Legislature(2017 - 2018)HOUSE FINANCE 519

04/17/2017 01:30 PM FINANCE

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HOUSE BILL NO. 25                                                                                                             
     "An   Act   relating    to   insurance   coverage   for                                                                    
     contraceptives  and   related  services;   relating  to                                                                    
     medical  assistance  coverage  for  contraceptives  and                                                                    
     related  services;  and   providing  for  an  effective                                                                    
3:31:21 PM                                                                                                                    
REPRESENTATIVE  MATT   CLAMAN,  SPONSOR,  read   a  prepared                                                                    
     Good  afternoon  members  of  the  Committee,  for  the                                                                    
     record,  my name  is Matt  Claman, and  I am  the State                                                                    
     Representative   for   House   District  21   in   West                                                                    
     Anchorage. First  off, I  would like  to thank  you all                                                                    
     for hearing House Bill 25 this afternoon.                                                                                  
     All  across  Alaska, women  do  not  always have  ready                                                                    
     access  to women's  health services.  Women living  and                                                                    
     working  in  rural  areas, the  tourism  industry,  the                                                                    
     military,  and  on  the  North  Slope  face  additional                                                                    
     barriers,  geographical  and  otherwise,  to  obtaining                                                                    
     greater access to family planning options.                                                                                 
     Currently, women  who use hormonal  contraceptives must                                                                    
     return to the  pharmacy every month to  three months to                                                                    
     refill  their  prescriptions.  House Bill  25  requires                                                                    
     health  insurers  to  offer  consumers  the  option  to                                                                    
     receive a 12-month supply  of hormonal contraception at                                                                    
     a time. The  women in my family support  House Bill 25,                                                                    
     and  that tells  me a  lot.  They support  it not  only                                                                    
     because it is often  time consuming and inconvenient to                                                                    
     obtain a prescription contraceptive  every 3 months or,                                                                    
     in  some  cases,  every  month,  but  they  support  it                                                                    
     because   they    know   that   improved    access   to                                                                    
     contraceptives  means  huge  reductions  in  unintended                                                                    
     Unintended  pregnancy  has  a profound  effect  on  the                                                                    
     overall  well-being  of  Alaskan  families.  Unintended                                                                    
     pregnancy  is  associated  with  adverse  maternal  and                                                                    
     child  health  outcomes.  Along with  health  concerns,                                                                    
     unintended  pregnancy  is  a dramatic  cost  driver  to                                                                    
     public  health  programs. I  believe,  and  I hope  the                                                                    
     members  of   the  committee  will  agree,   that  with                                                                    
     Alaska's financial challenges, we  should look for ways                                                                    
     to reduce  costs in the  short-term and  long-term, and                                                                    
     this bill does exactly that.                                                                                               
     House  Bill  25  makes  sense  for  Alaskan  women  and                                                                    
     families. With that,  I will turn it over  to my staff,                                                                    
    Lizzie Kubitz, to explain the details of the bill.                                                                          
LIZZIE KUBITZ, STAFF, REPRESENTATIVE MATT CLAMAN, read from                                                                     
a prepared statement:                                                                                                           
     Thank you members of the  committee, for the record, my                                                                    
     name is Lizzie Kubitz and  I am staff to Representative                                                                    
     Claman. Thank you all for hearing House Bill 25 today.                                                                     
     House Bill 25 would  require health insurance companies                                                                    
     to, at  the request  of the consumer,  provide coverage                                                                    
     for  a 12-month  supply of  contraceptives at  one time                                                                    
     and provide reimbursement to a  health care provider or                                                                    
     dispensing   entity.   In    the   bill,   prescriptive                                                                    
     contraceptives include  hormonal contraceptives, namely                                                                    
     oral  contraceptives,  commonly  known as  "the  pill."                                                                    
     Section 1  of the  bill lays this  out. Section  1 also                                                                    
     gives  health  care  insurers   the  ability  to  enact                                                                    
     reasonable  cost  containment measures.  In  subsection                                                                    
     (d), cost  containment is defined as  incentivizing the                                                                    
     use of generic or lower  cost medications or the use of                                                                    
     health   care  providers   or  pharmacies   that  offer                                                                    
     services or prescriptions at a lower rate.                                                                                 
     The  inclusion  of  this language  gives  insurers  the                                                                    
     ability   to  steer   towards   generics   as  a   cost                                                                    
     containment  strategy-a provision  that the  Department                                                                    
     of  Administration  has  advocated   for  as  it  could                                                                    
     substantially  reduce their  costs  in  covering a  12-                                                                    
     month supply of birth control.                                                                                             
     However,   subsection  (e)   states   if  the   covered                                                                    
     therapeutically  equivalent version  of a  prescription                                                                    
     contraceptive  is   not  available  or   is  considered                                                                    
     medically inadvisable  by the  health care  provider of                                                                    
     the  insured,  a  health care  provider  shall  provide                                                                    
     coverage  without  cost   sharing  for  an  alternative                                                                    
     therapeutically equivalent version  of the prescription                                                                    
     contraceptive that is prescribed for the insured.                                                                          
     The  inclusion of  this language  makes  it clear  that                                                                    
     even though  insurers will be allowed  to steer towards                                                                    
     generics,  if   a  particular   generic  or   brand  is                                                                    
     determined medically  inappropriate by the  health care                                                                    
     provider,  then   the  insurer  must   accommodate  the                                                                    
3:35:55 PM                                                                                                                    
Ms. Kubitz continued to read a prepared statement:                                                                              
     Finally,   Section   1   also  includes   a   religious                                                                    
     exemption, so health plans  sponsored by certain exempt                                                                    
     religious   employers   are    not   subject   to   the                                                                    
     requirements of Section 1.                                                                                                 
     Section  2 amends  AS  39.30.090(a),  which relates  to                                                                    
