GOOD AFTERNOON. WE'LL CALL TO
ORDER THE, UH, MARCH 19TH
MEETING OF THE ASSEMBLY
COMMITTEE ON HEALTH. HEARING OF
THE COMM COMMUNITY ON HEALTH.
UH, BEFORE WE BEGIN, I WOULD
LIKE TO MAKE A STATEMENT ON
PROVIDING TESTIMONY AT THIS
HEARING. WE SEEK TO PROTECT THE
RIGHT OF ALL WHO PARTICIPATE IN
THE LEGISLATIVE PROCESS SO THAT
WE CAN HAVE EFFECTIVE
DELIBERATION ON THE CRITICAL
ISSUES FACING CALIFORNIA. ALL
WITNESSES WILL BE TESTIFYING IN
PERSON. WE ALLOW TWO MAIN
WITNESSES FOR A MAXIMUM OF THREE
MINUTES EACH. ADDITIONAL
TESTIMONY WILL ALSO BE IN PERSON
AND LIMITED TO NAME POSITION AND
ORGANIZATION. IF YOU REPRESENT
ONE ALL TESTIMONY, COMMENTS ARE
LIMITED. TO THE BILL AT HAND. WE
DO NOT HAVE QUORUM AT THIS TIME,
SO WE WILL BEGIN AS A SUB
COMMITTEE. UH, WITH THAT WE ALSO
WANT TO RECOGNIZE, UH, THAT WE
HAVE A SUBSTITUTE MEMBER. THANK
YOU. ASSEMBLY MEMBER, JUAN
ALANIS WILL REPLACE ASSEMBLY
MEMBER VINCE WRONG FOR TODAY'S
HEARING ONLY FOR THE LETTER FROM
THE SPEAKER. WITH THAT WE WILL
MOVE TO OUR FIRST ITEM, WHICH IS
A B 1830. WELL. OH, SORRY. DR
AMB, UH, WHICH IS A B 1842
ASSEMBLY MEMBER REYES. HEALTH
CARE COVERAGE MEDICATION
ASSISTED TREATMENT.
THANK YOU SO MUCH. MS REYES, YOU
MAY BEGIN. AND YOU PUT YOUR MIC
ON. IS YOUR MIC ON?
GO AHEAD. THANK YOU. THE MIC IS
ON. THANK YOU. THANK YOU, MADAM
CHAIR AND COMMITTEE MEMBERS.
THANK YOU FOR THE OPPORTUNITY TO
PRESENT A B 1842. THIS BILL
WOULD PROHIBIT COMMERCIAL HEALTH
INSURERS FROM IMPOSING PRIOR
AUTHORIZATION RULES. THAT CREATE
BARRIERS FOR ACCESSING
MEDICATION ASSISTED TREATMENT.
MEDICATIONS SUCH AS BRO BRO NPH.
OR LONG ACTING. NALTREXONE. AND
SIGNIFICANTLY IMPROVE TREATMENT
FOR MANY SUBSTANCE USE DISORDERS
BY TREATING CRAVINGS AND
WITHDRAWAL SYMPTOMS. HOWEVER
MEDICATION ASSISTED TREATMENT
HAS BEEN UNDERUTILIZED. ALMOST
TWO THIRDS OF COMMERCIALLY
INSURED PERSONS IN CALIFORNIA
WITH DRUG OR ALCOHOL DEPENDENCE
DO NOT INITIATE TREATMENT. PRIOR
AUTHORIZATION REQUIREMENTS
CREATE UNNECESSARY BARRIERS THAT
DELAY OR INTERRUPT ACCESS TO
EFFECTIVE TREATMENT. A B 1842 IS
AN IMPORTANT FIRST STEP THAT
WILL REDUCE OVERDOSE RATES AND
SAVE LIVES. HERE TO TESTIFY IN
SUPPORT OF THE BILL. OUR DOCTOR
AMY MOEN, AND DOCTOR RODNEY
BORGER. DOCTOR MULLIN IS A
PROFESSOR OF EMERGENCY MEDICINE
AND DIVISION CHIEF OF ADDICTION
MEDICINE AT UC DAVIS AND
DIRECTOR OF THE CALIFORNIA
BRIDGE PROGRAM. DOCTOR BORGER IS
CHAIRMAN AND MEDICAL DIRECTOR OF
THE DEPARTMENT OF EMERGENCY
MEDICINE AT ARROWHEAD REGIONAL
MEDICAL CENTER FOR SAN
BERNARDINO COUNTY IN THE CITY OF
COLTON. YOU MAY PROCEED. THANK
YOU, UM. IN ADDITION TO, UH,
SUPERVISING THE EMERGENCY
DEPARTMENT AT ONE OF THE STATE'S
LARGEST EMERGENCY DEPARTMENTS IN
SAN BERNARDINO COUNTY. UM I ALSO
SUPERVISE. UH UH, THE
CORRECTIONS MEDICAL SYSTEM. UH
FOR OUR COUNTY AS WELL AS, UH,
FOUR LARGE PRIMARY CARE CLINICS.
AND UH, OPIATES CONTINUE TO
RAVAGE OUR COMMUNITY. UH DEATHS
AND OVERDOSES OF BOTH HARDCORE
USERS AND YOUNG TEENS
EXPERIMENTING FOR THE FIRST
TIME. ARE A NORM IN MY DAILY
EXPERIENCE. UM IT EVEN DRIVES.
UH, YOU KNOW, CRIMINAL BEHAVIOR
IN OUR IN OUR AREA. AND UM, AS
AN EMERGENCY PHYSICIAN, I SEE
THE, UH TOTAL FIRSTHAND THAT
ADDICTION AND OVERDOSE TAKES ON
PATIENTS AND FAMILIES. UM, IT'S
NOT ONLY THE, UH, THE PERSON
THAT IS INVOLVED. IT'S THE
ENTIRE COMMUNITY. IT'S UH
FATHERS, BROTHERS, SISTERS,
EMPLOYERS. ARE ALL IMPACTED. UH,
BY THIS, UH, THIS BIG PROBLEM.
UM, AT ARROWHEAD. WE'VE BEEN
TREATING FOLKS THROUGH THE
CALIFORNIA BRIDGE PROGRAM VERY
EFFECTIVELY AND CALIFORNIA
BRIDGE IS, UH, A PROGRAM THAT
THE STATE'S BEEN FUNDING WHERE
ADDICTS OR PEOPLE WITH ADDICTION
ISSUES CAN CAN PRESENT TO THE
EMERGENCY DEPARTMENT WHERE
THEY'VE BEEN PRESENTING FOR
YEARS, BUT WE HAVEN'T HAD AN
ABILITY TO GET THEM CONNECTED TO
COMMUNITY RESOURCES OR TREAT
THEM. WE'VE BEEN ABLE TO DO
THAT. UM AND WE HAVE ONE OF THE
LARGER PROGRAMS IN THE COUNTY.
THE GOOD THING IS IF A PATIENT
HAS MEDICAL, UH, YOU CAN, UH,
GET THEM CONNECTED WITH A
PRESCRIPTION AND COMMUNITY
RESOURCES AND A, UH, INPATIENT
PROGRAM. IF SOMEBODY HAS
INSURANCE, UH WHICH YOU THINK
WOULD MAKE THINGS EASIER. IT
ACTUALLY MAKES THINGS MUCH MORE
COMPLEX. I WANT TO TALK, UH,
GIVE YOU A STORY ABOUT, UH, TWO
PATIENTS THAT I'VE TREATED IN
THE LAST, UH, YEAR. UM THE FIRST
PATIENT AS A PATIENT WHO HAD
MEDI CAL WHO, UH, BECAME, UH,
DEPENDENT ON OPIATES BECAUSE OF
A BACK INJURY AT WORK. UM, HE
WASN'T DISABLED FOR HIS BACK
INJURY. HE WAS DISABLED FROM HIS
ADDICTION. UH, HE WAS COMPLETELY
UM, CUT OFF FROM HIS FAMILY. AND
HE WAS, UH, ABLE TO GET THROUGH
THE CALIFORNIA BRIDGE PROGRAM
AND IS, UH, SOBER TODAY. THEN I
HAD ANOTHER PATIENT WHO HAD A
PRIVATE INSURANCE. UH, WHO WE
MANAGED TO GET HIM INTO A 30 DAY
? UH, INPATIENT REHAB. HE
FINISHED 30 DAYS HE WAS SOBER.
HE HIS FAMILY WAS REALLY
APPRECIATIVE. AND, UM HE
COULDN'T GET HIS PRESCRIPTION.
