Legislature(2015 - 2016)CAPITOL 106
04/05/2016 03:00 PM House HEALTH & SOCIAL SERVICES
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HB 345-INSURANCE COVERAGE FOR CONTRACEPTIVES 3:05:49 PM CHAIR SEATON announced that the first order of business would be HOUSE BILL NO. 345, "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 date." 3:06:28 PM REPRESENTATIVE TALERICO moved to adopt the proposed committee substitute (CS) for HB 345, labeled 29-LS1503\H, Wallace, 3/22/16, as the working document. CHAIR SEATON objected for discussion. 3:07:24 PM MEGAN CAVANAUGH, Staff, Representative Matt Claman, Alaska State Legislature, shared the changes to the proposed committee substitute, Version H. She relayed that Version H removes the provisions that applied to over-the-counter contraceptives in the original bill on page 1, lines 11 - 12; page 2, lines 16 - 17; and page 3, lines 18 - 19. 3:08:15 PM REPRESENTATIVE MATT CLAMAN, Alaska State Legislature, as prime sponsor of HB 345, paraphrased from the sponsor statement [included in members' packets], which read as follows [original punctuation provided]: Unintended pregnancies have significant and negative consequences for individual women, their families, and society as a whole. Research links births resulting from unintended or closely spaced pregnancy to adverse maternal and child health outcomes and other social and economic challenges. With Alaska's fiscal challenges, we should look for ways to reduce costs in the shortterm and long-term. House Bill 345 will reduce costs associated with unintended pregnancies by making oral contraceptives more easily available to Alaskan women. In 2010, 48% of all pregnancies in Alaska were unintended. Alaska's unintended pregnancy rate in 2010 was 54 per 1,000 women aged 15-44. Of those unintended pregnancies, 60% resulted in births, 26% resulted in abortions, and the remainder resulted in miscarriages. Most unintended pregnancies are associated with significant public costs. In 2010, 64.3% of unplanned births in Alaska were publically funded, which resulted in a $42.9 million cost to the state. House Bill 345 seeks to reduce the costs of unintended pregnancies by making oral contraceptives more easily available to Alaskan women. A research study shows that women who were dispensed a 12-month supply of oral contraceptives were 30% less likely to have an unintended pregnancy than women who received a 1- or 3-month prescription. The study concluded that health insurance programs and public health programs may avert costly unintended pregnancies by increasing dispensing limits on oral contraceptives to a 1-year supply. HB 345 requires health care insurers, including Medicaid services, to cover 12 months of prescriptive oral contraceptives at a time. Alaskan women often face challenges while trying to access prescription contraceptives. Women living in rural Alaska have less access to healthcare services and therefore less reliable access to prescriptive contraceptives. Fisherwomen working on a boat for two or three months at a time need longer supplies of prescription oral contraceptives. This bill looks to reduce health care costs in Alaska by preventing unintended pregnancies and providing Alaskan women greater access to family planning options. 3:09:19 PM MS. CAVANAUGH clarified that the recently distributed fiscal note reflected the original version and not the proposed committee substitute, Version H. She explained that, additionally, a fiscal note was written for the Senate companion bill, SB 156, and reflected a $1.3 million cost savings for the state. CHAIR SEATON pointed out that the fiscal note for SB 156 was located in the committee packets. MS. CAVANAUGH reported that the proposed bill mandated that health care insurers provide coverage for a prescriptive contraceptive up to 12 months at one time. She defined prescriptive contraceptives as self-administered, hormonal contraceptives, namely oral contraceptives that do not require insertion or other types of administration by a medical professional. She said this was explained in Section 1 of the proposed bill, which contained a religious exemption as well as a definition for health care insurer, which included a self- insured employer, such as the State of Alaska. She moved on to explain that Section 2 of the proposed bill directed the Department of Health and Social Services to cover the 12 month supply of prescription contraceptives for eligible recipients of medical assistance. Section 3 of the proposed bill allowed for the 12 month supply of prescription contraceptives to be made available to Medicaid recipients, and Section 4 of the proposed bill related to the effective date. MS. CAVANAUGH stated that a major premise behind the proposed bill was that offering women greater access and availability to contraceptives reduced unintended