     policies of group insurance covering state employees-                                                                      
     by  adding  a  new  subsection (13)  to  capture  group                                                                    
     health  insurance  policies  covering  employees  of  a                                                                    
     participating governmental unit.                                                                                           
     Section 3 amends AS 39.30.091, which relates to self-                                                                      
     insurance and excess  loss insurance-by adding language                                                                    
     to capture  a self-insured group medical  plan covering                                                                    
     active state employees.                                                                                                    
     Sections  2  and 3  clarify  that  the requirements  of                                                                    
     Section 1 apply to active  state employees. I will note                                                                    
     for   the  record   that  Michele   Michaud  from   the                                                                    
     Department  of  Administration  is  present  to  answer                                                                    
     questions relating to Title 39.                                                                                            
     Section 4  directs the Department of  Health and Social                                                                    
     Services to  cover the 12-month supply  of prescription                                                                    
     contraceptives  for  eligible   recipients  of  medical                                                                    
     Section 5  directs the Department of  Health and Social                                                                    
     Services  to amend  and submit  for federal  approval a                                                                    
     state plan  for medical assistance  coverage consistent                                                                    
     with Section 4.                                                                                                            
     Section 6 is  a conditional effect of Section  4 of the                                                                    
     bill, and                                                                                                                  
     Sections 7 and 8 pertain to effective dates.                                                                               
     One major  premise behind  House Bill  25 is  that when                                                                    
     women   have  greater   access   and  availability   to                                                                    
     contraceptives,  unintended  pregnancies  are  reduced.                                                                    
     Reductions  in  unintended  pregnancies have  a  direct                                                                    
     cost savings  to the state,  which is reflected  in the                                                                    
     fiscal notes  from the Department of  Health and Social                                                                    
     Services. And I will note  for the record that Margaret                                                                    
     Brodie from  the Department is online  and available to                                                                    
    answer questions about the department fiscal notes.                                                                         
     According to a  study, which I believe is  in your bill                                                                    
     packets,  in 2010,  48% of  all  pregnancies in  Alaska                                                                    
     were  unintended.  Additionally,  the  study  estimates                                                                    
     that 64.3%  of the unintended pregnancies  in 2010 were                                                                    
     publicly  funded.  As  a  State,  Alaska  spent  $113.7                                                                    
     million  on  unintended  pregnancies.  Of  that,  $70.8                                                                    
     million  was paid  for by  the  federal government  and                                                                    
     $42.9 million was paid by the state.                                                                                       
     An additional study, included in  your packet, looks at                                                                    
     84,000  women  in  California who  were  given  various                                                                    
     supplies-1  month,  3   months,  and  yearlong-of  oral                                                                    
     contraceptives   .  The   researchers  of   that  study                                                                    
     observed a 30%  reduction in the odds  of conceiving an                                                                    
     unintended pregnancy when given  the yearlong supply of                                                                    
     oral contraceptives.  That study also showed  that over                                                                    
     the course  of the  year, California's  family planning                                                                    
     program paid  $99 more annually for  women who received                                                                    
     3  cycles, and  $44  more for  women  who received  one                                                                    
     cycle, than  it did for  women who received  a yearlong                                                                    
     supply all  at once. This  was mostly due to  the costs                                                                    
     of associated  visits and the  higher use  of pregnancy                                                                    
     tests among women who received  fewer cycles. Women who                                                                    
     received 3 cycles were almost  twice as likely as women                                                                    
     who received the  12-month supply to visit  a clinic to                                                                    
     get a pregnancy test.                                                                                                      
     It is important to note  that this bill does not change                                                                    
     who is  eligible for  coverage. What  the bill  does is                                                                    
     allow   women,  who   already   receive  coverage   for                                                                    
     prescription  contraceptives,  to  receive, if  she  so                                                                    
     chooses, 12 months of that prescription at one time.                                                                       
     I wanted to  take a moment to address  some concerns we                                                                    
     have received  from the  Alaska National  Federation of                                                                    
     Independent  Business   (NFIB)  and   America's  Health                                                                    
     Insurance Plan (AHIP).                                                                                                     
     The  NFIB has  brought forward  concerns about  whether                                                                    
     this bill  would apply to the  state employee programs.                                                                    
     We have  addressed that concern  with the  inclusion of                                                                    
     language found in Sections 2 and 3 of the bill.                                                                            
     An additional concern from the  NFIB is the cost burden                                                                    
     of supplying  12 months of  contraception at  one time.                                                                    
     In response to that  concern, multiple studies over the                                                                    
     past   two  decades   have  found   that  contraceptive                                                                    
     coverage  does not  raise insurance  premiums and  that                                                                    
     employers providing  such coverage  can, in  fact, save                                                                    
     money  by  avoiding  costs associated  with  unintended                                                                    
     pregnancy. The  average commercial insurer  payment for                                                                    
     all maternal  and newborn care  ranges from  $18,000 to                                                                    
     $28,000.  The  average  hormonal  birth  control  costs                                                                    
     range from $100 to $600  a year. By preventing just one                                                                    
     unintended pregnancy, an insurer  can save a minimum of                                                                    
     $17,000.  That   is  enough  savings  to   pay  for  29                                                                    
     additional years of contraception.                                                                                         
     AHIP also brought forward concerns.                                                                                        
     Their  initial concern  is that  a  12-month supply  of                                                                    
     contraceptives could compromise  patient safety, due to                                                                    
     potential decreased visits  to a prescribing physician,                                                                    
     and efficacy,  due to potential  improper storage  of a                                                                    