WHEN HE WAS DISCHARGED FROM THE
INPATIENT REHAB, THEY SAID, IT'S
GONNA TAKE ABOUT TWO WEEKS. HE
UH, RELAPSED DURING THIS, UH,
DURING THAT TWO WEEK PERIOD AND
HAD TO PRESENT BACK TO THE
EMERGENCY DEPARTMENT WHERE WE
DUSTED THEM OFF. GOT HIM BACK ON
SOME MEDICATION, GOT HIM BACK
AND RESTORED TO HIS FAMILY. UM
THE INSURANCE COMPANY PAID FOR
THE E Dð VISIT THE SECOND TIME
THEY DIDN'T SAVE ANY MONEY. AND
IN MY EXPERIENCE OF ALL THE
PEOPLE, THEY THEY'VE NEVER
REFUSED PAYMENT. UM FOR THIS
MEDICATION FOR THIS INDICATION
ALL IT DID IS PUT A TWO PLUS
WEEK BARRIER IN THE, UH,
PATIENT'S CARE THAT'S COMPLETELY
UNNECESSARY. AND, UM YOU KNOW,
PLEASE, UH, CONTINUE TO SUPPORT
THIS BILL. I THINK IT IT
RELIEVES A LOT OF UNNECESSARY
BURDEN AND WOULD REALLY BE
HELPFUL. THANK YOU. THANK YOU
AND SECOND WITNESS. WE HAVE A
THREE MINUTES EACH. THANK YOU.
I'M AMY MULLEN. I WORK FOR THE
CALIFORNIA BRIDGE PROGRAM, WHICH
IS OUR PROGRAM THAT WORKS WITH
OVER 270 OF OUR ACUTE CARE
HOSPITALS, AND WE'RE PROVIDING
ACCESS TO PATIENTS WITH OPIOID
USE DISORDER TO LIFE SAVING
MEDICATIONS LIKE BUPRENORPHINE.
I DO WANNA TAKE A MOMENT TO
THANK THE BRAVERY OF ASSEMBLY
MEMBER REYES FOR COMING HERE AND
TRYING TO PRONOUNCE
BUPRENORPHINE, UM, MULTIPLE
TIMES, SO THANK YOU. IT IS A
REMARKABLE MEDICATION THAT WORKS
AS A PARTIAL OPIOID SO IT TREATS
PEOPLE'S WITHDRAWAL SYMPTOMS. IT
TREATS THEIR CRAVING, BUT IT
DOES NOT CAUSE EUPHORIA LIKE
FENTANYL. IT DOES NOT CAUSE
PEOPLE TO STOP BREATHING LIKE
FENTANYL. UM IT REALLY JUST
HELPS THEM TO BETTER TO FEEL
NORMAL. BUT WITH FENTANYL, IT'S
A LITTLE BIT HARDER TO START
SOMEONE ON BUPRENORPHINE BECAUSE
YOU HAVE TO BE IN WITHDRAWAL. SO
WE ARE ABLE TO START SOMEONE ON
THIS LIFE SAVING MEDICATION IN
OUR EMERGENCY DEPARTMENTS. AND
THEN IF THEY CAN'T GET THE
PRESCRIPTION FILLED GO BACK INTO
WITHDRAWAL OFTEN RELAPSE. WE CAN
LOSE THEM TO REUSE, BUT WE'VE
LOST THAT REALLY IMPORTANT
OPPORTUNITY TO CONNECT THAT
PERSON TO TREATMENT AND TO LEAD
THEM ON THEIR ROAD TO RECOVERY,
SO WE OFTEN LOSE PEOPLE IN THAT.
DELAY PERIOD WHERE WE'RE KIND OF
TRYING TO DEAL WITH PRIOR
AUTHORIZATION, SO REALLY
APPRECIATE YOUR ATTENTION TO
THIS BILL AND YOUR ATTENTION TO
THE OVERDOSE CRISIS IN FENTANYL,
AND WE THINK THAT THIS IS A
REALLY KEY STEP IN HELPING TO
GET PEOPLE INTO RECOVERY. SO
THANK YOU VERY MUCH AND HAPPY TO
ANSWER ANY QUESTIONS. THANK YOU,
UH, CONSIDERATION. WE WILL TAKE
A MOMENT TO JUST ESTABLISH
QUORUM SECRETARY CAN TAKE THE
ROLE, PLEASE. HERE. WALDRON. I
GOT CURRY. RAMBLA. WENDY
CARRILLO. LAURA. ALANIS. HERE.
AMY. JOHN SAWYER MAINS. MCCARTY,
PHIL PATTERSON. RODRIGUEZ.
SANTIAGO. SHOW. WEBER. THANK
YOU. WE HAVE COR. I WE'LL MOVE
NOW TO ADDITIONAL WITNESSES IN
SUPPORT, PLEASE STATE YOUR NAME
ORGANIZATION AND POSITION ONLY.
THANK YOU, MADAM CHAIR MEMBERS
OF THE COMMITTEE, BRANDON MARCH
WITH THE CALIFORNIA MEDICAL
ASSOCIATION IN SUPPORT. GOOD
AFTERNOON. UH, KATIE VAN DYNES
WITH HEALTH ACCESS CALIFORNIA
AND SUPPORT. THANK YOU. THANK
YOU, MADAM CHAIR TIM MADDEN,
REPRESENTING THE CALIFORNIA
CHAPTER OF AMERICAN COLLEGE OF
EMERGENCY PHYSICIANS IN SPORT.
JOHN DINGER WITH THE STEINBERG
INSTITUTE IN SUPPORT. THANK YOU,
MADAM CHAIR AND MEMBERS ALEX
KAHN ON BEHALF OF THE CALIFORNIA
CHRONIC CARE COALITION. WE JUST
WANT TO APOLOGIZE FOR THE TARDY
LETTER, BUT, UH, WE'RE HERE IN
STRONG SUPPORT AND LOOK FORWARD
TO HAVING A LETTER IN SHORT
ORDER. GOOD AFTERNOON CHAIR.
MEMBERS OF THE COMMITTEE REINER
BDU, GO HERE WITH THE CALIFORNIA
HOSPITAL ASSOCIATION AND SUPPORT
THANK YOU. GOOD AFTERNOON CHAIR
MEMBERS, UH, DYLAN ELLIOTT ON
BEHALF OF THE CALIFORNIA ACADEMY
OF CHILD AND ADOLESCENT
PSYCHIATRY AND THE CALIFORNIA
STATE ASSOCIATION OF
PSYCHIATRISTS AND SUPPORT THANK
YOU. GOOD AFTERNOON, MADAM CHAIR
AND MEMBERS MARY LOVES WITH THE
CALIFORNIA NURSES ASSOCIATION IN
STRONG SUPPORT. WE, TOO, HAVE A
TARGET LETTER APOLOGY. THANK YOU
. ARE THERE ANY PRIMARY
WITNESSES IN OPPOSITION? THANK
YOU. WE WILL ALLOW TWO WITNESSES
AT THREE MINUTES EACH. TO
PRESENT TESTIMONY. PLEASE GO
AHEAD. UM, GOOD AFTERNOON CHAIR
AND MEMBERS OF THE COMMITTEE.
UH, ROBERT BOYKIN WITH THE
CALIFORNIA ASSOCIATION OF HEALTH
PLANS. REGRETTABLY HERE TODAY IN
OPPOSITION TO, UH, A B 1842.
THIS IS OBVIOUSLY AN IMPORTANT
ISSUE. HEALTH PLANS HAVE HEARD
THE CONCERNS AND ARE CONSTANTLY
LOOKING FOR WAYS TO STREAMLINE
THE PROCESS WHILE PROTECTING
PATIENTS AND DELIVER AND
DELIVERING HIGH QUALITY CARE.