pregnancies. This reduction in unintended pregnancies had a direct cost savings to the state, which was reflected in the provided fiscal note, which was drafted to the Senate version. She directed attention to the study [included in members' packets], which reported that, in 2010, 48 percent of pregnancies, about 8,000 pregnancies in Alaska, were unintended. She pointed out that the study had used the Centers for Disease Control and Prevention definition of an unintended pregnancy to mean either "mistimed, or the woman did not want to become pregnant at that time." She added that the study estimated that 3,000, or 64.3 percent of the unplanned pregnancies in 2010, were publicly funded. She reported that Alaska had spent almost $113 million on unintended pregnancies, that 70.8 percent was federally funded, while 42.9 percent was funded by the state. She relayed that these costs also had impacts on programs down the line, including foster care, and on the child's overall well-being. She shared that an additional study [included in members' packets] reviewed 84,000 women in California provided with varying amounts of oral contraceptives, and that those researchers observed a 30 percent reduction in the odds of pregnancy when given a year-long supply of oral contraceptives. Also reported in this study, the California family planning program paid $99 more annually for women who received three cycles of oral contraceptives and $44 more annually for women who received one cycle of oral contraceptives than it did for women who received the 12-month supply all at once. She shared that the additional costs were a result of pregnancy tests and associated visits. She noted that the proposed bill did not change who was eligible for coverage or what kind of prescriptions were being covered, the bill only allowed that women who currently received coverage for prescription contraceptives could receive the prescription for 12 months at one time, if they choose. She shared that there had been concerns expressed from the Small Business Association for whether the bill would apply to self-insured entities. She stated that the sponsor would continue to work with the group to address these concerns. She pointed out that an important inclusion to the proposed bill was for the definition of a health care insurer to include a self-insured entity, which did help to address some of the concerns. She declared that proposed HB 345 would offer "huge advantages for Alaskan women, from eliminating the inconvenience of refilling the prescription every one or three 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." She listed the difficulties that many women faced in refilling prescriptions. 3:14:50 PM REPRESENTATIVE TARR pointed out that the fiscal note showed a $1.3 million savings annually. 3:15:11 PM CHAIR SEATON opened public testimony on HB 345. 3:15:24 PM DIANA GREENE FOSTER, Researcher, University of California, San Francisco, explained that she was working on research for the State of California to evaluate and analyze the impact of year- long supplies for oral contraceptives. She shared that her research indicated that the benefits included a cost savings of almost $100 annually per person. She reported that there were fewer clinic visits and fewer pregnancy tests. She relayed that a second study linked family planning dispensing to claims for pregnancies, births, and abortions. The findings were that women who received a one year supply were less likely to have either a birth or an abortion in the subsequent year. She stated that oral contraceptives were the most commonly used reversible method of contraception in the United States, and that most unintended pregnancies and most abortions occurred to women using contraceptives inconsistently. She reported that one in five women in abortion clinics reported that they had unprotected sex because they ran out of birth control. She allowed that this change would offer a higher potential for women to avert unintended pregnancies. 3:17:50 PM CHAIR SEATON noted that a synopsis of her research is included in members' packets. 3:18:27 PM KENNI PSENAK LINDEN shared that, as a college student, she had been diagnosed with Stage 4 endometriosis and had been prescribed hormonal birth control to allow for the future possibility to have children. She reported on the difficulty of maintaining consistent use of birth control while being only allowed a one-month prescription, and stated that having a 12- month supply readily available "would have been a huge relief and would have given me much needed peace of mind about my health and my ability to choose what was best for me in consultation with my doctor." She asked that the proposed bill address access to birth control by dependents. She relayed the health difficulties of endometriosis, and shared that the prescriptions