     12-month supply of birth control.                                                                                          
     To address  the concern  of safety-research  shows that                                                                    
     birth control  pills can be safely  prescribed based on                                                                    
     a  careful review  of your  medical  history and  blood                                                                    
     pressure measurement. For most  women, no further exams                                                                    
     are necessary. A Centers for  Disease Control and World                                                                    
     Health   Organization   study   in   2013   recommended                                                                    
     dispensing  a   year's  supply  of   contraception  and                                                                    
     advising women  to return at  any time to  discuss side                                                                    
     effects, other  problems, or changing the  method being                                                                    
     used, but that no routine follow-up is required.                                                                           
3:41:21 PM                                                                                                                    
     To  address the  concern of  efficacy-according to  the                                                                    
     Centers  for  Disease   Control  and  Prevention,  oral                                                                    
     contraceptives  have  a shelf  life  of  three to  five                                                                    
     years,  depending on  the manufacturer.  This timeframe                                                                    
     can be diminished depending  on things like temperature                                                                    
     and moisture,  but we  trust that  women who  would opt                                                                    
     for a 12-month  supply (women who are  regular users of                                                                    
     hormonal  contraception)  know  how to  properly  store                                                                    
     their medication.                                                                                                          
     Additional  concerns from  AHIP  include waste,  fraud,                                                                    
     and abuse.                                                                                                                 
     To address  the concern of waste-in  the study included                                                                    
     in your  bill packets, researchers in  California found                                                                    
     that  women who  were  dispensed a  yearlong supply  on                                                                    
     average  "wasted"  about   one  cycle  of  prescription                                                                    
     contraceptives. Wasting  one cycle  of pills  is fairly                                                                    
     insignificant in  comparison to the cost  savings, such                                                                    
     as  fewer  total  clinician and  pharmacy  visits,  the                                                                    
     costs associated with pregnancy, and so on.                                                                                
     Overall, House  Bill 25 would have  huge advantages for                                                                    
     Alaskan  women. From  eliminating the  inconvenience of                                                                    
     refilling their prescription  every 1 or 3  months at a                                                                    
     time, to the  real inability for some  Alaskan women to                                                                    
     make it to the clinic,  hospital, or pharmacy to refill                                                                    
     that prescription  at all. Fisherwomen  sometimes spend                                                                    
     3 to 4 months out on a  boat at one time. Women who are                                                                    
     attending college  often have busy  schedules balancing                                                                    
     school  and a  job. Women  in rural  Alaska often  have                                                                    
     trouble  making it  to the  clinic or  hospital due  to                                                                    
     lack  of transportation  and  limited operating  hours.                                                                    
     This  bill ensures  the freedom  for  Alaskan women  to                                                                    
     make decisions about their health and their futures.                                                                       
Ms. Kubitz offered to answer any committee questions.                                                                           
3:43:50 PM                                                                                                                    
Representative   Wilson   asked   for  the   definition   of                                                                    
unintended pregnancy. Ms. Kubitz  replied that the pregnancy                                                                    
was   not   planned   or    desired   by   the   individual.                                                                    
Representative  Wilson countered  that it  was necessary  to                                                                    
know which definition applied -  unplanned or undesired. She                                                                    
spoke  to  concern  about  the fiscal  note.  She  spoke  to                                                                    
statistics  and   the  distinction  between   unplanned  and                                                                    
unwanted. She  believed that  not all  unplanned pregnancies                                                                    
were unwanted.                                                                                                                  
Co-Chair    Seaton   asked    Representative   Wilson    for                                                                    
clarification.  He  provided  the  scenario  where  a  woman                                                                    
misses taking  the pill due  to a  one month or  three month                                                                    
prescription  and  wondered  what distinction  she  inquired                                                                    
about.  Representative Wilson  referred to  analysis in  the                                                                    
fiscal  note and  expected savings  regarding the  number of                                                                    
unintended   pregnancies    due   to   the    twelve   month                                                                    
prescription.  She deduced  that the  "whole premise  behind                                                                    
the savings  in the  fiscal notes"  was based  on unintended                                                                    
pregnancies. She  relayed from  personal experience  that it                                                                    
was not a  problem to obtain contraceptives  for an extended                                                                    
period. She  believed the distinction between  unplanned and                                                                    
"unwanted" was germane to the fiscal notes.                                                                                     
3:46:13 PM                                                                                                                    
Ms. Kubitz replied  that the statistics only  applied to the                                                                    
rates  of  unintended  pregnancies.   She  cited  the  study                                                                    
["Increased Contraceptive Supply  linked to Fewer Unintended                                                                    
Pregnancies"  University of  California San  Francisco (copy                                                                    
on file)]  statistics that reported  a 30  percent reduction                                                                    
in the odds of a pregnancy  and a 46 percent decrease in the                                                                    
odds of  an abortion  for women given  a one-year  supply of                                                                    
birth control. She noted that  the "whole point" of the bill                                                                    
was  for  women   to  receive  the  entire   supply  of  the                                                                    
contraceptive  prescription  for   a  12-month  period.  She                                                                    
stated that  if women  had access they  were more  likely to                                                                    
use   it   which   limited    the   chance   of   pregnancy.                                                                    
Representative Wilson  reiterated her belief that  women had                                                                    
access to  contraceptives. She asked  whether the  bill made                                                                    
contraceptives available for men as well.                                                                                       
Representative   Claman   replied  that   "sadly"   hormonal                                                                    
prescription contraceptives were not available for men.                                                                         
Representative Wilson opined that  condoms could be provided                                                                    
for men. She  remarked that women must remember  to take the                                                                    
pill on a scheduled basis  or they risk pregnancy. The issue                                                                    