HOWEVER THIS BILL SEEKS TO
PROHIBIT HEALTH PLANS FROM
REQUIRING PRIOR AUTHORIZATION OR
STEP THERAPY FOR SEVERAL DRUGS
WHEN TREATING SOMEONE WITH A
SUBSTANCE USE DISORDER. IT'S
IMPORTANT TO NOTE THAT SOME OF
THESE DRUGS STILL REQUIRE A
SIGNIFICANT DETOX PERIOD WHICH
PRIOR AUTHORIZATION IS VITAL FOR
THIS HAS THE POTENTIAL TO REMOVE
ANY CHECK ON POSSIBLE ADVERSE
REACTIONS, UH FROM OTHER
MEDICATIONS. FROM OUR VIEWPOINT
UTILIZATION MANAGEMENT IS
NECESSARY FOR PATIENT SAFETY AND
COST EFFECTIVE CARE. UM ALSO
NOTE THAT THIS IS ONE OF SEVERAL
MANDATE BILLS THAT THE GOVERNOR
VETOED LAST YEAR BECAUSE OF COST
CONCERNS. REGRETTABLY MOST OF
THOSE BILLS ARE LARGELY
UNCHANGED THIS YEAR. LAST YEAR,
THE GOVERNOR'S VETO MESSAGE
REGARDING A B 1288 STATED THAT
UTILIZATION REVIEW IS AN
IMPORTANT TOOL FOR CONTINUING
HEALTH CARE COST PROTECTING
PATIENTS FROM UNANTICIPATED
BILLING AND ENSURING MEDICAL
NECESSARY CARE. UNFORTUNATELY A
B 1842 DOES NOT ADDRESS ANY OF
THOSE. POINTS RAISED IN THE
VETO. FOR THE REASON STATED
EARLIER. WE REGRETTABLY ASK FOR
A NÓ VOTE ON A B 1842. THANK YOU
FOR YOUR TIME TODAY. PLEASE GO
AHEAD. MADAM CHAIR MEMBER
STEPHANIE WATKINS ON BEHALF OF
THE ASSOCIATION OF CALIFORNIA
LIFE AND HEALTH INSURANCE
COMPANIES. IN THE INTEREST OF
TIME, I WILL ECHO MANY OF MY
COLLEAGUES COMMENTS. THERE WILL
BE MANY BILLS AND WE HAVE SEEN
MANY BILLS IN THE LEGISLATURE ON
PRIOR AUTHORIZATION AND STEP
THERAPY. I THINK THAT AS AS MY
COLLEAGUE MENTIONED, I THINK
THERE'S AN OPEN INTEREST IN
DIALOGUE ABOUT HAVING A
CONVERSATION ABOUT HOW WE CAN
ADDRESS ANY CONCERNS. I THINK
IT'S ONE THING THAT CAME UP. IS
THE CONVERSATION AROUND, UM,
SOMETHING TAKING TWO WEEKS TO
FILL A PRESCRIPTION. CERTAINLY
WOULD THINK THAT OUR MEMBERS
WOULD BE CONCERNED ABOUT THAT.
RIGHT NOW. THERE IS A
REQUIREMENT THAT WITH RESPECT TO
PRIOR AUTHORIZATION FOR RX, IT'S
A 24 AND 72 HOUR TIME PERIOD OF
A TURNAROUND IF THERE ARE ISSUES
, UM, THAT ARE HAPPENING OUTSIDE
OF OR THAT ARE ANOMALIES, WE
WOULD BE MORE THAN OPEN AND
WILLING TO HAVE THOSE
CONVERSATIONS LOOK FORWARD TO
HAVING THOSE. I THINK THIS IS AN
IMPORTANT PIECE OF THE
HEALTHCARE CONVERSATION TO MAKE
SURE PEOPLE HAVE ACCESS AND
TIMELY ACCESS TO IMPORTANT
MEDICATIONS. BUT WE ARE
CONCERNED ABOUT THE PRIOR
AUTHORIZATION OR STEP THERAPY.
AND ALSO I THINK I WOULD POINT
OUT THE ORIGINAL BILL DID
REFERENCE, UM, APPROPRIATE
GUIDELINES FOR PRESCRIBING AND I
THINK THAT'S ALSO AN IMPORTANT
PIECE TO ENSURE THAT PEOPLE ARE
GETTING ACCESS TO THE RIGHT
DRUGS AT THE RIGHT TIME. SO FOR
THOSE REASONS WE ARE OPPOSED
TODAY, BUT CERTAINLY LOOK
FORWARD TO THE POTENTIAL TO HAVE
AN OPEN DIALOGUE. IF THE MOVE
BILL MOVES FORWARD TODAY. THANK
YOU. THANK YOU. WE'LL NOW MOVE
ON TO ADDITIONAL WITNESSES IN
OPPOSITION, PLEASE STATE YOUR
NAME, ORGANIZATION AND POSITION.
MADAM CHAIR MEMBERS. JOHN WINGER
ON BEHALF OF AMERICA'S HEALTH
INSURANCE PLANS, WHICH IS ECHO
THE COMMENTS OF KAEPERNICK.
SEEING NÓ OTHER, UH, THIS IS IN
OPPOSITION. I WILL BRING IT BACK
TO THE MEMBERS OF THE COMMITTEE
FOR ANY QUESTIONS. DR ABU THANK
YOU, MADAM CHAIR. I'M GOING TO
BEGIN WITH AN APPRECIATION FOR
ASSEMBLY MEMBER REYES FOR
BRINGING THIS BILL BACK. IT'S
IMPORTANT FOR US TO ADDRESS THE
CRISES THAT WE HAVE BEFORE US AS
A STATE. AND I'M GRATEFUL THAT
YOU BROUGHT BOTH DOCTOR BORGER
AND DOCTOR MULLEN HERE WHO ARE
EMERGENCY PHYSICIANS ON THE
FRONT LINES WHO ARE EXPERIENCING
THAT CRISIS AND WE SHOULD LISTEN
TO THAT LIVED EXPERIENCE. I
SIMPLY WILL ADD MY OWN. HAVING
PRACTICED FOR 10 YEARS, HAVING
WORKED AT A ADDICTION RESEARCH
AND TREATMENT FACILITY AND
KNOWING THE IMPORTANCE THAT
THESE MEDICATIONS HAVE IN
HELPING TO SAVE LIVES, AND
ULTIMATELY IN SAVING US MONEY AS
A STATE AS A SYSTEM BY PROVIDING
THE RIGHT TREATMENT AT THE RIGHT
TIME THAT I LOOK FORWARD TO
SUPPORTING THIS MEASURE TODAY
AND JUST WANT TO THANK YOU FOR
BRINGING IT FORWARD. ANY OTHER
COMMENTS FROM ME. MR PATTERSON.
OKAY. THANK YOU. UM THINK IF YOU
KNOW JUST TO GO TO WHAT THE, UM
HEALTH PLAN SAID. I THINK I'VE
OR IF SOMEBODY WAS IN CRISIS, I
THINK, UM IT, YOU KNOW, WAITING.
EVEN 72 HOURS IS KIND OF A LONG
TIME WHEN THEY WHEN THEY GO INTO
EMERGENCY ROOM. I MEAN, I'M
HEARING OBVIOUSLY FROM OUR
DOCTORS AND HOSPITALS ALL THE
TIME ABOUT YOU KNOW HOW FULL
THEY A RE AND, UM WE ALL KNOW
THAT, BUT, UM YOU KNOW IF THERE
WERE SOME PROPOSED AMENDMENTS OR
SOMETHING THAT SAID, HEY, LOOK,
MAYBE SORT OF THE INITIAL WAS
COVERED, OR, YOU KNOW SOMETHING
LIKE THAT, UM, THAT COULD MAKE
SENSE. BUT I SUPPORTED THIS LAST
YEAR AND, UM AND INCLINED TO THE
GOVERNOR'S VETO DIDN'T SWAY ME.
UM SO I'LL BE SUPPORTING IT
AGAIN TODAY, BUT I WOULD BE OPEN
TO, UM YOU KNOW, CAUSE THIS
WON'T BE THE FIRST MANDATE BILL
THAT COMES UP THIS YEAR. UM YOU
KNOW, SOME KIND OF CONVERSATION
AROUND WHEN PEOPLE ARE IN CRISIS
. I MEAN, I THINK AND ESPECIALLY
IN EMERGENCY ROOM, WE GOTTA GET
TO THEM AND, UM, ADDRESS THEIR
ISSUES. AND, UM SO I'M
SUPPORTIVE OF THIS. THANK YOU.
MR JOHN SAWYER. I JUST WANT TO
QUICKLY UNDERSTAND WHAT WE'RE
ULTIMATELY VOTING ON BECAUSE
THERE'S A SUPPORT IF AMENDED. UM
ARE WE JUST STRAIGHT AHEAD. ARE
WE NOT DOING THE AMENDMENT.
WHAT? WHAT ARE WE DOING? SO THIS
? THIS IS DO PASS TO APPROACH TO
APPROACH. OK, THANK YOU. SO YOU
KNOW THEIR COMMENTS FROM
COMMITTEE. UH AS WELL AS YOU MAY
CLOSE. THANK YOU SO MUCH. I JUST
WANT TO REMIND US THAT THIS IS
FOR PRIOR AUTHORIZATION ON
MEDICATION USED TO TREAT
SUBSTANCE USE DISORDERS.
CALIFORNIA HAS ALREADY
AUTHORIZED THIS FROM ME
RECIPIENTS. SO THIS IS ALREADY
THE LAW FOR MEDICAL RECIPIENTS.
