the Subcommittee address the following concerns: * The amendment provided by Representative Martin; * The issue of addressing the identify of the father in the situation; * Any constitutional issues which need addressing by the Department of Law; and * How to compel a man/father to participate in the actual paternity and potential responsibility. HB 234 was HELD in Committee for further consideration.