did not  apply to condom  use. She believed  the legislation                                                                    
placed the burden  and fault on women.  Ms. Kubitz discerned                                                                    
that  adding condoms  would erode  the cost  savings in  the                                                                    
fiscal  note.  The  cost  savings in  the  fiscal  note  was                                                                    
predicated on  the amount of unintended  pregnancies avoided                                                                    
when  women  were  prescribed  a   twelve  month  supply  of                                                                    
contraceptives.   Representative  Wilson   wondered  whether                                                                    
current statute prohibited a twelve month prescription.                                                                         
MARGARET   BRODIE,  DIRECTOR,   DIVISION   OF  HEALTH   CARE                                                                    
SERVICES,   DEPARTMENT  OF   HEALTH  AND   SOCIAL  SERVICES,                                                                    
responded  that currently  all prescriptions  were available                                                                    
for  the maximum  of 90  days.  Representative Wilson  asked                                                                    
where she  could find the  provision in statute.  Ms. Brodie                                                                    
was uncertain and offered to provide the information later.                                                                     
Representative Wilson  referred to  Page 1,  line 11  of the                                                                    
bill  concerning  voluntary   sterilization  procedures  and                                                                    
wondered  whether  the provision  applied  to  both men  and                                                                    
women.  Ms. Kubitz  thought the  provision  applied to  both                                                                    
sexes. She  stated that  the provision  was added  to ensure                                                                    
sterilization was a covered service.                                                                                            
Ms. Brodie conveyed that sterilization  was covered for both                                                                    
3:52:24 PM                                                                                                                    
Representative  Neuman understood  that contraceptive  pills                                                                    
were  also used  for other  purposes such  as migraines.  He                                                                    
inquired  whether  other  uses   were  covered.  Ms.  Kubitz                                                                    
answered  in the  affirmative.  Representative Neuman  asked                                                                    
Representative Claman about facts  in the sponsor statement.                                                                    
He  referred to  the $42.9  million  cost to  the state  for                                                                    
unintended pregnancies  and asked for a  breakdown of costs.                                                                    
Ms. Kubitz  reported that  the number was  based on  a study                                                                    
included  in  members  bill   packets  from  the  Guttmacher                                                                    
Institute titled,  "State Facts About  Unintended Pregnancy"                                                                    
(copy on  file). She  informed the  committee that  the data                                                                    
was from 2010 and was  the most recent available. In Alaska,                                                                    
the state  and federal governments spent  $113.7 million for                                                                    
unintended pregnancies  broken down  to $70.8 million  or 52                                                                    
percent  was  spent  by the  federal  government  and  $42.9                                                                    
million was spent by the state.                                                                                                 
Co-Chair Seaton  verified that the cost  savings resulted in                                                                    
the  avoidance of  the  unintended  pregnancies. Ms.  Kubitz                                                                    
nodded affirmatively.                                                                                                           
Representative  Neuman maintained  that he  wanted a  better                                                                    
understanding of the costs associated  with the savings. Ms.                                                                    
Kubitz deferred to Ms. Brodie to clarify the numbers.                                                                           
3:57:10 PM                                                                                                                    
Ms. Brodie  relayed that  the cost  savings to  the Medicaid                                                                    
program was $1.355 million that  represented the cost of 420                                                                    
unintended  pregnancies for  the cost  of delivery,  medical                                                                    
services, and prenatal  doctor visits. Representative Neuman                                                                    
was "trying to add validity" to the statements provided.                                                                        
Representative   Grenn  quoted   the   following  from   the                                                                    
Guttmacher Institute document:                                                                                                  
     In 2010, 3000 or 64.3% of unplanned births in Alaska                                                                       
     were publically funded…                                                                                                    
Representative Grenn calculated from  the $43 million figure                                                                    
that  the cost  was  roughly $14.3  thousand per  unintended                                                                    
pregnancy.  He deduced  that the  amount was  approximate to                                                                    
the  cost  per delivery  from  his  personal experience.  He                                                                    
deemed  that the  facts provided  in  the sponsor  statement                                                                    
were  accurate.  He  thought that  complicated  births  were                                                                    
factored into  the calculations. Ms. Brodie  answered in the                                                                    
Co-Chair Seaton  wondered whether the fiscal  note reflected                                                                    
the  cost  of the  contraceptives  or  savings from  avoided                                                                    
births. Ms. Brodie explained that  the fiscal note reflected                                                                    
the   savings  from   unintended   pregnancies.  The   state                                                                    
currently  paid  for the  cost  of  the contraceptives  four                                                                    
times  a   year  along  with   dispensing  fees   each  time                                                                    
therefore;  no  additional  funding for  the  contraceptives                                                                    
were necessary. She added that  the costs for contraceptives                                                                    
would likely decrease due to fewer dispensing fees.                                                                             
Representative Grenn  suggested that the intent  of the bill                                                                    
was to provide access. He  wondered whether the intent of HB
25  was providing  access  or  cost savings.  Representative                                                                    
Claman responded  that the intent  was both, a  cost savings                                                                    
to the state and better access.                                                                                                 
4:02:02 PM                                                                                                                    
Representative Kawasaki agreed with  the underlying bill. He                                                                    
had  personally  obtained  a  90-day  prescription  for  the                                                                    
legislative session and  had to go to Fred Meyer  to have it                                                                    
refilled.   He  wondered   whether  a   physician  typically                                                                    
prescribed for twelve months or  did length of prescriptions                                                                    
correspond with  refills. Ms. Kubitz understood  that length                                                                    
of  prescription   was  dependent  on  what   the  insurance                                                                    
companies covered. Representative  Kawasaki wondered whether                                                                    
there might be  some situations where a  physician would not                                                                    
want  to   prescribe  a  12-month  prescription   for  birth                                                                    
control. Ms. Kubitz  responded that the purpose  of the bill                                                                    
allowed  a woman  to  opt for  a  12-month prescription  but                                                                    
ultimately   the   decision    belonged   to   the   doctor.                                                                    
Representative  Kawasaki  inquired  whether the  choice  was                                                                    