THIS IS NOW GOING TO EXTEND IT
TO PRIVATE INSURANCE. UM ALSO ON
THE GOVERNOR'S VETO MESSAGE, HE
SPECIFICALLY ASKED THAT WE TAKE
OUT METHADONE. IT HAS BEEN TAKEN
OUT. AND WITH THAT, I WOULD
RESPECTFULLY ASK FOR YOUR I
VOTE. I THANK YOU TO THE AUTHOR
FOR BRINGING FORWARD THIS BILL.
I THINK AGAIN IT IS INCREDIBLY
IMPORTANT FOR US TO BE ABLE TO
ENSURE THAT THERE'S PARITY
ACROSS OUR HEALTH CARE SYSTEM IN
ADDRESSING THIS CRISIS THAT WE
CONTINUE TO EXPERIENCE WITH
THAT, UH, SECRETARY, CAN YOU
CALL THE ROLL? WE PASS TO
APPROPRIATION BOR. I WANT TO I
WALDRON. WALDRON I AAR CURRY
CURRY. I ARAMBULA ARAMBULA I
WENDY CARRILLO, WENDY CARRILLO,
I FLORA. LANICE LANICE I. HANEY.
FILM SAWYER SAWYER I MOONSHINE.
MCCARTY JOE PATTERSON, JOE
PATTERSON, I. RODRIGUEZ
RODRIGUEZ I SANTIAGO TRAVEL.
TRAVEL I WEBER HOWEVER, I. THAT
BILL PASSES WITH A VOTE OF 11 TO
0. THANK YOU. MOVING ON NOW TO
ITEM NUMBER THREE A B 2132 LOW.
THANK YOU VERY MUCH, MADAM CHAIR
AND COLLEAGUES FOR ALLOWING ME
TO PRESENT 20 A B 2132. TO HELP
ASSIST IN TACKLING THE ISSUE OF
THE GROWING IMPACT ON
TUBERCULOSIS IN OUR STATE. IN
FACT, EVEN IN THE COUNTY OF
SANTA CLARA, UM IN ONE CALENDAR
YEAR CASES INCREASED 19% MEMBERS
OF THE LEGISLATURE ALSO PASSED A
SIMILAR PIECE OF LEGISLATION TO
TACKLE HEPATITIS AND CODIFIED
CLINICAL GUIDELINES AS WELL. I
RESPECTFULLY ASK FOR OUR VOTE TO
HELP TACKLE THIS ISSUE OF
PREVENTING TUBERCULOSIS AND HAVE
ADDITIONAL WITNESSES HERE IN
SUPPORT. THANK YOU. UH, EACH
WITNESS CAN HAVE THREE MINUTES
UP TO THREE MINUTES FOR THEIR
PRESENTATION. UM, GOOD AFTERNOON
, MADAM CHAIR, UM, VICE CHAIR
AND COMMITTEE MEMBERS. MY NAME
IS TANYA PAULLI. I AM A
PHYSICIAN AND THE èC E Ó OF
BREED, CALIFORNIA OF THE BAY
AREA, GOLDEN GATE AND CENTRAL
COAST. UM BREATH. CALIFORNIA HAS
BEEN CALIFORNIA'S LOCAL LUNG
HEALTH LEADER FOR OVER A CENTURY
AND WE'RE WORKING TO ENSURE, UH,
CALIFORNIA IS ONE OF THE
HEALTHIEST PLACES YOU TO LIVE IN
THE COUNTRY. UM THE AGENCY WAS
INITIALLY FORMED AS A Tð VÆ
SOCIETY IN 1911. BECAUSE THERE
WAS NÓ CURE FOR Tð B AT THE TIME
, AND WE WERE EXCLUSIVELY FOR
THE 1ST 40 YEARS TO TACKLE Tð B
AND, UM, WE WATCHED THE
ANTIBIOTIC DRUGS COME INTO BEING
OR DEVELOPED IN THE 19 SIXTIES,
AND WE WERE, UM, HOPING THAT
THIS WOULD MEAN THE END OF A Tð
B EPIDEMIC. HOWEVER SADLY NOW
OVER A CENTURY LATER, Tð B STILL
REMAINS A MAJOR HEALTH RISK.
BEFORE THE COVID-19 PANDEMIC. Tð
B WAS THE NUMBER ONE INFECTIOUS
DISEASE KILLER IN THE WORLD, AND
CALIFORNIANS CONTINUE TO BE
DISPROPORTIONATELY IMPACTED. WE
HAVE NOW AN ESTIMATED 2 MILLION
CALIFORNIANS INFECTED WITH Tð B
AND OF THESE 2,000,020% ARE NOT
AWARE OF THEIR DISEASE. Tð B IS
DEFINITELY UNDER DIAGNOSED, AND
ONE OF OUR CORE PROGRAMS AT
BREED. CALIFORNIA IS TO CONDUCT
EDUCATION TO THE COMMUNITY ABOUT
THE RISKS OF Tð B AND TO
ENCOURAGE THEM TO GET SCREENED.
WE ARE ESPECIALLY CONCERNED IN
OUR HOME COUNTY OF SANTA CLARA,
WHERE THERE WAS A 19% INCREASE
IN Tð B CASES IN JUST THE LAST
YEAR. SO WE'RE LUCKY IN
CALIFORNIA. WE HAVE GREAT Tð VÆ
CONTROLLERS, AND WE HAVE
AGENCIES LIKE US WHO SUPPORT AND
DO THE WORK TO EDUCATE AND
INFORM THE COMMUNITY MEMBERS
ABOUT THIS PROBLEM. WHAT'S
LACKING IS A REQUIREMENT THAT
SCREENING IS OFFERED TO ALL AT
RISK PATIENTS, STARTING WITH A
SIMPLE QUESTIONNAIRE TO
DETERMINE THAT RISK LEVEL. SO
OUR WITH OUR LONG HISTORY OF
COMMUNITY ENGAGEMENT, WE IT IS
PROVEN THAT COMMUNITY MEMBERS
WILL ASK FOR A OR SUBMIT TO
SCREENING IF THEY KNOW THAT
THERE IS AN INSURANCE COVERAGE
OR IF THERE'S ANOTHER FUNDER WHO
WILL COVER THAT TREATMENT, AND A
B 2132 WOULD MAKE THIS STANDARD.
THERE IS A POTENTIAL TO GREATLY
INCREASE THE NUMBER OF HIGH RISK
INDIVIDUALS WHO GET TESTED WITH
THIS BILL AND THEREBY THE POOL
OF Tð B INFECTION WILL REDUCE
WHETHER THEY HAVE A LATENT Tð VÆ
OR ACTIVE Tð, VÆ AND OUR AGENCY
AND OTHERS LIKE US WOULD GO AND
EDUCATE THEM THAT YOU DON'T HAVE
TO FEAR TALKING ABOUT IT TO
THEIR DOCTOR AND GETTING TREATED
SO THAT THEY KNOW THEIR
DIAGNOSIS. THANK YOU. NEXT
WITNESS. THANK YOU. GOOD MORNING
ASSEMBLY MEMBERS. MY NAME IS
DOCTOR AMY TANG I'M A PRIMARY
CARE PHYSICIAN AT NORTHEAST
MEDICAL SERVICES, AN FQ HÌ èC
IN THE SAN FRANCISCO BAY AREA.
SO NS SERVES ABOUT 72,000
PATIENTS PER YEAR. MOSTLY UM,
ASIAN ETHNICITY, LOW INCOME AND
ALSO UNINSURED AND LIMITED
ENGLISH PROFICIENT. SO WE CARE
FOR A POPULATION THAT FACES
MAJOR HEALTH DISPARITIES IN
VIRAL HEPATITIS B AS WELL AS
TUBERCULOSIS. IN FACT, IN 2022
20 25% OF ALL THE Tð B CASES IN
SAN FRANCISCO WERE AMONG
PATIENTS WHO RECEIVE THEIR
PRIMARY CARE AT OUR HEALTH
CENTER. SO THE LAST DECADE OR
SO. WE'VE WORKED VERY CLOSELY
WITH OUR PUBLIC HEALTH
DEPARTMENT ON TRYING TO PREVENT
THESE Tð B CASES FROM OCCURRING
IN THE FIRST PLACE, AND THIS
REALLY HINGES ON PRIMARY CARE,
COLLABORATING WITH PUBLIC HEALTH
TO IDENTIFY THOSE WHO ARE AT
RISK OF DEVELOPING Tð B DISEASE.
THIS REQUIRES A RISK ASSESSMENT
AND THEN A SIMPLE TEST AND THEN
A CONVERSATION WITH THE PATIENT
ABOUT THE BENEFITS OF GETTING
PREVENTATIVE TREATMENT. IN
RECENT YEARS, NEMS PARTICIPATED
AS A èC Dð èC SITE TO
DEMONSTRATE THE EFFECTIVENESS
AND BEST PRACTICES IN ROLLING
OUT Tð B PREVENTATIVE SERVICES.
