TO GO AHEAD AND GET STARTED WITH
OUR HEARING.
.
WELL LITTLE SHRIVER QUORUM.
WATCH I'M QUORUM.
.
BUT WE WILL GO AHEAD GET STARTED
AS A SUB COMMITTEE SO.
TODAY WE WILL.
WE WILL HEAR TWO WITNESSES PER
SIDE WITH THE LONG TIME LIMIT OF
THREE MINUTES EACH ADDITIONAL
WITNESSES WILL BE ASKED ONLY
STATE THEIR NAME AND
ORGANIZATION AND POSITION FOR
THE RECORD.
WE WILL HAVE A SPECIAL ORDER
BUSINESS TO HEAR AB THIRTY
EIGHTY SEVEN A BY MISTER KALRA
FROM THREE THIRTY TO FOUR THIRTY
TODAY.
DOT THIS IS OUR LAST.
BILL HEARING ON ASSEMBLY BILLS
WE HAVE THIRTY FIVE BILLS ON THE
AGENDA NASA MEMBERS BE PRESENT
AS MUCH AS POSSIBLE.
TWEENER SO.
A PHRASE I'M NOT AYE AYE DEBT
THAT I DON'T LIKE VERY MUCH
QUITE FRANKLY.
FOR THOSE YOU HAVE A POSITION
SOMEWHERE BETWEEN SUPPORT AND
OPPOSEOR THOSE OR WHO HAVE NO
POSITION BECAUSE OF THE LENGTH
OF OUR AGENDA I'M I'M NOT
ALLOWING EXTENSIVE TESTIMONY. IF
YOU SUBMITTED A LETTER TO THE
COMMITTEE AND AUTHOR. VERY
BRIEFLY EXPLAIN IF YOU DID NOT
SUBMIT A LETTER PLEASE ONLY GIVE
YOUR NAME ORGANIZATION AND
POSITION.
OF THE CONCERT FILM ARE PROPOSED
FOR CONSENT.
AND ANY MEMBER MAY PULL A HER
HAVE A BILL REMOVED FROM THE
CONSENT CALENDAR. SO THE
FOLLOWING BILLS A PROPOSED FOR
CONSENT TODAY ITEM NUMBER FIVE
AB TWENTY TWENTY NINE EDUARDO
GARCIA. ITEM NUMBER SEVEN AB
TWENTY ONE EIGHTEEN MISTER
COOLEY WITH AMENDMENTS.
AND WITH THE AGREEMENT THAT IF
THIS BILL SUBSTANTIALLY MINUTE
WE WILL CALL IT BACK TO HEALTH
COMMITTEE. MR Y. GARCIA'S BILL.
WITH AMENDMENTS AS WELL.
ITEM NUMBER FOUTEEN AB TWENTY
THREE TWENTY FIVE MISS IRWIN
ITEM NUMBER FIFTEEN AB TWENTY
THREE THIRTY THREE WOULD. ITEM
NUMBER TWENTY A BEEF TWENTY FOUR
SEVENTY ONE THURMAN.
ITEM NUMBER TWENTY THREE AB
TWENTY FOUR EIGHTY NINE
MAIENSCHEIN.
I NUMBER TWENTY SEVEN AB TWENTY
SIX EIGHTY SIX MISTER JONES
SAWYER. I NEVER TWENTY NINE AB
FIFTIES TWENTY SEVEN FIFTY
MISTER OBERNOLTE. ITEM NUMBER
THIRTY TWO AB TWENTY EIGHT
NINETY THREE MISS WALDRON. ITEM
NUMBER THIRTY THREE AB TWENTY
NINE SIXTY SEVEN MISS QUIRK SO
WITH AMENDMENTS.
AND ITEM NUMBER THIRTY FIVE ACR
ONE SEVENTY SEVEN MISTER JONES
SAWYER WITH AMENDMENTS.
THAT BEING SAID WE WILL. NOW
MOVE ON.
WE WERE LOOKING FOR AUTHORS
MISTER CHU I SEE YOUR PRESENT
WOULD YOU LIKE TO PRESENT YOUR
BILL.
SHE WILL BE PRESENTING A. B. TWO
ZERO TWO TWO.
AT WHEN YOU'RE READY SECOND
MISTER CHAIR OF THEIR MEMBERS
I'M HERE TODAY TO PERCENT AB TWO
ZERO TWO TWO. A BILL TO EXPAND
MENTAL HEALTH SERVICES TO EVERY
STUDENT.
ADD THEIR SCHOOLS.
THE BILL REQUIRED IT WILL BE ONE
OR MORE MENTAL HEALTH
PROFESSIONALS ON ALL ELEMENTARY
AND SECONDARY SCHOOL CAMPUSES.
AND ESPECIALLY OR ESTABLISH A
RACIAL ALL ONE MENTAL HEALTH
PROFESSIONAL FOR EVERY SIX
HUNDRED STUDENTS.
SCHOOL HAS THREE IDENTIFY ESTA
BASS PLACE TO PROVIDE EARLY
PREVENTION AND INTERVENTION FOR
MENTAL HEALTH.
MENTAL ILLNESS OR MENTAL
WELLNESS IS DIRECTLY LINKED TO
THEIR ACADEMIC SUCCESS.
SCHOOL CLIMATE A GRADUATION RATE
AND THE PREVENTION OF.
O. ABSENTEES OUT ABSENTEEISM A
SUSPENSION SUBSTANCE USE
DISORDER AND KEEPING KIDS ALL OF
JAIL.
CURRENTLY IN CALIFORNIA DO YOU
ARE SIGNIFICANT BARRIERS PUT
CHILDREN AND USE TO REACH
SERVICES INCLUDING
TRANSPORTATION COST LANGUAGE.
AND THIS STIGMA
OVER SEVENTY PERCENT OF TO
STUDENTSWITH MENTAL HEALTH
NEEDS ARE NOT RECEIVING
TREATMENT.
AND DOESN'T NUMBERED JUMPED TO
OVER EIGHTY PERCENT FOR CHILDREN
IN POVERTY OR WITH NINE ENGLISH
SPEAKING PARENTS
WE NEED TO DO BETTER FOR OUR
KIDS. THERE WAS ME TODAY IS
BRIAN LUNDGREN ON BEHALF OF THE
NATIONAL ALLIANCE ON MENTAL.
ILLNESS
SPEAK IN SUPPORT OF TO SPILL.
MISTER CHAIR AND MEMBERS BRIAN
LUNDGREN ON BEHALF OF THE
NATIONAL ALLIANCE ON MENTAL
ILLNESS CALIFORNIA NEMI
REPRESENTS.
NINETEEN THOUSAND MEMBERS AND
SIXTY TWO AFFILIATES INCLUDING
MANY PEOPLE LIVING WITH A
SERIOUS MENTAL ILLNESS.
THEIR FAMILIES AND SUPPORTERS
AND WE ARE PLEASED TO SUPPORT AB
TWENTY TWENTY TWO. OR SUPPORTERS
THERE THE FACT THAT NAM WE
STRONGLY BELIEVES IN ACCESS IN
SCHOOLS.
TO A COMPREHENSIVE ARRAY OF
SERVICES INCLUDING MENTAL
HEALTH.
ACCOMMODATIONS AND SUPPORT.
AS MR CHIU INDICATED OVER THREE
HUNDRED THOUSAND CALIFORNIA
CHILDREN BETWEEN THE AGE OF FOUR
ELEVEN.
.
NEED SOME TYPE OF MENTAL HEALTH
NEEDS HOWEVER A SEVENTY PERCENT
OF THEM ARE NOT OFFERED ANY
TREATMENT.
AND THOSE YOUNG FOLKS WHO LIVE
BELOW THE POVERTY LINE OVER
EIGHTY PERCENT ARE NOT OFFER
TREATMENT.
NOT ENOUGH SCHOOLS TODAY.
PROVIDE ON CAMPUS MENTAL HEALTH
SERVICES AND STUDENT PUPIL
SUPPORT PERSONNEL RATIOS ARE TOO
HIGH PROVIDE.
IT TOO HIGH TO PROVIDE A TIME
ACCESS THIS LEGISLATION SLIP.
SPIRITS A VIABLE SOLUTION AND
THIS AND THIS IS WHY NAM ME
CALIFORNIA IS PLEASED TO SUPPORT
THE BILL REQUEST YOUR
CONSIDERATION IN SUPPORT THANK
YOU.
OTHERS IN SUPPORT.
NATION.
TIFFANY PULLEYBLANK WITH THE
NATIONAL ASSOCIATION OF SOCIAL
WORKERS CALIFORNIA CHAPTER IN
STRONG SUPPORT.
VICTOR CHRISTY WITH CALIFORNIA
HELPLESS ADVOCATES REPRESENTING
COMMUNITY HEALTH CENTERS AND
SUPPORT.
ADRIN SO SOME OF THE STEINBERG
INSTITUTE AND SUPPORT.
CORRESPONDS WITH MENTAL HEALTH
AMERICA OF CALIFORNIA AS WELL AS
THE CALIFORNIA YOUTH EMPOWERMENT
NETWORK WHICH IS A PROGRAM OF
MHC. AND WE STRONGLY SUPPORT IT
AND I PERSONALLY STRONGLY
SUPPORTED THANK YOU.
JOY BURKHARD THE TWENTY TWENTY
MOM WE STRONGLY SUPPORT.
ZERO ANYONE IN OPPOSITION.
SEEING NO ONE BRING BACK THE
COMMITTEE FOR QUESTIONS OR
COMMENTS ANYONE ON THE
COMMITTEE.
MISTER MISTER BIGELOW.
BUT YOU HOW MANY.
.
WORKERS YOU THINK THIS WILL.
CREATE NEW POSITIONS IN THE
SYSTEM FOR.
I HAVEN'T DONE THE MATH SO BOTH
THAT THIS BILL WOULD REQUIRE ONE
FOR EVERY SIX HUNDRED STUDENT.
SO MAYBE THERE'S SOME A SCHOOL
IN THE RURAL AREA THE HOUSE LAST
THEM A TOOL SIX HUNDRED STUDENTS
AND ONE CAMPUS. THERE WILL
PROBABLY WILL CARE BECAUSE ALL
ADDITIONAL. HAVE AND MAKE SURE
THAT IS SO ONE TO SIX HUNDRED
RACIAL.
SO ANYBODY KNOWS THE TOTAL
NUMBER OF.
.
KATE WHO. TAKEN TWELFTH A
STUDENTS IN CALIFORNIA WE.
DIVIDED BY SIX HUNDRED WOULD YOU
GIVE TO THE ANSWER.
YEAH SO IF THERE'S AN
APPROXIMATE.
SIX
POINT SOMETHING MILLION STUDENTS
IN THE STATE OF CALIFORNIA.
BRIGHTEN THEIR HEALTHCARE IS NOT
CHEAP DISCO NOT VERY EXPENSIVE.
BUT IS THIS FACT OUT BUT WITHOUT
THE C. SEXUAL SERVICES WILL COST
IS SO SUCH A TIGHT HE MORE EVEN
MORE MONEY.
SO I GUESS MY QUESTION IS JUST
REALLY.
IF THERE'S ABOUT SIX MILLION.
STUDENTS AND WE USE YOU THE
NUMBER THAT YOU'RE USING FOR THE
BASIS.
OF ONE POINT SIX SO.
.
FOR EVERY SIX HUNDRED STUDENTS.
THAT'S GONNA BE AROUND TEN
THOUSAND SOME.
AND EMPLOYEES IT WITH AN
AVERAGE SALARY WAS JUST.
BASE IT UP.
FORTY THOUSAND DOLLARS WERE
TALKING HALF A BILLION DOLLARS
BUT WE'RE TRYING TO GET WILL GO
AFTER THAT MARIJUANA TAX MONEY.
I I UNDERSTAND THE HEART OF
MONEY THERE.
PRETTY EXPENSIVE SONG IT IS JUST
CURIOUS
APPRECIATE THAT. THANK YOU.
THE QUESTIONS OF THE AUTHOR MISS
WALDRON.
JUST FOR CLARIFICATION.
THE WAY IT'S STATE. LAW SCHOOL
DISTRICTS COUNTY OFFICE OF
EDUCATION OR CHARTER SCHOOLS.
FONG.
IN IN MY AREA CHARTER SCHOOLS
FALL UNDER THE PUBLIC.
DISTRICT.
SO. IT WOULD STILL BE LUMPED ON
THE LIKE THAT ALL THE OTHER
PUBLIC SCHOOLS AND IT WOULDN'T
BE THE CHARTER SCHOOL WOULD HAVE
TO DO IT THEMSELVES.
BECAUSE THEY DON'T EVEN HAVE SIX
HUNDRED STUDENTS IN THE SCHOOL.
IS THAT GROUP OF THE EURO WHAT
SHOULD NOT FIRED THROUGH. THERE
EXCLUDE A CHARTER SCHOOL BUT A
LOT OF CHARTER SCHOOL FALL. THAT
YOU USE TO SPACE HOPE FOR OUR
PUBLIC SCHOOLS. AND THAT SHOULD
BE IS THAT THAT'S ALSO INCLUDE
THAT BUT THERE ARE SOME CHARTER
SCHOOL THERE ARE. JUST YOU KNOW
OF A. OUTSIDE OPTED FOR A PUBLIC
SCHOOL.
THOUGH CAMPUSES
IN WHY I WANNA MAKE SURE THAT
THEY ARE ALSO CAPTURE.
IT. SHOULD BE ANYONE ELSE.
SEEING NO ONE WHICH LOOKED CLOSE
MISTER CHIPMAN THANK YOU VERY
MUCH A AGAIN THIS BILL WOULD
ENSURE THAT ALL CALIFORNIA
CHILDREN'S. HAVE ASKED US TO DO
IS VERY ESSENTIAL SERVICES AND I
RESPECTFULLY ASK FOR YOUR RIFLE.
THANK YOU VERY MUCH MISTER CHIU
YOUR BILL DOES ENJOYED YOU PASS
RECOMMENDATION SO WHEN WE HAVE A
QUORUM.
PUT IT UP FOR A VOTE OR A THINK
CONDUCT TO THANK YOU VERY MUCH.
NEXT.
.
THIS COMPANY ZERO.
YEAH.
DISCOVER YOUR YOU HAVE EIGHTEEN
TWENTY ONE THIRTY THREE.
I'M LOOKING FOR A LONG LIST TO
MAKE SURE NOT EVEN LEAVING
WELFARE.
THANK YOU.
WHENEVER YOU'RE READY.
GOOD AFTERNOON MISTER CHAIRMAN
MEMBERS I AM PLEASED TO PRESENT
TWENTY ONE FORTY THREE. WHICH
WOULD INCREASED ACCESS TO
PSYCHIATRIC SERVICES BY
PROVIDING AN INCENTIVE FOR
CURRENTLY LICENSED MENTAL HEALTH
PROFESSIONAL TO GAIN MEDICAL
TRAINING USING EXISTING TRAINING
PROGRAMS. FIRST I WOULD LIKE TO
SAY I AM HAPPY TO TAKE THE
COMMITTEE AMENDMENTS REMOVING
THE COLLECTION OF FEES FROM MPS
MPAS FOR THE LOAN PROGRAM.
CALIFORNIA IS FACING IT'S A
SHORTAGE OF MENTAL HEALTH
PROFESSIONALS WHO CAN WRITE ASK
ACCESS
TO PSYCHIATRIC SERVICES THERE
SIMPLY AREN'T ENOUGH GRADUATING
PSYCHIATRISTS TO MEET CURRENT
DEMAND. ONE IN FOUR
PSYCHIATRISTS POSITIONS IN
COUNTY MENTAL HEALTH PROGRAM
STATEWIDE OUR BACON AT ANY ONE
TIME. SOME ESTIMATES IT INDICATE
THAT DURING ANY ONE YEAR TWENTY
TO TWENTY FIVE PERCENT OF THE
POPULATION WILL BENEFIT FROM
MENTAL HEALTH SERVICES. AND
FIFTY PERCENT OF OUR POPULATION
OVER THEIR LIFETIME WILL REQUIRE
THE SERVICES IT IS CRITICAL THAT
WE ADDRESS THE CURRENT AND
FUTURE NEEDS OF OUR CITIZENS
PARTICULARLY IN UNDERSERVED
AREA.
AB TWENTY ONE FORTY THREE AMEND
STATUTES FOR EXISTING STATE
PROGRAMS SUCH AS THE MENTAL
HEALTH LOAN ASSUMPTION PROGRAM.
TO ALLOW DUAL STATUS TRAINEES
MEETING CERTAIN CRITERIA TO BE
ELIGIBLE FOR STUDENT LOAN
REPAYMENTS IF THEY'RE WILLING TO
WORK IN UNDERSERVED OR RURAL
COMMUNITIES.
INCREASING OPPORTUNITIES FOR
LICENSED PSYCHOTHERAPIST TO GAIL
TO GAIN DUAL LICENSURE AS
PHYSICIANS ASSISTANTS OR
PSYCHIATRIC MENTAL HEALTH NURSE
PRACTITIONERS WILL HELP.
FIND AND TO ATTRACT THEM TO
UNDERSERVED AND RURAL
COMMUNITIES GROWING THE
PSYCHIATRIC WORKFORCE WILL
EXPAND PSYCHIATRIC SERVICES TO
THOSE WITH MENTAL ILLNESS. WHICH
WILL LEAD TO REDUCE WAIT TIMES
FOR APPOINTMENTS AND MOST
IMPORTANTLY EARLY EARLIER
EVALUATION AND TREATMENT I ASK
FOR YOUR AYE VOTE.
SUPPORT THIS LOAN REPAYMENT
PROGRAM EXPANSION WITH ME TODAY
IS RANDALL HAGER FROM THE
CALIFORNIA PSYCHIATRIC
ASSOCIATION TO TEST TRANSPORT.
MISTER CHAIRMAN MEMBERS OF THE
COMMITTEE RENTAL HAGER FOR THE
PSYCHIATRIC ASSOCIATION ON WE
ARE THE SPONSORS OF THIS BILL.
IT'S NO SECRET TO ANYBODY THAT
ACCESS OF PSYCHIATRIC SERVICES
CAN BE CHALLENGING AND.
TIME CONSUMING WHEN PEOPLE TRY
TO FIND A PSYCHIATRIST
PSYCHIATRISTS.
OUR ABOUT SIXTY PERCENT OF THEM
ARE APPROACHING THE AGE OF SIXTY
FIVE ON SOME OF THE OBVIOUS
SOLUTIONS.
TO CREATING MORE PSYCHIATRIC
ACCESS ARE REALLY NOT FEASIBLE
AT THIS POINT IN TIME FOR
INSTANCE CREATING NEW RESIDENCY
TRAINING PROGRAMS. THEY ARE
DEPENDENT IN LARGE PART ON.
FEDERAL MONIES.
BUT THERE ARE LONG TIME
CONSUMING PROCESS IS SET UP SO
WE WHAT WE HAVE HERE TODAY IS
IS.
I AN ALTERNATIVE WHICH I THINK
IS AN INNOVATIVE.
IDEA OF THE LOAN REPAYMENT
PROGRAMS IN OUR STATE ARE
TESTED.
PHYSICIAN ASSISTANT AND NURSE
PRACTITIONER PROGRAMS ARE WELL
ESTABLISHED.
THE MENTAL HEALTH LOAN
PROFESSIONAL REPAYMENT PROGRAM
ALREADY EXISTS
SO WE ARE TAKING WHAT WE HOPE IS
THE NEXT STEP TOWARDS OFFERING
OPPORTUNITIES FOR. ALREADY
CURRENTLY TRAINED
PSYCHOTHERAPIST TO DENVER GONE
BECOME.
MEDICALLY TRAINED IN IN EITHER
OF THOSE TWO DISCIPLINES
IT'S MORE A MORE COMPREHENSIVE
APPROACH IT'S IT'S A. CONSISTENT
WITH INTEGRATED CARE.
IT'S GOING TO HELP US IN THE
TWO HUNDRED AND FIFTY AREAS IN
THE STATE THAT OUR VET LE
FEDERALLY DESIGNATED.
MENTAL HEALTH SERVICE.
ON AND UNDERSERVED AREAS AND
WE'RE.
REALLY PLEASED TO BELIEVE I
BRING THIS UP FOR YOU.
TO YOU AND.
URGE YOUR SUPPORT.
THANK YOU VERY MUCH OTHER OTHERS
IN SUPPORT.
HI TIFFANI PULLEYBLANK NATIONAL
ASSOCIATION OF SOCIAL WORKERS
CALIFORNIA CHAPTER IN SUPPORT.
ADRIN SO SOME OF THE STEINBERG
INSTITUTE IN SUPPORT.
MELISSA AND MO WITH SHIRE ANTI
ON BEHALF OF THE CALIFORNIA
ACADEMY OF CHILD AND ADOLESCENT
PSYCHIATRY IN SUPPORT.
TIM AND REPRESENT THE CALIFORNIA
CHAPTER OF AMERICA BECAUSE
EMERGENCY PHYSICIANS IN SUPPORT.
TOM REILLY REPRESENTING THE
AMERICAN COLLEGE OF PHYSICIANS
CALIFORNIA CHAPTERS IN STRONG
SUPPORT.
MELANIE THOMAS I'M A
PSYCHIATRIST WITH UCSF IN
SUPPORT.
MISTER THOMPSON CALIFORNIA
MEDICAL ASSOCIATION SUPPORT.
ANNOUNCE.
IS THERE ANYONE IN OPPOSITION.
SEE NO ONE BRING BACK TO
COMMITTEE QUESTIONS OR COMMENTS
FROM THE COMMITTEE.
THAT'S WHAT IT.
PLEASE AND. THANK YOU MISTER
CHAIR OF.
WHEN I FIRST SAW THIS I READ A
COUPLE TIMES BECAUSE I AM USED
TO IT FROM THE MEDICAL
PROFESSION. POSITIONS.
THE FACT THAT. WHEN YOU TALK
ABOUT MENTAL HEALTH WITH SO MUCH
IMPACTS YOUR PHYSICAL HEALTH AS
WELL. THAT I DIDN'T SEE REASON
WHY NOT TO.
LOOK INTO DOING IT AND.
YOU KNOW ESPECIALLY IN AREAS
WHERE THERE'S NO SERVICES
AVAILABLE OR VERY FEW IN RURAL
AREAS IS ALWAYS ONE OF THOSE.
AS WELL THAT YOU WANT TO BE
ABLE TO.
BE ACCESSIBLE TO PEOPLE SO THAT
THEY CAN CONTINUING CARE BECAUSE
THERE'S NOTHING WORSE THAN YOU
KNOW INITIATING CARE AND THEN
THEY DROP OFF JUST BECAUSE IT'S
TOO HARD TO GET.
TO THE SERVICES AND YOU KNOW
ANOTHER THING THAT'S ALSO. AN
ISSUE IS BEING ABLE TO SPEAK THE
LANGUAGE OF THE AREA SO YOU
KNOW.
AND EMPHASIS COULD BE ON YOU
KNOW BILINGUAL AND. THINGS LIKE
THAT AS WELL TO HOPE SO.
THANK YOU.
IF YOU ANYONE ELSE.
SEEING NO ONE.
WHICH A CLOSENESS GOVERNOR
THANK YOU MISTER CHAIRMAN THANK
YOU FOR THAT COMMENTED THERE'S
NO QUESTION THAT THE MORE THAT
YOU HAVE SOMEBODY THAT'S
CULTURALLY COMPETENT THAT
UNDERSTANDS. DIFFERENT LANGUAGES
IN DIFFERENT CULTURES IN THIS
SETTING IT'S REALLY IMPORTANT
SO.
THANK YOU VERY MUCH FOR THE
OPPORTUNITY PRESENT THIS TODAY
AND I RESPECTFULLY ASK YOUR AYE
VOTE.
BECAUSE YOU CAN SEE WHERE
OPERATE AS A SUBCOMMITTEE IT
DOESN'T ENJOY DO PASS
RECOMMENDATION WILL PUT IT UP
FOR A VOTE THANK YOU CHANCE
THANK YOU SO MUCH PERSONAL THAT
WAS QUIRK SILVA.
GIVE TWO BILLS BEFORE US BUT
ONCE I CONSENT.
GET THE TO WHAT TAKE THAT ONE
OFF NO GOOD THANK YOU PERFECT
PLEASE PROCEED WITH ITEM NUMBER
THIRTEEN AB TWENTY THREE
FIFTEEN.
GOOD AFTERNOON MISTER CHAIR AND
MEMBERS I'M OF PLEASED TO
PRESENT AB TWENTY THREE FIFTEEN
WHICH WOULD INSTRUCT THE
CALIFORNIA DEPARTMENT OF
EDUCATION IN CONJUNCTION WITH D.
H. CS AND APPROPRIATE
STAKEHOLDERS. TO DEVELOP
GUIDELINES AND BEST PRACTICES
FOR MENTAL HEALTH AND BEHAVIORAL
TELEHEALTH DELIVERY IN
CALIFORNIA SCHOOLS AS MANY OF
YOU HAVE BEEN AWARE OF
THROUGHOUT THE. COUNTRY WE HAVE
SEEN A MANY TRAUMATIC EVENTS
THAT HAVE PLAYED OUT IN THE NEWS
AND FOR MANY OF OUR STUDENTS
BEING ABLE TO PROCESS THOSE
EVENTS WHETHER THEY HAVE BEEN.
OF ATTACKS ON CAMPUSES WHETHER
THEY BE OF GUN RELATED THE
STUDENTS DON'T ALWAYS HAVE A
PLACE TO A REALLY GET THE
NECESSARY INTERACTION THAT THEY
NEED THIS WOULD BE A BEGINNING%
OF. LOOKING FOR GUIDELINES FOR
PUBLIC SCHOOLS TO START TO
INTRODUCE TELL AUTHORITY AND
THIS ACTUALLY CAME OUT OF ME
VISITING A SPEECH THERAPY CLINIC
IN ORANGE COUNTY WHERE THEY ARE
NOW SERVICE SEEN ON MANY MANY
UNDERSERVED YOUTH AT A COMMUNITY
CENTER USING TELESAT P.. SO WITH
THAT OF OUR HOPE IS THAT WE WILL
BEGIN TO LAY THE FOUNDATION SO
THAT OUR STUDENTS WOULD HAVE
ACCESS TO TELESERYE P..
PARTICULARLY WITH COUNSELORS AND
SO FORTH AND.
WE THINK THAT THE STATE
PARTNERSHIP IT'S TIMELY IN THE
SENSE THAT TECHNOLOGY IS
AVAILABLE AND READY AND WE.
DIRECTION
SO I HAVE WITH ME ARACELI
NAVARRO WITH THE CHILDREN'S
PARTNERSHIP TO TESTIFY AS WELL.
GREAT THAT AFTERNOON EVERYBODY.
THE CHILDREN'S PARTNERSHIP TCS
POLICE OF SPONSOR AB TWENTY
THREE FIFTEEN.
TCP BELIEVES THAT WE SHOULD
MEET CHILDREN.
WHERE THEY ARE IN OUR POLICY
APPROACH AND WITH THE VAST
MAJORITY OF CHILDREN ATTENDING
ONE OF THE STATE'S MORE THAN TEN
THOUSAND PUBLIC SCHOOLS
INTEGRATING TECHNOLOGY AND
ACCESS TO HEALTH CARE THROUGH
TELL HEALTH SERVICES TO MAKE
THAT?
IN ADDITION CHILDREN WHO ARE
HEALTHIER DO BETTER IN SCHOOL
THEREFORE SCHOOLS HAVE BOTH A
SIGNIFICANT ROLE TO PLAY IN A
STRONG INCENTIVE TO OUR FOR
PROMOTING THE HEALTH OF
CHILDREN.
UNFORTUNATELY AS STATED.
A LOT OF SCHOOLS DO NOT HAVE
THE RESOURCES IN PLACE TO
PROVIDE.
PEOPLE'S PHYSICAL MENTAL AND
BEHAVIORAL HEALTH CARE NEEDS AND
SO AGAIN.
THEY ARE A LOT MORE COMPLEX AND
SO WE CERTAINLY WANT TO ADDRESS
THIS THROUGH TELEHEALTH.
I'M WE ARE AWARE OF INNOVATIVE
TELEHEALTH MODELS AROUND THE
STATE AND WE'RE CURRENTLY
WORKING ON PUBLISHING A. AYE
REPORT WHICH OUTLINED SOME OF
THE MODELS ACROSS THE STATE THAT
OF COURSE WOULD.
HELPLESS.
GET CALIFORNIA TO HAVING A.
OUR OWN MODEL HERE AND
CERTAINLY KEEPING INTO ACCOUNT.
THOSE WHO PROVIDE THE SERVICES
AND THE AXIS.
WITHIN A SITE.
AS OUTLINED IN THE BILL THERE
ARE.
CONSIDERATIONS FOR OUR
REIMBURSEMENTS.
SCOPE OF WORK AND.
AND REALLY ULTIMATELY GETTING
THE STATE TO.
BE A PARTNER IN THIS WORK AS WE
ESTABLISHED AND.
GOOD OF THEIR OTHER WITNESSES IN
SUPPORT.
THEY BORN REPRESENT CALIFORNIA
SCHOOL NURSES ORGANIZATION IN
SUPPORT.
KATIE LADEN ON BEHALF OF THE
CHILDREN SPECIALTY CARE
COALITION IN SUPPORT THANK YOU.
ANA HOW SUPPLIED WITH UNITED
WAYS AND ALSO ON BEHALF OF THE
CHILDREN'S HEALTH COVERAGE
COALITION CONSISTING. OF THE
CHILDREN'S PARTNERSHIP CHILDREN
NOW A CALIFORNIA COVERAGE OF
HEALTH INITIATIVES UNITED WAYS
AND THE CHILDREN'S DEFENSE FUND
IN SUPPORT.
SIR ANYONE IN OPPOSITION.
SAY NO WE'RE BRING BACK TO THE
COMMITTEE FOR QUESTIONS OR
COMMENTS.
SEEN KNOWN WHICH ARE TO CLOSE
WAS WORK SO. I WOULD I WOULD
JUST LIKE US TO THINK OF FORWARD
AS WE LOOK TO DELIVER HEALTH IN
PUBLIC SCHOOLS. AND ANSWER YOUR
AYE VOTE THANK YOU VERY MUCH WAS
QUIRK SILVA WE THINK HE DOES
ENJOY DEPRESSED RECOMMENDATION
WHEN WE HAVE A QUORUM WILL UP
CALL FOR A VOTE. THANK YOU
MEMBERS VERY MUCH SO NEXT WOULD
BE MISS REYES AND THEN JUST AS A
UP AND WILL HAVE WITH DOCTOR
ARAMBULA FOLLOW. I KNOW THAT'S A
LITTLE OUT OF ORDER EFFECTS OF
THOSE AUTHORS MIGHT BE WATCHING
OUT THERE.
BUT THIS REYES HAS TWO BILLS
BEFORE US.
THANK YOU MISTER CHAIR AND
MEMBERS.
FIRST I WOULD LIKE TO ACCEPT THE
COMMITTEE.
I JUST AMENDMENTS TO ADDRESS
TECHNICAL ISSUES IN THE BILL.
WE APPRECIATE THE WORK OF THE
COMMITTEE STAFF ON THIS
IMPORTANT ISSUE.
HOSPITALS IN CALIFORNIA MUST
MEET CERTAIN SEISMIC
REQUIREMENTS ENACTED IN THE MID
NINETIES.
THE FIRST OF THESE DEADLINES IS
TO ENSURE THE BUILDING REMAIN
STANDING IN A MAJOR EARTHQUAKE.
THE FIRST DEADLINE IS JANUARY
FIRST TWENTY TWENTY.
OVER NINETY PERCENT OF HOSPITALS
HAVE MET THIS REQUIREMENT TO
DATE.
AB TWENTY ONE NINETY WILL
ADDRESS DELAYS EXPERIENCED BY
THE REMAINING FEW HOSPITALS.
THIS BILL ESTABLISHES BENCHMARKS
AND GUIDANCE FOR THESE REMAINING
HOSPITALS SHOULD THEY NEED AN
EXTENSION.
THE OFFICE OF STATEWIDE HEALTH
PLANNING AND DEVELOPMENT COULD
GRANT UP TO THIRTY MONTHS.
ADDITIONAL TIME PROVIDED THE
HOSPITAL AGREES TO TIME LINES
AND PENALTIES
SPECIFIED BY THE DEPARTMENT. AND
CAN MEET THE STANDARDS PROVIDED
FOR IN THE BILL.
TODAY WE HAVE KATHERINE SCOTT
REPRESENTING THE CALIFORNIA
HOSPITAL ASSOCIATION.
TO FURTHER EXPLAIN THE MANDATE
AND THE EXTENSION IN THE BILL.
GOOD AFTERNOON MEMBERS KATHERINE
LOTS OF CUT FIFTY CALIFORNIA
HOSPITAL ASSOCIATION.
OF THE AUTHOR.
AND SO MOMENT QUICKLY POINTED
OUT OUR AUTHORS ARE OUR
HOSPITALS ARE WORKING HARD TO
MEET THAT FIRST MANDATE WHICH IS
TO REMAIN STANDING AFTER A MAJOR
EARTHQUAKE. IT'S A. VERY
EXPENSIVE MANDATE FOR HOSPITALS
TO MEET WE'RE DOWN TO THE LAST
TWENTY OR SO HOSPITALS WHO WILL
WHO WILL DO THAT AYE IN THE
PROCESS WE HAVE A FEW HOSPITALS
THAT WILL NEED SOME EXTRA TIME
WITH THE WORK OF THIS COMMITTEE.
WE HAVE DEVELOPED A BILL THAT
WOULD.
ESTABLISH A FRAMEWORK FOR THOSE
EXTENSIONS HOLD THOSE HOSPITALS
TO THE EXTENSION AND CREATE A
PENALTY PROCESS OF FIVE THOUSAND
DOLLARS PER DAY IF THEY DON'T
MEET THEIR BENCHMARKS.
.
AS OUR HOSPITALS COMPLETE THESE
BENCHMARKS ON IT WILL BE
IMPORTANT TO.
MANAGE AND MAKE SURE THAT WE
UNDERSTAND OUR HOSPITALS ARE
BECAUSE IN TEN SHORT YEARS
THEY'RE GOING TO NEED TO MEET
THE FULLY OPERATIONAL STANDARD
WHICH THEY MULTI BILLION DOLLAR
STANDARD TO ENSURE HOSPITALS
OPERATIONAL AFTER THE
EARTHQUAKE.
LAST ESTIMATE ABOUT FIVE YEARS
AGO AS A HUNDRED AND TEN BILLION
DOLLARS FOR THAT MANDATE.
WE THINK THE I THINK THE
COMMITTEE FOR THEIR WORK AND ASK
FOR YOUR SUPPORT.
MR AT SHORT ON BEHALF OF LOMA
LINDA UNIVERSITY HEALTH HOW
WE'RE ONE OF THOSE HOSPITALS
THAT NEEDS A LITTLE BIT MORE
TIME TO COMPLETE OUR CURRENT ON
CONSTRUCTION. AYE WE ARE
BUILDING A ONE MILLION SQUARE
FOOT BRAND NEW FACILITY THAT
WILL INCLUDE CHILDREN'S HOSPITAL
BEDS ADDITIONAL IMPATIENT ADULT
BEDS.
AND IT'S A TO POINT FIVE
BILLION DOLLAR INVESTMENT IN THE
COMMUNITY I'M AND WE DO NEED
JUST A LITTLE BIT MORE TIME TO
COMPLETE THAT CONSTRUCTION WE
ARCHER AYE VOTE.
YOU VERY MUCH ARE THERE OTHERS
IN SUPPORT.
SEEING NO ONE IS THERE ANYONE IN
OPPOSITION.
COMING.
NOT QUITE NAM POSITION NOT YET
THERE IN SUPPORT.
WANTED TO THANK THE COMMITTEE.
FOR YOUR EFFORTS OUT ALONG WITH
THE CALIFORNIA HOSPITAL
ASSOCIATION TO COME UP WITH A
COMPREHENSIVE SOLUTION.
SEIU HAS BEEN ENGAGED IN MAKING
SURE OUR HOSPITALS GET FULLY
COMPLIANT WITH THE LAW ON
THROUGHOUT THE YEARS AND WE WANT
TO JUST.
REMAIN IN THE CONVERSATION AS A
COMMITTED STAKEHOLDER ON THIS
ISSUE TO MAKE SURE THAT ALL OF
OUR HOSPITALS GET THERE WE DO
HAVE CONCERNS WITH THE.
CATEGORY OF HOSPITALS THAT
WOULD BE COMPLETELY I'M STARTING
FROM SCRATCH.
IN THAT CASE WE WANT TO
CONTINUE TO WORK WITH THE AUTHOR
IN THE SPONSORS AND THE
COMMITTEE.
TO MAKE SURE THAT THERE ARE
SOME CLEAR PARAMETERS AROUND
THOSE HOT THAT CATEGORY OF
HOSPITALS.
AND TO MAKE SURE THAT WE
ACCOMPLISH THE GOALS OF THE
CHAIR OF THE COMMITTEE AND WITH
THAT WE JUST WANTED TO STATE ON
THE RECORD THANK YOU.
GOOD THANK YOU IS SIR.
ANYONE ELSE.
THE PRIVATE ESSENTIAL ACCESS
COMMUNITY HOSPITALS ADVENTIST
HEALTH IN THE ALLIANCE OF
CATHOLIC HEALTH CARE ALSO
SUPPORT.
QUESTIONS COMMENTS MYSTERIES.
I DON'T THINK YOU MISS RAISE
FOR.
FOR AUTHORING THIS BILL IT'S
VERY IMPORTANT IT'S IMPORTANT
THE REGION OF THE INLAND EMPIRE
ANOTHER LIMB LINDA'S BEEN
WORKING.
A FOR YEARS TO TRY TO FIX OTHER
FACILITY AND IT TURNS OUT THAT.
IT'S GOING TO BE A LITTLE BIT
DOWN.
CHEAPER IF THEY.
JUST RIPPED THE BUILDING DOWN
STAR LOVER AGAIN.
BUT IT'S INCREDIBLY IMPORTANT
SO.
I THINK THIS IS A.
IS GOOD WORK KIND ON YOUR
BEHALF AND THANK YOU I'M FOR
THOSE OF THEIR SUPPORTING AN
OBVIOUS PUT.
THANK YOU.
ANYONE ELSE.
I JUST LIKE TO THANK YOU A
MISTRESS FOR.
NOT ONLY TAKING ON THIS.
FOR A LONG LINDA BUT ALSO AS A
LARGER ISSUE.
GOT MULTIPLE HOSPITALS INVOLVES
I REALLY APPRECIATE THAT IT'S AN
ISSUE COMES UP EVERY COUPLE OF
YEARS. AS WE NEAR THE NEXT
SEISMIC DEADLINE ACTUALLY VERY
FIRST BILL I INTRODUCED WAS TO
WAS A BILL VERY SIMILAR TO THIS
FOR.
FRANK HOWARD HOSPITAL IN WILL
ITSELF SO APPRECIATE THE.
THAT YOU'RE A WORKING WITH
SPONSORS TO HELP.
YOU KNOW WITH WITH A WITH THE
VARIETY HERE.
AND WORK WITH THOSE. WHO
ALREADY HAVE THEIR SEISMIC PLANS
IN PLACE BUT JUST A LITTLE BIT
MORE TIME TO WORK ON THIS?
DUE TO UNFORESEEN CIRCUMSTANCES
SO THE BILL DOES ENJOY DO PASS
RECOMMENDATION WHEN WE HAVE A
QUORUM. ARE NOT QUITE THERE YET
WE GET CLOSE.
BUT WOULD YOU LIKE TO CLOSE.
I THANK THE COMMITTEE FOR THEIR
TIME AND RESPECTFULLY ASK FOR
YOUR AYE VOTE. THINK OF SO.
WE'RE GETTING CLOSER TO. WHERE
THEY'RE WHERE THEY'RE?
NO SECRETARY PLEASE TAKE THE
ROLE WELL WE HAVE.
WE TAKE THE ROLE IN AND NOW.
IT'S. A QUORUM CAN BE ELUSIVE SO
WE'RE GOING TO GRAB IT OR WE
CAN.
WOOD HERE. MAYES HERE AGAR
CURRY.
BIGELOW.
BONTA.
BURKE CARILLO.
FLORA. LOW MOAN.
MCCARTY. NAZARIAN RODRIGUEZ.
SANTIAGO.
THURMOND WALDRON.
WE HAVE A QUORUM.
YOU'RE MEANT TO.
OUT SO WE HAVE A MOTION.
.
THE MOTION IS SAID TO PASS.
AS AMENDED.
TO APPROPRIATIONS.
MOTION BY MISTER MAYES SECOND
BY MISTER BIGELOW MADAM
SECRETARY PLEASE CALL THE ROLL.
I WOULD I WOULD AYE MAYES FIGHT
MAYES AYE AGUIAR-CURRY. ACTOR
CORY I BIGELOW. BIGELOW AYE
BONTA.
BURKE
CARILLO.
CARILLO AYE FLORA FLORA AYE
LAMONT. MCCARTY NAZARIAN
RODRIGUEZ. RODRIGUEZ AYE
SANTIAGO THURMAN WALDRON.
WALDRON AYE.
YOUR BILL WAS OUT EIGHT ZERO SO
WILL KEEP IT OPEN FOR OTHERS TO
ADD ON SO MET WHICH LIKE SUCH
SECOND OFF.
YES THANK YOU CHAIRMAN WORD AND
MEMBERS OF THE COMMITTEE.
FIRST I WOULD LIKE TO NOTE THAT
WE WILL BE TAKING THE COMMITTEE
SUGGESTED AMENDMENTS.
PERTAINING TO DISCIPLINE.
AND MY OFFICE WILL CONTINUE TO
WORK WITH THE COMMITTEE STAFF ON
THE CRITERIA THAT WAS OUTLINED.
IN YOUR OTHER SUGGESTED
AMENDMENTS AS WE MOVE FORWARD.
AT THIS TIME I'D LIKE TO THANK
THE COMMITTEE ON CHAIR AND HIS
STAFF FOR YOUR CONTINUE TO. ON
THE SUBJECT.
CALIFORNIA HAS NEARLY EIGHT
MILLION PEOPLE WITH CRIMINAL
RECORDS.
THAT'S ONE IN EVERY FIVE
CALIFORNIANS.
IT'S BEEN SHOWN THAT THE BEST
MEASURE AGAINST RECIDIVISM.
IS GETTING A JOB TO SUPPORT
YOURSELF AND YOUR FAMILY.
APPROXIMATELY THIRTY PERCENT OF
ALL JOBS IN OUR STATE REQUIRE AN
OCCUPATIONAL LICENSE.
MANY OF THESE LICENSES HAVE
REGULATIONS WHICH IMMEDIATELY
DISQUALIFY ANYONE WITH A PRIOR
CONVICTION REGARDLESS OF THE
DEGREE HOW LONG AGO THE
CONVICTION WAS.
OR ANY TYPE OF REHABILITATION
COMPLETED.
AB TUNE TWO TWO NINE THREE
ADDRESSES THE LICENSING FOR EMTS
AND SIX TO PROVIDE THE PATH
REMEMBER OVER CONSERVATION
CAMPS.
WERE APPROXIMATELY FORTY FIVE
HUNDRED INMATES AROUND THE STATE
HAVE VOLUNTEERED TO BATTLE
FIRES.
TO DO WORK TOWARDS THEIR
CONSERVATION.
AND DO WORK TOWARD SCHOOL OUR
CONSERVATION EFFORTS BUT ARE
BARRED FROM GETTING THE REQUIRED
LICENSES TO USE THE SKILLS THEY
HAVE LEARNED. ONCE THEY'RE NO
LONGER INCARCERATED.
IN A NORMAL YEAR THESE INMATES
MAKE UP.
UP TO THIRTY PERCENT OF OUR
FOREST FIRE FIGHTERS.
THEY CONTRIBUTE OVER THREE
MILLION HOURS RESPONDING TO
FIRES.
AND OVER SEVEN.
IN OVER SEVEN BILLION HOURS AND
COMMUNITY SERVICE PROJECTS.
THEY ALSO HELP A STATE SAVE
APPROXIMATELY ONE HUNDRED
MILLION DOLLARS ANNUALLY.
THAT'S IN A NORMAL YEAR.
LAST YEAR WAS THE LARGEST AND
MOST DEVASTATING FIRE SEASON IN
OUR STATE'S HISTORY. AND THEIR
EFFORTS ALL AROUND THE STATE
WERE NO LESS EXTRAORDINARY.
I'M SORRY TO SAY THAT
CONSERVATION CAMP MEMBERS HAVE
EVEN PERISHED.
DURING TRAINING AND ON THE FRONT
LINES BATTLING OR FIRES FOR OUR
STATE.
THESE PEOPLE OUR TRUSTED AND
SKILLED ENOUGH TO RISK THEIR
LIVES WHILE THEY'RE
INCARCERATED.
WHEN RELEASED THEY WANT TO USE
THE SKILLS THEY'VE LEARNED AND
PUT THEM TOWARDS EARNING A
LIVING AND CONTRIBUTING TO THEIR
COMMUNITIES.
UNFORTUNATELY OUR STATE'S
RESTRICTIVE LICENSING SYSTEM IN
THIS AREA BARS THEM FROM DOING
SO.
AB TWENTY TWO NINETY THREE SIX
TO REMEDY.
IT'S TO REMEDY THAT WHILE ALSO
LOOKED TAKING PUBLIC SAFETY INTO
ACCOUNT.
HERE TO SPEAK ON THE BILL ARE
JAIL.
MYRICK FROM THE EAST BAY
COMMUNITY LAW CENTER AND DEVOTED
TO LAYER FROM LEGAL SERVICES FOR
PRISONERS WITH CHILDREN.
GOOD AFTERNOON I'M EVER TELL AIR
WITH LEGAL SERVICES FOR
PRISONERS WITH CHILDREN.
AS THE ASSEMBLY MEMBER JUST
SAID THIRTY PERCENT OF OUR
CURRENT FOREST FIRES ARE
CURRENTLY INCARCERATED THAT'S
FOUR THOUSAND FIVE HUNDRED
PEOPLE AND THEY GET PAID TWO
DOLLARS AN HOUR. CDC ARE SELECT
TO THOSE PEOPLE CAN BE AND
AUTOMATICALLY EXCLUDES PEOPLE
WITH CONVICTIONS FOR SEX
OFFENSES ARSONOR ESCAPE.
FIREFIGHTING IS A GROWTH
INDUSTRY FOR WHICH WE HAVE SEEN
THE STARK NEED FOR PEOPLE IN
THESE ROLES LAST YEAR ACROSS THE
STATE WITH COMMUNITIES AND HOMES
DECIMATED THE PRISON SYSTEM IS
TRAINING PEOPLE TO FILL THESE
POSITIONS BUT THE FIRE
DEPARTMENTS INCLUDING CAL FIRE
REQUIRE EMT CERTIFICATION FOR
THESE JOBS.
OUR COMMUNITIES DESERVE SKILLED
AND EXPERIENCED FIREFIGHTERS OUR
SOCIETY DESERVES A LICENSING
PROCESS THAT DOESN'T DUPLICATE
AND REINFORCE UNINTENTIONAL
RACIAL DISCRIMINATION. AND THESE
MEN AND WOMEN ARE DOING THIS
WORK WELL INCARCERATED THEY
DESERVE A FAIR CHANCE FOR A
LIVING WAGE TO DO THIS AFTER
INCARCERATION.
I WANT OF FURTHER EMPHASIZED
THAT THIS BILL GOES BEYOND JUST
THE CONSERVATION CAMP WORKERS.
EIGHT MILLION CALIFORNIANS HAVE
CONVICTION HISTORIES.
.
THIS BUT AND THAT SIGNIFICANTLY
MORE THAN THE FOUR THOUSAND FIVE
HUNDRED PEOPLE IN THESE CAMPS
THIS BILL PROVIDES A PATH FOR
PEOPLE WITH NON CONVICTIONS. SO
ARRESTS.
WITH CONVICTIONS THAT WERE NOT
SERIOUS ENOUGH TO WARRANT PRISON
TIME AND THEREFORE WEREN'T
ELIGIBLE FOR CONSERVATION CAMP
BECAUSE IT'S A CDC OUR PROGRAM.
AND ALSO FOR THOSE WITH CERTAIN
CONVICTIONS THAT HAVE SHOWN
REHABILITATION AND ARE OTHERWISE
ELIGIBLE TO PROTECT OUR
COMMUNITIES.
AND THANK YOU MY NAME IS.
THANK YOU MISTER CHAIRMAN OF
THE COMMITTEE MY NAME IS JAIL
MYRICK AND I'M WITH THE EAST BAY
CAN BE LAW CENTER AND JUST
BRIEFLY I WANT TO READ PORTIONS
OF TWO LETTERS WE WORK WITH
CLIENTS ON A REGULAR BASIS WERE
TRYING TO GET THEIR LIVES BACK
ON TRACK AND. WANT TO READ FROM
TWO OF THEM ONE.
I'M WRITING THIS LETTER TO
INFORM YOU WHO I AM A AND HOW
BEING CONVICTED OF A FELONY OVER
TWENTY SEVEN YEARS AGO IS STILL
AFFECTING ME. I'VE BEEN A
FIREFIGHTER IN THE BAY AREA FOR
TWENTY YEARS NOW AND THE
LONGSHOREMEN THE PAST FIVE. I
HAVE TWO WONDERFUL CAREERS IN A
LOVING FAMILY WITH A WIFE AND
FOUR SONS RANGING FROM NINE TO
TWENTY FOUR YEARS OF AGE. I WANT
TO PROMOTE TO THE POSITION OF
FIRE INVESTIGATOR WITHIN MY
DEPARTMENT BUT IN ORDER TO DO SO
I HAVE TO TAKE A FIRE ARMS AND
LAWS. OF OF OVER REST CLASS I
HAD TO SUBMIT MY FINGERPRINTS TO
THE DOJ AND OF COURSE I WAS
UNABLE TO BE CLEARED FOR THE
CLASSES BECAUSE OF MY
CONVICTION.
BECAUSE I CANNOT TAKE THESE
CLASSES I CANNOT BE PROMOTED
DESPITE HAVING WORKED HARD AS A
FIREFIGHTER FOR TWENTY YEARS I
HAVE BEEN A LAW ABIDING CITIZEN
THAT GOES TO WORK EVERY DAY WITH
TWO JOBS. RAISING A FAMILY OF
FOUR SCIENCE AND THIS HAS COME
BACK TO HURT ME TIME AND AGAIN
AND THEN THE OTHER LETTERS FROM
A WOMAN.
WELL WHO IS ACTUALLY A FIREFIGHT
BUT REGISTER AS EMT IN ANOTHER
STATE IN AUGUST THE TWENTY
FOURTEEN I WAS CONVICTED OF ONE
MISDEMEANOR DUE TO BEING AN
ABUSIVE RELATIONSHIP.
A FEW MONTHS.
POST CONVICTION I WAS ABLE TO
END THE RELATIONSHIP AND START
ANEW I STARTED AN EMERGENCY
MEDICAL TECHNICIAN PROGRAM AFTER
DECIDING THAT I WANT TO BE A
FIRST RESPONDER WITH ASPIRATIONS
OF BEING A FIREFIGHTER
PARAMEDIC.
I MOVED TO NEW YORK IN TWENTY
FIFTEEN FOR A CHANGE OF
ENVIRONMENT DURING THAT TIME I
OBTAINED MY NATIONAL REGISTRY.
OF EMT CERTIFICATION AND NEW
YORK STATE EMT CERTIFICATION
GAINING EMT EXPERIENCE FOR TO
SCAN FOR NINE MONTHS SINCE MY
RETURN TO THE BAY AREA IN SUMMER
TWENTY SIXTEEN I STARTED WORKING
WITH THE AMERICAN MEDICAL
RESPONSE.
AS THERE WILL CHAIR DRIVER AND
I'M CURRENTLY AT SABOL COLLEGES
FIRE ACADEMY WITH AN ANTICIPATED
GRADUATION DATE OF MAY TWENTY
FOURTH TWENTY EIGHTEEN
UNFORTUNATELY IT IS DUE TO
RESTRICTIONS IN OBTAINING BY
CALIFORNIA ANTI CARD. THAT I'M
CURRENTLY UNABLE TO PROBE
PROGRESS CAREER WISE. BOTH AT
AMERICAN MEDICAL RESPONSE AND IN
THE FIRE SERVICE THANK YOU.
YOU VERY MUCH DESERVED OTHER
OTHERS IN SUPPORT.
BETTER THAN I WITH THE EAST BAY
COMMUNITY LAW CENTER ON BEHALF
OF A COALITION OF OVER FIFTEEN
ORGANIZATIONS ACROSS THE STATE
OF CALIFORNIA ABOVE SUBMITTED
LETTERS OF SUPPORT. WE ARE IN
SUPPORT OF AB THIRTY THIRTY
NINE.
HELLO SABRINA CHRIS SAID HE WITH
ALL OF US ARE NONE IN STRONG
SUPPORT.
ERICA TING GOING ON BEHALF OF
POLICY LINK IN THE ALLIANCE FOR
BOYS AND MEN OF COLOR IN STRONG
SUPPORT THINK YOU.
THREE ONE IN OPPOSITION.
WHEN IT WAS RECORDED A LOT LIKE
TO SUPPORT ALSO ON THE SPEAKING
MAYBE HALF A LOT OF THE FANS
THAT ARE OUT THERE THANK YOU
THANK YOU THANK YOU SORRY.
GOOD AFTERNOON MISTER CHAIR AND
COMMITTEE MEMBERS.
MY NAME IS DAVID MAGNETO AND THE
ADMINISTRATOR FOR THE SACRAMENTO
COUNTY EMERGENCY MEDICAL SERVICE
AGENCY.
AND ON BEHALF OF THE EMERGENCY
MEDICAL SERVICE.
ADMINISTRATORS ASSOCIATION OF
CALIFORNIA I AM CURRENTLY A
PARAMEDIC LICENSE IN THE STATE
OF CALIFORNIA. FOR OVER TWENTY
YEARS AND AN EMT THAT'S BEEN
CENTER CERTIFIED IN THE STATE OF
CALIFORNIA. OF FOR OVER THIRTY
FIVE YEARS TWELVE THIRTY OF
THOSE YEARS BEING WITH THE
CALIFORNIA HIGHWAY PATROL.
I'M FOR BEFORE YOU TODAY.
TO EXPRESS M. SACKS CONCERN
REGARDING THIS BILL.
FIRST WE BELIEVE IT IS IMPORTANT
TO HOLD PARAMEDICS AND IAN TV'S.
TO A HIGHER STANDARD.
DUE TO THE NATURE OF THEIR WORK.
MANY OF THEIR PATIENTS ARE.
ELDERLY.
THE INFIRM AND ALONE.
THEY HAVE VERY LIMITED DIRECT
SUPERVISION Y. THERE ON A CALL.
IN THEIR ACCESS TO PATIENTS
IDENTITIES VALUABLES AND
MEDICATIONS ARE WIDELY OPEN.
LOCAL EMS AGENCIES ROUTINELY
CERTIFY.
EMTS WITH PAST CONVICTIONS.
THESE INDIVIDUALS MUST COMPLETE
THEIR PROBATION.
ALL COURT ORDERED REQUIREMENTS.
AND CURRENTLY LOCAL YOU MISS
AGENCIES USE THE EXISTING
LEGISLATIVE FRAMEWORK TO GUIDE
US IN OUR DECISION MAKING.
PROCESS.
WHEN A PERSON IS REHABILITATED.
SUCH AS IF THEY'VE COMPLETED ALL
THE COURT REQUIREMENTS.
THEY ARE ELIGIBLE FOR
CERTIFICATION.
BOTH THEIR ONLY A FEW EXCEPTIONS
SUCH AS PENAL CODE TO NINETY
CONVICTIONS AND MURDER. AND
CURRENTLY AS AN ADMINISTRATOR I
HAVE FOUR NEW. EMT APPLIQUE
APPLICANTS.
WHO HAVE SUBMITTED ALL THEIR
DOCUMENTS?
I'M WAITING FOR THE COURT
DOCUMENTS.
TO REVIEW ALL OF THEM HAVING
PRIOR CONVICTIONS.
AND SHOWING TRENDS.
BUT AS I LOOK AT THEIR BASIC
PEOPLE WORK RIGHT NOW.
EVEN WITH THEIR CONVICTIONS
THOSE FOUR WILL PROBABLY MOVE ON
TO BE CERTIFIED.
WE UNDERSTAND AND EMPATHIZE WITH
ASSEMBLY MEMBER RACES OBJECTIVES
HOWEVER.
WE'D LIKE TO NOTE THAT
FIREFIGHTERS ARE NOT CURRENTLY.
REQUIRED BY STATUTE TO HOLD AN
EMT OR PARAMEDIC CREDENTIAL.
BASIC PUBLIC SAFETY FOR STATE IS
ALL THAT IS REQUIRED. UNDER
STATUTE.
AND CAL FIRE WIDELY WILDLAND
FIREFIGHTERS ARE TRAINED.
TO BE FOR STATE CERTIFY
STANDARD.
AB TWO TWENTY TWO NINETY THREE
RESTRICTS THE CONSIDERATIONS OF
VIOLATIONS TO ONLY.
DODD ON DUTY BEHAVIOR HOWEVER WE
BELIEVE THAT THESE OFF DUTY
VIOLATIONS THAT WORK
CONSIDERATIONS SUCH AS DRIVING
UNDER THE INFLUENCE. DIRECTLY
RELATES TO ONE'S ABILITY TO
QUARK.
A FORM SAFELY WHILE ON DUTY.
IT'S THEIR PERSONAL CHOICES AND
A BILLY TO BE RESPONSIBLE. FOR
ONE'S ACTIONS THAT NEED TO BE
MONITORED AND HELD ACCOUNTABLE
ONCE THEY ARE CERTIFIED AS A.
EMT.
THE OLD THE EMS ADMINISTRATORS
ARE WILLING TO WORK WITH
STAKEHOLDERS AND EMS AUTHORITY
TO EVALUATE OUR EXISTING
REGULATIONS AND GUIDELINES TO
DETERMINE. THE UNNECESSARY
BOUNDARIES TO LICENSE YOUR
THANK YOU.
GOOD AFTERNOON STRUCTURE MEMBERS
OF THE COMMITTEE MY NAME'S KEVIN
BACK HIM A BOARD CERTIFIED
EMERGENCY PHYSICIAN I'M ALSO THE
CURRENT PRESIDENT. OF EMERGENCY
MEDICAL DIRECTORS ASSOCIATION OF
CALIFORNIA WHICH IS REPRESENTING
THE THIRTY THREE MEDICAL
DIRECTORS. THAT OVER THAT
STATUTORY AUTHORITY OVER THE
FIFTY COUNTIES IN THE STATE OF
CALIFORNIA.
I'VE SERVED AS MEDICAL DIRECTOR
ONE THE CMS AGENCIES FOR TEN
YEARS.
AND ARE I I CAN KNOWLEDGE THE
AUTHOR'S INTENT TO EXPAND THAT
CALIFORNIA'S FIREFIGHTING
CAPACITY. HOWEVER I'M GONNA TAKE
A BRIEF MOMENT SPUN YOU WHY THIS
BILL IS BOTH UNNECESSARY WINE
FORTUNATELY I HAVE TO OPPOSE IT.
THE LOCAL A MESS AGENCIES WITH
THEIR MEDICAL DIRECTORS ARE
CHARGED.
THE CERTIFICATION OF EMTS THIS
IS AN AWESOME RESPONSIBILITY.
BECAUSE THESE MEN AND WOMEN
RESPONDED TO THE HOMES OF OUR OF
OUR LOVED ONES IN OUR FAMILY
MEMBERS IN ADDITION IS MR BANG
KNOW POINTED OUT. ARE INVALID
INFIRMED AND PEOPLE AT RISK.
THIS IS THERE'S VERY LITTLE
DIRECT SUPERVISION OF THE CMT'S
WALL THEY'RE CHARGING THEIR
EMERGENCY CARE I'D EMPHASIZE
DIRECT THAT'S VISUAL ON SITE.
WHICH IS WHY LOCAL AMOS AGENCIES
HOLD THESE INDIVIDUALS TO A VERY
HIGH STANDARD.
WE HAVE CURRENT EXISTING
OPERATIONAL LEGISLATIVE
FRAMEWORK THAT THE MESSAGES HE'S
WORK UNDER TO GUIDE US.
WHEN A PERSON HAS PARTY LEGAL
TROUBLES.
AND WE DO CERTIFY THOSE.
ARE WITH PRIOR CONVICTIONS SO
LONG AS IF COMPLETED OF THEIR
COURT IMPOSED REQUIREMENTS
HOWEVER WE ALSO RIGHTFULLY
DISALLOW CERTIFICATION FOR THOSE
WHO'VE COMMITTED SEVERE
PENALTIES LA SUCH AS.
A PENAL CODE TO NINETY IN
VIOLENT FELONIES IN ADDITION AB
TWENTY TWO NINETY THREE A ROADS
ARE EXISTING AUTHORITY TO
MAINTAIN ACCOUNTABILITY. FOR
THOSE WHO HAVE PARDEE YOU WISE
OFF DUTY ACTS
AND THE MONITOR FITNESS TO
PERFORM LIFE SAVING TASKS.
FIREFIGHTERS PARTICULARLY
CALIFORNIA DEPARTMENT OF
FORESTRY FIREFIGHTERS ARE
ALLOWED TO BUT ARE NOT REQUIRED
TO BECOME EMTS.
CDF WILDLAND FIREFIGHTERS ARE
TRAINED BASIC FIRST DAY.
WHILE I CERTAINLY UNDERSTAND THE
AUTHOR FOR THE INTENT HERE IS
MEDICAL DIRECTOR THAT SIGNED THE
CERTIFICATION CARDS OF HUNDREDS
OF EMTS AND PARAMEDICS.
I'M CERTAIN WE CAN ACCOMPLISH
HER OBJECTIVE BY WORKING WITH
THE STATE EMS OF FORTY AND
STAKEHOLDERS UNDER CURRENT
LEGISLATIVE FRAMEWORK. TO
EVALUATE AND ADDRESS ANY
UNNECESSARY BARRIERS TO LICENSE
FROM CERTIFICATION
FOR THESE REASONS THE EMERGENCY
MEDICAL DIRECTOR ASSOCIATION OF
CALIFORNIA.
MUST REGRETFULLY OPPOSE AB
TWENTY TWO NINETY THREE THANK
YOU FOR YOUR TIME.
BUT AND OTHER OTHERS IN
OPPOSITION.
SEEING NO MORE BRING IT BACK TO
THE COMMITTEE FOR QUESTIONS OR
COMMENTS MISTER FLOOR.
AND THE PACIFIC THANK YOU TO THE
AUTHOR FOR BRINGING THIS UP
AROUND. I DO APOLOGIZE I'M HAVE
TO SPEAK IN OPPOSITION TO THIS
PARTICULAR BILL. THERE WAS A LOT
SAID TODAY ABOUT HELLFIRE IN THE
FIRE SERVICE IN.
AS YOU MAY KNOW THAT THAT IS
ACTUALLY WHERE I COME FROM I
WORK FOR CAL FIRE FOR A NUMBER
OF YEARS. AND IN THEIR MINIMUM
QUALIFICATIONS IT'S EIGHTEEN
YEARS OLD.
PERIOD.
SO THERE IS NO THIS CORRELATION
BETWEEN THE FIRE SERVICE AND AN
EMT TRAINING.
SPACES RELEASED A CAL FIRE IS
NOT EXACTLY ACCURATE.
BECAUSE IT IN THEIR OWN HOME.
QUALIFICATIONS SO JUST MAKE A
NOTE OF THAT BECAUSE I AM
CONCERNED.
AS AN EMT MYSELF AS A PARENT I
WENT TO PARAMEDIC SCHOOL IN SAN
JOAQUIN COUNTY.
WHEN WE GO INTO THESE HOMES.
THESE ARE TYPICALLY THE WORST
DAY THAT THESE PEOPLE NEVER HAD.
AND WHEN WE WALK INTO THEM THEY
HAVE TO HAVE THE UTMOST TRUST.
THAT THE PEOPLE THAT ARE THERE
TO HELP THEM.
ARE NOT GONNA DO SOMETHING.
TO HARM THEM
AND I FEEL BAD TO SPEAK
OPPOSITION THIS BILL BECAUSE
I'VE WORKED WITH EX CONS AT CAL
FIRE.
TWO THE GUYS I WORK WITH THE SAN
ANDREAS WERE FORMALLY
INCARCERATED AND SOME OF THE
BEST GUYS I'VE EVER MET MY LIFE.
AND THEY'RE INCREDIBLE HUMAN
BEINGS AND THEY HAVE A PATH TO
BECOME INCREDIBLE AND SUCCESSFUL
MEMBERS OF OUR SOCIETY WHICH IS
INCREDIBLY IMPORTANT.
BUT IF YOU'RE A RECOVERING
ALCOHOLIC
YOU PROBABLY SHOULD WORK IN A
BAR.
IF YOUR BANK ROBBER YOU PROBABLY
SHOULDN'T WORK AT A BANK TELLER.
AND SO WHEN WE TALK ABOUT THESE
FOLKS WHEN WE TAKE A PATIENT IN
THE HOSPITAL WE LOADED UP INTO
THE BACK OF AN AMBULANCE.
A LOT OF TIMES THEY DON'T HAVE A
MEDALIST.
BUT THIS HAS A BAG OF PILLS.
AND WE TAKE HIM TO THE ER WITH
US AND THE DOCTOR GOES THROUGH
THOSE OR THE MEDIC ON THE CALL
SO WE CAN TRY TO FIGURE OUT
WHAT'S GOING ON WITH THIS
PATIENT WHAT SUMMERS PREVIOUS
MEDICAL HISTORY MAY BE.
IT BE VERY VERY EASY TO TEMPT
SOMEBODY INTO.
SOME OF THE BEHAVIOR THAT THEY
MAY OR MAY NOT OF HAD IN THE
PAST AND OTHERS MY CONCERN IS.
WE WANT TO HELP THESE FOLKS OUT
WE WANT TO GET THEM TO BECOME
SUCCESSFUL. BUT IF THEY HAVE
ISSUES WITH SOME OF THESE THINGS
IN THE PAST
TO TEMPT THEM WITH THAT I THINK
IT COULD BE PROBLEMATIC FOR
THEIR OWN SUCCESS. SAYS MY
CONCERN TO THIS BILL AYE I DO
FILLED APOLOGIZE FOR BEING IN
OPPOSITION TO IT. BUT I DO THINK
THE EM THE FIREFIGHTER
CALIFORNIA I'M.
ANALOGY IS IS IS A GREAT
ANALOGY BECAUSE THAT'S A VERY
SUCCESSFUL PROGRAM. BUT IT
DOESN'T ACTUALLY RELATE TO THE
INDIAN THE LICENSURE THAT WE'RE
TALKING ABOUT IN THIS PARTICULAR
BILL THANK YOU VERSION.
TO BIGELOW.
CHYNA.
KIND OF PUT THAT IN PERSPECTIVE.
LIKE MY COLLEAGUE NEXT TO ME
OVER HERE HE GIVES A REALLY GOOD
SET OF REASONS.
KIND OF PUTTING IT IN
PERSPECTIVE FOR YOU. MY LICENSE
NUMBER IS ZERO ZERO ZERO THREE.
ONE AND TWO NO LONGER WITH US
TODAY SO MY HISTORY IN THE.
INDUSTRY IS PRETTY LENGTHY.
AND I UNDERSTAND.
.
HOW IT WORKS VERY WELL AND AND
AND LIKE?
THE PREVIOUS SPEAKER JUST SAID.
CALIPARI IF YOU'RE EIGHTEEN AND
BREATHING THEY WELCOME YOU AND.
YOU DON'T NEED US TO BE AN EMT
TO WORK THERE JUST HAVE THE
BASIC SKILLS IT IN BASIC FIRST
AID.
I'M NOT QUITE SURE WHAT WE'RE
TRYING TO ACHIEVE HERE.
AND AS THE ART DIRECTOR SPOKE A
MOMENT AGO. THE REAL THRUSTING
ISSUE FOR US IS.
THE SANCTITY OF CONFIDENCE WITH
THE PATIENT.
CRITICAL THAT WE HAVE.
THAT KIND OF CONFIDENCE IN THE
PEOPLE WHO WERE TREATING.
AS OUTLINED PREVIOUSLY WITH THE
PREVIOUS SPEAKER SO I'M NOT
QUITE SURE.
HOW THIS RESOLVES ANY OF THAT?
AND IN ESPECIALLY WHEN WE HAVE
FOLKS WHO OUTSIDE THE WORK
PARAMETER SOMETIMES STUMBLE IN
LIVE.
AND ARE UNABLE TO CONTINUE TO
PRACTICE.
OR UNABLE TO CONTINUE TO
PRACTICE BECAUSE THEY'VE.
MAYBE THEY'VE GOT A DUI ARREST
FOR SOMETHING THAT DOESN'T ALLOW
THEM TO HIM OUTSIDE THE
WORKPLACE.
TO CONTINUE ON FORTY CONTINUE
RECEIVING. ARE CONTINUING AT.
SUCH AS BOTH OF US.
I MEAN FOR MAY I EVER FOR THREE
MONTHS OUT OF EVERY YEAR EVERY
THURSDAY I GO HOME. AND TAKE A A
CONTINUING ED COURSE JUST KEEP
CURRENT.
AND SO I KIND OF. PERPLEXED
HERE SOME ASK YOU TRY TO HELP
GIVE US SOME.
GUIDANCE AND AN UNDERSTANDING OF
WHAT YOU'RE REALLY TRYING TO
ACHIEVE HERE BECAUSE IF I LOOK
AT THE FIRST PART OF THIS
PRESENTATION. IT DOESN'T
CORRELATE WITH THIS LATTER PART.
DEALING WITH THE BROADER SCOPE
OF FIRE.
WHAT HE REALLY TRYING TO
ACCOMPLISH?
THERE ARE THE TWO AREAS AND IN A
MOMENT I'LL LET OUR. ORDER THEM.
SPEAKERS ALSO ADDRESS IT.
WELL LOOK AT EMTS
JUST IN GENERAL WERE LOOKING
FIREFIGHTERS.
AND IF WE DO KNOW THAT.
THIRTY PERCENT AND THIS IS JUST
ONE OF THE ONE OF THE GROUPS
THAT NEEDS TO HAVE A LICENSE.
THIRTY PERCENT OF ALL JOBS
REQUIRE LICENSE
AND IT IT'S BEEN SAID BY SOME OF
THE SPEAKERS THAT. YOU YOU
PEOPLE MAKE MISTAKES.
YOU MAKE A MISTAKE AND YOU HAVE
A SOMETIMES
AND YOU COMPLETE YOUR SENTENCE
FOR SOME OF THEM IT BECOMES A
LIFE SENTENCE.
ESPECIALLY FOR PARTICULAR JOBS.
WE HAVE SPECIFICALLY EXCLUDED
ANY VIOLENT CRIME.
FROM FROM THE BILL.
SO WHEN ANY CONCERN THAT A
PERSON WOULD HAVE HAVING AN EMT
OR HAVING A FIREFIGHTER COME
INTO THEIR HOME I THINK IT WOULD
BE THE SAME CONCERN NO MATTER
WHAT.
YOU HAVING STRANGER WALK INTO
YOUR INTO YOUR INTO YOUR HOME.
BUT CLEARLY. BEFORE YOU GET THE
EMPTY BEFORE YOU GET THE JOB YOU
HAVE TO BE THAT IT. YOU HAVE TO
GO THROUGH THE PROCESS YOU'RE
NOT GUARANTEED A JOB JUST
BECAUSE YOU HAVE AN EMT LICENSE.
STILL HAVE TO GO THROUGH THE
PROCESS
AND THE EMPLOYER WILL STILL JUST
DECIDE WHO THEY'RE GOING TO
EMPLOY.
BUT MR CHURKIN I HAVE. CAN I
HAVE FOR THE RESPONSE PROVIDED.
YEAH I WOULD ALSO ADD A IN
RESPONSE TO A NUMBER OF THE
QUESTIONS BOMBER RELATING TO
ISSUES THAT ARE NOT IN THIS BILL
OF AND WHAT I MEAN IS. EARLY ON
THE MEMBER MENTIONED THAT.
SHE'S AGREEING TO THE A
DISCIPLINARY QUESTION SO
QUESTIONS IN TERMS OF WHETHER
SOMEONE FALLS OFF THE WAGON OR
GETS INTO TROUBLE WHILE THEY'RE
ON THE JOB WOULD NOT BE.
BE AN ISSUE HERE BECAUSE THIS
THE DISCIPLINARY PIECE WOULD
REMAIN THE SAME.
ALSO AS THE MEMBER STATED WERE
NOT INCLUDING.
VIOLENT.
FELONS UNDER SIX SIX POINTS
THAT.
SIX SIX SEVEN POINT FIVE WERE
ALSO NOT.
CHANGING WITH.
DRAMATICALLY THERE ARE.
TO NINETY SO.
WHEN YOU TALK ABOUT SORT OF
SEXUAL OFFENSES THAT WOULDN'T BE
IMPACTED HERE AS WELL ARM AND
THEN THE OTHER THING THAT I
WANTED TO MAKE SURE THAT WE
UNDERSTAND. IS THAT.
WHILE THERE MAY NOT BE A
REQUIREMENT FOR FIREFIGHTERS AT
CAL FIRE TO HAVE THE MT.
MOST. OF THE LOCAL AGENCIES.
DO REQUIRE IT AND AS A PRACTICAL
MATTER IF YOU DON'T HAVE EMT
YOU'RE GONNA HAVE A VERY HARD
TIME GETTING A JOB AS A
FIREFIGHTER AND THAT'S OUR
EXPERIENCE AND SO.
THOSE ISSUES THAT WE'RE TRYING
TO TO SOFT.
YEAH I WOULD JUST.
MAYBE MY EXPERIENCE IS DIFFERENT
BECAUSE I WORK WITH A MOMENT
DAILY BASIS.
AND I SEE WHO GETS HIRED WHO
DOESN'T GET HIRED.
BUTTON TO MY KNOWLEDGE.
ANYWAY IT SHOWS UP AND FILLED
OUT THE APPLICATION.
.
FOR THE MOST PART.
GETS ACCEPTED.
RIGHT AWAY AND THEN THEY'RE PUT
INTO THROUGH A FORTY HOUR BASIC.
OPS.
PROGRAM WHERE THEY GET THEIR
BASIC TRAINING.
AND FROM THERE THEY CAN EXPAND
GO ON TO THE NEXT LEVEL AND DO
THEIR HUNDRED SIXTY HOUR
TRAINING WHERE THEY'LL GET THEIR
DRIVER OPERATOR. AND ADDITIONAL
TRAININGS FOR WILDLAND AND
STRUCTURED TRAINING THAT GOES ON
FROM THERE DIDN'T LOOK MODE
MOVES ON OUT THOSE THAT WANT TO
GO ON TO GET DIFFERENT TWENTY
OUR.
TRAINING TO BECOME A A
NATIONALIZED.
EMT CERTAINLY CAN DO SO AND
THOSE THAT WANT TO JUST TAKE THE
STATE TRAINING WHICH I FORGET
WHAT THE HOURS ARE NOW.
ON THAT IS WHEN SIXTY SO YEAH.
AND.
THANKS FOR A GREAT GIFT.
SO THANK YOU FORGET.
.
THERE'S ZERO ZERO ZERO THREE
THAT'S WHY.
SOMETIMES.
I'M GETTING BORED ALONE.
THAT WAS NICELY DONE NICELY DONE
BAD HUMOR BAD HUMOR.
BUT.
IF YOU LOOK AT IT.
IN THAT NOW I DAY IT WAS A
HUNDRED TWENTY HOURS.
WE GOING TO HUNDRED SIXTY HOURS.
WHAT WAS REQUIRED DAN IS ALMOST
A MIRROR OF WHAT WE HAVE TODAY
THOUGH? AND AND. THE CHALLENGES
THOUGH WE'VE NOW CAN GO ON AND
GET THE THE NATIONALIZED LEVEL
WHERE WE CAN PRACTICE IN ANY
STATE WHICH I HAVE DONE.
THAT TAKES A GREAT DEAL OF
CONCENTRATION AND AND STUDY BUT
BACK HERE POINT.
FOLKS AT THE FIRE DEPARTMENT.
THAT ONE GOING TO BE A COMMON
EMT THAT'S ON THEIR TIME.
AND IN SOME FIRE DEPARTMENTS YOU
ACTUALLY PAY FOR YOU IF YOU WANT
ONE BUT THEY DON'T HOLD YOU
BACK.
LEAST EVERY FOUR DIFFERENT I
WORKED WITH IN HIS STATE SO I
I'M JUST A LITTLE PERPLEXED AND
MAYBE IN IS NOT ABLE TO GET
ACROSS THE LINE TODAY. AND
WOULDN'T BE ABLE TO ENCOURAGE
ANY OTHER MEMBER APPEARED TO
RECOGNIZE THE VALUE OF THIS BILL
AT THIS TIME.
BUT I APPRECIATE YOU PERCENT
THANK YOU.
THANK YOU THANK YOU FOR YOUR
INPUT.
ESTIMATES.
SO WHAT WHEN I FIRST THE.
LOOK AT THIS AND STAFF
RECOMMENDATION WAS AN OPPOSE AND
AS I BEGAN TO DIG INTO IT A
LITTLE BIT MORE.
I BECAME BEST SYMPATHETIC TO
THE CAUSE.
IT BECAUSE I THINK IN OUR
SOCIETY WE'VE GONE TOO FAR WHEN
YOU START TO THINK ABOUT PEOPLE
MAKE MISTAKES.
COMING FROM PREACHER'S KID BOMB
I WOULD SAY SEN HAPPENS.
.
AND.
WHEN WHAT WHEN IT WHEN IT
HAPPENS.
IT SEEMS AS THOUGH WE DON'T
JUST PUNISH YOUR AND THEN AFTER
PUNISHMENT THERE'S FORGIVENESS
IN THERE'S REDEMPTION IT SAYS IF
YOU NOW HAVE TO. BE FORGIVEN
OVER AND OVER AND OVER AGAIN AND
THEN AT THE PUNISHMENT AND THAT
BEING THE BECOMING A GREATER
THAN WHAT WHAT WAS ACTUALLY OF
SHOULD HAVE BEEN.
AND THEN SOME AS I'M LISTENING
I'M ALSO SYMPATHETIC TO HEARING
THESE GUYS TO MY LEFT.
BUT WHO HAVE BEEN IN THE
SERVICE AND UNDERSTAND IT BETTER
THAN A BETTER THAN I DO. BUT
THEN IT SEEMS AS THOUGH MAYBE
THERE'S.
AT SOME MIDDLE GROUND A THAT
THAT'S THAT'S HERE.
.
BECAUSE ALSO THEY JUST PUBLIC
LIABILITY FOR SOME THESE
AGENCIES AS WELL SO IS THERE IS
THERE IT IS THERE SOME MIDDLE
GROUND THAT YOU GUYS CAN FIND.
UNDERSTANDING WHAT MISS RACES
IS TRYING TO DO HERE IS THERE
SOME WAY OF BEING ABLE TO. ADD
TO TO THE TO TO ADDRESS THE
PROBLEM.
AND MAYBE FIND SOME AMENDMENTS
TO MAKE IT HAPPEN.
ABSOLUTELY SIR THERE IS MIDDLE
GROUND I BELIEVE.
IS AYE IS WE MENTIONED WE WE
BELIEVE THAT THIS IS.
HAY THAT THIS BILL HAS
OPPORTUNITIES ARM BUT THE
IMPORTANT POINT IS THE FACT WARY
HAVE A PROCESS IN PLACE.
IS MR MAGNETO POINT OUT HE
REVIEWS THESE ALREADY I DO AS
MEDICAL DIRECTOR SO THIS ISN'T
SOMETHING THAT'S NOT CURRENTLY
HAPPENING ALREADY NEMS AGENCIES
THROUGHOUT THE STATE.