ultimately up  to the patient  if the  12-month prescription                                                                    
was  advisable. Ms.  Kubitz responded  that  a twelve  month                                                                    
supply was an option rather than mandatory.                                                                                     
Representative Guttenberg relayed  information from personal                                                                    
experience  about the  difficulty of  obtaining the  refills                                                                    
for his personal prescriptions that  was prescribed every 30                                                                    
and 90 days. He suggested  that the way pharmaceuticals were                                                                    
prescribed was  part of the  inherent problem  of escalating                                                                    
costs.  He thought  that the  way drugs  were prescribed  by                                                                    
statute  was  burdensome and  expensive  for  the state.  He                                                                    
remarked that  Alaska was doing  health care by  statute. He                                                                    
asked   for  clarification.   Ms.   Brodie  responded   that                                                                    
prescribing had to be addressed  in statute so the insurance                                                                    
company  would know  coverage was  possible  for the  entire                                                                    
period of time.                                                                                                                 
4:07:44 PM                                                                                                                    
Vice-Chair Gara appreciated and supported the bill.                                                                             
Representative Wilson  asked whether Alaska  Care prohibited                                                                    
a  woman   from  receiving   a  12-month   prescription  for                                                                    
MICHELE   MICHAUD,  CHIEF   HEALTH  OFFICIAL,   DIVISION  OF                                                                    
RETIREMENTS  AND  BENEFITS,  DEPARTMENT  OF  ADMINISTRATION,                                                                    
replied that currently the plan  allowed for 90 days but the                                                                    
plan  administrator   who  was   the  Commissioner   of  the                                                                    
Department  of Administration  could  change  the amount  of                                                                    
coverage.    Representative   Wilson    asked   whether    a                                                                    
contraceptive prescription  could be extended before  the 90                                                                    
day  period  ran  out  through a  phone  call.  Ms.  Michaud                                                                    
responded  in the  affirmative and  added  that Alaska  Care                                                                    
allowed for vacation  overrides. Representative Wilson asked                                                                    
whether  any type  of contraceptive  coverage was  available                                                                    
for  men.   Ms.  Michaud  responded  in   the  negative  and                                                                    
elucidated  that condoms  were not  covered under  the plan.                                                                    
Representative Wilson  asked whether she was  aware of other                                                                    
provider's  practices  regarding  contraceptive  extensions.                                                                    
Ms. Michaud  responded that she  was uncertain of  how other                                                                    
providers handled the situation.  She assumed other insurers                                                                    
had  similar  provisions.  Representative  Wilson  requested                                                                    
more information  identifying the problem and  wondered what                                                                    
the bill was "trying to fix."                                                                                                   
Representative  Guttenberg  asked  for  a  definition  of  a                                                                    
vacation override.  Ms. Michaud explained that  the vacation                                                                    
override  was variable  and was  based  on the  individual's                                                                    
circumstances and  needs. She  elaborated that  the override                                                                    
had  to be  requested each  time it  was necessary,  even if                                                                    
work travel was  routine and overrides were  needed for each                                                                    
90-day prescription.                                                                                                            
Vice-Chair  Gara also  mentioned problems  when getting  his                                                                    
personal  prescriptions  refilled.  He  wondered  whether  a                                                                    
person's  doctor had  to be  contacted when  a contraceptive                                                                    
prescription  needed to  be refilled.  Ms. Kubitz  responded                                                                    
that  it  depended  on  whether refills  were  part  of  the                                                                    
prescription. She  reminded the committee that  the point of                                                                    
the bill  was access to a  twelve month supply all  at once.                                                                    
She  pointed out  that other  circumstances interfered  with                                                                    
women getting  to a pharmacy and/or  obtaining refills every                                                                    
90 days.                                                                                                                        
4:13:41 PM                                                                                                                    
Representative  Pruitt asked  what  percentage of  insurance                                                                    
plans  were separate  from  Alaska Care  in  the state.  Ms.                                                                    
Kubitz  responded that  the  bill  encompassed Alaska  Care,                                                                    
Medicaid recipients,  and private  health insurers.  She did                                                                    
not know actual percentages.                                                                                                    
Representative Pruitt asserted that  the state was unable to                                                                    
regulate all  private insurers. He wondered  what percentage                                                                    
of  private  insurances  the bill  affected.  Representative                                                                    
Claman  responded that  the bill  applied to  private sector                                                                    
insurers  and  underwriters  who covered  employees  in  the                                                                    
ANNA LATHAM    DEPUTY    DIRECTOR,    INSURANCE    DIVISION,                                                                    
DEPARTMENT OF  COMMERCE COMMUNITY AND  ECONOMIC DEVELOPEMNT,                                                                    
replied that roughly  50 percent of the  plans were captured                                                                    
under the  bill. She detailed  that the  Employee Retirement                                                                    
Income Security Act (ERISA) plans  and the self-insured were                                                                    
exempt but large  and small group plans and  State of Alaska                                                                    
plans  were covered  under  the legislation.  Representative                                                                    
Pruitt  asked that  if Alaska  Care and  Medicaid recipients                                                                    
were carved out what percentage  of covered plans were left.                                                                    
He felt  the legislation's  mandate affected small  "mom and                                                                    
pop" companies.                                                                                                                 
4:17:30 PM                                                                                                                    
SARAH BAILEY   INSURANCE   SPECIALIST    III   -   INSURANCE                                                                    
DIVISION,  DEPARTMENT   OF  COMMERCE,  responded   that  the                                                                    
division regulated  approximately 20  percent of  the health                                                                    
care  market  in  Alaska including,  individual,  small  and                                                                    
large employer.                                                                                                                 
Representative Pruitt asked whether  there was anything that                                                                    
prevented  private  insurers  from implementing  the  twelve                                                                    
month contraceptive  coverage. Ms.  Bailey responded  in the                                                                    
Representative Pruitt determined that  the bill mandated 12-                                                                    
month contraceptive coverage to  20 percent of the insurance                                                                    