AND SOME OF THE THINGS THAT
WE'VE LEARNED ARE IF WE OFFER A
SIMPLE TREATMENT REGIMEN, A LOT
OF OUR PATIENTS, MORE THAN HALF
OF OUR PATIENTS ARE WILLING AND
EAGER TO TAKE PREVENTATIVE Tð B
TREATMENT, BUT THIS CAN'T HAPPEN
UNLESS WE TEST PATIENTS AND
EDUCATE THEM ON THESE RISKS. WE
KNOW THAT TREATING Tð B DISEASE,
PARTICULARLY IN SOMEONE WHO
PRESENTS THE EMERGENCY
DEPARTMENT AND HAS TO GET
EMERGENCY SERVICES COSTS ABOUT
$45,000. BUT IF WE CAN IDENTIFY
THESE PATIENTS UP FRONT AND
OFFER PREVENTATIVE TREATMENT, IT
COSTS ABOUT $800. AND SO THIS IS
ALSO SOMETHING THAT CAN HELP
SAVE COSTS TO THE SYSTEM.
ADDITIONALLY ABOUT 10% OF THOSE
WHO PRESENT WITH Tð B DISEASE
END UP UNFORTUNATELY PASSING
AWAY BECAUSE THEY'VE BEEN
IDENTIFIED TOO LATE. SO THIS
ISSUE IS A HEALTH DISPARITY FOR
IMMIGRANT POPULATIONS AND OTHER
AT RISK POPULATIONS. COMMUNITIES
OF COLOR IN CALIFORNIA AND WE
HOPE THAT YOU TAKE THIS BILL.
SERIOUSLY WE ASK THAT YOU
SUPPORT A B 2132 AS THE ASSEMBLY
DID A FEW YEARS AGO WITH THE
HEPATITIS B BILL, THANK YOU VERY
MUCH. THANK YOU SO MUCH. ARE
THERE ANY ADDITIONAL WITNESSES
IN SUPPORT, PLEASE? STATE, YOUR
NAME ORGANIZATION AND POSITION
ONLY. GOOD AFTERNOON. MICHELLE.
WELCOME ON BEHALF OF CON CROSS
COUNTY AND SUPPORT. GOOD
AFTERNOON JOSH GOER ON BEHALF OF
THE SANTA CLARA COUNTY BOARD OF
SUPERVISORS IN SUPPORT. THANK
YOU A RE THERE ANY PRIMARY
WITNESSES IN OPPOSITION? MOVED
BY MR RODRIGUEZ SECONDED BY
DOCTOR ARAMBULA. NÓ UH,
WITNESSES. I N OPPOSITION. WE
WILL MOVE NOW TO COMMITTEE.
DOCTOR WEBER. THANK YOU SO MUCH
ASSEMBLY MEMBER LOW AND MY
FELLOW PHYSICIANS HERE, UM I'M I
AM HONESTLY HAVING A CHALLENGING
TIME WITH THIS PARTICULAR BILL.
BECAUSE WHAT I SEE IS US AS YOU
STATED FROM THE BEGINNING.
CODIFYING OR ESSENTIALLY PUT IN
PUTTING INTO LAW. WHAT ARE
ALREADY CLINICAL GUIDELINES. SO
I'M GONNA GO TO MY PHYSICIANS
WHO ARE PRIMARY CARE PROVIDERS
BECAUSE I AM A SPECIALIST. UM
WHAT ARE YOU DOING RIGHT NOW?
LIKE, DO YOU NOT ALREADY LOOK
AND DO A RISK ASSESSMENT? AND IF
THE PATIENT IS AT HIGHER RISK
FOR, UM, WHO COMES TO SEE YOU
WHO? WHO'S AT HIGHER RISK, YOU
KNOW, COMING FROM MAYBE SOMEONE
WHO'S UNSHELTERED OR, UH, YOU
KNOW, SOMEONE WHO'S
IMMUNOCOMPROMISED OR SOMEONE WHO
, UH, HAS RECENTLY VISITED OR
LIVED FROM ANOTHER COUNTRY. ARE
YOU NOT ALREADY DOING THAT RISK
ASSESSMENT AND THEN IF THEY ARE
AT RISK OFFERING THEM THE TEST.
IS THAT NOT WHAT YOU'RE DOING? I
THINK THAT FOR NORTHEAST MEDICAL
SERVICES BE BECAUSE THIS HEALTH
DISPARITY HAS BEEN BROUGHT TO
OUR ATTENTION VERY EARLY ON WITH
THE HEALTH DEPARTMENT AND
UNDERSTANDING THAT A LARGE
BURDEN OF THE DISEASE RESTS IN
OUR SPECIFIC POPULATION. WE'VE
ACTUALLY BEEN DOING A LOT FOR Tð
B OVER THE LAST DECADE, BUT I
THINK THAT OUR HEALTH CENTER IS
A VERY UNIQUE CASE HERE. IF YOU
THINK OF AN A LARGER, LIKE VERY
DIVERSE POPULATION LIKE KAISER
IN NOR NORTHERN CALIFORNIA, FOR
INSTANCE, WHERE THEY SEE, UM YOU
KNOW, PATIENT, MAYBE MOSTLY U S¼
BORN. UH, PATIENTS AND MAYBE A
SMALLER PROPORTION WHO ARE IN
THAT AT RISK CATEGORY. I DON'T
KNOW IF I CAN SAY THAT A LOT OF
OTHER PLACES ARE DOING THE
ROUTINE RISK ASSESSMENT FOR
THEIR ADULT PRIMARY CARE,
PREVENTATIVE SERVICES AND DOING
THE TESTING. UM WE ARE WORKING
WITH KAISER AS PART OF THE èC
Dð èC GRANT THAT I MENTIONED,
UM AND I DO THINK THAT THEIR
TESTING RATES ARE PROBABLY MUCH
LOWER THAN NORTHEAST MEDICAL
SERVICES. UH, I CAN'T REALLY SAY
ON THE RECORD. UM, BUT FOR US
BECAUSE IT'S TOP OF MIND. WE DO
PROBABLY. BEST PRACTICES MORE
OFTEN THAN UM, SOME OF THE OTHER
, UM, INSTITUTIONS OUT THERE.
AND SO I THINK THAT FOR THE
CALIFORNIA STATE ASSEMBLY TO PUT
A BILL FORWARD WOULD REALLY
INDICATE THAT WE ARE PRI
PRIORITIZING ADDRESSING A HEALTH
DISPARITY THAT AFFECTS OUR
IMMIGRANT POPULATIONS HERE IN
THE STATE, AND I DO ALSO WANT TO
POINT OUT THAT SINCE 1996 THE U
S¼ PREVENTATIVE SERVICES TASK
FORCE HAS HAD A RECOMMENDATION
TO SCREEN AT RISK INDIVIDUALS
FOR Tð B. AND THAT
RECOMMENDATION WAS UPDATED AND
RENEWED. I THINK JUST LAST YEAR,
BUT STILL WE HAVEN'T EVEN COME
CLOSE TO MOVING THE NEEDLE ON Tð
B ELIMINATION BECAUSE IN THE U
S¼ IT REALLY HINGES ON
IDENTIFYING THOSE WHO HAVE
LATENT Tð B. YEAH YEAH, I YEAH.