WHAT'S THE PROCESS FOR YOU GUYS
WHEN.
BECAUSE IT SEEMS LIKE THIS IS
FOR EXISTING LICENSE HOLDERS AS
WELL IF SOMEBODY DOES SOMETHING.
NOT IN THE LINE OF WORK.
IF SOMEBODY GOT IT DO YOU LIE
THAT IS THEIR LICENSE GET PULLED
IT RIGHT AWAY WHAT PROCESS DO
YOU HAVE WHAT KIND OF DISCRETION
DO YOU HAVE. AND THEN WHAT KIND
OF. A JUDGMENT DO YOU USE TO
BUILD A SAY YEP THIS GUYS OR
GALS GOOD IN THIS ONE IS NOT
GOOD.
BOOK BECAUSE AGAIN I'M VERY
SYMPATHETIC TO THIS BECAUSE IT
SEEMS LIKE THERE'S SOME GOOD
PEOPLE THAT MIGHT BE LEFT OUT
BECAUSE THEY'VE DONE SOMETHING
WRONG.
FIVE YEARS AGO TEN YEARS AGO
FIFTEEN YEARS AGO.
AND THERE'S NO THREAT.
OF OF ANY IF ANY HARM IN DOING
THE WORK SO WHAT.
IT WHETTED MY IDEAS COME UP WITH
THAT.
THERE IS THAT THE PROCESS IS IS
WHEN WE GET A. REPORT BACK FROM
THE DEPARTMENT OF JUSTICE THAT
AN EMT ADD THAT WE HAVE
CERTIFIED FOR INSTANCE.
HAS BEEN ARRESTED. IT STARTS
THE PROCESS SO ONCE THEY'RE DONE
WITH THEIR COURT CASE.
WE'D START LOOKING WE REQUEST
THE COURT DOCUMENTS
WHAT DID THEY.
WHAT WAS THERE CONVICTION HOW
LONG AGO AND IT'S BOTH FOR NEW
APPLICANTS AND?
RE CERTIFYING A EMTS ALSO WE USE
THE SAME PROCESS.
SO ONCE WE GET ALL THE DOCUMENTS
AND WE FIND OUT.
WHAT THEIR CONVICTION WAS WHAT
THE COURT ORDERED DID THEY
COMPLETE THE COURT REQUIREMENTS?
HOW LONG AGO THE THE CONVICTION
MAY HAVE BEEN?
WE PUT WE LOOK AT IT ALL AND
DOES IT MEET THE MODEL DISCOVERY
GUIDELINES
THAT PART ESTABLISHED.
BY THE STATE WHICH ALL THE
STAKEHOLDERS HAD IT APART AND
BACK INTO THE EARLY TWO THOUSAND
TEN.
THEN THE ADMINISTRATOR WILL MAKE
A RECOMMENDATION TO OUR MEDICAL
DIRECTOR YES THIS PERSON FOR
INSTANCE HAD FIRST TIME THE U.
WHY.
THEY ARE CURRENTLY EMPLOYED BY
THEIR EMPLOYER. AND THEY'VE DONE
ALL OF THE REQUIREMENTS THAT THE
COURT REQUESTED THEM.
WE FEEL THAT THIS PERSON IS
EIGHTEEN YOU WITH THEIR
RECERTIFICATION OR THEIR NEW
CERTIFICATION.
IN THE FOUR YEARS THAT I'VE BEEN
THE ADMINISTRATOR AT SACRAMENTO
COUNTY I'VE APPROVED.
PROBABLY CLOSE TO TWO THOUSAND
NEW AND RECERTIFY AND.
EMTS AND I'VE I'VE ONLY HAD ONE
WHERE I'VE HAD RECOMMENDED
DENIAL.
INTO REVOCATION OF THAT EMT
CERTIFICATION BECAUSE HE WAS
UNDER THE INFLUENCE.
WHILE ON DUTY.
SO WE HAVE THOSE PROCESSES IN
SACRAMENTO COUNTY IS NOT ONE OF
THE LARGEST AGENCIES BUT WHERE
LIKE SIXTEEN. IN NUMBERS BUT I
ALSO HAVE TO CERTIFY ALL THE
STATE.
AGENCIES SUCH AS CAL FIRE CHP.
PARK AND REC IF THEY HAVE AN E.
N. T..
THEY HAVE TO BECAUSE THEY'RE
HEADQUARTERED HERE IN SACRAMENTO
THE WAY THE STATUTE TO WRITTEN.
MY AGENCY OR THE WHAT IS THE ONE
THAT.
REVIEWS SOME AND APPROVES THEM
AND.
KEEP SOME CERTIFIED SO I HAVE
NOT JUST.
THE EMTS WITHIN THE COUNTY.
I HAVE BETWEEN ALL MY PROBABLY
WITH THE STATE AGENCIES I'M
LOOKING AT PROBABLY CLOSE TO TEN
THOUSAND EMTS IN THAT I CERTIFY.
REGULARLY SO THE PROCESS WORKS
AND IT WORKS IN ALL AGENCIES OF
ALL THIRTY THREE OF US.
MISTER RODRIGUEZ.
I THANK THE MEMBER FROM ARE
BRINGING THIS BILL FORWARD.
ANOTHER TORN AS I I SEE WHAT
YOU'RE TRYING TO DO IT AND I
THINK I ONE OF MY COLLEAGUES
HAVE TOOK THE WORDS OUT OF MY
MOUTH WHEN HE TALKED ABOUT.
YOU NOT AS AS AN EMT IF YOU'RE
WORKING OUT THERE.
REALLY DON'T HAVE A LOT OF
SUPERVISION WAS JUST YOU AND
YOUR PARTNER IN IN DEALING WITH
WITH PATIENTS AT THE WORST.
IN DEALING WITH PERSONAL
BELONGINGS AS WELL.
BUT ONE THING I MUST SAY YOU
NOT.
NOT BEING A FIREFIGHTER MYSELF
BUT BEING.
DISPATCHED TO WILDFIRES WITH.
.
FIRE PERSONNEL I CAN TELL YOU
THAT.
.
THOSE CAMP CREWS ARE IMMIGRANTS
HOW PEOPLE REFER THEM TO ONE OF
THE HARDEST WORKING GUYS OUT
THERE I THINK.
.
OUR COLLEAGUES ARE HERE CAN CAN.
CAN. AGREE WITH ME ON THAT THE
OTHER THE HARDEST WORKING GUYS
NOTHING ON THE FIRE LINE. I'VE
SEEN THEM I I'VE TING CARE SOME
OF THEM IF THEY GOT HURT.
BUT THEN OPPOSED IT PUTS ME AT
AN AWKWARD SITUATION ON ON THE
OTHER END OF IT. AS AN EMT AND
AND.
AND I THINK MOTHER KALI TALKED
ABOUT IT. NOT EVERY DEPARTMENT
REQUIRES A INTO LICENSE.
I'M SOME OF SOME DO AND SOME
DON'T SO I GUESS IN A SENSE IT
LIMITS.
YOUR AVAILABILITY RIGHT THAT YOU
CAN ONLY APPLY FOR CERTAIN
DEPARTMENTS
AND I THINK MAYBE AS.
TIME CHANGES MORE DEPARTMENTS
WILL START REQUIRING THAT.
BUT RIGHT NOW THEIR LIMITED
BECAUSE OF THAT NATURE.
.
SO WITH THAT SAID IT IS I'M TORN
BECAUSE YOU'RE TRYING TO DO GIVE
THEM A CHANCE I KNOW WE TALKED
ABOUT COUPLE PENAL CODES ABOUT
THE SECTIONS ABOUT.
THE TYPES OF CRIMES I DON'T KNOW
WHAT THOSE ARE SO MAYBE. IF
SOMEBODY OR THE MEMBER CONSENT
TO THE LIST OF WHAT WHAT KIND OF
CRIMES THAT WOULD BE. FALL
UNDER.
AND.
SECOND LOOK AT A LITTLE BIT
MORE.
I IN ON THE OTHER HAND TO.
.
WE TALK ABOUT WHEN OFFICE WHEN
INDIVIDUALS.
GET A ARE CAUGHT RIGHT OR THIS
THE DRUNK DRIVER AND WHATEVER WE
TALKED ABOUT THE PROCESS.
IT IS THERE A TIME LIMIT ON THAT
PROCESS WHETHER IT'S SIX MONTHS
A YEAR OR. IF SOMEBODY GETS
ARRESTED FOR THE DRUNK DRIVING
IS GOING TAKE FOR FIVE YEARS OR
OR OR DO WE LOOK AT.
GIVEN THIS PERSON THAT MAY HAVE
HAD AN ISSUE TOOK CORRECTED AND
COME BACK IS IS THERE ANY TALK
ABOUT. THAT TIME FRAME OF MISS.
THE OTHER CURRENT STATUTE
DOESN'T.
STATE A TIME LINE FOR THEY
PROCESS TO GO THROUGH. AS I SAID
BEFORE WE WE TRY TO WAIT INTELL.
THEIR CONVICTION IS DONE IN THE
COURT.
AND UNFORTUNATELY SOMETIMES
THAT TAKES A LOT.
AWHILE AGO MOST OF THE AGENCIES
THAT I DEAL WITH HERE IN
SACRAMENTO COUNTY. A THEY WILL
CONTINUE TO ALLOW THEIR EMPLOYEE
TO WORK WHETHER GOING THROUGH
THE COURT PROCESS.
BECAUSE THEY'RE LIGHT THEIR
CERTIFICATION IS STILL GOOD
UNTIL MY AGENCY TAKE SOME TYPE
OF ACTION ON IT.
WITH IT. AGAIN FIRST TIME DI Y.
FIRST TIME.
STAFF BASED ON WHAT IT IS.
WILL WILL WILL MAKE THE
RECOMMENDATION OF JUST DOING A
PROBATIONARY TYPE. CERTIFICATION
WHERE THEY CAN CONTINUE TO WORK.
BUT THEY HAVE TO CHECK IN WITH
MY AGENCY AND DO CERTAIN THINGS.
DURING THAT PROBATION BUT MOST
OF THE TIME THAT'S NOT UNTIL
AFTER THEIR COURT CASES.
THEN I JUST ONE MORE QUESTION
COMES TO MIND.
SO SAY IF.
THIS BILL MOVES FORWARD IT GETS
SIGNED BY THE GOVERNOR.
AND WE GIVE THESE INDIVIDUALS AT
THE SECOND CHANCE AT LIFE SO TO
SPEAK TO GET THEIR EMPTY
LICENSE.
SO I'M THINKING ABOUT.
SO IF I CAN GET MY EMT LICENSE
EVEN THOUGH I MAY HAVE HAD A
PASSPORT WE'VE YOU KNOW TO CARE
THAT.
BUT SOME OF THESE FIRE
DEPARTMENTS MAY HAVE AN ISSUE IF
YOU'RE LOOKING THE APPLY THE
FIRE DEPARTMENT. NOW THEY HAVE
THEIR OWN SETS OF EMPLOYMENT
QUALIFICATIONS OR SPEAK.
SUTTER OF THAT'S GOING TO POSE A
CHALLENGE FROM SO HERE I WANT TO
GET THEIR HOPES UP.
I GOT INTO LICENSE TODAY IN AND
THE YEAR I WANT TO GET HARD BY
THIS DEPARTMENT OF THAT
DEPARTMENT BUT THEN AS THEY DO
APPLY GO THROUGH THE PROCESS.
GUESS WHAT.
YOU HAVE THE SENIOR RECORD FROM
FIVE YEARS AGO OR TEN YEARS AGO
SO IT'S GONNA BE ANOTHER
ROADBLOCK FROM THEM I DON'T KNOW
IF WE'VE LOOKED AT THAT WOULD IT
WOULD HE THINK.
WILL HAVE YOU LOOKED AT THAT
AND I DO WANT TO JUST FOR YOU
ASKED ABOUT THE THING VIOLENT
CRIMES.
WE HAVE INCLUDED LANGUAGE IN THE
BILL THAT ALLOWS THE REGULATING
AUTHORITIES.
STILL DENY LICENSE BASED ON THE
FOLLOWING.
DIRECTLY IN ADVERSELY RELATED
CONVICTIONS WITH OF THE
PRECEDING FIVE YEARS.
VIOLENT FELONIES AS DEFINED IN
THE PENAL CODE WE'RE NOT
CHANGING WHAT A VIOLENT CRIME
IS.
A VIOLENT FELONY IS ALREADY
DEFINED THEIR TWENTY THREE THEIR
DEFINED IN THE PENAL CODE.
THIS BILL DOES NOT.
READ TO FIND THAT THEY'RE
ALREADY DEFINED.
PLUS ANY FELONIES THAT WOULD
PLACE SOMEONE ON THE SEX OFFENSE
REGISTRY THEY'RE EXCLUDED FROM
THIS.
THE. WE THERE'S TALK ABOUT CAL
FIRE AND.
.
COURSE WE'RE TALKING TO AN
EXPERT TO ASSEMBLY MEMBER FLORA.
THAT IS HIS PROFESSION.
BUT THEY THE CALIFORNIA
PROFESSIONAL FIREFIGHTERS HAVE
YOU IN OUR DISCUSSIONS WITH THEM
THEY HAVE TOLD US IT IS OFTEN A
CONDITION OF EMPLOYMENT IN
MUNICIPAL FIRE DEPARTMENTS. THAT
THEY THAT THE APPLICANT BE HAVE
AN E. EMMAUS.
BUT OUR EMT LICENSE.
WE HAVE WORKED WITH THE HEALTH
COMMITTEE HERE WITH THE STAFF
TRIED TO COME UP WITH.
RESPOND TO MANY OF THE CONCERNS
THAT HAVE BEEN VOICED HERE
TODAY.
AND WE DO WELCOME THE M. EMSA
EMSA NEWS AND OTHER STAKEHOLDERS
INPUT.
BECAUSE WE WANT TO WORK
DILIGENTLY TOWARDS A RESOLUTION
THAT ADDRESSES THE CONCERNS THAT
HAVE BEEN VOICED HERE AND UP BY
THE BY MY MEMBERS.
WE WANT TO BE ABLE TO PROVIDE
THIS OPPORTUNITY.
IT'S JUST OPENING A DOOR WE'RE
NOT SAYING THAT THEY WILL
AUTOMATICALLY NOW BE HIRED AS AN
EMT OR THAT THEY WILL
AUTOMATICALLY BE.
HIRED AS A IS.
AS A FIREFIGHTER.
WELL WERE NOT PRECLUDING THEM
FROM MOVING IN THAT DIRECTION.
THEY'VE ALREADY DONE THAT TYPE
OF SERVICE WITH THE CONSERVATION
CAMP.
THERE WERE GOOD ENOUGH TO DO
WITH THEIR. AND WE NOW WANT TO
BE ABLE TO PROVIDE THAT EVEN TO
BE TO BE QUALIFIED THROUGH THE
CONSERVATION CAMP THEY HAVE TO
GO THROUGH QUITE A PROCEDURE. TO
BE ACCEPTED TO BE PUT ON THE
FRONT LINES.
TO BE FIRE FIGHTING OUT TO
TO TO TO JOIN WITH THE FIRE
FIGHTING.
SO THAT THERE IS AN ENTIRE
PROCESS THAT HAPPENS BEFORE THEY
CAN DO THAT. THEN OUR SAYING.
WOULD LIKE TO APPLY FOR THESE
JOBS BUT MANY OF THE JOBS WE
WANT TO APPLY FOR DO REQUIRED
THIS WE'RE JUST SAYING LET'S
OPEN THE DOOR SO THEY CAN APPLY.
AND IT ISN'T A NO AT THE MOMENT
THEY APPLY. THEY NOW WERE GIVEN
THAT OPPORTUNITY THERE NO
GUARANTEES THERE NO GUARANTEES
FOR ANY OF US WHEN WE TO OBTAIN
A LICENSE
BUT DOORS ARE SHUT WHEN YOU
DON'T HAVE THE LICENSE. AND WE
WANT TO BE ABLE TO PROVIDE THAT
OPPORTUNITY FOR THEM.
WELL THANK YOU SO I I'M I'M
LOOKING TO SUPPORT IT BUT I'M
GONNA AND RESERVE MY RIGHT SEE
HOW THINGS COME UP FOR GETS TO
THE FLOOR. BUT WE CONTINUE WORK
WITH OPPOSITION AND.
REDEFINING SOME OF THESE THINGS
AND AND MOVED AROUND LUGGAGE
PROCESS OF ONE THANK FOR BRING
UP FOR AND WE WILL CONTINUE TO
WORK WITH STAKEHOLDERS THANK
YOU.
CARILLO.
Q..
THANK THE AUTHOR FOR PRE.
YOU ARE A TEN.
COMMITTEE AND.
LIKELY AYE TO POINT OUT THAT
WHEN YOU'RE SUPPORTERS IS AN
ORGANIZATION CALLED HOMEBOY
INDUSTRIES.
WHICH IS IN THE FIFTY FIRST
ASSEMBLY DISTRICT STARTED BY
FATHER GREG BOYLE.
IN THE COMMUNITY THAT I GREW UP
IN.
OFTENTIMES WE TALK ABOUT AND
THEIR MOTTO IS JOBS NOT JAILS
NOTHING STOPS A BULLET LIKE A
JOB.
WE OFTEN TALK ABOUT THE NEED FOR
MORE FIREFIGHTERS MAUREEN TEASE
VARIOUS OTHER PROFESSIONS ACROSS
OUR STATE. I ALSO SAID ON PUBLIC
SAFETY. TODAY WE DISCUSSED A
SIMILAR PUMP WE HAD A SIMILAR
CONVERSATION IN TERMS OF.
HOW CALIFORNIA ANOTHE DEFIER
DEPARTMENTS ARE? ARE NOT ABLE TO
HIRE THE FIRE.
THE FIREFIGHTERS THAT THEY WOULD
LIKE BECAUSE OF CERTAIN
RESTRICTIONS.
WE HAVE HAD SO THE STATE HAS HAD
SEVERAL.
.
FIRES ACROSS OUR STATE THAT HAVE
USED PRISON LABOR TO PUT THOSE
OUT.
OFTENTIMES VISA. MEN AND WOMEN
WOULD LIKE TO HAVE THE
OPPORTUNITY TO CONTINUE DOING
THE WORK THAT THEY HAVE BEEN
TRAINED FOR. CENTER NOT ALLOWED
BECAUSE OF THE RESTRICTIONS THAT
WE HAVE ACROSS OUR STATE.
THE STATE OF CALIFORNIA HAS ALSO
DONE INCREDIBLE WORK ON CRIMINAL
JUSTICE REFORM. THAT HAS OPENED
UP THE OPPORTUNITY FOR MEN AND
WOMEN ACROSS OUR STATE TO BE
ABLE TO LEAVE PRISON.
AND BE REUNITED WITH THEIR
FAMILIES.
WE FACE A HOUSING CRISIS
WE FACE A HOMELESSNESS
POPULATION INCREASE.
WE FACE ALL KINDS OF DOCUMENTS
THAT.
THESE MEN AND WOMEN ARE FACING
WHEN THEY RETURN HOME AND MY
COMMUNITY WERE ALSO FACING
GENTRIFICATION. IT'S DONE FOLKS
COMING BACK GETTING OUT OF
PRISON FIND IN THEIR COMMUNITY
NOT BEING THE WAY THAT IT USED
TO BE. THERE'S A LACK OF JOBS
THERE'S A LACK OF OPPORTUNITY
THERE'S A LACK OF RESOURCES.
THIS IS THE AN IDEA I THINK IT'S
A.
IT'S IT'S A MEASURE IN WAYS THAT
WE CAN ACTUALLY. BRING MORE
PEOPLE IN.
IF YOU HAVE.
SERVED YOUR TIME.
IF YOU ARE WILLING TO DO THE
WORK
IF YOU DO NOT FALL WITHIN THE
GUIDELINES THAT YOU HAVE ALREADY
LAID OUT IN TERMS OF YOU ARE
NOT.
GOING TO ENDANGER THE LIVES OF
THOSE THAT YOU.
WOULD WANT TO SERVE.
THIS IS A STEP IN THE RIGHT
DIRECTION FOR STATE. AND SO I AM
MORE THAN COMMITTED TO TO
WORKING WITH YOUR WITH YOUR
OFFICE AND WITH THOSE THAT HAVE
CONCERNS IN TERMS OF. HOW DO WE
AT THE END OF THE DAY MAKE SURE
THAT PEOPLE HAVE JOBS?
THE PEOPLE HAVE OPPORTUNITY THAT
IF THEY WANT TO SERVE AND DO
THIS WORK WHICH IS NOT EASY.
AS MEMBERS OF THIS COMMITTEE
KNOW THAT YOU DO THIS YOU'VE
DONE THIS IN THE PAST.
THAT WOULD PROVIDE THOSE
OPPORTUNITIES
AND THEN WE SET THE EXAMPLE THAT
CALIFORNIA IS A STATE.
WERE YOU CAN. YOU IF YOU COMMIT
A CRIME AND YOU PAYER IF YOU
PAID WITH THEIR TIME. THE YOU
WILL HAVE AN OPPORTUNITY TO GET
A JOB AND START OVER AND LIVE A
LIFE AND LIVE AND NOT ONLY
SURVIVE BUT THRIVE.
AND BE GOOD AT WHAT YOU DO.
SO THANK YOU FOR BRINGING THIS
TO OUR ATTENTION THANK YOU FOR
TO THE COMMENTS THAT HAVE MADE
THE DIALOGUE.
WHAT IT IS NOW?
AND I HOPE THAT YOU I HOPE AND
I URGE MY COLLEAGUES TO VOTE YES
ON THIS MEASURE THINK.
THANK YOU MISTER CHAIRMAN LET OF
THE AUTHOR'S COMMITTED TO WORK
THE STATE OR SOME OF THE BILL.
THIS FIGURE SECOND.
SO.
.
ANY OTHER QUESTIONS OR COMMENTS
FROM COMMITTEE.
CNN WILL BRING IT BACK TO HIS
WRIST FOR CLOTHES I DO WANT TO
THANK.
COMMITTEE MEMBERS FOR YOUR
INPUT I THINK IT'S REALLY
IMPORTANT ESPECIALLY THOSE OF
YOU WHO HAVE THIS EXPERIENCE.
I APPRECIATE THE EXPERIENCES
ESPECIALLY OF THAT THE.
TO BIGELOW THE TO OF HAD.
MANY OTHERS HAVE NOT HAD THE
POSITIVE EXPERIENCES THAT YOU
HAVE
AND I THINK PROVIDING THOSE
OPPORTUNITIES IS EXTREMELY
IMPORTANT ESPECIALLY WHEN WE
KNOW THAT THERE ARE. CERTAIN
CRIMES ARE ALREADY EXCLUDED
WHAT.
I WANT THE SAFETY OF OF ANYBODY
WHO'S EVER SERVED BY IAN MANY
EMPTY OR FIREFIGHTER I WANT THAT
JUST AS MUCH AS ANYBODY ELSE
WOULD WANT THAT. I'M NOT TRYING
TO PUT SOMEONE IS GOING TO CAUSE
HARM.
ODE TO AND NOT TRY TO PUT THEM
IT IN THE HOME SOMEBODY WHO'S
VULNERABLE.
BUT I ABSOLUTELY WANT TO PROVIDE
THAT SECOND CHANCE TO SOMEONE
WHO IS PAID THEIR DEBT TO
SOCIETY SIMPLY TO OPEN THE DOORS
THEY STILL HAVE TO GO THROUGH
THE PROCESS AS ANYBODY ELSE
WOULD.
I GIVE THEM THAT OPPORTUNITY AND
I DO MAKE A COMMITMENT TO.
MISTER CHAIRMAN AND MEMBERS TO
CONTINUE TO WORK WITH THE
STAKEHOLDERS TO TRY TO FIND A
WAY THAT WE WILL ALL BE ABLE TO
WORK. TOWARDS PROVIDING THAT
SECOND
BRITTANY THAT SECOND CHANCE
AND I THINK THE COMMITTEE FOR
THEIR TIME AND RESPECTFULLY ASK
FOR YOU AYE VOTE.
FIRST OFF THANK YOU I WANNA
THANK YOU.
MISS MISS
REYES FOR ACCEPTING THE
AMENDMENT AND YOUR COMMITMENT TO
WANTING TO WORK WITH THE
STAKEHOLDERS I THINK YOU YOU.
YOU HEARD A LOT FROM PEOPLE
HERE TODAY AND I THINK THAT
THERE.
I THINK THESE ARE ALL REALLY
GOOD COMMENTS IN AND
CONSTRUCTIVE I THINK EVERYONE
APPRECIATES WHAT YOU'RE TRYING
TO ACCOMPLISH IN AND WANT TO SEE
THAT YOUR YOUR SUCCESSFUL.
BUT OBVIOUSLY THERE IS THERE IS
THERE IS THERE IS STILL SOME
SOME WORK TO DO SO YEAH.
THE THE BILL DOES TO ENJOY A DO
PASS RECOMMENDATION WE HAVE A
MOTION FROM MISTER MAYES A
SECOND FROM INSIDE YOUR CAREER
THE MOTION IS TO PASS AS AMENDED
TO APPROPRIATIONS. AND
AUTOMATICALLY CALL THE ROLL
WOULD I WOULD I MAYES MAYES AYE
AGAR CURRY. AYE HURRY AYE
BIGELOW. BIGELOW NO BONTA.
BURKE.
BURKE I CARILLO.
CARILLO AYE FLORA. FLORA NO LOW
MOAN.
MCCARTY MCCARTY AYE NAZARIAN.
RODRIGUEZ.
SANTIAGO THURMOND WALDRON.
WALDRON NO.
THE VOTE IS SIX THREE YOU STILL
NEED A COUPLE VOTES WE STILL
HAVE SOME MEMBERS MISSING SO
WE'LL PUT THAT ON CALL.
THANK YOU VERY MUCH SO.
SO AT THE RISK OF IRRITATING OF
COLLEAGUE OUT THERE I'VE I'VE
GIVEN MR ABDUCTOR INTO THE PIT
PERMISSION TO GO NEXT.
DUCK MISS I'M LOOKING AT MR
MAIENSCHEIN I HOPE THAT HE'S
NOT.
NOTHING PERSONAL MISTER INTO.
THERE'S ANOTHER TWIST HERE TO
USE DOCTOR AND WAS GONNA PRESENT
A BILL AND I'M GONNA CHO PRESENT
A SECOND GO.
THEY WILL GO TO MR MAIENSCHEIN.
AND THEN JUST TO MESS THINGS UP
A BIT MORE MR MCCARTY WILL
PRESENT. A BILL PRIOR TO OUR
SPECIAL SESSION OKAY.
AND HE GOT ALL THAT GOOD I'M
GLAD BECAUSE I. I'M NOT SURE I
CAN REPEAT IT. SO.
DOCTOR ARAMBULA YOU HAVE BEFORE
US.
ITEM NUMBER SEVENTEEN AB TWENTY
THREE EIGHTY FOUR.
THANK YOU MISTER CHAIRMAN BEFORE
I BEGAN I WANT TO SAY THAT I'M
GOING TO BE ACCEPTING THAT
COMMITTEE AMENDMENTS THANK YOU.
CALIFORNIA LIKE THE REST OF THE
NATION IS GRAPPLING WITH A
SERIOUS HEALTH CARE DILEMMA.
HOW TO USE OPIOID MEDICATION TO
RELIEVE PAIN SAFELY AND
EFFECTIVELY WHILE AT THE SAME
TIME REDUCING THE RISK OF
PRESCRIPTION MEDICATION MISUSE?
ADDICTION AND OVERDOSE.
AS AN EMERGENCY ROOM PHYSICIAN I
SAW THE IMPACT THAT OPIOID ABUSE
HAVE ON FAMILIES FIRST HAND.
I BELIEVE THAT WE NEED TO ENSURE
WE ARE USING OPIOIDS EFFECTIVELY
AND DO OUR BEST TO TREAT
SUBSTANCE USE DISORDERS.
AB TWENTY THREE EIGHTY FOUR WILL
CONTINUE TO ADVANCE CALIFORNIA
IN THE DIRECTION OF RECOVERY.
AS IT REMOVES BARRIERS TWO SOME%
OF THE MOST EFFECTIVE AND
INNOVATIVE TREATMENT OF
SUBSTANCE ABUSE DISORDERS AND
MEDICATION ASSISTED THERAPY.
COMMONLY REFERRED TO AS AN A.
T..
MIT AS THE USE OF MEDICATIONS IN
COMBINATION WITH COUNSELING AND
BEHAVIORAL THERAPIES.
TO PROVIDE A WHOLE PATIENT
APPROACH TO THE TREATMENT OF
SUBSTANCE USE DISORDERS.
RESEARCH SHOWS
THAT.
A COMBINATION OF MEDICATION AND
COUNSELLING THERAPY CAN
SUCCESSFULLY TREAT THESE
DISORDERS AND FOR SOME PEOPLE
STRUGGLING WITH ADDICTION. ME T.
CAN HELP AND SUSTAIN RECOVERY.
ACCORDING TO THE CALIFORNIA
HEALTH BENEFITS REVIEW PROGRAM
ANALYSIS OF THIS BILL.
THERE IS A CLEAR AND CONVINCING
EVIDENCE THAT MEDICATIONS USED
TO TREAT ME T. FOR OPIOID USE
DISORDER ARE MORE EFFECTIVE THAN
PLACEBO OR NO TREATMENT FOR
RETENTION OF PATIENTS.
AND TREATMENT ABSTINENCE
FROM OPIOIDS AND BIRTH OUTCOMES.
THIS ANALYSIS ALSO PROJECTS THAT
IN THE FIRST YEAR POST MANDATE
OF THIS BILL. WE WOULD DECREASE
ILLICIT DRUG USE DECREASE OPIOID
OVERDOSE
DECREASE OVERDOSE RELATED
MORTALITY.
A DECREASE POOR MATERNAL AND
FETAL OUTCOMES AND TO ALSO
DECREASE HIV AND HEPATITIS C.
TRANSMISSION AMONG ABOUT TEN
THOUSAND NEW CALIFORNIAN ME TWO
USERS.
MEDICATION USED AN MA T. ARE
APPROVED BY THE FEDERAL DRUG
ADMINISTRATION AN EMMY T.
PROGRAMS ARE CLINICALLY TRICK.
DRIVEN AND TAILORED TO MEET EACH
PATIENT'S NEEDS.
CALIFORNIA IS LEADING THE
COUNTRY AND MULTI YEAR REDUCTION
OF OVERDOSE DEATHS FROM
PRESCRIPTION OPIOIDS.
AND NOW WE HAVE A CHANCE TO LEAD
AND PROVIDING CRITICAL RECOVERY
SERVICES AS WELL.
AB TWENTY THREE EIGHTY FOUR WILL
HAVE A DIRECT AFFECT IN REMOVING
BARRIERS TO ACCESSING HIGH
QUALITY EVIDENCE BASED CARE.
WITH THESE MEASURES I HOPE WE
ARE ABLE TO REDUCE THE MISUSE OF
OPIOIDS WHILE ALSO EFFECTIVELY
RELIEVING PAIN.
HERE TO TESTIFY IN SUPPORT IS
MEGHAN ALLRED FROM THE
CALIFORNIA MEDICAL ASSOCIATION.
GOOD AFTERNOON CHAIR MEMBERS
MAKE IT ALRIGHT ON BEHALF OF THE
CALIFORNIA MEDICAL ASSOCIATION.
SPONSORS OF AB TWENTY THREE
EIGHTY FOUR.
IT'S ONE OF THINK THE AUTHOR FOR
BEING WILLING TO TAKE THIS ON WE
OF REALLY HAVE BEEN FOCUSED ON
SHIFTING THE CONVERSATION TO.
PREVENTION AND TREATMENT NOW
THAT WE HAVE TAKEN A LOT OF THE.
PRESCRIPTIONS OFF THE MARKET WE
NEED TO.
GIVE THAT.
GIVE OPTIONS FOR TREATMENT TO
THOSE WHO NEED IT.
IN TWENTY SIXTEEN MORE THAN TWO
POINT ONE MILLION PEOPLE AGED
TWELVE AND ORDER LAST YEAR MET
THE DIAGNOSTIC CRITERIA FOR AN
OPIOID USE DISORDER.
TREATMENT OF OPIOID USE DISORDER
WITH MEDICATION ASSISTANT
TREATMENT HAS BEEN SHOWN TO BE
COST EFFECTIVE. SAFE AND
SUCCESSFUL WHEN USED
APPROPRIATELY FURTHER OPIOID
MAINTENANCE THERAPIES HAVE NOT
ONLY BEEN SHOWN TO INCREASE
ABSENCE FROM ILLICIT OPIOIDS.
BUT ALSO BEEN SHOWN TO REDUCE
MORTALITY FROM OVERDOSE WITH
EVEN A FRIEND HAVING COME
COMPARABLE MORTALITY REDUCTIONS
COMPARED TO METHADONE.
I.
WHEN PHARMACOTHERAPY IS
RANDOMIZED AND NOT SELF SELECTED
BY THE PATIENT DESPITE THIS
EVIDENCE ONLY TEN PERCENT OF
AMERICANS SEEKING MAC WERE ABLE
TO ACCESS THAT WITH INSURANCE
UTILIZATION MANAGEMENT POLICIES.
POSING A SIGNIFICANT OBSTACLE.
MANY HEALTH PLANS USE PRIOR
AUTHORIZATION REAUTHORIZATION
FAIL FIRST CRITERIA.
AND PLACE ANNUAL OR LIFETIME
MEDICATION LIMITS AS A MEANS OF
REDUCING EXPENDITURES BUT IN
DOING SO RESTRICT ACCESS TO
THESE TREATMENT SERVICES.
WELL THESE POLICIES HAVE THE
INTENTION OF REDUCING AN
APPROPRIATE CARE THEY ALSO
INTERRUPT PATIENT CARE DURING A
TIME IN WHICH ONE DAY OR LAST
CAN MAKE ALL THE DIFFERENCE.
NOT TO MENTION DIVERTING
POSITION RESOURCES AWAY FROM
DIRECT PATIENT CARE. I TWENTY
SEVENTEEN CALIFORNIA'S SOCIETY
OF ADDICTION MEDICINE SURVEY.
SURVEY OUR SURVEY OF ITS
POSITION MEMBERSHIP INDICATED
THAT FIFTY SIX PERCENT OF
RESPONDENTS FOUND IT DIFFICULT
TO ACCESS MAP FOR PATIENTS NEW
TO TREATMENT DUE TO INSURANCE
CARRIERS. WITH FORTY ONE PERCENT
EXPERIENCING SITUATIONS WHERE
PATIENTS WENT WITHOUT TREATMENT.
AND JUST TO QUOTE THE.
I'M DOCTOR DAVID KAHN PRESIDENT
OF.
CALIFORNIA SOCIETY OF ADDICTION
MEDICINE.
I WE DON'T REQUIRE DIABETICS TO
PROVE THEY ARE ATTENDING
NUTRITION VISITS FOR THEIR
INSURANCE TO COVER INSULIN A
MEDICINE THAT IS DEADLY AN
OVERDOSE. HOWEVER INSURANCE
COMPANIES FREQUENTLY CUT
PATIENTS OFF TREATMENT IF WE
DON'T SUBMIT DETAILED CLINICAL
RECORDS PROVING ATTENDANCE AT
COUNSELING AND DRUG SCREENS
SHOWING PERFECT COMPLIANCE
SOMETHING WE DON'T SEE OR EXPECT
IN ANY OTHER CHRONIC DISEASE.
WITH THAT WE ASK YOUR SUPPORT.
OTHER SUPPORT THANK YOU MISTER
CHAIRMAN WAS YES OUT TOM RENT
FREE WITH THE COUNTY BEHAVIORAL
HEALTH DIRECTORS ASSOCIATION.
THIS BILL IS CRITICALLY
IMPORTANT FOR A GIVEN THE OPIOID
MISUSE AND HEROIN EPIDEMIC THAT
IS DEVASTATING MANY CALIFORNIA
COMMUNITIES AND WE JUST HEARD
YOUR UP SUPPORT FOR ALL THE
REASONS THAT MY COLLEAGUES HAVE
MENTIONED.
OTHER SUPPORT ASSN DUTCH CHAIR
MEMBERS TO MAD REPRESENT
CALIFORNIA CHAPTER OF AMERICAN
CALLS EMERGENCY PHYSICIANS IN
STRONG SUPPORT.
MISTER CHAIR MEMBERS FRED NUMBER
REPRESENTING FORMATIONS
THANK YOU.
MISSY JOHNSON ON BEHALF THE
CALIFORNIA PHARMACISTS
ASSOCIATION IN SUPPORT BAQIR.
CARRIE PARKER ON BEHALF OF THE
CALIFORNIA SOCIETY OF ADDICTION
MEDICINE IN SUPPORT.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY WITH THE AUTHORS
AMENDMENT WE'VE CHANGED OUR
POSITION FROM A SUPPORT TO
AMENDED TO SUPPORT.
GOOD AFTERNOON ALL OF IRAQ FOR A
CALIFORNIA LIFE SCIENCES
ASSOCIATION IN SUPPORT
INTRICATE.
RIGHT SPENCER THE CALVARY
ACADEMY OF FAMILY PHYSICIANS AND
SPORT.
RANDALL HAGER FOR THE CALIFORNIA
PSYCHIATRIC ASSOCIATION AND
SUPPORT.
GOOD AFTERNOON SEAMUS WITH
CROWLEY ON BEHALF OF THE
CALIFORNIA CHRONIC CARE
COALITION AND EL CAMINOS IN
SUPPORT.
BETH BELFORD HEALTHAXIS
CALIFORNIA WE WERE PREVIOUSLY
OPPOSE UNLESS AMENDED WE
APPRECIATE THE WORK OF THE
AUTHOR IN THE COMMITTEE. AND
WILL BE REMOVING OUR OPPOSITION
WANTS THE BILLS AND PRINT HOPE
WITH A FEW MORE POLY XING
AMENDMENTS WILL BE IN
WHOLEHEARTED SUPPORT THANK YOU
THINK.
ANYONE IN OPPOSITION.
MISTER CHAIR TOM RILEY WITH THE
AMERICAN COLLEGE OF PHYSICIANS
AND STRONG SUPPORT.
YEAH I MISTER CHAIR MEMBERS NICK
LOUISE US ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF HEALTH
PLANS THAT WERE IN OPPOSITION TO
THIS BILL.
I MISS TERM MEMBERS WE TOTALLY
AGREE THAT YOU IF YOU'RE CRISIS
IS A SERIOUS ISSUE. ON INDEED
CONCERNS ABOUT OPIOID MIS USE
ADDICTION AND OVERDOSES OF WHAT
HEALTH PLANS IN CALIFORNIA AND
NATIONALLY TO TAKE A LEADERSHIP
ROLE IN THIS AREA.
FOR EXAMPLE OUR SISTER TRADE
ASSOCIATION YOU AMERICA'S
ASSOCIATES AMERICA'S HEALTH
INSURANCE PLANS RECENTLY
LAUNCHED ITS SAFE TRANSPARENT
OPIOID PRESCRIBING INITIATIVE OR
THE STOP INITIATIVE. WHICH IS
DESIGNED TO SUPPORT WIDESPREAD
WIDESPREAD ADOPTION OF CLINICAL
GUIDELINES FOR PAIN CARE IN
OPIOID PRESCRIBING.
HEALTH PLANS HAVE CONSISTENTLY
SUPPORTED THE CDC'S OPIOID
GUIDELINES TO PROMOTE EVIDENCE
BASED.
PAIN CARE AND REDUCE UNNECESSARY
OPIOID PRESCRIBING.
.
MANY HEALTH PLANS HAVE ALREADY
INSTITUTED NEW PROGRAMS THAT ARE
HELPING TO DRAMATICALLY REDUCE
HOW MUCH AND HOW OFTEN. OPIOIDS
ARE PRESCRIBED.
AND IN ADDITION TO THAT ENSURING
THE AVAILABILITY OF MEDICATION
ASSISTED TREATMENTS FOR
ADDICTION WHICH IS THE SUBJECT
OF THIS BILL IS SOMETHING THAT'S
WIDELY SUPPORTED BY PLANS.
ON IN MAY BE MOVING TO ENCOURAGE
A MORE USE OF THESE DRUGS.
WELL WE DON'T OBJECT TO THE
OVERALL GOAL OF REDUCING OPIOID
USE IN CALIFORNIA. THIS BILL IS
VERY VERY BROAD FROM OUR OF.
PERSPECTIVE HOW WE VIEW THIS IS
KIND OF A SUPER DRUG MANDATE
THAT CONTAINS ALL THE GREATEST
HITS THAT WE'VE SEEN BEFORE IN
DRUG MANDATE BILLS.
IT REQUIRES ANY AND EVERY FDA
APPROVED DRUG TO BE COVERED BY
HEALTH PLAN EVEN FUTURE DRUGS
THAT WE OBVIOUSLY DON'T KNOW
ANYTHING ABOUT THAT THIS POINT
IN TIME.
AND MAY NOT BE ANY BETTER THAN
WHAT CURRENTLY EXISTS ON THE
MARKET WHETHER IT'S IN GENERIC
FORM AND OR OR ANY MORE COST
EFFICIENT FORM.
SOME ALL FDA APPROVED DRUGS
UNDER THIS BILL.
WOULD BE COVERED WITHOUT
CONSIDERATION MEDICAL NECESSITY
WE DON'T VIEW THAT THE
AMENDMENT.
THAT IS TAKING TODAY IS TOTALLY
FIXING THAT ISSUE AND WE OF
COURSE DO NOT COVER ANY DRUGS
THAT ARE.
MEDICALLY UNNECESSARY.
ABSOLUTELY NO UTILIZATION
MANAGEMENT LIKE PRIOR
AUTHORIZATION TO STEP THERAPY
WOULD BE ALLOWED FOR ANY OF
THESE DRUGS I'M EVEN DRUGS IT
WOULD BE APPROVED BY THE FDA IN
THE FUTURE.
EVEN IF THERE ARE.
CLINICAL ARE COSTING SERRATIONS
IT SHOULD BE CONSIDERED AS A
PART OF A PLANS COVERAGE
GUIDELINES.
IN ADDITION.
THERE'S A VERY I TROUBLING.
LATEST AMENDMENTS TO THE BILL
ON A PLAN IN ITS COVERAGE
POLICIES CANNOT REQUIRE THAT THE
DRUG BE TAKEN IN CONJUNCTION
WITH THE BEHAVIORAL THERAPY.
A REGIMEN.
NO UTILIZATION MANAGEMENT AND
CANNOT REQUIRE THE PERSON TO
ALSO BE IN ANY KIND OF THERAPY
OR PEER SUPPORT RECOVERY
PROGRAM.
WE DON'T BELIEVE THIS BE
CONSISTENT WITH FEDERAL OR
MEDICAL COMMUNITY RECOGNIZE
DEFINITIONS.
A FOR INSTANCE THE SUBSTANCE
ABUSE MENTAL HEALTH SERVICES
ADMINISTRATION DEFINES MEDICAL A
MEDICATION ASSISTED TREATMENTS
AS.
THE USEOF FDA APPROVED
MEDICATIONS IN COMBINATION WITH
COUNSELING A BEHAVIORAL
THERAPIES.
TO PROVIDE A WHOLE PATIENT
APPROACH TO THE TREATMENT OF
SUBSTANCE ABUSE DISORDERS.
THE ADMINISTRATION'S ALSO
WEBSITE ALSO STATES THAT UNDER
FEDERAL LAW MATT PATIENTS MUST
RECEIVE COUNSELING. WHICH COULD
INCLUDE DIFFERENT FORMS OF
BEHAVIORAL THERAPY. I'M ALSO
FROM OTHER WEBSITE IN ORDER TO
RECEIVE HER MAINTAIN A WAIVER TO
ACTUALLY DELIVER THE DRUGS A
PHYSICIAN MUST BE CAPABLE OF
REFERRING A PATIENT COUNSELING
OR OTHER SERVICES.
MEMBERS EITHER MEDICAL
MEDICATION ASSISTED TREATMENTS
NAM MEDICATION ONLY TREATMENTS.
THIS IS A VERY BROAD BILL THAT
FROM OUR PERSPECTIVE SETS OF A
NUMBER OF TROUBLING PRECEDENCE.
AND.
THERE FOR WE ASK YOU TO VOTE NO
ON THIS BILL THANK YOU.
GOOD AFTERNOON
GOOD AFTERNOON CHAIRMAN HE
REPRESENT CALIFORNIA CHAMBER OF
COMMERCE.
I CAN'T CHAMBER POSES AB TWENTY
THREE EIGHTY FOUR CENTS THAT
WOULD AMONG OTHER THINGS MANDATE
COVERAGE FOR ALL MEDICATION
ASSISTED TREATMENT PRESCRIPTION
DRUGS FOR SUBSTANCE ABUSE
DISORDERS. AND WOULD ELIMINATE
QUALITY CONTROL AND COST
CONTAINMENT MECHANISMS FOR THE
TREATMENT BOTH OF WHICH WOULD
SIGNIFICANTLY INCREASE
HEALTHCARE COSTS.
CHIPPER BEST MATES THAT IF AB
TWENTY THREE EIGHTY FOUR TO
BECOME LAW. ANNUAL HEALTHCARE
EXPENDITURES IN CALIFORNIA WOULD
INCREASE BY TWENTY FOUR POINT
SIX MILLION DOLLARS
HOWEVER THE ANALYSIS ALSO STATES
THAT THE COST PROJECTED COULD BE
EXPONENTIALLY HIGHER IF LEGAL
INTERPRETATIONS OF THE BILL
DIFFER FROM THE ASSUMPTIONS IN
THEIR ANALYSIS.
WELL WELL INTENTIONED EMPLOYERS
AND INDIVIDUALS HAVE BEEN FACING
SIGNIFICANT INCREASES IN THEIR
HEALTH INSURANCE PREMIUMS FOR A
NUMBER OF YEARS.
THE INCREASE IN PREMIUMS AB
TWENTY THREE EIGHTY FOUR RESULTS
AND WILL FOLLOW ON INDIVIDUALS
AND SMALL TO MEDIUM SIZED
EMPLOYERS WHICH WILL HELP TO
DRIVE HEALTHY PEOPLE OUT OF THE
MARKETPLACE. THEREBY LEAVING
FEWER PEOPLE TO PAY FOR THIS
MANDATE.
FOR THESE REASONS CHAMBER
COMMERCE AS OPPOSED THE BILL
THANK YOU.
THREE MUCH OTHERS IN OPPOSITION.
STEPHANIE LICHENS ON BEHALF OF
THE ASSOCIATION OF CALIFORNIA
LIFE AND HEALTH INSURANCE
COMPANIES OPPOSED.
AT THE MOST PREFERRED LOCAL
HEALTH PLANS A CALIFORNIA ALSO
POST.
JOHN WINGER ON BEHALF AMERICA'S
HEALTH INSURANCE PLANS BUT.
PRE BACK TO COMMITTEE FOR
QUESTIONS OR COMMENTS IN THE
QUESTIONS.
SEE NOTES LIKE CLOSE DOCTOR
ARAMBULA YES.
I WANTED TO TOUCH ON SOME OF THE
THINGS THAT WERE SAID TODAY AND
THERE IS A GREAT PROBLEM WHICH
IS FACING OUR GREAT STATE. AND
THAT IS OPIOID USE DISORDERS.
AND TO COMBAT IT WE ACTUALLY
HAVE TO HAVE ALL TOOLS AVAILABLE
FOR US.
AND TO DO THAT I BELIEVE THIS
BILL HELPS US TO MOVE IN THAT
DIRECTION.
FOR US TO BE ABLE TO EFFECTIVELY
TREAT OPIOID USE DISORDERS WE
HAVE TO FOLLOW EVIDENCE BASED
MEDICINE AND I BELIEVE THAT THIS
BILL HELPS TO MOVE US FURTHER IN
THAT CONVERSATION.
THERE ARE TEN THOUSAND
CALIFORNIANS WHO WOULD BENEFIT
FROM THIS BILL.
THERE ARE TEN THOUSAND OF OUR
NEIGHBORS WHO ARE GONNA BE ABLE
TO ACCESS SERVICES THAT COULD
NOT HAVE ACCESS WITHOUT THIS
BILL. I HUMBLY REQUEST AND I'VE.
THANKS VERY MUCH DOCTOR
ARAMBULA.
THANK YOU FOR THE BRING THIS
BILL FOR IT'S UNFORTUNATE THAT
THIS BILL IS ACTUALLY NECESSARY.
BUT WHO WE BELIEVE MEDICAID
MEDICATED MEDICATIONS ASSISTANCE
TREATMENT IS PROVEN TO BE
CLINICALLY EFFECTIVE.
AND TO SIGNIFICANTLY REDUCE THE
NEED FOR INPATIENT
DETOXIFICATION SERVICES.
THE BILL ENJOYS A DO PASS
RECOMMENDATION ALAS MADAME
SECRETARY TO PLEASE CALL THE
ROLL. WE NEED A MOTION THAT I'M
SORRY.
QATAR AND MOTION.
AND A SECOND MOST MEMBERS HAVE
YOUR CURRY SECOND I MISS CARILLO
MOTION IS DO PASS AS AMENDED TO
APPROPRIATIONS MEN SECRETARY
PLEASE CALL THE ROLL WHAT. I
WHAT I MAYES MAYES NO ANCHOR
CURRY. ATTACKER CURRY I BIGELOW.
BIGELOW NO. BONTA. BURKE.
CARILLO.
CARILLO AYE FLORA.
FLORA NO LIMON.
LIMON AYE MCCARTY. MCCARTY AYE
NAZARIAN. RODRIGUEZ.
SANTIAGO THEREIN WALDRON.
WALDRON AYE.
IT'S IT'S A SIX THREE SO WE'LL
LEAVE THAT ON CALL AND YOU AND I
WILL PRESENT THE NEXT BILL AND
THEN.
THE VERY PATIENT NEVER PRESENT
MR MAIENSCHEIN WILL BE FOLLOWING
US
.
DOCTOR WOOD MISTER ARAMBULA.
THANK YOU MISTER CHAIR AND
MEMBERS INLAND AND ONCE AGAIN.
APPRECIATE THE OPPORTUNITY
REARRANGE THINGS HERE.
CHRIS PAUL I'D LIKE TO START BY
ACCEPTING THE COMMITTEES
AMENDMENTS.
HEALTHCARE IS A RIGHT.
AND YET NOT EVERYONE HAS IT.
SOME HAVE GREAT HEALTH CARE.
SOME HAVE INSURANCE BUT IT'S
EXPENSIVE
SOME BUYING FIND COVERAGE ON
AFFORDABLE.
SOME HAVE MEDI CAL.
A STRUGGLE TO FIND CARE.
AS SOME HAVE NOTHING.
WE ALL KNOW HOW COMPLEX OUR
HEALTHCARE SYSTEM IS.
BUT I DO NOT SEE A SILVER BULLET
ON THE HORIZON ASPIRATIONAL YES.
REALISTICALLY NO.
SO WHAT'S TO BE DONE.
IT'S GOING TO BE A JOURNEY.
WE NEED TO KNOW HOW TO PLOT OUR
COURSE.
THAT'S WHY I AND MY COLLEAGUE DR
ARAMBULA HAVE A BILL THAT
CREATES A PROCESS.
TO BUILD A ROAD MAP.
THE GOAL UNIVERSALLY PUBLIC
FUNDED HEALTH CARE.
THE BILL CREATES SEE ADVISORY
PANEL ON HEALTH CARE DELIVERY
SYSTEMS AND UNIVERSAL COVERAGE
WITHIN THE CALIFORNIA HEALTH AND
HUMAN SERVICES AGENCY.
AN INDEPENDENT PANEL THAT WILL
DEVELOP A PLAN THAT CLUED
INCLUDES A TIMELINE OF THE
BENCHMARKS AND STEPS NECESSARY
TO REACH THE GOAL.
S. CO CHAIRS OF THE ASSEMBLY
SELECT COMMITTEE ON HEALTH CARE
DELIVERY SYSTEMS AND UNIVERSAL
COVERAGE WE CAN MEAN A NUMBER OF
HEARINGS BEGINNING LAST FALL
MORE THAN THIRTY HOURS WORTH. TO
HEAR FROM MANY WALRUS RESPECTED
EXPERTS ABOUT WHERE WE ARE NOW.
WHERE WE NEED TO GO AND HOW TO
GET THERE?
AS WE DUG DEEP INTO THIS COMPLEX
POLICY ISSUE WE RECOGNIZE THAT
TO BE SUCCESSFUL YOU MUST DIVINE
OF DEFINED A PATHWAY THAT
ADDRESSES A NUMBER OF ISSUES.
INCLUDING CHALLENGES RELATED TO
STATE AND FEDERAL LAW.
MEDICARE'S FUNDED THROUGH
PROTECTED MEDICARE TRUST FUND
AND FEDERAL LAWS STAB WHICH IS
THE RULES FOR HOW THAT MONEY CAN
BE SPENT.
ACCESSING THOSE FUNDS WOULD
REQUIRE CONGRESSIONAL ACTION.
PROP NINETY EIGHT AMENDED THE
CONSTITUTION TO REQUIRE FORTY
PERCENT OF STATE GENERAL FUND
REVENUES GO TO K. THREE FOURTEEN
EDUCATION.
HOW WILL PROP NINETY EIGHT
AFFECT NEW BUT REVENUES BROUGHT
INTO HEALTHCARE?
BEGAN LIMITS.
FROM PROPOSITION THIRTEEN IN
FOR.
AMENDED THE CONSTITUTION TO
IMPOSED SPENDING LIMITS ON THE
STATE TO ENSURE THAT REVENUE IN
EXCESS OF THOSE LIMITS WOULD BE
RETURNED. TO THE TAXPAYERS.
WHAT CAN BE DONE ABOUT THAT?
CURRENTLY THREE POINT THREE
MILLION CALIFORNIANS GET
COVERAGE THROUGH SELF INSURED OR
SELF FUNDED PLANS THEY'RE
SUBJECT TO RISA.
ADMINISTERED BY THE US
DEPARTMENT OF LABOR. THEY ARE
EXEMPT FROM STATE SPECIFIC
HEALTH INSURANCE REGULATIONS AND
THEREFORE COULD NOT BE COMBINED
INTO A SINGLE SYSTEM.
IN ADDITION TO FEDERAL AND STATE
STATUTORY CHAMP CHALLENGES ANY
MEANINGFUL CHANGES TO THE
CURRENT SYSTEM MUST HAVE BEEN
THAT MECHANISM TO PREDICT AND
MANAGE SEVERAL THINGS INCLUDING.
THE EXTRA ORDINARY RISE IN
HEALTHCARE COSTS.
THE EXISTING AND PREDICTED
SHORTAGE AND PHYSICIANS AND
ALLIED HEALTH PROFESSIONALS.
FINALLY WE NEED.
A MULTI YEAR FINANCIAL MODEL
THAT INCLUDE STATE BUDGET
IMPLICATIONS ASSESSMENT OF
OPTIONS FOR RAISING REVENUES IN
MANAGING COSTS.
IDENTIFICATION OF THE SIZE OF
POTENTIAL REVENUE SOURCES FOR
PRUDENT RESERVE.
STAKEHOLDER ENGAGEMENT AND
ANALYTICAL PROCESS TO DEVELOP
COVERED BENEFITS ELIGIBILITY
SERVICE DEVELOPED DELIVERY
PROVIDER PAYMENTS.
QUALITY IMPROVEMENT.
WE NEED TO ESTABLISH A DATA
COLLECTION REPORTING SYSTEM TO
SUPPORT MANAGEMENT EVALUATION
TRANSPORTATION TRANSPARENCY AND
PUBLIC ACCOUNTABILITY.
RECOMMEND WE NEED
RECOMMENDATIONS TO BUILD AN IT
SYSTEM AND A FINANCIAL
MANAGEMENT SYSTEM CAPABLE OF
ADMINISTERING A UNIVERSAL AND
UNIFIED PUBLICLY FINANCED HEALTH
CARE SYSTEM.
WE NEED A FEASIBLE FINANCING
SYSTEM AN ANALYSIS OF THE NEED
FOR A VOTER APPROVAL OF ANY
FUNDING MECHANISM.
THIS BILL PROVIDES THE ROADMAP.
THAT THE MAP AND THE PATH WE
NEED.
TO MOVE FORWARD AND I'M ASKING
FOR YOUR SUPPORT MOVE THE BILL.
AND WHAT ABOUT AT THIS POINT TO
TURN THIS OVER TO DOCTOR
ARAMBULA.
I HAVE ALWAYS BELIEVED THAT
HEALTHCARE IS A HUMAN RIGHT. IT
IS BECAUSE OF THAT BELIEF THAT I
BECAME A DOCTOR.
THE CARE FOR THE RESIDENTS ALL
OF THE RESIDENTS OF THE SAN
JOAQUIN VALLEY.
I ALSO SAW MANY OF THE
LIMITATIONS OF OUR CURRENT
HEALTHCARE SYSTEM. PARTICULARLY
TO THOSE WHO ARE MOST VULNERABLE
WITHIN OUR COMMUNITIES.
AS ASSEMBLY MEMBER WOULD
ITERATED OUR HEARINGS IN THE
ASSEMBLY SELECT COMMITTEE ON
HEALTH CARE DELIVERY SYSTEMS AND
UNIVERSAL. COVERAGE HELPED US
UNDERSTAND THE COMPLEXITIES OF
THE HEALTHCARE SYSTEM AND THE
CHALLENGES WE MUST OVERCOME IN
ORDER TO GET TO UNIVERSAL
COVERAGE.
AB TWENTY FIVE SEVENTEEN AIMS TO
CREATE A ROADMAP TO HELP US
ENVISIONED THE PATH FORWARD
TOWARDS A UNIVERSAL.
PUBLICLY FUNDED HEALTHCARE
SYSTEM AND GET US THERE STEP BY
STEP.
THROUGH THIS BILL WE WILL START
OF COURSE TO SUCCESSFULLY
ADDRESS.
STATE AND FEDERAL LAW CHALLENGES
INCLUDING FEDERAL WAIVERS AND
STATUTORY CHANGES. AND STATE
CONSTITUTIONAL AMENDMENTS.
WE AS A LEGISLATURE SHOULD
ADDRESS THE HIGH COST OF
HEALTHCARE SO WE CAN ACHIEVE
MORE EQUITABLE ACCESS TO QUALITY
HEALTHCARE.
WE SHOULD WORK TOWARD MITIGATING
EXCESSIVE HEALTH INSURER PROFITS
AND ADMINISTRATIVE COSTS SO THAT
MORE MONEY IS SPENT ON DIRECT
CARE TO PATIENTS.
WE SHOULD PROVIDE ALL
CALIFORNIANS WITH HIGH QUALITY
HEALTHCARE REGARDLESS OF AGE.
INCOME RACE ETHNICITY
IMMIGRATION STATUS GENDER SEXUAL
ORIENTATION GEOGRAPHIC LOCATION
HEALTH STATUS OR ABILITY.
AND WE SHOULD TRAIN IN EMPLOYER
HEALTH CARE WORKFORCE THAT CAN
MEET THE HEALTHCARE NEEDS OF OUR
GREAT STATE.
MEMBERS ASSEMBLY MEMBER WOULD AN
I WHOLE HEARTEDLY INTEND TO DO
THIS
I AM PROUD TO JOIN WE AUTHOR
THIS MEASURE WITH ASSEMBLY
MEMBER WOULD. AND I HOPE WE CAN
COUNT ON YOUR SUPPORT.
THE DOCTOR ARAMBULA ANYMORE
WITNESSES IN SUPPORT.
MARRIED IF MANAGING FORESTS ON
BEHALF OF HEALTH ACCESS
CALIFORNIA WE HERE TO SUPPORT AB
TWENTY FIVE SEVENTEEN. THE BILL
ESTABLISHES AN ADVISORY
COMMITTEE TO DEVELOP A ROADMAP
TO UNIVERSAL COVERAGE SYSTEM
THAT INCLUDES A TIMELINE. AND
THE RECOGNITION OF THE BEARS TO
VARIOUS REFORMS LIKE THE STATE
CONSTITUTION AND FEDERAL LAW. WE
STRONGLY SUPPORT THE BILL'S GOAL
OF GUARANTEED ACCESS TO
HEALTHCARE THAT IMPROVES HEALTH
OUTCOMES LOWERS HEALTHCARE COSTS
AND REDUCES HEALTH DISPARITIES
FORD THESE REASONS WE ASK
ARRIVAL.
ANYMORE WITNESSES IN SUPPORT.
LINDA WAIT.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY IN SUPPORT.
DALE FOUNTAIN CONNECTING EVER SO
HEALTH CARE FOR CALIFORNIA.
REPRESENTING HUNDRED EIGHT
THOUSAND CALIFORNIANS SINGLE
PAYER SUPPORTERS IN FULL
SUPPORT.
THANK YOU.
ANGELA WILLIAMS CALIFORNIA LIKE
ALFA NETWORK IN STRONG SUPPORT.
GENTLEMAN JEFF TOWARD A KIA. I'M
NOT IN STRONG SUPPORT BECAUSE
LIKE OTHER LEGISLATION.
THERE ARE GONNA BE UNINTENTIONAL
CONSEQUENCES OF THIS.
AND THE BIGGEST CONCERNS GOING
TO BE IN ANY CAPACITY OF
ADVISORY.
IS EXACTLY WHO IS INFLUENCING
THIS.
SO ACCOUNTABILITY NEEDS TO BE
HIGHLY IN THERE SIR ANYONE SO
CONCERT I AM THAT NORMALLY
SUPPORTING IT.
ANY FURTHER WITNESSES IN
SUPPORT.
I ANY WITNESSES IN OPPOSITION.
SEEING NONE WILL COME BACK.
TO MEMBER COMMENTS OR QUESTIONS.
MISS WALDRON.
THANK YOU MISTER CHAIR I'M.
WHO WERE HOW DO YOU FORESEE THE
ADVISORY PANEL? YOU KNOW BEING
SET UP AS FAR AS THE MEMBERSHIP.
ON THE PANEL AND THE HEALTH AND
HUMAN SERVICES SERVICES
SECRETARY WOULD APPOINT THE
MEMBERS.
NO CAN SO IS NO.
CRITERIA LIKE THE.
YOU KNOW HAVE TO BE A CERTAIN
NUMBER OF HEALTH PROVIDERS OF.
HEALTH PLANS OR STAKEHOLDERS OR.
IS HAVE THEY HAVE GOTTEN UP FOR
ME.
STILL HAVEN'T GOTTEN IT SO.
YEAH.
THE ROADMAP WITH MAYBE A PIECE
MISSING AT THIS POINT OKAY.
SO JUST A COMMENT YOU KNOW
HAVING SERVED WITH THE TWO
DOCTORS ON THE UNIVERSAL CARE
SELECT COMMITTEE.
SO MUCH INFORMATION CAME OUT IS.
ALMOST SEEMS LIKE IT WAS.
IT JUST ENDED TOO SOON IN A WAY
EVEN THOUGH WE HAD SEVERAL
HEARINGS.
THERE'S JUST SO MUCH
INFORMATION.
.
YOU KNOW.
THE GOAL OF UNIVERSAL CARE IS
SOMETHING. I THINK EVERYONE
SHOULD BE ABLE TO SUPPORT.
BUT HOW YOU GET THERE OR THE
ROADBLOCKS IN AND WE CAME UP
WITH.
HAVING TO GET WAIVERS FROM THE
FEDERAL GOVERNMENT. YOU KNOW.
WHAT THAT WOULD INVOLVE I MEAN
THERE WERE SO MANY ISSUES AND
COSTS AND THE SURPRISING I KNOW
WE'VE TALKED ABOUT? LOOKING AT
IF THERE'S ANY WAY TO REDUCE
COSTS AND THAT JUST DIDN'T SEEM
TO ME HE. WAS OTHER.
STATES OR NATIONS WAS FACING AND
YOU KNOW IF WE WANNA.
WILL MOVE AHEAD AND REALLY
ANALYZE THAT. IT'S ALMOST LIKE
WE KEEP OUR SELECT COMMITTEE
GOING WELL WE TASK OTHERS TO
CONTINUE THE WORK TO GET BACK SO
I THINK THAT'S WHAT YOU. TRYING
TO ACCOMPLISH. Y. THINK I THINK
IT'S ON THIS IS SUCH A COMPLEX
TOPIC IN EACH ONE OF THOSE.
ISSUES THAT YOU BROUGHT UP
REALLY DESERVES A REALLY REALLY
DEEP DIVE TO REALLY COME UP
WITH.
WITH HOW WE COULD HOW WE COULD
MOVE PAST THOSE AND SO IT'S KIND
OF BEYOND THE PURVIEW OF THE
SELECT COMMITTEE IN MY OPINION
BECAUSE THERE ARE SO MANY
UNINTENDED CONSEQUENCES AS YOU
SAY. OUT O WE.
THAT TO THAT THE GOAL IS THAT.
AS WE AS WE MOVE YOU KNOW
THROUGH THESE.
THROUGH THESE CHALLENGES THAT
WE GET THE INFORMATION WE NEED
TO ALLOW US TO CONTINUE OUR DOWN
THE ROAD.
THIS I DON'T. DISAGREE COMMENT.
I WANT TO THANK YOU BOTH FOR
BRINGING THIS FORWARD AS WELL AS
ALL THE WORK YOU DID FOR THE
SELECT COMMITTEE WE WOULDN'T BE
WHERE WE ARE TODAY AND WITH AN
AUDIENCE LIKE WE HAVE TODAY
BECAUSE OF. THE CHANGES AND
THINGS THAT WE WANT TO CHIP AWAY
AT.
FIRST WHAT YOU LISTEN TO THIS
IN THE PUBLIC.
YOU ARE FOLLOWING UP.
BUT THE WORK THAT NEEDS TO BE
DONE IT'S A TOUGH ROAD NOW I AM
CONFIDENT THAT.
YOU'LL HELP US LEAD US DOWN
THAT WAY WITH AND. COMMITTEE
THAT IS SPOT ON SO.
AS THE GENTLEMAN SAID THE
UNINTENDED CONSEQUENCES AS WE
WENT THROUGH OTHER BILLS IN THE
PAST ON UNIVERSAL HEALTH CARE.
AND BOYS FEAR WHO WOULD BE LEFT
BEHIND AND HOPEFULLY BY THIS
ADVISORY COMMITTEE WE WILL LEAVE
ANYONE BEHIND.
DOCTORS WOULD LIKE TO CLOSE. I
JUST LIKE TO SAY.
FOR SMALL THANK YOU CAPTAIN
PRESENT THE BILL IN THIS THIS
WILL NOT AS SOME MAY CLAIM. THE
ROAD TO NOWHERE.
IT'S NOT A DELAY TACTIC.
WHAT IT IS IS WHAT WE BELIEVE
IS THE RESPONSIBLE AND
THOUGHTFUL WAY TO ADDRESS A
MULTIFACETED SYSTEM? THAT HAS
MANY MOVING PARTS.
AND ONE THAT HOLDS A HEALTH CARE
OF ALL CALIFORNIANS IN ITS
HANDS.
SUCCESS IN THE END WILL BE THE
CREATION OF A SUSTAINABLE
HEALTHCARE SYSTEM THAT PROVIDES
QUALITY. AND AFFORDABLE
HEALTHCARE TO EVERYONE IN
CALIFORNIA.
I RISK WE RESPECTFULLY ASK FOR
YOUR AYE VOTE.
THANK YOU WE DO HAVE A MOTION BY
MISS AGAR CURRY IN A SECOND BY A
MISS CARILLO LOCAL POLICE.
AYE AND THE MOTION IS TO PASS AS
AMENDED TO APPROPRIATIONS. WOULD
I WOULD I MAYES NO MAYES NO
AGUIAR-CURRY. I AGREE I BIGELOW.
BIGELOW NO. BONTA.
BURKE.
CARILLO.
I CARILLO AYE FLORA.
FLORA NO LIMON.
THE LOAN AYE MCCARTY. MCCARTY
AYE NAZARIAN. RODRIGUEZ.
SANTIAGO THURMOND WALDRON.
WALDRON AYE.
THREE.
IT VERY MUCH MR MAIENSCHEIN
EUROPE AND.
PISTONS ARE YOUR US AT ALL.
WELL YOU KNOW.
IT IS.
YOU ARE SIX WEEKS TO.
SO I WAS SIX THREE WE NEED TO
MORE.
GET BETTER AT THE MOMENT THANK
YOU.
MISTER MAY TAKE THANK YOU I DO
APOLOGIZE FOR THAT SHUFFLING
AROUND AND HAD YOU BACK I THINK
MISTER CHAIRMAN FROM I WOULD
HAVE JUST BEEN STUCK IN A
DIFFERENT COMMITTEE ANYWAY SO
IT'S NOT NO PROBLEM. ALTHOUGH I
DO WANT TO SAY JUST FOR THE
RECORD WE DID LOSE A NUMBER OF
WITNESSES WHO ARE HERE TODAY AND
I DO WANT REFLECT THAT FOR THE.
FOR THE REQUISITE NUMBER OF MOMS
WHO ARE HERE WHO DID END UP
HAVING TO LEAVE SO I FOR THE
RECORD I WANT TO MAKE SURE THAT
THAT THING.
IT'S NOTED THAT THEY WERE THERE
IN SUPPORT OF THE BILL FISHING.
I BEFORE I BEGIN I WILL BE
ACCEPTING THE AMENDMENTS
REFLECTED IN THE COMMITTEE
ANALYSIS WOULD LIKE TO THANK THE
CHAIRMAN A STAFF OF FOR WORKING
WITH ME ON THIS BILL I LOOK FOR
TO CONTINUE WORKING WITH THE
OPPOSITION. TO ADDRESS ANY
REMAINING CONCERNS
MATERNAL DEPRESSION IS THE MOST
COMPLICATED MOST COMMON
COMPLICATION OF PREGNANCY IN THE
UNITED STATES
SURPASSING SURPASSING JUST
ADDITIONAL DIABETES AND
PREECLAMPSIA COMBINED. MATERNAL
MENTAL HEALTH DISORDERS
INCLUDING DEPRESSION ANXIETY AND
THE MUCH MORE RARE BUT VERY
SERIOUS POSTPARTUM PSYCHOSIS
AFFECT ONE IN FIVE WOMEN. DURING
PREGNANCY OR THE FIRST YEAR
FOLLOWING CHILDBIRTH.
IT PRESENTS A SIGNIFICANT EARLY
RASTA PROPER CHILD DEVELOPMENT
THE MOTHER INFANT MONT AND THE
FAMILY. ADDITIONALLY MATERNAL
DEPRESSION HAS BEEN CONSISTENTLY
LINKED WITH CHILDREN'S PARK
COGNITIVE OUTCOME.
A RECENT STUDY BY UC SAN DIEGO
INDICATED THAT HIGHLY DEPRESSED
MOTHERS PROVIDE LESS EMOTIONAL
SUPPORT TO THEIR CHILDREN ACROSS
ALL AGES WHICH RELATED TO
CHILDREN'S LOWER AYE CUES.
SCREENING AND TREATMENT FOR
MATERNAL MENTAL HEALTH
CONDITIONS IS AN IMPORTANT TOOL
TO PROTECT CHILDREN FROM THE
POTENTIAL ADVERSE PHYSICAL. AND
DEVELOPMENTAL EFFECTS OF THESE
CONDITIONS AB TWENTY ONE NINETY
THREE WILL REQUIRE OBGYN IS TO
SCREEN PREGNANT PATIENTS FROM
ETERNAL MENTAL HEALTH DISORDERS.
AND DURING THE PERINATAL PERIOD
SOME MAY ARGUE THAT SCREENING
TAKES TOO MUCH TIME AND WE'VE
HEARD WE'VE EVEN HEARD THAT
IT'S.
IF A MOM IS ASKED ABOUT HER
FEELINGS SHE COULD BE IN TEARS
TOO LONG.
FOR THAT THE REIMBURSEMENT
RATES ARE NOT ENOUGH BUT HOW CAN
THIS BE A JUSTIFICATION TO A
FATHER LIKE RUDY CORONADO WHO
YOU WILL HEAR FROM SHORTLY.
MISTER CORONADO LOST THREE
DAUGHTERS UNDER THREE YEARS OLD
WHEN HIS WIFE TOOK THE LIVES OF
THEIR CHILDREN AFTER SUFFERING
AN UNDIAGNOSED CASE OF
POSTPARTUM DEPRESSION AND
PSYCHOSIS.
ADD PAGET IS ANOTHER FATHER THE
MUST HIS GRANDSON SHANE AND HIS
DAUGHTER CHARLENE WHO WAS NOT
SCREENED FOR MATERNAL DEPRESSION
HER CONDITION WAS DISCOVERED BY
HER HUSBAND AND MOTHER A LITTLE
TOO LATE.
CHARLIE TOOK HER OWN LIFE AND
THE LIFE OF HER SON SHANNON A
FEW DAYS PRIOR TO AN APPOINTMENT
HER FAMILY SOUGHT FOR HER FIGHT
PSYCHIATRIST.
ALTHOUGH MATERNAL MENTAL HEALTH
DISORDERS FORM THE MOST COMMON
COMPLICATION OF PREGNANCY
IMPACTING ROUGHLY A HUNDRED
THOUSAND CALIFORNIA WOMEN AND
FAMILIES EACH YEAR. THEY ARE
ALSO THE MOST UNDER DIAGNOSED
COMPLICATION IN AMERICA
ADDITIONALLY CALIFORNIA HAS
RECENTLY EXPERIENCED A
SIGNIFICANT UPWARD TREND IN
HOSPITALIZATION OF PREGNANT
WOMEN WHAT THE MENTAL HEALTH.
HEALTH DIAGNOSES
ACCORDING TO THE AMERICAN
ACADEMY OF PEDIATRICS
SCREENING MOTHERS FROM ETERNAL
DEPRESSION IS A PAST PRACTICE
FOR PRIMARY CARE PEDIATRICIANS
IN TWENTY FIFTEEN THE AMERICAN
CONGRESS OF OBSTETRICIANS AND
GYNECOLOGISTS. A COG RECOMMENDED
THAT CLINICIANS SCREEN PATIENTS
AT LEAST ONCE DURING THAT
PERINATAL PERIOD. THE UNITED
STATES PREVENTIVE TASK FORCE
ALSO RECOMMENDS DEPRESSION
SCREENING FOR PREGNANT AND
POSTPARTUM WOMEN.
THE CALIFORNIA TASK FORCE ON
MATERNAL MENTAL HEALTH IN WHICH
A CAUSE AND THE CALIFORNIA
ASSOCIATION HEALTH PLANS
PARTICIPATED PRESENTED REPORT TO
THE. CALIFORNIA LEGISLATURE THAT
SET A GOAL TO REACH AND EIGHTY
PERCENT SCREENING RIGHT BY
ABSTRACT. ABSTRACT PROVIDERS BY
THE YEAR TWENTY TWENTY ONE
THIS BILL WILL AID IN ACHIEVING
THAT GOAL.
AB TWENTY ONE NINETY THREE WILL
ADDRESS THESE PREVENTABLE AND
TREATABLE DISORDERS THAT ARE
SIMPLY FOLLOWING.
FALLING THROUGH THE CRACKS WITH
ME TO TESTIFY TODAY IN SUPPORT
OF THE BILL. OUR VENDOR RARE ANY
TO SAY OBGYN AND RUDY CORONADO A
CALIFORNIA RESIDENT WHO LOST HIS
FAMILY DUE TO MATERNAL MENTAL
HEALTH CONDITION
KELLY O'CONNOR QUE REPRESENTING
THE CO SPONSORS TWENTY TWENTY
MOM AND MATERNAL MENTAL HEALTH
NOW. IS ALSO AVAILABLE TO ANSWER
QUESTIONS.
PLEASE GO AHEAD FOR SWEETNESS.
THANK YOU FOR HAVING ME I'M HERE
TODAY TO SHARE AS A BOARD
CERTIFIED OBGYN AND MATERNAL
FETAL. MEDICINE SPECIALIST THAT
IT'S CRITICALLY IMPORTANT THAT
WE DETECT
AND ENSURE TREATMENT FOR
MATERNAL MENTAL HEALTH DISORDER
SUCH AS POST PARTUM DEPRESSION.
AB TWENTY ONE NINETY THREE WILL
ENSURE THAT MY COLLEAGUES
PRIORITIZE THIS URGENT MATTER.
AND HAVE A SYSTEM OF SUPPORT TO
DO SO.
THE BILL COMES OUT OF THE
CALIFORNIA TASK FORCE ON
MATERNAL MENTAL HEALTH THE TASK
FORCE WAS FORMED AT THE URGING
OF THE LEGISLATOR THROUGH ACR
ONE FORTY EIGHT. MULTIPLE
STAKEHOLDERS PARTICIPATED INTO
INCLUDING THREE OBGYN THIS AND
THE CALIFORNIA ASSOCIATION OF
HEALTH PLANS. THE REPORT NOTES
THAT IN CALIFORNIA TWENTY
PERCENT OF WOMEN WILL SUFFER
FROM A MATERNAL MENTAL HEALTH
DISORDERS SUCH AS POST PARTUM
DEPRESSION.
AND ROUGHLY FIFTY PERCENT OF LOW
INCOME MOTHERS WILL SUFFER JUST
DUE TO INCREASE STRESSORS.
THINK ABOUT THOSE NUMBERS JUST
FOR A MINUTE.
RESEARCH UNFORTUNATELY SHOWS
THAT THESE DISORDERS.
ARE NOT BEING DETECTED AND
TREATED.
DETECTION STARTS WITH HAVING
PATIENTS COMPLETE A QUICK
SURVEY.
THAT HAS BEEN CONFIRMED OTHER
VALIDATED SCREENING TOOL BY
RESEARCHERS.
THERE ARE HUNDREDS OF STUDIES
SHOWING THE EFFECTIVENESS
OF SCREENING TO DETECT THESE
DISORDERS AND THE IMPORTANCE OF
EARLY AND EFFECTIVE TREATMENT.
YET THE SCREENING RATES REMAIN
LOW. AND I BELIEVE THAT ONE OF
THE REASONS THESE ARE LOW
NUMBERS COMES FROM A LACK OF
APPROPRIATE REFERRAL. THAT WE
HAVE TO REFER TO BEHAVIORAL
HEALTH SPECIALIST ONCE WE
SUSPECT THAT THERE IS A MENTAL
HEALTH DISORDER.
RESEARCHERS LONG CONFIRMED
UNTREATED MATERNAL DEPRESSION
LEADS TO TREATMENT RESISTANT
DEPRESSION AND IMPACTS FAMILY
STABILITY. AS I TELL ALL MY
PATIENTS IF MOMS ARE IN A GOOD
PLACE THE FAMILY ISN'T IN A GOOD
PLACE.
IT'S ALSO CRITICAL BUT YOU KNOW
THAT HUNDREDS OF STUDIES CONFIRM
NEGATIVE CHILD OUTCOMES
WHEN THESE DISORDERS ARE LEFT
UNTREATED ONE ENTRY TO DURING
PREGNANCY THERE'S A HIGHER RISK
OF ADVERSE PREGNANCY OUTCOMES
INCLUDING LOW BIRTH WEIGHT
INFANTS.
AND PRETERM BIRTH.
THE WORST FAMILY OUTCOME IS
STUFF IN THOSE SUICIDE IS RARE
IT IS KNOWN TO BE THE LEADING
CAUSE OF DEATH IN THE PERINATAL
PERIOD.
IN THE CASE OF PSYCHOSIS A STATE
WHEN A MOTHER HAS A BREAK IN
REALITY SHE ALSO HAS A HIGHER
RISK OF HARMING HER CHILD.
AB TWENTY ONE NINETY THREE
REQUIRES WILL BE PROVIDERS TO
SCREEN AND FOR INSURANCE
COMPANIES TO PROVIDE US WITH
SUPPORT BY DEVELOPING A QUALITY
MANAGEMENT PROGRAM.