for hormonal birth control allowed her to continue with and graduate from college. She declared support for the proposed bill. 3:20:23 PM ROBIN SMITH stated that this was a good bill, and there was no reason not to pass it as it offered cost savings. She declared that this was a preventative care bill, as it prevented unintended and unwanted births and abortions. She listed 10 reasons why a doctor might prescribe birth control pills, other than to prevent pregnancy: protection against ovarian and endometrial cancer; prevention of ovarian cysts; prevent and treat endometriosis; prevent anemia; avoid migraines associated with menstrual periods; treat PMS; treat acne, and excess hair growth; and balance hormone deficiency. She declared that, as it was beneficial for women to have access to birth control pills, there were not any negatives associated with the proposed bill. 3:23:58 PM CATRIONA REYNOLDS, Clinic Manager, Kachemak Bay Family Planning Clinic, pointed out that she had sent in two pages of facts and data. She stated that consistent access to birth control should not be dependent on an insurance carrier. She listed the benefits for supplying 12 months of birth control protection, which included consistent use. 3:26:32 PM STEVEN SAMUELSON stated his support of the proposed bill, noting that people should not be hindered by legislation in pursuit of health, especially when discussed with a doctor. He pointed out that many women were working in the field and did not have immediate access to refills. He declared "people like sex, so why not have them be prepared." He reiterated his support of HB 345. 3:28:48 PM ELIZABETH FIGUS reported that during the summer fishing season she did not have time to visit a doctor. She allowed that, although some medical issues were unavoidable, it was "silly" and "unnecessary" not to pre-approve a birth control prescription. She declared that the proposed bill would save money and time for individual women, and would save the costs for unplanned pregnancies. She pointed out that, as contraception was already legal, it was only necessary to make the system be more fiscally efficient. She stated her support for proposed HB 345. 3:30:53 PM CHRISTINE NIEMI, The League of Women Voters - Alaska, paraphrased from a prepared statement [included in members' packets], which read as follows [original punctuation provided]: The League of Women Voters of Alaska strongly supports HB 345 (companion to SB 156), a bill related to insurance coverage for contraceptives and other services that reduce the risk of unintended pregnancies. At the national level, the League of Women Voters of the United States supports primary care for all, care that includes "prenatal and reproductive health." When women have the consistent ability to plan their pregnancies, their families benefit through greater financial well-being, healthier living conditions, healthier children, greater opportunities, and a myriad of additional benefits. While improving the quality of life for families, the ability to avoid unintended pregnancies also reduces costs for state and federal governments. In 2010 according to the Guttmacher Institute, the State of Alaska spent nearly $43 million on health costs related to unintended pregnancies while the federal government added another $71 million for a total cost of $114 million. Guttmacher reports that 48% of all pregnancies in Alaska in 2010 were unplanned and 64% of Alaska's unplanned pregnancies were publicly funded, representing the $43 million cost. In addition, the cost benefits of supporting women in their efforts to plan their pregnancies goes far beyond the cost of the pregnancy itself. A woman who is able to plan a pregnancy can better guarantee that her health is at optimum level prior to pregnancy, reducing the risk of a difficult pregnancy and trauma to the child. Such planning reduces the possibility of increased health problems for the child, problems which can follow the child for years and require increased health and education costs for the State. A planned pregnancy increases a woman's ability to manage her role as income provider for a family and allows that family the best opportunity to remain as financially independent as possible. Supporting affordable contraceptives prescribed on a 12-month basis will undoubtedly reduce the number of unintended pregnancies in Alaska, thereby increasing family wellbeing and reducing State costs. 2 HB 345 can assist women and families to plan pregnancies so they are ready for the added responsibility of a child. In addition, costs to the State for unintended pregnancies can be reduced. This is a win-win bill that deserves consideration by the Legislature especially as it struggles with the budget crisis. Thank you for your consideration. 