The Committee on Commerce and Labor was called to order at 3:45 p.m., on Monday, February 15, 1999. Chairman Barbara Buckley presided in Room 3142 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Guest List. All Exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

COMMITTEE MEMBERS PRESENT:

Ms. Barbara Buckley, Chairman

Mr. Richard Perkins, Vice Chairman

Mr. Morse Arberry, Jr.

Mr. Bob Beers

Ms. Merle Berman

Mr. Joe Dini, Jr.

Mrs. Jan Evans

Ms. Chris Giunchigliani

Mr. David Goldwater

Mr. Lynn Hettrick

Mr. David Humke

Mr. Dennis Nolan

Mr. David Parks

Mrs. Gene Segerblom

STAFF MEMBERS PRESENT:

OTHERS PRESENT:

Following roll call, Chairman Buckley explained the order in which the bills were to be heard. A.B. 108 and A.B. 109 were to be heard first. A.B. 60 would be heard last, because most of the people present were going to be testifying on A.B. 60. She would divide the remaining time equally between pro and con and noted the meeting would be adjourning at 5:20 p.m. because the Assembly would be re-convening at 5:30 p.m. She asked those testifying not to be repetitive in their testimony. Chairman Buckley said she would leave the record open for 1 week for individuals who wished to submit written testimony for the official record. She also alerted committee members the Friday meeting was tentatively set for 1:15 p.m. Chairman Buckley then opened the hearing on A.B. 108.

Fred Schmidt, Chief Deputy Attorney General and Consumer Advocate for the State of Nevada, stepped forward to present A.B. 108. He stated he had the Attorney General’s anti-trust attorney review Nevada’s anti-trust statutes to determine if they were consistent with the other 49 states’ statutes. The attorney determined the anti-trust statute, Nevada Revised Statute (NRS) chapter 598A, could be improved. Those changes were the bulk of A.B. 108.

Mr. Schmidt noted the first change was reflected in section 1, a simple change in the law that would allow the State of Nevada to sue for damages sustained directly or indirectly on the consumer’s behalf. He referred to Exhibit C and made reference to the "Illinois Brick" problem in Nevada Law, which was a 1977 Supreme Court case standing for the proposition that persons or entities who did not deal directly with the defendants generally lacked standing to sue for treble damages in an antitrust action. He also noted that Don Springmeyer, Board member of the Nevada Trial Lawyers Association supported A.B. 108 and Mr. Schmidt said he was not aware of any opposition to A.B. 108.

Assemblyman Dini referred to section 3, lines 39, 7, 8, and 9, and asked Mr. Schmidt if there would be a fiscal impact on the general fund.

Mr. Schmidt said there would not because there had been no anti-trust litigation pursued in Nevada in the past decade. If the state collected damages that exceeded $30,000 the funds would not automatically revert until the end of the biennium. He indicated they had settled their first anti-trust case, in which $21,000 was the settlement. Mr. Schmidt noted under current statute, the $21,000 would go into the Attorney General’s special fund and at the end of the fiscal year; any money in excess of $30,000 would revert to the general fund. He noted that if A.B. 108 was enacted, they would be able to keep that money between budget periods. Funds would not automatically revert to the general fund on an annual basis, but the legislature would deal with them on a biennial basis when it reviewed the budget.

There was no further testimony on A.B. 108, and the hearing was closed.

Mr. Schmidt indicated A.B. 109 was drafted by attorneys in Las Vegas in the Consumer Protection Division based on experiences they had in dealing with consumer protection cases. Patricia Jarman-Manning, Commissioner of Consumer Affairs Division of the Department of Business and Industry regretted she could not testify and was in favor of A.B. 109. Mr. Schmidt provided written testimony for the record (Exhibit D). He added a distinction would be made to an inquiring consumer between allegations against businesses and convictions or settlements against the business.

Chairman Buckley noted through advertisement she was aware of entities, which loaned money and claimed to repair bad credit, and asked Mr. Schmidt if his office examined those types of businesses to ensure they were properly licensed. He explained if the business had a 501C exemption from the Internal Revenue Service, his office would not able to investigate them. However, if it was a private for profit business, they would be able to do an investigation upon receiving a complaint from a consumer.

There was no further testimony on A.B. 109, and Chairman Buckley closed the hearing.

Assemblywoman Giunchigliani, Assembly District 9, introduced A.B. 60. She read written testimony into the record (Exhibit E). She clarified that A.B. 60 was not about pro-life or pro-choice. She provided the committee members a packet of information for their own use (Exhibit F).

Ms. Giunchigliani also stated for the record that the language in section 18, line 28 "reproductive health care" absolutely did not refer to abortion. She further noted the language was intended to refer to oral contraceptives, insertion contraceptives, and related exams.