THE HEALTH CRISIS IS NEGATIVELY
IMPACTING MY PATIENTS
CALIFORNIA'S FAMILIES AND OUR
SOCIETY.
SIR. DIFFICULT MA'AM EXITING
SIR.
I THANK YOU FOR GIVING ME THE
OPPORTUNITY OF SPEAKING TO USE
POWERFUL PEOPLE.
WHEN I WAS RUDY CORONADO.
I LOST MY FAMILY TO THIS
HORRIBLE DISEASE.
BY WIFE WAS A GOOD WOMAN. SHOOT
SHE WAS A EXTRA TECHNOLOGIES.
SHE WAS SIXTY HOURS AWAY FROM
BEING A DOCTOR.
SEVEN YEARS RESERVE MILITARY.
UNDER HER BELT.
SHE HAD A PSYCHOSIS REACTION AS
HE TOOK THE LIVES OF MY THREE
LITTLE GIRLS MAY TWENTIETH TWO
THOUSAND FOURTEEN BEFORE YEARS
NEXT MONTH.
THERE'S.
I'M I'M HERE IN SUPPORT OF THE
BILL BECAUSE NO ONE EVER TOLD US
ANYTHING OR NO ONE EVER ADVISES
US. OF THIS DISEASE WE KNOW
ABOUT IT POSTPARTUM.
I'M PRETTY SURE NEITHER NON ONE
OF YOU GUYS KNEW THAT IT WAS
THERE'S THREE STAGES TO POST
PARTUM. THAT NONE WAS NOBODY
THEY DON'T TELL US ABOUT IT
WARRANTED OR NOT SCHOOLED ABOUT
NOTHING LIKE THAT.
I'M SORRY FROM SPEECH I'M NOT
TOO GOOD AT THIS.
.
WELL ON GRASS.
I'M HERE IN SUPPORT.
TO MAKE SURE THAT AB TWENTY ONE
A THREE THIS PAST SO THAT ALL
THEIR HUSBAND OR FATHER GOES
THROUGH WHAT I'M GOING THROUGH
RIGHT NOW.
IT'S IT'S IT'S NOT EASY FOR FOR
ONE.
STUDIES FOR WANT TO LIVE WITH IS
IS NOT IN AND IT'S NOT EASY TO
DETECT IT.
THERE'S NOTHING BEING DONE ABOUT
IT TO TRY TO FIGURE IT OUT OR
LEARNED OR.
I'M SO SORRY.
THERE'S NOTHING BEING DONE ABOUT
IT THERE'S NOTHING BEING DON'T
WORRY NOT TOLD NOTHING I'M JUST
A REGULAR PERSON I'M NOT IS
KILLING NONE OF THESE FOLKS
HERE.
BUT ONE THING THAT THEY DON'T
TELL US IS NOTHING ABOUT THIS
DISEASE WORDS. WERE NOT TOLD
ABOUT IT.
CAROL WAS WAS WAS WAS A STRONG
WOMAN WAS A STRONG WOMAN SHE
SHE'S.
SHE'D NEVER MISSED AN
APPOINTMENT SCISSORS WHO ALWAYS
WENT ALL REPLY MEANS NEVER GOT
SCREEN TO AWAIT THE WITH
ANYTHING.
I.
I'M SORRY.
I AM.
WE WERE A HAPPY FAMILY. WE WERE
OF A WE WERE A HAPPY FAMILY WITH
HE WOULDN'T HAVE THE LUXURIES
BUT WE NEED OF NOTHING.
WE WORKED WE WORKED SHE WENT TO
SCHOOL WE WORK THAT WE WORK
TOGETHER.
OUR KIDS WERE HAPPY IT
EVERYTHING WAS GOOD. JUST FROM
ONE DAY TO ANOTHER SHE FLIPPED
OUT.
AND WHAT MADE IT HAPPEN WHO
KNOWS.
HOW WHAT CAN I DO TO FIGURE OUT
WHAT SHE WAS GOING? AND NO CLUE.
NOW THAT THIS HAPPENED I'VE SEEN
I'VE SEEN OPEN MY EYES AND I'VE
NOTICED A LOT MORE WOMEN COME
FORWARD AND BRING IT OUT. THEY
DON'T TALK ABOUT IT DIDN'T
THEY'VE THEY FEAR THE FACT THAT
THEY MIGHT THINK THEIR KIDS
AWAY.
THEY WILL TALK TO US HUSBAND
BECAUSE THEY MIGHT THINK THEY
WORK DAY WE THINK THAT THEY'RE
CRAZY.
BUT IN REALITY YOU REALLY ARE
THE KIND OF GOING THROUGH IT
EVERY SINGLE WOMAN THAT HAS A
CHILD. GOES THROUGH THESE.
EVERY SINGLE ONE ON BUT NOBODY
TALKS ABOUT IT AND THEY
ESPECIALLY DON'T WANT TO TALK
ABOUT IT BECAUSE IT'S IN THEIR
MIND.
WHAT ARE YOU GUYS AND I THINK
ALL ON CRAZY YOU GONNA TAKE MY
BABY ONLY?
THAT'S WILL COSTUMES MIND I
FEEL.
AND THAT'S WHY THEY DON'T NOBODY
EVER TALKS ABOUT IT.
I'M HERE TO ENSURE DRUM THAT.
THE MONEY TO ENSURE BUT TO LET
YOU GUYS KNOW THAT PLEASE LET
LET LET DO SOMETHING ABOUT IT
YOU GUYS WILL BE THE FIRST ONES
TO NOT TODAY EVERYONE KNOWS
ABOUT IT IN EUROPE IS A FOR THIS
IS REAL.
IT'S S. ACCEPTED IT'S IT'S.
I'M GOING THROUGH THE WORST
THINGA HUMAN BEING CAN GO
THROUGH AND I'M STILL STE.
PORTING THE WOMAN THAT THE THIS
BECAUSE I KNOW SHE WAS OF THE
LONG.
SHE HAS A SHE'S GOING THROUGH A
THREE LIFE SENTENCES AND I FEEL
BAD BECAUSE OF WHAT SHE'S GOING
THROUGH. BECAUSE I KNEW HER.
I HATE WHAT I'M GOING THROUGH IN
MY LIFE BUT IF THIS HAD HAPPENED
I WOULDN'T BE HERE.
SPEAKING THROUGH YOU PEOPLE
ABOUT IT AND TO TRY TO HELP
ANOTHER ANOTHER FATHER. AND
MOTHER FOR THEM NOT TO HAPPEN
WOULD HAPPEN WAS HAPPENING TO
ME.
I'M SORRY I DON'T KNOW WHAT
VOTES THROUGH WHAT ELSE TO SAY.
OTHER THAN THE PLEASE LISTEN TO
THESE PEOPLE BECAUSE THEY REALLY
ARE TRYING TO DO SOMETHING ABOUT
IT. AND YOU GUYS WOULD BE THE
ONES THAT HAVE THE FIRST HAND
AND UPPER HAND. TO BEGIN
SOMETHING TO TO BEGIN TO DO
SOMETHING ABOUT IT AND EDUCATE
US FATHERS OF NEW FATHERS. ABOUT
THIS DISEASE TO AT LEAST GIVE US
A HEADS UP AND IT DOESN'T HEAR
FROM. FROM THE BACK.
SOME DON'T KNOW WHAT ELSE TO SAY
THANK YOU VERY MUCH FOR YOUR
TIME.
THANK YOU VERY MUCH PLEASE NEVER
APOLOGIZE FOR SPEAKING FROM THE
HEART.
THANK YOU.
OTHERS IN SUPPORT.
HI MY NAME IS KELLY LOCKWOOD I'M
A LICENSED CLINICAL SOCIAL
WORKER AND MOTHER AND PORT.
LISA STOCK IN AND BACK IT
STOCKTON WITH NAPA MOMS IN
SUPPORT.
THERE PADGETT A DAD AND A
GRANDFATHER THAT LOST BOTH HIS
DAUGHTER AND HIS
GRANDSON.
HE JOHN WROTE US WITH THE
STEINBERG INSTITUTE IN SUPPORT.
JOSEPHINE AT ANY DOES NOT SENATE
WITH CHILDREN NOW IN STRONG
SUPPORT.
KELLY BE MARCH OF DOT.
WOMEN FOR OF HARRY PART OF
MENTAL HEALTH DISORDERS IN
STRONG SUPPORT.
CHAPLAIN LAME OTHERWISE LAKE
COUNTY IN STRONG SUPPORT.
ROSARIO GARCIA POSTPARTUM DOULA
IN SUPPORT.
NICOLE CAN GUESS LICENSED
MARRIAGE AND FAMILY THERAPIST IN
STRONG SUPPORT SENDING
POSTPARTUM SUPPORTED
NATIONAL. IT'S A PROGRAM THAT
SUPPORTS WOMEN.
IN ADVOCACY AND SUPPORT AND IN
TRAININGS. AND IT'S A PROGRAM
THAT SUPPORTS. ALL THROUGHOUT
THE UNITED STATES WOMEN WITH UP
POST PARTUM OR HARRY NATAL. MOOD
DISORDERS AND. OTHER ANXIETY AND
AS WELL AS THIRTY FIVE OTHER
COUNTRIES IN THE WORLD.
SO THIS IS NOT JUST A UNITED
STATES PRO.
PICK HERE.
I'M MICHAEL LANDON ABA. I AM A.
PSYCHOLOGIST IN PRIVATE PRACTICE
IN CALIFORNIA AND I TREAT WOMEN
WITH PERI NATAL.
MENTAL DISORDERS INCLUDING
PROBLEMS WITH INFERTILITY. FETAL
LOSS.
DEPRESSION.
AND ALL THAT TRAGIC THINGS THAT
CAN HAPPEN DURING THE COURSE OF
PRODUCING A CHILD WHICH IS A
HIGH RISK ENDEAVOR.
PRESENTLY THOUGH A WOMAN NEEDS
TO. SELF DIAGNOSE HERSELF.
LOCATE CARE FINANCE CARE CHAU UP
IN AN UNFAMILIAR PLACE FOR
TREATMENT.
BY THE TIME WHEN SHE SAID HER
MOST VULNERABLE.
IN OFTEN UNABLE TO EVEN GET OUT
OF BED HER BRUSH YOUR TEETH.
WE'RE ASKING TOO MUCH IN FACT
WERE ASKING THE IMPOSSIBLE AND
PLACING BOTH THE WOMAN AND HER
INFANT AT RISK.
NONE OF US WOULD LIKE TO SEE
MARK OUR MOST VULNERABLE
CITIZENS PLACED IN A SITUATION.
WITH IT IMPAIRED CAREGIVER
THAT'S HAPPENING ALL TOO
FREQUENTLY AND WE NEED A SAFETY
NET IN PLACE TO ALLOW. PEOPLE TO
BE PROTECTED AND TO BE ABLE TO
ACCESS THE CARE THAT THEY NEED
AND DESERVE. THANK YOU I SUPPORT
STRONGLY SUPPORTS AB TWENTY ONE
NINETY THREE.
THANK YOU JUST NAME AND
ORGANIZATION PLEASE
CAN RELIGION ON BEHALF THE
CALIFORNIA PAN ETHNIC HEALTH
ORGAN SUPPORT.
MAJOR FORCE ON BEHALF OF HEALTH
ACCESS CALIFORNIANS SUPPORT.
HI I'M CHRISTA MCAULIFFE FROM
NAPA MOANS AND TWENTY TWENTY MOM
IN STRONG SUPPORT FOR.
HI AMBER PRESERVED IN A LICENSE
ECOLOGISTS AND BOARD MEMBER OF
TWENTY TWENTY MONTHS.
Q..
JOINT BURKHARD MOTHER IN SANTA
CLARITA CALIFORNIA WE ALSO HAVE.
A BOOK HERE OF ABOUT FIFTY OTHER
MOTHERS WHO COULDN'T JOIN US
TODAY WE ALL STRONGLY SUPPORT
THE SPELLING.
MOTION ME MUKHERJEE CERTIFIED
NURSE MIDWIFE IN PSYCHIATRIC
NURSE PRACTITIONER IN SUPPORT.
MELANIE THOMAS LICENSE
PSYCHIATRIST AT DEPARTMENT OF
PSYCHIATRY AT UCSF AND SUPPORT
THANK YOU.
HI I'M KILEY ENACHE I'M AN
OCCUPATIONAL THERAPIST I'M WITH
TWENTY TWENTY MOM AND THE RETURN
TO ZERO CENTER FOR HIM.
I STRONGLY SUPPORT THIS BILL.
Q..
A ROLE MARTINEZ MY WIFE TOOK HER
OWN LIFE BECAUSE POSTPARTUM
PSYCHOSIS AND STRONG SUPPORTER.
I AM ANGELINA SPICER I AM A POST
PARTUM DEPRESSION.
SURVIVOR.
AND I AM IN STRONG SUPPORT.
CHAIRMAN MEMBERS OF THE
COMMITTEE RENTAL HAGER FOR THE
CALIFORNIA PSYCHIATRIC
ASSOCIATION AND PARTICULARLY ON
BEHALF OF THE TOWN OF LESSONS
SKYTREE COMMITTEE WERE IN
SUPPORT.
ANYONE IN OPPOSITION.
WITH THE BILL
.
RIGHT SPENCER WITH THE AMERICAN
COLLEGE OF OBSTETRICS AND
GYNECOLOGY. NINE.
WE HAD A OF POSITION HERE
PRESENT BUT YOU HAVE HAD A
CALLED UNEXPECTEDLY SO. I WILL
TRY DO MY BEST ARTICULATE HIS
WORDS.
I'VE.
WE I REGRET WE HAVE OPPOSE
UNLESS AMENDED POSITION ON THE
BILL.
THE FIRST LIKE TO THANK MR
MANGE I'VE TAKEN ON THIS ISSUE.
A IT'S A IT'S A BIG ONE AND A
LOT OF A ONE.
IN I COULDN'T SAY I SAY THAT
WITH CERTAINTY THAT A COG AGREES
WITH.
HIS AND THE WITNESSES
VIEWS TOWARD SCREENING.
A COG.
IS THE STANDARD OF CARE FOR OPG
Y. HANDS TO SCREEN THEIR
PATIENTS.
A CUT GUIDELINES SUGGEST AT
LEAST ONCE DURING PERINATAL
PERIOD FOR DEPRESSION AND
ANXIETY SYMPTOMS THERE SHOULD BE
A SCREENING.
MOST OBGYN SCREEN OF EVEN MORE
I'M ONCE BEFORE ONCE AFTER.
AND THAT'S JUST THE MINIMUM OF
WHAT THEY DO I THINK WHERE THE
PROBLEM WE HAVE AND FRANKLY THE
ONLY PROBLEM THAT WE HAVE WITH
THIS BILL. NOT THE TEN AND ALL
IS THE FACT THAT IT'S A MANDATE
ON ONE SCREEN.
WHEN YOU OF MANDATE MEDICAL
GUIDELINES IN STATUTE BECOME
STATIC AND THAT'S HOW MEDICAL
GUIDELINES SHOULD OPERATE.
MEDICAL GUIDELINES ARE FLUID ON
YOU STUDY YOU EMPLOYMENT AND
THEN YOU GO FROM THERE AND THEN
YOU STUDY YOU UP WHEN YOU GO
FROM THERE. AYE YEAH I WILL
ADMIT EVEN THE.
SCREENING THAT THEY'RE TALKING
ABOUT RIGHT HERE THAT IS A CALL
GUIDELINES
ON THE WE DON'T KNOW WHAT THE
FUTURE MAY HOLD AND SO. THAT IS
THE PREMISE OF OUR POSITION ON
THIS BILL. AND WE DO LOOK FOR TO
WORK WITH MR MAIENSCHEIN ON THIS
ISSUE AND HELP TO TRY TO IMPROVE
THE RESOURCES FOR THESE PATIENTS
BUT THEY NEED AN APPROPRIATE
TREATMENT.
BUT UNTIL THEN AND AS LONG AS A
MANDATE IS IN THE BILL AYE WE
REGRETTABLY HAVE TO OPPOSE THANK
YOU.
GOOD AFTERNOON I'M JENNIFER WITH
THE CALIFORNIA ASSOCIATION
HEALTH PLANS AND WE ARE OPPOSED
TO THIS BILL. ON THIS BILL
CREATES A CONDITION SPECIFIC
CARVE OUT UNDER EXISTING AT
COVERAGE FOR MENTAL HEALTH
SERVICES.
HEALTH PLANS STRONGLY AGREE WITH
A CRITICAL VALUE OF DELIVERY
HEALTH SERVICES FOR POSTPARTUM
DEPRESSION. AND CURRENTLY COVER
MENTAL HEALTH SERVICES.
I INCLUDING POSTPARTUM
DEPRESSION.
THE TO BURP ACCOUNT FOR ANY
HEALTH BENEFITS REVIEW HALF
PROGRAM REPORT INDICATES THAT A
HUNDRED PERCENT OF HEALTH PLAN
IN ROWLEY'S HAVE COVERAGE TO
MENTAL HEALTH SCREENINGS. DURING
THE PRENATAL AND POSTPARTUM
PERIODS.
HOWEVER THIS BILL GOES MUCH
FURTHER THAN THAT.
AND IT THAT REQUIRE MUCH OPPOSE
GOES MUCH FURTHER THAN CURRENT
PRACTICE BY REQUIRING HEALTH
PLANS TO PROVIDE AND CASE
MANAGEMENT AND OR QUALITY
REPORTING THAT'S MENTIONED IN
THE AMENDMENTS. REGARDING
POSTPARTUM CARE.
DEVELOPING AN ENTIRE NEW
MANAGEMENT SYSTEM FOR ONE
CATEGORY OF SERVICE.
WILL COULD NOT CONSTITUTE AN
EXTREME BURDEN AND INCREASED
COSTS FOR HEALTH PLANS.
WHICH UNFORTUNATELY IS FACTORED
INTO PREMIUMS
ON IN THIS JUST ISN'T A YEAR.
THAT WE WANT TO SEE PREMIUM
INCREASES OCCURRING.
I'M IN OR ALSO CONCERNED ABOUT.
ACCESS TO THE NETWORK
REQUIREMENTS BECAUSE OUR
SPECIFIC REFERENCE TO PROVIDER
TYPES WITHIN THE BILL.
SO I APPRECIATE THAT THIS IS OF
A REAL ISSUE THAT EXIST WITHIN
OUR STATE. WERE VERY I'M
SENSITIVE TO THE IMPACT OF HIS
DISEASES HAVE ON. A WOMEN IN
THAT WITNESSES THAT WE'VE HEARD
PROVIDING TESTIMONY TODAY.
WE'VE HAD NUMEROUS
CONVERSATIONS WITH THE AUTHORS
OFFICE IN THE SPONSORS AND WE
APPRECIATE. THAT THOSE.
CONVERSATIONS THAT WE HAVE AND
WHAT FOR CONTINUING THEM.
I DO KNOW THAT NEXT MONTH THOSE
MENTAL HEALTH HELP HEALTH
AWARENESS MONTH. WE'VE HAD SOME
DISCUSSIONS ABOUT EDUCATING IN
REDUCING THE STIGMA FOR POST
PART OF TO MAKE IT EASIER FOR
WOMEN TO ACCESS THE CARE THAT'S
CURRENTLY. THEY HAVE COVERAGE
FOR THROUGH THEIR HEALTH PLAN
PREMIUMS.
WELL WE'RE JUST NOT SURE THAT
THIS IS THE A NEW BENEFIT
MANDATES IS EXACTLY.
OF THE APPROPRIATE WAY TO GO.
.
FOR SPECIFIC DISEASE CARVE OUT
SINCE WE COVER ALL MENTAL HEALTH
SERVICES.
AND HERE TO ANSWER ANY
QUESTIONS.
OTHERS IN OPPOSITION
STEPHANIE LICHENS ON THE OF THIS
ISSUE XIN CALIFORNIA LIFE AND
HEALTH INSURANCE. BE SUPPOSED.
IF.
MICHELLE BACO THE CALIFORNIA
MEDICAL ASSOCIATION WE ARE IN
OPPOSE MUST AMENDED THANK YOU.
SHERRI MCCUE REPRESENT THE
CALIFORNIA CHAMBER OF COMMERCE
WE ARE OPPOSING THE CEMENTED
LOOK FOR TO CONTINUE TO WORK
WITH THE AUTHORED ADDRESS OUR
CONCERNS WITH THE COST OF THIS
BILL COULD ADD TO THE SYSTEM
THANK YOU.
MARIN HIGGINS REPRESENTING
AMERICA'S HEALTH INSURANCE PLANS
IN OPPOSITION.
JERRY HICKS REPRESENTING THAT
CALIFORNIA ACADEMY OF FAMILY
PHYSICIANS WE ARE OPPOSE MUST
AMENDED AND I WOULD ASSOCIATE
MCOT COMMENTS WITH.
RIGHT SPENCER'S.
CONCERNS THEY ARE THE SAME THANK
YOU.
PREFECTURE COMMITTEE FOR
QUESTIONS OR COMMENTS.
WALDRON.
THANK YOU MISTER CHAIR OF.
I.
SUPPORT WHAT YOU'RE TRYING TO DO
WITH THIS BILL THAT I HAVE SOME
QUESTIONS.
.
MAYBE I COULD START WITH THE
OPPOSITION JUST FOR
CLARIFICATION.
SOME OF THE ISSUES INVOLVED.
YEAH THE MOM HAS ONE TYPE OF
INSURANCE THE CHILD MIGHT BE
COVERED UNDER ANOTHER. THIS
DIFFERENT KINDS OF.
YOU KNOW COVERAGES.
HOW WOULD THIS BILL AFFECT?
THAT.
AS FAR AS NAVIGATING YOU KNOW
RECOVERED.
THAT'S VERY QUESTION I THINK
THAT THE COVERAGE REQUIREMENTS
WOULD DEPEND ON WHO'S DOING THE
SCREEN SPECIFICALLY IF THE SPELL
WAS.
AND ACTED AND THE PEDIATRICIAN
AND PROVIDED THE SCREEN AND I
DURING THE PEDIATRIC VISIT FOR
THE CHILD AND IDENTIFIED THAT
THE MOTHER WAS SUFFERING FROM
POSTPARTUM. IF THE MOTHER OF THE
CHILD WERE UNDER DIFFERENT
INSURANCE PERHAPS THE FATHER OR
ANOTHER PARENT. PROVIDED THE
CHILD'S INSURANCE AND THE MOTHER
WAS ON HER OWN.
THAT HOW THE CASE MANAGEMENT
WOULD GO BETWEEN A PEDIATRICIAN
WHO TO IS RESPONSIBLE FOR THE
CARE OF THE MOTHER AND FOR THE
TREATING MENTAL HEALTH PROVIDER
IN TWO DIFFERENT SYSTEMS I'M NOT
SURE HOW THOSE WOULD INTERACT.
I DO KNOW THAT THE HEALTH PLAN
WITH THE CHILD'S INSURANCE WILL
BE COVERING. YOU NO THE
PEDIATRIC ISIT AND THE MOTHER'S
HEALTH INSURANCE WOULD BE
COVERING THE MOTHER'S MENTAL
HEALTH SERVICES.
BUT HOW THOSE TWO WOULD BE
MANAGED IF YOU HAD TWO DIFFERENT
PROVIDERS NOT NECESSARILY WITH
ONE INSURANCE COMPANY. HOW THE
CASE MANAGEMENT COORDINATION
WOULD WORK IS A QUESTION THAT WE
WE HAVE AS WELL?
SO DOES THE BILL REQUIRE THE
OBGYN TO DO THE INITIAL POST
PARTUM.
SCREENING.
OKAY.
BUT THEN LATER THEY ALWAYS GO
FOR THE WELL BABY. SO.
DOES A COVER THAT TOO I MEAN
BECAUSE THERE'S A PROGRESSION.
YOU KNOW I I THINK IT'S A LITTLE
BIT OF SORT OF.
MAYBE THIS IS ALL ABOUT APPLES
AND ORANGES THAT YOU'RE I THINK
YOU'RE ASKED ABOUT INSURANCE
COVERAGE ISSUE AND THIS ISN'T
THIS IS NOT WHAT THIS BILL IS
THIS IS A SCREENING AND SHE'LL.
BE OBG.
DOWN THE ROAD WHAT MIGHT HAPPEN
IN TERMS OF TREATMENT.
YEAH THAT'S ABOUT IT IS THAT
THAT AS A PROBLEM BUT THAT'S AN
ONGOING PROBLEM THAT WOULD BE
SEPARATE FROM MY DEL THERE ISN'T
ENOUGH TREATMENT WE GOING TO
THAT AND WE WE HAVE.
BUT THIS IS THIS IS SIMPLY ABOUT
THE SCREEN.
BECAUSE RIGHT NOW.
THE NUMBER I'M GONNA SUPPORT THE
BILL TODAY BECAUSE HONEST I WANT
ONE I'M TRYING TO GET TO THESE
QUESTIONS SO THAT MAYBE WE COULD
WORK SOMETHING OUT AS THIS GOES.
IN UP TO BURBS SAYING THAT
HUNDRED PERCENT OF ENROLLEES
WITH HEALTH INSURANCE RIGHT NOW.
HAVE COVERAGE FOR MENTAL HEALTH
SCREENINGS DURING PRENATAL POST
PARTUM PERIOD.
SO. BUT YOU KNOW A PART OF THE.
THE ISSUE IS.
YOU KNOW YOU GO FOR WELL BABY
VISIT NOW YOU'RE NOT WITH AN
OBGYN IT'S A TOTALLY DIFFERENT
SCENARIO.
YOU DON'T WANT TO. MISS THAT
COVERAGE IS I MEAN THAT HAS TO
BE WORKED OUT I THINK IS.
THAT SORT OF JUST YEAH IT AT TEN
MS WHAT WE'VE WE HAVE WORKED IN
AYE I THINK AS MR SPENCE AND
OTHERS WOULD ATTEST WE HAVE WE
HAVE HAD COUNTLESS MEETINGS ON
THIS AND WE WILL CONTINUE TO DO
THAT'S I THINK. MOST OF YOUR
QUESTIONS WILL BE ABLE TO GET
ANSWERED I WOULD SAY THOUGH IT I
THINK THERE'S A DIFFERENCE
BETWEEN COVERAGE ISSUE.
AND SCREEN THIS THIS STILL
REFERS TO SCREEN.
SO AS AS COVERAGE MAY PROGRESS
IN TERMS OF TREATMENT OF A MAMA
WHAT'S GOING ON WITH THE BABY
THAT.
THAT'S NOT WHAT'S ENTAILED
WITHIN THE PARAMETERS OF THIS
BILL THAT THAT IS SOMETHING THAT
I THINK THIS COMMITTEE SHOULD
ADDRESS. BUT IT'S NOT THAT'S
GOING TO BE ADDRESSED WAY
THROUGH THIS VEHICLE ONE. OF THE
OTHER THING I HAD WAS FOURTEEN
STATES HAVE ALREADY PASSED LAWS
RELATING.
SIMILAR.
BUT THERE'S DIFFERENT WON SOME
OF THEM EDUCATION MANDATE.
SCREENING MANDATES.
POSTPARTUM DEPRESSION AWARENESS
CAMPAIGNS WITH JUST VERY
CRITICAL.
HAS TO BE IN THE TASK FORCE WAS
TO LOOK AT.
SO.
WE'RE LOOKING AT THE SCREENING
MANDATES.
AND. WHAT HAVE YOU SEEN AS FAR
AS OTHER STATES THAT HAVE DONE
SCREENING MANDATES HOW THAT HAS
WORK OR NOT WORK?
JOY BURKHARD I WAS WITH THE
MATERNAL MENTAL HEALTH TASK
FORCE THAT ISSUED THE REPORT.
THAT I THINK EACH OF OUR
COMMITTEE MEMBERS HAVE RECEIVED
A COPY OF LAST YEAR A IT IS THE
TASK FORCE FUNCTION MUCH LIKE A
BLUE RIBBON COMMISSION. IT WAS A
CALLED FOR BY ACR ONE FORTY
EIGHT THE LEGISLATIVE WOMEN'S
CAUCUS.
SPONSORED THAT RESOLUTION THE
REPORT WAS ISSUED LAST YEAR AND
HERE AT THE LEGISLATURE AND.
IT DOCUMENT SOME OF THE WORK
THAT OTHER STATES HAVE DONE.
THIS WORK HERE IN CALIFORNIA I
THINK IT'S IMPORTANT THAT
EVERYONE KNOWS OF HAS BEEN IN
THE WORKS FOR ROUGHLY TEN YEARS.
RESOLUTIONS AWARENESS
RESOLUTIONS CAMP AWARENESS
CAMPAIGNS ALL THOSE THINGS HAVE
BEEN ADDRESSED NOT PUBLICLY
FUNDED YET.
AND THERE IS ANOTHER BILL THAT.
THAT A BRAIN MAIENSCHEIN IS ALSO
ADDRESSING THE PUBLIC HEALTH.
A FUNDING BILL FEDERAL FUNDS
BILL WHICH WE HOPE WILL ADDRESS
A PUBLIC AWARENESS CAMPAIGN AS
WELL. ON THE REPORT CALLS FOR
THE URGENT NEED TO SCREEN.
SCREEN WOMEN SO THESE STORIES
DON'T KEEP HAPPENING IT'S A
STARTING PLACE WE KNOW IT'S A.
VERY COMPLEX PROBLEM THAT
THERE'S MULTIPLE PLAYERS THAT
CAN AND TAKE A ROLL. THE REPORT
ACKNOWLEDGES THE CRITICAL ROLE
OF THE OBGYN IN SCREENING FOR
THESE DISORDERS BECAUSE THEY CAN
OCCUR AS FREQUENTLY DURING
PREGNANCY. NOT JUST IN THE POST
PARTUM WE DON'T TALK ABOUT THAT
OFTEN WE ALSO KNOW A LOT OF
WOMEN WILL SUFFER FROM A
DEPRESSION OR ANXIETY. BEFORE
THEY GET PREGNANT
THESE DISORDERS WHEN LEFT
UNTREATED CAN LEAD TO PRETERM
BIRTH WHICH WE NO COST THE
STATE.
THOUSAND MILLIONS OF DOLLARS ON
AND IT'S CRITICALLY IMPORTANT
THAT OBGYN SERVICE THE HOME
BASE.
NO OTHER DOCTOR SHOULD NOT ON
SCREEN SO DOCTOR SHOULD SCREEN
OTHER SHOULD AS WELL BUT O.
BITCOINS MUST BE THE HOME BASE
AND THAT'S OF KNOWLEDGE IN THIS
REPORT.
.
STILL MY LAST QUESTION IS THERE
A BEST PRACTICE PROTOCOL.
CURRENTLY ON WELL CHILD VISITS.
IS THAT PART OF WHAT.
A PEDIATRICIAN IS LOOKING AT.
YEAH AND IF I COULD.
.
BRIAN IF WE COULD MENTION ONE OF
THE AMENDMENTS THAT WERE LOOKING
OUT ITS TO HAVE OBGYN SCREEN AND
PERHAPS DROP THE SCREENING
MANDATE ON OTHER PROVIDERS WE
WANT TO ACKNOWLEDGE.
THAT FIRST TIME.
SO AT YOUR QUESTION ABOUT
PEDIATRICIANS.
MCMURRAY.
PEDIATRICIANS BUT VERY VERY ST
ASSOCIATIONS HAVE COME OUT WITH
POSITIONS ON THE IMPORTANCE OF
SCREENING PEDIATRICIANS ARE VERY
INTERESTED IN THIS.
THIS I'M WORK BECAUSE UNTREATED
DEPRESSION NEGATIVELY IMPACTS AS
YOU HAVE HEARD CHILD
DEVELOPMENT.
SEWED PEDIATRICIANS ARE
INTERESTED THERE NOT THE MOTHERS
DR WHICH IS WHY OBGYN SO CALLED
OUT AS BEING CRITICALLY
IMPORTANT OBGYN SCAN PRESCRIBE
CREATE.
TREATMENT.
PATHWAYS SIX CETERA THAT'S NOT
THE ROLE OF THE PEDIATRICIAN AT
THE DOCTOR OF THE BABY OR THE
INFANT NOT THE THE MOTHER. DOES
I HOPE.
RIGHT.
SO THEY HAVE A BEST PRACTICE
PROTOCOL THAT THEY YEAH AND SO
DOES A COG THE AMERICAN COLLEGE
OF OBSTETRICS AND GOING
GYNECOLOGY AND TOOLS ARE BEING
ISSUED BY A CAUGHT. UP AS WE
SPEAK.
LEADER THE SURE THEY'LL BE
MULTIPLE TOOLS THAT WILL BE
AVAILABLE THROUGH AN EXPERT
WORKGROUP WHICH ON SEVERAL OF US
RUN THE TASK FORCE HAVE A
PRIVILEGE TO SIT ON.
THANK YOU I I'M. YOU KNOW
LOOKING FORWARD TO SEE HOW THIS
EVOLVES BECAUSE.
THE WAY THE HEALTH PLANS.
WORK
ON THAT NOW.
IT'S A LITTLE DIFFERENT THAN HOW
YOU'RE TRYING TO DO IT AND I'M.
CURIOUS TO SEE HOW THIS COMES
TOGETHER.
ON BECAUSE THEY MAY BE.
AWAY TO DO WHAT YOU WANNA DO.
THAT MAYBE COULD BE WORKABLE AND
I DON'T KNOW BUT.
THAT LIST.
WHY WAS SAYING THAT ON THE
RECORD?
OTHER QUESTIONS COMMENTS FROM
THE COMMITTEE.
SEEN MUCH SEEN OBJECT CLOSENESS
BUT MAY I WOULD.
JUST A COUPLE JUST A COUPLE
QUICK RESPONSES ON. THE TASK
FORCE.
THAT. ACT ACTUALLY THAT THE.
SOME OPPONENTS PARTICIPATED AND
DECLARED.
THAT OBSTETRIC PROVIDERS OF THE
HOME BASE FOR SCREENING AND
TREATMENT AND RECOMMENDED THAT
WOMEN ARE SCREEN THROUGHOUT THE
PREGNANCY IN THE IMMEDIATE POST
PARTUM.
PERIOD AND IT ALSO URGED HEALTH
INSURERS TO ASSIST OBG Y. ANTS
WITH ONGOING PATIENT CARE
OVERSIGHT MANAGEMENT THAT WAS
PRESENTED.
PARTICIPATE IN AND PRESENTED TO
THIS LEGISLATURE AS PART OF A
SOLUTION TO POST PARTUM
DEPRESSION.
I WOULD ALSO SAY TO YOU IN
TERMS OF THE STANDARD OF CARE.
THIS IS THE STANDARD.
SCREEN IS.
THAT IS HOW YOU GET OUT THE
STANDARD OF CARE.
AND SO WELL IN SOME SENSE I
UNDERSTAND WHAT WAS SAID ABOUT
THEIR NOT FLUID.
.
HOW ARE THEY ARE THEY ARE FLUID
WHERE I WOULD DISAGREE AS TO ASK
ARE NOT FLUID IN THE SENSE THAT
THEY'RE ON AN AD?
BASIS.
DATE WE SET THINGS AND LAW.
AND THEN IF THIS AS THE STATE OF
SCIENCE
ADVANCES IN MEDICAL KNOWLEDGE
MASSES THAT LONG MAY CHANGE
BUT WE DON'T JUST HAVE ADHOC.
EVERYBODY DO WHAT THEY WANT
THAT'S ACCORDING TO THEIR
VERSION OF REALITY SO WITH THIS
I MEAN I THINK YOU SAW FROM THE
TESTS MY HERE TODAY AND FOR THE
NUMBERS OF PEOPLE HERE MANY MORE
WHO WOULD LIKE TO BE HERE THIS
IS. THIS IS A REALLY SIGNIFICANT
PROBLEM WE TALK ABOUT ADDRESSING
MENTAL HEALTH MANY TIMES IN THIS
LEGISLATURE THIS IS A LARGE
COME.
OF.
AND I WOULD STRONGLY. URGE AND
AYE VOTE AND REQUEST AN AYE
VOTE.
I FROM THIS COMMITTEE THANK YOU
MISTER.
THANK YOU MR MAIENSCHEIN AND I
VERY MUCH APPRECIATE YOU
BRINGING THIS BILL FORWARD AND
APPRECIATE YOUR WITNESSES AND.
AND THE TESTIMONY AND THANK YOU
FOR. COMING INTO THAT WAS VERY%
DIFFICULT AND.
I'D VERY MUCH APPRECIATE WE VERY
MUCH APPRECIATED.
THE BILL DOES ENJOY A DO PASS
RECOMMENDATION I KNOW YOU'RE
GOING TO CONTINUE WORKING ON
THIS.
I'M NOT THRILLED ABOUT THEM. IN
THE AND MANDATING THINGS ON
PROVIDERS.
HOWEVER I THINK.
I THINK WE NEED TO MESSAGE OUT
THERE AND CLEARLY.
IT'S NOT HAPPENING TO A CERTAIN
TO A CERTAIN SIGNIFICANT NUMBER
OF PEOPLE OUT THERE AND.
THERE ARE CONSEQUENCES FOR THAT
AND WE NEED TO CHANGE THAT AND
SO I APPRECIATE YOU BRINGING
THAT NO FORWARD.
AND AS I SAID IT DOES ENJOY DO
PASS RECOMMENDATION AND AND I
KNOW YOU WILL BE COMMITTED TO
CONTINUING TO WORK ON THIS SO
ASK MADAM SECRETARY.
PLEASE CALL THE ROSES DO PASS AS
AMENDED TO APPROPRIATIONS.
AND I.
CARE MEMBER WHO MADE MOTIONS BUT
THEY WERE GREAT MOTIONS. AND
DON'T HAVE THIS AGUIAR-CURRY
AND.
AND MISS PERFECT SO THANK YOU.
MADAM SECRETARY PLEASE CALL THE
ROLL.
WOULD I WOULD I MAYES.
MAYES BOMBARDING AGUIAR-CURRY.
BIGELOW.
BIGELOW NOT VOTING WANT.
SIR.
TO MAKE THOSE CHANGES.
YOU COULD YOU CAN ACCEPT MR
MAIENSCHEIN.
TODAY IT'S A NO.
BUT IF YOU WORK ON THAT CHANGES
I'M HOLDING MY OWN HERE MISTER
AND TRACKING WHAT THAT YEAH I
THINK I THINK I GOT IT.
BIGELOW NO BONTA.
BONTA AYE BURKE.
BURKE I CARILLO.
CARILLO AYE FLORA.
FLORA NOT VOTING THE MONK. LIMON
AYE MCCARTY. MCCARTY AYE IN THIS
AREA.
RODRIGUEZ SANTIAGO BERMAN.
WALDRON.
WALDRON AYE.
SEVEN ONE YOU NEED ONE MORE
VOTE.
WITH THAT WE'RE GOING TO. MOVE
INTO OUR SPECIAL ORDER OF
BUSINESS WHICH IS GOING TO BE
ITEM NUMBER ONE OF NASCAR
COMMITTEE MEMBERS WHO ARE NOT
PRESENT TO PLEASE.
COME TO THE DYESS AND AND WITH
THIS AND PARTICIPATE IN THIS.
I KNOW YOU'RE OUT THERE.
ORTEGA
THE LINE.
SAY FOR.
I LOVE.
ALRIGHT
.
OKAY. LET'S GO AHEAD AND GET
STARTED GET STARTED.
WE COULDN'T.
.
GET THE PAPER GET THE DOOR
CLOSED THEREIN
OKAY WE'RE GOING TO GO AHEAD
GET STARS TO LOOK DIFFERENT THAN
OUR NORMAL COMMITTEE
PRESENTATION WE ALLOW EACH
EACH SIDE TO PERCENT FOR FIFTEEN
MINUTES TOTAL. SO EVERYONE SPLIT
UP.
SO.
.
AND THAT DOES NOT INCLUDE YOU
MISTER KALRA.
I REGRET I REGRET THAT FOR THE
COMMITTEE MEMBERS BUT.
THANK YOU VERY MUCH MR CHAIRMAN
MEMBERS I'D LIKE TO START OFF BY
THANKING THE CHAIR IN HIS
PERSONAL AND COMMITTEE STAFF FOR
THEIR TIRELESS. EFFORTS ON THIS
BILL. AND WORKING WITH ME.
I APPRECIATE THE WORK AND EFFORT
I'M GRATEFUL FOR ALL THE TIME
YOU PUT INTO THIS MEASURE AND
ALSO LIKE TO COMMEND THE WORK OF
THIS COMMITTEE AND MEMBERS OF
THE SELECT COMMITTEE. WHICH ARE
NUMEROUS HEARINGS THROUGHOUT THE
STATE HEARING FROM EXPERTS
STAKEHOLDERS AND THE PUBLIC ON
THE IMPORTANT DISCUSSION. ON HOW
TO EXPAND ACCESS TO HEALTHCARE
WHILE CONTROLLING COSTS.
THOSE HEARINGS ARE CRITICAL TO
GETTING A. B. THIRTY EIGHTY
SEVEN TO WHERE WE ARE NOW AND I
TRULY APPRECIATE YOUR
LEADERSHIP.
SECONDLY I WANT TO THANK THE
COMMITTEE MEMBERS AND THEIR
STAFF FOR THEIR TIME QUESTION
ASKS.
AND CONCERNS THAT HAVE BEEN
RAISED.
THE AMENDMENTS WE HAVE MADE AND
THOSE PROPOSED AS AUTHOR
AMENDMENTS IN THE COMMITTEE
ANALYSIS ARE REFLECTIVE OF HOW
WE HAVE WORKED TO RESPOND TO AN
ADDRESSES MANY OF THE QUESTIONS.
AND CONCERNS THAT HAVE BEEN
RAISED TO DATE. BOPPING IS
HEADED OUT A MATRIX WHICH HAS.
.
TWELVE SUBSTANCE OR BLEVINS
SUBSTANTIVE AMENDMENTS WE'VE
TAKEN PLUS FOR COMMERCE OF
COMMITTEE POLICY COMMENTS THAT
WERE ALSO GOING TO BE.
INCORPORATING AS AMENDMENTS AS
THIS BILL IT WERE TO MOVE
FORWARD.
WOULD BE INCLUDED IN THE BILL
AS WELL SO FIFTEEN TOTAL
SUBSTANTIVE AMENDMENTS AND WE
LOOK FORWARD TO CONTINUING THE
PROCESS OF WORKING ON AN
IMPROVING THE BILL.
OF WITH THAT.
WELL GLAD I'LL GLADLY ACCEPT
AMENDMENTS TO ADDRESS ALL THE
POLICY COMMENTS AS AUTHORS
AMENDMENTS IN THE COMMITTEE
ANALYSIS. AND A MOCK UP IN TABLE
SUMMARY AS MENTION IS BEING
DISTRIBUTED FOR OF ALL OF YOU TO
REVIEW.
OVER THE PAST TEN YEARS
CALIFORNIA HAS MADE GREAT
STRIDES IN INCREASING ACCESS TO
HEALTH CARE WHY ARE UNINSURED
POPULATIONS DROPPED. BY NEARLY
HALF.
HOWEVER. ALTHOUGH WE HAVE MADE
TREMENDOUS STRIDES IN INCREASING
ACCESS TO HEALTH CARE MANY
CONTINUE TO FOREGO NEEDED
MEDICAL TREATMENT BECAUSE OF THE
CONTINUED YOUR BY YOUR INCREASES
AND HEALTHCARE COSTS.
HEALTHCARE HAS BECOME FAR TOO
EXPENSES AND IF IT CONTINUES
WILL BECOME UNSUSTAINABLE NOT
JUST FOR THOSE WITHOUT
INSURANCE.
BUT ALSO FOR THOSE WITH IT.
NOT ONLY DOES IT IMPACT THE
STATE'S ABILITY TO FUND
IMPORTANT PRIORITIES SUCH AS
EDUCATION TRANSPORTATION. AND IS
HAVING A SIGNIFICANT IMPACT ON
THE ABILITY OF CALIFORNIA
BUSINESSES TO AFFORD. AN OFFER
HEALTHCARE BENEFITS TO THEIR
EMPLOYEES.
IN FACT OVER THE PAST TEN YEARS
STATE BUDGET EXPENDITURES ON
HEALTH CARE HAVE INCREASED BY
EIGHT PERCENT YEAR OVER. YEAR
THE PAST TEN YEARS AND
CALIFORNIA'S BUSINESSES ARE
INCREASINGLY FOR DON OFFERING
THEIR EMPLOYEES HEALTHCARE
INSURANCE WERE ONLY FIFTY FIVE
PERCENT OF CALIFORNIA COMPANIES.
HAVE REPORTED PROVIDING
HEALTHCARE INSURANCE TO
EMPLOYEES TWO THOUSAND SIXTEEN
WHICH IS DOWN FROM SIXTY NINE
PERCENT IN TWO THOUSAND.
MOST IMPORTANTLY WE'RE SEEING
PEOPLE MAKE SERIOUS AND
POTENTIALLY DEBILITATING HELD
DECISIONS DUE. TO THE COST OF
HEALTHCARE.
IN A RECENT REPORT BY THE
UNIVERSITY OF CHICAGO WAS FOUND
UP FORTY PERCENT OF AMERICANS
SKIPPED A RECOMMENDED MEDICAL
TESTS OR TREATMENT. DUE TO COST.
WHAT ALL THIS INFORMATION
DEMONSTRATES THAT THE CURRENT
TRAJECTORY OF HEALTHCARE COSTS
IS UNSUSTAINABLE?
IT BEGAN TEN YEARS TO GO ON
UNADDRESSED IN THAT COULD WELL
ACCESS TO CARE WILL WORSEN.
HEALTHCARE DISPARITIES WILL
INCREASE AND THE
DISPROPORTIONATE USE OF MEDICAL
CARE BETWEEN THOSE WHO CAN AND
CANNOT AFFORD THEIR HEALTHCARE
WILL EXPAND.
THIS IS WHY I HAVE OP AUTHORED
AB THIRTY EIGHTY SEVEN THE
HEALTH CARE PRICE RELIEF ACT
WHICH WILL ESTABLISH AN
INDEPENDENT HEALTH CARE COST.
QUALITY AND EQUITY COMMISSION TO
SET REASONABLE BASED AMOUNTS
HOSPITALS DOCTORS AND OTHER
PROVIDERS OF HEALTHCARE SERVICE
CAN COLLECT FROM PARIS.
THE ELEVEN MEMBER COMMISSION
WOULD BUILD OFF OF WOULD BUILD
OFF OF MEDICARE REYES NOT LOWER.
THAN A HUNDRED PERCENT DETERMINE
PROVIDER BASE AMOUNTS AND I JUST
MEDICARE ADVANTAGE REYES TO
ESTABLISH A CAPITATED AMOUNT
THAT HEALTH PLANS MUST USE AS A
BASIS FOR PREMIUMS.
BY BUILDING UPON EXISTING MODELS
WE CAN ESTABLISH A TRANSPARENT
PROCESS BY WHICH INCREASES IN
HEALTHCARE COSTS CAN BE KEPT
REASONABLE. CONTINUE TO EXPAND
ACCESS TO CARE AND PROVIDE OUR
HEALTH CARE INDUSTRY WITH THE
ABILITY TO RECEIVE A FAIR RETURN
ON INVESTMENT.
IN DOING SO WE CAN HELP ADDRESS
THE LONG TERM SUSTAINABILITY OF
OUR HEALTHCARE SYSTEM BY
DRESSING UNREASONABLE AND
EGREGIOUS RATES WHILE
MAINTAINING ACCESS TO QUALITY
CARE FOR ALL.
I WANTED ALSO ADDRESS SOME OF
THE QUESTIONS WE HAVE REGULARLY
HEARD ABOUT THE BILL. SIDE LEGAL
HELP TO CLARIFY WHERE CERTAIN
ELEMENTS OF GOT LOST IN
TRANSLATION OR MISINFORMATION IS
ADDED TO THE CONFUSION ABOUT THE
BILL.
A FREE CONCERNED THAT THERE'S
BEEN REYES IS THAT THIS BILL
WOULD LET LEAD TO RATIONING OF
CARE AND COST POSITIONS TO FLEE
THE STATE AND HOSPITALS CLOSE
OUR DOORS.
THIS IS NOT TRUE RATHER A. B.
THIRTY EIGHTY SEVEN WHAT COUNTER
WHAT WE ARE ALREADY SEEING IN
OUR HEALTHCARE SYSTEM
TODAY THE RATION OF HEALTHCARE
BY THE PEOPLE WHO NEED IT. THE
MOST
AYE DO THE COST OF CARE MANY ARE
REGULARLY CHOOSING TO FORGO A
NETIQUETTE I NAY A NEEDED
MEDICAL. TREATMENT OR TO PAY THE
RENT.
THE FOOD ON THE TABLE OR PAY
THEIR UTILITY BILL.
THIS BILL WOULD ENSURE THAT
RATES ARE REFLECTIVE OF THE NEED
TO MAINTAIN AND EXPAND ACCESS TO
NOT JUST QUALITY MEDICAL CARE
BUT AFFORDABLE MEDICAL CARE.
REGARDING PHYSICIANS AND
HOSPITALS WE ARE ALREADY
EXPERIENCING A SHORTAGE OF
PRIMARY CARE PHYSICIANS WHO ARE
ON THE FRONTLINE OF OUR
HEALTHCARE SYSTEM AND WATCHING
US HOSPITAL'S CONSOLIDATE. AND
SHUDDER HEALTHCARE FACILITIES IN
THE PROCESS.
AS OPPOSED TO OUR CURRENT
REALITY ASSAULT RATION
HEALTHCARE DUE TO COST AB THIRTY
EIGHTY SEVEN WOULD ENSURE THAT
PROVIDER RATES ARE TIED TO
IMPROVING HEALTH OUTCOMES AND
REDUCING HEALTH DISPARITIES.
FURTHER AB THIRTY EIGHTY SEVEN
ALSO TAKES INTO ACCOUNT WHAT IS
NEEDED TO RECRUIT AND RETAIN A
QUALIFIED HEALTHCARE WORKFORCE.
AND THAT THERE'S A FAIR AND
REASONABLE RETURN ON INVESTMENT
FOR PROVIDERS.
ANOTHER CONCERN WE HAVE HEARD IS
THAT THIS BILL DOES NOTHING TO
ADDRESS INADEQUATE MEDICAL RATES
WHICH ARE A DRIVER OF COST
SHIFTING BETWEEN COMMERCIAL AND
MEDI CAL RATES.
ALTHOUGH THERE ARE SIGNIFICANT
RESEARCH THAT DEMONSTRATES THAT
COST SHIFTING FROM A MORE
CONSERVATIVE VIEWPOINT HAS
OCCURRED. ABOUT USUALLY AT A
RELATIVELY LOW RATE THE BILL
DOES INCLUDE LANGUAGE TAKE INTO
ACCOUNT THE NUMBER OF. NUMBER OF
MEDI CAL PATIENTS PROVIDERS
SERVE
THE FISCAL IMPACT ASSOCIATED AND
MAKE ADJUSTMENTS TO THE RATE AS
NECESSARY.
LASTLY CONCERN WE HAVE HEARD
REGULARLY THIS BILL AS A VEILED
ATTEMPT AND MEANT MEDICARE FOR
ALL OR TO KEEP RATES AT AT OR
NEAR MEDICARE AMOUNTS.
THIS IS UNTRUE AND AS AN
ARGUMENT THAT I BELIEVE IS
MISLEADING A MISREPRESENTATION
OF EFFORTS MY OFFICE MADE TO
HELP STAKEHOLDERS READ THROUGH
THE BILL LANGUAGE.
SPECIFICALLY IN ONE OF THE
DOCUMENTS WE USED TO HELP
STAKEHOLDERS UNDERSTAND THE
DIFFERENT PROVISIONS WE INCLUDED
AN EXAMPLE OF HOW THE MEDICARE
RATE CAN BE USED TO DETERMINE
PROVIDER MAYES.
FOR EXAMPLE WOULD READ THAT
RATES COULD BE UNDER TWENTY FIVE
PERCENT HUNDRED PERCENT MEDICARE
OR HIGHER.
HOWEVER SOME MISREPRESENTED THIS
AFTER TO STATE THAT THE BILL
WOULD SET RATES AT A HUNDRED
PERCENT TWENTY FIVE PERCENT
MEDICARE AND RESULT IN AN
ESTIMATED EIGHTEEN BILLION
DOLLARS IN LOST REVENUE FOR THE
OVER. FOREIGNER HOSPITALS IN
CALIFORNIA THAT PAYMENT
REDUCTIONS WILL NEED AN ESTIMATE
A HUNDRED SEVENTY FIVE THOUSAND.
OF HEALTH CARE WORKERS LOSING
THEIR JOBS.
THAT'S OF OF A HYPOTHETICAL
DOES NOT BASED IN FACT AND IT'S
INCORRECT AND MISLEADING.
RATHER AS MANY OF YOU KNOW
MEDICARE RATES ARE OFTEN USED BY
POSITIONS HOSPITALS INSURERS TO
NEGOTIATE THEIR CONTRACT AND A
CONTRACT RAISE. IT IS USED AS
THE FOUNDATION UPON WHICH
POSITIONS MEDICAL GROUPS
HOSPITALS CLINICS HEALTHCARE
PLANS AND INSURERS NEGOTIATE
THEIR RATES. THIS IS THE SAME
APPROACH USED FOR A. B. THIRTY
EIGHTY SEVEN ONE THAT DOES NOT
SET A PROVIDER RATE CEILING JUST
THE OPPOSITE THAT SETS A FLOOR
USING EXISTING. MEDICARE RATES
I'M NOT LOOKING TO GO BACK AND
SET RATES WHERE THEY WERE TWENTY
YEARS AGO THIS IS THE PROSPECT
OF BILL WHEREBY THE COMMISSION
WILL BE LOOKING AT TODAY. AND
GOING INTO THE FUTURE.
THE NOTION OF THIS ONLY GONNA
LEAD TO CUTS IN CURRENT RATES
ARE SIMPLY NOT TRUE. AS THE
COMMISSION IS REQUIRED TO SET
REYES A FAIR MARKET VALUE. AND
FOSTER A MORE ACTIVE WILL
HEALTHCARE SYSTEM FOR ALL
CALIFORNIANS
SIMPLY PUT SHARON MEMBERS THE
STATUS QUO IS UNACCEPTABLE.
AND IF WE MAINTAIN THIS IS THE
WAY THE SYSTEM IS CURRENTLY SET
UP WE'RE GONNA SEE MORE
CALIFORNIANS MORE SMALL
BUSINESSES NOT BE ABLE TO AFFORD
HEALTHCARE AND FRANKLY. BUT THE
PROVIDERS THE HOSPITALS THE
DOCTORS GOING INTO THE FUTURE
THEY WON'T NEED AND DESERVE A
SUSTAINABLE SYSTEM TO.
AND SO THE THIS BILL SEEKS TO
ENSURE THAT EVERYONE CAN COME TO
THE TABLE AND PROVIDE INPUT TO
ENSURE THAT THE RATES THAT ARE
SET ARE ONES THAT ARE FAIR TO
EVERYONE. BUT THAT DON'T HAVE
THESE UNEXPECTED INCREASES THAT
REALLY MAKE IT AN UNSUSTAINABLE
SYSTEM FOR ALL.
WITH THAT I HAVE WITH ME ARE CO
SPONSORS FOR A. B. THIRTY EIGHTY
SEVEN WILL BE TESTIFYING IN
SUPPORT OF THE BILL. ARE PLASTIC
SECRETARY TREASURER FOR THE
CALIFORNIA LABOR FEDERATION.
CHRIS ROCK PRESIDENT OF UNITE
HERE LOCAL FORTY NINE AND TAM MA
WITH HEALTH ACCESS THINK
RESEARCHER.
GERMAN.
MEMBERS MY NAME IS ART PULASKI.
I'M THE EXECUTIVE SECRETARY
TREASURER OF THE CALIFORNIA
LABOR FEDERATION.
THANK YOU DOCTOR WORD FOR ALL
THAT YOU DO.
YOU DON'T SEE ME. YOU DON'T
OFFICE HE ME HERE GIVING
TESTIMONY.
BUT HEALTHCARE IS AN ISSUE THAT
TOUCHES.
ALL OF OUR MEMBERS TWO MILLION
OF THEM.
AND ALMOST ALL CALIFORNIANS.
SINCE TWO THOUSAND AND TWO.
PREMIUMS FOR JOB BASED INSURANCE
IN CALIFORNIA HAVE RISEN BY TWO
HUNDRED AND THIRTY FOUR PERCENT.
SOMETHING IS VERY WRONG.
THIS IS BEFORE THEN LONG BEFORE
THEN WE HAVE WORKED HARD EVERY
ASPECT OF HEALTH CARE FOR
CONSUMERS.
TWO THOUSAND THREE.
BECAUSE WE SPONSORED ESPY TO THE
JOHN BURTON BILL.
THAT WOULD CALLED ON ALL
EMPLOYERS ALMOST ALL EMPLOYERS
IN THE STATE OF CALIFORNIA.
TO GIVE OUR HEALTH INSURANCE TO
THEIR EMPLOYEES.
WHO WORKED ON THE AFFORDABLE
CARE ACT?
HE'S TAKEN ON INSURANCE
COMPANIES HEALTH PLANS AND BIG
PHARMA.
OUR TRUST FUND SAID NEGOTIATE
COVERAGE FOR TWO MILLION
FAMILIES.
CONTINUOUS GREAT FOR WAYS TO CUT
COSTS.
THROUGH ALL THIS AND MORE WE
HAVE LEARNED THE ONLY WAY TO
CONTAIN COSTS.
IS TO ADDRESS HIGHER PRICES.
ACROSS THE BOARD THROUGH THE
ENTIRE INDUSTRY.
ARE FEDERATION IS A STRONG
SUPPORTER OF SINGLE PAYER.
S. B. FIVE SIX TWO.
AND TO ACHIEVE SINGLE PAYER.
WE MUST REDUCE THE COSTS OF
MEDICAL CARE.
AB THIRTY EIGHTY SEVEN.
IS ABOUT SETTING A FAIR AND
TRANSPARENT PROCESS FOR HEALTH
CARE RATES.
RIGHT NOW THOSE PRICES ARE
LARGELY CONTROLLED BY MEDICAL
MONOPOLIES.
ESSENTIALLY THEY CHARGE WHATEVER
THEY CAN.
WHENEVER THEY CAN.
SUTTER HEALTH HERE IN SACRAMENTO
IS JUST ONE EXAMPLE OF THAT.
WE HAVE LEARNED THAT THE FREE
MARKET SYSTEM.
FOR ALL OTHER ESSENTIAL
SERVICES.
DOES NOT WORK.
WE IS CONTROLLED BY MY NOT
MONOPOLISTIC PRICE CITY.
OF COURSE IT DOESN'T WORK FOR
HEALTH CARE EITHER.
THOSE PRICES ARE PUSHING
HEALTHCARE SYSTEM TO THE BRINK.
PUSHING FAMILIES EMPLOYERS ALIKE
OVER THE EDGE.
EVERY MOMENT WE WAIT MORE
FAMILIES WILL BE HEARD.
THEY NEED URGENT ATTENTION WE
ARE JUNE VOTE YES THANK YOU VERY
MUCH.
GOOD AFTERNOON CHAIRMAN WOULD
AND MEMBERS OF THE COMMITTEE. MY
NAME IS CHRIS RACKING ON THE
PRESIDENT OF UNITE HERE LOCAL
FORTY NINE. A UNION OF THIRTY
SIX HUNDRED HOTEL RESTAURANT A
CASINO WORKERS BASED HERE IN
SACRAMENTO.
OUR MEMBERS ARE THE
HOUSEKEEPER'S IN THE BARTENDERS
WHO WAIT ON YOU AT THE SHERATON
GRAND SACRAMENTO AND TO CITIZEN
HOTEL. IS THE COOKS IN THE
BOUNCERS WHO SERVE YOU AT
THUNDER VALLEY IN CAST CREEK
CASINOS.
WE ARE UNION OF LOW WAGE WORKERS
TO GENERATE PROFITS FOR
CORPORATIONS THAT MAKE BILLIONS
OF DOLLARS A YEAR.
I'M HERE TODAY REPRESENTING
UNITE HERE AND INTERNATIONAL
UNION OF TWO HUNDRED SEVENTY
FIVE THOUSAND HOSPITALITY
WORKERS ACROSS THE U. S. AND
CANADA.
ALONG WITH THE CALIFORNIA LABOR
FEDERATION AS YOU ARE YOU
CALIFORNIA THE TEAMSTERS AND
HEALTH ACCESS
WE ARE CO SPONSORS OF AB THIRTY
EIGHTY SEVEN BECAUSE THE
INCREASING COST OF HEALTHCARE
HAS CREATED A CRISIS THAT
THREATENS THE ABILITY. OF
MILLIONS OF WORKERS BOTH ARE
MEMBERS IN THOSE WITHOUT UNIONS
HAVE A SHOT AT MIDDLE CLASS
LAUGHS.
WE RESET CRISIS POINT AND THINGS
CANNOT CONTINUE AS THEY ARE.
I'VE BEEN IN SACRAMENTO SINCE
TWO THOUSAND FIVE IN A
NEGOTIATED DOZENS OF CONTRACTS
WITH HOTEL COMPANIES CORPORATE
CAFETERIA FRANCHISEES IN TRIBAL
GAMING OPERATORS. REPRESENTING
HUNDREDS OF MILLIONS OF DOLLARS
IN WAGES PENSIONS AND HEALTH
CARE CONTRIBUTIONS.
IN THAT TIME I'VE HAD LIED TO
MANY HARD UGLY MEETINGS WITH
COURAGEOUS GROUPS OF WORKERS WHO
ARE FORCED TO MAKE AN IMPOSSIBLE
CHOICE AT THE END OF TOUGH
CONTRACT NEGOTIATIONS.
THEY STRUGGLE TO WIN NINETY
CENTS FOR A BUCK FROM THE
COMPANY BUT THEY HAVE TO DECIDE
WHETHER TO PUT THAT MONEY INTO
RAISES OR HEALTH CARE
CONTRIBUTIONS.
WHEN YOU'RE TRYING TO SUPPORT
YOUR FAMILY ON TWELVE OR
THIRTEEN DOLLARS AN HOUR AND PAY
FOR HOUSING AND LIVING EXPENSES
IN CALIFORNIA THAT'S A REALLY
PAINFUL CHOICE.
WORKERS ARE FORCED TO PUT LOTS
OF THE MONEY THEY WIN IN
BARGAINING OFTEN THE MAJORITY OF
IT INTO PROTECTING THEIR HEALTH
CARE.
THIS IS HAPPENING EVERYWHERE IN
SAN FRANCISCO HOTELS NOW PAY
MORE THAN THE STATE MINIMUM WAGE
JUST TO FUND THEIR HOUSEKEEPERS
HEALTH CARE.
EACH YEAR INSURANCE COMPANIES
DEMAND MORE MONEY FOR THE SAME
BENEFITS FROM OUR HEALTH CARE
TRUST FUNDS REGARDLESS OF
WHETHER OR NOT OUR MEMBERS WENT
TO THE HOSPITAL MORE LESS OFTEN
IN THE LAST YEAR.
INSTEAD OF PUTTING DESPERATELY
NEEDED MONEY INTO THE POCKETS OF
LOW WAGE WORKERS IF IT OFTEN
FEELS LIKE WE'RE TRANSFERRING
TENS OF MILLIONS OF DOLLARS FROM
ONE MULTIBILLION DOLLAR
INDUSTRY.
THE HOSPITALITY INDUSTRY TO
ANOTHER THE MEDICAL INDUSTRIAL
COMPLEX
AND ALL OF THIS AT THE EXPENSE
OF WORKING FAMILIES.
AND WHY DOES THE COST OF HEALTH
CARE KEEP INCREASING
SEVERAL AB THIRTY EIGHTY SEVEN
BILL SPONSORS HAVE SPONSORED
PREVIOUS LEGISLATION TO MAKE
HEALTH CARE COSTS MORE
TRANSPARENT.
INFORMATION FROM THOSE BILL SHOW
THAT SEVENTY FIVE PERCENT OF THE
TO TWENTY EIGHTEEN PREMIUM
DOLLAR IS PROJECTED TO GO TO
DOCTORS AND HOSPITALS. AND
EIGHTY THREE PERCENT OF MEDICAL
COST INCREASES LAST YEAR
RESULTED FROM PRICE INFLATION.
THIS CONFIRMS A CONSENSUS IN THE
EXPERT LITERATURE THAT THE CORE
PROBLEM WITH HEALTHCARE COSTS IN
OUR COUNTRY AND IN CALIFORNIA IS
HIGH PRICES.
AB THIRTY EIGHTY SEVEN ESTOPPEL
PUBLIC POLICY THAT GETS TO THE
HEART OF THIS ISSUE WE'RE URGING
WHAT MOVIE FOR WITHOUT DELAY
THANK YOU.
GOOD AFTERNOON MISTER CHAIR AND
MEMBERS I AM TAM MA AND ON THE
LEGAL AND POLICY DIRECTOR WITH
HEALTH ACCESS CALIFORNIA THE
STATE HEALTHCARE CONSUMER
ADVOCACY COALITION. WE ARE PROUD
TO CO SPONSOR AB THIRTY EIGHTY
SEVEN.
THE BILL IS CAREFULLY CRAFTED TO
ENSURE THE INDUSTRY GETS A FAIR
RATE FOR THE SERVICES THEY
PROVIDE.
THE COMMISSION AND THE BILL
WOULD DO THREE THINGS
FIRST IT WOULD SET THE BASE
RATE.
SECOND WOULD HEAR APPEALS AND
THIRD SET A GLOBAL BUDGETS.
FIRST THE COMMISSION WITHOUT THE
BASE RATE FOR DOCTORS HOSPITALS
AND HEALTH PLANS USING MEDICARE
AS A BENCHMARK.
WE CHOSE MEDICARE BECAUSE IT IS
A TRIED AND TRUE PROCESS FOR
SETTING FARE RATES THAT ARE
TRANSPARENT TO EVERYONE.
AND MOST IMPORTANTLY MEDICARE
DOES NOT ALLOW THE RELATIVE
MARKET POWER OF MAJOR HEALTH
CARE PLAYERS TO DICTATE PRICES.
FOR STATE LICENSED HEALTH PLANS
AND INSURERS SELLING TO
EMPLOYERS AND INDIVIDUAL
CONSUMERS. THE BILL WOULD USE
MEDICARE ADVANTAGE AS THE BASIS
FOR PREMIUMS.
MEDICARE ADVANTAGE PLANS ARE
PRIVATE MEDICARE PLANS LIKE THE
ONES OFFERED BY KAISER AND
HEALTH NUTS.
AB THIRTY EIGHTY SEVEN DOES NOT
A DO MANAGED CARE OR VALUE BASED
PURCHASING.
HEALTH PLANS AND PROVIDERS WOULD
CONTINUE TO NEGOTIATE A CONTRACT
WITH ONE ANOTHER AND HEALTH
PLANS WOULD STILL BE REQUIRED TO
HAVE ENOUGH DOCTORS AND
HOSPITALS AND THEIR NETWORKS TO
GUARANTEE TIMELY ACCESS TO CARE.
LAW AS THEY DO TODAY.
THE RATE PAID TO HEALTH PLANS
WOULD BE ADJUSTED BY AGE. RISK
LEX AND OTHER PERMISSIBLE RATING
FACTORS BECAUSE PEOPLE IN THEIR
THIRTIES USE LESS HEALTH CARE
THAT PEOPLE IN THEIR SEVENTIES
AND EIGHTIES.
FOR DOCTORS AND HOSPITALS TO
PROVIDE CARE OUTSIDE OF THE
CONTRACT WITH THE STATE LICENSE
HEALTH PLAN THE BASE RATE WILL
BE BASED ON WHAT MEDICARE PAYS
PROVIDER WITH ONE HUNDRED
PERCENT OF MEDICARE AS THE
FLOOR.
THIS WOULD APPLY TO OUT OF
NETWORK CAREAS WELL AS THE CARE
THAT SIX MILLION CALIFORNIANS
GET FROM THEIR EMPLOYER OR YOU
TRUST UP BUT OR YOU TRUST FUND.
OFFERING A SELF INSURED PLAN.
THE AUTHORS AMENDMENTS TAKEN
TODAY ALLOW SUCH PLANS TO OPT IN
TO USING THE BASE RATE.
USING THE MEDICARE RIGHT BILLS
AND A NUMBER OF ADJUSTMENTS FOR
GEOGRAPHIC REGION AND PARTICULAR
SPECIALTIES.
IT ALSO INCORPORATES DIFFERENCES
AND LABOR AND ALL OTHER
OPERATING COSTS.
THE COMMISSION MUST REVEAL
ADJUST THE BASE RATES EACH YEAR
FOR THE RATES REFLECT CURRENT
COSTS AND NEEDS.
AND WHAT SETTINGS.
THE RACE EACH YEAR THE
COMMISSION MUST CONSIDER FACTORS
THAT ARE CRITICAL TO ENSURING
CALIFORNIA'S CAN ACCESS CARE.
SUCH AS MAINTAINING AN ADEQUATE
WORKFORCE OF PHYSICIANS AND
OTHER HEALTHCARE WORKERS.
MAKING SURE PEOPLE IN RURAL
AREAS AND UNDERSERVED URBAN
AREAS CAN GET CARE.
AND CERTAIN THE PROVIDERS ARE
GETTING A FAIR RETURN ON
INVESTMENT
AND CAN STAY FINANCIALLY
SOLVENT.
AND MAKING SURE THAT THE BASE
RATE IS ADJUSTED TO TACKLE
EXISTING FUNDING INEQUITIES FOR
PROVIDERS THAT RELY ON MEDI CAL.
THE SECOND RESPONSIBILITIES THE
COMMISSION IS TO CONSIDER
APPEALS FROM DOCTORS HOSPITALS
AND HEALTH PLANS FOR AMOUNTS
HIGHER THAN THE BASE RATE.
THEY WOULD NEED TO JUSTIFY WHY A
HIGHER RATE AS APPROPRIATE TO
ENSURE ACCESS.
SUCH AS BUT ANTICIPATED COSTS
RESULTING FROM NATURAL DISASTERS
OUTBREAKS OF DISEASE AND CHANGES
IN LABOR AND CAPITAL COSTS.
FINALLY THE THIRD THING THE
COMMISSION IS CHARGED WITH DOING
IS ESTABLISHING A GLOBAL CAP
EACH YEAR SO INCREASES IN OUR
OVERALL HEALTH CARE SPENDING TO
NOT RISE FASTER THAN INFLATION.
THIS IS ALSO WITH THE COMMISSION
CAN MONITOR I ANY INCREASES IN
VOLUME SPIKES IN SPENDING OR
OTHER ISSUES THAT NEED TO BE
REMEDIED SO PROVIDERS TO
ECONOMIZE. IN WAYS THAT HURT
PATIENTS.
AB THIRTY EIGHTY SEVEN TACKLES
THE PROBLEMS WE SEE IN HEALTH
CARE PRICING TODAY WHERE
PROVIDER IN HOSPITAL MONOPOLIES
CHARGE WHATEVER THEY WANT WITH
VERY LITTLE OVERSIGHT.
AS CONSUMER ADVOCATES WE WANT
PEOPLE TO HAVE MEANINGFUL ASKS
US TO CARE AND A LARGE PART OF
THAT EQUATION IS LOWERING
OVERALL COSTS SO WE CAN SUSTAIN
OUR HEALTH CARE SYSTEM AND MAKE
IT WORK FOR EVERYONE.
ON BEHALF OF HEALTH ACCESS I
RESPECTFULLY ASK ME AYE VOTES ON
A. B. THIRTY EIGHTY SEVEN.
YOU VERY MUCH THIS POINT WILL
LAST FOR OTHERS IN SUPPORT.
IT WOULD JUST BE HER NAME AND
POSITION ONLY.
LOOK YOU HAVE TO RUN ITS OKAY.
MISTER CHAIR MEMBERS MICHELLE
CABINET I WITH THIS YEAH YOU
CALIFORNIA WE ARE PROUD CO
SPONSOR OF THIS BILL THINK YOU.
DALE FOUNTAIN ENACT UNIVERSAL
HEALTH CARE FOR CALIFORNIA
REPRESENTING HUNDRED EIGHT
THOUSAND SINGLE PAYER SUPPORTERS
IN CALIFORNIA. WE FULLY SUPPORT
AB THIRTY EIGHTY SEVEN THANK
YOU.
KIMBERLY CHEN ABOUT THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK IN SUPPORT.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY IN STRONG
SUPPORT.
CHRISTOPHER GALIANO THE
CALIFORNIA IMMIGRANT POLICY
CENTER IN SUPPORT.
GEN CAN ARE ON BEHALF OF SEIU
LOCAL ONE THOUSAND REPRESENTING
OVER NINETY SIX THOUSAND PUBLIC
WORKERS ACROSS THE STATE IN
SUPPORT.
I BET MARTINEZ WITH UNITE HERE
AND CASTRO CASINO STRONG
SUPPORT.
HAVE YOU INFILL GRAYSON CASINO
STRONG SUPPORT.
MARGIE CA CERRO CREIGHTON CASINO
UNITE HERE STRONGLY SUPPORT.
ROBERT FLAT THUNDER VALLEY
CASINO STRONGLY SUPPORT.
MISTER CHAIR SET BROWN HERE
REPRESENTING MORE THAN THREE
HUNDRED THOUSAND MEMBERS OF THE
CALIFORNIA TEACHERS ASSOCIATION
AND STRONG SUPPORT.
THANK YOU MISTER CHAIR AND
MEMBERS TROSZYN BROWN OF THE
CALIFORNIA FEDERATION OF
TEACHERS AND SUPPORT THANK YOU.
I THINK YOU MISTER CHAIR AND
MEMBERS AMY HIND SHANK WITH UP
THE CW A LOCAL NINETY ONE
NINETEEN WITH FIFTEEN THOUSAND
UNIVERSITY PROFESSIONAL AND
TECHNICAL MEMBERS IN STRONG
SUPPORT.
THEN AFTER UNITED HERE IN
SUPPORT.
YOU CAN VIOLENCE HE.
BUT I CAN.
DANNY SO GATO OUR CASH CREEK
CASINO IN SUPPORT.
MARIO A. DATING TO UNITE HERE
SUPPORT.
OUR DEAN UNITE HERE IN SUPPORT.
SHANE GUSMAN ON BEHALF OF THE
CALIFORNIA TEACHERS PUBLIC
AFFAIRS COUNCIL THE I'LL W. THE
AMALGAMATED TRANSIT UNION
MACHINISTS.
UTILITY WORKERS ON SPORT.
ALTHOUGH GOMEZ UNITE HERE IN
SUPPORT.
GOTTA AND ON THOSE GUYS PRETTY
SO I SUPPORT.
SOMBER THAWED UNITE HERE AND
THE AIRPORT SUPPORT.
ISN'T THAT SAD ABOUT THIS UP FOR
YOUR SUPPORT.
IF THAT VIOLENCE YOUNG. UP ALL
YOUR SUPPORT.
AND CACHE CREEK STRONGLY
SUPPORT.
AGING GONZALEZ UNITE HERE
SUPPORT.
SENATE UP BEYOND UNITE HERE IN
SUPPORT.
JULIA REESE UNITE HERE I
SUPPORT.
PLUS IT'LL CLICK THROUGH THE
NIGHT HERE I SUPPORT.
MATTHEW EINSTEIN NIGHT HERE IN
SUPPORT.
LIMON COSTA BLOCK CALIFORNIA
WHITES RETIRED AMERICANS WITH
ONE MILLION MEMBERS IN SUPPORT.
JOHN RACE OPENING NIGHT HERE ON
THAT SUPPORT.
SHE BONDED TO MARCOS UNITED
DOMESTIC WORKERS ASKED ME LOCAL
THIRTY NINE THIRTY IN SUPPORT.
SO WITH GENEROUS WITH UNITE HERE
I'M A STRONG SUPPORT.
NOTE AND THAT'S WHAT I HEAR A
SUPPORT.
IN VETS UNITE HERE.
SUPPORT.
THIS IS THE WHOLE UNITED HERE
SUPPORT.
JACK RUBIN REPRESENTING.
UNITE HERE INTERNATIONAL UNION
AND WE WHOLE HEARTEDLY SUPPORT
THIS BELL.
TOUGH ACT FOLLOW DOUG BLOOD.
IN STRONG SUPPORT.
ANYONE ELSE.
MAY WANNA STAY. WE HAVE
QUESTIONS
COMMITTEE SO WILL LAST
OPPOSITION
FORWARD AND AND WAS SHARED
OPTION COMES FORWARD I. BELIEVE
I DON'T KNOW IF THE TIME THERE'S
STILL A FEW MINUTES
OBSERVERS AWARENESS WHICH OUT
SOME OF THE WITNESSES WE COULD
NOW LAW BOTHER COMING UP
OKAY PLEASE WHEN YOU'RE VERY
MUCH MISTER CHAIRMAN AND MEMBERS
OF THE COMMITTEE I AM CARMELLA
OIL. THE PRESIDENCY OF THE
CALIFORNIA HOSPITAL ASSOCIATION
HERE IN STRONG OPPOSITION TO AB
THIRTY EIGHTY SEVEN. WHICH IS A
BIG BAD BILL FOR THE HEALTH OF
CALIFORNIANS.
THE PROPONENTS ARGUE THAT THIS
BILL WOULD MAKE HEALTHCARE MORE
AFFORDABLE AND THEREFORE MORE
ACCESSIBLE IN CALIFORNIA.
IT DOES NOT AND UNFORTUNATELY
THE OPPOSITE IS TRUE.
THE BILL AMOUNTS TO HUGE CUTS
FOR DOCTORS HOSPITALS DENTISTS
AND OTHERS.
AND LOST ACCESS TO CARE FOR
EVERYONE.
BUT THIS BILL DOES NOTHING TO
REDUCE THE ACTUAL UNDERLYING
COST OF CARE.
WHAT I MEAN WHAT DOES THIS BILL
DO?
IT'S LIKE WALKING INTO A
RESTAURANT.
HAVING DINNER.
GETTING A CHECK FOR TWENTY
DOLLARS AND LEADING A TEN DOLLAR
BILL ON THE TABLE.
THAT TEN DOLLAR BILL PAYING LESS
THAN THE CHECK.
DOESN'T CHANGE THE COST OF THE
MEAL.
DOESN'T CHANGE THE WAGES PAID TO
THE WAITRESS OR TO THE CHEF.
DOESN'T CHANGE THE EXPENSES
OCCURRED BY THAT RESTAURANT
OWNER.
HE SIMPLY IS LEFT WITH HALF THE
AMOUNT.
THIS BILL CREATES A PROCESS
THE ONLY CAPS THE PRICES PAID.
TO DOCTORS AND HOSPITALS AND
PHYSICIANS AND DENTISTS AND
OTHERS AND HEALTH PLANS.
IT'S SOMETHING WE HAVEN'T DONE
IN THE UNITED STATES
SINCE THE NIXON WAGE AND PRICE
CONTROLS OF THE NINETEEN
SEVENTIES.
AND FOR THOSE WHO THINK THIS
PROPOSAL. IS ANYTHING LIKE THE
RATE SETTING SYSTEM IN MARYLAND
HAVING SERVED NINE YEARS AS THE
PRESIDENT CEO OF THE MARYLAND
HOSPITAL ASSOCIATION. I'M HERE
TO TELL YOU THAT THAT IS NOT AT
ALL THE CASE NOTHING COULD BE
FURTHER FROM THE TRUTH.
THIS BILL DOES NOTHING TO
ADDRESS THE UNDERLYING DRIVERS
OF HEALTH CARE COSTS NOR DOES IT
ACKNOWLEDGED. AND SEPARATE
HEALTHCARE SPENDING INCREASES
SOME OF THE HEALTHCARE SPENDING
INCREASES THAT WE ARE INCURRING.
