GOOD AFTERNOON. WE'LL CALL TO
ORDER THE. THE COMMITTEE HEARING
OF ASSEMBLY HEALTH, TODAY ON
APRIL 23RD. BEFORE WE BEGIN, I
WOULD LIKE TO MAKE A STATEMENT
ON PROVIDING TESTIMONY AT THIS
HEARING, WITNESSES WILL BE
TESTIFYING IN PERSON. WE ALLOW
TWO MAIN WITNESSES FOR A MAXIMUM
OF TWO MINUTES EACH. WE WILL
MAKE TIME. WE WILL TAKE UP ITEM
NUMBER THREE, AB 2075. ALVAREZ
AS SOON AS WE CAN, AS FIRST
ORDER IF POSSIBLE. ONE OF THE
WITNESSES HAS REQUESTED AN ADA
ACCOMMODATION THROUGH THE RULES
COMMITTEE AND WILL BE TESTIFYING
REMOTELY. ITEM 12 AB 2467. BAUER
KHN WILL BE SECOND ON THE
AGENDA BY PRIOR AGREEMENT.
SHOULD THE AUTHOR BE HERE IN
TIME FOR AB 2200, WHICH I KNOW
MANY OF YOU ARE HERE FOR? WE
WILL ALLOW TEN MINUTES EACH FOR
SUPPORT AND OPPOSITION, THEN AN
ADDITIONAL 15 MINUTES FOR BOTH
SUPPORT AND OPPOSITION. ME TWO
TESTIMONY ALL ME TWO OR
ADDITIONAL TESTIMONY WILL BE
STRICTLY LIMITED TO NAME,
POSITION AND ORGANIZATION. IF
YOU REPRESENT ONE. ALSO, WE HAVE
ON SPECIAL ORDER AS A SPECIAL
ORDER OF BUSINESS OF THE DAY.
TODAY AB 2200 CHOLERA GUARANTEED
HEALTH CARE FOR ALL, WHICH WILL
START AT THREE AND HAVE A HARD
STOP AT 4:00. VOTE ONLY. WE WILL
HAVE AB 2690. LEE IS ON THE
AGENDA AND WE WILL ENSURE THAT
THERE IS NO PRESENTATION,
WITNESS TESTIMONY OR DISCUSSION
ON THIS BILL IS VOTE ONLY AND ON
THE CONSENT CALENDAR FOR THE DAY
. THE FOLLOWING BILLS ARE
PROPOSED FOR CONSENT FOR TODAY'S
HEARING. ANY MEMBERS OF THE
COMMITTEE MAY REMOVE A BILL FROM
CONSENT ITEM FOR AB 2101.
RODRIGUEZ ITEM NINE AB 2348.
RODRIGUEZ WITH AMENDMENTS. ITEM
11 AB 2383 WENDY CARRILLO WITH
AMENDMENTS. ITEM 13 AB 2563
EASILY. ITEM 19 AB 2726 FLORA
WITH AMENDMENTS. ITEM 20 AB 2756
BURNER. ITEM 21 AB 2767,
SANTIAGO, WITH AMENDMENTS. ITEM
24 AB 2843 PETRIE-NORRIS. ITEM
30. AB 3156 JOE PATTERSON WITH
AMENDMENTS. ITEM 32 H.R. 58.
JACKSON WITH THAT, I THINK WE
ACTUALLY GOING TO MOVE TO THE
AUTHOR THAT IS HERE. WE WILL BE
OPERATING AS A SUBCOMMITTEE
UNTIL WE ARE ABLE TO ESTABLISH
QUORUM, AND WE WILL START WITH
WITH ASSEMBLY MEMBER WARD, WHICH
IS ITEM NUMBER 25, AB 2893.
EARLY BIRD CATCHES THE WORM.
THANK YOU, MADAM CHAIR. GOT
LUCKY THIS AFTERNOON. I KNOW YOU
HAVE A LONG SCHEDULE AHEAD OF
YOU, SO I APPRECIATE BEING HERE
BEFORE YOU TODAY. I WANT TO
START BY THANKING THE COMMITTEE
STAFF FOR THEIR HARD WORK ON
THIS BILL. AS CALIFORNIA
CONTINUES TO NAVIGATE THE MENTAL
HEALTH NEEDS OF OUR UNHOUSED
POPULATION, ALONG WITH THE STATE
HOUSING CRISIS, WE'VE LEARNED
THAT THESE ISSUES ARE OFTEN
INTERTWINED, AN OPTION THAT HAS
BEEN WORKING FOR PEOPLE WHO FIND
THEMSELVES IN THIS POSITION IS
RECOVERY HOUSING, FOR WHICH
FOCUSES ON TREATMENT, BUT NOT TO
THE EXTENT OF CLINICAL SETTINGS.
RECOVERY HOUSING ALLOWS
FLEXIBILITY AND IS STABLE ENOUGH
TO PROVIDE AN ENVIRONMENT WHERE
PEOPLE CAN SUCCESSFULLY PROGRESS
OUT OF THEIR ADDICTION. AB 2920
2893 ESTABLISHES A STATE
CERTIFICATION PROCESS FOR
RECOVERY HOUSES THROUGH THE
DEPARTMENT OF HEALTH CARE
SERVICES. THIS CERTIFICATION
STANDARDIZES CARE AND
REQUIREMENTS FOR ALL RECOVERY
HOUSES IN CALIFORNIA, WHILE ALL
MAKING ALSO MAKING IT AVAILABLE
AS A TOOL THE STATE CAN USE TO
ADDRESS TREATING OUR UNHOUSED
POPULATION. I ACKNOWLEDGE THAT
THIS BILL IS BEING HIGHLY
TECHNICAL, WITH FURTHER
DEFINITION CLARITY NEEDING TO BE
ADDRESSED, AND THAT'S SOMETHING
THAT I CAN ASSURE THE CHAIR AND
COMMITTEE THAT I WILL CONTINUE
TO WORK WITH MY SPONSOR AND
OTHER ORGANIZATIONS IN THE
INDUSTRY ON. WE WANT THIS BILL
TO BE CLEAR FOR IMPLEMENTATION
AND WITH IT, PROVIDE ANOTHER
TOOL THAT BALANCES OUR STATE'S
SUBSTANCE ABUSE TREATMENT NEEDS
AND HOUSING SHORTAGE. I HAVE
TESTIFYING IN SUPPORT OF THIS
BILL, JASON ROBINSON, THE CHIEF
PROGRAM OFFICER OF SHARE
COLLABORATIVE HOUSING, THE
SPONSOR OF THIS BILL.
ASSEMBLYMEMBERS, THANK YOU.
THERE WE GO. ESTEEMED COMMITTEE
MEMBERS, THANK YOU FOR
CONSIDERING ASSEMBLY BILL 2893,
WHICH WILL CREATE A
CERTIFICATION PROCESS TO BRING
RECOVERY RESIDENCES FOR PEOPLE
EXPERIENCING MENTAL HEALTH AND
HOMELESSNESS INTO CALIFORNIA'S
CONTINUUM OF HOUSING OPTIONS AND
HOMELESS SERVICES. RECOVERY
RESIDENCES OFFER MUCH NEEDED
COMMUNITY SUPPORTS AND HOUSING
FOR CALIFORNIA'S MOST VULNERABLE
CITIZENS. AS EARLY AS 2010, THE
NATIONAL HEALTH INSTITUTE HAS
BEEN EMPHASIZING THE IMPORTANCE
OF SOCIAL SUPPORT AS A LEADING
INDICATOR OF WELLNESS FOR PEOPLE
EXPERIENCING MENTAL HEALTH
ISSUES. STUDIES HAVE SHOWN THAT
THE AMOUNT AND QUALITY OF SOCIAL
SUPPORTS ACCOUNT FOR 40% OF
WHETHER OR NOT PEOPLE ARE OKAY.
RECOVERY RESIDENCES ACTIVATE
SAMHSA'S FOUR PILLARS OF
RECOVERY HEALTH, HOME, PURPOSE,
AND COMMUNITY. USING PEER
SUPPORT TO CONNECT PEOPLE TO
COMMUNITY WHERE THEY DEVELOP
BROAD, ORGANIC SOCIAL NETWORKS
THAT STRENGTHEN AS PEOPLE MOVE
FORWARD IN THEIR GOALS. AB 2893
SEEKS TO DEFINE RECOVERY
RESIDENCE MODEL AS ABSTINENCE
BASED, NON ABSTINENCE BASED AND
HOUSING FIRST SO THAT THOSE
RECOVERY RESIDENCES FOLLOWING
HOUSING FIRST PROTOCOLS ARE
ELIGIBLE FOR REFERRALS AND
FUNDING THROUGH THE STATE'S
HOUSING AND HOMELESS SERVICES
CONTINUUM, THEREBY VASTLY
INCREASING OPTIONS FOR HOUSING
AND SERVICES AS CALIFORNIA'S
PEER WORKFORCE GROWS. AFTER THE
PASSAGE OF SB 803, RECOVERY
RESIDENCES ARE EFFECTIVE,
EFFICIENT, AND IMMEDIATE
SOLUTIONS IN LA COUNTY. THEY
HAVE ACCOUNTED FOR 10% OF
PLACEMENTS FOR PEOPLE WITH
MENTAL HEALTH ISSUES IN RECENT
YEARS, AT A FRACTION OF THE
COST. AS THE TOTAL BUDGET FOR LA
COUNTY PEER RUN RECOVERY
RESIDENCES IS UNDER 2 MILLION,
THEIR EVIDENCE BASED PRACTICES
YIELD OUTSTANDING OUTCOMES A 96%
HOUSING RETENTION RATE OVER FOUR
YEARS, 57% EMPLOYMENT RATE, 62%
OF RESIDENTS CONNECTED TO
NON-SUBSIDIZED HOUSING, AND 41%
OF PEOPLE MOVING IN WITHIN 24
HOURS. AB 2893 WILL CREATE A
STANDARD CERTIFICATION PROCESS
AND SCALE THESE RESOURCES FOR
PEOPLE EXPERIENCING MENTAL
HEALTH AND HOMELESSNESS. THANK
YOU, THANK YOU. GO AHEAD. YOU'LL
HAVE TWO MINUTES ONLY HERE TO
PROVIDE TECHNICAL SUPPORT. THANK
YOU. THANK YOU. ARE THERE ANY
OTHER WITNESSES IN SUPPORT?
RANDY HICKS OF CALIFORNIA
DISABILITY RIGHTS. I JUST GOT A
HOLD OF THIS BILL, JUST YOUR
NAME. OKAY. RANDY HICKS IN
CALIFORNIA IS A DISABILITY
RIGHTS. WE ARE NOT IN SUPPORT,
BUT WE ARE SUPPORT IF IT HAS AN
ACCESSIBILITY PIECE IN IT. THANK
YOU FOR THE ADA. OKAY. THANK YOU
. ANY OTHER WITNESSES IN SUPPORT
SEEING NONE. ANY PRIMARY
WITNESSES IN OPPOSITION. SEEING
NONE. ANY OTHER WITNESSES IN
OPPOSITION. I'LL BRING IT BACK
TO THE COMMITTEE FOR ANY
QUESTIONS OR COMMENTS. MR. WARD,
THANK YOU FOR BRINGING FORWARD
THIS BILL. I KNOW THAT YOU ARE
INCREDIBLY PASSIONATE AND A
LEADER IN ADDRESSING THE BROADER
ISSUE OF THE HOUSING CRISIS THAT
WE ALL ARE EXPERIENCING, AND I
KNOW THAT YOU'VE, KIND OF DIVED
INTO THIS AREA THAT IS, YOU
KNOW, CERTAINLY HEALTH RELATED
AND THAT THERE IS A LOT STILL TO
BE WORKED OUT, IN THIS
LEGISLATION, I'M THANKFUL THAT
YOU'LL CONTINUE TO WORK WITH OUR
COMMITTEE TO DO SO AS THIS BILL
MOVES FORWARD, SHOULD IT PASS
OUT OF COMMITTEE, WHICH I AM
RECOMMENDING. AND WITH THAT, YOU
MAY CLOSE. THANK YOU, MADAM
CHAIR. AT THE TIME, THAT IS
APPROPRIATE, WOULD RESPECTFULLY
REQUEST AN AYE VOTE. THANK YOU
SO MUCH, MR. WOOD. THANK YOU.
OKAY. WE ARE GOING TO MOVE ON TO
ITEM THREE, AB 2075. ALVAREZ.
ASSEMBLY MEMBER. ALVAREZ. GO
AHEAD WHEN YOU CAN. THANK YOU,
MADAM CHAIR AND ASSEMBLY MEMBERS
OF THE COMMITTEE. I APPRECIATE
THE OPPORTUNITY TO TALK ABOUT
ASSEMBLY BILL 2075. THE RESIDENT
ACCESS PROTECTION ACT. CHAIR,
I'D LIKE TO FIRST STATE THAT,
ACCEPTING THE COMMITTEE
AMENDMENTS. THANK YOU VERY MUCH
FOR THE WORK ON BEHALF OF YOUR
COMMITTEE STAFF ON THE BILL. AND
AGAIN, WE'RE ACCEPTING THE
AMENDMENTS, AS PRESENTED HERE,
ASSEMBLY BILL 2075 WOULD PROVIDE
PROVIDE RESIDENTS OF A LONG
TERME CARE FACILITY WITH THE
RIGHT TO IN-PERSON, ON SITE
ACCESS TO VISITORS DURING A
PUBLIC HEALTH EMERGENCY, AS LONG
AS THEY FOLLOW THE SAME SAFETY
PROTOCOLS THAT ARE OUTLINED BY
PUBLIC HEALTH OFFICIALS AND
REQUIRED BY STAFF. IF WE HAVE,
LEARNED MANY VALUABLE LESSONS
DURING THE PANDEMIC AND
CERTAINLY SINCE THE PANDEMIC,
PANDEMIC, NOT NOT LEAST OF WHICH
IS THAT HALTING VISITATION
RIGHTS FOR OUR LOVED ONES IN
LONG TUM CARE FACILITIES HAS A
MAJOR IMPACT ON THEIR MENTAL
HEALTH AND THEIR PHYSICAL
WELL-BEING. SO, FOR EXAMPLE, THE
JOURNAL OF AMERICAN MEDICAL
DIRECTORS ASSOCIATION ASSESSED
THE IMPACT OF THE PANDEMIC ON
THE WELL-BEING OF NURSING HOME
RESIDENTS IN 2020 AND FOUND THAT
LONG STAY RESIDENTS HAD A 15%
INCREASE IN DEPRESSIVE SYMPTOMS
AND A 150% INCREASE IN
UNPLANNED, SUBSTANTIAL WEIGHT
LOSS. RECOGNIZING THIS, A FORMER
COLLEAGUE OF OURS INTRODUCED
ASSEMBLY BILL 2005 46 AND AB
2546 WOULD HAVE SIMILARLY
ESTABLISHED VISITATION RIGHTS IN
LONG TUM CARE FACILITIES DURING
A PUBLIC HEALTH EMERGENCY, AS
THIS BILL ATTEMPTS TO DO. BUT
THROUGHOUT THAT LEGISLATIVE
PROCESS, THE BILL WAS AMENDED TO
CREATE A WORKING GROUP TO
DEVELOP RECOMMENDATIONS
REGARDING THE BEST VISITATION
POLICIES AND PRACTICES FOR LONG
TUM CARE FACILITIES DURING THE
PUBLIC HEALTH EMERGENCY. IT IS
BASED ON THAT WORKING GROUP,
WHICH MET FIVE TIMES OVER THE
COURSE OF SIX MONTHS, WHICH
INCLUDED PARTICIPANTS FROM
ADVOCACY GROUPS, STATE AGENCIES,
FACILITIES THEMSELVES, PUBLIC
HEALTH OFFICIALS AND MEDICAL
GROUPS. THAT WE COME BEFORE YOU
WITH THIS BILL. IN ITS PUBLISHED
REPORT OF OCTOBER OF LAST YEAR,
THE WORKING GROUP WAS CLEAR AND
ITS TAKEAWAY STATED, QUOTE, IT
IS ESSENTIAL FOR FAMILY AND
FRIENDS TO HAVE ACCESS TO
RESIDENTS, INCLUDING DURING A
STATE OF EMERGENCY. AB 2075 IS A
RARE OPPORTUNITY TO PASS
LEGISLATION THAT HAS UNDERGONE A
PROCESS THAT I THINK WE ALL
VALUE, WHICH IS TO BE THOROUGH
AND THOUGHTFUL AND ENGAGE
STAKEHOLDERS BEFORE COMING
BEFORE YOU WITH LEGISLATIVE
PROPOSALS, THE LEGISLATURE
RECOGNIZED THE PROBLEM AND
ESTABLISHED A WORKING GROUP WITH
STAKEHOLDERS, AND NUMEROUS
PERSPECTIVES WERE PART OF THAT
DISCUSSION TO UNDERSTAND AND
ULTIMATELY PRODUCE THE
RECOMMENDATIONS THAT WE HAVE IN
THIS BILL ON HOW TO SOLVE A
PROBLEM AS IT RELATES TO SOME OF
THE CONCERNS, I'M SYMPATHETIC TO
THE VIEW THAT WE NEED TO FIND A
BALANCE BETWEEN PUBLIC SAFETY
AND ENSURING THAT VISITATION
RIGHTS ARE FOR RESIDENTS ARE NOT
IMPEDED. AGAIN, TO THAT END, WE
HAVE INCLUDED PROVISIONS TO
ENSURE FLEXIBILITY FOR STATE AND
LOCAL AUTHORITIES WHEN HANDLING
PUBLIC HEALTH EMERGENCIES BY
AUTHORIZING THEM TO DEFINE HOW
VISITORS CAN DEMONSTRATE THAT
THEY ARE PROFICIENT ENOUGH IN IN
FOLLOWING SAFETY PROTOCOLS, AND
TO CAP THE AMOUNT OF VISITORS
THAT CAN ASCENSION THAT CAN
VISIT SIMULTANEOUSLY AT A
FACILITY. SIMILARLY, WE ADDED
LANGUAGE THAT ENSURES FACILITIES
ONLY PROVIDE PERSONAL PROTECTIVE
EQUIPMENT IF IT HAS BEEN
PROVIDED TO THEM FOR THE PURPOSE
OF VISITORS. WE ALSO CLARIFIED
THAT PERSONAL PROTECTIVE
EQUIPMENT IS PRIORITIZED FOR
STAFF. FINALLY, THROUGH THE
COMMITTEE'S AMENDMENTS, WE ARE
ALSO ADDING LANGUAGE TO CLARIFY
THAT IN A CASE OF A PUBLIC
HEALTH EMERGENCY THAT REQUIRES
AN EVACUATION, VISITATION RIGHTS
CAN BE HALTED UNTIL THE
EVACUATION HAS BEEN COMPLETED.
STILL, I'M FULLY COMMITTED TO
CONTINUING TO WORK ON THIS
LANGUAGE TO ENSURE WE ARE
STRIKING THE RIGHT BALANCE
BETWEEN THE PUBLIC HEALTH,
SAFETY AND THE VISITATION
RIGHTS, AND I WELCOME OTHER
SUGGESTIONS TO THAT EFFECT. AB
2075 IS ESSENTIAL TO ENSURE THAT
THOSE OF US THAT HAVE LOST LOVED
ONES IN LONG TUM CARE FACILITIES
DON'T EVER HAVE TO GO THROUGH
WHAT THEY WENT THROUGH DURING
THE PANDEMIC. AND WITH THAT, I'D
LIKE TO INTRODUCE, TONY,
CHICOTEL FROM THE CALIFORNIA
ADVOCATES FOR NURSING HOME
REFORM TO BE OUR FIRST WITNESS.
THANK YOU. YOU'LL HAVE TWO
MINUTES. GOOD AFTERNOON. THANKS
FOR THE OPPORTUNITY TO TESTIFY
ON BEHALF OF AB 2075. TWO YEARS
AGO, I WAS HERE TESTIFYING A
VERY SIMILAR BILL TO AB 2546. IT
WAS TURNED INTO A STAKEHOLDER
WORK GROUP AND A LOT OF RESIDENT
ADVOCATES AND I WERE REALLY
HEARTENED BY THE CONVERSATIONS
THAT WE HAD. THE DEPARTMENT OF
AGING DID A REALLY WONDERFUL JOB
FACILITATING THE DISCUSSION,
FINDING SHARED VALUES AMONG VERY
DIFFERENT PERSPECTIVES AND
PRODUCING RECOMMENDATIONS THAT
BALANCE BALANCE, RESIDENT ACCESS
TO THE PEOPLE WHO LOVE THEM,
WITH THE NEED TO ENSURE THAT
ACCESS DOES NOT ENDANGER THEM.
THE WORKGROUP'S RECOMMENDATIONS
ARE THE ROADMAP FOR AB 2075.
RESIDENTS ARE GUARANTEED ACCESS
TO THE PEOPLE WHO CARE FOR THEM
BEST, WHILE GIVING STATE AND
LOCAL PUBLIC HEALTH OFFICIALS
THE ABILITY TO IMPOSE ANY SAFETY
MEASURES THEY FEEL ARE NECESSARY
TO ENSURE RESIDENT SAFETY, SO
LONG AS THEY ARE NO MORE
STRINGENT THAN WHAT IS REQUIRED
OF FACILITY STAFF. LAST MONTH,
MY FATHER IN LAW DIED IN A
NURSING HOME, A REALLY GOOD ONE
IN OAKLAND CALLED SAINT PAUL'S
TOWERS. IT WAS SAD, OF COURSE,
BUT I WAS TREMENDOUSLY GRATEFUL
THAT ON THE MORNING OF THE DAY
THAT HE DIED, I WAS ABLE TO
SPEND SOME TIME WITH HIM ALONE
AND SIT WITH HIM AND TELL HIM
HOW MUCH I LOVED HIM AND HOW
MUCH HE MEANT TO ME AND THE REST
OF OUR FAMILY. IT DIDN'T DAWN
ON, DIDN'T DAWN ON ME UNTIL LAST
NIGHT AS I WAS THINKING ABOUT
BEING HERE TODAY, THAT HAD THIS
HAPPENED 3 OR 4 YEARS AGO, I
WOULDN'T HAVE BEEN ABLE TO SPEND
THAT TIME WITH HIM. SAYING
GOODBYE IS OFTEN A LIFE'S
ULTIMATE BLESSING, AND IT WAS
DENIED TO TENS OF THOUSANDS OF
CALIFORNIA NURSING HOME
RESIDENTS DURING COVID WHO DIED
WHILE THEIR LOVED ONES WERE
LOCKED OUT. WITH SO MANY
IMPORTANT THINGS LEFT UNSAID AND
UNHEARD, AB 2075 SAYS, LET'S
NEVER DO THAT AGAIN. THANK YOU,
THANK YOU AND I'LL REMIND
EVERYONE THAT WE HAVE A WITNESS
THAT WILL BE PARTICIPATING.
TELEPHONICALLY, WHO'S RECEIVED
AN ADA ACCOMMODATION FROM THE
RULES COMMITTEE
.
MADAM CHAIR, INTRODUCE HER.
HOPEFULLY SHE COMES ON THE LINE.
IT'S NANCY STEVENS, A NURSING
HOME RESIDENT WHO WAS PERSONALLY
IMPACTED BY THE CURTAILING OF
THE VISITATION RIGHTS DURING THE
PANDEMIC. HOPEFULLY, NANCY IS ON
THE LINE
.
MISS STEVENS, IF YOU CAN HEAR US
, YOU CAN START YOUR TESTIMONY
WHENEVER YOU'RE ABLE
.
UNFORTUNATELY, I DON'T THINK
WE'RE ABLE TO ESTABLISH A SOLID
CONNECTION TO MISS STEVENS. WE.
WE ARE ON THE PHONE WITH HER,
BUT I DON'T THINK SHE'S ABLE TO
RESPOND AT THIS POINT. SO, I
DON'T BELIEVE THAT'S GOING TO
CHANGE. WE'LL MOVE ON AND SHOULD
SHE BE CONNECTED WITH WILL ALLOW
HER TO OFFER TESTIMONY? ARE
THERE ANY OTHER WITNESSES IN
SUPPORT THAT? CHAIR MEMBERS
CATHY MOSSBERG WITH LEADING AGE
CALIFORNIA IN SUPPORT. I AM
SORRY FOR THE INTERRUPTION. MY
NAME IS NANCY STEVENS, AND I'M
SORRY FOR THE, MISCUE, BUT I'LL
JUST BE GIVING MY NAME. MY
ORGANIZATION'S, AND, MY POSITION
. I THINK YOU YOU ARE ONE OF THE
TWO PRIMARY WITNESSES. MY NAME
IS NANCY STEVENS. GO AHEAD.
PLEASE GO. YOU DON'T. YOU CAN
OFFER A TWO MINUTE TESTIMONY.
YES. MY NAME IS NANCY STEVENS.
I'M SO SORRY FOR THE
MISCOMMUNICATION AND
INTERRUPTION. I'LL JUST BE
GIVING MY NAME. OKAY. THANK YOU
SO MUCH, WE WILL MOVE TO ANY
OTHER PEOPLE WHO WANT TO,
WITNESSES AND SUPPORT. PLEASE
PETERHANSEL, ADVOCACY VOLUNTEER
FOR AARP CALIFORNIA AARP IS IN
SUPPORT OF THE BILL. EDEN
ROSALES, REPRESENTING OFFICE OF
THE STATE LONG-TUM CARE
OMBUDSMAN. PROUD CO-SPONSORS OF
THIS BILL IN SUPPORT. SELENA
KOBE HORNBACK WITH THE
CALIFORNIA ASSISTED LIVING
ASSOCIATION AND SUPPORT ANY
PRIMARY WITNESSES IN OPPOSITION.
PLEASE COME FORWARD. YOU'LL HAVE
EACH TWO MINUTES.
PLEASE BEGIN. THANK YOU. CHAIR,
AND GOOD AFTERNOON. MY NAME IS
DOCTOR CAMERON KAISER. I'M THE
DEPUTY PUBLIC HEALTH OFFICER FOR
THE COUNTY OF SOLANO HERE ON
BEHALF OF THE HEALTH OFFICERS
ASSOCIATION OF CALIFORNIA, WE
FIRST WANT TO EXPRESS, THANKS TO
ASSEMBLY MEMBER ALVAREZ FOR
BRINGING AB 2075 FORWARD. AND WE
STAND IN FULL AGREEMENT THAT
MAINTAINING VISITATION AND
SOCIAL CONNECTIONS FOR OUR MOST
VULNERABLE IS EXTREMELY
IMPORTANT. HOWEVER, ALTHOUGH WE
ALSO APPRECIATE THE CHANGES MADE
IN RESPONSE TO OUR CONCERNS, HØI
POSITION REMAINS OPPOSED UNLESS
AMENDED, IN PARTICULAR TO THE
PROPOSED FINAL SENTENCE OF
SECTION 1439.73. THIS CHAPTER
MAY NOT BE OTHERWISE SUSPENDED,
SUPERSEDED, OR MODIFIED. SUCH
LANGUAGE, OF COURSE, OFTEN HAS
UNINTENDED CONSEQUENCES. DURING
AN EMERGENCY. IT IS IMPOSSIBLE
TO PREDICT WHAT STEPS MAY BE
NECESSARY TO TAKE, AND WE NEVER
TAKE LIGHTLY ANY STEP THAT
IMPAIRS PUBLIC ACTIVITY LIGHTLY.
ALTHOUGH THE BILL SAYS THAT
VISITORS AND RESIDENTS MAY NOT
BE HELD TO STANDARDS GREATER
THAN THAT OF STAFF, THEY ALSO
FAILS TO RECOGNIZE THAT STAFF
MAY BE TRAINED IN THE USE OF
PERSONAL PROTECTIVE EQUIPMENT
AND ARE REGULATED BY STATE
AGENCIES IN A WAY THAT THE
PUBLIC GENERALLY IS NOT.
MOREOVER, THE CLAUSE ISN'T EVEN
NECESSARY FOR THIS BILL TO
ACHIEVE ITS AIMS. HEALTH OFFICER
ORDERS ARE ALWAYS SUBJECT TO
JUDICIAL REVIEW, AND BY
CODIFYING IN STATUTE THE
IMPORTANCE OF VISITATION AND
PERSONAL INTERACTION. WITHOUT
THAT LANGUAGE, THE BILL CAN
STILL EFFECTIVELY EXPRESS THAT
THEY SHOULD BE CONSIDERED AND
PROPERLY WEIGHED AGAINST PUBLIC
AND PERSONAL RISK, AS WOULD BE
APPROPRIATE DURING A PUBLIC
HEALTH CRISIS. AS A PUBLIC
HEALTH PROFESSIONAL. HELLO? CAN
ANYBODY HEAR ME? I'M UNMUTED ON
MY END. DO YOU WANT ME TO
CONTINUE? CHAIR, PLEASE GO
AHEAD. I'M UNMUTED ON MY END.
YOU ARE NOT MUTED ON, ON YOUR
ENDS, MISS STEVENS. WE CAN HEAR
YOU. ARE YOU INTENDING TO OFFER
TESTIMONY FOR TWO MINUTES? WE
ARE IN THE MIDDLE OF OPPOSITION
TESTIMONY. WE'RE GOING TO
PROCEED WITH THAT. APOLOGIES FOR
THE INTERRUPTION. QUITE ALL
RIGHT, MADAM CHAIR, AS A PUBLIC
HEALTH PROFESSIONAL AND ALSO AS
ONE OF THE MILLIONS OF AMERICANS
WHO HAVE LOST FAMILY MEMBERS TO
COVID 19, INCLUDING MY OWN
FATHER WHO DIED DURING THE DELTA
WAVE, I DO ASK THAT THE TOOLS
WHICH WE'VE ALWAYS RESPONSIBLY
USED TO PROTECT THE PUBLIC BE
KEPT INTACT. WE DON'T KNOW WHAT
THE NEXT PANDEMIC WILL
POTENTIALLY BRING, AND THE BILL,
AS WRITTEN, WILL IMPAIR OUR
ABILITY TO RESPOND. I APPRECIATE
THE COMMITTEE'S CONSIDERATION.
THANK YOU. GO AHEAD, MADAM CHAIR
AND MEMBERS. BETSY ARMSTRONG
WITH THE COUNTY HEALTH
EXECUTIVES ASSOCIATION,
REGRETFULLY HERE IN OPPOSE
UNLESS AMENDED POSITION. THE
COVID 19 PANDEMIC WAS
UNPRECEDENTED AND UNPRECEDENTED
ACTIONS WERE TAKEN WITH THE
HEALTH AND SAFETY OF
CALIFORNIANS FRONT OF MIND.
PUBLIC HEALTH OFFICIALS WORKED
TIRELESSLY TO UNDERSTAND THE
VIRUS AND PROTECT OUR
COMMUNITIES UNDER CONSTANTLY
CHANGING CONDITIONS. PUBLIC
HEALTH OFFICIALS HAVE BEEN
SCRUTINIZED, HARASSED AND EVEN
THREATENED FOR IMPLEMENTING
PUBLIC HEALTH MEASURES THAT WE
KNOW SAVED LIVES. LOCAL HEALTH
DEPARTMENTS GAINED PRAGMATIC AND
ACTIONABLE EXPERIENCE DURING THE
PANDEMIC, AND HAVE ALREADY BEGUN
IMPLEMENTING LESSONS LEARNED.
LOCAL HEALTH DEPARTMENTS HAVE
IMPROVED LINES OF COMMUNICATION
AND HAVE HIRED INFECTION
PREVENTIONISTS TO WORK WITH
THESE FACILITIES TO KEEP
RESIDENTS HEALTHY AND MINIMIZE
THE SPREAD OF DISEASE. WE
ABSOLUTELY ACKNOWLEDGE THE VALUE
AND IMPORTANCE OF FAMILY AND
VISITORS TO RESIDENTS IN THESE
FACILITIES. HOWEVER WE MUST ALSO
BE MINDFUL OF POTENTIAL PUBLIC
HEALTH THREATS THAT COULD
POTENTIALLY ENDANGER RESIDENTS,
FACILITY STAFF AND OUR
COMMUNITIES. WHILE WE APPRECIATE
THE ENGAGEMENT WITH THE AUTHOR'S
OFFICE AND THE PROPONENTS OF
THIS BILL, UNFORTUNATELY WE ARE
UNABLE TO AGREE TO AMENDMENTS
THAT DO NOT ALIGN VISITATION IN
A PUBLIC HEALTH EMERGENCY WITH
PUBLIC HEALTH GUIDANCE AND
MEASURES. PUBLIC HEALTH GUIDANCE
IS TAILORED TO THE THREAT IT
CONSIDERS WHO IS MOST
VULNERABLE, THE PERSONAL
PROTECTIVE EQUIPMENT, HOSPITAL
BEDS AND OTHER RESOURCE
AVAILABILITY, INCLUDING WHETHER
THERE'S A VACCINE TO PREVENT THE
SPREAD OR MEDICATION TO MINIMIZE
THE EFFECTS OF THE VIRUS, AND
EVOLVES AS THE SCIENCE EVOLVES.
THIS IS WHY WE FIND IT
CHALLENGING TO FIND AN AMENDMENT
THAT WILL ALWAYS SAFELY ALLOW
VISITATION DURING PUBLIC HEALTH
EMERGENCIES. AND LET ME
EMPHASIZE, WE DO NOT WANT TO
ELIMINATE LIMIT VISITATION AS
OUR FIRST, SECOND, OR THIRD
CHOICE, AB 2075, WOULD LEAVE
PUBLIC HEALTH WITH LESS TOOLS TO
PROTECT LONG TUM CARE FACILITIES
AND OUR COMMUNITIES AT LARGE.
WHEN THE NEXT PUBLIC HEALTH
THREAT COMES. IT'S NOT A MATTER
OF IF. IT'S A MATTER OF WHEN,
IT'S FOR THESE REASONS, WE
REMAIN OPPOSED, UNLESS AMENDED,
TO ENSURE VISITATION IS DONE IN
ACCORDANCE WITH PUBLIC HEALTH
ORDERS AND GUIDANCE. THANK YOU,
THANK YOU. ANY OTHER WITNESSES
IN OPPOSITION, PLEASE COME
FORWARD. SEEING NONE, WE'LL
BRING IT BACK TO COMMITTEE FOR
QUESTIONS AND COMMENTS. DOCTOR
WEBER. GOOD AFTERNOON. THANK YOU
SO MUCH FOR BRINGING THIS BILL
FORWARD AND ALLOWING FOR US TO
HAVE A CONVERSATION AROUND IT,
IT IS MY UNDERSTANDING THAT,
PRIOR TO THE PANDEMIC, THERE WAS
NO STOPPING OF VISITATION, IS
THAT CORRECT THAT THIS IS THE
FIRST TIME THAT SOMETHING LIKE
THIS HAS HAPPENED? YEAH. GO
AHEAD. YEAH. IT'S IT WAS VERY,
VERY RARE. THERE WERE SOME
ISOLATED INCIDENTS WHERE A
NOROVIRUS WOULD BREAK OUT IN A
LONG TUM CARE FACILITY, AND THE
LOCAL PUBLIC HEALTH OFFICERS
WOULD SHUT DOWN ACCESS FOR DAYS
OR MAYBE A WEEK OR SO. BUT VERY
RARE. LESS THAN ONCE A YEAR.
YEAH. AND I THINK THAT THIS WAS
DONE AROUND COVID BECAUSE IT WAS
THE UNKNOWN. AND WE INITIALLY
HAD NO IDEA OF HOW IT WAS
TRANSMITTED, WHO COULD GET IT.
WE HAD NO VACCINE, AND SO THERE
WAS A NEED TO NOT ONLY PROTECT
THE RESIDENTS, BUT ALSO THE
WORKERS AS WELL, AND SO I YES,
I'M SORRY. PLEASE GO AHEAD.
DOCTOR WEBER. WITH THIS BILL,
PRETTY MUCH KIND OF ELIMINATING
THE ABILITY FOR THESE FACILITIES
TO HAVE AUTONOMY BASED ON WHAT'S
GOING. OH, MY GOODNESS, THE, THE
CHALLENGE IS THAT ONCE THE
SPEAKER IS KIND OF ON, WE CANNOT
, TAKE THEM OFF UNTIL THIS ITEM
IS NO LONGER ON THE AGENDA. SO
APOLOGIES FOR THE INTERMITTENT
INTERRUPTIONS. WE'LL JUST WORK
THROUGH IT. THANK YOU. THAT'S
ALL RIGHT. SO CAN WE REALLY
BELIEVE THAT VISITATION CAN
ALWAYS BE DONE SAFELY UNDER THE
THREAT OF A PUBLIC HEALTH THREAT
? SO THE THAT THAT IS THE INTENT
. AND THAT'S WHY THE LEGISLATION
IS WRITTEN WITH STATING THAT
VISITORS MUST, MEET ALL OF THE
REQUIREMENTS THAT ARE PLACED ON
STAFF THAT WORK AT THESE
FACILITIES. SO THAT THEY TAKE
THE PRECAUTIONS THAT ARE
REQUIRED AND FOLLOW THE
PROTOCOLS AS SET FORWARD BY
PUBLIC HEALTH OFFICIALS. SO
THAT'S DEFINITELY WHAT THE
INTENT IS. RIGHT. AND I THINK
ONE OF THE THINGS THAT THE
OPPOSITION JUST STATED IS THAT
OFTENTIMES AND WHAT WE SAW WAS
THAT THOSE WITHIN THE HEALTH
CARE SPACE HAD TO LEARN CERTAIN
TECHNIQUES AND MAKE SURE THEY
KNEW HOW TO MASK AND GLOVE AND
GOWN. ACCORDING THAT, SOMEONE
WHO'S NOT WITHIN THE HEALTH CARE
SPACE WOULD NOT NECESSARILY
KNOW. SO MY QUESTION STILL
REMAINS DO WE BELIEVE THAT,
VISITATION CAN ALWAYS BE DONE
SAFELY UNDER ANY PUBLIC THREAT?
WELL I WOULD SAY THAT THAT'S
THAT'S DEFINITELY AN OPINION. DO
WE BELIEVE I, I BELIEVE THAT IT
CAN IF WE TAKE THE GUIDANCE THAT
IS GIVEN BY THE PUBLIC HEALTH
OFFICIALS AND THAT GETS APPLIED,
IF THAT GUIDANCE IS NOT APPLIED,
THEN THEN THAT THAT WOULD NOT BE
THE CASE. BUT I THINK SO. OKAY.
I WOULD PROBABLY DISAGREE FROM A
HEALTH CARE STANDPOINT, BUT,
ALONG THOSE LINES OF GUIDANCE
AND ENSURING THAT PEOPLE ARE
FOLLOWING THE GUIDANCE, WE HAVE
THIS CONTINUED DISCUSSION IN
THIS COMMITTEE AND IN OTHER
COMMITTEES DEALING WITH
WORKFORCE SHORTAGES, ESPECIALLY
WITHIN LIKE THE HEALTH CARE
SPACE FOR THIS COMMITTEE, AND SO
WHAT IF THE STAFF AT THAT
FACILITY IS STRETCHED TO THE
POINT WHERE THEY DON'T FEEL LIKE
THEY COULD SAFELY MONITOR TO
ENSURE THE SAFETY OF NOT ONLY
THE VISITORS, BUT THE RESIDENTS
AND THEMSELVES? YEAH, I, I THINK
THIS IS YOU'RE BRINGING UP THE
POINT THAT I THINK PERHAPS THE
PUBLIC HEALTH OFFICIALS HAVE,
WHICH MAYBE WE DON'T HAVE THE
SOLUTION ON HOW TO ADDRESS THAT
BALANCE, AND I'LL BE THE FIRST
ONE TO ACKNOWLEDGE THAT. I THINK
THIS IS A, OPPORTUNITY FOR US TO
WEIGH IN ON HOW MUCH WE THINK
IT'S IMPORTANT TO ALLOW
VISITATION VERSUS RESTRICTED
AND, JUST BEING I THINK EVEN THE
OPPOSITION SAID IT. WE HAVE NOT
FOUND THE LANGUAGE THAT STRIKES
THAT BALANCE ENTIRELY. AND I
DON'T KNOW, WE'LL CONTINUE TO
TRY TO FIND THAT LANGUAGE. WE
HAVE NOT COME UP WITH THAT
LANGUAGE TODAY. OKAY. WELL,
AGAIN, I DO APPRECIATE YOU
BRINGING THE BILL FORWARD. AND
IF THE BILL MOVES OUT OF THE
COMMITTEE, I LOOK FORWARD TO
SEEING WHAT THE FINAL LANGUAGE
WOULD BE, KEEPING IN MIND ALL OF
THE DIFFERENT NUANCES, THE
THINGS THAT, YOU KNOW, THE
OPPOSITION HAS STATED SOME OF
THE QUESTIONS THAT I HAVE SAID
AND ALSO KEEP IN MIND THE
WORKERS THEMSELVES, BECAUSE
CAUSE I REMEMBER DURING THE
PANDEMIC, HEALTH CARE WORKERS
WERE OFTENTIMES CONCERNED ABOUT
GOING INTO FACILITIES, BUT AT
LEAST THEY HAD THE REASSURANCE
THAT THOSE WHO LIVED THERE WERE
NOT NECESSARILY AS EXPOSED
BECAUSE YOU DIDN'T HAVE A BUNCH
OF PEOPLE COMING IN AND OUT FROM
WHOEVER BEING EXPOSED TO
WHATEVER. SO YOU ALSO HAVE TO
KEEP IN MIND THE PEOPLE THAT
WORK THERE, BECAUSE YOU NEED
THOSE DOORS TO STAY OPEN AND YOU
DON'T WANT THE WORKERS TO NOT GO
TO WORK BECAUSE THEY'RE
CONCERNED ABOUT THEIR OWN
SAFETY. SO THANK YOU SO MUCH
AGAIN FOR BRINGING THIS FORWARD.
AND I LOOK FORWARD TO SEEING
WHAT THE FINAL THANK YOU. AND I
DON'T KNOW THAT THIS ADDRESSES
THOSE CONCERNS THAT YOU RAISED,
BUT, THIS WAS A CONCERN FROM
ANOTHER COMMITTEE MEMBER WHO'S
NOT HERE TODAY ABOUT,
QUARANTINE. AND IN THE EARLY
STAGES WHEN WE DIDN'T KNOW WHAT
THE RIGHT PROTOCOLS WERE, THERE
WAS QUARANTINE IN EFFECT. AND
THIS THIS BILL WOULD NOT
SUPERSEDE THAT. IF THAT WAS A
REQUIREMENT, THEN YOU WOULD NOT
BE ALLOWED TO HAVE ACCESS IF
THERE WAS A QUARANTINE ORDER.
AND SO I WOULD ASSUME THAT
DURING A PROCESS OF TRYING TO
FIGURE OUT WHAT THE RIGHT
PROCEDURES AND PROTOCOLS WOULD
BE IF IT WAS THAT, SUBSTANTIAL
OF A OF A HEALTH CONCERN, THERE
WOULD BE A QUARANTINE, ORDER IN
PLACE WHILE THAT GETS FIGURED
OUT. AND THEN WHILE THAT GETS
FIGURED OUT, THEN THE PROTOCOLS
AND PROCEDURES WOULD BE PUT OUT
AND, AND THEY'D HAVE TO FOLLOW
ALL OF THOSE PROTOCOLS AND
PROCEDURES. AGAIN, I DON'T KNOW
THAT THAT ACTUALLY ANSWERS YOUR
CONCERN, BUT I THINK THAT DOES
GIVE US AN OPPORTUNITY TO FIGURE
OUT WHAT THE RIGHT, APPROACH
WOULD BE IN ORDER TO ALLOW
VISITATION THAT IS SAFE, TAKING
INTO CONSIDERATION YOUR OTHER
CONCERN, WHICH I THINK WE NEED
TO, WHICH IS, HOW STRETCHED THIN
THOSE WHO ARE HEALTH CARE
PROVIDERS AND STAFF, ARE DURING
SOME OF THESE VERY UNIQUE
CIRCUMSTANCES, LIKE WE FACED IN
COVID. THANK YOU.
ASSEMBLYMEMBERS CHAU. I WANT TO
THANK THE AUTHOR FOR BRINGING
THIS BILL FORWARD. I KNOW, I'M
GUESSING THE TESTIMONY THAT
DIDN'T HAPPEN WAS GOING TO BE
INCREDIBLY COMPELLING. AND, AND
I, I UNDERSTAND WHERE YOU'RE
COMING FROM AND COMPLETELY
RESPECT IT, AND I KNOW WE
HAVEN'T REALLY GOT TO TALK ABOUT
THIS BILL. I'M GOING TO BE
SUPPORTING IT TODAY, BUT
RESERVE, TO SEE HOW THE
CONVERSATIONS GO AROUND THIS
WHEN IT COMES TO THE FLOOR. I
THINK THAT, YOU'RE TRYING I KNOW
THAT YOU'RE TRYING TO STRIKE A
REALLY IMPORTANT BALANCE, RIGHT?
THAT BEING ABLE TO HAVE ACCESS
TO FAMILY AND LOVED ONES IS
CRITICAL FOR PEOPLE'S HEALTH,
ACTUALLY. AND WE NEED TO
RECOGNIZE THAT. BUT, AS SOMEONE
WHO I SEE A LOT OF NURSES IN THE
ROOM AND I WAS WORKING AT CNA
WHILE WE WERE IN THE MIDDLE OF
THE PANDEMIC, AND IT WAS
TERRIFYING, RIGHT? AND IT WAS
TERRIFYING FOR NURSES, AND WE'VE
SEEN THAT, YOU KNOW, PEOPLE WEAR
MASKS OR THEY DON'T, OR THEY
PULL IT DOWN OVER THEIR NOSE AND
IT REALLY DOESN'T WORK. RIGHT.
AND SO, SO IT'S HARD TO HAVE
THAT KIND OF 100, TRUST THAT
THAT WOULD BE, WOULD BE ABLE TO
BE EXECUTED IN A SAFE WAY, IF
THEY HAVE THE STAFF TO MAKE SURE
THAT IT'S EXECUTED IN THE SAFE
WAY. AND AT THE END OF THE DAY,
YOU'RE TRYING TO PROTECT PUBLIC
HEALTH, RIGHT? AND THE HEALTH OF
THE PATIENTS. AND SO, SO I LOOK
FORWARD TO, YOU KNOW, CONTINUED
CONVERSATIONS. I'M CONFIDENT I
HAVE SO MUCH RESPECT FOR THE
AUTHOR AND KNOW THAT YOU WILL
WORK TO FIND THE RIGHT BALANCE
IN THIS BILL, AND SO WE'LL, YOU
KNOW, BE SUPPORTING IT TODAY ON
THAT, ON THAT ASSUMPTION. THANK
YOU, WELL, I KNOW MR. ALVAREZ,
THAT THIS ISSUE IS A DEEPLY
PERSONAL TO YOU AND I APPRECIATE
YOUR PASSION FOR THIS ISSUE AND
TRYING TO AS ASSEMBLY MEMBER
SHIAVO SAID, STRIKE THAT RIGHT
BALANCE. I KNOW THAT YOU'LL
CONTINUE TO WORK ON THIS BILL
SHOULD IT MOVE FORWARD. AND WE
LOOK FORWARD TO SUPPORTING IT,
WITH AN I VOTE RECOMMENDATION.
THÀNH TODAY, ONCE WE HAVE A
QUORUM, PLEASE GO AHEAD AND
OFFER A CLOSE. I JUST THANK YOU.
THANK YOU FOR THE THOUGHTFUL,
FEEDBACK. WE'VE GOT SOME WORK
AHEAD AND OBVIOUSLY COMMIT TO
DOING THAT. AND APPRECIATE AGAIN
THE COMMITTEE'S WORK AND,
APPRECIATE THE RECOMMENDATION
WITH THE AMENDMENTS. THANK YOU.
THANK YOU. NEXT, WE WILL BE
MOVING TO FILE ITEM NUMBER 12,
AB 2467 BAUER-KAHAN. ZERO.
GOOD AFTERNOON, MADAM CHAIR AND
COMMITTEE. AND THANK YOU SO MUCH
FOR ACCOMMODATING MY RELIGIOUS
NEEDS TODAY. I DO REALLY
APPRECIATE THE COMMITTEE FOR
THAT, TODAY I'M PROUD TO PRESENT
AB 2467, A BILL THAT CREATES
MANDATED HEALTH CARE COVERAGE
FOR THOSE EXPERIENCING
PERIMENOPAUSE AND MENOPAUSE
RELATED SYMPTOMS. THE BILL WAS
CREATED IN PART DUE TO
CONVERSATIONS WE HAD DURING THE
SELECT COMMITTEE ON REPRODUCTIVE
HEALTH, WHERE WE FOCUSED ON
MENOPAUSAL CARE. IN THE
INFORMATIONAL HEARING, WE TALKED
ABOUT THE LACK OF KNOWLEDGE AND
RESEARCH SURROUNDING MENOPAUSE
AND ITS APPROPRIATE TREATMENTS
FOR ALL THE WOMEN IN THE ROOM
AND WATCHING WHO, LIKE ME, HAVE
TALKED TO COUNTLESS DOCTORS AND
BEEN GIVEN LITTLE TO NO
INFORMATION ON HOW TO HANDLE
PERIMENOPAUSE. WE KNOW THAT THIS
IS A LITTLE UNDERSTOOD, A LITTLE
STUDIED, LITTLE RESEARCH, AND
LITTLE CARED FOR PART OF OUR
JOURNEY AS WOMEN. AND A STUDY BY
BONAFIDE ON THE STATE OF
MENOPAUSE. ONLY ONE THIRD OF
WOMEN BETWEEN THE AGES OF 40 AND
64 SAY THEIR HEALTH CARE
PROVIDERS, EVER TALKED TO THEM
ABOUT WHAT TO EXPECT WHILE GOING
THROUGH MENOPAUSE IN COMPARISON,
ISSUES AFFECTING MEN OF THE SAME
AGE, SUCH AS ERECTILE
DYSFUNCTION, ARE WIDELY
CONSIDERED MEDICALLY NECESSARY
AND THEREFORE COVERED BY
INSURANCE. DOCTORS ARE WORKING
HASTILY TO MAKE SURE THAT WE ARE
CARED FOR, AND WE'RE OFTEN NOT
GETTING THE CARE WE NEED. AS ONE
OF THE LEADING STATES IN THE
NATION FOR HEALTH CARE, WE ARE
LETTING HALF OF OUR CONSTITUENCY
DOWN AS THEY GO THROUGH THIS
LIFE TRANSITION. FURTHERMORE
RACE AND ETHNICITY PLAY ANOTHER
ROLE IN THE RANGE AND SEVERITY
OF SYMPTOMS THAT PEOPLE FACE.
RESEARCH SHOWS THAT WHITE WOMEN
EXPERIENCE HOT FLASHES FOR AN
AVERAGE OF SIX AND A HALF YEARS,
WHILE BLACK WOMEN AN AVERAGE OF
TEN YEARS. WOMEN REACH THE PEAK
OF THEIR CAREER WHILE
SIMULTANEOUSLY COMBATING
MENOPAUSE. IT IS ESTIMATED THAT
THERE'S A LOSS OF $1.8 BILLION
OF PRODUCTIVITY IN THE WORKPLACE
DURING THIS TIME PERIOD. THERE
ARE PROVEN TREATMENT OPTIONS OUT
THERE, AND WOMEN SIMPLY DO NOT
KNOW THEY EXIST OR THEY ARE NOT
FULLY COVERED BY OUR HEALTH CARE
PROVIDERS. WE NEED TO BREAK DOWN
THIS STIGMA AND BRING MENOPAUSE
TO THE FOREFRONT BY ENSURING
FULL EQUITY IN THE HEALTH CARE
SPACE. WITH ME TODAY TO TESTIFY
IN SUPPORT OF THIS BILL IS
DOCTOR WESTON, WHO TRAINS IN THE
FIELD OF HUMAN SEXUALITY AND
LARA SON, WHO WILL SPEAK TO HER
OWN EXPERIENCE IN THIS SPACE.
YOU'LL EACH HAVE TWO MINUTES. GO
AHEAD. THANK YOU FOR HAVING ME.
I'M GOING TO SPEAK THROUGH TWO
UNDERNEATH, TWO HATS TODAY. AS A
PERSON IN HER 70S, I'M 71. I'VE
BEEN THROUGH THIS PARTICULAR SET
OF CIRCUMSTANCES, BUT ALSO AS A
PRACTICE, A PERSON IN PRACTICE
FOR 41 YEARS, IN 2002, THE
WOMEN'S HEALTH INITIATIVE WAS
PUBLISHED, AND IT CHANGED
TREATMENT OF MENOPAUSE FOR MORE
THAN 20 YEARS. IT FRIGHTENED MDS
AWAY FROM PRESCRIBING HORMONE
REPLACEMENT THERAPY FOR
MENOPAUSAL WOMEN, WHICH HAD BEEN
DONE SINCE THE 1970S IN THE
WOMEN'S HEALTH INITIATIVE STUDY,
ORAL ESTROGEN WAS USED INSTEAD
OF TRANSDERMAL, WHICH MEANS
THROUGH THE SKIN, AND A TYPE OF
PROGESTERONE WAS USED THAT
CARRIED RISKS WITH IT. THE
AVERAGE AGE OF WOMEN IN THE
STUDY WAS 63, NOT 50. WHEN MOST
WOMEN ENTER MENOPAUSE, MANY WERE
OVERWEIGHT AND HAD BEEN SMOKERS.
THE POPULATION THAT WAS STUDIED
WAS FLAWED AND THE
INTERPRETATIONS WERE FLAWED AND
YET IT RULES THE TREATMENT
TODAY, BECAUSE MDS FEAR LAWSUITS
, THE DATA WILL CONVINCE THE
ALREADY CONVINCED THE MENOPAUSE
EXPERTS WHO FOLLOW THE DATA,
WOMEN ARE TOLD TO TAKE
SUPPLEMENTS, EAT YAMS OR
MEDITATE, OR SOMETIMES THEY'RE
PUT ON ANTIDEPRESSANTS. THERE
ARE TWO NON-HORMONAL TREATMENTS
FOR THE SMALL PERCENTAGE OF
WOMEN WHO CANNOT USE ESTROGEN.
LET ME PUT IT THIS WAY I CANNOT
READ WITHOUT MY GLASSES. THE
TREATMENT FOR THAT IS
EYEGLASSES. NOT BEING TOLD TO
TRY HARDER, HAVE A BETTER
ATTITUDE. AT 71 NOW MYSELF, I
WATCH SIMILAR AGE WOMEN HAVE
THEIR HORMONE TREATMENT
DISCONTINUED BY THEIR MDS, AND
THERE'S A GENERATION OF WOMEN
WHO HAVE GONE UNINFORMED AND
UNTREATED AND IT STILL PERSISTS
TODAY. A RECENT ARTICLE
PUBLISHED ON APRIL 12TH, TEN
DAYS AGO, IT SUMMARIZED MUCH OF
WHAT I'M SAYING TODAY. ONE OF
THE POINTS THAT IT MAKES IS THAT
FOR MOST WOMEN, CONTINUING
HORMONE REPLACEMENT THERAPY
AFTER AGE 65 IS SAFE. AND IN
FACT, HEALTHY, PARTICULARLY FOR
THE CARDIOVASCULAR SYSTEM. I'M
NOT A RADICAL PERSON. I JUST
KNOW THAT WHEN I HAVE
ACCIDENTALLY FORGOTTEN TO
REPLACE MY ESTROGEN PATCH, MY
HOT FLASHES RETURN. MY SLEEP IS
POOR AND MY MOOD IS LESS CALM.
OCCASIONALLY, MY HUSBAND WILL
ASK IF I HAVE REMEMBERED TO
SWITCH MY PATCH. IF BY CHANCE I
AM A LITTLE BIT CRANKY, IT IS
USUALLY BECAUSE I HAVE FORGOTTEN
TO SWITCH MY PATCH WHEN I'VE
ASKED Ã WHEN I WHEN ASKED ABOUT
WHAT I'M GOING TO STOP MY
HORMONE REPLACEMENT THERAPY, I
ANSWERED THAT THEY CAN PEEL OFF
MY ESTROGEN PATCH WHEN I AM
LAYING IN THE COFFIN. SO
ENTERTAINING. ALTHOUGH BEYOND
TWO MINUTES. SO PLEASE WRAP UP
YOUR COMMENTS ARE OKAY. I'LL
STOP. I HAVE ONE MORE PARAGRAPH.
I'LL HEAR IT LATER. GOOD
AFTERNOON CHAIR AND MEMBERS.
THANK YOU SO MUCH FOR HAVING ME
HERE. LORD SALON HERE
REPRESENTING MYSELF. USUALLY YOU
SEE ME IN THE ENERGY SPACE AS I
WORK FOR SEMPRA, BUT TODAY I'M
HERE REPRESENTING MYSELF AND ALL
THE WOMEN THAT ARE SEEKING
ACCESS AND TREATMENT FOR
MENOPAUSAL SYMPTOMS. NOW FOR ME,
SINCE I'VE TURNED 50, I'VE
DISCOVERED THIS INCREDIBLE SENSE
OF SELF. I FEEL MUCH MORE
CONFIDENT ABOUT MYSELF. I'M
LETTING MYSELF GO GRAY. I'M
REALLY EMBRACING THIS STAGE OF
MY LIFE. IN FACT, I TURNED 51
LAST WEEK AND I'M GOING TO HAVE
A REVERSE QUINCEANERA. LET'S
JUST DO THAT ALL OVER AGAIN.
LET'S JUST. I'M REALLY ENJOYING
THIS STAGE OF MY LIFE. BUT WITH
ALL THIS ALSO COMES SOME OF THE
DOWNSIDES AND THE DOWNSIDE IS
THE, HORMONAL IMBALANCE THAT
COMES FROM THE DROP OF
PROGESTERONE, PROGESTERONE,
ESTROGEN AND TESTOSTERONE IN MY
BODY. HONESTLY, AS DOCTOR WESTON
HAD EXPLAINED, IT'S A CRAZY LACK
OF SLEEP. THERE'S BRAIN FOG,
THERE'S THIS. REALLY, WHAT IS
WHAT THESE MOOD FLUCTUATIONS
THAT I DON'T EVEN RECOGNIZE
MYSELF ANYMORE. I'M JUST KIND OF
TURNING INTO THE HULK HERE AT
TIMES. I DON'T EVEN KNOW WHY.
AND AND THERE'S THE INEVITABLE
DROP IN LIBIDO, WHICH I THINK IS
REALLY UNFORTUNATE AS WELL, I
WENT TO MY DOCTOR TO ADDRESS ALL
THESE ISSUES, AND THEY
MENTIONED, OBVIOUSLY ESTROGEN
AND PROGESTERONE AND
TESTOSTERONE AS A TRIO OF THE
SEX HORMONES THAT NEED TO BE TO
BE, SUPPLEMENTED. WHEN I WENT IN
THE NHÀ AND ASKED MY INSURANCE
TO COVER, THEY COVERED THE
ESTROGEN. NO PROBLEM, GAVE ME
SOME TROUBLE WITH PROGESTERONE,
AND SAID THEY WILL NOT COVER
TESTOSTERONE BECAUSE I AM NOT
MALE. THAT WAS THEIR THEIR
REASONING FOR IT. AND WHEN I
WENT AHEAD AND APPEALED IT ALONG
WITH MY DOCTOR AND DID A PEER TO
PEER REVIEW WHERE SHE PRESENTED,
SCIENTIFIC ARTICLES AND
INFORMATION, THEY SPOKE TO THEIR
DOCTORS INTERNALLY AND THEY CAME
BACK AND THEY SAID THAT IT WAS
NOT MEDICALLY NECESSARY. VÆ. AND
SO, THANK YOU. AT TIME, I JUST
WANT TO MENTION THAT WHEN I
LOOKED INTO PAYING OUT OF POCKET
FOR TESTOSTERONE MONTHLY, IT'S
$595 A MONTH FOR 30 DAY
TREATMENT OF TESTOSTERONE. AND I
THINK THAT IT IS UNFAIR AND A
VERY MYOPIC VIEW OF INSURANCE
COMPANIES AND THEIR PHARMACIES
THAT THEY DO NOT COVER THIS FOR
WOMEN WHO ARE, YOU KNOW,
ESPECIALLY LOW INCOME AND WOULD
BE IMPACTED, YOU KNOW, WOMEN OF
COLOR. THANK YOU. THANK YOU SO
MUCH. ANY WITNESSES IN SUPPORT
OF THE WOMEN'S? IF THERE ARE ANY
WITNESSES IN OPPOSITION WHO ARE
GOING TO BE PRIMARY WITNESSES,
PLEASE COME FORWARD. GOOD
AFTERNOON. BARBARA MÀ WITH
ASTELLAS PHARMACEUTICALS AND
SUPPORT. GOOD AFTERNOON, CRAIG
SWAIN WITH BAYER IN SUPPORT. ANY
PRIMARY WITNESSES IN OPPOSITION?