market in the  state. He wondered whether  his statement was                                                                    
accurate.   Ms.   Latham   answered  in   the   affirmative.                                                                    
Representative  Pruitt asked  about the  religious exemption                                                                    
in the bill. He read the  following [page 3, lines 1 through                                                                    
     the state a health care insurance plan in the group                                                                        
     market 1 to a religious employer is  exempt from the                                                                       
     requirements  of  this  section  with  respect  to  the                                                                    
     health care  insurance  plan of  the religious employer                                                                    
     if   the  religious   employer  opposes   the  coverage                                                                    
     required  under this section and is an                                                                                     
    (1) organization that meets the criteria set out in                                                                         
     26 U.S.C. 6033(a)(3)(A)(i) or (iii) (Internal                                                                              
     Revenue Code of  1986), as amended; or                                                                                     
     (2) eligible organization that has self-certified in                                                                       
    the form and manner specified by the United States                                                                          
     Secretary of Labor or has provided notice to the                                                                           
     United States Secretary of Health and Human Services,                                                                      
     under the requirements set out in 45 C.F.R.                                                                                
     147.131(b)(1) - (3).                                                                                                       
Representative  Pruitt commented  that there  were employers                                                                    
that  had legitimate  religious concerns.  He wondered  what                                                                    
protections  the  legislation  provided  to  employers  with                                                                    
religious affiliations.  Ms. Latham responded that  based on                                                                    
her assessment religious groups were exempt.                                                                                    
Ms. Kubitz pointed  out that the bill was  tailored to match                                                                    
provisions  in  the  Affordable  Care  Act  (ACA)  regarding                                                                    
religious  employers   and  organizations   exemptions.  She                                                                    
believed  that the  12-month contraceptive  mandate did  not                                                                    
apply to the religiously exempt group.                                                                                          
Representative Pruitt  remarked that ACA could  be repealed.                                                                    
He  asked  whether  religious  entities  would  be  able  to                                                                    
maintain their exemptions. Ms. Latham  responded that if the                                                                    
ACA  was repealed  so would  the  contraception mandate  and                                                                    
religious   organizations  and   would  "probably   need  an                                                                    
exemption."  Representative Pruitt  suggested that  the bill                                                                    
created a  mandate regardless of  the ACA. He  disagreed and                                                                    
asserted that HB  25 was based on the ACA  as a guideline to                                                                    
some of  the provisions  in the bill.  Representative Claman                                                                    
was  unsure  how a  court  would  handle the  situation.  He                                                                    
predicted  that  the  department and  courts  would  provide                                                                    
exceptions. The  intent in the  bill provided  for religious                                                                    
exemptions and he  thought that a court  would interpret the                                                                    
exemption to apply even if the ACA was repealed or altered.                                                                     
4:24:41 PM                                                                                                                    
Representative Pruitt  remembered that years ago  a previous                                                                    
proposed  constitutional  amendment  meant  to  protect  the                                                                    
Permanent Fund  Dividend referenced  an existing  statute. A                                                                    
legal  opinion  regarding   the  amendment  determined  that                                                                    
attaching it to existing statute  that was possible to alter                                                                    
was tenuous. He  believed that the same  argument applied to                                                                    
the religious  exemption provision in HB  25. Representative                                                                    
Claman  thought that  the number  of hypothetical  arguments                                                                    
were limitless and maintained that  he answered the question                                                                    
to the best of his ability.                                                                                                     
Vice-Chair  Gara recommended  adding a  date to  the statues                                                                    
that referenced the ACA provisions  and noted that there was                                                                    
precedent  for that  type of  clarification. He  exemplified                                                                    
the language, "as existed on  January 1, 2017" and suggested                                                                    
that the  language could be  added later by amending  HB 25.                                                                    
Representative Claman agreed to examine the issue.                                                                              
Co-Chair  Seaton  surmised  that  Section  1  contained  the                                                                    
language,  "the   health  care  insurer  that   offers"  and                                                                    
interpreted  that if  the ACA  was  repealed the  provisions                                                                    
would  not   apply.  If  the   insurer  no   longer  offered                                                                    
contraceptive  coverage due  to  the repeal  the statute  no                                                                    
longer  applied  to  those insurers.  He  thought  that  the                                                                    
scenario was  "frustrating." Healthcare was driving  much of                                                                    
the budget  and economy of  the state. He believed  that the                                                                    
discussion should  focus on passing bills  that help control                                                                    
costs and improve efficiency in the health care system.                                                                         
4:28:32 PM                                                                                                                    
Representative Wilson  shared her  concern that  Alaska Care                                                                    
and Medicaid could  change the policy on its own  and if so,                                                                    
why  it  wasn't changed.  She  wondered  if the  legislation                                                                    
would force a  doctor to prescribe a  12 month prescription.                                                                    
She stated  that some doctors  wanted to see  patients every                                                                    
three  months. Ms.  Kubitz  replied that  the  bill did  not                                                                    
place a mandate on the  doctors. Most doctors who prescribed                                                                    
contraceptives would  not think that numerous  checkups were                                                                    
necessary.  Representative   Wilson  inquired   whether  any                                                                    
insurance  company could  provide information  regarding the                                                                    
necessity of the legislation and  what if anything prevented                                                                    
them from covering a 12 month supply of contraceptives.                                                                         
Vice-Chair  Gara was  given the  gavel to  temporarily chair                                                                    
the meeting.                                                                                                                    
Vice-Chair Gara OPENED Public Testimony.                                                                                        
ALYSON CURREY LEGISLATIVE    LIAISON,   PLANNED   PARENTHOOD                                                                    
VOTES NORTHWEST AND HAWAII, read a prepared statement:                                                                          
     Thank you, Mr.  Chair and members of  the committee for                                                                    