ARE GOOD IT'S THE RESULT OF
HAVING COVERED MILLIONS MORE
CALIFORNIANS UNDER THE
AFFORDABLE CARE ACT HEALTH CARE
SPENDING SOME IS REALLY
IMPORTANT REALLY GOOD AND WE
SHOULD ACKNOWLEDGE THAT. THE
IMPACT OF THIS BILL.
IT IS UNPRECEDENTED.
FOR HOSPITALS THAT WOULD RESULT
IN A KIND OF EIGHTEEN BILLION
DOLLARS A YEAR.
SIXTY PERCENT OF HOSPITALS IN
THE STATE OF CALIFORNIA WOULD BE
OPERATING IN THE RED AT A LOSS.
THAT IS DOUBLE THE NUMBER TODAY.
AND AS A RESULT HOSPITALS WILL
CLOSE.
AND I WOULD LIKE TO SAY
SINCERELY I'VE SPENT THIRTY
YEARS IN THE HOSPITAL
ASSOCIATION. AREA OF WORK.
I HAVE NEVER.
THREATEN HOSPITAL CLOSURES I'M
HERE TO TELL YOU THAT THE
FINANCIAL IMPACT OF THIS ORDER
OF MAGNITUDE WOULD RESULT IN
HOSPITAL CLOSURES IN THE STATE
OF CALIFORNIA. IN ADDITION AND
MORE IMPORTANT A HUNDRED AND
SEVENTY FIVE THOUSAND JOBS LOST.
THAT'S NOT WHAT YOU WANT TO HAVE
HAPPEN THAT'S NOT WHAT WE WANT
TO HAPPEN WHY IS THAT. ON WE DID
BRING A CHART TO HELP EXPLAIN.
IT IS BECAUSE YOU CAN SEE IN
THAT CHART MEDICARE TODAY
PROVIDING CARE FOR PEOPLE OVER
THE AGE OF SIXTY FIVE.
PAYS LESS THAN THE COST
OF CARING FOR A SENIOR. MEDICARE
PAYS TWENTY THREE PERCENT LESS
THAN THE COST OF CARING FOR A
SENIOR IN THE HOSPITAL MEDI CAL
PAYS THIRTY TWO PERCENT LESS
THAN THE COST.
TREATING A MEDI CAL PATIENT IN
THE HOSPITAL. AND YES
THOSE COSTS
PURPOSELY SHIFTED BY GOVERNMENT
UNDER FUNDING ON TO PRIVATELY
INSURED INDIVIDUALS. MEANING THE
PRICES THE PRIVATELY INSURED
INDIVIDUALS PAY ARE HIGHER WHAT
WOULD THIS BILL DO. IT DOES NOT
FILL THE EMPTY BUCKET OF
MEDICARE IT DOES NOT FILL THE
EMPTY BUCKET OF MEDICAID ALL IT
DOES IS TAKE THAT PRIVATE
INSURED AMOUNT AND BRING IT
DOWN.
YES WHAT THIS RED LINE SHOWS YOU
IS WHAT WOULD HAPPEN IF RATES
WERE SET AT A HUNDRED AND TWENTY
FIVE PERCENT OF MEDICARE. IT
COULD BE MORE IT COULD BE LESS
IT IS SIMPLY UNCLEAR IN THE BILL
WE USED A FIGURE THAT WAS BEING
DISCUSSED AS THE BILL WAS
INTRODUCED AT A HUNDRED AND
TWENTY FIVE PERCENT OF MEDICARE.
THAT IS A RECIPE FOR DISASTER.
IT'S IS ALSO A PROBLEM BECAUSE
HOSPITALS STILL HAVE TO PAY THE
EXPLODING COSTS OF CARE LABOR.
DRUGS
SURGICAL SUPPLIES EMERALD EYES
OTHER IMAGING EQUIPMENT I. T.
SYSTEMS AND THE ENORMOUS COST OF
BEING SEISMICALLY PREPARED
HUNDREDS OF BILLIONS OF DOLLARS
IN THIS STATE.
THAT DOESN'T GO AWAY IF WE
SIMPLY PAY LOWER PRICES
HOSPITALS HAD TWO CHOICES SHORT
CHANGE PATIENT CARE.
THAT IS.
THERE LARGEST CHANGEABLE COST IS
NEXT.
AND THAT MEANS LAYING OFF
WORKERS.
OUR WORKERS COMPRISE MORE THAN
SIXTY PERCENT OF A TYPICAL
HOSPITAL'S COST IT IS THE ONLY
CHOICE THAT THIS PRICE CAPPING
BILL ALLOWS. AND UNDER THIS BILL
PATIENTS WILL STILL BE STRAPPED
WITH OUT OF POCKET DRUG COSTS
AND OTHER COMMON OUT OF POCKET
MEDICAL EXPENSES.
NO MANY SAY THERE IS WIDESPREAD
AGREEMENT. THAT WE HAVE TO
ADDRESS THE ISSUE OF THE
AFFORDABILITY OF HEALTH CARE
IT'S GOT TO BE ADDRESSED AND THE
SOLUTIONS WE SHOULD LOOK TO
SHOULD NOT COMPROMISE EITHER THE
QUALITY OR AVAILABILITY. OF CARE
IN CALIFORNIA. AB THIRTY EIGHTY
SEVEN IS A FLAWED APPROACH FOR
TRYING TO DEAL WITH THIS
IMPORTANT ISSUE.
I WILL SAY THAT THE CALIFORNIA
HOSPITAL ASSOCIATION STANDS
READY.
PLAY A LEADERSHIP ROLE IN THIS
DISCUSSION ABOUT MAKING CARE
MORE AFFORDABLE IN THE STATE OF
CALIFORNIA AND HELPING US ALL TO
SCRUTINIZE WHAT IS A VERY
COMPLEX PROBLEM. IDENTIFY
SOLUTIONS AND MOVE WITH ALACRITY
IN THAT DIRECTION WITHOUT
COMPROMISING THE CARE FOR
MILLIONS.
WITH THAT MISTER CHAIRMAN WE
URGE A NO VOTE ON THIS BILL.
THANK YOU MISTER CHAIR AND
COMMITTEE MEMBERS I CAN GO VERY
SHORT AND SAY WHAT SHE SAID.
FOR PHYSICIANS.
I'M DOCTOR TED MAYES OF THE
CURRENT PRESIDENT OF THE
CALIFORNIA MEDICAL ASSOCIATION.
I'M A FULL TIME EAR NOSE AND
THROAT HEAD AND NECK SURGEON IN
SAN DIEGO IN SOLO PRIVATE
PRACTICE IT'S NOT DEAD YET.
MY PRACTICE INCLUDES MEDICARE
MANAGED CARE. MEDICARE DUAL
ELIGIBLES PP OWES H. M. O.'S AND
UNINSURED INDIVIDUALS.
I PRACTICE CLINICAL MEDICINE.
BUT I'M ALSO AN EMPLOYER.
THE BUSINESS ADMINISTRATOR.
PRIOR AUTHORIZATION APPEALS
EXPERT UNWILLINGLY.
AND MORE AND MORE A DATA ENTRY
SPECIALIST COMPLYING WITH MYRIAD
COSTLY RULES AND REGULATIONS
AND REPORTING REQUIREMENTS OFTEN
DUE TO LEGISLATION. JUST TO GET
REIMBURSED FOR MY CLINICAL
SERVICES.
I'M HERE TODAY TO VOICE CMA'S
CONCERNS WITH A. B. THIRTY
EIGHTY SEVEN. AND THE NEGATIVE
EFFECTS IT WILL HAVE ON OUR
HEALTHCARE SYSTEM.
WE HAVE SERIOUS FEARS ABOUT THE
SIGNIFICANT UNINTENDED QUANT
CONSEQUENCES SHOULD THIS BILL
BECOME LAW.
IT WOULD MAKE CALIFORNIA THE
ONLY STATE IN THE NATION.
A FIXED POSITION PAYMENTS AND
COMMERCIAL MARKETS.
ANY PROPOSED SOLUTION TO OUR
HEALTH CARE SYSTEM THAT FAILS TO
ADDRESS CALIFORNIA'S
UNREASONABLY LOW MEDICARE RATES.
IS NO SOLUTION TO HEALTHCARE
CRISIS AND ALL.
MEDI CAL THE COUNTRY'S LARGEST
MEDICAID PROGRAM PROVIDES
HEALTHCARE TO ALMOST FOURTEEN
MILLION CALIFORNIANS ONE THIRD
OF THE STATE'S POPULATION.
WELL RECENT COVERAGE GAINES
SHOULD BE CELEBRATED.
CALIFORNIA PERSISTS IN BEING
AMONGST THE WORST STATES WHEN
WHEN IT COMES TO MEDI CAL
PROVIDER RATES.
PAYING RATES WELL BELOW THE COST
OF PROVIDING SERVICES AND
PHYSICIANS OFFICE AS WELL
CONSUMING DISPROPORTIONATELY
MORE ADMINISTRATIVE TIME THAN
MOST OTHER PAYERS.
THIS RESULTS IN MANY PHYSICIANS
CHOOSING NOT TO SEE MANY. OR IN
FACT ANY MEDI CAL PATIENTS.
AND THE STATE SHIFTING COSTS FOR
MEDICARE BENEFICIARIES ON TO THE
PURCHASERS OF COMMERCIAL
INSURANCE PRODUCTS.
AB THIRTY EIGHTY SEVEN WILL
EXACERBATE ACCESS PROBLEMS THAT
DOES NOTHING TO CORRECT THE
UNFAIR LOW FEE SCHEDULE FOR MEDI
CAL SERVICES. WHICH REMAINS
NEARLY UNCHANGED IN THE THIRTY
YEARS I'VE PRACTICED.
BY RATE SETTING ONLY COMMERCIAL
PRODUCTS AB THIRTY EIGHTY SEVEN
WILL MAKE IT EVEN HARDER FOR
THOSE STILL WANTING TO SEE MEDI
CAL PATIENTS.
TO KEEP THEIR PRACTICES VIABLE.
NOTHING IN THIS BILL MEANING
FULLY ADDRESSES THE PROBLEMS OF
MEDI CAL RATHER. IGNORING THE
MEDI CAL ISSUES WHILE IMPOSING
COMMERCIAL RATE CUTS BASED ON
MEDICARE WILL MAKE ALREADY POOR
ACCESS TO SPECIALTY AND EVEN
PRIMARY CARE FOR MEDI CAL
BENEFICIARIES. EVEN WORSE.
IT IS OUR STRONG BELIEF THAT
PASSAGE OF AB THIRTY EIGHTY
SEVEN WILL LEAD TO REDUCED
WORKFORCE OF PHYSICIANS.
CALIFORNIA HAS MUCH TO OFFER IN
TERMS OF CLIMATE AND ACTIVITIES.
BUT NOT AT THE COST OF BEING
UNABLE TO PAY BACK LOANS
PURCHASE NEEDED EQUIPMENT. AND
REMAIN FINANCIALLY VIABLE IN
PRACTICE.
THIS WILL IMPACT POSITIONS IN
ALL SIZES A PRACTICE.
PROPONENTS SAY THAT U. S.
POSITIONS GET PAID MORE THAN
THEIR EUROPEAN COUNTERPARTS.
BUT THEY FAILED TO POINT OUT THE
PUBLIC POLICY REGION REASONS FOR
THAT BEING SELF.
CALIFORNIA EXPECTS POSITIONS TO
SELF FINANCE THEIR COLLEGE IN
MEDICAL EDUCATION.
LEAVING MEDICAL SCHOOL GRADUATES
TO GRADUATE WITH HUNDREDS OF
THOUSANDS OF DOLLARS OF PERSONAL
DEBT.
PHYSICIANS UNLIKE IN THE
EUROPEAN NO FAULT SYSTEM MUST
SELF FINANCE THEIR LIABILITY
COSTS WITH PREMIUMS IN THIS
STATE TOPPING FIFTY THOUSAND
DOLLARS ANNUALLY.
ADMINISTRATIVE COSTS ARE NEARLY
DOUBLE THAT OF EUROPEAN SYSTEMS.
AND PHYSICIANS NOW SPENT TWENTY
FIVE TO FIFTY PERCENT OF THEIR
TIME DOING UNREIMBURSED
ADMINISTRATIVE TASKS.
CALIFORNIA IN FACT HAS THE
HIGHEST COST TO PRACTICE
MEDICINE IN THE ENTIRE NATION.
AB THIRTY EIGHTY SEVEN DOES
NOTHING TO ADDRESS THESE
PROBLEMS INFECTED FAILS TO EVEN
ADDRESS THE ACTUAL RISING COST
TO POSITIONS IN ORDER TO DELIVER
CARE. AND SIMPLY LIMITS
PAYMENTS.
CALIFORNIA POSITIONS ARE ALREADY
LEAN AND EFFICIENT.
OVER THE LAST TWENTY FIVE YEARS
THE GROWTH FOR PER CAPITA
SPENDING A POSITION SERVICES IN
CALIFORNIA. HAS RISEN ONLY THREE
POINT FIVE PERCENT PER YEAR THE
LOWEST IN THE ENTIRE NATION.
IT IS NOT HYPERBOLE TO SAY THAT
MANY PHYSICIANS WOULD
POTENTIALLY LEAVE THE STATE.
OR RETIRE EARLY.
AND WE WOULD CLEARLY STRUGGLE TO
RECRUIT THE NEXT GENERATION OF
POSSESSIONS TO COMMON PRACTICE
HERE.
FINALLY WE DO NOT HAVE FAITH
THAT ELEVEN POLITICAL APPOINTEES
WILL BE ABLE TO ACCURATELY
DETERMINE THE RATES OF OVER A
HUNDRED THOUSAND POSITIONS.
IN A WAY THAT WOULD ENSURE OUR
PRACTICES WOULD REMAIN VIABLE.
POTENTIAL FOR DISASTER HERE IS
IMMENSE.
THERE ARE MANY MORE CONCERNS AND
I'D BE HAPPY TO SPEND MORE TIME
WITH ANY ONE OF YOU AND GOING TO
GREATER DETAIL. SHOULD THIS
POORLY CONCEIVED PRICE FIXING
PROPOSAL UNFORTUNATELY MOVE
FORWARD AFTER TODAY'S HEARING.
THIS BODY RECENTLY COMMISSION
THE UCSF REPORT THROUGH THE
SELECT COMMITTEE ON HEALTH CARE
DELIVERY AND UNIVERSAL ACCESS.
WHICH RECOMMENDED TO POLICIES
THAT THE LEGISLATURE OUGHT TO BE
TACKLING.
ONE RAISING MEDI CAL PROVIDER
RATES.
TO ENSURING THAT THE STATE HAS A
SUFFICIENT POSITION WORKFORCE TO
MEET THE NEEDS OF A GROWING
POPULATION.
AB THIRTY EIGHTY SEVEN FLIES IN
THE FACE OF THESE
RECOMMENDATIONS BY GUARANTEEING
THAT CALIFORNIA WILL BE ONE OF
THE WORST STATES IN WHICH TO
PRACTICE MEDICINE.
YES THERE ARE PROBLEMS WITH
AFFORDABLE ACCESS TO CARE.
AND WE ARE TRYING TO BE PART OF
THE SOLUTION FOR UNIVERSAL
ACCESS.
BUT AB THIRTY EIGHTY SEVEN IS
CLEARLY NOT THE ANSWER WE URGE A
NO VOTE THANK YOU.
GOOD AFTERNOON SHARON MCKEE
REPRESENT THE CALIFORNIA CHAMBER
OF COMMERCE THERE'S NO
DISAGREEMENT THE HEALTHCARE
COSTS ARE RISING AND MAKE IT
MORE DIFFICULT FOR EMPLOYERS AND
EMPLOYEES TO FOR QUALITY
ACCESSIBLE CARE. HENCE MY
TESTIMONY ON A FEW OTHER BILLS
THIS AFTERNOON.
THE PROPONENTS OF AB THIRTY
EIGHTY SEVEN ARGUED THAT THEIR
APPROACH WILL CONTROL HEALTHCARE
COSTS
BUT IN PRACTICE THE PROPOSAL MAY
IN FACT RESULT IN LESS ACCESS TO
CARE IN THE SHORT TERM. AND
ACCELERATE COST INCREASES IN THE
LONG TERM.
IT'S IMPORTANT TO NOTE THAT THE
BILL WILL INTERFERE WITH AN
EMPLOYER'S ABILITY TO NEGOTIATE
FOR BENEFIT DESIGNS AND COSTS
FOR THEIR EMPLOYEES.
AB THIRTY EIGHTY SEVEN EMPOWERS
THE COMMISSION IN ADDITION TO
SETTING RATES TO PROVIDERS AND
INSURERS TO DECIDE THE LEVEL OF
CO PAYS DEDUCTIBLES COINSURANCE
AND ANY OTHER SHARE OF COSTS FOR
SERVICES. EMPLOYERS LIKE COVER
CALIFORNIA ARE ACTIVE PURCHASERS
ACTIVE PURCHASERS NEGOTIATE WITH
HEALTH PLANS ON PRICES NETWORKS
AND QUALITY MEASURES.
THE ULTIMATE PRICE PLAYS A KEY
ROLE AND OTHER FACETS OF HEALTH
OF A HEALTH PLAN SUCH AS THE
NUMBER OF DOCTORS OFFERED TO
PATIENTS OR COST SHARING.
THE BILL WOULD ALSO REDUCE
ACCESS TO CARE MANY ECONOMISTS
BELIEVE PRICE CONTROLS KEEP
PRICES ARTIFICIALLY LOW AND
SUPPLY DOES NOT KEEP UP WITH
DEMAND.
IN THE CASE OF HEALTH CARE THE
LACK OF SUPPLY WOULD MEAN FEWER
HEALTH CARE PROVIDERS.
WITHOUT AN ADEQUATE SIX SUPPLY
OF HEALTHCARE PROVIDERS
CONSUMERS MAY PAY LESS BUT THEY
MAY NOT HAVE ACCESS TO THE CARE
THEY NEED.
SO EMPLOYEES MAY BE INSURED BUT
THEY MAY NOT HAVE THE ABILITY TO
SEE THEIR PROVIDER.
AB THIRTY EIGHTY SEVEN FAILED TO
TAKE INTO ACCOUNT THE MAJOR
CAUSES OF WRITING MEDICAL CARE
COSTS.
SIMPLY CAPPING RATES WILL NOT
MAKE COSTS IN THE HEALTHCARE
SYSTEM DISAPPEAR. IT WILL LIMIT
CHOICES NEGATIVELY IMPACT ACCESS
AND IN THE LONG TERM INCREASED
COSTS FOR EMPLOYERS AND THEIR
EMPLOYEES FOR THESE REASONS WE
RESPECTFULLY OPPOSE THE BILL.
BUT THERE ARE OTHERS IN
OPPOSITION.
STERN JUST YOUR NAME AND
ORGANIZATION.
THANK YOU MISTER CHAIRMAN
MEMBERS MARINO HERON
REPRESENTING CITY OF HOPE
NATIONAL MEDICAL CENTER IN
OPPOSITION THANK YOU.
THE SUCH SHORT ON BEHALF OF THE
PRIVATE ESSENTIAL ACCESS
COMMUNITY HOSPITALS THE ALLIANCE
A CATHOLIC HEALTHCARE. OTHER
ADVENTIST HEALTH LOMA LINDA
UNIVERSITY HEALTHY ASSOCIATION
NORTHERN CALIFORNIA COLLEGES IN
THE MEDICAL ONCOLOGY ASSOCIATION
OF A PACK OF THE MEDICAL
ONCOLOGY ASSOCIATION OF SOUTHERN
CALIFORNIA AND OPPOSE.
CAPTION HOUSE COVERS IN THE
DISTRICT HOSPITAL LEADERSHIP
FORUM THE CALIFORNIA ACADEMY OF
PHYSICIAN ASSISTANTS BICU
NIGHT HOSPITAL ASSOCIATION
OPPOSITION.
DOUBLE SHIP OUT ON BEHALF OF THE
UNION OF AMERICAN PHYSICIANS AND
DENTISTS WE REPRESENT OVER FIVE
THOUSAND DOCTORS IN PUBLIC AND
PRIVATE SECTOR. AND BOTH
CALIFORNIA WASHING STATE AT THIS
JUNCTURE WERE STILL REVIEWING
THE LEGISLATION WE DO HAVE SOME
CONCERNS BUT ONE APPLAUD THE
LEADERSHIP AND MISTER CARLA FOR
ADVANCING A BILL THAT REALLY. IS
VERY DIFFICULT TO DO DEAL WITH A
VERY DIFFICULT PROBLEM SO
ENSUING MONTHS WE HOPE THAT.
IT'S A PROGRESS THAT.
CAN BE WORKED ON AND WE CAN
MOVE FORWARD BUT THIS JUNCTURE
WE HAVE NO FORMAL POSITION BUT
WE ARE CONCERNED THANK YOU.
SHAWN FLANAGAN TO HAVE A
HOSPITAL CORPORATION OF AMERICA
IN OPPOSITION.
RANDALL HEGER M. BEHALF OF THE
CALIFORNIA PSYCHIATRIC
ASSOCIATION WE ARE OPPOSE.
I'M DOCTOR ROGER HICKS TIME
PRESIDENT OF THE CALIFORNIA
URGENT CARE ASSOCIATION WHICH
REPRESENTS URGENT CARE CENTERS
THROUGHOUT THE STATE WE OPPOSE.
WHERE'S DR MUN DISSEMINATE AGO
TREASURER OF THE URGENT CARE
ASSOCIATION OF AMERICA AND ALSO
A.
ORDER OF EMERGING CARE.
STRONGLY OPPOSE.
ALL ROCK GRAY CALIFORNIA LIFE
SCIENCES ASSOCIATION IN
OPPOSITION.
STEPPING Y. CANS ON THE AFTER
THIS INITIATION OF CALIFORNIA
LIFE AND HEALTH INSURANCE
COMPANIES OPPOSED.
SEAN DOES THE NATIONAL
FEDERATION OF INDEPENDENT
BUSINESS REPRESENTING OVER
TWENTY THOUSAND SMALL BUSINESS
OWNERS ALSO OPPOSED.
MICHELE O'ROURKE ON BEHALF OF
MALINA HEALTH CARE AND
OPPOSITION.
THERESA START BECAUSE A
PERMANENT DAY IN STRONG
OPPOSITION.
KELLY BUCKS ON BEHALF OF THE
ASSOCIATION OF CALIFORNIA
HEALTHCARE DISTRICTS IN
OPPOSITION.
KELLY BEAM ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF NURSE
ANESTHETISTS IN OPPOSITION.
IF.
JERRY HEXUM MAY HAVETHE
CALIFORNIA ACADEMY OF FAMILY
PHYSICIANS IN THE CALIFORNIA
ASSOCIATION OF AYE PHYSICIANS
AND SURGEONS IN OPPOSITION.
RAINY BARRIER THERE READING
ASSOCIATES ON BEHALF OF PORAC
THE CALIFORNIA CHILDREN'S
HOSPITAL ASSOCIATION.
THE CALIFORNIA OPTOMETRIC
ASSOCIATION
THE CALIFORNIA SOCIETY FOR
RESPIRATORY CARE. AND I THINK
THAT OUR CALIFORNIA UP TO MAKE
IT OPTOMETRIC ASSOCIATION THANK
YOU.
RIGHT SPENCER WITH THE AMERICAN
COLLEGE OF OBGYN IS THE IN THE
CALIFORNIA PUT YAK MEDICAL
ASSOCIATION WALLS OF SAN DIEGO
CHAMBER OF COMMERCE IN
OPPOSITION.
MARIN HIGGINS REPRESENTING THE
ADVANCED MEDICAL TECHNOLOGY
ASSOCIATION OPPOSITION.
JONATHAN CLAIMED OFF A SCRIPT
SELF IN OPPOSITION.
JENNIFER TANNAHILL WITH AARON
REGION ASSOCIATES ON BEHALF OF
THE CALIFORNIA DENTAL HYGIENISTS
ASSOCIATION.
BRANTON INTO SPENCER WITH THE
CALIFORNIA DENTAL ASSOCIATION IN
OPPOSITION.
I DAVID GONZALEZ ABOUT AMERICA'S
PHYSICIAN GROUPS IN OPPOSITION.
JENNIFER SIGN ON BEHALF OF THE
OSTEOPATHIC PHYSICIANS AND
SURGEONS OF CALIFORNIA THE
CALIFORNIA ASSOCIATION A HEALTH
FACILITIES AND THE CALIFORNIA
RETAILERS ASSOCIATION IN
OPPOSITION.
ALISON RAIMI WITH BLUE SHIELD OF
CALIFORNIA IN OPPOSITION.
MICHAEL TELL PROVINCE ST JOSEPH
HEALTH IN OPPOSITION.
KATHLEEN SORIANO ON BEHALF THE
CUT MEDICINE OF THE UNIVERSITY
OF SOUTHERN CALIFORNIA AND
OPPOSITION.
BRYCE DOUGHERTY AND BEHALF THE
CALIFORNIA DECIDED
ANESTHESIOLOGISTS
THE CALIFORNIA ORTHOPEDIC
ASSOCIATION IN THE CALIFORNIA
AMBULATORY SURGERY ASSOCIATION
IN OPPOSITION.
FRED MADE ON BEHALF OF THE
CHAMBER OF COMMERCE ALLIANCE OF
VENTURA. IN SANTA BARBARA COUNTY
IN OPPOSITION.
TIM AND REPRESENT CALIFORNIA
CHAPTER OF AMERICA BECAUSE
EMERGENCY PHYSICIANS THE
CALIFORNIA RHEUMATOLOGY ALLIANCE
THE CALVARY SOCIETY PLASTIC
SURGEONS IN THE CALIFORNIA
CHAPTER OF THE AMERICAN COLLEGE
OF CARDIOLOGY ALL OPPOSED.
MICHAEL HAWKINS FOR REPRESENT
TENET HEALTHCARE IN OPPOSITION
THANK YOU.
VIDEO BORN REPRESENTING AMERICAN
ACADEMY OF PEDIATRICS CALIFORNIA
DIVISION YOUR POST.
IF.
NICOLE WATERMAN ON BEHALF OF THE
SAN BERNADINO COUNTY PART OF
SUPERVISORS IN OPPOSITION.
ANGELA LANTERN ON BEHALF OF THE
CHILDREN SPECIALTY CARE
COALITION REPRESENTING PEDIATRIC
SUB SPECIALIST IN OPPOSITION.
NICHOLAS CALIFORNIA ASSOCIATION
OF HEALTH PLANS OPPOSE.
LET SHEPHERD REPRESENTING
STAMFORD HEALTH CARE IN
OPPOSITION.
LEAH BARRELS REPRESENTING OUR
CAMINO HOSPITAL IN OPPOSITION.
TOM REILLY CALDERON AMERICAN
COLLEGE OF PHYSICIANS SUPPOSED.
ANYONE ELSE.
OKAY WILL BRING IT BACK TO THE
COMMITTEE.
REPLACEMENT.
OBSERVERS.
CHECK A. ASIDE MR CHERUB LE MAI
WITNESSES A PRESERVED FIVE
MINUTES I THINK IT.
DISCUSS YOUR STOP IT THAT'S OKAY
OF THEM. REBUTTAL BEEF OTHER
FIFTEEN THEY PREVENT TEN WITH
THE PRESSING WITNESSES WOULD
THAT BE OKAY WITH YOU MISTER
CHAIR.
TURKISH AND WE HAD TO WE HAD
AGREED UPON THAT. THANK YOU
VERSION SO WE HAVE.
HOW MUCH?
WE HAVE FIVE MINUTES. I THANK
YOU VERY MUCH FOR SURE.
MISTER CHAIR MEMBERS SARAH
FLOCKS IN THE CALIFORNIA LABOR
FEDERATIONS THANK YOU SO MUCH
FOR THIS OPPORTUNITY.
THE OPPOSITION IS DEFENDING A
SYSTEM THAT WE KNOW IS BROKEN.
IT IS BROKEN FOR WORKERS FOR
EMPLOYERS FOR GOVERNMENT AND FOR
PATIENTS IN CALIFORNIA.
MOST OF ALL IT'S BROKEN FOR
COMMUNITIES THAT ALREADY HAVE A
SHORTAGE OF PROVIDERS WHO HAVE A
LACK OF ACCESS FOR RURAL AREAS.
AND IT IS BROKEN FOR MEDI CAL
PATIENTS
AND MEDI CAL PROVIDERS.
THIS BILL IS NOT ABOUT PUNISHING
PROVIDERS AT ITS CORE IT IS
ABOUT ACCESS
AND IT'S ABOUT ADDRESSING THE
INEQUITIES IN OUR CURRENT SYSTEM
THAT LEAD TO A LACK OF ACCESS.
THAT'S WHY THE NAME OF THE
COMMISSION IS THAT COMMISSION ON
HEALTH CARE COST QUALITY IN
EQUITY YOU CANNOT SEPARATE THEM.
I WANT TO START OFF BY
ADDRESSING THE.
CHART THE MATH DOESN'T ADD UP.
WHICH TIES INTO THE ISSUE OF
MEDI CAL REIMBURSEMENT AND
ACCESS.
A SUBSTANTIAL BODY OF EVIDENCE
SHOWS THAT PROVIDERS THAT
DISPROPORTIONATELY SERVE LOW
INCOME AND ELDERLY POPULATIONS
THE MEDI CAL AND MEDICARE
POPULATIONS.
CHARGE LOWER PRICES TO PRIVATE
PAYERS
IN FACT A TWENTY SIXTEEN STUDY
THAT FOUND THAT FOR EVERY
PERCENT INCREASE. IN THE
MEDICAID POPULATION SO THE MEDI
CAL POPULATION IN CALIFORNIA THE
AVERAGE HOSPITAL CHARGE TO
PRIVATE PAYERS DECREASED BY ONE
POINT TWO PERCENT WHICH IS A
DROP OF ELEVEN HUNDRED DOLLARS.
NOT INCREASE DECREASE.
AND WHY.
BECAUSE PROVIDERS WITH HIGH MEDI
CAL AND MEDICARE POPULATIONS ARE
MORE EFFICIENT AND COST
EFFECTIVE. IN OTHER WORDS THEY
DO MORE WITH LESS
COSTS ARE NOT IMMUTABLE.
IN FACT MED PAC WHICH IS THE
MEDICARE PAYMENT ADVISORY
COMMISSION WHICH ADVISES
CONGRESS ON MEDICARE.
SAYS THAT IN A QUOTE WHEN A
HOSPITAL RECEIVES HIGHER
PAYMENTS FROM COMMERCIAL PAYERS
THE FINANCIAL PRESSURE ON THE
HOSPITAL'S LOWER. IT THEREFORE
HAS LESS INCENTIVE
KEEP ITS COSTS LOW.
ON THE FLIPSIDE MED PAC HAS ALSO
SHOWN THE PROVIDERS UNDER
FINANCIAL PRESSURE WHO RESEARCH
RECEIVE LOWER COMMERCIAL RE
EMBRACE REIMBURSEMENTS ARE ABLE
TO RESTRAIN THEIR COSTS.
HI COMMERCIAL PRICES.
ARE NOT CORRELATED WITH SERVING
LARGE POPULATIONS OF MEDI CAL
ARE MEDICARE THEY ARE CORRELATED
WITH HAVING MONOPOLY POWER.
IF YOU ARE IN IN AN AREA WHERE
YOU CAN COMMAND HIGHER PRICES
THEN YOU WILL. YOU WILL HAVE
HIGHER COMMERCIAL PRICES
REGARDLESS OF YOU SERVE A SINGLE
MEDI CAL IN RELIEF OR NOT.
AND WHY. BECAUSE WE LET THEM
BECAUSE THE COMMERCIAL MARKET IS
FRAGMENTED OPAQUE AND DRIVEN BY
PROFIT.
AB THIRTY EIGHTY SEVEN SIX TO
REMEDY THE INEQUITIES THAT WE
HAVE IN OUR EXISTING BROKEN
SYSTEM BY TAKING IN ACCOUNT
PROVIDERS THAT SERVE MEDI CAL
POPULATIONS THAT ARE IN RURAL
AREAS THAT ARE IN UNDERSERVED
COMMUNITIES. WHERE THERE ARE IT
IS A LACK OF ACCESS WHEN THEY
SAT BASE RATES?
THAT WILL CREATE A LINK A
REASONABLE LINK BETWEEN MEDI CAL
AND COMMERCIAL RATES THIS IS A
LINK THAT DOES NOT EXIST RIGHT
NOW. THIS BILL WILL BRING
TRANSPARENCY AND FAIRNESS TO ARE
CURTAINS CURRENT SYSTEM OUR
CURRENT SYSTEM THAT REWARDS
MONOPOLIES AND DEVALUES THE
PROVIDERS THAT MAKE UP OUR
SAFETY NET AND PROVIDE CARE. TO
THE IN THE IN THE ARE MOST RURAL
AND UNDERSERVED COMMUNITIES.
CHAIR AND MEMBERS MITCHELL HAVE
DATA WITH SEIU CALIFORNIA WE ARE
ONE OF THE CO SPONSORS OF THIS
BILL. I'M I WANT TO SPEAK TO A
FEW OF THE POINTS AND
PARTICULARLY THE POINT SPACEY HA
THAT THIS BILL WOULD LEAD TO
BILLIONS OF DOLLARS IN CUTS AND
A HUNDRED AND SEVENTY FIVE
THOUSAND JOBS LOST IN. HOSPITAL
SECTORS WE REPRESENT HOSPITAL
WORKERS WE SEE THIS AS A THINLY
VEILED THREAT THE FACT OF THE
MATTER IS THE COMMISSION IS
REQUIRED TO TAKE INTO ACCOUNT
WHEN SETTING. THE BASE RATE A
FAIR RETURN ON INVESTMENT
REASONABLE LABOR COSTS INCLUDING
THE COSTS OF BARGAINING
AGREEMENTS CAPITAL INVESTMENTS
AND CHANGES IN THE DELIVERY OF
CARE. THERE ALSO WITH AMENDMENT
SEEKING IN THIS COMMITTEE TAKING
INTO ACCOUNT THE AMOUNT OF.
MEDI CAL PURPOSE
POPULATION SERVED AND SO ALL OF
THAT IS BUILT INTO THE BASE RATE
WHAT WE ARE TALKING ABOUT HERE
IS MAKING COST SHIFTING. REAL
ACTUALLY REWARDING THOSE
PROVIDERS THAT ARE DOING MORE IN
THE PUBLIC PROGRAMS RATHER THAN
LETTING ARBITRARY MARKET FORCES
DECIDE THAT. DOCTORS AND
HOSPITALS IN NORTHERN CALIFORNIA
SHOULD GET PAID THIRTY FIVE TO
SEVENTY PERCENT HIGHER THAN
DOCTORS AND HOSPITALS IN LOS
ANGELES AND SOUTHERN CALIFORNIA.
WITH RESPECT TO THE PHYSICIAN
POPULATION DOCTORS ARE BECOMING
MORE AND MORE CONSOLIDATED OVER
THE LAST TEN YEARS OR LESS
ACTUALLY.
WE'VE MOVED TO HALF OF ALL
PHYSICIANS IN HOSPITAL OWNED
PHYSICIAN GROUPS AND WE PUT AN
AMENDMENT IN THAT SAYS NO
DOCTORS WITHOUT DATA ABSENT THE
DATA THE COMMISSION CANNOT MOVE
TO SET RATES FOR HOSPITALS AND
DOCTORS.
THANK YOU.
SO
YOU HAD TWO MINUTES LEFT ON ON
THE OPPOSITION SO THEY'RE GOING
TO GET A CHANCE TO.
AND WILL SHARE THIS QUICKLY.
WE DO HOPE WE HAVE THE
OPPORTUNITY TO UNPACK FOR YOU
THE CONFUSION THAT SEEMS TO
EXIST BETWEEN PRICES.
COSTS
AND DOING STUDIES AND ALL THE
REST TO COUPLE POINTS PLEASE DID
YOU KNOW. THAT IN CALIFORNIA.
HOSPITAL COSTS ARE SIX AND A
HALF PERCENT BELOW THE NATIONAL
AVERAGE DID YOU KNOW THAT
CALIFORNIA'S HOSPITAL COSTS ARE
IN THE BOTTOM QUARTILE THE
BOTTOM TWENTY FIVE PERCENT. OF
COSTS NATIONALLY WE WANT TO TALK
ABOUT VARIATION DID YOU KNOW
THAT NORTHERN CALIFORNIA HAS THE
TOP TWELVE CITIES IN TERMS OF
WAGES IN THE ENTIRE UNITED
STATES.
WE WELCOME CONVERSATION TO TALK
MORE ABOUT THE UNDERLYING
DRIVERS BUT PLEASE DO NOT BE
FOOLED BY NUMBERS AND DATA THAT
ARE BEING THROWN AT YOU THERE
ARE REAL REASONS AN IMPORTANT
REASONS FOR VARIATIONS IN COST.
AND THE DIFFERENCE BETWEEN COSTS
AND PRICES.
THANK YOU I'LL TRY TO DO THIS
QUICKLY.
IT IS A BROKEN SYSTEM FOR
PROVIDERS AS WELL WE RECOGNIZE
THAT WE WANT TO SEE IT FIXED BUT
WE WANT TO SEE A FIX
RESPONSIBLY.
WE ARE FOR TRANSPARENCY BUT WE
ARE NOT FOR PRICE FIXING THAT
DOESN'T DEAL WITH ACTUAL COSTS.
THE FACT THAT THIS BILL CONTAINS
GLOBAL CAPS
BELIES ANY ARGUMENT THAT IT
WOULD KEEP UP WITH THE ACTUAL
COST OF CARE.
IF CAPS HAVE TO BE REDUCED
BECAUSE WE OVER EXPENDED. ON
NEEDED MEDICAL SERVICES WHY
PUNISH THE PROVIDERS ON THE BACK
AND.
AND MAY I REMIND THE LEGISLATURE
THAT THIS LEGISLATURE HAS HAD
SIMILAR LANGUAGE ABOUT
PERCENTAGE OF MEDICARE IN THE
PAST.
THIS BILL DOES NOT DEFINE WHAT
THAT PERCENT YES BUT THIS
LEGISLATURE HAS PLAYED WITH A
HUNDRED PERCENT IN S. B. FIVE IN
AB FIVE THIRTY THREE. AND A
HUNDRED AND TWENTY FIVE PERCENT
IN AB SEVENTY TWO FOR NON
CONTRACT PROVIDERS GIVING THE
BULK OF CARE IN THE EMERGENCY
ROOM WHEN THERE ARE NO
CONTRACTED PROVIDERS AVAILABLE.
WHY DO WE BELIEVE THAT THE
LEGISLATURE WOULD NOT LOOK AT A
HUNDRED TO A HUNDRED AND TWENTY
FIVE PERCENT WHICH IS WELL BELOW
THE COST OF CARE? ONE LAST
COMMENT
MEDICARE IN THE LAST TWENTY
YEARS HAS FALLEN WAY BELOW THE
ACTUAL INFLATION RATE.
IN WHAT IT PAYS POSITIONS IN
THIS STATE AND NATION WIDE IT IS
NOT A GOOD. MARKER.
OKAY.
NOW QUESTIONS FROM THE
COMMITTEE.
SO
STERN BANKS I THINK AS CHAIR. I
WAS KALRA WHAT BOB AND I WANT TO
THANK YOU FOR THE EFFORT IN TEND
TO THIS BILL.
TO ADDRESS.
ON AFFORDABILITY IN OUR
HEALTHCARE SYSTEM
AND HOWEVER SICK COME AS NO
SURPRISE THAT I'M I DON'T
SUPPORT THIS PARTICULAR APPROACH
IS TO COST CONTAINMENT.
I DON'T THINK THAT GOVERNMENT
PRICE SETTING IS THE BEST
THE BEST APPROACH AND WE'VE
HEARD SOME OF THAT IN. AMONGST
THE WITNESSES TODAY DO HAVE A
COUPLE OF QUESTIONS.
A FOR YOU IF THAT'S OKAY.
BUT IT IS WELL KNOWN AS A SOME
THE WITNESSES TALKED ABOUT ABOUT
COST SHIFTING IN HEALTH CARE AS
A RESULT OF LOW REIMBURSEMENT
RATES IN IN MEDI CAL. A FOR
HOSPITALS THAT HAVE A LARGE
SHARE OF MEDI CAL PATIENTS
AND I CAN THINK OF A HANDFUL OF
THEM BOUT WITH IN THE INLAND
EMPIRE WHERE I REPRESENT.
I'M HOW WOULD THEY MAKE ENDS
MEET IF THEY FURTHER SQUEEZE
PAYMENTS FROM PRIVATE PAY
PATIENTS.
IT SEEMS TO BE UNWORKABLE.
THANK YOU FOR THE QUESTION AND
THE REALITY IS FIRST OF ALL
THERE'S A. A FALSE PRESUMPTION
THAT'S BEEN PUT FORTH THAT THOSE
THAT ARE TAKING ON MORE MEDI CAL
AND MEDICARE PATIENTS ARE BARB
DOING IT SIMPLY BY. INCREASING
COMMERCIAL RATES THE REALITY IS
THAT THE FACTS DON'T DICTATE
THAT
THE FACTS ACCEDED TO THAT THOSE
THAT TAKE MORE MEDI CAL.
AND MEDICARE PATIENTS ACTUALLY
GET A LOWER COMMERCIAL RATE WHAT
IS DRIVING THE COMMERCIAL RATES
IS NOT THAT THEY'RE ALL TAKING
CARE. OF THOSE THAT ARE ON MEDI
CAL BUT I WILL TELL YOU THIS
THAT IN THIS BILL WE DO HAVE THE
OPPORTUNITY.
AND IT'S INCLUDED NOT ONLY.
IN THE ORIGINAL.
BUT DROPPED IN THE AMENDED
DRAFT BUT ALSO IN.
IN MY ACCEPTING THE POLICY
RECOMMENDATIONS FROM THE CHAIR
AND THE STAFF AND THE STAFF.
TO ACTUALLY FIND WAYS TO MAKE
UP FOR THOSE CLINICS HOSPITALS
DOCTORS THAT TAKE. MORE MEDI CAL
PATIENTS AND WE DO THAT BY JUST
IN THE COMMERCIAL RATE IN A WAY
THAT REWARDS THEM. REWARDS THEM
FOR TAKING CARE OF THE MOST
VULNERABLE IN OUR STATE AND
REWARDS THEM.
FOR ACTUALLY DOING A PUBLIC
SERVICE THE REALITY IS IF IT
WERE TRUE IF IT WERE TRUE THAT
THOSE THAT TOOK ON MORE MEDI CAL
PATIENTS WERE BEING COMPENSATED
APPROPRIATELY BY COMMERCIAL
RATES AND WE DON'T WANT TO MESS
WITH THE COMMERCIALLY BECAUSE OF
IT. THEN IN SO MANY RULE
COMMUNITIES WHERE THEY HAVE AN
EXCESS OF MEDICAL RATES THEN
THEY WOULDN'T HAVE DOCTORS BEING
PAID LESS THAN DOCTORS AND OTHER
COMMUNITIES ON THE COMMERCIAL
RATES AND IN FACT. IN MANY RURAL
COMMUNITIES DOCTORS OF GETTING
COMMERCIAL RATES EVEN BELOW
MEDICARE RIGHT NOW AND WHY IS
THAT. THE DOCTORS HAVE NO
LEVERAGE THEY HAVE NO BARGAINING
POWER WITH THESE CONSOLIDATED
SYSTEMS WITH THESE MONOPOLISTIC
MONOPOLISTIC HOSPITALS AND AND.
THE DEAD TAPES SUGGEST THAT
THEY DO IS JUST NOT TRUE.
AND SO MY AND MY MY ANSWER TO
YOU THE SHORT ANSWER IS MEDI
CAL.
.
IT'S ABSOLUTELY NOT ONLY
INCLUDED IN THIS IS GONNA BE A
MAJOR PART OF WHAT WE'RE GOING
TO CONTINUE TO WORK ON IN THE
WEEKS AHEAD HOW DO WE ACCOUNT
FOR THE FACT THAT. WE HAVE SO
MANY MEDI CAL.
PATIENTS IN OUR STATE AND HOW
THE WE INCENTIVIZE DOCTORS TO
NOT ONLY TAKE MEDI CAL PATIENTS
AND MEDICARE PATIENTS BUT FOR
DOCTORS TO GOING TO RURAL
COMMUNITIES UNDERSERVED
COMMUNITIES WHERE THEY DON'T GO
RIGHT NOW. AND THEY DON'T GO
THERE BECAUSE THE COMMERCIAL
RATES DON'T INCENTIVIZE AND.
THING I REPRESENT A RURAL AREA
AND.
LIKE I GET SOME
SOME CONTRADICTORY NAM.
ARGUMENTS FROM I'M SO MY LOCAL
UP LOCAL DOCKS IN HEALTHCARE
PROVIDERS. THAT I'M HAPPY TO
TALK TO THEM IT IT I GOT A
COUPLE OF QUESTIONS A COUPLE
MORE IF.
IF THIS BILL SUPPOSED TO REIN
IN COSTS A WHITE AS A SOLELY
FOCUS ON GOVERNMENT PRICE FIXING
HAS THIS.
WHAT ABOUT UTILIZATION IN THE
COST OF LABOR FOR EXAMPLE WHICH
ARE ALSO MAJOR COST DRIVERS?
WELL THAT'S PART OF THE REASON
THE AND I'M GLAD YOU MENTIONED
UTILIZATION BECAUSE THE LAST
SEVERAL YEARS. UP WITH WITH THE
THE AFFORDABLE CARE ACT WE HAVE
SEEN INCREASED ACCESS TO PEOPLE
HAVE UPPER HEALTH INSURANCE CARD
YOU SEE HEALTHCARE COSTS GO UP
BUT UTILIZATION HAS GONE DOWN.
SO THAT TELLS US THAT PEOPLE ARE
ARE ARE RATIONING THEIR
HEALTHCARE BECAUSE COSTS ARE
GOING UP AND SO THAT IT'S.
THE THE.
.
EUROPEAN QUESTIONING AND.
THAT POINT ENTITIES RELIGIOUSLY
UTILIZATION IN THE COST OF LABOR
WHY ARE WE LOOKING AT ALL THOSE
COSTS ARE ALL THOSE COSTS ARE
ACCOUNTED FOR. AND THE README
AND ONE OF THE THE COMMENTS MADE
BY OPPOSITION WHICH ACTUALLY IS
AS IS AN IMPORTANT PART OF.
I COUNTING FOR ALL THOSE
INCREASED COSTS AND IF YOU LOOK
AT WHAT CAN BE ACCOUNTED FOR IN
THE BASED AT BASE COSTS AND
ADJUSTMENTS IT IS INCREASED
LABOR COSTS. IT IS.
.
THE.
ENOUGH YOU HAVE MAINTENANCE OR
IF YOU HAVE NEW FACILITIES ARE
BUILDING.
AND SO THE IMPORTANT ASPECT OF
THE GLOBAL CAP WHICH WAS
REFERRED TO IS TO ENSURE YES IF
WE DO SET RATES FOR BUT SERVICES
WE DON'T WANT TO SEE HAPPEN IS
WHAT WE SAW HAPPEN IN MARYLAND
IS THAT PEOPLE JUST STARTED.
INCREASING NUMBER THE SERVICES
THEY DID TO MAKE MORE MONEY AND
IT WAS NASA CONNECTED TO CARE.
AND AND WHAT WAS NEEDED SO THAT
MARYLAND A FEW YEARS AGO
RECOGNIZING THAT SORT OF PUTTING
GLOBAL CAPSULAR DEFERRED OR A S.
YEAH YOU REPRESENTATIVE IN TERMS
OF LABOR COSTS. BUT I MENTION
THE GLOBAL CLOCK CAP BECAUSE
THAT IS A WAY TO ENSURE THAT
COST ON TO SPIRAL OUT OF
CONTROL.
ON LABOR SIDE WHAT HAVE YOU AND
THEN THE HOSPITAL OR THE
DOCTOR'S AT THE DEAL WITH THAT
BECAUSE THEY ARE GETTING LESS ON
THE POLL ON THE. RIGHT SIDE.
THANK YOU OF VICE CHAIR MAYES.
IN OUR COLLECTIVE BARGAINING
AGREEMENTS WITH HOSPITALS LABOR
COST INCREASES HAVE BEEN STEADY
AT AROUND TWO PERCENT WE ACCOUNT
FOR MAYBE ONE TO TWO PERCENT OF
OVERALL COST INCREASES IN THE
HOSPITAL SECTOR. WHICH.
HAS BEEN OUT PIECING
PRESCRIPTION DRUG CROSS COSTS AS
THE NUMBER ONE FASTEST GROWING.
PRICE INCREASE IN HEALTH CARE
SO. LET ME REPHRASE THAT
HOSPITAL COSTS HAVE BEEN GOING
UP FASTER THAN PRESCRIPTION DRUG
COSTS
AND.
WE CAN PROVIDE A CITATION ON
THAT BUT CLEARLY IF WERE ONE
PERCENT TWO PERCENT OF THE
OVERALL PRICE INCREASES OVER
TIME AND HOLDING STEADY.
WE'RE NOT REALLY THE DRIVER OF
THAT HIGH. PRICE.
WELL IT AND IT JUST ONE MORE
QUESTION BECAUSE IT ACTION
WHAT'S GOING TO GET TO THAT TO
THAT POINT I MEAN IN READING
THIS OVER THE LAST COUPLE OF
DAYS IT SEEMED LIKE THE
ECONOMICS IN THE POLITICS OF
THIS.
A SEEM LITTLE OFF
A BECAUSE WHEN YOU TALK ABOUT.
.
YEAH I DON'T I GUESS I'M I'M.
THE QUESTION I HAVE IS HOW WILL.
HELP ME UNDERSTAND HOW WE CAN
HAVE COLLECTIVE BARGAINING IN
UNREGULATED PAY RAISES AND
BENEFIT INCREASES FOR CERTAIN
GROUPS OF HEALTH CARE PROVIDERS
LIKE NURSES AND. I AM ALLIED
HEALTH PROFESSIONALS WHAT THE
SAME TIME COMPLETELY
CONSTRAINING THE RATES AND
CHARGES OF THE PEOPLE THE
HOSPITAL'S OPPOSITION GROUPS.
WHO HAVE TO PAY THOSE WORKERS IT
IN ECONOMIC SENSE IN IT AND FROM
AN ECONOMIC PERSPECTIVE IT JUST
DOESN'T DOESN'T MAKE SENSE HOW
DO WE? HOW DO WE? JUSTIFY THOSE
TO. THOSE PAY RATE INCREASES ARE
ACCOUNTED FOR AND HOW THE RATES
ARE JUST.
SO IF THERE IS OF A BARGAINING
UNIT HOSPITAL AND THEY AGREED TO
GIVE THE NURSES A TWO PERCENT
PAY RAISE WELL IN THE AND NUMBER
THERE'S AN ANNUAL. REVIEW SO
THAT OTHER. AS THAT OCCURS RATES
CAN BE ADJUSTED BY THAT SAME
PERCENTAGE ACCOUNT FOR THAT.
IN FACT THE COMMISSION IS
REQUIRED TO FACTOR LABOR COSTS
INTO THE BASE RATE SO NOT. NOT
THE YOU KNOW YOU CAN COME BACK
HIM GONNA APPEAL IT THE BASE
RATE NEEDS TO FACTOR IN YOUR THE
COST OF LABOR THE COST OF DOING
BUSINESS. PLUS A REASONABLE RATE
OF RETURN. AND IN ADDITION ON
TOP OF THAT ACT AREAS WHERE
THERE ACCESS PROBLEMS ALL OF
THAT IS IN THE BASE
ANYTHING ABOVE THAT YOU CAN
APPEAL FOR BUT ALL OF THAT
SHOULD BE ACCOUNTED FOR IN THE
BAIT WE'RE NOT TALKING ABOUT A
SORT OF ONE. A HOMOGENEOUS
ACROSS THE BOARD RATE IT'S
ACTUALLY BASED ON MEDICARE WHICH
DOES HAVE VARIATION WITHIN IT BY
REGION AND BY.
PROVIDERS SERVICE.
OKAY KIND OF THE OPPOSITION
THAT.
MISTER CHAIRMAN RESTORE TALK
ABOUT THE CALIFORNIA MEDICAL
ASSOCIATION I JUST BRIEFLY WANT
RESPOND TO SOME OF THOSE
COMMENTS I THINK THE FIRST ONE
WOULD BE. THAT WE HAVE GREAT
CONCERN THAT AN ELEVEN MEMBER
COMMISSION IS GOING TO
ACCURATELY SEPARATES FOR BEFORE
UNDER HOSPITALS OVER A HUNDRED
THOUSAND PHYSICIANS. IN A MANNER
THAT ECONOMICALLY VIABLE I KNOW
THAT THE LANGUAGE THAT THE
PEOPLE TAKE THESE FACTORS INTO
ACCOUNT. BUT IF THEY GET IT
WRONG.
THE RAT THE RAMIFICATIONS FOR
THE HEALTH CARE INDUSTRY IS.
QUITE SEVERE AND SECONDLY THE
STATISTICS THAT ARE CITED BOTH
IN THE ATTACK LANGUAGE AND THAT
THE PROPONENTS CONTINUE SITE ARE
BASED ON NATIONAL A STATISTICS
AND SO I THINK WE WANT TO POINT
OUT IN CALIFORNIA. AGAIN THE
POSITION GROWTH WITH OVER THE
LAST TWENTY FIVE YEARS IS BASED
ON MEDICARE DATA ACROSS ALL
PAYERS IS THREE POINT SIX
PERCENT THE NATIONAL AVERAGE IS
FOUR POINT FIVE AT WE ARE THE
LOWEST AS FAR AS WAS USED IN
SERVICE AS HAS BEEN THE LOWEST
GROWTH. OF ANY STATE I'M SO THE
FACT THAT NOW AS A RESULT OF
THAT WE HAVE TO PUT FAITH IN
ELEVEN MEMBER COMMISSION THAT'S
SUPPOSED TO TAKE INTO ACCOUNT
ALL THESE FACTORS.
QUICKLY IS REALLY UNREALISTIC
AND AS FAR AS THE WORLD ACCESS.
MOST OF YOUR RURAL MEMBERS TO
RURAL HOSPITALS ARE SEEN
PATIENTS ON MEDI CAL AND
MEDICARE.
THIS BILL ALTHOUGH IT SPEAKS TO
MEDI CAL MEDICARE DOES NOTHING
IN ANY MEANINGFUL WAY.
TO RAISE THOSE RATES WERE
INCREASED ACCESS IF IF THEY WANT
TO PUT IN AN INCREASE IN MEDICAL
RATES UP TO MEDICARE I THINK
THAT'S A CONVERSATION WE COULD
HAVE. BREWING TALK ABOUT THIRD
OF THE MARKET AND AGAIN MEDI CAL
ON POSITION SERVICES BATES ABOUT
SIXTY PERCENT. OF OF MEDICARE
AND IT'S OFTEN BELOW COST.
IF I MAY I'D LIKE TO UNDERSCORE.
HONESTLY ON WORKABILITY OF
APPEALS SYSTEM.
HAVING SPENT MANY YEARS IN
MARILYN THIS IS NOT AT ALL HOW
THE SYSTEM IN MARYLAND WORKS IT
WAS A SYSTEM THAT WORKED
SUCCESSFULLY FOR FORTY YEARS AND
THEN.
THE STATE.
TOOK A WHOLE NEW APPROACH.
BUT THERE THE RATES ARE SET
BASED ON THE UNDERLYING COSTS
EXPERIENCED BY A HOSPITAL. HAS A
VERY OFTEN HIGHER IN AN URBAN
AREA AND THEY ARE IN A RURAL
AREA. THEIR HIGHER FOR A
TEACHING HOSPITAL THAN A NON
TEACHING HOSPITAL THEY HAVE TO
REFLECT THE CHALLENGE
ENVIRONMENT THAT HOSPITALS
TREATING LARGE NUMBERS OF
MEDICARE AND MEDICAID WITH
SIGNIFICANT. UNDER FUNDING NEED
TO STAY AFLOAT IT IS NOT AN
APPEALS PROCESS IS A VERY
KNOWLEDGEABLE GROUP OF PEOPLE
KNOWLEDGE ABOUT THE HOSPITAL'S
CIRCUMSTANCE SETTING
DIFFERENTIAL RATES THERE IS NO
TIME. TO MEDICARE. AND BY THE
WAY.
FOR A COUNTRY THAT IS JUST
INCREASED OUR FEDERAL DEFICIT BY
ONE AND A HALF TRILLION DOLLARS.
WHAT HAPPENS TO FEDERAL MEDICARE
PAYMENTS HAS MORE TO DO WITH
WHAT'S GOING ON WITH THE FEDERAL
DEFICIT AND DEBT THAN IT DOES
WITH ANY HEALTHCARE POLICY? WHY
WOULD WE IN CALIFORNIA ONE A
TETHER OURSELVES TO A RATE
THAT'S BEING DRIVEN? BY DEFICITS
AND DEBT.
MISS MISTER CHAIR BY GOOD REVIEW
IF I COULD RESPOND TO THAT YOU
KNOW ALL ALL. ALL OF THOSE
FACTORS ARE ACCOUNTED FOR IN
THIS BILL IN THE BASE
ADJUSTMENTS AND WOULDN'T EVEN
REQUIRED APPEAL OF COURSE THE
APPEAL PROCESS AND STILL
AVAILABLE. SO WHETHER IT'S A
TEACHING HOSPITAL A RESEARCH
FACILITY IN A RULE COMMUNITY IN
URBAN COMMUNITY HIGHER COST
LIVING LOWER COST LIVING THAT'S
ALL CAUGHT ACCOUNTED FOR IN THE
ADJUSTED BASE RATE.
AND WILL BE ACCOUNTED FOR IN THE
FACT THAT. THE ACKNOWLEDGMENT
THAT AND RURAL COMMUNITIES THEY
ONLY TAKE MEDI CAL ON MEDICARE
PATIENTS IS A PROBLEM.
THE FACT THEY DON'T HAVE
SPECIALIST THOSE COMMUNITIES AS
A PROBLEM.
AND I THINK THAT A WE ACTUALLY
HAVE ACCOUNT FOR THOSE
COMMERCIAL RATES AND GIVE
CREDIT.
TO THOSE DOCTORS IN THOSE
PROVIDERS THAT ARE. SOLELY
TAKING CARE OF LOW INCOME
CALIFORNIANS THE WE CANNOT YOU
JUST COMMERCIAL RATES
ACCORDINGLY BECAUSE RIGHT NOW
THEY DON'T HAVE THE LEVERAGE TO
DO THAT.
IN THE CURRENT ENVIRONMENT.
JERRY JUST FIVE IF I CAN CLOSE
BY JUST SAYING.
AGAIN MISTER KALRA UNDERSTAND OF
THE PROBLEM I'M I THINK IT'S
SOMETHING THAT WE ALL NEED TO TO
WORK OUT WORK ON.
I LOOK FORWARD TO IN THE NEXT.
COMING MONTHS WORKING WITH THE
CHAIR LAMP OTHER MEMBERS OF THIS
COMMITTEE AND STAKEHOLDERS AMONG
WORKING SOMETHING WORK BUT I'M
WORKING ON SOMETHING THAT WE CAN
ALL.
THEM THOUGH BUT. WORK ON
TOGETHER A TO TRY TO LOWER THE
COST IN OUR HEALTH CARE SYSTEM I
JUST THINK THIS THE THE WRONG
APPROACH
THE BODY NOT.
IF THERE.
THANK YOU SO CHAIR ON THANK YOU
TO THE AUTHOR IN TO ALL THE
PRESENTERS.
SIR SOME AMERICANA.
I'LL GET YOU ADDRESS OR OR YOU
WITNESSES ADDRESS ONE OF THE
ASSERTIONS THAT WAS MADE THAT
THIS BILL. WOULD LEAD OPPOSITION
SECESSION LEAD THE STATE AND ON.
BEALL. WELL I I HAD A BUNCH
MEETINGS.
RECENTLY ON THIS ISSUE AND THAT
WAS THE NUMBER ONE CONCERN THAT
WAS PRESENTED THAT.
POSITIONS WOULD.
BASICALLY BE IN A POSITION
WHERE THEY COULDN'T.
EARN ENOUGH IN THEIR PRACTICE
IN TO PAY OFF LOANS AND THAT IT
WOULD NOT BE SUCH A TREAT AN
ACCESS PROBLEM WHICH YOU KNOW
UPS YOU WANT CONTROL COSTS BUT
WE DON'T CREATE NEXUS PROBLEM.
COULD SPEAK TO THAT PLEASE SURE
OF AND UNDER OUR IS ISSUES WITH
ACCESS TO POSITIONS IN MANY
PARTS OF OUR STATE RIGHT NOW.
AND A LOT OF THAT HAS TO DO WITH
THE THAT THE DIFFERENTIAL AND
HOW THEY'RE COMPENSATED AND
THEIR ABILITY.
TO BE ABLE TO HAVE A PRACTICE.
OR FOR HOSPITALS.
THAT THAT CLOSE IN THEIR
COMMUNITY HOT BILL TO PROVIDE
DOCTORS THAT COMMUNITY AYE AND
THERE'S NO DOUBT THAT I MEAN AS
INDICATED. IN OUT OF THE. RIGHT
NOW WHAT HE IN TERMS JUST TAKING
MEDICARE PATIENTS LONGER SENIOR
FINE DOCTOR TAKING MORE AND
MORE.
MEDICARE PATIENTS.
AND SO AND AND HAS REFERRED TO.
CERTAIN COMMUNITIES WHERE
DOCTORS ARE ONLY TAKING MEDICARE
AND MEDICAL PATIENTS AND
PRESUMABLY THIS WOULD NOT IMPACT
THEM BUT THIS WOULD IT WOULD
HAVE THE OPPORTUNITY TO DO IS
ACTUALLY. BOOSTTHE PAPER SOME
DOCTORS IN COMMUNITIES WHERE
THEY'RE NOT GETTING COMPENSATED
ENOUGH IT'S NOT A.
SALARY OR A PAY CUT.
TO THE HEALTHCARE INDUSTRY.
AND. FURTHERMORE IN
ACKNOWLEDGEMENT TYPICALLY THE
CHAIRS GREAT INTEREST IN AND
CONCERN UP WHICH IS WHAT YOU'VE
ECHOED RIGHT NOW WITH WITH THE
DOCTORS AND HOW DIFFICULT IT IS
FOR DOCTORS. COMING OUT OF
MEDICAL SCHOOL WITH A LOT OF
DEBT.
DE.
AFFRONT FIRST OF ALL DOCTORS ARE
NOT BE INCORPORATING THIS INTO
THEIR DATA AND THAT AND THAT
WILL BE TAKE AT LEAST THREE
YEARS TO GET DATA. OF REAL
INFORMATION SECONDLY WE BELIEVE
THAT WITH THIS IN PLACE YOU'LL
HAVE A SAVINGS AND PUBLIC PLANS.
WITH THOSE SAVINGS NOT ONLY TO
BE SEEK TO HELP IMPROVE MEDI CAL
REIMBURSEMENT RATES BUT WE ALSO
WANT TO AB FUND AT A MUCH HIGHER
LEVEL PROGRAMS THAT RIGHT NOW.
ARE AVAILABLE TO DOCTORS THERE
JUST UNDER FUNDED THEY'RE
WEIGHTLESS FOR THEM DOCTORS
GOING INTO RESIDENTS HE'S PUT UP
LONG REPAYMENT PROGRAMS.
WE WANNA WORK OF REDUCE LOAN
DEBT FRY DOCTORS COMING OUT OF
MEDICAL SCHOOL AND WE THINK THAT
WE CAN DO THAT WITH COST SAVINGS
ON THIS BILL.
WITH COSTS AND THE COSTUMES
WOULD BE A REDUCTION IN THE
EXPECTED RISE IN HEALTHCARE
COSTS IN THE DO WHAT ONE OR TWO
DECADES AHEAD WITHOUT ALONE WE
EXPECT THAT WE CAN HAVE IN
PUBLIC PLANS ALONE. BILLIONS OF
DOLLARS IN SAVINGS
YOU MENTION MEDICARE RATES IS
GOING ON A MISSION MEDICARE RESA
OUT YOU KNOW A LOT OF US HAVE
WORKED ON THIS FOR A LONG TIME
CONCERNED ABOUT HOW LOW MEDICARE
REIMBURSEMENT RATES ARE. UP
WOULD SHOOT WHICH YOU STATE WHAT
YOU WERE SAYING A MINUTE AGO
ABOUT.
YOU'RE CREATING MORE
OPPORTUNITIES BECAUSE AS I
UNDERSTAND IT SOME OF THE
DOCTORS WHO ACCEPT PRIVATE PAY
AND MEDI CAL ESSENTIALLY USE A
PRIVATE PAY PATIENTS TO HELP IN
A WAY. UP MAKE UP FOR THE FACT
THAT THE MEDICARE RATES REALLY
LOW AND AND YOU'RE SAYING THAT
THERE'S ANOTHER OPPORTUNITY
THAT.
THAT THOUGHT THANK YOU MET THE I
THINK IN A STATEMENT THAT'S THE
ARGUMENT THAT SOMETHING REALITY.
AND IN FACT.
THIS COMMISSION CAN SET THAT AS
A REALITY THAT THOSE DOCTORS ARE
TAKING MORE MEDI CAL PATIENTS
MEDICARE BUT PATIENTS WOULD GET
A HIGHER REIMBURSEMENT THE
COMMERCIAL RATE. THE REALITY IS
THAT'S NOT THE COST DRIVER OF
THE COST WEBER IS NOT BECAUSE
DOCTORS ARE TAKING MORE MEDI CAL
MEDICARE PATIENTS DESPISES IS
IT'S SIMPLY NOT TRUE.
AND MANY OF THE HOSPITALS OF
YOU SEEN DRAMATIC INCREASE IN
RATES IS NOT BECAUSE THOSE
HOSPITALS HAVE THE DISPROPORTION
NUMBER MEDI CAL OR MEDICARE
PATIENTS COMPARED TO OTHER
HOSPITALS THAT DON'T SEE. THAT
KIND OF INCH INCREASING RATES
AND SO THIS COMMISSION WILL HAVE
THE OPPORTUNITY TO ACTUALLY.
I BELIEVE A LEAD TO THAT LEAD TO
THE RECOGNITION OF THOSE DOCTORS
AND HOSPITALS ARE ACTUALLY
TAKING PATIENTS THAT ARE ANNIE
TAKING MEDICARE AND TAKING MEDI
CAL PATIENTS.
AND TO COMPENSATE THEM
INCENTIVIZE THEM FOR DOING THAT
PARTICULARLY IN RURAL
COMMUNITIES.
AS INDICATED IF AND RURAL
COMMUNITIES OF THEIR SEEM ALSO
MEDI CAL MEDICARE PATIENTS AND
THERE'S A LOT OF SPECIALISTS AND
ANOTHER THAT WILL GO A FAMILY
PRACTITIONERS OTHERS ARE GOING
TO RURAL COMMUNITIES ARE.
HEAVILY UNDERSERVED RIGHT NOW
WELL IF THEY'RE ABLE TO GET MORE
ON THE COMMERCIAL RATES GUESS
WHAT YOU CAN HAVE A GREATER
INCENTIVE FOR DOCTORS TO GO INTO
THOSE RULE COMMUNITIES. AND
THOSE UNDERSERVED COMMUNITIES IN
OUR STATE.
I I'M SECURE AS WELL AS QUESTION
I'M SURE THE OPPOSITION WOULD
LIKE TO ADDRESS THAT PROBLEM BUT
I'D LIKE TO DISCUSS THIS FINAL
QUESTION TO THE AUTHOR AND HIS
TEAM.
.
IT'S ABOUT DRUG COSTS NOT
INCLUDED HERE SINCE THAT'S
REALLY ONE OF THE THINGS ONE OF
THE OTHER COSTS THAT CONSUMERS
OFTEN FEEL THE PINCH. ON WHY
THEY'RE NOT INCLUDED AND THEN
JUST ABOUT THE.
THIS IS A QUESTION DO YOU AND
TO THE OPPOSITION ABOUT THE
STRUCTURE OF THE COMMISSION
ITSELF.
MUCH HAS BEEN SAID THAT THIS
COMMISSION CAN NOT PROPERLY SET
RATES.
IN A WAY THAT KEEPS THE PACE
WITH THIS INDUSTRY I WOULD LIKE
YOU TO ADDRESS THAT AND IF THE
OPPOSITION WOULD ADDRESS THAT
I'M SURE YOU CAN ADDRESS THE
PIECE ABOUT. UP MEDI CAL RATES
AS IT RELATES TO.
A PRIVATE PRACTICE THANK YOU.
THEM IN SO.
THE OTHER CHALLENGES I THINK IT
AND MANY IN THE LEGISLATURE HAVE
FACED A BECAUSE I KNOW. MANY OF
THE LEGISLATURE. HAVE GRAPPLED
WITH THE ISSUE OF. PERCEPTION
DRUGS.
AND PHARMACEUTICAL COSTS.
SO THERE ARE SOME CHALLENGES IN
TERMS OF THE COMMERCE CLAUSE OF
OF WHAT WE CAN DO BUT I DO
BELIEVE THROUGH THIS BILL WE CAN
DO MORE THAN WE'VE EVER DONE
BEFORE. AND SOME OF THE POLICY
RECOMMENDATIONS THAT.
MOVED FROM THE CHAIR AND HIS
STAFF THAT WE ARE ACCEPTING A
DOES EVEN FURTHER THAN THE
LANGUAGE BEING CLUED IN TERMS OF
JUST DOING A REPORT. ON
PRESCRIPTION DRUGS BUT I
ACTUALLY FINDING WAYS IN WHICH
WE CAN DETERMINE METHODS OF THE
STATE GOVERNMENT ACTUALLY CAN
ACT ON PRESCRIPTION DRUGS.
SO ONE OF THE KEY THINGS ABOUT
THIS COMMISSION THE OPPORTUNITY
PROVIDES RATHER THAN HAVING US
AS MUCH AS I BUT I BELIEVE IN
ALL OF US HERE. DECIDE HOW MUCH
WEIGHT SHOULD BE AND DECIDE WHAT
THE COSTS RIDERS ARE IS TO GET
EXPERTS AND GET A COMMISSION
HAVE A EXPERTS ON THE ADVISORY
COMMITTEE ADVICE COMMISSION HAD
EXPERTS STAFFS.
STOP THAT IS WHAT'S GOING TO
HELP US DETERMINE WHAT THE
HEALTH OF THE DRIVERS OF HEALTH
COSTS ARE AND AND CONTAIN THEM
NOT CUT THEM NOT SLASH THEM
CONTAINED THEM. AND IT'S GONNA.
UP AND IT'S GOING UP I'M.
ALLOW US TO IDENTIFY AND SHINE A
LIGHT ON THOSE AREAS THAT
WHETHER WE HAVE CONTROL OVER AND
NOT.
EXPOSE THEM UNSELFISHLY THE
PHARMACEUTICALS AND SHOULD YOUR
DRUGS WILL BE DID SB SEVEN TWO
LAST YEAR IS A GREAT START. BUT
THROUGH THIS COMMISSION WE CAN
FURTHER EXPOSED THAT'S THE
THOUGH TRUE COST DRIVER.
AND IT'S NOT THE DOCTORS IN THIS
OP HOSPITALS THAN GREAT YOU KNOW
WHAT THE RATES ARE GONNA CHANGE
THE DOCTORS A HOSPITAL SO MUCH.
AND WE CAN THEN TURN OUR
ATTENTION AND FOCUS ON THAT BUT
WHICH DOES AFFECT THE RATES.
AS TO.
AND THE FIRST QUESTION WAS
POSED A QUESTION ABOUT ABOUT THE
STRUCTURE OF THE KID AND I
COMMISSION I THINK A LOT'S BEEN
SAID THAT THIS COMMISSION CAN'T
PROPERLY SET RATES ARE THAT WILL
FALL BEHIND OUR THAT APPEALS
WILL BE. SORT OF UNREAL THE.
SURE THIS NINE MEMBER
COMMISSION.
IF YOU COULD ADDRESS THAT SURE
IT'S IDEA BEHIND THIS IS THAT IT
WOULD BE A LIVING WAGE.
AND BEFORE WE EVEN GOT TO RATES
WE DO TAKE A LEAST THREE YEARS.
OF A IN GETTING DATA.
AND AND GETTING REAL DATA THAT
WE CAN USE TO HELP TO ESTABLISH
THE RATES ONCE RATES ARE SET THE
REEVALUATED EVERY YEAR THEY ARE
JUST OF EVERY YEAR COST LIVING
GO DIG INTO GENERAL COST OF
LIVING INCREASES. THINKING TO
RATES OF THE UNCERTAIN SYSTEMS I
JUST DID A LABOR AGREEMENT AND
COST ONE UPPER ONE AT ONE
SEGMENT OF THE LABOR FORCE. AND
SO IT'S A LIVING COMMISSION.
THAT'S NOT A COMMISSION IS GOING
TO LOOK AT EVERY FIVE YEARS IT'S
AN ANNUAL REVIEW AT AND THEN
ANNUAL ADJUSTMENT OF RATES.
I'M DEFICIT OBSERVED.
MISTER MISTER BY MAY.
.
SO EAT DE.
THE CASSETTE COMMISSION
GOVERNANCE WAS VERY MUCH BASED
ON SUCCESSFUL MODELS THAT COVER
CALIFORNIA.
SO WHICH IS INDEPENDENT.
HAS STRONG CONFLICT OF OF
INTEREST STANDARDS.
AND IS MADE UP OF EXPERTS
EXPERTS IN HEALTH CARE FINANCING
AND HEALTH CARE ECONOMICS IN A
NUMBER OF DIFFERENT AREAS AND
ACTUALLY BASED ON SOME OF THE
EXPERIENCE IN MARYLAND OF
HAVING.
AN INDEPENDENT BOY THAT HAS
BUILT FLEXIBILITY INDEPENDENCE
AND AUTHORITY TO REACT
THE CHANGES IN THE MARKET.
AND TO SET RATES.
WITH THE GUIDANCE THAT THE
LEGISLATURE SETS OUT IN TERMS OF
WHAT THEY WANT TO SEE
ADJUSTMENTS FOR.
BUT HAS THAT EXPERTISE AND
INDEPENDENCE THE OTHER THING IS
IS THAT THERE IS AN ADVISORY
COMMITTEE.
WHICH IS REQUIRED TO ME AND
GIVE ADVICE AND INPUT TO THAT
COMMISSION THAT IS MADE UP OF
MEMBERS OF THE HEALTH CARE
INDUSTRY THEIR VOICES ARE
INCREDIBLY IMPORTANT IN SETTING
THESE RATES.
AND THE AUTHOR IS ACCEPTING
AMENDMENTS THAT WOULD ADD EVEN.
MORE PROVIDERS LIKE SPECIFY
PROVIDERS SUCH AS PRIMARY CARE
DOCTORS BEHAVIORAL HEALTH I'M A
SOLO PRACTITIONER. BECAUSE THAT
IS AN IMPORTANT VOICE SO ALL OF
THAT WILL BE PART OF THE
ADVISORY COMMITTEE EXPERTS ON
THE COMMISSION. AND IN SETTING
THE PACE AMOUNTS THE COMMISSION
WILL TAKE PUBLIC COMMENT WRITTEN
TESTIMONY THERE WILL BE A
PROCESS WHERE THE STAKEHOLDERS
GO IN AND TALK ABOUT. WHY
CERTAIN RATES NEED TO BE A
CERTAIN WAY SO ALL OF THAT IS IS
BAKED INTO THE PROCESS?
AND THERE'S GUIDANCE INTO WHAT
WHAT THEY NEED TO TAKE INTO
ACCOUNT SO IT HAS INDEPENDENCE
BUT HAS GUARD RAILS TO MAKE SURE
THAT THERE IS.
AFFECTED UPS AND THEN ALSO WITH
THE GLOBAL CAP THAT IS BASICALLY
AWAY FOR THE COMMISSION TO KIND
OF TRACK ARE THEIR SPIKES IN
PRESCRIPTION DRUGS ARE THEIR
SPIKES IN. VOLUME ARE THERE
OTHER ISSUES THAT ARE GOING ON
THAT THIS COMMISSION NEEDS TO
LOOK AT THAT WOULD CAUSE THERE
TO BE AN ADJUSTMENT IN THE BASE
AMOUNT.
AND SO THAT'S THE IDEA BEHIND
THE GOVERNMENTS OF THE.
THANK YOU KNOW THROUGH THE CHAIR
IF IF THE OPPOSITION TO ADDRESS
SOME OF THE MEDI CAL STUFF.
THANK YOU.
THANK YOU MRS THURMAN APPRECIATE
THE OPPORTUNITY RESPOND.
FIRST OF ALL THERE'S BEEN A LOT
OF INTERESTING IDEAS PUT OUT
ABOUT HOW TO INCREASE MEDI CAL
THROUGH THIS BUT THEY'RE NOT IN
THE BILL.
THEY'RE JUST SIMPLY NOT IN THE
BILL.
AS FAR AS THE.
WHETHER OR NOT COMMERCIAL RATES
REALLY OFFSET LOSSES.
COME TO MY OFFICE COME TO THE
DOCTORS AROUND ME. THE ONLY
REASON I CAN SEE MEDI CAL
PATIENTS IS BECAUSE I TAKE
COMMERCIAL RATES.
I WOULD BE OUT OF BUSINESS AND
IN FACT.
TWO THOUSAND SEVEN I SHUT MY
DOOR TO THE FEE FOR SERVICE
MEDICARE PROGRAM.
BECAUSE I WAS ONE OF THE LAST
THE ANTI PHYSICIANS IN SAN DIEGO
COUNTY STILL SEEING THOSE FOLKS.
AND THEY WERE BANKRUPTING MAY
BECAUSE I COULDN'T SEE
COMMERCIAL PATIENTS TO OFFSET MY
LOSSES.
SO IT IS SIMPLY TRUE.
THAT THERE IS AN OFFSET THAT THE
STATE IS PUTTING ON THE
COMMERCIAL RATES.
WE CAN GIVE YOU THE DATE I'M
SURE.
AS FAR AS COMMENTS HERE ABOUT
THE CONSOLIDATION DRIVING UP
COSTS.
THIS BILL WOULD INCREASE
CONSOLIDATION DOCTORS LIKE
MYSELF IN THE LATTER PART OF OUR
PRACTICES AND I WILL TELL YOU I
WILL BE ONE OF THOSE DOCTORS
WILL LOOK TO AN EARLY
RETIREMENT.
I PRACTICE THIRTY YEARS I COULD
PROBABLY PRACTICE ANOTHER FIVE
TO TEN.
AS A SOLO PRACTITIONER MY ONLY
OPTIONS UNDER THIS BILL ASSUMING
THAT WE SEE THE SAME BEHAVIORS
BY THE LEGISLATURE SETTING RIGHT
OR THIS. THIS WITH A PANEL
SETTING RIGHTS.
WOULD BE TO JOIN A LARGER
ORGANIZATION FURTHER INCREASING
CONSOLIDATION.
OR CLOSE MY PRACTICE
CONSOLIDATION DRIVES UP PRICES.
THAT IS NOT WHERE WE WANT TO
PUSH PHYSICIANS AND OTHER
HEALTHCARE PROVIDERS.
IN TERMS OF HOW THIS COMMISSION
WOULD WORK TO WATCH AND MAKE
SURE THESE ARE REASONABLE RATES
DEALING WITH INCREASED LABOR
COSTS AND INCREASE INFLATION.
LET ME REMIND EVERYBODY IN THE
ROOM ABOUT SOMETHING CALLED THE
SG ARE.
AND THE DOC FIX THAT WE HAD TO
GO AFTER EVERY YEAR FOR A
DECADE.
BECAUSE MEDICARE WAS ALSO GOING
TO TAKE CARE OF THOSE THINGS AND
NEVER DID.