THANK YOU FOR THAT. AND I DID
READ, UH, THE UPDATED
RECOMMENDATIONS IN A MA. THAT
WAS, UH, ACTUALLY HAVE IT RIGHT
HERE. UM THAT WAS UPDATED IN
2020. THREE SO IS IT YOUR
STATEMENT? BECAUSE YOU YOU DON'T
KNOW WHAT'S GOING ON IN IN OTHER
FACILITIES THAT THOSE CLINICIANS
ARE ACTUALLY NOT PRACTICING THE
GUIDELINES THAT THEIR OWN
COLLEGES RECOMMEND. BECAUSE
AGAIN I'M NOT A PRIMARY CARE
PHYSICIAN, BUT I DID LOOK INTO,
UM YOU KNOW, THE AMERICAN
ACADEMY OF FAMILY PHYSICIANS AND
THEIR RECOMMENDATION IS FOR
THEIR PROVIDERS TO FOLLOW THIS U
S¼ PREVENTATIVE SERVICE TASK
FORCE, SO THEY ARE TASKED WITH
ALREADY DOING WHAT'S IN THIS
BILL. SO YOU'RE THINKING THAT
THEY'RE NOT FOLLOWING THEIR
COLLEGES RECOMMENDATIONS? I
THINK THERE'S DEFINITELY UNDER
SCREENING. I THINK THE ONLY HARD
OUTCOMES YOU COULD LOOK AT ARE
THE NUMBER OF ACTIVE Tð B CASES
PER YEAR. RIGHT SO THE
ASSUMPTION IS THAT A LOT OF
THESE PATIENTS WHO DO DEVELOP Tð
B WERE NOT SCREENED, OR EVEN IF
THEY WERE MAYBE THEY WEREN'T
LINKED TO CARE OR OFFERED
PREVENTATIVE TREATMENT. UM
OTHERWISE, IT'S HARD TO REALLY
KNOW THE TRUE NUMBER BECAUSE I
DON'T THINK THAT THE Tð B
TESTING IS REPORTABLE FOR BOTH
POSITIVE AND NEGATIVE, AND THAT
THAT LED TO ANOTHER QUESTION
THAT I HAD BECAUSE THERE'S A LOT
OF INFORMATION ABOUT OUR Tð VÆ
SCREEN. OUR Tð VÆ POSITIVE TESTS
GOING UP RIGHT AND IN ORDER TO
LINK IT TO PHYSICIANS, NOT
FOLLOWING CURRENT CLINICAL
GUIDELINES. DO WE HAVE, UM, ANY
KIND OF STUDIES OUT THERE THAT
SHOW THAT HAVE LOOKED AT THESE
INDIVIDUALS AND THEY SAY, OH,
I'VE TESTED POSITIVE NOW, BUT I
JUST RECENTLY SAW MY PRIMARY
CARE PROVIDER WITHIN THE LAST
SIX MONTHS WITHIN THE LAST YEAR,
AND THEY JUST DIDN'T DO THE
ASSESSMENT. AND THEY DIDN'T TEST
ME LIKE DO WE HAVE THAT? I
COULDN'T FIND THAT STUDY. BUT
MAYBE THAT'S YOU KNOW, OUT THERE
AND I JUST DIDN'T SEE IT TO
ACTUALLY LIKE. VALIDATE THE NEED
TO PUT THIS IN LAW. I I'M NOT
FAMILIAR WITH LARGE STUDIES. BUT
I CAN AT LEAST SAY THAT IN 2022
WHEN WE WERE AWARE THAT 25% OF
THE CASES IN SF WERE FROM OUR
OWN INSTITUTION, WE DID LOOK AT
ALL THESE CASES INTO THE
ELECTRONIC HEALTH RECORDS TO SEE
WHERE THERE ARE SEVERAL MISSED
OPPORTUNITIES FOR THESE AND IT'S
REALLY A MIX. IT'S A MIX OF, UM,
SITUATIONS, SO FOR SOME OF THEM
THEY WERE NEWER PATIENTS, AND
THERE WASN'T REALLY MUCH
OPPORTUNITY TO HAVE DONE THE
TESTING. SOME OF WERE VERY
ESTABLISHED AND HAD BEEN WITH US
FOR DECADES. BUT THERE'S A LOT
OF VARIABILITY IN PROVIDER
PRACTICE. AND THERE ARE OTHERS
WHO HAD TESTED POSITIVE BUT HAD,
UM NOT TAKEN. BE PREVENTATIVE
TREATMENT, SO I THINK THE GAMUT
IS REALLY OF SITUATIONS IS
REALLY ALL OVER THE PLACE. SO I
CAN ONLY SPEAK FOR OUR HEALTH
CENTER, A PLACE THAT ACTUALLY
DOES PAY A LOT OF ATTENTION TO
THIS AND DOING A LOT OF PROVIDER
EDUCATION. BUT YOU STILL GET
THOSE CASES. YEAH, UM AND SO YOU
KNOW, I, UM I JUST I'M LOOKING
AT THIS AND IT'S ALREADY A
CLINICAL RECOMMENDATION. IT'S
ALREADY SOMETHING THAT
INDIVIDUAL ORGANIZATIONS, UM,
TELL THEIR PROVIDERS. IT'S KIND
OF LIKE I'VE I'VE LIKEN IT TO
SOMEONE COMING UP HERE AND
SAYING THAT WE NEED TO DO A BILL
THAT REQUIRES Ó BGY N S¼ TO
FOLLOW A COG RECOMMENDATIONS FOR
PAP SMEAR SCREENING RIGHT?
BECAUSE WE STILL HAVE CERVICAL
CANCER CASES OUT THERE. UM OR WE
DO A BILL THAT STATES. UH, WE
NEED TO REQUIRE THAT PHYSICIANS
OR HEALTH CARE PROVIDERS OFFER
FLU VACCINES EVERY YEAR. UM
BECAUSE OUR OUR UPTAKE IS LOWER.
AND I JUST, UM I DON'T BELIEVE
THAT WE NEED TO BE NECESSARILY
PUTTING INTO STATUE CLINICAL
GUIDELINES. UM THAT PROVIDERS
ARE ARE ALREADY SUPPOSED TO BE
DOING NOW, IF IT IF THEY WEREN'T
DOING IT, AND IF WE HAVE DATA
THAT THEY'RE NOT. I THINK THAT'S
A DIFFERENT SITUATION. BUT YOU
KNOW, EVEN TO WHAT YOUR POINT
IS, SOME OF THE PATIENTS THAT
WERE POSITIVE FOR Tð B HAD NEVER
EVEN BEEN SEEN BY A PRIMARY CARE
PROVIDER IN YOUR FACILITY. UM
SOME OF THEM MAY HAVE SEEN OTHER
PROVIDERS THAT WEREN'T
NECESSARILY PRIMARY CARE THAT
WOULDN'T NORMALLY SCREEN FOR Tð
B ANYWAY, AND WOULDN'T BE
COVERED IN THIS BILL. AND SO
WHEN I READ THIS BILL, I SAID,
OK, THIS IS IMPORTANT, BUT IT'S
ALREADY, UH, IN CLINICAL
GUIDELINES, AND THERE'S NOTHING
THAT ACTUALLY STATES THAT YOU
HAVE TO DO IT. IT'S JUST A
RECOMMENDATION. AND IF A
PHYSICIAN DOESN'T OR PROVIDER
DOESN'T THEN THERE'S NOTHING.
THERE'S NÓ RECOURSE WHICH YOU
KNOW THERE SHOULDN'T BE SO IT'S
JUST I. I WAS JUST KIND OF
SCRATCHING MY HEAD TO TRY TO
FIGURE OUT WHAT IS THE PURPOSE.
AND WHAT WOULD BE A DIFFERENCE
IN THE OUTCOME. AND I HAVEN'T
BEEN MOVED OR SWAYED, UM BY THE
READING OF THE BILL, OR THE
CONVERSATIONS REALLY APPRECIATE
YOU ALL BEING HERE, SO I
PERSONALLY CANNOT SUPPORT THIS,
AS IS, BUT WE'LL CONTINUE TO
HAVE CONVERSATIONS WITH THE
AUTHOR. THANK YOU. ANY OTHER
COMMENTS FROM THE COMMITTEE.
THAT UM, JUST TO ANSWER THE
QUESTION. SO THE THIS THIS BILL,
UM WOULD ACTUALLY PROVIDE US A
FRAMEWORK LIKE I HAD ALREADY
MENTIONED IN OUR COMMENT. UH, I
COME WITH THE èC B Ó
PERSPECTIVE. WE GO OUT TO A LOT
OF COMMUNITY, UM MEMBERS AND
TALK TO THEM ABOUT IT. AND THERE
HAVE BEEN TIMES NOW. THIS IS
JUST A WORD FOR WORD THAT I CAN
TALK. UH, BUT THERE HAVE BEEN
CASES WHERE PEOPLE ARE SCARED TO
TALK TO THEIR DOCTOR. BUT WITH
THIS REQUIRED BENEFIT, WE CAN GO
AND TELL THEM THAT THERE IS
REQUIRED BENEFIT THAT YOU CAN
TALK TO YOUR DOCTOR GET SCREENED
, AND, UM PEOPLE ARE ALSO
WORRIED ABOUT THE PAYMENT RIGHT?
SO THAT IS THAT'S ACTUALLY A BIG
ISSUE. SO WHEN THEY GET TO KNOW
THAT, OK, THERE'S SOMETHING LIKE
THIS A REQUIREMENT THAT YOU
COULD GO AND ASK YOUR DOCTOR GET
SCREENED AND TREATED FOR THAT.
IT WILL AND, UM LIKE DOCTORS,
TANG SAID. IT IS GOING TO ALSO
SAVE A LOT OF MONEY. UM AND TIME
FOR THE PATIENT AND THE SYSTEM.