MADAM CHAIR, MEMBERS STEPHANIE
WATKINS, ON BEHALF OF THE
ASSOCIATION OF CALIFORNIA LIFE
AND HEALTH INSURANCE COMPANIES.
REGRETTABLY, HERE IN OPPOSITION
TODAY, THAT BEING SAID, I WOULD
BE REMISS IF I DIDN'T RECOGNIZE
THE WORK THE AUTHOR AND SPONSORS
AND COMMITTEE HAVE DONE ON THIS
ISSUE, AS WELL AS ACKNOWLEDGED
THE AMENDMENTS THAT ARE BEING
PROPOSED TODAY TO REMOVE THE
REFERENCE TO A SPECIFIC BRAND
NAME DRUG, WHICH WAS CERTAINLY
CONCERNING. UNFORTUNATELY, WE
STILL HAVE SOME CONCERNS WITH
THE REMAINING LIST OF COVERAGE
REQUIREMENTS, SPECIFICALLY AS IT
CONCERNS THE INCLUSION OF
BIOIDENTICAL HORMONE TREATMENT.
WELL, MOST OF MY MEMBERS IS
NOTED IN ANALYSIS COVER THE
LION'S SHARE OF DRUGS LISTED BY
IDENTICAL HORMONES ARE UNIQUE
AND THAT MANY ARE NOT FDA
APPROVED. AS REFERENCED IN THE
ANALYSIS. THERE IS LIMITED
EVIDENCE THAT COMPOUND
BIOIDENTICAL HORMONES ARE
EFFECTIVE TREATMENT FOR
MENOPAUSE SYMPTOMS. USE OF
COMPOUND IDENTICAL HORMONES IS
ONLY RECOMMENDED FOR PATIENTS
WITH AN ALLERGY TO AN ACTIVE
PHARMACEUTICAL INGREDIENT OR
INACTIVE INGREDIENT OF A DRUG
PRODUCT APPROVED BY THE FDA, OR
DOCUMENTED REQUIREMENT FOR A
DIFFERENT DOSAGE FROM THE THOSE
AVAILABLE. THIS IS DUE TO
SERIOUS CONCERNS ABOUT THE
SAFETY, EFFICACY, AND
STANDARDIZATION OF THESE DRUGS,
WHICH ARE NOT REGULATED BY THE
FDA. FOR THESE REASONS, WE WOULD
SUGGEST BIOIDENTICAL HORMONES BE
EXCLUDED FROM THE LIST UNTIL
THERE IS MORE EVIDENCE TO SHOW
THEIR EFFECTIVENESS. WITH THAT
BEING SAID, AS IF THE BILL DOES
MOVE FORWARD TODAY, WE LOOK
FORWARD TO HAVING FUTURE
CONVERSATIONS. I THINK ALL OF MY
MEMBERS KNOW THE IMPORTANCE OF
COVERAGE AND ACCESS FOR WOMEN
FOR THESE SERVICES, AND WITH
THAT, WE LOOK FORWARD TO FUTURE
CONVERSATIONS. THANK YOU. ANY
OTHER WITNESSES IN OPPOSITION?
I, ROBERT BOYKIN WITH THE
CALIFORNIA ASSOCIATION OF HEALTH
PLANS. I'D LIKE TO ALIGN OUR
COMMENTS WITH, EBCLC. THANK YOU
FOR YOUR TIME. THANK YOU, MADAM
CHAIR. JACKIE, ON US, ON BEHALF
OF THE AMERICA'S HEALTH
INSURANCE PLANS, ALIGN OUR
COMMENTS WITH ALEC AS WELL.
THANK YOU. I'LL BRING IT BACK TO
THE COMMITTEE FOR QUESTIONS OR
COMMENTS. DOCTOR WEBER. SO GOOD
AFTERNOON. WANT TO THANK THE
AUTHOR. AND, THOSE WHO CAME AND
SPEAK IN SUPPORT OF THIS VERY,
VERY IMPORTANT BILL AND ALSO TO
HIGHLIGHT THE DISCREPANCY WITHIN
OUR HEALTH CARE SYSTEM IN TERMS
OF WHAT WE FOCUS ON AND WHAT WE
COVER BASED ON SOMEONE'S GENDER.
SO THANK YOU SO MUCH FOR THAT, I
DO WANT TO, HIGHLIGHT THERE WAS
ONE PART THAT JUST JUMPED OUT TO
ME, IN THIS BILL. AND, YOU KNOW,
AS AN OBGYN, I HAVE TREATED
PATIENTS, WITH MENOPAUSE. BUT I
ALSO I WAS VERY LUCKY TO BE AT A
HEALTH CARE FACILITY PRIOR TO
COMING HERE WHERE WE ACTUALLY
HAD PEOPLE THAT SPECIALIZE, DID
FELLOWSHIPS OR TRAINING AND
CERTAIN THINGS. AND SO, YOU
KNOW, I DID PD GYN, ONE OF MY
COLLEAGUES, ACTUALLY FOCUSES ON
MENOPAUSE HEALTH, AND SHE LEADS
OUR MENOPAUSE HEALTH PROGRAM AT
UCSD AND IS ACTUALLY A CERTIFIED
MENOPAUSE PROVIDER THROUGH THE
NORTH AMERICAN MENOPAUSE
SOCIETY. SO I REACHED OUT TO HER
BECAUSE I REMEMBER A LOT OF THE
DISCUSSIONS THAT WE WOULD HAVE
AROUND BIOIDENTICAL HORMONES
AND, IT CAN BE SOMEWHAT
CONFUSING BECAUSE BIOIDENTICAL
OR BIOSIMILAR LÀ ARE SUPPOSED TO
BE THOSE THAT ARE JUST WHAT ARE
OVARY WOULD PRODUCE. RIGHT? AND
SO THERE ARE SOME FDA APPROVED
ONES THAT, ARE SUPPORTED BY
MEDICINE AND SHOULD DEFINITELY
BE COVERED. THE CONCERN COMES IN
WHEN YOU JUST HAVE THE BROAD
BIOIDENTICAL HORMONES BECAUSE IT
PULLS IN THOSE THAT ARE NOT FDA
APPROVED, AND IT DOES INCLUDE
WHAT WAS REFERRED TO AS LIKE
SOME OF THE COMPOUNDS, SOME OF
THE CREAMS WHERE THERE IS NO
SCIENTIFIC EVIDENCE, THE DOSE
CAN VARY BASED ON WHERE YOU GO
AND IN ACTUALITY, IT MAY BE A
SITUATION WHERE YOU'RE GETTING
TOO LOW OF A DOSE THAN WHAT YOU
SHOULD BE GETTING, OR AT TIMES,
SOMETIMES EVEN TOO HIGH OF A
DOSE, WHICH COULD PUT YOU AT
INCREASED RISK FOR THINGS LIKE
ENDOMETRIAL CANCER. EXCUSE ME?
UTERINE CANCER. SO, WHAT I WOULD
SUGGEST OR I WOULD RECOMMEND IS
NOT TO STRIKE THE BIO IDENTICAL
HORMONES, BUT JUST INCLUDE FDA
APPROVED BIOIDENTICAL HORMONES.
AND SO I WILL BE SUPPORTING IT
TODAY BECAUSE, IT IS JUST IN
CONCEPT. AND I THINK THAT'S JUST
A SMALL TWEAK. AND I'M SORRY I
DIDN'T GET TO YOU BEFORE, BUT
THIS WAS LIKE A LAST NIGHT,
SOMETHING I DID LAST NIGHT. BUT
I WOULD JUST RECOMMEND THAT YOU
CHANGE THAT TO ADD FDA APPROVED
BIOIDENTICAL HORMONES, THANK
YOU, DOCTOR ROBERT, I REALLY
APPRECIATE YOU BEING HERE AND
ALL THE FEEDBACK YOU PROVIDE ON
THESE BILLS. AND I KNOW WE'RE
DOING A LOT RIGHT NOW, SO I
APPRECIATE THAT WE DIDN'T GET TO
ALL THIS BEFORE. AND TO BE
HONEST, THE ANALYSIS WAS THE
FIRST PLACE WHERE THAT WAS
RAISED FOR ME AND I, I ACTUALLY
DO WANT TO EXPRESS MY GRATITUDE
TO THE FOLKS THEY DO SUCH A GOOD
JOB, AND I THINK THEIR ANALYZES
ARE ALWAYS REALLY HELPFUL, AND
SO WE ARE LOOKING AT THAT. WE'RE
WORKING WITH THE OB GYNS TO
FIGURE OUT HOW TO DO THIS IN A
WAY THAT COVERS THOSE. YOU KNOW
THAT, FOR EXAMPLE, THEY CAN'T.
THE ADHESIVE IS SOMETHING
THEY'RE ALLERGIC TO SO THAT
EVERYONE HAS THE FULL RANGE OF
OPTIONS THAT ARE FDA APPROVED.
AND SO PART OF WHAT'S BEEN
COMPLICATED ABOUT THIS IS THAT
THERE ISN'T A GREAT CONSENSUS
BECAUSE OF THE LACK OF TRAINING
AND WHAT IS MENOPAUSAL AND
PERIMENOPAUSAL CARE SUCH THAT WE
FELT LIKE WE HAD TO LIST IT OUT
SO THAT THE THINGS THAT OB-GYNS
ARE COVERED, BUT WE'RE MAKING
SURE WE'RE FOCUSING ON THAT
SPECIFIC THING AND ADDRESSING
IT. SO I APPRECIATE YOUR
FEEDBACK. SEEING NO OTHER
COMMENTS FROM THE COMMITTEE, I
WANT TO I SIT ON THE SELECT
COMMITTEE WITH YOU, AND THANK
YOU SO MUCH, CHAIR, FOR HAVING
THAT, SELECT COMMITTEE. IT WAS
ALSO, ENLIGHTENING AND
THANKFULLY I'M USING. BUT THE
REALITY IS THAT WE ARE DEALING
WITH REALLY DEVASTATING IMPACTS
OF PERIMENOPAUSE AND MENOPAUSE
NOT BEING ADDRESSED IN THE WAY
THAT THEY SHOULD BE. AND THANK
YOU TO THE WITNESS TO FOR
SHARING YOUR STORIES, BOTH OF
YOU, FOR THE IMPACTS OF NOT
HAVING OUR HEALTH CARE SYSTEM
REALLY PROVIDE THE NECESSARY,
TREATMENTS THAT WOULD ENABLE US
TO BE ABLE TO LIVE, LIVE FULL
LIVES. I TOO AM GOING TO HAVE A
REVERSE QUINCEANERA, VERY
SHORTLY, AND I'LL BE PARTYING
WITH YOU. WITH THAT, WE STILL DO
NOT HAVE QUORUM. BUT I ASK THAT
YOU CLOSE. THANK YOU, MADAM
CHAIR AND COMMITTEE AGAIN FOR
YOUR SUPPORT ON THIS BILL. AND,
YOU KNOW, AS I FACE DOWN
MENOPAUSE MYSELF, I THINK IT IS
SO CRITICAL THAT WE HAVE THESE
CONVERSATIONS THAT WE WORK FOR
GENDER EQUITY IN THE HEALTH CARE
SPACE, AND THIS IS A HUGE STEP
IN THE RIGHT DIRECTION, ALTHOUGH
MUCH MORE IS NEEDED, AND I KNOW
WE WILL DO THAT WORK TOGETHER.
SO THANK YOU. WITH THAT, I
RESPECTFULLY ASK FOR I VOTE WHEN
THE TIME COMES. I JUST WANT TO
CLARIFY THAT YOU'LL BE ACCEPTING
THE COMMITTEE AMENDMENTS. YES.
THANK YOU, MADAM CHAIR. THANK
YOU.
WE'LL BE MOVING ON TO ITEM EIGHT
AB 2271. ORTEGA.
PLEASE GO. PUT YOUR. SIT ON. CAN
YOU HEAR ME? OKAY. THANK YOU,
MADAM CHAIR AND COMMITTEE
MEMBERS, FOR THE OPPORTUNITY TO
PRESENT AB 2271 TODAY. AND THANK
YOU TO THE COMMITTEE FOR THEIR
HARD WORK ON THE ANALYSIS. AB
2271 IS AN URGENT BILL THAT WILL
HELP AVOID A CLOSURE OF A JUST
DISTRESSED HOSPITAL IN MY
DISTRICT, SAINT ROSE HOSPITAL IS
A DISTRESSED SAFETY NET HOSPITAL
IN HAYWARD. THE THREE TREATS
MOSTLY LOW INCOME MEDI-CAL AND
MEDICARE PATIENTS. IT HAS THE
ONLY EMERGENCY ROOM AND
MATERNITY WARD IN THE CITY OF
HAYWARD. SAINT ROSE CURRENT
FINANCIAL SITUATION IS DIRE. THE
HOSPITAL WILL FACE BANKRUPTCY
AND POSSIBLE CLOSURE IN THE NEXT
SIX MONTHS. IF ANOTHER ENTITY
DOES NOT ACQUIRE THE HOSPITAL.
ALAMEDA HEALTH SYSTEM, A PUBLIC
STATE CREATED HOSPITAL SYSTEM,
IS IN THE BIDDING PROCESS TO BUY
SAINT ROSE, BUT REQUIRES
FINANCIAL ASSISTANCE TO DO SO IN
THE FORM OF LOAN FORGIVENESS. TO
AID ARES IN ACQUIRING SAINT ROSE
AND AVOIDING A CLOSURE. THIS
BILL WOULD FORGIVE TWO OF SAINT
ROSE'S LOANS AND LOAN FOR THE
DISTRESSED HOSPITAL PROGRAM AND
CONSTRUCTION FINANCE LOAN. IF
SAINT ROSE WERE TO CLOSE, MORE
THAN 150,000 RESIDENTS IN MY
DISTRICT WOULD BE LEFT WITHOUT A
SAFETY NET. HOSPITAL AN
EMERGENCY ROOM OR A MATERNITY
WARD. HERE, TEST IS TESTIFYING
AND SUPPORT IS JAMES JACKSON,
CEO OF ALAMEDA HEALTH SYSTEM,
AND MICHAEL CRLA WITH SAINT ROSE
HOSPITAL. PLEASE GO AHEAD.
YOU'LL EACH HAVE TWO MINUTES.
GOOD AFTERNOON. AS ASSEMBLY
MEMBER ORTEGA SAID, SAINT ROSE
IS A STANDALONE COMMUNITY
HOSPITAL LOCATED IN THE CITY OF
HAYWARD THAT HAS SERVED THE
RESIDENTS OF CITY OF HAYWARD AND
SURROUNDING COMMUNITIES FOR MORE
THAN 50 YEARS AS A SAFETY NET,
HEALTH AS A SAFETY NET HEALTH
CARE PROVIDER SAINT ROSE FACES A
NUMBER OF FINANCIAL CHALLENGES
AND IS IN SIGNIFICANT FINANCIAL
DISTRESS DESPITE ITS BEST
EFFORTS AND CONTINUED SUPPORT
FROM ALAMEDA COUNTY AND OTHERS,
SAINT ROSE CANNOT AND WILL NOT
BE ABLE TO ACHIEVE FINANCIAL
SUSTAINABLE CITY ON ITS OWN AND
MUST BECOME PART OF A LARGER
HEALTH SYSTEM. ABSENT AN
AGREEMENT FOR SAINT ROSE TO
BECOME PART OF A LARGER HEALTH
SYSTEM, SAINT ROSE WILL NOT BE
ABLE TO WITHSTAND ITS ONGOING
LOSSES AND WILL BE FORCED TO
MAKE DIFFICULT DECISIONS ABOUT
THE AVAILABILITY OF SERVICES IN
THE COMMUNITY AND POTENTIAL
CLOSURE OVER THE NEXT SEVERAL
MONTHS. THIS WILL OBVIOUSLY
ADVERSELY AFFECT PATIENTS AND
THE OVERALL HEALTH CARE SAFETY
NET IN ALAMEDA COUNTY, SAINT
ROSE SEES APPROXIMATELY 28,000
PATIENTS IN ITS EMERGENCY
DEPARTMENT EACH YEAR, AND ADMITS
MORE THAN 3400 PATIENTS TO ITS
HOSPITAL FOR CARE EACH YEAR. AND
THE LARGE, VAST MAJORITY OF
THOSE PATIENTS ARE LOW INCOME
PATIENTS WHO QUALIFY FOR
MEDI-CAL AND UNINSURED UNINSURED
PATIENTS. OTHER AREA HOSPITALS
WILL NOT BE ABLE TO ABSORB THOSE
PATIENTS IF SOMETHING WAS TO
HAPPEN TO SAINT ROSE, SAINT ROSE
HAS BEEN PROACTIVELY LOOKING AT
SOLUTIONS AND LAST WEEK, SAINT
ROSE AND ALAMEDA HEALTH SYSTEM
ENTERED INTO A LETTER OF INTENT
TO EXCLUSIVELY EVALUATE THE
OPPORTUNITY FOR SAINT ROSE TO
BECOME PART OF ARES. OVER THE
NEXT 90 DAYS, EVERYONE'S WORKING
TO OVERCOME ANY OBSTACLES IN
THAT TO PREVENT THAT FROM
HAPPENING. ONE OF THOSE
OBSTACLES IS SAINT ROSE'S DEBT,
WHICH IT'S ABOUT $30 MILLION
INSURED BY CAL CAL MORTGAGE, AND
THEN THE DISTRESSED HOSPITAL
LOAN THAT WAS UNDER THE
DISTRESSED HOSPITAL LOAN PROGRAM
. ALAMEDA HEALTH SYSTEM CAN'T
TAKE ON SAINT ROSE WITHOUT THAT
DEBT FORGIVENESS. THANK YOU. YOU
HAVE TWO MINUTES. THANK YOU,
MADAM CHAIR. COMMITTEE MEMBERS,
THANK YOU FOR THE OPPORTUNITY TO
SPEAK WITH YOU TODAY. MY NAME IS
JAMES JACKSON. I'M THE CEO OF
THE ALAMEDA HEALTH SYSTEM. I
COME TO YOU TODAY REPRESENTING
THE HEALTH SYSTEM WITH A SINCERE
APPEAL FOR YOUR SUPPORT OF AB
2271 ASSEMBLY MEMBER ORTEGA, I
OFFER MY SINCEREST GRATITUDE FOR
AUTHORING THIS IMPORTANT BILL.
THIS LEGISLATION IS CRITICAL TO
SAFEGUARDING VITAL HEALTH CARE
ACCESS FOR THE RESIDENTS OF
HAYWARD, CALIFORNIA, AND THE
BROADER REGION. SAINT ROSE
HOSPITAL IS ONE OF ONLY THREE
GENERAL ACUTE DISPROPORTIONATE
SHARE HOSPITALS IN OUR COUNTY,
AND IT STANDS AS A BEACON OF
CARE FOR OUR COMMUNITY TODAY, DE
SAINT ROSE CONFRONTS ACUTE
FINANCIAL CHALLENGES AND I'M
HERE TODAY TO URGE YOU TO
PREVENT A HOSPITAL CLOSURE. I
ASK THAT YOU CONSIDER THE
RAMIFICATIONS OF A POTENTIAL
CLOSURE OF SAINT ROSE. 75% OF
SAINT ROSE'S HOSPITAL EMERGENCY
ROOM VISITS ARE SENIOR CITIZENS
AND OR LOW INCOME PATIENTS WHO
QUALIFY FOR MEDICARE AND OR
MEDI-CAL, OR THEIR INDIGENT
PATIENTS WITH NO HEALTH CARE
INSURANCE AT ALL. SAINT ROSE
HOSPITAL HAS THE ONLY EMERGENCY
DEPARTMENT IN THE CITY OF
HAYWARD, AND THE EMERGENCY
DEPARTMENT REGULARLY OPERATES AT
MORE THAN 100% OF THEIR STANDARD
CAPACITY. IF SAINT ROSE HOSPITAL
WERE TO CLOSE, IT WOULD HAVE A
RIPPLE EFFECT THROUGHOUT THE
COUNTY. ALREADY, THE COUNTY'S
ALREADY FULL EMERGENCY
DEPARTMENTS DATA SHOWS THAT THE
NEIGHBORING HOSPITALS WOULD BE
OVERWHELMED IF THEY SAW THE 10
TO 15,000 MORE VISITS ANNUALLY
THAT WOULD BE ANTICIPATED.
THERE'S HOPE. THE ALAMEDA HEALTH
SYSTEM, APPRECIATING THE URGENCY
OF THIS SITUATION, HAS EMBARKED
UPON EXCLUSIVE NEGOTIATIONS WITH
SAINT ROSE HOSPITAL. OUR
OVERARCHING OBJECTIVE IS
RESOLUTE TO INTEGRATE SAINT ROSE
HOSPITAL INTO OUR SAFETY NET
SYSTEM, THEREBY PRESERVING ITS
INDISPENSABLE SERVICES AND
ENSURING THE WELFARE OF THIS
COMMUNITY AS A SAFETY NET HEALTH
CARE SYSTEM IN ALAMEDA COUNTY,
THE ALAMEDA HEALTH SYSTEM IS
DEVOTED TO SERVING THE NEEDS OF
ALL COUNTY RESIDENTS, INCLUDING
THE RESIDENTS OF THE CITY OF
HAYWARD, AND HAS THE REQUISITE
OPERATIONAL AND CLINICAL
STRENGTHS TO ASSIST SAINT ROSE
HOSPITAL IN DEVELOPING THE
PROGRAM, SERVICES AND
EFFICIENCIES NECESSARY TO BECOME
MORE FINANCIALLY VIABLE. A
FORMIDABLE OBSTACLE LOOMS IN OUR
PATH, AND THAT'S SAINT ROSE
HOSPITAL'S OUTSTANDING CAPITAL
DEBT. I APPRECIATE THAT I'M AT
TIME, BUT I JUST WANTED TO
ACKNOWLEDGE THAT BY ENDORSING AB
2271, YOU ARE NOT MERELY
ENACTING LEGISLATION. YOU'RE
CHAMPIONING THE HEALTH AND
WELFARE OF OUR COMMUNITIES FOR
POSTERITY. THANK YOU VERY MUCH.
THANK YOU. ANY OTHER WITNESSES
IN SUPPORT, ANY PRIMARY
WITNESSES IN OPPOSITION OR OTHER
OPPOSITION? SEEING NONE. I'LL
BRING IT BACK TO THE COMMITTEE.
ANY COMMENTS FROM THE COMMITTEE?
I WILL JUST OFFER, I KNOW
ALAMEDA HEALTH SYSTEM VERY WELL.
IT'S ASSEMBLY MEMBER ORTEGA AND
I SHARE, SHARE THAT IN COMMON.
AND CERTAINLY I KNOW THAT THE
STRUGGLES OF SAINT ROSE HAVE
BEEN, ONGOING JUST BECAUSE OF
THE SHEER FACT OF, AS YOU
STATED, THE PAYER MIX IS SUCH
THAT IT PRIMARILY SERVES
MEDICALLY, UNINSURED PATIENTS
AND MEDI-CAL ELIGIBLE PATIENTS
AS WELL, I KNOW THAT ASSEMBLY
MEMBER ORTEGA IS YOUR BIGGEST
CHAMPION IN THIS ROOM FOR, JUST
TAKING THE TIME TO BE ABLE TO
MOVE VERY SWIFTLY. I WANT TO
THANK THE COMMITTEE FOR STAFF
FOR OPERATING, SO SWIFTLY TO BE
ABLE TO GET THIS BILL HEARD IN
TIME, TO BE ABLE TO GIVE YOU THE
NECESSARY OPPORTUNITY TO SAVE
SAINT ROSE. AND I KNOW THAT ANY
ISSUES RELATED TO THIS POTENTIAL
MERGER WILL GET EXAMINED. MORE,
ROBUSTLY AS WE MOVE FORWARD WITH
THAT, I HAVE, IN MY
RECOMMENDATION TO PASS OUT OF
COMMITTEE. AND ONCE WE HAVE
QUORUM, WE WILL DO THAT ASSEMBLY
MEMBER ORTEGA, WOULD YOU LIKE TO
CLOSE? I UNDERSTAND THAT WE HAVE
A CRITICAL, URGENCY THROUGHOUT
THE STATE WHEN IT COMES TO
DISTRESSED HOSPITALS, AND I
APPRECIATE ALL OF THE MEMBERS
TODAY AND HOPING TO EARN YOUR
AYE VOTE. SO WE CANNOT JUST SAVE
SAINT ROSE FROM CLOSING, BUT
OTHER DISTRESSED HOSPITALS THAT
PROVIDE HEALTHY, SAFE, HEALTHY
NET. RESOURCES FOR COMMUNITIES
OF COLOR, OUR SENIORS AND OUR
MOST DISTRESSED. THANK YOU SO
MUCH. AND I RESPECTFULLY ASK FOR
YOUR AYE VOTE. THANK YOU. WE'LL
MOVE ON TO ITEM TEN AB 2352.
ERWIN.
MIKE, IS IT WORKING NOW? ALL
RIGHT. THANK YOU. I'M PLEASED TO
PRESENT AB 2352, WHICH SEEKS TO
CREATE A LEGAL FRAMEWORK FOR
PSYCHIATRIC ADVANCE DIRECTIVES
REFERRED TO AS PEDS, BY ADDING
ON TO THE PROVISIONS RELATED TO
ADVANCED ADVANCE HEALTH CARE
DIRECTIVES AND SIMPLE TERMS.
PADS ARE DOCUMENTS COMPLETED BY
INDIVIDUALS WHO HAVE BEHAVIORAL
HEALTH CHALLENGES. THIS ALLOWS
THEM TO CONTINUE TO COMMUNICATE
PREFERENCES ABOUT INTERACTING OR
CARING FOR THEM DURING A FUTURE
BEHAVIORAL HEALTH CRISIS TO
FIRST RESPONDERS AND HEALTH CARE
PROVIDERS. EXAMPLES OF
INFORMATION INCLUDED IN A PAD
INCLUDE PREFERRED DE-ESCALATION
TECHNIQUES OR NAMING A TRUSTED
SUPPORT PERSON TO SERVE AS A
HEALTH CARE ADVOCATE. THIS BILL
HAS BEEN CRAFTED IN
COLLABORATION WITH THE PROJECT
TEAM BEHIND THE MENTAL HEALTH
SERVICES OVERSIGHT AND
ACCOUNTABILITY COMMISSIONS,
INNOVATIVE INNOVATION PROJECT ON
PADS, WHICH INVOLVES SIX
DIFFERENT COUNTIES AND ONE
REGIONAL MENTAL HEALTH
AUTHORITY. THE INNOVATION
PROJECT'S GOAL IS TO EXPAND THE
USE OF PADS IN THEIR
JURISDICTIONS, PRESERVE
INDIVIDUAL SELF-DETERMINATION
AND IMPROVE POSITIVE OUTCOMES
FOR PEOPLE AT RISK OF
INVOLUNTARY CARE. THE GOAL OF
THE LEGISLATION IS TO CREATE A
STATUTE WHICH BOLSTERS
INDIVIDUALS CONFIDENCE AND
ABILITY TO COMPLETE A PAD, AND
ENSURES FIRST RESPONDERS AND
BEHAVIORAL HEALTH PROFESSIONALS
THAT THEY HAVE ACCESS TO PADS.
IN THE MOMENT WHEN THEY MAKE IT,
WHEN THEY CAN MAKE A DIFFERENCE
IN AN INDIVIDUAL'S CARE. I
ACKNOWLEDGE THAT THERE'S STILL
WORK TO BE DONE, ADDING LANGUAGE
AROUND ACCESS, AND WE'RE
AWAITING TECHNICAL ASSISTANCE
FROM DOJ ON WHAT STATUTORY
LANGUAGE MIGHT BE REQUIRED TO
LEVERAGE CLEATS OR OTHER DIGITAL
SYSTEMS TO COMMUNICATE WITH LAW
ENFORCEMENT. POINT. I WOULD LIKE
TO THANK THE COMMITTEE STAFF WHO
HAS WORKED VERY DILIGENTLY WITH
MY STAFF, I'D LIKE TO THANK OUR
SPONSORS AND THE OPPOSITION TO
IDENTIFY MY AMENDMENTS, AND
REFOCUS THE BILL, BRINGING US
CLOSER TO AGREEMENT. I AM
ACCEPTING THE COMMITTEE'S,
AMENDMENTS PROPOSED ON PAGE 12.
AND NOW I WOULD LIKE TO
INTRODUCE TWO OF MY PRIMARY
WITNESSES, KAREN SAHOTA FROM THE
CONCEPTS FORWARD CONSULTING. THE
PROJECT LEAD FOR THE PADS
INNOVATION PROJECT, AND KENDRA
ZOLLER, DEPUTY DIRECTOR OF
LEGISLATIVE AFFAIRS OF THE
MENTAL HEALTH SERVICES OVERSIGHT
AND ACCOUNTABILITY COMMISSION.
THÀNH, WHO IS HERE TO SHARE
INFORMATION ABOUT THE
COMMISSION'S ROLE WITH THE
INNOVATION PROJECT. THANK YOU.
GOOD AFTERNOON, MADAM CHAIR AND
COMMITTEE MEMBERS. AGAIN. MY
NAME IS KAREN SAHOTA AND I'M THE
LEAD PROJECT DIRECTOR FOR THE
MULTI-COUNTY PSYCHIATRIC ADVANCE
DIRECTIVE PROJECT, OR WHAT WE
CALL THE PADS PROJECT. SINCE THE
1990S, MENTAL HEALTH PREFERENCES
HAVE BEEN HIDDEN IN THE MORE
COMMON ADVANCED HEALTH CARE
DIRECTIVE FOR DECADES.
PSYCHIATRIC ADVANCE DIRECTIVES
REMAIN AN UNKNOWN TOOL FOR
BEHAVIORAL HEALTH CRISIS
INTERVENTION, DEMONSTRATING THE
POWER OF COLLABORATION AND
ONGOING PARTICIPATION OF FAMILY
MEMBERS. THE PEER COMMUNITY,
FIRST RESPONDERS, CRISIS TEAMS,
HOSPITAL STAFF ALL PARTICIPATING
IN THE PROJECT IDENTIFY THAT
CREATING A STANDALONE PAD IS
INDEED A CRUCIAL STEP IN
RECOGNIZING THE GAP IN CRISIS
SERVICES AND ADDRESSING THE
SPECIFIC NEEDS OF INDIVIDUALS
WITH BEHAVIORAL HEALTH
CONDITIONS. BY PROVIDING A
DIGITAL PLATFORM WITH
STANDARDIZED COMPONENTS,
ENSURING PORTABILITY ACROSS
DIFFERENT LOCATIONS WITHIN
CALIFORNIA, AND EMPHASIZING
VOLUNTARY PARTICIPATION AND
CONSENT, YOU'RE NOT ONLY
PROMOTING ACCESSIBILITY, BUT
ALSO EMPOWERING INDIVIDUALS TO
ADVOCATE FOR THEIR OWN
PREFERENCES AND NEEDS DURING A
TIME OF CRISIS. AB 2352
RECOGNIZES A STANDALONE PAD AS A
DOCUMENT THAT REDUCES THE STIGMA
OF BEHAVIORAL HEALTH CONDITION,
AND IT CREATES ACCESSIBILITY FOR
ALL INDIVIDUALS, INCLUDING THE
HOMELESS OR EVEN THOSE WITH A
CO-OCCURRING CONDITION. THIS
BILL ALSO ACKNOWLEDGES THE NEED
FOR DIGITAL TRANSFORMATION AND
THE ROLE OF TRUSTED OUTREACH
WORKERS AND PEER SUPPORT
SPECIALISTS IN FACILITATING AND
WITNESSING THIS DOCUMENT. THE
BILL WILL ALLOW THE USE OF A
STANDALONE PAD AND A BEHAVIORAL
HEALTH CRISIS SITUATION,
EXPANDING ITS USE BEYOND A
HEALTH CARE SETTING. WHEN A
PERSON MAY HAVE LOST DECISION
MAKING CAPACITIES. THIS IS THIS
IS A CRUCIAL ASPECT THAT AB 2352
EMPHASIZES THE IMPORTANCE OF
REDUCING RECIDIVISM OF
INCARCERATION AND
HOSPITALIZATION THROUGH
PERSONALIZED CARE AND
SENSITIVITY, AND UNDERSCORING
THE POTENTIAL IMPACT OF A
STANDALONE PAD ON IMPROVING
OUTCOMES FOR INDIVIDUALS
EXPERIENCING A BEHAVIORAL HEALTH
CRISIS. THE PROJECT LOOKS
FORWARD TO CONTINUED
COLLABORATION OF OUR COUNTIES
AND STAKEHOLDERS, AND I THANK
YOU FOR YOUR TIME AND URGE YOUR
SUPPORT FOR AB 2352. THANK YOU.
THANK YOU. TWO MINUTES. GOOD
AFTERNOON. KENDRA ZELLER, ON
BEHALF OF THE MENTAL HEALTH
SERVICES OVERSIGHT AND
ACCOUNTABILITY COMMISSION, I
APPRECIATE THE CHANCE TO BE WITH
HERE, WITH YOU HERE TODAY. THE
GOALS OF THIS PROJECT ARE REALLY
SIMPLE AND STRAIGHTFORWARD. THE
INTENT IS TO CAPTURE THE WISHES
AND DESIRES OF AN INDIVIDUAL
WHEN THEY ARE NOT IN A CRISIS,
AND TO BE RESPECTFUL OF THOSE
DESIRES AND WISHES. WHEN SOMEONE
IS IN A CRISIS AS A STRATEGY TO
REDUCE THE LIKELIHOOD OF THAT
CRISIS ESCALATING AND REDUCE LAW
ENFORCEMENT INVOLVEMENT AND
SPEED THE PACE AT WHICH WE CAN
PROVIDE SERVICES TAILORED TO A
PERSON'S INDIVIDUAL NEEDS. THE
COMMISSION SAW THIS OPPORTUNITY
WITH THE COUNTY SEVERAL YEARS
AGO TO DE-ESCALATE CRISIS VERY
EARLY IN THE PROCESS, AS
OUTLINED IN THE ANALYSIS,
IMPLEMENTING THIS GOAL IS
COMPLICATED AND WE APPRECIATE
THE WORK DONE BY THE AUTHOR
SPONSOR, OPPONENTS IN THE
COMMITTEE STAFF. THE COMMISSION
DOES NOT HAVE A FORMAL POSITION
BECAUSE WE MEET ON THURSDAY, BUT
OUR CHAIR HAS AUTHORIZED US TO
ASK THE COMMITTEE TO MOVE THE
BILL FORWARD SO WE CAN CONTINUE
TO WORK WITH THE STAKEHOLDERS
AND ADDRESS THE ADDRESS, THE
ISSUES WE SEE THIS LEGISLATION
AS KEY TO PUTTING IN PLACE
STRATEGIES TO IMPROVE OUTCOMES
ACROSS THE STATE, AND WE ARE
COMMITTED TO WORKING WITH OUR
PARTNERS AND THE AUTHOR TO MOVE
THIS BILL FORWARD. THANK YOU AND
HAPPY TO ANSWER ANY QUESTIONS.
THANK YOU. ANY OTHER WITNESSES
IN SUPPORT? HELLO. MY NAME IS
RACHEL CHAMBERS, AND I'M THE
CO-EXECUTIVE DIRECTOR OF A PEER
RUN ORGANIZATION CALLED PAINTED
BRAIN. AND WE SUPPORT THIS BILL.
THANK YOU. ANY PRIMARY WITNESSES
IN OPPOSITION
?
YOU'LL HAVE TWO MINUTES EACH.
GOOD AFTERNOON, MADAM CHAIR AND
MEMBERS. MISS ERWIN, DEB ROTH
WITH DISABILITY RIGHTS
CALIFORNIA WITH AN OPPOSE UNLESS
AMENDED. POSITION WE APPRECIATE
THE AUTHOR'S WILLINGNESS TO WORK
WITH US. AND I DON'T KNOW THAT
I'VE EVER HEARD A SHOUT OUT
GIVEN TO OPPONENTS IN AN
AUTHOR'S PRESENTATION. THÀNH. SO
THANK YOU FOR THAT VERY MUCH.
THE COMMITTEE AMENDMENTS, WE
THINK, ARE A BIG STEP IN THE
RIGHT DIRECTION, DRC SUPPORTS
PADS. WE CO-SPONSORED
LEGISLATION LAST YEAR TO
ESTABLISH PADS IN CALIFORNIA
LAW. A PAD IS A FORM OF AN
ADVANCE DIRECTIVE OF IT IS STILL
AN ADVANCE DIRECTIVE. IT SHOULD
BE AS ENFORCEABLE AS ANY OTHER
ADVANCE DIRECTIVE. IT SHOULD
LOOK AS MUCH AS POSSIBLE LIKE
ANY OTHER ADVANCE DIRECTIVE, ONE
OF THE WAYS IN WHICH IT COULD DO
THAT IS BY RETAINING THE OPTION
TO DESIGNATE AN AGENT FOR
DECISION MAKING. THAT'S SOMEONE
YOU WOULD GIVE POWER OF ATTORNEY
TO FOR REASONS WE DON'T FULLY
UNDERSTAND. THE AUTHOR IS
REMOVING THAT AND YOU DON'T HAVE
THAT OPTION. IF YOU DO A
STANDALONE PAD. I'M ASSUMING
THAT IF IT'S AN INTEGRATED PAD,
THAT WOULD BE THAT IT WOULD BE
KEPT. I'M NOT SURE, SOME PEOPLE
SAY PADS ARE DIFFERENT AND THAT
THEY DON'T COUNT AS MUCH BECAUSE
THEY ARE PREFERENCES. AND THAT'S
ACTUALLY NOT FULLY ACCURATE. A
PAD CONTAINS INSTRUCTIONS JUST
LIKE ANY OTHER ADVANCE
DIRECTIVE, AND IN THEIR SIMPLEST
DESCRIPTION, THÀNH. THESE
INSTRUCTIONS TELL A HEALTH CARE
PROVIDER. PLEASE FOLLOW MY
PREFERENCES WHENEVER POSSIBLE.
ALL IF PADS DON'T HAVE THE SAME
LEGITIMACY AS ANY OTHER, ADVANCE
HEALTH DIRECTIVE, WHAT'S GOING
TO MAKE A HEALTH CARE PROVIDER
PAY ATTENTION TO THEM? THANK YOU
. GOOD AFTERNOON, CHAIR AND
COMMITTEE MEMBERS KAREN VICARI,
MENTAL HEALTH AMERICA OF
CALIFORNIA, ALSO PROUD
CO-SPONSORS LAST YEAR OF
PSYCHIATRIC ADVANCE DIRECTIVES
LEGISLATION, I WANT TO THANK THE
COMMITTEE, THE COMMITTEE STAFF,
THE AUTHOR AND THE SPONSORS FOR
WORKING WITH US TO ADDRESS OUR
CONCERNS. IN ADDITION TO THE
CONCERNS MENTIONED BY DISABILITY
RIGHTS, WE ALSO BELIEVE THAT AB
2352 MUST ACCOUNT FOR A BROAD
RANGE OF PAD SOURCES, NOT JUST
THE INNOVATION PROJECTS DIGITAL
PAD, WHILE THE INNOVATION
PROJECTS PAD FORM MIGHT BE
DETAILED, PADS CAN ARISE FROM
MULTIPLE SOURCES AND WILL ARISE
FROM MULTIPLE SOURCES. OUTSIDE
OF THESE COUNTY LED PADS. THUS,
PAD STATUTE SHOULD BE SOMEWHAT
DETAILED. FOR INSTANCE, MOST
STATES WITH PADS LEGISLATION
INCLUDE A FORM WITH SPECIFIC
MENTAL HEALTH DECISIONS. PAD
STATUTES GENERALLY LIST SPECIFIC
INFORMATION COMMONLY INCLUDED IN
A PAD, SUCH AS MEDICATION
PREFERENCES, FACILITY
PREFERENCES, AND PREFERRED MEANS
OF CRISIS INTERVENTION. PAD
STATUTES ALSO GENERALLY ADDRESS
THE ISSUE OF ACCESS, WHERE A PAD
IS STORED, WHO HAS ACCESS TO IT,
AND HOW TO ENSURE IT IS FOUND
WHEN A CRISIS ARISES. ALSO
REGARDING ACCESS, THE BILL IS
SILENT ON LAW ENFORCEMENT. WHAT
DO WE EXPECT LAW ENFORCEMENT TO
DO IN A CRISIS? IF THERE'S A PAD
AND WHICH PARTS DO THEY HAVE
ACCESS TO, ARE THEY REQUIRED TO
FOLLOW THE PADS INSTRUCTIONS?
AND YOU SHOULD YOU LIMIT THE
INFORMATION THAT LAW ENFORCEMENT
HAS ACCESS TO ADDITIONAL AB 2352
DOESN'T ADDRESS WHAT HAPPENS
WHEN A PERSON IS IN CRISIS. THE
TRUE VALUE OF A PAD IS THERE USE
DURING CRISIS WITH A MENTAL
HEALTH CRISIS, THE DETERMINATION
OF CAPACITY IS NOT AS CLEAR AS
WITH A MEDICAL CRISIS, WHEN A
PERSON MAY BE UNCONSCIOUS OR
HEADING INTO SURGERY. A MENTAL
HEALTH CRISIS MAY HAVE TIMES
WHEN THE PERSON HAS CAPACITY TO
MAKE DECISIONS AND TIMES WHEN
THEY DON'T. A B 2352 IS SILENT
ON THE ISSUE OF WHO DETERMINES
INCAPACITY AND HOW THAT
DETERMINATION IS REVERSED WHEN
CAPACITY IS REGAINED. THANK YOU.
THE HEALTH CARE ADVOCATE ROLE
SHOULD BE CLARIFIED. THAT'S OUR
LAST POINT. AND AGAIN I JUST
REALLY WANT TO THANK THE
COMMITTEE FOR THE AMENDMENTS AND
FOR THEIR WORK ON THIS AND THE
SPONSORS AND THE AUTHOR ALSO,
AND THE AUTHOR AT THE COMMITTEE
STAFF. YES. I WANTED TO THANK
THEM, TOO. THANK YOU ALWAYS HAVE
TIME TO BE ABLE TO GIVE A SHOUT
OUTS TO MY AWESOME COMMITTEE
STAFF, THANK YOU, ANY OTHER
OPPOSITION IN THE ROOM? I'LL
BRING IT BACK TO THE COMMITTEE.
I JUST, THANK YOU FOR THIS,
BILL. I KNOW IT'S A COMPLICATED
ISSUE. I WONDER IF YOU CAN JUST
KIND OF RESPOND TO THE
OPPOSITION AND LET US KNOW KIND
OF HOW YOU'RE WORKING WITH THEM
GOING FORWARD, I WILL LET MY
EXPERTS ACTUALLY ADDRESS THAT,
BUT I DO WANT TO SAY THE,
DISABILITY RIGHTS HAS BEEN ON
THE ADVISORY COMMITTEE, FOR THE,
THE PILOT PROGRAM, AND WE HAVE
BEEN MEETING WITH THEM IN BOTH
OF THE COMMITTEES, WE'VE TAKEN A
LOT OF AMENDMENTS, AND THERE'S A
LOT OF BACK AND FORTH. SO WE'VE
ALL BEEN ACTING IN, IN GOOD
FAITH. YES, AND SO I THINK PART
OF THE, THE ASPECT OF THAT IS
THE, THE INNOVATIONS AND WE ARE
REALLY LOOKING AT DOING A SYSTEM
WIDE CHANGE. AND THERE ARE
DEFINITELY SOME NUANCES THAT
HAVE TO BE WORKED THROUGH, ONE
OF THE ASPECTS IS THAT OF A
CRISIS, AND ESPECIALLY WITH LAW
ENFORCEMENT, MY BACKGROUND ALSO
IS IN LAW ENFORCEMENT AND SIT
AND SO KNOWING THAT WE ALSO HAVE
LAW ENFORCEMENT ON OUR COMMITTEE
TELLING US WE DON'T NEED ALL THE
INFORMATION WE WOULD LIKE TO
KNOW WHAT IS MOST PERTINENT IN A
CRISIS IN A, IN A SITUATION
WHERE I CAN HELP DE-ESCALATE A
SITUATION AND SO WE ARE WORKING
WITH LAW ENFORCEMENT AS WELL,
AND IDENTIFYING EXACTLY WHAT
PARAMETERS THEY WOULD NEED. SAME
WITH HEALTH CARE AND HOSPITAL
SETTINGS. AND SO MAKING SURE
THAT THE RIGHT AMOUNT OF DETAILS
GO, PLUS OFFERING FULL CONSENT
FOR THE INDIVIDUAL THAT IS
CREATING THE PAD. SO THEY CAN
EITHER OPT TO NOT PROVIDE
INFORMATION TO LAW ENFORCEMENT
OR HOSPITALS, OR THEY CAN OPT TO
PROVIDE ALL OF IT. SO THOSE ARE
SOME OF THE ADVANTAGES OF THE
DIGITAL ASPECT OF PADS. AND BY
NO MEANS ARE WE WANTING TO TAKE
PADS. AND THE IMPORTANCE OF
MENTAL HEALTH PREFERENCES OUT OF
AN ADVANCED HEALTH CARE
DIRECTIVE. BUT ONE OF THE
MISSING PIECES IN A CRISIS IS
WHAT DO WE DO IN THE MOMENT? HOW
DO WE DE-ESCALATE? HOW DO WE
PREVENT SOMEONE FROM GOING INTO
A HOSPITAL OR INTO OR BEING
INCARCERATED? SO THOSE ARE
REALLY THOSE KEY COMPONENTS THAT
WE'RE LOOKING AT RIGHT NOW AND
WORKING AND WORKING THROUGH WITH
EVERYONE. THANK YOU. ANY OTHER
COMMENTS FROM COMMITTEE NOT
SEEING ANY, I WANT TO THANK THE
AUTHOR FOR BRINGING FORWARD THIS
PIECE OF LEGISLATION. I THINK
YOU'VE HIT INTO A VERY CRITICAL
AREA FOR US TO MAKE SURE THAT WE
GET RIGHT, IN TERMS OF ADVANCED,
CARE DIRECTOR DIRECTIVES,
INCLUDING OUR PSYCHIATRIC
ADVANCED DIRECTIVES AND I KNOW
THAT YOU, HAVE BEEN DILIGENTLY
WORKING WITH OUR COMMITTEE
STAFF, AND I KNOW THAT OUR
COMMITTEE STAFF WILL CONTINUE TO
BE INVOLVED IN, IN MOVING THIS
BILL FORWARD SHOULD THIS BILL
MOVE FORWARD AND, AND WORKING ON
THE AMENDMENTS THAT REALLY, GET
TO THE INTENDED GOAL OF THIS
WITH THAT, WE STILL DO NOT HAVE
A QUORUM, BUT YOU ARE FREE TO
CLOSE. JUST WHEN THE TIME IS
RIGHT, I RESPECTFULLY ASK FOR
YOUR. I VOTE. THANK YOU.
ASSEMBLY MEMBER IRWIN. THANK
YOU. WE WILL MOVE ON TO ASSEMBLY
MEMBER BERMAN. ITEM NUMBER 17,
AB 2668.
PLEASE GO AHEAD. GOOD MORNING.
COLLEAGUES GOOD AFTERNOON
COLLEAGUES. GOOD. WHATEVER IT
IS. COLLEAGUES IN THE FALL, I
MET WITH TWO HIGH SCHOOL
STUDENTS WITH ALOPECIA WHO
SHARED THEIR STORIES ABOUT THE
CRITICAL ROLE THAT WIGS PLAY IN
SELF-ESTEEM AND MENTAL HEALTH.
AND THEY WERE THE INSPIRATION
FOR AB 2668. THE LACK OF HEALTH
INSURANCE COVERAGE FOR WIGS
MEANS THAT CALIFORNIANS WITH
MEDICAL HAIR LOSS ARE FORCED TO
PAY OUT OF THEIR OWN POCKET. THE
COST OF WIGS DEPENDS ON A NUMBER
OF FACTORS, INCLUDING LENGTH AND
THE AVERAGE COST IN THIS SHOCKED
ME. THE AVERAGE COST IS
APPROXIMATELY $1,500. IF
PATIENTS CANNOT AFFORD THIS
COST, THEN THEY DO NOT HAVE
ACCESS TO A WIG AND THE BENEFITS
IT PROVIDES IS TO REMOVE THIS
BARRIER. AB 2668 WOULD PROVIDE
COVERAGE FOR A WIG FOR
CALIFORNIANS EXPERIENCING
PERMANENT OR TEMPORARY MEDICAL
HAIR LOSS DUE TO ALOPECIA,
CHEMOTHERAPY, OR OTHER HEALTH
CONDITIONS. IMPORTANTLY, THIS
BILL INCLUDES PARAMETERS WHICH
REQUIRE A LICENSED PROVIDER TO
PRESCRIBE TO PRESCRIBE A WIG FOR
TREATMENT, LIMIT COVERAGE TO NO
MORE THAN ONE WIG IN A YEAR, AND
CAP THE AMOUNT OF COVERAGE FOR A
WIG TO $750. I RESPECTFULLY ASK
FOR YOUR AYE VOTE, AND I AM
HONORED TO BE JOINED BY WENDY
PETKA, PARENT OF ONE OF THE HIGH
SCHOOL STUDENTS WHO CONVINCED ME
TO AUTHOR THIS BILL AND ADRIANA
ZHANG, REPRESENTING CALIFORNIA
ADVOCATES FOR ALOPECIA. THANKS.
YOU'LL EACH HAVE TWO MINUTES
AND. YEP, YOU GOT IT. GOOD
AFTERNOON, MADAM CHAIR.
COMMITTEE MEMBERS AND SUPPORTIVE
STAFF, MY NAME IS WENDY PETKA,
AND I'M HERE TODAY IN PLACE OF
MY 17 YEAR OLD DAUGHTER, MIRANDA
HUANG, WHO WANTED VERY MUCH TO
BE HERE HERSELF TO TELL YOU HER
STORY. BUT AS YOU CAN
APPRECIATE, SHE'S A SENIOR IN
HIGH SCHOOL AND OUR, OUR
EDUCATION DOESN'T LET UP. EVEN
THOUGH THEY'RE SENIORS. WE HAVE
GOOD SCHOOLS, THIS IS HER
MESSAGE, AND I'M GOING TO READ
IT TO YOU. I WAS DIAGNOSED WITH
PATCHY ALOPECIA AREATA AT AGE
11, IN SIXTH GRADE. AND EVEN
THEN, I DIDN'T TRULY UNDERSTAND
THE SCOPE OF MY CONDITION OR THE
FACT THAT THERE WAS NO REAL
TREATMENT FOR IT. TO ME, ALL
ALOPECIA MEANT WAS THAT MY
FRIENDS COULDN'T BRAID MY HAIR
ANYMORE IN CLASS BECAUSE THEY
THEY'D SEE MY BALD SPOTS FOR
BACKGROUND, ALOPECIA AREATA IS
AN AUTOIMMUNE DISEASE THAT
ENCOMPASSES DIFFERENT LEVELS OF
HAIR LOSS, RANGING FROM COIN
SIZE PATCHES THAT I HAVE TO
COMPLETE, HAIR LOSS ACROSS THE
BODY. GIVEN THAT I WAS DIAGNOSED
AT SUCH A YOUNG AGE, MY
CONFIDENCE QUICKLY PLUMMETED AND
AS I BEGAN MIDDLE SCHOOL, WHICH
AS WE ALL KNOW, IS A HORRIBLE
TIME, AND I HATED SEEING MYSELF
IN ANY PHOTOS. AND I NEVER TRULY
EMBRACED DISCUSSING MY CONDITION
WITH MY PEERS. EVEN NOW, I HAVE
COME TO REALIZE THAT HAIR IS
NEVER JUST HAIR. IT IS IMPORTANT
THAT WE WEAR IT LIKE CLOTHES. IT
IS PART OF OUR IDENTITY AND WHEN
IT IS TAKEN FROM US, PEOPLE
CAN'T IGNORE IT. INSTEAD, THEY
USE IT AS A LABEL AND IT HURTS
AND CONSUMES US. ASSEMBLY
MEMBERS. THE MENTAL HEALTH COST
TO YOUNG PEOPLE WITH THIS
DISEASE IS VERY REAL. I CAN
ATTEST THIS TO THIS PERSONALLY,
AS HER MOM. THIS IS WHY MIRANDA
AND I KINDLY ASK YOU TO SUPPORT
AB 2668. THANK YOU FOR YOUR TIME
. THANK YOU. YOU'LL HAVE TWO
MINUTES. GOOD AFTERNOON. MY NAME
IS ADRIANA ZHANG. I AM A CURRENT
SOPHOMORE AT STANFORD
UNIVERSITY, BUT I AM HERE
PROUDLY REPRESENTING THE
CALIFORNIA ADVOCATES FOR
ALOPECIA Ã, CO-SPONSOR OF AB
2668. FOR YEARS AGO, MY SISTER
KNOCKED ON MY BEDROOM DOOR AT 6
A.M. IN THE MORNING, ASKING FOR
ME TO BRAID HER HAIR. AND
ADMITTEDLY, I LOOKED AT HER
REALLY CONFUSED BECAUSE I WAS
DIAGNOSED WITH ALOPECIA AREATA
SINCE I WAS TEN YEARS OLD, I
COMPLETELY LOST MY HAIR AND MY
EYEBROWS TWO SEPARATE TIMES IN
THE PAST NINE YEARS, AND AFTER
SOME YOUTUBE VIDEOS AND AFTER
PRACTICING ON HER, I EVENTUALLY
PROBLEM SOLVED. AND I BRING THAT
SAME PROBLEM SOLVING HERE AND
WHY I'M IN FRONT OF YOU ALL
TODAY. THE WIGS GAVE ME THE
CONFIDENCE TO GET THROUGH MIDDLE
SCHOOL, TO GET OUT OF MY HOUSE
AND BE ABLE TO TALK TO PEOPLE
WITHOUT FEELING JUDGED. HOWEVER,
THE COST OF WIGS, AS YOU'VE
PREVIOUSLY HEARD, IS A LARGE
BARRIER, ESPECIALLY FOR PATIENTS
WHERE Ã MEDICATIONS DON'T WORK.
IT'S IMPORTANT FOR THEM TO HAVE
ACCESS TO A WIG, AND IT PLAYS A
CRUCIAL ROLE IN THEIR ROLE IN
THEIR MENTAL HEALTH. THE COST OF
WIGS ARE REALLY HIGH, BUT I
BELIEVE THAT ALL PEOPLE DESERVE
TO EXPRESS THEIR IDENTITY AND
CULTURE, REGARDLESS OF THEIR
FINANCIAL STATUS. COMPARED TO
CURRENTLY AVAILABLE MEDICATIONS,
WIGS ARE REALISTICALLY THE MOST
AFFORDABLE OPTIONS FOR BOTH
PATIENTS AND INSURERS, SO I KNOW
YOU ALL ARE PROBLEM SOLVERS HERE
TODAY REGARDING MENTAL HEALTH
ISSUES TO FINANCIAL EQUITY AND
DODD, I RESPECTFULLY URGE YOU TO
JOIN EIGHT OTHER STATES IN THE
UNITED STATES IN SUPPORTING 2668
WIG ACCESS LEGISLATION. THANK
YOU, THANK YOU. ANY OTHER
WITNESSES IN SUPPORT? FAITH
FORGES ON BEHALF OF THE
CALIFORNIA AGENTS AND HEALTH
INSURANCE PROFESSIONALS, AND
SUPPORT. THANK YOU, MADAM CHAIR.
MEMBERS. DON SHINSKY ON BEHALF
OF THE CALIFORNIA SOCIETY OF
DERMATOLOGY AND DERMATOLOGIC
SURGERY IN SUPPORT. MADAM CHAIR
MEMBERS, AUTUMN OGDEN SMITH WITH
THE AMERICAN CANCER SOCIETY
CANCER ACTION NETWORK IN STRONG
SUPPORT. THANK YOU, THANK YOU.
ANY WITNESSES IN OPPOSITION IN
.
GOOD AFTERNOON, CHAIR. MEMBERS
OF THE COMMITTEE, ROBERT BOYKIN
WITH THE CALIFORNIA ASSOCIATION
OF HEALTH PLANS. REGRETTABLY, IN
OPPOSITION TO AB 2668. FIRST, I
WOULD LIKE TO THANK THE AUTHOR
AND HER OFFICE FOR THE OPENING
DIALOG REGARDING THIS TOPIC, WE
UNDERSTAND AND RESPECT THE
AUTHOR'S INTENT WITH THE BILL.
HOWEVER, WE ARE OPPOSED DUE TO
THE COST ASSOCIATED WITH THE
MANDATE. ACCORDING TO THE
CALIFORNIA HEALTH BENEFITS
REVIEW PROGRAM, THIS BILL WILL
INCREASE ANNUAL PREMIUMS BY 29.5
MILLION FOR ALL CALIFORNIANS. IT
ALSO EXCEEDS THE ESSENTIAL
HEALTH BENEFITS, LEAVING THE
STATE ON THE HOOK FOR THE
DEFRAYED COST. AS NOTED IN THE
ANALYSIS, THE CHAIR'S ASSEMBLY
BILL 2914 AND SENATE BILL 1290,
INTRODUCED THIS YEAR, CONVEYS
THE LEGISLATURE'S INTENT TO
REVIEW THE CALIFORNIA'S HB
BENCHMARK PLAN AND ESTABLISH A
NEW BENCHMARK PLAN FOR THE 2027
PLAN YEAR. WHILE WE LOOK FORWARD
TO SEEING THAT PROCESS AND OPEN
DIALOG TAKE PLACE IN THE INTERIM
, WE FEEL THAT ANY NEW MANDATE
SHOULD BE HELD FOR THE POSSIBLE
INCLUSION OF A NEW BENCHMARK
PLAN. FOR THE REASONS STATED, WE
RESPECTFULLY ASK FOR A NO VOTE.
THANK YOU FOR YOUR TIME TODAY.
THANK YOU. ANY OTHER WITNESSES
IN OPPOSITION? STEPHANIE
WATKINS, ON BEHALF OF THE
ASSOCIATION OF CALIFORNIA LIFE
INSURANCE COMPANIES, ALSO IN
OPPOSITION. THANK YOU. JACKIE
ONIS, ON BEHALF OF AMERICA'S
HEALTH INSURANCE PLANS,
RESPECTFULLY OPPOSED SEEING NO
OTHER OPPOSITION. I'LL BRING IT
BACK TO COMMITTEE. GO AHEAD. THE
WITNESSES, THANK YOU SO MUCH FOR
YOUR ADVOCACY AND TESTIMONY. THE
AUTHOR, THANK YOU SO MUCH FOR
YOUR ADVOCACY, AND I'D LOVE TO
BE ADDED AS A COAUTHOR. THANK
YOU VERY MUCH. APPRECIATE THAT.
MR. BERMAN, I WANT TO THANK YOU
FOR BRINGING FORWARD THIS BILL
AND, QUITE FRANKLY, FOR HEARING
THE CALL FROM TWO HIGH SCHOOL
STUDENTS THAT BROUGHT THIS TO
YOUR ATTENTION. AND THANK YOU
FOR REPRESENTING YOUR HIGH
SCHOOLER. AND HOPEFULLY SHE'S
GOING TO DO WELL IN HER STUDIES.
IN HER SENIOR YEAR. AND THANK
YOU FOR NOT HAVING SENIORITIS,
BUT REALLY WANT TO APPRECIATE
YOU ALL SHARING YOUR STORIES.
AND ALSO THE SOLUTION THAT WOULD
HELP TO ADDRESS NOT ONLY THE,
PHYSICAL TREATMENTS, BUT ALSO
THE MENTAL HEALTH CONCERNS
RELATED TO DEALING AND
ADDRESSING ALOPECIA. SO WITH
THAT, WITH THAT, WE, I WILL BE
RECOMMENDING AN I VOTE FOR THIS
TO MOVE OUT OF COMMITTEE. MR.
BERMAN, WOULD YOU LIKE TO CLOSE?
YOU ARE BOTH. DO YOU HAVE
SOMETHING TO SAY? YES REAL
QUICK. OH. GO AHEAD. I WANTED TO
BE ADDED ON AS A COAUTHOR, AS
SOMEONE WHO'S HAD ALOPECIA
AREATA. I GOING TO SUPPORT IT
TODAY AND WOULD LIKE TO BE ADDED
AS A COAUTHOR. THANK YOU SIR.
APPRECIATE THAT. APOLOGIES. I
THOUGHT YOU WERE POINTING AT
THEM AND THEN THEY WERE SAYING
NO POINTING. I JUST, THANK YOU
SO MUCH, MR. BERMAN IS CLOSE.
WHEN THE TIME COMES,
RESPECTFULLY ASK FOR I VOTE.