FORTUNATELY THE FEDERAL
GOVERNMENT HAD A LITTLE BIT MORE
SPARE CASH THEN THE STATE HAS
NEVER COME UP WITH. TO MAKE UP
FOR THOSE LOSSES YEAR AFTER YEAR
AND KEEP DOCTORS OFFICE OPEN.
FOR MEDICARE AND I WILL REMIND
ALSO THAT THERE ARE COUNTIES IN
THIS STATE.
THAT COULD NOT HAVE THAT THERE
WAS NO PATIENT ENTERING
MEDICARE.
THAT COULD FIND OPPOSITION
ACCEPTING THEM PARTICULARLY IN
SPECIALTIES LIKE ORTHOPEDICS
BECAUSE THEY SIMPLY DIDN'T COVER
THE COSTS OF CARE THE DOCTORS
WERE NOT WILLING TO SEE MEDICARE
LET ALONE MEDIC CALATHUS RATES.
IN TERMS OF GLOBAL BUDGETING.
IF WE DON'T INCLUDE PHARMA.
IN ANY PART OF THIS BILL.
HOW DO U. GLOBALLY BUDGET AND
NOT END UP CUTTING PAYMENT?
TO PHYSICIANS HOSPITALS DENTISTS
AND OTHER HEALTH CARE PROVIDERS
WHEN FORMA INCREASES ARE STILL
OUT OF CONTROL.
FINALLY THE IDEA OF AN APPEALS
PROCESS.
MANY OF YOU ARE PROBABLY
FAMILIAR WITH INDEPENDENT
DISPUTE RESOLUTION THAT'S COME
UP MANY TIMES BEFORE.
IT IS A FAILED PROCESS IN MANY
WAYS BECAUSE INDIVIDUAL
PRACTITIONERS OR EVEN SMALL
GROUPS OF PRACTITIONERS SIMPLY
DON'T HAVE THE TIME AND THE
FINANCIAL RESOURCES TO GO AFTER
HEALTH PLANS CURRENTLY. THAT ARE
UNDER PAYING CLAIMS OR REFUSING
TO PAY REASONABLE CLAIMS FOR
MEDICALLY NECESSARY CARE.
THERE IS NO EXPECTATION THAT
SMALLER PRACTICES AND EVEN
MEDIUM SIZED PRACTICES ARE GONNA
HAVE THE WHEREWITHAL TO GO UP
AGAINST THE COMMISSION.
THAT HAS AT THIS TIME ORIGINALLY
OUT OF NINE MEMBERS KNOW
PHYSICIANS.
AND NOW MAYBE ONE PHYSICIAN ON A
PANEL OF ELEVEN.
THERE'S MUCH TO BE DONE BEFORE
THIS BILL HAS ANY SENSE TO IT.
THANK YOU.
AND IF I MAY ADD ASSEMBLY MEMBER
THANK YOU FOR THE OPPORTUNITY
THE FUNDAMENTAL FLAW HERE IS
THAT THIS BILL THIS APPROACH.
ATTACKS ONLY ONE ASPECT.
SPENDING IN PRICING DOES ADDRESS
MEDICARE DOESN'T ADDRESS
MEDICAID. WE ARE NOW ON A RACE
TO THE BOTTOM.
IT ALSO DOESN'T TAKE INTO
ACCOUNT.
FROM A HOSPITAL ORGANIZATIONS
PERSPECTIVE THE PLANNING THAT IS
NEEDED.
TO OPERATE A SIGNIFICANT
ORGANIZATION ONE WHY MEAN BY
THAT.
IN MARYLAND THE RATE SETTING
COMMISSION FOCUSED ON RATES OF
INCREASE.
THIS PROPOSES TO READ BASS
THE RATES AT WHICH HOSPITAL'S
PHYSICIANS AND OTHERS ARE SET.
FOR AN ORGANIZATION THAT EMPLOYS
TENS OF THOUSANDS OF
INDIVIDUALS.
THAT HAS TO PLAN NOT ONLY FOR
THE CARE THEY'RE PROVIDING TODAY
BUT THE CARE THEY'RE GOING TO BE
PROVIDING IN FIVE TO TEN YEARS
WITH BOARDS OF TRUSTEES FROM THE
COMMUNITY WHO GOVERN THOSE
DECISIONS.
THEY CAN'T WAIT TO NO THREE
HUNDRED SIXTY FIVE DAYS AT A
TIME.
WHAT THEY'RE GOING TO BE PAID
FOR THE SERVICES THAT THEY NEED
TO PROVIDE
SO THIS SYSTEM IS NOT ONLY NOT
TAKING INTO ACCOUNT THE
UNDERLYING COSTS OF CARE? LABOR
DRUGS AND ALL THE REST THE
DEGREE OF SUBSIDY THAT'S NEEDED.
AND AS THE PROPONENTS HAVE
ARGUED IF YOU'RE A HOSPITAL
TREATING THE LARGE NUMBERS OF
MEDICARE AND MEDICAID PATIENTS.
THEY HAVE NO PATIENCE TO SHIFT
THOSE UNFUNDED COSTS TO AND
THEIR WORKING DAY BY DAY TO MAKE
ENDS MEET BUT THE SYSTEM
CERTAINLY DOES NOT TAKE INTO
ACCOUNT THE PLANNING. THAT'S
NEEDED TO TAKE CARE DELIVERY
WHERE WE NEED IT TO BE. IN
MARYLAND ONE OF THE FLAWS OF THE
RATE SETTING SYSTEM IS THAT
MARYLAND HAD AN OLDER.
SET OF CAPITAL OLDER HOSPITALS
OLDER FACILITIES BECAUSE IT
WASN'T UNTIL THE RATE SETTING
COMMISSION RELEASED FUNDS. THAT
HOSPITALS COULD THEN PLANET TEN
YEAR CYCLE. OF REPLACING THAT
PHYSICAL PLANT SO THERE IS MUCH
TO BE LEARNED I BELIEVE FROM THE
SYSTEMS THAT ARE OUT THERE THIS
BILL DOES NOT DO. MAKES YOU
WON'T ANSWER MY QUESTIONS WAS
INTERESTING ABOUT COUNT.
LABOR COSTS DRUG COSTS IN OTHER
COSTS BUT THE AUTHOR DID SAY
THAT THE STRUCTURE CREATES A WAY
TO ADDRESS POTENTIAL DRUG COSTS
IN THE STATE. AND HAS BUILT IN A
WAY TO ADDRESS WITH LABOR COSTS
AND SO I THINK WHAT'S
CHALLENGING IS THAT WE'VE HEARD
FROM TWO SIDES ON THE SAME
ISSUES AND THEY'RE CITING
DIFFERENCE THAT'S DATA.
BUT A BUT THE AUTHOR DID
ADDRESS THAT THERE'S A WAY TO
ADDRESS LABOR COSTS IN DRUG
COSTS AND SO.
CLEARLY THERE'S SOME CHALLENGES
HERE BUT I THINK THERE'S
SOMETHING CREATIVE TO WORK WITH
LAW ENFORCEMENT WHEN I THINK
BOTH SIDES THREE QUESTIONS YOU
CREATIVELY.
TO BIGELOW.
THANK YOU TO THE AUTHOR.
I FIND IT.
LIKE MANY MEMBERS HERE A KIND
OF.
IF USING SCENARIO HERE.
AND WHEN I TRIED TO LOOK AT THIS
AND TRY TO UNDERSTAND THAT THERE
ARE TENS OF THOUSANDS OF
PROVIDERS.
BOTH INDIVIDUAL AND HOSPITALS.
THAT ARE GOING TO BE.
THAT'S GONNA BE A STAGGERING
NUMBER WHO ALL HAVE INDIVIDUAL
SOCIO ECONOMIC.
CHALLENGES.
DOES YOUR.
I'LL CONTEMPLATE. A SEPARATELY.
PAYMENT PROGRAM FOR EACH
INDIVIDUAL DOCTOR AND HEALTH
PLAN.
YEAH DOT NODDED FOR EVERY
INDIVIDUAL DOCTOR. THEN HOW WILL
THEY BE ABLE HOW WILL ANY
SUCCESS COME FROM THIS IF YOU'RE
NOT ABLE TO TAKE INTO ACCOUNT.
THE LABOR COSTS THE AND THE
PATIENT LOAD.
WHAT WE DO TAKE INTO ACCOUNT?
ITALIAN HOW IN THE* SO. AS
MENTIONED A COUPLE TIMES LABOR
COSTS ARE TAKE INTO ACCOUNT AND
SO THAT'S SOMETHING THAT CAN BE
ADJUSTED IN THE BASE ADJUSTMENT
NOT EVEN AN APPEAL. BUT ACTUALLY
A BASS ADJUSTMENT AND THEIR.
IS A LARGE SCALE OPERATION HAS
A LOT OF LABOR WHERE THEY DO
THEY HAVE A BARGAINING UNIT. AND
THE CONTRACTS WE APPLAUD THAT
CAN BE FACTORED IN TO A RATE
INCREASE OF THAT INDIVIDUAL BUT.
.
BUT IT'S JUST LIKE RIGHT NOW IF
I CAN BUY DIFFER ON HOW MEDICARE
WORKS HOW MEDICARE RATES ARE SET
ALREADY HAS NOT LET EVERY DOCTOR
HAS INDIVIDUAL MEDICARE WAIT
THEY GET. IT'S ALSO BASE OUR
REGION SPACE ON COST ADJUSTMENT
OR WHAT HAVE YOU RIGHT BEFORE
YOU RESPOND THAT CLEARLY IT'S A
ONE ONE SIZE FITS ALL.
CURRENTLY AND WHAT YOU'RE
OPENING THE DOOR TO IS A TENS OF
THOUSANDS
SOLUTION FOR A PLAN.
YOU'RE GOING TO HAVE CONFLICT
BUILT INTO THIS AND. AND I KNOW
YOU WANT RESPOND TO THAT BUT
WITH ONLY NINE MEMBERS
INCREASING GET ELEVEN.
IS A REALLY GOING TO BE ENOUGH.
ABILITY FOR THIS COMMISSION TO
ADDRESS THAT MAGNITUDE OF AN
ISSUE A CHALLENGE.
IT'S IS A MAJOR ENDEAVOR AND
THAT'S WHY IT WILL BE UP OF
FUNDED COMMISSION TO ALLOW STAFF
STARTUP TO THAT ADVISORY
COMMITTEE. TO HELP PROVIDE
INFORMATION ALLOW FOR A PROCESS
IS SET BOTH BASE RATES ADJUSTED
RATES AND ALLOW FOR AN APPEALS
PROCESS AS WELL. AYE IF THERE'S.
A PARTICULAR NEED IT IS A
DOCTOR.
BUT A COUNTRY TO STOP THE NEEDS
THAT THEY HAVE UP FACILITIES
ISSUES BUT THEY HAVE TO ACCOUNT
FOR. THOSE ARE ALL THINGS ARE
VERY INDIVIDUALIZED THAT FRANKLY
RIGHT NOW. IT'LL GET COMPENSATED
FOR THAT THE TAKE THAT OUT OF
THEIR OWN GENERAL FUND OF THEIR
ALL OF THEIR OPERATIONS.
AND SO AND THEIR DOCTORS SUCH AS
THE OUR OUR GOOD DOT HERE THE
RIGHT TESTIFIED SAYING. YOU KNOW
THE COMMERCIAL RATES.
HELP ME TO OFFSET OUR MEDICARE
MEDICAL MEDICARE MEDICAL RATES
WELL THEN WHO THE ACTOR THAT
CAN.
BE ANNOUNCED SO IF THAT'S THE
CASE IN THE REGION HE PRACTICES.
THEN THAT COULD VERY WELL BE
WHAT COMMERCIAL RATES ARE SET
THAT THIS IS NOT ABOUT. CUTTING
AYE I KNOW THAT.
.
THERE THERE WAS A SUGGEST THAT
WE'RE GONNA RE BASS.
BUT THE RATES ARE THE REALITY IS
WE BATES IS NOT EQUAL REDUCE.
AND SO ON UP TO A DEFERRED TO
THIS AREA HERE ON THE POINT OF
HOW YOU ACCOUNT FOR INDIVIDUAL
INDIVIDUAL ICONS GIVEN THE FACT
THAT MEDICARE DOESN'T DO THAT.
BUT HOW WITH THIS ACCOUNT FOR
LOCALIZED DIFFERENCES IN CLASS.
IT'S A BIGELOW THAT'S AND AN
EXCELLENT QUESTION AND I THINK
WHEN WE.
AND WE'RE CONTEMPLATING WHAT THE
AUTHOR THE STRUCTURE OF THIS
BILL WE REALIZE THAT THERE IS A
TRIED AND TRUE FORMULA OUT THERE
WHICH IS THE WORKHORSE OF
MEDICARE. WE REALIZED WE DID NOT
NEED A COMMISSION TO REINVENT
THE WHEEL AND SAT AS YOU SAID
TEN THOUSAND DIFFERENT.
RATES FOR ALL THE PROVIDERS IN
THE STATE ESPECIALLY A STATE AS
LARGE AS AS CALIFORNIA. THE
MEDICARE SYSTEM DOES THE WORK
FOR US AND THAT'S WHY MEDICARE
IS USED AS THE BENCHMARK IN THE
BASIS FOR THE COMMISSION TO SET
RATES. MEDICARE TAKES INTO
ACCOUNT
COST
THE COST OF CARE LABOR COSTS IT
DOES ADJUSTMENTS FOR REGIONAL
WAGE DIFFERENCES IT LOOKS THAT
IF A FACILITY DOES MEDICAL
EDUCATION. IF THEY ALL HAVE A
DISPROPORTIONATE SHARE OF
MEDICAID OUT OR LOW INCOME
BENEFICIARIES AND EVEN DOES AN
ADDITIONAL PAYMENT IF THERE'S AN
OUT LIAR CASE IF THERE HAPPENS
TO BE A CASE WHERE. IT IS VERY
VERY EXPENSIVE.
EVEN DEALS WITH CRITICAL ACCESS
HOSPITALS
THOSE ARE HOSPITALS I BELIEVE
THERE'S THIRTY FOUR IN THE STATE
OF CALIFORNIA THAT ARE IN. RURAL
AREAS AND THEIR SMALL HOSPITALS
THAT REALLY ARE THE ONLY SOURCE
OF CARE FOR MEDICARE ENROLLEES
AND SO A LOT OF THAT WORK IS
DONE.
AND SO MEDICAID PROVIDERS WHO
ACCEPT MEDICARE.
KNOWWHAT THAT IS AND THE
COMMISSION IS GOING TO USE THAT
AS THE BASIS.
TO MAKE ADJUSTMENTS THAT MAKE
SENSE FOR THE STATE OF
CALIFORNIA AND FOR THE VARIOUS
THINGS THAT ARE BUILT INTO. THE
BELL I MEAN.
WE HAVE TO MAKE SURE THAT THESE
RATES ALLOW FOR STATE LAW
REQUIREMENTS SUCH AS TIMELY
ACCESS LANGUAGE ACCESS AND
NETWORK ADULTS ADEQUACY.
THOSE ARE ALL EXISTING STATE
LAWS THAT ARE NOT GOING TO
DISAPPEAR THE BASE RATES HAVE TO
ACCOUNT FOR THE.
THE OTHER THING IS IS THAT IN
CALIFORNIA FORTY PERCENT OF
MEDICARE ENROLLEES ARE IN
MEDICARE ADVANTAGE.
THE REASON THAT'S SO IMPORTANT
IS THAT IN CALIFORNIA WE DO HAVE
A VERY UNIQUE.
DELEGATED MODEL.
WE HAVE INTEGRATED SYSTEMS LIKE
KAISER THAT HAVE DONE INCREDIBLE
WORK.
AND REALLY DO SOME VALUE BASED
CARE.
THE INTENT OF AB THIRTY EIGHTY
SEVEN IS NOT TO DISRUPT THAT
MODEL.
WE DID NOT WANT TO DISRUPT THE
WORK THAT CALIFORNIA HAS DONE TO
GET TO VALUE BASED CARE. AND SO
THE BILL VERY CLEARLY USES
MEDICARE ADVANTAGE.
AND A PERCENTAGE OF MEDICARE
ADVANTAGE RISK ADJUSTED OF
COURSE FOR THE TO HER POPULATION
TO BE ABLE TO SET THE CAPITATED
PAYMENTS TO HEALTH PLANS.
IT DOES NOT INTERFERE WITH THE
CONTRACTS RELATIONSHIPS THAT
HEALTH PLANS HAVE WITH
CONTRACTED PROVIDERS
IT WAS VERY IMPORTANT TO US
ESPECIALLY WITH THE LABOR
MOVEMENT HAVING SIXTY FIVE
PERCENT ENROLLMENT IN KAISER
PLANS.
BUT THAT WOULDN'T DISRUPT THIS
MODEL AND SO JUST TO ANSWER YOUR
QUESTION A LOT OF THE WORK IS
DONE BY THE FEDERAL GOVERNMENT.
AND THE COMMISSION WILL ADJUST
FOR THE REALITIES TO CALIFORNIA.
SO WHEN WHEN I HEAR THAT.
I'M I'M. ALMOST HEARING IS STILL
A ONE SIZE FITS ALL.
PLATFORM.
AND WHAT'S WRITTEN IN THE BILL.
WHICH WAS TO GIVE.
MOST PEOPLE IN UNDERSTANDING
THAT THERE WOULD BE SOME. OFF
RAMPS FOR UNDERSTANDING HOW TO
APPEAL THAT'S ALMOST OFF THE
TABLE BECAUSE WE'RE A GONNA BE
PREDETERMINED.
SO I'M A LITTLE CONCERNED MAYBE
THE OPPOSITION. SINCE YOU
COMMENTED A MAYBE YOU CAN MAYBE
ADDRESS THAT.
IF YOU'RE ME YES PLEASE THANK
YOU SOME WOMEN UP THE BILL DOES
CONTEMPLATE SETTING DIFFERENT
RATES FOR DIFFERENT HOSPITALS
AND DIFFERENT PHYSICIAN GROUPS
IT'S RIGHT THERE IN THE BILL AT
THE COMMISSION DOES HAVE THE
POWER TO SET. DIFFERENT RATES
FOR DISINFORMATION GROUPS IN THE
SAME GEOGRAPHIC AREA OF THE FACT
THAT WE'RE SAYING THAT MEDICARE
RT TAKE THIS INTO ACCOUNT FOR
ONE. OF THERE'S A LOT OF
PROBLEMS AND MEDICARE ESPECIALLY
AT NIGHT WHEN THEY WOULD ZONE
DIFFERENT COUNTIES AS URBAN OR
OR RURAL.
IT AS A MEDICAL ASSOCIATION
WE'VE WE'VE HAD A LOT OF TROUBLE
THE FEDERAL GOVERNMENT.
MAKING SURE THAT THAT MEDICARE
RATES ARE SET AT ESTABLISHED
LEVEL BUT TO YOUR QUESTION OF
WHETHER THIS IS THE ONE SIZE
FITS ALL APPROACH TO TO US
THERE'S JUST A FULL DELEGATION
THE COMMISSION THE COMMISSION
COULD SET ONE WAY IF THEY WANTED
TO. OR THEY COULD SAID DIFFERENT
RATE FOR EVERY POSITION A
POSITION GROUP IN THE STATE OF
CALIFORNIA SO THERE REALLY IS NO
ANSWER YOUR QUESTION BECAUSE
IT'S ALL DELEGATED TO THE
COMMISSION AND THE COMMISSION
SHALL TAKE INTO ACCOUNT THESE
DIFFERENT ITEMS BUT AT THE END
OF THE DAY. WHAT HAPPENS IF THEY
GET IT WRONG A ACCESS TO CARE
THE HEALTHCARE DELIVERY SYSTEM
REALLY GETS HURT AND SO?
I THINK FOR FOR OUR ASSOCIATION
THE
THE CONCERN THAT WE HAVE IS NO
EASY ANSWERS ARE NO THESE
QUESTIONS CAN BE ANSWERED.
IN FACT THEY LEAVE THE ANSWERS
TO THE COMMISSION AND AGAIN AT
ELEVEN PEOPLE WE HAVE ONE
POSITION ON THERE UP MOST OF IT
WOULD SAY IS IS.
.
TILTED TOWARD PURCHASERS THERE'S
A REPRESENT OF LABOR UNIONS IN
THERE'S ACTUALLY EVEN INTERVENOR
FEES OR SOME PROPONENT OF BILL
CASTIGATE WITNESS AN ADVOCACY
FEES TO.
LOBBYING FROM THE COMMISSION SO
WE DON'T HAVE ANY CONFIDENCE
THAT ELEVEN PEOPLE WILL BE ABLE
TO ACCURATELY SET THE RATE FOR
ALL THE PROVIDERS IN THE
HOSPITAL IN OUR IN OUR STATE. SO
HELP ME.
HAVING HEARD THAT MAYBE SOMEONE
CAN ADDRESS THAT THERE IS A
SECTION IN THE BILL.
AND IN FACT IT'S ONE ZERO ZERO
SIX POINT I'M SIX ONE ZERO
POINT.
A. THAT WOULD ALLOW THE
COMMISSION TO WORK MONEY TO
ADVOCACY ORGANIZATIONS.
WHAT ORGANIZATIONS AND FOR WHAT
PURPOSES?
MAYBE YOU COULD ADDRESS THAT
YEAH AND WE ACTUALLY HAVE AGREED
TO TAKE ON THE.
SUGGESTION UP FROM THE CHAIR.
BUT TO CAP HOW MUCH TO BE SPENT
ON THAT OVER THE COURSE OF THE
YEAR.
AND SO. THAT'S. THE PPP.
.
SO ANNA.
THE MATRIX THE ITS THE.
PURCHASE A PARTICIPATION
PROGRAMS SOME OF THE NEW COMPANY
POLICY COMIC JUST SAYS SIMPLY
PPP. BUT IF YOU LOOK AT THE
STAFF REPORT UNDER PAGE TWENTY
FIVE THEIR SUGGESTION.
TO BOTH SUNSET.
THE TO SUNSET THE PROGRAM AND
TO HAVE A CAP AS TO HOW MUCH CAN
BE SPENT. EVERY YEAR ON THAT
THOSE SUGGESTION I KNOW THERE'S
BEEN I'VE SEEN SOME OPPOSITION
LETTERS OR SUGGEST MILLIONS TO
CAN GO TO SO I'LL GREG. GROUP A
YEAR TO LOBBY RIGHT. EXPLICITLY
OF SEEKING TO LIMIT THAT FOR A
THOUSAND DOLLARS A YEAR AND A
SON SENATE PROVIDE YEARS THE
REASON WHY IS THAT IS THOSE
EARLY YEARS THAT. WE. WOULD
REQUIRE INPUT AND SOME OF THE
ORGANIZATIONS THAT ARE NONPROFIT
ORGANIZATIONS.
IS JUST TO MAKE SURE THAT WE
GET THEIR PROPERTY BUT FOR SOME
THE THE.
THINK TANKS AND OTHERS THAT CAN
PROVIDE INFORMATION IS NOT
UNIQUE THEIR OTHER COMMISSIONS
IN THE SAME THING.
IN FACT AN EXCUSE ME IF I MAY
DONE IT'S MODELED OFF OF THE
INTERVENOR PROGRAM FOR FOR
EXAMPLE THE DEPARTMENT OF
MANAGED HEALTHCARE WHERE GROUPS
LIKE HEALTH ACCESS.
THE CALIFORNIA PAN ETHNIC
HEALTH NETWORKING CONSUMERS
UNION.
DO GET FEES FOR.
AT PETITIONING ON ON ISSUES
SUCH AS TIMELY ACCESS TO CARE ON
BEHALF OF CONSUMERS AND SO THE
INTENTION HERE IS TO REPLICATE
SUCCESSFUL SYSTEM THAT WE'VE
SEEN IN OTHER AREAS OF POLICY
MAKING.
HOMELESS ALWAYS IN THE EYE OF
THE BEHOLDER AND.
AND UNDERSTOOD BUT THERE'S
ALWAYS.
THE STORIES THAT WE WERE TOLD
AND TAUGHT.
IF YOU ONLY HEAR ONE SIDE. YOU
DON'T HAVE A FIRM BALANCED.
APPROACH TO MAKE IT AN INFORMED
DECISION. SO SHOULDN'T THERE BE
AN ABILITY TO HAVE BOTH SIDES
PRESENTED. AND IF YOU'RE GOING
TO PRESENT ONE SIDE WITH THE
ABILITY WITH FUNDING XIN THE
OTHER SIDE GET THE SAME LEVEL.
OF ATTENTION AND ABILITY WELL
THERE'S AN ADVISORY COMMITTEE
AND I'M I'M HAPPY TO HAVE OUR.
SPONSORS HERE SPEAK ABOUT
THERE'S AN ADVISORY COMMITTEE
THAT'S CHOCK FULL OF EXPERTS
FROM ALL CROSS INDUSTRY.
I CLUED IN FROM SMALLER
PRACTICES AND EVEN ADDING IN THE
RURAL COMMUNITIES AS WELL. AND
SO THERE'S GONNA BE A PLENTY OF
OPPORTUNITY FOR FEEDBACK THE
REASON WHY. THAT PARTICULAR.
THE BOTTOM IS IN THERE IS THAT.
THE AVERAGE CONSUMER.
DOESN'T HAVE EXPERTS TO COME IN
X. IF IT WERE NOT FOR THESE
NONPROFITS
TO COME IN AND SPEAK ON THEIR
BEHALF OF WHILE OTHER ASPECTS OF
THE INDUSTRY INCLUDING LABOR
INCLUDING. THE DOCTORS AND
HOSPITALS THEY HAD ADVOCACY THEY
HAVE LOBBYING THEY HAVE ABA
EXPERTS THAT CAN PROVIDE DATA TO
THE.
COMMISSION IS SO IT'S IT'S JUST
TO PROVIDE THE CONSUMER
PERSPECTIVE THAT OTHERWISE WOULD
NOT BE THERE.
OR MAYBE.
BOTH SCIENCE STILL AREN'T BEING
RESENTED.
WITH A PERSPECTIVE FROM TWO
DIFFERENT.
DECISION.
AND.
BECAUSE YOU GOT EXPERTS ON THIS
SITE.
DOESN'T NECESSARILY MEAN THAT
ALL EXPERTS ARE PRESENT.
TO PUT GIVE THE INFORMATION THAT
THERE'S A THERE'S A ROBUST
ADVISORY COMMITTEE THAT'S FULL
OF TONS OF FOLKS FROM ACROSS
INDUSTRY I'M HAPPY TO GO THROUGH
EACH ONE IS LISTED IN. A IN
THERE'S LAWS WITH THE AMENDMENTS
BUT THERE THERE'S PLENTY OF
OPPORTUNITY FOR EXPERTISE FROM
INDUSTRY TO PROVIDE INPUT THOSE
LAWS A HOSPITAL AND A DOCTOR
REPRESENTATIVE ON THE
COMMISSION.
THAT'S NOT REFORM THE INTERVENOR
PORTION
LET ME LET ME MOVE ON A BECAUSE
I DON'T THINK YOU MISTER
CHAIRMAN FOR BEING SO INDULGENT.
ON MAY BE.
MAYBE SOMEONE CAN ADDRESS THIS.
I UNDERSTAND THAT.
ANOTHER STATE OF WEST VIRGINIA
HAS HAD A SIMILAR.
SET OF RATE SETTING LAWS OF THE
COMMERCIAL INSURANCE.
BUT IT WAS RECENTLY. REPEAL.
MAYBE YOU CAN ADDRESS THAT.
WHY?
CAN SOMEONE UP THERE IS AND I
WOULD BE HAPPY TO AND JUST THAT
HISTORY HERE. RATE SETTING.
WAS EXPERIMENTED WITH STARTING
ABOUT FORTY YEARS AGO THERE WERE
ORIGINALLY FIVE STATES THAT HAD
RATE SETTING PROGRAMS.
WEST VIRGINIA WAS DIFFERENT
BECAUSE WEST VIRGINIA ORIGINALLY
ONLY HAD RATE SETTING FOR THE
PRIVATE INSURANCE SIDE THEY WERE
UNABLE. TO GET THE WAIVERS
NECESSARY TO DO RATE SETTING ON
THE MEDICARE AND MEDICAID SIDE
OF THE EQUATION.
ALL OF THE OTHER STATES LET RATE
SETTING GO BY THE WAYSIDE AND
THE REASON THAT WEST VIRGINIA.
HAS NOW BEEN BATTLING FOR THE
LAST SEVERAL YEARS AND WAS
SUCCESSFUL IN UP REMOVING RATE
SETTING IS BECAUSE OF THOSE
OTHER TWO BARS.
SO THEY'RE EXPERIENCING EXACTLY
THE CHALLENGE WE'RE TALKING
ABOUT THAT IS WHEN THEY MOVED TO
RATE SETTING MEDICARE AND
MEDICAID. REIMBURSING IT COST
AS MEDICARE AND MEDICAID AND
FEDERAL AND STATE BUDGET
PRESSURES ABOUT GREW. AS THOSE
RATES WENT BELOW COST THEY
COULDN'T JUST SET RATES FOR THE
PRIVATE SECTOR IT RESULTED IN
LOSSES. AND THAT'S WHEN THE
HOSPITAL COMMUNITY IN PARTICULAR
IN THE STATE OF WEST VIRGINIA
MOUNTED AN EFFORT TO HAVE IT
REPEAL THE MORE SUCCESS.
SO AS WE SEE THIS STORY INTO A
FACT WE CAN START TO SEE HOW
WHAT'S BEING PRESENTED HERE.
IT IS COMING BACK TO A ONE SIZE
FITS.
ALL WITH LITTLE OPPORTUNITY FOR
INJECTION.
AND WE ALREADY KNOW THAT MANY OF
THE PEOPLE.
THAT ARE TRYING TO PROVIDE
HEALTHCARE SERVICES TO EVERYONE.
THAT DEBT THAT ARE IN NEED AND I
REPRESENT THAT RULE AREA THAT
YOU. SPEAK ABOUT AND I KNOW IT
VERY DEARLY WHEN MOST MY
DOCTORS.
OR A CLOTHES SHOP BECAUSE THEY
CAN'T.
STAND BUSINESS IT'S BEEN VERY
CHALLENGING.
BUT. I FIND IT JUST PERPLEXING
HERE THAT THERE'S SO MANY OPEN
ENDED QUESTIONS.
THAT WERE TRYING TO PUSH A BILL
FORWARD.
WHEN IS STILL NEEDS MORE TIME TO
BE.
ADDRESSED.
SOME OF THE THINGS THAT I STILL
THINK THAT ARE OF CONCERN TO
THIS. IS WHEN WE LOOK AT SOME OF
THE. SOME OF THESE PLANS.
ARE FROM OUT OF STATE AND BY
OTHER STATES ARE NOT GOING TO BE
MANDATED.
UNDER THE SAME TERMS AND
CONDITIONS AS THE ONES WITHIN
THE STATE HOW COULD YOU ADDRESS
THAT FOREST TODAY.
MISTER BIGELOW IS YOUR QUESTION
AROUND HEALTH PLANS THAT ARE OUT
OF STATE HEALTH PLANS YEAH. THE
REASON THAT WE'RE FOCUSING ON.
REGULATING DOCTORS HOSPITALS AND
HEALTH PLANS.
AND HAVE.
COMMISSION IS DIRECTED TO LOOK
AT PRESCRIPTION DRUGS IS BECAUSE
IN THE STATE OF CALIFORNIA. WE
CAN REGULATE HEALTH PLANS
DOCTORS AND HOSPITALS.
WE CANNOT. PRESCRIPTIONDRUGS
BECAUSE THERE'S FEDERAL
PREEMPTION AND THERE'S THE
COMMERCE CLAUSE AND LOTS OF.
LEGAL ISSUES.
AND SO THAT'S ONE OF THE REASON
PRESCRIPTION DRUGS ARE OUT BUT.
THE STATE HAS THE POWER TO
REGULATE HEALTH PLANS AND SO
THAT'S WHAT THEY ARE GOING TO.
DO IF THEY ARE SELLING IN
CALIFORNIA THAN THEY ARE
REGULATED BY THE STATE OF
CALIFORNIA.
CAN.
SO WE CAN'T WE DON'T HAVE TO
WORRY ABOUT OUR STATE ENTITIES
BEING ABLE TO PROVIDE CERTAIN
THINGS IN THE STATE OF
CALIFORNIA AND NOT BE REGULATED.
AND GET A DIFFERENT VALUE. ON
RETURN.
NO THE PLANTS THAT ARE PROVIDE
AIR IN CALIFORNIA ARE REGULATED
EVERITT THERE HAVE CALIFORNIA
ENROLLEES ARE REGULATED BY THE
STATE WHEN ASKING A DIFFERENT
WAY ARE FEDERAL CONSUMER
PROTECTION LAWS AS STRONG AS
CALIFORNIA BECAUSE.
AND WHAT THE CALIPHATE FOR
PLANTS THAT ARE REGULATED IN
HEALTH PLANS REGULATE IN THE
STATE OF CALIFORNIA ARE SUBJECT
TO THE CONSUMER PROTECTIONS
CALIFORNIA.
ARE.
OUR PATIENTS PROTECTED FROM A
BALANCED BILLING.
AB SEVENTY TO WHICH THERE IS CO
AUTHORS HERE.
PROTECTS CONSUMERS FROM
SURPRISE MEDICAL BILLS SO WE'RE
NOT GONNA HAVE A CONFLICT
BETWEEN FEDERAL. LAWS AND
CALIFORNIA'S.
MAYBE YOU GUYS CAN MAYBE IT GOT
YOU'RE REFERRING TO ADDRESS A
PLAN. I CANNOT I CAN REFER TO IT
AS A RESULT YEAH I WANT TO NAME
ANY.
IS THAT WE DON'T GET IT TO COME.
YEAH THERE'S A LOT OF A LOT OF
AND EMPLOYERS HAVE ARE SELF
INSURED A LOT OF UNIONS HAVE
LABOR MANAGEMENT TRUST FUNDS.
THOSE ARE SOMETIMES REFERRED TO
AS A RISK APPLY ANSWER TAPPED
PARTIES OR SELF INSURED PLANS.
THOSE ARE REGULATED BY THE
DEPARTMENT OF LABOR UNDER
SOMETHING CALLED THE RISA.
AND ARISTA PLANS ARE NOT
SUBJECT TO REGULATION BY THE
STATE OF CALIFORNIA.
.
THE BUT THE WAY THAT THIS BILL
IS CRAFTED IS THAT RISA PLANS
CAN OPT IN TO HAVING THE RATES
THAT ARE AT THE BASE AMOUNTS
THAT ARE SET BY THE COMMISSION.
BUT IT DOES NOT IN ANY WAY
IMPOSE UPON OR REGULATE SELF
INSURED AGGRESSIVE PLANS BECAUSE
THAT WOULD BE PREEMPTED BY THE
STATE OF CALIFORNIA.
THANK YOU COULD YOU MAYBE
ADDRESS THAT ES DE ANOTHER
CONCERN THAT WE HAVE THERE'S
ABOUT SIX MILLION LIVES
CURRENTLY AT THAT ARE ON A
RESERVE PLANS OVER SUPPLANTED
NOT REGULATED BY THE STATE OF
CALIFORNIA THAT MEANS I'M NOT
KEEN PROTECTIONS DON'T APPLY TO
THEM SO YES THEY COULD. HAVE
DIFFERENT LEVELS OF OF BENEFITS
STRUCTURE.
OF POOR BELOW WHAT CALIFORNIA
OFFERS A INDEED THE RESUPPLY
ENDS ACTUALLY CAN CAN AVAIL
THEMSELVES OF THE RATE SET BY
THIS COMMISSION WITHOUT IT
HEARING TWENTY THE CONSUMER
PROTECTIONS OF THE STATE OF
CALIFORNIA. AND THAT AND THAT'S
JUST A FACT.
OKAY READ MISTER CHAIRMAN THANK
YOU VERY MUCH FOR GIVING ME A
LITTLE EXTRA TIME.
WE'RE GONNA WE'RE GONNA MOVE
ALONG AND ASK THAT IN FUTURE
QUESTIONS THAT WE HAVE ONE
MEMBER OF THE. UP SUPPORT ONE
MEMBER FROM OPPOSITION
RESPOND TO THE QUESTION NOT ALL
THREE AND SO WE CAN GET WE GOT
WE WE NEED TO WE NEED TO GET
THROUGH.
A LOT MORE BILLS AT TODAY TO AND
WE'RE ALMOST TWO HOURS AND OUR
DISCUSSION I DO NOT WANT TO
LIMIT THE DISCUSSION I THINK
THESE ARE IMPORTANT QUESTIONS
BUT. QUESTIONS BEEN ANSWERED
PLEASE DON'T ASK IT AGAIN.
SO THE NEXT PERSON TO ASK GO
WILL BE MISSED BURKE AND ON DECK
IS MISTER BONTA WON'T.
PEOPLE KNOW WHERE THEY ARE IN
THE QUEUE SO.
SO I HAVE TWO QUESTIONS THERE
PRETTY MUCH THE SAME QUESTIONS I
ASKED THE SPONSORS WHEN THEY
CAME TO MY OFFICE AND THEN I
HAVE A COUPLE COMMENTS FOR
OPPOSITION I'M MAKING QUESTION
STILL CONTINUES TO BE WHAT IS
YOUR PROJECTED SAVINGS WITH
THIS.
PROGRAM AND THEN OR WITH THIS.
GROUP AND THEN MY OTHER QUESTION
WHICH IS STILL PRAYER THE SAME
QUESTION IS EITHER I DO HAVE
SOME CONCERN NOT TOO DIFFERENT
FROM MR BIGELOW IS THAT THERE'S
THIS I'M GETTING THE SENSE AND
ACTUALLY MISTER CHAIRMAN AS
WELL.
IS I'M GETTING THE SENSE THAT
THERE HASN'T BEEN A REAL
STAKEHOLDER PROCESS AND AND WHAT
CONCERNS ME NOW IS THAT.
DO YOU HAVE ANY MODELING ON WHAT
THE EFFECT THIS WILL HAVE ON
HOSPITALS CAN YOU SHOW US. THE
ACTUAL BALANCE SHEET OR HOW YOU
PROJECT THIS WILL WORK WITH THE
FOUR HUNDRED DIFFERENT KINDS OF
HOSPITALS THAT WE HAVE HERE IN
THE STATE OF CALIFORNIA. AND
THEN MY NEXT QUESTION IS YOU SAY
THIS IS GOING TO ALLOW MORE
ACCESS FOR URBAN AND RURAL
COMMUNITIES HOWEVER YET I SEE
NONE OF THEM HERE SUPPORTING
YOU.
AND THAT GIVES ME GREAT PAUSE.
SO THOSE ARE MY QUESTIONS.
FOR THE SUPPORTERS AND THEN I AM
A FEW QUESTIONS FOR THE.
SO ON THE OVERALL PROJECTED
SAVINGS.
AND MODELING QUESTION.
WE WERE PURPOSEFUL IN NOT
SETTING THIS AS A CAP BILL.
THERE'S NOT A A SPECIFIC
TARGETED MEDICARE RATE THAT WE
SET MAY RATES THAT THAT WOULD
HAVE BEEN ONE APPROACH THERE IS
NOT ONE OVERALL SORT OF.
SAVINGS NUMBER THAT WE'RE AIMING
FOR HERE BECAUSE WE DON'T
BELIEVE THAT IT IS PRUDENT.
TO CUT FOR THE SAKE OF CUTTING
THERE IS A REASON THAT THIS IS
ABOUT BOTH IMPROVING ACCESS AND
QUALITY IN HEALTH CARE WHILE
ALSO CONSTRAINING UNREASONABLE.
PRICE INCREASES THEY'RE NOT
TIED TO OUTCOMES THAT ARE NOT
TIED TO QUALITY THAT ARE TIED TO
UTILIZATION.
WE DON'T PRESUME TO KNOW WHAT
THAT IS IN A COMPLEX HEALTHCARE
MARKET
RATHER THE BILL IS VERY MARYLAND
INSPIRED.
BUT THE BILL SORT OF REVISITS
MARILYN'S EXPERIENCE THEY
STARTED IN NINETEEN SEVENTY ONE
WHEN THE HEALTH CARE ENVIRONMENT
WAS QUITE DIFFERENT.
AND WE ASK OURSELVES WHAT WOULD
MARILYN DO IN TWENTY EIGHTEEN WE
HAVE A SENSE OF THAT THEY ARE
LOOKING TO PULL WITHIN THEIR
COMMISSION. PHYSICIAN COSTS
PRESCRIPTION DRUG COSTS TO THE
EXTENT ALLOWED BY FEDERAL LAW.
AND OUTPATIENT COSTS AND
SERVICES INCLUDING OF A GLOBAL
CAP.
IN MARILYN'S EXPERIENCE THE DID
NOT START WITH ALL PEERS
THE LAW WAS PASSED IN NINETEEN
SEVENTY ONE. AND IT TOOK UNTIL
NINETEEN SEVENTY SEVEN FOR THEM
TO GET THE NECESSARY WAIVERS TO
PULL IN THE PUBLIC PROGRAMS BUT
IT PRECEDED ANYWAY WITH SETTING
RATES.
WE UNDERSTAND THAT THE COST
DRIVERS AND HEALTH CARE ARE A
FUNCTION OF MUCH MORE THAN
HOSPITAL COSTS IN A VACUUM.
YOU DO HAVE TO FACTOR IN OTHER
COMPONENTS
SO THE PART OF THE REASON WHY WE
DID THE THE REVIEW OF LITERATURE
IN THE OUTCOMES IN THE SUCCESSES
AND WHAT WORKED AND WHAT DIDN'T.
OVER THE COURSE OF FORTY YEARS
AGO. YOU KNOW EXPERIMENT WITH.
REGULATING THE INDUSTRY THE
REGULATION WORKED
ACTUALLY AND IN MARYLAND IT
WORKED PARTICULARLY WELL DUE TO
THE FLEXIBILITY BECAUSE IT WAS
NOT OVERLY PRESCRIPTIVE.
BECAUSE IT ALLOWED FOR THE
COMMISSION TO SHIFT OVER TIME.
THE PROBLEM IS THAT IT WAS
FOCUSED SOLELY ON HOSPITALS AND
NOT ON THE BROADER HEALTH CARE
SYSTEM WHICH THEY ARE NOW TRYING
TO FIX.
AND SO THE SHORT ANSWER IS IT'S
HARD TO GIVE YOU AN ANSWER
BECAUSE PART OF WHAT WE'RE
TRYING TO ACHIEVE HERE IS
PRECISELY THE OPPOSITE OF ONE
SIZE FITS ALL. WE COULD HAVE
GONE THAT ROUTE WE DIDN'T WE'RE
TRYING TO BE CAREFUL ABOUT
ENSURING THAT THIS REALLY IS
ABOUT ENSURING ACCESS. AND
CORRECTING FOR MARKET FAILURES
IN THE HEALTHCARE SYSTEM WHICH
ARE EVIDENT IN. UNNECESSARY
HOSPITAL CLOSURES BECAUSE A
PROVIDER CAN'T COMPETE BECAUSE
THEY'RE IN A REGION THAT IS TOO
POOR.
TO ATTRACT PHYSICIANS AND
COMMERCIAL PAYMENTS TO IT.
SO I DON'T KNOW THAT ANSWER THE
QUESTION.
HONESTLY I THINK.
AND THIS IS A HUGE HIT WITH THE
RECORD OF WHAT YOU ARE ASKING
FOR IS IS.
MONUMENTAL.
AND TO NOT HAVE HAD A PROCESS I
DON'T THINK YOU DO RESPONDED TO
THE STAKEHOLDER PROCESS EITHER
TO HAVE A PROCESS IN WHICH YOU
HAVE NOT INCLUDED STAKEHOLDERS
OF WHICH YOU'RE TALKING ABOUT
FOUR HUNDRED HOSPITALS. AND WORK
TOGETHER TO GET TO WHAT ARE THE
REALISTIC THERE ARE I MEAN A
BALANCE SHEET IS NOT CONJECTURED
THAT IS NUMBERS THAT YOU HAVE TO
ADD TOGETHER TO MAKE SURE YOU'RE
NOT THE RIGHT. TO MAKE SURE
YOU'RE MEMBERS ARE PAID WHAT
THEY DESERVE TO BE PAID WHICH I
BELIEVE IT.
SO IT GIVES ME GREAT PAUSE THAT
THAT PROCESS HAS NOT HAPPENED
IT'S AN IMPORTANT PROCESS WAS
AND I DO AT NO ONE LIKES DOING
IT IT'S HARD WORK IT TAKES A LOT
OF TIME. AND YES IT DOES NOT
FALL ALWAYS IN OUR DEADLINES TO
DO THINGS IN THIS YEAR BUT WITH
SOMETHING THIS BIG IT SHOULD BE
WRITTEN IRRESPONSIBILITY.
SO THAT IS NOT ONE THAT'S THE
FIRST THING I AT GALLAGHER HAD.
IF I COULD JUST RESPOND TO THAT
THE TWO QUESTIONS WHAT ONE IS ON
HOW MUCH YOU EXPECT TO SAY WELL.
THAT'S WHAT WE'RE DOING HERE
THAT WE WERE ACTUALLY SETTING
RATES RIGHT HERE RIGHT NOW I CAN
TELL YOU WE'RE GONNA SAVE X.
BILLIONS X. MILLIONS. AND AND
WE'RE GONNA GIVE THIS MUCH
ACCESS.
THAT IS UP.
A FALSEHOOD COULD CHART BUT
THERE CHOOSING A NUMBER ENDING
THAT WE'RE NOT DOING THAT.
IF WE DID THAT ARM THE BILL TO
GIVE YOU THOSE ARE THOSE NUMBERS
TO BE OUT AS WE DON'T WANT TO DO
THAT WE THAT'S IDEA OF GETTING
EXPERTS.
TO ACTUALLY SET THE RATES SET
THE BASEMENTS OF THE JUST AMAZED
ALLOW THE FLEXIBILITY
AT THE END OF THE DAY MAY BE
COSTLY FLAT WHERE THEY ARE. AND
THEY WON'T GO UP TEN PERCENT A
YEAR THE MIKE WHAT THREE PERCENT
A YEAR WHICH YOU'RE SUGGESTING
IT'S COSTING TOO.
YOU'RE SELLING IT AS COST
CONTAINMENT AND THAT IS COST
CONTAINMENT SO MIKE MINE CURIOUS
I GUESS FURTHER AGAIN IS NOT THE
QUESTION IS IF IN FACT THIS IS
COST CONTAINMENT IN THAN FACT
THIS WILL GIVE. MORE ACCESS TO
URBAN AND RURAL COMMUNITIES HAVE
YOU I MEAN THERE SHOULD BE ONE
HOSPITAL THERE SHOULD BE ONE
THAT WOULD BE WILLING TO GO
THROUGH WITH YOU AND AND AND SEE
WHAT THIS ACTUAL PROCESS WOULD
LOOK LIKE WITH YOUR EXPERTS.
BEFORE WE MOVE THIS BILL INTO
ACTION
WHAT I'M NOT SURE WHY WE WOULD
WHY WE WOULD DO THIS WITHOUT ANY
DATA OR ANY ACTUAL ACTUAL
NUMBERS AT THIS IS THAT THIS IS
NOT SOMETHING THAT IS.
.
THIS IS NOT SOMETHING THAT'S TO
BE TAKEN LIGHTLY. AND WHEN A
HOSPITAL IT'S GOING TO GOING TO
THE RED BOOK FOR A FIRST OF ALL
THERE ARE NUMBER HAAS WAS IN THE
BED THEIR NUMBER OF HOSTELS THAT
ARE CLOSE INCLUDING MY OWN
BACKYARD. ENDS AND SO THAT'S
ALREADY HAPPENING BUT I WILL SAY
THIS CLUB IS THE TOLL OF THE
JIMMY CONCERN.
ONE IS A REASON WHY WE PUT INTO
PLACE THAT OF THE BILL AND THEN
I WANT TO THANK THE CHAIR WHO
REALLY HARD ON THIS.
STRINGENT DATA COLLECTION.
AND THAT DATA CLUTCH IS GOING TO
HAPPEN WITH ALL STAKEHOLDERS IS
GOING TO HAPPEN BEFORE WE SET
RATES FOR PHYSICIANS.
SECONDLY THERE'S A ROBUST
ADVISER COMMITTEE THIRD THIS
BILL STILL HAS A WAY TO GO AT MY
DOOR HAS BEEN OPEN FROM DAY ONE.
I'M AND I'M LOOKING AT THE.
DOZENS OF LETTERS FROM OPPOSITE
LOOK
WE WERE GETTING CHAMBER OF
COMMERCE OPPOSITION EVEN THOUGH.
HAVING SOME COST TEN IT IS GOING
TO BE GOOD FOR ALMOST EVERY
EMPLOYER IN OUR STATE BUT WE
KNOW THAT HOSPITAL'S A LARGE
CHRISTIAN GROUPS ARE MEMBERS OF
THOSE CHAMBERS. UNLESS WE HAVE
TO BE REALISTIC ABOUT WHO'S
GOING TO COME TO THE TABLE RIGHT
NOW MIGHT DOORS BEEN OPEN IT'S
GOING TO BE OPEN TOMORROW JUST
AS IT HAS BEEN YESTERDAY.
AND I YOU KNOW THAT IF. I WANNA
SIT DOWN AND TALK A WITH THE
STAKEHOLDERS ON ALL THESE
DETAILS IN THE MEANTIME WE'RE
TALKING WITH WEBER WILL TALK TO
US I'VE TALKED TO PLENTY OF
DOCTORS WHO ARE THOUGH UNDER NOT
UNDER THE GUISE. OF
ORGANIZATIONS WILL CONTACT US
OBVIOUSLY THE CHAIR OF THE
COMMITTEE STAFF AND PLENTY OF
OTHER STAKEHOLDERS THERE YOU
WERE PART OF THE OF THE YOUR
LONG OF THE OF THE SELECT
COMMITTEE HEARINGS WHICH. DID
IDENTIFY COST CONTAINMENT.
AS A CRITICAL COMPONENT OF WHAT
WE NEED TO DO THIS IS COST
CONTAINMENT NOT COST CUTTING.
IT'S COST CONTAINMENT SO THAT WE
CAN CONTROL THE RATE OF GROWTH
IN THE OUT YEARS SO THAT WE CAN
HAVE SOME SORT EXPECTATIONS BUT
THERE'S NO COST CONTAINMENT. OR
ANYTHING THAT WILL GO ON PLACE
UNTIL ALL THE DATA IS THERE WITH
ALL THE STAKEHOLDERS AT THE
TABLE IT REQUIRES IT IN THE
BILL.
THE BILL ACTUALLY DETAILS WHO
NEEDS TO BE AT THE TABLE AND UP
WITH THE AMENDMENTS SEVERAL
GOING TO BE ADDING ALSO INCLUDES
THE DATA PEACE REQUIRES A LEAST
THREE YEARS. OF DATA BEFORE WE
TOUCH OF ANY POSITION.
SO IS THERE A WAY TO COLLECT
BACK TO YOU KNOW.
BEFORE WE PUT THIS COMMISSION
INTO PLAY.
THE I MEAN ISN'T THAT SORT OF
THE RESPONSIBLE THING TO DO IS
TO COLLECT THE DATA FIRST AND
THEN MOVE FORWARD WITH THE
COMMISSION AND NO WITHOUT
COMMISSION REALLY SHOULD LOOK
LIKE IMPACT.
THE ON THE PHYSICIAN ADD DATA
BE IT THE STATE OF CALIFORNIA
ALREADY COLLECTS OF ROBUST DATA
ON HOSPITALS THROUGH THE OFFICE
OF STATEWIDE HEALTH PLANNING AND
AND DEVELOPMENT POSH BUT.
SO WE HAVE A LOT THERE ALREADY
WE ALSO HAVE A LOT OF DATA
THANKS TO THE GOOD WORK OF THE
LEAPER FED AND HEALTH ACCESS ON.
IT INSURANCE RATE FILINGS IN
THE COMMERCIAL MARKET WHAT WE
ARE MISSING RIGHT NOW IS
PHYSICIAN DATA AND THE
AMENDMENTS TAKEN IN THIS
COMMITTEE.
REQUIRE THAT WE NOT MOVE ON
DOING ANYTHING TO SET RATES FOR
PHYSICIANS UNTIL THE COMMISSION
HAS THAT DATA.
SO THAT IT'S ALREADY.
NOW IN THE BILL.
I AND ONE LAST COMMENT THAT I
HAVE QUESTIONS FOR THE
OPPOSITION I PROMISE I'LL BE
REALLY FAST THINK.
.
AGAIN AGAIN I WOULDN'T I WOULD
ASK I WOULD FEEL MUCH MORE
COMFORTABLE IF WE WERE
COLLECTING THAT DATA BEFORE WE
PUT THE COMMISSION INTO PLACE
THAT'S JUST A STATEMENT. NOW OUT
TO THE OPPOSITION I WILL SAY THE
SAME THING I SAID TO YOU IN MY
OFFICE WHICH IS THIS IS KIND OF
WHAT YOU GET.
THIS IS KIND OF WHAT HAPPENS
WHEN YOU. LEAVE THINGS STATUS
QUO WHEN YOU DON'T DO ANYTHING
ABOUT IT.
I'M I KNOW YOU MADE A COMMENT
THAT YOU'RE HAPPY TO WORK WITH
THIS BUT YOU HAD YEARS TO WORK
ON COST CONTAINMENT AND YOU
HAVEN'T DONE IT. AND NOW HERE WE
ALL IN THIS POSITION DO I LIKE
THIS BILL NO.
BUT. IS COST CONTAINMENT A
SERIOUS ISSUE THAT MUST BE
ADDRESSED YES
AND THEY DON'T THINK YOU WOULD
BE AT THIS TABLE AND I DON'T
THINK YOU WOULD ADDRESS IT IF
THIS BILL OR SOME OF THE OTHER.
ONES WERE HERE.
SO I HAVE TO TELL YOU AS MUCH AS
I DON'T LIKE THIS.
I AM GLAD WE'RE HAVING A
CONVERSATION IT'S AN IMPORTANT
CONVERSATION AND IF THIS PUT
YOUR FEET TO THE FIRE TO FINALLY
DO SOMETHING ABOUT IT. THEN I'M
HAPPY IT'S HERE AND THAT'S ALL I
HAVE TO SAY ON THE MATTER. IF
I'VE NAY PERHAPS WE COULD.
SHARE THIS QUICKLY.
I AM NEW TO THIS POSITION I
UNDERSTAND OUR ORGANIZATION HAS
BEEN HERE FOR A LONG TIME I HAVE
BEEN HERE FOR FIVE MONTHS. AS I
HAVE EXPRESSED TO THE SPONSORS
OF THIS BILL WE DON'T NEED TO BE
FORCED TO THE TABLE ON THIS
DISCUSSION THERE'S NOTHING MORE
IMPORTANT.
EVERYONE NOT ONLY IN THE STATE
OF CALIFORNIA IN THE UNITED
STATES TO ADDRESS THE ISSUE OF
HEALTH CARE AFFORDABILITY THERE
ARE WAYS TO ADDRESS
AFFORDABILITY I WAS PLEASED TO
BE PART OF THAT EFFORT IN
MARYLAND. BY THE WAY MARYLAND
LET RATE SETTING GO FIVE YEARS
AGO NOW.
ONTO NEW THINGS WE SHOULD BE AT
THAT LEADING EDGE OF POLICY
DEVELOPMENT HERE IN THE STATE OF
CALIFORNIA WE SHOULD BE
ADDRESSING AFFORDABILITY I AM
PLEASED NOT ONLY TO PLAY A ROLE
IN TERMS OF OUR ASSOCIATION. BUT
TO PLAY A LEADING ROLE IN THAT
CONVERSATION.
I THINK YOU'RE JUST LIKE I SAID
JUST ONE.
ONE PER PERSON SO BOB MISS.
MISTER BONTA AND THEN MISS
CARILLO POPPED OUT BUT AFTER IT
BURKE MISSED CREEL NOT BACK THEN
MISS LAMONT SO PLEASE AND WE'LL
TRY TO KEEP. IT OFF OPEN THIS
WILL BE SHORT MA'AM THANK YOU
MISTER KALRA UP FOR YOUR
PRESENTATION AND. THANK YOU TO
ALL THE STAKEHOLDERS ON ON BOTH
SIDES FOR FOR THIS DISCUSSION I
THINK WE'VE.
.
EMBARK ON A REALLY IMPORTANT
DISCUSSION AND AND AND AND
THAT'S SORT OF MY OF MY FIRST
POINT I THINK IS PERHAPS ONE OF
MOST IMPORTANT ISSUES YOU CAN
DISCUSS WE CAN BE DISCUSSING AND
HEALTH CARE THE UNSUSTAINABLE
RISING COST OF HEALTHCARE WE'VE
HAD.
JOINT COMMITTEE HEARINGS ON IT
IT COMES UP AND ANIMATES ALMOST
EVERY DISCUSSION IN HEALTH CARE
ANYWHERE YOU TALK ABOUT IT SO. I
I REALLY APPRECIATE THAT
WILLINGNESS TO TAKE THIS ISSUE.
HEAD ON I THINK PROBABLY IN THIS
ROOM THERE IS WIDE AGREEMENT ON
WHAT THE PROBLEM IS I DON'T
THINK ANYONE WILL DENY THAT
RISING COSTS ARE PROBLEM.
I THINK FOR SURE THERE'S WIDE
DISAGREEMENT AND I WHAT THE
APPROPRIATE SOLUTION AS I AM I
WILL SAY THAT. IF THIS WERE A
PROBLEM THAT WERE EASY TO SOLVE
AND WERE AMENABLE TO THAT A
QUICK AND EASY SOLUTION WOULD
HAVE A BY NOW WE DON'T. BECAUSE
IT'S HARD AND IT'S TRICKY AND
IT'S DIFFICULT SO I'M ALSO NOT
SHOCKED THAT WE DON'T HAVE.
AGREEMENT IN THE FIRST
COMMITTEE THE FIRST HOUSE THAT
WE HAVE THIS THINGS WRAPPED UP
IN A BOW AND AND AND AND READY
TO GO.
SO M..
I APPRECIATE YOU DESIRE TO TAKE
THIS ON. I HAVE REAL CONCERNS
THAT A SIGNIFICANT ABOUT THIS
BILL I SHARE THEM WITH YOU WHEN
AND AND OTHERS IN THIS ROOM. LOT
OF THEM HAVE BEEN NAMED ALREADY
TODAY I JUST KIND OF GO THROUGH
IT REAL QUICKLY I I YOU KNOW WE.
.
AS AS DEMOCRATS AS AS AS HUMANS
CARE DEEPLY ABOUT ACCESS TO HIGH
QUALITY HEALTHCARE THAT THAT
REALLY DRIVES OUR COMMITMENT TO
THE HEALTH CARE.
I WONDER IF IT'S GONNA BE
UNDERMINED AS AS AN UNINTENDED
CONSEQUENCE OF POINTS OF THIS
BILL. AND I UNDERSTAND WHAT YOU
SAID ABOUT REWARDING IN
RECOGNIZING THOSE THAT TAKE ON
MORE MEDI CAL.
I ALSO HEAR REGULARLY FROM
PROVIDERS WERE TALKING ABOUT
THEIR OWN PRACTICE THAT.
YOU KNOW THAT MIX OF THE
COMMERCIAL PAYER THAT THAT AND
MEDICARE PAYERS AND MEDICAL
PAIRS COMBINED HELP THEM.
HAVE A HAVE A BUSINESS THAT'S
SUSTAINABLE ON THAT THE
COMMERCIAL RATES SUBSIDIZE
ESSENTIALLY THE MEDICARE RIGHT I
THINK A MEDIC COUNTIES HAVE TO
GET HIGHER THEY JUST DO. SO I'M
NOT SAYING THAT YOU THINK THIS
IS THE ONLY SOLUTION I AM I
THINK WE CAN STILL PURSUE SOME
OF THE OTHER SOLUTIONS THAT WE
HAVE TO BIG BILLS THE LOT OF US
SUPPORTED TO RAISE MEDICARE
RATES LIKE THAT SHOULD BE PUT BY
THE WAYSIDE.
AS BEEF CONTINUE TO EXPLORE
THIS ISSUE OF IF THAT'S WHAT THE
THE WILL THIS BODY HAS. A WAY
ABOUT THE PROVIDER SHORTAGE
WE'VE WE'VE THAT IN AND WHETHER
THIS WILL EXACERBATE IT.
IF THIS IS THE ONLY STATE THAT
HAS A.
AT COMMISSION THAT SETTING RATES
AND OTHER STATE DOES.
AND IT'S ALREADY HARD TO TO TO
TO LIVE HERE AND WORK HERE AS A
PROVIDER BECAUSE OF OF STUDENT
DAD AND AND.
WHAT WE NEED TO DO MORE ON A
GRADUATE MEDICAL EDUCATION THE
WHAT WILL THAT DO THAT'S BEEN
REYES I AND I I I KNOW YOU'VE
ADDRESSED IT TO TO SOME EXTENT
BUT I STILL THINK THAT'S A
CONCERN THAT WE HAVE TO? GET OUR
ARMS AROUND.
YOU KNOW THIS BILL TAKES ON.
SOME COST DRIVERS BUT NOT ALL.
WE NEED TO HAVE A GLOBAL A
UNIVERSAL THAT APPROACH AND I
KNOW THAT WE HAVE LIMITS WE HAVE
RISA THAT WE HAVE THE COMMERCE
CLUB HAS. YOU KNOW I GET THE
FEDERAL INTERPLAY WITH STATE LAW
WE CAN'T DO IT ALL. BUT I THINK
WE NEED TO TRY OUT TO THE EXTENT
WE CAN ADDRESS ALL COST DRIVERS.
AT A HIGH PRICE SPECIALTY DRUGS
ARE A COST DRIVER.
I. T. SEISMIC. EQUIPMENT.
GENERAL WASTE INEFFICIENCY IS
INEFFICIENCY ARE COST RIDERS YOU
KNOW.
MAYBE WILL LEAVE THAT. IT
COMMERCIAL RATES ACCOMPA SOME OF
THOSE ARE ALL OF THOSE ME MAYBE
YOU DON'T BUT I THINK THOSE ARE
THOSE ARE REAL.
AND THEN FINALLY YOU KNOW THIS
ISSUE THAT WAS RAISED BY MY MISS
BURKE.
.
AND AND IT'S SOMETHING THAT I.
DEEPLY BELIEVE AND IS IS IS HOW
WE GET THERE IS IMPORTANT.
BUT THE PROCESS.
THIS
IMPACTS ALL OF US.
PROVIDER COMMUNITY FOR SURE
THAT.
AND
I THINK ALL VOICES NEED TO BE IN
THE ROOM AT ALL WHILE I'M.
SEEKING TO BE TAKEN OFF THE
TABLE AS WE DISCUSS THIS I I
KNOW YOU HAVE A WILLINGNESS TO
HAVE THAT CONVERSATION.
AYE AYE I ENCOURAGE YOU TO
CONTINUE TO HAVE THAT
WILLINGNESS ENCOURAGE THOSE WHO
HAVEN'T HAD THEIR VOICES IN THE
ROOM TO TO GO TO THAT ROOM. AND
EXPRESS THEM TO PUT THE BEST
IDEAS ON THE TABLE AND HAVE THEM
COMPETE AND IN IN THE.
.
YOU KNOW IT IN THE INTELLECTUAL
DEBATE OVER IDEA TO SEE WHICH
ONES PREVAIL AND ANTI TO FIND A
SOLUTION TO THIS NEED WILL FIND.
AS I'VE AS I'VE SEEN THROUGH
THIS PROCESS AND OTHER TIMES
THAT THERE'S.
SOME OPPORTUNITIES TO ITS OF TO
FIND COMMON GROUND YOU CAN'T GET
THERE IF YOU DON'T SEEK IT.
AND SO I JUST WANNA COURAGE YOU
TO SORT OF DO WHAT YOU CAN TO
CULTIVATE A PROCESS FOR ALL
STAKEHOLDERS AT THE TABLE SO.
I'LL JUST SAY I DON'T THINK WITH
BILLS READY TODAY.
BUT I DON'T THINK IT HAS TO BE
READY TODAY AND IN THE FIRST
HOUSE IN THE IN IN THE I AM THE
FIRST COMMITTEE. I AM. I WILL BE
LOOKING AT A VERY CLOSELY AS A
PROCEEDS TO SEE HOW YOU ADDRESS
THESE MAJOR CONCERNS THAT I AND
OTHERS HAVE RAISED.
AND I RESERVE MY RIGHT TO A
VOTE DIFFERENTLY IN THE FUTURE
BUT TODAY I'M GONNA VOTE AYE AND
APPRECIATE TAKING ON THIS VERY
TOUGH ISSUE. I KNOW IT'S NOT
EASY AND I URGE ALL STAKEHOLDERS
TO HOT TO TRY TO FIND COMMON
GROUND TO GET TO SOLUTION THAT
CAN WORK THANK YOU.
CARILLO.
YES.
THANK YOU MISTER CHAIRMAN. WHO
THINK IT TO THE AUTHOR FOR
BRINGING THIS TO OUR ATTENTION I
WOULD SAY THAT?
ALL GREAT SOCIETIES ARE DEFINED
BY THE COURAGE OF OUR
CONVICTIONS
TO BE BOLD AND COURAGEOUS IN
ADDRESSING ISSUES THAT ARE.
HARD.
TO DO HARD CONVERSATIONS TO
HAVE.
I MET WITH YOURSELF WHEN
SUPPORTERS WITH OPPOSITION.
WANTED TO HEAR ALL PERSPECTIVES.
AND ONE OF THE THINGS THAT I
TOOK AWAY FROM WAS A YOUNG MAN
WHO IS A DOCTOR WHO IS STUDYING
TO BECOME A DOCTOR ACTUALLY ON
HIS LAST YEAR OF RESIDENCY WHO
SAID HE'S GOING TO BE GRADUATING
WITH TWO HUNDRED THOUSAND
DOLLARS IN DEBT.
AND THAT YOU KNOW IS IS A REAL
ISSUE ACROSS THE BOARD NOT ONLY
FOR STATE BUT FOR THE ENTIRE
COUNTRY.
AND TO THINK ABOUT HIM BECOMING
A DOCTOR AND WHAT THAT LOOKS
LIKE TO PRACTICE YOU DON'T GO
INTO THE FIELD OF MEDICINE OR IN
THE FIELD OF LAW ENFORCEMENT.
OR ANY OTHER FIELD BECAUSE
YOU'RE IN A FOR YOURSELF YOU DO
IT BECAUSE YOU WANT HELP PEOPLE.
AND I THINK THAT WE'RE IN A
SITUATION RIGHT NOW WHERE WE
UNDERSTAND THAT THE COST OF
HEALTH CARE. IS NOT AFFORDABLE
EVEN THE AFFORDABLE CARE ACT IS
NOT AFFORDABLE AS GOOD AS IT IS.
MANY PEOPLE JUST CAN'T
BEFORE TO BE HONEST THE TO YOUR
POINT VERY EARLY ON.
IN THE DISCUSSION ABOUT
RATIONING OF HEALTHCARE.
THAT IS A VERY REAL THING.
I DO BELIEVE THAT THERE'S AN
OPPORTUNITY FOR US TO HAVE A
BROADER LARGER CONVERSATION
ASIDE FROM THIS COMMITTEE WHICH
IS CLEARLY NOT ENOUGH TIME WITH
ALL THE MANY QUESTIONS AND
CONCERNS AND COMMENTS THAT.
MEMBERS HAVE BEEN AND I'M SURE
THE PUBLIC HAS AS WELL AND
STAKEHOLDERS HAVE.
TO COME TO A FINAL CONCLUSION AS
TO WHAT THIS IS WHAT I DO
APPRECIATE. OF IT.
IS THAT IT SETS THE TONE FOR
WHAT THE COMMISSION COULD
POTENTIALLY BE LIKE.
AND THAT IF WE CAN HAVE THIS
CONVERSATION HERE.
ELEVEN PEOPLE WHILE IT MAY SEEM
A SMALL NUMBER IS CERTAINLY MORE
THAN WHAT WE HAVE NOW WHICH IS
NONE.
AND SO TO EVEN COME TO THE TABLE
WITH DIFFERENT VIEWPOINTS
DIFFERENT IDEAS DIFFERENT
SOLUTIONS WHICH IS WHAT WE ALL
WANT TO HEAR I MEAN WE CAN HEAR
ABOUT ALL THE PROBLEMS ALL DAY
LONG.
BUT WE WANT TO COME TO A
CONCLUSION AS TO WHAT WE DO TO
ENSURE THAT PEOPLE.
NOT ONLY HAVE AXIS BUT CAN USE.
THE HEALTH CARE SO THAT THEY'RE
NOT LANDING IN EMERGENCY ROOMS
SO THAT THEY'RE NOT WITHOUT
CARE.
SO THAT IT IS AFFORDABLE AND THE
PEOPLE THAT WANT TO PRACTICE
MEDICINE OUR STATE CANNOT.
AND SO I COMMEND THE HOSPITALS
FOR BEING AT THE FOREFRONT.
OF THAT CONVERSATION FOR
PROVIDING CARE AS WELL AS THE
SUPPORTERS OF THIS BILL ISN'T.
AND IN INTRODUCING IDEAS AND THE
THOUGHT PROCESS US TO WHAT WE
CAN DO TO ENSURE THAT EVERYONE
THAT CALLS CALIFORNIA HOME CAN
HAVE ACCESS TO QUALITY
HEALTHCARE. I THINK THAT'S WHERE
WE ALL WANT TO GET OUT I MEAN
WE'VE TALKED A LITTLE BIT ABOUT
THE COST OF PRESCRIPTION DRUGS
WE TALKED A LITTLE BIT ABOUT
MEDICARE AND IDEA THAT.
SOME OPPOSED EVEN THE BEGINNING
OF THAT SEVERAL DECADES AGO AND
NOW HAS PROVIDED.
COVERAGE TO MILLIONS OF
AMERICANS.
WE HAVE AN OPPORTUNITY THESE
CONVERSATIONS ARE NEVER EASY.
AND CLEARLY WE'RE NOT GOING TO
COME TO A SOLUTION RIGHT NOW.
BUT I HOPE THAT ALL THE
STAKEHOLDERS WHETHER THEY'VE
BEEN A PART OF THE CONVERSATION
BEFORE.
OR WHETHER.
THEY'RE INCLINED TO DO SO NOW
CAN HELP THAT AND AGAIN LIKE I
WANT TO BE PART OF THE DIALOGUE
BECAUSE I BELIEVE. THAT WE CAN
COME TO A SOLUTION I DON'T
BELIEVE ANYBODY AT THE
TABLE-RIGHT NOW. IS SAYING WE
DON'T
WANT TO HAVE A SOLUTION.
THE QUESTION IS HOW DO WE GET
THERE.
SO I COMMEND YOU FOR BRINGING
THIS TO TO.
.
THIS COMMITTEE IT'S NOT EASY TO
BE IN MANY WAYS A FIRING SQUAD.
WITHIN A ALL OF OUR QUESTIONS
COMMENTS CONCERNS.
AND IN DOING SO IN A WAY THAT
BRINGS DIGNITY TO THE ISSUE. AND
TO THE PEOPLE THAT YOU'RE TRYING
TO SERVE.
AND SO I WILL BE VOTING YES ON
YOUR ON YOUR BILL. AND I WOULD
ENCOURAGE THE THE REST OF THE
COMMITTEE TO CONSIDER VOTING YES
AS WELL SO THAT WE CAN BEGIN THE
CONVERSATION. AND BRING EVERYONE
THAT HAS AN OPINION A THOUGHT
PROCESS AND HOW WE CAN ENSURE
ACCESS TO QUALITY HEALTHCARE TO
EVERY CALIFORNIA AND THAT
INCLUDES WHETHER YOU OPPOSE OR
SUPPORT OR IN BETWEEN.
TO MAKE SURE THAT AT THE END OF
THE DAY WERE DOING WHAT WE CAN.
TWO.
TRY TO SOLVE A PROBLEM THAT IS
NOT GONNA BE SOLVED OVERNIGHT
BUT THAT REQUIRES THAT WE. BEGIN
TO TALK ABOUT IT AND BEGIN TO
HAVE SOME ACTION ON IT. MORE
THAN JUST THE OUTSIDE
CONVERSATION SO THANK YOU FOR
YOUR WORK AND THANK YOU TO BOTH
SIDES.
FOR BRINGING ALL OF YOUR
DIFFERENT PERSPECTIVE TO THE
TABLE BECAUSE ARE IMPORTANT.
AND CERTAINLY CONVERSATIONS THAT
ARE NEED.
SO MISS LIMON WE HAVE FIVE
MEMBERS WAITING TO SPEAK SO
IRATE SO I WILL BUILD UP WITH
WALDRON A THINK A LOT OF MY
COLLEAGUES HAVE SHARED SOME OF
THE CONCERNS I'M GONNA TRY TO
LIMIT IT TO ONE QUESTION FOR
EACH SIDE. UP FOR THE SUPPORTERS
MY FIRST QUESTION IS.
WHAT IF THIS DOESN'T WORK WHAT
HAPPENS THEN?
WE DEFAULT TO THE CURRENT SYSTEM
WHICH IS ALSO NOT WORKING. AND
IS DRIVEN BY.
PURE MARKET CONSIDERATIONS
AND MONOPOLISTIC TAKEOVERS OF
OUR HEALTH CARE I MEAN THIS THE
CURRENT. REALITY IS.
SUPER NOT GREAT AND I THINK THAT
WE DO HAVE MODELS THAT.
WE CAN DRAW FROM THAT WE CAN
LEARN FROM AND APPLY. AND REALLY
CALIFORNIA HAS AN OPPORTUNITY TO
LEAVE HERE SO. IT IT IS YOU KNOW
WE'RE TAKING ON SOMETHING THAT
IS CHALLENGING WERE TAKING ON
SOMETHING THAT IS ONE OF THE
MOST IMPORTANT ISSUES FACING OUR
STATE TODAY.
AND.
YOU KNOW OVER TIME WE WILL GET
TO REALIZE.
YOU DON'T MAKE ADJUSTMENTS IF
WE'RE NOT.
OVERLY PRESCRIPTIVE AND I THINK
THAT IS THE BIG TAKEAWAY FROM
MARYLAND IS WE NEED TO.
ALLOW FOR ADJUSTMENTS TO BE
MADE OVER TIME ONE MORE THING
ALL SAY ON THAT. THERE IS A TON
OF EXPERIMENTATION THAT HAPPENS
ALL THE TIME AND HEALTHCARE
POLICY.
PAYMENT REFORM IS ONE BIG
EXPERIMENT IN ONE BIG IDEA. THE
IDEA OF VALUE VERSUS VOLUME THAT
YOU CAN PULL THE MONETARY LEVERS
AND MAKE OUTCOMES BE DIFFERENT
BASED ON THAT. THAT IS BEING
DRIVEN BY BOTH THE PUBLIC SECTOR
AS WELL AS THE PRIVATE SECTOR
THEY'RE EASY TON OF
EXPERIMENTATION THAT'S
HAPPENING.
AND GUESS WHAT. IN THAT PROCESS.
THEIR HAVE BEEN NEGATIVE
CONSEQUENCES.
AND WE KEEP GOING BECAUSE TRYING
FOR BETTER IS IMPORTANT.
BUT THAT IS THE TRUTH ABOUT OUR
CURRENT REALITY.
AND THE EVIDENCE THAT YOU'RE
USING IS THAT MARILYN OR WHAT
EVIDENCE ARE YOU USING. THAT
THIS HAS A CHANCE OF WORKING.
YOU'VE TALKED ABOUT DATA BUT
DATA IS NOT EVIDENCE WHAT'S THE
EVIDENCE YOU'RE USING THAT THIS
IS GOING TO HELP GET YOU THERE.
WELL IT'S THE THE GRAND
EXPERIMENT WITH MEDICARE IT'S
THE GRAND EXPERIMENT WITH
MARYLAND IT IS THE GRAND
EXPERIMENT IN MASSACHUSETTS.
YOU KNOW THE COUNTRIES OF
FRANCE GERMANY THE NETHERLANDS
HAVE ALL USE OUR MEDICARE
PAYMENT SYSTEM TO MODEL THEIR
OWN.
IN FACT I WILL SAY BECAUSE IT
HASN'T BEEN SAID TO ME THAT WHEN
THEY THAT SELECT COMMITTEE
LOOKED AT WHAT IS EVERYBODY ELSE
DOING THAT WE'RE NOT DOING
THAT'S MAKING THEIR SYSTEMS BOTH
CHEAPER AND HIGHER QUALITY.
HAVE.
COSTS ARE LOWER BUT THEY'RE
GETTING BETTER OUTCOMES FROM
THEIR SYSTEMS THE ONE THING THEY
ALL HAD IN COMMON WAS THAT THEY
REGULATED. PRICES.
AND SO THAT THAT IS ESSENTIALLY
THE STARTING POINT FOR THIS
CONVERSATION THE ONE THING THAT
ALL INDUSTRIALIZED WEALTHY
NATIONS TO IN THEIR HEALTH CARE
SYSTEMS IS THEY REGULATE PRICES.
IN HEALTHCARE.
SO I GUESS FOR ME IS A LISTEN TO
THIS THE CONCERN I HAVE IS THAT.
.
YOU KNOW I APPRECIATE THAT
EXPERIMENTATION IS NEEDED BY
ALSO.
.
YOU KNOW THE ANSWER THAT WELL
WE'LL JUST FAILED LIKE THE
SYSTEM IS FAILING NOW IS REALLY
HARD.
IT IT'S JUST A HARD ANSWER TO
KIND OF GRAPPLE WITH BECAUSE IF
THE SYSTEM FAILS. OUR COMMUNITY
FEELS WITH IT.
.
SO YOU KNOW THIS ARE SOME OF THE
QUESTIONS THAT WE'RE ASKING
OURSELVES NUMBER ONLY ASKING
OURSELVES THESE QUESTIONS
BECAUSE WE CARE AND BECAUSE WERE
INVESTED IN TRYING TO SEE WHAT
THE SOLUTION WOULD BE.
AT FOUR IN THE OPPOSITION YOU
TALKED ABOUT AND WANTING TO BE
AT THE TABLE TO ADDRESS HEALTH
CARE AFFORDABILITY WHAT ARE YOU
DOING NOW TO ADDRESS HEALTH CARE
AFFORDABILITY. AND WHAT HAVE YOU
PUT ON THE TABLE.
WE HAVE BEEN AT THE TABLE ALL
ALONG TRYING TO FIND SOME
ANSWERS IT IS AS WE'VE HEARD
OTHERS IN THE NATION SAY
COMPLEX.
WHAT PART OF CMA RIGHT NOW IS
PART OF THE CARE FOR ALL
CALIFORNIA COALITION THAT HAS
PUT FORWARD OTHER IDEAS ON HOW
TO DEAL WITH THE COST?
WE'RE WE'RE WE'RE SUPPORTING
THAT COALITION AND SOME OF THE
SOME OF THE BILLS THAT ARE
BEFORE THE LEGISLATURE NOW.
I WILL TELL YOU FROM CALIFORNIA
MEDICAL ASSOCIATION STANDPOINT
WE HAVE AN ANNUAL SESSION.
THIS IS BEEN AN ONGOING
DISCUSSION AT THE ANNUAL SESSION
OF OUR HOUSE OF DELEGATES
REPRESENTING PHYSICIANS IN
ALMOST A PRACTICE ALL OVER THE
STATE OF CALIFORNIA.
WE ARE IN THE PROCESS NOW WE'RE
GETTING OUR AGENDA FOR NEXT YEAR
WHY NOT NEXT YEAR THIS COMING
OCTOBER.
AND WELL WE USUALLY TACKLE FOR
FIVE MAJOR ISSUES AT THAT
MEETING.