YEAH, I. I DO THINK IT'S PRETTY
COMPELLING TO HEAR THAT, UH,
THERE'S A PREVENTATIVE CARE
OPTION OF SPENDING ABOUT $800 TO
AGAINST THE $45,000 IN EMERGENCY
DEPARTMENT CARE THAT COMES FROM
BEING ABLE TO DO THIS, AND I
ALSO THINK IT'S COMPELLING THAT,
UH, WE KNOW THAT WE HAVE, UH
ABOUT 4200 DEATHS A YEAR TO Tð B
HAPPENING, UH, EXPECTED BY 2040.
SO THAT IS A SIGNIFICANT NUMBER
OF UH, POPULATION THAT COULD BE
IMPACTED BY JUST HAVING THE
ABILITY TO HAVE ADDITIONAL
SCREENING. AS HAS BEEN LAID OUT
IN THIS IN THIS LEGISLATION. GO
AHEAD. SORRY SORRY CHAIR. UM
THIS DOESN'T CHANGE. WELL LET ME
ASK THE AUTHOR DOES THIS CHANGE
COVERAGE? DOES THIS REQUIRE
COVERAGE IF IT'S NOT ALREADY
THERE. I. I CAN'T HEAR. N NÓ.
OK UM, WITH THIS OPEN UP THE
ABILITY FOR PEOPLE TO BE
SCREENED THAT ARE NOT ALREADY
ABLE TO BE SCREENED. AND IS THE
OPPORTUNITY TO BE ABLE TO DO SO.
WHILE THE GUIDELINES ARE NOT
CODIFIED, THEY'RE STILL CLOSE TO
2 MILLION INDIVIDUALS THAT DON'T
KNOW THAT RECOGNITION THAT THEY
HAVE Tð B. SO THIS THERE IS A
MISSING LINK TO HELP ENSURE THAT
WE ARE AS PROACTIVE AS POSSIBLE,
RIGHT? BUT I GUESS MY QUESTION
IS. IS THIS SOMEHOW GOING TO
OPEN UP THE DOORS FOR PEOPLE TO
BE SCREENED THAT WERE NOT
ALREADY ABLE TO BE SCREENED
RIGHT NOW? I THINK THAT'S THE
LIKE AN INTENT TO HELP ENHANCE
THAT PROCESS. HENCE THE HENCE
THE LEGISLATIVE INTENT. I TO.
I'M GOING TO ASK, UH, THE AUTHOR
TO JUST, UH, PROVIDE ANY
ADDITIONAL RESPONSE IN YOUR IN
YOUR CLOTHES. THAT MOTION IS
PASS TO APPROPRIATIONS. IT
FIRST. YEAH. AUTHOR. WOULD YOU
LIKE TO CLOSE? SURE JUST TO JUST
TO REMIND THE MEMBERS OF THE
COMMITTEE AS WELL TO THIS BILL.
PROPOSAL MIRRORS LEGISLATIVE
PROPOSAL LAST YEAR ASSEMBLY BILL
789, WHICH CODIFIED CLINICAL
GUIDELINES WITH RESPECT TO
HEPATITIS B AND èC, WHICH THIS
MEMBERS OF THIS COMMITTEE ALL
UNANIMOUSLY VOTED. UH UH, IN
SUPPORT OF, UM, AS AS PUBLIC
RECORD, AND SO, UH, WE HOPE THAT
THIS WILL INCREASED OPPORTUNITY
FOR ACCESS ON ADDRESSING A VERY
IMPORTANT ISSUE, ESPECIALLY
BEING RESPONSIVE TO THE UPTICK
IN CASES AND RESPECTIVELY. AS
FOR I YOU HAVE A MOTION? OH, WE
HAVE A MOTION IN A SECOND. THE
MOTION IS TO PASS TO
APPROPRIATIONS. UH, WITH THAT
POLICE SECRETARY CALDERO FONTA.
I WANT TO I WALDRON WALDRON, I
AGAR CURRY. EDGAR CURRIE. I
ARAMBULA ARAMBULA I WENDY
CARRILLO. WE CARE HØI FLORA.
ALANIS ALANIS, I. HANEY. ANY I
JOHN SAWYER. SAWYER. I MAINS
SHINE. MEANS RIGHT? I'M MCCARTY.
PHIL PATTERSON. JOE PATTERSON. I
RODRIGUEZ. RODRIGUEZ SAIZ
SANTIAGO CHAVO. DOUBLE I WEBER.
WE NÓ. THAT BILL PASSES WITH A
VOTE OF 12 TO 1. THANK YOU.
WE'LL MOVE ON NOW TO ITEM NUMBER
ONE A B 1830 DOCTOR ARAMBULA.
THANK YOU, DOCTOR. AMBAR, YOU
MAY BEGIN WHENEVER YOU'RE READY.
THANK YOU, MADAM CHAIR AND
MEMBERS. I WILL BEGIN BY
THANKING YOUR COMMITTEE STAFF
AND ACCEPTING THE COMMITTEE
AMENDMENTS. ALL PREGNANCIES
SHOULD BE SUPPORTED BY
CULTURALLY APPROPRIATE MEANS.
MAYBE 1830 SUPPORTS HEALTHY
PREGNANCIES BY EXPANDING
MANDATORY FOLIC ACID
FORTIFICATION TO CORN MASA FLOUR
MASA TO PREVENT BIRTH DEFECTS.
DAILY CONSUMPTION OF FOLIC ACID
DECREASES THE RISK OF NEURAL
TUBE DEFECTS SUCH AS SPINA
BIFIDA AND ANENCEPHALY BY MORE
THAN HALF BABIES WITH SPINA
BIFIDA CAN EXPERIENCE SYMPTOMS
RANGING FROM MILD NERVE DAMAGE
TO SEVERE PARAPLEGIA. AND AY IS
FATAL FOR INFANTS. SINCE NEURAL
TUBE DEFECTS OCCUR IN THE
EARLIEST STAGES OF FETAL
DEVELOPMENT, IT CAN BE TOO LATE
TO TAKE FOLIC ACID SUPPLEMENTS.
BY THE TIME A PERSON KNOWS THAT
THEY ARE PREGNANT. TO ADDRESS
HIGH RATES OF NEURAL TUBE
DEFECTS. THE F Dð A REQUIRED
THAT ALL ENRICHED CEREAL GRAIN
PRODUCTS BEFORE DEFIED WITH
FOLIC ACID BEGINNING IN 1998.
WHILE MASA IS A STAPLE FOR MANY
LATINO CUISINES, MASA WAS
OMITTED FROM THE 1998 MANDATE.
AS A RESULT, LATINOS WERE LEFT
WITHOUT A CULTURALLY APPROPRIATE
AVENUE FOR OBTAINING FOLIC ACID
IN THEIR DIETS THROUGH
FORTIFICATION. UNFORTUNATELY
LATINO COMMUNITIES REMAIN AT A
DISPROPORTIONATELY HIGH RISK FOR
NEURAL TUBE DEFECTS. A HIGHER
RATE OF NEURAL TUBE DEFECTS IN
LATINO COMMUNITIES IS A SYMPTOM
OF A BROADER DISEASE OF HEALTH
INEQUITY. MANDATORY
FORTIFICATION OF MASA THROUGH A
B 430 WILL WRITE THIS WRONG AND
PREVENT NEW MOTHERS AND PARENTS
FROM LO LOSING CHILDREN TO NEURO
TUBE DEFECTS. TESTIFYING AND
SUPPORT OF A B 1830 IS RYAN
SPENCER FROM THE AMERICAN
COLLEGE OF GYNECOLOGY. THANK
YOU. YOU'LL HAVE THREE MINUTES.
THANK YOU, MADAM CHAIR RYAN
SPENCER BEHALF OF THE AMERICAN
COLLEGE OF Ó, BGY N DISTRICT
91 OF OUR PHYSICIAN MEMBERS,
DOCTOR, MEGAN JONES WAS UNABLE
TO MAKE IT TODAY. SO I'D LIKE TO
SHARE HER EXPERIENCE WITH ISSUE
AND WHY ACOG IS SPONSORING THE
MEASURE. DOCTOR JONES PRACTICES
IN THE CENTRAL COAST OF
CALIFORNIA. AND AS A MATERNAL
FETAL MEDICINE PHYSICIAN, SHE
CARES THE MOST COMPLICATED
PREGNANCIES. THE REGION'S
HOSPITALS DELIVER APPROXIMATELY
SEVEN OR SORRY 6000 BABIES
COLLECTIVELY EVERY YEAR AND HER
AND HER PARTNER, SEE
APPROXIMATELY 100 WOMEN DAILY
MAJORITY OF THE PATIENT.