REALLY APPRECIATE IT. THANKS.
THANK YOU SO MUCH. WE WILL MOVE
ON TO THE NEXT ITEM. ALL RIGHT.
GOOD LUCK TODAY. THANK YOU, WE
ARE STILL OPERATING IN A FILE
ITEM ORDER BEFORE OUR SPECIAL
ORDER OF BUSINESS, WHICH WILL
BEGIN AS CLOSE TO THREE AS
POSSIBLE. THAT BEING SAID, ITEM
NUMBER 14, AB 2574 VALENCIA.
THANK YOU, MADAM CHAIR. I WILL
BE BRIEF TO HOPEFULLY MAYBE
SQUEEZE IN ONE MORE BEFORE 3:00,
IF POSSIBLE. WHEN I STARTED AND
MADAM CHAIR AND MEMBERS, I'D
LIKE TO START BY THANKING THE
CHAIR AND HER TEAM FOR
DILIGENTLY WORKING ON AB 2574
AND ACKNOWLEDGE MY LEGISLATIVE
ASSISTANT, KATIE GUTHRIE, FOR
HER WORK ON THIS BILL. I'LL BE
ACCEPTING THE COMMITTEE
AMENDMENTS. AB 2574 WILL REQUIRE
EACH ORGANIZATION THAT OPERATES,
CONDUCTS, OWNS, OR MAINTAINS A
CERTIFIED PROGRAM OR A LICENSED
FACILITY TO DISCLOSE TO THE
DEPARTMENT OF HEALTH CARE
SERVICES WHETHER A LICENSEE,
GENERAL PARTNER, DIRECTOR, OR
OFFICER OF THE LICENSEE OWNS A
RECOVERY RESIDENCE, HAS A
FINANCIAL INTEREST IN THAT
RECOVERY RESIDENCE, OR HAS A
CONTRACTUAL RELATIONSHIP WITH A
NON CERTIFIED OR NON LICENSED
ENTITY THAT PROVIDES
PROFESSIONAL SERVICES, ADDICTION
TREATMENT OR RECOVERY SERVICES
TO THE CLIENTS OF CERTIFIED
PROGRAMS. A LOT OF INFORMATION,
BUT IT NEEDED TO BE STATED. THIS
BILL WILL ALLOW DCS THE
AUTHORITY TO SUSPEND OR REVOKE
THE CERTIFICATION OF A PROGRAM,
OR A LICENSE OF A FACILITY FOR
FAILING TO DISCLOSE THIS
REQUIRED INFORMATION. AB 2540
SEVEN'S GOAL IS TO PROVIDE A
GREATER UNDERSTANDING OF THE
FINANCIAL RELATIONSHIPS THAT
LICENSE TREATMENT FACILITIES AND
CERTIFIED PROGRAMS HAVE WITH THE
RECOVERY RESIDENCES WITHIN OUR
COMMUNITIES. ACCORDING TO THE
CALIFORNIA HUMAN AND HEALTH
SERVICES DATA, THERE ARE 1801
LICENSED ALCOHOLISM AND DRUG
TREATMENT FACILITIES STATEWIDE,
AND MANY OF THESE FACILITIES ARE
CONCENTRATED IN SOUTHERN
CALIFORNIA, WITH 331 RESIDING
WITHIN ORANGE COUNTY. THE
DISCLOSURE OF THIS INFORMATION
WILL ALLOW THE DEPARTMENT TO
PROVIDE EFFECTIVE OVERSIGHT AND
TO TAKE ACTION AGAINST BAD
ACTORS. WITH ME TO PROVIDE
TESTIMONY IS A COUNCIL MEMBER
FROM ONE OF THE CITIES I
REPRESENT, MR. DAVID PENALOSA
FROM THE CITY OF SANTA ANA, AND
THEN CAROLYN GRINDER FROM THE
LEAGUE OF CALIFORNIA CITIES,
WHO'S A SPONSOR OF THE BILL.
YOU'LL EACH HAVE TWO MINUTES.
PLEASE GO AHEAD. THANK YOU,
MADAM CHAIR. GOOD AFTERNOON,
HONORABLE CHAIR BONTA AND
MEMBERS OF THE COMMITTEE. MY
NAME IS DAVID PENALOSA, AND I
SERVE AS THE COUNCIL MEMBER IN
THE CITY OF SANTA ANA, AS WELL
AS THE SECOND VICE PRESIDENT OF
THE LEAGUE OF CALIFORNIA CITIES
ORANGE COUNTY DIVISION. I AM
HERE TO SPEAK IN SUPPORT OF AB
257 FOR SANTA ANA, AS WELL AS
MANY OTHER CITIES IN ORANGE
COUNTY, IS HOME TO MANY RECOVERY
RESIDENCES. MOST OF THESE
FACILITIES ARE LOCATED WITHIN
RESIDENTIAL NEIGHBORHOODS, AS
OPPOSED TO AREAS OF THE CITY
WHERE CONCENTRATIONS OF MEDICAL
FACILITIES OR OTHER SUPPORTIVE
SERVICES. THE CITY UNDERSTANDS
THAT RECOVERY RESIDENCES DOES
PROVIDE A WIDE RANGE OF BENEFITS
TO RESIDENTS THAT ARE RECOVERING
FROM ADDICTION. UNFORTUNATELY,
THERE ARE INSTANCES WHEN
UNLICENSED FACILITIES ARE
OPERATING UNDER THE RADAR AS A
RECOVERY RESIDENCE. WHILE THE
STATE LAW REQUIRES THE
DEPARTMENT OF HEALTH CARE
SERVICES TO LICENSE AND REGULATE
DRUG ABUSE, RECOVERY AND
TREATMENT FACILITIES, IT DOES
NOT REQUIRE A DCS TO LICENSE
RECOVERY RESIDENCES WITHOUT THE
LICENSING OF THESE FACILITIES,
IT IS IMPOSSIBLE FOR STATE CITY
AND LOCAL MUNICIPALITIES TO
TRACK WHERE THESE FACILITIES ARE
LOCATED. THE CONDITION OF THE
FACILITIES OR COMPLAINTS
ASSOCIATED WITH THE FACILITIES.
ADDITIONALLY THE DEPARTMENT
LACKS DATA ON THE FINANCIAL
RELATIONSHIPS A RECOVERY
RESIDENCE HAS WITH THE LICENSED
TREATMENT FACILITY OR CERTIFIED
PROGRAMS. THIS BILL WILL HELP
THE HCS DCS PROVIDE BETTER
OVERSIGHT AND THE ABILITY TO
INVESTIGATE THESE FINANCIAL
RELATIONSHIPS BETWEEN THE
RECOVERY RESIDENCES, TREATMENT
FACILITIES, AND CERTIFIED
PROGRAMS. IT IS FOR THESE
REASONS THAT I, ON BEHALF OF THE
CITY OF SANTA ANA, IS IN SUPPORT
OF AB 2574. I ENCOURAGE THE
COMMITTEE TO APPROVE THIS
MEASURE. THANK YOU SO MUCH FOR
YOUR TIME. THANK YOU. TWO
MINUTES. GOOD AFTERNOON, CHAIR
AND MEMBERS. MY NAME IS CAROLINE
GRINDER AND I'M HERE ON BEHALF
OF THE LEAGUE OF CALIFORNIA
CITIES, WHICH IS PROUD TO
SPONSOR AB 2574 RESIDENTIAL
RECOVERY HOUSING PROVIDES A
RANGE OF BENEFITS TO SOME OF
CALIFORNIA'S MOST VULNERABLE
RESIDENTS, AND IT'S CRITICAL
THAT THEIR NEEDS ARE PRIORITIZED
OVER PROFITS. THAT'S WHY
COMPLIANCE WITH STATE LICENSING
LAWS ADMINISTERED THROUGH THE
DEPARTMENT OF HEALTH CARE
SERVICES IS ESSENTIAL TO
SAFEGUARDING RESIDENTS
WELL-BEING AND MAINTAINING
QUALITY CARE. HOWEVER, FOR TOO
LONG, CITIES HAVE STRUGGLED TO
WORK WITH THE DEPARTMENT TO
ENSURE THAT BAD ACTORS ARE
OPERATING IN THEIR COMMUNITIES.
ARE HELD ACCOUNTABLE, WHICH HAS
BEEN TO THE DETRIMENT OF THOSE
RECEIVING CARE AND THE BROADER
COMMUNITY. WE BELIEVE AB 2574 IS
A STEP FORWARD IN ADDRESSING
CASES IN WHICH LICENSED
FACILITIES PROVIDE SERVICES TO
THE RESIDENTS OF A SOBER LIVING
HOME, BUT THE SOBER LIVING HOME
IS NOT INCLUDED WITHIN THE
FACILITIES. LICENSURE. SIMPLY
PUT, IF RESIDENTS OF AN
UNLICENSED, SOBER LIVING HOME
ARE RECEIVING NONMEDICAL
SERVICES FROM A LICENSED
FACILITY, THEN THE SOBER LIVING
HOME IS AN INTEGRAL PART OF THAT
FACILITY AND SHOULD BE REGULATED
BY THE STATE UNDER THE
FACILITIES LICENSE. THIS WILL
HELP ENSURE THAT A RECOVERY
RESIDENCE THAT'S OPERATED AS A
BUSINESS WITH A LICENSED
TREATMENT FACILITY IS REGULATED,
LIKE BUSINESSES AND NOT
RESIDENTIAL HOMES, AS A NUMBER
OF DRUG AND ALCOHOL TREATMENT
FACILITIES CONTINUES TO RISE IN
RESPONSE TO THE STATE SUBSTANCE
USE CRISIS, THE DEPARTMENT FACES
A MAJOR HURDLE IN MONITORING AND
REGULATING THESE FACILITIES.
WITH BILLIONS IN THE PIPELINE
FOR THE BEHAVIORAL HEALTH
HOUSING ACROSS THE STATE NOW
MORE THAN EVER, WE NEED TO
REEXAMINE THE OVERSIGHT OF THESE
FACILITIES AND ENSURE THAT THOSE
RECEIVING CARE AND THE
SURROUNDING COMMUNITIES ARE SET
UP FOR SUCCESS. OVER THE LAST
DECADE, CAL CITIES HAS SPONSORED
SEVERAL LEGISLATIVE ATTEMPTS TO
ADDRESS CONCERNS RAISED BY
CITIES RELATED TO TRANS AGENCY
AND ACCOUNTABILITY FOR THESE
FACILITIES. WE'RE CONTINUING TO
FOCUS ON ENACTING LEGISLATIVE
SOLUTIONS THAT SAFEGUARD EVERY
PERSON'S WELL-BEING AND CARE. WE
BELIEVE THE TRANSPARENCY
PROVIDED BY AB 2574 IS A STEP IN
THE RIGHT DIRECTION TO ENSURING
SOBER LIVING HOMES THAT ARE
PROVIDING SERVICES AND SHOULD BE
LICENSED ARE ON THE DEPARTMENT'S
RADAR SO THAT WE CAN ENSURE
SWIFT ACTION. FOR THOSE REASONS,
WE BELIEVE AB 2574 WILL HELP
MEET OUR SHARED GOALS OF
ENSURING RECOVERY HOUSING MEETS
STANDARDS FOR PATIENTS CARE AND
WHICH IS CENTRAL TO THE
EFFECTIVE TREATMENT OUTCOMES AND
COMMUNITY WELL-BEING THAT WE'RE
ALL HOPING FOR. WE THANK THE
COMMITTEE FOR ALL THE WORK ON
THE AMENDMENTS, AND WE URGE THE
COMMITTEE TO PASS THIS
LEGISLATION. THANK YOU SO MUCH.
THANK YOU. ANY ADDITIONAL
WITNESSES IN SUPPORT? SEEING
NONE, WE'LL BRING FORWARD ANY
WITNESSES IN OPPOSITION. SEEING
NONE BACK TO THE COMMITTEE. WITH
THAT, MISTER VALENCIA, THANK YOU
SO MUCH FOR BRINGING THIS BILL
FORWARD AND FOR YOUR WORK WITH
MY COMMITTEE ON AMENDMENTS TO
ADDRESS OUR CONCERNS. I THINK
WE'VE STRUCK AN APPROPRIATE
BALANCE OF BOLSTERING OVERSIGHT
AND ENFORCEMENT WITHOUT ERECTING
BARRIERS TO THIS TYPE OF HOUSING
THAT IS SO INCREDIBLY CRUCIAL
FOR OUR CONTINUUM OF SUBSTANCE
USE DISORDER CARE. I KNOW THAT
YOU'LL CONTINUE TO WORK ON THIS
BILL AS WE MOVE FORWARD WITH
THAT. WOULD YOU LIKE TO CLOSE?
ABSOLUTELY. THANK YOU, MADAM
CHAIR, ENSURING THAT FOLKS ARE
RECEIVING THE HEALTH CARE
NECESSARY IS AT THE CORE OF THIS
BILL. AND HAPPY TO CONTINUE
THOSE CONVERSATIONS. I WOULD
LIKE TO NOTE THAT WITH THE
AMENDMENTS THAT WE ACCEPTED, THE
CALIFORNIA REALTORS ASSOCIATION
IS ALSO REMOVING THEIR
OPPOSITION OAN. WITH THAT, IN
CLOSING, I APPRECIATE YOUR TIME
AND RESPECTFULLY ASK FOR A YES
VOTE. THANK YOU, THANK YOU. WHEN
WE ESTABLISH QUORUM, WE WILL
MOVE THAT THROUGH. I'M GOING TO,
I KNOW THAT MR. ZUBIATE HAS A
VERY, QUICK BILL. I'M GOING TO
SQUEEZE IT IN, BEFORE WE MOVE TO
SPECIAL ORDER. AB 2613, ITEM
NUMBER 15.
PLEASE GO AHEAD WHENEVER YOU'RE
READY, MR. ZUBIATE. THANK YOU,
MADAM CHAIR. VERY APPRECIATIVE
OF YOU SQUEEZING US IN, I'M THE
PROUD AUTHOR OF AB 2613, A BILL
THAT CREATES A RARE DISEASE
ADVISORY COUNCIL IN CALIFORNIA,
OTHERWISE KNOWN AS DAC. THE DAC
IS CREATED IN THE MEMORY OF
JACQUELINE MARYSBURG, MY SISTER,
WHO ENDURED A THREE YEAR BATTLE
WITH ALS, ALSO KNOWN AS LOU
GEHRIG'S DISEASE, AND FRANKLY,
INSPIRED ME TO SEEK PUBLIC
OFFICE IN PART TO ADDRESS THE
SIGNIFICANT CHALLENGES PEOPLE
GRAPPLING WITH A WITH RARE
DISEASES ARE EXPERIENCING, AS
WELL AS PEOPLE GRAPPLING WITH A
BROKEN SOCIAL SAFETY NET. WITH
OVER 10,000 RARE DISEASES
AFFECTING 1 IN 10 CALIFORNIANS,
IT'S DIFFICULT FOR STATE POLICY
MAKERS AND GOVERNMENT OFFICIALS
TO HAVE AN IN-DEPTH
UNDERSTANDING OF THE ISSUES
FACED BY PERSONS AFFECTED BY
RARE DISEASES AND THE RESOURCES
NEEDED TO SUPPORT THEM. THE DAC
WILL BE COMPRISED OF
STAKEHOLDERS ACROSS THE RARE
DISEASE COMMUNITY, AND WILL ACT
AS AN ADVISORY BODY TO THE
LEGISLATURE, FACILITATING
CONSULTATION WITH EXPERTS ON
RARE DISEASES AND IN DEVELOPING
POLICY RECOMMENDATIONS WITH
DIVERSE MEMBERSHIP AND BROAD
COMMUNITY SUPPORT, A CALIFORNIA
DAC WILL SERVE AS A VALUABLE
RESOURCE AS OUR HEALTH CARE
SYSTEM EVOLVES WITHOUT AN DAC.
CALIFORNIA LAWS AND REGULATIONS
THAT AFFECT THE RARE DISEASE
COMMUNITY WILL BE DEVELOPED
WITHOUT CONSULTATION OF IMPACTED
STAKEHOLDERS, LEAVING THIS
VULNERABLE POPULATION AT GREATER
RISK OF POOR HEALTH AND PUBLIC
POLICY OUTCOMES. THE CREATION OF
THIS DAC WILL HAVE A FISCAL
IMPACT, AND I'M WORKING WITH
STAKEHOLDERS TO FIND
ALTERNATIVES TO STATE FUNDING TO
ALLEVIATE THIS ISSUE.
SPECIFICALLY, I'M IN THE PROCESS
OF CONVERSATIONS WITH UCLA, WHO
HAS A RARE DISEASE CENTER OF
EXCELLENCE. THE CENTER OFFERS
WORLD CLASS DOCTORS IN ALL MAJOR
SPECIALTIES AND BRINGS TOGETHER
MEDICAL TEAMS EXPERIENCING
EXPERIENCE IN DIAGNOSING AND
TREATING A VARIETY DISEASE OF
RARE, WIDE RANGE OF RARE
DISEASES AND IS INTERESTED
POTENTIALLY IN HOSTING THIS.
THIS ENDEAVOR, A STRONG DAC CAN
ALSO HELP RELIEVE BURDENS ON THE
STATE BY EXPEDITIOUSLY
DELIVERING DIRECT FEEDBACK
SOLUTIONS AND RESOURCES TO
POLICY MAKERS WITH ONE COMMUNITY
VOICE, I APPRECIATE THE
COMMITTEE'S ANALYSIS OF THE
BILL, AND I AGREE TO ACCEPT THE
COMMITTEE'S AMENDMENTS
CLARIFYING LANGUAGE RELATED TO
THE APPOINTMENT OF A SECRETARY
TO THE DAC. YOU KNOW, MY SISTER
IN THE FINAL, MONTHS AND YEAR OF
HER LIFE WOULD OFTEN CALL ME AT
THE END OF THE DAY. JUST AT A
LOSS AT, YOU KNOW, SHE'D SPEND
ALL DAY ON THE PHONE TRYING TO
FIGURE OUT HOW TO MEET SORT OF
HER NEEDS, AND ALWAYS WONDERED
WHY OUR SOCIAL SAFETY NET WAS SO
BROKEN, WHY PEOPLE WITH RARE
DISEASES WERE LEFT OUT, WHY SHE
WOULD HAVE TO, YOU KNOW, SHE WAS
IN A WHEELCHAIR, WAS HOUSEBOUND
AND COULD NOT GET OUT OF THE
HOUSE WITHOUT WITHOUT HELP AND A
VAN THAT ALLOWED HER TO GET OUT.
YOU KNOW, BECAUSE OF ALL THAT.
AND SHE, AND, YOU KNOW, WE HAD
SOCIAL SERVICE PROGRAMS WHERE
SHE WOULD LITERALLY HAVE TO GO
IN AND WAIT IN LINE AND SPEND
ALL DAY TO GET TO GET SERVICES
THAT SHE NEEDED, YOU KNOW, ONE
OF THE LAST THINGS SHE ASKED ME
BEFORE, PROBABLY ABOUT SIX
MONTHS, IS SHE BASICALLY SAID,
YOU KNOW, RICK, I HOPE THAT YOU
WILL RUN FOR OFFICE AND REALLY
FOCUS ON PEOPLE WITH RARE
DISEASES AND PEOPLE THAT NEED
HELP AND ARE EXPERIENCING JUST
CHALLENGES WITH OUR BROKEN
SOCIAL SAFETY NET, SO, YOU KNOW,
JUST AS MY SISTER KNEW THAT HER
EFFORTS WOULD, YOU KNOW, NOT
BENEFIT HER. YOU KNOW, HER
EXPERIENCES, A SIREN ALERTING US
TO THE DEEPLY FLAWED PUBLIC
POLICY APPROACH TO ADDRESSING
RARE DISEASES, YOU KNOW, RARE
DISEASES ARE RARE. SO PEOPLE
HAVE VERY FEW OPPORTUNITIES TO
SORT OF BE AT THE TABLE IN
PUBLIC POLICY IS MADE WITHOUT
THEM. AND THIS, THIS COUNCIL
WILL PARTIALLY ALLEVIATE THAT, I
KNOW I RESPECTFULLY ASK FOR YOUR
AYE VOTE WHEN THE TIME COMES.
AND WITH ME TODAY I HAVE LINDSAY
VIZCARRA, WHO'S THE STATE
PUBLIC, THE STATE POLICY MANAGER
OF THE NATIONAL ORGANIZATION FOR
RARE DISORDERS, SPONSOR OF THE
BILL. AND MICHAEL, WHO THE
PATIENT ADVOCATE, PROVIDE
ADDITIONAL INFORMATION TO ASSIST
WITH QUESTIONS. MADAM CHAIR AND
MEMBERS, MY NAME IS LINDSAY
VIZCARRA, AND I'M THE STATE
POLICY MANAGER AT THE NATIONAL
ORGANIZATION FOR RARE DISORDERS,
OR NORD. I'M ALSO A RESIDENT OF
CALIFORNIA. I LIVE UP IN CHICO
AND I'M A RARE DISEASE PARENT
MYSELF. TWO OF MY THREE CHILDREN
HAVE RARE DISEASES. I'M SO
PLEASED TO BE HERE TODAY IN
SUPPORT OF AB 2613, WHICH WOULD
HELP ESTABLISH A RARE DISEASE
ADVISORY COUNCIL, OR DAC, IN
CALIFORNIA. FOR THOSE NOT
FAMILIAR WITH NORD, WE'RE THE
LEADING INDEPENDENT ADVOCACY
ORGANIZATION IN THE UNITED
STATES, REPRESENTING THE MORE
THAN 30 MILLION PEOPLE LIVING
WITH ONE OF OVER 10,000 RARE
DISEASES IN THE UNITED STATES. A
RARE DISEASE IS DEFINED AS ANY
CONDITION THAT AFFECTS FEWER
THAN 200,000 PEOPLE. DOCS VARY
IN IN COMPOSITION IN SIZE, IN
HOUSING AGENCY AND DUTIES, BUT
THEY ALL HAVE THE COMMON GOAL OF
GIVING RARE DISEASE PATIENTS AND
THEIR FAMILIES A UNIFIED VOICE
IN STATE GOVERNMENT. WITH AN
ESTIMATED 1 IN 10 AMERICANS
LIVING WITH A RARE DISEASE, IT'S
CRITICAL THAT EVERY HEALTH
POLICY DISCUSSION THE RARE
DISEASE COMMUNITY'S UNIQUE
PERSPECTIVE CAN BE CONSIDERED A
RARE DISEASE. PATIENTS FACE
UNIQUE CHALLENGES EVERY DAY,
FROM OBTAINING AN ACCURATE
DIAGNOSIS AND ACCESSING AND
ACCESSING MEDICAL SPECIALISTS
WITH KNOWLEDGE OF THEIR
CONDITION, TO BATTLING FOR FAIR
INSURANCE COVERAGE OF THEIR
TREATMENT AND CARE. I KNOW THAT
ONE FIRSTHAND. CALIFORNIA'S DAC
WOULD HELP ADDRESS THESE ISSUES
BY PROVIDING A FORUM FOR
STAKEHOLDERS ACROSS THE RARE
DISEASE COMMUNITY KNOWLEDGEABLE
ABOUT THE NEEDS OF RARE DISEASE
PATIENTS, AND TO HELP THEM TO
MAKE RECOMMENDATIONS TO YOU TO
HELP THE RARE DISEASE COMMUNITY.
IN ADDITION TO SERVING THE RARE
DISEASE COMMUNITY, THE DAC WILL
HELP RELIEVE SOME OF THE FISCAL
BURDEN ON THE STATE BY
EXPEDITIOUSLY DELIVERING DIRECT
FEEDBACK, SOLUTIONS AND
RESOURCES TO CALIFORNIA
GOVERNMENT DECISION MAKERS WITH
REGARD TO DRUG COSTS, RESEARCH,
EDUCATION, AND THE DIAGNOSIS AND
TREATMENT OF RARE DISEASES. TO
DATE, 28 STATES HAVE ESTABLISHED
AN DAC. OUR LETTER OF SUPPORT
LISTS 27. BUT I'M THRILLED TO
ANNOUNCE THAT MISSISSIPPI JUST
SIGNED THE 28TH INTO LAW JUST A
COUPLE OF WEEKS AGO. THANK YOU
FOR YOUR TIME AND I URGE YOUR
AYE VOTE, MADAM CHAIR AND
COMMITTEE MEMBERS. GOOD
AFTERNOON. MY NAME IS MIKE HÌ,
RESIDENT OF OAKLAND, A MEMBER OF
THE COALITION FOR CALIFORNIA
RARE DISEASE ADVISORY COUNCIL,
OR DAC. THANK YOU FOR THE
OPPORTUNITY TO SPEAK WITH YOU IN
SUPPORT OF CREATE AND DAC IN
CALIFORNIA. I'M A FATHER OF TWO
BOYS, MOUTON AND MÐI, WHO ARE 16
AND 13 YEARS OLD NOW. THEY'RE
BOTH AFFECTED BY AN ULTRA RARE
GENETIC DISEASE CALLED
MUCOPOLYSACCHARIDOSIS TYPE TWO
OR PS TWO. IT'S A SYSTEMIC
DISEASE THAT AFFECTS EVERY
TISSUE AND ORGAN, WHICH CAUSES
PHYSICAL DISABILITIES,
DEVELOPMENTAL DELAYS, AND
EVENTUALLY LEADS TO ORGAN
FAILURES AND DEATHS IN THE EARLY
ADULTHOOD. WITH ONLY ABOUT 400
DIAGNOSED PATIENTS IN THE ENTIRE
COUNTRY, VIRTUALLY NO ONE KNOWS
ABOUT THE DISEASE, INCLUDING
MANY OF THEIR DOCTORS. DURING
THE PAST 13 YEARS BATTLING WITH
THE RARE DISEASE, MY FAMILY HAVE
EXPERIENCED THE MANY CHALLENGES
THAT THE RARE DISEASE COMMUNITY
FACE EVERY SINGLE DAY, FROM
DIAGNOSIS, DIAGNOSTIC ODYSSEY TO
ACCESSING PROPER MEDICAL CARE
AND THERAPIES, BATTLING
INSURANCE COVERAGE, PUBLIC
SCHOOL PLACEMENT, OBTAINING
REGIONAL CENTER SUPPORT, JUST TO
NAME A FEW. AS A RARE DISEASE
FAMILY, WE MUST EDUCATE EVERYONE
WHO COMES TO INTERACT WITH MY
BOYS AND TO ADVOCATE FOR EVERY
BIT OF RESOURCE AND SUPPORT THEY
NEED IN OUR GREAT STATE OF
CALIFORNIA. IT WAS ESTIMATED
THAT ONE OUT OF TEN INDIVIDUALS
LIVE WITH A RARE DISEASE. OUR
GOAL IS FOR THE DAC TO RAISE
AWARENESS ABOUT RARE DISORDERS,
PROVIDE VALUABLE INFORMATION AND
KNOWLEDGE TO POLICYMAKERS, AND
TO BECOME A RESOURCE TO
INDIVIDUALS AND FAMILIES LIKE
OURS, AS WELL AS TO MEDICAL
PROVIDERS WHO SUPPORT THESE
PATIENTS. WE HOPE CALIFORNIA
WILL JOIN THE 28 OTHER STATES
THAT HAVE ENACTED ARDEX TO
SUPPORT AND HELP GIVE VOICE TO
THE RARE DISEASE PATIENTS AND
FAMILIES. THANK YOU. THANK YOU.
ANY OTHER WITNESSES IN SUPPORT?
LIN KUNST, EXECUTIVE DIRECTOR OF
THE HEMOPHILIA COUNCIL OF
CALIFORNIA AND STRONG SUPPORT.
THANK YOU. I'M JENNIFER
CANVASSER, THE FOUNDER AND
EXECUTIVE DIRECTOR OF THE
NECROTIZING ENTEROCOLITIS
SOCIETY. AND ON BEHALF OF MY
SON, MICAH, WHO DIED FROM A RARE
DISEASE AND BABIES LIKE HIM, I'M
IN SUPPORT. HI, I'M KELLY GOSS.
I'M MANAGING DIRECTOR OF
ADVOCACY FOR THE ALS
ASSOCIATION, WHICH IS A MEMBER
OF NORD, AND WE'RE IN STRONG
SUPPORT. DIÆN NGUYEN,
REPRESENTING THE HEMOPHILIA AND
SICKLE CELL CENTERS THROUGHOUT
THE 13 WESTERN STATES,
ESPECIALLY CALIFORNIA. WE ARE IN
STRONG SUPPORT. THANK YOU, THANK
YOU. ANY WITNESSES IN OPPOSITION
? SEEING NONE. I'LL BRING IT
BACK TO THE COMMITTEE FOR ANY
QUESTIONS. SEEING NONE, I'LL
JUST OFFER A COMMENT. GO AHEAD.
I JUST WANTED TO SAY JUST A LOT
OF RESPECT FOR THE AUTHOR. I
KNOW YOU'VE BEEN A CHAMPION FOR
YOUR SISTER. I'M REALLY
APPRECIATE THAT. THANK YOU. MR.
ZUBIATE. I WANT TO THANK YOU,
ASSEMBLYMEMBER ZUBER, FOR
BRINGING FORWARD THIS BILL. I
WANT TO ACKNOWLEDGE THAT THIS
BILL IS NAMED FOR YOUR SISTER,
JACQUELINE MARIE ZUBER, WHO
ENDURED A THREE YEAR BATTLE WITH
ALS AND THANKFUL THAT, SOMETHING
POTENTIALLY BEAUTIFUL CAN COME
FROM, I'M SURE, THAT VERY
PAINFUL EXPERIENCE, THE RARE
DISEASE ADVISORY COUNCIL CREATED
BY THIS BILL, WILL SERVE AS A
RESOURCE TO STATE GOVERNMENT IN
MAKING SOUND POLICY TO SERVE
CALIFORNIANS WITH RARE DISEASES.
AND THANK YOU FOR BEING A
CHAMPION OF THIS BILL. WOULD YOU
LIKE TO CLOSE? I RESPECTFULLY
ASK FOR YOUR VOTE. THANK YOU
VERY MUCH. THANK YOU SO MUCH. WE
WILL NOW MOVE TO OUR SPECIAL
ORDER OF BUSINESS AB 2200. ITEM
NUMBER ONE AS MR. CARL. AS
ASSEMBLY MEMBER. KALRA IS COMING
UP TO THE PRESENTATION TABLE. I
WANT TO JUST, REMIND EVERYONE
THAT WE ARE GOING TO ALLOW TEN
MINUTES EACH FOR SUPPORT AND
OPPOSITION. THEN AN ADDITIONAL
15 MINUTES FOR BOTH SUPPORT AND
OPPOSITION, OPPOSITION FOR ME TO
TESTIMONY ALL ME TO TESTIMONY,
OR ADDITIONAL TESTIMONY WILL
STRICTLY BE LIMITED TO NAME,
POSITION AND ORGANIZATION. IF
YOU REPRESENT ONE, WE WILL START
THIS SPECIAL ORDER OF BUSINESS
AT 310 AND ENDED AT 410.
ASSEMBLY MEMBER KALRA, YOU CAN
BEGIN. THANK YOU SO MUCH, MADAM
CHAIR, I WOULD FIRST LIKE TO
RECOGNIZE THAT THE THOROUGH
COMMITTEE ANALYSIS AND ACCEPT
THE PROPOSED AMENDMENTS. AND I
REALLY APPRECIATE THE HARD WORK
AND MANY HOURS PUT INTO THIS BY
THE COMMITTEE STAFF AND BY YOU,
MADAM CHAIR, AS WELL AS SENATE
BILL 2200, THE CALIFORNIA
GUARANTEED HEALTH CARE FOR ALL
ACT IS THE POLICY FRAMEWORK FOR
A SINGLE PAYER HEALTH CARE
SYSTEM DRIVEN BY QUALITY OF
CARE, NOT PROFITS, THAT IS
EFFICIENT, NOT WEIGHED DOWN BY
ADMINISTRATIVE WASTE, AND THAT
BUILDS A THRIVING HEALTH CARE
NETWORK UPON A FOUNDATION OF
EQUITY. THE LAST TIME THIS
COMMITTEE PASSED OUT A POLICY
BILL ON SINGLE PAYER, THE WORLD
WAS STILL HEALING FROM A GLOBAL
PANDEMIC THAT EXPOSED SERIOUS
VULNERABILITIES AND INEQUITIES
IN OUR CURRENT SYSTEM. IT WAS
DURING THIS ONCE IN A GENERATION
MOMENT THAT MANY QUESTIONED OUR
STATUS QUO SYSTEM, A SYSTEM THAT
INCOMPREHENSIBLY TIES ACCESS TO
HEALTH CARE TO EMPLOYMENT, A
SYSTEM THAT THOROUGHLY THAT THAT
THROUGH COSTLY CO-PAYS AND
DEDUCTIBLES, CRUELLY FORCES
PEOPLE TO RATION THE CARE THEY
NEED A SYSTEM THAT PAYS THE MOST
AMONG HIGH INCOME COUNTRIES FOR
SOME OF THE WORST HEALTH
OUTCOMES, A SYSTEM THAT ALLOWS
THOUSANDS TO DIE AND MILLIONS TO
GO BANKRUPT EVERY YEAR. SO WHERE
ARE WE NOW? ACCORDING TO OUR
RECENT 2023 HEALTH SURVEY,
NEARLY TWO THIRDS OF
CALIFORNIANS ARE WORRIED ABOUT
UNEXPECTED MEDICAL BILLS AND
AFFORDING OUT-OF-POCKET COSTS.
THE AVERAGE COST OF FAMILY
PREMIUMS FOR JOB BASED COVERAGE
CLIMBED 7% TO NEARLY $24,000 PER
YEAR IN 2024. LAST YEAR, 46% OF
US ADULT WORKERS WITH JOB BASED
COVERAGE REPORTED HAVING
DIFFICULTY AFFORDING THEIR
HEALTH CARE. THAT'S MILLIONS OF
WORKERS AND THEIR FAMILIES, AND
OVER HALF OF WORKERS HAVE A
LARGE DEDUCTIBLE BILL. WHAT DOES
THAT MEAN FOR PRACTICAL
PURPOSES? THAT MEANS THAT
THEY'RE CHOOSING WHETHER THEY
CAN AFFORD TO ACTUALLY ACCESS
THE HEALTH CARE THEY SUPPOSEDLY
HAVE OR NOT. HEALTH CARE
AFFORDABILITY IS A TOP ISSUE FOR
CALIFORNIANS, AND MANY ARE
UNABLE TO AFFORD THE HIGH COST
OF CARE OR FEAR OF LOSING THEIR
COVERAGE IN AN ECONOMIC DOWNTURN
. EVEN WITH THE EXPANSION IN
MEDI-CAL, 2.6 MILLION IN
CALIFORNIA WILL REMAIN UNINSURED
. AS MANY ON THIS COMMITTEE KNOW
TOO WELL. WE HAVE SOME OF THE
WORST HEALTH DISPARITIES, AND
VULNERABLE POPULATIONS FACE
GREATER RISKS AND LESS ACCESS TO
SAFETY NET PROGRAMS, BLACK
CALIFORNIANS HAVE THE HIGHEST
RATES OF INFANT MORTALITY.
PEOPLE OF COLOR IN CALIFORNIA
ARE 20% MORE LIKELY TO HAVE
ASTHMA AND 10% MORE LIKELY TO BE
DIABETIC. THE HOSPITAL DEATH
RATE AMONG RACIAL AND ETHNIC
CATEGORIES IS PRACTICALLY 10%
HIGHER ACROSS THE BOARD,
COMPARED TO WHITE CALIFORNIANS.
MILLIONS OF CALIFORNIANS LIVE IN
AREAS WITH ACUTE SHORTAGES OF
HEALTH CARE PROFESSIONALS. MORE
THAN 1 IN 5 CALIFORNIANS LIVE IN
A PRIMARY CARE SHORTAGE AREA,
AND THERE ARE MORE AND MORE THAN
1 IN 4 LIVING IN MENTAL HEALTH
CARE SHORTAGE AREA. WE HEAR
ABOUT HOSPITAL CLOSURES ON THE
REGULAR EVERY DAY IN RURAL
COMMUNITIES AND IN URBAN
COMMUNITIES. IT'S FOR THESE
REASONS AND A REFUSAL TO ACCEPT
OUR STATUS QUO THAT I BRING AB
2200 FOR YOUR CONSIDERATION. AB
2200 WOULD ENACT A COMPREHENSIVE
FRAMEWORK OF GOVERNANCE,
BENEFITS, PROGRAM STANDARDS AND
HEALTH CARE COST CONTROL FOR A
SINGLE PAYER HEALTH CARE
COVERAGE SYSTEM IN CALIFORNIA.
THIS SYSTEM WOULD BE CALLED CAL
CARE, AND IT WOULD BE AVAILABLE
TO ALL CALIFORNIA RESIDENTS. CAL
CARE IS DESIGNED TO COVER ALL
MEDICALLY NECESSARY AND
APPROPRIATE CARE, AS DETERMINED
BY A PATIENT'S TREATING HEALTH
CARE PROVIDER OR INTEGRATED
TEAM, AND CONSISTENT WITH THE
PATIENT'S BEST INTERESTS.
CALIFORNIANS WILL HAVE ACCESS TO
COMPREHENSIVE HEALTH CARE
COVERAGE, INCLUDING AND NOT
LIMITED TO ALL PRIMARY AND
PREVENTATIVE CARE, HOSPITAL AND
OUTPATIENT SERVICES,
PRESCRIPTION DRUGS, DENTAL,
VISION, AUDIOLOGY, REPRODUCTIVE
HEALTH SERVICES, MATERNITY AND
NEWBORN CARE, GENDER AFFIRMING
CARE, LONG TERME SERVICES, AND
SUPPORTS OF MENTAL HEALTH AND
SUBSTANCE ABUSE TREATMENT,
LABORATORY AND DIAGNOSTIC
SERVICES, AND AMBULATORY
SERVICES. AT ITS CORE, CAL CARE
IS A SIMPLIFIED PUBLIC PAYMENT
SYSTEM FOR QUALITY CARE TO OUR
HEALTH CARE PROVIDERS THAT WILL
SET FAIR RATES BASED ON
MEDICARE, BUT CAN BE ADJUSTED TO
ATTRACT A CERTAIN OPTIMAL RESULT
OR ENSURE ADEQUATE REIMBURSEMENT
FOR SERVICES RENDERED. INSTEAD
OF HOSPITALS BARELY GETTING BY
OR CHARGING CONSUMERS
UNATTAINABLE PRICES, CAL WOULD
NEGOTIATE GLOBAL BUDGET FOR
INSTITUTIONAL PROVIDERS LIKE
HOSPITALS, FACILITIES AND
CLINICS. SO WE CAN ACTUALLY FUND
WHAT SHOULD BE A PUBLIC GOOD.
HEALTH CARE PROVIDERS WILL HAVE
THE ABILITY TO APPEAL THE CAL
CARE BOARD FOR AN ALTERNATIVE
RATE, OR MAKE ADJUSTMENT ON
THEIR BUDGETS IN A TRANSPARENT
MANNER. FINALLY, THE GLOBAL
OPERATING BUDGETS FOR HOSPITALS,
CLINICS AND OTHER INSTITUTIONAL
PROVIDERS INCLUDE FUNDING FOR
GRADUATE MEDICAL EDUCATION. WE
HAVE MADE AMENDMENTS TO THE LAST
VERSION OF CAL CARE.
SPECIFICALLY, WE ADDED A PUBLIC
RETIREMENT BENEFITS ADVISORY
PANEL, OFFICE OF HEALTH EQUITY.
MORE DETAIL ON SPECIAL PROJECT
BUDGET TOWARDS RURAL AND
MEDICALLY UNDERSERVED AREAS, FEE
FOR TIME PAYMENT MODELS AND
EMPHASIS ON CARE COORDINATION
AND PREVENTION. WE'RE ALSO
TAKING SPECIAL ATTENTION AT
ADDRESSING OUR HEALTH CARE
WORKFORCE SHORTAGE AND RETENTION
, AND A NUMBER OF WAYS. FOR
EXAMPLE, A MAIN TENET OF
CALCAIRES METHODOLOGY IS
MAINTAINING AN OPTIMAL WORKFORCE
TO DELIVER QUALITY AND EQUITABLE
HEALTH CARE. AB 2200 HAS
PROVISIONS TO INCREASE PAYMENT
RATES IN AREAS THAT HAVE
PROVIDER SHORTAGES. THE CALGARY
BOARD WILL BE ABLE TO INCREASE
PAYMENT RATES TO IMPROVE THE
AVAILABILITY AND ACCESSIBILITY
OF HEALTH CARE, AND CAL CARE
INCLUDES A SPECIAL PROJECTS
BUDGET TO BE USED TO INCREASE
PAYMENT RATES TO IMPROVE THE
AVAILABILITY AND ACCESSIBILITY
OF HEALTH CARE SERVICES IN RURAL
AND MEDICALLY UNDERSERVED AREAS.
UP TO 1% OF THE ENTIRE BUDGET
WILL BE DEDICATED TO PROGRAMS
PROVIDING HEALTH CARE, WORKFORCE
EDUCATION, RECRUITMENT AND
RETENTION, AND THERE WILL BE A
CAL CARE HEALTH WORKFORCE GROUP
THAT WILL CONTINUE TO IDENTIFY
EFFORTS TO IMPROVE WORKFORCE AND
ADDRESS ISSUES OF ATTRITION.
SPECIAL PROJECTS IN CALCAIRE
WILL FUND THE CONSTRUCTION,
RENOVATION OR STAFFING OF HEALTH
CARE FACILITIES IN RURAL OR
OTHER UNDERSERVED COMMUNITIES.
IT WILL ALSO PRIORITIZE THOSE
PROJECTS THAT ADDRESS THE HEALTH
INEQUITIES THAT PERVADE TODAY.
FULL EQUITY IN OUR HEALTH SYSTEM
WILL ONLY BE ACHIEVED THROUGH A
SINGLE PAYER SYSTEM OF
GUARANTEED HEALTH CARE FOR ALL,
THE OFFICE OF HEALTH EQUITY, NOW
IN CAL CARE, WILL SUPPORT THE
BOARD THROUGH DATA COLLECTION,
ANALYSIS AND RECOMMENDATIONS ON
ISSUES THAT INCLUDE BARRIERS TO
CARE AND ACCESS, EQUITABLE
DISTRIBUTION OF HEALTH CARE
SERVICES, DISCRIMINATION IN
HEALTH CARE SETTINGS, AND MORE.
STUDY AFTER STUDY HAS SHOWN THAT
A SINGLE PAYER HEALTH CARE
SYSTEM WITH COMPREHENSIVE
COVERAGE FOR ALL WOULD PRODUCE
MASSIVE SAVINGS ON HEALTH CARE
COSTS. AS A RESULT, CALIFORNIA
COULD PROVIDE BETTER HEALTH CARE
COVERAGE TO ALL AND DO SO FOR
LESS MONEY THAN OUR CURRENT
SYSTEM. BY SIMPLIFYING OUR
HEALTH CARE SYSTEM, CAL CARE
WOULD SAVE BILLIONS IN
ADMINISTRATIVE COSTS BY DIRECTLY
NEGOTIATING PRESCRIPTION DRUG
PRICES AND PROVIDER PAYMENTS ON
A STATEWIDE BASIS, CAL CARE
WOULD BE ABLE TO LOWER PRICES
FOR DRUGS AND HEALTH CARE
SERVICES, RESULTING IN
SUBSTANTIAL SAVINGS OVERALL.
ALSO IN THE BILLIONS, THE
GOVERNOR'S HEALTHY CALIFORNIA
FOR ALL COMMISSION FOUND THAT
UNDER A SINGLE PAYER MODEL WITH
NO COPAYS OR OTHER COST SHARING,
AND WITH BENEFITS THAT INCLUDE
LONG TERME SUPPORTS AND SERVICES
FOR ALL, CALIFORNIA WOULD SAVE
BETWEEN 32 AND 213 BILLION,
BILLION DOLLARS OVER TEN YEARS,
COMPARED TO OUR CURRENT SYSTEM.
OPPONENTS WILL SAY CALIFORNIA
CAN'T AFFORD TO SUSTAIN THIS
SYSTEM. BUT THE COMMISSION ALSO
FOUND A HIGHER RATE OF GROWTH IN
SPENDING TO OUR TO OUR CURRENT
SYSTEM. AND UNDER A SINGLE PAYER
SYSTEM, THE GAP OF FUNDING
NEEDED IS $16 BILLION LESS THAN
WHAT CALIFORNIA HAS ALREADY PAID
FOR EMPLOYER CONTRIBUTIONS,
PREMIUMS AND OUT OF POCKET
EXPENSES THAT OUR STATUS QUO
REQUIRES US TO PAY. THE REALITY.
THE REALITY IS THAT CAL CARE IS
NOT ONLY GOOD FOR CALIFORNIA
BUSINESSES, IT IS GOOD FOR
CALIFORNIA BUSINESSES WHO ARE
BEING PUMMELED WITH YEAR OVER
YEAR INSURANCE PREMIUMS, PREMIUM
INCREASES WITH NO ABILITY TO
NEGOTIATE OR PUSH FOR SOME SENSE
OF MODERATION. THE COMMISSION
CONDUCTED POLLING THAT FOUND
THAT 65% OF CALIFORNIANS WITH
LOW INCOMES AND 72% OF
CALIFORNIANS OF COLOR WITH LOW
INCOMES SUPPORTED PROPOSAL TO
REPLACE ALL MEDICARE AND
MEDI-CAL COVERED CALIFORNIA AND
PRIVATE JOB BASED INSURANCE
PLANS WITH A SINGLE STATEWIDE
GOVERNMENT PROGRAM THAT WOULD
COVER HEALTH CARE FOR ALL PEOPLE
WHO LIVE IN CALIFORNIA,
REGARDLESS OF INCOME. CAL CARE
WILL SAVE LIVES, THE COMMISSION
REPORTED A UNIVERSAL HEALTH CARE
SYSTEM WOULD SAVE AN ESTIMATED
4000 LIVES EVERY YEAR IN THIS
STATE. INEVITABLY, SOMEONE WILL
ASK HOW WE WILL PAY FOR CAL
CARE, ESPECIALLY IN TODAY'S
BUDGET CLIMATE. AB 2200 IS A IS
THE POLICY FRAMEWORK AND A
POLICY BILL THAT'S NEEDED TO
ENGAGE THE FEDERAL GOVERNMENT ON
A CONSOLIDATED WAIVER, AND THERE
WOULD NEED TO BE A FISCAL
ANALYSIS ON WHAT FUNDING WILL BE
NEEDED TO FULLY TRANSITION AND
IMPLEMENT IT. THIS MAY TAKE
YEARS, BUT WE SHOULD AND MUST
ACT NOW AND MAKE PROGRESS ON THE
POLICY. OR WE DON'T EVEN GET TO
ANY POINT OF DISCUSSING HOW WE
CAN CREATE REAL COST SAVINGS FOR
CALIFORNIANS, MEMBERS, MEMBERS.
WE HAVE AN OPPORTUNITY TO SET
THE STAGE FOR UNIVERSAL,
AFFORDABLE, EQUITABLE HEALTH
CARE JUSTICE FOR ALL IN
CALIFORNIA AND BE A MODEL FOR
THE NATION ON WHAT A PROGRESSIVE
ALTERNATIVE TO OUR FRAGMENTED,
PROFIT DRIVEN STATUS QUO WOULD
LOOK LIKE. IMAGINE FOR A MOMENT
HOW CALIFORNIA WOULD HAVE FARED
UNDER A SINGLE PAYER UNIVERSAL
HEALTH CARE SYSTEM DURING THE
COVID 19 PANDEMIC. PEOPLE THAT
IMMEDIATELY LOST THEIR JOBS
WOULD STILL HAVE THEIR HEALTH
CARE. HOSPITALS WOULD NOT NEED
TO WORRY ABOUT A PAY SOURCE. THE
STATE WOULD BE BETTER
COORDINATED ON PROVIDING ACCESS
TO VULNERABLE COMMUNITIES AND
DIRECTING CRITICAL HEALTH CARE
SERVICES LIKE PPE AND VACCINES.
AND MOST IMPORTANTLY, LIVES
WOULD HAVE BEEN SAVED. ONE
PUBLISHED STUDY EXAMINED THE
POTENTIAL BENEFITS NATIONWIDE
AND ESTIMATED THAT THE UNITED
STATES WOULD HAVE SAVED 212,000
LIVES IN 2020 ALONE, AND THAT
$160 BILLION IN MEDICAL MEDICAL
EXPENSES ASSOCIATED WITH COVID
19 HOSPITALIZATIONS COULD HAVE
BEEN AVERTED. CAL CARE IS NOT
JUST A HEALTH CARE JUSTICE BILL.
IT'S A RACIAL JUSTICE BILL. IT'S
AN ECONOMIC JUSTICE BILL. IT'S A
IT'S A GENDER JUSTICE BILL. IT'S
ABOUT AFFIRMING THE FUNDAMENTAL
RIGHT TO HEALTH CARE, A RIGHT
THAT SHOULD NEVER, EVER BE
CONTINGENT ON YOUR JOB, ON YOUR
WEALTH, OR WHERE YOU LIVE OR
WHERE YOU WERE BORN WITH ME TO
PROVIDE SUPPORTING TESTIMONY IS
MICHELLE GUTIERREZ B¢O, AN RN
AND PRESIDENT OF CALIFORNIA
NURSES ASSOCIATION. CARMEN K¾T,
POLICY SPECIALIST WITH THE
CALIFORNIA NURSES ASSOCIATION,
AND ISHMAEL ARMENDARIZ,
PRESIDENT OF THE OAKLAND
EDUCATORS ASSOCIATION AND
REPRESENTATIVE ON BEHALF OF THE
CALIFORNIA TEACHERS ASSOCIATION.
THANK YOU. AND JUST AS A
REMINDER, YOU WILL ALL
COLLECTIVELY HAVE TEN MINUTES.
CAN YOU HEAR ME? I'M MICHELLE
GUTIERREZ, VÚI. I'M A PRESIDENT
OF THE MIGHTY CALIFORNIA NURSES
ASSOCIATION, AND I'VE BEEN A
REGISTERED NURSE FOR OVER 26
YEARS, REPRESENTING OVER 100,000
RNS ACROSS THE STATE. CNA Ã IS
A PROUD SPONSOR OF AB 2200. AS A
NURSE IN AN ADULT FAMILY
MEDICINE OUTPATIENT CLINIC IN
FREMONT, I WITNESSED PREVENTABLE
HEALTH CARE TRAGEDIES EVERY
SINGLE DAY THAT RESULT FROM OUR
PROFIT DRIVEN SYSTEM OF
INSURANCE. PATIENTS FORGO THE
MEDICATION AND CARE THEY NEED
SIMPLY BECAUSE THEY CANNOT
AFFORD IT. MEANWHILE, HEALTH
PLAN MIDDLEMEN DENY CARE TO
BOOST CORPORATE BOTTOM LINES. I
CANNOT TELL YOU HOW MANY TIMES A
DAY I WORK FIVE DAYS A WEEK. IN
THE LAST 23 YEARS AT KAISER, AS
A CHARGE NURSE OF THE CLINIC, I
CANNOT TELL YOU HOW MANY TIMES A
DAY I HAVE TO BEG MY PATIENT,
WHO WORKED 2 TO 3 JOBS JUST TO
PAY FOR HEALTH CARE INSURANCE.
THEY HAVE NO INTENTIONS OF USING
UNLESS THEY ARE DYING. I WOULD
LIKE FOR YOU TO TAKE A PAUSE AND
REMEMBER THAT STATEMENT, BECAUSE
I DON'T WANT TO WASTE TODAY
UNLESS WE MOVE FORWARD. THEY ARE
COUNTING ON US. AS THE COVID
PANDEMIC RUTHLESSLY DEMONSTRATED
, HIGH HEALTH CARE COSTS AND
POOR HEALTH OUTCOMES PERSIST
BECAUSE ACCESS TO AN INSURANCE
PLAN IS NOT THE SAME AS
GUARANTEED HEALTH CARE FOR ALL,
OUR CURRENT PROFIT DRIVEN SYSTEM
IS DEEPLY INEFFICIENT, URGENT,
UNAFFORDABLE AND UNSUSTAINABLE
FOR CALIFORNIA AND OUR PATIENTS.
IT IS DESIGNED TO SQUEEZE EVERY
DOLLAR AND CENT FROM OUR HEALTH.
AS A NURSE, I HAVE A
PROFESSIONAL DUTY TO ENSURE THAT
MY PATIENTS RECEIVE THE CARE
THERAPEUTIC CARE THEY NEED. THIS
IS WHY UNION NURSES ADVOCATE FOR
UNIVERSAL, GUARANTEED HEALTH
CARE FOR ALL UNDER A SINGLE
PAYER SYSTEM, THE LEGISLATURE
MUST ACT WITH URGENCY TO PASS
CAL CARE BECAUSE ANY DELAY WILL
BE PAID THROUGH THE HEALTH AND
LIVES OF OUR PATIENT S WE MUST
ACT NOW. CAL CARE WOULD
ESTABLISH A SINGLE STANDARD OF
CARE FOR ALL CALIFORNIANS,
REGARDLESS OF INCOME, REGARDLESS
OF EMPLOYMENT OR IMMIGRATION
STATUS, AND REGARDLESS OF
WHETHER AN INSURANCE COMPANY
THINKS WE ARE PROFITABLE. ALL
EVERYONE GETS THE SAME HIGH
QUALITY CARE. EVERYBODY IN,
NOBODY OUT. STUDY AFTER STUDY
HAS SHOWN THAT A SINGLE PAYER
SYSTEM LIKE CAL CARE IS THE ONLY
SOLUTION THAT WOULD ALLOW
EVERYONE TO GET THE CARE THEY
NEED WHILE REDUCING HEALTH CARE
SPENDING. OVERALL, WITH CAL CARE
CALIFORNIA WOULD SAVE LIVES AND
SAVE TENS OF BILLIONS EACH YEAR.
THIS SAVINGS WOULD GO TOWARDS
PROVIDING COMPREHENSIVE CARE TO
ALL. IN OTHER WORDS, CAL CARE
WOULD CONTROL COSTS WITHOUT
RESORTING TO CARE RATIONING.
IMPORTANTLY, CAL CARE WOULD NOT
ONLY SAVE MONEY, BUT IT WOULD
IMPROVE THEIR LIVES AND PRACTICE
OF NURSES LIKE ME AND DOCTORS
LIKE YOU, WE'D SPEND LESS TIME
AND RESOURCES NAVIGATING
INSURANCE AND HAVE MORE TIME FOR
OUR PATIENTS, RESULTING IN
BETTER CARE FOR OUR UNION
MEMBERS. CAL CARE TAKES HEALTH
CARE OFF THE BARGAINING TABLE
PERMANENTLY. THIS GIVES US MORE
BARGAINING STRENGTH TO WIN
BETTER WORKING CONDITIONS, SAFE
STAFFING, AND OTHER PROTECTIONS
ON THE SHOP FLOOR. THIS IS WHY
CAL CARE HAS THE ENDORSEMENT OF
DOZENS OF CALIFORNIA UNIONS,
WHICH REPRESENT OVER 2.3 MILLION
UNION MEMBERS ACROSS THE STATE.
AS UNION NURSES, WE UNDERSTAND
THAT CAL CARE IS AN ACT OF
SOLIDARITY BY PLACING EVERY
PERSON IN CALIFORNIA INTO ONE
SYSTEM IN SOLIDARITY WITH ONE
ANOTHER, WE WOULD COME CLOSER TO
ACHIEVING HEALTH EQUITY. IT IS
MY DUTY AS A NURSE TO ADVOCATE
FOR MY PATIENTS AND SUFFERING
UNDER OUR TIERED SYSTEM OF CARE.
HEALTH CARE MUST BE TREATED AS A
HUMAN RIGHT, NOT A COMMODITY. WE
URGE YOU TO VOTE IN SUPPORT OF
CAL CARE TODAY SO WE CAN BEGIN
TO HEAL OUR BROKEN HEALTH CARE
SYSTEM. THANK YOU SO MUCH FOR
YOUR TIME. YEAH. GOOD AFTERNOON,
CHAIR BONTA AND COMMITTEE
MEMBERS. I'M CARMEN C¢M S¼, LEAD
REGULATORY POLICY SPECIALIST
WITH THE CALIFORNIA NURSES
ASSOCIATION SINCE LAST SESSION,
WE'VE WORKED DILIGENTLY TO
INCORPORATE FEEDBACK FROM
LEGISLATORS AND STAKEHOLDERS,
AND WE WANT TO THANK YOU AGAIN
FOR YOUR TIME TODAY. AND I WANT
TO TOUCH ON SOME KEY COMPONENTS.
CAL CARE IS ULTIMATELY A
REINVESTMENT OF OUR HEALTH CARE
DOLLARS INTO CARE. INSTEAD OF
BALLOONING PRICES,
ADMINISTRATIVE COMPLEXITY, AND
CORPORATE PROFITEERING ARE ON
SAVINGS. THE HEALTHY CALIFORNIA
FOR ALL COMMISSION ALSO FOUND
THAT IT WOULD SAVE $40 BILLION
EACH YEAR ON INSURANCE
ADMINISTRATION ALONE. AND WHEN
IT COMES TO RECEIVE CARE, CAL
CARE ELIMINATES INSURANCE
BARRIERS AND FINANCIAL BARRIERS
TO CARE. CAL CARE CREATES ONE
NETWORK OF PROVIDERS SPANNING
THE STATE, WHERE CARE WOULD BE
FREE AT THE POINT OF SERVICE.
WITH CAL CARE, WE WOULD GET
MORE, PAY LESS, AND PROVIDE CARE
, COMPREHENSIVE BENEFITS AND
HIGH QUALITY CARE TO EVERYONE IN
THIS FRAMEWORK. IMPORTANTLY,
ESTABLISHES THE POLICY
LEGISLATION REQUIRED UNDER
FEDERAL LAW TO BEGIN NEGOTIATING
FEDERAL WAIVERS NEEDED TO
INCORPORATE PUBLIC PROGRAMS INTO
CAL CARE FOR PROVIDER
REIMBURSEMENTS. CAL CARE ALIGNS
PAYMENTS CLOSER TO COST AND USES
OUR BULK PURCHASING POWER TO WIN
FAVOR PRICES FOR EVERYONE. FOR
RURAL AND UNDERSERVED AREAS,
PAYMENT RATES WOULD BE ADJUSTED,
ADJUSTED UPWARDS TO ENSURE THAT
THEY HAVE THE RESOURCES THEY
NEED TO STAY OPEN. BY
STABILIZING FUNDING FOR
HOSPITALS AND CLINICS THROUGHOUT
THE STATE, WE CAN FINALLY COMBAT
THE EPIDEMIC OF HEALTH CARE
CLOSURES IN RURAL AND LESS
AFFLUENT AREAS AND FOR
COMMUNITIES OF COLOR, WHICH
LEADS US TO A REALLY IMPORTANT
POINT OF CAL CARE. IT CREATES
THE FRAMEWORK TO BEGIN
DISMANTLING THE STRUCTURAL
RACISM AND STRUCTURAL HEALTH
INEQUITIES THAT OUR CURRENT
SYSTEM IS BUILT UPON. A NEW
OFFICE OF HEALTH EQUITY WOULD
IDENTIFY DISTRIBUTIONAL GAPS IN
OUR HEALTH CARE INFRASTRUCTURE,
AND IT WOULD DEVELOP PROGRAMS TO
ADDRESS DISPARITIES IN RURAL AND
MEDICALLY UNDERSERVED AREAS,
INCLUDING PROGRAMS TO MEET THE
CULTURAL AND LINGUISTIC NEEDS OF
ALL PATIENTS. SAVINGS FROM THE
ELIMINATION OF INSURANCE
ADMINISTRATION, AND PROFITEERING
COULD BE USED FOR ADDITIONAL
STAFF, EXTENDED OFFICE HOURS OR
HOSPITAL RENOVATION AND
CONSTRUCTION, AND TO BOOST
HEALTH CARE STAFFING AND OTHER
RESOURCES. THE BILL INCLUDES
PROVISIONS ON HEALTH CARE,
WORKFORCE RECRUITMENT AND
RETENTION PROGRAMS, AND FUNDING
WOULD BE AVAILABLE TO BUILD A
DIVERSE WORKFORCE PIPELINE AND
TO KEEP NURSES AND OTHER HEALTH
CARE WORKERS IN GOOD, SAFE JOBS
WITH SAFE STAFFING LEVELS WHILE
THEY CARE FOR PATIENTS. PASS
PASSING CAL CARES POLICY
LEGISLATION TODAY IS IMPORTANT
IS AN IMPORTANT FIRST STEP THAT
NEEDS THAT. CALIFORNIA NEEDS TO
TAKE ON THE PATH TOWARDS
IMPLEMENTING GUARANTEED HEALTH
CARE FOR ALL AS A RIGHT. THANK
YOU. GOOD AFTERNOON, MADAM CHAIR
AND COMMITTEE, MY NAME IS
ISHMAEL ARMENDARIZ, AND I AM
SPEAKING ON BEHALF OF THE
CALIFORNIA TEACHERS ASSOCIATION.