     the opportunity  to testify today.   My name  is Alyson                                                                    
     Currey.   I  am a  resident of  Juneau and  I represent                                                                    
     Planned Parenthood Votes Northwest & Hawaii.                                                                               
     Planned  Parenthood  has  provided  birth  control  and                                                                    
     other high-quality  health care  across the  nation for                                                                    
     more than 100  years and we strongly support  HB 25. In                                                                    
     Alaska, we  currently serve  more than  7,700 patients,                                                                    
     which includes providing birth  control to nearly 3,000                                                                    
     women.  There   are  many  different  kinds   of  birth                                                                    
     control, and no  one method will work  for every person                                                                    
     at  every  stage  of  their life.  Women  who  are  not                                                                    
     satisfied  with their  contraceptive  method, are  less                                                                    
     likely to use it  consistently. Therefore, every person                                                                    
     should  have full  access to  the birth  control method                                                                    
     that  works best  for them,  without barriers  based on                                                                    
     cost and  regardless of their insurance  plan, in order                                                                    
     to  increase  consistent  use.   House  Bill  25  would                                                                    
     remove such barriers.                                                                                                      
     Family  planning is  a basic  economic issue  for women                                                                    
     and  families.  Unintended  pregnancies  put  women  at                                                                    
     greater  risk  of  homelessness,  family  hunger,  poor                                                                    
     birth  outcomes, and  long-term dependence  on publicly                                                                    
     funded  programs. Family  planning  also creates  costs                                                                    
     savings  for   public  and  private   insurance  plans.                                                                    
     Allowing women  to access a full  range of FDA-approved                                                                    
     contraceptives and  providing a year's supply  of birth                                                                    
     control instead of limiting dispensing  to one or three                                                                    
     cycles  lowers   direct  costs  on   follow-up  visits,                                                                    
     pregnancy  tests, and  long-term costs  associated with                                                                    
     unintended pregnancies.                                                                                                    
     Eight other  states have passed legislation  similar to                                                                    
     HB 25,  including Washington, Virginia  and California.                                                                    
     In  an analysis  of California's  bill, the  California                                                                    
     Health   Benefits  Review   Program   found  that   the                                                                    
     reduction in  unintended pregnancies and  doctor visits                                                                    
     would result in about $42.8  million in savings for the                                                                    
     state  in  its  first  year of  existence.  AK's  cost-                                                                    
     savings analysis  of HB 25  shows a higher  savings per                                                                    
     By  taking steps  to  decrease unintended  pregnancies,                                                                    
     the state  will decrease  its long-term  social service                                                                    
     spending and  save money. Please  support comprehensive                                                                    
     birth control access  for all women and vote  yes on HB
4:35:23 PM                                                                                                                    
ELIZABETH FIGUS, SELF,  SITKA, spoke in favor of  HB 25. She                                                                    
shared that she was a  doctoral student at the University of                                                                    
Alaska in  Fairbanks and Juneau  resident and in  the summer                                                                    
months she skippered  a troll fishery tender.  She felt that                                                                    
the bill was a "no brainer"  in a state where so many people                                                                    
worked in  remote locations seasonally. She  spoke about the                                                                    
unnecessary expense  and difficulty in finding  any time for                                                                    
doctor's  appointments or  pharmacy visits  during her  busy                                                                    
fishing  season.  She  believed  the  bill  was  only  about                                                                    
streamlining  prescription pick-ups.  She  was certain  that                                                                    
the  committee   "understood  the  importance   of  economic                                                                    
efficiency for all Alaska residents."   She urged members to                                                                    
vote "yes" on the bill.                                                                                                         
4:37:04 PM                                                                                                                    
ELIZABETH EILERS,  SELF, JUNEAU,  spoke in  favor of  HB 25.                                                                    
She  stated that  "politicians cannot  grow the  economy and                                                                    
simultaneously limit  access to  birth control"  and thought                                                                    
that the  "state's economic health and  women's reproductive                                                                    
health  were linked."  She indicated  that she  paid a  high                                                                    
amount for birth control and  believed that created numerous                                                                    
challenges to  access. She  spoke of the  high costs  of all                                                                    
types  of  birth  control  in  out-of-pocket  expenses.  She                                                                    
thought  meaningful  access  to  a variety  of  methods  was                                                                    
"critical" and a women's right.  She maintained that without                                                                    
insurance   coverage  the   cost   of   birth  control   was                                                                    
unattainable. She  urged members to  support HB 25  and "not                                                                    
leave women behind."                                                                                                            
4:38:58 PM                                                                                                                    
ALICA   CARGILL,  POLICY   SPECIALIST,  ALASKA   NETWORK  ON                                                                    
DOMESTIC   VIOLENCE  AND   SEXUAL  ASSAULT,   supported  the                                                                    
legislation. She spoke  to "contraceptive coercion," access,                                                                    
and equity. She relayed that  in FY16 her agency served over                                                                    
6,300  women  and  was  "heavily  invested  in  reproductive                                                                    
health, access,  and equity." She explained  that "power and                                                                    
control  was  the overall  basis  of  domestic violence  and                                                                    
sexual assault."  She stated that  "a victim's  autonomy was                                                                    
fundamental  in both  preventing and  responding to  violent                                                                    
acts. One  critical element of  this autonomy was  access to                                                                    
both  affordable  and consistent  reproductive  healthcare."                                                                    
She  felt that  the  bill enabled  a  women's autonomy.  She                                                                    
explained  that contraceptive  coercion was  when an  abuser                                                                    
controlled  a woman's  ability to  contraceptive access  and                                                                    
use.  She  explained that  the  bill  expanded coverage  for                                                                    
long-acting reversible  contraceptives such  as intrauterine                                                                    
devices  and  implants  and assisted  the  woman  living  as                                                                    
safely  as  possible  in  the   short-term.  She  felt  that                                                                    