INCLUDES MIGRANT WORKERS AND
SPANISH AND MEECO SPEAKING
COMMUNITY MEMBERS. DIABETES
RATES ARE ELEVATED STRUGGLES
WITH MANY SOCIAL DETERMINANTS OF
HEALTH ARE PERVASIVE, LIKE A
CONTRIBUTING TO THE FETAL
ABNORMALITIES THAT SEE SUCH A
SUCH AS NEURAL TUBE DEFECTS OR
N TDS. IMPLEMENTING STRATEGIES
TO IMPROVE DIABETES AND CHRONIC
ILLNESS, WHICH NEGATIVELY
IMPACTS PREGNANCY WILL REQUIRE
HUGE EFFORTS OVER LONG PERIODS
OF TIME. BUT THERE CAN BE A
FOCUS ON SIMPLE CHANGES ALONG
THE WAY THAT COULD BE QUITE
EFFICIENT IN REDUCING RISK IN A
SHORT PERIOD OF TIME. CORN MASA
FLOUR IS A CULTURAL STAPLE FOR
MANY OF THEIR COMMUNITY MEMBERS
MONEY TO BUY PRENATAL VITAMINS
OR A CAR TO ATTEND A PRENATAL
VISIT IS A LUXURY. THIS WHERE
CHANGES THIS IS WHERE CHANGES
THE FORTIFIED CORN MASA FLOUR
WITH FOLK ACID CAN HELP PROVIDE
A BASIC NUTRIENT FOR ALL THEIR
MOTHERS AND CHILDREN. DOCTOR
JONES RECENTLY CARED FOR TWO
PREGNANCIES WITH N Tð Dð OR
SPINA BIFIDA IN THE LAST THREE
MONTHS AND STANDARD OF CARE HAS
TURNED TOWARD IN UTERO SURGERY.
BOTH OF THE PATIENTS DECLINED
THIS DUE TO INABILITY TO SECURE
TRANSPORTATION TO GET TO THE
CENTER THREE HOURS AWAY. THEY
DIDN'T HAVE CHILD CARE TO WASH
THEIR OTHER KIDS AT HOME. THEY
DIDN'T FEEL COMFORTABLE WITH THE
LANGUAGE BARRIER WITH OPTIONS
FOR IMPROVEMENT OF THEIR
CONDITION. THESE FAMILIES STILL
HAD AN ONEROUS TASK OF EXECUTING
WHILE PRENATAL DIAGNOSIS AND
MANAGEMENT IS IMPORTANT.
PREVENTION SHOULD BE A FOCUS,
BUT HOW CAN A FAMILY IN MY
COMMUNITY OR THEIR COMMUNITY
FOCUS ON PREVENTION WHEN THEY
STRUGGLE WITH SECURING BASIC
NEEDS? ONE THE LEADING CONCERNS
WITH SOCIAL DETERMINANTS OF
HEALTH IS FOOD INSECURITY, AND
THIS IS ONE AREA THAT WE MAY BE
ABLE TO HELP MAKE A DIFFERENCE.
BE INEXPENSIVE, INEXPENSIVE AND
EASILY ATTRIBUTABLE FOR MOST
HORN MASA FLOUR CONSUMES MUCH OF
THE DIET OF MANY OF THEIR
COMMUNITY MEMBERS. FURTHERMORE
FOLK ACID FORTIFICATION OF CORN
MASA FLOUR CAN HELP DECREASE THE
RISK OF N Tð Dð S¼ CLEFT LIP
AND IMPROVED PRENATAL NUTRITION.
IT IS NECESSARY IT IS EQUITABLE.
IT COULD BE SO IMPACTFUL FOR THE
MANY FAMILIES THAT CAN AVOID
PRACTICING COMPLICATIONS WITH
THIS CHANGE. FOR ALL THESE
REASONS, ACOG IS PLEASED TO
SPONSOR A 1830 ASKS FOR YOUR
IPHONE. THANK YOU. MOVED BY
MAJORITY LEADER AKIR CURRY.
SECONDED BY MS WALDRON, VICE
CHAIR, WALDRON. THANK YOU FOR
THE TESTIMONY. ARE THERE ANY
ADDITIONAL WITNESSES IN SUPPORT?
THANK YOU, MADAM CHAIR MEMBERS,
BRYCE DOCHERTY ON BEHALF OF THE
AMERICAN ACADEMY OF PEDIATRICS,
CALIFORNIA AND STRONG SUPPORT.
AFTER MADAM CHAIR MEMBERS DAVID
PISANI MARCH OF DIMES IN
SUPPORT. AFTERNOON JOSH GARGER
ON BEHALF OF THE COUNTY HEALTH
EXECUTIVES ASSOCIATION OF
CALIFORNIA IN SUPPORT. ARE THERE
ANY ADDITION A ANY WITNESSES IN
OPPOSITION? THE N WILL BRING IT
BACK TO COMMITTEE FOR COMMENT OR
QUESTIONS. THANK YOU FOR
BRINGING THIS BILL FORWARD. I
REMEMBER YEARS AGO WHEN MY
MOTHER USED TO TAKE CARE OF SOME
OF THE CHILDREN THAT WERE IN
THE, UH, FARM WORKER HOUSING AND
TWO HEAD CLEFT PALLETS, AND
THEY'RE ALWAYS TRYING TO FIGURE
OUT WHAT IT WAS. AND THEN IT
CAME BACK TO IT WAS PROBABLY
LACK OF FOLIC ACID. THIS IS A
GREAT BILL. THANK YOU VERY MUCH
FOR BRINGING FORWARD. THANK YOU,
UH, DOCTOR, EMBLA, YOU MAY CLOSE
THANK YOU, MADAM CHAIR. I
RESPECTFULLY ASK FOR AN I VOTE.
THANKS SO MUCH, I THINK
ADDRESSING HEALTH DISPARITIES
BEGINS BEFORE BIRTH AND RESEARCH
SHOWS THAT WHEN BIRTHING PEOPLE
CONSUME ENOUGH FOLIC ACID DURING
PREGNANCY, THE RISK OF BABIES
DEVELOPING NEURAL TUBE DEFECTS
DECREASES SIGNIFICANTLY. I THINK
THIS IS A VERY SMART, UH AND,
UH, CULTURALLY COGNIZANT BILL,
SO THANK YOU FOR BRINGING IT
FORWARD WITH THAT SECRETARY
KENNY COLOR. MOTION IS DUE PASS
AS AMENDED TO APPROPRIATIONS
BONTA IB I, WALDRON WALDRON, I
AGAR CURRY CURRY, I ARAMBULA
RAMLA I WENDY CARRI. WENDY
CARRILLO HØI FLORA. ALANIS
AYLAN, I HANEY. IN I JOHN
SAWYER. JOHN SAWYER, I MAY
SHINE. MAIN TRAIN. I'M A CARDI.
JO PATTERSON. PATERSON I
RODRIGUEZ RODRIGUEZ. I SANTIAGO
BRAVO! DOUBLE I WEBER. HOWEVER,
I. THAT BILL PASSES WITH A VOTE
OF 13 TO 0. WE NOW MOVE TO OUR
CONSENT. THERE ARE NÓ BILLS
PROPOSED FOR CONSENT TODAY. UH
AND SO WE WILL OPEN THE ROLLS
FOR ANY MEMBERS WHO NEED TO ADD
ON FOR VOTES. A B 1842 REYES.
LAURA. AN ANY I MOONSHINE MAINS
SHINE, I MCCARTY SANTIAGO. A B
2132 LOW. OKAY?
WE WILL HOLD OPEN THE ROLE FOR
ANOTHER FIVE MINUTES. IF THERE
ARE ANY COMMITTEE MEMBERS WHO
WOULD LIKE TO ADD ON. MM.
HEY, THIS IS JOHN DON SHE'S
KEEPING THE WORLD OPEN. FIVE.
OK, THANK YOU. OK. BYE BYE.
HEY, THIS IS JOHN DOWN IN LET
HIM KNOW. THE. OK, THANK YOU.
HEY, THIS IS JOHN. YOU LET HIM
KNOW THAT THE CHAIR IS KEEPING.
YEAH. IT'S IN SWING SPACE. HE'S
HE'S OVER IN THE CAPITOL. YEAH.
JUST SHOOT HIM A TEXT AND SEE
WHAT HE DOES. OK, PERFECT.
HELLO, MR FLORA. WE WILL ADD ON.
MAYBE 1830 FLORA FLORA. I
MCCARTHY, SANTIAGO 14 0. IT'D BE
14. I'M 1842 FLORA. ARE NOT
VOTING. MCCARTY, SANTIAGO 13 0
13 0. A B 2132 FLORA FLORA. I
MCCARTHY, SANTIAGO 13 TO 1. NOW
AT 13 TO 1.
WE ARE ADJOURNING. THE HEARING
FOR THE COMMITTEE ON HEALTH FOR
MARCH. 19TH 2024. THANK YOU.