THE RECOMMENDATION FROM OUR
GROUP THAT PUTS TOGETHER THAT
AGENDA AND IS NOW GOING TO OUR
BOARD. IS AN ALL SESSION ON COST
CONTAINMENT COST IN AFFORDABLE
ACCESS TO HEALTH CARE.
WE'RE NOT BLIND TO IT WE ACCEPT
THE CHALLENGE WE WANT TO BE PART
OF THAT SOLUTION TO THE ISSUE.
AND WE CONTINUE TO BE THERE WHAT
WE ARE CONCERNED ABOUT OUR
DRACONIAN BACKWARD LOOKING WAYS
OF TRYING TO FIX THE SYSTEM.
AND I APPRECIATE THAT THERE'S A
CONVERSATION HAPPENING BUT I
ALSO THINK THAT THERE HAS TO BE
SOMETHING MORE CONCRETE PUTS A
TABLE WE'VE HAD A YEARS OF
KNOWING THAT OUR SYSTEM THAT
NEEDED FIXING. I'M AND I SPENT
YOU KNOW MORE THAN TWO HOURS
ACTUALLY WITH LOCAL CMA
REPRESENTATIVES TALKING ABOUT
THIS.
AND WHAT CAME OUT AFTER A TWO
HOUR CONVERSATION IS THEIR
REGRET THAT THEY HAVEN'T BROUGHT
A CONCRETE SOLUTION TO THE
TABLE.
AND THAT'S A PROBLEM AND SO I
THINK A LESSON FOR EVERYBODY OUT
THERE IS UNLESS WE'RE BRINGING
SOLUTIONS TO THE TABLE.
THIS IS GOING TO KEEP HAPPENING
UP AYE ICY THIS BILL AS A
CONVERSATION AND THAT NEEDS TO
HAPPEN I'VE SAID IF THERE'S NOT
A BILL THERE'S NOT A
CONVERSATION.
UGH BUT I HAVE GREAT CONCERNS I
HAVE GREAT CONCERNS ABOUT THE
BILL BECAUSE.
YET WHAT'S BEEN TALKED ABOUT IS
URBAN AND RURAL WELL AS THE
SIXTH LARGEST ECONOMY THERE'S A
WHOLE LOT IN BETWEEN. AND IN A
COMMUNITY THAT HAS A HIGH COST
OF LIVING WHERE I MYSELF CAN
ONLY GO SEE A PROVIDER ON A
FRIDAY OR SATURDAY. AND THAT
ALONE IS REALLY DIFFICULT TO
FIND.
I I I THINK BACK TO THIS IDEA
WILL THIS IS GREAT. IF YOU. IF
YOU END UP AYE CAPPING RATES.
THAT'S GONNA HELP FOLKS BUT WHAT
HAPPENS IF THE RATES ARE CAPPED
AND I CAN'T FIND A HOSPITAL OR
DOCTOR IT DOES ME AND MY
COMMUNITY NO GOOD. TO CAP RATES
IF THERE'S NOT A DOCTOR TO SEE
AND HOSPITAL TO GO TO AND I
THINK THAT THIS IS PART OF THE
GREATER CONVERSATION.
AND THIS IS PART OF THE CONCERN
UP THAT I HAVE. I AM GOING TO
SUPPORT THE BILL TODAY I HAVE A
LOT OF RESERVATIONS ABOUT THIS
BECAUSE AS BEEN SAID THERE'S A
LOT AT TO CONSIDER AND I DON'T
WANT A REPEAT A LOT OF THE
THINGS THAT I THINK.
COLLEAGUES HAVE SAID.
BUT I WANT US TO THINK ABOUT
THAT BECAUSE IN SOME COMMUNITIES
THAT IS REALLY.
THE FEAR AND WERE NOT DRIVEN ON
FEAR THAT FEAR IS REAL I TALKED
TO HUNDREDS OF PEOPLE IN MY
COMMUNITY THAT STRUGGLE TO
FIGURE OUT WHERE TO GO PEOPLE
SAY WILL GO TO A KAISER GUESS
WHAT I DON'T HAVE BEEN WHERE YOU
LIVE.
AND SO I THINK THAT THAT'S.
SOMETHING DATA I WILL BE TAKEN
INTO CONSIDERATION AND AS THIS
BILL MOVES FORWARD I WILL
CONSIDER WHETHER OR NOT THEY CAN
CONTINUE TO SUPPORT IT.
BUT I DEFINITELY AT I
UNDERSTAND THAT THERE'S REASON
TO HAVE THIS CONVERSATION AND I
HOPE THAT WE WILL SEE A
DIFFERENT EFFORT AN EFFORT.
THAT REALLY STARTS TO MAKE
COMPROMISES AROUND WHAT NEEDS TO
HAPPEN TO MOVE THIS FORWARD.
GUIDE AND UP WE HAVE FIVE FOUR
FOUR MEMBERS PLUS ME WOULD LIKE
TO SPEAKS UP WE COULD.
MOVING HERE WE'VE GOT WE ALSO
HAVE UP. THIRTY OTHER BILLS.
TODAY.
WE'VE ONLY PROOF WE'VE ONLY
VOTED ON ONE BILL.
SO JUST JUST JUST SAY HAVE.
PLEASE.
THANK YOU MISTER CHAIR OKAY.
I'LL TRY THOSE FRANCESTHE CAN
HEAR CHRISTMAS SO MANY THOUGHTS
OF JUST ERASED HALF MY QUESTIONS
SLOW.
OKAY SO THE PURPOSE THE
RESERVES RIGHT IN THE BILL.
YOU KNOW.
.
SECTION ONE HUNDRED SIX OH THREE
IT TALKS ABOUT.
SETTING THE AMOUNTS ACCEPTED.
PAYMENT.
DETERMINE METHODS FOR STATE
GOVERNMENT TO REDUCE THE COSTS
OF PRESCRIPTION DRUGS AND
MEDICAL DEVICES PAID FOR BY
PRIVATE PURCHASERS.
CONTROL IN STATE CARE COST IN A
MANNER INTENDED TO IMPROVE
HEALTH CARE QUALITY. IMPROVE
OUTCOMES AND REDUCE HEALTH
DISPARITIES FOR ALL CALIFORNIANS
SO ANNA TALK ABOUT SOMETHING
THAT.
WAS TOUCHED UPON BUT NOT REALLY
TALKED ABOUT THAT'S PATIENTS.
IN ONE OF MY BIGGEST DRIVERS
BEING ON HEALTH COMMITTEE HAS
ALWAYS BEEN PATIENTS
PATIENT CARE. PATIENT ACCESS
SO.
IF THIS COMMISSION WILL FORMED
AN IN THEM AND PICK SOMETHING UP
RIGHT OUT.
.
RARE DISEASE PATIENTS.
FACE CHRONIC LIFE THREATENING
DISEASES ON SOME OF THE
COUNTRY'S HIGHEST TREATMENT
COST.
DISEASES.
SUCH AS THOSE COVERED UNDER THE
CALIFORNIA CHILDREN'S SERVICES
CCS PROGRAM.
AND LATER THE GENETICALLY
HANDICAPPED PERSONS PROGRAM G.
HPP.
REQUIRE ACCESS TO SPECIALIZED
EXPENSIVE CARE AND THERAPIES FOR
LIFE.
SO YOU KNOW TAKE HEMOPHILIA THE
AVERAGE COST OF IN THE DOLE.
IN FOR YEARS THREE HUNDRED
THOUSAND DOLLARS.
HOW WOULD THIS ISSUE BE
ADDRESSED BY THE COMMITTEE?
WHO'S LOOKING TO REDUCE COSTS.
OF CARE.
AND I GUESS WHAT I'M ASKING FOR
IS A COMMITMENT THAT.
THESE PATIENTS WILL BE FUNDED.
SO I'M SORRY.
MISS WALDRON.
THAT MANY OF THE PROGRAMS THAT
YOU MENTIONED ARE PUBLIC
PROGRAMS M. CCS FOR EXAMPLE IS A
MEDI CAL PROGRAM. WHOSE REACH
GOES FAR BEYOND THE MEDI CAL
ELIGIBLE POPULATIONS IF YOU HAVE
A VERY SICK CHILD WHOSE HEALTH
CARE EXPENSES WOULD EXCEED A
CERTAIN AMOUNT OF THE FAMILY'S
INCOME. THAT FAMILY CAN QUALIFY
FOR CCS EVEN THOUGH THEY'RE NOT
MEDI CAL ELIGIBLE WE HAVE
MEDICARE WHICH ALSO SERVES
PEOPLE WITH DISABILITIES.
AND SO MANY OF OF THE HIGH
NEEDS POPULATIONS YOU'RE TALKING
ABOUT ARE ALREADY COVERED.
UNDER PUBLIC PROGRAMS.
THIS BILL IS SPECIFICALLY
DIRECTED TO LOOK AT THE
COMMERCIAL MARKET TO THE EXTENT
THAT WE DO HAVE INDIVIDUALS
WITH.
VERY S. SIGNIFICANT HEALTH CARE
MEDICARE PAYMENT SYSTEM IS
ALREADY.
PERFECTLY SORT OF SET UP
TO DEAL WITH THOSE I'M
REIMBURSEMENTS BECAUSE THEY DO
COVER I'M VERY SICK POPULATIONS
ALREADY.
ONE OF THE PROBLEMS WITH RARE
DISEASE AND GENETIC INVOLVED
DISEASE IS THAT.
IT CAN TAKE UP TO EIGHT YEARS
BEFORE PEOPLE EVEN DIAGNOSED.
AND AT THAT POINT THERE PROBABLY
COULD BE IN A COMMERCIAL PLAN.
NOT IN THE MEDICARE PLAN.
SO YOU HAVE PROVIDERS THAT ARE
DOING TESTING THIS GENETIC
TESTING ALL THOSE THINGS I I
JUST BRINGING THIS OUT OF THE
RECORD BECAUSE.
IT'S AN ISSUE THAT COULD FALL BY
THE WAYSIDE. YOU KNOW WHICH WAS
A DISCUSSION WE HAD IN OUR
UNIVERSAL SINGLE PAYER
COMMITTEES TO THAT.
NO THERE'S SOME UNIQUE CASES
THAT WE WANT TO BE SURE THOSE
PATIENTS STILL HAVE CARE.
THANK YOU FOR SPEAKING OUT ON
BEHALF OF THOSE PATIENTS WITH
THOSE UNIQUE SITUATIONS AND
CERTAINLY THAT'S SOMETHING THAT
WILL BE COUNTY FOUR AS INDICATED
ME THOSE PROGRAMS ALREADY PUBLIC
PROGRAMS FUNDED BY MEDICARE. BUT
TO THE EXTENT THAT THERE ARE
SITUATIONS THAT'S NOT THE CASE
ABSOLUTELY THAT THOSE WOULD BE
PEOPLE THAT WILL BE OUT OF THE
CONVERSATION AS TO. HOW WE SET
UP BY THE ENSURE QUALITY
OUTCOMES OCCUR?
ON IT IN A SMALL MARKET REFERRAL
SPAWNED A IS SO MY COMMENTS WERE
COMPARING CALIFORNIA TO
DIFFERENT EUROPEAN COUNTRIES.
YOU KNOW OUR CONCERN HERE IS NOT
OR DOCTORS GOING TO CANADA TO
OUR DOCTORS GOING TO OREGON SO
FOR THOSE PROGRAMS IT WOULD BE.
NOT THAT THEY'RE NOT FUNDED BY
BETTER CAL BUT THERE'S JUST NO
SPECIALIST ACTUALLY PROVIDE THE
SERVICE.
AND SO THAT WE ARE CONCERNED
THERE.
OKAY.
.
YEAH I WANT I'M GONNA TALK ABOUT
MEDICAL NECESSITY HOPE THAT THE
COMMITTEE THE COMMISSION WITH
THE FIND THAT.
SO REGARDING FOREIGN MILITARIES.
AND WE KNOW THAT'S ALWAYS AN
ISSUE THAT'S ALWAYS BEEN AN
ISSUE FOR ME TRYING TO GET
PATIENTS ACCESS.
THE.
TREATMENT THAT THE PHYSICIAN
WANTS.
THE PATIENT I HAVE.
WILL ACCEPTING TREATMENTS REMAIN
UNCHANGED TO WORSEN UNDER THIS
COMMISSION.
THE HOPE THAT IT THAT THE THE
GREATER ACCESS MEANING YOU CRANK
THAT'S THE OF THE HOPE OF THE
COMMISSION WERE CERTAINLY NOT
LOOKING TO CHANGE ACCESS. OR
REDUCE THE ABILITY FOR DOCTORS
OR HOSPITALS BUILT RETREAT
PATIENTS.
INSULT THE IT COULD INCREASE
ACCESS BY BOB IN IN CERTAIN
COMMUNITIES WHERE THERE MAY NOT
BE ACCESS RIGHT NOW IF YOU HAVE
THE ABILITY FOR A DOCTOR TO BE
ABLE TO SUSTAIN THEMSELVES. UP
BECAUSE THEY COULD GET HIGHER
COMMERCIAL RACING THEY CURRENTLY
GET THAN YOU COULD ACTUALLY
INCREASE ACCESS BUT ABSOLUTELY
NOT NOT INTENDING ON REDUCING
ACCESS AT ALL IN ANY WAY.
SO THE FORMULA AREAS THAN WITH
THOUGHT BECAUSE.
THE FORMALLY ORDERS AS THEY
STAND NOW WITH. REMAIN NO
CHANGES TO CLINICAL PRACTICE
WOULD BE MADE UNDER THE SPELL.
OKAY BECAUSE PART OF THEIR.
DRIVING IS TO LOOK AT REDUCING
THE COST OF DRUGS AND MEDICAL
DEVICES.
AND.
.
CONTROL HER IN STATE HEALTH CARE
COSTS OF ONE OF THE FIRST THINGS
THAT CAME OUT IN THE SINGLE
PAYER COMMITTEE WAS.
FORMULARIES AND DRUGS AND TRYING
TO MATCH THEM UP TO.
.
YOU KNOW THE THE VETERANS
AFFAIRS AND THEN.
THEREFORE MILLER SO I'M JUST
CONCERNED BECAUSE I WANT TO
INCREASE THE FOR MILLER ACCESS
NOT RESTRICTED FURTHER.
OKAY.
SO THE BILL ADDRESSES HEALTH
PLAN PREMIUMS.
.
ALL THE DIFFERENT PLANS A
DIFFERENT THOUGH THAN DESIGNED
DIFFERENTLY.
I'M.
HOW DOES THE BILL DO ANYTHING
TO?
PREVENT
THE CALLS FROM FROM SIMPLY BEING
PASSED THOUGHT THAT THOUGH COST
OF THE PREMIUMS COPAYS BECAUSE
NOW THEY.
PREMIUMS ARE SUPPOSED TO BE
REDUCED
BUT SOMEWHERE THAT COSTS US A
GOES LIKE SQUEEZING A TO.
TOOTH PASTE STIR
IT GOES ONE SIDE OR THE OTHER
THE COSTS ARE NOT GOING TO GO
AWAY.
SO.
WHAT'S GOING TO PREVENT THAT
FROM BEING PUSHED ONTO HIGHER
DEDUCTIBLES OR CO PAYS.
THROUGH THE CHAIR BY MAY AND
MISS WALDRON TO GREAT QUESTION
AND.
ALL OF THE STATE AND FEDERAL
LAWS RELATING TO UP CAPPING AND
PREVENT AND AND WENT MANAGING
OUT OF POCKET COSTS ARE STILL IN
PLACE THE AFFORDABLE CARE ACT
HAS LIMITS. ON WHAT INDIVIDUALS
CAN PAY OUT OF POCKET AND YEARLY
THERE ARE LIMITS ON DEDUCTIBLES
THAT CURRENTLY AT SEVEN THOUSAND
ABOUT SEVEN THOUSAND FOR AN
INDIVIDUAL. ALL OF THAT IS IN
PLACE THERE'S ALSO LIMITS ON.
PREVENTING HEALTH PLANS FROM
BEING ABLE TO HAVE A LIMIT ON
HOW MUCH CARE THEY PAY FOR
ANNUALLY OR OVER A LIFETIME SO
THAT YOU SEE GOT RID OF LIFETIME
LIMITS. IN THEIR STATE
PROTECTIONS IN TERMS OF NETWORK
OUT TO SEA ADEQUACY TIMELY. AND
ACCESS TO CARE AND LANGUAGE
PROTECTIONS ALL THE PROTECTIONS
AROUND.
TAPPING OUT OF POCKET COSTS ARE
THEY ALL STAY IN PLACE UNDER
THIS LAW.
SO WHERE WITH THE COSTS AGO
WOMEN HOW THAT THE COVERS.
THE IDEA IS THAT OF THIS BILL IS
TO REALLY GET AT PRICES.
UTILIZATION HAS GONE DOWN IN
THIS COUNTRY AND PRICES HAVE
SKYROCKETED. AND SO THE IDEA IS
TO GUIDE OF GET A HANDLE ON THE
PRICES THAT ARE CHARGED.
BECAUSE THAT'S AND WE'VE SEEN WE
DID S. B. FIVE WAS SPONSORED S.
B. FIVE FORTY SIX.
COUPLE YEARS AGO WHICH BROUGHT
TRANSPARENCY TO THE WAY HEALTH
PLAN SET PREMIUMS AND FOR THE
LARGE GROUP. AND WE HAVE NOW TWO
YEARS OF ROBUST DATA THERE'S
BEEN TWO PUBLIC MEETINGS.
AND ONE OF THE THINGS THAT THEY
SHOWED IS THAT A BIG DRIVER ONE
OF THE THINGS THAT ARE REALLY
DRIVING INCREASES IN PREMIUMS
AND WHAT CONSUMERS ARE SPENDING
OUT OF POCKET. IS DOCTORS AND
HOSPITALS.
PRESCRIPTION DRUGS IS A PIECE OF
GUIDANCE ONE OF THE FASTEST
GROWING.
PARTS DRIVER COST DRIVERS IN OUR
SYSTEM BUT DOCTORS AND HOSPITALS
ARE THE BIGGEST CHUNK OF WHAT WE
ARE SPENDING OUR PREMIUM DOLLARS
ON.
JUST BRIEFLY DOCTORS AND
HOSPITALS ARE THE MAIN PART OF
ANY MEDICAL SERVICE SO THAT
ACTUALLY MAKES SENSE.
OKAY A I THINK WE WE WANT CEMEX
VERY QUICKLY.
OKAY SO AS FAR AS.
HOW MANY HOSPITALS ARE IN
MARYLAND?
FORTY HOSPITALS IN THE STATE OF
MARYLAND.
SO FORTY AND THEY WERE ABLE TO.
LOOK AT THOSE ON THE COMMITTEE
THEY HAD AT THE TIME THEY HAD
RATES SETTINGS BUT.
I WAS JUST DOING SIMPLE MATH IF
YOU SUBTRACT.
CHRISTMAS WEEK AND.
.
NEW YEAR'S WEEK THAT'S FIFTY
WEEKS IN THE YEAR FOUR HUNDRED
HOSPITALS THAT'S EIGHT WEEKS
THIS COMMITTEE WOULD HAVE TO BE
WORKED ON NOT EVEN TO MENTION
THE HUNDRED THOUSAND. OR SO
PROVIDERS.
WITH ACTUAR EARLY ACTUARIAL IS A
RETURN ON INVESTMENT ALL OF THE
THINGS THAT HAVE TO LOOK AT.
WOULD HAVE TO HAVE A HUGE STAFF.
LET'S JUST.
COMMENTS. IF I MAY ASSEMBLY
MEMBER AND IN THE STATE OF
MARYLAND REMEMBER THE RATE
SETTING SYSTEM WAS ALL ABOUT
LOOKING AT THE RATE OF INCREASE.
IT DID NOT LOOK AT WHAT THIS
BILL IS PROPOSING IN THAT IS TO
SET. INDIVIDUAL RATES AT SOME
BASE
FOR ALL PHYSICIANS AND DENTISTS
AND HOSPITALS FORTY HOSPITALS
ONLY AND WAS TO CONTROL THE RATE
OF INCREASE OVER TIME.
OKAY JUST VERY QUICKLY COMMENTS
ON THEM.
.
OKAY SO.
SO PLAYERS YOU KNOW SEEM TO BE
MOVING TO COMPARATIVE
EFFECTIVENESS OF TREATMENT AND
SERVICES IN ORDER TO DECIDE.
WHAT TO PAY FOR A MONTH NOT TO
PAY FOR?
BUT FOR PATIENTS WITH RARE
DISEASES AND OTHER CHRONIC
DISEASES YOU KNOW.
ARE EXPENSIVE TO TREAT THE REAL
CONCERN IS THAT.
A NEW PAYER LIKE AN OLD PAIR OF
CAPT BECAUSE FOCUSES ON
COMPARATIVE COST EFFECTIVENESS
RATHER THAN CLINICAL
EFFECTIVENESS.
TREATMENTS AND SERVICES SO.
PHILIP WE'RE GONNA BE LOSIN
QUALITY OF CARE TO.
MAKE UP FOR THAT ON THE OTHER
END.
.
IN IN OUR UNIVERSAL CARE.
COMMITTEE WE LOOK AT OTHER
COUNTRIES AND OTHER STATES
AND WE'RE GOVERNMENT SET RATES
AND REGULATED PRICES BUT ALL THE
COSTS ROSE NO ONE WAS ABLE TO
GET A HANDLE ON REDUCING COSTS
BECAUSE THAT WOULD HAVE BEEN
SOMETHING WE ALL WOULD'VE
REALLY.
LOOK THAT CLOSER.
IN ANY MEANINGFUL WAY BUT. YOU
KNOW WHEN YOU LOOK AT THESE
OTHER.
HIGH INTENSITY CHRONIC DISEASES
RARE DISEASES IN EXETER. YOU
KNOW AND MY CONCERN FOR ACCESS
FOR THE UNDER SERVED WITH THE
QUALITY CARE NOT JUST THE BASE
CARE HOW DO WE GET NEW
INNOVATIONS.
IN LIFE SCIENCE TO FOLKS IF
EVERYTHING'S GOING TO BE CAPPED.
WHERE'S THE INCENTIVE FOR AN
INVASION INNOVATION IN OUR
STATE.
PERSONALIZE MEDICINE IS
SOMETHING WE'RE TRYING TO LOOK
AT SO THAT WE CAN ACTUALLY IN
THE LONG TERM REDUCE COSTS IF WE
TREAT THE PATIENT THE RIGHT WAY.
AND MISS BURKE AND I HAVE A
BILL TALK UP BAKA GENETIC
TESTING I MEAN IF WE KNOW WHAT
WE'RE DEALING WITH IT'S CHEAPER
TO TREAT.
BUT INSTEAD OF BRINGING THE META
CHO UP WHICH A FEW OF US HAVE
TALKED ABOUT WE NEED TO IMPROVE
MEDI CAL.
AND THE RATE.
I FEEL THIS BILL IS BRINGING.
A COMMERCIAL CARE NOW.
SO THAT'S MY CLOSING STATEMENT.
STERN MISSOURIAN FOLLOWED BY MR
MCCARTY AND SO WILL KEEP MOVING
ALONG HERE GUYS PLEASE.
THANK YOU MISTER CHAIR.
AND MISTER CHAIR I VERY MUCH
APPRECIATE YOUR PATIENCE AND
YOUR.
CALM TONE AND HOW WE'RE CARRYING
ON THANK YOU VERY MUCH.
MY PLEASURE MISTER THIS AREA.
UP AT I I GOTTA MAKE AN
OBSERVATION AND THIS HAS NOTHING
TO DO WITH THE COMMITTEE BUT. I
REMEMBER SITTING IN THIS
COMMITTEE ROOM FOR ABOUT FIVE OR
SIX HOURS.
WHEN MISTER BONTA WAS CHAIR.
AND WE DISCUSSED THE VACCINATION
BILL.
A.
I WISH WE GAVE THAT PERIOD OF A
TIME TO THIS BILL THIS'S
WHISPERED TALKING ABOUT CHANGING
AND AGAIN THIS IS NO REFLECTION
TO THE CHAIR OF COURSE THIS IS
JUST. A COMMENTARY ON THE WAY WE
PROCESS THINGS HERE. WITH THIRTY
FOUR BILLS IN ONE NIGHT WHEN ONE
OF THEM MAKES SUCH A.
DRASTIC CHANGE IMPACT AND AND
AND AND INDUSTRY.
.
I THINK ONCE ITS OWN TIME.
RATHER THAN BEING FOCUS THAT
WITH A THIRTY THREE OTHERS.
SO.
COUPLE OF BASIC QUESTIONS AND
THEN A THIRD QUESTION OF
SOMETHING THAT I HAVEN'T REALLY
HEARD BEING RAISED ABOUT. A AND
MAYBE I'M WRONG ON THIS BUT
FIRST OF ALL.
EIGHTEEN BILLION DOLLAR ISSUE
WITH THE OF THE LOSS FROM
HOSPITALS CAN YOU. PLEASE.
OFFER SOME LEVEL OF DETAIL
GIVEN.
THE TIME CRUNCH WE HAVE OF WHERE
DO YOU GET THAT I KEEP ON
HEARING THAT BUT I HAVEN'T.
WOULD BE HAPPY TWO AND IT'S VERY
SIMPLE IF I MAY USE THIS CHART
TO EXPLAIN. BASICALLY WHAT WE'RE
TALKING ABOUT IS TAKING THAT
GRAYBAR PRIVATE INSURANCE THE
EIGHTEEN BILLION DOLLARS IS THE
IMPACT IF THE RATES WERE SET AT
ONE HUNDRED AND TWENTY FIVE
PERCENT. OF MEDICARE SO IT'S
VERY THIS IS ALL STATE DATA IT'S
VERY EASY FOR US TO MODEL. ONE
HUNDRED AND TWENTY FIVE PERCENT
OF THE MEDICARE RATES TODAY
WOULD BRING IT TO THAT RED LINE
SHOT SLIGHTLY ABOVE COST BECAUSE
MEDICARE. PAYS TWENTY THREE
PERCENT BELOW COST TODAY THREE
HUNDRED TWENTY FIVE PERCENT OF
MEDICARE IT'S BARELY BREAKING
EVEN THAT'S THE EIGHTEEN BILLION
DOLLARS. IF THEY WERE SET AT
MEDICARE RATES THE LOSSES WOULD
BE FAR GREATER. IF THEY WERE SET
AT HIGHER THAN A HUNDRED AND
TWENTY FIVE PERCENT OF MEDICARE
THE LOSSES WOULD BE LESS.
BUT IT BEGS THE QUESTION WHETHER
THERE IS ANY COST CONTAINMENT
ANY PRICE SAVINGS.
GET.
I'D LOVE TO HEAR FROM YOU.
THAT OF MISTER COLOCAR KALRA BUT
JUSTANSWER THEN THEN THAT GOES
BACK TO THE ASSUMPTION OF THE.
IN THE FIRST EXAMPLE YOU GAVE OF
THE RESTAURANT WHERE YOU.
WE PAY A BILL AND THEN YOU
RECEIVE A BILL AND THEN YOU MAKE
A PAYMENT THAT'S NOT HAVE TO
SIGH HEFTY AMOUNT OF THE BILL.
WELL.
THAT ALL DUE RESPECT THAT
EXAMPLE DOESN'T REALLY APPLY
HERE BECAUSE.
THAT.
SUGGESTS THAT THE PLAYERS DON'T
KNOW WHAT THEY'RE WALKING INTO.
THE REALITY IS THE WHOLE IDEA IS
THAT THE.
THE FACTORS INVOLVED IN THE COST
OF WHAT THE RESTAURANT IS GONNA
CHARGE IS ALREADY GONNA HAVE
ASSUMED THE LOWER PRICES.
SO YOU KNOW WHAT YOUR PAIN.
THAT THAT THAT KIND OF THEN
ERODES THE ARGUMENT ON THIS
DOESN'T. MATTER YOU'RE TALKING
ABOUT. COSTS IF I MAY OFFER A
ANOTHER PERSPECTIVE A TO THE
QUESTION THAT WAS ASKED.
BY ASSEMBLY MEMBER WALDRON. ON
THE COST OF CARE WHETHER THAT'S
FOR A VERY EXPENSIVE PEDIATRIC
CASE.
FOR AN INDIVIDUAL WITH CANCER.
FOR SOMEONE NAME BUT YOU KNOW
THOUSAND OTHER CONDITIONS THE
ACTUAL COST OF THAT CARE DOESN'T
CHANGE AT ALL. WHAT THIS BILL
DOES IS SIMPLY SAY WE'RE GONNA
DETERMINE HOW MUCH WE'RE GONNA
PAY YOU FOR THAT SERVICE?
SO THE DOCTORS AND THE NURSES
AND THE SURGERY AND CHEMOTHERAPY
AND EVERYTHING ELSE THAT'S A
PART OF THAT VISIT. IS STILL
THERE THE DRUGS ARE STILL GOING
UP A TEN POINT SIX PERCENT A
YEAR. ALL OF THE CLUSTER THERE
WERE SIMPLY SETTING HOW MUCH
WOULD BE PAID FOR THAT VISIT
THAT'S WHERE THE CHALLENGE AND
THE LOSSES AND THE CONCERN ABOUT
PHYSICIANS LEAVING THE STATE.
AND HOSPITAL CLOSURES COMMIT.
AND THE IDEA BEHIND THE
COMMISSION IS A SET.
SET THE COST. SET THE PAYMENT
BASED ON WHAT THE COSTS ACTUALLY
ARE.
I IN SO BY PUTTING.
SOMEBODY A FICTITIOUS CHART UP
THERE AS TO WHAT BUT EVEN THOUGH
WE'VE SAID.
WE'VE SAID TIME AND AGAIN
THERE'S A ME FLEXIBILITY WITH
COMMISSION WHAT I MEAN BY
PETITIONS OF NO ONE OF SADNESS
AT HOW TO DRIVE SENT ACROSS THE
BOARD. DOES ALLOW THIS REPEATED
EIGHTEEN BILLION DOLLARS
HUNDREDS OF YOU BY THE HOUSE TO
BE USED TIME AND AGAIN I'VE SEEN
DOZENS OF LETTERS WITH THAT
CLEARLY THE FOLKS ABOUT THOSE
LETTERS AND ACTUALLY THE BILL.
BECAUSE IF THEY HAD A REALIZE NO
ONE IS SUGGESTING SETTING RATES
AT HUNDRED AND TWENTY FIVE
PERCENT AND IT ALSO DOESN'T
ACCOUNT FOR ALL THE DIFFERENT.
ADJUSTMENTS THAT CAN BE MADE
THAT HOSPITALS AND AND.
PROVIDERS ACTUALLY SEE CLINTON
IN REAL TIME. AND SO. THAT'S WHY
IT'S NOT VERY HELPFUL TO HAVE A
CHART ALTHOUGH I DO. UNDERSTAND
WHY BUT IN THOSE NUMBERS OUT
THERE AYE IS EASIER.
BUT THEN ACTUALLY.
LOOKING AT WHAT THE BILL DOES
AND DOES NOT.
IF I MAY THOUGH ASSEMBLY MEMBER
IF THE BILL SPECIFIED THE NUMBER
WE COULD GIVE YOU AN EXACT.
NUMBER.
YOU NEED EARLY OFFERING OF THE
BILL HUNDRED TWENTY FIVE PERCENT
MEDICARE IS WHAT WAS BEING
DISCUSSED THAT'S WHY WE MODELED
IT. IF THE BILL SPECIFICALLY
TELLS US WHAT PERCENT OF
MEDICARE WE COULD MODEL THAT.
AS WELL WOULD BE HAPPY THAT IS
NOT WHAT WAS DISCUSSED IN THE
BILL WAS SIMPLY AS AN EFFORT TO.
DEMONSTRATE TO STAKEHOLDERS WHAT
THE WHAT THE PURPOSE OF THE
COMMISSION IS AND SAID HONEY
TWENTY FIVE COM HUNDRED KEEPER
SENT DOT DOT DOT. THEY TOOK
HUNDRED TWENTY FIVE PERCENT OF
THE US WERE SAYING WAS GONNA
HAPPEN IT'S FALSE. I UNDERSTAND
WHY THEY'RE BEING SOME DESIRE
FOR FOR. THE CONFUSION CREATED
HERE OFTENTIMES IS INTENTIONAL.
ARM THAT IS NOT WHAT WE EVER
SUGGESTED
AND SO THAT'S WHY I'M SAYING
IT'S NOT HELPFUL.
THE CONVERSATION AND WE'RE NOT
GOING TO GIVE A NUMBER BECAUSE
WE'RE NOT THIS BILL DOES NOT SET
A NUMBER.
IF WE DID IDIOT WHOLLY DIFFERENT
CONVERSATION AND I THINK TO BE
SOME MERIT DARDEN'S ME MADE
OPPOSITION IF THAT'S WHAT THIS
BILL ACTUALLY DID IT'S JUST THAT
HAVE US IS THAT IS THAT IS THAT
A NUMBER.
VOTER RESPECT
NOT A COUNTERPOINT COUNTERPOINT
HERE IT'S NOT SIXTY MINUTES
TODAY.
BUT BUT JUST PLEASE ADDRESS THE
QUESTION.
THANK YOU MISTER CHAIR I IDEA
LIKE.
HAVEN'T HEARD FROM KAISER
PERMANENTE ON THIS.
I KNOW THEY HAD SOME CONCERNS I
DON'T OF PAIRS OF REPRESENTATIVE
WOULD LIKE TO. AT LEAST SPEAK TO
SOME OF THEIR CONCERNS.
IF MISTER CHAIR YOU.
A COMFORTABLE IN ALLOWING
SOMETIMES.
COUPLE MINUTES HERE.
AND AND NO PRESSURE TERESA.
THANK YOU THANK YOU MISTER IS
THERE AND.
WE DID SEND IN AN OPPOSE LETTER.
WE DO HAVE SIGNIFICANT CONCERNS
WITH THE BILL FRANKLY FOR. ALL
THE REASONS YOU YOU HAVE HEARD
ABOUT TODAY.
JUST IN TERMS OF THE IMPACT ON
OUR OUR DELIVERY SYSTEM.
.
TO THE EXTENT.
AND AGAIN IT'S UNCLEAR WHAT THEY
THE IMPACT WOULD BE IN TERMS OF
MONEY BEING REMOVED FROM THE
SYSTEM BUT. WE HAVE THIRTY SIX
HOSPITALS IN CALIFORNIA AND.
FOUR HUNDRED MEDICAL OFFICE
BUILDINGS AND WE I WORK WITH OUR
MEDICAL GROUPS TWELVE THOUSAND
POSITIONS AND SO IT WOULD HAVE.
SIGNIFICANT IMPACT ON OUR
ABILITY TO RUN OUR INTEGRATED
DELIVERY SYSTEM SOUP MORE
SPECIFICALLY SINCE YOU ARE AN
INTEGRATED SYSTEM.
CAN YOU ELABORATE A LITTLE BIT
MORE ABOUT WHAT EXACTLY THE
IMPACT WOULD BE BECAUSE I THINK
THERE WERE AMENDMENTS THAT WERE
TAKEN TO CLARIFY THAT THE BILL
IS NOT INTENDED TO IMPACT
CONTRACTED RATES.
SO THE CAPITATED RATE THAT WE
PAY ARE DELEGATED MEDICAL GROUP
THIS SPONSORS ARE. NODDING BUT.
THE HEALTH PLAN WOULD BE SET
WOULD BE PAID ARRAY BASED ON
MEDICARE ADVANTAGE.
SO. WE WOULD STILL BE EXPECTED
TO RUN OUR DELIVERY SYSTEM.
WITH A RATE THAT WOULD BE VERY
DIFFERENT FROM WHAT WE GET
TODAY.
SO WHILE THEY'RE NOT INTENDING
TO IMPACT THE CONTRACTED RATES.
WHICH MAKES SENSE BECAUSE THAT.
REALLY IS SORT OF RATE SETTING
IT'S AGREED TO BETWEEN THE PAIR
IN THE PROVIDER AND THAT'S HOW
YOU GET TO VALUE. AND. YOU KNOW
OUTCOMES PERFORMANCE SPACE CARE
WHICH IS WHAT WE ALL WANT TO
ACHIEVE. BUT IF YOU.
THEORETICALLY LOWER WHAT WE'RE
GETTING DIDN'T AS THE PAIR.
THEN THAT'S LESS MONEY IN THE
SYSTEM FOR EVERYTHING ELSE.
THANK.
OKAY.
BUT ONCE OF.
LIKE YOUR CONVERSATION BUT I.
WE GOT THAT WERE SHAKING HER
HEAD TO GET WELL GIVEN WHAT I'M
HEARING THOUGH IT FOR FIRST OF
ALL IF IF YOU DON'T TRY TO TAKE
A CERTAIN STEP AND.
IN IN IN ADDRESSING AN ISSUE
YOU'RE NEVER GONNA MOVE.
AND PART OF THE CHALLENGE OF
WHAT I'M HEARING RIGHT NOW AND
WHAT WE USUALLY HERE. IS JUST
THE NEGATIVES OF WHAT'S
SOMETHING.
OF OF HOW SOMETHING IS NOT GOING
TO WORK.
INSTEAD OF TRYING TO FIGURE OUT
HOW WE CAN MAKE SOMETHING WORK.
I'M NOT WILLING TO SUPPORT THIS
BILL TODAY BECAUSE. OF AND I
DON'T WANT TO ELABORATE ON JUST
THE NEGATIVES.
I THINK IF IF THERE IS A BODY
THAT'S COMMISSION TO LOOK AT
SOMETHING FULL TIME.
IT'S NOT.
FAR OUT OF REACH THAT IT CAN
POTENTIALLY TRIED TO ADDRESS
SOME OF THE ISSUES.
AND IT CAN'T BE MORE CHALLENGING
THAN WHAT WE'VE BEEN DEALING
WITH RIGHT NOW WHEN.
SOME OF THE A LOT OF THE
SOLUTIONS ARE. COMPROMISED TO
THE POINT WHERE IT BECOMES.
RELATIVELY INEFFECTIVE OR. ALICE
MARGINAL OF IMPACT.
.
BUT WILL ONE OF THE THINGS THAT
I WAS CONCERNED ABOUT WAS MORE
OF JUST THE ACCOUNTABILITY.
OF OF THIS COMMISSION.
AT WHAT WHEN YOU ESTABLISH IT.
YOU'RE NOT VOTING FOR THESE
PEOPLE THESE ARE SELECTED
INDIVIDUALS.
SO.
.
WHAT ARE THE PRESSURES THAT WILL
FORCE UP?
FORCE UPON THIS BODY.
TELL.
HOW IT MAKES DECISIONS AND HOW
IT MANEUVERS AND HOW?
A IT RESPONDS MOST. IMPORTANTLY.
VIDEO IS THIS SOMETHING THAT
WOULD BE BETTER SERVED IF IT WAS
UNDER THE.
INSURANCE COMMISSIONERS.
A DEPARTMENT SO THAT THERE IS A
POLITICAL ENTITY WHO GETS
ELECTED STATEWIDE WHO THEN. IS
MORE ACCOUNTABLE LIKE. THAT I'M.
I HAVEN'T THOUGHT THIS THROUGH I
JUST WANTED TO SUGGEST THAT ONLY
BECAUSE I FELT THAT THERE NEEDS
TO BE A GREATER ACCOUNTABILITY
ON THIS BODY.
SURE YEAH AND MISS SHARE OF A
GOOD I I APPRECIATE THAT
CONCERNED I THINK THAT THE KEY
IS TO MAKE AS TO THAT MUCH
INDEPENDENT. I DO NOT HAVE
SIMPLY HAVE ELECTED OFFICIALS ON
IT BECAUSE WE SEE WHAT'S
HAPPENED IN OUR POLITICAL SYSTEM
AND AND. IT IN HOW ELECTIONS ARE
WON AND LOST IF YOU HAVE A JUST
UNDER THE INSURANCE COMMISSION
THAT YOU'RE TALKING ABOUT ONE
ELECTED INDIVIDUAL. THAT WOULD
HAVE ALL THAT POWER.
AND THAT'S WHY THE THOUGH THE
APPOINTEES ARE SELECTED FROM
THREE DIFFERENT. OF MOVIE THE
GUBERNATORIAL SENATE ASSEMBLY OF
WHICH ALLOWS FOR THE CROSS
SECTION ALSO.
OF IT IF IT DETAILS THE KINDS
OF PEOPLE WE WANT ON IT.
BICU ONE FOLKS I DO HAVE.
CERTAIN AGREES EXPERTISE
OTHER TERM LIMITED AS WELL.
OF A EN AND SO.
THERE THERE'S ALWAYS GONNA BE A
QUESTION AS TO WHAT THE PEOPLE
DO THE RIGHT THING I THINK WHAT
YOU DO IS GREAT INDEPENDENT
SYSTEM. THAT HAS COMPLEMENT JUST
RULES IN PLACE THAT HAD BEEN HAS
SOME TRANSPARENCY OPEN MEETINGS
AND THEN YOU ALLOW THE ADVISORY
COMMITTEE WHICH IS MADE UP OF A
WIDE RANGE OF FOLKS WHO
INDUSTRY.
THAT ADVISE THEM AGAIN IN A
VERY OPEN AND TRANSPARENT MANNER
AND YOU GET THE MOST OUT OF
ACTION CAN MONEY CAN DO THE
DETAILS TO THE RESEARCH. DO THE
STUDY AND DO THE HOMEWORK I IS
THERE A FULL PROOF WAY.
I DON'T KNOW IF WE FOUND ONE YET
BUT IT IS FULL PROOF IS IT CAN
GET IT'S NOT DIFFERENT THAN
OTHER COMMISSIONS OF THE STATE
IS EMPLOYED AND I THINK THAT.
THIS COMMUNE OPPORTUNITY GET
INDEPENDENT FOLKS ARE FOCUSING
ON THE DATA AND INFORMATION NOT
ON THE POLITICS.
AND MISTER CHAIR THANK YOU VERY
MUCH FOR THE OPPORTUNITY I I
JUST.
THANK YOU FOR THE ANSWER I I
DON'T THINK THAT'S EXACTLY WHAT
I WAS LOOKING FOR ONLY BECAUSE
IT'S.
.
WE'RE CHANGING THERE'S A SYSTEM
HERE.
ADAM AND AND IT'S DIFFICULT TO
JUST PLACE INDIVIDUALS WHO. UP
WILL NOT HAVE CERTAIN PRESSURES
ON THEM TO PERFORM.
AND TO BE ACCOUNTABLE SO I
THINK THAT'S SOMETHING THAT WE
NEED TO. BE MINDFUL OF AND WORK
THROUGH.
SO ABSOLUTELY THANK YOU FOR
YOUR EFFORTS ABSOLUTELY I THINK.
MR MCCARTY.
AND THEN MISTER SANTIAGO.
THANK YOU MISTER CHAIR PATRICK
MISTER KALRA.
I. WON'T ASK YOU ONE ONE
QUESTION.
LOT OF QUESTIONS ASKED I COULD
ASK PLENTY MORE BUT. IT'S
IN LATE BUT BEFORE THAT I AM
GOING TO VOTE FOR THE BILL.
AN IMPERFECT SOLUTION SOMEWHAT
UNEASY.
BUT I DO THINK AS MR BONTA SAID
WE HAVE.
UNSUSTAINABLE ESCALATING COSTS
THAT WE'RE NOT ADDRESSING AND
THE CURRENT SITUATION. IS IS NOT
GOING TO WORK.
SOME NOT SO MY QUESTION IS THIS.
IN THE NECK WITH A LITTLE OF
THIS WILL HAPPEN TO ME IN THE
NEXT.
FEW DAYS OR WEEKS I'LL BE
WALKING AROUND MY NEIGHBORHOOD
WITH MY DOG.
AND I WON'T RUN INTO A NO
OFFENSE A HOSPITAL.
EXECUTIVE I WON'T RUN INTO AN
HMO EXECUTIVE BUT I WILL RUN
INTO A DOCTOR.
PROBABLY A FAMILY DOCTOR AND
THEY'LL BE UNEASY ABOUT THE
SQUEEZE.
SO WHAT WOULD YOU TELL.
POSITIONS OUT THERE.
WITH THAT.
YOU KNOW THEY MAY NOT BE
SPECIALISTS NAY MAIM NAY MAYBE
APPETITE AS SOON THAT MAYBE THEY
DON'T PUTS BUT THEY'RE GOING TO
FEEL THAT THIS WILL SQUEEZE.
THE AVERAGE DOCTOR IN
CALIFORNIA.
WHAT WOULD YOU TELL THEM?
TO.
TO ATTEMPT TO SATISFY THEIR
KIDS.
WHY WAS START BY SAYING THAT?
THAT THIS BILL IS NOT INTENDED
TO SQUEEZE.
DAM.
BUT THE BALLY PRACTITIONERS ARE
ANY DOCTOR FOR THAT MATTER BUT
YOU'RE YOU'RE RAISING THE ISSUE
SPECIFICALLY AND I UNDERSTAND
WHY FAMILY PRACTITIONERS SOLO
PRACTITIONERS.
OTHER ALREADY FEELING SQUEEZE
RIGHT NOW WITH GRINS.
AND UP IN MANY CASES THEY'RE
UNDERPAID.
AND I THINK THAT THIS BILL
WOULD HAVE THE OPPORTUNITY TO
ACTUALLY PAY THEM WHAT THEY
DESERVE. ALLOW THE COMMERCIAL
RATES THEY DON'T RESPECT US ALL
PRACTITIONERS WHAT LEVERAGE THEY
HAVE RIGHT NOW. TO INCREASE THE
RACE THEY GET.
VERY LITTLE.
THIS WILL ACTUALLY GIVE THEM THE
OPTION TO HAVE SOME LEVERAGE AND
HAVE THE OPPORTUNITY TO
ACTUALLY.
NUMBER CONTINUE UP TO WORK AS A
FAMILY PRACTITIONER OR
PEDIATRICIAN.
IN IN THE COMMUNITY IN WHICH
THEY LIVE.
AND W. DO HAPPEN DISHES IN THERE
THAT INCLUDE CONSIDERATION A
WORKFORCE NEEDS ROGAN A BE
PUTTING OF RESOURCES INTO FUNDS
THAT RIGHT NOW ARE SEVERELY
UNDERFUNDED. TO HELP WITH THE
MEDICAL SCHOOL DEBT AND TRAINING
FOR HEALTHCARE PROFESSIONALS.
IN ORDER TO BUILD A PIPELINE
BUT WHAT I WOULD SAY THAT. TO
ANY INDIVIDUAL DOCTOR NOT
FRANKLY SAID THIS TO A NUMBER OF
THEM THAT HAVE CALLED ME
PERSONALLY AND TALKING ABOUT
THIS BILL TALKED MY STAFF ABOUT
THIS BILL. EYES OTHERS DOES NOT
ABOUT TARGETING DOCTORS
THERE'S AND AND THAT WE WANT
DOCTORS OTHER DOCTORS AND
HEALTHCARE PROFESSIONALS I DO
MOST SERVICE. I TO GET PAID.
IN AND TO GET THE RESOURCES
THEY NEED TO CONTINUE IN
PRACTICE.
THERE'S A YOUNG DOCTOR.
THEY NOT ONLY HAVE TO CONSIDER.
THEIR PRACTICE FOR THE NEXT
FOUR FIVE YEARS BUT THAT IT THE
NEXT HOPEFULLY THIRTY FORTY PLUS
YEARS.
AND SO THE SYSTEMS UNSUSTAINABLE
DOES A BENEFIT THEM AND THE WAY
THAT THE SYSTEM HAS BEEN GOING
AS WE EVEN HEARD FROM MISTER
BIGELOW LOT OF PRACTICE ARE
CLOSING DOWN BUT THE CURRENT
SYSTEM.
SO WE HAVE TO DO SOMETHING
DIFFERENT TO CREATE A SYSTEM
THAT SUSTAINABLE AND THAT
INCLUDES ENSURING IT SUSTAINABLE
FOR DOCTORS. AND MISTER.
MCCARTY IF I MAY AT SEIU
REPRESENTS.
THE COMMITTEE OF. INTERNS AND
RESIDENTS.
WHO ARE AN AMAZING GROUP OF US
STUDENT PHYSICIANS WHO ALSO
DEDICATE THEIR TIME TO THE
UNION?
AND THERE IS A A BIT OF GOOD
NEWS IN THIS PICTURE.
CALIFORNIA RANKS FIRST IN THE
NATION FOR PERCENTAGES OF BOTH
MEDICAL STUDENTS AND RESIDENTS
WHO
CHOOSE TO REMAIN IN THE STATE.
AND.
OUR GOAL CERTAINLY IS NOT TO
SEE THEM OF LEAVE.
ONE OF THE THINGS THAT I WILL
POINT OUT YOU TO IS KIND OF AT A
POINT IN HISTORY WHEN. UP PRIOR
LEGISLATURE PASSED NURSE
STAFFING RATIOS CALIFORNIA WAS
UNDER A TERRIBLE NURSE AS
NURSING SHORTAGE. AND THE RATIOS
HELPED TO.
COMPEL.
DOES THE GOVERNOR GOVERNOR GRAY
DAVIS AND SUBSEQUENTLY GOVERNOR
SCHWARZENEGGER TO INVEST NINETY
MILLION DOLLARS INTO A NURSE
TRAINING AND EDUCATION. WE HAVE
ERASE THE NURSING SHORTAGE IN
THE STATE OF CALIFORNIA AS A
RESULT AND I DO THINK THAT ONE
OF THE WAYS THAT WE CAN GET TO
ACTUALLY DOING SOMETHING ON
PHYSICIAN RECRUITMENT AND
RETENTION AND LOAN
REIMBURSEMENT.
IS BY.
CREATING A SIGNIFICANT POLICY
CHANGE BECAUSE ITIT'S BEEN FAR
TOO LONG SINCE WE'VE SEEN A REAL
DECENT INVESTMENT IN LOW
REIMBURSEMENT FOR PHYSICIANS
HOUSES.
A FOLLOW UP LOS
YOU KALRA I KNOW THAT THAT.
CHANGES HARD TO THIS IS WHAT
YOU'RE PROPOSING IN THE GET
CHANGES PRODUCT TO CANCEL.
ONE CAN'T IS ONE HUNDRED PERCENT
CERTAIN OF THE DEVICE.
TERRIBLE THINGS CAN HAPPEN.
THE OTHER CAMP IS CAUTIOUSLY
OPTIMISTIC.
ON THE UPSIDE IT'S MY CHANGES SO
HARD.
SO ARE YOU ARE YOU.
ARGUING THAT.
THE THAT'S THAT THAT YOU COULD
MAKE A STRAIGHT FACE THAT A
GREAT NUMBER OF DOCTORS WOULD
BUT HAVE THEIR SITUATIONS. ARE
INCREASE AS FAR AS THAT THAT
THAT THE FINANCIAL WHEREWITHAL
AND THAT.
THAT BY.
MAKING SOME ADJUSTMENTS AT THE
ENDS THAT THAT WHOLE OVER ALL
THAT MANY THAT MORE THAN. FIFTY
PERCENT ARE CERTAIN POTENTIALLY
BETTER OFF.
WELL. CERTAINLY UP WHO AGREE
NUMBER THEM WOULD I CAN
CERTAINLY SAY THAT AND I CAN
THAT'S OUR GOAL.
OUR GOAL IS TO DO THAT BECAUSE
WE DO KNOW THAT THEIR PLENTY. OF
SOLO PRACTITIONERS WHETHER
THEY'RE IN URBAN AREAS WITH
THEIR MIDDLE CLASS NEIGHBORHOODS
OR RULE COMMUNITIES OTHER
STRUGGLING RIGHT NOW. AND OUR
GOAL IS TO. MAKE THEIR PRACTICES
SUSTAINABLE.
AS AS MUCH AS IT IS TO MAKE.
HEALTHCARE COSTS FOR BUSINESSES
AND PROFOUNDLY SUSTAINABLE AS
WELL.
SANTIAGO NAY MISSING HERE.
MISTER KALRA GOD BLESS YOU FOR
TAKING UP THIS ISSUE.
LOOK I'M NOT I'M NOT IN LOVE
WITH THIS BILL.
FOR SHARON IN UNITED HAD SOME
CONVERSATIONS.
BUT I WILL SAY THAT I'M HEAD
OVER HEELS AND SWEPT OFF MY FEET
ON THE ABILITY TO CONTAIN COSTS.
AND THAT MOTIVATES ME. ABOUT
THE WANT TO SUPPORT THIS BILL TO
GET OUT DRIVE TO GET AMERICAN
CONVERSATION.
I DO UNDERSTAND AND AGREE WITH
THE FACT THAT HEALTHCARE IS
RISING AND WE NEED TO FIGURE OUT
A WAY TO CONTAIN A. REDUCE ITS
COST.
AND SURE THAT EVERYBODY HAS
QUALITY HEALTHCARE.
MONTH I I AM SYMPATHETIC.
TOWARDS THOSE AT THE BARGAINING
TABLE.
CONTINUING TO HAVE TO FIGHT
OVER THIS ISSUE OVER AND OVER
AND OVER.
AND.
WHAT WHAT I HAD A CHALLENGE WITH
IT AND ALL SAY IT? OUT LOUD
ALTHOUGH UNITED TALKED IN AND
SPONSORS OF TALK.
IT IS.
YOU KNOW I CHALLENGE WITH
TARGETING PEOPLE.
AND YOU KNOW MY DOCTOR PERSON
TOO OBVIOUS.
AND IN FACT I LOVE MY DOCTOR AND
MOST OF YOU KNOW I'VE RECENTLY
HAD SURGERY AND.
HAD SURGERY HE CALL THE NEXT
MORNING CONTINUE TO CALL THE
ONCE EVERY COUPLE WEEKS.
AND I KINDA LIKE THE FACT THAT
YOUMAY BE IN THE SYSTEM FOR
SOME TIME I KINDA LIKE THE FACT
THAT HE MAY HAVE MADE. A LOT OF
MONEY BECAUSE IT MOTIVATES THEM
TO DO BETTER. AND IT MOTIVATED
THEM TO GIVE ME THE BEST QUALITY
OF CARE.
AND.
IN MY CHALLENGE WITH THE BILL
ORIGINALLY. IT IS THAT.
ALTHOUGH I HERE NOW CLEARLY IT'S
NOT TARGETING PROVIDERS WHEN I
REDID IT DID LOOK LIKE IT'S
TARGETING PROVIDERS.
AND AND.
AND. I WAS IN A PHILOSOPHICAL.
.-THE LIMIT HERE BECAUSE FOR THE
SAME REASON THAT I WANT TO
PROTECT THE NURSE.
NURSES WAIT FOR THE SAME REASON
I WANT PROTECT A JANITOR'S WHAT
WAGE INCREASE AND FOR THE SAME
REASONS THAT I WANT. A
CONSTRUCTION TRADES.
EMPLOYED TO INCREASE HIS OR HER
WAGE
IS THE SAME REASON NOW
PHILOSOPHIC THAT I HAVE TO BE
CHALLENGED TO.
ALLOW SOMEBODY TO DO THE BEST
THEY POSSIBLY CAN.
IN THE MARKETPLACE.
I DO ACKNOWLEDGE. THAT THERE
ARE SOME.
BUT I WOULD CALLS THROUGH SOME.
EXAGGERATED COST OR OR REAL HIGH
COST.
I MEAN CERTAINLY EARNED IS
CERTAINLY IN THE SPECIALTIES.
SPECIAL SPECIAL PROCEDURES
CERTAINLY AN UNPLANNED
PROCEDURES.
I KNOW WHICH BUT THIS IS THE
DILEMMA THAT I MEAN.
I WAS ALSO LITTLE BIT HARD
PRESSED.
COULD BECAUSE SEVERAL YEARS AGO
I POSED A BILL THAT HAD A
SIMILAR PARADISE. AND I THINK
IT'S A BUT A BILL THAT MISTER
BONTA CARRIED.
I HOPE I GET THE NUMBER RIGHT.
AB THREE FIVE FIVE.
BECAUSE IT DID CITY FLOOR IN
THE DID TALK ABOUT GOING TO A
PANEL.
AND IDEA AT THAT POINT AT THAT
POINT HOW MANY BELIEVE THAT.
THAT THIS WAS SOMETHING THAT WAS
FEASIBLE.
MEANING SETTING A FLOOR AND
DOCTORS EARLIER BOTH OF THIS
PANEL TO.
TO PROTEST THE INCOME I MEAN
THE THE.
PROCEDURE PRICE
OR WHAT THEY BRING IN SORRY.
.
AND I'M HOPING THAT SOMETHING
THAT CAN BE WORKED ON I DON'T
KNOW WHAT THE PERFECT SOLUTION
IS AND AND ALL THE.
ALL THAT I'VE SAID.
BUT I AM COMFORTABLE WITH
UNDERSTANDING WHERE YOU'RE
TRYING TO GET IN THAT SOMETHING
THAT I WANT TO SUPPORT AND I
WOULD URGE. ALL TO SUPPORT.
.
UNFORTUNATELY RAN OUT OF TIME
AND WE'VE GOT TO GET THIS. SIDE
I THINK CONVERSATION CONTINUE.
LOOK I'M STILL SKEPTIC ON THE
COMMISSION.
I I'VE SEVEN NUMBER OF TIMES
RIGHT AYE. AYE A LIST OWNER I'M
WITH YOU KNOW IT SHOULD BE STATE
DEPARTMENT HOW LIKE THE IDEAS
WITH ON OUR ULTIMATELY YOU WILL
MAKE THE DECISION AS TO WHAT
THE.
THE FAIREST APPROACH.
MIGHT BE.
AT BOTH.
BUDDHA CONSULTING WITH THEIR
SPONSORS AND HOPEFULLY
CONSULTING WITH THE OPPOSITION.
.
AND HOW
LIKE A A I JUST FINE HARD IN
SOME CASES TO BELIEVE.
THAT IT DIDN'T A BILL WE CREATE
A FAIR SYSTEM.
BUT BUT I'M HOPEFUL THAT IF
ANYONE CAN DO IT.
HEY I IT'S GOING TO BE YOU KNOW
I'M HOPEFUL ALSO THAT YOU PUT
SOME SORT OF.
STAKEHOLDER PROCESS TOGETHER AND
THAT YOU WILL AND THAT YOU WILL
TAKE INTO CONSIDERATION.
WITH THE OPPOSITION SAYS I
THINK THAT THAT'S MERITED AYE
IT'S HARD TO FORESEE A
COMMISSION.
DESIGNING A RATES THAT ARE GOING
INCLUDE FACILITY UPGRADES ARE
THEY'RE GONNA INCLUDE.
IT.
ANY NATURAL BECAUSE I ME WHAT
HAPPENS IF THE FACILITY UPGRADE
HAPPENS IMMEDIATELY OR A NEW
FACILITY HAS TO COME ON LIVES
EVERYBODY'S.
PRICES SPIKE UP FOR ONE YEAR
AND THEN GO DOWN FOR ANOTHER
YEAR LEGAL QUESTIONS ARE HARD.
TO ANSWER.
BUT I RECOGNIZE ROLL THIS
TOGETHER.
BUT I DO HAVE HE CHALLENGED.
ORIGINALLY WHEN I READ THE BILL
AND FELT LIKE IT TARGETED
SPECIFIC GROUP OF PEOPLE AND I
HAVE A BETTER UNDERSTANDING OF
IT.
I AND I'M CONFIDENT THE DOOR
CONVERSATIONS THAT YOU'LL
ADDRESS SOME OF THOSE CONCERNS
IT'S HIM FOR I WILL FACE. A.
GOOD GOD RESERVE MY RIGHT THE
TAKE A LOOK AT IT AGAIN ON THE
FLOOR. AYE BUT I THINK IT'S
IMPORTANT CONVERSATION HAD AND.
.
GOD BLESS YOU FOR DOING IT. I
CAN THINK OF ANYBODY BETTER THAT
WOULD TAKE UP THE CHALLENGE.
I AND THE HUSTLE OF DOING THIS
THANK YOU.
THE SECULAR CURRY.
THANK YOU SO MEMBER CARL FOR
BRINGING THIS FORWARD AND
ADDRESSING ALL THE QUESTIONS OF
THE COMMITTEE.
.
I'VE SAID TIME AND TIME AGAIN WE
NEED TO MAKE SURE WE HAVE HEALTH
CARE FOR ALL ON WHAT YOU NEED.
ME THROUGH A FOLLICLE.
BE RESPECTFUL. AND NOT LEAVE
ANYBODY OUT.
ONE OF THE THINGS THAT CAME UP
TODAY THAT AND WE DON'T NEED
GOING TO DETAIL NOW BECAUSE BEEN
A LONG TIME AND I MEAN MISTER
WHEN I STEPPED OUT BUT. MAJOR
DRIVER FOR THE HEALTH CARE.
WE RECOGNIZES LOW MEDI CAL
REIMBURSEMENT RATES INS NOT
ADDRESSED IN THE BILL THAT I CAN
SEE.
THE OTHER THING I WOULD WANT TO
COME BACK AND TALK TO YOU ABOUT
IS.
.
HECK WE COMPASS THIS BILL DOES
SEEKING INCREASED MEDI CAL RATES
AS WELL.
SO THOSE A COUPLE THINGS BUT
RECURSOS FIVE BEEN ANSWERED BUT
I AM VERY CONCERNED I'M A REAL
COMMUNITY WE HAVE FORTY PERCENT
FORTY SIX PERCENT ON MEDI CAL.
I I APPRECIATE YOU SAYING RURAL
SO MUCH BUT WHEN YOU SAY RURAL I
WANT YOU TO REALIZE RURAL NORTH
TO SACRAMENTO.
BECAUSE I FEEL LIKE OUR
DISTRICT IT'S LEFT OUT A LOT AND
I WOULD LIKE YOU I WOULD LIKE
THEM SO I'M HOPING I CAN GET
YOUR COMMITMENT TODAY. THAT WE
WILL HAVE SOMEONE ON YOUR
COMMISSION FROM A RURAL AREA
THAT OBVIOUSLY HAS THAT IS THE
QUALIFICATIONS. AND IT'S REALLY
IMPORTANT THAT WE HAVE SOME
REPRESENTATION IN OUR AREA.
AMID A VOTE FOR YOUR BILL TODAY.
.
BECAUSE I WANT TO CONTINUE THE
CONVERSATION I SAID YESTERDAY IN
A. BILL OF RUNNING SPLIT
TOUGHEST AS IF NOT NOW WHEN.
.
NEW.
I KNOW I WON DYING TO WORK WITH
I DIDN'T CATCH YOUR NAME IS ON
THE OPPOSITION TO YOUR BRAND
NEW.
I AM JUST REALLY INTRIGUED WITH
THE KNOWLEDGE OF GREEN TO THE
TABLE AND THAT YOUR WILLINGNESS
TO WORK WITH EVERYONE. AND I
CAN'T WAIT TO HAVE THOSE
CONVERSATIONS BILL FURTHER.
SO I'M ASKING ALL OF YOU.
SPONSORS OF THE OPPONENTS.
.
TO WORK TOGETHER.
BECAUSE YOU KNOW IS NOT AN
ANSWER.
AND.
I MEAN VOTE FREE TODAY BUT I
WANT TO MAKE IT REALLY CLEAR SO
THERE'S NO MISTAKE WHEN IT COMES
TO THE FLOOR.
IF I'M NOT COMFORTABLE WITH IT
THEN AND THEY'VE ALL WORKED
TOGETHER TO. HAVE SOME KIND OF
COLLABORATION AND.
RESPECT FOR THE WHOLE SYSTEM.
I'M NOT I MEA I CAN AFFORD SO
THANK YOU VERY MUCH LONG GUIDE
YOU CAUGHT ME AS SAYING RULE
OUT.
AS.
AND I ALSO EXCITED ABOUT WORKING
WITH CAMILLA CLEARLY SOMEONE
THAT BRINGS A LOT OF EXPERTISE.
OKAY I THINK EVERYBODY HAS
SPOKEN EXCEPT FOR ME.
AND I GOT A LOT OF NOTES AND I'M
NOT GONNA BELIEVE FOR A LOT OF
POINTS BUT IT THERE ARE SOME.
MYTHS I'M A PUT SOME THINGS OUT
THERE THAT I THINK ARE IMPORTANT
THAT THAT DIDN'T COME UP
POSSIBLY.
OR DICK CAME UP THAT I MAY MAY
NOT AGREE WITH.
.
NOBODY TALKED ABOUT WHAT HAPPENS
WHEN MEDICARE RATES GO DOWN THAT
ONE POINT THREE TRILLION DOLLAR
DEFICIT INCREASE IS GOING TO
CAUSE MEDICARE RATES TO GO DOWN.
THAT'S ALSO CAN AFFECT MEDICAID.
THAT IS A SIGNIFICANT CHALLENGE
GOING FORWARD.
AND ALTHOUGH SAVINGS THAT WE'RE
TALKING ABOUT MAY EVAPORATE.
WITH THOSE DECREASE IN MEDICARE
RATES.
THIS IS MORE COMMENTARY NOT
ASKING TO CONTENT JUMP JUSTICES
COMMENTARY.
.
TALKED ABOUT HOSPITALS BEING A
DRIVER IN THE COST AND THEY ARE
THE LEADING COST OF I BELIEVE
THAT CAME FROM.
MICHELLE CREEK CABRERA ABOUT
THEIR THAT THE LEADING COST
ABOUT THE FASTEST GROWING COST.
THAT MAY BE TRUE.
BUT.
DRUG PRICES ARE ONE OF THE
REASONS THAT HOSPITALS ARE.
COSTS ARE GOING UP AND SURGERY
CENTERS
AND THOSE ARE SIGNIFICANT SO WE
LEARNED THAT LAST YEAR WE TALKED
ABOUT DRUG PRICES. YES DRUG
PRICES MAY BE ON DRUGS MAY ONLY
BE THIRTEEN PERCENT BUT WHEN YOU
FACTOR IN HOSPITALS AND SURGERY
CENTERS THAT NUMBER GOES UP TO
OVER TWENTY.
SO SO.
JUST PUTTING THE INFORMATION
PRINT IT MAY INFORMATION OUT
THERE.
I AM CONCERNED WE HEARD A BILL
TODAY WE HAVE TWENTY HOSPITALS
WE WE WE'RE WE'RE WE'RE LOOKING
AT SEISMIC EXTENSION ON SEISMIC.
HUNDRED AND TEN BILLION DOLLARS.
WHAT WHAT HAPPENS IN THE FUTURE
OUR ABILITY TO REBUILD HOSPITALS
LOMA LINDA IS TEARING DOWN A
HOSPITAL IN BUILDING A MILLION
SQUARE FEET I CAN'T EVEN
COMPREHEND A MILLION SQUARE
FEET?
I CANNOT COMPREHEND MILLION
ANYTHING.
.
BUT THAT IS A HUGE HUGE COST
HUGE COST
AND THAT'S THAT'S SIGNIFICANT.
STUDENT DEBT I WISH IT WAS TWO
HUNDRED THOUSAND FOR FOR
RESIDENTS GET NOW SCHOOL BUT
THAT NUMBER IS.
FOR A LOT OF PEOPLE IS WAY
HIGHER THAN THAT.
AND WHILE YOU DID SO SOMEONE DID
SAY THAT YEAH THERE WE'VE WE
HAVE NIPPED THE BOTTOM ON
NURSING SHORTAGES NOT MY
DISTRICT. HUMBOLDT COUNTY.
NURSING SHORTAGE CRISIS.
AND SO WHILE I APPRECIATE THE
NUMBER OF TIMES YOU SAID RURAL.
YOU OUGHT TO COME TO MY
DISTRICT.
YOU DON'T KNOW RURAL INTO YOU'VE
ACTUALLY EXPERIENCED IT COME TO
MISS AGUIAR-CURRY.
FLORA.
PARTS MISTER MAYES MISTER
BIGELOW.
CHALLENGES ARE DIFFERENT.
THEY'RE VERY DIFFERENT AND EVEN
WITH INCREASE MEDICARE RATES.
I DON'T SEE HOW WE GET DOCTORS
WHERE WE NEED THEM TO GET
BECAUSEWE HAVE TO PAY DOCTORS
WERE THAT WE HAVE TO HELP THEIR
EDUCATION AND SO. YOU TALKED
ABOUT INST PEOPLE SOMEONE TALK
BUT IN THE INDUSTRIAL KIND EYES
COUNTRIES AND HOW THEY HAVE. THE
ONE THING THAT THEY'VE ALL DONE
TO IT TO MAKE HEALTHCARE MORE
AFFORDABLE IS IS FIX PRICES.
THERE'S TWO THINGS.
OTHER THING THEY'VE DONE IS
SUBSIDIZED MEDICAL EDUCATION FOR
ALL PROVIDERS NOT JUST DOCTORS.
BUT NURSES AND EVERYONE ELSE.
SO WE NEED TO GET THAT OUT THAT
THAT'S A BIG BIG COMPONENT FOR
US GOING FORWARD.
.
I COULD GO ON.
AND I I I DO GET CONCERNED
ABOUT.
WHEN REVENUES GO DOWN BUT THIS
AT MEAN TO THE WORK FORCE.
AND.
AND I I DO HAVE HAVE CONCERNS
ABOUT DOT SO.
A LOT A LOT HERE.
BUT I WANT TO SAY YOU KNOW.
I KNOW THE COST IN AFFORDABILITY
IS IS A REAL PROBLEM ONCE A
PERSONAL STRUGGLE FOR SO MANY
PEOPLE SO MANY PEOPLE IN MY
DISTRICT.
AND I'M GOING THROUGH.
AT FAMILY ISSUE NOW WITH.
RELATIVES BEEN HOSPITAL FOR
ALMOST FOUR WEEKS.
I SHUDDER TO THINK WHAT THAT'S
GOING TO COST IN THE AND.
I DON'T HOW OR HOW MANY DOCTORS
WHO HAVE SEEN.
SCENE.
SEEN THIS PERSON.
AND IT'S A IT'S YOU CHALLENGES
AND FAMILIES ALL OVER THE
COUNTRY ARE STRUGGLING WITH THIS
SO COST IS A REAL REAL ISSUE.
IN OUR CAPITAL DISTRICT OFFICES
WE'VE GOT HUNDREDS OF CALLS IT'S
NOT AN EXAGGERATION HUNDREDS OF
CALLS. WE KNOW THAT THEIR FEARS
ARE REAL AND SOME OF THESE FEARS
ARE GENERATED FROM THAT
CHALLENGES E'RE FACING WITH THE
FEDERAL GOVERNMENT. WHO'S
LOOKING FOR WAYS TO TO TO MAKE
OUR LIVES HARDER HERE.
AS HEALTHCARE PROVIDERS AS AS
HOSPITALS OR WHATEVER TO PROVIDE
CARE PEOPLE THAT REALLY NEED IT.
I WANT TO THANK THE AUTHOR AND
SPONSORS BECAUSE OF THEIR
DEDICATION TO TRY TO TIP FOR
HAVING THIS DISCUSSION.
TRYING TO MAKE UP ABOUT
HEALTHCARE MORE AFFORDABLE.
I ALSO WANT TO THANK YOU FOR THE
COURAGE. TO BRING UP A REAL
DIFFICULT CONTROVERSIAL SUBJECT.
AND YOUR WILLINGNESS TO WORK
WITH ME IN MY STAFF TO ADDRESS
SOME TO SOME ISSUES I TELL
PEOPLE OVER AND OVER AGAIN.
THAT.
I'M AYE AYE. AYE ASK HARD
QUESTIONS BECAUSE WE HAVE TO
HAVE THE ANSWERS AND IT IS NOT
IT IS NOT IN THE SPIRIT OF
TRYING TO.
SQUASH AND ISSUE IT'S IN THE
SPIRIT OF TRYING TO UNDERSTAND
AND BRING THOSE ISSUES OUT SO WE
CAN TALK ABOUT THEM.
I THINK YOU'VE WITNESSED TODAY.
THAT MANY MEMBERS OF THIS
COMMITTEE HAVE QUITE FEW
CONCERNS ABOUT THE BILL AND
WHETHER IT'S THE RIGHT APPROACH.
.
I THINK EVERYONE ON THIS
COMMITTEE WANTS TO ADDRESS COST
CONTAINMENT.
BUT THEY'RE NOT REALLY
CONFIDENT THAT RATE REGULATIONS
THE RIGHT RIGHT DIRECTION.
I THINK IT'S PRETTY OBVIOUS THE
BILL'S GOING WITHOUT A COMMITTEE
TODAY.
AND.
AS IT CONTINUES TO THE MOVE
THROUGH THE PROCESS I HOPE TO BE
OPEN TO FURTHER DISCUSSIONS
YOU'VE HEARD MANY PEOPLE TALK
ABOUT OF A ROBUST STAKEHOLDER
PROCESS.
AND TO THE EXTENT THAT THAT IS
POSSIBLE.
I'D LIKE TO SEE THE A JUST FOR
IT THE AT ISSUES ADDRESSED IN A
WAY THAT INCENTIVIZE IS.
COST CONTAINMENT. WHILE
MINIMIZING THE POTENTIAL IMPACTS
THAT THAT IT COULD HAVE.
VERY DIFFERENT CARROT A CARROT.
NOT NECESSARILY A STEP.
.
AFTER THOSE TWO ARGUING AGAINST.
AB THIRTY EIGHTY SEVEN.
.
THANK YOU REALIZED YOU SHOULD
REALIZE A COST CONTAINMENT ISN'T
GOING AWAY. MAKERS TO HEAR THAT
CMA AS ACCIDENT VOTE THEIR
ENTIRE HOUSE OF DELEGATES TO
THIS ISSUE.
AS WE TALKED WITH.
FORMA.
THE LAST COUPLE OF YEARS NO IS
NOT.
AN ADEQUATE ANSWER.
RATING POTENTIAL SOLUTIONS TO
THE TABLE WORK WITH US.
IF THIS BILL IS NOT SUCCESSFUL
IN THE LONG RUN A BILL WILL COME
BACK.
WE NEED TO WORK COLLABORATIVELY
TO SOLVE THIS THIS IS A HUGE
HUGE ISSUE FOR PEOPLE.
AND.
YOU KNOW.
JUST.
WE'VE GOT TO COME TOGETHER AND
NOT NO NO CANNOT BE THE ANSWER.
THAT THAT THERE'S TOO MUCH AT
STAKE FOR CALIFORNIANS WE CANNOT
CONTINUE DOWN THIS PATH.
AND.
I HOPE THAT IN THE SPIRIT OF
THAT THAT AS WE MOVE FORWARD WE
CAN CONTINUE TO CONTINUE THESE
DISCUSSIONS.
WITH THAT.
.
IS THE CHAIR LIKE TO MOVE THE
BILL SO I CAN.
.
YOU NO CLEARLY BILLS NOT PERFECT
BUT I THINK THE AUTHOR IS
DEMONSTRATED A FRAMEWORK.
THAT CAN ADDRESS ALL THE ISSUES
THAT CAME UP TODAY AND I WANT TO
COMMEND THE AUTHOR.
FOR FIELDING ALL THE CONCERNS
THAT HAVE COME UP TODAY.
IN PARTICULAR THE CONCERNS THAT
I HEARD ABOUT.
ABOUT DOCTORS AND.
FOR TAKING IT SINCERELY BECAUSE
THERE WERE SERIOUS CONCERNS AND
YOU'VE ADDRESSED THEM.
I THINK THAT THIS BILL IS TAKING
WHAT'S BEST ABOUT MARILYN.
IT'S SAYING THAT WE CAN EXPAND
ON IT.
IN A CALIFORNIA KIND WAY.
I REALLY APPRECIATE MY
COLLEAGUES WHO. REALLY BEEN
DIRECT AND FORTHRIGHT ABOUT.
WHAT THE LIKE WHAT THEY'RE
CONCERNED ABOUT A I THINK THE
CONVERSATIONS BEEN VERY ROBUST?
AND IT CREATES A PATHWAY FOR HOW
TO STRENGTHEN THE BILL.
I APPRECIATE.
THE UNIQUE.
OPPORTUNITY TO PROVIDE MORE MEDI
CAL ACCESS BY GIVING INCENTIVES
TO THOSE POSITIONS WHO WILL
SERVE THOSE.
WHO ARE MEDI CAL I THINK IS A
VERY?
UNIQUE INTERESTING PROVISION IN
THE BILL. AND I HOPE THAT ALL MY
COLLEAGUES HERE WILL SUPPORT IT
TODAY EVEN IF YOU HAVE CONCERNS
AND GIVEN AN OPPORTUNITY TO
CONTINUE TO WORK THROUGH THE
PROCESS. AND STAKEHOLDER PROCESS
TO MOVE BEFORE I MOVE THE BILL
FOR.
SO WOULD YOU LIKE TO CLOSE
HOPEFULLY BRIEFLY.
THANK. THANK YOU MISS SUDDENLY
HOT BUT ADEQUATELY.
I PERCENT THINKING AS CHAIR AND
YOU KNOW THE AMENDMENTS ARE MUCH
OF WHICH WERE IN.
INCLUDED BASED UPON STAKEHOLDER
FEEDBACK AS WELL AS FEEDBACK
FROM THE CHAIR AND OTHER
MEMBERS.
OF OUR NINE AND THE JUST THE
BEGINNING.
TO THE CONVERSATION THAT IS
REQUIRED GOING FORWARD IT THIS
IS A OF OF UNFORTUNATE ABOUT
THIS FILM WITH THIS COMMITTEE.
AND AS INDICATED THAT DOESN'T
TAKE INTO ACCOUNT.
.
OR AS THE POP SYNDICATE IS
TAKING ACCOUNT THE MAJOR DRIVERS
HEALTH BECAUSE I BELIEVE THIS
COMMISSION DOES HAVE THE ABILITY
TO DO JUST THAT.
TO THE GREATEST EXTENT WE
POSSIBLY CAN THAT'S WHY INCLUDES
PACIFIC CONCERNS REGARDING
PRESCRIPTION DRUGS OF THE EDI
CAL OF THE ISSUE.
DOCTOR SHORTAGE IN ON ON. WHAT
WE'RE DOING IS TRYING TO PUT IN
PLACE SOME KIND OF COST AND WHAT
WE'RE NOT DOING IS HAVING THE
LEGISLATURE SET RATES AN ADHOC
FASHION THAT?
THAT ARE FIXED THAT ARE GOING
TO A BOOTH THAT WOULD SOMEHOW.
.
CRIPPLE THE ABILITY FOR DOCTORS
TO BE ABLE TO PROVIDE SERVICES
WHAT HAPPENED A DOESN'T WORK
WE'RE NOT TAKING OVER THE ACTUAL
DELIVERY SYSTEM. TO GO BACK TO
THE STATUS QUO. I AND I JUST
WANTED.
CLOSE BY TWO THINGS WHO BY COULD
MISTER CHAIR OF A ONE IS THAT I
UNDERSTAND HOW. POLITICS WORKS
AND HOW ABOUT HIS USUAL WORKS IN
THIS BUILDING IN MANY STATE
HOUSES AROUND THE NATION.
.
AND I WOULD JUST SAY THE STATUS
QUO UP AN INITIAL LIKE THIS IS
UNACCEPTABLE.
I'D THIS BILL MAKES OUT OF THIS
COMMITTEE I RESPECTFULLY URGE
OPPOSITION TO UP ó ABANDONED
POLITICS AS USUAL PLEASE COME
JOIN ME ALONG WITH MY
COLLEAGUES.
SPONSORS OTHER STAKEHOLDERS.
GIVE US SUGGESTIONS AND I
PROBABLY WON A CLOSE BY THANKING
THE CHAIR FOR HIS EXTRAORDINARY
DEDICATION NOT JUST INVENTING
THIS BILL. BUT DURING HIS ENTIRE
TIME THE LEGISLATURE
PARTICULARLY THE LAST YEAR AS
THE ASSEMBLY IN THE SLOT
COMMITTEE MEMBERS OF WORKED
IDENTIFY CHALLENGES AND
OPPORTUNITIES TO IMPROVE OUR
HEALTHCARE DELIVERY SYSTEM. IS
YOUR WORK ALONG WITH THE WORK MY
COLLEAGUES THAT HAVE INSPIRED ME
TO TAKE THIS PAST WAS MEANINGFUL
COST CONTAINMENT OF AN INDUSTRY
SO VITAL TO THE PEOPLE WE
REPRESENT. I BELIEVE THAT
HEALTHCARE IS A RIGHT.