AND I'M A VERY PROUD SPECIAL
EDUCATION TEACHER AND PRESIDENT
OF THE OAKLAND EDUCATION
ASSOCIATION, 3000 MEMBERS
STRONG, I MEAN, HERE TO TALK
ABOUT HOW CAL CARE WOULD IMPROVE
EDUCATION IN CALIFORNIA. I WANT
TO JUST MAKE A COUPLE OF POINTS
SO WE BARGAIN HEALTH CARE. THIS
YEAR, WE WERE, COLLECTIVELY
BARGAINING WITH OUR DISTRICT AND
WITH KAISER. AND KAISER CAME
WITH A 25% INCREASE TO OUR
HEALTH CARE IN ONE YEAR. NOW
IMAGINE THIS. THEY CAME WITH
THEIR SLIDES. THE FIRST SLIDE
SAID ONE, YOU HAVE A LOT OF
WOMEN. YOU EMPLOY A LOT OF
WOMEN. THE SECOND SLIDE SAID
YOUR BIRTH RATES HAVE GONE UP,
WHICH COSTS MONEY. THEN THE
THIRD SLIDE SAID YOU EMPLOY A
LOT OF PEOPLE OF COLOR AND
THEY'RE EXPENSIVE TO EMPLOY.
BECAUSE OF THIS, YOUR RATES ARE
GOING UP 25. THAT IS MONEY THAT
IS COMING OUT OF OUR CLASSROOMS,
MONEY THAT IS INTENDED TO RETAIN
TEACHERS AND TO KEEP TEACHERS IN
OUR ALREADY SYSTEMS. THAT'S
DRIVING US OUT. SO BY TAKING
HEALTH CARE OFF THE BARGAINING
TABLE, THAT WOULD ALLOW US TO
INVEST INTO OUR CLASSROOMS TO
RETAIN TEACHERS BECAUSE TEACHERS
ARE LEAVING THE CLASSROOM, WE
CAN INVEST IN TEACHERS. WE CAN
INVEST IN SERVICES SUCH AS
COUNSELORS, SOCIAL WORKERS,
NURSES, BUT MORE IMPORTANTLY, IT
ENSURES THAT EVERY SINGLE
TEACHER AND EVERY SINGLE STUDENT
AND EVERY FAMILY THAT COMES INTO
OUR CLASSROOM HAS ACCESS TO HIGH
QUALITY HEALTH CARE. AND THAT IS
WHY, WE SUPPORT THIS. SO I URGE
YOU TO SUPPORT THE BILL, TO VOTE
FOR THE BILL AND I URGE YOU TO
STAND WITH CALIFORNIA NURSES AND
STAND WITH CALIFORNIA TEACHERS,
AND LET'S GET THIS DONE. THANK
YOU. THANK YOU. WE'LL NOW HAVE
PRIMARY OPPOSITION COME FORWARD.
YOU'LL COLLECTIVELY HAVE TEN
MINUTES. THANK YOU, MADAM CHAIR.
AND MEMBERS, NICK LOUISOS WITH
THE CALIFORNIA ASSOCIATION OF
HEALTH PLANS, CAP REPRESENTS 40
PLUS STATE LICENSED HEALTH PLANS
IN THE STATE OF CALIFORNIA,
DELIVERING HIGH QUALITY AND
COORDINATED CARE TO
APPROXIMATELY 27 MILLION
CALIFORNIANS. OUR MEMBERS
OPERATE IN ALL MARKETS.
INDIVIDUAL EMPLOYER, AND PUBLIC
PROGRAMS LIKE MEDI-CAL, CAP ALSO
SUPPORTED THE MANAGED CARE
ORGANIZATION TAX LAST YEAR,
WHICH IS A TAX ON OUR MEMBERS
AND OUR CONSUMERS, MORE
SPECIFICALLY, YOUR CONSTITUENTS,
TO INVEST MORE MONEY IN THE
MEDI-CAL PROGRAM TO IMPROVE
RATES FOR PROVIDERS AND IMPROVE
THE DELIVERY SYSTEM, CAP IS PART
OF A COALITION THAT IS STRONGLY
OPPOSED TO AB 2200, OUR
COALITION CONSISTS OF DOCTORS,
HOSPITALS, EMPLOYERS AND OTHERS
THAT ARE STRONGLY OPPOSED TO
THIS BILL BECAUSE IT IS TOO
COSTLY, ELIMINATES CHOICE,
THRASHES OUR EXISTING DELIVERY
SYSTEM, AND IGNORES THE HARD
WORK THAT WE HAVE DONE IN
CALIFORNIA AND THE HARD WORK
THAT WE ARE STILL DOING OVERALL
MEMBERS. IT MAKES ZERO SENSE TO
REPLACE OUR CURRENT HEALTH CARE
SYSTEM WITH A COSTLY, UNTESTED
NEW SYSTEM THAT WOULD HURT
PATIENT CARE, ESPECIALLY WHEN
WE'RE MAKING STRIDES ON
AFFORDABILITY AND ARE SO CLOSE
TO ACHIEVING UNIVERSAL COVERAGE
IN THE STATE OF CALIFORNIA.
THANKS TO ACTIONS BY THIS
GOVERNOR AND THE STATE
LEGISLATURE, CALIFORNIA IS
CLOSER THAN EVER TO ACHIEVING
UNIVERSAL HEALTH CARE FOR ALL.
SINCE COVERED CALIFORNIA'S FIRST
OPEN ENROLLMENT PERIOD IN 2013,
CALIFORNIA'S UNINSURED RATE HAS
FALLEN, FALLEN FROM 17.2% TO
JUST 6.5. NEARLY 1.8 MILLION
PEOPLE ENROLLED IN COVERED
CALIFORNIA PLANS DURING THE MOST
RECENT OPEN ENROLLMENT PERIOD.
THAT IS, A RECORD NUMBER OF
HEALTH INSURANCE SIGNUPS IN THE
STATE WITH NEW POLICIES
BEGINNING IN 2024, VIRTUALLY ALL
CALIFORNIANS WILL HAVE ACCESS TO
HEALTH COVERAGE, AND WE CONTINUE
TO MAKE STRIDES IN MAKING HEALTH
CARE MORE AFFORDABLE FOR LOW AND
MIDDLE INCOME CALIFORNIANS. NEW
SUBSIDIES PROVIDED UNDER THE
AMERICAN RESCUE PLAN HAVE
SIGNIFICANTLY IMPROVED ACCESS TO
AFFORDABLE HEALTH CARE FOR ALL.
COVERED CALIFORNIA IS ALSO IN
THE PROCESS OF IMPLEMENTING A
COST SHARING REDUCTION SUBSIDIES
FOR PEOPLE AT COVERED
CALIFORNIA. CURRENTLY, TWO
THIRDS OF COVERED CALIFORNIA'S
CUSTOMERS ARE ELIGIBLE FOR
COMPREHENSIVE, COMPREHENSIVE
COVERAGE AT A COST OF LESS THAN
$10 PER MONTH. ADDITIONALLY, THE
OFFICE OF HEALTH CARE
AFFORDABILITY IS ON THE VERGE OF
SETTING A STATEWIDE SPENDING
TARGET IN HEALTH CARE THAT WILL
ENCOMPASS VIRTUALLY ALL SECTORS,
CAP SUPPORTS A WORKABLE,
MULTI-YEAR SPENDING TARGET, AS
WELL AS THE OVERALL MISSION OF
THE OFFICE OF HEALTH CARE
AFFORDABILITY MEMBERS. ONE THING
THAT YOU HEAR FROM THE
SUPPORTERS OF THIS BILL IS THAT,
YOU KNOW, CALIFORNIANS, YOU
KNOW, ARE OPPOSED TO OR, YOU
KNOW, BELIEVE THAT WE SHOULD
COMPLETELY CHANGE OVER OUR
EXISTING HEALTH CARE SYSTEM.
AND, YOU KNOW, WE HAVE FOUND
THAT CALIFORNIANS ARE SATISFIED
WITH THEIR HEALTH CARE, THAT
THEY RECEIVE FOR THEMSELVES AND
THEIR FAMILIES TODAY AND WANT TO
AND ACTUALLY WANT TO BUILD ON
THE PROGRESS THAT WE'VE MADE
UNDER THE AFFORDABLE CARE ACT
AND NOT START OVER WITH THE NEW
HEALTH CARE SYSTEM. AND YET,
TODAY, WE'RE CONSIDERING A
MASSIVE, COSTLY AND UNTESTED
SYSTEM THAT WOULD DESTROY THE
PROGRESS THAT WE'VE MADE THUS
FAR. A RECENT LAO LEGISLATIVE
ANALYST'S OFFICE ANALYSIS OF
THIS BILL OR SINGLE PAYER, I
SHOULD SAY NOT THE SPECIFIC
BILL. SINGLE SINGLE PAYER
LEGISLATION IN THE PAST PEGGED
THE ANNUAL COST OF SINGLE PAYER
AT ROUGHLY $500 BILLION
ANNUALLY. THAT IS MORE THAN
TWICE THE TYPICAL STATE BUDGET,
AND WE DON'T HAVE A FUNDING PLAN
ASSOCIATED WITH THIS BILL. AND
WE'LL HEAR MORE ABOUT THAT LATER
. ALMOST HALF OF THE FUNDING
ROUGHLY $200 BILLION ANNUALLY,
WOULD REQUIRE A WAIVER FROM THE
FEDERAL GOVERNMENT IN THE FORM
OF CONGRESSIONAL ACTION. EVEN IF
GRANTED, THIS COULD BE REVOKED
BY A LATER CONGRESS, LEAVING
CALIFORNIA'S SINGLE PAYER
SYSTEM. IF IT IS ENACTED WITH A
MASSIVE BUDGETARY SHORTFALL, THE
OTHER HALF OF THE FUNDING AROUND
TWO, $250 BILLION, WOULD BE PAID
FOR BY TAXPAYERS IN THE FORM OF
HIGHER TAXES ON JOBS, INCOME,
SERVICES AND MORE, IF THE
CONGRESSIONAL WAIVER, DOES NOT
HAPPEN OR GETS REVOKED, THE
TAXES WOULD NEED TO BE DOUBLED,
ROUGHLY. CALIFORNIANS, BY AND
LARGE, OPPOSE THE TAX INCREASES
THAT WOULD BE NECESSARY FOR A
SINGLE PAYER SYSTEM, AND ACCESS
TO QUALITY HEALTH CARE, IF ONE
OF THE OTHER THINGS EXCUSE ME
THAT YOU HEAR FROM THE
SUPPORTERS OF THIS BILL IS THAT,
YOU KNOW, YOU KNOW, OTHER
COUNTRIES HAVE ENACTED SOME SORT
OF SINGLE PAYER PARADISE IN
OTHER IN OTHER COUNTRIES, BUT,
YOU KNOW, IF YOU REALLY LOOK AT
THE EVIDENCE, ACCESS TO QUALITY
HEALTH CARE HAS SUFFERED
TREMENDOUSLY IN OTHER SINGLE
PAYER SYSTEMS. ACCORDING TO SOME
STUDIES, THE MEDIAN WAIT TIME,
IN CANADA, A COUNTRY WITH A
SINGLE PAYER SYSTEM, BETWEEN A
REFERRAL FOR A GENERAL
PRACTITIONER TO A SPECIALIST
PROCEDURE IS 27.7 WEEKS. THAT'S
IN CONTRAST TO THE WAIT TIME IN
THE UNITED STATES, WHICH IS
WHICH IS UNDER 30 DAYS, ABOUT 26
DAYS. ALSO, BRITAIN'S NATIONAL
HEALTH CARE SERVICE IS IN CRISIS
AS IT DEALS WITH THE LACK OF
FACILITIES AND EQUIPMENT COST
INCREASES AND AN EXODUS OF
HEALTH CARE PROVIDERS IN THAT
SYSTEM. INDEED, SOME, YOU KNOW,
PROVIDER FEES THAT ARE JUST
STARTING OUT IN THE BRITISH
HEALTH CARE SYSTEM ARE PAID LESS
THAN BARISTAS AND FAST FOOD
WORKERS IN THAT COUNTRY. AND SO
I DON'T KNOW HOW YOU YOU WOULD
BE ABLE TO SUSTAIN A WORKFORCE
NECESSARY TO, TO KEEP THE SYSTEM
GOING, MEMBERS, AS YOU KNOW,
CALIFORNIA IS FACING A MASSIVE
BUDGET DEFICIT. OUR PRIORITY
SHOULD BE SAFEGUARDING THE
EXISTING PROGRAMS AND SERVICES
THAT WE HAVE IN PLACE NOW AND
NOT PASSING LEGISLATION FOR $500
BILLION HEALTH, HEALTH CARE
SYSTEM THAT HAS NEVER BEEN
TESTED, SINGLE PAYER WOULD FORCE
ALL 39 MILLION CALIFORNIANS OUT
OF THEIR EXISTING COVERAGE,
INCLUDING MEDICARE, EMPLOYER
BASED COVERAGE, AND COVERED
CALIFORNIA PLANS INTO AN
UNTESTED SYSTEM WITH NO ABILITY
TO OPT OUT. CALIFORNIANS OPPOSE
SINGLE PAYER THAT OFFERS NO
ABILITY TO OPT OUT OR TO CHOOSE
PRIVATE COVERAGE. THEY OPPOSE A
SINGLE PAYER SYSTEM THAT
ELIMINATES MEDICARE AS AN OPTION
FOR SENIORS, CALIFORNIANS WANT
THE RIGHT TO CHOOSE PRIVATE
COVERAGE, INSTEAD, SINGLE PAYER
COULD ELIMINATE PATIENTS. WILL
ELIMINATE PATIENTS CHOICE, OF
COVERAGE AND COULD ENDANGER
THEIR CHOICE OF PHYSICIANS.
HOSPITALS AND OTHER PROVIDERS.
CALIFORNIA WOULD LOSE DOCTORS TO
OTHER STATES, LEADING TO LONGER
WAIT TIMES AND REDUCE ACCESS TO
CARE, AND THEN MEMBERS. YOU
KNOW, I'LL CLOSE WITH THIS, YOU
KNOW, SB 770 WAS LEGISLATION
THAT WAS PASSED LAST YEAR AND
THAT THAT IS INITIATING A
PROCESS TO EXPLORE THE NECESSARY
FEDERAL WAIVERS FOR A SINGLE
PAYER SYSTEM, PASSING FULL
LEGISLATION, IS NOT ONLY
PREMATURE, BUT HIGHLY
QUESTIONABLE AT THIS TIME FOR
THIS AND FOR BUDGETARY REASONS.
AND UNTIL WHETHER WE KNOW A
WAIVER IS EVEN POSSIBLE, THE
STATE OF CALIFORNIA, WE
SHOULDN'T BE CONSIDERING THIS
BILL. SO, YOU KNOW, I THINK
THAT'S A GOOD PLACE FOR ME TO
STOP. AND I'LL PASS IT OVER TO
PRESTON FROM CAL CHAMBER. THANK
YOU. WE'RE OPPOSED TO THIS BILL,
AND WE URGE YOU TO VOTE NO. ALL
RIGHT. THANK YOU, MADAM CHAIR.
MEMBERS. PRESTON YOUNG FROM THE
CALIFORNIA CHAMBER OF COMMERCE
HERE TODAY IN OPPOSITION TO AB
2200. BUT FIRST, I JUST WANT TO
MAKE IT ABUNDANTLY CLEAR WE
COMPLETELY AGREE THAT EVERY
CALIFORNIAN IS ENTITLED TO
RECEIVE AFFORDABLE AND
ACCESSIBLE HEALTH CARE. HOWEVER,
AFFORDABLE HEALTH CARE COVERAGE
IS DIFFERENT THAN A GOVERNMENT
RUN BUREAUCRACY PROPPED UP BY A
MONUMENTAL TAX INCREASES. IF
WE'RE GOING TO TALK ABOUT SINGLE
PAYER, THEN WE ALSO HAVE TO TALK
ABOUT HOW IT'S GOING TO BE
FUNDED. UNFORTUNATELY, AB 2200
DOESN'T DO THAT. EVERYONE CAN
AGREE THE PROPOSALS CONTAINED
WITHIN THIS BILL WILL REQUIRE
TAXING CALIFORNIANS HUNDREDS OF
BILLIONS OF DOLLARS EVERY SINGLE
YEAR. THIS IS COMPLETELY
CONTRARY TO AFFORDABLE HEALTH
CARE. THIS UNSUSTAINABLE TAX
BURDEN WILL FALL DIRECTLY ON THE
SHOULDERS OF CALIFORNIA'S
EMPLOYERS, WHICH IS WHY WE'RE
HERE TODAY IN OPPOSITION. FIRST,
LET'S TALK ABOUT COSTS, A PIECE
OF LEGISLATION OF THIS MAGNITUDE
AND COMPLEXITY SHOULD CONTAIN A
FUNDING MECHANISM. HOWEVER, WE
DON'T HAVE THE BENEFIT OF SEEING
SUCH A PROPOSAL TODAY. SO WE'RE
LEFT TO GUESS AT HOW THIS WILL
BE PAID FOR. IT'S INDISPUTABLE.
AB 2200 WILL INCREASE TAXES FOR
CALIFORNIA'S EMPLOYERS AND
EMPLOYEES BY HUNDREDS OF
BILLIONS OF DOLLARS EVERY SINGLE
YEAR. THE HEALTHY CALIFORNIA FOR
ALL COMMISSION INDICATED THAT
CALIFORNIA'S TOTAL HEALTH
EXPENDITURES IN 2022 WERE $517
BILLION. THAT'S ABOUT ONE
SEVENTH OF OUR GROSS STATE
PRODUCT, ACCORDING TO THE OFFICE
OF HEALTH CARE AFFORDABILITY.
CALIFORNIA'S PER CAPITA HEALTH
CARE SPENDING IN 2020 WAS
$10,299. EVEN ASSUMING FEDERAL
FUNDING STAYS IN PLACE, AB 2200
WOULD REQUIRE A SIGNIFICANT TAX
CONTRIBUTION PER EACH
CALIFORNIAN TO EVEN PARTIALLY
APPROACH THESE FIGURES THAT
NEEDS TO BE KEPT IN CONTEXT.
CALIFORNIA ALREADY HAS THE
HIGHEST GAS TAX RATE IN THE
COUNTRY, THE HIGHEST SALES TAX
RATE IN THE COUNTRY, THE HIGHEST
PERSONAL INCOME TAX RATE IN THE
COUNTRY, THE EIGHTH HIGHEST
CORPORATE TAX RATE IN THE
COUNTRY. AND I THINK WE CAN ALL
AGREE THAT WE HAVE A HOUSING
AFFORDABILITY CRISIS NOW, AB
2200 IMPLEMENTATION WOULD
REQUIRE LAYERING THE BIGGEST TAX
INCREASES IN STATE HISTORY, NOT
ONCE, BUT YEAR AFTER YEAR, ONTO
STRUGGLING CALIFORNIANS TO THE
STATE CAN REINVENT AND TAKE
OVER. ONE OF THE MOST COMPLEX
SYSTEMS THAT EXISTS IN OUR
SOCIETY. ALSO THE LAST ITERATION
OF THIS BILL INCLUDED A PROPOSED
PAYROLL TAX, WHICH I ASSUME WILL
BE ON THE TABLE. AGAIN, THIS IS
WORTH MENTIONING SINCE OUR
STATE'S UNEMPLOYMENT INSURANCE
FUND IS INSOLVENT AND INCREASED
PAYROLL TAXES ARE ALREADY BEING
ASSESSED ON OUR STATE'S
EMPLOYERS. FURTHERMORE IF THE
BILL WERE IMPLEMENTED, THE TAX
INCREASES WOULDN'T BE STATIC.
THEY WOULD HAVE TO ANNUALLY GROW
WITH HEALTH CARE COSTS YEAR
AFTER YEAR, MEANING THE ENORMOUS
TAX INCREASES WOULD HAVE AN
UNLIMITED PACE OF GROWTH.
VERMONT ENACTED A SINGLE PAYER
BILL IN 2011, BUT THAT WAS
DERAILED WHEN THE STATE REALIZED
IT RISKED ECONOMIC SHOCK IF, THE
INSTITUTED THE 11.5% PAYROLL TAX
THAT THEY PLANNED ALONG WITH A
PERSONAL INCOME TAX RATE
INCREASE. VERMONT'S GOVERNOR AT
THE TIME, GOVERNOR SHUMLIN,
STATED AND I QUOTE, WHAT I
LEARNED THE HARD WAY IS IT ISN'T
JUST ABOUT REFORMING THE BROKEN
PAYMENT SYSTEM. PUBLIC FINANCING
WILL NOT WORK UNTIL YOU GET
COSTS UNDER CONTROL. ALSO WORTH
MENTIONING SINGLE PAYER HEALTH
CARE WILL COST NEARLY DOUBLE OUR
STATE BUDGET. THIS IDEA CAN'T BE
PAID FOR IN SURPLUS YEARS. NOW
WE'RE HAVING THIS CONVERSATION
WHEN THE STATE'S FACING A 38 TO
$73 BILLION DEFICIT. NEXT, WE
OPPOSE AB 2200 BECAUSE IT WILL
DRIVE EMPLOYMENT ELSEWHERE. AB
2200 WILL ERADICATE FREEDOM OF
CHOICE FOR CONSUMERS, WHILE
HEAVILY TAXING EMPLOYERS WHO
EXPAND IN CALIFORNIA. SINCE THIS
WOULD BE A STATE SYSTEM AND NOT
NATIONALIZED HEALTH CARE,
EMPLOYERS AND EMPLOYEES WOULD BE
FREE TO LEAVE SO THEY COULD
CHOOSE THEIR OWN PRIVATE HEALTH
CARE RATHER THAN BEING FORCED TO
PARTICIPATE IN A STATE
BUREAUCRACY, THEY'LL LEAVE TO
AVOID THE HIGHEST TAXES IN THE
COUNTRY, AND EMPLOYERS WILL
LEAVE TO AVOID ENORMOUS GROSS
RECEIPTS, TAXES, AND PAYROLL
TAXES WHILE BEING ABLE TO EXPAND
ELSEWHERE. THIS EXODUS WILL
PUNISH REMAINING CALIFORNIANS
WITH HIGHER TAXES IN ORDER TO
OFFSET THE FUNDING SHORTFALL,
LAST, CALIFORNIA IS APPROACHING
NEAR UNIVERSAL HEALTH CARE
COVERAGE, RENDERING AB 2200.
PLEASE WRAP UP YOUR COMMENTS.
YES. THANK YOU SO MUCH. WE
OPPOSE AB 2200 FOR THESE
REASONS. WE ASK FOR A NO VOTE
TODAY. THANK YOU. I'M GOING TO
BRING IT BACK TO THE COMMITTEE
FOR QUESTIONS OR COMMENTS. I'M
GOING TO BRING IT BACK TO THE
COMMITTEE FOR QUESTIONS OR
COMMENTS, TO BE ABLE TO ALLOW
SOME MEMBERS TO BE ABLE TO OFFER
INSIGHT. ASSEMBLY MEMBER SHIAVO,
THANK YOU AND MY APOLOGIES. I,
PRESENTING SIX BILLS TODAY. I
GOT TO GO CHAIR A COMMITTEE
SHORTLY, BUT I DID WANT TO ASK
SOME QUESTIONS AND MAKE SOME
COMMENTS. AND I HAVE SOME
QUESTIONS FOR THE SPONSOR. BUT
FIRST I WANTED TO ASK
OPPOSITION. IF YOU COULD JUST
CLARIFY, YOU WERE TALKING ABOUT
THE $500 BILLION. ARE YOU WHAT
IS THAT OUT OF THE, THE STUDY
THAT WAS COMMISSIONED BY THE
HEALTHY CALIFORNIA FOR ALL
COMMISSION BY UC BERKELEY LABOR
CENTER, THAT WAS THE LEGISLATIVE
ANALYST'S OFFICE ANALYSIS OF THE
PRIOR SINGLE PAYER BILL. RIGHT.
SO I THINK, OKAY, I THINK WHERE
THAT NUMBER IS COMING FROM AND I
JUST, YOU KNOW, HOPE THAT WE CAN
CLARIFY THAT HERE, IS ACTUALLY
STATING WHAT THE COST OF HEALTH
CARE WILL BE OVER TEN YEARS IF
WE DO NOTHING. THAT'S THE
CURRENT COST OF HEALTH CARE. SO
THAT IS NOT NECESSARILY THE COST
OF IMPLEMENTING A SINGLE PAYER
BILL. THAT IS THE COST THAT WE
ARE ALREADY GOING TO BE PAYING
FOR HEALTH CARE, AND THAT STUDY
WAS BASED ON FROM 2020 TO 2030.
SO THAT TEN YEAR, WE'RE KIND OF
IN THE MIDDLE OF IT. AND MAYBE
AN UPDATE WOULD BE A GOOD IDEA.
BUT RIGHT. BUT I THINK THAT
THEY'RE REFERENCING IT. SO, YOU
KNOW, THAT SAME STUDY SAID THAT
WE WOULD ACTUALLY SAVE $152
BILLION OVER THAT TEN YEAR
PERIOD EVERY NEARLY EVERY STUDY
THAT HAS LOOKED AT SINGLE PAYER
HAS SAID THAT WE WILL SAVE MONEY
. IT'S NOT REALLY DEBATED AT
THIS POINT. IT WILL SAVE MONEY.
IT WILL COVER EVERYONE. THOSE
ARE THE BASIC TENETS OF SINGLE
PAYER, AND WE KNOW THAT. AND WE
SEE THAT HAPPEN IN OTHER
COUNTRIES. AND WHILE YOU QUOTE,
YOU KNOW, WAIT TIMES IN OTHER
COUNTRIES, WHICH I WOULD
DISPUTE, WE HAVE WAIT TIMES
HERE, AND AS SOMEONE WITH DECENT
HEALTH INSURANCE, I HAVE HAD TO
WAIT MONTHS WHEN MY INSURANCE
CALLS ME AND SAYS I NEED TO COME
IN, THEY DON'T EVEN HAVE AN
APPOINTMENT FOR ME AND THEY'RE
TELLING ME I NEED TO GO IN, AND
WE HAVE PEOPLE WHO CAN'T AFFORD
TO USE THEIR INSURANCE AND
THEY'RE WAITING UNTIL THEY DIE,
WE ARE THE ONLY COUNTRY WHERE
PEOPLE GO BANKRUPT AND IT IS THE
NUMBER ONE REASON FOR BANKRUPTCY
IS MEDICAL BANKRUPTCY. EVERY
YEAR, YEAR AFTER YEAR. SINCE I
CAN REMEMBER WORKING ON THIS
ISSUE, WHICH HAS BEEN OVER 15
YEARS, SO WE DON'T HAVE THAT IN
OTHER COUNTRIES. AND, AND, YOU
KNOW, I UNDERSTAND, CONCERNS
AROUND THE BUDGET RIGHT NOW. I
WOULD HAVE REALLY LOVED FOR THIS
TO PASS WHEN IT WAS 1400 AND
WHEN WE HAD A BUDGET SURPLUS OF
BILLIONS OF DOLLARS BEEN ABLE TO
SET ASIDE MONEY TO REALLY START
THIS PROGRAM BECAUSE, HOPEFULLY
WE WOULD SEE THE FRUITION OF
THOSE SAVINGS COMING IN IN YEARS
GOING FORWARD THAT WE ACTUALLY
REALLY NEED, RIGHT NOW. BUT YOU
KNOW, TO SAY THAT, THAT WE WANT
TO CONTINUE TO TWEAK AROUND THE
EDGES, I THINK IS SHORTSIGHTED.
AND ANYONE THAT I TALK TO IN
HEALTH CARE SEES A FISCAL CLIFF
AHEAD OF US THAT WE CANNOT
AFFORD OUR HEALTH CARE SYSTEM IS
UNAFFORDABLE, AND, AND WE KNOW
THAT, THAT, THAT WE HAVE TO WE
HAVE TO MAKE A CHANGE THIS IS
THE ONLY ONE THAT SAVES MONEY
AND COVERS EVERYONE, PREVENTS
DEATH AND PREVENTS BANKRUPTCY.
AND IF PEOPLE WANT TO GO FIGURE
OUT HOW MUCH THEY COULD SAVE,
THERE'S A CONVENIENT CALCULATOR
AND HEALTHY CALIFORNIA, WEBSITE.
THE HEALTHY CALIFORNIA COALITION
WEBSITE THAT ACTUALLY CAN HELP
PEOPLE CALCULATE THOSE DOLLARS,
YOU KNOW, WHEN IT COMES TO
BUSINESS, I WOULD THERE'S A
PHENOMENAL DOCUMENTARY CALLED
FIX IT AND IT'S A SERIES. AND
THE FIRST ONE REALLY FOCUSES ON
WHAT BUSINESSES WOULD SAVE, YOU
KNOW, I'M A SMALL BUSINESS
OWNER. MY I COME FROM A FAMILY
OF SMALL BUSINESS OWNERS, MY
PARENTS OWNED THEIR SMALL
BUSINESS, WOULD PAY FOR HEALTH
INSURANCE FOR MY DAD'S ONE
EMPLOYEE BEFORE THEY PAID FOR
IT. FOR OUR FAMILY, WE KNOW THAT
COVERING THE COST OF HEALTH
INSURANCE FOR BUSINESSES,
ESPECIALLY SMALL BUSINESSES, IS
CRUSHING. IT IS CRUSHING THEM,
AND SO WHEN YOU LOOK AT THIS
ISSUE FOR BUSINESSES, I THINK
THAT THIS IS ACTUALLY A HUGE
BENEFIT FOR THEM, AND SOMETHING
THAT THEY ARE DESPERATELY
LOOKING FOR CHANGE AND
IMPROVEMENT ON. AND IT'S ONE OF
THE REASONS THAT WE HAVE HUGE
BUSINESSES LIKE AMAZON TRYING TO
CREATE THEIR OWN HEALTH CARE
SYSTEM BECAUSE THEY ARE SO
FRUSTRATED WITH THE HIGH COST OF
HEALTH CARE. RIGHT. YOU KNOW, I,
I DO HAVE SOME QUESTIONS THAT I
WANT TO ASK THE SPONSORS AND,
AND BETTER UNDERSTAND SOME OF
THE THINKING ON THE BILL AS
WELL. AND I KNOW THAT AB 2200
DIRECTS THE STATE ADMINISTRATION
TO APPLY FOR FEDERAL WAIVERS,
AND IT DOES NOT IN ANY WAY
CONSTRAIN WHAT THE GOVERNOR
NEGOTIATES WITH THE FEDERAL
GOVERNMENT, AND AS A RESULT OF
THOSE NEGOTIATIONS WILL BE
APPLIED BY CAL CARE GOVERNING
BOARD, WHO WILL HAVE COMPLETE
AUTHORITY TO DESIGN AND
IMPLEMENT THE PROGRAM. I KNOW IN
THE LAST ITERATION IN 1400, THE
PROGRAM WOULD COME BACK TO THE
LEGISLATURE AT A POINT. IT
SOUNDS IT LOOKS LIKE THAT'S
TAKEN OUT IN THIS ITERATION OF
THE BILL. AND I JUST, WANTED TO
BETTER UNDERSTAND THE LOWER
INVOLVEMENT FROM THE
LEGISLATURE. AND WHAT THE
THINKING IS THERE. THANK YOU,
ASSEMBLY MEMBER BROUGH. AND WE
REALLY APPRECIATE YOUR YOUR
ONGOING LIFE'S WORK ON SINGLE
PAYER, AND, YOU KNOW, I THINK
ONE OF THE, THE, THE POINTS ON
ON THE QUESTION OF FEDERAL
FEDERAL WAIVERS, BECAUSE THIS
BILL IS, IS FOCUSING ON A POLICY
BILL, AND, AND WE'VE TAKEN THE,
THE ACA WITH THE FINANCING, AND
PUT THAT ASIDE FOR NOW. WE
REALLY WANTED TO FOCUS ON THE
POLICY LEGISLATION, SO THAT
THERE WASN'T ANY CONFUSION
ABOUT, YOU KNOW, THE LEGISLATURE
ACTING ON A FINANCING PLAN
BECAUSE THE PLAN IS TO BE ABLE
TO SPEAK TO THAT, IN THE YEARS
TO COME, AFTER WE GET THE POLICY
LEGISLATION MOVING FORWARD AND
JUST, YOU KNOW, SO THAT EVERYONE
IS CLEAR WITH THE FEDERAL
WAIVERS, CONGRESS HAS DOESN'T
HAVE ANYTHING TO DO WITH FEDERAL
WAIVERS, IT IS A PROCESS THAT
HAS BEEN OUTLINED IN THE
AFFORDABLE CARE ACT, WITH, WITH,
WITH THE DEPARTMENT OF U.S.
DEPARTMENT OF HEALTH AND HUMAN
SERVICES, AND THEY HAVE VERY
STRICT REGULAR LINES THAT
INCLUDE A REQUIREMENT THAT A
BILL HAS TO BE PASSED, A POLICY
LEGISLATION HAS TO BE PASSED
BEFORE IT CAN ACTUALLY START, TO
CONSIDER A FEDERAL WAIVER, AND,
YOU KNOW, ON, ON A NUMBER OF
POINTS THAT ASSEMBLY MEMBER
SHABO POINTED OUT. I JUST WANTED
TO CLARIFY THAT THE SAVINGS THAT
THE HEALTHY CALIFORNIA FOR ALL
COMMISSION FOUND THAT IT WAS
VERY SPECIFIC. IT'S THE CLOSEST
STUDY THAT WE HAVE ON THE BILL
THAT WE HAVE BEFORE US TODAY ON
AB 2200, WHERE IT INCLUDES NO
COPAYS, LONG AND LONG TERME CARE
FOR ALL AND THE RANGE JUST
DEPENDS ON HOW HOW MUCH THE UC
BERKELEY LABOR CENTER HAD
ESTIMATED, IN TERMS OF THE
INCREASE IN, IN INFLATION
GENERALLY. SO DEPENDING ON HOW
MUCH INFLATION HAPPENS, WE WILL
SAVE EITHER BETWEEN 30 BILLION
TO 200 BILLION PLUS. SO AN AND I
JUST WANT TO MENTION, YOU KNOW,
THE, THE LEGISLATIVE, THE
LEGISLATIVE AUTHORITY. SO THAT
AMENDMENT OR THAT THAT TEXT
YOU'RE REFERRING TO WAS AN
AMENDMENT THAT WAS TAKEN THE
LAST ITERATION WHEN THERE WAS A
SEPARATE ACA, LEGISLATIVE
AUTHORITY WILL CERTAINLY BE
ATTACHED, PARTICULARLY THE
FINANCING COMPONENT OF IT, WHEN
IT DOES GET TO THAT AT SOME
LATER STAGE. BUT THAT BEING
SAID, LIKE THERE'S A THERE IS
DEFINITELY A FINE BALANCE OF
MAKING SURE THAT THE COW CARE
BOARD'S POWERED VERSUS HAVING TO
COME BACK TO THE LEGISLATURE FOR
TOO MUCH. AND ENCUMBERING THE
KIND OF THE DAILY OPERATIONS OF
CARE BEING EFFECTIVE, BUT
DEFINITELY OPEN TO MORE
SUGGESTIONS AND THOUGHTS ON IT.
AND WE CAN GIVE YOU MORE
BACKGROUND ON WHY THAT WAS DONE
BACK WHEN UNDER THE EARLIER
ITERATION, IN CONTEXT OF THE
ACA, AND MORE THAN HAPPY TO GET
BACK TO YOU ON THAT. THANK YOU.
YEAH, I MEAN, I WOULD LOVE TO
WORK MORE CLOSELY. I HAVEN'T HAD
AN OPPORTUNITY TO DO THAT AS I
HAVE NOT HAD AN OPPORTUNITY TO
BE A COAUTHOR, SO, YOU KNOW,
HOPEFULLY THAT CAN CHANGE. BUT
I, I HAVE TO GO CHAIR A
COMMITTEE IN TEN MINUTES, AND I
KNOW OTHER PEOPLE HAVE
QUESTIONS. I JUST WANT TO, YOU
KNOW, MAKE JUST ONE MORE
COMMENT, THIS. SO AS SOMEONE WHO
WORKED AT CNA FOR 13 YEARS, I
SEE FRIENDS HERE WHO I'VE BEEN
IN THE TRENCHES WITH ON THIS
ISSUE AND HAVE DEEP, DEEP,
INCREDIBLE RESPECT, FOR THE WORK
AND HOLDING THE LINE ON THIS
ISSUE AND MOVING IT FORWARD FOR,
FOR DECADES, FOR DECADES. AND,
AND ALSO THE STAFF WHO HAVE
WORKED REALLY HARD FOR MANY
YEARS. I'VE BEEN THERE, I'VE
BEEN UP I HAVE A PICTURE OF ME
WITH MY DAUGHTER SLEEPING ON THE
SOFA, WHILE I WAS WORKING ON
GETTING READY FOR A PREVIOUS
ITERATION OF THIS BILL UNTIL TWO
IN THE MORNING ON A REGULAR
BASIS. AND SO I KNOW HOW MUCH
WORK IS GOING INTO THIS, AND AT
THE SAME TIME, YOU KNOW, IT'S
BEEN DECADES AND IT'S KIND OF
THE SAME. IT'S THE SAME
APPROACH. AND I HOPE THAT THIS
WILL GET ACROSS THE FINISH LINE
THIS TIME, BUT IF IT DOESN'T, I
REALLY HOPE THAT THERE IS AN
HONEST, REFLECTION ON WHETHER OR
NOT THIS IS THE RIGHT STRATEGY,
I THINK THAT THERE, REALLY NEEDS
TO BE AN HONEST DISCUSSION
AROUND THE APPROACH THAT IS
HAPPENING RIGHT NOW, I HAVE, YOU
KNOW, SERIOUS CONCERNS. WE'VE
HAD MANY YEARS TO BRING TOGETHER
PEOPLE TO FIND RESOLUTION TO BIG
ISSUES LIKE THE GANN LIMIT AND
PROP 98, I HAVE NOT HEARD ABOUT
PROGRESS THAT'S HAPPENING THERE.
I HOPE THERE IS. AND, YOU KNOW,
HAPPY FOR YOU TO, TO ANSWER
THAT. BUT I'LL HAVE TO LEAVE AND
I'LL WATCH IT LATER, I, I, YOU
KNOW, I SEE A LOT OF DIVISION IN
THE MOVEMENT, AND I DON'T THINK
WE CAN WIN DIVIDED, AND I THINK
THAT, I THINK THAT, YOU KNOW,
THIS IS IT'S A BIG, COMPLICATED
ISSUE, AND YOU NEED A LOT OF
PEOPLE AT THE TABLE IN A REAL
WAY TO BE ABLE TO PUSH THIS OVER
THE TOP. THAT'S HOW WE SEE BIG
POLICY HAPPEN IN SACRAMENTO, AND
I, I DON'T SEE THAT. AND SO, I
WILL BE SUPPORTING IT TODAY AS I
HAVE, YOU KNOW, SUPPORTED IT FOR
MANY, MANY YEARS, I REALLY,
REALLY HOPE THAT THOSE THINGS
CHANGE. I REALLY DO, AND, I
THINK THAT THAT I'LL LEAVE IT AT
THAT. THANK YOU VERY MUCH. THANK
YOU. ASSEMBLY MEMBER SHIAVO. WE
ARE GOING TO JUST MAKE SURE THAT
WE ARE ENSURING THAT WE HAVE A
ROBUST CONVERSATION AND ALSO
BALANCING THE FACT THAT WE HAVE
STILL A VERY, LONG, REMAINDER OF
THE AGENDA. WE ARE GOING TO GO
WITH DOCTOR WEBER AND THEN
DOCTOR MR. JONES-SAWYER AND THEN
MR. PATTERSON. THANK YOU. CHAIR.
AND, SEEING THE TIME AND AFTER
TALKING WITH YOUR CHAIR, I WILL
KEEP MY QUESTION IS VERY, VERY
LIMITED, BECAUSE I DO WANT TO
GIVE OTHERS THE OPPORTUNITY. AND
I ALSO WANT TO MAKE SURE THAT
THOSE WHO CAME HERE HAVE THE
OPPORTUNITY TO SPEAK. SO, FIRST,
I WANT TO START BY THANKING THE
AUTHOR AND THE SPONSORS, I HAVE
THE UTMOST RESPECT FOR THE
AUTHOR OF THIS BILL, AND YOU
KNOW WHAT YOU HAVE DONE ONCE
AGAIN, OR WHAT YOU ALL HAVE DONE
ONCE AGAIN, IS TO HIGHLIGHT A
SIGNIFICANT ISSUE WITHIN OUR
HEALTH CARE SYSTEM, NOT ONLY
HERE IN CALIFORNIA, BUT WITHIN
THE UNITED STATES. YES, HEALTH
CARE IS A RIGHT, BUT IT IS NOT
AFFORDABLE. AND THERE ARE SO
MANY ISSUES, SO MANY OBSTACLES,
SO MANY BARRIERS, FOR PATIENTS
TO GET THE CARE THAT THEY
DESERVE FOR PROVIDERS TO BE ABLE
TO PROVIDE THE CARE THAT THAT
THEY SHOULD, AND, YOU KNOW,
LIKE, I'VE SAID TO MANY PEOPLE
WHO HAVE COME TO TALK TO ME
ABOUT THIS, THIS IS IN MY
OPINION, SOMETHING THAT SHOULD
BE DISCUSSED AND PASSED AT A
FEDERAL LEVEL, IT SHOULD NOT BE
SOMETHING THAT CALIFORNIA IS
TRYING TO DO ALONE, BUT IT IS
SOMETHING THAT WE SHOULD HAVE
THROUGHOUT THE COUNTRY, I AM A
LITTLE CONFUSED AS TO WHAT WOULD
HAPPEN IF THIS BILL WERE TO BE
PASSED, AS IS, BUT WE DON'T HAVE
TIME FOR ME TO REALLY GO INTO
THAT, SO, SO MY CONCERNS, THIS
BILL HAS A LOT OF HOLES IN IT.
THERE'S A LOT OF UNANSWERED
QUESTIONS, AND THIS IS A VERY,
VERY IMPORTANT ISSUE. WE'RE
TALKING ABOUT THE HEALTH CARE
FOR ALL CALIFORNIANS, CURRENT
AND IN THE FUTURE, I READ THE
BILL IN ITS ENTIRETY, ALL 70
PLUS PAGES, AND, AND SO I'M JUST
GOING TO FOCUS ON A FEW
CONCERNS. I'M NOT GOING TO TALK
ABOUT THE GRANT WAIVERS. I'M
OTHER PEOPLE HAVE TALKED ABOUT
IT. I'VE TALKED ABOUT THAT
BEFORE. I'M NOT GOING TO TALK
ABOUT TAXES FOR PEOPLE. I'M SURE
OTHER PEOPLE MIGHT TALK ABOUT
THAT, ONE OF MY CONCERNS IS THE
CAL CARE BOARD. THIS BILL GIVES
THIS BOARD TREMENDOUS AUTHORITY,
NOW THEY WILL RECEIVE STATE AND
HOPEFULLY FEDERAL MONEY. HOWEVER
IT IS A, QUOTE, INDEPENDENT
ENTITY NOT AFFILIATED WITH ANY
AGENCY OR DEPARTMENT. IF YOU
LOOK THROUGH THE BILL, IF YOU
READ THE BILL OR EVEN JUST READ
THE ANALYSIS, THE THINGS THAT
THIS PARTICULAR CAL CARE BOARD
IS OVER, WHICH IS THE FINANCIAL
STRUCTURE, THE PROVIDER
INSTITUTION CONTRACTS, BUILDING
MAINTENANCE, EMPLOYEE STAFFING,
CREATING EMPLOYMENT STRUCTURE,
NEGOTIATING PRICES, FOR NOT ONLY
DRUGS, BUT DEVICES, FEES AND
NEGOTIATING PROVIDER AGREEMENTS.
I MEAN, ANY AND EVERYTHING. THIS
BOARD IS OVER AND DESPITE THE
FACT THAT IT'S GOING TO BE USING
STATE FUNDS, FEDERAL FUNDS,
THERE'S NO SIGNIFICANT OVERSIGHT
OR ACCOUNTABILITY OR A PLACE FOR
THE LEGISLATURE TO INPUT IN THIS
BOARD IN THIS BILL, AS IS. AND I
THINK THAT MIGHT HAVE BEEN ONE
OF THE THINGS THAT ASSEMBLY
MEMBER SHIAVO WAS GETTING AT,
YOU KNOW, ONE OF THE ONE OF MY
CONCERNS IS THAT IN THE BILL, WE
PASS THIS RIGHT. AND THE ONLY
THING THAT PROHIBITS IT FROM
ACTUALLY GOING INTO EFFECT IS IT
SAYS A BILL WOULD PROHIBIT
SPECIFIC PROVISIONS FROM
BECOMING OPERATIVE UNTIL THE
SECRETARY OF THE SECRETARY OF
CALIFORNIA HEALTH AND HUMAN
SERVICES GIVE WRITTEN NOTICE TO
THE SECRETARY OF THE SENATE AND
THE CHIEF CLERK OF THE ASSEMBLY,
THAT THE TRUST FUND HAS THE
REVENUES, AND THEN THE
CALIFORNIA HUMAN SERVICES AGENCY
WILL BE REQUIRED TO PUBLISH A
COPY. THAT'S IT. IT DOESN'T SAY
ANYTHING ABOUT ONCE ALL OF THESE
THINGS ARE FIGURED OUT, IT'S
COMING BACK TO THE LEGISLATURE
SO THAT WE KNOW EXACTLY WHAT WE
WOULD BE IMPLEMENTING. THERE'S
NOTHING IN HERE THAT NECESSARILY
STATES THAT IF CAL CARE
IMPLEMENTS A POLICY, IT'S GOT TO
COME BACK TO US. AND I THINK WE
KNOW OF ANOTHER COMMISSION THAT
LEGISLATORS CONTINUOUSLY
COMPLAIN ABOUT THAT HAS ALL OF
THIS AUTHORITY TO GO OUT HERE
AND INCREASE PRICES. AND WE HAVE
NO SAY YET. WE'RE THE ONES THAT
REPRESENT. SO I'M CONCERNED
ABOUT ABOUT THE SIGNIFICANT
AUTHORITY THAT YOU'VE GIVEN TO
THE CAL CARE BOARD WITH NO OTHER
, INPUT FROM THE LEGISLATURE.
THE OTHER THING I DISCUSSED THIS
LAST WEEK ON A BILL BY GIVING
PROVIDERS WAS THE ABILITY TO
ESSENTIALLY DECIDE WHAT THEY
WANT TO DO FOR THEIR PATIENT,
PUTTING IT IN OUR HANDS, YOU
DISCARD EVIDENCE BASED
METHODOLOGY, YOU DISCARD BEST
PRACTICE GUIDELINES, AND YOU
ESSENTIALLY DECIDE WHAT
PRACTITIONERS WANT TO DO FOR
THEIR PATIENTS. RIGHT. AND THAT
IS VERY SCARY BECAUSE
REMEMBERING WHAT HAPPENED IN
COVID, JUST BECAUSE I HAVE AN MD
BEHIND MY NAME, DOES NOT MEAN
THAT I AM PRACTICING EVIDENCE
BASED MEDICINE. AND WE SAW THAT
WITH PROVIDERS SAYING, DON'T GET
VACCINES, TAKE THIS WEIRD
MEDICINE RIGHT, THAT NOBODY SAYS
IS CORRECT, BUT I'M THE
PROVIDER, AND I THINK THAT'S
WHAT'S BEST. IT ALSO ALLOWS FOR
CONTROL AND DISCRIMINATION
WITHIN OUR HEALTH CARE SYSTEM,
BECAUSE I, AS A PROVIDER, CAN
CHOOSE TO GIVE YOU A CERTAIN
MEDICATION OR CHOOSE TO TREAT
YOU A CERTAIN WAY. BUT ANOTHER
PATIENT THAT WALKS THROUGH MY
DOOR WHO LOOKS DIFFERENT, WHO
MAY COME FROM A DIFFERENT
BACKGROUND, DIFFERENT GENDER,
WHATEVER HOWEVER I CAN, I CAN
IMPOSE MY BIASES AND MY
DECISION. WHERE NOW, WHEN YOU
HAVE, YOU HAVE STANDARDS
PRACTICE, YOU KNOW, YOUR
STANDARDS OF HOW WE PRACTICE
EVIDENCE BASED APPROACH. IF YOU
START TO VEER, THERE ARE
CHECKPOINTS, RIGHT? AND IT MAY
EVEN BE THE INSURANCE COMPANIES
AT TIME THAT SAY, WE'RE NOT
GOING TO COVER THIS MEDICATION,
IT'S ALSO EXPENSIVE BECAUSE WHEN
YOU ELIMINATE THAT STEP THERAPY
THAT SAYS, I CAN CHOOSE TO AS A,
AS A SURGEON, YOU COME IN WITH
PELVIC PAIN. I DON'T NECESSARILY
HAVE TO WORK YOU UP. I CAN JUST
GO STRAIGHT TO A DIAGNOSTIC
LAPAROSCOPY. I DON'T HAVE TO GO
THROUGH THE STEPS TO SAY, LET ME
TRY NSAIDS. LET ME SEE IF
HORMONAL THERAPY WORKS. LET ME
TRY. YOU KNOW ANOTHER THING
BEFORE I TAKE YOU FOR THE MORE
EXPENSIVE PROCEDURE. SO
CONCERNED ABOUT THAT, I'VE I'VE
TALKED ABOUT THIS ALSO SO MANY
TIMES AROUND THIS ISSUE,
ALLOWING CALIFORNIA TO CONTINUE
TO BE COMPETITIVE, TO GET
PROVIDERS TO COME HERE. I AM
CONCERNED WITH THE WAY IN WHICH
THIS BILL IS STRUCTURED, THAT WE
CREATE A SYSTEM WHERE WE WOULD
NO LONGER BE COMPETITIVE TO GET
PROVIDERS, NOR TO MAINTAIN THE
PROVIDERS THAT WE HAVE,
ESPECIALLY AROUND SPECIALTY
CARE. THERE'S A SECTION IN THE
BILL THAT EXPLICITLY STATES
THERE SHALL BE A PRESUMPTION
THAT MEDICARE FEE FOR SERVICES
FOR REIMBURSEMENT CONSTITUTE
REASONABLE FEE FOR SERVICE,
WHICH IS INTERESTING WHEN JUST
IN FEBRUARY OF THIS YEAR, THE
AMA PUBLISHED AN ARTICLE THAT
SAYS, QUOTE, WHAT DOCTORS WISH
PATIENTS KNEW ABOUT THE MEDICARE
PHYSICIAN PAYMENT SYSTEM, AND IT
HIGHLIGHTED THE FACT THAT
MEDICARE RATES HAVE NOT KEPT UP
WITH INFLATION, AND ACTUALLY,
WHEN YOU ADJUST FOR INFLATION,
MEDICARE PHYSICIAN PAY OVER THE
LAST 23 YEARS HAS BEEN CUT BY
30. SO WE ARE COMING OUT OF THE
BOX GOING TO, PROVIDE OUR
PROVIDERS LESS MONEY AND THINK
THAT THEY'RE GOING TO COME OR
STAY IN PRACTICE HERE IN
CALIFORNIA. WE ALREADY HAVE A
PROVIDER SHORTAGE, AND IF WE
DON'T DO THIS CORRECTLY, WE WILL
JUST WORSEN THAT, WE ARE ALSO
REMOVING, YOU KNOW, INDIVIDUAL
AUTONOMY, WHICH, YOU KNOW, IF
SOMEONE ONE OF THE THINGS THAT
JUMPED OUT AT ME IS THAT IF A
PERSON WAS ELIGIBLE FOR AN
INCOME RELATED SUBSIDY, RIGHT,
AND THEY DECIDED, I DON'T WANT I
DON'T WANT IT, I DON'T WANT TO
APPLY FOR THIS IN THE BILL. THEY
HAVE TO THEY HAVE TO APPLY FOR
IT. AND IF THEY DO NOT, THEN
THEY WILL LOSE THEIR CAL CARE
COVERAGE, RIGHT? IF THEY HAVEN'T
APPLIED OR PROVIDED THE
INFORMATION WITHIN 60 DAYS, IT'S
GONE. AND SO I'M JUST I'M VERY
CONCERNED ABOUT SOME OF THE
THINGS THE WAY IN WHICH THE, THE
THAT ARE ACTUALLY IN THE BILL,
NOT THE CONCEPT. WE HAVE GOT TO
FIX OUR HEALTH CARE SYSTEM, BUT
THE THINGS THAT ARE CURRENTLY IN
THE BILL ARE VERY, VERY
CONCERNING. AND THE FACT THAT IF
THIS PASSES AS WRITTEN, IT
DOESN'T COME BACK TO US AT ALL.
ALL OF THESE THINGS ARE DONE ALL
OF THESE THINGS ARE IMPLEMENTED.
LET'S SAY THE MONEY GETS THERE.
A LETTER IS JUST SENT STATING
THE MONEY IS THERE, HEALTH CARE
IS OFF AND RUNNING, AND SO, YOU
KNOW, I THINK THAT THERE IS A
LOT MORE WORK TO BE DONE.
DEFINITELY APPRECIATE YOUR
PERSISTENCE WITH THIS AND THE
SPONSORS PERSISTENCE WITH THIS,
BUT I THINK THAT THIS IS SO
IMPORTANT THAT IF WE'RE ABLE TO
DO IT, WE NEED TO DO IT IN A
MANNER THAT WILL ACTUALLY HELP
CALIFORNIANS AND NOT ULTIMATELY
END UP HARMING THEM. SO THANK
YOU. I IF I MIGHT, I'M SURE I'M
ACTUALLY GOING TO, HAVE WELL,
I'M GOING TO ESTABLISH QUORUM
RIGHT NOW. MY APOLOGIES.
SECRETARY PLEASE CALL THE ROLL.
HERE PRESIDENT WALDRON. WALDRON,
PRESIDENT EDGAR CURRY, TIGER
CURRY, PRESIDENT. ARAMBULA
ARAMBULA PRESENT. WENDY CARILLO.
WENDY CARILLO. PRESIDENT LAURA
HANEY, JONES-SAWYER PRESENT.
JOHN SAWYER, PRESENT. SHANE
MCCARTY. JOE PATTERSON. JOE.
PATTERSON, PRESIDENT. RODRIGUEZ.
SANCHEZ SANTIAGO. SCHIAVO WEBER.
WEBER. PRESENT. AND WE WILL
CONTINUE WITH, COMMITTEE
MEMBERS. QUESTIONS AND COMMENTS.
I'LL MOVE TO ASSEMBLY MEMBER
JONES SAWYER AND THEN GO BACK TO
YOU BEFORE MR. PATTERSON ASKS
HIS QUESTION. OKAY AND THEN
MAYBE I CAN MOVE THIS ALONG BY
ASKING MR. CORA TO ANSWER THESE
THREE QUESTIONS. MAYBE IN YOUR
SUMMARY OR IMMEDIATELY AFTER AND
MAYBE WE CAN BRING THIS DOWN, TO
A LEVEL THAT PEOPLE WHO ARE
LISTENING HOPEFULLY CAN, CAN
POSSIBLY UNDERSTAND FROM, FROM A
CONSUMER, JUST FROM PEOPLE WHO
ARE, WHO HAVE TO USE THESE, AS
YOU ALL KNOW, OR YOU MAY NOT
KNOW, I'M SOMEONE THAT HAS
LIFETIME LIFE INSURANCE. I MEAN,
HEALTH INSURANCE WITH THE CITY
OF LOS ANGELES AT ONE TIME I HAD
DOUBLE INSURANCE WITH BOTH THE
STATE OF CALIFORNIA AND THE CITY
OF LOS ANGELES. MANY OF YOU HAVE
SEEN ME HOBBLE AROUND THIS
BUILDING AND OTHER BUILDINGS
WITH A KNEE PROBLEM, A KNEE
PROBLEM THAT I'VE BEEN WORKING
THROUGH WITH KAISER FOR THE LAST
SIX MONTHS. SO I DON'T KNOW
WHERE YOU GOT YOUR SPECIALIST SO
YOU CAN GET THE PEOPLE IN 29
DAYS. AND IT WASN'T UNTIL THIS
PAIN GOT TO A TEN PLUS LEVEL
THAT I FINALLY HAVE GOTTEN, AND
THIS IS SOMEONE THAT HAS HEALTH
INSURANCE. I FINALLY GOT
SOMEBODY TO TELL ME THAT
HOPEFULLY WITHIN TWO WEEKS, THEY
CAN TELL ME WHEN THEY CAN DO THE
SURGERY. AND I HAVE HEALTH
INSURANCE. LET ME SAY THIS
AGAIN. I'M SUPPOSED TO HAVE ONE
OF THE BETTER HEALTH INSURANCE,
AND EVERY MEMBER ON THIS
COMMITTEE, EVERY MEMBER IN THIS
BUILDING, EVERY LOBBYIST HAVE
SEEN ME STRUGGLE, STRUGGLE FOR
OVER SIX MONTHS WITH THIS MALADY
. I JUST HOPE WHATEVER WE'RE
DOING WILL NOT INCREASE THE
LEVEL OF CARE THAT IS NEEDED FOR
INDIVIDUALS. BECAUSE YOU'LL LOSE
ME IN A IN A MINUTE IF THAT IS
THE CASE. THIS THE REASON I'M
GOING TO GO AHEAD AND MOVE THIS
ALONG AND DO THE DO THE MOTION
IS THAT I WANT TO CONTINUE THIS
BECAUSE RIGHT NOW IT'S NOT
WORKING FOR ME. AND IN TWO WEEKS
WHEN I VISIT MY DOCTORS AND THEY
TELL ME ANOTHER SIX MONTHS, I
WILL LOSE IT AND THEY WILL BE
CALLING LAPD ON MY BECAUSE I
CAN'T TAKE IT ANYMORE. SO THAT'S
ONE FOR ME. I NEED TO KNOW THAT.
AND THIS IS JUST FOR ANYBODY OUT
THERE THAT'S LISTENING. THEY
JUST NEED TO KNOW WHETHER OR NOT
THIS IS GOING TO IMPROVE THEIR
HEALTH, QUALITY OF CARE ONCE
WHATEVER WE DO, ONCE THIS IS
DONE, TWO TOO MANY. YOU KNOW, I
HAVE A MOTHER WHO WILL BE
TURNING 88 ON THURSDAY. IT'S HER
BIRTHDAY, SHE JUST WE JUST
BROUGHT HER BACK FROM THE
HOSPITAL, FOR SENIORS OUT THERE,
I'M WORRIED ABOUT THEIR QUALITY
OF CARE, RIGHT NOW, I PAY
ADDITIONAL INSURANCE FOR HER SO
THAT SHE DOESN'T HAVE TO LOSE
HER HOME. SHE DOESN'T HAVE TO.
WE DON'T HAVE TO GO INTO DEBT TO
PAY FOR HER BECAUSE SHE HAS
DIABETES. SHE'S ON DIALYSIS. SHE
HAS HEART PROBLEMS. AND SHE'S
PROBABLY IN A HOSPITAL ONCE A
MONTH WITH SOME KIND OF
EMERGENCY CARE. AND IF YOU THINK
ABOUT THAT, JUST THE DIALYSIS
ALONE COULD BE CATASTROPHIC. IF
WE HAD TO COME OUT OF US WITH
OUT OF POCKET. AND SO FOR THOSE
SENIORS WHO HAVE ONGOING MEDICAL
MALADIES, WE NEED TO MAKE SURE
WE TAKE CARE OF THEM FIRST. YES,
THIS IS A NICE ESOTERIC
DISCUSSION AND BUDGETS AND BUT
AT THE END OF THE DAY, I DON'T
CARE. WE GOT TO TAKE CARE OF
THEM AND THE ADDITIONAL MONEY
THAT I PAY FOR MEDIC, CAL AND
MEDICARE COMES TO LIKE $600 A
MONTH AND I HAVE INSURANCE, SO I
PAY ANOTHER $1,000 A MONTH FOR
ME AND MY MOTHER SO THAT WE CAN
HAVE MEDICAL COVERAGE ON TOP OF
WHAT THE CITY OF LOS ANGELES
ALREADY PUTS IN. SO THAT'S A
REAL CONCERN. AND THEN LASTLY,
WHEN MY MOTHER FIRST GOT SICK, I
REMEMBER GETTING HER CREDIT CARD
BILL AND IT HAD CLOSE TO $12,000
ON IT. I SAID, MÀ, WHAT THE HECK
IS GOING ON? AND IT WAS FOR
PRESCRIPTION DRUGS. IT WAS FOR
ABOUT 100 PILLS. MY LORD, AT
$120 EACH OR MORE THOUSAND
DOLLARS. I MEAN, IT WAS
RIDICULOUS, THE AMOUNT OF MONEY.