3:32:36 PM ALYSON CURREY, Planned Parenthood of the Great Northwest and the Hawaiian Islands, stated support for insurance coverage for a 12 month supply of birth control when supplied by a health care provider. She added that 1 in 4 women said they had missed pills because of not being able to get them in time. She reported that a one year supply dramatically improved consistent use, lowered unintended pregnancies, and hence, reduced abortions. 3:34:10 PM SAMANTHA SAVAGE stated her support for HB 345 and she paraphrased from a prepared statement [included in members' packets], which read as follows [original punctuation provided]: I am writing today to encourage you to support SB 156. For many many women oral contraception is their method of choice for various personal medical reasons. Alaskan women face more barriers trying to access all medications due to geographic and occupational reasons (women who live and work in rural communities or on fishing vessels for example). Speaking from my own life as someone who left the Mat-Su Valley to attend school in Fairbanks, trying to get my prescription refilled was an incredible burden as I could only have it refilled on a month by month basis. Having the ability to have 12 months of birth control covered by an insurance plan and Medicaid at one time saves in costs related to doctors visits to the women seeking medication, and it saves money related to unintended pregnancy. I urge your support of this bill that would have a positive impact on the lives of many Alaskan women. 3:35:36 PM CAITLIN HEDBERG urged support of the proposed bill. She shared that she is a professional woman, and that she often traveled for work. She noted that it was a burden having to re-supply birth control, reporting that missing a pill or starting a new cycle because of an interruption to access wreaks havoc on the human body. She had experienced an unintended pregnancy due to a lack of access for birth control. She pointed out that her insurance would only allow a one month supply at a time. She concluded that the proposed bill was the fiscally responsible choice for the state and for the women of the state. 3:38:49 PM MAXINE DOOGAN, Community United for Safety and Protection, reported that she represented current and former sex workers in Alaska, sex trafficking victims, and their allies. She declared support for HB 345 as it expanded access to health care. 3:39:33 PM CHAIR SEATON closed public testimony on HB 345 after ascertaining no one further wished to testify. 3:39:41 PM REPRESENTATIVE WOOL stated that he supported the proposed bill as it "totally makes sense." He asked if this was an insurance bill, and whether it had been previously possible for a 12 month prescription for birth control pills. MS. CAVANAUGH replied that currently women could not get a 12 month supply of oral contraceptives at one time, as it was usually limited to one or three month supplies. REPRESENTATIVE WOOL mused that the current state of insurance regulations would not cover the payments for more than three months. 3:41:32 PM MARGARET BRODIE, Director, Director's Office, Division of Health Care Services, Department of Health and Social Services, explained that a Medicaid prescription was on a month-by-month basis, with those individuals under 18 years of age able to get a 3 month prescription. In response to Chair Seaton, she said that the proposed bill would change the situation for a 12 month prescription, but that it would be necessary to ensure that the individual was eligible for all 12 months, and if not, the department would have to reimburse the federal government for its share of the prescription that the individual was not eligible. MS. BRODIE, in response to Chair Seaton, replied that private insurance, dependent on the plan, was for either a one month or a three month prescription. REPRESENTATIVE WOOL directed attention to the benefit savings in the analysis of the fiscal note, and asked about the difference between the 9 percent failure rate and the 7 percent failure rate, resulting in 120 unintended pregnancies. He questioned whether all of the unintended pregnancies had resulted in childbirth. MS. BRODIE expressed her agreement that the 120 pregnancies would not all result in live birth, and she offered her belief that this had been taken into consideration in the calculations. 3:45:14 PM CHAIR SEATON said that HB 345 would be held over. 3:45:45 PM REPRESENTATIVE TARR declared that this problem with access had been long standing. She pointed out that young families had not testified, noting that they were very challenged with the demands of parenthood and working. She opined that the proposed bill would be very beneficial to young families. 3:46:58 PM CHAIR SEATON removed his objection to the proposed committee substitute. There being no further objection, Version H was adopted as the working draft. [HB 345 was held over.]