AND AS LEGISLATORS OF THIS GREAT
STATE IF WE ABDICATE OUR
RESPONSIBILITY TO ENSURE THAT
ACCESS TO AFFORDABLE HEALTHCARE
IS AVAILABLE TO ALL
CALIFORNIANS.
THEN WE'RE IGNORING WHEN THE
GREATEST THREATS TO SUSTAINABLE
ECONOMY. AND THE HEALTH AND WELL
BEING OF FUTURE GENERATIONS.
THE STATUS QUO ISN'T GOOD ENOUGH
FOR ME THE STATUS QUO ISN'T GOOD
ENOUGH FOR CALIFORNIANS I KNOW.
THE STATUS QUO ISN'T GOOD ENOUGH
FOR YOU AND I RESPECTFULLY ASK
ME I DON'T.
THANK YOU ONCE AGAIN MISTER
KALRA THANK YOU TO EVERYONE.
SPONSORS
OPPOSITION WITNESSES APPRECIATE
APPRECIATE THE DIALOGUE MEMBERS.
THEM SECRETARY.
WE DO HAVE A MOTION SORRY WEBER
MOTION TO HAVE A SISTER.
THE MOTION OF THE MOTION IS BY
MR THURMAN THE SECOND IS BY
MISTER SANTIAGO THE MOTION IS TO
PASS AS AMENDED TO
APPROPRIATIONS.
AND SECRETARY PLEASE CALL THE
ROLL WOULD I THINK WOULD AYE
MAYES. MAYES NO ANGER CURRY.
AGAR CURRY I BIGELOW. BIGELOW
NOW BONTA. BONTA AYE BURKE.
CARILLO YES
CARILLO AYE FLORA.
FLORA NOVA MON.
MCCARTY. MCCARTY AYE NAZARIAN
AYE NAZARIAN AYE RODRIGUEZ.
SANTIAGO AYE AYE SANTIAGO AYE
THURMAN. THURMOND AYE WALDRON.
WILDER NO.
THE BILL IS OUT DATA FOR WILL
LEAVE THE ROLE OPEN FOR OTHERS
TO ADD ON THANK YOU MISTER KALRA
THINK HEROES.
WE'RE GONNA MOST MR MCCARTY FOR
ONE BILL. AND HE'S GOING TO.
WELL WELL. WELL YOU GET THE ONE
FIRST.
I WANTED TIME MISTER MISTER
MCCARTY AND WRITTEN DIFFERENCE
YOUR WITNESS THE FOLLOWED BY MR
KILEY
OKAY THIS RECORD.
THANK YOU MISTER CHAIR AND.
MEMBERS AND THANK YOU FOR
COMMENTING.
OUR WITNESS HERE.
I HAVE BEFORE US SEVENTEEN FORTY
FOUR.
WHICH WOULD MAKE AFTER SCHOOL
PROGRAMS IN CALIFORNIA ELIGIBLE
FOR FUNDING FROM PROP SIXTY FOR
THE ADULT USE OF MARIJUANA ACTED
FIRST I. WANT TO THANK OUR
COMMITTEE OR STAFF FOR WORKING
WITH US AS WE KNOW CALIFORNIA
VOTERS PASSED THIS MEASURE UP TO
BILLION DOLLARS WILL BE. BEFORE
US TO DECIDE SIMILAR TO OUR CAP
AND TRADE PROGRAM WILL HAVE A
LOT OF GOOD IDEAS.
LA DEBATE ON HOW TO SPEND THOSE
MONIES I JUST WHAT DID WANT TO
NOTE THAT WHEN THIS WAS BEFORE
THE VOTERS IN THE BALLOT
STATEMENT.
IT PROMISE THAT THIS WOULD RAISE
BILLIONS FOR AFTER SCHOOL
PROGRAMS TO HELP KIDS STAY IN
SCHOOL. AND THERE WERE TV ADS
THAT FOCUSED ON JUST THIS.
PROP FIFTY FOUR FUNDS AFTER
SCHOOL PROGRAM SO THAT SAID THE
MESSAGE IS VERY SIMPLE. WE
SHOULD KEEP THAT PROMISE I MADE
TO THE VOTERS AND FOCUS ON AFTER
SCHOOL PROGRAM TO SERVE ABOUT A
HALF A MILLION KIDS.
DEALING CALIFORNIA UNDERSERVED
COMMUNITIES DO A WORLD A GOOD
KEEPING KID SAFE OUT OF TROUBLE
AND THAT WITH ME TODAY. OUR I
REPRESENT FOR A SACRAMENTO
pCAPTAIN KATHY LESTER WHO HAVE
KNOWN A LONG TIME WORKING HERE
IN SACRAMENTO. AND THE
CALIFORNIA AFTER SCHOOL ADVOCACY
ALLIANCE.
GOOD EVENING MY NAME IS KATHY
LESTER A CAPTAIN WITH SACRAMENTO
POLICE DEPARTMENT I'VE BEEN
THERE FOR TWENTY FOUR YEARS
CURRENTLY AYE OVERSEAS DIVISION
OF OUT REACHING ENGAGEMENT WHICH
ENCOMPASSES ALL OF OUR SCHOOL
PROGRAMS. AND OVERSEAS ABOUT
FIFTY FIVE THOUSAND AYE CHILDREN
SACRAMENTO CITY SCHOOLS I AM
PLEASED TO REPRESENT SACRAMENTO
POLICE CHIEF DANIEL HAHN. AND TO
SPEAK IN SUPPORT OF THE FOUR
HUNDRED MEMBERS OF FIGHT CRIME
INVEST IN KIDS THIS IS AN
ORGANIZATION OF POLICE CHIEFS
SHERIFF'S DISTRICT ATTORNEYS AND
CRIME VICTIMS. AND CHIEF HAN HAS
BEEN A LONG TIME MEMBER OF FIGHT
CRIME INVEST IN KIDS.
WE SUPPORT AB SEVENTEEN FORTY
FOUR BECAUSE AFTER SCHOOL
PROGRAMS ARE CRITICAL TO
EFFECTIVE CRIME FIGHTING
EFFORTS.
I UNDERSTAND THE MANY BENEFITS
OF AFTER SCHOOL PROGRAMS NOT
ONLY AS A WORKING PARENT OF
THREE CHILDREN BUT ALSO FROM MY
EXPERIENCES AS A POLICE OFFICER.
WE KNOW THAT AFTER SCHOOL
PROGRAMS KEEP KIDS ENGAGED THEY
PREVENT CRIME AND THEY TEACH
VALUABLE SOCIAL EMOTIONAL SKILLS
WHICH HELP THEM BE SUCCESSFUL
LATER IN LIFE. AFTER SCHOOL
PROGRAMS HELPED CUT CRIME
IMMEDIATELY BY KEEPING KIDS OFF
THE STREETS AWAY FROM GANGS AND
DRUGS DURING THE CRITICAL TIME
OF THREE PM TO SIX PM.
AND THEN THE LONG TERM THE IT
ALSO HELPED CUT CRIME BY KEEPING
KIDS ENGAGED IN SCHOOL.
IMPROVING ATTENDANCE ON HELPING
THEM DEVELOP STRONG
RELATIONSHIPS BETWEEN ADULTS AND
KEEPING KIDS ON TRACK TO
GRADUATE. UCLA DID A STUDY
RECENTLY.
OF THE.
OF AFTER SCHOOL PROGRAMS AND
THE LOS ANGELES UNIFIED SCHOOL
DISTRICT AND THEY FOUND.
WHILE TRACKING CHILDREN BETWEEN
ELEMENTARY AND HIGH SCHOOL THAT
KIDSTHAT PARTICIPATE IN AFTER
SCHOOL PROGRAMS HAD A TWENTY
PERCENT LESS CHANCE OF BEING A
DROP OUT THERE WERE THIRTY
PERCENT LESS LIKELY. TO ENGAGE
IN CRIME.
SO CALIFORNIA HAS MADE SOME
GREAT INVESTMENTS IN AFTER
SCHOOL PROGRAMS.
THEY AND SUPPORTING PROGRAMS
OVER FOUR THOUSAND SCHOOLS DALY
MORE FUNDING IS NEEDED TO
SUSTAIN EXISTING PROGRAMS THAT
STRUGGLE WITH LOW REIMBURSEMENT
RATES. AND TO ESTABLISH NEW
PROGRAMS INCLUDING I'M IN NEARLY
THREE THOUSAND LOW INCOME
SCHOOLS THAT RECEIVE A LITTLE OR
NO STATE AND FEDERAL FUNDING.
INVESTING IMPROPER IS AIR
INVESTING PROP A SIXTY FOUR
FUNDS IN AFTER SCHOOL PROGRAMS
MAKES COMMON SENSE AND THE
CONNECTION IS REALLY VERY CLEAR.
NOT ONLY DOES DRUG USE LIKE
OTHER COMPLECTED BE PEAK AFTER
SCHOOL RESEARCH SAYS THAT
PARTICIPATING IN AFTER SCHOOL
NOT ONLY REDUCES DECIDE DRUG USE
BUT ALSO PROVIDES FOR PHYSICAL
ACTIVITY. AS WELL AS A
PRODUCTIVE AND HEALTHY
ENVIRONMENT FOR CALIFORNIA'S
KIDS AND FOR THIS REASON LAW
ENFORCEMENT LEADERS ACROSS THE
STATE SUPPORT EIGHTY FORTY. AB
SEVENTEEN FORTY FOUR THANK YOU
FOR THE OPPORTUNITY TO SHARE
PERSPECTIVE.
THE THINGS I THINK.
YEAH.
THIS.
GOOD EVENING JENNIFER DIETRICH
ON BEHALF OF THE PARTNERSHIP FOR
CHILDREN AND YOUTH AND THE
CALIFORNIA AFTER SCHOOL ADVOCACY
ALLIANCE WHERE. COALITION OF
TWENTY MORE THAN TWENTY AFTER
SCHOOLPROGRAMS AND ADVOCACY
ORGANIZATIONS ACROSS CALIFORNIA
THAT SERB HUNDREDS OF THOUSANDS
OF STUDENTS.
EACH DAY.
WE STRONGLY SUPPORT AB SEVENTEEN
FORTY FOUR TO HELP ENSURE THAT
THE PROMISE OF PROP SIXTYFORCE
CAT.
SO THAT A PORTION OF THE TAX
REVENUE WOULD GO TO AFTER SCHOOL
PROGRAMS IN CALIFORNIA'S MOST
UNDERSERVED COMMUNITIES.
AS ASSEMBLY MEMBER MCCARTY HAS
ARTICULATED PROP SIXTY FOUR
CAMPAIGN ADVERTISEMENTS
PROMINENTLY FEATURED AFTER
SCHOOL PROGRAMS AS A. PRINT AS A
PRIME BENEFICIARY.
PROP SIXTY FOUR TAX REVENUE.
BUT THERE ARE NO ASSURANCES THAT
AFTER SCHOOL PROGRAMS WILL SEE A
DIME.
SO THAT'S WHY AB SEVENTEEN FORTY
FOUR IS NEED AT.
AND. IN ADDITION TO THE HEALTH
AND SAFETY ASPECTS OF OF AFTER
SCHOOL PROGRAMS THEY ALSO HELP
TO PROVIDE HUNDREDS OF
ADDITIONAL ACADEMIC HOURS AN
ENRICHMENT ACTIVITIES FOR THE
STUDENTS. WHO NEED THEM MOST?
AFTERSCHOOL PROGRAMS FUNDED BY
THE STATE AND FEDERAL
GOVERNMENTS.
EIGHTY PERCENT OF THEM ARE
ELIGIBLE FOR FREE AND REDUCED
PRICE MEALS.
BUT WITHOUT ADDITIONAL FUNDING
FROM THE STATE OF CALIFORNIA
THESE AFTER SCHOOL PROGRAMS ARE
AT RISK OF SHUTTING DOWN PUBLIC
FUNDING HASN'T KEPT PACE WITH
THE RISING COSTS OF PROVIDING A
QUALITY PROGRAM.
IN DECEMBER WE DID A SURVEY OF
AFTER SCHOOL PROGRAMS
REPRESENTING MORE THAN TWO
HUNDRED SCHOOL DISTRICTS ACROSS
CALIFORNIA. NINETY EIGHT
PERCENT.
OF STATE FUNDED AFTER SCHOOL
PROGRAMS SAID THAT THEY WOULD BE
NEGATIVELY BE NEGATIVELY
IMPACTED IF THEY DON'T RECEIVE
ADDITIONAL FUNDING FROM THE
STATE.
IMPACTS LIKE DIFFICULTY
ATTRACTING AND RETAINING
QUALITY.
STAFF HAVING TO REDUCE
PROFESSIONAL DEVELOPMENT FOR
STAFF HAVING TO REDUCE ACADEMIC
SUPPORT AND ENRICHMENT
ACTIVITIES FOR STUDENTS.
THESE ARE THE PEOPLE AND THE
SUPPORT THAT BILL THOSE
PROTECTIVE AND RESILIENCY
FACTORS THAT HELP PREVENT
SUBSTANCE USE.
KEEPS KIDS IN SCHOOL AND BOOST
THEIR ACADEMIC SUCCESS AND WELL
BEING.
UNDER FUNDING ALSO REDUCES THE
NUMBER OF STUDENTS SERVED IN OUR
SURVEY NEARLY A FOURTH OF STATE
PROGRAMS ARE VERY LIKELY TO
CLOSE THEIR DOORS WITHIN THE
NEXT TWO YEARS WITHOUT
ADDITIONAL FUNDING. AND AS IT IS
OVER TWENTY NINE HUNDRED LOW
INCOME SCHOOLS DON'T RECEIVE
STATE OR FEDERAL FUNDING FOR THE
AFTER SCHOOL PROGRAMS SO FOR
EXAMPLE ONE IN FOUR PROGRAMS
THAT APPLIED FOR FEDERAL FUNDING
LAST YEAR. DIDN'T RECEIVE ANY SO
THERE'S NO SHORTAGE OF DEMAND
BUT THERE'S A SHORTAGE OF
FUNDING SO WE PLEASE ASK THAT
THE COMMITTEE VOTE I AND AB
SEVENTEEN FORTY FOUR TO KEEP THE
PROMISE.
VOTERS THAT TAX REVENUE FROM
PROP SIXTY FOUR GOES TO PROGRAMS
THAT EFFECTIVELY SUPPORTS
CHILDREN AND YOUTH AND PREVENT
REDUCE SUBSTANCE USE IN
COMMITTEES THAT BEEN
DISPROPORTIONATELY AFFECTED BY
THE WAR ON CRIME. HORN DRUGS.
THANK THANK YOU VERY MUCH OTHERS
IN SUPPORT JUST YOUR NAME AND
ORGANIZATION.
MISTER CHAIR AND MEMBERS ANDREA
BALL OF THE HALF OF THE
CALIFORNIA SCHOOL BOARDS
ASSOCIATION IN SUPPORT.
JESSICA HAY ON BEHALF OF THE
CALIFORNIA AFTER SCHOOL NETWORK
IN SUPPORT.
CAN LUIS ON BEHALF CHILDREN NOW
IN SUPPORT.
STENA MARCELLUS ON BEHALF OF THE
SAN FRANCISCO UNIFIED SCHOOL
DISTRICT IN THE CALIFORNIA
ALLIANCE OF BOYS AND GIRLS CLUB
IN SUPPORT.
MEDI PORN REPRESENTING AMERICAN
CAN YOU PEDIATRIC CALIFORNIA
DIVISION IN SUPPORT THANK YOU.
CHRIS SLEPT WARMLY CALIFORNIA
STATE ALLIANCE OF YMCAS IN
SUPPORT.
I HAVE JUST BEEN ALSO ON BEHALF
OF STATE SUPERINTENDENT OF
PUBLIC INSTRUCTION TOM TOWARD
EXTENDING SUPPORT.
MUCH.
IS THERE ANYONE IN OPPOSITION.
SEE NO ONE BRING BACK TO THE
COMMITTEE FOR QUESTIONS OR
COMMENTS.
SEEN NINE WHICH I LIKE TO CLOSE
MISTER ACCORDING.
THANK YOU ASPIRATE.
SO YOU HAVE A OF THE FIRST I
THINK YOU FOR BRINGING TO GO
FORWARD AND I I I I. AGREE.
COMPLETELY WITH THE INTENT.
I HOPE THAT THE TAX REVENUE IS
ROBUST ENOUGH TO DELIVER ON THE
PROMISE.
WE SHALL SEE IN TIME.
AS AS THAT HAPPENS BUT TO
APPRECIATE I APPRECIATE WHAT
YOU'RE DOING PROCEDURE WITNESSES
AND OUT THE BILL ENJOYS A DO
PASS RUSH RECOMMENDATION. WE
HAVE A MOTION BY ITS DO PASS AS
AMENDED TO APPROPRIATIONS
MOTIONS BY MR THURMAN THE
SECONDS BY MR MAYES ABOUT
SECRETARY PLEASE CALL THE ROLL
WOULD. I WOULD I MAYES.
AGUIAR-CURRY. AGUIAR-CURRY AYE
BIGELOW.
BIGELOW AYE BONTA BONTA AYE
BURKE.
BURKE I CARILLO.
FLORA.
FLORA ISLA MON.
MCCARTY AYE MCCARTY AYE THIS
AREA.
RODRIGUEZ.
SANTIAGO. SANTIAGO AYE THURMAN
THURMOND AYE WALDRON.
THE BILL HAS NINE VOTES ITS
OUTGOING THANK YOU VERY MUCH MR
MCCARTY WILL GET YOUR OTHER ONE
A LITTLE LATER MR KILEY.
KILEY HAVE ITEM NUMBER ELEVEN.
AB TWENTY TWO EIGHTY SEVEN.
THANK YOU MISTER CHAIRMAN RESIDE
IT'S BEEN A LONG HEARING AND
SAID IT IS NOT THAT CLOSE TO TO
BEING OVER SO I'M GONNA SKIP
OVER OUR REMARKS I. I WAS GOING
TO GIVE ABOUT. THE.
THAT THE MAGNITUDE OF MENTAL
HEALTH NEEDS IN CALIFORNIA THE
GAPS THAT EXISTS IN ACCESS TO
TREATMENT IN THE AYE REPORTS BY
THE LITTLE HOOVER COMMISSION THE
STATE AUDITOR THAT HAVE. I HAVE
DOCUMENTED A LOT OF THIS OF
COURSE OF THEIR QUESTIONS ABOUT
THAT WE CAN NOT CERTAINLY I I
DELVE INTO ANY OF THOSE TOPICS
NOT AS QUICKLY SUMMARIZE FOR YOU
AT THIS BILL DOES TO ADDRESS
THAT. ARE THE ISSUE I'M IN THIS
BILL WOULD ADDRESS THESE ISSUES
BY REQUIRING THE MENTAL HEALTH
SERVICES OVERSIGHT AND
ACCOUNTABILITY COMMISSION TO DO
THREE THINGS.
FIRST DEVELOP A FISCAL
PROGRAMMATIC AND HOW COME
TRANSPARENCY AND ACCOUNTABILITY
STRATEGY FOR LOCAL GOVERNMENT
MENTAL HEALTH.
I ASKED SECOND DEVELOP A FISCAL
PROGRAMMATIC AN OUTCOME
TRANSPARENCY AND ACCOUNTABILITY
STRATEGY FOR STATE GOVERNMENT
MENTAL HEALTH.
THIRD ASSESS THE ADEQUACY OF
EXISTING STATUTORY AND
REGULATORY DATA REPORTING
REQUIREMENTS STRATEGIES AND
PRACTICES AND THIS INCLUDES
MAKING RECOMMENDATIONS TO THE
GOVERNOR AND LEGISLATURE FOR
STREAMLINING AND STRAIGHTEN
THOSE STRATEGIES. TO REDUCE
COSTS AND IMPROVE THE USE OF
INFORMATION TO GUIDE PROGRAM
FISCAL AND RELATED DECISIONS
I THE BILL WOULD ALSO REQUIRE.
THE COMMISSION TO REPORT BACK
TO THE LEGISLATURE NO LATER THAN
TWENTY TWENTY WHEN UPDATE ON THE
PROGRESS OF THE TRANSPARENCY AND
ACCOUNTABILITY STRATEGY.
I RESPECT RESPECTFULLY ASK WE
ARE AYE VOTE AND WITH ME TODAY
TO OFFER THE DISCUSS THESE
ISSUES IS TOBY EWING. WHO IS THE
EXECUTIVE DIRECTOR OF THE MENTAL
HEALTH SERVICES OVERSIGHT AND
ACCOUNTABILITY?
GOOD EVENING MISTER CHAIR AND
MEMBERS MY NAME IS TOBY DOING
I'M THE EXECUTRIX OF THE MENTAL
HEALTH SERVICES OVERSIGHT
ACCOUNTABILITY COMMISSION THE
BILL WOULD GIVE THE COMMISSION
EXPLICIT AUTHORITY TO TO BUILD
THE STRATEGY. TO MAKE SURE THAT
OUR MENTAL HEALTH SYSTEM IS
TRANSPARENT AND ACCOUNTABLE IN
TERMS OF THE DOLLARS THAT
COUNTIES RECEIVE TO PROVIDE
SERVICES TO FOLKS IN NEED THE
TYPES OF SERVICES THAT ARE
THERE.
INCLUDING ENSURING THAT WE
ADDRESS THAT THE RACIAL AND
ETHNIC DISPARITIES THAT ARE
CHALLENGING ACROSS THE STATE.
AND THEN THE THIRD PIECE IS THE
OUTCOMES.
THE THAT THE COMMISSION HAS
BEEN WORKING WITH THE AUTHOR TO
CRAFT THIS ALTHOUGH THE
COMMISSION MEETS THURSDAY TO
TALK ABOUT THE BILL AND DOES NOT
HAVE AN EXPLICIT SUPPORT
POSITION WE'D APPRECIATE THE
OPPORTUNITY TO CONTINUE TO WORK
WITH THE AUTHOR. TO STRENGTHEN
THIS AND MAKE SURE IT'S ALIGNED
WITH THAT THE BROAD GOALS THAT
THE COMMISSION HAS IN OUR
ABILITY TO ACTUALLY SUPPORT
PUBLIC ACCOUNTABILITY IN TERMS
THE MENTAL HEALTH SYSTEM. HAPPY
TO RESPOND TO ANY QUESTIONS YOU
MIGHT HAVE.
OTHERS IN SUPPORT.
SEE NO IS THERE ANYONE IN
OPPOSITION TO THE BILL.
GOOD EVENING I'M MARRIED THERE
WITH COUNTY BEHAVIORAL HEALTH
DIRECTORS ASSOCIATION THANK YOU
FOR HEARING OUR COMMENTS TONIGHT
WE HAVE IN OPPOSED POSITION ON
THIS BILL. WE BELIEVE.
IT'S DUPLICATIVE AND
UNNECESSARY NUMEROUS OF THE DATA
POINTS HAVE BEEN OUTLINED IN
THIS STATUTE ARE CURRENTLY
COLLECTED BY THE DEPARTMENT OF
HEALTH CARE SERVICES. AND THE
OVERSIGHT AND ACCOUNTABILITY
COMMISSION. SO WE FEEL THE
STATUTE DOESN'T REFLECT ALL THE
GREAT WORK THAT IS BEING DONE.
IN THE DATA COLLECTION AND
ANALYSIS AREA AND IN FACT WE
HAVE A SEPARATE PROPOSAL TO
EVALUATE THE MENTAL HEALTH
SERVICES ACT TO LEVERAGE ALL
THAT DATA THAT IS CURRENTLY.
COLLECTED IN FOR THESE REASONS
WE OPPOSE THE SPELL.
IS THERE ANYONE ELSE IN
OPPOSITE.
WE KNOW AND BRING BACK TO THE
COMMITTEE FOR QUESTIONS
COMMENTS.
BEEN MOVED I.
SUBS ARE WE HAVE.
.
A MOTION AND A SECOND.
I DO I DO YOU HAVE.
.
SOME COMMENTS AND THEN I'LL
ALLOW YOU TO CLOSE A SAID.
YOU KNOW THE BILL WOULD
SUBSTANTIALLY AMENDED AT THE
LAST MINUTE.
THE PREVIOUS VERSION THE BILL
ESTABLISHED AN ENTIRELY NEW
DEPARTMENT.
FOUR OF THE OVERSIGHT OF MENTAL
HEALTH FUNDS LAST WEEK AS
AMENDED TO IN TWO INSTEAD
ESTABLISH A STATUTE. O. INSTEAD
YOU NUMEROUS NEW REQUIREMENTS ON
LOCAL GOVERNMENTS IN THE SPIRIT
OF ACCOUNTABILITY AND
TRANSPARENCY SOMETHING THAT I
FEEL VERY STRONGLY ABOUT.
BUT I WOULD I WOULD SAY THIS IS
IT THIS WAS LAST WEEK A HUGE
REWRITE OF THE BILL.
WHILE THE COMMISSION IS ALREADY
DOING MOST OF WHAT THE WORK AT
THAT OF THAT THAT THIS BILL
REQUIRES WE DIDN'T REALLY HAVE
ADEQUATE TIME TO HAVE THE
STAKEHOLDER DISCUSSIONS.
DE ACTUALLY SPEAK WITH THE
STATE BECAUSE IT WOULD BE
AFFECTED BY THE BILL.
THAT'S THE REASON I DON'T HAVE A
RECOMMENDATION ON THE ON THE
BILL AT THIS POINT SO I'M LIKE.
COMMITTEE MAY YOU KNOW HOWEVER
THEY HAVEN'T USED TO VOTE THAT
THAT'S.
THAT'S THAT'S MY CONCERN.
WITHOUT ALL OF THE WHAT YOU GO
AHEAD AND CLOSE IF YOU LIKE MR
KILEY.
YES THINK MISTER CHAIR AND I
APPRECIATE THAT I I WILL TELL
YOU THAT THIS IS BEEN A TWO YEAR
EFFORT FOR US I. IN TRYING TO.
MOVE THE BALL FORWARD AYE WHEN
IT COMES TO AN ISSUE THAT I
THINK WE ALL I RECOGNIZE IN
THAT'S BEEN RECOGNIZED WITH A
LITTLE WHO HOOVER COMMISSION. I
AND SEVERAL TIMES BY THE STATE
AUDITOR INCLUDING AGAIN JUST A A
COUPLE MONTHS AGO AND I IT'S
TRUE THAT.
WHEN WE FIRST SET OUT WE WERE
DOING SOMETHING BROADER.
BUT WE'VE BEEN MEETING WITH
STAKEHOLDERS.
OF OF ALL KINDS AYE THROUGHOUT
THE LAST TWO YEARS AND OF REALLY
I THINK CHISELED OUT AND AN AREA
OF SOME CONSENSUS AND I
UNDERSTAND THEIR CONCERNS AYE
THAT I'LL I'LL GET TO THAT IN
JUST A SECOND BUT I'M. WE
ARRIVED AT THE CONCLUSION THAT
PERHAPS THE BEST STEP WE COULD
TAKE.
WHEN IT COMES TO OUR BEING ABLE
TO MORE EFFECTIVELY DELIVER
MENTAL HEALTH CARE SERVICES WAS
TO GET THE DATA AYE THAT TOBY
AND HIS COMMISSION AND OUR LOCAL
I. HEALTHCARE LEADERS NEED. IN
ORDER TO FIGURE OUT WHAT IS
WORKING SO THAT WE CAN DO MORE
OF IT SO THAT WE CAN REACH MORE
PEOPLE.
THAT WE CAN SAVE MORE LIVES IN
TURN AROUND MORE LIVES
AND I THERE'S A LOT OF OTHER AYE
MEASURES GOING ON IN THE
LEGISLATURE RIGHT NOW THAT ARE
IMPORTANT AND ARE SEEKING TO
ADDRESS THIS PROBLEM AS WELL. I
THINK THIS IS A REALLY IMPORTANT
STEP. I'M AND WE'RE VERY MUCH I
YOU KNOW I. OPEN AND WILLING TO
CONTINUING THE CONVERSATION TO
ADDRESS THESE CONCERNS I WILL
SAY THAT TO THE EXTENT THAT
THERE IS A CONCERN ABOUT.
THEY'RE ALREADY BEING EXISTING
REPORTING REQUIREMENTS ACTUALLY
PART OF OUR BILL THIS IS IN.
SUBSECTION SEE IS TO SUPPORT
ENHANCE TRANSPARENCY OUTCOME
ACCOUNTABILITY THE COMMISSION SO
ASSESS THE ADEQUACY OF EXISTING
STATUTORY REGULATORY DATA
REPORTING REQUIREMENT STRATEGIES
AND PRACTICES AND MAKE
RECOMMENDATIONS TO THE GOVERNOR
AND LEGISLATURE FOR
STREAMLINING.
AND STRENGTHENING THOSE
STRATEGIES TO REDUCE COSTS AND
IMPROVE THE USE OF INFORMATION
TO GUIDE PROGRAM FISCAL AND
RELATED DECISIONS I THINK THE
IMPACT OF THIS WON'T BE TO
INCREASE ANY BURDENS ARE ON YOUR
AND BUT RATHER TO MAKE SURE THAT
THE AT THE DATA THAT WE'RE
GETTING. IS IS WHAT WE NEED IN
ORDER TO MAKE INFORMED DECISIONS
GOING FORWARD AYE SO I THANK
VERY MUCH THE COMMITTEE FOR ITS
COOPERATION AND I RESPECTFULLY
ASK YOUR ABOUT.
SO WE HAVE A MOTION.
BY A MISTER BIGELOW A SECOND BY.
MISTER FLORA MEANT SECTOR
PLEASE ADD THAT MOTIONS TO
PATRICK REPARATIONS MEN
SECRETARY OF PLEASE CALL THE
ROLL.
WOULD.
WHAT NOT VOTING MAYES?
AGAR CURRY. AGUIAR-CURRY NOT
VOTING BIGELOW.
BIGELOW AYE BONTA.
BURKE.
BURKE NOT VOTING CARILLO.
FLORA
FLORA I LIMON.
MCCARTY.
MCCARTY I NAZARIAN.
RODRIGUEZ.
SANTIAGO.
SANTIAGO AYE BERMAN.
WALDRON.
WALDRON AYE.
GET FIVE VOTES IN A WHOLE SLEW
OF MISSING MEMBER SO WILL LEAVE
THE BILL ON BECAUSE. I THINK IT
IS A TACTIC.
.
LOOKING UP MISTER SOLACE YOUR
NEXT.
IN FILE ORDER.
I THINK. THE BILL NUMBER TWENTY
EIGHT SIXTY ONE YOU HAVE A
MOTION.
THINK RISK CHAIRWOMAN JUST AS
STATE OPERATES SAYING I'LL TAKE
THAT COMMITTEE AMENDMENTS THAT
STAFF WORK ON THE MAKE THE BILL
IMPLEMENTABLE. APART FEDERAL
PARTICIPATION IN THINK THE CHAIR
OF THE COMMITTEE FOR THEIR WORK
THIS IS A BILL THAT ADDRESSES
THE HOPI OPIOID EPIDEMIC YOU
TELL HEALTH SERVICES APPRECIATE
AYE VOTE THANK YOU FOR THE
MOTION.
HI THANK YOU MISTER MEMBERS TOM
READ THROUGH WITH CALIFORNIA
BEHAVIORAL HEALTH DIRECTORS ARE
THIS IS A GREAT BILL THAT'S
GOING TO SAVE LIVES WE ENCOURAGE
YOUR SUPPORT I'M HAPPY TO ANSWER
ANY QUESTIONS.
TO OTHERS IN SUPPORT.
THE SHUTTLE COLUMBIA HAVE THE
SAN DIEGO COUNTY FOR SUPERVISORS
SUPPORT.
ZERO ANYONE IN OPPOSITION.
SHE KNOW WILL BRING BACK TO THE
COMMITTEE FOR QUESTIONS OR
CRIME.
SEEN.
DID YOU ACCEPT OUR AMENDMENTS
MISTER SOLACE YES THAT'S WHAT I
FIRST STARTED WITH.
IT'S BEEN A LONG GAMES FOR
SOLACE I DON'T REMEMBER THAT WAS
HE WAS JUST VERY WELL.
SO WE HAVE OF MOTION BY MISTER
SANTIAGO A SECOND BY MISS
WALDRON THE MOTIONS DO PASS AS
AMENDED TO APPROPRIATIONS MANY.
TERRY PLEASE CALL THE ROLL WOULD
I WOULD I MAYES.
MAYES NOT VOTING AGUIAR-CURRY.
AND YOUR CAREER AYE BIGELOW.
BIGELOW AYE BONTA.
BURKE.
BURKE I.
CARILLO.
FLORA. FLORA ISLA MON.
MCCARTY.
NAZARIAN. RODRIGUEZ.
SANTIAGO.
SANTIAGO AYE BERMAN. BERMAN AYE
WALDRON WALDRON AYE.
MAYES I.
THANK YOU AYE CIGARETTE NINE
ZERO ON YOUR BILLS OUT THANKS
VERY MUCH MR SONGS.
LOOKING AROUND FOR FACES.
MISTER FRAZIER. GROUND.
KNOW WHAT MISTER FRAZIER GO
FIRST HE'S BEEN.
LIKE.
MISTER CHAIRMAN WE HAVE A FEW I
WAS SORT OF LIKE TO DISCUSS.
YOU'RE LOSING SUPPORT RAPIDLY
MISTER FRAZIER.
GOOD AFTERNOON.
RIGHT AFTER GOOD EVENING
CHARITON MEMBERS.
I LIKE TO BEGIN BY SAYING THAT I
ACCEPT THE COMMITTEES
RECOMMENDED AMENDMENT OUTLINED
ON PAGE FOUR OF THE ANALYSIS.
SOME OF OUR WITNESSES HAD TO
LEAVE TODAY BECAUSE A PET PLANE
FLIGHT SO WE WILL BE A LOT
BRIEFER THAN WE INTENDED TO BE.
AB THIRTY THIRTY TWO WOULD
REQUIRE HOSPITALS WITH A
PRENATAL UNIT TO DEVELOP AND
IMPLEMENT A QUALITY MANAGEMENT
PROGRAM RELATING TO MATERIAL. OF
MATERNAL MENTAL HEALTH WHICH
ALSO INCLUDES POSTPARTUM
DEPRESSION.
THIS BILL IS A MODEST STEP
TOWARD ADDRESSING THE MENTAL
HEALTH NEEDS OF OUR MOTHERS AND
OUR CHILDREN.
AB THIRTY THIRTY TWO AUGMENTS
THE RECOMMENDATIONS OF THE
CALIFORNIA'S OF MATERNAL MENTAL
HEALTH TASK FORCE.
ONE IN FIVE OF NEW OR EXPECTANT
MOTHERS
WILL EXPERIENCING A MENTAL
HEALTH DISORDER. DURING A
PREGNANCY OR THE FIRST YEAR
FOLLOWING CHILDBIRTH.
IT IS IMPERATIVE THAT WE BREAK
THE STIGMA ATTACHED TO MH
DISORDERS AND ADDRESS THE NEEDS
OF NEW MOTHERS.
FAR TO OFTEN NEW MOTHERS
EXPERIENCING SEVERE DEPRESSION
AND ANXIETY FEEL ASHAMED
INADEQUATE. OR SCARED AND DO NOT
SEEK THE CLINICAL ASSESSMENT
TREATMENT THEY DESPERATELY NEED.
MATERNAL DEPRESSION IS AN
ECONOMIC BURDEN. ON THE UNITED
STATES.
THE COST OF UNTREATED DEPRESSION
INCLUDE LOSS OF PRODUCTIVITY AND
MEDICAL COSTS AND ALSO.
UNTREATED MATERNAL MENTAL
DEPRESSION NEGATIVELY IMPACTS
EMPLOYMENT HOUSEHOLD INCOME
BURNING THE PUBLIC ASSIST
ASSISTANCE SYSTEM.
AND THE WORST CASE MOTHERS AND
FAMILY SUFFER THE MOST
SIGNIFICANT COST.
SUICIDE.
MEMBERS I UNDERSTAND UNLESS YOU
MOVE THERE ARE CONCERNS WITH THE
BILL IN ITS CURRENT FORM.
HOWEVER I INTEND TO WORK CLOSELY
WITH CH A.
HE HEALTH CARE PROVIDERS MEDICAL
STAFF AND STAKEHOLDERS TO ENSURE
THAT THIS BILL PROVIDES ALL
ENTITIES.
WITH THE NECESSARY TOOLS TO
SUPPORT NEW MOTHER STRUGGLING
FROM MH DISORDERS.
WITH ME TODAY'S CHOI BURKHART
WITH TWENTY TWENTY MONTHS.
AND DOCTOR MELANIE THOMAS THE
PSYCHIATRISTS WHO WORKS AT SAN
FRANCISCO GENERAL HOSPITAL.
WELL GOOD EVENING EVERYONE ENVY
I'M REALLY APPRECIATE YOUR LONG
NIGHTS IT'S VERY EVIDENT THAT
YOU CARE ABOUT THE HEALTH OF OUR
OUR STATES THANK YOU.
FOR THAT.
AND WE ARE CONCERNED THAT YOU
MAY BE HAVE NOT EATEN AS MOTHER
SO YEAH WE WILL WE HAVE TO HEAR
ABOUT LATER YEAH.
WELL WE ON OUR BACK AGAIN IN OUR
ASKING FOR YOUR SUPPORT ON
ANOTHER IMPORTANT BILL TO
ADDRESS MATERNAL MENTAL HEALTH
DISORDERS AS YOU'VE HEARD
EARLIER. MANY WOMEN.
ARE IMPACTED A HUNDRED THOUSAND
WOMEN IN OUR STATE EACH YEAR. OF
THE TASK FORCE ON MATERNAL
MENTAL HEALTH AGAIN AN
INDEPENDENT TASK FORCE WHICH
INCLUDED THE COST OF CALIFORNIA
HOSPITAL ASSOCIATION. RECOMMENDS
THAT HOSPITALS ARE ALSO AN
IMPORTANT KEY STAKEHOLDERS AND
SHOULD BE ADDRESSING MATERNAL
MENTAL HEALTH. UP IN IN WAYS
THAT SEE THE SEE FIT AND WE ASK
FOR YOUR SUPPORT ON A. B. THIRTY
THIRTY TWO TONIGHT THINK YOU.
GOOD EVENING ANDI AM DOCTOR
MELANIE THOMAS I'M A
PSYCHIATRIST AND A RESEARCHER
WHO WORKS AT SAN FRANCISCO
GENERAL HOSPITAL EMPLOYEE BY
UCSF. AND THANK YOU ALL FOR
STAYING LATE AND I KNOW I'M
HUNGRY AND I'M SURE YOU ARE TOO.
AND I AM ALSO A MOTHER I'M ALSO
SOMEONE WHO HAS MY OWN
EXPERIENCE WITH A PSYCHIATRIC
ILLNESS. AND I TAKE THIS BILL
VERY SERIOUSLY AND I'M SURE THAT
YOU WELL AS WELL.
AND I JUST WANNA ADDRESS AND THE
QUESTION ABOUT WHY HOSPITALS I
WORK IN A HOSPITAL WHENEVER
COUNTY HOSPITALS I WORK ACROSS
DISCIPLINES BUT COLLEAGUES IN IT
WILL BE KIND FAMILY MEDICINE AND
PEDIATRICS. TO ATTEMPT TO
INTEGRATE CARE FOR WOMEN WHO ARE
PREGNANT AND POSTPARTUM WHO WALK
THROUGH THE DOORS OF OUR
HOSPITAL.
AND I BELIEVE THAT SUPPORT OF AB
THREE OH TO PRIO THREE TWO AM IS
CRITICAL I THINK IT'S IMPORTANT
TO HAVE OUR HOSPITALS AND PURSUE
THESE PROGRAMS THROUGH THEIR OWN
QUALITY MANAGEMENT. AND AND BE
HELD ACCOUNTABLE FOR DEVELOPING
PROGRAMS FOR THESE WOMEN. AND I
HAVE.
ALL KINDS OF EXAMPLES OF HOW
WOMEN FALL THROUGH THE CRACKS
IN OUR OUTPATIENT MENTAL HEALTH
CARE SERVICES MAKING THE
INVOLVEMENT OF THE HOSPITAL'S
CRITICAL TO REACH THESE WOMEN.
AND IN THE INTEREST OF TIME I
WON'T SHARE THEM ALL WITH YOU
AND BUT JUST KNOW THAT THAT THEY
DO EXIST AND THE BAD ALTHOUGH A
SHORT HOSPITAL STAY. THE LABOR
AND DELIVERY AND THE POST PARTUM
STATE DOES GIVE US AN
OPPORTUNITY TO INFLUENCE THESE
WOMEN AND THE LIVES OF THEIR
CHILDREN THINKING.
YOU VERY MUCH THERE'S OTHERS IN
SUPPORT.
RIGHT SPENCER WITH AMERICAN
COLLEGE OF OBGYN STRYCHNINE WE
DON'T HAVE AN OFFICIAL POSITION
YET. AND WE HAVE HAD SOME VERY
GOOD DISCUSSIONS WITH THE
AUTHORS OFFICE AND SO WE WILL BE
RECOMMENDING A SPORT AT THE NEXT
BOARD MEETING SO THANK YOU.
THANK YOU.
JACK AWAY WITH MY OTHERWISE ONLY
COUNTY AND ALSO REPRESENTING
EVERYBODY FROM AB TWO ONE NINE
THREE FROM EARLIER THAT HAD TO
LEAVE OUT WE ARE IN STRONG
SUPPORT.
Q..
CAN LEARN AS CHILDREN NOW IN
SUPPORT.
BARBARA GLAZER WITH THE
CALIFORNIA HOSPITAL ASSOCIATION
WE DO NOT HAVE A FORMAL POSITION
AT THIS TIME WE HAVE EXPRESSED
CONCERNS WE'VE MET WITH THE
AUTHORS STAFF SEVERAL TIMES. WE
VERY MUCH APPRECIATE THE
AMENDMENTS AND WE LOOK FORWARD
TO CONTINUING TO WORK WITH YOU
THANK YOU.
IS THERE ANYONE IN OPPOSITION.
SEE NO ONE BRING BACK TO THE
COMMITTEE FOR QUESTIONS OR
COMMENTS
IT'S OF THE AUTHOR.
WITNESSES.
LIKE WHICH I CLOSE MISTER
FRAZIER THANK YOU MISTER CHAIR
THIS IS FOR THE MOMS. RESPECT
WEST RIVAL.
WE HAVE A MOTION.
HAS IT I'M SORRY.
ALL RIGHT HERE SOAP. GROSS LOVE
WILL SLOW HERE LOCAL LOW BLOOD
SUGAR.
MY HANDS ARE SHAKEN.
SO THEM.
TIM MOST THE MOTION BY MISTER
AGUILAR CURRY THE SECOND BY
MISTER TERM.
THE MOTION IS TO PASS AS AMENDED
TO APPROPRIATIONS.
MAD SECRETARY PLEASE CALL THE
PRO WOULD I WOULD I MAYES MAYES
AYE ANGER CURRY. AGUIAR-CURRY
AYE BIGELOW.
BIGELOW AYE BONTA.
BURKE.
BURKE I CARILLO.
FLORA. FLORA AYE LOW MOAN.
MCCARTY.
NAZARIAN.
RODRIGUEZ.
SANTIAGO. SANTIAGO AYE THURMOND.
THURMOND AYE WALDRON LAWLER
CITED.
NINETEEN.
NIGERIA GOES OUT THANK YOU SO
MUCH THANK YOU MISTER CHAIRMAN.
THANK YOU.
YOUR JONES SAWYER
.
THANK YOU ARE.
GOOD.
I'LL MAKE THIS QUICK GOOD
EVENING MEMBERS UP AB. TWENTY
GOT TWENTY SIX NINETY ONE WERE
REQUIRED TO CALIFORNIA
DEPARTMENT OF EDUCATION TO
DEVELOP MATERIALS AND ONLINE
TRAINING MODULE ON HOW TO USE
TRAUMA INFORMED CARE AT SCHOOLS.
STUDIES NOW SHOW THAT NEARLY
EVERY.
SCHOOL EVERY EVERY SCHOOL HAS
CHILDREN WHO HAVE BEEN EXPOSED
TO OVERWHELMING DRAMATIC
EXPERIENCES SUCH AS WITNESSING
VIOLENCE BETWEEN THEIR
CARETAKERS.
BEING TO DIRECT TARGET OF ABUSE
AND OF AND ALL KINDS OF
ADVERSITY.
THE ASUS STUDY HAS SHOWN A
STRONG ASSOCIATION BETWEEN HIGH
H. ESCORTS AND PERFORMS AT
SCHOOL INCLUDING THE HIGHER RISK
OF LEARNING AND BEHAVIOR
PROBLEMS.
DRUM INFORM SCHOOL INITIATIVE
WILL ALLOW CALIFORNIA CATCH UP
WITH STATES LIKE MASSACHUSETTS
OHIO MICHIGAN AND OTHERS HAVE
ALREADY IMPLEMENTED TRAUMA
INFORMED. CARE PROGRAM FOR THE
SCHOOLS MEMBERS I RESPECTFULLY
ASK FOR GUY VOTE.
AND.
PAMELA GIVES REPRESENTING MY LOS
ANGELES COUNTY OFFICE OF
EDUCATION WE STRONGLY SUPPORT
THE BILL OUR SUPERINTENDENT DR
DEBORAH EDUARDO IS A SOCIAL
WORKER. AND AN EDUCATOR AND HIS
STRONG WE MADE.
HAS MADE TOM INFORMED CARE
PRIORITY IN OUR OFFICE.
FOR THE REASONS.
OF THE NUMBER OF CHILDREN WE
SERVE WHO ARE INCARCERATED AND
ALSO PROBATION REFERRED WE ALSO
SERVE FOSTER YOUTH HOMELESS
YOUTH AND JUST THE GENERAL
POPULATION OF STUDENTS WHO MIGHT
ALSO HAVE FACED TRAUMATIC.
EVENTS SO FOR THESE REASONS WE
STRONGLY URGE YOUR SUPPORT FOR
THE BILL THANK YOU.
THANK YOU ANY ADDITIONAL
WITNESSES IN SUPPORT.
SAYING NANA WITNESSES IN
OPPOSITION.
SING NINE COME BACK TO TO
MEMBERS FOR QUESTIONS OR
COMMENTS THERE IS A MOTION BY
MISTER SANTIAGO AND WHO IS THIS.
AND.
MR BIGELOW'S A SECOND JENNY
QUESTIONS OR COMMENTS.
YES I HURRY I JUST HAVE A BRIEF
COMMENT THANK YOU FOR BRINGING
THIS FORWARD UNLIKELY A CO
SPONSOR OF.
ON THE UNDERGROUND. COMPLEX THAT
IN KINDERGARTEN CLASSES AND READ
WITH KINDERGARTENERS.
AND YOU CAN TELL THE KIDS THAT
HAVE HAD TRAUMA IN THEIR LIFE.
AND JUST THE DISRUPTION THAT
THEY ARE TO THE CLASSROOM AND I
WISH I AM REALLY HAPPY TO SEE
THAT THE NURSES ARE ALL ON BOARD
ON THIS THE SCHOOLS BECAUSE.
THEY'RE THE FIRST ON THE FIRST
IN LINE TO SEE A LOT OF THE TIME
THIS HAPPENED BECAUSE I THINK
IT'S MUCH. MORE.
YOU'RE WELCOME.
THE MOTION IS TO PASSED TO PASS
APPROPRIATIONS OF LOOK CLOSE
RESPECT FLATTERY AYE VOTE.
CALL THE ROLL.
WOULD WOULD AYE MAYES AYE MAYES
AYE AGUIAR-CURRY ANCHOR CURRY I
BIGELOW. BIGELOW AYE BONTA.
BURKE.
BURKE I CARILLO.
FLORA.
NAZARIAN.
RODRIGUEZ SANTIAGO.
SANTIAGO AYE THURMAN.
THURMOND I.
WALDRON.
THAT IS EIGHT ZERO YOUR BILL IS
OUT THANK YOU FIX VERY MUCH
MISTER JONES SAWYER.
WE STILL HAVE ONE AUTHORED CUP
OF AUTHORS WHO HAVE.
BILLS THAT ARE NOT COMMITTEE
MEMBERS.
BUT WE DO HAVE COMMITTEE
MEMBERS WHO HAVE BILLS.
SO MISS BURKE WHICH USED SINCE
THE OTHER MEMBERS ARE HERE WHICH
LIKE TO PRESENT YOUR BILL MUST
BURKE.
GOOD FOR YOU ARE YOU ARE YOU
DOING THAT WITH HER.
WOULD YOU LIKE ME TO PERCENT MY
FOR BILL SENATE. OKAY.
I WILL PRESENT THEIR LOSSES.
LIMON RODRIGUEZ SPRING MCCARTY
HAS MISTER I'M THE ONLY ONE
HOUSE HERE SO I'LL DO MY FOR
BILL SENT.
ORACLE THINKS.
I DON'T KNOW ABOUT THAT
.
DOT WOULD. THANK YOU MISTER
THANK YOU MISTER CHAIRMAN
MEMBERS.
PURSE PRESENTING AB TWENTY FOUR
SIXTEEN.
FIRST EXCEPT THE TECHNICAL
AMENDMENTS.
TO CLARIFY THE BILL APPLIES TO
MEDICARE MANAGED CARE PLANS
LICENSED BY THE DEPARTMENT OF
MANAGED HEALTHCARE AND DELAY
IMPLEMENTATION OF THIS BILL
UNTIL. THE YEAR TWENTY TWENTY
SINCE COVER CALIFORNIA
NEGOTIATIONS ARE CURRENTLY UNDER
WAY.
THE REQUIRES HEALTH PLANS TO
NEGOTIATE WITH COVER CALIFORNIA
TO ENSURE THAT COUNTIES HAVE
MORE CHOICES IN HEALTHCARE
OPTIONS.
I RESPECTFULLY REQUEST AN IBM.
THE DOCTOR WOULD YOU WOULD YOU
WANT ANYBODY ELSE TO.
ANY OF ANY OTHER WITNESSES IN
SUPPORT SHE'S SHE'S READY TO BE
REALLY GREAT ARE I HAVE AND J.
FLORES WOULD HELP ACCESS
CALIFORNIA HERE I COME TO
SUPPORT AB TWENTY FOUR SIXTEEN.
ENCOURAGES MORE MEDICARE MANAGED
CARE PLANS TO PARTICIPATING
COVER CALIFORNIA CREATING AN
ADDITONAL OPTION FOR MANY LOW
AND MODERATE INCOME CALIFORNIANS
TO CHOOSE FROM WHICH IS A GREAT
THING WE ASK FOR YOUR ARRIVAL.
THANK YOU THEM ANYMORE WITNESSES
IN SUPPORT.
WESTERN CENTER ON LAW AND
POVERTY IN SUPPORT THANK YOU.
GRAY ANYMORE SUPPORTERS.
SEEING NONE LAME WITNESSES IN
OPPOSITION.
PLEASE COME FORWARD.
SAY NOT CONNECTED MEMBERS
QUESTIONS OR COMMENTS.
BUT WOULD LIKE TO CLOSE.
I JUST HAVE MORE CHOICES FOR FOR
COUNTIES I THINK WILL ACTUALLY
IMPROVE THE SYSTEM AND.
HOPEFULLY YOU CAN HELP WITH
PRICES AND.
AND AVAILABILITY OF PLANTS
RESPECTFULLY ASK YOUR AYE VOTE.
THANK YOU AND WE DO HAVE A
MOTION BY MISTER BIGELOW AND A
SECOND BY MISTER FLORA. AND TO
THE MOTION IS TO PASS AS AMENDED
TO APPROPRIATIONS.
WELL I'M SORRY IT WAS WAS IT
MISTER SANTIAGO IS THE SECOND.
GRAYSON MOTIONS TO PASS AS
AMENDED TO APPROPRIATIONS PLEASE
CALL THE ROLL.
WOULD I WOULD AYE MAYES AYE
MAYES AYE ACKER CURRY FIGURE
CREE AYE BIGELOW. BIGELOW AYE
BONTA.
BURKE I CARILLO.
FLORA.
FLORA NOT VOTING LIMON.
MCCARTY. NAZARIAN RODRIGUEZ
SANTIAGO.
SANTIAGO AYE BERMAN. THURMOND
AYE WALDRON.
SO YOU JUST
SEVEN AYE VOTES BUT ON CALL.
IT'S VERY MUCH
IT'S MOVE ON TO.
FROM NINETEEN AB TWENTY FOUR
TWENTY SEVEN THANK YOU MISTER
CHAIR UPPERSIDE EXCEPT THE
AMENDMENTS TO DELETE REFERENCE
TO INSURERS AND CLARIFY THAT IT
WILL APPLY FOR. TO FOR PROFIT
MEDI CAL MANAGED CARE PLANS
ONLY.
AND TO NEW AND RENEWAL OF
EXISTING MEDICARE MANAGED
CARE PLAN PROPER CONTRACTS ALL
THIS ALSO THE DEFINITION OF ANTI
COMPETITIVE CON A CONDUCTOR
PRACTICE CURRENTLY IN THIS BILL
WAS BROUGHT TO OUR ATTENTION.
CONTINUE TO LOOK INTO THE
DEFINITION AND ITS RELATION TO
AN EXISTING GENERAL.
EXISTS IN OUR.
ATTORNEY GENERAL AUTHORITY ALSO
EXTENDED THE ACS MAY ALREADY
HAVE THE AUTHORITY WITH RESPECT
TO MLR TO TERMINATE THE CONTRACT
FOR ANY NON COMPLIANCE WITH
EXISTING LAW. THIS BILL MAKES
THAT DETERMINATION A
REQUIREMENT.
BILL I REQUIRES THE STATE TO
DETERMINE A CONTRACT FOR NOT FOR
PROFIT.
FOR FOR FOR A FOR PROFIT
MEDICARE MANAGED CARE PLANS HAVE
ENGAGED IN ANTI COMPETITIVE
CONDUCT OR IF THEY ARE NOT
SPENDING ENOUGH ON PATIENT CARE
COMPARED WITH OVERHEAD AND
ADMINISTRATIVE COSTS RESPECT
ASPIRIN I'VE OF.
THE DOCTOR WOULDN'T ANY
WITNESSES IN SUPPORT.
ANYBODY ELSE WANT TO.
SO I LEVEL IF YOU START OUT.
ABOUT THE CALIFORNIA MEDICAL
ASSOCIATION STRONG THRONGS FOR
THIS BILL THANK YOU.
I WAS IMPRESSIVE.
ANY FURTHER WITNESSES IN
SUPPORT.
SING NINE ANY.
WITNESSES AND OPPOSITION PLEASE
COME FORWARD IF.
A GOOD EVENING EVERYONE I'M
JENNIFER ALI WITH THE CALIFORNIA
ASSOCIATION OF HEALTH PLANS IN
CAP AS OPPOSED AB TWENTY FOUR
TWENTY SEVEN.
I'M DISPARITIES BILL AND
UNFAIRLY TARGETS FOR PROFIT MEDI
CAL MANAGED CARE PLANS FOR
DISCIPLINARY ACTIONS
AS A RESULT THIS BILL COULD
RESULT IN LOSS OF MANY OF THE
MEDI CAL.
CARE.
AND MAKE MEDI CAL MANAGED CARE
HEALTH PLAN CONTRACTS THERE BY
DISRUPTING ACCESS TO HEALTH CARE
FOR MEDI CAL BENEFICIARIES.
AT A TIME WHEN WE NEED TO ENSURE
THAT CONSUMERS HAVE A CHOICE.
THIS BILL IS PREMATURE AND
UNNECESSARY LAST YEAR NEW MLR
WAS WAS CREATED FOR MEDI CAL
MANAGED CARE PLANS. ON AN S. B..
ONE SEVENTY ONE BY SENATOR
HERNANDEZ THIS BILL PASSED ON
THE ASSEMBLY FLOOR WITH THE
SEVENTY NINE TO ZERO VOTE.
UNDER S. B. ONE SEVENTY ONE
MEDICARE MANAGED CARE PLANS ARE
REQUIRED TO PAY REMAINS TO DE A
MAGE SEE OR TO THE H. CS WHEN
THEY OPERATE OUTSIDE OF THEIR
MEDICAL LOSS RATIO. THIS WILL
BEGIN ON JULY FIRST TWENTY
TWENTY THREE.
THE DELAYED EFFECTIVE DATE.
WAS NECESSARY BECAUSE THE RATE
SETTING PROCESS FOR MEDI CAL
MANAGED CARE PLAN RATES.
IS CHANGING BASED ON NEW FEDERAL
REGULATIONS ARE NOW REQUIRE THE
RATES TO BE SET ON A PROSPECTIVE
BASIS
ONCE THE RATE PROCESS IS SETTLED
IN OUR REMAINS RULES WILL KICK
INTO PLACE.
AND OTHER WORDS WHEN THE PROCESS
IS ALREADY WE ALREADY HAVE A
PROCESS.
THAT INCLUDES AMERICAN AS A
MECHANISM WHEN MEDI CAL MANAGED
CARE PLANS FAIL TO MEET THEIR
AND ALL OUR REQUIREMENTS.
I'M HERE TO ANSWER ANY QUESTIONS
ON THE RATE SETTING PROCESS AND
I JUST WANT TO NOTE THAT.
.
AND THAT'S IT.
ANY OTHER WITNESSES IN
OPPOSITION.
JOHN WHEN YOU'RE ON THE OUT THE
ANTHEM BLUE CROSS.
IN THE INTERCITY I'M
UNDERSUPPLY MY COMMENTS OF CAPS.
THANK YOU ANYMORE.
OPPOSITION.
SING NOW WILL COME BACK TO THE
QUESTIONS COMMENTS FROM.
MEMBERS.
I DO BELIEVE WE HAVE.
A MOTION FROM MISTER CENTEL GO
IN WAS THAT.
.
FROM BURKE. AS AS THE SECOND.
I'D LOVE TO.
DO YOU WANT TO CLOSE.
I JUST RESPECT WEBSPHERE ABOUT.
A GREAT DIED THE MOTION IS TO
PASS AS AMENDED TO
APPROPRIATIONS HIS CALL. WOULD I
WOULD I MAYES SNOW MAYES NO
AGUIAR-CURRY. ANGER CURRY I
BIGELOW.
BIGELOW NO BONTA.
WORK.
BURKE I CARILLO.
FLORA.
FLORA NO. LOW MOAN.
MCCARTY.
THIS AREA RODRIGUEZ.
SANTIAGO.
SANTIAGO I'D THURMOND.
BERMAN I.
WALDRON. WILDER NO.
FIVE TO FOUR PUT ON CALL FOR
* THAT THANK YOU.
YEAH OKAY MOVING ON TO ITEM
NUMBER OR WHATEVER ITEM NUMBER
S. EYES AT TWENTY ONE IS AT A
TWENTY FOUR SEVEN. MAYBE TWENTY
FIRST OF NOVEMBER IS THE HOUSE
HAS SO GOOD AT LEAST WRITE YOUR
BILL DOCTOR WOULD MAKE YOU.
AB TWENTY FOUR SEVENTY TWO AS AS
YOU ALL KNOW THE* COMMITTEE
ON HEALTH CARE DELIVERY SYSTEMS
AND UNIVERSAL COVERAGE CONNECTED
FIVE INFORMATIONAL HEARINGS TO
IDENTIFY THE BEST AND QUICKEST
PATH TO UNIVERSAL COVERAGE FOR
CALIFORNIA.
S. PORTRAIT STRATEGIES FOR
IMPROVING OUR HEALTHCARE SYSTEM
ONE OF THE TOPICS OF THE SELECT
COMMITTEE DISCUSSES THE
VIABILITY OF A STEPS IN A PUBLIC
OPTION IN AN EFFORT TO INCREASE
PLAN COMPETITION. AND IMPROVE
THE AFFORDABILITY OF HEALTH CARE
MANY CALIFORNIA COUNTIES IN
CALIFORNIA HAVE ONLY ONE WILL
ONLY TOUR FEWER HEALTH PLAN
CHOICES. AND THIS OP THIS
LIMITED OPTION IS IMPACTING NOT
JUST THE PRICES OF HEALTH CARE
BUT ALSO THE QUALITY OF
HEALTHCARE THAT CONSUMERS
RECEIVE.
HOWEVER WE RECOGNIZE THE
COMPLICATIONS OF ESTABLISHING A
PUBLIC OPTION BECAUSE AMONG
OTHER REASONS.
OF THE EXTENSIVE NETWORK OF
LOCAL HEALTH PLANS AND THE HEAVY
CONCENTRATION MANAGED CARE IN
THE EXISTING MEDICARE PROGRAM.
AB TWENTY FOUR SEVENTY TO WOULD
REQUIRE COVER CALIFORNIA TO
PREPARE A FEASIBILITY ANALYSIS
TO DETERMINE THE POSSIBILITY OF
A PUBLIC HEALTH INSURANCE OPTION
IN CALIFORNIA.
IT WE BELIEVE THIS TO
ESTABLISHES A THOUGHTFUL
APPROACH TO THE PUBLIC OPTION
ISSUE AND I RESPECT THAT'S RIGHT
NOW.
THANK YOU DOCTOR WOULD ANY
WITNESSES AND SUPPORT. IS
QUICKLY QUICKLY GETS NJ FLOORS
WOULD HELP ACCESS CALIFORNIA
HERE IN SUPPORT AB TWENTY FOUR
SEVEN TWO WE THINK THAT IT IS
FITTING FOR COVER CALIFORNIA TO
DEVELOP AN ANALYSIS OF DIFFERENT
PUBLIC OPTIONS THAT CAN BE
OFFERED BOTH ON AND OFF
EXCHANGE.
IN THE INDIVIDUAL MARKET WE ASK
FOR YOUR AYE VOTE THANK YOU PRE
SHEET THAT AND LOOK FOR THE
WITNESSES.
YES CHEN FLORIAN BEHALF OF
WESTERN CENTER ON LAW AND AND
POVERTY AND SUPPORT THANK YOU.
RIGHT SPENCER THE CALIFORNIA
ACADEMY OF FAMILY PHYSICIANS IN
SUPPORT
THANK YOU ANY FURTHER WITNESSES
IN SUPPORT.
SAYING NONE OF MOVE ON TO
WITNESSES IN OPPOSITION.
SEEING NONE ALL COME BACK TO
MEMBER QUESTIONS COMMENTS.
BUT WOULD LIKE TO CLOSE RESPECT
THAT'S HERE I GO WE DO HAVE.
DO YOU KNOW MOTION.
ON A TEN A MOTION.
DID YOU.
OKAY SO WE'RE GOING TO CALL THAT
WANNA AGUIAR-CURRY MAKE THE.
MOVE THE BILL AND AUTUMN BURKE A
SECONDED.
.
AND.
PLEASE CALL THE ROLL.
THOSE ARE THE MOTION IS TO PASS
APPROPRIATIONS.
WOOD I WOULD AYE MAYES AYE MAYES
AYE ANCHOR CURRY.
ABSOLUTELY AGAR CURRY I BIGELOW.
BIGELOW AYE BONTA.
BURKE BURKE I CARILLO. FLORA.
FLORA I LOW MOAN. MCCARTY
NAZARIAN RODRIGUEZ SANTIAGO.
SANTIAGO AYE THEREIN. THURMOND
AYE WALDRON WALDRON AYE.
NINE ZERO THAT BILL IS OUT SO
WE'RE GONNA MOVE ON TO A FILE
TWENTY FOUR AB TWENTY FIVE A TWO
SECONDS CREDIT ANALYST BILL
THANK YOU GET IT YAKKING
THANKFULLY.
FIRST OF ALL I'D LIKE TO ACCEPT
THE.
SUGGESTED AMENDMENTS OUT
OUTLINED IN THE ANALYSIS AB
TWENTY FIVE GO TO WOULD REQUIRE
THE SECRETARY OF CALIFORNIA
HEALTH AND HUMAN SERVICES
AGENCY.
ARE TO ESTABLISH AND IMPLEMENT
AND ADMINISTER THE CALIFORNIA
HEALTH CARE PAYMENTS DATABASE IN
TWO THOUSAND SIXTEEN THIS CUT
COMMITTEE HELD AN INFORMATIONAL
HEARING ON DRUG COSTS. AND THE
PANELISTS FROM IN MINNESOTA
INDICATED THAT MINNESOTA'S ALL
PAYMENTS DATABASES GUIDED THE
STATE'S POLICY IN CONTROLLING
COSTS.
THE BILL AIMS TO DO THE SAME THE
GOAL OF THE STATE OF BASIS TO
GATHER THE DATA WE NEED.
TO OBTAIN A COMPLETE PICTURE OF
WHAT HEALTHCARE COSTS.
RESOURCES USED TO TREAT PATIENTS
AND VARIATIONS IN THE TOTAL COST
TO TREAT AN ILLNESS OR MEDICAL
EVENT.
WELL KNOW THAT THE HEALTHCARE
SYSTEM IS EXPERIENCING PRICE
INCREASES IN FOR MANY INCLUDING
CONSUMERS AND EMPLOYERS THIS IS
BECOMING AN UNSUSTAINABLE. BY
COLLECTING THE DATA IT WILL IN
FIRM FORM US ON HOW TO ESTABLISH
COST CONTAINMENT MEASURES. THAT
WORKS FOR EVERYONE AND I
RESPECTFULLY ASK YOUR I'VE.
THANK YOU DOCTOR WOULD.
AND ANYWAY THIS ISN'T SUPPORT.
AND A FOREST AGAIN WOULD HELP
ACCESS CALIFORNIA PLEASED TO
SUPPORT AB TWENTY FIVE OH TO
THAT WOULD CREATE A HEALTH CARE
DATABASE ON HEALTH CARE COST
QUALITY AND SOCIAL DETERMINANTS
OF HEALTH. AND REQUIRE ANALYSIS
OF SUCH DATA WE LOOK FORWARD TO
WORKING WITH THE AUTHOR TO
ENSURE PRICING INFORMATION
REFLECTS WHAT PLANS OR OTHER
PEERS PAY AND NOT THE CHARGES.
OR STICKER PRICES THOUGHT BY
PROVIDERS WE ASK FOR YOUR
ARRIVAL. THANK YOU DECIDE
WITNESSES FOR.
GEN FLOOR IN BEHALF OF WESTERN
CENTER ON LAW AND POVERTY WE
ESPECIALLY APPRECIATE THE
ABILITY TO EVALUATE SOCIAL
DETERMINANTS OF HEALTH THINK
THANK YOU ANY FURTHER. WITNESSES
IN SUPPORT.
THERE IS THERE ANY DONE
TESTIMONY OPPOSITION.
SEEING NONE I GOT TWO WORDS I TO
CLOSE.
YES AYE I LIKE SAID THIS THIS IS
A BIG DEAL.
DATA IS REALLY REALLY CRITICAL
FOR GOING TO LOOK TO REALLY
CONTROL COSTS AND AND THE SIX IT
THIS WILL LOOK AT DATA ACROSS
THE BOARD FOR AS FAR FOR
EVERYTHING. RELATED TO HEALTH
CARE IT'S BEEN DONE IN OTHER
STATES IT'S NOT INEXPENSIVE. BUT
IT IS A GOLD MINE LITERALLY OF
INFORMATION THAT WILL ALLOW US
TO TO FORMULATE HEALTHCARE
POLICY GOING FORWARD
RESPECTFULLY ASK DR.
THE DOCTOR WOULD AGAR CURRY
MOVED BURKE A SECOND IS.
SECULAR PLEASE CALL THE ROLL
THOUGH THE MOTION IS TO PASS AS
AMENDED APPROPRIATIONS.
WOULD I WOULD AYE MAYES AYE
MAYES AYE AGUIAR-CURRY.
YES MA'AM.
AGAR CURRY I.
BIGELOW.
BIGELOW NOT VOTING BONTA.
BURKE.
BURKE I CARILLO.
FLORA.
FLORA I LOW MOAN.
MCCARTY NAZARIAN RODRIGUEZ
SANTIAGO. SANTIAGO AYE BERMAN
THURMOND AYE WALDRON.
WALDRON AYE.
ZIGGS EARLIER BILLS OUT THANK
YOU VERY MUCH.
.
THIS BURKE MISS WALDRON.
I.
EVERYONE.
TRIVIA HOW ARE YOU. AND FABULOUS
THANK YOU GOOD AFTERNOON. GOOD
EVENING.
IT ORIGINALLY SAID GOOD MORNING
THAT AND THEN I CHANGED IT TO
AFTERNOON AMOUNT TO GOOD
EVENING.
GOOD EVENING WITH SUCH AN IMPACT
CHAIR AND MEMBERS OF THE
COMMITTEE TODAY I'M HERE TO
PRESENT ASSEMBLY BILL TWENTY
EIGHT FIFTY. A BILL WHICH WOULD
AUTHORIZE THE DEPARTMENT OF
PUBLIC HEALTH TO APPROVE THE
REQUIRED SIXTY HOURS OF
CLASSROOM TRAINING. FOR
CERTIFIED NURSING ASSISTANTS TO
BE OFFERED THROUGH ONLINE OR
DISTANCE LEARNING CLASSES.
CALIFORNIA SKILLED NURSING
FACILITIES ARE FACING A
WORKFORCE SHORTAGE THROUGHOUT
THE STATE WITH OVER FOURTEEN
MILLION PEOPLE ON MEDI CAL AND
ELEVEN HUNDRED CALIFORNIANS
TURNING SIXTY FIVE.
YEARS OLD EVERY DAY THEY MUST
BE AND THAT. THERE MUST BE AN
ATTRACTIVE AND SUSTAINABLE
WORKFORCE SOMEPLACE.
IN ORDER TO CARE FOR AGING
POPULATION THIS BILL WILL HELP
ADDRESS CALIFORNIA SKILLED
NURSING FACILITIES WORKFORCE
SHORTAGE BY MODERNIZING THE
CLASSROOM TRAINING REQUIREMENT
TO BECOME A CNA. I GIVEN THAT
THAT.
THE CONVENIENCE OF IT AND
EFFICIENCY OF ONLINE COURSEWORK
ALLOWING POTENTIAL CMA'S THE
OPTION OF PURSUING THIS PORTION
OF THEIR CERTIFICATION ONLINE IS
A COMMON SENSE APPROACH. TOWARDS
MODERNIZING THE CERTIFICATION
PROCESS AND ENCOURAGING MORE
PEOPLE TO GET INTO THE FIELD.
WITH ME TODAY I HAVE JENNIFER
SNYDER ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF HEALTH
OF FACILITIES THE SPONSOR OF
THIS LEGISLATION.
JENNIFER CIDER ON BEHALF
RECOVERY ASSOCIATION HOPE
FACILITIES WE APPRECIATE THAT
SOME OF HER RUBIO AND HANDLING
THIS ARE BUILT THIS BILL FOR US
THIS YEAR.
WE AS MANY OF YOU KNOW.
THERE WILL BE NEW STAFFING
REQUIREMENTS FOR SCHOOL NURSING
FACILITIES WILL BE EFFECTIVE
JULY FIRST OF THIS YEAR.
AND WE ESTIMATE THAT AT LEAST TO
A SEVENTEEN HUNDRED NEW
CERTIFIED NURSING ASSISTANTS
WILL BE REQUIRED TO SUPPLY AND
THAT NEED TO BE AND.
OUR FACILITIES ARE EXTREMELY
CONCERNED ABOUT WHERE THOSE SEE
AN AIDS ARE GOING TO COME FROM
OF THIS BILL IS ACTUALLY ONE WAY
FOR MANY OF OUR FACILITIES TO
GET A LITTLE BIT MORE CREATIVE
WITH THEIR TRAINING PROGRAMS.
AND PROVIDE BETTER ACCESS TO
INDIVIDUALS FOR ONLINE AND
DISTANCE LEARNING.
TO GET THEIR TRAINING DONE
THROUGH.
DIFFERENTMEANS AND THERE ARE
MANY OTHER STATES THAT PROVIDE
ONLINE TRAINING FOR CNN IS THERE
ARE ALSO MANY OTHER HEALTHCARE
PROFESSIONALS THAT USE ONLINE OR
DISTANCE LEARNING. ARE RIGHT NOW
THAT PART OF PUBLIC HEALTH DOES
NOT HAVE THE AUTHORITY TO DO
THIS AT LEAST NOW THEY WILL HAVE
THE AUTHORITY TO APPROVE I'M
SOME OF OUR TRAINING PROGRAMS.
TO HANDLE CLASSROOM HOURS
THROUGH ONLINE TRAINING ONE WAY
THAT WE CAN ADDRESS THE WORK FOR
SHORTAGE THAT WE ARE AND IN THE
MIDDLE OF IN CALIFORNIA SO WE
APPRECIATE YOUR AYE VOTE ON THE
BILL THINK YOU.
VERY MUCH OF THE OTHERS IN
SUPPORT.
SEE NO ONE IS THERE ANYONE IN
OPPOSITION.
SEE NO ONE WILL BRING IT BACK TO
THE COMMITTEE FOR QUESTIONS OR
COMMENTS ANYONE ON THE COMMITTEE
HAVE A QUESTIONER COMMENT.
SEEING NONE WE HAVE.
.
THE MOTION BY MISTER SANTIAGO A
SECOND BY MISTER BIGELOW. A
WHICH I CLOSED HIS RUBIO THANK
YOU ARE THIS RESPECTFULLY ASK
FOR A AYE VOTE. SO THE MOTION IS
DO PASSED APPROPRIATIONS MADAMS.
CALDERON WHERE'D I LED AYE MAYES
MAYES AYE AGAR CURRY.
AGUIAR-CURRY I BIGELOW. BIGELOW
AYE BONTA.
BURKE.
BURKE I.
CARILLO.
FLORA.
FLORA ISLA MON.
LIMON AYE MCCARTY MCCARTY AYE.
MISSOURIAN.
RODRIGUEZ.
SANTIAGO.
SANTIAGO ARE THURMAN. BERMAN AYE
WALDRON.
WALDRON AYE.
ELEVEN ZERO YOUR BILL IS OUT
THANK YOU VERY MUCH MISS RUBIO.
.
IT'S MCCARTY THEN MISS.
YET QUITE GLAD I'M SORRY.
HIP HOP AB TWENTY FOUR EIGHTY
SIX.
THANK YOU MISTER CHAIR AT THE
LATE HOUR I DID LOSE MY
WITNESSES THEY WERE HERE FOR
SEVERAL HOURS.
WHO I HAVE ONE THING YOU DO LOSE
SOME ARE? SO I HAVE THE.
OPIOID ADDICTION PREVENTION A
REFILL TATIAN ACTS.
JOIN THE AUTHORED BY MYSELF IN
MISTER GALLAGHER I DID LOSE HIM.
BY THIS CREATES A ON A SMALL
SURCHARGE ON PRESCRIPTION
OPIOIDS IN CALIFORNIA FOR
MANUFACTURERS THAT CONTRACT WITH
THE STATE. TO BE PUT ON THE
PREFERRED DRUG LIST FOR SALES
THIS IS. AN OPTIONAL.
IDEA WE HAVE THAT WE KNOW THAT
PRESCRIPTION OPIOIDS DO SERVE A
LEGITIMATE PURPOSE IN PAIN
MANAGEMENT BUT OUR NATION AS.
ALSO FALLEN VICTIM TO THE
CULTURE OF OVER PRESCRIPTION
CAUSING MILLIONS AMERICANS TO
BECOME ADDICTED TO THESE
DANGEROUS DRUGS. WE KNOW THAT.
THREE AND FOR NO NEW HERRING
USERS WERE RECENTLY A ABUSING
PRESCRIPTION DRUGS.
WEEK WE HAVE INCREASE
HEALTHCARE COSTS
PLACING FINANCIAL BURDENS ON
TAXPAYERS REDUCING ACCESS TO
EMERGENCY ROOMS WE NEED IS
SOMETHING WE NEED MORE TREATMENT
WE MORE PREVENTION ACROSS
CALIFORNIA. CERTAIN THE GENERAL
FUND COULD PAY FOR THIS WE HEARD
FROM THE LAST HEARING.
FOR THREE HOURS WE HAVE OTHER
NEEDS IN OUR HEALTHCARE SYSTEM
SO WE THINK THE INDUSTRY THE
MANUFACTURERS HAVE A
RESPONSIBILITY AS WELL TO HELP
WITH THIS ISSUE. SO WITH THIS WE
THINK WE HAVE A CREATIVE
SOLUTION.
ASKING FOR THESE ENTITIES WHO
WANT TO PARTICIPATE IN OUR MEDI
CAL FORMULARY PROCESS TO PAY.
INTO A ON.
INTO A HUG A REBATE ON A
SURCHARGE FUND THAT WILL PAY FOR
A RE HAPPENED PREVENTION
SERVICES ACROSS CALIFORNIA. ASK
YOUR AYE VOTE AND WITH ME TODAY
MISTER GRANT FREE. THANK YOU AYE
TOM RENT FREE WITH THE
CALIFORNIA BE ABLE HEALTH
DIRECTORS THIS IS ANOTHER GREAT
BILL WILL HELP PROVIDE RESOURCES
FOR.
OUR TREATMENT SYSTEM TO BE ABLE
TO.
ADDRESS THE OPIOID CRISIS AND
OUT WE URGE YOUR SUPPORT I'M ALL
I'VE ALSO BEEN ASKED TO.
TO EXPRESS THE SUPPORT OF THE A
CALIFORNIA.
SOCIETY ADDICTION MEDICINE BUT
ALSO IN SUPPORT THANK YOU.
ANYONE ELSE IN SUPPORT.
NO ONE IS THERE ANYONE IN
OPPOSITION.
NO ONE BRING BACK TO THE
COMMITTEE FOR QUESTIONS OR
COMMENTS
TO RECEIVE MAYES. I'M SORRY I
KNOW IT'S THE LATE HOUR AND ONE
HAS TO.
DID TO BELABOR THIS BUT WHEN I
LOOK AT THIS.
I KNOW YOU GUYS HAD A SIMILAR
BILL I'M LAST YEAR AND THAT WAS
A. ATTACKS.
THIS IS A REBATE.
BUT IT LOOKS LIKE IT'S THE SAME
THING I'M SURPRISED THERE ISN'T
ANY OPPOSITION.
AND.
THEM SO THAT THEY THEN I I
THINK BUT I LOOK AT THIS IT
SEEMS LIKE THIS IS THAT
PROVERBIAL THE CAMEL'S NOSE
UNDER THE UNDER THE TENT.
AND AND THAT IS OUR SLIPPERY
SLOPE THAT. I'M MIXING METAPHORS
NOW BUT.
.
BUT BUT.
TELL ME HOW THIS IS DURING THE
MATURE US YOU'RE THE FIRST OF
ALL OUR FRIENDS ARE HERE ALLEGE
COUNCIL DIDN'T HOLIDAY AND.
ATTACKS
AND SO IT'S.
.
IT'S VOLUNTARY SO THERE ARE
ENTITIES THAT WANT TO. WORK WITH
CALIFORNIA TO BE ABLE TO SELL
THEIR PLAYER THEIR PRODUCTS ON
THE FORMULARY. PAINKILLERS
OPIATES AND WE ASKED THEM IF
THEY'D LIKE TO PARTICIPATE WITH
US
TO GIVE US THE DISCOUNT KNOW
WHAT WE'RE PAYING AYE ANNUAL
BASIS. AND WILL TAKE THAT EXTRA
DISCOUNT AND PUT IN A SEPARATE
FUND.
WE'VE BEEN DOING THIS FOR YEARS
WITH THAT AIDS MEDICATION. IN
NOT IN CALIFORNIA SO IT IS.
.
YEAH IT WOULD IT'S A SURCHARGE
THAT WOULD BE THAT WOULD BE
PLACED ARE ON THIS TRANSACTION.