Landra Reid, representing Senator Harry Reid, read written testimony into the record in favor of A.B. 60 (Exhibit G). She noted that the health care industry had done a poor job of responding to women’s health needs. She added that women spent 68 percent more in out-of-pocket costs for health care than men.

Assemblyman Goldwater asked Ms. Giunchigliani if A.B. 60 covered Employment Retirement Income Security Act (ERISA) plans, and would A.B. 60 allow coverage of male contraceptives.

She noted A.B. 60 covered Chapter 689A (Individual Health Insurance), Chapter 689B (group and blanket health insurance), and Chapter 695B (nonprofit corporations for hospital medical and dental) of Nevada Revised Statutes (NRS). ERISA would be segregated. That would leave 28 percent of Nevada’s residents without coverage.

Chairman Buckley stated in order to save time, she would call witnesses in sets of two, even if they had not signed in together.

Lisa Appelrouth Guzman, Director, Nevada Empowered Woman’s Project, an advocacy group for low-income women, testified in favor of A.B. 60, she had written testimony, (Exhibit H). Ms. Appelrouth Guzman addressed what A.B. 60 meant to low-income women, and noted it seemed insurance companies would benefit from providing contraceptive coverage, in lieu of the thousands of dollars they paid in prenatal and delivery costs.

Cookie Bible, Nurse Practitioner, Advanced Practitioner of Nursing, Planned Parenthood, Washoe County Health Department, testified in favor of A.B. 60. She provided the committee members with a packet of information (Exhibit I) and spoke briefly about the cost of contraceptives in the Planned Parenthood office in which she worked. The use of oral contraceptives reduced ovarian and uterine cancer specifically the use of Depo-Provera and Norplant reduced uterine cancer. She noted the copper Intra Uterine Device (IUD) did not act as an abortive agent because the sperm did not circumvent the uterus. It was important to note many recent studies reflected copper IUDs did not cause tubal pregnancies, which had not been true in the past. She told the committee members she would provide additional information or statistics they might need.

Ms. Giunchigliani pointed out in the information she had provided, was a statement on contraceptive methods, which would provide committee members with additional information.

Dorothy E. Riley, Master of Science in Nursing, Registered Nurse, President-elect, Nevada Nurses Association spoke next in favor of A.B. 60. Written testimony was provided to the committee members (Exhibit J). She emphasized the benefits of hormonal replacement therapy and pointed out osteoporosis struck women regardless of ability to pay for treatment. She thanked Ms. Giunchigliani and the committee for addressing the importance of A.B. 60.

Ronald M. Renter, Lutheran Advocacy Ministry in Nevada, spoke briefly in support of A.B. 60. He suggested the committee consider adding a narrowly defined exemption for "religious conscience." He further noted religious groups operated health care plans and would have a difficult time complying with

A.B. 60.

Sara Chvilicek, Chair of the Nevada Women’s Lobby, testified briefly in support of A.B. 60, she had written testimony, (Exhibit K). She noted A.B. 60 would improve health outcomes for women of all ages. It would help to prevent unwanted pregnancies and would reduce the rate of abortions. She suggested if men went through menopause, hormone replacement therapy would be mandated.

Jan Gilbert, Northern Nevada Coordinator of the Progressive Leadership Alliance of Nevada, also speaking on behalf of State of Nevada’s Employee Association and Retired Employees, expressed support for A.B. 60. She provided written testimony (Exhibit L) that emphasized how pleased her organization was with A.B. 60 because of its importance to women. She noted to make contraception more available was cost effective. Ms. Gilbert suggested all women would support A.B. 60 and urged a "do pass."

Chairman Buckley reiterated the record would be left open for those who were not able to testify. She noted she wanted to give each side equal time and indicated Alicia Smally and Alison Gaulden would be the last to testify in favor of A.B. 60.

Alicia Smally, President of the National Association of Social Worker, Nevada Chapter, read written testimony in support of A.B. 60 (Exhibit M). She noted contraceptive equity was important for women in Nevada. She explained that if insurance coverage included prescription drugs, then prescription contraceptives and related medical examinations must be included in the coverage as well. She stated A.B. 60 was a comprehensive and fair bill that addressed women’s health needs.

Alison Gaulden, Associate Vice President of Public Affairs, Planned Parenthood Mar Monte, indicated she was adding to the testimony of Cookie Bible. She referred to the information Ms. Bible had provided (Exhibit I), charts on pages 5 and 9 that indicated percentages of Americans who supported the requirement of health insurance to cover contraceptives. She submitted written testimony (Exhibit N) and remarked Planned Parenthood’s mission was to prevent abortions and unintended pregnancies, and was appreciative of A.B. 60.