unintended pregnancies  could occur without  the long-acting                                                                    
reversible   contraceptives.  She   noted  the   correlation                                                                    
between  unintended pregnancies  and domestic  violence that                                                                    
imposed "an even greater vulnerability  for the victim." She                                                                    
added that the bill  increased women's access in underserved                                                                    
rural populations.                                                                                                              
4:41:25 PM                                                                                                                    
Representative  Wilson  asked   whether  she  was  concerned                                                                    
because  the  bill  only applied  to  insurers  who  already                                                                    
covered  contraceptives  and  some   might  choose  to  halt                                                                    
coverage due  to increased  costs related  to the  bill. She                                                                    
wondered if she  was concerned with the  possibility of less                                                                    
coverage. Ms. Cargill responded  that she had not considered                                                                    
the  scenario and  would like  to do  further research.  She                                                                    
guessed  that  her  agency would  still  support  the  bill.                                                                    
Representative  Wilson was  concerned  about any  unintended                                                                    
4:42:53 PM                                                                                                                    
PAMELA SAMASH  SELF, RIGHT  TO LIFE, NENANA, opposed  HB 25.                                                                    
She  expressed concern  over the  discussion regarding  cost                                                                    
savings  from unintended  pregnancies  in rural  populations                                                                    
and  equated  it to  a  discussion  about "rural  population                                                                    
control." She  talked about doctors wanting  to have routine                                                                    
follow-ups as  a way  to prevent  serious side  effects. She                                                                    
believed   that    unintended   pregnancies    were   called                                                                    
"miracles."  She said  children  were the  "future" and  not                                                                    
"dollar signs."   She restated her opposition to  HB 25. She                                                                    
did not believe  in giving women 12 months  of birth control                                                                    
and did not want to pay for emergency contraceptives.                                                                           
4:45:56 PM                                                                                                                    
PAIGE HOGSON,  SELF, ANCHORAGE, spoke  in support of  HB 25.                                                                    
She offered  that a lot  of research existed  that supported                                                                    
the benefits of the  legislation; for women, their families,                                                                    
cost saving  for the  state, and  society. She  related that                                                                    
the access delayed child bearing  until planned. She thought                                                                    
Alaska needed to be proactive.  She urged members to support                                                                    
the bill.                                                                                                                       
4:47:04 PM                                                                                                                    
ROBIN  SMITH,  SELF,  ANCHORAGE,   indicated  that  she  was                                                                    
driving and would prefer to testify the following morning.                                                                      
Vice-Chair Gara agreed to the request.                                                                                          
4:47:38 PM                                                                                                                    
JUSTINE WEBB, SELF,  FAIRBANKS, spoke in favor of  HB 25 She                                                                    
shared that she was a  social work student at the University                                                                    
of Alaska  in Fairbanks  and grew up  in Sitka.  She relayed                                                                    
from  personal   experience  the  issues   and  difficulties                                                                    
regarding  her limited  access  to contraceptives  receiving                                                                    
only a 30  day supply at a time. She  had missed classes and                                                                    
experienced  other  inconveniences accessing  contraception.                                                                    
She  conveyed   that  she  was   not  able  to   refill  her                                                                    
prescription with only  2 days of pills left.  She could not                                                                    
imagine the  added difficulties  of accessing  birth control                                                                    
in remote  areas of  the state in  light of  her experiences                                                                    
living  in urban  areas. She  asked members  to support  the                                                                    
4:50:04 PM                                                                                                                    
VHEMIA    PETERSON,   SELF,    ANCHORAGE,   supported    the                                                                    
legislation.  She  relayed  that   she  graduated  from  the                                                                    
University of  Alaska in Anchorage and  currently worked two                                                                    
jobs and volunteered and participated  in the community. She                                                                    
felt that her access to a  long term supply of birth control                                                                    
contributed  to  her  success. She  noted  the  high  sexual                                                                    
assault and abuse rate for women  as well as a wide wage gap                                                                    
between  men and  women. She  urged members  to support  the                                                                    
4:51:38 PM                                                                                                                    
Vice-Chair Gara indicated the meeting would recess until                                                                        
April 18, 2017 at 9:45 a.m. He relayed the agenda for the                                                                       
afternoon meeting.                                                                                                              
^RECESSED UNTIL TUESDAY, APRIL 18, 2017 AT 9:45 A.M.                                                                          

Document Name Date/Time Subjects
HB124 Explanation of changes from ver A to ver D 4.6.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 124
HB124 Sectional Analysis ver D 4.6.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 124
HB124 Sponsor Statement 3.22.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 124
HB124 Support Documents - Letters of Support 4.11.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 124
HB091 Supporting Document - APOC Funding 031317.pdf HFIN 4/17/2017 1:30:00 PM
HB 91
HB091(STA) Sectional Analysis.pdf HFIN 4/17/2017 1:30:00 PM
HB 91
HB091(STA) Sponsor Statement.pdf HFIN 4/17/2017 1:30:00 PM
HB 91
HB025 Opposing Document-Emails 4.14.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
HB025 Opposing Document-Letter NFIB 4.14.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
HB025 Sectional Analysis ver O 4.14.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
HB025 Sponsor Statement 4.14.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
HB025 Summary of Changes 4.14.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
HB025 Supporting Document-ADN Commentary 4.14.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
HB025 Supporting Document-Cost Savings Study 4.14.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
HB025 Supporting Document-Emails 4.14.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
HB025 Supporting Document-Guttmacher Alaska Statistics 4.14.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
HB025 Supporting Document-Guttmacher Public Costs from Unintended Pregnancies 4.14.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
HB025 Supporting Document-Letters 4.14.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
HB025 Supporting Document-UCSF Study Newspaper Article 4.14.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
HB025 Supporting Document-Unintended Pregnancies Study 4.14.17.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
SB88_Oppose_041417.pdf HFIN 4/17/2017 1:30:00 PM
SB 88
HF SB 88 4-15-17 v1_0.pdf HFIN 4/17/2017 1:30:00 PM
SB 88
CSSB 88 revised Maps - 4.3.2017.pdf HFIN 4/17/2017 1:30:00 PM
SB 88
CSSB 88 - Sponsor Statement - version R.pdf HFIN 4/17/2017 1:30:00 PM
SB 88
CSSB 88 - Sectional Analysis.pdf HFIN 4/17/2017 1:30:00 PM
SB 88
CSSB 88 - Letters of Support.PDF HFIN 4/17/2017 1:30:00 PM
SB 88
CSSB 88 - letters of opposition.PDF HFIN 4/17/2017 1:30:00 PM
SB 88
CSSB 88 - letters of opposition.PDF HFIN 4/17/2017 1:30:00 PM
SB 88
CSSB 88 - federal bill.pdf HFIN 4/17/2017 1:30:00 PM
SB 88
CSSB 88 - Fact Sheet.pdf HFIN 4/17/2017 1:30:00 PM
SB 88
CSSB 88 - Explanation of Changes version J to version R.pdf HFIN 4/17/2017 1:30:00 PM
SB 88
HB25_Support_04172017.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
HB25_Oppose_04172017.pdf HFIN 4/17/2017 1:30:00 PM
HB 25
HB 25 - Support Document Letter 3-3-17.pdf HFIN 4/17/2017 1:30:00 PM
HB 25