AND AGAIN IT'S NOT IT'S NOT IT'S
NOT FORCES SOMEONE DOESN'T WANNA
PARTICIPATE WITH CALIFORNIA TO
GET ON THE FORMULARY. THEY DON'T
HAVE TO TO PARTICIPATE THEIR
FOURTH ATTACK.
OTHER QUESTIONS.
THE NUN UM.
FIRST BOB PRETTY PRETTY YOUR
PERSISTENCE ON ON THIS ISSUE
OBVIOUSLY.
IT THE OPIOID ADDICTION
CHALLENGES WERE FACING IN THE
LACK OF RESOURCES FOR TREATMENT
IS AS PARTICULARLY VEXING.
I APPRECIATE YOU BRINGING THE
BILL FORWARD OF THE BILL DOESN'T
DO.
DOES ENJOY DO PASS
RECOMMENDATION.
TO WE HAVE A MOTION.
WE DO NOT HAVE A MOTION HOWEVER.
NUMBER OF MOTION BY MISTER
RODRIGUEZ AND WE HAVE A SECOND
BY MISTAKE YOUR CAREER THE
MOTION WOULD BE TO PASS TO
APPROPRIATIONS.
MADAM SECRETARY PLEASE CALL THE
ROLL.
I. THOUGHT I WOULD I WOULD I
MAYES.
THERE'S NOT VOTING AGAR CURRY.
AGAR CURRY I BIGELOW.
BIGELOW NO BONTA.
BURKE.
BURKE I CARILLO.
FLORA.
FLORA NOT VOTING.
LIMON.
LIMON AYE MCCARTY.
MCCARTY AYE THIS AREA.
RODRIGUEZ.
RODRIGUEZ I SANTIAGO.
SANTIAGO AYE BERMAN. THURMOND
AYE WALDRON.
FATHER I.
NINETY.
NINE ZERO THE VOTE WAS A NINE
POINT BUT CERTAIN NINE ONE THE
BILL IS OUT.
MISS BURKE AND MISS WALDRON
WILL LET YOU GO NEXT CAN WE TO
THEM WE TAKE UP ABOUT A VOTE ON
THE.
CONSENT CALENDAR.
I'LL GIVE YOU THE NUMBERS.
ITEM IT'S AB TWENTY THREE.
I'M SORRY IT'S IT'S AB TWO ZERO
TWO NINE.
MR GARCIA AB TWENTY ONE EIGHTEEN
MISTER COOLEY AB TWENTY THREE
TWENTY FIVE MISTER WHEN AB
TWENTY THREE THIRTY THREE WOULD.
AB TWENTY FOUR SEVENTY ONE
THURMAN. AB TWENTY FOUR EIGHTY
NINE MAIENSCHEIN AB TWENTY SIX
EIGHTY SIX JONES SAWYER. AB
TWENTY AB TWENTY NINE SIXTY
SEVEN OH
QUIRK SILVA AND ACR ONE SEVENTY
SEVEN JONES SAWYER SO WE DO HAVE
A MOTION. BY MISTER THURMAN THE
SECOND BY MISTER SANTIAGO.
MEMSIC TRIP PLEASE CALL THE
ROLL WOULD I WOULD I MAYES.
MAYES EYEING AGAR CURRY.
AND YOUR CAREER I BIGELOW
BIGELOW AYE BONTA.
BURKE.
BURKE I CARILLO.
FLORA.
FLORA I LIMON.
THE BONE AYE MCCARTY.
MCCARTY I NAZARIAN.
RODRIGUEZ.
RODRIGUEZ I SANTIAGO.
SANTIAGO AYE BERMAN.
THURMOND AYE WALDRON.
WALDRON AYE.
CARILLO CONSENT COUNTY.
CARILLO I.
THAT'S FOURTEEN ZERO.
MISS BURKHALTER. THIRTEEN ZERO
MISS BURKE WAS ABOUT.
THANK YOU MISTER CHAIRMAN RISK
ASSEMBLY WOMAN.
WALDRON I PRESENT YOU AB TWENTY
THREE FORTY TWO WHICH REQUIRES
HEALTH PLANS INSURANCE AND DEEP
SIESTA COVER SCREENINGS. GENETIC
COUNSELING AND TESTING FOR BROCK
MUTATION IN WOMEN WHO HAVE NOT
BEEN DIAGNOSED WITH BREAST
CANCER OVER CANCER BUT WHO COULD
BE. CONSIDERED A HIGH RISK.
WITH THAT I WILL ALLOW US I
WILL HAVE ASSEMBLY MEMBER
WALDRON COMPLETE THE PRISON
TASTE.
THANK YOU I'M JUST REALLY
BRIEFLY.
IT'S IMPORTANT THAT ALL WOMEN
THAT NEED GENETIC COUNSELING.
AND TESTING RECEIVE THESE VITAL
SERVICES BREAST AND OVARIAN
CANCER DOES NOT DISCRIMINATE
DOES NOT CARE WHETHER YOU ARE
RICH OR POOR THAT DOESN'T CARE
YOUR POLITICAL VIEWS MOVE THE
BILL. AND THAT IS WHY I AM SO
STRONGLY INCLINED TO JOIN THE
AUTHOR ON THIS BILL THANK YOU.
VERY MUCH
WITNESSES IN SUPPORT.
GOOD EVENING MISTER CHAIRMAN
REYES LESS AND MORE WITH SHALL
ENTER INTO THE HAIR ON BEHALF OF
THE CITY OF LOS ANGELES PROUD TO
SPONSOR THE SPELL. AND JUST
BRIEFLY ONE I THINK
ASSEMBLYMEMBERS BURKE AND
LODGING FOR AUTHORING THIS
IMPORTANT DEL.
OVARIAN CANCER IS ONE OF THE
DEADLIEST OF GYNECOLOGICAL
CANCERS THAT CAN HAPPEN TO
ANYONE AT ANY AGE AND PART OF
THE REASON FOR THE HIGH
MORTALITY RATES IS THAT
DETECTION OFTEN COMES TOO LATE.
THE CITY OF LA WAS INSPIRED TO
SPONSOR THIS BILL BY THE OVARIAN
CANCER CIRCLE AND THE STORY OF
ROBIN BABY WHO LOST HER FIGHT
WITH OVARIAN CANCER AT ONLY
TWENTY YEARS OLD.
MADE BY ROBIN STORY THE LOS
ANGELES CITY COUNCIL HELD A
SPECIAL PRESENTATION IN
SEPTEMBER FOR OVARIAN CANCER
AWARENESS MONTH. AND FOLLOWING
THAT MANY ANGELENOS INCLUDING
CITY HALL EMPLOYEES REACHED OUT
WITH STORIES OF THEIR OWN.
AND THIS BILL WILL HELP
SAFEGUARD COVERAGE FOR
CALIFORNIA WOMEN AND MEN
REGARDLESS OF THE STATUS OF THE
AFFORDABLE CARE ACT AT THE
FEDERAL LEVEL AND FOR THESE
REASONS WE RESPECTFULLY ASK YOU
TO VOTE.
A MUCH
OTHERS IN SUPPORT.
ASSOCIATION OF NORTHERN
CALIFORNIA ONCOLOGISTS IN THE
SOUTHERN CALIFORNIANS SUPPORT
ALL OF OUR GREAT CALIFORNIA LIFE
SCIENCES ASSOCIATION IN STRONG
SUPPORT THANK YOU.
ANYONE ELSE.
IS THERE ANYONE IN OPPOSITION TO
THE BILL.
REMAIN GENERALLY WITH CALIFORNIA
ASSOCIATION HEALTH PLANS ON MY
MEMBERS CURRENTLY COVER BRCA THE
BROKEN SCREEN IT'S REQUIRED IT'S
RECOMMENDED BY THE UNITED STATES
PREVENTIVE SERVICES TASK FORCE.
WITHIN A RECOMMENDATION ON AND
SO ARE OPPOSITION OF THE BILLS
IT'S REFERENCING A CERTAIN AN
EXACT PASS THAT NEEDS TO BE DONE
WHICH MAY NOT.
STAY CURRENT WITH AS MEDICAL.
SCIENCE IMPROVES AND THERE MAY
BE ADDITIONAL JEAN SCREENS IN
THE FUTURE.
THAT'S ALL PLANT THANK YOU. FOR.
JOHN WINGER ON BEHALF AMERICA'S
HEALTH INSURANCE PLANS WE HAVE A
SIMILAR CONCERNS IT'S CAPITAL
LOOK FOR TO WORK WITH THE AUTHOR
ON. ON.
REFERENCING THE THE GUIDELINES
RATHER THAN PUTTING THEM IN THE
STATUTE THANKS.
THREE ANYONE ELSE IN OPPOSITION.
SCENE NUMBER BRING BACK TO THE
COMMITTEE FOR QUESTIONS OR
COMMENTS.
ANYONE.
TO KNOW WHAT WOULD YOU LIKE TO
CLOSE WITH ASPECT THERE BECAUSE
THEY WILL THANK YOU VERY MUCH WE
HAVE A MOTION.
BY MISTER MAYES THE SECOND BY
MS CARILLO. OF THE MOTION IS TO
PASS TO APPROPRIATIONS MADAM
SECRETARY PLEASE CALL THE ROLL.
WOULD.
IT AYE MAYES MAYES AYE AGAR
CURRY.
I GUESS CURRY AYE BIGELOW.
BIGELOW AYE BONTA BURKE.
BURKE I CARILLO I.
CARILLO I'VE FLORA.
FLORA I LIMON.
LIMON I MCCARTY. MCCARTY AYE IN
THIS AREA.
RODRIGUEZ RODRIGUEZ AYE
SANTIAGO.
THURMOND. THURMOND AYE WALDRON.
MODERN AYE.
TWELVE ZERO YOUR BILL IS OUT
THANK YOU VERY MUCH MR WHEN.
AS IRWIN YOU HAVE AB TWENTY SIX
FORTY THREE.
AB TWENTY SIX FORTY THREE
EXPANDS HEALTH CARE COVERAGE OF
GENERAL ANESTHESIA TO THE DENTAL
OFFICE SETTING FOR CERTAIN
POPULATIONS CHILDREN UNDER
SEVEN.
PEOPLE WITH DEVELOPMENTAL
DISABILITIES.
WHEN ANESTHESIA IS MEDICALLY
NECESSARY FOR DENTAL SERVICES
THE BILL ALSO AMENDS REQUIRED
INFORMATION INFORMED CONSENT TO
INCLUDE A REFERENCE TO NON
SURGICAL TREATMENT OPTIONS.
I DENTAL CAVITIES ARE THE MOST
CHRONIC.
CHILDHOOD DISEASE AFFECTING
NEARLY TWO THIRDS OF AMERICAN
CHILDREN BY. GRADE THREE PAIN
AND INFECTION RELATED TO CABBIES
RESULTS IN A LOSS OF FIFTY ONE
MILLION SCHOOL HOURS EACH YEAR.
WHEN TREATMENT IS NEEDED TO
ADDRESS CAVITIES IN YOUNG
CHILDREN OF PEOPLE WITH SPECIAL
NEEDS THOSE UNABLE TO.
COOPERATE WITH TRADITIONAL
DENTAL TREATMENT GENERAL
ANESTHESIA IS OFTEN THE ONLY
OPTION FOR. SITE I HAD THE
PROVISION OF THE CARE.
OF ONE THIS IS THE CASE DENNIS
HAVE THREE OPTIONS HOSPITAL
AMBULATORY SURGERY CENTER AND
THE DENTAL OFFICE AND RIGHT NOW
INSURANCE IS NOT COVER THAT OUR
OFFICE SO.
.
I WOULD LAST A FEW OF OUR
WITNESSES BUT I'M SURE YOU'RE
VERY HAPPY ABOUT THAT.
GOOD GOOD EVENING CHAIR MEMBERS.
BREANNA PITTMAN SPONSOR WITH
THE CALIFORNIA DENTAL
ASSOCIATION I AM PLEASED TO BE
THE CO SPONSOR OF THIS BILL.
DOCTOR POWERS ORDER. GRIZZARD
ó WITH THE CALIFORNIA SOCIETY
OF PEDIATRIC DENNIS WHOSE ARE A
CO SPONSOR WAS HERE AND JUST HAD
TO LEAVE TO CATCH
FLIGHT.
SO EGGS AT EXISTING LAW
REQUIRES THAT MEDICAL PLANS
COVER THE COST OF GENERAL
ANESTHESIA.
IN SPECIFIC VULNERABLE
POPULATIONS WHICH WERE JUST
DESCRIBED.
BUT IT REQUIRES OF THE STREET
IN THE CAR AND HOSPITAL OR
SURGERIES CENTER. THIS COVERAGE
OR CRIME AND ACKNOWLEDGES THAT
THE REASON FOR ANESTHESIA IS NOT
THE DEVIL TREATMENT ITSELF BUT
IS.
TO UNDERLYING MEDICAL CONDITION
OR AGE OF THE PATIENT
A HEALTHY AND ADULT FOR EXAMPLE
WOULD BE ABLE TO SIT THROUGH A
DENTAL TREATMENT TO RECEIVE
MULTIPLE FILLINGS OR CROWNS WALL
SOME OF THESE POPULATIONS JUST
AREN'T ABLE TO.
.
REMOVING THE SETTING RESTRICTION
ON EXISTING COVERAGE WILL REMOVE
THE COST BARRIERS FOR SOME OF
OUR MOST VULNERABLE CALIFORNIANS
ENSURING TIMELY ACCESS CAN BE
PROVIDED IN THE LEAST DRAMATIC
SETTING.
AND WHAT THE LOWEST COST BURDEN
FOR FAMILIES.
I'M CDA IS TRYING TO IMPROVE
ACCESS TO DENTAL SEDATION
ANASTASIA BORE ALSO COMMITTED TO
DECREASING THE NEED WHEREVER
POSSIBLE. AND THE CHANGE IN THE
INFORMED CONSENT THAT WAS
MENTIONED.
IS REALLY INTENDED TO MAKE SURE
THAT FAMILIES OF MINORS ARE.
.
INFORMED OF THE ALTERNATIVES AND
IT'S REALLY JUST CONTINUATION OF
OUR EFFORTS THERE SOBRE DIVING
FLUORIDE IS A NEW TREATMENT
THAT'S AVAILABLE IT CAN ACTUALLY
IT'S A MEDIC IN THE DOCUMENT THE
PONTIFF CAN. SLOW OR STOP.
THE DEVELOPMENT OF CAVITIES AND
SO CAN BE A REALLY GOOD
ALTERNATIVE FOR SOME OF THESE
POPULATIONS TO INSTEAD OF HAVING
THEM UNDERGO ANESTHESIA JUST FOR
SIMPLE CLEANING OR SOME THINGS.
TO REALLY TRY TO PROMOTE THAT
AND WE THINK THAT THE INFORMED
CONSENT IS A SMALL PIECE ABOUT
SO.
.
THANK YOU FOR LETTING ME TALK ON
AN URGENT AYE VOTE.
OTHERS IN SUPPORT HOW MISTER
CHAIR MEMBERS BREAK STOCKARD IN
BEHALF OF THE CALIFORNIA SOCIETY
OF ANESTHESIOLOGISTS AND.
DELIGHTED TO FINALLY BE ABLE TO
SUPPORT A CDA SPONSORED
PEDIATRIC DENTAL HONESTY
SHOULDN'T THANKS VERY MUCH.
IF.
OTHERS IN SUPPORT OF ANYONE
ELSE.
ANGELA LANTERN ON BEHALF OF THE
CALIFORNIA ASSOCIATION ANDERSON
ASSISTANCE AND SUPPORT. YOU VERY
MUCH.
IS THERE ANYONE IN OPPOSITION
.
ROOM WELL HELLO AGAIN JENNIFER
OUT WITH CALIFORNIA ASSOCIATION
HEALTH PLANS IDEA WE REPRESENT
FORTY EIGHT PUBLIC AND PRIVATE
ORGANIZATIONS THAT COLLECT.
COLLECTIVELY PROVIDE HEALTH CARE
COVERAGE TWENTY SIX MILLION
CALIFORNIA.
WE OPPOSE AB TWENTY SIX FORTY
THREE A BILL THAT CREATES A
COSTLY NEW MANDATE. A REQUIRED
HEALTH PLANS TO COVER ANASTASIA
SERVICES AND AN OFFICE.
ASK THE PROPONENTS OF ALREADY
STATED HEALTH PLANS CURRENTLY
COVER ANASTASIA FOR DENTAL
SERVICES WHAT IS PROVIDED IN A
HOSPITAL OR OUTPATIENT SETTING.
AND IT SOME OF THOSE OF
COVERAGE REQUIREMENTS IS THAT
THAT FACILITY BEING CONTRACT
WITH THE HEALTH PLAN.
AND SO WHAT THIS MANDATE DOES IT
MOVES IT'S OUTSIDE OF.
HEALTH INJURED CONTRACTED
ENTITIES AND MOVES INTO OUR
NETWORK NON CONTRACTED DENTAL
OFFICES
WHICH MAY CREATE REIMBURSEMENT
ISSUES ON THE BACK END FOR THIS
BILL.
YOU KNOW WE'VE HEAD A LOT ABOUT
HEALTHCARE COSTS
RIGHT THIS IS AN EXPENSIVE
MANDATE ITS MOST EXPENSIVE
MANDATE THAT WE FOR ABOUT. IN
THE COMMITTEE TODAY. NO PREMIUM
INCREASE IN THE TO BURKE RECORD
A SEVENTY FIVE MILLION OVERALL
TOTAL COSTS THE SYSTEM IS A
UPPER TO FORTY MILLION SAVED IN
THE ANNOUNCERS. AND THAT'S A LOT
OF MONEY.
.
YOU KNOW MY MEMBERS REALLY TRY
TO KEEP PREMIUMS AFFORDABLE TO
ENSURE THE VIBRANT SUCCESS THAT
WE HAVE. WITH NINETY THREE
PERCENT OF OF CALIFORNIANS
CURRENTLY COVERED BY HEALTH
INSURANCE IN ITS MANDATES LIKE
THIS. TO JEOPARDIZE OUR ABILITY
TO KEEP.
HEALTH PREMIUMS AFFORDABLE.
THANK YOU.
CHAIR MEMBERS KATHY MOSSBERG
RIPS INTO LOCAL HEALTH PLANS
CALIFORNIA THE SIXTEEN NOT FOR
PROFIT MEDI CAL MANAGED CARE
PLANS OUR CONCERNS ARE SIMILAR
BUT JUST TO BE CLEAR THE ISSUE
OF NON CONTRACTING PROVIDERS IS
A BIG ONE FOR US. WHEN THERE IS
A CONTRACTING PROVIDER WE
CREDENTIALED AND WE LOOK AT
QUALIFICATIONS WOULD LOOK AT
FACILITIES AND CHECK THEM FOR
SAFETY.
THAT WOULD BECAUSE THESE ARE
NOT CONTRACTING WE WOULDN'T BE
ABLE TO DO THAT ARE HAPPY DOING
THAT SO WE DO A LOT OF CONCERNS
FOR THIS AS AS.
AS WE SEE THIS IN PLAY SO
UNFORTUNATELY WE ARE POSED THIS
TIME.
OPPOSITE.
YEAH I JOHN LINGER ON BEHALF
AMERICA'S HEALTH INSURANCE PLANS
WE LINE OUR COMMENTS OF VILLAGE
PC AND CAP.
ANYONE ELSE.
IT'S YOU KNOW AND I'M OF COURSE
ISN'T A RUNAWAY PLEASE
YOU DON'T MIND.
NO YOU YEP KNOW EITHER ONE OF
YOU DOESN'T MATTER. OH MAYBE
BOTH OF YOU.
DOES ANYBODY ELSE HAVE ANY
QUESTIONS.
MR RESTRAINTS.
YEAH I'M NOT SURE I CAN SUPPORT
THIS BILL TODAY BUT I LIKE IT.
AND THE REASON I LIKE IT IS
BECAUSE.
I DO THINK THERE'S GOTTA BE
MORE IN A.
DENTISTRY AND AND MEDICINE.
THIS FALL.
I HAD THE OPPORTUNITY ABLE TO
HEAR ABOUT WHAT MINNESOTA'S
DOING AND HEARING ABOUT HOW
THEY'RE ACTUALLY LOWERING COSTS.
A BECAUSE OF.
THEIR INTEGRATED NAM.
SERVICE BETWEEN BED DENTISTRY
IN MEDICINE AND I THINK THIS IS
A STEP IN THE RIGHT DIRECTION I
DON'T LIKE THE COSTUMES THAT
WOULD NOT THE WAY THE SYSTEM. IS
SET UP BUT I LIKE THE
DIRECTIONS.
AND IF YOU WANTED TO. YOU KNOW.
TALK ABOUT THAT A LITTLE BIT BUT
AND MARK OR NOT WAS TO QUESTIONS
MORE A STATEMENT BUT I WOULD
LIKE TO SEE MORE INTEGRATION.
WELL I THINK THAT THE CURRENT
SYSTEM IS INTEGRATED RIGHT
BECAUSE THEY'RE GOING TO THE
HOSPITAL THEY'RE GOING TO THE
OUT PATIENT SURGERY THEY'RE
GOING TO A MEDICAL FACILITY FOR
THIS TREATMENT AND WHAT THIS
DOES KIND OF. FROM WHAT I HEARD
YOUR COMMENTS IS THIS KIND D.
INTEGRATES IT RIGHT IT'S POINTED
OUT OF THE HEALTH AND MOVING ITS
WHOLLY INTO THE DENTAL.
BUT IT'S A LATE HOUR I'M SURE
AND ARTICULATE VERY WELL.
WILL COME BACK AND HAVE SOME
MORE CONVERSATION ABOUT THIS
ABOUT THAT.
TO ANYONE ELSE IN THE WORLD
QUESTION.
YES MY QUESTION MY QUESTION IS.
AS A DENTIST AND AND.
.
IT'S ALREADY ALMOST IMPOSSIBLE
TO GET GENERAL ANESTHESIA
COVERAGE FOR A CHILD IN THE
HOSPITAL SETTING.
IT JUST ISN'T APPROVED VERY
OFTEN.
THAT IS THE MOST EXPENSIVE
SETTING.
TO PROVIDE CARE.
ABSOLUTE MOST EXPENSIVE SO THE
DENTAL OFFICE.
IN THE RIGHT SET YOU UP WITH THE
RIGHT SUPERVISION WITH THE
RIGHT.
PRECAUTIONS IS THE LEAST
EXPENSIVE SETTING.
SO YOU'RE YOU'RE YOUR YOUR
CONTENTION ABOUT NOT WANTING
THIS BILL IS BECAUSE IT WAS
BECAUSE OF. NOT NON CONTRACTING
PROVIDERS.
WHY WOULDN'T YOU WANT A CONTRACT
WHAT COULD YOU WHICH PROHIBIT
YOU FROM CONTRACTING WITH
PROVIDERS TO PROVIDE THIS
SERVICE?
TO HELP THESE KIDS AND TO HELP
THESE PEOPLE IN VULNERABLE
POPULATIONS TO GET THE CARE THEY
NEED.
IN A VERY INEXPENSIVE SETTING
CHUCK JUST I WOULD JUST SPEAK TO
THE MEDI CAL SYSTEM IN MEDI CAL
AT THE DENTAL IS GENERALLY A
CARVED OUT.
A CARVED OUT ISSUE SO.
WE CERTAINLY HAVE PLANS LOOKING
AT TRYING TO LOOK AT A CARVIN
SITUATION WHERE I THINK THAT
WOULD SOLVE IT BUT I THINK
THAT'S OUR ISSUE. WHEN YOU DO IT
IN THOSE FACILITIES WE DO COVER
IT AND SO WE HAVE CREDENTIALS
FACILITIES AND LOOKED AT IT BUT
I THINK THE MEDI CAL ISSUES
BECAUSE IT'S CARVED OUT.
AND THE AND THE PRIVATE SECTOR.
PRIVATE SECTOR NOT ALL OF OUR
OUR COMMERCIAL PLANTS CURRENTLY
YOU DON'T. INCLUDE A DENTAL
BENEFIT SOME DO SOME DON'T SOME
HAVE EMBEDDED AND SOME DO NOT.
AND SO.
YOU KNOW WHEN WE CONTRACT WITH A
PROVIDED PROVIDER IS MISS
MUSBURGER STATED THERE IS A
CREDENTIALING PROCESS THAT THEY
GO THROUGH AND SO. TO JUST HAVE
A BLANKET BENEFIT THAT SAYS YOU
DON'T OWE YOU CAN HAVE IT IN IN
THE DENTAL OFFICE IN YOUR HEALTH
PLANS GOING TO COVER THAT.
THAT'S THAT'S AN ONE IN
INCREASED COSTS FOR US BECAUSE
WE THINK UTILIZATION IS GONNA GO
OUT.
BUT TO WE DON'T. WE MAY NOT HAVE
A RELATIONSHIP WITH THOSE
PROVIDERS.
AND SO THEN THAT PUTS PRESSURE
YOU KNOW ADDITIONAL
ADMINISTRATIVE COSTS ON THE
PLANS OF WE HAVE TO GO OUT AND
AND CONTRACT WITH A SLEW OF NEW
PROVIDERS TO COVER THIS MANDATE.
THAT IT'S GONNA BUMP UP ON OUR
NETWORK ADEQUACY REQUIREMENTS
THAT WE HAVE WITH OUR
REGULATORS.
SO YOU DO YOU YOU YOU REALLY
DON'T WANT TO CONTRACT WITH
ADDITIONAL PROVIDERS. DO I DON'T
THINK IT'S A MATTER THAT WE
DON'T WANT TO I MEAN IT'S JUST.
YOU KNOW IT'S IT'S GOOD WE WERE
COMPLETELY HAVE THERE'S THE
POTENTIAL THAT WILL HAVE TO
COMPLETELY RETOOL RE TUNE THE
RETOOL A RETURNON THE EXISTING.
NETWORK TO ENSURE THAT THESE
PROVIDERS ARE CONTRACTED WHEN
WERE ALREADY COVERING THE
SERVICE IN A DIFFERENT SETTING
THE MOST EXPENSIVE SETTING YOU
COULD POSSIBLY COVERED AND. THAT
AND THAT'S MY POINT AND THAT'S
AND I APPRECIATE MR MAZES OF
COMMENT TO ABOUT.
HOW CAN WE GET TO A POINT WE CAN
INTEGRATE A DENTISTRY IN
MEDICINE MORE FOR SITUATIONS
JUST LIKE THIS BECAUSE I
APPRECIATE?
YOU DO HAVE A SETTINGS YOU CAN
DO IT BUT IT IS THE MOST
EXPENSIVE WAY TO DO IT. AND HERE
IS AN ALTERNATIVE AND YES OR
MAYBE ADDITIONAL COSTS BUT. FOR
THE PEOPLE THE NEEDS OF THIS
POPULATION.
THE SEDATION IS NOT A DENTAL
ISSUE IT'S A MEDICAL ISSUE THEY
CANNOT HAVE THE CARE WITHOUT
SOME MEDICAL INTERVENTION.
THAT'S THE ISSUE HERE AND SO
THAT'S WHERE THE INTEGRATION IS
MISSING. AND IT IS A LEUPOLD
SALUTE POLYGONAL WHERE FOR
THIRTY YEARS AND I WISH YOU
WOULD CHANGE BECAUSE QUITE
FRANKLY WAS A LOT OF PEOPLE THAT
ARE NOT GETTING THE CARE THEY
NEED.
WHICH LEADS TO OTHER KINDS OF
PROBLEMS DOWN THE ROAD AND.
I JUST WISH.
WE COULD BE WORKING TOWARDS
SOLUTION INSTEAD OF JUST SAYING
NOW IT'S JUST ANOTHER MANDATE.
SO ANYWAY.
IT'S LAKE.
.
THIS SHORT SOAPBOX BUT YOU KNOW
IT IS AN ISSUE THAT I'VE WATCHED
FOR THIRTY YEARS AND.
AND
PEOPLE DON'T GET THE CARE THEY
NEED BECAUSE OF THIS.
THIS WHOLE RIGHT HERE. AND YET
YOU'RE WILLING TO PAY FOR IN THE
MOST EXPENSIVE SETTING
OCCASIONALLY.
NOT VERY OFF IT'S VERY RARE THAT
I ACTUALLY HEAR ABOUT THESE
CASES ACTUALLY BECAUSE NUMBER
ONE.
THERE AREN'T THE FACILITIES
AVAILABLE.
AND HOSPITALS DON'T WANT TO
GIVE UP THEIR OR SWEETS IN
GENERAL FOR FOR THESE PROCEDURES
BECAUSE THEY'RE NOT. VERY.
PROFITABLE.
AND AND THERE'S JUST A LOT
THERE'S A LOT OF ISSUE THE LOT
OF ISSUES HERE SO IT IS EASIER
TO IS TO NOT CONTRACT IT OR TO
NOT. COVER IT AND AND MEANWHILE.
PEOPLE DON'T GET THE SERVICES
THEY NEED THE CARE THEY NEED.
ANYWAY.
WHICH I COULDN'T BUT I THINK WE
JUST CLOSE FOR ME. BUT.
I I WOULD SAY IT'S NOT ONLY
THAT THAT AND AND OFFICE CAN
PROVIDED AT A MUCH LOWER COST
BUT IT'S ALSO A MUCH LESS
DRAMATIC SETTING FOR THESE
VULNERABLE POPULATIONS SO.
WITH THAT I ASK FOR YOUR
DISTRIBUTOR AMENDMENTS.
I'M SORRY DID YOU TO FURTHER
DOWN.
THANK YOU APPRECIATE THAT SO WE
HAVE A MOTION BY MISTER THURMOND
A SECOND BY MISS LIMON.
AND SECRETARY OF THAT THE
MOTIONS TO PASS AS A MAN.
PERFECT.
OF THE.
WELL FOR.
LEYVA.
WOW. A FIRST.
PLEASE SAID THAT THE BUSHES TO
PASS AS AMENDED TO
APPROPRIATIONS MEMSIC TRIP
PLEASE CALL THE ROLL WHEN I
WOULD AYE MAYES. MAYES NOT
VOTING AGAR CURRY. AGAR CURRY I
BIGELOW.
BIGELOW NOT VOTING BONTA.
BURKE.
BURKE I CARILLO.
CARILLO AYE FLORA.
FLORA I LIVE ALONE.
LIMON AYE MCCARTY.
MCCARTY AYE THE SYRIAN.
RODRIGUEZ RODRIGUEZ AYE
SANTIAGO.
THURMOND.
THURMOND AYE WALDRON.
WALDRON NOT VOTING.
BIGELOW VOTING TO KNOW.
THAT.
NINE TWO ONE. YOUR YOUR BILLS
OUT. THEN TAKE YOU VERY MUCH
THIS GREAT DINNER BUT WENT ON.
THIS MONTH.
IN AUGUST ONE.
THANK YOU TURN MEMBERS. AB
EIGHTEEN SIXTY TWO OR ADAM
REMOVES A SUNSET ON ORAL
CHEMOTHERAPY.
THIRD.
THANK YOU. WITH ME TODAY I HAVE.
IS MILAN FLOWERS A DIVA BARNEY
DOCTOR CAME ASSISTANT PROFESSOR
OF MEDICINE AT UC DAVIS IN
AUTUMN ODD CHEN DIRECTOR OF
STATE LEGISLATION FOR THE
CALIFORNIA.
AMERICAN CANCER SOCIETY ACTION.
YEAH THEY CAN PROVIDE TESTIMONY
IN QUESTIONS AND WE DO HAVE A
MOTION.
THESE.
HELLO MY NAME IS MORE ON FLOWERS
I'M BRIAN COSTELLO FLOWERS
STARTING.
YOU MAY OR MAY NOT REMEMBER HER
BUT SHE TRAVELED HERE WITH MY
FATHER RON TO GIVE OUR POWERFUL
TESTIMONY FOR EP TWO ONE NINE
WITH ASSEMBLY MEMBER HENRY T.
PRAYER.
MY MOM WAS FIRST DIAGNOSED WITH
STAGE TWO BREAST CANCER IN TWO
THOUSAND SEVEN. I WAS NINE YEARS
OLD AND MY BROTHER CAMERON WHO
IS HERE TODAY WAS FOUR YEARS
OLD.
SHE BOB VERY VERY HARD WHILE
WORKING FULL TIME IN HELPING MY
FATHER RAISED MY BROTHER AND I.
MY MOM WENT IN APRIL TWO
THOUSAND TWELVE HER FIVE YEAR.
HER FIFTH YEAR IN REMISSION THAT
THE CANCER HAD RECURRED.
LUCKILY SHE WAS ABLE TO SEE THE
BONE ACTION.
IT'S LIKELY SHOULD BE ABLE TO
SEE THE BILL PASSED BUT SHE WAS
UNABLE TO EXPERIENCE AND SEE THE
BONE ACTION.
SHE PASSED AWAY EARLY TWO
THOUSAND FOURTEEN.
I NEVER REALIZED TALKS WITH MY
MOM'S TREATMENTS ACTUALLY WHERE
UNTIL SHE PASS.
OF COURSE MY PARENTS NEVER
TALKED ABOUT FINANCIAL HARDSHIPS
MY BROTHER AND I WE WERE YOUNG.
MY PARENTS ALWAYS MADE SURE WE
HAD CLOTHES ON OUR BACK
WE HAD THE FOOD WE HAD A ROOF
OVER OUR HEADS.
BUT I NEVER REALIZED THE
MAGNITUDE OF BILLS THAT WERE
PILING UP IN THE FINANCIAL
HARDSHIP YOU'RE ACTUALLY IN.
A LOT OF PEOPLE IN OUR COMMUNITY
WOULD BRING MEALS FOR US EVERY
WEEK YOU'D GET ANONYMOUS
SPONSORS SO THAT WE CAN CONTINUE
ON OUR EXTRACURRICULAR
ACTIVITIES.
I WE THOUGHT IT WAS BECAUSE MY
MOM WAS SICK WHICH IT WAS BUT IT
WAS ALSO BECAUSE WE'RE IN SUCH A
FINANCIAL HARDSHIP.
THIS MEDICATION THAT POTENTIALLY
COULD SAVE MY MOM'S LIFE WAS
BREAKING MY PANTS POCKETS.
I REMEMBER MY FATHER SHOWING ONE
OF HER ORAL CHEMOTHERAPY
MEDICATIONS THE SMALL BOTTLE
CONTAINING ONLY THIRTY PILLS
BECAUSE TWO THOUSAND SEVEN
HUNDRED AND FIFTY THREE DOLLARS
AND FORTY TWO CENTS.
ALL THESE DIFFERENT MEDICATIONS
WERE CAUSING MY PANTS THOUSANDS
AND THOUSANDS OF DOLLARS.
ONE DAY I WAS HOPING MY FATHER
SORT THROUGH ALL THE BILLS. WE
LEARNED THAT MY MOM WAS SIGNING
UP FOR EVERY CREDIT CARD SHE
RECEIVED IN THE MAIL.
JUST SO SHE COULD PAY FOR THESE
MEDICATIONS.
MY DAD TOLD ME THERE WERE TIMES
THAT THEY STRUGGLE TO PAY FOR
HOME AND THEN MY MOM'S PARENTS
WOULD HELP OUT WITH THE MORTGAGE
FROM TIME TO TIME.
THESE MEDICATIONS WERE SO
EXPENSIVE TO CONTINUE AND AFTER
FIGHTING FOR SEVEN YEARS MY MOM
DECIDED SHE WAS TOO TIRED.
SHE NO LONGER HAD A FIGHT AND
HER SOMETIMES CANCER RIGHT
ATTACKS MULTIPLE PEOPLE IN A
FAMILY.
UNFORTUNATELY CANCER SEEMS TO
LOVE MY FAMILY.
FIRST MY MOTHER.
THEN. THEN WERE FATHER.
MY GRANDFATHER. AND MY YEAH.
I'M HEARTBROKEN TO SEE THAT MY
GRANDFATHER'S HOUSE WITH THIS
LAST NOVEMBER. AND MY AT WHICH
WAS THREE WEEKS AGO.
MY GRANDMOTHER HOW LOSING.
TWO DAUGHTERS AND HER HUSBAND OF
SIXTY YEARS TO CANCER SHE IS NOW
COMPLETELY ALONE.
THIS IS BEEN A TRAUMATIC TIME
FOR MY FAMILY AND I.
JUST IMAGINE FOR ONE MOMENT THE
EMOTIONAL TRAUMA CANCER HAS HAD
ON MY FAMILY. ALARM SLOWED THE
FINANCIAL ASPECT OF IT.
NO ONE DESERVES CANCER.
AND NO FAMILY. AND ALSO THE
HARDSHIP. AND ALSO THE FINANCIAL
ASPECT OF IT.
NO ONE DESERVES THE HARDSHIPS
OCCURS ALONG WITH THAT MENTALLY
PHYSICALLY AND FINANCIALLY.
I HOPE YOU WILL COME SOONER AB
EIGHTEEN SIXTY EVER SUCH U. HAS
PAST I CAN'T HELP BUT WHAT THE.
BUT WHAT IF ONE OF THESE
MEDICATIONS THAT WE CANNOT
AFFORD SAVED HER LIFE.
MY MOM COULD HAVE BEEN HERE TO
SEE MY BROTHER AND GROW UP MY
BROTHER AND I CRAWL UP AND SEE
WHAT WE'VE ACCOMPLISHED.
MAYBE THESE MEDICATIONS COURTESY
MY GRANDFATHER MY AUNT'S LIFE AS
WELL. IMAGINE YOURSELF IN MICE
MOMS SITUATION. WOULD YOU FEEL
COMFORTABLE PAYING FOR
MEDICATION THAT IS SO EXPENSIVE
THAT YOU NEED IN ORDER TO
SURVIVE. WOULD IT BE WORTH
CONTINUING FOR YOUR FIGHT.
PLEASE WELL I FOR AB EATEN
SIXTEEN.
THANK YOU.
UP MOST OF YOU HAVE HEARD.
SOME ON BEING CALLED A BREAST
CANCER SURVIVOR AYE I PERSONALLY
CALL MYSELF A CANCER LIFE FOR
SOMEONE THAT LIVES WOULD AND
FIGHTS CANCER ON A DAILY BASIS.
MY NAME IS A DIVA BARNEY AND
THIS IS A VERY SHORT SHORT SHORT
VERSION OF MY STORY.
A TWO THOUSAND AND FIVE I WAS
TWENTY SEVEN YEARS OLD.
AND I WAS CLIMBING THE LADDER
MY CAREER IN SWEDEN. HAPPILY
MARRIED AND WAS JUST ABOUT TO
HAVE A CHILD.
OUT WHEN WE FOUND A LUMP IN MY
LEFT BREAST.
A LUMP THAT TURNED OUT TO BE
STAGE ONE CANCER.
STAGE ONE WAS FINE I GOT TREATED
AND LIFE WAS GOING ON JUST A FEW
MONTHS OF TREATMENTS AND I WAS.
I WAS LIVING LIFE AGAIN.
TWO THOUSAND AND EIGHT HOURS NOW
THIRTY YEARS OLD DIVORCED WITH
NO KIDS.
AND SO I DECIDED I WILL
FACILITATE REAM OF MINE TO GO
AND WORK IN THE U. S..
THAT IT'S BEEN ON MY BUCKET
LIST.
UNFORTUNATELY I HAVE TO DO A OR
THAT WAS FORTUNATE BECAUSE I
HAD%
TO DO A FULL BODY HEALTH CHECK
FOR THE INSURANCE.
I AND THAT'S WHEN THEY FOUND TWO
NEW TUMORS AYE IN MY BROTHER AND
MY PREVIOUSLY TREATED BREAST.
SO MY BREAST CANCER HAD COME
BACK BUT STILL STAGE ONE HOWEVER
I HAVE TO DO THE TOUGHEST
TREATMENTS OUT WHICH INCLUDED IV
CHEMO CARE.
I BECAME A CARE WAS REALLY
HORRIFIC AND.
ANYTHING YOU CAN IMAGINE AND
SIDE EFFECTS I HAD.
.
WHILE I WAS STE A DEALING WITH
THE SIDE EFFECTS I ACTUALLY PUT
TOGETHER MY SECOND COMPANY AND
THAT WAS THE COMPANY THAT TOOK
ME LATER ON IN TWO THOUSAND
ELEVEN TO THE AND UNITED STATES.
OUGHT TO SILICON VALLEY TO
FULFILL MY DREAM.
FAST FORWARD TWO THOUSAND
FIFTEEN HOURS NOW A THIRTY SEVEN
YEAR OLD BAD A CEO. AND HAPPILY
MARRIED FOR TWO YEARS WITH A
WONDERFUL MAN NAMED CHRIS.
AGAIN I WANTTO START A FAMILY
AN IVF WAS MY ONLY OPTION.
THE FERTILITY CLINIC WANTED TO
DO A MAMMOGRAM.
YES AGAIN TURNED OUT I HAD
BREAST CANCER AGAIN HOWEVER IN
MY OTHER BREAST.
AND THAT WAS OKAY BECAUSE IT WAS
SUPER EARLY STAGE SO MASTECTOMY
AND IT WOULD BE ALL GONE.
HOWEVER WHEN I RECOVERED FROM
THEM MY SURGERY I HAD A CT SCAN
AS AN ANTI E. R. VISIT AND
TURNED OUT THAT MY PREVIOUS
BREAST CANCER HAS SPREAD
THROUGHOUT MY BODY AND IT WAS IN
SEVERAL SPOTS IN MY SPINE.
MY LIFE CHANGED FOREVER AGAIN
BUT THIS TIME I WAS FACED WITH
MORTALITY I SUDDENLY HAD A
BREAST CANCER DIAGNOSIS THAT
WILL EVENTUALLY KILL ME.
THEY GAVE ME THREE TO FIVE YEARS
THAT WAS THREE YEARS AGO. AND I
HAVE TO BE IN TREATMENT FOR THE
REST OF MY LIFE.
THEY PUT ME ON SEVERAL DIFFERENT
TREATMENTS BUT THEY ENDED UP NOT
WORKING LONG TERM AND MY CANCER
HAD NOW ALSO SPREAD TO MY LUNGS.
I ALSO HAD A NEW TYPE OF
RADIOSURGERY OUT THAT BLASTED
THE BIGGEST HUMOR'S I HAD IN MY
SPINE BUT PUT ME IN A
WHEELCHAIR.
WHERE I WAS FOR ABOUT A YEAR?
I HAD TO FIGHT MY BACK TO
MOVEMENT AGAIN.
IN THE SUMMER OF TWO THOUSAND
FIFTEEN SOMETHING WONDERFUL
HAPPENED.
I WAS PUT ON IN U. ORAL CHEMO
TREATMENTS.
A TREATMENT THAT HAS BEEN
WORKING FLAWLESSLY FOR TWENTY
NINE MONTHS I'M WALKING AGAIN I
HAVE A GREAT LIFE.
TREATMENT THAT MADE ME TO MORE
FREE.
I NOW HAVE A TEN TO FIFTEEN YEAR
LIFE PROGNOSIS.
AND SOMEWHAT GOOD QUALITY OF
LIFE.
SPIKE LIVING WITH CANCER IN ITS
SIDE EFFECTS I HAVE AN
ABSOLUTELY GREAT LIFE I TRAVEL A
LOT ENJOY FOR. TIME WITH FAMILY
AND FRIENDS
CHALLENGE MYSELF WITH A LOT OF
NEW THINGS EVERY NEW YEAR.
I AM I ALSO TAKE ON BOARD RULES
AND.
FUNCTION AS AN ADVOCATE FOR THE
BREAST CANCER STAGE FOR BREAST
CANCER COMMUNITY. AMAZON THE
SUSAN G. KOMEN.
BOARD A AND.
SAN FRANCISCO AFFILIATE.
ME AND MY HUSBAND DECIDED TO
FULFILL OUR DREAM OF HAVING A
FAMILY SO ARE.
WE HAD DECIDED TO USE A
SURROGATE OUR SURROGATE IS TODAY
THIRTEEN TODAY ACTUALLY THIRTEEN
WEEKS PREGNANT WITH OUR SON SO
WE ARE OVER THE MOON.
SO WHY AM I TELLING YOU ALL THIS
WELL I AM ONE OF THE LUCKY ONES
I GOT THE BEST TREATMENT YOU CAN
IMAGINE.
I GOT THE NEW GROUNDBREAKING
ORAL CHEMO TREATMENT THAT WAS
OUT IN THE MARKET HOLD NEAR
TREATMENTS I TAKE ONE PILL.
EVERY DAY FOR TWENTY ONE DAYS
AND HAVE A SEVEN DAY BREAK AND
THEN I'M ON IT AGAIN.
ONE OF THESE PILLS COST FIVE
HUNDRED DOLLARS THAT'S TEN
THOUSAND FIVE HUNDRED DOLLARS A
MONTH.
IF MY INSURANCE DIDN'T COVER IT
I WOULD BE OUT ON THE STREET.
NOT EVERYONE IS AS LUCKY AS I AM
I PERSONALLY KNOW TWO YOUNG
WOMEN IN MY SUPPORT GROUP.
THAT ARE. ALSO SUPPOSED TO BE ON
THE SCRUB GROUNDBREAKING
TREATMENT THEY HAVE THE EXACT
SAME TYPE OF A CANCER IN TUMOR
TYPES THAT I HAD.
BUT THEY'RE UNDER INSURERS
INSURED AND CAN THEREFORE NOT
AFFORD IT.
THEY STILL TRY TO TAKE IT THOUGH
EVERY TIME WE MEET.
SCRAMBLE ALL THE PILLS THAT THE
OTHER PATIENTS THE OTHERS MET
SISTERS IN THE GROUP HAVE
LAUGHED.
SO SOMETIMES THEY TAKE FIVE
PILLS A MONTH AND THAT'S NOT
WHAT THEY'RE SUPPOSED TO DO.
SO UNFORTUNATELY THEIR CANCER
HOSPITAL GRASSED.
AND NOW THEY HAVE TO BE ON MORE
TOXIC TREATMENTS WED LESS
EFFECTIVE AT TREATMENTS WITH
MORE TOXIC.
AND THEY ARE NOT THE ONLY ONES
PATIENTS ARE DYING BECAUSE THEY
CANNOT AFFORD TO NEW LIFE
CHANGING ORAL TREATMENTS THAT
ARE AVAILABLE TODAY.
WE REALLY NEED BILL A. B.
EIGHTEEN SIXTY.
PLEASE UNDERSTAND THAT PEOPLE
ARE UNKNOWN UNDERINSURED AND ON
AND UNINSURED ARE DYING IN
GREATER NUMBERS WITHOUT THIS
THAT YOU CAN MAKE A GREAT CHANGE
IN THEIR LIVES TODAY. THANK YOU.
OTHER WITNESSES SUCH AS YOUR
NAME AND POSITION.
EDWARD CAM ASSISTANT PROFESSOR
OF MEDICINE AND HUMAN TOUCH
ONCOLOGY AT UC DAVIS APPEAR
REPRESENTING ASSOCIATION OF
NORTHERN CALIFORNIA COLLEGES.
AND THE MEDICAL ONCOLOGY
ASSOCIATION OF SOUTHERN
CALIFORNIA.
OTHERS IN SUPPORT.
I HAVE AUTUMN OGDEN'S MET WITH
THE AMERICAN CANCER SOCIETY
CANCER ACTION NETWORK AS A. CO
SPONSOR OF THIS BILL AND ALSO
HERE TO ANSWER ANY QUESTIONS.
THE BILL.
KELLY MAC MILLAN EXECUTIVE
DIRECTOR FOR SUSAN G. KOMEN
NORTHERN CENTRAL COAT CALIFORNIA
ALSO CO SPONSOR AND SUPPORT OF
THIS BILL.
MARY VALDEZ WITH HEALTHAXIS
CALIFORNIANS SUPPORT.
BUT THE GREATEST WITH THE
AMERICAN LUNG ASSOCIATION
CALIFORNIANS STRONG SUPPORT.
SECURE.
KEVIN POWELL THIRTY ANSWER PAYER
I FULLY SUPPORT THIS BILL.
I TOOK OFF I FULLY SUPPORT.
KAMAN FLOWERS ON FLOWERS BROTHER
STAND IN SUPPORT.
LISA FLOWERS MULLIN STEPMOTHER
HAD FULLY SUPPORT.
I RUN FLOWERS FATHER AND FULL
SUPPORT OF BILL.
AB ONE EIGHT SIX ZERO.
AFTER THE NOSE GRANDMOTHR I
LOST MY MOTHER TO BREAST CANCER.
SHE HAD EIGHT GIRLS AND TWO OF
US WENT WITH THIS.
I STRONGLY SUPPORT.
MAINLY FLOUR IS MORE ON FLOWERS
AND OLDER SISTER AND I AM IN
FULL SUPPORT.
SHIRAZ MORNINGS COUSIN AND I
FULLY SUPPORT.
KILL ASSUMES FULLY SUPPORT THANK
YOU.
KIMBERLY BEARDEN I'M A BREAST
CANCER SURVIVOR AND A DEAR
FRIEND OF BRENDA.
FLOWERS.
I AM IN FULL SUPPORT.
OVERALL GREAT CALIFORNIA LIFE
SCIENCES ASSOCIATION IN SUPPORT.
WHERE TOP ON BEHALF OF VIACOM IN
SUPPORT?
ANNOUNCES IT ANYONE ENOUGH
POSITION.
PLUS I'M JENNIFER HOLLYWOOD
CALIFORNIA ASSOCIATION HEALTH
PLANS.
.
YOU KNOW WE HAVE A OPPOSE
POSITION ON AB EIGHTEEN SIXTY.
ON WE DON'T WISH Y. CLARIFY
HEALTH PLANS CURRENTLY COVER OR
ORDERLY ADMINISTRATED.
FORMERLY ADMINISTRATOR SO TIRED
ANTI CANCER DRUGS BECAUSE THEY
ARE IMPORTANT TOOLS.
TO FIGHT AGAINST CANCER.
OVER WE OPPOSE THIS BILL.
BECAUSE IT LEGISLATIVELY SETS
THE.
PER PRESCRIPTION COPAYMENT OF
FOR THESE EXPENSIVE DRUGS AT TWO
HUNDRED WHICH IS LESS THAN THE
TWO HUNDRED FIFTY DOLLAR PRICE
CAP FOR ALL OTHER OUTPATIENT
DRUGS.
I'M JUST LITTLE HISTORY THIS CAP
WAS SEVEN WAS THE FIRST.
PRESCRIPTION DRUG CAP THAT WAS
SET INTO TO THE LEGISLATURE INTO
STATUTE AND SINCE THEN THERE'S
BEEN A TWO HUNDRED FIFTY DOLLAR
PER PRESCRIPTION COST CAP. FOR
ALL OTHER OUTPATIENT DRUGS
AND SO WE WOULD LIKE.
.
YOU KNOW THE SHERIFF COST FOR AN
OF THESE TYPE OF MEDICATIONS TO
FIT THE RUBRIC THAT ALL OTHER
DRUG OUTPATIENT DRUGS I ADHERE
TO.
YOU KNOW WE UNDER.
YOU NO UNDER CURRENT LAW HEALTH
PLANS YOU KNOW WE HAVE TO.
IMPLEMENT THAT COST CARE CAP FOR
ANTI CANCER DRUGS WAS DIFFERENT
FROM ALL OTHER OUTPATIENT PRINT
PRESCRIPTION DRUGS IN THIS IS
ADMINISTRATIVELY BURDENSOME.
WHEN THEIR PRESCRIPTION DRUG
CAPS IN PLACE NOT IN STATUTE.
YOU KNOW KIND OF INSULATES THE
CONSUMER FROM THE ACTUAL COST OF
THOSE DRUGS AND HELPS THEM
ACCESS THEM WITH THE SAME TIME
THE HEALTH PLANS HAVE TO ABSORB
THE. EXTREMELY HIGH COSTS FOR
ALL THESE DRUGS WHICH GET
SOCIALIZED OUT ON THE PREMIUM
AND THAT'S THE DIRECTION OF THE
APPROACH THAT WE'VE CHOSEN TO
TAKE. WHO WERE SAYING AS WE'D
LIKE THIS DRUG TO FALL UNDER THE
RUBRIC WITH ALL THE RAP
DISTRICTS THINK?
ANYONE ELSE IN OPPOSITION.
CNN WILL BRING IT BACK TO THE
COMMITTEE FOR QUESTIONS OR
COMMENTS ANYONE.
MISS KOREA THINK YOU KNOW I LIKE
TO THINK THE AUTHOR FOR BRINGING
THIS TO OTHERS COMMITTEE.
I AM THE KNEES OF OF. MY AUNT
WHO HAD A DOUBLE MASTECTOMY AND
DIED OF BREAST CANCER.
TO MY AUNTS HAVE HAD ADDITIONAL
DEVELOPMENTS UPSWINGS.
AND LIKELY THERE.
THEIR HEALTH IS OKAY.
AND I THINK THIS IS AN
INCREDIBLY CRITICAL CRITICAL.
MEASURE TO THINK ABOUT IN TERMS
OF THE HEALTH. AND WELFARE OF
CALIFORNIANS ACROSS OUR STATES I
THINK YOU.
ANYONE ELSE ESTIMATES.
DID A MUCH OF I HEARD YOU
CORRECTLY WAS A ROOM.
FOR.
FTA HEALTH PLANS FOR AN
AMENDMENT THAT WOULD GET YOU HAS
THIRTY TWO TO BE SUPPORTIVE FOR
NOW.
SOME SOME OF THE OTHER HEALTH
PLANS SO SHE ASIANS HAVE AN
OPPOSING WAS A MINUTE POSITION
ON IT AND THEY'VE LIKE THAT I
BELIEVE THERE ASK IS THAT THE
COST.
DESCRIPTION COST CAP HE SAID IT
TO FIFTY SO MIR'S WHAT'S IN
PLACE FOR ALL OTHER OUTPATIENT
DRUGS.
BIGELOW.
SO IT SEEMS LIKE THERE'S SOME
ROOM FOR AGREEMENT HERE.
AND MOVEMENT.
THERE'S TWO COURSES.
THE PLANS CAN MOVE TO THE TWO
FIFTY.
AND MAYBE WORK WITH YOU AND
HAVE.
SOME SOLIDARITY ON THIS VERY
IMPORTANT ISSUE.
LAKE SECOND COURSES.
WE REDUCE EVERYTHING TO TWO
HUNDRED.
AND MAKE IT ACROSS THE BOARD.
WHAT CHOICE?
OF THOSE TWO WOULD YOU LIKE TO
HAVE.
AS AN OPPORTUNITY SO I A
ACTUALLY WOULD LIKE TO CLARIFY
THAT THERE IS A PRICE INDEX
INCLUDED IN THIS AND SO. I'M
GONNA HAVE.
WITH. A LOT OF THE TO THIS
PLACE.
I THINK IT SO WHEN THIS BILL WAS
PASSED FIVE YEARS AGO.
IT WAS A HARD NEGOTIATION AND
WE DID AND OF HAVING A CPI INDEX
ADDED TO THE BILL. AND IT HAS
NOT BEEN UTILIZED BY THE HEALTH
PLANS.
AND WHEN YOU LOOK AT THE CPI FOR
THE.
MEDICAL PRICE INDEX UNDER THAT
COMES IN THE E. CATEGORIES.
AND YOU AVERAGE A COSTS THEY
COULD OF BEEN IT ABOUT TWO
HUNDRED TWENTY DOLLARS AND IT
WILL CONTINUE TO INCREASE OVER
THE YEARS AS THE PRICE INDEX
GOES UP SO THEY CAN UTILIZE IT
OR NOT UTILIZE IT AS THEY SEE
FIT AND IF NOT.
SAU.
HAVING HEARD THAT.
YOU'RE STILL AT GROUND ZERO.
AND YOU'RE ALSO ASKING FOR THE
SUNSET TO BE REMOVED.
SO WHY NOT TAKE THE OPPORTUNITY.
TO NEGOTIATE A REALLY GOOD DEAL
HERE.
IN ONE WAY BRING.
EVERYONE TO PARITY AT THE TWO
FIFTY AND LET THEM USE THE CPI
INDEXING.
OR REDUCE EVERYBODY DOWN TO THE
TWO HUNDRED AND LET THEM CAPTURE
THE CPI AT THAT LEVEL
SEEMS LIKE YOU HAVE AN
OPPORTUNITY TO WIN. AND GET
EVERYBODY WHAT THEY WANT.
WE HAVE AT TWO HUNDRED PLUS CPI
RIGHT NOW AND IF SOMEONE BRINGS
US CONSIDERATIONS AND AMENDMENTS
WILL CONSIDER THAT WE'VE. YET TO
SEE IT SO I'M I'M SUGGESTING
THAT RIGHT NOW APES FAVORITE
YEAH I APPRECIATE THE
SUGGESTIONS I DON'T KNOW THAT
THAT'S WHERE WE'RE AT THIS
MOMENT BUT I APPRECIATE IT. AND
I THINK WE'LL CONTINUE TO HAVE A
CONVERSATION.
BUT RIGHT NOW IT'S AT TWO
HUNDRED PLUS CPA I'M I DON'T
THINK I'M.
TOTALLY ARTICULATING
SINCE EVERYBODY IS ALREADY AT.
A TWO FIFTY ARE ALL THE OTHER
PRODUCTS OR TWO FIFTY.
AND YOU'RE ASKING THESE TO BE
SEPARATE AT TWO HUNDRED.
WOULD THAT NOT BE GOOD FOR YOU
TO HAVE EVERYBODY AT THE TWO
FIFTY WHERE THEY'RE ALL.
AT PARITY OR WOULD IT BE EASIER
FOR YOU TO REDUCE EVERYBODY.
FROM TWO FIFTY DOWN TO TWO
HUNDRED AND HAVE EVERYBODY AT
PARITY AND STILL ENJOY THE. THE
GROWTH OF CPI.
YEAH COULD IT GOOD BUSINESS AND
INTERVENE AS THE AS THE CHAIR
PROPITIATE WHY ARE YOU DOING
MISTER CHAIR I APPRECIATE WE'RE
GOING OUT OF THAT.
THE BILL DOESN'T CALL TO REDUCE
EVERYTHING TO TWO HUNDRED AND IT
TOTALLY NOT I'M TALKING AS AN
OPTION.
AND I'M SURE THEAUTHOR WOULD.
CONSIDER.
FURTHER DISCUSSIONS WITH BOTH
SIDES ON ON THIS PARTICULAR
ISSUE.
BUT SHE IS ASKING FOR THE
REMOVAL OF A SUNSET.
PRE EXISTING BILL BUT WAS IT
WORTH IT WAS SET AT TWO HUNDRED.
SO OF THAT IS THAT'S WHAT'S
BEFORE US WITH THE CP I.
THAT HASN'T BEEN UTILIZED.
SO.
I'M SURE THAT THE AUTHOR WOULD
BE HAPPY CONSIDER CONTINUE
DISCUSSIONS MOVING FORWARD AS IF
THE BILL MOST OUR COMMITTEE BUT
I APPRECIATE THE SPIRIT WHICH
YOU'RE PRESENTING THAT. AND.
I'M I'M SURE THAT SHE WILL TAKE
THAT CONSIDERATION.
IF ANYONE ELSE.
SAME SCENE NO ONE TO TO HAVE
MUCH.
WE HAVE A MOTION AND A SECOND
WOULD YOU LIKE TO CLOSE MISMA I
RESPECTFULLY ASK FOR AN AYE
VOTE.
THE MOTION BY MS CARILLO A
SECOND BY MISS DURING HIS AREA
AND THAT THE MOTION IS TO PASS
TO APPROPRIATIONS MADAM
SECRETARY PLEASE CALL THE ROLL.
WOULD I WOULD AYE MAYES AYE
MAYES AYE AGUIAR-CURRY. ANCHOR
CURRY I BIGELOW.
BIGELOW NOT VOTING BONTA.
BURKE.
BURKE I CARILLO AYE CARILLO AYE
FLORA FLORA AYE LOW MOAN.
LOW MOAN AYE MCCARTY.
MCCARTY AYE NAZARIAN. IS THERE
AND I RODRIGUEZ.
RODRIGUEZ I SANTIAGO.
THURMOND.
THURMOND AYE WALDRON.
BUT ELEVEN ZERO YOUR BILL IS
OUT.
MISTER RODRIGUEZ.
HERE THE LAST BILL OF THE
EVENING.
WELL I MEAN YOU KNOW WE'VE GOT
SOME WORK TO DO BUT.
WE HAVE WORK TO DO BUT YOU ARE
THE LAST BILL.
SO MISTER RODRIGUEZ YOU HAVE
BEFORE US AB TWENTY ONE OH TO.
HAVE A MOTION AND A SECOND
MISTER RODRIGUEZ.
PLEASE PROCEED.
TARA MEMBERS.
MISTER CHAIR MEMBERS AB TWENTY
ONE OUGHT TO. CLARIFY THE
CALIFORNIA MERGING MEDICAL
SERVICES SORTIES ROLE IN
ALLOWING OUT OF STATE.
FIRE AND PARAMEDIC PERSONNEL TO
GIVE AID IN CALIFORNIA DURING
THE STATE OF EMERGENCY.
MEMBERS WE ALL KNOW LAST YEAR
CALIFORNIA EXPERIENCE TERRIBLE
FIRES.
WE RELIED ON CORPORATION.
FROM ACROSS STATE LINES TO HELP.
FOR FUTURE EMERGENCIES
STREAMING M. SAYS APPROVAL
PROCESS WILL ALLOW OUT OF STATE
FIRST RESPONDERS TO COME TO OUR
AID MORE QUICKLY.
I WILL BE WORKING WITH
STAKEHOLDERS AND MS ON LANGUAGE
TO SPEED UP THE APPROVAL PROCESS
FOR THESE FIRST RESPONDERS TO
PROVIDE MEDICAL AID IN
CALIFORNIA.
AND I'VE VOTE WILL HELP US
BETTER RESPOND TO EMERGENCIES
THANK YOU.
TO YOUR WITNESS HER.
IS THERE ANYONE TO SUPPORT.
THE ADDITIONAL PEOPLE IN SUPPORT
OF THE AUTHOR.
SEE NO ONE IS THERE ANYONE IN
OPPOSITION.
SEE KNOWN TO BRING BACK TO THE
COMMITTEE FOR QUESTIONS OR
COMMENTS ANY QUESTIONS OR
COMMENTS FROM THE COMMITTEE.
SEEN THAT WOULD LIKE TO CLOSE
MISTER RODRIGUEZ.
I RESPECTFULLY ASK YOUR FREE
IPAD THINKING WE HAVE A MOTION
BY.
MISS BURKE A SECOND BY MISS
CARILLO THE MOTION IS TO PASS TO
APPROPRIATIONS MADAM SECRETARY
PLEASE CALL THE ROLL. WOULD I
WOULD I MAYES.
I HURRY.
I CARE CURRY AYE BIGELOW.
BIGELOW AYE BONTA.
BURKE BURKE I CARILLO.
CARILLO AYE FLORA. FLORA AYE LOW
MOAN.
LIMON AYE MCCARTY.
MCCARTY I IN THIS AREA IN. THIS
AREA AYE RODRIGUEZ AYE.
RODRIGUEZ AYE SANTIAGO.
THURMAN. THERE AND I'VE WALDRON.
SELECT.
SO THAT HAS ELEVEN.
ELEVEN ZERO.
IF THERE WAS OUT MISTER
RODRIGUEZ SO.
SO. I WOULD ASK THAT MEMBERS
COME BACK SO THAT WE COULD.
FINISH OUR VOTING.
PLEASE COME BACK.
PLEASE.
SO WE CAN ALL GO HAVE DINNER
SOMETIME.
PARDON.
AND ARE IN BE SOMEPLACE WE CAN
HAVE DINNER SOMETIME. OKAY.
OKAY.
WE'RE GONNA WAIT TWO OR THREE
MINUTES ARE UP.
LISA. WAS MISSING.
ONE TWO
RE.
.
SO WE GOT TO.
SO MISTER BONTA MISTER SANTIAGO.
MISTER MAY MISTER MAYES IS BAD.
YEAH.
A COUPLE MINUTES AND.
ANYBODY HAVE MISTER BONTA ON
SPEED DIAL.
ONLY FOR CULTURE.
NO.
WE GO. AGAIN MUST BE DEATH.
THAT'S WHAT HEREBY SKINNER.
SAN.
I HEAR SOMEBODY.
PLEASE WAIT NINE MISTER BONTA
.
AND.
ALRIGHT PART IT. WAS LAST PERSON
BY TEN BY SINNERS WHEN I'M WITH
I THINK THAT WAS WHO HE SAID. BY
THING MISS RUNS BY DINNER.
BUT ANYWAY.
SO WE'RE JUST UP THE SORT THE
TOP OF THE ORDER.
ITEM NUMBER ONE EIGHTY THIRTY
EIGHTY SEVEN PLEASE OPEN THE
ROLL CALL THE ABSENT MEMBERS
BURKE.
I BURKE I. LIMON AYE THURMOND
AYE.
RODRIGUEZ.
RODRIGUEZ I
SELECT.
THAT IS ELEVEN FOR.
ITEM NUMBER TWO AB SEVENTEEN
FORTY FOUR MCCARTY PLEASE OPEN
THE ROLL CALL THE ABSENT MEMBERS
MAYES.
MAYES I.
CARILLO.
I'M SORRY WITNESSES BY THE
MEMBER TWO SEVENTEEN FORTY FOUR
MISTER MCCARTY.
I.
CARILLO I'M LIMON.
LIMON AYE THIS AREA.
NAZARIAN AYE RODRIGUEZ RODRIGUEZ
AYE WALDRON WALDRON AYE FIFTEEN.
THAT'S FIFTEEN ZERO ITEM NUMBER
THREE AB EIGHTEEN SIXTY MUSLIM
OWNED PLEASE OPEN THE ROLL CALL
THE ABSENT MEMBERS.
BONTA.
I THOUGHT I.
SANTIAGO.
WELL I SANTIAGO AYE.
THURMOND. BERMAN I'M SORRY
WALDRON.
NUMBER EIGHTEEN SIXTY MUSLIM
OWN.
NOT VOTE.
NOT VOTING.
WHAT ARE NOT VOTING?
THAT'S THIRTEEN ZERO A LONG TIME
AGO.
ITEM NUMBER FOUR WAS PRESENTED
AB TWENTY TWO TWO THOUSAND
TICKETS AND WE DON'T HAVE A
MOTIONS I WOULD LET TO HAVE A
SUPER. SOME OBJECT.
THIS MISTER THURMAN MOVES MISTER
BONTA SECONDS.
AB TWO ZERO TWO TWO.
MEDICINE THIS A MATH MOTION IS
TO PASS APPROPRIATIONS MADAM
SECRETARY PLEASE CALL THE ROLL
WOULD I WOULD I MAYES. MAYES NOT
VOTING AGAR CURRY ACTOR CURRY I
BIGELOW.
BIGELOW NO BONTA BONSAI BURKE.
BURKE I CARILLO. CARILLO AYE
FLORA.
FLORA NOT VOTING LIMON.
THOUGHT I MCCARTY. MCCARTY AYE
NAZARIAN. NAZARIAN AYE
RODRIGUEZ.
RODRIGUEZ I SANTIAGO. SANTIAGO
THURMAN. THURMOND AYE WALDRON.
WATER NO.
THAT'S ELEVEN TO TO ITEM NUMBER
SIX AB TWENTY ONE OUT TO
RODRIGUEZ.
HOUSE OR NEED THAT CAN SCAN SEC
COUNTER DISCO BACK TO THAT.
OUT THAT THAT'S ITEMS NUMBER
FIVE.
SEVEN FOURTEEN FIFTEEN TWENTY
TWENTY THREE.
TWENTY SEVEN. TWENTY NINE THIRTY
TWO THIRTY THREE AND THIRTY
FIVE.
PLEASE OPEN THE ROLL CALL THE
ABSENT MEMBERS POCKETS ACCOUNT
BONTA. BONTA AYE.
NAZARIAN.
I WAS THERE AND I.
SO IT'S FIFTEEN ZERO SO WE'RE
BACK TO ITEM NUMBER SIX AB
TWENTY ONE OH TO MISTER
RODRIGUEZ.
OPEN THE ROLL CALL THE ABSENT
MEMBERS.
MAYES.
MAYES NOT VOTING.
BONTA AYE BONTA AYE SANTIAGO.
SANTIAGO AYE THURMOND.
I'M SORRY EC.
WALDRON.
WALDRON NOT VOTING.
OH SORRY I'M SORRY WALDRON I'D.
SORRY.
MAYES NOT VOTING AYE.
THAT'S FIFTEEN ZERO.
ITEM NUMBER EIGHT.
AB TWENTY ONE FORTY THREE OF US
CABALLERO OF LOOKING FOR A
MOTION
SO MOVED.
THAT MOTION BY MISS CARILLO
SECOND BY MISTER SANTIAGO MEN
SECRETARY PLEASE CALL THE ROLL
MOTION IS TO PASS TO
APPROPRIATIONS.
AS AMENDED TO APPROPRIATIONS.
SO WHAT ARE I WOULD AYE MAYES
MAYES AYE AGAR CURRY
AGUIAR-CURRY AYE PICCOLO.
BIGELOW AYE BONTA. BONTA AYE
BURKE AYE BURKE AYE CARILLO AYE
CARILLO AYE FLORA. FLOOR I
LIMON.
LIMON AYE MCCARTY MCCARTY AYE
NAZARIAN.
THIS AREA AND I RODRIGUEZ
RODRIGUEZ AYE SANTIAGO. SANTIAGO
AYE THURMOND. THURMOND AYE
WALDRON. WALDRON AYE.
IT'S FIFTEEN ZERO ITEM NUMBER
NINE.
AB TWENTY ONE NINETY PLEASE
OPEN THE ROLL CALL THE ABSENT
MEMBERS.
BONTA. BONTA AYE BURKE.
BURKE I LIMON LOW MOAN AYE
MCCARTY.
MCCARTY I NAZARIAN.
NAZARIAN AYE SANTIAGO.
WHAT?
ITEM NUMBER I. AB TWENTY ONE
NINETY.
SANTIAGO AYE THURMOND. BERMAN
AYE FIFTEEN.
THAT'S FIFTEEN ZERO ITEM NUMBER
TEN PLEASE LIFT THE CALL CALL
THE ABSENT MEMBERS AB TWENTY ONE
NINETY THREE MAIENSCHEIN.
AGUIAR-CURRY. AGAR CURRY I.
NAZARIAN.
I'VE.
WAS THERE AND I RODRIGUEZ.
RODRIGUEZ AYE SANTIAGO AYE AYE
SANTIAGO AYE THURMAN. THURMOND
AYE.
ONE.
THAT'S TWELVE TO ONE ITEM NUMBER
ELEVEN AB TWENTY TWO EIGHTY
SEVEN MISTER KILEY PLEASE OF
LIFT THE CALL CALL THE ABSENT
MEMBERS.
MAYES AYE AYE MAYES AYE.
BONTA.
BONTA AYE.
CARILLO AYE KOREA AYE. LOW MOAN.
SOLANO AYE. NAZARIAN. NAZARIAN
AYE RODRIGUEZ.
ROAD.
RODRIGUEZ NOT VOTING.
THURMOND.
THURMOND I.
WOULD CHANGE VOTE TO I WOULD NOT
VOTING AYE.
THAT'S TWELVE ZERO.
ITEM NUMBER TWELVE AB TWENTY
TWO NINETY THREE MISS RAY S. UP
PLEASE LIFT THE CALL CALL THE
ABSENT MEMBERS.
BONTA BONTA AYE.
LEARN. ABOUT AYE NAZARIAN.
HI NAZARIAN AYE RODRIGUEZ.
RODRIGUEZ AYE SANTIAGO. SANTIAGO
AYE THURMAN THURMOND AYE.
TWELFTH NPOS TWELVE TO THREE
ITEM NUMBER THIRTEEN.
AB TWENTY THREE FIFTEEN MISS
QUIRK SILVA AND SEARCH OF
EMOTION.
SECOND MOTION BY MISS CARILLO
SECOND BY MISS WALDRON.
MADAM SECRETARY THE MOTION IS TO
PASS TO APPROPRIATIONS BEEN
SECRETARY PLEASE CALL THE ROLL
WOULD I WOULD I MAYES MAYES AYE
ACTOR CURRY. TIGER CURRY I
BIGELOW. BIGELOW I'VE FOUGHT SO.
BONTA AYE BURKE BURKE I CARILLO
AYE THREO AYE FLORA.
FLORA I LIVE ON.
LIMON AYE MCCARTY. MCCARTY AYE
NAZARIAN LIKE THIS AREA AND I
RODRIGUEZ.
RODRIGUEZ I SANTIAGO. SANTIAGO
AYE THURMAN AYE BERMAN AYE
WALDRON. WALDRON AYE FIFTEEN.
THAT'S FIFTEEN ZERO. ITEM NUMBER
SIXTEEN AB TWENTY THREE FORTY
TWO MISS BURKE PLEASE LIFT THE
CALL AYE MISSY HAS HE USED TO
OPEN THE ROLL CALL THE ABSENT
MEMBERS BONTA. BONTA AYE
NAZARIAN AYE MASURIAN AYE
SANTIAGO ON SANTIAGO AYE.
IT'S FIFTEEN ZERO ITEM NUMBER
SEVENTEEN AB TWO THREE EIGHT
FOUR DOCTOR ARAMBULA PLEASE LIFT
THE CALL CALL THE ABSENT MEMBERS
BONTA. SPONSOR AYE BURKE. BURKE
I.
NAZARIAN TYPED IN THIS AREA AND
I RODRIGUEZ RODRIGUEZ AYE
SANTIAGO. SANTIAGO AYE THURMAN.
THURMOND AYE.
THAT IS TWELVE TO THREE ITEM
NUMBER EIGHTEEN AB TWENTY FOUR
SIXTEEN WOULD PLEASE LIFT THE
CALL AND CALL THE ABSENT MEMBERS
BONTA. BONTA AYE CARILLO AYE
CARILLO. LOW MOAN LIMON AYE
MCCARTY. MCCARTY AYE IN THIS
AREA. THIS AREA AYE RODRIGUEZ.
RODRIGUEZ AYE WALDRON WALDRON
AYE.
FOURTEEN.
THAT'S FOURTEEN ZERO ITEM NUMBER
NINETEEN AB TWO FOUR TWO SEVEN
WOULD PLEASE LIFT CALL CALLED
THE ABSENT MEMBERS.
BONTA. BONTA AYE.
CARILLO AYE KOREA AYE LOW MOAN.
THE WORD I MCCARTY. MCCARTY AYE
IN THIS AREA. NAZARIAN AYE
RODRIGUEZ RODRIGUEZ AYE.
IT'S ELEVEN TO FOUR ITEM NUMBER
TWENTY ONE AB TWENTY FOUR
SEVENTY TWO WOULD PLEASE OPEN
THE ROLL CALL THE ABSENT
MEMBERS.
BONTA. BONTA AYE CARILLO AYE
CARILLO AYE LEVINE. LIMON AYE
MCCARTY.
MCCARTY I NAZARIAN. NAZARIAN AYE
RODRIGUEZ RODRIGUEZ AYE COOKING
ZERO.
IT'S FIFTEEN ZERO ITEM NUMBER
TWENTY TWO. AB TWENTY FOUR
EIGHTY SIX MCCARTY PLEASE. OPEN
THE ROLL CALL THE ABSENT MEMBERS
BONTA BONTA AYE CARILLO AYE
CARILLO AYE. NAZARIAN.
IS THERE AND I.
HE'S NOT GOING TO.
MAYES NOT VOTING TO KNOW.
BOB STARED AT THIS TWELVE TO TO.
ITEM NUMBER TWENTY FOUR AB
TWENTY FIVE TO WOOD. PLEASE OF
OPEN THE ROLL CALL THE ABSENT
MEMBERS BONTA. BONTA AYE CARILLO
AYE CARILLO I LIMON. LIMON AYE
MCCARTY.
MCCARTY AYE NAZARIAN. AYE
NAZARIAN AYE RODRIGUEZ RODRIGUEZ
AYE.
THIS FOURTEEN ZERO ITEM NUMBER
TWENTY FIVE AB TWO FIVE ONE
SEVEN WOULD. PLEASE LIFT THE
CALL CALLED THE ABSENT MEMBERS.
BONTA. BONTA AYE BURKE BURKE I.
THIS AREA IN. THIS AREA AND I
RODRIGUEZ
RODRIGUEZ SIZE SANTIAGO.
SANTIAGO AYE THURMOND. THURMOND
AYE.
ELEVEN TO THREE ITEM NUMBER
TWENTY SIX AB TWO SIX FOUR THREE
IRWIN PLEASE OPEN THE ROLL CALL
THE ABSENT MEMBERS BONTA. BONTA
AYE. BECAUSE AREAS LIKE THIS
AREA AND I'M SANTIAGO. SANTIAGO
AYE.
BUT ONE OF THE.
YES.
YOU KNOW FLORA FROM HIGH TO. LOW
VOTING.
YOU THINK. I AM TWENTY SIX FLORA
TWELVE SIX YET NOT VOTING YOU
COMING UP. WE DO AS I.
SO LET'S A PUBLIC EVENT. ONE THE
LEVEL TWO ONE. ITEM NUMBER
TWENTY EIGHT AB TWO SIX NINE ONE
MISTER JONES SAWYER.
PLEASE.
OPEN THE ROLL CALL THE ABSENT
MEMBERS.
BONTA BONTA I CARILLO I'M
CARILLO I LIMON. LIMON AYE
MCCARTY.
MCCARTY I IN THIS AREA.
NAZARIAN AYE RODRIGUEZ.
RODRIGUEZ AYE WALDRON.
WALDRON AYE FIFTEEN.
FIFTEEN ZERO.
ITEM NUMBER THIRTY AB TWO EIGHT
FIVE ZERO ISS RUBIO PLEASE OPEN
THE ROLL CALL THE ABSENT MEMBERS
BONTA. BONTA AYE CARILLO AYE
CARILLO AYE NAZARIAN.
NAZARIAN AYE RODRIGUEZ.
RODRIGUEZ I FIFTEEN THAT'S
FIFTEEN ZERO ITEM NUMBER. THIRTY
ONE AB TWO EIGHT SIX ONE SALAS
PLEASE OPEN THE ROLL CALL THE
ABSENT MEMBERS BONTA. BONTA AYE
CARILLO AYE KOREA AYE WILL MOAN.
LIVE ON AYE MCCARTY. MCCARTY AYE
NAZARIAN.
THIS AREA AYE RODRIGUEZ.
RODRIGUEZ AYE.
AND FINALLY ITEM NUMBER THIRTY
FOUR AB THREE ZERO THREE TWO
FRAZIER PLEASE OPEN THE ROLL
CALL THE ABSENT MEMBERS BONTA.
PLOTS I CARILLO. CARILLO I
LIVE ALONE.
LIMON AYE MCCARTY.
MCCARTY I KNOWS AREA. NAZARIAN
AYE RODRIGUEZ. RODRIGUEZ AYE.
FIFTEENTH ZERO.
AT FIFTEEN ZERO.
AND IN ONE OF MY TWO FIVE SEVEN.
OKAY.
I DON'T.
TO TELL.
THAT WAS A HABITUAL CHAIR.
THAT'S HOW.
HE'S GOT A.
SO.
PLEASE SEVENTEEN IS. GREAT. SO I
JUST JUST A CLARIFYING AB TWO
FIVE ONE SEVEN THE FINAL VOTE IS
TWELVE THREE.
AND WITH THAT.
FROM NOVELTY.
NOT YOU MISTER.
WE GOES FROM I WAS RODRIGUEZ
GOES FROM. NOW VOTING TO.
YEAH I IT TWO TWO TWO. EIGHT
SEVEN RODRIGUEZ NOT VOTING TIME
I.
WHICH IS WHAT
THAT WOULD GO AHEAD IN A CHAIR
IN THE MEETING THANK YOU VERY
MUCH MEETING ADJOURNED