There were no further questions or comments in favor of A.B. 60. In order to hear different perspectives of individuals who were opposed to A.B. 60, Chairman Buckley also called witnesses in pairs.

Brother Mathew Cunningham testified on behalf of The Roman Catholic Diocese of Reno and Las Vegas and provided written testimony in opposition to A.B. 60 (Exhibit O). He highlighted major concerns the Diocese had with A.B. 60.

(1.) A.B. 60 mandated all forms of abortion coverage. (2.) Contraceptive mandates should be rejected as attacks on the religious freedom and the rights of those who objected to provide for payment for artificial contraception. (3.) There did not appear to be any "conscience language" in the bill, and (4.) As the bill was written, it might have been construed to include any number of procedures. He stated his organization seriously opposed A.B. 60, and hoped that it would be rejected.

Patricia Glenn, President of Right to Life testified against A.B. 60 and read from written testimony (Exhibit P). The issues most objectionable to her organization were abortion and its attendant problems, the role of government in citizen’s private lives, and its ability to tax citizens and to mandate certain uses of public and private money. Ms. Glenn added there was just as much evidence that showed an increase of contraception increased the incidents of abortion, as the opposite.

Brandi Dupont, Bachelor of Science, Certified Natural Family Planning Practitioner, testified next in opposition to A.B. 60. She provided written testimony for the record (Exhibit Q). She pointed out that A.B. 60 did not equally cover Natural Family Planning Services. She also noted that teens wanted to be educated on the physical, social, and emotional health risks that accompanied early pre-marital sexual behavior, they did not simply want to discuss the risks. She also pointed out many women were not even aware that Natural Family Planning methods were available. She urged the committee to oppose A.B. 60.

Fred Hillerby, representing Hometown Health Plan (HHP) and Nevada Association of Health Plans (NAHP) spoke against A.B. 60. He stated that he was testifying in opposition from a business perspective, rather than an emotional or moral perspective. He pointed out HHP and NAHPs reluctance to support mandating benefits was because of the consequence of inflation of medical insurance premiums that would cause individuals to be uninsured. He pointed out only 30 percent of Nevadans would be affected if A.B. 60 passed. It did not have the wide scope that may have been projected.

Mr. Hillerby noted he was aware of only one Hometown Health plan, which did not provide contraceptive coverage, and St Mary’s did not do so because of religious reasons. Section 2 of the bill stated the insurance company must offer all contraceptives approved by the Food and Drug Administration (FDA). He noted Hometown Health did not provide all of the drugs the FDA approved. Instead, through formularies by pharmacists and doctors specific ones were selected as being the best medicines to have available for plan members. Hometown Health would not provide all types of contraceptives approved by the FDA.

Mr. Hillerby disagreed with Ms. Giunchigliani’s point that the language "reproductive health care" section 18, line 28, did not intend to include anything other than contraceptives and related exams. He stated that was not how the language read. He also noted the bill included "any willing provider" provisions. He pointed out that in Preferred Provider Organizations (PPO) and Health Maintenance Organizations (HMO) cases, a limited number of physicians participated in those plans, and A.B. 60 would undermine the provisions to provide quality providers and to keep the cost down.

Marie Soldo, Health Plan of Nevada (HPN) and the Nevada Association of Health Plans (NAHP) testified in opposition to A.B. 60. She noted section 7 could be perceived to mandate coverage of infertility services and other types of benefits which were currently excluded. In addition, if the managed care elements such as prior authorization, medical necessity, and limited provider groups were eroded, the result would be a greater increase in premiums; she estimated that increase to be 6 percent.

Chairman Buckley asked Ms. Soldo if the increase included perceived expansions of "any willing provider", fertility drugs, and contraceptives. Ms. Soldo responded the estimated increase in premiums excluded contraceptives and hormone replacement therapy already covered. The premium increase estimate included the managed care elements which would be prohibited by the bill including any willing provider, medical necessity, and prior authorization. She noted the average premium would be $120.00 per year for a single person and $300.00 per year for a family.

Chairman Buckley asked Mr. Hillerby if "all plans except St. Mary’s" referred to HMO plans. He said that statement referred to HMOs in the Hometown Health Association. Chairman Buckley noted there could have been other insurance companies that did not provide contraceptive devices.

Ms. Giunchigliani asked Mr. Hillerby if the HMOs in his association provided all five forms of contraception that had been discussed (oral contraceptives, Norplant, Depo-Provera, progestin intrauterine devices, and diaphragms).

Mr. Hillerby stated they covered oral contraception, but he was not certain if the others were included. The wording in A.B. 60 would not allow medical necessity to determine what type of contraceptive would be prescribed.