AND IT WASN'T UNTIL WE WERE ABLE
TO GET HER INTO OBAMACARE AT
THAT TIME. THAT'S HOW LONG IT
GO. IT GOES. THAT COST WOULD
HAVE BEEN INCURRED FOR HER FOR
THE LAST TEN YEARS. SO
PRESCRIPTION DRUGS AND THAT COST
IS JUST AS DEBILITATING FOR
PEOPLE OUT THERE, WHETHER YOU'RE
POOR OR WHETHER YOU'RE YOU
YOU'VE WORKED A LONG TIME AND
YOU HAVE INSURANCE. IF I HAVE TO
PUT OUT A WHOLE LOT OF MONEY
GOING FORWARD ON PRESCRIPTION
DRUGS, THAT IS A NONSTARTER. AND
SO IF YOU CAN ANSWER THOSE
QUESTIONS BECAUSE THOSE ARE
THOSE ARE REALLY, I THINK,
IMPORTANT QUESTIONS TO SENIORS,
TO PEOPLE WHO WORK EVERY DAY AND
THE PEOPLE WHO HAVE TO HAVE
PRESCRIPTION DRUGS, THEY NEED TO
KNOW THAT IF WE MOVE FORWARD
WITH THIS, THAT THE QUALITY OF
LIFE WILL NOT GO DOWN. EVEN MORE
SO, BECAUSE WE MADE THIS, THIS
HAPPEN. BEFORE ANY RESPONSE, I
HEARD A MOTION. DO I HAVE A
SECOND DOCTOR? ARAMBULA. THANK
YOU. AND I SAID YOU COULD ANSWER
IT AND I'LL LET YOU RESPOND,
WOULD YOU PREFER IF OTHERS GO
AND THEN I'LL JUST GIVE ONE
RESPONSE? MR. PATTERSON, THAT
WOULD BE GREAT. THANK YOU.
GREAT. THANK YOU, FIRST OF ALL,
PLEASE, FOR THE LOVE OF GOD,
DON'T MAKE MR. JONES. SAWYER,
GRUMPY, NEXT WEEK OR IN A COUPLE
WEEKS, APPRECIATE THE, CHAIR FOR
GIVING ME SOME TIME HERE, I DO
WANT TO TAKE A MOMENT TO, TO.
WELL, FIRST OF ALL, MAKE
EVERYONE A LITTLE MAD. I THINK,
BUT, YOU KNOW, I THINK A LOT OF
THIS COMES FROM, YOU KNOW, THE
ELEPHANT IN THE ROOM. I MEAN,
I'VE ONLY BEEN ON THIS COMMITTEE
FOR A YEAR, BUT IT SEEMS LIKE A
DAILY OCCURRENCE, WHETHER IT'S
IN THIS COMMITTEE OR JUST
WHETHER IT'S WITH MY
CONVERSATIONS WITH, DOCTORS OR
HOSPITALS OR, YOU KNOW, THE
FRUSTRATIONS ESSENTIALLY GETTING
PAID AND, YOU KNOW, I JUST THINK
IT'S, FOR EXAMPLE, JUST THE
OTHER DAY, THERE WAS OPPOSITION
ON A BILL TO OPPOSE, SUBSTANCE,
SOMEBODY DYING OF AN OVERDOSE.
AND WE'RE GOING TO TRY TO GET
BACK TO THEM IN 72 HOURS, IN
ORDER FOR THE DOCTOR TO PROVIDE
THAT MEDICINE. I HAVE OPPOSITION
ON MY BILL TODAY THAT WOULD
SIMPLY CONTINUE EXISTING
COVERAGE OF, MAKE SURE
COLORECTAL CANCER SCREENINGS ARE
COVERED. IF SOME QUESTIONS ARE
BROUGHT IN BECAUSE OF SOME
LITIGATION AND SOME OTHER
STATES. SO I THINK WE HAVE TO
GET SERIOUS AS A, YOU KNOW,
REALLY TOGETHER. I MEAN, I WANT
TO WORK WITH EVERYBODY TO MAKE
SURE THAT, YOU KNOW, THERE WHEN
PEOPLE HAVE HEALTH INSURANCE AND
WHEN THE PROVIDERS ARE PROVIDING
THAT, THAT SERVICE THAT WE KNOW
THAT IT'S GOING TO BE PAID
BECAUSE, I MEAN, IT IS A
CONSTANT THAT I PUT TOGETHER A
MEDICAL ADVISORY GROUP OF ALL
SORTS OF PEOPLE. AND I WE
COULDN'T EVEN GET PAST AGENDA
ITEM NUMBER ONE, BECAUSE IT A
LOT OF FRUSTRATIONS FROM A,
EVERY ALL MY CONSTITUENTS THAT
ARE IN THE MEDICAL FIELD AND
IT'S SOMETHING WE REALLY HAVE TO
ADDRESS. BUT I DO HAVE OF A LOT
OF CONCERNS ABOUT, GOVERNMENT
RUN HEALTH CARE. AND I'M NOT
JUST SAYING THAT OUT OF SOME,
YOU KNOW, PHILOSOPHICAL VIEW,
BUT LIKE, RIGHT NOW I'M DEALING
WITH, YOU KNOW, AN ISSUE WHERE
INDIVIDUALS WHO ACTUALLY HAD
PRIVATE INSURANCE OR WERE ON
TRICARE THAT ARE BEING FORCED
ONTO, MEDI-CAL AND THEIR DOCTORS
, THERE ARE NO DOCTORS THAT
COVER THEIR SPECIALTY
DEVELOPMENTAL DISABILITIES. AND
DESPITE LOTS OF WORK WITH THE
DEPARTMENT AND THINGS LIKE THAT,
I MEAN, WE JUST CAN'T I MEAN,
THEY'RE LOSING THEIR COVERAGE
RIGHT NOW, DESPITE THE FACT THAT
THEY HAVE INSURANCE AND THEY
WANT TO STAY ON THEIR INSURANCE.
AND I THOUGHT THAT WAS ALL GOING
TO BE SOLVED. YOU KNOW, SPEAKING
OF OBAMACARE, I THOUGHT THAT WAS
ALL, GOING TO BE FIGURED OUT
THERE, BUT I ACTUALLY DON'T THAT
THAT IS A PROBLEM OF A
GOVERNMENT MANDATED, SYSTEM. AND
THEY REALLY JUST WANT TO KEEP
THEIR PRIVATE INSURANCE. AND SO,
YOU KNOW, OBVIOUSLY WE'VE HAD
CONVERSATIONS HERE ABOUT THE
COSTS AND THINGS LIKE THAT, YOU
KNOW, OBVIOUSLY WE'RE GOING TO
NEED SOME DETAILS. I DO THINK,
THE CHAMBER BROUGHT UP A GOOD
POINT ABOUT WHAT BUSINESSES, IF
THERE'S SOME RUNWAY A COUPLE OF
YEARS, THREE YEARS, YOU KNOW,
BEFORE WE REALLY KNOW THE
EXPENSES OR WHAT IT'S GOING TO
COST, YOU KNOW, I THINK THEY'RE
GOING TO START THINKING LIKE,
HEY, WHAT'S MY LONG TERME GAIN
IN THREE YEARS FROM NOW? YOU
KNOW, MAYBE I SHOULD LEAVE THIS
STATE NOW SO I DON'T HAVE TO
PARTICIPATE IN THIS EXPENSE IF
THEY DON'T KNOW IT, IF THEY
DON'T KNOW THOSE QUESTIONS, THE
ANSWERS TO THOSE QUESTIONS IN
ADVANCE. SO, YOU KNOW,
OBVIOUSLY, I MEAN, IT'S PROBABLY
NO SURPRISE TO YOU I'M NOT GOING
TO SUPPORT THIS TODAY, BUT, YOU
KNOW, YOU'RE ALWAYS BRINGING THE
SMALL ITEM ISSUES BEFORE THE
LEGISLATURE. SO THANKS FOR DOING
THAT. AND PLEASE, JUST DON'T
MAKE MR. JONES-SAWYER MAD. I'M
GOING TO HAVE, WENDY CARRILLO
ASK THE LAST OR MAKE THE LAST
COMMENT FROM COMMITTEE, AND THEN
WE'LL GIVE IT BACK OVER TO YOU
FOR ANY COMMENTS. THANK YOU.
MADAM CHAIR, AND I FEEL IT
NECESSARY TO ALSO GIVE A
DISCLAIMER ON BEHALF OF MY
COLLEAGUE FROM SOUTH LA WHO,
WILL NOT GET LAW ENFORCEMENT
INVOLVED IN, IN HIS SITUATIONS
MOVING, MOVING FORWARD, BUT I DO
AGREE WITH A LOT OF HIS,
SENTIMENT. I THINK, A LOT OF US
HAVE PERSONAL EXPERIENCES WHEN
IT COMES TO, LACK OF QUALITY OF
HEALTH CARE, LACK OF
INSUFFICIENT QUALITY HEALTH
CARE, OVER LIKE INCREDIBLY
BURDENSOME, COST ASSOCIATED WITH
HEALTH CARE. A LOT OF FOLKS IN
MY COMMUNITY OF ASSEMBLY
DISTRICT 52, WHICH INCLUDES EAST
LOS ANGELES, NORTHEAST LA, RELY
ON THE EMERGENCY ROOM. AND
THAT'S ALREADY INCREDIBLY COSTLY
, A LOT OF COMMUNITY CLINICS ARE
BECOMING, LESS AND LESS
AVAILABLE IN OUR COMMUNITY. LESS
AND LESS DOCTORS AND NURSES,
AFFORDABILITY OF HEALTH CARE,
ALL OF THESE THINGS ARE TRUE.
AND I REALLY JUST WANT TO BRING
INTO THE SPACE, A GENTLEMAN THAT
WE LOST, ADI BARKAN, WHO HAS
BEEN AT THE FRONT LINES OF
MEDICARE FOR ALL, FOR MANY YEARS
AND WHILE WE MAY DISCUSS ISSUES
RELATED TO HEALTH CARE AND
DISPROPORTION UNIT AGES, ADI WAS
39 WHEN WE LOST HIM, AND WE LOST
HIM TO ALS. AND HE WAS A FAMILY.
HE WAS A FAMILY MAN, HUSBAND,
FATHER AND A STAUNCH ADVOCATE
FOR HEALTH CARE AND WE KNOW IN
THIS MOVEMENT SO MANY PEOPLE
THAT WE CONTINUE TO LOSE BECAUSE
OF, JUST AN INABILITY TO RECEIVE
HEALTH CARE IN TIME OR
PREVENTATIVE, I WANT TO THANK
THE AUTHOR FOR ALL OF HIS
DILIGENCE AND HARD WORK AND
HAVING THE MEETINGS NECESSARY AT
THE FEDERAL LEVEL TO GET
CALIFORNIA GET THE FEDERAL
WAIVER TO EVEN BEGIN THIS
CONVERSATION AS TO WHAT IT WOULD
LOOK LIKE, AND I THINK IT'S
IMPORTANT THAT WE RECOGNIZE ALL
THE WORK THAT'S BEING DONE
ACROSS THE STATE AND ACROSS THE
COUNTRY. I COMPLETELY, YOU KNOW,
WANT TO SAY RESPECT THE
OPPOSITION AND THEIR POINT OF
VIEW. BUT AT SOME POINT IN ALL
OF OUR LIVES, REGARDLESS OF WHO
WE WORK FOR OR HOW MUCH MONEY WE
MAKE OR, YOU KNOW, WHERE WE ARE
IN LIFE, WE WILL KNOW SOMEONE
THAT IS IMPACTED BY THE LACK OF
HEALTH CARE, HEALTH CARE
COVERAGE, OR GOOD QUALITY HEALTH
CARE. AND WE WILL KNOW SOMEONE
THAT IS GOING TO GO BANKRUPT
BECAUSE OF THEIR HIGH COST OF
BILLS. WE KNOW SOMEONE THAT'S
GOING TO LOSE THEIR HOME, LOSE
THEIR LIVELIHOOD, LOSE THEIR
JOB, LOSE EVERYTHING THEY HAVE
BECAUSE THEY ARE TRYING TO LIVE
THEIR LIFE WITH A DISEASE AND
ILLNESS. A FAMILY MEMBER GOING
THROUGH CANCER. WE'VE HEARD THE
STORIES AND THERE ARE MILLIONS
OF THEM ACROSS THE COUNTRY. I
WANT TO THANK THE ADVOCATES THAT
ARE HERE, SOME I KNOW ARE HERE
FROM FROM LOS ANGELES AND
VARIOUS OTHER PLACES ACROSS
CALIFORNIA FOR THEIR CONTINUED
ADVOCACY. SOME CONSTITUENTS OF
MINE WHO ARE IN THE ROOM OR ARE
WATCHING, BACK HOME AND COULDN'T
MAKE THE TRIP UP HERE, IT TAKES
EFFORT TO COME UP HERE AND HAVE
30S OR 10S OF TESTIMONY AND TO,
YOU KNOW, REALLY COMMIT ANY FREE
TIME THAT YOU HAVE TO FIGHT FOR
HEALTH CARE AND NOT ONLY FIGHT
IT FOR YOURSELF AND FOR YOUR
FAMILIES, BUT FIGHT IT FOR EVERY
PERSON ACROSS THE STATE OF
CALIFORNIA, BECAUSE THAT'S WHO
YOU'RE FIGHTING FOR. AND THAT'S
WHO THE NURSES ARE FIGHTING FOR.
SO I'M PROUD TO BE A JOINT
AUTHOR, PROUD TO, CONTINUE TO
SUPPORT THE POLICY IN A VARIETY
OF DIFFERENT WAYS. FOR THE PAST
FEW YEARS, CONTINUE TO PUT
PRESSURE ON THE FEDERAL
GOVERNMENT TO REALLY MOVE
FORWARD WITH THE PROMISES THAT
THEY WERE THAT WERE MADE DURING
CAMPAIGNS AND PROMISES THAT WERE
MADE HERE TO THE 40 MILLION
PEOPLE THAT CALL CALIFORNIA
HOME. NOTHING IS EVER PERFECT. I
THINK THE CONVERSATIONS, RELATED
TO HEALTH CARE IN THE STATE ARE
CRITICAL. WE KNOW THAT THE STATE
OF CALIFORNIA IS COMING WITH
MORE AND MORE DOUBLE SENIORS AT
THE SAME TIME, LACK OF AGAIN, AS
I'LL MENTION, LACK OF
PROFESSIONAL, HEALTH CARE
PERSONNEL TO TAKE CARE OF OUR
COMMUNITIES. THE MORE THAT WE
WORK ON THIS, I THINK, GIVES US
IN A BETTER SPACE AND MORE AND
MORE PEOPLE ARE SUPPORTIVE OF
THE WORK THAT IS BEING DONE.
THERE'S A LOT OF WORK TO BE
DONE, BUT I THINK WE'RE HEADED
IN THE RIGHT DIRECTION. AND
WHILE, I THINK POLICY COMMITTEES
ARE ALWAYS HARD, IT'S ALWAYS
HARDER TO PRESENT AND SIT WITH
YOUR OPPOSITION AND TRY TO COME
TO COMMON GROUND AND TRY TO
REALLY TELL THE STORIES OF
EVERYDAY PEOPLE WHO ARE
SUFFERING, AND WHO REALLY WANT
US TO DO WHAT'S RIGHT FOR THEM.
AND SO I, I'M HAPPY TO BE
SUPPORTIVE OF THE BILL AND
CONTINUE TO MOVE THE
CONVERSATION FORWARD. THANK YOU,
THANK YOU, MADAM CHAIR, AND I'LL
TRY TO ANSWER SOME OF THE
QUESTIONS VERY QUICKLY.
APPRECIATE SOME OF THE CARILLO
FOR HER LONG STANDING SUPPORT
AND FOR COMMENTS TODAY, AS TO
DOCTOR WEBER, WHO MADE SOME
EXCELLENT POINTS, ONE OF THE
POINTS THAT SHE MADE WAS SHE
BELIEVES THAT WE SHOULD BE
PASSED AT A FEDERAL LEVEL. THE
ACA WAIVER PROCESS WAS CREATED
SO THAT STATES COULD MOVE
FORWARD WITH THE VARIETY OF
PROGRAMS, INCLUDING POTENTIALLY
A SINGLE PAYER PROGRAM. SO IT'S
BEEN SET UP IN A MANNER FOR
STATES TO TAKE THE LEAD, TO BE
THE ONES THAT MOVE FORWARD WITH
IT. IT'S THE SAME WAY THAT MANY
OTHER COUNTRIES, CANADA, AS AN
EXAMPLE, THAT STARTED AT THE
STATE LEVEL, AND ACTUALLY EACH
STATE HAS THEIR OWN PROGRAM THAT
THAT THE FEDERAL GOVERNMENT
HELPS TO FUND, AND SO THAT'S THE
REASON WHY WE LEAD AS A STATE ON
THE POLICY, ONE OF THE QUESTIONS
SHE RAISED, ALSO A GOOD ONE IN
TERMS OF, YOU KNOW, GIVING
DOCTORS, NURSES THE AUTONOMY TO
MAKE THAT DECISION, THE
DECISIONS IN THE OPERATING ROOM
OR IN THE HOSPITAL ROOM, REALLY
THE REASON WHY THAT'S IN THERE
IS THAT WE DON'T WANT ALGORITHMS
TO OVERRIDE THE BEST JUDGMENTS
OF THOSE THAT ARE ACTUALLY
CARING FOR OUR PATIENTS. NOW,
CAN WE TIGHTEN UP THE LANGUAGE?
BECAUSE WE DEFINITELY WANT TO
EVIDENCE BASED AND MORE THAN
HAPPY TO WORK WITH DOCTOR WEBER
TO ENSURE THAT LANGUAGE MAKES IT
VERY CLEAR THAT WE STILL WANT TO
MAKE SURE THAT THEY'RE USING
BEST PRACTICES, EVIDENCE BASED
PRACTICES, BUT WE DON'T WANT TO
HAVE IS SOME ALGORITHM OR SOME
OR WHAT WE SEE NOWADAYS AN
INSURANCE COMPANY TELLING A
DOCTOR THAT THEY CAN'T DO WHAT
THEY SEE AS MEDICALLY FIT, IN IN
TERMS OF, CAL CARE BOARD HAVING
TOO MUCH POWER. LOOK, THIS BILL
IS THE POLICY BILL, AND I WANT I
WANT TO MAKE THAT VERY CLEAR.
THIS IS THE POLICY BILL ON HOW
THE ACTUAL OPERATION OF CAL CARE
WOULD FUNCTION. IT'S IN AS WAS
MENTIONED EARLIER, THERE ARE
MANY OTHER STEPS THAT HAVE TO BE
IN PLACE, INCLUDING THE FUNDING
OF A SYSTEM THAT THE LEGISLATURE
WOULD HAVE TO APPROVE AND GIVE
AUTHORITY TO, AND RELEASE THOSE
FUNDS TO THE BOARD. SO THERE'S
PLENTY OF OPPORTUNITY, AND OUR
INTENTION IS TO HAVE LEGISLATIVE
AUTHORITY THROUGH THAT PROCESS.
WHAT WE DON'T WANT TO HAVE, AND
THIS IS THAT BALANCING ACT, AS I
HAVE EVERY YEAR. YOU HAVE TO GO
BACK TO THE LEGISLATURE TO
CHANGE SOMETHING, DO THIS AND
OTHER. WE NEED THE BOARD, THE
BOARD TO BE ABLE TO OPERATE
INDEPENDENTLY BECAUSE IT IS A
SYSTEM THAT'S GOING TO REQUIRE
THAT LEVEL OF ATTENTION. BUT IT
DOES NOT REMOVE LEGISLATIVE
AUTHORITY OR RELATIONSHIP
BETWEEN THE LEGISLATURE AND THE
BOARD. BUT MORE THAN HAPPY TO
LOOK AT LANGUAGE THAT WOULD
BETTER SATISFY SOME OF OUR
COLLEAGUES IF THEY THINK THERE
NEEDS TO BE MORE LANGUAGE IN THE
POLICY BILL, THAT MAKES THAT
VERY CLEAR, THAT THE LEGISLATURE
IS NOT COMPLETELY CUT OUT OF, OF
THE OPERATION OF CAL BOARD IN
TERMS OF ESPECIALLY THE
FINANCING ASPECT OF IT, TO
SENATOR PATTERSON, YOU KNOW, I
APPRECIATE HIS COMMENTS, THE
REALITY IS THAT WHEN WE TALK
ABOUT BUSINESSES, BUSINESSES ARE
BEING FLEECED RIGHT NOW, THEY'RE
BEING COMPLETELY FLEECED, AND
THEY HAVE VERY LITTLE CONTROL
OVER HOW MUCH THEY'RE BEING
CHARGED OR HOW MUCH THEIR RATES
ARE GOING UP YEAR OVER YEAR. IF
WE CAN RELIEVE THEM OF THAT
OBLIGATION, IF WE CAN RELIEVE
THEM OF THAT AND HAVE THEM HAVE
SOMETHING THAT'S A FRACTION OF
THAT, WHICH IS WHAT WOULD HAPPEN
UNDER A SINGLE PAYER PROGRAM, WE
WOULD ACTUALLY MAKE IT MORE
COMPETITIVE FOR BUSINESSES TO BE
IN CALIFORNIA, ESPECIALLY
KNOWING THAT NOW THEY CAN GET
RID OF ALL THEIR ADMINISTRATIVE
COSTS OF HAVING TO WORRY ABOUT
THEIR EMPLOYEES HEALTH CARE,
WHICH IS ENORMOUS, COST ON
BUSINESSES. AND LET'S KEEP IN
MIND THAT CALIFORNIANS RIGHT
NOW, INCLUDING CALIFORNIA
BUSINESSES, ARE PAYING THE
HIGHEST HEALTH CARE TAXES IN THE
WORLD. THEY'RE JUST NOT CALLED
TAXES. THEY'RE CALLED PREMIUMS,
AND THEY'RE CALLED CO-PAYS.
THEY'RE CALLED ADMINISTRATIVE
COSTS. SO WE CAN PLAY THE GAME
OF, OH, YOU'RE GOING TO BE TAXED
THIS AND OTHER. LET'S BE REAL,
WE HAVE THE MOST EXPENSIVE
SYSTEM IN THE WORLD, AND WE DO
NOT HAVE THE BEST OUTCOMES TO
ASSEMBLYMAN REGINALD JONES
SAWYER POINTS OF THESE WAIT
TIMES. AND LET ME TELL YOU THIS,
I MY FATHER'S RIGHT THERE IN THE
FRONT ROW. I TAKE CARE OF HIM.
HE'S HE'S ON MEDICARE. I TAKE
HIM TO HIS APPOINTMENTS. I KNOW
HOW LONG IT TAKES TO GET AN
APPOINTMENT. I KNOW MUCH HOW
MUCH HE PAYS OUT OF POCKET. I
KNOW HE HAS TO HAVE MEDICARE
ADVANTAGE, WHICH WAS, AGAIN, A
PRIVATIZATION OF OUR MEDICARE
SYSTEM. AND WE'RE LUCKY THAT HE
CAN AFFORD TO DO THAT IF HE
CAN'T AFFORD TO DO IT. GUESS HOW
LONG HIS WASTE TIME WAIT. TIME
IS GOING TO BE FOREVER. AND SO I
REALLY APPRECIATE THE COMMENTS
FROM ASSEMBLYMAN JOHN SAWYER.
ABSOLUTELY. THE GOAL IS TO MAKE
SURE EVERYONE HAS ACCESS TO HIGH
QUALITY CARE. AND THE REALITY IS
WE CAN DO BETTER THAN MEDICARE.
WE CAN PROVIDE LONG TERME CARE.
WE CAN PROVIDE VISION AND
DENTAL. MY DAD HAS SPENT $6,000
FOR HEARING AIDS. HE HAS TO PAY
THOUSANDS FOR DENTAL WORK.
THAT'S A REALITY OF WHAT PEOPLE
ARE GOING THROUGH. AND YOU'RE
LUCKY IF YOU'RE THE ONES THAT
CAN AFFORD IT. THOSE ARE MY
ANSWERS TO THOSE QUESTIONS.
THANK YOU. WE ARE GOING TO NOW
MOVE TO ME, TWOS, JUST AS A
REMINDER, BECAUSE WE ARE OVER
THE TIME THAT WE ALLOTTED FOR
THIS SPECIAL ORDER OF BUSINESS,
WE ARE GOING TO HAVE CAP ME TWOS
AT 15 MINUTES. AND IF YOU ARE IN
SUPPORT OR OPPOSITION, YOU
SHOULD BE LINING UP NOW.
WHEREVER WE GET AFTER 15 MINUTES
IS WHERE WE ARE GOING TO STOP.
THE SECRETARY IS GOING TO START
THE START THE CLOCK. THANK YOU.
THANK YOU. BRIAN HARR WITH THE
CALIFORNIA FACULTY ASSOCIATION.
WE STRONGLY, WE STAND IN STRONG,
SOLIDARITY WITH THE NURSES. AND
WE APPLAUD THE AUTHOR FOR
CARRYING THIS VERY IMPORTANT
BILL. THANK YOU, MADAM CHAIR,
AND MEMBERS, TIM TAYLOR WITH THE
NATIONAL FEDERATION OF
INDEPENDENT BUSINESS IN
OPPOSITION. THANK YOU. ANNIE
CHAO WITH THE CALIFORNIA
TEACHERS ASSOCIATION IN SUPPORT,
IN THE NAME OF MY NIECE, ALICIA
BATES, WHO WAS KILLED BECAUSE OF
MEDICAL APARTHEID. AS A MEMBER
OF BLACK LIVES MATTER, LOS
ANGELES AND BLACK LIVES MATTER
CALIFORNIA, I STAND IN STRONG
SOLIDARITY WITH THE BILL, AND I
THANK THE ASSEMBLY MEMBER FOR
BRINGING THE BILL FORWARD.
INSTEAD OF SAVING AS A PERSON
WHO HAS FOUGHT FOR SINGLE PAYER
FOR OVER 35 YEARS WITH BLACK
LIVES MATTER GRASSROOTS AND THE
FANNIE LOU HAMER INSTITUTE, WE
FIRMLY SUPPORT THIS BILL. YOU,
DYLAN ELLIOTT, ON BEHALF OF
SHASTA COUNTY, REGRETFULLY
OPPOSED RYAN HICKS, CALIFORNIA'S
DISABILITY RIGHTS AND DISABILITY
ADVOCATE, IN STRONG SUPPORT.
DEAN TYLER WITH THE CALIFORNIA
MANUFACTURERS AND TECHNOLOGY
ASSOCIATION, RESPECTFULLY
OPPOSED. THANK YOU, MADAM CHAIR.
TOM SHEEHY, REPRESENTING THE
CALIFORNIA LANDSCAPE CONTRACTORS
ASSOCIATION, IN OPPOSITION. MY
NAME IS HEATHER ABLOG. I'VE BEEN
A NURSE FOR 23 YEARS, 17 OF
WHICH AT KAISER AND SACRAMENTO
IN THE EMERGENCY ROOM. I'M
ABSENT LUTELY POSITIVELY SUPPORT
AB 2200. THANK YOU. NADINE.
PERU. KANE. WE SUPPORT THE
AMERICAN FEDERATION OF LABOR.
I'M GOING TO SCREW THIS UP. IT'S
ASKED ME AND I'M NERVOUS AND I'M
SORRY, BUT IT'S ALSO IT'S
COUNCIL 57 AND THE RETIREES,
CHAPTER 57 AND 35,000 MEMBERS
STRONG. THANK YOU. DAN PLONSEY,
MATH TEACHER, ON BEHALF OF MY
STUDENTS WHO HAVE HAD THEIR
EDUCATION DERAILED AND IS A
MEMBER OF BERKELEY FEDERATION OF
TEACHERS, WHICH HAS PASSED A
RESOLUTION IN STRONG SUPPORT.
GOOD AFTERNOON. JOHAN CARDENAS
WITH THE CALIFORNIA ETHNIC
HEALTH NETWORK. AND WE SUPPORT,
WE SUPPORT IN CONCEPT. THANK YOU
. TINA RUFO, 35 PLUS YEAR UNION
NURSE WITH CALIFORNIA NURSES
ASSOCIATION, IN STRONG SUPPORT.
HI, MY NAME IS MELODY MENDENHALL
. I'M AN ONCOLOGY NURSE
PRACTITIONER FROM LOS ANGELES, I
COME OUT IN STRONG SUPPORT OF
THIS BILL. HONORABLE CHAIR AND
MEMBERS AMY HINES-IKE
REPRESENTING UNITE HERE LOCAL 11
AND THEIR 32,000 MEMBERS IN
STRONG SUPPORT. THANK YOU.
BRITTANY CLARK, ON BEHALF OF
CALIFORNIA SCHOOL EMPLOYEES
ASSOCIATION AND STRONG SUPPORT.
MADAM CHAIR MEMBERS, RANDY
MARTIN, ON BEHALF OF THE AIDS
HEALTHCARE FOUNDATION, WHICH IS
ALSO A MANAGED CARE PLAN IN
STRONG SUPPORT. THANK YOU, FIRST
HARLAN BUTTE COUNTY HEALTHCARE
COALITION, IN STRONG SUPPORT AS
WELL. I AM WILL TOPOROFF, 28
YEAR NURSE PRACTITIONER WORKING
IN HIV PRIMARY CARE. I'M HERE IN
STRONG SUPPORT OF AB 2200. THANK
YOU. AFTERNOON. CHAIR MEMBERS
JESSICA MORAN WITH THE
CALIFORNIA DENTAL ASSOCIATION IN
OPPOSITION. THANK YOU. JANE KIM,
CALIFORNIA DIRECTOR OF WORKING
FAMILIES PARTY. THIS IS OUR TOP
PRIORITY AND WE ARE IN STRONG
SUPPORT. ALSO, FORMER SAN
FRANCISCO SUPERVISOR AND
INDIVIDUAL SUPPORT. HI, I'M
JENNY OSGOOD WITH THE SACRAMENTO
CHAPTER OF THE DEMOCRATIC
SOCIALISTS OF AMERICA, AND WE
ARE IN STRONG SUPPORT. HELLO. MY
NAME IS WILLIAM WHITE. I SPEAK
ON MY OWN BEHALF AS A WORKING
CLASS 26 YEAR OLD PERSON, I
WOULD RATHER SEE THE LEGISLATURE
ENACT A SYSTEM, NEW SYSTEM WITH
SOME ORGANIZATION IN SUPPORT OR
OPPOSITION. PLEASE SUPPORT
STRONG SUPPORT. THANK YOU. LEAH
GRIFFIN WITH THE AMERICAN
FEDERATION OF STATE COUNTY
MUNICIPAL EMPLOYEES IN SUPPORT
AND CONSENT. THANK YOU. GOOD
AFTERNOON. TIM VALDERRAMA WITH
THE WHITMAN GROUP ON BEHALF OF
BLUE SHIELD OF CALIFORNIA, IN
OPPOSITION. ANGELICA GONZALEZ,
ON BEHALF OF KAISER PERMANENTE
IN OPPOSITION. JANE SIM LIM,
BOARD MEMBER, HEALTH CARE FOR US
AND ALSO REPRESENTING ASIAN
PACIFIC ISLANDERS FOR CAL CARE
IN STRONG SUPPORT. CAROLINE
O'RIORDAN, FOUNDER, HOLLYWOOD
FOR CAL CARE, IN STRONG SUPPORT.
JONATHAN CARDIFF I SIT ON THE ON
THE BOARD OF DIRECTORS OF THE
CALIFORNIA FACULTY ASSOCIATION.
THIS NOT ONLY ENDORSED IT BUT
URGES STRONG SUPPORT. JENNIFER
SNYDER WITH CAPITAL ADVOCACY ON
BEHALF OF THE CALIFORNIA LIFE
SCIENCES IN OPPOSITION. JULIE
NIELSEN WITH THE NATIONAL UNION
OF HEALTH CARE WORKERS AND
HEALTHY CALIFORNIA NOW, PER OUR
LETTER AND SUPPORT. GOOD
AFTERNOON, MARK FAROOQ. ON
BEHALF OF THE CALIFORNIA
HOSPITAL ASSOCIATION. IN
OPPOSITION. MADAM CHAIR MEMBERS
YVONNE FERNANDEZ, CALIFORNIA
LABOR FEDERATION AND SUPPORT.
ANTHONY AUGUSTINE, ON BEHALF OF
THE FAMILY BUSINESS ASSOCIATION
OF CALIFORNIA, IN OPPOSED. THANK
YOU. MITCH STEIGER WITH CFT, A
UNION OF EDUCATORS AND
CLASSIFIED PROFESSIONALS ALSO IN
STRONG SUPPORT. I'M ROBIN
SUNBEAM FROM MENDOCINO COUNTY. I
REPRESENT NOT ONLY THE
DEMOCRATIC CENTRAL COMMITTEE AND
THE INLAND MENDOCINO DEMOCRATIC
CLUB, BUT ALSO THE MENDOCINO
WOMEN'S POLITICAL COALITION, AND
THEY ARE ALL IN STRONG SUPPORT.
KELLY BROOKS, ON BEHALF OF THE
SANTA CLARA COUNTY BOARD OF
SUPERVISORS AND SUPPORT. RACHEL
BHAGWAT, ACLU CALIFORNIA ACTION
IN SUPPORT. MCKINLEY THOMPSON.
MORLEY, ON BEHALF OF THE CITY OF
SACRAMENTO IN SUPPORT. SANDRA
POOLE, ON BEHALF OF WESTERN
CENTER ON LAW AND POVERTY IN
SUPPORT. SAVANNAH JORGENSEN, ON
BEHALF OF THE LUTHERAN OFFICE OF
PUBLIC POLICY, CALIFORNIA, IN
STRONG SUPPORT SIMON HIATT,
WORKING FAMILIES PARTY OF
CALIFORNIA, CENTRAL CENTRAL
VALLEY CHAPTER IN STRONG SUPPORT
ANNE-MARIE GARCIA, A MEDI-CAL
RECIPIENT WHO HAD TO BECOME POOR
TO BEAT ONE. BUT IT'S THROUGH
KAISER AND I FEEL SO NØ THEY'VE
BEEN BACK. I'M SORRY. I'M JUST
LUCKY, THAT'S ALL. IT MAKES ME
SAD THAT I HAD TO BE POOR TO GET
BETTER HEALTH CARE THAN I GOT
BEFORE. FROM WORK. WE HAVE TO
START SOMEWHERE. I WANT THIS TO
GO. WELL, ON BEHALF OF THE SOUTH
BAY PROGRESSIVE ALLIANCE IN
ENTHUSIASTIC SUPPORT. ÓRDENES
WITH HEALTH ACCESS CALIFORNIA
AND SUPPORT. THANK YOU. GOOD
AFTERNOON, ALEX KAHN ON BEHALF
OF UCONN, A REGIONAL COALITION
OF CHAMBERS OF COMMERCE AND THE
CALIFORNIA BUILDERS ALLIANCE IN
RESPECTFUL OPPOSITION. CATHERINE
GALE, PRINCIPAL AT CATHERINE
GALE CONSULTING, SMALL BUSINESS
SUPPORT. NIELSEN TÂM, DELEGATE
AT THE CALIFORNIA DEMOCRATIC
PARTY AND OFFICER OF THE
CHILDREN'S CAUCUS, IN STRONG
SUPPORT. GOOD AFTERNOON, JESSE
GONZALEZ, CALIFORNIA WORKING
FAMILIES PARTY, SAN FRANCISCO,
IN STRONG SUPPORT. GOOD
AFTERNOON, MATT AIKEN WITH THE
ASSOCIATION OF CALIFORNIA LIFE
AND HEALTH INSURANCE COMPANIES
IN OPPOSITION. GOOD AFTERNOON.
SHERRY MCCUE, REPRESENTING THE
CALIFORNIA CORRECTIONAL PEACE
OFFICERS ASSOCIATION BENEFIT
TRUST FUND AND NAPA, CALIFORNIA,
IN RESPECTFUL OPPOSITION. THANK
YOU, MADAM CHAIR. MEMBERS, JOHN
NORWOOD ON BEHALF OF THE
INDEPENDENT INSURANCE AGENTS
ASSOCIATION. THANK YOU. IN
OPPOSITION. PATRICIA JOHNSON,
I'M A RN, FORMER CNA MEMBER. I'M
ON THE BOARD OF WELLSTONE
PROGRESSIVE DEMOCRATS OF
SACRAMENTO. SO STRONG SUPPORT.
HI, ROBERT COPELAND, DSA
SACRAMENTO MEMBER AND CALIFORNIA
ALLIANCE OF RETIRED AMERICANS
MEMBER. STRONG SUPPORT. KAREN
GALE, RETIRED. SACRAMENTO IN
STRONG SUPPORT. CHRISTOPHER
SANCHEZ, REPRESENTING THE
CONSUMER FEDERATION OF
CALIFORNIA IN SUPPORT. MY NAME
IS CASEY FRITZ, CO-CHAIR OF THE
SACRAMENTO DEMOCRATIC SOCIALISTS
OF AMERICA, AND WE VOTED TO
SUPPORT THIS BILL. MEGAN
SHUMWAY, RETIRED OBSTETRIC AND
PUBLIC HEALTH NURSE AND RETIRED
CHP DEPUTY DIRECTOR IN STRONG
SUPPORT. DEREK GRASTY, BOARD
PRESIDENT, MOUNT PLEASANT
ELEMENTARY SCHOOL DISTRICT,
REPRESENTING MYSELF IN STRONG
SUPPORT. SUSAN PODESTA,
PRESIDENT OF THE AMERICAN RIVER
DEMOCRATS. WE STRONGLY SUPPORT
AB 2200. SALLY GWEN SATTERLEE
AND ARE IN FOR MANY YEARS AND
TANIT, I WAS GOING TO DO THIS,
YEAH. VERY STRONG SUPPORT FOR
THE CALIFORNIA NURSES
ASSOCIATION. AND SANTA CRUZ FOR
BERNIE OF 2000 PEOPLE. I'M
REPRESENTING IN SANTA CRUZ FOR
BERNIE. AND THEN, OF COURSE, ALL
THE NURSES. THANK YOU. THAT
THREE WITH REEB GOVERNMENT
RELATIONS REPRESENTING MILITARY
OFFICERS ASSOCIATION OF AMERICA
CALIFORNIA COUNCIL OF CHAPTERS
OPPOSED. SEIU 2015. STRONG
SUPPORT. MY NAME IS CELIA
COPELAND SEIU LOCAL OF 2015.
STRONG SUPPORT. BRANDON MARTY
WITH THE CALIFORNIA MEDICAL
ASSOCIATION IN OPPOSITION. MY
NAME IS DOCTOR JOHN COFFER. I AM
THE SENIOR DIRECTOR OF POLICY
WITH PUBLIC HEALTH ADVOCATES,
AND WE ARE IN STRONG SUPPORT.
THANK YOU. JOIN CONNECTICUT,
CALIFORNIA HISPANIC CHAMBERS OF
COMMERCE, RESPECTFULLY IN
OPPOSITION. THOMAS CRONIN, LOCAL
RESIDENT IN STRONG SUPPORT OF AB
2200. THANK YOU. MARTHA COLE, RN
FOR OVER 40 YEARS, PEDIATRIC
ONCOLOGY NURSE AT CHILDREN'S
HOSPITAL OAKLAND. STRONG
SUPPORT, CALIFORNIA NURSES
ASSOCIATION IN. SHIRLEY TOY
NURSE FOR OVER 44 YEARS. DEAN A
MEMBER STRONG SUPPORT. SERVICE
CALIFORNIA NURSES ASSOCIATION A
MIGHTY MIGHTY NURSE IN FULL
SUPPORT. JOE DONAHUE, REGISTERED
NURSE SINCE LATE 1970S. SO
THAT'S 40 SOME YEARS. STILL A
MEMBER OF CALIFORNIA NURSES
ASSOCIATION. THÀNH PROGRESSIVE
DEMOCRATS OF AMERICA, MONTEREY
AREA CHAPTER. STRONG SUPPORT,
PLEASE. GREG MILLER I'M A
RETIRED RN AND, WORKED AS A
HOSPITAL STAFF NURSE FOR 35
YEARS, STRONG SUPPORT AND ALSO A
MEMBER OF THE SANTA CLARA COUNTY
SINGLE PAYER HEALTH CARE
COMMISSION, WHICH ALSO IS
STRONG, STRONGLY SUPPORT. FAITH
BORGESS ON BEHALF OF CALIFORNIA
AGENTS AND HEALTH INSURANCE
PROFESSIONALS IN OPPOSITION. HI.
CONNIE CHU WITH CALIFORNIA
WORKING FAMILIES PARTY, BAY AREA
AND I SUPPORT. HANNAH CAPELLO,
SEIU 2015, LONG TIME IHSS HOME
CARE WORKER AND CHAIR OF THE
ALAMEDA COUNTY PUBLIC AUTHORITY
FOR IN-HOME SUPPORT SERVICE,
STRONGLY SUPPORT THIS BILL.
THANK YOU. THANK YOU, MADAM
CHAIR. JACKIE ONIS, ON BEHALF OF
AMERICA'S HEALTH INSURANCE PLANS
AND ELEPHANT'S HEALTH
RESPECTFULLY OPPOSED. ALSO ASKED
TO REGISTER OPPOSITION ON BEHALF
OF CIGNA. THANK YOU. I WILL
BRING IT BACK FOR COMMENT BEFORE
I ALLOW A BRIEF CLOSE FROM
ASSEMBLY MEMBER KALRA, I WANT TO
THANK YOU. ASSEMBLY MEMBER
KALRA, FOR YOUR CONTINUED
COMMITMENT TO MAKING SURE THAT
EVERY CALIFORNIAN HAS
AFFORDABLE, QUALITY HEALTH CARE
AND FOR YOUR COMMITMENT TO
CONTINUE TO WORK ON THIS BILL
AND THIS FRAMEWORK. EACH TIME
THIS PROPOSAL COMES FORWARD TO
THE LEGISLATOR, LEGISLATURE, WE
GET INCREMENTALLY CLOSER TO
ACHIEVING HEALTH CARE AS A RIGHT
THAT ALL CALIFORNIANS DESERVE.
THIS BILL SEEKS TO ADDRESS WHAT
IS WRONG WITH OUR CURRENT
SYSTEM, A HEALTH CARE SYSTEM
THAT IS EXPENSIVE AND UNEQUAL
DEPENDING UPON INSURANCE TYPE.
WE'VE MADE ENORMOUS STRIDES
SINCE THE IMPLEMENTATION OF THE
ACA, WHERE THE UNINSURED RATE
HAS FALLEN AND CONSUMERS
PROTECTIONS HAVE MADE HEALTH
CARE MORE ACCESSIBLE. STILL,
BARRIERS EXIST IN HEALTH CARE
DELAYS AND INCREASED PREMIUMS
AND OUT OF POCKET COSTS. AND IN
FACT, WE SIT HERE AS A HEALTH
COMMITTEE WEEK AFTER WEEK,
HEARING LEGISLACIÓN THÀNH THAT
ATTEMPTS TO TRY TO FIX THIS
FRANKENSTEIN OF A SYSTEM IN THIS
AGENDA ALONE. OAN WE ARE
SEEKING TO MAKE SURE THAT WE
HAVE COVERAGE FOR MENOPAUSE,
THAT WE HAVE NEWBORN SCREENING
PROGRAMS AVAILABLE TO EVERYONE,
THAT WE CAN ENSURE THAT OUR
CLINICS ARE ARE ADEQUATELY
COVERED IN SUPPORTING CONTROLLED
SUBSTANCES THAT ARE DISTRESSED.
HOSPITALS ARE NOT CLOSED WHEN
THEY NEED TO. WITH SAINT ROSE
HOSPITAL THAT WE ENSURE WE HAVE
FINANCIAL SOLVENCY FOR OUR
DIFFERENT BOARDS, THAT WE ENSURE
THAT WE HAVE AWARENESS AROUND
ABORTION SERVICES IN THE WAY
THAT WE NEED TO, AND WE GO ON
AND ON AND ON. HUMAN MILK WITH
ALL ASPECTS OF OUR HEALTH CARE
SYSTEM THAT CONTINUE TO NOT
SERVE, SERVE EVERY CALIFORNIAN.
I KNOW THAT YOU HAVE BEEN IN
THIS STRUGGLE FOR A VERY LONG
TIME, AND I WANT TO THANK EACH
AND EVERY ADVOCATE WHO TOOK TIME
TO COME HERE TO THE STATE OF
CALIFORNIA. AND IN THIS HEARING
ROOM, TO CONTRIBUTE YOUR VOICE
TO WHAT WE NEED TO ENSURE MOVES
FORWARD. WE KNOW THAT THIS IS
JUST A FRAMEWORK THAT YOU ARE
STARTING WITH, AND, AND WE KNOW
THAT YOU PURPOSELY SEPARATED THE
FRAMEWORK FROM AND THE POLICY
DISCUSSION FROM HOW WE WOULD
FUND THAT. AND I THINK THAT WAS
A SMART WAY FOR US TO GO,
BECAUSE IT PROVIDES AN
OPPORTUNITY FOR US TO TAKE A
REAL HARD LOOK AT SOME OF THE
POLICY COMPONENTS. AND I THINK
YOU HEARD FROM COMMITTEE MEMBERS
SOME ASPECTS OF THIS POLICY
FRAMEWORK THAT STILL NEED,
SIGNIFICANT WORK FOR US TO BE
ABLE TO MOVE FORWARD. AND I KNOW
THAT YOU WILL TAKE HEED WITH
THOSE ASPECTS AND CONTINUE TO
WORK ON THOSE SHOULD THIS BILL
BE ABLE TO MOVE FORWARD. I
SUPPORT THIS BILL. TODAY. I
SUPPORTED, ASSEMBLY BILL 1400. I
ASK RESPECTFULLY ASK TO BE A
COAUTHOR AT THIS TIME ON THIS
BILL AND I KNOW THAT YOU WILL
CONTINUE AS I DO, TO SUPPORT
EVERY CALIFORNIAN AND THIS
CONVERSATION TO ENSURE THAT WE
HAVE ADEQUATE HEALTH CARE FOR
EVERYBODY THAT IS AFFORDABLE. I
WANT TO THANK YOU FOR YOUR WORK
AND KNOW THAT WE WILL CONTINUE
WITH ALL PROPONENTS AND
STAKEHOLDERS THROUGHOUT OUR
HEALTH CARE SYSTEM TO MOVE
TOWARDS A BETTER CALIFORNIA WITH
THIS LEGISLATION. SO WITH THAT,
I, WE WERE OPTIMISTIC IN OUR
COUNT, WE DID NOT ACTUALLY HAVE
QUORUM, WITH EIGHT, WE NEED
NINE. SO WE ARE GOING TO
ESTABLISH QUORUM AND, REFER BACK
AND VOTE ON THIS BILL. BUT I
WILL GIVE YOU JUST A SHORT TWO
MINUTE CLOSE. WELL, THANK YOU SO
MUCH, MADAM CHAIR, FOR YOUR LONG
TIME SUPPORT OF HEALTH, JUSTICE
AND FOR BEING SO GRACIOUS AND
GIVING ME CREDIT WHEN THERE'S
FOLKS BEHIND ME THAT HAVE BEEN
IN THIS FIGHT WAY LONGER THAN I
HAVE. AND I WOULD SIMPLY SAY
THAT I'M SO GRATEFUL TO MY
COLLEAGUES, TO THOSE ON THE
HEALTH COMMITTEE, I KNOW MANY OF
YOU HAVE BEEN FIGHTING IN SO
MANY DIFFERENT WAYS TO INCREASE
ACCESS, BUT THE REALITY IS WE
KNOW OUR SYSTEM IS BROKEN. IT'S
UNSUSTAINABLE, AND THE REALITY
IS THAT WITH THE MOST EXPENSIVE
SYSTEM IN THE WORLD, WE HAVE TO
ASK THE QUESTION, WHO'S PAYING
FOR IT NOW AND HOW? HOW ARE THEY
PAYING FOR IT? WE'RE PAYING FOR
IT OUT OF OUR PAYCHECKS. WE'RE
PAYING FOR IT OUT OF GATHERING
ALL OF OUR LIFE SAVINGS. WE'RE
PAYING FOR IT BY MAKING CHOICES
OVER FOOD VERSUS MEDICATION
VERSUS HOUSING. WE'RE PAYING FOR
IT WITH LIVES LOST IN THE
STREETS. WE'RE PAYING FOR IT
WITH THE HIGHEST NUMBER OF THOSE
ENTERING INTO HOMELESSNESS BEING
SENIORS BECAUSE THEY GET INTO A
MEDICAL EMERGENCY AND THEY LOSE
THEIR HOME BECAUSE THEY CAN'T
PAY THEIR DEBTS. THE REALITY IS
THAT WE KNOW THERE'S A BETTER
WAY. WE KNOW THERE'S A BETTER
WAY, BECAUSE NOT ONLY DO OTHER
PLACES DO IT, BUT EVERY
LEGITIMATE STUDY HAS SHOWN THAT
WE HAVE THE MOST CONVOLUTED,
EXPENSIVE, AND UNJUST AND
IMMORAL SYSTEM THAT YOU COULD
POSSIBLY CREATE. WE CAN DO
BETTER. AND THE REALITY IS THAT
WE KNOW A STATE IS GOING TO LEAD
AND BE THE FIRST ONE TO DO THIS.
IT MUST BE CALIFORNIA.
CALIFORNIA IS THE ONE THAT CAN
DO IT BECAUSE WE HAVE THE A
LARGE ENOUGH GDP, WE CAN MAKE IT
HAPPEN AND ULTIMATELY IT'S NOT
GOING TO BE EASY. I DO REALLY
APPRECIATE THE FEEDBACK,
ESPECIALLY ON THE POLICY
COMPONENTS OF THIS DOCTOR WEBER,
SENATOR SCHIAVO, WE'RE GOING TO
TAKE ALL THAT INTO ACCOUNT AND
KEEP MOVING IT FORWARD, BUT THE
REALITY IS THAT IT DOES SEEM
LIKE WE KEEP ON REPEATING
OURSELVES BY BRINGING THIS BILL
FORWARD AND FORWARD. BUT THE
REALITY IS ALSO THAT WE'RE NOT
GOING TO STOP. AND NELSON
MANDELA ONCE SAID, IT ALWAYS
SEEMS IMPOSSIBLE UNTIL IT'S
DONE. AND THE REALITY IS THAT WE
TOGETHER CANNOT STOP BECAUSE
PEOPLE ARE DYING. AND WE KNOW
THAT EVERY SINGLE YEAR WE HAVE A
SYSTEM THAT IS PROFITING THE
VERY FEW WHILE THE MASSES
SUFFER. AND SO I URGE SUPPORT OF
THIS BILL, WHEN THERE'S A MOTION
FOR IT. I'M SO GRATEFUL TO THE
CHAIR. I'M SO GRATEFUL TO THE
COAUTHORS, OUR SPONSORS, AND
EVERYONE HERE IN SUPPORT AND
EVERYONE AROUND THE STATE IN
SUPPORT. I'D BE SO GRATEFUL FOR
YOUR AYE VOTE. THANK YOU. THAT
CONCLUDES OUR SPECIAL ORDER OF
BUSINESS RIGHT NOW. AND THANK
YOU SO MUCH, ASSEMBLY MEMBER
KALRA, FOR PRESENTING AB 2200.
WE WILL MOVE ON NOW TO MISTER
WALLACE, ITEM NUMBER 23, AB
2789.
READY FOR ME, PLEASE GO AHEAD
WHEN YOU'RE READY, MR. WALLACE,
GOOD AFTERNOON, MADAM CHAIR. AND
MEMBERS. I HAVE AN EQUALLY
CONTROVERSIAL BILL, I'M HERE
TODAY TO PRESENT ASSEMBLY BILL
2789. THIS BILL WILL CREATE A
ONE STOP SHOP WEBSITE TO GUIDE
NEW MARRIED INDIVIDUALS ON HOW
TO CHANGE THEIR NAME. OUR STATE
WAS THE BIRTHPLACE OF
TECHNOLOGICAL INNOVATION, AND WE
DON'T CURRENTLY HAVE AN EASY TO
FOLLOW, FREE ONLINE RESOURCE TO
HELP PEOPLE CHANGE THEIR LAST
NAMES. AS A RESULT OF THIS
DEFICIT, MANY INDIVIDUALS ARE
PURCHASING NAME CHANGE KITS THAT
CAN COST UPWARDS OF $100. WITH
THE COST OF LIVING GOING UP, I
BELIEVE IT'S IMPORTANT THAT WE
PROVIDE A FREE GOVERNMENT
RESOURCE TO SOLVE THIS ISSUE,
ESPECIALLY WHEN WE HAVE AN
INTEREST IN KEEPING DATA
ACCURATE FOR OUR GOVERNMENT
AGENCIES. THE STATE COURTS
CURRENTLY HAVE AN ONLINE HOW TO
GUIDE, WHICH ISN'T
COMPREHENSIVE. UNDER MY BILL,
THE WEBSITE WILL INCLUDE A LIST
OF ALL AGENCIES THAT MUST BE
NOTIFIED, INCLUDING FEDERAL
AGENCIES SUCH AS THE SOCIAL
SECURITY ADMINISTRATION, THE
DEPARTMENT OF STATE, THE
CALIFORNIA STATE AGENCIES
INCLUDING THE DEPARTMENT OF
MOTOR VEHICLES, THE DEPARTMENT
OF PUBLIC HEALTH, AND LICENSING
AGENCIES SUCH AS THE STATE BAR
AND DEPARTMENT OF CONSUMER
AFFAIRS. GOVERNMENT SHOULD MAKE
LIFE EASIER, NOT MORE
CONVOLUTED, AND CHANGING A NAME
AFTER MARRIAGE SHOULD BE SIMPLE,
NOT A BURDEN. AB 2789 WILL
SIMPLIFY THE NAME CHANGE PROCESS
BY PROVIDING TRANSPARENT
INFORMATION THAT IS EASILY
ACCESSIBLE IN ONE PLACE. THANKS
SO MUCH. ARE THERE ANY OTHER
WITNESSES IN SUPPORT? ANY IN
OPPOSITION? BRING IT BACK TO THE
COMMITTEE FOR COMMENTS. SEEING
NONE. MR. WALLACE, I WANT TO
THANK YOU FOR BRINGING FORWARD
THIS BILL. I KNOW THAT, OUR
COMMITTEE HAS BEEN WORKING WITH
YOU, AND KNOW THAT THERE ARE,
WAYS THAT WE CAN CERTAINLY
STRENGTHEN AN OPPORTUNITY FOR
THIS TO HAPPEN AND APPRECIATE
YOU BRINGING FORWARD THIS BILL.
WE WILL VOTE ON IT AS WE CAN.
PLEASE FEEL FREE TO CALL US,
THANK YOU, MADAM CHAIR, AND
THANK YOU TO THE COMMITTEE STAFF
FOR WORKING WITH US ON THIS
BILL. JUST RESPECTFULLY ASK FOR
AN AYE VOTE WHEN THE OPPORTUNITY
COMES. THANK YOU. WE'RE GOING TO
MOVE FORWARD WITH THE AUTHORS
WHO ARE IN THE ROOM, MOVING TO
ITEM NUMBER TWO, AB 2064
JONES-SAWYER AND I WILL MAKE A
CALL OUT TO AUTHORS WHO ARE
VIEWING THE SCREEN RIGHT NOW.
PLEASE COME DOWN. WE'RE TRYING
TO MOVE IN FILE ORDER. AND WOULD
LOVE FOR COMMITTEE MEMBERS TO
COME. SO THAT WE CAN ESTABLISH
QUORUM.
THANK YOU, MADAM CHAIR. I
PRESENT, AB 2064, WHICH WILL
ESTABLISH THE COMMUNITY VIOLENCE
INTERDICTION GRANT PROGRAM. THIS
BILL IS AMONG THE 14 PRIORITY
BILLS IDENTIFIED BY THE
CALIFORNIA LEGISLATIVE BLACK
CAUCUS AS PART OF THE
REPARATIONS PACKAGE. THIS BILL,
WHICH WOULD BE ADMINISTERED BY
THE CALIFORNIA HEALTH AND HUMAN
SERVICES AGENCY, WILL ENSURE
FUNDING FOR COMMUNITY DRIVEN
SOLUTIONS TO DECREASE VIOLENCE
IN OUR SCHOOLS AND
NEIGHBORHOODS, AS OPPOSED TO THE
CONTINUED THÀNH OF
INCARCERATION. THESE FUNDS WOULD
BE SECURED THROUGH AN
APPROPRIATION OF THE SAVINGS
FROM ANY FUTURE PRISON CLOSURE
WITHIN THE STATE BY USING FUNDS
FOR THESE PREVENTATIVE PROGRAMS,
WE REDUCE INCARCERATION EVEN
FURTHER AND FOCUS ON FINDING
SOLUTIONS TO CRIME BEYOND THE
INCARCERATION OF OUR MOST
VULNERABLE AND UNDERSERVED
POPULATIONS. AB 2064 ALLOWS FOR
TRUE REHABILITATION FOR PUTTING
AN EMPHASIS ON THE COMMUNITY AND
VICTIMS IMPACTED, GIVING THEM A
VOICE AND REDUCING MONETARY
EXPENDITURES ACCRUED ON
IMPRISONMENT, WHICH HAS NOT BEEN
SHOWN TO REDUCE RECIDIVISM.
THANK YOU. AND I RESPECTFULLY
ASK FOR YOUR AYE VOTE. THANK YOU
SO MUCH. ANY ADDITIONAL SUPPORT?
SAMANTHA'S AMY SAMANTHA JOHNSON,
ON BEHALF OF THE GREATER
SACRAMENTO URBAN LEAGUE IN
SUPPORT. THANK YOU. ANY
WITNESSES IN OPPOSITION? THÀNH
SEEING NONE. BRING IT BACK TO
THE COMMITTEE FOR COMMENT. I
WILL OFFER COMMENTS. I WANT TO
THANK YOU, ASSEMBLY MEMBER
JONES-SAWYER, FOR BRINGING
FORWARD THIS BILL. WE KNOW THAT
THIS IS A PART OF THE
REPARATIONS TASK FORCE
RECOMMENDATIONS AND SUPPORTED BY
THE CALIFORNIA LEGISLATIVE BLACK
CAUCUS, WE KNOW THAT THIS IS,
WELL, I PERSONALLY KNOW THAT
THIS IS SOMETHING THAT YOU HAVE
BEEN WORKING ON FOR A VERY LONG
TIME. AND AND THAT YOU ENDEAVOR
TO ENSURE, THAT CALIFORNIA HAS
AN OPPORTUNITY TO CREATE
LEGITIMATE PATHWAYS FOR VIOLENCE
INTERVENTION THROUGH YOUTH
DEVELOPMENT AND REALLY WANT TO
SUPPORT YOUR CONTINUED EFFORT IN
THIS REGARD. SO WITH THAT, WHEN
WE HAVE THE OPPORTUNITY, WE
SHALL VOTE. BUT PLEASE FEEL FREE
TO CLOSE. THANK YOU. AND I WON A
UNIQUE THINGS ABOUT THIS IS THAT
THIS IS BASED ON AN OPPORTUNITY
REYES THAT WE MAY HAVE FROM
SAVINGS FROM CLOSING PRISONS
THAT ARE, THAT ARE EMPTY, THAT,
THAT, THAT HAVE NO LONGER HAVE
THEIR AT THE END OF THEIR USEFUL
LIFE. AND SO THIS PROVIDES AN
OPPORTUNITY Kò, TO FOR THE FIRST
TIME LOOK AT SAVINGS THAT WE CAN
ACCRUE AND THEN APPLY THOSE
SAVINGS TO CREATE EVEN MORE
SAVINGS BY REDUCING THE AMOUNT
OF CRIME IN OUR COMMUNITIES. SO
I RESPECTFULLY ASK FOR YOUR AYE
VOTE. THANK YOU. ASSEMBLY
MEMBER. WE WILL MOVE ON NOW. TO.
ITEM NUMBER 27, AB 2942 VIA.
PLEASE GO AHEAD WHENEVER YOU'RE
READY. OKAY I'M TRYING TO CATCH
MY BREATH HERE. THANK YOU, MADAM
CHAIR. I WANT TO START BY
THANKING THE CHAIR AND COMMITTEE
STAFF FOR WORKING WITH MY OFFICE
ON THIS IMPORTANT BILL, AND I
WILL BE ACCEPTING THE COMMITTEE
AMENDMENTS, MAYBE 2942
ESTABLISHES A PILOT PROGRAM TO
INCREASE ACCESS AND DIVERSITY IN
CLINICAL TRIALS FOR CANCER
TREATMENT. THE AMERICAN CANCER
SOCIETY DATA ON BREAST CANCER
SHOWS THAT MORTALITY RATE HAS
DECREASED BY ONLY 1% PER YEAR,
FROM 2012 THROUGH 2021. THE
RECOMMENDATIONS, FOR
ACCELERATING THIS PROGRESS IS BY
REDUCING RACIAL DISPARITY AND AB
2942 DOES THAT. RIGHT NOW THERE
IS NO INSURANCE BENEFIT OR
CLINICAL TRIALS OF THIS NATURE.
EXCUSE ME. THIS MEANS THAT ONLY
THOSE WITH ACCESS TO FACILITIES
THAT OFFER THESE TRIALS AND THE
FINANCIAL RESOURCES TO PAY OUT
FOR PAY OUT OF POCKET CAN
PARTICIPATE IN THESE TRIALS. AB
2942 SPECIFICALLY CREATES A
PROGRAM THAT IS FUNDED, WOULD
FUND CLINICAL TRIALS FOR AT
LEAST 80 PATIENTS FROM DIVERSE
COMMUNITIES, INCLUDING WOMEN AND
PEOPLE OF COLOR. THIS PILOT
PROGRAM IS SPECIFICALLY SPECIFIC
TO THE NOVEL ALLERGENIC, CELL
BASED CANCER THERAPIES, WHICH
TARGETS SEVERAL TYPES OF CANCER,
INCLUDING BREAST, OVARIAN,
THYROID, AND PROSTATE CANCER.
THE INNOVATIVE TREATMENT IS NON
INVASIVE, INVASIVE, AND THE COST
SIGNIFICANTLY LESS THAN
CHEMOTHERAPY AND RADIATION. THIS
TREATMENT IS ALREADY IN CLINICAL
TRIALS. PHASE AND HAS PROVEN
SUCCESS IN HUMAN TRIALS. HOWEVER
THE TRIALS ARE LARGELY IN FOR
MORE AFFLUENT INDIVIDUALS. AB
2942 IS THE FIRST OF ITS KIND
BECAUSE IT ADDRESSES ACCESS
ISSUES HOLISTICALLY BY PROVIDING
ALL WRAPAROUND SERVICE THAT
ACCOMPANYING CARE. THIS INCLUDES
TRANSLATION, LANGUAGE SERVICE,
MEAL DELIVERY, TRANSPORTATION,
AND CHILD AND ELDERLY CARE.
INCREASING ACCESS TO CARE IS A
IS THE FOREFRONT OF CALIFORNIA'S
LONG TERME GOAL. THIS, COUPLED
WITH WITH THE INNOVATION THAT IS
FURTHER THROUGH DIVERSITY
CLINICAL TRIALS, MAKES AB 2942
ESSENTIAL TO ADVANCE THESE THESE
GOALS. WITH ME TODAY IS DOCTOR
KAREN ABOODY, PROFESSOR,
PROFESSOR AND PROFESSOR,
DEPARTMENT OF STEM CELL BIOLOGY
AND REGENERATIVE MEDICINE, CITY
OF HOPE AND WENDY. PIZARRO,
CHIEF LEGAL OFFICER OF CAL LU█T
BIOTHERAPY. THANK YOU. THIS.
RIGHT. OKAY. TWO MINUTES. THANK
YOU. HI. MY NAME IS DOCTOR KAREN
ABOODY, FOLLOWING MY TRAINING AT
MOUNT SINAI AND HARVARD, I
JOINED CITY OF HOPE NATIONAL
CANCER CENTER, 22 YEARS AGO,
I'VE BEEN THE DIRECTOR OF A
TRANSLATIONAL RESEARCH LAB.
DEVELOPING NEW CANCER TREATMENTS
THAT ARE MORE EFFECTIVE AND LESS
TOXIC TO PATIENTS, WE ARE
CURRENTLY IN CLINICAL TRIALS FOR
GLIOMA AND HEADED TOWARDS
OVARIAN AND BREAST CANCER. THAT
APPLICATION RUNS, I'VE PARTNERED
WITH CO-LEAD BIOTHERAPY SIX THE
PAST FIVE YEARS TO HELP MOVE
THESE NOVEL THERAPIES MORE
QUICKLY TO CLINICAL TRIALS FOR
THESE PATIENTS. I'M HERE TODAY
AS A PHYSICIAN, DEEPLY COMMITTED
TO THE FIGHT AGAINST CANCER AND
AS AN ADVOCATE FOR HEALTH EQUITY
TO EXPRESS MY STRONG SUPPORT FOR
AB 2942. THIS IMPORTANT
LEGISLATION PROMISES TO BROADEN
THE ACCESSIBILITY OF INNOVATIVE
CANCER TREATMENTS TO UNDERSERVED
POPULATIONS, THEREBY TAKING A
SIGNIFICANT STEP FORWARD IN OUR
COLLECTIVE QUEST TO OFFER HOPE
AND CARE TO EVERY SEGMENT OF OUR
SOCIETY, REGARDLESS OF ECONOMIC
STATUS, GENDER OR COLOR. AS A
DOCTOR SPECIALIZING IN STEM CELL
DELIVERED ANTI CANCER, VIRAL
IMMUNOTHERAPY REYES, I'VE
WITNESSED FIRSTHAND THE
DEVASTATING IMPACT OF CANCER ON
PATIENTS AND THEIR FAMILIES. THE
JOURNEY IS PROFOUNDLY MORE
DIFFICULT FOR PATIENTS FROM LOW
INCOME BACKGROUNDS AND MINORITY
COMMUNITIES, WHO OFTEN FACE
INSURMOUNTABLE BARRIERS IN
ACCESSING THE LATEST TREATMENTS
AVAILABLE. ASSEMBLY BILL 2942
PROPOSES A PRACTICAL AND
COMPASSIONATE SOLUTION BY
ESTABLISHING A GRANT FRAMEWORK
TO PROVIDE ACCESS TO PROMISING
CANCER THERAPIES FOR INDIVIDUALS
WHO MIGHT OTHERWISE BE EXCLUDED
FROM SUCH MEDICAL ADVANCEMENTS.
BY DOING SO, THIS LEGISLATION
NOT ONLY AIDS IN LEVELING THE
PLAYING FIELD FOR HEALTH ACCESS,
BUT ALSO ENRICHES CLINICAL
TRIALS WITH BROADER DIVERSITY
AND PARTICIPANT DEMOGRAPHICS.
THIS DIVERSITY IS CRUCIAL AS IT
LEADS TO MORE COMPREHENSIVE DATA
COLLECTION AND ANALYSIS, HELPING
TO ENSURE THAT NEW CANCER
TREATMENTS ARE EFFECTIVE ACROSS
A WIDER RANGE OF POPULATIONS.
THIS BILL ALIGNS OUR MORAL AND
PROFESSIONAL OBLIGATION TO
ENSURE THAT EVERY PATIENT,
REGARDLESS OF STATUS, HAS ACCESS
TO THE MOST NOVEL TREATMENTS
AVAILABLE FOR CANCER. THANK YOU.
GOOD AFTERNOON, MADAM CHAIR AND
ASSEMBLY MEMBERS OF THE HEALTH
COMMITTEE. MY NAME IS WENDY
PIZARRO, AND I'M THE CHIEF LEGAL
AND CHIEF DIVERSITY OFFICER OF
CARLGUARDINO BIOTHERAPEUTICS. WE
ARE A CANCER IMMUNOTHERAPY
COMPANY, INNOVATIVELY USING STEM
CELLS TO EFFECTIVELY TARGET
TUMORS IN OUR FIGHT TO CURE
CANCER SUCH AS GLIOMA OR BRAIN
CANCER. TRIPLE NEGATIVE BREAST
CANCER, MELANOMA AND HEAD AND
NECK. FIRST, I WOULD LIKE TO
ACKNOWLEDGE DOCTOR KAREN ABOUTI
SEATED NEXT TO ME. SHE IS OUR
RESEARCH PARTNER AND ONE OF THE
COUNTRY'S LEADING PHYSICIAN,
SPECIALIZING IN CANCER
TREATMENTS IN BRAIN AND OVARIAN
CANCER WIENER FROM CITY OF HOPE
IN LOS ANGELES. SHE IS ALSO A
MENTOR TO MANY WOMEN IN THE STEM
FIELD. I WOULD ALSO LIKE TO
THANK OUR BILLS, SPONSORS OF
BILL 2942, NAMELY AUTHOR AND
ASSEMBLY MEMBER CARLOS VILLA.
WHAT, WHAT, WHAT A YEAH, YES AND
COAUTHOR DOCTOR AKILAH WEBER.
TOGETHER WE ARE PROUD TO SUPPORT
ASSEMBLY BILL 2942, WHICH WOULD
EXPAND ACCESS AND DIVERSITY IN
INNOVATIVE CANCER CLINICAL
TRIALS. KHALIDI WAS FOUNDED IN
2014 AND IS BASED IN SAN DIEGO,
CALIFORNIA, ONE OF THE STATE'S
LEADING HUBS FOR BIOTECH
INNOVATION. CONSISTENT WITH THE
GOALS OF PRESIDENT BIDEN'S
CANCER MOONSHOT PROGRAM, ONE OF
CLYDE'S MAIN GOALS IS TO HELP
REDUCE CANCER DEATHS BY 50% BY
2043, USING AFFORDABLE, SCALABLE
AND UNIVERSAL STEM CELL DELIVERY
PLATFORMS TO TREAT MULTIPLE
INDICATIONS OF CANCER. THE
SECOND LEADING CAUSE OF DEATH IN
CALIFORNIA. WE AIM TO REACH ALL
DEMOGRAPHICS AND COMMUNITIES
PROMOTING HEALTH EQUITY IN
BIOTECHNOLOGY AND HEALTH CARE
INNOVATION. ACCESS AB 2942 IS
ONE MEANINGFUL AND CONCRETE WAY
TO ACHIEVE THIS GOAL. THANK YOU.
THANK YOU. ANY ADDITIONAL
WITNESSES IN SUPPORT, ANY
OPPOSITION? I'LL BRING IT BACK
TO THE COMMITTEE. THANK YOU SO
MUCH, MR. VILLA, FOR BRINGING
FORWARD THIS BILL. MOST OF US
KNOW SOMEONE WHO HAS BEEN
TOUCHED BY CANCER, AND WE VERY
MUCH APPRECIATE THE OPPORTUNITY
TO ESTABLISH A GRANT PROGRAM,
THROUGH THIS BILL THAT WOULD
PROVIDE ACCESS TO INNOVATIVE
THERAPIES AND WRAPAROUND
SERVICES. WITH THAT, WOULD YOU
LIKE TO CLOSE, JUST JUST ECHO
WHAT YOU SAID, MADAM CHAIR. I
MEAN, IT'S EVERY ONE OF US HAVE
KNOW SOMEBODY AND SOMEONE THAT'S
BEEN TOUCHED. I MEAN, AND THAT'S
GOING TO CONTINUE TO GO AND THIS
IS THIS BILL REALLY IS JUST
REALLY TRYING TO PUT A STOP TO
THIS. SO I RESPECTFULLY ASK FOR
A VOTE. THANK YOU SO MUCH. WHEN
WE HAVE AN OPPORTUNITY TO VOTE,
WE WILL THANK YOU, WE'LL MOVE ON
NOW TO ASSEMBLY MEMBER TO ITEM
NUMBER 28, AB 3045.
THANK YOU. CHAIR AND MEMBER OF
THE COMMITTEE AB 3045 WILL
CELEBRATE CONTRIBUTION OF
INDIVIDUALS OF ASIAN AMERICAN
AND PACIFIC ISLANDER DESCENT BY
ALLOWING THEM TO INCLUDE THEIR
ASIAN ZODIAC SIGN WHEN
PURCHASING A DECORATIVE BIRTH
CERTIFICATE, ACCORDING TO THE US
CENSUS, CALIFORNIA HAS A
POPULATION OF OVER 6 MILLION
ASIAN AMERICANS, ACCOUNTING FOR
15% OF OUR STATE POPULATION.
DESPITE BEING A SIGNIFICANT PART
OF CALIFORNIA POPULATION AND
PLAYING A KEY ROLE IN CALIFORNIA
HISTORY, ASIAN CULTURE IS OFTEN
LEFT UNDER REPRESENTED IN
CALIFORNIA. UNDER CURRENT LAW,
THE STATE REGISTRAR IS
AUTHORIZED TO PROVIDE DECORATIVE
HEIRLOOM BIRTH CERTIFICATE WITH
CALIFORNIA STATE SEAL ON THEM
UPON REQUEST AND PAYMENT OF A
FEE. THESE BIRTH CERTIFICATES
ARE NOT OFFICIALLY DOCUMENTED,
BUT MAKE US SPECIAL. KEEP SAKE
AB 3045 WILL CELEBRATE ASIAN
CULTURE BY AUTHORIZING THE STATE
REGISTRAR TO INCLUDE THE ASIAN
ZODIAC SIGN CORRESPONDING WITH
THE APPLICANT. DATE OF BIRTH.
WHEN SOMEONE ORDERS A DECORATIVE
BIRTH CERTIFICATE. FOR MANY
ASIAN AMERICAN INDIVIDUALS, THE
ASIAN ZODIAC HÌ, THE PERSONAL
SIGNIFICANCE REFLECTING BELIEF,
TRADITION AND VALUE PASSED DOWN
FROM GENERATION TO GENERATION.
IF PASSED, THE STATE REGISTRAR
WOULD BE AUTHORIZED TO
COLLABORATE WITH LOCAL ARTISTS
TO OBTAIN THE APPROPRIATE
ARTWORK BY ASIAN ZODIAC SYMBOL.
ANYONE WOULD THEN BE ABLE TO
REQUEST THE ADDITION OF THE
ASIAN ZODIAC SIGN ON THESE
DECORATIVE BIRTH CERTIFICATE,
AND PAY A REASONABLE FEE TO
COVER THE COST OF THE ARTWORK AS
CURRENTLY AUTHORIZED UNDER
ASSISTED STATUTE. THIS IS A
MEANINGFUL OPPORTUNITY TO
CELEBRATE ASIAN AMERICAN CULTURE
WITHOUT ANY COST OF THE STATE.
I'M HONORED TO PRESENT MY
WITNESS, DOCTOR WU, FOR DOCTOR
PHAM RECEIVED HIS BACHELOR'S
DEGREE AT UCI AND HIS PHD AT
ASIAN AMERICAN STUDIES AT
CORNELL UNION UNIVERSITY. HE HAS
BEEN A PROFESSOR AT UCI, UC
DAVIS AND UCLA, AND CURRENTLY
SERVE AT THE CHAIR OF LAUP AS
THE CHAIR OF ELEVATE DOCTOR PHAM
HAS CONSULTED FOR THE FEDERAL
GOVERNMENT, UNIVERSITY AND
FORTUNE 500 COMPANIES ARE
FORTUNE 500 COMPANIES WERE
AUTHORIZED ORDERING NUMBER.
NUMEROUS PUBLICATIONS REGARDING
ASIAN AMERICAN HISTORY AND
LEADERSHIP. DOCTOR PHAM, THANK
YOU. GOOD AFTERNOON. PLEASE PUT
ON YOUR MIC. OH, THERE WE GO.
THANK YOU. GOOD AFTERNOON,
CHAIRWOMAN AND MEMBERS OF THE
COMMITTEE AGAIN, I'M DOCTOR VU
PHAM AND I HAVE A BACKGROUND IN
ASIAN AMERICAN STUDIES AS WELL
AS EXECUTIVE EDUCATION AND
BUSINESS. SO YOU CAN CALL ME A
PRACADEMIC. I APPLY IT BOTH
WAYS, AND I'M REALLY GRATEFUL TO
BE HERE DUE TO ASSEMBLYMAN TO.
BECAUSE BECAUSE, AS YOU KNOW,
THE HEIRLOOM, THE LITTLE KNOWN
HEIRLOOM BIRTH CERTIFICATE
PROGRAM IS UNDERUTILIZED AND
QUITE UNKNOWN BY MOST
CALIFORNIANS. AND SO I'M
GRATEFUL FOR THE OPPORTUNITY TO
ADVOCATE FOR THAT. AND
REPRESENTATION MATTERS. WE HAVE
APPROXIMATELY 6 MILLION ASIAN
AMERICANS HERE IN CALIFORNIA,
ALMOST A THIRD OF ALL ASIANS IN
THE US. AND AS YOU KNOW, THERE
ARE PROBABLY MANY OF US WHO
SUBSCRIBE TO THE ASIAN ZODIAC.
AND THAT'S OUR BIRTH YEAR. IT
REALLY DETERMINES OUR SPIRITUAL
BELIEFS, OUR PERSONALITY, AND
WHO WE ARE AS PEOPLE. SO IN
HAVING AB 3045, THIS WOULD HONOR
OUR CONTRIBUTIONS TO AMERICA AS
WELL AS SPECIFICALLY TO
CALIFORNIA. AND IT WOULD ALLOW
US AND OUR ALLIES TO REALLY HAVE
AN HEIRLOOM COMMEMORATIVE BIRTH
CERTIFICATE. AND FINALLY, I'LL
GIVE YOU, EVEN ECONOMIC IMPACT.
BASICALLY, ASIAN AMERICANS ARE
BUYING POWER IS 41% HIGHER THAN
THE AVERAGE AMERICAN. AND WE
OVER LIFETIME HOUSEHOLD WILL
SPEND ABOUT $1 MILLION MORE THAN
MOST AMERICANS. SO THIS IS A
WONDERFUL WAY TO HONOR US AND
KEEP US IN AMERICA, KEEP US IN
CALIFORNIA. I PLAN TO BE HERE IN
CALIFORNIA, AND I'M VERY
GRATEFUL FOR ASSEMBLYMAN TO FOR
THE OPPORTUNITY TO REALLY
ADVOCATE FOR THIS. THANK YOU.
ANY OTHER WITNESSES IN SUPPORT?
ANY WITNESSES IN OPPOSITION?
SEEING NONE. I'LL BRING IT BACK
TO COMMITTEE FOR COMMENTS. MR.
PATTERSON, WELL, THANK YOU.
ASSEMBLY MEMBER TO, YOU KNOW,
SOMETIMES YOU LEARN THINGS,
THROUGH THIS PROCESS JUST BY,
HAVING LEGISLATION THAT BRINGS
IT FORWARD. AND I THINK IT'S
GREAT. I MEAN, IT'S NOT GOING TO
BE ANY, EXPENSE OF THE
GOVERNMENT. AND, YOU KNOW,
PEOPLE PAY THEIR OWN FEE IF THEY
WANT TO BE HONORED AND RECOGNIZE
SOMETHING THAT'S IMPORTANT TO
THE AAPI COMMUNITY. SO THANKS
FOR BRINGING THIS TO THE
ATTENTION AND LOOKING FORWARD TO
SUPPORTING IT WHEN SOMEDAY WE
HAVE, QUORUM HERE. REALLY
APPRECIATE YOUR COMMENT. WE ARE
SO CLOSE, SO CLOSE. MR.
PATTERSON, ASSEMBLY MEMBER TO I
ALSO WANT TO THANK YOU FOR
BRINGING FORWARD THIS, WHAT I
THINK IS A VERY IMPORTANT BILL
THAT SUPPORTS THE GREAT
DIVERSITY OF CALIFORNIA BY
CREATING AN ASIAN ZODIAC
HEIRLOOM BIRTH CERTIFICATE,
SOMETHING THAT, MY CHILDREN AND
SO MANY OTHERS WOULD HAVE
BENEFITED FROM BEING ABLE TO
HAVE, AND I WANT WOULD LOVE TO
BE A COAUTHOR IF YOU WOULD
CONSIDER ALLOWING ME TO BE SO.
YEAH, IT'S MY HONOR. YES. THANK
YOU. WITH THAT, WOULD YOU LIKE
TO CLOSE? I WENT WITH IT. I WANT
I REALLY WANT TO THANK THE CHAIR
AND COMMITTEE STAFF FOR WORKING,
WITH MY OFFICE, AND I
RESPECTFULLY ASK FOR YOUR VOTE.
THANK YOU. AND YOU SHALL HAVE
THAT CONSIDERATION IN VERY
SHORTLY. THANK YOU SO MUCH.
THANK YOU FOR COMMITTEE MEMBERS.
WE ARE NOW IN THE PHASE OF
HEARING ONLY COMMITTEE MEMBER
BILLS. SO PLEASE GET READY TO
PRESENT AND, AND COME AND JOIN
US SO THAT WE CAN VOTE ON YOUR
WONDERFUL BILLS, WE WILL MOVE
FORWARD WITH IN FILE ORDER,
ASSEMBLY MEMBER HANEY, AB 2115.
I DON'T KNOW, HANEY. YOU COME
LIKE, JUST SHOW UP AND THEN YOU
GET TO, I DON'T KNOW, BILLS ALL
DAY. IT'S GOOD. GOOD TIMING. I
GUESS, THANK YOU, MADAM CHAIR
AND MEMBERS. AB 2115 WILL
TRANSFORM CALIFORNIA FROM A
STATE WITH THE MOST RESTRICTIVE
METHADONE LAWS INTO A STATE THAT
LEADS IN ACCESSIBILITY FOR
METHADONE TREATMENT, WHICH WILL
SAVE LIVES. METHADONE IS PROVEN
TO BE THE MOST EFFECTIVE
TREATMENT FOR PEOPLE WITH OPIOID
ADDICTION. IT HELPS THEM CHANGE
THEIR LIVES AND TRANSITION TO
SOBRIETY. IT WORKS BY EASING THE
DEBILITATING SYMPTOMS OF OPIOID
WITHDRAWAL. FOR PEOPLE WHO HAVE
QUIT DRUGS LIKE HEROIN AND
FENTANYL, IT ALSO REDUCES THE
LIKELIHOOD OF DYING FROM AN
OPIOID OVERDOSE BY MORE THAN 50.
HOWEVER, FEWER THAN 1 IN 10
PEOPLE IN THE US WITH OPIOID
ADDICTION ARE CURRENTLY ENROLLED
IN TREATMENT, AND THOUSANDS ARE
DYING EACH YEAR DURING THE COVID
19 PANDEMIC, THE FEDERAL
GOVERNMENT RELAXED MANY
METHADONE RESTRICTIONS. THESE
RELAXED RESTRICTIONS LEAD TO LED
TO A HIGHER RATE OF ENROLLMENT
AND INCREASED PATIENTS ACCESS TO
THIS MEDICATION. IN APRIL OF
2024, THE BIDEN ADMINISTRATION,
RECOGNIZING THAT REDUCING
TREATMENT BARRIERS SAVE LIVES,
ADOPTED THESE RULES AND MADE
THEM PERMANENT. HOWEVER,
CALIFORNIA CONTINUES TO HAVE
OUTDATED METHADONE POLICIES THAT
ARE MORE RESTRICTIVE THAN
FEDERAL REGULATIONS. THIS IS
LEADING TO AMBIGUITY FOR
PROVIDERS AND PATIENTS,
ULTIMATELY RESULTING IN LESS
PATIENTS HAVING ACCESS TO
METHADONE. TOO MANY PEOPLE ARE
DYING EACH YEAR BECAUSE OF THESE
UNNECESSARY LAWS AND
BUREAUCRATIC HURDLES. THESE
INTENSE REQUIREMENTS, LIKE
STANDING IN LINE EVERY DAY TO
RECEIVE A SINGLE DOSE OF
METHADONE, OFTEN DISSUADES
PATIENTS FROM PURSUING CARE.
THEY HAVE TO SPEND FAR TOO MUCH
TIME GETTING ENROLLED AND THEN
STAYING ENROLLED. THAT THAT
DISRUPTS OTHER ASPECTS OF THEIR
RECOVERY, LIKE FINDING A JOB AND
STABLE HOUSING. IT OFTEN BECOMES
EASIER FOR THEM TO SELF-MEDICATE
THEIR SYMPTOMS BY BUYING DRUGS
OFF THE STREET. ADDITIONALLY, IN
MANY AREAS, THE FACT THAT THEY
HAVE TO LINE UP EVERY DAY AT
THESE CLINICS CAUSES THEM TO BE
PREYED ON BY PEOPLE WHO WANT TO
SELL ILLEGAL, DEADLY DRUGS.
CALIFORNIA'S LAWS NEED TO BE
UPDATED SO THAT PATIENTS ARE
ABLE TO ACCESS MEDICATION THAT
CAN SAVE THEM, NOT ILLICIT
DEADLY DRUGS LIKE FENTANYL THAT
CAN KILL THEM. AB 2115 WILL
ALLOW THEM TO DO THAT BY MAKING
SURE CALIFORNIA METHADONE
REGULATIONS ARE ARE ALIGNED WITH
FEDERAL RECOMMENDATIONS
PROVIDING PATIENTS EASIER ACCESS
TO TREATMENT, REMOVING AMBIGUITY
AND PREVENTING UNNECESSARY
DEATHS. WITH ME TODAY IN SUPPORT
OF THE BILL IS DOCTOR CRISTI
SORIN FROM THE SAN FRANCISCO
DEPARTMENT OF PUBLIC HEALTH, AND
DOCTOR MARLENE MARTIN, AN
ASSOCIATE PROFESSOR OF MEDICINE
AT UCSF. THANK YOU. YOU'LL EACH
HAVE TWO MINUTES. THANK YOU.
GOOD AFTERNOON, CHAIR BONTA. AND
MEMBERS OF THE HEALTH COMMITTEE.
THANK YOU FOR THE OPPORTUNITY TO
TESTIFY IN SUPPORT OF AB 2115.
MY NAME IS CHRISTY SOREN. I'M
THE DEPUTY MEDICAL DIRECTOR FOR
SUBSTANCE USE SERVICES FOR THE
SAN FRANCISCO DEPARTMENT OF
PUBLIC HEALTH, A PRIMARY CARE
AND ADDICTION MEDICINE
PHYSICIAN. WE ARE WITNESSING
UNPRECEDENTED NUMBER OF PEOPLE
DYING FROM OPIOID OVERDOSE.
THANKFULLY, WE HAVE LIFE SAVING
MEDICATION. METHADONE TREATMENT
REDUCES THE RISK OF DEATH BY 50.
YET LESS THAN A QUARTER OF
PEOPLE WITH OPIOID ADDICTION
RECEIVE THIS LIFE SAVING
MEDICATION. AB 2115 HAS THE
OPPORTUNITY TO CHANGE THAT BY
ALIGNING CALIFORNIA METHADONE
REGULATIONS TO FEDERAL
REGULATIONS IN TWO KEY WAYS.
FIRST, IT UPDATES STATE
REGULATIONS THAT GOVERN
METHADONE CLINICS. SECOND, IT
PERMITS PHYSICIANS OUTSIDE OF
METHADONE CLINICS TO PROVIDE
THREE DAYS OF MEDICATIONS
THROUGH A PROVISION KNOWN AS THE
72 HOUR METHADONE RULE. AB 2115
MAKES A SMALL YET IMPACTFUL
CHANGE TO 72 HOUR METHADONE BY
ALLOWING A PHYSICIAN TO DISPENSE
UP TO THREE DAYS OF MEDICATIONS
FROM A CLINIC SUPPLY. WHILE THAT
PATIENT NAVIGATES TO LONG TERME
CARE DATA SUPPORTS PROVIDING
MORE THAN ONE DAY OF MEDICATION
IS BOTH SAFE AND IMPROVES
RETENTION AND CARE. THE FIRST
FEW DAYS OF TREATMENT ARE
CRITICAL WHEN A PATIENT IS
EXPERIENCING SEVERE, FLU LIKE
SYMPTOMS AND INTENSE CRAVINGS.
AB 2115 WOULD ALLOW PHYSICIANS
TO START TREATMENT IN THAT
CRITICAL MOMENT OF NEED, AND AT
TIMES WHEN METHADONE CLINICS ARE
OFTEN NOT OPEN FOR REFERRALS.
THIS IS PRESSING FOR SAN
FRANCISCO, WHERE TWO PEOPLE ON
AVERAGE DIE A DAY FROM OPIOID
OVERDOSE. FOR OTHER COUNTIES,
IT'S EVEN MORE PRESSING. IN SAN
BENITO COUNTY, THE NEAREST
METHADONE CLINIC CAN BE OVER AN
HOUR DRIVE AWAY IN DEL NORTE AND
HUMBOLDT COUNTIES, THEY HAVE THE
HIGHEST OVERDOSE FATALITY RATES
IN THE STATE AND YET ONLY ONE
METHADONE CLINIC EACH. THESE
DISTANCES CAN BE INSURMOUNTABLE
DURING THAT CRITICAL TIME OF
ENTERING TREATMENT. INSTEAD OF
BASING REGULATIONS AND OUTDATED
PRACTICES, THE AB 2115 UPLIFTS
METHADONE TREATMENT TO BE BOTH
PATIENT CENTERED AND ROOTED IN
EVIDENCE. I HAVE LOST PATIENCE
AND LOVED ONES TO OVERDOSE, AND
I'VE SEEN PEOPLE STRUGGLING WITH
OPIOID ADDICTION TRANSFORM THEIR
LIVES WITH EFFECTIVE MEDICATION.
WE HAVE AN OPPORTUNITY TODAY TO
INCREASE ACCESS TO LIFE SAVING
MEDICATIONS. THANK YOU FOR
SUPPORTING THE HEALTH OF PEOPLE
WITH OPIOID ADDICTION AND THE
HEALTH OF ALL CALIFORNIANS. I'M
HAPPY TO ANSWER ANY QUESTIONS.
GOOD AFTERNOON. GOOD AFTERNOON,
CHAIR BONTA AND MEMBERS OF THE
HEALTH COMMITTEE. THANK YOU FOR
THE OPPORTUNITY TO SPEAK WITH
YOU. MY NAME IS MARLENE MARTIN
AND I AM AN ASSOCIATE PROFESSOR
AT UCSF AND DIRECTOR OF THE
ADDICTION CARE TEAM AT SAN
FRANCISCO GENERAL. I AM HERE
SUPPORTING ASSEMBLY BILL 2115,
WHICH ALIGNS CALIFORNIA'S
OUTDATED METHADONE PRACTICES
WITH WHAT FEDERAL STANDARDS AND
RESEARCH DICTATE IS SAFE. I AM
HERE REPRESENTING MY OWN VIEWS
AS A DOCTOR AND ADDICTION EXPERT
ON THE FRONT LINES. AB 2115 WILL
INCREASE THE NUMBER OF PEOPLE
WHO RECEIVE TREATMENT, DECREASE
COSTS FOR TAXPAYERS AND MOST
IMPORTANTLY, SAVE LIVES. BECAUSE
METHADONE TREATMENT IS THE MOST
EFFECTIVE TREATMENT FOR AN
OPIOID ADDICTION, CURRENTLY,
ONLY 1 IN 10 PEOPLE WITH AN
OPIATE ADDICTION RECEIVE
TREATMENT. GETTING METHADONE
TREATMENT TODAY MEANS ARRIVING
AT 6 A.M, WAITING HOURS FOR
INTAKE, AND RETURNING DAILY TO
GET MEDICINE. THESE ARE
MEDICINES SO CALLED LIQUID
HANDCUFFS. AB 2115 WOULD ALLOW
PEOPLE NOT YET ENROLLED IN
METHADONE TO ACCESS A BRIDGE
PRESCRIPTION WHILE THEY ENROLL.
INCREASE THE AMOUNT OF METHADONE
A PATIENT CAN TAKE HOME BETWEEN
APPOINTMENTS, AND EXPEDITE ENTRY
INTO TREATMENT. LET ME BE CLEAR
WITH AN OVERDOSE CRISIS RAGING
IN CALIFORNIA, WE NEED THIS
LEGISLATION. AB 2115 MAKES
FISCAL SENSE WHEN WE MAKE
ADDICTION TREATMENT MORE
ACCESSIBLE, WE DECREASE COSTS
AND SAVE LIVES. LET ME TELL YOU
A STORY ABOUT MY PATIENT. HE HAD
STARTED METHADONE IN THE
HOSPITAL AND WAS ACCEPTED TO
DISCHARGE TO A PLACE WHERE HE
COULD CONTINUE RECOVERING FROM
THE ASSAULT THAT BROUGHT HIM TO
THE HOSPITAL WITH AB 2115. I
COULD HAVE DISCHARGED HIM WITH A
FEW DAYS OF METHADONE. INSTEAD,
HE REMAINED HOSPITALIZED UNTIL
MONDAY AT THE TAXPAYERS EXPENSE.
WHEN THE METHADONE CLINIC WOULD
BE OPEN FOR NEW ENROLLMENTS. AB
2115 WILL SAVE LIVES BY MAKING
METHADONE MORE ACCESSIBLE, WHILE
METHADONE REDUCES OVERDOSE IN
ALL CAUSE MORTALITY BY 50. BUT
MOST OF THE PEOPLE WHO NEED IT
CANNOT ACCESS IT RIGHT NOW. NO
OTHER MEDICATION THAT I
PRESCRIBE AS A DOCTOR HAS THAT
EFFECT. AB 2115 WILL INCREASE
THE NUMBER OF PEOPLE ON
TREATMENT, DECREASE COSTS, AND
SAVE LIVES. IT WILL BRING
CALIFORNIA UP TO DATE WITH
PRACTICES THAT OTHER STATES HAVE
ALREADY ADOPTED, AND IT IS MUCH
NEEDED IN THE MIDST OF AN
OVERDOSE EPIDEMIC. THANK YOU FOR
THE OPPORTUNITY TO SHARE MY
TESTIMONY. THANK YOU. ARE THERE
ANY OTHER WITNESSES IN SUPPORT?
VANESSA GUGINO WITH CP PUBLIC
AFFAIRS ON BEHALF OF THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK HERE IN SUPPORT. GOOD
AFTERNOON, DYLAN ELLIOTT, ON
BEHALF OF THE CALIFORNIA STATE
ASSOCIATION OF PSYCHIATRIST IN
SUPPORT. KELLY BROOKS, ON BEHALF
OF THE BOARDS OF SUPERVISORS OF
SANTA CLARA AND SAN DIEGO
COUNTIES. GOOD AFTERNOON, KELLY
MCMILLAN. ON BEHALF OF THE
COUNTY OF SAN MATEO. ANY
WITNESSES IN OPPOSITION? I'M
JENNIFER ALLEY WITH THE
CALIFORNIA ASSOCIATION OF
CALIFORNIA OPIOID MAINTENANCE
PROVIDERS. EXCUSE ME. WE
ACTUALLY HAVE A CONCERNS
POSITION, BUT WE WOULD LIKE TO
ADDRESS THE COMMITTEE. WITH YOUR
PERMISSION, PLEASE GO AHEAD, SO
COMP REP RESENTS CALIFORNIA'S
NARCOTIC TREATMENT PROGRAMS,
COMMONLY REFERRED TO AS NPS
COMPS. MEMBERS HAVE BEEN
ADVOCATING FOR IMPROVING ACCESS
TO HIGH QUALITY, EVIDENCE BASED
MEDICATION ASSISTED TREATMENT
USING METHADONE FOR OVER 30
YEARS, AND AS SUCH, WE FULLY
SUPPORT THE INTENT OF THIS
LEGISLATION TO INCREASE ACCESS
TO TREATMENT FOR INDIVIDUALS
WITH OPIOID USE DISORDER. WE DO,
HOWEVER, HAVE SOME CONCERNS WITH
THE BILL. WE'VE SUBMITTED
LANGUAGE TO THE AUTHOR, AND
WE'RE CONTINUING OUR
CONVERSATIONS WITH THE SPONSORS.
WE WANT TO ENSURE THAT THERE IS
A PROCESS FOR PATIENTS TO,
ACCESS ONGOING OPIOID USE
DISORDER TREATMENT AFTER
RECEIVING MEDICATION UNDER THE
72 HOUR RULE. THIS IS SIMILAR TO
WHAT OTHER STATES HAVE DONE. WE
WANT TO MAKE SURE THAT THERE'S A
WARM HANDOFF OR A BRIDGE TO
TREATMENT, AND WE WANT TO HAVE A
PROCESS IN PLACE FOR THE CLINIC
TO VERIFY THAT METHADONE ISN'T
BEING ACCESSED FROM OTHER
LOCATIONS, AND WE WANT TO MAKE
SURE THAT PATIENTS ARE RISKED OR
EDUCATED REGARDING THE RISKS OF,
OF TAKING METHADONE. AND LASTLY,
WE'D LIKE TO HAVE A DATA
COLLECTION PROCESS IN PLACE SO
WE CAN TRACK THE OUTCOMES OF
INDIVIDUALS RECEIVING
MEDICATIONS UNDER THE 72 HOUR
RULE TO DETERMINE HOW WE CAN
IMPROVE ACCESS ONGOING FOR ALL
CALIFORNIANS AND PEOPLE IN THIS
VERY BAD CRISIS. THANK YOU SO
MUCH. THANK YOU. ANY OTHER
OPPOSITION? SEEING NONE, I'LL
BRING IT BACK TO COMMITTEE FOR
QUESTIONS OR COMMENTS. ASSEMBLY
MEMBER HANEY, DID YOU WANT TO
ADDRESS THE CONCERNS THAT WERE
RAISED? WE'RE CONTINUING TO HAVE
THE CONVERSATION ABOUT THAT.
CERTAINLY WE WANT TO MAKE SURE
THAT WHEN PEOPLE DO HAVE THAT
HANDOFF, AND HAVE THAT BRIDGE
DOSE, THAT THEY'RE ABLE TO
CONNECT TO AND CONTINUE IN
TREATMENT. AND WE WERE IN
CONVERSATION WITH, YOUR
COMMITTEE STAFF AROUND THAT. AND
THE BEST WAY TO DO THAT, AND
WE'LL CONTINUE TO DO THAT AS THE
AS THE BILL MOVES, MOVES
FORWARD. THANK YOU. AND I WANT
TO THANK YOU FOR BRINGING THIS
BILL FORWARD. I KNOW THAT YOU'VE
BEEN WORKING VERY DILIGENTLY
OVER THE COURSE OF YOUR TIME
HERE IN THE LEGISLATURE TO
ENSURE THAT WE'RE TAKING A
PUBLIC HEALTH APPROACH TO OUR
HOMELESSNESS CRISIS AND TO JUST
A BROADER APPROACH TO
INTERVENTION AND RECOVERY SO
THAT EVERYONE CAN ACCESS CARE.
VERY THANKFUL FOR THAT. I LOOK
FORWARD TO SUPPORTING THIS BILL
WHEN WE HAVE A QUORUM. THANK
YOU. THANK YOU. I'M SORRY. IT
LOOKS LIKE I SCARED SOME PEOPLE
AWAY WITH THIS ONE, BUT I
APPRECIATE IT, MADAM CHAIR AND I
JUST WOULD SAY, THERE'S A LOT
THAT WE HAVE TO DO TO CONFRONT
WHAT IS THE MOST DEADLY EPIDEMIC
THAT WE'RE FACING IN OUR STATE.
WE HAVE TO MAKE IT A LOT HARDER
TO ACCESS THESE DEADLY DRUGS.
AND A LOT EASIER TO GET ONTO
TREATMENT. THIS BILL WOULD MAKE
HUGE STRIDES IN MAKING THE MOST
EFFECTIVE EVIDENCE BASED
TREATMENT MORE ACCESSIBLE FOR
MORE PEOPLE. AND WITH THAT, IT
WILL SAVE MANY LIVES IN OUR
STATE AND WILL GREATLY IMPROVE
OUR BATTLE AGAINST FENTANYL. AND
WHEN THE TIME COMES, WE'D LOVE
TO HAVE THE SUPPORT OF THE
COMMITTEE. THANK YOU. THANK YOU.
WE WILL. WITH, MR. FLORES
PERMISSION. MOVE ON TO ITEM
NUMBER 31, AB 3245. PATTERSON.
PLEASE PROCEED. GREAT. THANK YOU
VERY MUCH, I THANK YOU FOR
ALLOWING ME TO GO RIGHT NOW SO I
CAN, GO TO MY OTHER COMMITTEES
WHERE I SERVE AS VICE CHAIR,
GOOD AFTERNOON, MADAM CHAIR. AND
MEMBERS. I'LL BE ACCEPTING THE
COMMITTEE AMENDMENTS TODAY. HERE
TO PRESENT AB 3245, WHICH
REQUIRES A HEALTH PLAN, CONTRACT
AND INSURANCE POLICY TO PROVIDE
COVERAGE WITHOUT COST SHARING
FOR A COLORECTAL CANCER
SCREENING TEST ASSIGNED EITHER
GRADE A OR GRADE B BY OTHER
ACCREDITED OR CERTIFIED
GUIDELINE AGENCIES, INCLUDING
THE AMERICAN CANCER SOCIETY, IN
SHORT, THERE'S SOME LITIGATION
GOING ON IN ANOTHER STATE THAT
JEOPARDIZES THE CURRENT, THE
CURRENT PROCESS TO ENSURE THAT
THIS COVERAGE IS IN PLACE. AND
SO WE JUST WANT TO MAKE SURE
OBVIOUSLY, I THINK IT'S
IMPORTANT TO EVERYBODY TO ENSURE
THAT, COLORECTAL SCREENING
CONTINUES AS IS, THERE SHOULD BE
NO ADDITIONAL COSTS ON THE PLANS
OR ANYTHING LIKE THAT. AND
RECENTLY WHEN THIS BILL WAS
BROUGHT TO MY ATTENTION, I HAD A
FRIEND WHO HAD JUST TURNED 40
WHO IS A DIAGNOSED WITH, WITH
COLORECTAL CANCER. AND,
FORTUNATELY, THEY DID CATCH IT
EARLY ENOUGH, ALTHOUGH HE WAS
KIND OF FIGHTING, TO GET THAT
SCREENING. AND, THEY FOUND IT AT
STAGE THREE, AND HE WENT THROUGH
PRETTY INTENSIVE, YOU KNOW,
TREATMENT, OBVIOUSLY. AND
FORTUNATELY, TEN YEARS LATER,
HE'S HERE WITH US TODAY. AND
THAT'S A REALLY GREAT THING. SO
I UNDERSTAND THE IMPORTANCE OF
THIS SCREENING AND I WANT TO
MAKE SURE IT CONTINUES. AND
WE'LL, SO THAT'S WHY WHEN THIS
BILL IS BROUGHT TO MY ATTENTION,
I DECIDED TO, TO INTRODUCE IT.
AND WITH ME, I HAVE, DEAN
GAROFALO WITH, CALIFORNIA LIFE
SCIENCES. PLEASE GO AHEAD, MR.
GRAFILO. YOU HAVE TO PRESS THE
MIC. THANK YOU. SO REMEMBER,
CHAIR MEMBERS RAFEAL WITH
CAPITAL ADVOCACY ON BEHALF OF
THE CALIFORNIA LIFE SCIENCES.
PARDON ME FOR BEING A LITTLE
WINDED. I WAS ON THE OTHER SIDE
OF THE BUILDING. BèC. WHAT YOU
DID, FLORA. SEE WHAT YOU DID? WE
ARE IN SUPPORT OF AB 3245, WHICH
WOULD REQUIRE HEALTH PLANS TO
COVER COLORECTAL CANCER
SCREENING. CALIFORNIA LIFE
SCIENCES REPRESENTS OVER 1200
ENTITIES REPRESENTING
PHARMACEUTICAL, BIOTECH, AG,
MEDICAL TECHNOLOGY AND ACADEMIC
RESEARCH INSTITUTIONS THROUGHOUT
CALIFORNIA FOLLOWING CANCER.
COLORECTAL CANCER IS A THIRD
MOST COMMON CANCER DIAGNOSED IN
BOTH MEN AND WOMEN EACH YEAR IN
THE UNITED STATES. IN 2023, OVER
150,000 ADULTS IN THE UNITED
STATES WERE DIAGNOSED WITH
COLORECTAL CANCER. THESE NUMBERS
INCLUDED OVER 106,000 NEW CASES
OF COLON CANCER AND OVER 46,000
NEW CASES OF RECTAL CANCER, AND
OVER 50,000 DEATHS FROM THIS
DISEASE OCCURRED IN THE UNION.
IN THE UNITED STATES. JUST LAST
YEAR ALONE. HOWEVER, WHEN
COLORECTAL CANCER IS FOUND EARLY
, IT CAN OFTEN BE CURED.
THANKFULLY, THE DEATH RATE FROM
THIS TYPE OF CANCER IN 2020, IN
THE UNITED STATES WAS 57% LESS
THAN WHAT IT WAS IN 1970 DUE TO
IMPROVEMENTS IN TREATMENT AND
INCREASED SCREENING, WHICH
DETECTS COLORECTAL CHANGES
BEFORE THEY TURN CANCEROUS.
THROUGH AB 3245 CALIFORNIANS
WILL HAVE INCREASED ACCESS TO
COLORECTAL CANCER SCREENINGS
THAT CAN POTENTIALLY SAVE THEIR
LIVES, OR AT LEAST CATCH THE
CATCH THE CANCER EARLY ENOUGH TO
SAVE THE COST OF THE MOST
EXPENSIVE AND ARDUOUS LATE STAGE
TREATMENTS. FOR THESE REASONS,
CALIFORNIA LIFE SCIENCES
STRONGLY SUPPORTS AB 3245. THANK
YOU. THANK YOU. ANY OTHER
WITNESSES IN SUPPORT? THANK YOU.
DYLAN ELLIOTT, ON BEHALF OF THE
CALIFORNIA MEDICAL ASSOCIATION,
IN SUPPORT ANY WITNESSES IN
OPPOSITION? SEEING NONE, I WILL
BRING IT BACK TO THE COMMITTEE,
I WANT TO THANK YOU, ASSEMBLY
MEMBER PATTERSON, FOR BRINGING
THIS BILL FORWARD. MY FATHER
ACTUALLY DIED OF COLORECTAL
CANCER, BECAUSE HE WASN'T
SCREENED EARLY ENOUGH. AND HAD
TO BATTLE ONE OF THE MOST
DEVASTATING DISEASES THAT WE CAN
IMAGINE. SO I WANT TO THANK YOU
FOR BRINGING FORWARD THIS
LEGISLATION TO ENSURE THAT THIS
KIND OF SCREENING CAN HAPPEN.
WITH THAT, PLEASE CLOSE. WELL,
REALLY SORRY ABOUT YOUR FATHER.
AND THANK YOU FOR SHARING THAT,
TODAY. AND, YOU KNOW, OBVIOUSLY
THIS HAS IMPACTED A LOT OF
PEOPLE. I KNOW ACTUALLY SEVERAL
PEOPLE WHO HAVE ALSO SUCCUMBED
TO IT. AND I THINK THE SCREENING
IS REALLY IMPORTANT. AND YOU
KNOW, THE ONE ADDED BENEFIT TO
THIS BILL OF ANYTHING IS JUST TO
GET, DEAN OVER HERE AND AS FAST
AS POSSIBLE, AROUND THE CAPITAL
HAS TO DO WHAT WE DO EVERY DAY
ON TUESDAYS. SO WITH THAT, I ASK
FOR AN AYE VOTE. THANK YOU, MR.
PATTERSON. AND, HOPEFULLY YOU
CAN WRAP UP YOUR TIME AT THE
PRIVACY SO THAT WE CAN ESTABLISH
A QUORUM AND VOTE ON YOUR
BEAUTIFUL BILL. THANK YOU. WE,
WE'LL MOVE NOW TO ITEM SEVEN, AB
2198. FLORA.
THANK YOU, MADAM CHAIR AND
COMMITTEE MEMBERS AND STAFF,
TODAY WE'RE GOING TO PRESENT AB
2198. IN 2022, CALIFORNIA. BUT I
LOVE IT. CALIFORNIA CODIFIED,
FEDERAL REGULATIONS PERTAINING
TO APPLICATION PROGRAMS,
INTERFACING FOR MEDICAL, DENTAL,
VISION INSURANCE PLANS. WHILE
THE FEDERAL GOVERNMENT DID NOT
APPLY THESE REQUIREMENTS TO
DENTAL AND VISION PLANS,
CALIFORNIA LAW DID. AB 2198 IS
AN ATTEMPT TO ALIGN CALIFORNIA
LAW WITH FEDERAL LAW, SIMILAR TO
THE LANGUAGE IN SB 598 THAT
PASSED UNANIMOUSLY OUT OF THIS
COMMITTEE LAST YEAR TO ADDRESS
SOME OF THE CONCERNS THAT THE
COMMITTEE ANALYSIS CORRECTLY
STATES THAT I AM OFFERING AUTHOR
AMENDMENTS THAT, NUMBER ONE,
DELETE FULL EXEMPTIONS INSTEAD
OF ESTABLISHING A JANUARY 1ST,
2027 IMPLEMENTATION DATE. NUMBER
TWO EXEMPTS ALL SMALL DENTAL AND
VISION PLANS UNDER 90,000
ENROLLEES. AND WITH ME TODAY IS
MATT BACH REPRESENTING
CALIFORNIA ASSOCIATION OF DENTAL
PLANS TO HERE TO HELP ANSWER ANY
TECHNICAL QUESTIONS. THANK YOU,
MADAM CHAIR. MATT BACH,
REPRESENTING CALIFORNIA
ASSOCIATION OF DENTAL PLANS.
AGAIN, THANK YOU TO MR. LARA AND
THE COMMITTEE FOR WORKING WITH
US. THIS IS AN IMPORTANT ISSUE.
AGAIN, UNFORTUNATELY, CALIFORNIA
DID NOT CAPTURE THE EXEMPTION
FOR DENTAL PLANS. SO THESE APIS
ARE VERY EXPENSIVE TO IMPLEMENT.
THEY TAKE A LONG TIME, SO AT
LEAST WE DO APPRECIATE THE
DELAYED IMPLEMENTATION. THAT
WILL GIVE US SOME TIME TO RAMP
UP AND DO THESE, WE CERTAINLY
APPRECIATE THE SMALL PLAN
EXEMPTION. AGAIN, THESE ARE VERY
EXPENSIVE TO DO, WE COULD LOSE
THOSE REGIONAL PLANS IF THEY DO
NEED TO IMPLEMENT THESE APIS, SO
AGAIN, NO, IT'S BEEN A LONG DAY.
HAPPY TO ANSWER ANY QUESTIONS.
AND WE LOOK FORWARD TO WORKING
WITH THE OPPOSITION AS WE MOVE
FORWARD. THANK YOU. ANY OTHER
WITNESSES IN SUPPORT? ANY
WITNESSES IN OPPOSITION? GOOD
AFTERNOON. CHAIR AND MEMBERS.
JESSICA MORAN WITH THE
CALIFORNIA DENTAL ASSOCIATION.
WE HAVE AN OPPOSED, UNLESS
AMENDED, POSITION ON THE BILL AS
IT'S IN PRINT. WE ARE LOOKING
FORWARD TO REVIEWING THE
AMENDMENTS AND WORKING WITH THE
SPONSORS AND COMMITTEE, ON
ADDRESSING OUR CONCERNS. THANK
YOU. GOOD EVENING, CHAIR AND
MEMBERS, KATIE VAN DINES WITH
HEALTH ACCESS CALIFORNIA. WE ARE
OPPOSED TO THE BILL IN PRINT, WE
THINK DENTAL AND VISION BENEFITS
ARE REALLY IMPORTANT TO
CONSUMERS. AND WE LOOK FORWARD
TO THE DAY WHEN THEY'RE TREATED
THE SAME AS OTHER TYPES OF
BENEFITS, WE APPRECIATE THE WORK
OF THE AUTHOR. THE COMMITTEE AND
THE SPONSOR ON THE AMENDMENTS
NOTED IN THE ANALYSIS. AND WE
ARE REVIEWING THOSE, AND I WILL
YES. THANK YOU. YEAH WE WILL
LOOK FORWARD TO REVIEWING THE
AMENDMENTS WHEN THEY'RE IN
PRINT. THANK YOU. THANK YOU.
VANESSA KHN, ON BEHALF OF THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK, SORRY TO SAY THAT WE'RE
OPPOSED TO THE BILL IN PRINT,
BUT WE DO VERY MUCH APPRECIATE
THE EFFORTS OF THE AUTHOR, OF
THE SPONSORS AND VERY MUCH OF
THE STAFF ON THE EFFORTS THAT
YOU'VE MADE ON THE LANGUAGE IN
FRONT OF US TODAY. SO WE'LL BE
ANALYZING THOSE AND LOOKING
FORWARD TO SEEING THE BILL.
THANKS SO MUCH. I WILL BRING IT
BACK TO THE COMMITTEE FOR ANY
COMMENT OR QUESTION. SEEING
NONE, MR. FLORES, ME CLOSE. JUST
RESPECTFULLY ASK FOR AN AYE
VOTE. THANK YOU. WE CAN MOVE ON
NOW TO ITEM NUMBER. 16 AB 2637
SHIAVO, FOLLOWED BY ITEM 18 AB
2670 SHIAVO.
MADAM CHAIR MEMBERS, THANK YOU
FOR THE OPPORTUNITY TO PRESENT
AB 2637 TO YOU TODAY. I WANTED
TO START BY THANKING THE
COMMITTEE FOR THEIR STAFF AND
STAFF FOR THEIR DILIGENCE IN
THIS BILL. I COMMIT TO
CONTINUING TO WORK WITH THE
CHAIR AND THE COMMITTEE TO
ENSURE THE APPROPRIATE
GUARDRAILS ARE IN PLACE, THE
CALIFORNIA HEALTH FACILITIES
FINANCING AUTHORITY, OR CHFA,
HAS A NUMBER OF PROGRAMS THAT
ASSIST HOSPITALS IN FINDING THE
FINANCING THEY NEED FOR
INFRASTRUCTURE, EQUIPMENT AND
MORE. ONE TOOL ALLOWS CHFA TO
CONNECT HOSPITALS IN GOOD
FINANCIAL STANDING WITH THIRD
PARTY INVESTORS. THESE ARE
PRIVATELY FUNDED LOANS. THIS CAN
INCLUDE LEASE PAYMENTS, SALARIES
AND OPERATING COSTS. HOWEVER
EXISTING STATUTE LIMITS LOAN
REPAYMENT TERMS TO TWO YEARS AND
THIS HAS SEVERELY LIMITED THE
ABILITY OF THIS FINANCIAL TOOL
TO SUPPORT HOSPITALS. AS AN
EXAMPLE, DURING THE PANDEMIC,
MANY HOSPITALS HAD DIPS IN
REVENUE ACCESSING A LOAN TO
FINANCE SHORT TERME COSTS AND
REPAYING OVER MULTIPLE DECADES
DISPERSES THE FINANCIAL PRESSURE
TO HOSPITALS, GIVEN THE ABILITY
OF THE TREASURER'S OFFICE TO
SECURE TAX EXEMPT LOANS WITH
TYPICALLY LOWER RATES EXTENDING
THE REPAYMENT TIMELINE WILL HELP
HOSPITALS SAVE MONEY, AND THEY
SHOULD IN TURN OAN TO THIS
TOOL. GET THROUGH A BUMPY PATCH
HERE TO TESTIFY IN SUPPORT IS
DEPUTY TREASURER SHAHEEN MORTON
AND CAROLYN ABU BISHARA. BISHARA
YES. OKAY, GOOD, EXECUTIVE
DIRECTOR OF THE CALIFORNIA
HEALTH FACILITIES FINANCING
AUTHORITY. WE ARE GOING TO
ESTABLISH A QUORUM FIRST. WOOHOO
TO PRESENT TO PRESENT WALDRON.
WALDRON, PRESENT. EDGAR CURRY
ARAMBULA. WENDY CARILLO LARA
LARA PRESENT. HANEY HANEY.
PRESENT. JOAN SAWYER. JOAN.
SAWYER, PRESENT. MAIENSCHEIN
MCCARTY. JOE. PATTERSON.
RODRIGUEZ. RODRIGUEZ. PRESENT
SANCHEZ. SANTIAGO SANTIAGO.
PRESENT. CHAVO. CHAVO. PRESENT
WEBER. WEBER. PRESENT. WE HAVE
NINE PRESENT. QUORUM IS
ESTABLISHED. PLEASE GO AHEAD
WITH YOUR TESTIMONY. AWESOME.
THANK YOU VERY MUCH. MOVED BY
SANTIAGO, SECONDED BY RODRIGUEZ.
PLEASE GO AHEAD WITH YOUR TO
MAKE MY TESTIMONY BRIEF. KI¾M
MORTON, DEPUTY TREASURER HERE ON
BEHALF OF FIONA MA, STATE
TREASURER, AS WAS MENTIONED, THE
CALIFORNIA HEALTH FACILITIES
FINANCE AUTHORITY, OTHERWISE
KNOWN AS CHÁVEZ, WHICH THE
TREASURER SITS AS THE CHAIR.
THIS CAME TO US AS HIGHLIGHTED
THROUGH THE PANDEMIC, THE
VULNERABILITY OF HEALTH CARE
SECTOR. HOSPITALS WERE
FINANCIALLY UNPREPARED TO HANDLE
THE OVERWHELMING INFLUX OF
PATIENTS REQUIRING INTENSIVE
CARE, PERSONAL PROTECTIVE
EQUIPMENT AND OTHER ESSENTIAL
RESOURCES AS CHÁVEZ SOUGHT TO
PROVIDE FINANCIAL RELIEF TO
THOSE HOSPITALS, WE FOUND THAT
CURRENT LAW CURRENTLY HINDERED
THE PROGRAM FROM EFFECTIVE
ADDRESSING THE URGENT NEEDS OF
HOSPITALS DURING THE CRISIS.
THUS CAME ABOUT WITH AB 2637,
WHICH SEEKS TO EMPOWER TFA TO
EXTEND LONG TERME WORKING
CAPITAL FINANCING BEYOND THEIR
CURRENT 24 MONTH LIMITATION AND
ADDRESSING A SIGNIFICANT GAP IN
EXISTING FINANCING OPTIONS,
PROVIDING VITAL SUPPORT TO
HEALTH CARE INSTITUTIONS THAT
ARE CREDIT WORTHY, WITH THAT, AS
MYSELF AND EXECUTIVE DIRECTOR,
CAROLYN BASHARA AS WELL. YEAH
GOOD AFTERNOON, MADAM CHAIR. AND
MEMBERS OF THE COMMITTEE. THANK
YOU FOR HAVING US. I'M CAROLYN
ABUBAKAR, THE EXECUTIVE DIRECTOR
OF THE CALIFORNIA HEALTH
FACILITIES FINANCING AUTHORITY.
I'LL REFER TO IT AS AS SCFA.
WHEN THE COVID PANDEMIC OUTBREAK
BEGAN IN EARLY 2020 AND THE
GOVERNOR DECLARED THE STATE OF
EMERGENCY SCFA AND ITS SISTER
AUTHORITY, THE EDUCATIONAL
FACILITIES AUTHORITY, WHICH I'M
ALSO A DIRECTOR OF, CONVENED A
TASK FORCE, A COVID 19 TASK
FORCE THAT INCLUDED A NUMBER OF
BOND FINANCING PROFESSIONALS,
INCLUDING LAWYERS, THE ATTORNEY
GENERAL'S OFFICE, BOND COUNSELS,
FINANCIAL ADVISORS, BANKERS,
EVEN ASSOCIATIONS TO KIND OF
COME UP WITH NEW WAYS OF HELPING
THE HOSPITALS WEATHER THE
PANDEMIC. THE NUMBER ONE
REQUESTED RELIEF THROUGH THAT
TASK FORCE WAS LONG TERME
WORKING CAPITAL FINANCING. SO
CURRENTLY, TFA AND THE
EDUCATIONAL FACILITIES AUTHORITY
THAT WE OVERSEE AT THE
TREASURER'S OFFICE, WE ALREADY
PROVIDE CAPITAL FINANCING, WHICH
IS BUILDINGS, INFRASTRUCTURE AND
EQUIPMENT. WHAT WE'RE TRYING TO
DO IS TO ACTUALLY ALLOW LONG
TERME WORKING CAPITAL, WHICH IS
BASICALLY SALARIES OPERATING
COSTS, SUPPLIES, PAYMENT ON
ACTUALLY LOANS AS WELL. AND SO
UNDER FEDERAL TAX LAW, IT IS
ALLOWED TO DO LONG TERME WORKING
CAPITAL FINANCING. HOWEVER, THE
STATE LAW HAS FURTHER
RESTRICTIONS THAT HAVE BEEN IN
PLACE SINCE THE 80S THAT PREVENT
US FROM DOING LONG TERME WORKING
CAPITAL FINANCING. IT LIMITS US
TO JUST TWO YEARS, AND WE'RE
TALKING ABOUT, WE'RE TALKING
ABOUT THE HOSPITALS NEED THE
ASSISTANCE TO PAY FOR INCREASING
SALARIES AFTER THE PANDEMIC.
WE'VE SEEN A SKYROCKETING
SALARIES, SUPPLY COSTS, THE
PURCHASE OF PERSONAL PROTECTIVE
EQUIPMENT AND TESTS, AND ALSO,
LONG OF DIFFERENT EXPENDITURES
THAT WERE UNFORESEEN PRIOR TO
THE PANDEMIC. AND SO WE WANT TO
AB 2637 IS GOING TO IS GOING TO
ADDRESS THE PROGRAMMATIC
INEQUITY OF BASICALLY ALIGNING
ALL THE ISSUERS THROUGHOUT THE
STATE OF CALIFORNIA. THERE ARE
OTHER ISSUERS, ONE THAT WE
OVERSEE, SEVERAL IN THE
TREASURER'S OFFICE THAT ALLOW
LONG TERME WORKING CAPITAL AND
OTHER LOCAL GOVERNMENTS THAT
ISSUE WORKING CAPITAL. AND SO
WE'RE JUST TRYING TO ALIGN THAT
AND BEING ABLE TO PROVIDE A COST
EFFECTIVE TOOL IN THE
TREASURER'S OFFICE. ONE THING
WE'RE KNOWN FOR AT SHAFA, WE
HAVE A VERY COST EFFECTIVE,
PROGRAM. WE HAVE COMPETITIVE
FEES, WE HAVE AN EFFICIENT BOND
ISSUING PROCESS. AND SO WE WANT
TO MAKE SURE THAT WE HAVE ALL
THE TOOLS AVAILABLE FOR THE
HOSPITALS AS THEY NEED THEM, AND
TO BE READY FOR THE NEXT,
DETRIMENTAL EVENT THAT COULD
HAPPEN IN THE FUTURE. AND SO WE
RESPECTFULLY REQUEST YOUR AYE
VOTE AND HAPPY TO ANSWER ANY
QUESTIONS. THANK YOU. ANY OTHER
WITNESSES IN SUPPORT? GOOD
EVENING MADAM CHAIR AND MEMBERS.
CONNIE DELGADO, ON BEHALF OF THE
DISTRICT HOSPITAL LEADERSHIP
FORUM IN SUPPORT. GOOD EVENING.
VANESSA GONZALES WITH THE
CALIFORNIA HOSPITAL ASSOCIATION
HERE IN SUPPORT. THANK YOU. ANY
WITNESSES IN OPPOSITION? SEEING
NONE, I WILL BRING IT BACK TO
THE COMMITTEE. ASSEMBLY MEMBER,
I APPRECIATE YOU BRINGING
FORWARD THIS BILL, YOU AND I
HAVE HAD SEVERAL CONVERSATIONS
ABOUT THIS BILL, AND I JUST WANT
TO KIND OF CONTINUE TO VOICE MY
CONCERN THAT WE ARE ALLOWING
DIFFERENT HOSPITALS, INCLUDING
THOSE WHO ARE SEEMINGLY FINE.
OKAY, RIGHT NOW, BUT POTENTIALLY
THAT WILL BECOME DISTRESSED OVER
TIME TO INCUR LONG TERME DEBT
OVER THE COURSE OF 20 OR, YOU
KNOW, 30 TO 40 YEARS, TO FINANCE
EVERYDAY OPERATING EXPENSES, I'M
SURE THERE WAS A VALID REASON
FOR THE LIMITATION OF TWO YEARS
AT THE TIME THAT THE ORIGINAL
LEGISLATION ALLOWING THE STATE
TO TAKE ON THESE WORKING CAPITAL
LOANS OR TO OFFER THESE WORKING
CAPITAL LOANS WAS, PUT FORWARD.
I HAVE CONCERNS THAT WE ARE,
STRETCHING OUR OUR ABILITY TO
REALLY ENSURE THAT, THAT THE
HOSPITALS THAT WE WOULD BE
PUTTING THROUGH THESE THE
OFFERING THIS FINANCING OPTION
TO WOULD, WOULD BE BURNING
THROUGH THEIR WORKING CAPITAL
AND, IN SHORT, CREATING MORE OF
A TENUOUS SITUATION FOR THEM,
MORE LIKELIHOOD THAT THEY WOULD
THEN NEED TO BE CONSOLIDATED,
AND ON AND ON IT GOES IN TERMS
OF, THE KIND OF CONSOLIDATION
THAT WE ACTUALLY DON'T BELIEVE
IS HEALTHY FOR, INCREASED
ACCESS. SO I WOULD LOVE FOR YOU
TO OFFER AN OPPORTUNITY TO
RESPOND TO THAT, BUT I DO
ENCOURAGE YOU TO CONTINUE
WORKING ON THE ON FINDING THE
SWEET SPOT, IF YOU WILL, WITH
THE LENGTH OF TIME FOR THIS OR
AN ALTERNATIVE WAY TO BE ABLE TO
CONTROL THE MECHANISM OF THIS.
AND, I'LL LEAVE IT AT THAT IF
YOU'D LIKE TO CLOSE IN YOUR
RESPONSE YET. I COMPLETELY
UNDERSTAND THE CONCERNS THAT YOU
HAVE AND APPRECIATE THE CHAIR
AND STAFF. YOU KNOW, RAISING
THESE THOUGHTFUL CONCERNS TO,
FOR US TO CONTINUE TO GRAPPLE
WITH AND FIGURE OUT A SWEET SPOT
FOR THIS BILL. LIKE I SAID
EARLIER, YOU KNOW, I MEAN, THIS
IS INTENDED FOR, FOR HOSPITALS
THAT ARE IN GOOD FINANCIAL
STANDING, AND THEY HAVE TO PROVE
THAT TO GO THROUGH. AND I'LL LET
MY WITNESSES ADD MORE DETAILS IF
THEY CAN. BUT, YOU KNOW, THAT IS
REALLY THE INTENTION OF THE
BILL. I SHARE YOUR CONCERNS
AROUND CONSOLIDATION, AND AROUND
CORPORATE BUYOUTS OF HOSPITALS.
AND SO WE DON'T WANT TO YOU
KNOW, HAVE AN UNINTENDED
CONSEQUENCE LIKE THAT. AND I
THINK THAT, THAT WE CAN WORK
TOGETHER TO FIGURE OUT A
SOLUTION THAT MAKES SENSE, MY
UNDERSTANDING OF THE SITUATION
IS THAT IF THEY DON'T GET
FINANCING HERE, WHICH IS LOWER
FEES, LOWER RATES, YOU KNOW,
BETTER FINANCING AND HELPS WITH
THAT FINANCIAL VIABILITY THAT
THEY'LL GO OUT ON THE MARKET AND
GET A WORSE RATE, BE IN MORE
DEBT, AND IT'LL BE A WORSE
FINANCIAL SITUATION. SO SO WE'RE
KIND OF TRYING TO, YOU KNOW,
FIGURE OUT A BALANCE TO THAT,
AND I'LL LET MY WITNESSES ADD
ON. I WOULD BE HAPPY TO CHIME
IN. THANK YOU, CHAIR. MADAM
CHAIR. SO ON A COUPLE OF NOTES.
SO THE RESTRICTION HAS BEEN IN
PLACE SINCE THE 80S. AND WE KIND
OF CHECKED ON THAT. AND THE
HEALTH CARE ENVIRONMENT HAS
CHANGED SIGNIFICANTLY SINCE THE
80S, REVENUES HAVE NOT INCREASED
AS MUCH AS OBVIOUSLY AFTER THE
PANDEMIC, EXPENSES HAVE
INCREASED, SALARIES HAVE
INCREASED, COSTS HAVE INCREASED.
AND SO BACK IN THE 80S, IT WAS
DECIDED THAT THERE WAS NOT GOING
TO BE A DEMAND FOR WORKING
CAPITAL LOANS. AND SO THERE WAS
NOT A NEED TO ACTUALLY HAVE LONG
TUM WORKING CAPITAL LOANS. AND
WE WENT BACK THROUGH THE
ANALYSIS AND KIND OF DID SOME
RESEARCH AS TO WHY THAT WAS
PLACED. BUT ON THE OTHER NOTE,
WHEN A BOND COMES TO JAFFA AND
APPLIES FOR A BOND, IT GOES
THROUGH A RIGOROUS ANALYSIS.
THERE ARE NUMEROUS ANALYSIS THAT
ARE INVOLVED. WE HAVE A
FINANCIAL ADVISOR AT JAFFA THAT
GOES THROUGH THE ANALYSIS OF A
FINANCIAL CAPABILITY OF A
HOSPITAL TO REPAY ITS DEBT,
JAFFA STAFF IN-HOUSE. WE DO THAT
ANALYSIS. WE ALSO HAVE A BANKER
THAT SELLS THE BONDS, WILL DO
THE ANALYSIS AS WELL AS THE
INVESTORS THEMSELVES. SO AN
INVESTOR IS GOING TO BE BUYING
THE BONDS. IT'S NOT STATE FUNDS.
SO THEY INVESTOR BEFORE THEY
MAKE AN INVESTMENT BECAUSE
THEY'RE HOPING FOR A RETURN.
THEY DO A FULL FINANCIAL
ANALYSIS OF THE HOSPITAL AND
DECIDE IF THEIR RISK IF THEY'RE
IF THEY'RE A RISK FUL HOSPITAL
OR THEY'RE CREDIT WORTHY
HOSPITAL, THEY WILL NOT INVEST
IN A HOSPITAL THAT IS GOING TO
FILE FOR BANKRUPTCY OR CLOSE ITS
DOORS. THEY ARE GOING TO DO
THEIR ANALYSIS. AND TYPICALLY
THE DEALS GET RATED BY THE THREE
RATING AGENCIES IN THE STANDARD
AND POOR'S, FITCH RATINGS AND
MOODY'S INVESTOR SERVICES.
THERE'S A PUBLIC RATING THAT'S
DISTRIBUTED TO THE ENTIRE PUBLIC
MARKET THAT SHOWS WHAT THEIR
FINANCIAL STANDING IS. SO
THERE'S NOBODY'S GOING INTO AN
ISSUANCE WITHOUT KNOWLEDGE OF
THEIR FINANCIAL SITUATION. AND
SO I THINK SINCE, IN CHÁVEZ
HISTORY, THERE HASN'T BEEN A
DEFAULT ON A BOND OR, VERY, VERY
MAYBE NOT THAT I CAN RECALL. SO
ANYTHING I CAN HELP ADD
INFORMATION. I'M HAPPY TO CHIME
IN. IT MAKES SENSE TO ME THAT
THERE HASN'T BEEN A DEFAULT WITH
A WITH A WINDOW OF TWO YEARS TO
BE TO HAVE TO REPAY THAT, TO
REPAY THAT LOAN. AGAIN, I DO
HAVE CONCERNS WITH OFFERING
WORKING CAPITAL THAT'S UNCAPPED
IN TERMS OF THE AMOUNT OF
CAPITAL THAT A HOSPITAL IS ABLE
TO TAKE ON THROUGH THIS PROGRAM
AND OR A LIMITATION ON THE TERMS
OF THE LOAN. I DON'T, FOR THE
SAKE OF TIME. I DON'T THINK THAT
WE NEED TO CONTINUE TO DISCUSS
THIS. I'VE SHARED MY CONCERNS
WITH YOU. ONGOINGLY. I AM GOING
TO BE SUPPORTING THIS BILL, AT
THIS TIME, BUT I CERTAINLY
RESERVE THE RIGHT TO MAKE A
DIFFERENT DECISION ABOUT THIS ON
THE FLOOR. AND WE, AS A
COMMITTEE, WILL BE MONITORING
THIS BILL VERY CLOSELY AS IT
MOVES TO THE PROCESS. THANK YOU,
MADAM CHAIR. WITH THAT, WOULD
YOU LIKE TO CLOSE? THANK YOU.
NO, I APPRECIATE YOUR OPENNESS.
CERTAINLY DO WANT TO FIGURE OUT
GUARDRAILS FOR THAT. MAYBE IT
MAKES SENSE TO HAVE SOME KIND OF
CAP. MAYBE IT MAKES SENSE TO,
YOU KNOW, TALK ABOUT CAP YEARS
AND WE'RE OPEN TO THOSE
CONVERSATIONS. ABSOLUTELY, SO
WITH THAT RESPECTFULLY REQUEST
AND I VOTE. THANK YOU. THANK
YOU. WE WILL MOVE ON TO YOUR
SECOND ITEM. OH, OH, WE CAN VOTE
NOW. WAS THE MOTION IN THE
SECOND. WE HAVE MOTIONS SANTIAGO
AND RODRIGUEZ, WE SHALL.
SECRETARY, PLEASE CALL THE ROLL.
THE MOTION IS TO PASS TO
APPROPRIATIONS. BONTA I BONTA I
WALDRON. WALDEN I AGUIAR-CURRY
AGUIAR-CURRY I ARAMBULA WENDY
CARILLO LARA LARA I HAINEY HANEY
I JONES-SAWYER JOHN SAWYER I
MAIENSCHEIN CARDI. YO. PATTERSON
RODRIGUEZ. RODRIGUEZ I SANCHEZ.
SANCHEZ. NØ. SANTIAGO SANTIAGO I
BROUGH I WEBER. WEBER I. THAT
MEASURES OUT WITH A VOTE OF 10
TO 1. THANK YOU. WE WILL MOVE ON
TO AB 2670. ITEM NUMBER 18.
THANK YOU, MADAM CHAIR AND
COMMITTEE MEMBERS. WE ARE ALL
AWARE OF THE CRISIS FACING
ABORTION RIGHTS IN AMERICA, AS
WELL AS THE ROLE CALIFORNIA IS
PLAYING TO ENSURE PEOPLE ACROSS
THE STATE OF THE COUNTRY ARE
ABLE TO FIND THE CARE THEY NEED
AND DESERVE. HOWEVER, MANY
CALIFORNIANS DON'T KNOW WHERE TO
ACCESS ACCURATE AND TRUSTED
INFORMATION ABOUT WHERE THEY CAN
SEEK REPRODUCTIVE HEALTH CARE
WHEN THEY NEED IT. IN FACT,
THERE ARE MANY WHO ARE ACTUALLY
DECEIVING PEOPLE ACROSS THE
STATE ABOUT WHERE THEY CAN
ACCESS MEDICALLY ACCURATE,
COMPREHENSIVE CARE. CRISIS MOVED
BY MAJORITY LEADER AGUIAR-CURRY,
SECONDED BY DOCTOR WEBER. CRISIS
PREGNANCY CENTERS ARE LIKE AS WE
ALSO MAY CALL THEM, FAKE CLINICS
OR CLINICS THAT USE KNOWN
DECEPTIVE PRACTICES TARGET
VULNERABLE POPULATIONS TO DRAW
THEM IN FOR CARE BY CLAIMING
THEY PROVIDE COMPREHENSIVE CARE
AND HAVE NO EQUIPMENT, OFTEN NO
MEDICAL LICENSES. STAFF AND ARE
NOT MEDICAL CLINICS, AS WELL AS
NO CAPACITY OR WILLINGNESS TO
PROVIDE ABORTIONS. EVEN REFER
PEOPLE TO ABORTIONS IN MOST
CASES ACROSS CALIFORNIA, THESE
CLINICS ACTUALLY OUTNUMBER
ABORTION CLINICS BY 20, MAKING
IT MORE LIKELY FOR PEOPLE TO
SEEK CARE AND FIND THESE CLINICS
RATHER THAN THE ONES THAT
ACTUALLY PROVIDE ACCURATE
MEDICAL INFORMATION AND
COMPREHENSIVE CARE. INSTEAD,
THEY MISLEAD AND LIE TO WOMEN
ABOUT REPRODUCTIVE HEALTH CARE
AND OPTIONS, AND BLACK BLOCK
THEM FROM ACCESSING ABORTION
CARE OR CONFUSE LOTS OF PEOPLE
IN OUR COMMUNITY. IN THE WORST
CASES, THESE ARE MET WITH
SHAMING, FEAR TACTICS AND BEING
FED MISINFORMATION ABOUT
ABORTIONS DURING A TIME THAT CAN
LEAD TO HIGHER RATES OF
INFERTILITY, DEPRESSION, AND
SUICIDE. IN AN ATTEMPT TO ASSURE
THAT PEOPLE KNOW WHERE THEY CAN
GET ACCURATE INFORMATION AND
WHERE THEY CAN ACCESS CARE, AB
2670 WILL PROMPT THE LAUNCH OF A
PUBLIC AWARENESS CAMPAIGN TO
COMMUNICATE THE FACTS ABOUT
ACTUAL PREGNANCY CARE AND
ABORTION SERVICES THROUGH
ABORTION, CA.GOV. THE WEBSITE
THAT WAS CREATED, IN A RESPONSE
TO THE DOBBS DECISION WHEN WOMEN
NEED TO ACCESS HEALTH CARE, IT'S
CRITICAL THAT INFORMATION THEY
GET IS TIMELY, FACTUAL, AND THAT
PROVIDERS HAVE THEIR BEST
INTEREST IN MIND, NOT AN AGENDA
TO DISCOURAGE YOU FROM SEEKING
ABORTION CARE. WITH AB 2670,
FACTUAL INFORMATION WILL BE
DELIVERED TO THE GENERAL PUBLIC
AS WELL AS THOSE IN THE HEALTH
CARE SPACE, AND ENSURE ANYONE
SEEKING ABORTION CARE KNOWS
WHERE TO GET MEDICALLY ACCURATE,
COMPREHENSIVE AND UNBIASED
INFORMATION. REST ASSURED THAT
STATES ACROSS OUR COUNTRY
CONTINUE TO FACE NEW AND MORE
EXTREME BANS ON ABORTION AND
OTHER REPRODUCTIVE HEALTH CARE.
CALIFORNIA WILL REMAIN A BEACON
OF HOPE AND A LEADER IN
PROVIDING CARE TO THOSE WHO NEED
IT. I HAVE TODAY WITH ME, KIM
ROBINSON FROM BLACK WOMEN FOR
WELLNESS AS A WITNESS AND ALSO
DOCTOR KELLY PFEFFER, EXECUTIVE
DIRECTOR OF AREA MEDICAL, TO
TESTIFY. THANK YOU SO MUCH.
PLEASE GO AHEAD. YOU HAVE TWO
MINUTES. GOOD AFTERNOON, AND
THANK YOU, MADAM CHAIR AND
COMMITTEE MEMBERS. MY NAME IS
KIM ROBINSON. I'M THE COMMUNITY
LIAISON WITH BLACK WOMEN FOR
WELLNESS, BLACK WOMEN FOR
WELLNESS IS A REPRODUCTIVE
JUSTICE, COMMUNITY BASED
ORGANIZATION COMMITTED TO
IMPROVING THE HEALTH STATUS AND
WELL-BEING OF BLACK WOMEN AND
GIRLS. AND I'M HERE TO EXPRESS
OUR STRONG SUPPORT OF AB 2670.
THIS BILL WILL WORK TO MITIGATE
THE HARMS FROM ABRUPT
DISRUPTIONS THAT MAY COME FROM
DELAYS AND IMPEDIMENTS TO TIMELY
ABORTION AND REPRODUCTIVE HEALTH
SERVICES THAT INDIVIDUALS FACE
WHEN THEY ARE MISLED BY CERTAIN
PREGNANCY CLINICS, AND ISSUE
THAT ESPECIALLY IMPACTS OUR
COMMUNITY. K¾T. THANK YOU TO
ASSEMBLY MEMBER SHABO AND HOLDEN
FOR YOUR LEADERSHIP ON THIS
CRITICALLY IMPORTANT ISSUE. AND
FOR IDENTIFYING THIS AS A
NECESSARY FOR THE IMPROVEMENT OF
THE HEALTH STATUS OF PREGNANT
PEOPLE, A CORE TENET OF
REPRODUCTIVE JUSTICE FRAMEWORK
WHICH GUIDES OUR WORK IS
RECOGNITION OF OUR BASIC HUMAN
DIGNITY. IN JUNE 2022, THE US
SUPREME COURT OVERTURNED ROE V
WADE, LEAVING THE RIGHT TO
ABORTION UP TO INDIVIDUAL STATES
. THE NEGATIVE IMPACT OF
ABORTION BANS GOES BEYOND ACCESS
TO ABORTION CARE. IT ALSO
AFFECTS THOSE WHO EXPERIENCE
PREGNANCY LOSS, MISCARRIAGE AND
COMPLICATIONS DUE TO OB GYN
DEPARTMENT CLOSURES. ACROSS
CALIFORNIA, THERE'S A LACK OF
REPRODUCTIVE HEALTH SERVICES AND
EXPERTISE IN MEDICALLY
UNDERSERVED COMMUNITIES. IT IS
CRITICALLY IMPORTANT FOR MEDICAL
ENTITIES TO GIVE TIMELY AND
ACCURATE INFORMATION. THIS BILL
WILL REQUIRE THAT THE
DEPARTMENTS TO DEVELOP AN
AWARENESS CAMPAIGN AS STATED, TO
PUBLICIZE THE INTERNET WEBSITE
ABORTION CA.GOV TO THE GENERAL
PUBLIC HEALTH CARE PROVIDERS,
HEALTH CARE PROFESSIONAL
ASSOCIATES AND SOCIETIES. HEALTH
CARE EMPLOYERS AND LOCAL PUBLIC
HEALTH OFFICES AND HEALTH
DEPARTMENTS. THIS REQUIREMENT
WILL ENSURE THAT PEOPLE ARE
GIVEN THE ABILITY TO OBTAIN THE
NECESSARY INFORMATION THAT THAT
WILL ALLOW THEM TO MAKE THE BEST
HEALTH CARE DECISIONS FOR
THEMSELVES. I HAVE PERSONALLY
SEEN WHAT RECEIVING
MISINFORMATION CAN DO. I WORKED
FOR OVER 12 YEARS FOR WOMEN'S
HEALTH SPECIALISTS OF NORTHERN
CALIFORNIA. REPRODUCTIVE HEALTH
CLINIC. CLINIC ABORTION CARE WAS
ONE OF MANY PROVIDED SERVICES
OFFERED. WE HAD COUNTLESS
PREGNANT PEOPLE SHARE VARIED,
INACCURATE SOURCES IN AN ATTEMPT
TO INSTILL FEAR AND DETER THEM
FROM HAVING AN ABORTION. THANK
YOU. I'M GOING TO WRAP UP YOUR
COMMENT. THANK YOU SO MUCH FOR
HAVING ME, MADAM CHAIR MEMBERS,
I'M DOCTOR KELLY PIPER, I'M AN
ABORTION PROVIDER, HAVE BEEN FOR
25 YEARS. I WORK IN RURAL
CALIFORNIA IN ARIZONA FOR ABOUT
40 MORE DAYS, AND I RUN AN
ABORTION CLINIC IN WICHITA,
KANSAS THAT'S DESIGNED TO SERVE
TEXAS TEXANS AND OKLAHOMANS.
EVERY DAY IN CLINIC, I SEE
PEOPLE IN CRISIS AS THEY GET A
PREGNANCY TEST. THEY PANIC. MOST
ARE PARENTS, AND THEY KNOW WHAT
IT IS TO PARENT. AND THEY LOOK
ON THE INTERNET TRYING TO GET
HELP, AND MANY OF THEM END UP IN
PLACES WHERE THEY CAN EASILY BE
GIVEN MISINFORMATION AND EVEN
FAKE TEST RESULTS. IN MOST
MEDICAL CARE, IF I GET A TEST
RESULT FROM ANOTHER CLINIC, I
BELIEVE IT. IF I GET AN
ULTRASOUND FROM ONE OF THESE
CLINICS, I HAVE TO REPEAT IT
BECAUSE SO OFTEN IT'S WRONG.
PEOPLE ARE GIVEN FAKE ULTRASOUND
REPORTS TO CONVINCE THEM THAT
THEY'RE FURTHER ALONG TO TRY AND
DELAY CARE, AND EVERY DAY I SEE
PEOPLE HARMED BY THIS
MISINFORMATION, AND MOST
PATIENTS HAVE NO IDEA THAT THEIR
INFORMATION IS NOT PRIVATE. THIS
THESE CLINICS ARE NOT LICENSED.
THEY ARE NOT REQUIRED TO FOLLOW
MEDICAL PRIVACY LAWS, AND
THEY'RE NOT REQUIRED TO GIVE
ACCURATE INFORMATION. AND SO I
HAD ONE PATIENT WHO WENT TO GET
AN ULTRASOUND IN ONE OF THESE
PLACES. AND THE NEXT DAY SHE WAS
CALLED BY AN ANTI-ABORTION
ACTIVIST TRYING TO SHAME HER
ABOUT HER DECISION WHEN SHE
THOUGHT HER CELL PHONE WOULD
HAVE BEEN PRIVATE. I SEE
PATIENTS WEEPING BECAUSE THEY
ARE CONVINCED WHEN THEY HAVE AN
ABORTION THAT THEY'LL NEVER BE
ABLE TO HAVE A HEALTHY
PREGNANCY. ABORTION DOESN'T
CAUSE INFERTILITY, IT DOESN'T
CAUSE CANCER, OR IT DOESN'T
CAUSE MENTAL ILLNESS. BUT THESE
MYTHS HAVE BEEN DISPROVEN AND
YET ARE REPEATED IN MANY OF
THESE CENTERS. CALIFORNIA HAS A
PLACE TO GO FOR RELIABLE
INFORMATION, BUT PEOPLE DON'T
KNOW ABOUT IT, PLEASE SUPPORT AB
2670. IT'S THE WAY FOR PEOPLE TO
GET INFORMATION THEY NEED IN A
TIME OF CRISIS, SO THEY CAN BE
GUIDED TO REAL HEALTH CARE.
THANK YOU, THANK YOU. ANY OTHER
WITNESSES IN SUPPORT? GOOD
EVENING, LANA SCHULER WITH BLACK
PERFORMERS ACTION PROJECT AND
SUPPORT. THANK YOU. THANK YOU.
ANY WITNESSES IN OPPOSITION?
SEEING NONE, I WILL BRING IT
BACK TO COMMITTEE FOR COMMENT OR
QUESTIONS. I WANT TO THANK YOU,
ASSEMBLY MEMBER SCHIAVO, FOR
BRINGING FORWARD THIS BILL. I
KNOW THAT YOU'VE BEEN WORKING ON
THIS PARTICULAR ISSUE OF
ENSURING THAT THERE IS ADEQUATE
AND TRUE INFORMATION SHARED TO
PEOPLE WHO ARE SEEKING ABORTION
AND REPRODUCTIVE HEALTH CARE. I
APPRECIATE THAT YOU, FOUGHT YOUR
WAY TO BEING ABLE TO HAVE THIS
OPPORTUNITY TO ESTABLISH
ABORTION. GOV. AND VERY THANKFUL
FOR YOU FOR DOING SO WITH THAT.
WOULD YOU LIKE TO CLOSE? THANK
YOU SO MUCH, WE JUST THINK IT'S
SO CRITICAL THAT WE HAVE TIMELY,
PRODUCTIVE REPRODUCTIVE HEALTH
CARE AND THAT IT'S ESSENTIAL
THAT IT'S MET WITHOUT DELAY AND
ANY DECEITFUL TACTICS USED BY
THESE CLINICS. SO, YOU KNOW,
PEOPLE WHO ARE ATTEMPTING TO
IMPEDE DON'T GET IN THE WAY OF
PEOPLE HAVING THE CHOICE TO MAKE
THE DECISION THAT'S BEST FOR
THEIR FAMILY AND THEIR HEALTH
CARE NEEDS. I WANT TO THANK
ASSEMBLY MEMBER HOLDEN FOR JOINT
AUTHORING THIS BILL AND
RESPECTFULLY REQUEST AN AYE
VOTE. THANK YOU, THANK YOU. WE
HAVE A MOTION AND A SECOND.
WE'LL PLEASE CALL THE ROLL. THE
MOTION IS DO PASS TO
APPROPRIATIONS ONTO I ONTO I
WALDRON. WALDRON NÓ AGUIAR-CURRY
AGUIAR-CURRY I ARAMBULA WENDY
CARILLO WENDY CARILLO I LARA
LARA NØ HANEY. HANEY I JOAN
SAWYER. JOHN SAWYER I MEAN,
SHANE MCCARTY. JOE PATTERSON.
RODRIGUEZ. RODRIGUEZ I SANCHEZ.
SANCHEZ. NÓ. SANTIAGO SANTIAGO I
BROUGH I WEBBER, WHOEVER I. THAT
MOTION MEASURE IS OUT 9 TO 3.
THANK YOU. WE'LL BE MOVING ON TO
ITEM NUMBER 6AB 2180. WEBBER.
THANK YOU, DOCTOR WEBBER. PLEASE
GO AHEAD. GOOD EVENING, CHAIR
AND COMMITTEE. I AM HERE TODAY
TO PRESENT A B 2180, WHICH WOULD
PROHIBIT CALIFORNIA REGULATED
HEALTH INSURERS AND HMOS FROM
UTILIZING COPAY ACCUMULATORS IF
THE PATIENT HAS A CHRONIC OR
TERMINAL ILLNESS, I WILL BE
ACCEPTING THE COMMITTEE
AMENDMENTS AND WOULD LIKE TO
FIRST OF ALL, THANK THE
COMMITTEE AND THE CHAIR FOR
WORKING WITH US ON THIS BILL AND
LOOK FORWARD TO CONTINUING TO
WORK OUT SOME OF THE FINER
DETAILS ON THE SB 17 REPORTING
IN THE UPCOMING DAYS. COPAY
ACCUMULATORS ARE HARMFUL
PRACTICE INCREASINGLY USED BY
HEALTH INSURERS THAT CAN LEAVE
PATIENTS WITH SIGNIFICANT OUT OF
POCKET COST COPAY ACCUMULATORS
ALLOW INSURANCE AND PHARMACY
BENEFIT MANAGERS TO POCKET
PATIENT ASSISTANT ATTENDED TO
HELP PATIENTS MEET THEIR SHARE
OF COST. INSTEAD OF COUNTING
THOSE PAYMENTS TOWARDS THE
ENROLLEES ANNUAL OUT OF POCKET
LIMIT FOR INDIVIDUALS LIVING
WITH CHRONIC OR TERMINAL
ILLNESS, OUT OF POCKET COSTS CAN
ADD UP QUICKLY WHEN HAVING TO
PAY THE HEALTH PLANS. MAXIMUM
AMOUNT YEAR AFTER YEAR, MAKING
IT DIFFICULT TO AFFORD ESSENTIAL
MEDICATIONS AND TREATMENT. THIS
IS ESPECIALLY TRUE FOR PATIENTS
DIAGNOSED WITH CONDITIONS THAT
REQUIRE SPECIALTY MEDICATIONS TO
MANAGE THEIR CONDITIONS. OVER
THE PAST DECADE, INSURERS HAVE
INCREASINGLY SHIFTED THE COST
SHARE OF SPECIALTY MEDICATIONS
TO PATIENTS BY INCREASING
DEDUCTIBLES AND CHARGING
COINSURANCE FOR SPECIALTY
MEDICATIONS, WHICH ALLOWS
CALIFORNIA REGULATED PLANS TO
AVOID CALIFORNIA DÍAS $250
MONTHLY COPAY CAP FOR
PRESCRIPTION DRUGS. AS A RESULT,
MANY PATIENTS MUST RELY ON
FINANCIAL ASSISTANCE FROM THIRD
PARTIES TO AFFORD THEIR VITAL
MEDICATIONS EVEN THOUGH THEY
HAVE HEALTH CARE COVERAGE.
HOWEVER INSURERS ARE
INCREASINGLY UNDERMINING THIS
ASSISTANCE BY NOT COUNTING THE
AMOUNT OF MONEY COVERED BY
MANUFACTURERS OR CHARITY COPAY
ASSISTANCE PROGRAMS TOWARDS THE
ENROLLEES ANNUAL DEDUCTIBLES AND
OUT OF POCKET LIMIT. INSTEAD THE
COPAY ASSISTANCE FUNDS ARE
ACCEPTED BY HEALTH PLANS OR
PBMS, BUT NOT COUNTED TOWARDS
THE PATIENTS COST SHARING
OBLIGATION. BANNING COPAY,
ACCUMULATOR TIERS FOR
CHRONICALLY AND TERMINALLY ILL
PATIENTS CAN ALSO HELP AVOID
SITUATIONS IN WHICH INDIVIDUALS
MAY FORGO NECESSARY TREATMENTS
DUE TO COST CONCERNS BY HELPING
PATIENTS MAINTAIN ADHERENCE TO
THEIR MEDICATIONS. THIS
LEGISLATION CAN LEAD TO BETTER
OUTCOMES FOR PATIENTS AND LOWER
LONG TERME COSTS FOR OUR ENTIRE
HEALTH CARE SYSTEM BY REDUCING
COSTLY EMERGENCY ROOM VISITS AND
HOSPITALIZATIONS. ADDITIONALLY,
THESE COPAY ASSISTANCE PROGRAMS
HELP ADDRESS HEALTH INEQUITIES
BY MAKING NECESSARY MEDICATIONS
AVAILABLE TO UNDER-INSURED OR
UNDER-RESOURCED PATIENTS WHO
OTHERWISE WOULD HAVE TO CHOOSE
BETWEEN FOOD AND MEDICINE. IT IS
IMPERATIVE THAT WE TAKE ACTION
TO ENSURE THAT ALL PATIENTS HAVE
ACCESS TO THE CARE THEY NEED.
WITHOUT FACING FINANCIAL
OBSTACLES. TO DATE, 20 STATES
BOTH RED AND BLUE HAVE BANNED
THEIR USE. I WOULD LIKE TO ADD
CALIFORNIA TO THIS LIST. AB 2180
IS SPONSORED BY THE ALS
FOUNDATION. CYSTIC FIBROSIS
RESEARCH INSTITUTE, HEMOPHILIA
COUNCIL OF CALIFORNIA
RHEUMATOLOGY ALLIANCE, AND
SICKLE CELL DISEASE FOUNDATION,
AND IS SUPPORTED BY OVER 80
PATIENT ADVOCACY GROUPS AND
PHYSICIAN ORGANIZATIONS. I HAVE
WITH ME TODAY, DOCTOR DIANE
NOUGAT, TO TALK ABOUT WHY THIS
BILL IS IMPORTANT TO PHYSICIANS.
AND LYNN KUNST FROM THE
HEMOPHILIA COUNCIL TO DISCUSS
THE IMPORTANCE OF THIS BILL TO
PATIENTS AND THEIR CAREGIVERS.
THANK YOU. MOVED BY AGUIAR-CURRY
. SECONDED BY ARAMBULA. PLEASE
GO AHEAD WITH YOUR. YES. THANK
YOU, DOCTOR WEBER AND, GOOD
AFTERNOON, CHAIRPERSON BONTA.
AND ALSO TO THE ALL THE ASSEMBLY
MEMBERS THAT ARE HERE. I'M A
PEDIATRIC HEMATOLOGIST. I'VE
BEEN TAKING CARE OF CHILDREN
WITH BLOOD DISORDERS, HEMOPHILIA
AND SICKLE CELL FOR 40 YEARS.
AND IN THAT TIME SINCE 1980,
I'VE SEEN THE INNOVATION AND NEW
PRODUCTS AVAILABLE FOR SICKLE
CELL AND FOR HEMOPHILIA AND
OTHER BLOOD DISORDERS BE
DEVELOPED. IT'S BEEN
TRANSFORMATIVE. YOU DON'T SEE
PATIENTS CRIPPLED WITH
HEMOPHILIA OUT IN YOUR
COMMUNITIES ANYMORE, THANKS TO
THE INNOVATIONS THAT HAVE
OCCURRED AND MANY OF THESE DRUGS
HAVE BEEN DEVELOPED IN OUR
STATE. AND I'M PROUD TO SAY THAT
CALIFORNIA HAS A FOCUS ON HEALTH
CARE, AS DO THE PHARMA COMPANIES
THAT DEVELOP THEM HERE. THIS IS
ALSO TRUE FOR SICKLE CELL DRUGS
THAT ARE QUITE EXPENSIVE, AND
PREVENT PATIENTS WITH SICKLE
CELL FROM HAVING MANY OF THE
SIDE EFFECTS THAT RESULT IN PAIN
AND CRIPPLING AND ORGAN FAILURE
OVER THE YEARS. SO ALTHOUGH I'VE
SEEN IT BE TRANSFORMATIVE NOW IN
THE LAST TEN YEARS, I'VE SEEN
MANY OF THESE PATIENTS GIVE UP
OR NOT HAVE ACCESS TO THE DRUGS
THAT THEY NEED, AND THIS IS
RESULTING IN BLEEDING IN OUR
PATIENTS WITH BLEEDING
DISORDERS, HEAD BLEEDS, JOINT
BLEEDS, WHICH ARE IN THE LONG
TERME, PATIENTS WITH
DISABILITIES THAT WE WILL ALL
TAKE CARE OF OVER THE FUTURE
YEARS, NOT TO MENTION THE
QUALITY OF LIFE THAT THEY'RE
GOING TO EXPERIENCE, THAT THEY
COULD AVOID ALL OF THESE
PATIENTS, SICKLE CELL AND
HEMOPHILIA CAN LIVE NORMAL LIVES
IF THEY HAVE ACCESS TO THEIR
MEDICATIONS. UNFORTUNATELY,
WHAT'S HAPPENED WITH THE CO-PAY
ACCUMULATOR AS DOCTOR WEBER IS
JUST A DEFINED, IS THAT PROGRAMS
THAT WERE DEVELOPED FOR TO
BENEFIT PATIENTS ARE NOW
BENEFITING. THE PBMS AND THE
INSURANCE COMPANIES. THIS IS
ALSO DETRIMENTAL TO ALL OF OUR
CLINICS THAT I REPRESENT, BOTH
IN SICKLE CELL AND HEMOPHILIA,
BECAUSE THEY TAKE CARE OF SICKER
PATIENTS AND THEY SPEND A LOT OF
TIME TRYING TO GET INSURANCE. SO
THANK YOU FOR YOUR SUPPORT OF
THIS BILL. THANK YOU,
CHAIRPERSON BONTA AND MEMBERS OF
THE ASSEMBLY HEALTH COMMITTEE.
I'M LYNN KINTZ. I'M THE
EXECUTIVE DIRECTOR OF THE
HEMOPHILIA COUNCIL OF
CALIFORNIA. I'M A PATIENT LIVING
WITH HEMOPHILIA AND THE DAUGHTER
OF A FATHER WHO LIVED WITH
SEVERE HEMOPHILIA, AND I'M HERE
TODAY ON BEHALF OF HCC AND THE
OTHER ORGANIZATIONAL SPONSORS
AND MORE THAN 80 PATIENT AND
PROVIDER GROUPS TO ASK YOU TO
SUPPORT AB 2180, WHICH WILL BAN
THE HEALTH CARE COPAY
ACCUMULATOR POLICIES. TOGETHER,
WE REPRESENT CHRONIC AND
TERMINALLY ILL PATIENTS IN
CALIFORNIA WITH NO GENERIC OR
THERAPEUTIC EQUIVALENT THERAPIES
WHO ARE BEING VICTIMIZED BY
THESE POLICIES. THIS BILL IS NOT
ABOUT DISCOUNT COUPONS. THIS IS
ABOUT FINANCIAL ASSISTANCE FOR
CHRONIC AND TERMINALLY ILL
PATIENTS WHO SIMPLY CANNOT
AFFORD TO PAY THEIR ANNUAL
MAXIMUM OUT OF POCKET PREMIUMS
OR OUT OF POCKET MAXIMUMS YEAR
AFTER YEAR, WITHOUT HELP IN
ORDER TO AFFORD THEIR VITAL
MEDICATIONS, WHETHER FROM A
MANUFACTURER OR FROM A
CHARITABLE FOUNDATION.
ASSISTANCE FUNDS SHOULD COUNT
TOWARDS A PATIENT'S OUT OF
POCKET ANNUAL COST SHARING
OBLIGATION. MOST PEOPLE HAVE
LITTLE OR NO CHOICE IN THEIR
COVERAGE. OUR CFREE CO-SPONSOR
WAS SHOCKED TO LEARN THAT THEIR
OWN BLUESHIELD PLAN HAD A COPAY
ACCUMULATOR POLICY. EVEN WITH
THESE PREDATORY PRACTICES, IN
EFFECT, THEIR PREMIUM RATES
STILL INCREASED BY OVER 12, WITH
LIMITED AFFORDABLE OPTIONS, THEY
WERE FORCED TO SELECT A NEW PLAN
THAT STILL CONTAINS THESE
POLICIES. ACCUMULATOR POLICIES
NEGATIVELY IMPACT PATIENTS
TREATMENT ADHERENCE AND
EXACERBATE HEALTH INEQUITIES.
PEOPLE OF COLOR ARE FAR MORE
LIKELY TO HAVE PLANS WITH COPAY
ACCUMULATOR POLICIES, AND
STUDIES SHOW THAT PATIENTS ARE
MORE LIKELY TO ABANDON TREATMENT
WHEN OUT OF POCKET. PRESCRIPTION
COSTS EXCEED $100, WITH 70% OF
PATIENTS ABANDONING THE
PRESCRIPTION WHEN THE COST HITS
$250, SO WE JUST WANT TO ASK
THAT YOU WILL PLEASE PROTECT
PATIENTS FROM THIS UNJUST AND
HARMFUL COPAY ACCUMULATOR
POLICIES UTILIZED BY HEALTH
PLANS AND PBMS. AND WE THANK YOU
FOR YOUR CONSIDERATION AND
SUPPORT. THANK YOU. ANY OTHER
WITNESSES IN SUPPORT? VANESSA
CADENA, ON BEHALF OF THE
CALIFORNIA ACADEMY OF FAMILY
PHYSICIANS HERE IN SUPPORT. TIM
MADDEN, REPRESENTING THE
CALIFORNIA, CALIFORNIA
RHEUMATOLOGY ALLIANCE, WE'RE A
CO-SPONSOR, ALSO REPRESENTING
THE CALIFORNIA CHAPTER OF THE
AMERICAN COLLEGE OF CARDIOLOGY,
THE CALIFORNIA SOCIETY OF
PLASTIC SURGEONS, AND
PINCHHITTING FOR THE CROHN'S AND
COLITIS FOUNDATION, AND ALL IN
SUPPORT. DILLON ELLIOTT, ON
BEHALF OF THE CALIFORNIA MEDICAL
ASSOCIATION IN SUPPORT. THANK
YOU. AUTUMN OGDEN SMITH WITH THE
AMERICAN CANCER SOCIETY CANCER
ACTION NETWORK, ALSO IN SUPPORT.
THANK YOU, JENNIFER SNYDER WITH
CAPITAL ADVOCACY ON BEHALF OF
THE CALIFORNIA LIFE SCIENCES AND
SUPPORT. AND JUST WANT TO ECHO
THE COMMITMENT TO WORKING ON
FURTHER AMENDMENTS WITH THE
AUTHOR AND THE COMMITTEE
RELATIVE TO SB 50, SB 17
REPORTING, AND JUST WANT TO
APPRECIATE THE COMMITTEE'S WORK
IN THAT REGARD. THANK YOU.
SANDRA POOLE, ON BEHALF OF
WESTERN CENTER ON LAW AND
POVERTY, IN SUPPORT KELLY GOSS
ON BEHALF OF THE ALS ASSOCIATION
AND A PROUD SPONSOR OF THIS BILL
AND STRONG SUPPORT. HØI KELLY
MACMILLAN, ON BEHALF OF
CHILDREN'S SPECIALTY CARE
COALITION AND SUPPORT. CHAIR
GONZALEZ, ON BEHALF OF MY
CLIENTS, THE AMERICAN DIABETES
ASSOCIATION, THE ASSOCIATION OF
NORTHERN CALIFORNIA ONCOLOGISTS,
ALSO KNOWN AS AN C , AND THE
MEDICAL ONCOLOGY ASSOCIATION OF
SOUTHERN CALIFORNIA, ALSO KNOWN
AS MOSQUE, IN STRONG SUPPORT.
ALEX KHAN, ON BEHALF OF THE
CALIFORNIA CHRONIC CARE
COALITION, IN STRONG SUPPORT.
MADAM CHAIR MEMBERS RANDALL
MARTIN, ON BEHALF OF THE AIDS
HEALTH CARE FOUNDATION, IN
STRONG SUPPORT. THANK YOU. THANK
YOU. ANY WITNESSES IN OPPOSITION
?
THANK YOU, MADAM CHAIR AND
MEMBERS. NICK LOUISOS, ON BEHALF
OF THE CALIFORNIA ASSOCIATION OF
HEALTH PLANS, IN OPPOSITION TO
THIS BILL. AND I JUST WANT TO
ACKNOWLEDGE, YOU KNOW, WE HAVE
HAD CONVERSATIONS WITH THE
AUTHOR OF THIS BILL IN THE PAST
ABOUT THE AFFORDABILITY OF
HEALTH CARE. AND, YOU KNOW, WE
KNOW, YOU KNOW, THE HER HEART'S
IN THE RIGHT PLACE ON THE ISSUE,
BUT WE JUST FUNDAMENTALLY
DISAGREE WITH THE MOTIVATIONS OF
THIS BILL, AND WE DO RECOGNIZE
THE ESCALATING COSTS OF
PRESCRIPTION DRUGS AND THE DRUG
PRICES THAT ARE SET BY THE DRUG
MANUFACTURERS, AND THEY ARE
LEADING TO, YOU KNOW, SOME
BURDENS ON HARDWORKING FAMILIES
IN THE STATE OF CALIFORNIA. BUT
THIS IS FUNDAMENTALLY THE WRONG
APPROACH. I MEAN, ONE OF THE
SUPPORTERS OF THIS BILL SAID
THAT THIS BILL IS NOT ABOUT
COPAY COUPONS. IT IS ABOUT
CO-PAY COUPONS. I MEAN, IT'S
BASICALLY STATUTORILY ENSHRINES
THE MARKETING TACTICS OF THE
DRUG MANUFACTURERS INTO OUR
BENEFIT DESIGN. AND WE THINK
THAT'S INAPPROPRIATE BECAUSE
WHAT THAT DOES, IT STEERS PEOPLE
AWAY FROM GENERICS AND OTHER
ALTERNATIVES THAT WORK AND INTO
EXPENSIVE BRAND NAME DRUGS. THAT
IS THE WHOLE POINT OF THE CO-PAY
COUPON. AND THE BILL,
PARTICULARLY THE WAY THAT HAS
BEEN AMENDED, REQUIRES US TO
CONSIDER THAT AS PART OF THE
BENEFIT. NOW, I WILL SAY,
MEMBERS THAT IT'S ALSO VERY
IMPORTANT TO NOTE THAT THE
FEDERAL GOVERNMENT RECOGNIZES
THE MARKETING TECHNIQUES OF THE
MANUFACTURERS HERE, AND THAT THE
VERY POLICY THAT 2180 CODIFIES
MEDICARE AND MEDICAID HAVE
DEEMED A KICKBACK. AND THAT'S
NOT OUR WORDS. THAT'S
CHARACTERIZATION BY THE FEDERAL
GOVERNMENT. SO THEY'VE
DETERMINED THAT THE CO-PAY
COUPONS INDUCE PATIENTS TO USE
SPECIFIC DRUGS, WITH TAXPAYERS
PICKING UP THE TAB, BECAUSE
THESE TACTICS ARE NOT ALLOWED
UNDER FEDERAL PROGRAMS, YOU
KNOW, THE SUPPORTERS OF THIS
BILL, YOU KNOW, PARTICULARLY THE
DRUG MANUFACTURERS, ARE
INTENTIONALLY TARGETING
COMMERCIAL PLANS THROUGH BILLS
LIKE 21, 80, AND FULLY INSURED
EMPLOYERS, FAMILIES AND
INDIVIDUALS. SO IT'S CRITICAL TO
UNDERSTAND KIND OF THE
ANTI-CONSUMER ELEMENTS OF THESE
CO-PAY COUPON MARKETING TACTICS,
THE MANUFACTURERS OFTEN OFFER
COUPONS FOR A NARROW SELECTION
OF DRUGS, THEY SOMETIMES OFFER
THE PATIENTS COUPONS FOR A VERY
LIMITED PERIOD OF TIME, AND THEY
REGULARLY DISCONTINUE THE
COUPONS WITHOUT TELLING THE
PATIENT. AND WE THINK, YOU KNOW,
IF YOU'RE GOING TO GO FORWARD
WITH SOMETHING LIKE THIS, THERE
NEEDS TO BE WAY MORE CONSUMER
PROTECTIONS, ASSOCIATED WITH
THIS AND MORE TRANSPARENCY. WE
RECOGNIZE THERE'S SOME
AMENDMENTS THAT ARE BEING TAKEN,
BUT BASED ON OUR INITIAL READ,
WE DON'T KNOW HOW THOSE WOULD BE
IMPLEMENTED. SO WE'RE STRONGLY
OPPOSED TO THIS BILL. THANK YOU.
PLEASE GO AHEAD. THANK YOU,
MADAM CHAIR. MEMBERS. PRESTON
YOUNG FROM THE CALIFORNIA
CHAMBER OF COMMERCE HERE TODAY
IN RESPECTFUL OPPOSITION TO AB
2180, OBVIOUSLY, THE AUTHOR HAS
GOOD INTENTIONS WITH THE BILL.
THE OPPOSITION THÀNH TODAY STEMS
FROM THE UNINTENDED CONSEQUENCES
THAT COME ALONG WITH AB 2180.
THE REASON FOR OUR OPPOSITION IS
THE COST IMPACT WILL HAVE ON
CALIFORNIA'S EMPLOYERS PRIOR TO
THE AMENDMENTS IN THE BILL,
ANTICIPATED AB 2180 WOULD
INCREASE EMPLOYER AND ENROLLEE
PREMIUMS OVER $52 MILLION.
COLLECTIVELY, THE PER MEMBER PER
MONTH COST INCREASE RANGE FROM
0.03% FOR LARGE GROUP DMHC
REGULATED PLANS TO 0.17% IN THE
CDI REGULATED SMALL GROUP
MARKET. THESE FIGURES COULD BE
DIFFERENT BASED ON RECENT
AMENDMENTS, AND WE APPRECIATE
THE COMMITTEE ANALYSIS
INDICATING AN UPDATED ANALYSIS
WOULD BE HELPFUL IN THIS
SITUATION, WHEN YOU LOOK AT THE
MANDATES AND MANDATE TYPE BILLS
AS STANDALONES, I UNDERSTAND THE
PREMIUM INCREASES AND THE COST
INCREASES DON'T LOOK
SIGNIFICANT. BUT WHEN YOU PUT IT
INTO CONTEXT AND YOU YOU LOOK AT
THE HEALTH CARE LANDSCAPE
OVERALL, IT ALL DOES ADD UP.
OVER THE LAST FIVE YEARS, THE
AVERAGE PREMIUM FOR FAMILY
COVERAGE AND EMPLOYER SPONSORED
PLANS HAS INCREASED 20% IN 2023.
THE AVERAGE ANNUAL PREMIUMS FOR
CALIFORNIA EMPLOYER SPONSORED
FAMILY HEALTH CARE COVERAGE
REACHED $23,968. WORKERS, ON
AVERAGE, PAID $6,575 TOWARDS THE
COST OF COVERAGE. SO WHILE WE
CERTAINLY APPRECIATE THE
AUTHOR'S INTENTIONS, WE REMAIN
CONCERNED ABOUT THE UNINTENDED
COST INCREASES ASSOCIATED WITH
THIS BILL. SO FOR THESE REASONS,
WE OPPOSE. THANK YOU FOR YOUR
TIME AND YOUR CONSIDERATION. ANY
OTHERS IN OPPOSITION? MADAM
CHAIR, MEMBERS, JOHN WINGER, ON
BEHALF OF AMERICA'S HEALTH
INSURANCE PLANS, ALSO OPPOSED.
GOOD EVENING. MATT AIKEN WITH
THE ASSOCIATION OF CALIFORNIA
LIFE AND HEALTH INSURANCE
COMPANIES ALSO IN OPPOSITION.
WITH THAT, I WILL BRING IT BACK
TO THE COMMITTEE FOR ANY
QUESTION OR COMMENT. DOCTOR
WEBER, CERTAINLY WANT TO GIVE
YOU THE OPPORTUNITY, AND YOU CAN
DO IT AT YOUR CLOSING TO MAKE AN
IMPORTANT DISTINCTION BETWEEN
THESE SO-CALLED COUPONS AND
THESE PATIENT ASSISTANT PROGRAMS
AND THE APPLICATION OF YOUR
LEGISLATION. 2180 TO THAT AND
ANYTHING ELSE THAT YOU MIGHT BE
ABLE TO SUPPORT. I, HAVE HAD AN
OPPORTUNITY ACTUALLY, TO SPEND
TIME WITH THE PROPONENTS OF THIS
BILL, AND IN POLICY
CONVERSATIONS WITH YOU, DOCTOR
WEBER. AND I BELIEVE THAT WE
ABSOLUTELY NEED TO BE ABLE TO
ADDRESS, WHAT IS JUST AN
INCREDIBLY, FRIGHTENING WAY IN
WHICH WE ENSURE THAT PEOPLE
DON'T HAVE THE KIND OF CARE THAT
THEY NEED TO WITH PRESCRIPTION
CARE. SO VERY APPRECIATIVE THAT
YOU WERE ABLE TO BRING THIS BILL
FORWARD AND THAT YOU'LL CONTINUE
TO WORK WITH THE COMMITTEE ON
MAKING SURE THAT WE, ADDRESS
SOME OF THE PROPONENTS,
OPPONENTS CONCERNS AS WE MOVE
FORWARD. WELL, THANK YOU, CHAIR,
I DEFINITELY WANT TO THANK, ONCE
AGAIN, THE COMMITTEE AND YOU FOR
REALLY WORKING AND DIGGING IN
DEEP WITH THIS BILL AND
CONTINUING TO MAKE IT THE BEST
BILL POSSIBLE. I WANT TO THANK
THE SUPPORTERS WHO HAVE COME OUT
TO EITHER GIVE TESTIMONY OR GIVE
ME TOOS, WANT TO THANK AS WELL
THE OPPOSITION, WE HAVE HAD HIGH
LEVEL CONVERSATIONS, BUT I'M
ALWAYS OPEN TO ANY SUGGESTIONS
THAT THEY MAY HAVE, WHICH I HAVE
NOT RECEIVED YET AS TO HOW WE
CAN ENSURE THAT, THE MONEY THAT
PATIENTS ARE BEING GIVEN TO HELP
WITH THE COST OF MEDICATIONS ARE
ACTUALLY GIVEN TO THE PATIENTS
AND NOT THE INSURANCE COMPANIES
AND NOT THE PBMS. SO WHENEVER
THEY HAVE SUGGESTIONS, THEY KNOW
WHERE TO FIND ME, BUT I WANT TO
TOUCH ON A COUPLE OF THINGS.
COPAY ACCUMULATORS ARE NOT
COUPONS, AS WAS STATED BEFORE,
BUT THERE WAS ANOTHER STATEMENT
THAT THAT WAS MADE ABOUT THE
SELECTION OF DRUGS AND THE FACT
THAT PEOPLE ARE BEING STEERED
AWAY FROM GENERIC DRUGS. THE
REALITY IS, THESE THIS BILL IS
FOCUSED ON THOSE WITH CHRONIC
ILLNESSES AND TERMINAL
ILLNESSES, CHRONIC CONDITIONS
AND TERMINAL ILLNESSES. THERE
WAS A PREVIOUS VERSION THAT JUST
SAID WE SHOULDN'T HAVE COPAY
ACCUMULATORS FOR ANYBODY, BUT
THIS YEAR WE'VE COME BACK AND
REALLY BEEN VERY FOCUSED. AND
THE REASON WHY WE TALK ABOUT
SPECIALTY DRUGS IN THIS
PARTICULAR AREA IS BECAUSE
THERE'S OFTENTIMES NOT A GENERIC
FOR THESE, FOR THESE SPECIFIC
CONDITIONS. THESE ARE CONDITIONS
WHERE WE ARE DOING A LOT IN THE
AREAS OF R&D TO ENSURE THAT,
THE, THE ISSUES THAT SICKLE CELL
PATIENTS HAD TO DEAL WITH TEN
YEARS AGO ARE NOT SOMETHING THAT
THEY HAD TO DEAL WITH TODAY IN
THE WORLD OF SICKLE CELL, WE'RE
NOW TALKING ABOUT GENE THERAPY.
THERE'S NO GENERIC FOR THAT. AND
THERE WON'T BE. RIGHT. AND SO WE
RELY AND WE WANT OUR COMPANIES
TO CONTINUE TO IMPROVE UPON THE
MEDICATIONS THAT WE HAVE TO
OFFER. INDIVIDUALS WITH CHRONIC
ILLNESSES AND TERMINAL ILLNESSES
SO THAT THEIR QUALITY OF LIFE
CAN IMPROVE, SO THAT WE'RE NOT
SPENDING AN EXORBITANT AMOUNT OF
MONEY ON HOSPITALIZATIONS,
TRANSFUSIONS, ORGANS, INFECTION,
TREATMENTS. AND SO WHEN YOU TALK
ABOUT SPECIALTY DRUGS, THEY'RE
OFTENTIMES NOT GENERIC. AND, YOU
KNOW, SOMEONE HAD ALSO MENTIONED
SOMETHING ABOUT WHO'S SUPPORTING
THIS BILL. I THINK WE SAU WHO'S
SUPPORTING THIS BILL. IT'S THE
PATIENTS AND THE PATIENT
ADVOCACY GROUPS, THE PEOPLE WHO
ARE ON THE GROUND THAT KNOW THAT
THIS IS REALLY, FOR MANY
PATIENTS, LIFE OR DEATH. IF THEY
CAN'T AFFORD THEIR MEDICATIONS,
IF THEY'RE HAVING TO CHOOSE
BETWEEN KEEPING THEIR LIGHTS ON,
BUYING FOOD, OR PAYING FOR THEIR
MEDICATIONS, DESPITE THE FACT
THAT THEY HAVE ANOTHER PROGRAM
THAT'S ASSISTING THEM WITH THEIR
MEDICATION, THAT'S A CHOICE THAT
THEY SHOULDN'T HAVE TO MAKE. AND
SO WITH THAT, I RESPECTFULLY ASK
FOR YOUR VOTE ON AB 2180 WILL
CONTINUE TO WORK ON IT, BUT WE
REALLY HAVE TO STEP UP AND MAKE
SURE THAT THESE PATIENTS THAT
NEED MORE ARE ABLE TO RECEIVE
THE MEDICATIONS THAT WE HAVE
DEVELOPED FOR THEM. THANK YOU.
THERE'S A MOTION AND A SECOND
THANK YOU, DOCTOR WEBER. MOTION
IS DUE PASS AS AMENDED TO
APPROPRIATIONS. PLEASE CALL THE
ROLL ONTO AYE WALDEN. WALDEN
AYE. AGUIAR-CURRY. AGUIAR-CURRY.
AYE. ARAMBULA. ARAMBULA AYE.
WENDY. CARILLO. WENDY. CARILLO.
AYE. LARA. LARA AYE. HANY. ANEY.
AYE. JOAN. SAWYER. JOHN. SAWYER
AYE. MAIENSCHEIN MCCARTY. DR.
PATTERSON RODRIGUEZ. RODRIGUEZ.
AYE. SANCHEZ SANCHEZ. AYE.
SANTIAGO. SANTIAGO. AYE WEBER.
WEBER. AYE. THAT MEASURES OUT 12
TO 0. THANK YOU, DOCTOR WEBER.
WE'LL MOVE ON TO FILE ITEM 29,
AB 3059, ALSO BY DOCTOR WEBER.
THANK YOU. CHAIR. GOOD AFTERNOON
AGAIN. COMMITTEE MEMBERS, I'M
HERE TO PRESENT AB 3059, WHICH
WILL IMPROVE HEALTH OUTCOMES FOR
PREMATURE INFANTS. THIS BILL
REQUIRES THAT COMMERCIAL HEALTH
PLANS INCLUDE COVERAGE FOR
MEDICALLY NECESSARY DONOR HUMAN
MILK. IF THE DONOR MILK IS
SOURCED FROM AN ACCREDITED MILK
BANK WITH AN EXISTING TISSUE
BANK LICENSE, THIS BILL ALSO
WAIVES THE REQUIREMENT FOR THE
HOSPITAL TO ACQUIRE THAT SAME
LICENSE TO PROVIDE DONOR MILK TO
INFANTS IN THE NICU, ALSO KNOWN
AS NEONATAL INTENSIVE CARE UNITS
, THE AMERICAN ACADEMY OF
PEDIATRICS RECOMMENDS THAT WHEN
A MOTHER'S OWN MILK IS NOT
AVAILABLE, THAT DONOR MILK BE
PROVIDED TO VERY LOW BIRTH
WEIGHT INFANTS. THESE ARE VERY,
VERY SMALL BABIES THAT WEIGH 3.3
POUNDS OR LESS. DONOR MILK IS
USED IN THE NICU TO SUPPORT THE
HEALTH AND SURVIVAL OF VERY LOW
BIRTH WEIGHT INFANTS, AND HAS
BEEN SHOWN TO DECREASE THE
INCIDENCE OF A DEVASTATING BOWEL
DISEASE KNOWN AS NECROTIZING
ENTEROCOLITIS, OR NEC. THE
INCIDENCE OF NEC IS AROUND 60%
HIGHER FOR HISPANIC AND BLACK
INFANTS WHEN COMPARED TO OTHERS,
AND BLACK AND HISPANIC MOTHERS
HAVE LOWER RATE OF PROVIDING
MILK TO THEIR BABIES IN THE NICU
DUE TO A VARIETY OF FACTORS,
SUCH AS HAVING TO RETURN TO
WORK, HAVING TO TAKE CARE OF
OTHER KIDS AT HOME, LACK OF
TRANSPORTATION, LESS OF
LACTATION SUPPORT, ETC. BY
PASSING AB 3059, WE'RE HELPING
CLOSE THE HEALTH, GAP
DISPARITIES BEGINNING AT BIRTH.
NOW, DONOR MILK IS A COVERED
BENEFIT UNDER MEDI-CAL, BUT
EXISTING LAW DOES NOT CLEARLY
DEFINE IT AS A COVERED BENEFIT.
UNDER COMMERCIAL HEALTH PLANS,
AB 3059 WOULD ENSURE PARITY AND
REQUIRE THAT ALL COMMERCIAL
HEALTH PLANS PROVIDE COVERAGE
FOR MEDICALLY NECESSARY DONOR
MILK. AB 3059 WOULD ALSO ADDRESS
A CHALLENGE. THE CHALLENGE IN
ESTABLISHING A DONOR MILK
PROGRAM. ABOUT 12% OF NICUS IN
CALIFORNIA DO NOT USE DONOR MILK
, AND ONE OF THE MAIN BARRIERS
TO ESTABLISHING THIS PROGRAM IS
THE REQUIREMENT THAT THE
HOSPITAL OBTAIN A TISSUE BANK
LICENSE IN ORDER TO STORE AND
DISTRIBUTE THIS MILK. AB 39 WILL
ADDRESS THIS REGULATORY BARRIER
BY EXEMPTING HOSPITALS FROM
HAVING TO OBTAIN A TISSUE BANK
LICENSE IN ORDER TO DISTRIBUTE
DONOR MILK TO INFANTS IN THE
NICU. HERE TO SPEAK WITH ME IN
SUPPORT IS DOCTOR LISA
STELLWAGEN, MEDICAL DIRECTOR OF
THE èC HEALTH MILK BANK, AND
JENNIFER CANVASSER, FOUNDER AND
EXECUTIVE DIRECTOR OF NEXT
SOCIETY. THANK. MOVED BY
AGUIAR-CURRY, SECONDED BY
ARAMBULA. PLEASE PRESS THE
MICROPHONE BUTTON. GOOD EVENING
CHAIR AND MEMBERS. MY NAME IS
LISA STELLWAGEN. I'M A
PEDIATRICIAN AND THE MEDICAL
DIRECTOR OF THE UNIVERSITY OF
CALIFORNIA HEALTH MILK BANK IN
SAN DIEGO. ON BEHALF OF THE
UNIVERSITY OF CALIFORNIA, I'M
HERE AS A PROUD SPONSOR TO
EXPRESS OUR SUPPORT OF AB 3059,
OUR MILK BANK PROVIDES SAFE,
PASTEURIZED HUMAN MILK DONATED
BY BREASTFEEDING PARENTS TO
SUPPORT NICUS AND FAMILIES
STATEWIDE. HUMAN MILK BOTH
MOTHER'S MILK AND DONOR MILK.
THE MOTHER'S MILK IS NOT
SUFFICIENT IN VOLUME OR SAFETY.
CAN BE LIFE SAVING FOR THE
SMALLEST PREMATURE INFANTS,
REDUCING THE RISK OF NECROTIZING
ENTEROCOLITIS, WHICH IS A LIFE
THREATENING AND CATASTROPHIC
BOWEL CONDITION. THROUGH OUR
WORK, WE HAVE IDENTIFIED SEVERAL
BARRIERS THAT PREVENT CRITICALLY
ILL INFANTS FROM ACCESSING DONOR
MILK AS YOU HAVE HEARD FROM
DOCTOR WEBER, WE ARE GRATEFUL TO
DOCTOR WEBER FOR AUTHORING THIS
BILL TO ADDRESS THE BARRIERS IN
ACCESS AND HOPE TO IMPROVE THE
SURVIVAL OF BABIES IN NEED IN
OUR STATE. I'M HAPPY TO ANSWER
ANY TECHNICAL QUESTIONS AND
RESPECTFULLY ASK FOR YOUR AYE
VOTE. THANK YOU. ANY ADDITIONAL
SUPPORT? Þ. MADAM CHAIR AND
MEMBERS OF THE COMMITTEE. MY
NAME IS JENNIFER CANVASSER. I
LIVE IN DAVIS AND I ASK THAT YOU
PLEASE SUPPORT AB 3059 TO
PROVIDE MEDICALLY FRAGILE BABIES
WITH THE LIFE SAVING PROTECTION
THEY NEED FROM HUMAN MILK. WHEN
MY SON MICAH WAS BORN AT 27
WEEKS GESTATION, WEIGHING JUST 2
POUNDS, HE WAS IMMEDIATELY TAKEN
TO THE NICU. I HAD NEVER STEPPED
FOOT INTO A NICU. I HAD NEVER
SEEN A BREAST PUMP, BUT I BEGAN
PUMPING EVERY TWO HOURS AROUND
THE CLOCK. AND DESPITE MY
DESPERATE EFFORTS, NOT A DROP OF
MILK CAME IN FOR MORE THAN 48
HOURS, AND MICAH NEEDED TO BE
FED. I WAS TOLD THAT MICAH WOULD
RECEIVE FORMULA. I WAS NOT
INFORMED AND I DID NOT KNOW TO
ASK ABOUT PASTEURIZED DONOR
HUMAN MILK. DESPITE HIS
PREMATURITY, MICAH INITIALLY DID
WELL, BUT OUR LIFE CHANGED
FOREVER WHEN HE WAS SIX WEEKS
OLD AND HE WAS DIAGNOSED WITH
NECROTIZING ENTEROCOLITIS, ALSO
KNOWN AS NEC OR NEC, A DISEASE
THAT I HAD NEVER HEARD OF. NEC
CAUSED MICAH'S INTESTINES TO
BECOME SEVERELY INFLAMED, AND HE
BECAME PAINFULLY DISTENDED AND
HE WAS INTUBATED. HIS DISEASE
PROGRESSED AGGRESSIVELY, AND
WITHIN HOURS MICAH'S INTESTINES
WERE NECROTIC. HE WAS SEPTIC,
AND HE NEEDED MULTIPLE BOWEL
RESECTIONS. HE WENT INTO RENAL
FAILURE AND HIS ENTIRE BODY
BECAME SEVERELY FLUID
OVERLOADED, TO THE POINT WHERE
HE COULD NOT OPEN HIS EYES OR
MOVE ANY PART OF HIS BODY. MICAH
REMAINED IN THE ICU, AND JUST
BEFORE HIS FIRST BIRTHDAY, I
HELD MICAH ON MY CHEST AS HE
TOOK HIS LAST BREATH AND HE DIED
FROM NECROTIZING ENTEROCOLITIS.
NEC TERRORIZES NICU FAMILIES AND
CLINICIANS IN THE NICU. NEC
COMES ON SUDDENLY AND PROGRESSES
RAPIDLY UPON DIAGNOSIS. MANY
BABIES HAVE ONLY HOURS OR DAYS
BEFORE THEIR INTESTINES BECOME
NECROTIC, PROGRESSING TO SEPSIS
AND MULTISYSTEM ORGAN FAILURE
AND TRAGICALLY, DEATH. AFTER
MICAH PASSED, I FOUNDED THE NEC
SOCIETY BECAUSE I KNOW MY STORY
IS NOT UNIQUE. THE NEXT SOCIETY
IS NOW THE WORLD'S LEADING
NONPROFIT, WORKING TO ADVANCE
NEC RESEARCH AND PROTECTIVE,
EQUITABLE CARE. MOTHER'S MILK
PROVIDES THE MOST PROTECTION
AGAINST NEC. IF MOTHER'S MILK IS
NOT AVAILABLE, THEN PASTEURIZED
DONOR HUMAN MILK OFFERS THE NEXT
BEST PROTECTION. ALL OF OUR
BABIES IN OUR NICU URGENTLY NEED
ACCESS TO HUMAN MILK, REGARDLESS
OF WHERE THEY LIVE OR THEIR
FAMILY'S ECONOMIC STATUS. AB
3059 WILL HELP PROTECT FAMILIES
FROM THE DEVASTATION THAT I LIVE
WITH EVERY DAY WITHOUT MICAH IN
MY ARMS, AND RIGHT NOW, AS I
SPEAK, MORE BABIES ARE BEING
DIAGNOSED WITH AND DYING FROM
NEC. OUR BABIES CANNOT WAIT AND
I ASK THAT YOU PLEASE PASS AB
305959 AND PROVIDE EVERY INFANT
IN THE NICU WITH THE LIFESAVING
BENEFITS OF HUMAN MILK AND
PROTECTION AGAINST NEC. THANK
YOU. THANK YOU FOR SHARING THAT
TESTIMONY. OTHERS IN SUPPORT.
JENNIFER SNIDER, CAPITAL
ADVOCACY ON BEHALF OF THE
CALIFORNIA LIFE SCIENCES IN
SUPPORT. VANESSA GONZALEZ WITH
THE CALIFORNIA HOSPITAL
ASSOCIATION HERE IN SUPPORT.
THANK YOU. DYLAN ELLIOTT, ON
BEHALF OF THE CALIFORNIA MEDICAL
ASSOCIATION AND SUPPORT. THANK
YOU. KELLY BROOKS, ON BEHALF OF
THE CALIFORNIA ASSOCIATION OF
PUBLIC HOSPITALS AND HEALTH
SYSTEMS SYSTEMS AND THE SANTA
CLARA COUNTY BOARD OF
SUPERVISORS IN SUPPORT. HØI
KELLY MCMILLAN, ON BEHALF OF
CHILDREN'S SPECIALTY CARE
COALITION IN SUPPORT. HIGH I'M
DOCTOR ALLISON FULLER FROM
PROLACTA BIOSCIENCE IN SUPPORT
IF AMENDED. CAN I MAKE A QUICK
COMMENT ON THE AMENDMENT? AS A
TWEENER, YES. GO AHEAD. OH THANK
YOU. I'D LIKE TO THANK YOU FOR
THE OPPORTUNITY TO COMMENT ON AB
3059. AS I SAID, MY NAME IS
DOCTOR ALLISON FULLER HERE FOR
PROLACTA BIOSCIENCE. WE ARE A
CALIFORNIA COMPANY WITH 100% OF
OUR MANUFACTURING HAPPENING HERE
IN CALIFORNIA, BOTH IN THE CITY
OF INDUSTRY AND LU█T. WE EMPLOY
OVER 375 PEOPLE, ABOUT 75% OF
THOSE ARE CALIFORNIA RESIDENTS.
OUR PRODUCT IS A HUMAN MILK
DERIVED HUMAN MILK. FORTIFIER
IT'S A MOUTHFUL, BUT IT'S USED
IN ABOUT 70 NICUS HERE IN
CALIFORNIA AND ABOUT 500 NATIONS
WIDE. WE ALSO SUPPLY DONOR MILK
TO SEVERAL NICUS IN CALIFORNIA.
WE WHOLEHEARTEDLY SUPPORT THE
INTENT OF THIS BILL, AND WE
SUPPORT IF AMENDED, TO ADDRESS
JUST A COUPLE OF TECHNICAL
ISSUES THAT WE THINK ARE MORE
ABOUT THE WAY THE BILL WAS
DRAFTED. REALLY THIS BILL ONLY
EXTENDS REIMBURSEMENT FOR DONOR
MILK FOR TWO OF THE THREE MILK
BANKS THAT OPERATE IN THE STATE,
AND NOT THE THIRD US BEING
PROLACTA. SO WE WOULD JUST ASK
THAT YOU INSTEAD COVER MILK
THAT'S PROVIDED BY ANY MILK BANK
THAT'S LICENSED BY A TISSUE
BANK, AND NOT JUST THOSE THAT
ARE MEMBERS OF THE TRADE
ASSOCIATION. HABANA. THANK YOU.
THANK YOU, DOCTOR WEBER, DO YOU
WANT TO RESPOND? RESPOND TO THAT
PARTICULAR CONCERN. THANK YOU.
ANY OTHER ANY OTHER OPPOSITION?
SEEING NONE, I'LL BRING IT BACK
TO THE COMMITTEE FOR A QUESTION
OR COMMENT. DOCTOR WEBER, YOU
MAY CLOSE. WHEN? Ã, THANK THE
COMMITTEE. REALLY WANT TO THANK
THOSE WHO CAME IN TO SPEAK IN
SUPPORT OF THIS BILL, IT IS
EXTREMELY IMPORTANT THAT WE DO
NOT CONTINUE TO HAVE STORIES
LIKE WE HEARD OF MICAH. THANK
YOU. THIS BILL, I'M ALL ABOUT
EVIDENCE BASED, AND THIS BILL
COVERS, THE MILK THAT HAS BEEN
SHOWN VIA EVIDENCE, TO DECREASE
THE INCIDENCE OF NAKED. IT'S NOT
ABOUT DIFFERENT COMPANIES. IT IS
ABOUT WHAT THE EVIDENCE SHOWS.
AND WITH THAT, I WOULD LIKE TO
ASK FOR YOUR SUPPORT ON VOTING
AYE ON AB 3059. THANK YOU. THANK
YOU FOR BRINGING FORWARD THIS
BILL, DOCTOR WEBER. AND, I
BELIEVE I ASKED TO BE A COAUTHOR
MY CHIEF OF STAFF IS VERY
PASSIONATE ABOUT THIS ISSUE, AND
WE WERE SORRY NOT TO HAVE BEEN
ABLE TO BRING THIS FORWARD. BUT
YOU ARE DEFINITELY THE RIGHT
AUTHOR TO DO SO. WITH THAT, THE
MOTION IS Dð PASS TO
APPROPRIATIONS. PLEASE CALL THE
ROLL I. I WALDRON WALDEN I
AGUIAR-CURRY. ARAMBULA ARAMBULA
I WENDY CARILLO. WENDY CARILLO I
LARA LARA I HANEY. HANEY I
JONES-SAWYER SAWYER. I
MAINSTREAM MCCARTY KHÓ.
PATTERSON RODRIGUEZ. RODRIGUEZ I
SANCHEZ. SANCHEZ I SANTIAGO.
SANTIAGO I SABO. WEBER WEBER. I
AGAR. AGAR. CURRY. I. THAT
MEASURES OUT 12 TO 0. THANK YOU,
DOCTOR WEBER TO ALL COMMITTEE
MEMBERS WHO ARE NOT IN THE
HEARING ROOM. WE ARE ON OUR LAST
TWO BILLS. WE BELIEVE THEM TO
HOPEFULLY WILL GO, FAIRLY
QUICKLY. SO PLEASE COME TO THE
HEARING ROOM SO THAT YOU CAN
REGISTER YOUR VOTE.
WE MOVE TO ITEM 22 AB 2786 BY
OUR CHAIRWOMAN
.
GOOD EVENING. MEMBERS AB 2786
WILL ESTABLISH A PATHWAY FOR
MOBILE FARMERS MARKETS, OR MFMS,
TO BE AUTHORIZED AS WILK
VENDORS, WHICH SUPPORTS THE
CONSUMPTION OF FRESH FRUIT AND
VEGETABLES THROUGH WILK FARMERS
MARKETS. NUTRITION PROGRAMS.
HOWEVER, MOBILE FARMER MARKETS
ARE NOT CURRENTLY ABLE TO BE
AUTHORIZED AS WILK VENDORS BY
WAY OF BACKGROUND, AN MFM SERVES
AS A CONSOLIDATED FARMER'S
MARKET THAT CAN BE TRANSPORTED
IN A VEHICLE BY BRINGING FRUITS,
VEGETABLES, AND OTHER GOODS
DIRECTLY TO COMMUNITIES. MFMS
MAKE NUTRITIOUS, CULTURALLY
RELEVANT OPTIONS MORE ACCESSIBLE
TO INDIVIDUALS WHO MIGHT
OTHERWISE RELY ON CONVENIENCE
STORES WITH LIMITED AVAILABILITY
OF FRESH PRODUCE. AB 2786
ESTABLISHES THE DEFINITION OF A
MOBILE FARMER'S MARKET AND STATE
RETAIL FOOD CODE, AND REQUIRES
THE DEPARTMENT OF PUBLIC HEALTH
TO ESTABLISH CRITERIA FOR THE
AUTHORIZATION OF MOBILE FARMERS
MARKETS. AS WITH VENDORS
UNDERSTANDING THAT WILK IS A
FEDERALLY FUNDED PROGRAM, I WILL
CONTINUE TO WORK WITH DPH TO
ENSURE THAT THIS BILL IS IN
ACCORDANCE WITH FEDERAL
REGULATIONS. BY ALLOWING WILK
PARTICIPANTS TO USE THEIR
BENEFITS AS MFMS. THIS BILL WILL
INCREASE ACCESS TO NUTRITIOUS
FOOD FOR LOW INCOME COMMUNITIES,
AND WE KNOW THAT THAT WORKS AS A
PREVENTATIVE AND CURATIVE EFFECT
FOR SO MANY CALIFORNIANS WITH ME
TODAY, I HAVE ELLEN OLAK EAST
BAY FOOD ACCESS PROGRAM MANAGER
AT FRESH APPROACH, DARYL AND
TURNER FOOD ACCESS AND EDUCATION
PROGRAM SPECIALIST AT THE FRESH
APPROACH, AND I THANK THEM FOR
STAYING SO LATE TO TESTIFY. MOVE
TO BILL. GOOD EVENING. COMMITTEE
MEMBERS. MY NAME IS ELLEN OLAK
AND I AM HERE TODAY ON BEHALF OF
THE NONPROFIT WHERE I WORK.
FRESH APPROACH. WE ARE ONE OF
THE CO-SPONSORS OF AB 2786,
ALONG WITH THE AGRICULTURAL
INSTITUTE OF MARIN, AND SPEAK ON
BEHALF OF THE CALIFORNIA MOBILE
FARMERS MARKET COALITION. FRESH
APPROACH STARTED THE FIRST
MOBILE FARMERS MARKET IN
CALIFORNIA IN 2013 AS A WAY TO
SUPPORT LOCAL FARMERS AND TO
BRING FRESH, NUTRIENT DENSE
PRODUCE TO UNDERSERVED
COMMUNITIES IN THE BAY AREA AT
AN AFFORDABLE COST. TODAY,
CALIFORNIA HAS FIVE ACTIVE MFMS
WITH AN ADDITIONAL FOUR IN THE
PLANNING STAGES. MFMS ARE
PROVEN, INNOVATIVE MODELS
DESIGNED TO BRING FRESH, LOCALLY
GROWN FRUITS, VEGETABLES AND
OTHER FARM FRESH GOODS DIRECTLY
TO UNDERSERVED AREAS. MFMS
OPERATE ON WHEELS, TRAVELING TO
NEIGHBORHOODS WHERE ACCESS TO
NUTRITIOUS, CULTURALLY RELEVANT
OPTIONS IS LIMITED, AND WHERE
INDIVIDUALS MAY OTHERWISE HAVE
TO RELY ON CONVENIENCE STORES.
AS ASSEMBLYMEMBER BONTA NOTED,
WITH LIMITED AVAILABILITY OF
FRESH PRODUCE, THIS FRESH
PRODUCE IS GROWN BY CALIFORNIA
FARMERS, MOST OF WHOM ARE FAMILY
FARMERS WITH SMALL TO MID SIZE
OPERATIONS. DESPITE THE
POPULARITY OF MFMS TO ADDRESS
FOOD INSECURITY IN CALIFORNIA,
PARTICIPANTS IN THE WILK PROGRAM
CANNOT CURRENTLY PURCHASE FRESH
FRUITS AND VEGETABLES AT MFMS
WITH THEIR BENEFITS. HOWEVER,
PEOPLE WHO SHOP WITH CALFRESH,
FEDERALLY KNOWN AS SNAP, ARE
ABLE TO USE THEIR BENEFITS AND
RECEIVE A MARKET MATCH THROUGH
THE CALIFORNIA NUTRITION
INCENTIVE PROGRAM AT MFMS. AB
2786 WOULD ALLOW BENEFICIARIES
TO USE THEIR BENEFITS AT MOBILE
FARMERS MARKETS AND INCREASE
ACCESS TO NUTRITIOUS FOOD FOR
UNDERSERVED COMMUNITIES ACROSS
THE STATE. I URGE YOU TO VOTE
AYE ON AB 2786. THANK YOU SO
MUCH FOR YOUR TIME. HELLO
COMMITTEE MEMBERS, MY NAME IS
DARRYLIN TURNER. I AM A
NUTRITION EDUCATION AND FOOD
ACCESS SPECIALIST AT FRESH
APPROACH. I BECAME A MOTHER AT
22. I WAS A HARD WORKING COLLEGE
STUDENT WHO NEEDED SUPPORT. I
VIVIDLY REMEMBER BEING APPROVED
FOR WICK AND GOING TO THE
SUPERMARKET WITH MY NEW
VOUCHERS, WHICH HELPS TO SUPPORT
MOTHERS LIKE ME STRETCHING THEIR
FOOD DOLLARS. THEY CAN RECEIVE
VOUCHERS TO SHOP AT FARMERS
MARKETS TOO, THROUGH THE FARMERS
MARKET NUTRITION PROGRAM FROM
MAY TO NOVEMBER. CALIFORNIA
FEEDS THE NATION AND GROWS SO
MUCH HEALTHY FOOD. YET PARENTS
WHO ARE WICK RECIPIENTS CANNOT
USE THEIR BENEFITS AT OUR MOBILE
FARMERS MARKETS, WORKING IN
NUTRITION AND FOOD EQUITY. NOW,
I AM CONSTANTLY DISAPPOINTING
CUSTOMERS AT THE MOBILE FARMERS
MARKETS WHO ARE WICK RECIPIENTS.
THIS IS A HUGE INJUSTICE TO
FAMILIES. THEY DESERVE QUALITY
PRODUCE AND OTHER FOODS JUST
LIKE ANY OTHER CONSUMER, AND
ALLOWING THE USE OF THESE
VOUCHERS AT THE MOBILE FARMERS
MARKETS WILL UNDOUBTEDLY ELEVATE
THE LIVES OF MANY. THERE IS A
HUGE DEMAND HERE AND PEOPLE ARE
ATTEMPTING TO EDUCATE THEMSELVES
AND PUT THEIR HEALTH FIRST. WICK
RECIPIENTS ARE TYPICALLY
ASSIGNED A NUTRITIONIST OR A
DIETITIAN TO ASSIST THEM ALONG
THEIR PREGNANCY AND THROUGHOUT
EARLY PARENTHOOD, ACCESS TO
KNOWLEDGE ABOUT THE ARRAY OF
PRODUCE IS ACCESSIBLE RIGHT FROM
LOCAL FARMERS. SUPPORTS BOTH
HEALTHY EATING AND OUR LOCAL
ECONOMY. FOOD CAN BE MEDICINE IF
USED CORRECTLY, AND SUPPORTING
THIS IDEA WILL HELP PREVENT AND
OR LIMIT THINGS LIKE OBESITY,
OBESITY AND DIABETES. IF I WOULD
HAVE BEEN ABLE TO USE MY WICK
VOUCHERS AT THE MOBILE FARMERS
MARKET, THERE WOULD HAVE BEEN
LESS FOOD WASTE AND I WOULD HAVE
MORE PESTICIDE FREE, CULTURALLY
RELEVANT OPTIONS FOR MYSELF AND
MY CHILDREN. I URGE YOU TO VOTE
YES ON THIS BILL. THANK YOU.
THANK YOU. DO WE HAVE ANY OTHER
WITNESSES IN SUPPORT? PLEASE
COME FORWARD. HI, ANDY
NADJARI'S, THE CEO OF THE
AGRICULTURAL INSTITUTE OF MARIN
IN SUPPORT AND ALSO WANT TO
SHARE SUPPORT FROM SOME OF OUR
MEMBERS. THE NORTH COAST GROWERS
ASSOCIATION, THÀNH SERIES,
COMMUNITY PROJECT, NAPA FARMERS
MARKET, ROUTE ONE, FARMERS
MARKET, BUTTE COUNTY LOCAL FOOD
NETWORK, CENTER FOR LAND BASED
LEARNING, EXTRA FOOD, EVERYONE'S
HARVEST STAGE AND MARIN FOOD
POLICY COUNCIL. THANK YOU, THANK
YOU. DO WE HAVE ANY WITNESSES IN
OPPOSITION? SEEING NONE,
QUESTIONS? COMMENTS FROM THE
COMMITTEE. MISS WEBER? I JUST
WANT TO ONCE AGAIN THANK THE
CHAIR FOR CONTINUING TO REMIND
US ABOUT THE IMPORTANCE OF FOOD
AND THE LINKAGE OF FOOD TO
HEALTH, I TOO, ABSOLUTELY LOVE
THIS BILL AND WOULD LOVE TO BE A
COAUTHOR OF POSSIBILITY. THANK
YOU, THANK YOU. I AGREE WITH
THAT AS WELL. IT'S A GREAT BILL,
WHICH I WILL BE SUPPORTING, WE
DO HAVE A MOTION DO PASS TO
APPROPS. WOULD YOU LIKE TO
CLOSE? I KNOW IT'S LATE IN THE
DAY. I DID WANT TO JUST LIST OUT
QUICKLY WHERE WE CURRENTLY HAVE
MOBILE FARMERS MARKETS. WE HAVE
THEM IN ALAMEDA, CONTRA COSTA,
MARIN, SACRAMENTO, SAN
FRANCISCO, SAN MATEO, SANTA
BARBARA AND SANTA CLARA
COUNTIES, WITH ADDITIONAL FOR,
MOBILE FARMERS MARKETS IN
PLANNING STAGES IN NAPA, LOS
ANGELES AND SAN LUIS OBISPO
COUNTIES. WE ALREADY HAVE,
THROUGHOUT THE STATE, MOBILE
FARMERS MARKETS REALLY BEING
ABLE TO PROPEL US FORWARD. AND
WE VERY MUCH HOPE THAT WE CAN
HAVE WILK PARTICIPANTS ENSURE
THAT THIS IS SOMETHING THAT THEY
CAN USE, AS WE HEARD FROM OUR
BEAUTIFUL TESTIMONY TODAY. SO
THANK YOU. WITH THAT, I
RESPECTFULLY REQUEST YOUR AYE
VOTE. THANK YOU, MADAM
SECRETARY, PLEASE CALL THE ROLL
ONTO I BONTA I WALDRON. WALDEN,
I AGUIAR-CURRY IGER CURRY I
ARAMBULA ARAMBULA I WENDY
CARILLO WENDY CARILLO I LARA
LARA I HAINEY HANEY I
JONES-SAWYER JONES-SAWYER I
MAIENSCHEIN MAIENSCHEIN I
MCCARTY. GO. PATTERSON
RODRIGUEZ. RODRIGUEZ. I SANCHEZ.
SANCHEZ. I SANTIAGO. SANTIAGO. I
BROUGH. WEBER. WEBER. I. 13
ZERO. YOUR BILL IS OUT. WE WILL
LEAVE THE ROLL OPEN TO ADD ON.
WE MOVE TO ITEM 20 6AB 2914.
THANK YOU. MEMBERS A, B 29, 14
OPENS THE DOOR TO A DISCUSSION
OF WHETHER OR NOT CALIFORNIA
SHOULD ENTERTAIN A NEW SET OF
ESSENTIAL HEALTH BENEFITS YEAR
AFTER YEAR, AND IN FACT, HEARING
AFTER HEARING, WE SEE MANDATE
PROPOSALS THAT ARE OUTSIDE OF
THE CURRENT BENEFIT AND VETOED
ON THE BASIS THAT SUCH A BENEFIT
WOULD EXCEED THE CURRENT EAPS.
RATHER THAN GO DOWN THE SAME
PATH, WE SHOULD GIVE OURSELVES
AN OPPORTUNITY TO REVISIT THESE
BENEFITS, AND THIS BILL ALLOWS
SUCH A PROCESS TO HAPPEN. WE
WILL GET TO LISTEN TO
STAKEHOLDERS, COMPARE AND
CONTRAST THE DIFFERENT OPTIONS,
AND MAKE AN INFORMED DECISION AS
TO HOW MUCH WE WILL NEED TO PAY
IN TERMS OF PREMIUM DOLLARS FOR
THOSE NEW BENEFITS. THIS BILL
ALLOWS US TO FINALLY BREAK FREE
OF THE LIMITATIONS OF OUR
CURRENT HB BENCHMARKING PROGRAM,
AND WITH THAT, I HAVE ONE
WITNESS TODAY IN SUPPORT FROM
HEALTH ACCESS CALIFORNIA. GOOD
EVENING, DIANNA DOUGLAS WITH
HEALTH ACCESS CALIFORNIA,
CALIFORNIA STATEWIDE CONSUMER
HEALTH ADVOCACY ORGANIZATION
HEALTH ACCESS IS PLEASED TO
SUPPORT AB 2914 AND BELIEVES A
REEXAMINATION OF OUR STATE'S
BENCHMARK PLAN IS TIMELY,
NECESSARY AND HAS THE POTENTIAL
TO REDUCE HEALTH INEQUITIES AND
INCREASE ACCESS TO CARE. THOUGH
THE CURRENT PLAN MAY HAVE BEEN
SATISFACTORY WHEN ORIGINALLY
SELECTED IN 2014, IN THE DECADES
SINCE, WE HAVE SEEN POTENTIAL
FOR FURTHER LEVERAGING THE ACA
TO ENSURE CONSUMERS ARE COVERED
FOR THE CARE THEY NEED.
CURRENTLY, COVERAGE FOR
IMPORTANT BENEFITS SUCH AS
DENTAL SERVICES, HEARING AIDS
FOR CHILDREN, DURABLE MEDICAL
EQUIPMENT, AND FERTILITY
SERVICES ARE JUST SOME EXAMPLES
OF THOSE THAT ARE LEFT TO THE
DISCRETION OF PLANS AND ARE
OFTEN NOT COVERED AT ALL. A
STRATEGIC EXAMINATION OF OUR
BENCHMARK PLAN WITH A PROCESS
THAT ALLOWS FOR SIGNIFICANT
STAKEHOLDER ENGAGEMENT, WILL
ALLOW US TO RECONSIDER THE WIDE
ARRAY OF BENEFITS THAT COULD
BECOME THE NEW STANDARD FOR
CALIFORNIANS. THANK YOU. AND WE
RESPECTFULLY ASK FOR YOUR AYE
VOTE. THANK YOU. DO WE HAVE ANY
OTHER WITNESSES IN SUPPORT?
PLEASE COME FORWARD. I JUST WANT
TO SAY BRIEFLY, MADAM CHAIR
MEMBERS, NICK LOUISOS WITH THE
CALIFORNIA ASSOCIATION OF HEALTH
PLANS. YOU KNOW, THE PROCESS
ENVISIONED BY THIS BILL IS ONE
THAT WE'RE SUPPORTIVE OF. IT'S
THE RIGHT APPROACH TO LOOKING AT
MANDATES INSTEAD OF THE
HAPHAZARD APPROACH THAT WE DO ON
ONE ON ONE BILLS, YOU KNOW, WHEN
THE LEGISLATURE AND THE
ADMINISTRATION PICKED THE HBS
ORIGINALLY, THEY TOOK THEIR TIME
, THEY DID THE ANALYTICAL WORK,
AND THEY LOOKED AT IT
COMPREHENSIVELY IN TERMS OF
AFFORDABILITY AND ACCESS
PERSPECTIVE. AND THAT'S THE
RIGHT APPROACH. WE DO BELIEVE IF
THIS BILL MOVES FORWARD AT THIS
POINT ON, IT WOULD BE GREAT IF
THERE WAS A MORATORIUM ON
INDIVIDUAL MANDATE BILLS MOVING
FORWARD. AND THEN WE ALSO THINK
THAT, YOU KNOW, THE PROCESS
SHOULD ALSO, TAKE INTO
CONSIDERATION THE WORK THAT'S
BEING DONE AT THE OFFICE OF
HEALTH CARE AFFORDABILITY, WHICH
IS ON THE VERGE OF IMPLEMENTING
A STATEWIDE SPENDING TARGET. AND
SO WE WOULDN'T WANT THAT TO
CONFLICT WITH THE AFFORDABILITY
WORK THAT'S BEING DONE THERE. SO
THANK YOU. THANK YOU, NORA LYNN,
ON BEHALF OF CHILDREN. NOW, LET
CALIFORNIA KIDS HEAR CALIFORNIA
HANDS AND VOICES AND THE HEARING
LOSS ASSOCIATION OF AMERICA,
CALIFORNIA CHAPTER ALL IN
SUPPORT. THANK YOU, SANDRA
POOLE, ON BEHALF OF WESTERN
CENTER ON LAW AND POVERTY, ON
SUPPORT. GOOD EVENING, KELLY
MCMILLAN, ON BEHALF OF THE
CHILDREN'S SPECIALTY CARE
COALITION. GOOD EVENING, MATT
AKIN WITH THE ASSOCIATION OF
CALIFORNIA LIFE AND HEALTH
INSURANCE COMPANIES WITH THE
SUPPORTING CONCEPT POSITION.
THANK YOU. GOOD EVENING, CHAIR
MEMBERS. JESSICA MORAN AT THE
CALIFORNIA DENTAL ASSOCIATION.
WE HAVE A SUPPORTIVE, AMENDED
POSITION AND ASK THAT THE
COMMITTEE AMEND THE BILL TO
INCLUDE ADULT DENTAL AT THE
APPROPRIATE TIME. THANK YOU,
THANK YOU. ANY WITNESSES IN
OPPOSITION? SEEING NONE.
COMMITTEE COMMENTS. WE HAVE A
MOTION. WE NEED A SECOND. OKAY.
QUESTIONS? NO WOULD YOU LIKE TO
CLOSE? THANK YOU. MEMBERS.
SENATOR ROTH HAS A ANOTHER BILL
IN THE SENATE MOVING THROUGH AS
WELL, I THINK IT IS THE
CERTAINLY THE BELIEF OF THE
LEGISLATURE, BOTH ON THE SENATE
AND ASSEMBLY SIDE, WITH THIS
BILL PASSING THROUGH COMMITTEE,
HOPEFULLY, THAT WE NEED TO BE
ABLE TO REALLY THINK ABOUT THE
BENCHMARKING PROCESS AS IT AS IT
IS HAPPENING RIGHT NOW. AND AND
I THINK TOGETHER, COLLECTIVELY,
THE LEGISLATURE CAN HAVE A VERY
PRODUCTIVE CONVERSATIONS WITH
THE ADMINISTRATION TO MAKE SURE
THAT THAT IS THE CASE. WITH
THAT, I RESPECTFULLY REQUEST
YOUR I VOTE. THANK YOU. WE HAVE
A MOTION AND A SECOND Dð PASS TO
APPROPRIATIONS. MADAM SECRETARY,
PLEASE CALL THE ROLL. BONTA I
WALDEN WALDEN I AGAR CURRY
AGUIAR-CURRY I ARAMBULA ARAMBULA
I WENDY CARILLO WENDY CARILLO I
LARA LARA I HANEY. HANEY I
JONES-SAWYER SAWYER I
MAIENSCHEIN EINSTEIN I MCCARTY.
JOE PATTERSON. RODRIGUEZ.
RODRIGUEZ I SANCHEZ. SANCHEZ I
SANTIAGO. SANTIAGO I SABO.
WEBER. WEBER. I. 13 ZERO. THE
BILL IS OUT. AND NOW WE GET TO
DO ALL OUR ADD ONS TO ALL OF
THESE BILLS THAT WE HEARD TODAY
.
THANK YOU. WE WILL BEGIN WITH
THE CONSENT CALENDAR. MEMBERS
CAN I HAVE A MOTION AND A
SECOND? MOVED BY ARAMBULA,
SECONDED BY RODRIGUEZ.
SECRETARY, PLEASE CALL THE ROLL.
BONTA I BONTA I WALDRON. WALDEN
I AGUIAR-CURRY AGUIAR-CURRY I
ARAMBULA ARAMBULA I WENDY
CARILLO WENDY CARILLO I LARA
LARA I HANEY. HANEY I
JONES-SAWYER GUN. SAWYER I
MAIENSCHEIN MAIENSCHEIN I
MCCARTY. MCCARTY I JOE PATTERSON
. RODRIGUEZ. RODRIGUEZ I SANCHEZ
. SANCHEZ I SANTIAGO. SANTIAGO I
. WEBER. WEBER I. CONSENT
CALENDAR IS OUT WITH A VOTE OF
14 TO 0 MEMBERS. WE WILL NOW
TAKE UP ITEM NUMBER 30 3AB 2960
LI. THE MOTION IS Dð. PASS TO
APPROPRIATIONS. REMOVING FROM
PASS AS AMENDED. REMOVING FROM A
RECONSIDERATION. THIS IS VOTE
ONLY FOR THE SAKE OF THE
COMMITTEE. I WILL READ OFF THE
AMENDMENTS THE AUTHOR IS
PROPOSING AMENDMENTS TO REQUIRE
SYPHILIS TESTING IN CLINICS AND
EDS AS FOLLOWS. AS OUTLINED IN
THE. IN THE MOST RECENT
GUIDELINES PUBLISHED BY THE CDC
TO APPLY TO A PERSON WHO IS
SEXUALLY ACTIVE AND AT LEAST 15
YEARS OF AGE. TO CLARIFY THAT A
CLINIC OR ED MAY OFFER A
SYPHILIS TEST TO A PATIENT UNDER
THE AGE OF 15, AS PERMITTED
UNDER CURRENT LAW, TO STRIKE
INTENT LANGUAGE REGARDING THE
PREFERRED TREATMENT FOR A
PREGNANT PERSON WITH SYPHILIS
AND TO ADD A FIVE YEAR SUNSET
WITH THAT. CAN I HAVE A MOTION
FOR RECONSIDERATION? MOVED BY
ARAMBULA. SECONDED BY
JONES-SAWYER SECRETARY. PLEASE
CALL THE ROLL I BONTA I WALDEN.
WALDEN NOT VOTING EDGAR CURRY.
EDGAR CURRY I ARAMBULA ARAMBULA
I WENDY CARILLO. WENDY CARILLO I
FLORA LARA NOT VOTING HANEY
HANEY I JONES-SAWYER
JONES-SAWYER I MAIENSCHEIN
MAIENSCHEIN NOT VOTING MCCARTY.
MCCARTY. IJO. PATTERSON
RODRIGUEZ. RODRIGUEZ. NOT
VOTING. SANCHEZ. SANCHEZ. NØ
SANTIAGO. SANTIAGO. NOT VOTING.
SCHIAVO WEBER. WEBER. I. THAT
MEASURE IS ON CALL. IT NEEDS ONE
MORE VOTE. MEMBERS. WE WILL MOVE
NOW TO ITEM NUMBER ONE, AB 2200.
THE MOTION IS DUE. PASS AS
AMENDED TO A PROPS. WE NEED A
MOTION AND A SECOND. SO MOVED BY
CARRILLO, SECONDED BY ARAMBULA.
SECRETARY, PLEASE CALL THE ROLL.
BONTA I WALDRON. WALDEN. NO.
AGAR. CURRY AGAR. CURRY. NOT
VOTING. ARAMBULA ARAMBULA I
WENDY. CARILLO. WENDY. CARILLO I
FLORA. LARA. NO. HANEY. HANEY I
JOHN SAWYER. JOHN. SAWYER I MEAN
SHINE, SHINE I MCCARTY MCCARTY.
I JOE PATTERSON. SO PATTERSON.
NÓ. RODRIGUEZ. RODRIGUEZ. NOT
VOTING. SANCHEZ SANCHEZ. NO.
SANTIAGO SANTIAGO I CHAVO. WEBER
WEBER. NOT VOTING. THAT MEASURES
ON CALL. IT NEEDS ONE MORE VOTE.
ITEM TWO AB 2064 JONES. SAWYER
WE NEED A MOTION AND A SECOND
MOVED BY ARAMBULA, SECONDED BY
SANTIAGO. THE MOTION IS DUE.
PASS TO APPROPRIATIONS. PLEASE
CALL THE ROLL. BONTA I WALDRON.
WALDEN I AGAR CURRY AGAR. CURRY
I ARAMBULA ARAMBULA I 1D CARILLO
WENDY CARILLO I LARA LARA I
HANEY. HANEY I JONES. SAWYER.
JONES. SAWYER I MAIENSCHEIN
MAIENSCHEIN I MCCARTY. MCCARTY I
JOE PATTERSON. SO PATTERSON I
RODRIGUEZ. RODRIGUEZ I SANCHEZ.
SANCHEZ. NØ. SANTIAGO SANTIAGO I
. WEBER. WEBER. I. THAT MEASURE
IS OUT WITH A VOTE OF 14 TO 1.
ITEM NUMBER THREE AB 2075. WE
NEED A MOTION AND A SECOND MOVED
BY ARAMBULA, SECONDED BY
SANTIAGO. THE MOTION IS Dð PASS
TO APPROPRIATIONS. SORRY. DO
PASS AS AMENDED TO
APPROPRIATIONS. SECRETARY,
PLEASE CALL THE ROLL. BONTA I
BONTA I WALDEN. WALDEN I AGAR
CURRY AGUIAR-CURRY I ARAMBULA
ARAMBULA I WENDY CARILLO WENDY
CARILLO I LARA LARA I HANEY.
HANEY I JOHN SAWYER. JOHN SAWYER
I MAIENSCHEIN MAIENSCHEIN I
MCCARTY. MCCARTY I JOE PATTERSON
, JOE. PATTERSON I RODRIGUEZ.
RODRIGUEZ I SANCHEZ. SANCHEZ I
SANTIAGO. SANTIAGO I. WEBER
WEBER. NOT VOTING. THAT MEASURES
OUT 14 TO 0. WE ARE ON TO. ITEM
NUMBER FOUR IS ON CONSENT. ITEM
NUMBER FIVE AB 2115 HANEY. THE
MEASURE IS Dð. PASS TO
APPROPRIATIONS. I NEED A
MEASURE. AYE THANK YOU. WALDRON.
SECONDED BY SANTA CARGO.
SECRETARY, PLEASE CALL THE ROLL
ONTO AYE. ONTO. AYE. WALDEN.
WALDEN. AYE. AGUIAR-CURRY
AGUIAR-CURRY. AYE. ARAMBULA.
ARAMBULA. AYE. NGUYEN DE
CARILLO. WENDY. CARILLO. AYE.
LARA. LARA. AYE HANEY. HANEY.
AYE. JONES. SAWYER JONES.
SAWYER. AYE. MAIENSCHEIN
MAIENSCHEIN. AYE. MCCARTY.
MCCARTY. IJO. PATTERSON JO.
PATTERSON. AYE. RODRIGUEZ.
RODRIGUEZ. AYE. SANCHEZ SANCHEZ.
AYE. SANTIAGO. SANTIAGO. AYE
WEBBER. WEBBER. AYE THAT
MEASURES OUT 15 TO 0. BROUGH
BROUGH. AYE. 16 ZERO. THAT'S
MEASURES OUT 16 TO 0. WE'LL MOVE
ON FOR ADD ONS TO AB 2180. WE
NEED TO LIFT THE CALL. NO ADD
ONS AB 2180 WEBER FOR ADD ONS.
MAIENSCHEIN MAIENSCHEIN. AYE
MCCARTY. MCCARTY AYE. PATTERSON.
GO. PATTERSON. AYE SABO. AYE.
THAT MEASURES NOW AT 16 TO 0.
ITEM SEVEN AB 2198. FLORA WE
NEED A MOTION. GENTLEMEN AND
GENTLEWOMEN MOVED BY
AGUIAR-CURRY, SECONDED BY
SANCHEZ. PLEASE CALL. THE ROLL
MOTION IS Dð. PASSES AMENDED TO
APPROPRIATIONS ONTO AYE. ONTO.
AYE. WALDEN. WALDEN. AYE.
AGUIAR-CURRY AGAR. CURRIE. AYE.
ARAMBULA. ARAMBULA. AYE. WENDY.
CARRILLO WENDY. CARILLO. NØ.
WENDY. CARRILLO. AYE FLORA.
LARA. AYE. HANEY HANEY. AYE.
JOHN. SAWYER. HANEY. HANEY. AYE.
JOHN. SAWYER JOHN. SAWYER. AYE.
MAINE. SHINE. MAINE. SHINE. AYE
MCCARTY. MCCARTY. AYE. JOE.
PATTERSON. JOE PATTERSON. AYE.
RODRIGUEZ. RODRIGUEZ. AYE.
SANCHEZ SANCHEZ. AYE. SANTIAGO.
SANTIAGO AYE. SHABU SHABU. AYE.
WEBER. WEBER AYE. 16 ZERO. THAT
MEASURES OUT 16 TO 0. MOVING ON
TO ITEM NUMBER EIGHT AB 2271.
ORTEGA, NITA MOTION AND A
SECOND. MOVED BY SANTIAGO,
SECONDED BY AGUIAR-CURRY. THE
MOTION IS DUE. PASS TO
APPROPRIATIONS. SECRETARY,
PLEASE CALL THE ROLL. AYE, AYE.
WALDEN. WALDEN. AYE. AGAR. AGAR.
CURRIE AYE. ARAMBULA. ARAMBULA.
AYE. WENDY. CARILLO. WENDY.
CARILLO AYE. FLORA. LARA. AYE.
HANEY. HANEY. AYE. JONES-SAWYER
JONES-SAWYER. AYE. MAIENSCHEIN.
MAIN SHRINE. AYE. MCCARTY
MCCARTY. AYE. PATTERSON. JO.
PATTERSON. AYE. RODRIGUEZ
RODRIGUEZ. AYE. SANCHEZ.
SANCHEZ. NOT VOTING. SANTIAGO.
SANTIAGO. AYE SABO. AYE. WEBER.
WEBER AYE. 15 ZERO. THAT
MEASURES OUT 15 TO 0, ITEM
NUMBER NINE IS ON CONSENT. ITEM
NUMBER TEN, AB 2352. ERWIN I
NEED A MOTION AND A SECOND. I'M
JUST GOING TO PICK. I HEARD
ALTOS, SANTIAGO AND SANCHEZ
SECOND. MOTION IS DUE. PASS TO
APPROPRIATIONS APPS, DO PASSES
AMENDED TO APPROPRIATIONS.
SECRETARY, PLEASE CALL THE ROLL
ONTO AYE. AYE. WALDEN. WALDEN.
AYE. AGUIAR-CURRY AGAR. CURRIE.
AYE. ARAMBULA. ARAMBULA. AYE.
WENDY. CARRILLO WENDY. CARILLO.
AYE. FLORA. LARA. AYE. HANEY
HANEY. AYE. JOHN. SAWYER. JOHN.
SAWYER. AYE. MAIENSCHEIN
MAIENSCHEIN. AYE. MCCARTY.
MCCARTY. IJO. PATTERSON JO.
PATTERSON. NOT VOTING.
RODRIGUEZ. RODRIGUEZ AYE.
SANCHEZ. SANCHEZ. AYE. SANTIAGO
SANTIAGO. AYE. SHABU SHABU. AYE.
WEBER WEBER. AYE THAT MEASURES
OUT 15 TO 0. WE'RE GOING TO GO
BACK TO THE LEE AND THEN, ITEM
NUMBER ONE, JUST SO I CAN, FOR
THE SAKE OF FLOW, JUST MOVE ON
FROM ITEM NUMBER TEN. SO FOR ADD
ONS OR SORRY, LIFTING THE CALL
ON ITEM NUMBER 33 AB 2960. CALL
THE ROLL. JOE PATTERSON. BROUGH.
BROUGH. AYE NINE ZERO. I'M
SORRY. NINE ONE. THAT MEASURE IS
OUT. 9 TO 1. WE'RE GOING TO GO
BACK TO ITEM NUMBER ONE. AB
2200. LIFTING THE CALL. CHOLERA
PLEASE CALL THE ROLL SABO
BROUGH. AYE AYE. FOR THAT
MEASURE IS OUT NOW. 9 TO 4, ITEM
NUMBER TWO FOR ADD ONS, AB 2064
BROUGH CHAU VÚI MEASURES 15
ZERO. ITEM NUMBER THREE FOR ADD
ONS AB 2075 BROUGH CHAU VÚI 15
ZERO. ITEM NUMBER FIVE AB 2115.
FOR ADD ONS. OKAY SO WE'RE BACK
TO TEN. OKAY. 12, WE'LL MOVE TO
CONSENT FOR ADD ONS. JOE
PATTERSON. JOE PATTERSON. AYE
BROUGH. BROUGH. AYE AYE.
MEASURES NOW 16 ZERO FOR
CONSENT. MOVING ON TO FILE ITEM
NUMBER 12, AB 2467. THE MOTION
IS Dð. PASS AS AMENDED TO
APPROPRIATIONS. I NEED A MOTION.
AND A SECOND MOVED BY WALDRON,
SECONDED BY. ARAMBULA PLEASE
CALL THE ROLL. AYE, AYE.
WALDRON. WALDRON. AYE. AGAR
CURRIE. AGUIAR-CURRY. AYE.
ARAMBULA. ARAMBULA. AYE WENDY.
CARILLO. WENDY. CARILLO. AYE.
LARA. LARA. AYE HANEY. HANEY.
AYE. JOHN. SAWYER. JONES-SAWYER
AYE. MAIENSCHEIN. MAIENSCHEIN.
AYE. MCCARTY. MCCARTY AYE.
PATTERSON. JOE. PATTERSON. AYE.
RODRIGUEZ RODRIGUEZ. AYE.
SANCHEZ. SANCHEZ. AYE. SANTIAGO
BAUER. KHN SANTIAGO. AYE SABO.
AYE. WEBER. WEBER. AYE. 16 ZERO.
MEASURES OUT 16 ZERO. ITEM 14 AB
2574. VALENCIA. DO PASS TWO
APPROPRIATIONS. NEED A MOTION.
Ó DO. PASS IS AMENDED. NEED A
MOTION AND A SECOND. SANTIAGO
JOHN SAWYER. NO. JOHN SAWYER
SECONDS, PLEASE CALL THE ROLL.
AYE, AYE. WALDRON WALDRON. AYE.
AGUIAR-CURRY. AGAR. CURRIE. AYE.
ARAMBULA ARAMBULA. AYE. WENDY.
CARILLO. WENDY. CARILLO AYE.
LARA. LARA. AYE. HANEY. HANEY
AYE. JOHN. SAWYER. JOHN. SAWYER.
AYE. MAIENSCHEIN. MAIENSCHEIN
AYE. MCCARTY. MCCARTY. AYE.
PATTERSON JO. PATTERSON. AYE.
RODRIGUEZ. RODRIGUEZ. AYE.
SANCHEZ SANCHEZ. AYE. SANTIAGO.
SANTIAGO. AYE SABO. AYE. WEBER
WEBER. AYE. 16 MEASURES THAT 16
ZERO. ITEM 15 AB 2613. ZIPPER
MOTION IS DUE. PASS AS AMENDED
TO APPROPRIATIONS. NEED A MOTION
AND A SECOND, SORRY. ARAMBULA.
AND WALDRON, PLEASE CALL THE
ROLL ONTO AYE. ONTO AYE.
WALDRON. WALDRON. AYE.
AGUIAR-CURRY. AGAR CURRIE. AYE.
ARAMBULA. ARAMBULA. AYE. WENDY.
CARILLO WENDY. CARRILLO. AYE.
FLORA. FLORA. AYE. HANEY HANEY.
AYE. JOAN. SAWYER. JOHN. SAWYER.
FEINSTEIN MAIENSCHEIN. AYE.
MCCARTY. MCCARTY. AYE PATTERSON.
PATTERSON. AYE. RODRIGUEZ.
RODRIGUEZ AYE. SANCHEZ. SANCHEZ.
AYE. SANTIAGO SANTIAGO. AYE.
SHABU SHABU. AYE. WEBER WEBER.
AYE. THAT MEASURES THAT 16 ZERO.
ITEM 16 FOR ADD ONS. AB 2637
ZERO. ARAMBULA. ARAMBULA. AYE.
WENDY. CARILLO. WENDY. CARILLO.
AYE MAIENSCHEIN. MAIENSCHEIN.
AYE. MCCARTY. MCCARTY AYE.
PATTERSON. GO. PATTERSON. AYE.
SANCHEZ. NØ TO. AYE 16 ZERO.
THAT MEASURE PASSES NOW. 16
ZERO. ITEM NUMBER 17, AB 2668.
BERMAN MOTION IS Dð PASS TO
APPROPRIATIONS. NEED A MOTION
AND A SECOND ARAMBULA SANTIAGO,
PLEASE CALL THE ROLL. BONTA.
AYE, AYE. WALDRON. WALDRON AYE.
AGAR. AGAR. CURRIE. AYE.
ARAMBULA. ARAMBULA AYE. WENDY.
CARILLO. WENDY. CARILLO. AYE.
FLORA. FLORA. AYE HANEY. HANEY.
HANEY. AYE JOAN. SAWYER. JOHN.
SAWYER. AYE. MAIENSCHEIN.
MAIENSCHEIN AYE. MCCARTY.
MCCARTY. AYE. PATTERSON. JOE.
PATTERSON AYE. RODRIGUEZ.
RODRIGUEZ. AYE. SANCHEZ SANCHEZ.
AYE. SANTIAGO. SANTIAGO. AYE Þ.
CHAU. AYE. WEBER. WEBER AYE. 16
ZERO. MEASURES OUT 16 ZERO. ITEM
18 AB 2670 FOR ADD ONS. ARAMBULA
ARAMBULA. AYE MAIENSCHEIN.
WEINSTEIN. AYE. MCCARTY MCCARTY.
AYE. PATTERSON LARSON. NO.
THAT'S 12 TO 4. THAT MEASURES
OUT 19 THROUGH 21 ARE ON
CONSENT. ITEM NUMBER 22 AB 2786.
BONTA WE VOTED ON THAT ONE FOR
ADD ONS. MCCARTY MCCARTY. AYE.
PATTERSON. SO PATTERSON. AYE
SABO. ITEM AS YOU'RE NOW A 16 TO
0 ITEM NUMBER 23 AB 2789
WALLACE. MOTION IS DUE. PASS TO
APPROPRIATIONS. I NEED A MOTION
AND A SECOND MOVE BY ARAMBULA,
SECONDED BY WALDRON. PLEASE CALL
ROLL. AYE ADRIN. WALDRON. AYE.
AGUIAR-CURRY. AGUIAR-CURRY AYE.
ARAMBULA. ARAMBULA. AYE. WENDY.
CARILLO WENDY. CARILLO. AYE.
LARA. LARA. AYE. HANEY AMY. AYE.
JOHN. SAWYER. JOHN. SAWYER. AYE.
MAIENSCHEIN MCSHANE. AYE.
MCCARTY. MCCARTY. IJO. PATTERSON
JO. PATTERSON. AYE. RODRIGUEZ.
RODRIGUEZ. AYE SANCHEZ. SANCHEZ.
AYE. SANTIAGO. SANTIAGO AYE.
AYE. WEBER. WEBER. AYE. 16 ZERO.
MEASURES OUT 16 TO 0. 24 IS ON
CONSENT. ITEM NUMBER 25, AB
2893. WARD MOTION IS DUE. PASS
TO APPROPRIATIONS. I NEED A
MOTION IN A SECOND. MERIMBULA.
SANTIAGO, PLEASE CALL THE ROLL
ONTO. AYE. ONTO. AYE. WALDRON
WALDRON. AYE. AGUIAR-CURRY.
AGUIAR-CURRY. AYE. ARAMBULA
ARAMBULA. AYE. WENDY. CARILLO.
WENDY. CARILLO. AYE. FLORA LARA.
AYE. HANEY. HANEY. AYE. JOHN.
SAWYER JOHN. SAWYER. AYE.
MAINTAIN. MAIN SHRINE. AYE.
MCCARTY MCCARTY. AYE. PATTERSON.
JO. PATTERSON. NOT VOTING.
RODRIGUEZ. RODRIGUEZ. AYE.
SANCHEZ SANCHEZ. NOT VOTING.
SANTIAGO. SANTIAGO. AYE BROUGH.
BROUGH. AYE. WEBER WEBER. AYE.
14 ZERO. THAT MEASURES OUT 14 TO
0. ADD ONS FOR 26. ITEM 26 AB
2914. BONTA MCCARTY. MCCARTY.
AYE. PATTERSON SO. PATTERSON.
AYE. BROUGH SABO. AYE. 16 ZERO.
THAT MEASURES OUT 16 ZERO. NOW.
ITEM 27 AB 2942 VÆ VALLAPUDUA
MEASURE AYE. MOTION IS Dð PASS
AS AMENDED TO APPROPRIATIONS.
NEED A MOTION AND A SECOND.
SANTIAGO ARAMBULA, PLEASE CALL
THE ROLL. AYE. AYE. WALDRON.
WALDRON. AYE. AGUIAR-CURRY AGAR.
CURRIE. AYE. ARAMBULA. ARAMBULA.
AYE. WENDY CARILLO. WENDY.
CARILLO. AYE. LARA. LARA. AYE.
HANEY HANEY. AYE. JOHN. SAWYER.
JOHN. SAWYER. AYE. MAIENSCHEIN
WEINSTEIN. AYE. MCCARTY.
MCCARTY. AYE. PATTERSON SO.
PATTERSON. AYE. RODRIGUEZ.
RODRIGUEZ AYE. SANCHEZ. SANCHEZ.
AYE. SANTIAGO. SANTIAGO AYE.
SHABU SHABU. AYE. WEBER. WEBER
AYE. 16 ZERO. MEASURES OUT 16 TO
0. ITEM NUMBER 28, AB 3045 TO
MOTION IS DUE. PASS TO
APPROPRIATIONS. I NEED A MOVED
BY FLORA, SECONDED BY ARAMBULA.
PLEASE CALL THE ROLL ONTO. AYE.
ONTO. AYE. WALDRON. WALDRON.
AYE. AGAR CURRIE. AGAR. CURRY.
AYE. ARAMBULA. ARAMBULA AYE.
WENDY. CARILLO. WENDY. CARILLO.
AYE. FLORA LARA. AYE. HANEY.
HANEY. AYE. JOHN. SAWYER OAN.
SAWYER. AYE. MAIENSCHEIN.
MAIENSCHEIN. AYE. MCCARTY
MCCARTY. AYE. PATTERSON. JOE.
PATTERSON. AYE. RODRIGUEZ
RODRIGUEZ. AYE. SANCHEZ.
SANCHEZ. AYE. SANTIAGO SANTIAGO.
AYE. CHAU. VÚI WEBER. WEBER.
AYE. 16 ZERO. THAT MEASURES OUT
16 TO 0. ITEM 29 AB 3059 FOR ADD
ONS. MAIENSCHEIN MAIENSCHEIN.
AYE. MCCARTY MCCARTY. AYE. JOE
PATTERSON, THIS IS WEBER. YEA
PHÐ. PATTERSON. AYE. SABO SABO.
AYE. 16 ZERO MEASURES NOW OUT 16
ZERO 30 ON CONSENT 31 AB 3245
JOE PATTERSON AN DO PASS AS
AMENDED. AND I NEED A MOTION AND
A SECOND MOVED BY SANTIAGO,
SECONDED BY FLORA. PLEASE CALL
THE ROLL ONTO. AYE. ONTO. AYE
WALDRON. WALDRON. AYE. AGAR.
CURRIE. AGAR. CURRIE AYE.
ARAMBULA ARAMBULA. AYE. WENDY.
CARILLO WENDY. CARRILLO. AYE.
FLORA. LARA. AYE. HANEY HANEY.
AYE. JOHN. SAWYER. JOHN. SAWYER.
AYE. MAIENSCHEIN MAIENSCHEIN.
AYE. MCCARTY. MCCARTY. IJO.
PATTERSON C . PATTERSON. AYE.
RODRIGUEZ. RODRIGUEZ. AYE.
SANCHEZ SANCHEZ. AYE. SANTIAGO.
PONTI AYE. WEBER WEBER. AYE. 16
ZERO. THAT MEASURES OUT 16 ZERO.
AND THAT, MY DEAR COMMITTEE
MEMBERS, IS ADJOURNMENT