Chairman Buckley asked Mr. Hillerby to provide her with information on what types of contraception the HMOs in his association were covering, so she could provide it to each committee member.

Ms. Soldo noted her organization estimated the cost of eliminating drug formularies because the language in A.B. 60 was so broad. She stated 95 percent of employers serviced by HPN purchased pharmacy benefits, all of which covered contraceptives. A.B. 60 prohibited offering prescription drug benefit plans with out-of-pocket cost differentials.

Chairman Buckley suggested the committee take a look at other insurance companies, noting it could be more of an issue with them than HMOs.

Ms. Giunchigliani asked Ms. Soldo if she could identify which areas she thought the word "any" included when looking at her formularies. It would be helpful when considering potential amendments. Ms. Soldo agreed. Ms. Giunchigliani further noted A.B. 60 would affect the core benefit in that it was an equity issue. If there was a choice between 10 different plans, those contraceptives would be a part of that plan.

Mr. Hettrick was interested to know if Mr. Hillerby and Ms. Soldo thought

A.B. 60 would put limitations on age. He asked if a family had coverage, would a daughter be covered and would there be any type of parental consent requirements.

Chairman Buckley suggested the question was in neither of the witnesses’ field of expertise and suggested it could be addressed to an individual in drafting or in the Insurance Division. There were no further questions for Mr. Hillerby or Ms. Soldo.

April Townley, Deputy Administrator for the Division of Health Care Finance and Policy (DHCFP) testified next. She provided written testimony (Exhibit R). She clarified Medicaid coverage for contraceptives, hormone replacement therapy and reproductive health care, and explained the impact of requiring managed care organizations to provide those services to Medicaid enrolled participants. She also clarified the "existing contractual language for essential community providers", and explained the impact that inclusion of provider types or services in state law had on Medicaid.

Laurie England, Chief of Managed Care for the DHCFP expressed she did not have a pro or con stance, but needed clarification on particular items in A.B. 60 which were referenced in (Exhibit R), sections contained in pages 2 through 8. She spoke about the implications A.B. 60 would have on managed care.

Ms. Townley noted Medicaid expenses would increase if they were required to pay the providers directly. She stated all enrollees had notification they could go out of plan for those services, and that did not require prior authorization from the HMO. She then addressed the consequences to Medicaid when state law was changed (Exhibit R), page 2, stating there was a conflict about not having state funds to support a state mandate.

Chairman Buckley apologized that there was time for only one more witness to testify in opposition to A.B. 60. She said written comments would be accepted for the record, and distributed to committee members, if requested.

Janine Hanson, State President of the Nevada Eagle Forum was concerned HMOs were going to be mandated to cover reproductive health care if A.B. 60 passed, but chiropractic services, optical services or an alternative physician would not be mandated. In section 20 line 17, the definition of "Essential community provider" would cover Planned Parenthood. She felt some of Planned Parenthood’s business had been eliminated because HMOs required an individual to use only doctors provided by them.

.

Ms. Hanson quoted a Planned Parenthood article on political advocacy (Exhibit S), highlighted portions, pages 1 and 2, that stated that Planned Parenthood Mar Monte actively worked at the local state and federal levels to create and pass legislation. She stated that while she was not against what the article said, she felt A.B. 60 would help Planned Parenthood’s bottom line. She continued to quote from (Exhibit S) highlighted portions, pages 3 and 8, which indicated Planned Parenthood’s involvement in changing legislation on that issue. She did not think Planned Parenthood should be asking for privileged coverage in A.B. 60. She encouraged the committee to not make A.B. 60 a special interest legislation that was specifically designed to help increase the financial outcome of a specific advocacy organization. She did not want tax money or insurance money to be mandated to help support Planned Parenthood.

Mr. Nolan asked how she stood on the hormonal replacement issue. She responded she did not think it should be mandated through A.B. 60.

Chairman Buckley thanked the public for the professional conduct and presentations from both sides and closed the hearing on A.B. 60. She noted again that the record would remain open to written testimony for the committee members to review before work session.

Chairman Buckley then asked the committee members to take action on the following Bill Draft Request (BDR):

• BDR 53-778- removes limitations on payment of death benefit for transportation of remains of deceased employees beyond continental limits of United States (A.B. 253).

ASSEMBLYWOMAN GIUNCHIGLIANI MOVED TO INTRODUCE BDR 53-778.

ASSEMBLYMAN HUMKE SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

Chairman Buckley adjourned the meeting at 5:20 p.m.

Written testimony was submitted for the record during the following week, Exhibits T through Z.

RESPECTFULLY SUBMITTED:

Meagen Colard,

Committee Secretary

APPROVED BY:

Assemblywoman Barbara Buckley, Chairman

DATE: