GOOD AFTERNOON. WE'LL CALL TO
ORDER THE ASSEMBLY HEALTH
COMMITTEE HEARING FOR TUESDAY,
JUNE 25TH. BEFORE WE BEGIN, I
WOULD LIKE TO MAKE A STATEMENT
ON PROVIDING TESTIMONY AT THIS
HEARING, ALL WITNESSES WILL BE
TESTIFYING IN PERSON. WE ALLOW
TWO MAIN WITNESSES FOR A MAXIMUM
OF TWO MINUTES EACH.
ADDITIONALLY, TESTIMONY WILL,
TESTIMONY WILL BE LIMITED TO
NAME, POSITION, AND
ORGANIZATION. IF YOU REPRESENT
ONE. FOR TODAY'S HEARING, ONLY
ASSEMBLY MEMBERS WOOD AND
JACKSON WILL SUBSTITUTE FOR
ASSEMBLY MEMBERS JOAN SAWYER AND
MAIENSCHEIN, RESPECTIVELY,
REMOVED FROM THE AGENDA. WE HAVE
SB 1033 BY MENGIBAR AND SB 1339
BY ALAN, WHO HAVE REMOVED THIS
ITEM AT THE AUTHOR'S REQUEST ON
CONSENT PROPOSED FOR CONSENT
TODAY. ANY OF THE MEMBERS OF THE
COMMITTEE MAY REMOVE A BILL FROM
CONSENT, BUT ON CONSENT WE HAVE.
ITEM ONE AGER 16 LO TO THIRD
READING. ITEM TWO H.R 105 DIXON
TO THIRD READING. ITEM THREE
H.R. 107. WALDRON TO THIRD
READING. ITEM FIVE SB 945.
ALVARADO GIL TO NATURAL
RESOURCES. ITEM TEN SB 1099
NGUYEN TO APPROPRIATIONS. ITEM
12 SB 1258 DALI TO
APPROPRIATIONS. ITEM 13 SB 1290
ROTH TO APPROPRIATIONS. ITEM 18
SB 1511 HEALTH WITH AMENDMENTS
TO APPROPRIATIONS. WITH THAT, WE
WILL BEGIN AS A SUBCOMMITTEE AS
SOON AS WE HAVE AN AUTHOR TO
PRESENT.
UP. FIRST WE HAVE ITEM SIX. SB
954 BY MENGIBAR.
WIENER. MERRILEES THANK YOU,
SENATOR. MADAM CHAIR, HEALTH
COMMITTEE MEMBERS. I'M BACK
AGAIN WITH A BILL THAT THIS
COMMITTEE SAW LAST YEAR. AND WE
JUST GOT A BIG, HUGE WIN IN
INCLUDING THE BUDGET. SO I DON'T
THINK IT WILL GET VETOED THIS
TIME. SO SB 954, AND I'D LIKE TO
JUST FOCUS ON THE HEALTH PURVIEW
OF THIS OF THE BILL. IT GOT OUT
OF EDUCATION, AND THAT'S FOR THE
EXTERNAL INTERNAL CONDOMS TO BE
DISTRIBUTED IN SCHOOL, BUT UNDER
THE HEALTH PURVIEW. WHAT WE WANT
TO DO IS MAKE SURE, SINCE
CURRENT LAW RIGHT NOW DOES NOT
REQUIRE ONE TO PROVIDE
IDENTIFICATION FOR PURCHASING
CONTRACEPTION OVER THE COUNTER,
NON-PRESCRIPTION CONTRACEPTION,
WE WANT TO MAKE THAT EXPLICIT,
BECAUSE WHAT WE'RE SEEING IS,
CASHIERS, PHARMACISTS. SO FORTH
ARE ASKING FOR AN ID, EVEN
THOUGH IT'S NOT STATE LAW. WE
WANT TO PUT IT IN STATUTE THAT
YOU DO NOT NEED TO PRESENT AN ID
TO PURCHASE NON-PRESCRIPTIVE
CONTRACEPTION OVER THE COUNTER.
THIS IS AT A RESPONSE FOR WHAT
WE'RE SEEING IN THE INCREASE OF
STIS ACROSS CALIFORNIA, WHERE
ABOUT 50% OF OUR NEW STIS ARE OF
THOSE BETWEEN THE AGES OF 15
AND, 25 YEARS OLD, ENCOMPASSING
A MAJORITY OF THE YOUTH. AND
WHAT THE STORIES ARE TELLING US
THAT THEY'RE BEING TURNED AWAY
AND IT'S NOT DETERRING THEM FROM
PARTICIPATING IN SEXUAL
INTERCOURSE. IT'S IN FACT
ACTUALLY HAVING THEM PARTICIPATE
WITHOUT BEING PROTECTED. AND WE
JUST WANT TO MAKE SURE ONCE THEY
MAKE THAT PERSONAL DECISION THAT
THEY ARE SAFE WITH ALL THE
RESOURCES AND TOOLS AVAILABLE AT
THEIR DISPOSAL. WITH THAT, I'M
SURE I'D LIKE TO TURN OVER TO MY
WITNESS FOR TESTIMONY. THANK
YOU. YOU'LL HAVE TWO MINUTES.
THANK YOU. CHAIR MEMBERS, THANK
YOU FOR YOUR TIME TODAY. I'M
KATHY MOSSBERG, AND I'M HERE
TODAY REPRESENTING ESSENTIAL
ACCESS HEALTH, ONE OF THE
CO-SPONSORS OF THIS MEASURE.
ESSENTIAL ACCESS HEALTH, WORKS
TO CHAMPION AND PROMOTE QUALITY
SEXUAL AND REPRODUCTIVE HEALTH
CARE FOR ALL. I WANT TO
RECOGNIZE AND THANK SENATOR
MENGIBAR FOR HER LEADERSHIP ON
THIS ISSUE. SB 954, SIMPLY
STATED, HELPS TEENAGERS OBTAIN
CONDOMS WITHOUT THE FEAR OF
HARASSMENT OR SOCIAL STIGMA. FOR
TEENS WHO ARE SEXUALLY ACTIVE,
CONDOMS HELP PROTECT THEM FROM
BOTH PREGNANCY AND STIS. WE KNOW
THIS COMMITTEE IS WELL AWARE OF
THE HIGH INCIDENCES OF STIS
AMONG OUR YOUTH. OVER HALF OF
STIS IN CALIFORNIA ARE AMONG
PEOPLE BETWEEN THE AGES OF 15
AND 24. WE ALL KNOW CONDOMS WORK
TO REDUCE UNWANTED OUTCOMES, BUT
THE REAL PROBLEM LIES IN THE
FACT THAT WE KNOW THAT CONDOM
USE AMONG SEXUALLY ACTIVE TEENS
HAS DECLINED OVER THE LAST
DECADE. TEENS HAVE LONG REPORTED
FACING MULTIPLE BARRIERS TO
ACCESSING CONDOMS. OUR YOUTH
PARTNERS ON THIS BILL HAVE
STRESSED HOW MANY YOUNG PEOPLE
TODAY ACTUALLY CAN BE
DISCOURAGED FROM OBTAINING
CONDOMS VERY QUICKLY. I'D LIKE
TO SHARE ONE OF THE SOME
INFORMATION FROM ONE OF OUR
STUDENT LEADERS FROM THE YES FOR
CONDOMS CAMPAIGN, MARTIN URREA,
WHO COULD NOT BE HERE TODAY. HE
HAS, HE HAS. AND WHAT HE HAS
SAID ABOUT THIS PROBLEM, MARTIN
STATES, AS A HIGH SCHOOL SENIOR,
I CAN'T STRESS ENOUGH HOW
CRUCIAL ACCESS TO CONDOMS IS FOR
OUR WELL-BEING. I'VE WITNESSED
FRIENDS FACE UNNECESSARY
HURDLES, LIKE BEING ASKED FOR ID
WHEN PURCHASING CONDOMS, OR NOT
BEING ABLE TO SPEAK WITH PARENTS
ABOUT SEX AND CONTRACEPTION DUE
TO STIGMA. ONE FRIEND CONFIDED
IN HIM ABOUT A TRAUMATIC
EXPERIENCE THEY HAD WITH A
PREGNANCY SCARE BECAUSE THEY
DIDN'T HAVE ACCESS TO CONDOMS,
EASILY ACCESSIBLE TO THEM. THIS
IS A SIMPLE, STRAIGHTFORWARD
BILL THAT WILL HELP OUR TEENS.
FOR THESE REASONS, AND ON BEHALF
OF THE STUDENT LEADERS, WE
PARTNER WITH AND OUR
CO-SPONSORS, GENERATION UP UNITE
FOR REPRODUCTIVE AND GENDER
EQUALITY, CALIFORNIA BLACK WOMEN
FOR WELLNESS ACTION PROJECT, AND
THE CALIFORNIA SCHOOL BASED
HEALTH ALLIANCE. WE RESPECTFULLY
ASK FOR YOUR AYE VOTE. THANK YOU
FOR YOUR TIME TODAY. THANK YOU.
ARE THERE ANY OTHER WITNESSES IN
SUPPORT? PLEASE COME FORWARD.
ISABELLA AGUERO WITH THE HEALTH
OFFICERS ASSOCIATION OF
CALIFORNIA IN SUPPORT. ABIGAIL
ALVAREZ WITH THE SAN FRANCISCO
AIDS FOUNDATION AND APLA HEALTH
IN SUPPORT. NORA LYNN WITH
CHILDREN NOW IN SUPPORT. MARTIN
RADOSEVICH ON BEHALF OF
REPRODUCTIVE FREEDOM FOR ALL.
CALIFORNIA IN SUPPORT. GREG
PULSIFER ON BEHALF OF EQUALITY
CALIFORNIA IN SUPPORT. TAYLOR
JACKSON WITH THE CALIFORNIA
PRIMARY CARE ASSOCIATION IN
SUPPORT. RACHEL BHAGWAT, ACLU
CALIFORNIA ACTION AND SUPPORT.
MADAM CHAIR AND MEMBERS. RAND
MARTIN, ON BEHALF OF THE AIDS
HEALTHCARE FOUNDATION, IN
SUPPORT CLINT HOPKINS, OWNER OF
PUCCI'S PHARMACY IN SACRAMENTO,
IN SUPPORT LETIZIA REYES ON
BEHALF OF CALIFORNIA LATINAS FOR
REPRODUCTIVE JUSTICE AND SUPPORT
. THANK YOU. ARE THERE ANY
PRIMARY WITNESSES IN OPPOSITION?
THANK YOU. YOU'LL HAVE TWO
MINUTES. PLEASE PUT ON YOUR
MICROPHONE. OH CAN YOU HEAR ME?
THERE WE GO, CHAIR MEMBERS. MY
NAME IS GREG BURT WITH THE
CALIFORNIA FAMILY COUNCIL, OVER
THE PAST DECADE, THIS
LEGISLATIVE BODY HAS CHAMPIONED
THE DISTRIBUTION OF CONDOMS AND
COMPREHENSIVE, COMPREHENSIVE SEX
EDUCATION AS A PANACEA FOR OUR
YOUTH. ESCALATING SEXUALLY
TRANSMITTED INFECTION RATES. YET
AS THESE RATES HAVE SOARED, SO
HAS YOUR RELIANCE ON THESE
MEASURES ACCUMULATING IN THE
HEALTHY YOUTH ACT PASSED IN
2015? THIS LAW WAS SUPPOSED TO
PROTECT KIDS FROM STIS AND SLOW
INFECTION RATES. NOW ASK
YOURSELF, DID IT WORK? DID STI
RATES GO DOWN OVER THE LAST
DECADE? NO, THE EXACT OPPOSITE
HAPPENED. STI RATES HAVE NOW
REACHED EPIDEMIC PROPORTIONS,
WITH SYPHILIS AND GONORRHEA
RATES SKYROCKETING OVER THE LAST
DECADE OR SO. SO THE QUESTION IS
WHY DOES THE AUTHOR GET HER
CONFIDENCE THAT FREE CONDOMS ARE
THE ANSWER? DOES THIS BILL
REQUIRE WARNING LABELS ON THE
CONDOM DISPENSERS, TELLING TEENS
THAT LATEX WILL NOT PROTECT THEM
FROM THE SYPHILIS EPIDEMIC?
CONDOMS WILL ALSO NOT PROTECT
TEENS FROM HERPES, GENITAL
WARTS, MONKEYPOX BECAUSE THESE
STIS ARE SPREAD BY SKIN TO SKIN
CONTACT, HANDING OUT FREE
CONDOMS GIVES TEENS A FALSE
SENSE OF SECURITY AND TELLS
YOUTH THAT CONDOMS WILL PROTECT
THEM FROM DISEASES LIKE
SYPHILIS. WHEN THE SCIENCE SAYS
THE OPPOSITE. ULTIMATELY, YOU
HAVE TO CONVINCE YOU TO STOP
HAVING SEX WITH MULTIPLE
PARTNERS. IF YOU WANT TO STOP
THE SPREAD OF STIS. THIS BILL
PROMOTES A HOOK UP CULTURE WHERE
YOUTH HAVE MEANINGLESS,
MEANINGLESS SEX FOR FUN WITH
MULTIPLE PARTNERS. HOW MANY
YOUNG PEOPLE ARE YOU WILLING TO
SACRIFICE? WHAT? WHAT STI RATES
ARE YOU WILLING TO TOLERATE
BEFORE YOU'RE WILLING TO
CONSIDER A DIFFERENT OPTIONS?
FOR THIS REASON, PLEASE VOTE NO.
THANK YOU, THANK YOU. ARE THERE
ANY OTHER WITNESSES IN THE ROOM
IN OPPOSITION? SEEING NONE, I'LL
BRING IT BACK TO THE COMMITTEE
FOR ANY QUESTIONS OR COMMENTS.
DOCTOR WEBER. THANK YOU. CHAIR,
WELL, FIRST OFF, I WANT TO THANK
THE AUTHOR AND THE AND THE
SUPPORTERS FOR BRINGING THIS
BILL FORWARD. YOU KNOW, I THINK
WE DEFINITELY NEED MORE
EDUCATION, AND MORE ACCESS TO
CERTAIN THINGS LIKE CONDOMS
BECAUSE THEY CAN DECREASE STIS.
IT'S VERY EASY TO SAY THINGS
LIKE, YOU KNOW, HERPES OR
SYPHILIS, BUT YOU DON'T REALLY
KNOW EXACTLY WHERE THE LESION
IS. IT COULD BE COVERED BY THE
CONDOM. AND, AND THEREFORE IT
WOULD PROTECT SOMEONE FROM
GETTING SOMETHING LIKE THAT. SO
I THINK THIS IS A GREAT BILL, I
DO TAKE ONE ISSUE WITH THE PART
OF IT THAT HAS REALLY NOTHING TO
DO WITH YOUR BILL. IT'S REALLY
MORE OF A FEDERAL MANDATE, AND
THAT IS THE ABILITY FOR
NONPRESCRIPTION CONTRACEPTION,
NON-PRESCRIPTION CONTRACEPTION
INCLUDES CONDOMS, BUT IT ALSO
INCLUDES BIRTH CONTROL PILLS.
AND, ALTHOUGH I AM VERY MUCH IN
FAVOR OF PROVIDING CONTRACEPTION
TO PEOPLE WHO NEED IT AND WHO
ARE AT A STAGE IN THEIR
DEVELOPMENT, ONE OF MY CONCERNS
IS THAT WHEN YOU ALLOW FOR
ANYBODY TO GET IT, THEY MAY NOT
NECESSARILY BE A GOOD CANDIDATE
BASED ON THEIR MEDICAL HISTORY,
AND IT MAY NOT BE THE RIGHT TIME
FOR THEM. YOU KNOW, IT'S
INTERESTING. I WAS IN CLINIC ON
FRIDAY THIS PAST FRIDAY, I THINK
I HAD LIKE A 9 OR 10 YEAR OLD
PATIENT, AND SHE CAME IN WITH
SOME MENSTRUAL ISSUES. AND THE
NURSE THAT WAS WITH ME, THIS WAS
ONE OF HER FIRST TIMES THAT SHE
HAD BEEN WITH ME. SHE WAS LIKE,
DO YOU PRESCRIBE BIRTH CONTROL
PILLS TO ANYBODY AT ANY AGE? AND
I SAID, YES, AS LONG AS THEY
STARTED THEIR PERIOD. AND THIS
IS ONE OF THE FLAWS HERE WITH
THE FEDERAL ABILITY TO BE ABLE
TO GO IN AND GET A BIRTH CONTROL
PILL OVER THE COUNTER IS WE
DON'T EVEN KNOW IF THESE
INDIVIDUALS HAVE STARTED THEIR
CYCLE. THAT IS A KEY CRITICAL
POINT BEFORE ANYONE WHO DEALS
WITH TEENS PRESCRIBE SOMEONE A
BIRTH CONTROL PILL. BECAUSE WE
DO KNOW THAT IF YOU HAVE NOT
STARTED YOUR PERIOD, YOU SHOULD
NOT BE ON THIS KIND OF HORMONAL
THERAPY. AND I CALL IT HORMONAL
THERAPY AND NOT NECESSARILY THE
BIRTH CONTROL PILLS, BECAUSE
THERE ARE CERTAIN CONSEQUENCES.
AND ADDITIONALLY IT MASKS. SO
MANY OTHER THINGS. YOU HAVE NO
IDEA HOW MANY PATIENTS I HAVE
DIAGNOSED WITH EITHER,
ANATOMICAL ISSUES OR CHROMOSOMAL
ISSUES OR ENDOCRINE ISSUES WHO
COME TO ME AT 15, 16 YEARS OLD
BECAUSE THEY'VE NEVER STARTED
THEIR PERIOD. AND THAT IS HOW
WE'RE ABLE TO REALLY DIG DEEP
AND FIND THINGS. AND SO IF
YOU'RE GIVING SOMEONE HORMONAL
THERAPY PRIOR TO THEM EVEN
STARTING THEIR MENSES, AND IF
YOU CAN GET IT OVER THE COUNTER,
NOBODY'S ASKING BASIC THINGS.
SO, YOU KNOW, THIS IS A GOOD
BILL. MY ISSUE WITH IT IS NOT
THE BILL. IT'S JUST THE FACT
THAT ON A FEDERAL LEVEL, THEY
HAVE ALLOWED THIS WITHOUT ANY
KIND OF PROTECTIONS TO ENSURE
THAT INDIVIDUALS WHO WILL BE
GETTING, THESE BIRTH CONTROL
PILLS OVER THE COUNTER ARE
ACTUALLY READY AND ARE MEDICAL
CANDIDATES. THAT BEING SAID, I
WILL SUPPORT IT BECAUSE I THINK
PROVIDING MORE EDUCATION AND
MORE ABILITY FOR PEOPLE TO GET
THINGS LIKE CONDOMS AND BIRTH
CONTROL, IF THEY HAVE STARTED
THEIR CYCLE IS A GOOD IDEA. BUT
I DO THINK THAT THE FEDERAL
GOVERNMENT NEEDS TO FIX THIS
BECAUSE WE COULD POTENTIALLY BE
DOING MORE HARM THAN GOOD
WITHOUT BY NOT REQUIRING BASIC
QUESTIONS. THANK YOU. AND JUST
TO CLARIFY, THIS BILL IS
EXCLUSIVELY AROUND CONDOM BE
BECAUSE IT'S A NON PRESCRIPTIVE
CONTRACEPTIONS. THE CONDOM PIECE
IS ONLY FOR THE SCHOOLS ON THE
RETAILERS. THE LANGUAGE IS NOT
PRESCRIPTIVE. CONTRACEPTION SO
THERE ARE OTHER ITEMS THAT ARE
INCLUDED IN THERE CURRENTLY IN
THE STATE. AND FEDERAL
GOVERNMENT THERE ARE NO
RESTRICTIONS TO AGES. SO WE'RE
NOT CHANGING ANYTHING. WE'RE
JUST MATCHING THE LAW. AND I
THINK THE ASSEMBLYMEMBERS JUST
DOESN'T LIKE THE FEDERAL LAW. SO
I CAN'T SPEAK ON THAT. BUT WE DO
HAVE LANGUAGE IN THE BILL THAT
SAYS, SHOULD THE FEDERAL
GOVERNMENT CHANGE THE AGE
RESTRICTION, THAT THAT WOULD
SUPERSEDE MY BILL, MY BILLS, AND
IT WOULD ALIGN IT AND MATCH IT
SHOULD IT EVER BRING DOWN
RESTRICTIONS ON AGE, ON AGES?
THANK YOU, MR. PATTERSON. GREAT.
THANK YOU. FOR THE LAST COUPLE
OF YEARS, I'VE BEEN HERE FOR
NOW, 18 MONTHS, VERY LONG, 18
MONTHS. I USE A JOKE THAT I HAD
A FULL SET OF HAIR WHEN I
STARTED THIS JOB, I'VE BROUGHT A
BILL TO THIS COMMITTEE, AND, AND
IT'S GOTTEN OUT OF THIS
COMMITTEE, AND IT'S GOTTEN,
BEYOND THIS, MADE LESS PROGRESS
THIS YEAR THAN LAST YEAR,
UNFORTUNATELY. BUT I'M TRYING TO
I THINK THE BIGGEST CHALLENGE
FACING OUR CHILDREN RIGHT NOW
ARE THE BIGGEST THREAT,
ESPECIALLY PEOPLE IN THE 9 TO
12, AGE RANGE. THESE DAYS IS,
POTENTIAL FENTANYL POISONING.
AND WHEN I LOOK AT LIMITED
SCHOOL RESOURCES AND THE THINGS
THAT THEY WOULD HAVE TO PAY,
EVEN WITH AN APPROPRIATION, YOU
KNOW, MY PREFERENCE WOULD BE TO
SEE NALOXONE IN EVERY SCHOOL,
FOR THOSE POISONINGS, NOT ONLY
FOR THE STUDENTS, BUT FOR THE
STAFF, AS WELL, AND IT DID ENJOY
BROAD BASED SUPPORT, BUT IT'S
HARD FOR ME TO I MEAN, I HAVE
OTHER CONCERNS WITH THIS BILL,
BUT I JUST THINK, AND, YOU KNOW,
MY PERSONAL OPINION OF IF WE'RE
GOING TO HAVE LIMITED FUNDS, I'D
RATHER SEE THAT IN SCHOOL
PERSONALLY, THAN, DISTRIBUTION
OF CONDOMS. SO, JUST MY $0.02 ON
THAT. SO THANK YOU. THE
BEAUTIFUL THING ABOUT THE 120
LEGISLATORS HERE IS THAT WE ALL
BRING IN UNIQUE PERSPECTIVES,
AND WE GET TO WORK AT AN ARRAY
OF THINGS. IF 120 LEGISLATORS
ONLY WORKED ON ONE THING, WE
WOULDN'T GET A LOT OF STUFF
DONE. AND I COMMEND YOU,
ASSEMBLY MEMBER, FOR FOCUSING ON
FENTANYL. I THINK THAT'S A HUGE
CRISIS. I HAVE MORE OF A HEALTH
BACKGROUND, NOT NOWHERE NEAR THE
GOOD DOCTOR HERE, THE TIP OF THE
ICEBERG, AND MY FOCUS IS A LOT
ON HEALTH. AND I'M PROUD AT
LEAST TO SAY WE'VE ALLOCATED. I
THINK, $30 MILLION TO DISTRIBUTE
NALOXONE TO DIFFERENT
COMMUNITIES. THAT IS ABOUT TO BE
VOTED ON THIS WEEK. I HOPE YOU
CAN VOTE ON THAT BECAUSE THAT'S
A WAY MORE THAT'S A LOT OF MONEY
THAT'S GOING TO COME DOWN TO
DIFFERENT CBOS THAT ARE WILL BE
ABLE TO DISTRIBUTE. AND I'M
PROUD, AT LEAST FOR MY SCHOOL.
LAUSD JUST VOTED, TO BE ONE OF
THE FIRST SCHOOL DISTRICTS TO
ALLOW, NARCAN TO BE ADMINISTERED
BY PEERS OR TO BE ON SCHOOL
CAMPUSES. AND I THINK WE COULD
BOTH, ELEVATE THOSE ISSUES AS
WELL AS THESE SIMULTANEOUSLY,
SEEING NO OTHER QUESTIONS OR
COMMENTS FROM COMMITTEE. DO YOU
WANT TO USE THAT AS YOUR CLOSING
? YES. AND RESPECTFULLY ASK FOR
AN AYE VOTE. THANK YOU. AND WHEN
WE HAVE A QUORUM, WE WILL
CONSIDER THE MOTION. THANK YOU.
THANK YOU.
WE ARE MOVING TO AFTER A VERY
HEATED RACE, TO ITEM NUMBER 11,
SB 1238, BY EGGMAN. SPEAKS,
OKAY, HERE WE GO, GOOD AFTERNOON
EVERYBODY. TODAY I AM
PRESENTING, SB 1238, AND I
WANTED TO THANK THE COMMITTEE
AND THE STAFF FOR THE
AMENDMENTS. THIS IS AND I WILL
SAY THIS IS MY LAST MENTAL
HEALTH BILL THAT I WILL PRESENT
IN ANYBODY'S COMMITTEE, AND SO,
I HOPE, I HOPE IT GOES SMOOTH.
THAT WAS A LITTLE CATHOLIC GUILT
UP FRONT. SO, SB 1238, IT WILL
BE AMENDED TO ALLOW, PSYCHIATRIC
UNITS AND MENTAL HEALTH
REHABILITATION CENTERS TO TREAT
STANDALONE, SEVERE SUBSTANCE USE
DISORDERS IN ADDITION TO MENTAL
HEALTH DISORDERS AND
CO-OCCURRING, IT ALLOWS THE
DEPARTMENT OF HEALTH CARE
SERVICES, THE FLEXIBILITY TO
AUTHORIZE ADDITIONAL TYPES AS
THEY COME ONLINE. SO, YOU KNOW,
WE'VE DONE A LOT OF WORK ON
MENTAL HEALTH. AND,
CONSERVATORSHIP AND CARE COURT
AND EVERYTHING WE'VE DONE AND
OUR OPTIONS FOR WHERE PEOPLE
WILL GO HAS NOT QUITE KEPT UP,
SO THIS THEN ALLOWS DESIGNATED
FACILITIES TO BE ABLE TO TAKE
PEOPLE ON A LOCKED HOLD IN
PLACES THAT WE DIDN'T, SECURE.
HOLD THAT WE DIDN'T NECESSARILY
THINK ABOUT BEFORE, AND THEN
ALSO ALLOW, THE FLEXIBILITY FOR
THE HEALTH DEPARTMENT TO
CONTINUE WITH NEW PROGRAMS, COME
ONLINE, NEW FACILITIES COME
ONLINE FOR THEM TO BE ABLE TO
SAY, OKAY, THIS ONE'S
APPROPRIATE FOR THIS LEVEL OF
CARE WITH ME TODAY. I HOPE IT
MAYBE NOT. IS RANDALL HAGAR WITH
THE PSYCHIATRIC PHYSICIANS
ALLIANCE OF CALIFORNIA? HERE HE
IS. IT'S LIKE MAGIC. THANK YOU.
YOU'LL HAVE TWO MINUTES. THANK
YOU. MADAM CHAIR, RANDALL HAGER
FOR THE PSYCHIATRIC PHYSICIANS
ALLIANCE OF CALIFORNIA. WE WERE
SPONSORS OF SB 43 LAST YEAR. AND
AFTER ITS ENACTMENT, ONE OF THE
FIRST THINGS THAT WE STARTED
HEARING WAS, WHAT ARE WE GOING
TO DO WITH THE FOLKS WHO ARE
GRAVELY DISABLED AND HAVE A
SEVERE SUBSTANCE USE DISORDER,
AND SO AS I STARTED TO TALK TO
MY FOLKS, A NUMBER OF WHOM ARE
MEDICAL DIRECTORS AT, DIFFERENT
KINDS OF PSYCHIATRIC FACILITIES,
I REALIZED THAT A LOT OF PEOPLE
WHO HAVE CO-OCCURRING ILLNESSES
THAT ARE SEVERE MENTAL ILLNESS
AND SUBSTANCE SUBSTANCE USE
DISORDERS ARE BEING TREATED IN
THOSE VERY SAME FACILITIES. SO
THERE IS A CLINICAL CAPACITY, IS
WHAT I LEARNED, AND MANY OF THE
FACILITIES OUT THERE IN THE
COMMUNITY THAT CAN PROVIDE
DELIVER, SUBSTANCE USE TREATMENT
SERVICES TO INDIVIDUALS. AND
WHAT WE DID FIND, EVEN FURTHER
WAS THAT A LOT OF THOSE
FACILITIES WERE PROHIBITED BY IN
REGULATION, BY, REGULATIONS.
THAT SAID, YOU CAN'T ADMIT
SOMEBODY IF THEY HAVE A SOLO
SUBSTANCE USE DISORDER. SO
LOOKING FOR A VERY QUICK WAY TO
TRY TO GET THE PROCESS KICK
STARTED, EVEN AS WE HAVE OTHER
KINDS OF FACILITIES, FOR
INSTANCE, FROM THE BISHOP
PROGRAM, THAT ARE, COMING ONLINE
EVEN AS WE SPEAK, WE THOUGHT
THAT AN INTERMEDIATE AND A, YOU
KNOW, SORT OF A, A, A MEASURE
THAT WOULD HELP US GET STARTED,
WOULD BE TO SEE, TO THE,
ACCREDITATION OF THOSE
FACILITIES, CHANGE THOSE
REGULATIONS, ALLOW THEM TO ADMIT
INDIVIDUALS THAT HAVE THE
SUBSTANCE USE DISORDER AND
GRIEVE DISABILITY AT THE SAME
TIME. SO THAT'S, YOU KNOW, KIND
OF THE BACK STORY ABOUT HOW WE
GOT HERE TODAY AND THE BILL AS
IT IS. I THINK DOES QUITE WELL
IN GETTING US DOWN THE ROAD A
LITTLE BIT. THERE THANK YOU. ARE
THERE ANY OTHER WITNESSES IN
SUPPORT PLEASE APPROACH THE
MICROPHONE. LEAH BARROWS, ON
BEHALF OF CALIFORNIA HOSPITAL
ASSOCIATION, IN SUPPORT. MADAM
CHAIR DYLAN ELLIOTT, ON BEHALF
OF THE CALIFORNIA STATE
ASSOCIATION OF PSYCHIATRISTS AND
MAYOR LONDON BREED, PLEASED TO
BE CO-SPONSORS AND IN STRONG
SUPPORT. THANK YOU, ARJUN
KRISHNA, ON BEHALF OF THE
CALIFORNIA MEDICAL ASSOCIATION,
WE ARE IN SUPPORT. JEFF NEAL
REPRESENTING SAN DIEGO COUNTY,
ALSO IN SUPPORT. JENNIFER
SNYDER, REPRESENTING THE
CALIFORNIA ASSOCIATION OF HEALTH
FACILITIES IN SUPPORT. THANK
YOU. ARE THERE ANY WITNESSES IN
OPPOSITION?
THANK YOU, MADAM CHAIR. AND
MEMBERS. MICHELLE CABRERA WITH
THE COUNTY BEHAVIORAL HEALTH
DIRECTORS ASSOCIATION OF
CALIFORNIA. AND, FIRST, I WANT
TO SAY WE WERE ON RECORD AS
OPPOSED TO THE ORIGINAL VERSION
OF THE BILL, THE TECHNICAL
ASSISTANCE AMENDMENTS PROPOSED
BY DHS. IF ADOPTED, WOULD VERY
LIKELY REMOVE OUR OPPOSITION.
HOWEVER, I WILL NOTE THAT THERE
ARE SEVERAL COMMENTS IN THE
ANALYSIS WHICH WE CERTAINLY
ALIGN WITH, WHICH ARE THAT THE
PROPOSED DHCS TECHNICAL
ASSISTANCE AMENDMENTS WOULD
LIMIT THE MODIFICATION TO THE
PSYCHIATRIC HEALTH FACILITIES
AND THE MENTAL HEALTH
REHABILITATION FACILITIES TO
SERVING ONLY THOSE INDIVIDUALS
WHO MEET THE SEVERE SUBSTANCE
USE DISORDER CRITERIA. THAT'S A
DIAGNOSTIC CRITERIA, AND WE
BELIEVE THAT THAT IS AN UNFAIR
RESTRICTION OR LIMITATION. IN
OTHER WORDS, WE WOULD LIKE TO
SEE ALL PSYCHIATRIC HEALTH
FACILITIES, ALL MENTAL HEALTH
REHABILITATION FACILITIES, BRING
THE FLOOR UP ON THEIR ABILITY TO
TREAT ALL SUBSTANCE USE
DISORDERS ACROSS THE BOARD,
CONSISTENT WITH THE MENTAL
HEALTH TREATMENT PROVIDED IN
THESE FACILITIES AND THOSE WE
WOULD LIKE TO CONTINUE TO WORK
WITH THE AUTHOR AND SPONSOR ON
MOVING FORWARD. THANK YOU. PRIOR
TO MOVING TO ADDITIONAL
OPPOSITION, I'M GOING TO MAKE
SURE THAT WE CAN ESTABLISH
QUORUM. SECRETARY, PLEASE CALL
THE ROLL BONTA HERE. BONTA
PRESENT. WALDRON. WALDRON.
PRESENT. AGUIAR-CURRY AGAR.
CURRY. PRESENT. ARAMBULA
ARAMBULA. PRESENT. WENDY.
CARILLO LARA. LARA PRESENT.
HANEY. WOULD WOULD PRESENT.
JACKSON MCCARTY. JOE PATTERSON.
JOE. PATTERSON. PRESENT.
RODRIGUEZ RODRIGUEZ. PRESENT.
SANCHEZ SANTIAGO. CHAVO CHAVO.
PRESENT WEBER. WEBER. PRESENT.
WE HAVE A QUORUM AT 231, ANY
OTHER WITNESSES IN OPPOSITION?
GOOD AFTERNOON, CHAIR AND
MEMBERS. BETH MALINOWSKI, THE
S¼, SEIU CALIFORNIA. WE'VE BEEN
OPPOSED UNLESS AMENDED POSITION.
APPRECIATE ALL THE INCREDIBLE
WORK THAT CONTINUES TO REFINE
THE BILL AND LOOK FORWARD TO
CONTINUING CONVERSATIONS WITH
THE MEMBER AND HER STAFF. THANK
YOU. ON BEHALF OF MENTAL HEALTH
AMERICA OF CALIFORNIA,
DISABILITY RIGHTS CALIFORNIA AND
CAL VOICES IN OPPOSITION. HELLO,
RACHEL BHAGWAT, ACLU CALIFORNIA
ACTION IN OPPOSITION. THANK YOU.
SEEING NO OTHER OPPOSITION, I
WILL BRING IT BACK TO THE
COMMITTEE FOR A COMMENT OR
QUESTION. MR. PATTERSON, JUST
READING THROUGH THE ANALYSIS,
DOES THIS, THIS GIVES COUNTIES
THE CONTROL TO CHOOSE THE
FACILITIES. THEY HAVE TO BE
FIRST APPROVED BY THE COUNTIES
AND THEN HEALTH CARE, THEN THE
STATE DESIGNATE. CORRECT. OKAY.
GREAT. THANK YOU. I KNOW THAT,
SENATOR, YOU'VE HAD MANY
CONVERSATIONS WITH COMMITTEE ON
THIS, AND I KNOW THAT WE KIND OF
HAVE ONE OUTSTANDING ISSUE THAT
WAS RAISED BY THE OPPOSITION IN
TERMS OF THE LIMITATION THAT
THIS BILL KIND OF STILL, EMPLOYS
FOR INDIVIDUALS WITH SUBSTANCE
USE DISORDERS AND LIMITING THAT
SERVICE FOR, FOR OTHERS, WOULD
YOU LIKE TO MAKE A COMMENT ON
THAT IN YOUR CLOTHES? WE'RE
HAPPY TO CONTINUE TO BE IN
CONVERSATION ON THOSE ISSUES. I
THINK WE ALWAYS NEED TO BE
CAREFUL NOT TO HAVE THE HIGHEST
COST OF CARE FOR EVERYBODY, I
THINK PEOPLE NEED TO BE AT THE
APPROPRIATE LEVEL OF CARE ALL
THE TIME, AND WE'RE WELL OPEN TO
THOSE CONVERSATIONS ABOUT WHERE
THAT MIGHT BE. THANK YOU. I JUST
WANT TO ACKNOWLEDGE, SENATOR, AS
YOU MENTIONED, NO CATHOLIC HERE
WANT TO JUST ACKNOWLEDGE THAT
THIS IS YOUR FINAL BILL IN
ASSEMBLY HEALTH COMMITTEE. AND I
WANT TO ACKNOWLEDGE YOUR
EXTENSIVE EFFORTS, PARTICULARLY
IN THE MENTAL HEALTH SPACE AND
OVERALL IN HEALTH, FOR THIS
LEGISLATURE. IT'S SOMETHING THAT
HAS WILL CERTAINLY LEAVE AN
INDELIBLE LEGACY. ON CALIFORNIA.
SO THANK YOU FOR YOUR WORK.
THANK YOU. WITH MOVED BY
RODRIGUEZ. SECONDED BY WALDRON,
WITH THAT, WE'LL CALL THE ROLL.
THE MOTION IS DO PASS, AS
AMENDED TO APPROPRIATIONS. BONTA
I BONTA I WALDRON WALDRON I AGAR
CURRY I BELIEVE THIS IS THE LAST
TIME WE WANT TO SAY AYE TO A
BILL FOR YOU. AGUIAR-CURRY. AYE
ARAMBULA. WENDY CARRILLO. LARA.
LARA. AYE. HANEY WOULD WOULD.
AYE JACKSON. MCCARTY. JOE
PATTERSON. JOE. PATTERSON. AYE.
RODRIGUEZ. RODRIGUEZ. AYE
SANCHEZ. SANTIAGO. SHABU SHABU.
AYE. WEBER. WEBER AYE. MEASURES
9 TO 0. THAT MEASURES OUT. THANK
YOU, SENATOR. MOVING ON TO ITEM
17 SB 1432. CABALLERO YES.
MATTHEW THANK YOU. SENATOR,
WHENEVER YOU'RE READY. THANK
YOU, MADAM CHAIR. AND MEMBERS,
I'D LIKE TO START OFF BY,
ACCEPTING THE COMMITTEE
AMENDMENTS. AND THANK YOU FOR
THE OPPORTUNITY TO PRESENT SB
1432, WHICH ESTABLISHES A VIABLE
, TRANSPARENT AND ACCOUNTABLE
PATHWAY FOR HEALTH FACILITIES TO
ACHIEVE SEISMIC COMPLIANCE. AS
MANY OF YOU ARE AWARE, HEALTH
CARE ACCESS FOR ALL IS IN
JEOPARDY GIVEN THE DISTRESSED
FINANCIAL AND OPERATIONAL
CONDITIONS OF CALIFORNIA
HOSPITALS, SOME OF WHICH ARE IN
YOUR DISTRICT. THE ALFRED E
ALQUIST HOSPITAL SEISMIC SAFETY
ACT REQUIRES THAT BY JANUARY
1ST, 2030, ALL HOSPITAL
BUILDINGS HAVE THE CAPACITY TO
PROVIDE PATIENT SERVICES
FOLLOWING AN EARTHQUAKE PURSUANT
TO CURRENT STATE LAW, HOSPITALS
THAT DO NOT COMPLY WITH THIS
2030 SEISMIC STANDARD WILL BE
REQUIRED TO CLOSE THEIR DOORS TO
PATIENT CARE BECAUSE THEY WILL
LOSE THEIR LICENSE TO OPERATE,
AND I WANT TO EMPHASIZE THAT
BECAUSE, I'VE HAD A HOSPITAL
CLOSE IN MY DISTRICT OVER THE
PAST YEAR AND A HALF, TWO YEARS,
AND THERE'S NOTHING MORE
DEVASTATING TO A COMMUNITY THAN
TO LOSE THE ONLY HOSPITAL IN THE
COUNTY, IT IS ON TRACK TO REOPEN
BY THE END OF THE YEAR. BUT WHAT
I CAN TELL YOU IS THERE THAT
MOST OF THE MEDICAL STAFF THAT
WORKED AT THAT HOSPITAL HAS LEFT
TO GO SOMEWHERE ELSE, AND TRYING
TO RECRUIT IN A DISADVANTAGED
RURAL COMMUNITY BECOMES VERY,
VERY DIFFICULT. AND SO, THE
REALLY THE NEXUS OF THIS BILL IS
THAT ONE SIZE DOESN'T FIT ALL.
AND, IF THE ULTIMATE PENALTY
THAT THE HOSPITALS FACE IS
CLOSURE BECAUSE THEY CAN'T
OPERATE, THEY DON'T HAVE A
LICENSE, THEN WE NEED TO DO
EVERYTHING WE CAN TO FIGURE OUT
WHAT ARE THE ELEMENTS WE NEED TO
DO TO MAKE SURE THAT HOSPITALS
CAN MEET THEIR SEISMIC SAFETY
REQUIREMENTS, CAN CONTINUE TO
OPERATE IN A PROFITABLE MANNER,
CAN CONTINUE TO MEET THE HIGH
DEMAND FOR MEDI-CAL SERVICES,
MEDI-CAL AND MEDICARE SERVICES
IN THE COMMUNITY. ACCORDING TO A
2019 RAND INSTITUTE STUDY, THE
ESTIMATED COST OF UPGRADES AND
CONSTRUCTION FOR ALL CALIFORNIA
HOSPITALS. TO COMPLY WITH THIS
2030 SEISMIC STANDARD RANGE FROM
2034 BILLION TO 140 BILLION,
DEPENDING ON COMPLIANCE APPROACH
. WHETHER RETROFITTING A
BUILDING OR CONSTRUCTING NEW
ONES, THE TIME FRAME AND THE
COST TO MEET THE 2030 STANDARDS
ARE A MAJOR CHALLENGE,
ESPECIALLY FOR FINANCIALLY
DISTRESSED HOSPITALS. THE RAND
STUDY SUGGESTS THE COST OF
UPGRADES WOULD PUT 40% OF
CALIFORNIA HOSPITALS IN SEVERE
FINANCIAL DISTRESS, IN IMMEDIATE
RISK OF BANKRUPTCY. COMMUNITY
AND PUBLIC HOSPITALS WOULD TAKE
THE MOST SIGNIFICANT HIT,
FURTHER HINDERING ACCESS TO CARE
FOR THE MANY MEDI-CAL AND
MEDICARE PATIENTS WHO DEPEND ON
THEM. HOSPITAL FINANCES WERE
SEVERELY IMPACTED DURING THE
COVID 19 PANDEMIC, CAUSING NEW
FINANCIAL AND OPERATIONAL
CHALLENGES, LEAVING MANY
HOSPITALS IN DISTRESS FROM FROM
2019 TO 2020. CALIFORNIA
HOSPITALS TOTAL NET INCOME
DECREASED BY $4.49 BILLION. AND
AS YOU KNOW, MANY HAD TO UTILIZE
THEIR RESERVES IN ORDER TO CARRY
THEM THROUGH, THE COVID PERIOD.
MORE THAN 50% OF CALIFORNIA
HOSPITALS LOSE MONEY EVERY DAY
TO CARE FOR PATIENTS.
FURTHERMORE, AS HOSPITALS
CONTINUE TO FACE SIGNIFICANT
COST PRESSURES, MANY ARE FORCED
TO REDUCE SERVICES TO KEEP THEIR
DOORS OPEN. HOSPITALS ARE
ESSENTIAL, ESSENTIAL, ESSENTIAL
TO OUR COMMUNITY'S HEALTH AND
WELL-BEING IN CALIFORNIA. MUST
ACT QUICKLY TO PREVENT FURTHER
LOSS WHILE STILL PUSHING THESE
FACILITIES TOWARDS COMPLIANCE.
THIS IS WHY SB 1432 IS A
CRITICAL COMPONENT TO IMPROVE
SEISMIC SEISMIC SAFETY IN OUR
LOCAL HOSPITALS BY ESTABLISHING
A FRAMEWORK THAT IS NOT A ONE
SIZE FITS ALL APPROACH, BUT
RECOGNIZES REGIONAL HEALTH CARE
CHALLENGES THAT ONE ENHANCE
TRANSPARENCY TO THE LOCAL
COMMUNITIES AND WORKERS TOO.
DEMANDS ACCOUNTABILITY WITH
MILESTONES AND COMMITMENTS, AND
THREE CREATES A VIABLE PATHWAY
FOR HOSPITALS TO MEET SEISMIC
COMPLIANCE STANDARDS. ACCORDING
TO EACH UNIQUE CIRCUMSTANCE AND
AT THE SAME TIME PROVIDE
CRITICAL HEALTH CARE TO OUR
COMMUNITIES. I GREATLY
APPRECIATE THE COLLABORATION
WITH THE ASSEMBLY CHAIR, BONTA,
SENATOR ROTH, THE SENATE AND THE
ASSEMBLY, HEALTH COMMITTEES, AND
MANY STAKEHOLDERS ON THIS MAJOR
EFFORT TO GET THE BILL RIGHT.
WE'VE HELD MEETINGS, EXTENSIVE
MEETINGS WITH ALL THE
STAKEHOLDERS. A NUMBER OF THEM,
TO GET THEIR FEEDBACK AND INPUT.
AND, AND THAT HAS BEEN
CRITICALLY IMPORTANT. THE BILL
REFLECTS A LOT OF THE COMMENTS
AND THE CONCERNS THAT WERE
RAISED. I ALSO APPRECIATE THE
GREAT WORK OF HCI TO PROVIDE
TECHNICAL ASSISTANCE.
AMENDMENTS. MANY OF WHICH WOULD
HAVE BEEN ACCEPTED AND ARE IN
PRINT TODAY. THIS REFLECTS OUR
COMMITMENT TO FINDING A VIABLE,
WORKABLE SOLUTION. ALL OF US
HAVE A SHARED INTEREST IN
KEEPING HOSPITALS ON THE PATH TO
COMPLIANCE, TO KEEP OUR
HOSPITALS OPEN, FUNCTIONING IN
AN EMERGENCY, AND TO KEEP OUR
WORKERS AND PATIENTS SAFE. THE
COST OF DOING NOTHING IS
HOSPITAL CLOSURES AND LACK OF
HEALTH CARE ACCESS IN
COMMUNITIES ACROSS THE STATE,
WHICH CALIFORNIA SIMPLY CANNOT
AFFORD. SB 1432 IS A SOLUTION
THAT ALLOWS HOSPITAL TO SEE A
VIABLE PATHWAY TO COMPLIANCE
WITH CRITICAL TRANSPARENCY AND
ACCOUNTABILITY MEASURES THAT
ENSURE THE INTENT OF THE SEISMIC
SAFETY ACT IS MET. ONE OF THE
THINGS THAT I LEARNED AS BECAUSE
I HAD ONE HOSPITAL THAT CLOSED
AND TWO ONE OF WHICH CLOSED AND,
AND ALSO THE HOSPITAL IN
HOLLISTER THAT FILED FOR
BANKRUPTCY IS THAT THERE WAS NO
NOTICE TO THE COMMUNITY, AND
THAT INCLUDED THE LOCAL CITY
COUNCIL MEMBERS AS WELL AS THE
ELECTED OFFICIALS, MYSELF AND
THE ASSEMBLY MEMBERS THAT
REPRESENT BOTH OF THOSE
HOSPITALS. WE HAD NO CLUE THAT
THE HOSPITAL HOSPITAL WAS IN
DISTRESS. AND THAT'S PART OF
WHAT IS EMBODIED IN THIS
TRANSPARENCY MEASURE, I NOTED
THAT THE OPPONENTS HAVE SOME
OTHER COMMENTS IN REGARDS TO
THINGS THAT WOULD BE HELPFUL IN
THE BILL, AND I AGREE WITH THOSE
THINGS. WE'VE I'VE NEVER
RECEIVED ANY LANGUAGE FROM THE
OPPONENTS. SPECIFIC TO HOW WE
CAN MAKE THE BILL BETTER OTHER
THAN THROUGH OUR MEETINGS. AND
SO I WILL CONTINUE TO PROVIDE
OPPORTUNITIES TO AMEND THE BILL
AND TO BRING IT BACK TO THE
COMMITTEE FOR THE CHAIR AND THE
COMMITTEE. CONSULTANT TO LOOK
AT. WE WANT THIS TO WORK AND THE
WHOLE IDEA IS TO FOR THOSE THAT
HAVE FAILED TO MEET THEIR
REQUIREMENTS AND HAVE THE MONEY,
RESOURCES TO DO SO, THEY'RE
GOING TO HAVE TO, GET THROUGH H
K THROUGH THAT PROCESS AND
EXPLAINED WHY THEY'RE NOT ON THE
PATH TO DOING THE RIGHT THING
FOR THOSE THAT DON'T HAVE THE
RESOURCES, THE LEGISLATURE MAY
NEED TO PUT UP MONEY, EITHER
THROUGH BONDS OR GENERAL FUND,
TO ENSURE THAT THEY HAVE THE
RESOURCES THROUGH LOW INTEREST
LOANS AND THOSE KINDS OF THINGS,
IN ORDER TO BE ABLE TO MEET THE
COMPLIANCE. THAT'S FOR THE
FUTURE. THAT'S NOT IN THE BILL
TODAY. BUT, IF THERE'S ONE THING
THAT I'VE LEARNED IN TERMS OF
SEISMIC COMPLIANCE IS THAT ONE
SIZE REALLY DOESN'T FIT ALL. AND
SOMETIMES THERE ARE RESOURCES
THAT NEED TO BE AVAILABLE IN
ORDER FOR THE, THE ENTITIES THAT
JUST DON'T HAVE THE RESOURCES TO
DO IT, TO GET TO GET IT DONE.
AND, AND, AND EVERYBODY WILL
KNOW BECAUSE THERE'S
TRANSPARENCY IN, IN THE BILL
THAT REQUIRES IT. SO, WITH ME
HERE TODAY, I'M VERY PLEASED TO,
HAVE KELLY ASH WITH DIGNITY
HOSPITAL AND TIM JACOBY WITH
SCRIPPS HEALTH. CATHERINE AUSTIN
SCOTT WITH THE CALIFORNIA
HOSPITAL ASSOCIATION. I'M GOING
TO DEFER OUR TESTIMONY TO OUR
TWO HOSPITALS. BUT HERE FOR
QUESTIONS AND ANY CONCERNS.
THANKS. YOU'LL EACH HAVE TWO
MINUTES. HONORABLE CHAIR,
MEMBERS OF THE HEALTH COMMITTEE.
MY NAME IS TIM JACOBY, AND I'M
THE CORPORATE VICE PRESIDENT OF
CONSTRUCTION FACILITIES FOR
SCRIPPS HEALTH. AND I'M
RESPONSIBLE FOR THE DESIGN AND
CONSTRUCTION AT OUR FIVE
HOSPITAL CAMPUSES IN SAN DIEGO,
INCLUDING ALL SEISMIC COMPLIANCE
WORK. WE TAKE THE STATE SEISMIC
MANDATE VERY SERIOUSLY. TO DATE,
WE HAVE SPENT OVER $1.7 BILLION
ON SEISMIC COMPLIANCE. OUR
HOSPITALS ARE SAFE AND MEET THE
CURRENT REQUIREMENTS SO THEY
WILL NOT COLLAPSE IN AN
EARTHQUAKE. WE ESTIMATE IN
TODAY'S DOLLARS WE STILL HAVE $3
BILLION OF WORK LEFT TO DO TO
MEET THE SEISMIC, REQUIREMENTS.
LIKE ALL HOSPITALS, WE LOST OVER
THREE YEARS DURING THE PANDEMIC.
WE ARE JUST NOW RECOVERING FROM
THE FINANCIAL HARDSHIPS.
ADDITIONALLY, OUR HOSPITAL, LIKE
MANY OTHERS, HAVE UNIQUE AND IN
MANY CASES INSURMOUNTABLE
CHALLENGES. MEETING THE CURRENT
2030 SEISMIC OPERATIONAL MANDATE
. FOR EXAMPLE, THE FINAL
BUILDING REQUIRING CONSTRUCTION
AT OUR ENCINITAS HOSPITAL CAMPUS
HAS BEEN CHALLENGED WITH LOCAL
LAND USE DELAYS, COMPLEXITIES TO
AVOID PATIENT DISRUPTIONS AND
COMPLICATIONS THROUGHOUT THE
CONSTRUCTION PROCESS. IT TOOK
TEN YEARS TO GET THE MASTER PLAN
AND BUILDING PERMIT APPROVALS
WITH THE CITY. WE ARE NOW UNDER
CONSTRUCTION. WE WILL NOT SLOW
OUR WORK, BUT ONE DELAY WILL
PREVENT US FROM MEETING THE 2030
DEADLINE. AS IT IS, WE WILL NOT
BE COMPLETED UNTIL THE END OF
2029. THE COMPLEXITY OF THESE
PROJECTS CANNOT BE OVERSTATED.
OF OUR FIVE HOSPITALS, WE FACE
THE TOUGHEST CHALLENGE THAT
MERCY, SCRIPPS MERCY, A LARGE,
DISPROPORTIONATE,
DISPROPORTIONATE SHARE OF
HOSPITAL IN THE HEART OF
DOWNTOWN SAN DIEGO. THE HOSPITAL
SAW 12,800 HOMELESS PATIENTS
LAST YEAR, A STAGGERING NUMBER.
MERCY IS A TEACHING HOSPITAL AND
IS ALSO A LEVEL ONE TRAUMA
CENTER. MERCY IS LANDLOCKED AND
WHILE IT IS SAFE, IT CANNOT BE
RETROFITTED TO MEET THE 2030
MANDATE. IT MUST BE REBUILT. THE
HOSPITAL CONSTRUCTION PROCESS IS
BOTH COMPLICATED AND EXPENSIVE.
WE SUBMITTED PLANS FOR THE CITY
APPROVAL SIX YEARS AGO, AND WE
JUST RECEIVED. PLEASE FINISH
YOUR THOUGHT AND WE JUST
RECEIVED OUR CONDITIONAL USE
PERMIT A FEW MONTHS AGO, AND
PLANS HAVE BEEN SUBMITTED TO
OSHPD. THANK YOU. THANK YOU. GO
AHEAD. GOOD AFTERNOON MEMBERS.
THANK YOU FOR THE TIME. I'M
KELLY ASH, I'M THE CALIFORNIA
VICE PRESIDENT OF PUBLIC POLICY
FOR DIGNITY HEALTH, AND I'M HERE
REPRESENTING OUR 31 HOSPITALS
STATEWIDE AS THE LARGEST
MEDI-CAL PROVIDER OF SERVICES IN
CALIFORNIA, DIGNITY HEALTH
CONSIDERS OURSELVES A LONG TERM
PARTNER WITH THE STATE OF
CALIFORNIA, ENSURING ACCESS FOR
MEDI-CAL BENEFICIARIES, JUST
LAST YEAR ALONE, WE PROVIDED
OVER 600,000 INPATIENT DAYS AND
1.2 MILLION OUTPATIENT VISITS
ANNUALLY. AFTER ALL,
SUPPLEMENTAL PAYMENTS, INCLUDING
THE PROVIDER FEE, WE LOSE ABOUT
HALF $1 BILLION A YEAR, AT COST.
SERVING THESE MEDI-CAL PATIENTS.
EVEN WITH THE SIGNIFICANT LOSSES
OF MEDI-CAL, WE HAVE ALSO
INVESTED OVER $2 BILLION IN
REACHING SEISMIC COMPLIANCE. OUR
BUILDINGS ARE 2020 COMPLIANT AND
WILL REMAIN STANDING DURING AN
EARTHQUAKE TO PROTECT OUR
PATIENTS, PROVIDERS AND
CAREGIVERS, PERHAPS THE BEST WAY
TO UNDERSTAND OUR STATUS DIGNITY
HEALTH IS STARTING, OUR WE
STARTED OUR JOURNEY WITH 87
NON-COMPLIANT SBC ONE BUILDINGS.
WE'VE HAD TO TAKE 18 OUT OF
COMMISSION. AND THE REMAINING
ARE ALL AT LEAST 2020 COMPLIANT,
BUT NONE OF OUR HOSPITALS ARE
FULLY 2030 COMPLIANT, FOR
EXAMPLE, CALIFORNIA HOSPITAL AND
MEDICAL CENTER IN LOS ANGELES IS
COMPLETING AN OVER $200 MILLION
NEW PATIENT CARE TOWER AT
COMPLETION THAT TOWER WILL BE
2030 COMPLIANT. HOWEVER, THERE
ARE SIX OTHER BUILDINGS ON THAT
CAMPUS THAT ARE NOT CURRENTLY
COMPLIANT, AND WE ARE TRYING TO
PLAY TETRIS IN ORDER TO GET
THESE SERVICES, MAINTAIN THE
SERVICES WHILE BRINGING THESE
BUILDINGS UP TO COMPLIANCE, AND
WE KNOW THAT THAT WILL TAKE A
LOT OF TIME AND HUNDREDS OF
MILLIONS OF MORE DOLLARS TO GET
THAT DONE. IF WE CAN'T GET THOSE
OTHER BUILDINGS DONE, THE ENTIRE
HOSPITAL WOULD HAVE TO CLOSE, AT
EACH OF OUR HOSPITALS, LIKE I
MENTIONED EARLIER, IT IS ABOUT
TETRIS MOVING AROUND SERVICES
AND MAINTAINING ACCESS WHILE
STILL ADVANCING THE SEISMIC
STANDARDS, WE'VE GOT BILLIONS IN
ADDITIONAL INVESTMENTS THAT WE
NEED TO MAKE, BUT WE WANT TO
MAKE SURE WE'RE DOING THIS WITH
PROPER ACCESS AND CARE FOR OUR
COMMUNITY. SO WE URGE YOUR
SUPPORT. THANK YOU. THANK YOU.
ARE THERE ANY OTHER WITNESSES IN
SUPPORT? PLEASE COME FORWARD.
GOOD AFTERNOON. DANIEL SANCHEZ
WITH CALIFORNIA ADVOCACY HERE ON
BEHALF OF LA CORPORATIVA
CAMPESINA, THE CALIFORNIA
FARMWORKERS INSTITUTE OF
EDUCATION AND LEADERSHIP
DEVELOPMENT, CALEXICO WELLNESS
CENTER, AND CALIFORNIA HUMAN
DEVELOPMENT ON SUPPORT. THANK
YOU. SOUMYA NHÀ, ON BEHALF OF
MEMORIAL CARE HEALTH SYSTEM IN
SUPPORT. GOOD AFTERNOON, MADAM
CHAIR AND MEMBERS, JOHN DOHERTY,
ON BEHALF OF SCION HEALTH. SCION
HEALTH, OPERATING AS KINDRED
HOSPITALS IN CALIFORNIA IN
SUPPORT OF. THANK YOU, PRESTON
YOUNG FROM THE CALIFORNIA
CHAMBER OF COMMERCE HERE TODAY
IN SUPPORT. GOOD AFTERNOON,
MADAM CHAIR. MEMBERS ALFREDO
MEDINA HERE ON BEHALF OF
CEDARS-SINAI IN SUPPORT. GOOD
AFTERNOON, MADAM CHAIR. I WOULD
KIDANI ON BEHALF OF THE
CALIFORNIA CHILDREN'S HOSPITAL
ASSOCIATION IN SUPPORT. THANK
YOU. KELLY BROOKS, ON BEHALF OF
THE CALIFORNIA ASSOCIATION OF
PUBLIC HOSPITALS AND HEALTH
SYSTEMS AND SUPPORT NICOLE
WATERMAN ON BEHALF OF SAN
BERNARDINO COUNTY, IN SUPPORT.
DAN CHASE, ON BEHALF OF THE
UNIVERSITY OF CALIFORNIA IN
SUPPORT. JEFF NEIL ON BEHALF OF
CONTRA COSTA COUNTY AND SUPPORT.
THE SET SHORT ON BEHALF OF SAINT
AGNES MEDICAL CENTER PEACH, THE
ALLIANCE OF CATHOLIC HEALTH CARE
AND LOMA LINDA UNIVERSITY HEALTH
IN SUPPORT. READ NOTE WE'RE
REPRESENTING STANFORD HEALTH
CARE AND SUPPORT MEGAN LOPER ON
BEHALF OF THE UNITED HOSPITAL
ASSOCIATION AND SUPPORT JOHN
FLANAGAN ON BEHALF OF HCA IN
SUPPORT. THANK YOU. GOOD
AFTERNOON. ALEJANDRO SOLIS, ON
BEHALF OF COMITÉ CIVICO EL VALLE
AND LOS AMIGOS DE LA COMUNIDAD
IN SUPPORT. THANK YOU. GOOD
AFTERNOON, MADAM CHAIR, AND
MEMBERS, CONNIE DELGADO, ON
BEHALF OF THE DISTRICT HOSPITAL
LEADERSHIP FORUM IN SUPPORT.
THANK YOU. ARE THERE ANY PRIMARY
WITNESSES IN OPPOSITION?
THANK YOU. YOU'LL EACH HAVE TWO
MINUTES. THANK YOU, MADAM CHAIR
AND MEMBERS. GOOD AFTERNOON. MY
NAME IS MARTY LOPEZ, AND I'M
WITH THE. I'M A LEGISLATIVE
ADVOCATE FOR THE CALIFORNIA
NURSES ASSOCIATION, REPRESENTING
MORE THAN 100,000 REGISTERED
NURSES THROUGHOUT CALIFORNIA.
RESPECTFULLY, IN OPPOSITION TO
SB, S 1432. WE APPRECIATE THE
DIALOG WITH THE AUTHOR AND THE
ADDITION OF A OF AMENDMENTS OF
MEASURABLE ACCOUNTABILITY. BUT
WE REMAIN IN OPPOSITION. SORRY,
I LOST MY PLACE, WE APPRECIATE
YOU. AND, WE REMAIN IN
OPPOSITION TO ALL THE, ANY
FURTHER EXTENSIONS FOR SEISMIC
COMPLIANCE FOR CALIFORNIA
HOSPITALS? HOSPITALS HAVE HAD 30
YEARS TO IMPLEMENT SEISMIC
SAFETY REQUIREMENTS AND WOULD
ENSURE THAT WOULD ENSURE THAT
THEY CAN REMAIN OPEN AND
FUNCTIONAL IN THE EVENT OF A
MAJOR EARTHQUAKE. IN THE 1994
NORTHRIDGE EARTHQUAKE, THEY
ACTUALLY LIVED THROUGH 11
HOSPITALS WERE SEVERELY DAMAGED,
AND EIGHT WERE FORCED TO
EVACUATE PATIENTS, INCLUDING
BABIES, DOWN STAIRCASES WITHOUT
LIGHTING. NURSES AND OTHER
HEALTH CARE WORKERS AT THE
HOSPITALS THAT MORNING
DESPERATELY TRIED CARING FOR
THEIR PATIENTS IN DARKNESS,
WITHOUT SERVICES, WITHOUT
FUNCTIONING EQUIPMENT,
ELECTRICITY OR WATER, AND AT
RISK FOR THEIR OWN SAFETY.
DURING THE NORTHRIDGE
EARTHQUAKE, THOUSANDS WERE
INJURED AND THE PUBLIC EXPECTS
HOSPITALS TO BE THERE WHEN
DISASTER HITS. STANDING NEARBY
TO READY TO TREAT THOSE THAT
WILL UNDOUBTEDLY BE IN NEED OF
CARE. CIRCUMVENTING SEISMIC
SAFETY REQUIREMENTS. NOW WITH
YET ANOTHER DELAY GAMBLES WITH
THE LIVES OF PATIENTS, NURSES
AND OTHER HEALTH CARE WORKERS.
SCIENTISTS AGREE THAT WE ARE
OVERDUE FOR A MAGNITUDE STRONGER
THAN NORTHRIDGE. SHOULD THAT
HAPPEN, WE COULD SEE A SIMILAR
SCENARIO TO 1994. A LINE IN THE
SAND MUST BE DRAWN FOR MEETING
SEISMIC COMPLIANCE. IT'S NOT
ADDITIONAL TIME THAT HOSPITALS
NEED, BUT OVERSIGHT,
ACCOUNTABILITY AND PRIORITY
PRIORITIZATION. PRIORITIZING
COMPLIANCE. WE ARE TAKING A
GAMBLE WITH THE LIVES OF PEOPLE
IN THE STATE, AND CALIFORNIA
MUST CONTINUE TO HOLD ITS
HOSPITALS ACCOUNTABLE TO ITS
HIGHEST SEISMIC STANDARDS, WITH
NO EXTENSION TO THE OF THE 2030
COMPLIANCE DEADLINE. AND WE ASK
THAT YOU OPPOSE SB 1432. THANK
YOU. GOOD AFTERNOON, MATT, I'M
HERE ON BEHALF OF SEIU
CALIFORNIA. WE'D LIKE TO THANK
THE COMMITTEE CHAIR AND THE
STAFF AND THE AUTHOR FOR THEIR
WORK ON THE BILL. AND CONVENING
STAKEHOLDERS, TO HAVE, YOU KNOW,
DISCUSSIONS ABOUT THIS REALLY
IMPORTANT POLICY AND HOW DO WE
MAKE SURE CALIFORNIA IS PREPARED
FOR THE NEXT MAJOR EARTHQUAKE AS
MENTIONED, IT IS A MATTER OF,
WHEN NOT IF THAT WE'RE GOING TO
GET A MAJOR EARTHQUAKE IN
CALIFORNIA. AND UNFORTUNATELY,
BY COINCIDENCE, OFTEN WE TALK
ABOUT THIS BILL. WE ARE REMINDED
IN CALIFORNIA THAT THERE'S AN
EARTHQUAKE HAPPENS, AND IT'S
OFTEN NOT THE PLACE WE MOST
EXPECT EITHER. AND SO FOR SEIU,
WE THINK IT'S REALLY CRITICAL
THAT WE'RE COMING INTO
COMPLIANCE WITH THE 2030 SEISMIC
STANDARDS. AS MENTIONED, THIS IS
SOMETHING WHERE HOSPITALS HAVE
HAD DECADES TO PREPARE FOR THIS.
AND HAVE CONTINUED TO TRY TO
KICK THE CAN DOWN THE ROAD AND
UNFORTUNATELY, AS THE BILL
CURRENTLY IN PRINT, BEFORE YOU
WOULD ENSURE THAT HOSPITALS ARE
REALLY NOT COMING INTO
COMPLIANCE FOR ANOTHER 15 YEARS.
AND SO THAT'S JUST CONTINUING TO
RISK PATIENTS, WORKERS AND
GAMBLING WITH THEIR WORK, JUST
ON SOME OF THE POINTS THAT WAS
MADE EARLIER TODAY, THE
CALIFORNIA HEALTH CARE
FOUNDATION RECENTLY CAME OUT
WITH A STUDY, TALKING ABOUT THE
FINANCIAL HEALTH OF HOSPITALS,
SAYING LAST YEAR THAT HOSPITALS
MADE $9 BILLION IN PROFITS. SO
PRETTY SIGNIFICANT REVENUE
BOUNCE BACK FROM A DIFFICULT
YEAR DURING THE PANDEMIC, ALSO,
YOU KNOW, I JUST REALLY WANT TO
APPRECIATE THE TECHNICAL
ASSISTANCE THAT WAS PROVIDED BY
THE ADMINISTRATION. AND YOU
KNOW, LOOK FORWARD TO CONTINUED
DIALOG ON THAT. WE DO THINK THAT
THAT PUTS US ON A SAFER PATH TO
COMPLIANCE IN CALIFORNIA, MAKING
SURE THAT HOSPITALS CAN TAKE THE
TIME THAT THEY NEED IF THAT
INDIVIDUAL FACILITY NEEDS, BUT
ALSO DOESN'T GRANT A BLANKET
EXTENSION FOR ALL HOSPITALS IN
CALIFORNIA. AS MENTIONED, THERE
ARE SOME HOSPITALS THAT CAN COME
INTO COMPLIANCE BY 2030, AND WE
THINK THAT'S CRITICAL THAT
HOSPITALS DO. SO IF HOSPITALS
NEED MORE TIME. I THINK THE
TECHNICAL ASSISTANCE AFFORDS
THEM THAT OPPORTUNITY AND A
PATHWAY TO DO SO. SO, I THINK
THAT IS CRITICAL SORT OF STEP
AND APPRECIATE THE TECHNICAL
ASSISTANCE THERE, SO JUST IN
CONCLUSION, YOU KNOW, WHILE WE
CONTINUE TO LOOK FORWARD TO THE
ONGOING DISCUSSION, JUST FOR THE
BILL BEFORE YOU TODAY, WE ARE
STILL RESPECTFULLY OPPOSED.
THANK YOU. ANY OTHER WITNESSES
IN OPPOSITION? PLEASE COME
FORWARD TO THE MIC. MADAM CHAIR
MEMBERS, STEVE BAKER WITH AARON
READING ASSOCIATES FOR THE
PROFESSIONAL ENGINEERS IN
CALIFORNIA. GOVERNMENT, OPPOSED
UNLESS AMENDED. THANK YOU. GOOD
AFTERNOON, CHAIR MEMBERS. JANICE
O'MALLEY FROM ASK ME CALIFORNIA
REPRESENTING MANY NURSES HEALTH
CARE PROFESSIONALS AND THOSE IN
EMERGENCY MEDICAL SERVICES ALSO
IN RESPECTFUL OPPOSE UNLESS
AMENDED. THANK YOU, BETH CAPELL.
TEAMSTERS AND UNITE HERE ON
BEHALF OF OUR HEALTH CARE
WORKERS AND ALSO THE FAMILIES
WHO DEPEND ON THESE HOSPITALS
BEING THERE AFTER AN EARTHQUAKE
AND FUNCTIONAL. THANK YOU, MADAM
CHAIR AND MEMBERS. MEGAN SUBERS,
ON BEHALF OF THE CALIFORNIA
PROFESSIONAL FIREFIGHTERS,
RESPECTFULLY OPPOSED JULIE
NIELSEN FOR THE NATIONAL UNION
OF HEALTH CARE WORKERS OPPOSED,
UNLESS AMENDED. THANK YOU, THANK
YOU. WITH THAT, I WILL BRING IT
BACK TO THE COMMITTEE FOR ANY
COMMENT OR QUESTION. DOCTOR
WOOD, THANK YOU, MADAM CHAIR.
AND THANK YOU, SENATOR
CABALLERO, FOR BRINGING THE BILL
FORWARD TODAY. I'M HAPPY TO
SUPPORT YOUR BILL TODAY, MEETING
SEISMIC REQUIREMENTS HAS BEEN A
CHALLENGE, FOR MANY YEARS,
ESPECIALLY FOR SMALL RURAL
HOSPITALS. LIKE SO MANY IN YOUR
DISTRICT AND, AND MINE, WE KNOW
THAT FOR THE BENEFIT AND
PROTECTION OF ALL PATIENTS AND
THE HOSPITAL STAFF IN EVERY
HOSPITAL IN THE STATE, WE HAVE
TO FIGURE OUT HOW TO MAKE SURE
HOSPITALS MEET THEIR OBLIGATIONS
IN THIS NEXT DECADE. ONCE AND
FOR ALL. AND CERTAINLY BEFORE WE
EXPERIENCE A SIGNIFICANT AND
DESTRUCTIVE EARTHQUAKE. AND I
HOPE MR. LEGGETT IS NOT CORRECT,
THAT THERE'LL BE ANOTHER
EARTHQUAKE SOON, BUT I'M HERE TO
KEEP THIS WORK MOVING FORWARD SO
THAT PATIENTS CAN CONTINUE TO
GET THE CARE THEY NEED WHEN THEY
NEED IT, WHERE THEY NEED IT, AND
TO PROTECT THE HOSPITAL STAFF
THAT PROVIDES IT. THANK YOU.
THANK YOU. MAJORITY LEADER.
SENATOR, HOW MANY YEARS HAVE WE
BEEN WORKING ON THESE THINGS? I
JUST WANT TO SCREAM, BUT
OBVIOUSLY I'M GOING TO SUPPORT
THE BILL TODAY, AND I WOULD JUST
LIKE TO SEE MORE CONSISTENCY
ACROSS ALL OF OUR SEISMIC BILLS
THAT ARE OUT THERE RIGHT NOW.
AND I HOPE YOU CAN WORK TOGETHER
TO COME UP WITH A STRONG BILL,
YOU KNOW, AND I THINK OF 2030,
I'M THINKING, WHO BEHIND US WILL
BE HERE TO MAKE SURE THESE
THINGS GET IMPLEMENTED AND THEN
WE'RE NOT DOING THIS WHOLE DANCE
AGAIN, BUT ANYWAY, I WOULD HOPE
THAT WE CAN WORK ON SOMETHING A
LITTLE BIT TIGHTER. AND, WE'LL
LOOK AT IT AGAIN WHEN YOU GET TO
THE FLOOR. BUT I AM TRULY BEHIND
THESE THINGS. IT'S BEEN SUCH A
LONG ROAD. AND, I THINK WE'VE
SEEN 2 OR 3 OF THESE ALREADY
THIS YEAR. DIFFERENT SEISMIC,
BILLS. AND SO HOPEFULLY WE CAN
COME TO A FAIR LANDING ON THIS.
SO THANK YOU VERY MUCH FOR
BRINGING IT. AND AGAIN, I'LL
SUPPORT IT TODAY. THANK YOU VERY
MUCH. I APPRECIATE THAT BECAUSE
THE BILL ATTEMPTS TO GET AWAY
FROM ONE OFF BILLS ONE HOSPITAL
AT A TIME. WE'RE WE'RE GRANTING
RELIEF AND WE'RE GRANTING RELIEF
BECAUSE NONE OF US IS WILLING TO
SAY, WELL, THAT HOSPITAL JUST
NEEDS TO CLOSE BECAUSE THEY
DIDN'T DO WHAT THEY WERE
SUPPOSED TO DO, SO THIS IS A WAY
FOR US TO SET UP A STRUCTURE AND
THEN TO SAY THERE'S
TRANSPARENCY. SO NOW THE
COMMUNITY KNOWS THAT THIS
HOSPITAL HAS ASKED FOR MORE TIME
AND THAT THAT THERE ARE THERE
RESOURCES ARE GOING TO BE
QUESTIONED WHERE THEY'RE USING
THEM AND HOW THEY'RE USING THEM.
BECAUSE THE OTHER ISSUE THAT I
HAD, FRANKLY, WITH MY HOSPITAL
THAT CLOSED IS THAT THEY'RE A
PRIVATE NONPROFIT. THEY DON'T
HAVE TO TELL US ANYTHING ABOUT
THEIR FINANCES. WE WANT STATE
MONEY, BUT THEY WOULD NOT SHARE
THEIR FINANCES. AND THAT'S
REALLY FRUSTRATING FOR US TO BE
ABLE TO EVALUATE WELL WHAT'S
REALLY GOING ON. AND, AND IS THE
INVESTMENT THAT THE STATE MAKES
IS THAT INVESTMENT GOING TO BE
MANAGED FISCALLY? RIGHT SO
THAT'S THE REASON THAT THERE'S
TRANSPARENCY AND THERE'S A
THERE'S DEADLINES AND THERE'S
REPORTING, HOPEFULLY THAT
CHANGES SO THAT WE KNOW WHAT'S
GOING ON WITH THE HOSPITALS IN
OUR REGION. THANK YOU. THANK YOU
VERY MUCH. THANK YOU, MR.
RODRIGUEZ, ONCE AGAIN, I WANT TO
THANK THE AUTHOR FOR, BRINGING
THIS BILL FORWARD. OBVIOUSLY,
THE LAST TWO WEEKS, WE'VE HAD A
BILL REGARDING SEISMIC DELAYS OR
EXTENSIONS, ONE THING I JUST
WANTED TO POINT OUT WITH THE
OPPOSITION WAS TALKING ABOUT THE
30 YEARS SINCE I THINK THE
ORIGINAL SEISMIC COMPLIANCE,
BILL, I GUESS, WAS IN 1994.
RIGHT. SO IT'S BEEN 30 YEARS
TRYING TO CATCH UP TO MAKE THESE
, COMPLIANCES. AND OBVIOUSLY THE
FIRST ONE WAS THE 20,000, 2008
STANDARDS. NOW WENT TO 2020. NOW
WE'RE LOOKING 2030 AND MAYBE
BEYOND. RIGHT. SO IS THERE A
REASON WHY IT'S BEEN 30 YEARS.
HOW STILL HARD FOR SOME
HOSPITALS TO STRUGGLE OR MAYBE
TO THE WITNESSES AND SUPPORT.
WHY IT'S BEEN A CHALLENGE. IF WE
HAD 30 YEARS KNOWING THIS, THAT
WE'RE STILL IN A SITUATION WHERE
IT'S CHALLENGING TO FIND THE
FUNDING TO ADDRESS IT, THAT
LATTER PART IS PROBABLY ONE OF
THE KEY POINTS, I DO WANT TO
MAKE SURE WE'RE ALL AWARE THAT
WE NEED TO BREAK THIS IN TWO.
THE FIRST DEADLINE WAS TO ENSURE
OUR HOSPITALS REMAIN STANDING.
SO REALLY STRUCTURALLY MADE
SURE. I OFTEN SAY HOSPITALS ARE
SOME OF THE SAFEST BUILDINGS IN
YOUR BACKYARD BECAUSE THEY
STRUCTURALLY WERE INSURED, THAT
THEY DON'T COLLAPSE. SO OUR
HOSPITALS 98, 94, 98% OF OUR
HOSPITALS ARE DETERMINED TO NOT
REACH THAT COLLAPSE STANDARD, AN
EXPENSIVE STANDARD. SO BACK TO
THAT LAST POINT. OUR HOSPITALS
HAD TO A FIGURE OUT WHAT THE
RULES WERE WHEN THE BILL WAS
PASSED. TOOK TIME TO FIGURE OUT
WHAT THE RULES OF THE ROAD WERE
FOR THAT, AND THEN THE RULES
CHANGED AGAIN, SO WE GOT TO A
PLACE WHERE BETWEEN 2015 AND
2020, WE COULD ACCOMPLISH THE
MAJORITY OF THOSE HOSPITALS
REMAINING STANDING. THIS IS A
NEW STANDARD. SO WE ARE ASKING
HOSPITALS TO BE FULLY
OPERATIONAL. SO ON TOP OF THOSE
NOT THOSE STRUCTURAL STANDARDS,
OUR HOSPITALS HAVE TO ENSURE THE
LIGHTS TURN ON FULL POWER WORK
SURGICAL SUITE WORKS ERS FULLY
CAPABLE. OXYGEN'S RUNNING. IT'S
A VERY INTENSE STANDARD WHILE
BEING LANDLOCKED OFTENTIMES AND
MANAGING SERVICES AT THE SAME
TIME BECAUSE THE LAST THING OUR
HOSPITALS WANT TO DO IS TAKE
SERVICES OFFLINE IN ORDER TO
MANAGE THAT CONSTRUCTION. SO
IT'S A LOT MORE DETAILED,
FRANKLY, BECAUSE THEY'RE GOING
INTO THE ACTUAL PATIENT ROOMS AS
OPPOSED TO WRAPPING THE BUILDING
AND STEEL OR DOING OTHER
STRUCTURAL COMPONENTS. IT'S THE
NONSTRUCTURAL. IT'S, YOU KNOW,
BRACING, ANCHORING WATER, ETC.
SO IT'S JUST A VERY COMPLEX
STANDARD. AND WE HIT THE FIRST 1
IN 2020, 22, 25 FOR SOME FOLKS
WHO ARE STILL WORKING ON THAT, A
FEW FOLKS LEFT TO THE BILLS
YOU'VE SEEN, BUT NOW WE'VE GOT,
YOU KNOW, WE'RE BEARING ON TEN
YEARS TO DO THIS COMPLEXITY. AND
THEN REMEMBER, AND, YOU KNOW, WE
SPENT THREE YEARS MANAGING 2 TO
3 YEARS MANAGING COVID, WHICH WE
TOOK OUR BUILDINGS, REARRANGED
THEM, STOPPED CONSTRUCTION FOR
THE MOST PART. AND THEN CAME
BACK ONLINE SO THAT THAT THREE
YEARS EXTENSION, WE'RE LOOKING
FOR KIND OF HONORS THAT REQUEST
AS WELL. AND THEN LEADING UP TO
ANOTHER QUESTION, YOU JUST
TALKED ABOUT THE COMPLIANCE WITH
BUILDINGS CAN BE STANDING RIGHT
THAT I THINK STAFF APOLOGIZE
FOR. I DIDN'T CATCH YOUR NAME,
BUT YOU TALKED ABOUT NO MATTER
WHAT, THESE HOSPITALS WILL BE
STANDING IS THEIR GUARANTEES
THAT WHAT'S HAVE BEEN DONE, THE
CONSTRUCTION OF THESE FACILITIES
THAT THE BUILDINGS WILL STAY
STANDING BECAUSE ONCE AGAIN, WE
HAVEN'T BEEN TESTED RIGHT. WE
HAVEN'T HAD A MAJOR EARTHQUAKE
SINCE NORTHRIDGE. AND THERE'S
BEEN A LOT OF COMPLIANCE AND
CHANGING OF PLANNING AND
BUILDING SINCE THEN. SO THERE
ARE GUARANTEES IN A SENSE,
BECAUSE YOU STATED THE BUILDINGS
ARE GOING TO STAY STANDING NO
MATTER WHAT. SO IS THAT A
GUARANTEE? NO MATTER WHAT TYPE
OF EARTHQUAKE WE GET, WHETHER
IT'S IN NORTHERN CALIFORNIA OR
SOUTHERN CALIFORNIA, THAT THAT
BUILDING WILL STAY INTACT. THERE
HAS BEEN THE ENGINEERING
STANDARDS, YOU KNOW, TO MEET THE
2020, WHICH IS A NON-COLLAPSIBLE
STANDARD OR EXTENSIVE, AND IT
WAS GREAT MODELING THAT WAS DONE
. OBVIOUSLY, YOU DON'T DO A, YOU
KNOW, A COLLAPSE TEST. YOU DO
THE EXTENSIVE MODELING AND THAT
MODELING HAS BEEN DONE AND IT
PRETTY MUCH VERIFIES THAT THESE
BUILDINGS WILL STAND, SO YES,
I'M VERY CONFIDENT IN THAT WITH
THE MODELING THAT'S BEEN DONE BY
MANY DIFFERENT SOURCES. OKAY AND
I JUST HAD ONE MORE QUESTION ON,
ON PAGE SIX OF THE ANALYSIS,
THEY TALK ABOUT TRANSFER PLANS.
I DON'T KNOW IF ANYBODY HAS IT.
LOOK AT IT. IT SAYS THERE
REQUIRES A PLAN TO ADDRESS
CONTINUING CARE FOR HOSPITALS,
PATIENTS FOLLOWING A SEISMIC
EVENT THROUGH ALTERNATIVE CARE
SITES ON HOSPITAL CAMPUSES AND
TRANSFERS TO OTHER CARE
FACILITIES. SO THAT BRINGS TO
MIND ON MOBILE FIELD HOSPITALS
THAT WE SHOULD LOOK AT, SOME
TYPE OF INSURANCE PLAN, RIGHT.
THAT AS WE'RE LOOKING TO EXTEND
THESE, REQUIREMENTS FOR
HOSPITALS TO STAY AFLOAT, THAT
WE SHOULD START LOOKING AT MAYBE
FIELD HOSPITALS THAT WOULD BE A
BACKUP PLAN IN SOME OF THESE
AREAS. IT WOULD BE NICE TO HAVE
ONE IN NORTHERN CALIFORNIA,
SOUTHERN CALIFORNIA, IN THE
EVENT SOMETHING DRASTIC HAPPENS
WHERE A HOSPITAL OR FACILITY
GOES DOWN, THAT WE HAVE A PLAN
IN PLACE WITH A MOBILE FIELD
HOSPITAL. RIGHT? IT JUST SEEMS
TO MAKE SENSE. BUT I DON'T KNOW
WHY. NOBODY REALLY TALKS ABOUT
MOBILE FIELD HOSPITALS AS A
BACKUP PLAN, BECAUSE WE KNOW
IT'S GOING TO HAPPEN IN
CALIFORNIA. EARTHQUAKES HAPPEN.
THAT MAJOR ONE IS WAY OVERDUE.
SO I WOULD JUST LIKE TO SEE IF
WE CAN START TALKING ABOUT THAT
DISCUSSION ABOUT HAVING SOME
TYPE OF A MOBILE FIELD HOSPITAL
PLANS IN PLACE, AND THAT THESE
COUNTIES AND CITIES HAVE A PLAN
TO EVACUATE FOLKS IF NEEDED.
RIGHT. BECAUSE WHO'S GOING TO BE
THE ONES DOING IT? ARE LOCAL
POLICE OFFICERS? OUR
FIREFIGHTERS THERE IN THE CITIES
OR COUNTIES AND THE SETTINGS TO
WAS THE RURAL SETTING OR THE
URBAN SETTING THAT THOSE LOCAL
AREAS JURISDICTIONS HAVE THOSE
PLANS IN PLACE WORKING TOGETHER
WITH THAT COMPONENT OF A MOBILE
FIELD HOSPITAL, SO I DON'T KNOW
IF THAT'S SOMETHING I JUST
WANTED TO PUT OUT THERE TO YOU
GUYS. MAYBE YOU GUYS CONSIDER
AND LOOK AT THAT, THE STATE
ACTUALLY HAS PREVIOUSLY
CONSIDERED THIS, AND, IT'S A
CONVERSATION FOR ANOTHER DAY,
BUT WE ACTUALLY, AS A STATE
INVESTED IN SOME MOBILE FIELD
HOSPITALS. WHAT WE FOUND TO BE,
AND I'LL INVITE TIM TO, TO BE AS
HELPFUL IS OUR HOSPITALS
ACTUALLY COORDINATE WITH THEIR
FELLOW HOSPITALS, BECAUSE OFTEN
THESE THINGS ARE REGIONAL, AND
THEY WORK WITH HOSPITALS OUTSIDE
THEIR REGION TO MANAGE THOSE
TRANSFER PLANS AS WELL, BECAUSE
THEY HAVE ACTIVE DOCTORS,
ACTIVE, PLANS ACT, AND THEY
ACTIVELY PRACTICE THESE PLANS OF
HOW WE MANAGE THOSE DISASTERS.
BUT WE WANTED TO MAKE SURE THAT
WAS TRANSPARENT AS WELL. TO YOUR
GOOD POINT, BECAUSE FRANKLY, IN
OUR CONVERSATIONS WITH OUR LOCAL
FIREFIGHTERS, THEY GOT VERY
CONCERNED. BUT YOU KNOW, AND
WANT TO KNOW WHAT'S THE PLAN,
WHAT YOU KNOW, HOW ARE WE GOING
TO DO THIS? HOW IF THREE
HOSPITALS GO DOWN, ARE WE GOING
TO MANAGE THIS? THEY WORK WITH
US. BUT FRANKLY, WE ALSO WANTED
TO KNOW WHAT'S THE PLAN FOR
CONSTRUCTION, BECAUSE WE WILL
HAVE TO TAKE BEDS OUT OF SERVICE
AND THAT WILL IMPACT OUR ERS.
AND WHAT IS THE REGIONAL PLAN
FOR THAT? BECAUSE THE LAST THING
WE WANT TO DO IS TAKE SIX OF THE
SAME SERVICE OUT IN THE REGION
AND NOT HAVE, WHETHER IT BE
COMPLETE SURGICAL, YOU KNOW, MED
SURGE, BEHAVIORAL, WHATNOT. SO,
SO YES, I THINK WE'LL CONTINUE
THAT CONVERSATION. OKAY, WELL,
SENATOR, I REALLY WANT TO GET
THERE. I THINK I CAN, BUT I'M
STILL JUST HAVING A COUPLE
ISSUES WITH IT. I JUST ONE ONE
LAST QUESTION. ARE THERE ANY
PROVISIONS STATING THAT IF YOU
GET THE THREE YEAR OR FIVE YEAR
EXTENSION, THAT THAT'S IT. THERE
WILL BE NO OTHER EXTENSIONS
DEPENDING ON WHAT OCCURS. SO
SOMEBODY DON'T COME BACK IN A
COUPLE OF YEARS. OH, WE NEED
ANOTHER EXTENSION BECAUSE OF X,
Y AND Z. SO THE EXTENSION WITH
WHAT'S REQUIRED TO GET AN
EXTENSION IS THAT YOU HAVE PLANS
IN PLACE. AND THOSE PLANS, ARE,
ARE FAIRLY SPECIFIC ABOUT,
EXACTLY WHAT YOU NEED TO
RETROFIT OR TO TEAR DOWN AND
REBUILD, IT STARTS TO INCLUDE
DRAWINGS AND PERMITS AND THE
FINANCIAL PLAN. SO IT'S NOT JUST
A, OH, WE'RE GOING TO DO IT, AND
THEN YOU DON'T DO ANYTHING. YOU
HAVE TO START SHOWING H Kò THE
ACTUAL WORK THAT YOU'RE DOING.
AND H Kò WILL MAKE A
DETERMINATION AS TO WHETHER
YOU'RE ENTITLED TO ANY, EXTRA
TIME OR NOT. AND THE WHOLE IDEA
IS TO, IS TO IS FOR THOSE
HOSPITALS THAT ARE IN A IN THAT
HAVE THE CAPACITY THAT THAT THEY
START ACTUALLY DOING THE WORK.
AND THE OTHER PART OF IT THAT
BECAME FAIRLY SIGNIFICANT IS
THAT A NUMBER OF THESE
HOSPITALS. SO, SO THOSE OF YOU
WHO LIVE IN URBAN CENTERS HAVE A
PLETHORA OF BENEFIT BECAUSE YOU
HAVE A NUMBER OF HOSPITALS IN
YOUR REGION AS OPPOSED TO MADERA
THAT HAS ONE HOSPITAL IN MERCED
THAT ONLY HAS A COUPLE OF
HOSPITALS AND SO IF YOU HAVE
HOSPITALS THAT NEED TO DO
RETROFITS OR RECONSTRUCTION IN
IN A REGION THAT H. Kò CAN
FIGURE OUT HOW NOT TO HAVE THEM
ALL OFFLINE AT THE SAME TIME,
BECAUSE YOU MAY HAVE TO CLOSE
SOME SERVICES, SOME SERVICES, AS
YOU DO THE RETROFIT OR AS YOU AS
YOU REBUILD, AS YOU TEAR DOWN
AND REBUILD. AND SO IT WOULD BE
A STAGGERED SCHEDULE AND IT
GIVES H Kò THE FLEXIBILITY TO BE
ABLE TO APPROVE THAT SO THAT
IT'S NOT ONE SIZE FITS ALL. YOU
GET THIS THREE YEARS AND THAT'S
ALL THERE IS TO IT. AND NOT
EVERYBODY NEEDS THE THREE YEARS
EXCEPT FOR THAT. IF YOU LOOK AT
WHERE WE ARE TODAY, UNLESS
THEY'VE GOT FINANCING, THEY HAVE
THE PERMITS. YOU HEARD THAT IT
TOOK THE CITY CLOSE TO TEN YEARS
TO FINISH THE PERMITS, FOR THEM
TO ACTUALLY START THE BUILDING.
IF THERE'S THAT KIND OF DELAY
THAT'S OUTSIDE OF THE CONTROL OF
THE HOSPITAL, AND H. KAI WILL
HAVE THE AUTHORITY TO BE ABLE TO
GRANT EXTRA TIME AND MAYBE AS
WELL, TO WEIGH IN AND TELL THE
CITY, YOU BETTER GET MOVING ON
THIS, BECAUSE THEY NEED TO BE
ABLE TO DO THIS WORK BY A
CERTAIN DATE. SO TO ANSWER YOUR
QUESTION, THERE'S FLEXIBILITY.
OKAY. GREAT. I APPRECIATE THAT.
I MAY BE LAYING OFF I KNOW YOU
WANT TO LOOK AT SOME OTHER
THINGS TO MAYBE GET IN A BETTER
PLACE, BUT, REALLY ONCE AGAIN,
THANK YOU FOR YOUR WORK. I THINK
THIS IS PROBABLY THE BETTER BILL
THAT I'VE SEEN LATELY REGARDING
SEISMIC ACTIVITIES FOR HOSPITALS
AND THE EXTENSION. SO THANK YOU
VERY MUCH. I APPRECIATE THAT
PRODUCT. THANK YOU. THANK YOU.
ASSEMBLY MEMBER SANTIAGO
APPRECIATE YOU WORKING ON THIS
ISSUE. THANK YOU VERY MUCH. AND
I'M PREPARED TO SUPPORT IT HERE.
BUT I KNOW THAT SOME OF THE
CONCERNS YOU MIGHT BE WORKING
ON, I'M GLAD TO HEAR YOU SAY
THAT. YOU KNOW, SOME OF THE
BECAUSE THERE ARE LEGITIMATE
REASONS AS TO WHY I PUSHED OFF.
IF THERE'S A LOCAL, MUNICIPALITY
WHO'S NOT MOVING ON PERMITS,
ETC. BUT BUT I DON'T NEED AN
ANSWER ON THIS ONE PARTICULAR
PIECE. BUT BUT THERE IS ALSO
FAIR TO SAY THAT IN SOME CASES,
HOSPITALS ARE JUST KIND OF
PUSHED IT AND NOT ALL, BUT SOME
HAVE PUSHED OR KICKED THE CAN
DOWN THE ROAD. I REMEMBER BEING
A YOUNG STAFFER ABOUT 20 YEARS
AGO WHEN THIS ISSUE WAS FIRST
COMING UP AT THE BEGINNING OF
THE BEGINNING OF THE CENTURY,
AND I. AND THERE WAS A PUSH AT
THE TIME AND THE ARGUMENTS WERE
PRETTY MUCH THE SAME. RIGHT.
WHICH IS LIKE, NOT ENOUGH
FINANCING THIS AND THAT. AND AS
YEARS GO BY, WE KIND OF DEAL
WITH THIS OVER AND OVER IN THE
LEGISLATURE. I'M HOPING THAT YOU
COULD FINE TUNE TO ADDRESS SOME
OF THE CONCERNS IN TERMS OF THE
HOSPITALS THAT CAN POTENTIALLY
DO IT, THAT THEY ACTUALLY DO IT.
AND IF THERE ARE LEGITIMATE
CONCERNS, AS YOU HAVE STATED,
SORRY, THE, THE WITNESSES HAVE
STATED WHERE THERE WAS A
MUNICIPALITY THAT SAT ON IT FOR
A NUMBER OF YEARS, I DON'T KNOW
HOW MUCH REAL YOU KNOW, WORK WE
CAN DO ON THAT, EXCEPT FOR MAYBE
WEIGH IN AS STATE LEADERS TO THE
LOCALS, BUT IT JUST HAS TO LAND
SOMEWHERE. SO AT SOME POINT IN
TIME, THE CONCERNS ABOUT A
HOSPITAL NOT COMING DOWN AND,
ARE ADDRESSED DURING AN
EARTHQUAKE BECAUSE THIS HAS TO
HAPPEN, SO I KNOW THERE'S A
LITTLE BIT OF WORK LEFT ON THIS,
OR LOTS OF WORK, DEPENDING ON
WHO YOU ASK, BUT I'M HOPING THAT
YOU WOULD SIT DOWN WITH THE
OPPOSITION AND CONTINUE TO WORK
ON SOME OF THOSE SO THAT WE DO
GET THIS MOVING AND, YOU KNOW,
SOMEDAY I'M GOING TO RETIRE AND
LOOK BACK AND GO, HEY, IT GOT
DONE. YOU KNOW, IT DIDN'T TAKE,
IT DIDN'T TAKE ANOTHER 20 YEARS
TO GET DONE. AND HERE WE ARE
BACK AT THE SAME TABLE WITH
DIFFERENT ADVOCATES PUSHING FOR
ANOTHER TEN YEARS. 20 YEARS, AND
THAT'S REALLY THE ONLY CONCERN
THAT I WOULD HAVE NOT
NECESSARILY ADDRESSED TO YOUR
BILL, BUT JUST ADDRESSED TO THE
GENERAL TOPIC AND ISSUE AT HAND,
WHICH IS, AGAIN, BEGINNING OF
THE CENTURY. I, I DEALT WITH
THIS AS A YOUNG STAFFER AND
DEALT WITH THIS LATER ON AS A
SENIOR STAFFER AND THEN DEALT
WITH IT SEVERAL, YOU KNOW, IN
THE LAST TEN YEARS IN THE
LEGISLATURE, BUT I'M HOPING THAT
AND I TRUST THAT YOU'RE THE ONE.
YOU'RE THE 1 OR 1 OF THE PEOPLE
IN THE BUILDING THAT COULD
ACTUALLY NAIL THIS DOWN IN A WAY
THAT'S BONA FIDE FORCE. THOSE TO
DO THE RIGHT THING WHEN THEY'RE
ELIGIBLE AND CAN FINANCIALLY DO
THAT. AND FOR THOSE WHO HAVE
LEGITIMATE CONCERNS THAT YOU'D
BE ABLE TO BALANCE THAT NEEDLE.
SO I'M PREPARED TO LOOK AT WHAT
YOU HAVE AS IT GETS TO THE
FLOOR. BUT PREPARE TO SUPPORT IT
TODAY BECAUSE I UNDERSTAND
BECAUSE I TRUST IN YOUR WORK
THAT IF ANYBODY CAN LAND THIS
THING, YOU'RE GOING TO BE ABLE
TO SIT DOWN WITH THE OPPOSITION
AND SIT DOWN WITH THE HOSPITALS.
LOOK, I'VE BEEN ON THE OTHER
SIDE OF THE TABLE WITH YOU.
YOU'RE STRAIGHT. IF YOU TELL
SOMEBODY, HEY, THIS IS WHAT YOU
CAN DO. THIS IS WHAT YOU WISH
YOU COULD DO. BUT I'M NOT GOING
TO LET YOU DO IT. I TRUST IN
THAT AND HAVE FAITH IN YOUR WORK
TO BE ABLE TO LAND THAT SORT OF
WORK. THANK YOU. I APPRECIATE
THAT. THANK YOU. ASSEMBLY MEMBER
SCHIAVO. THANK YOU, LIKE MY
COLLEAGUE, I HAVE MEMORIES OF
OVER A DECADE AGO WORKING ON
THIS ISSUE, TOO. AND I KNOW IT
WAS BECAUSE MY DAUGHTER IS ABOUT
TO TURN 12, AND IT WAS MY LAST
DAY OF WORK AND I WAS SO
PREGNANT I HAD TO TURN SIDEWAYS
AT THE PODIUM TO BE ABLE TO
SPEAK ON THE ISSUE WHERE THERE
WAS A PUSH FOR AN EXTENSION FOR
A HOSPITAL, AND YOU KNOW, THIS,
IT'S JUST BEEN GOING ON A LONG
TIME, AND IT DOES FEEL LIKE THE
CAN HAS BEEN KICKED DOWN THE
ROAD A LOT, AND SO I KNOW IN
SOME OF THE CONVERSATIONS, I'M
SORRY I MISSED THE PRESENTATION.
I WAS PRESENTING A BILL. BUT IN
SOME OF THE CONVERSATIONS I'VE
HAD, ABOUT THIS, I KNOW THAT
THERE HAS BEEN, HOPES EXPRESSED
THAT THIS COULD BE THE EXTENSION
TO END ALL EXTENSIONS AND THAT
WOULD BE AMAZING, IF THAT WERE
TO HAPPEN. BECAUSE I THINK AT
THE END OF THE DAY, WHAT WE WANT
IS WE WANT TO MAKE SURE THESE
HOSPITALS ARE SAFE. THEY'RE
FUNCTIONING FOR BOTH PATIENTS
AND STAFF, AND, AND I THINK, YOU
KNOW, IT'S CRITICAL WE GET THERE
AS THE PERSON WHO REPRESENTS
NORTHRIDGE, YOU KNOW, WE KNOW
ALL TOO WELL HOW IMPORTANT THIS
IS. SO, I KNOW THERE'S ONGOING
CONVERSATIONS HAPPENING. I HOPE
THAT, YOU KNOW, THAT THAT WILL
CONTINUE. I KNOW, SOUNDS LIKE
YOU'RE AN AMAZING NEGOTIATOR. SO
I HAVEN'T GOT TO EXPERIENCE IT
MYSELF, BUT I LOOK FORWARD TO
IT, AND, YOU KNOW, AND I HOPE
THAT THE TECHNICAL ASSISTANCE
IS, YOU KNOW, INCORPORATED. AND,
AND THOSE CONVERSATIONS MOVE
FORWARD AS WELL. SO I WILL, GIVE
A COURTESY. YES. TODAY, AND
THEN, YOU KNOW, SEE WHERE THINGS
ARE AT FOR THE FLOOR. THANK YOU
VERY MUCH. APPRECIATE THAT,
SENATOR, I ALSO WILL BE
SUPPORTING THIS BILL. I DID WANT
TO JUST BECAUSE THIS IS A
HEARING. THAT'S WHY WE'RE HERE,
GIVE US AN OPPORTUNITY TO,
SUNLIGHT SOME OF THE ISSUES THAT
I KNOW THAT YOU WILL CONTINUE TO
WORK ON. THE FIRST IS RELATED TO
ENSURING THAT OUR HOSPITALS ARE
ABLE TO KEEP ON TRACK WITH THEIR
PLANS, GIVEN THE I, THE ASSEMBLY
MEMBER. RODRIGUEZ. YOU KNOW, IT
WOULD BE GREAT IF WE COULD HAVE
A THAT'S IT PROVISION, IN THIS
IN, IN THIS LEGISLATION, AS IT
MOVES FORWARD, WE'RE ESSENTIALLY
COUNTING ON SB 1432 AND THE
ACCOMPANYING BILL THAT DOCTOR
WOOD IS MOVING FORWARD TO HAVE
THAT BE THE GLOBAL, SEISMIC
RETROFITTING PLAN FOR ALL OF US
TO BE ABLE TO, FOLLOW THROUGH
BECAUSE WE DON'T WANT ANY MORE
ONE OFFS. SO ONE ISSUE, I JUST
WANT TO JUST OFFER AN
OPPORTUNITY FOR THE OPPOSITION
TO SPEAK TO ON THIS IS THE
REALITY IS THAT HOSPITALS HAVE
RECEIVED $9 BILLION IN, IN, IN
PROFITS, MOST RECENTLY,
ACCORDING TO RECENT STUDIES, ON
THE COST SIDE OF SEISMIC
RETROFITTING, WE ALSO HAVE THE
ISSUE OF WHEN A HOSPITAL IS
DOING A RETROFIT, THERE'S ALSO
AN OPPORTUNITY TO BUILD A
BEAUTIFUL LOBBY AND DO OTHER
THINGS THAT ARE NOT, NECESSARY
FOR THE PURPOSE OF ENSURING THAT
A HOSPITAL IS OPERATIONAL PAST
THE, ACCORDING TO THE 2030,
SEISMIC RETROFITTING GOALS THAT
WE HAVE IN PLACE. SO MY QUESTION
IS, ONE, IS, IS THERE AN
OPPORTUNITY TO ENSURE IN THIS
LEGISLATION THAT WE ARE ACTUALLY
CALCULATING COSTS AROUND THE
COSTS ASSOCIATED WITH HAVING,
OPERATIONAL FACILITY AS OPPOSED
TO THE ADDITIONAL COSTS THAT ARE
NICE TO HAVE FOR CONSUMERS BUT
ARE NOT RELATED TO THE SPECIFICS
OF THE HOSPITAL? AND
SECONDARILY, IS THERE A WAY FOR
US TO BE ABLE TO KNOW THAT WE'RE
MOVING FORWARD WITH THE ACTUAL
PLAN? THAT THE HOSPITAL IS
PRESENTING? THIRD ISSUE FOR ME
IS AROUND TO YOUR SENATOR POINT
OF NOT ONE SIZE FITS ALL. I
THINK ONE OF THE CHALLENGES THAT
I'VE HEARD IN CONVERSATION OVER
MULTIPLE MEETINGS IS THIS,
AUTOMATIC EXTENSION, THREE YEAR
EXTENSION, AND THAT BEING
PROBLEMATIC BECAUSE THERE ARE
HOSPITALS THAT ARE KIND OF
MOVING TOWARDS BEING ABLE TO BE
ON TRACK AND DON'T NEED THAT
ADDITIONAL TIME. SO WE WANT THEM
TO KEEP ON THEIR, ON THEIR
STATUS. SO I JUST WANTED TO HAVE
AN OPPORTUNITY FOR THE
OPPOSITION TO SPEAK TO ANY KEY
ISSUES THAT THEY WILL BE
LISTENING TO, HAVING MOVEMENT
ON, OVER TIME AS THIS CONTINUES,
SHOULD GET OUT OF THIS
COMMITTEE. BUT THOSE ARE THE
CONCERNS THAT I WANT TO MAKE
SURE I GET ADDRESSED AS WE
CONSIDER THIS BILL. SO MATT LÀ
AND JUST APPRECIATE THOSE
QUESTIONS. I THINK PARTICULARLY
THE BLANKET EXTENSION WANTS
SUBMITTING A PLAN IS ONE WHERE
WE FIND THE MOST PROBLEMATIC,
BECAUSE WE DO THINK THAT IS
GOING TO JUST MAKE CALIFORNIA
LESS SAFE, BECAUSE YOU'RE GOING
TO HAVE HOSPITALS TAKE THE
ADDITIONAL THREE YEARS AND
APPRECIATE THE PANDEMIC AND
APPRECIATE WHAT HOSPITALS WENT
THROUGH. AND, YOU KNOW, OUR
WORKERS ARE FACING THOSE
CHALLENGES. BUT THOSE CHALLENGES
ALSO ARE UNDERSCORED BY, YOU
KNOW, WHAT WORKERS DIDN'T HAVE
DURING THE PANDEMIC AND HOW WE
WEREN'T PREPARED. AND SO I WOULD
HATE TO REPEAT REPEAT THAT
MISTAKE BY HAVING OUR HOSPITALS
NOT BE PREPARED AGAIN AND
WORKERS NOT HAVING THE TOOLS
THEY NEED, AS WE WERE TALKING
ABOUT THE STRUCTURAL STANDARDS,
ONE NOTE I WROTE DOWN IS, YOU
KNOW, YES, HOSPITALS HAVE MET
THE STRUCTURAL STANDARDS, BUT
WHAT THAT REALLY MEANS FOR
NURSES AND HEALTH CARE WORKERS
IN THE HOSPITAL IS THAT THEY'LL
STILL BE EVACUATING PATIENTS.
THEY'LL BE EVACUATING PATIENTS
WITH ELECTRICAL WIRES. AND THIS
WAS THE CASE IN NORTHRIDGE AND
WATER AND NOT BEING ABLE TO USE
THE ELEVATORS, WHICH AS SOMEONE
WHO PERSONALLY HAS MOVED
PATIENTS AROUND A HOSPITAL, I
WILL TELL YOU THAT IS INCREDIBLY
PROBLEMATIC. AND TO THINK YOU'RE
DOING THAT DURING AN EMERGENCY
WHERE YOU DON'T HAVE THE SUPPORT
THAT YOU TYPICALLY WOULD HAVE
AND DOING IT UNDER JUST NOT
IDEAL CIRCUMSTANCES IS GOING TO
HAVE REAL IMPACT ON PATIENT CARE
AND PATIENT AND OUR VULNERABLE
PATIENTS WHO MAYBE CAN'T
MAINTAIN AND, CONTINUE TO CARE
FOR IT IN THE PLACE. SO I WOULD
SAY THE BLANKET EXTENSION ON THE
FIRST YEAR IS REALLY THE FOR AT
LEAST SEIU, ONE OF OUR MOST
PROBLEMATIC PIECES. WE DO
APPRECIATE THE CONVERSATION WITH
BOTH THE AUTHOR AND SPONSOR
AROUND, YOU KNOW, TRYING TO MAKE
SURE WE'RE GETTING TO THE REAL
COST OF THE RETROFIT. AND WE'VE
SEEN, YOU KNOW, SORT OF WILD
NUMBERS OUT THERE, ON TERMS OF
THE TOTAL COST OF COMPLIANCE.
BUT WHEN WE SORT OF DUG INTO IT,
WE DO REALIZE THAT, YOU KNOW,
THERE'S THE COST OF REBUILDING
COMPLETELY. THERE'S ALSO THE
COST OF THE RETROFITTING. BUT
SOMETIMES IT'S LITERALLY PUTTING
BRACING AROUND PIPES TO MAKE
SURE THAT THE PIPES ARE NOT
GOING TO BREAK DOWN. AND SO
THOSE CAN BE TWO WILDLY
DIFFERENT COSTS. AND JUST
APPRECIATE THAT THERE IS SOME
OPPORTUNITY TO GET TECHNICAL
ASSISTANCE FROM HØI TO TRY TO
ADDRESS THAT, SO AND THEN
LASTLY, YOU KNOW, WE HAVE
PROVIDED A NUMBER OF IDEAS ON
ACCOUNTABILITY AND HAPPY TO PUT
THAT IN LEGISLATIVE COUNCIL FORM
OR AND SUBMIT THAT TO THE AUTHOR
AS WE CONTINUE TO HAVE THOSE
CONVERSATIONS, SOME OF THOSE
COULD BE, FOR EXAMPLE, THAT
WE'VE DISCUSSED, LIKE, YOU KNOW,
HAVING A MONITOR ON THE BOARD TO
MAKE SURE THAT HOSPITALS ARE
PRIORITIZING COMPLIANCE WITH THE
LAW, AND SO LOOK FORWARD TO
CONTINUED CONVERSATIONS ON
THOSE. ALSO, YOU KNOW, BUILDING
PERMITS, YOU KNOW, HOSPITALS
OFTEN HAVE TO GET BUILDING
PERMITS AND REALIZING THAT, YOU
KNOW, IN A DAY, OFTENTIMES THIS
IS ABOUT PRIORITIZATION AND
MAKING SURE THAT THE HOSPITAL IS
PRIORITIZING THEIR ABILITY TO
PROVIDE CARE AFTER A MAJOR
EARTHQUAKE. SO MARIE LOPEZ,
CALIFORNIA NURSES ASSOCIATION
YES, WE AGREE WITH S¼ DÍAS
COMMENTS IN ADDITION TO THAT, WE
JUST WANT TO HIGHLIGHT THAT SOME
OF THESE HOSPITALS HAVE STATE OF
THE ART EQUIPMENT. THEY'RE
THEY'RE BRAND SPANKING NEW, AND
YET THEY'RE NOT IN COMPLIANCE
WITH THE SEISMIC REQUIREMENTS.
AND SO I THINK IT IS A MATTER OF
PRIORITIZATION. AND SO THE
TRANSPARENCY, AMENDMENTS THAT
HAVE BEEN ACCEPTED, WE
APPRECIATE THAT. BUT WE'RE ALSO
CONCERNED ABOUT THE ONE OFFS AS
WELL. WHAT'S TO PREVENT OTHER
HOSPITALS TO COME IN AND
INDIVIDUALLY ASKING FOR THEIR
HOSPITALS TO RECEIVE FURTHER
EXTENSIONS? AGAIN, IT'S BEEN 30
YEARS. WE'RE GAMBLING ON OUR
STATE NOT EXPERIENCING A MAJOR
EARTHQUAKE, AND THAT OUR
HOSPITALS ARE GOING TO BE
PREPARED AND READY TO ACCEPT,
INJURED INDIVIDUALS THAT WE KNOW
ARE GOING TO BE LOOKING TOWARD
THE HOSPITALS, AND THE EMERGENCY
CREWS ARE GOING TO BE TAKING
THEM THERE. AND SO THEY NEED TO
BE PREPARED. AND I THINK OUR
STATE, POPULATION EXPECTS THAT.
AND YOU KNOW, AND DON'T AND, ARE
IN A PLACE WHERE THEY'RE,
THEY'RE NOT GOING TO THERE'S NO
OTHER PLACE FOR THEM TO BE
TAKEN, IN THE EVENT OF A MAJOR
CATASTROPHE. SO I THINK IT'S
REALLY, REALLY IMPORTANT THAT WE
REALLY, AGAIN, DRAW THAT LINE IN
THE SAND AND END THIS ONCE AND
FOR ALL. IF THERE'S ANY WAY FOR
YOU TO ADDRESS, PERHAPS THE
QUESTION THAT I RAISED AROUND.
ABSOLUTELY, ABSOLUTELY. MADAM
CHAIR, YOU ASKED ABOUT TWO ITEMS
AS I WROTE THEM DOWN. I I WROTE
IT AS CALCULATE THE OPERATIONAL
COSTS, AND HAVE AN ACTUAL PLAN.
BOTH OF THOSE ARE IN THE BILL.
AND, THERE IS NO AUTOMATIC THREE
YEARS EXTENSION. YOU HAVE TO
PRODUCE A PLAN. AND THE PLAN,
FOR EXAMPLE, HAS TO HAVE THE,
WHAT YOU HAVE DECIDED, IS IT A
RETROFIT OR IS IT A TEAR DOWN
AND REBUILD? WHAT IS IT GOING TO
COST? WHERE IS YOUR FINANCING
GOING TO COME FROM? WHAT ARE
YOUR BUILDING PLANS, WHAT DO
THEY LOOK LIKE? AND HAVE YOU
SUBMITTED THEM TO THE LOCAL
JURISDICTION TO GET APPROVAL,
HAVE YOU STARTED TO OBTAIN
PERMITS? IN OTHER WORDS, BASED
ON WHERE YOU ARE IN THE PROCESS,
YOU HAVE TO BE SPECIFIC ABOUT
WHERE YOU ARE AND WHAT YOU'RE
DOING. AND THAT'S THE ONLY WAY
YOU GET EXTRA TIME. OTHERWISE,
YOU'RE EXPECTED TO COMPLY WITH
THE 2030 MANDATE. AND AS YOU
SAID, AS MANY HAVE SAID, THERE
ARE SOME THAT ARE ON THAT
PATHWAY NOW, WHETHER THEY GET
FINISHED OR NOT IS THERE ARE ALL
KINDS OF FOR ANYBODY THAT'S EVER
DONE A CONSTRUCTION PROJECT,
ESPECIALLY A MULTI-MILLION
DOLLAR CONSTRUCTION PROJECT.
THERE ARE THINGS THAT HAPPEN,
WHETHER IT'S SUPPLY CHAIN
DISRUPTIONS OR, LACK OF STAFF OR
THE FINISHING TOUCHES TO GET A
BUILDING OPERATIONAL, WE HOPE
THAT, AS THE WITNESS STATED
TODAY, THEY GET DONE IN 2029,
WILL WILL THEY NEED EXTRA TIME?
PROBABLY NOT, AND WE EXPECT THEM
TO FINISH THAT. BUT IF THEY DO,
THEY CAN COME INTO HØI AND SAY,
HERE'S WHAT'S GOING ON AND
HERE'S WHAT HAS CAUSED THE
DELAY, AND HERE'S WHEN WE'LL BE
FINISHED. AND THEY WILL BE HELD
TO THOSE DATES, AND WE'VE GIVEN
H. Kò THE AUTHORITY TO BE ABLE
TO MAKE THAT DETERMINATION AND
THEN TO GIVE REPORTS TO THE
LEGISLATURE SO WE KNOW WHAT'S
GOING ON, THE CHALLENGE RIGHT
NOW IS THAT I THINK I CAN SAY
WITH A GREAT DEAL OF CERTAINTY
THAT IF SOMEONE RAN A BILL THAT
SAYS, MY HOSPITAL NEEDS EXTRA
TIME, THAT MOST OF US WILL BE
WOULD BE LOATH TO VOTE AGAINST
IT. WE BELIEVE DESPERATELY IN
HOSPITALS. WE WANT THEM TO
MAINTAIN THEIR SERVICES AND TO
STAY OPEN. AND WHAT LED ME DOWN
THIS PATH TO GET INVOLVED IN, IN
SEISMIC WAS, I SERVED ON THE
CITY COUNCIL WHEN WE HAD MAJOR
EARTHQUAKES AND NUMBER ONE IS
ALL THE CITIES WERE REQUIRED TO
DO AN ANALYSIS OF THEIR OLD
DOWNTOWNS TO DETERMINE WHETHER
THERE WERE THERE WERE RISKS. AND
ONCE THAT WAS DONE AND WE HAD
THAT REPORT, WE HAD ANOTHER
EARTHQUAKE. AND, AND IT IT
BECAME A MANDATE TO RETROFIT
THOSE DOWNTOWNS. IF OUR PLANS
SHOWED THAT THERE WAS RISK, WE
REQUIRED OUR SMALL BUSINESSES IN
THE DOWNTOWN TO DO A RETROFIT OF
UNREINFORCED MASONRY AND AFTER
YEARS OF EXTENDING IT AND
EXTENDING IT, WE FINALLY
REALIZED WE GOT TO PUT UP SOME
MONEY BECAUSE THEY DON'T. IT WAS
A DILAPIDATED DOWNTOWN, A LOT OF
HOMELESS. THE BUSINESSES DIDN'T
HAVE THE MONEY TO RETROFIT. SO
WE WENT TO OUR LOCAL COMMUNITY
BANK WHERE WE HAD OUR CITY MONEY
, AND WE SAID, OUR MONEY'S IN
YOUR BANK. YOU'RE A COMMUNITY
BANK. WE NEED TO WORK TOGETHER.
WE WILL WE WILL PROVIDE SURETY.
IF YOU DO LOW INTEREST TO NO
INTEREST LOANS. AND THAT'S WHAT
THEY DID. THEY MADE THOSE LOANS
AVAILABLE TO THE BUSINESS
COMMUNITY. THE CITY BACKSTOPPED
THEM. NEVER EVER HAD TO PAY OUT
EVER. BECAUSE EVERYBODY RETROFIT
IN. IT TOOK CARE OF THE
SITUATION. SO THE ISSUE WITH
THIS IS TO GET US SET UP SO WE
KNOW WHAT ARE THE HOSPITALS THAT
ARE AT RISK OF HAVING THE MOST
TROUBLE RETROFITTING AND AT SOME
DATE IN THE FUTURE THERE THERE
MAY NEED TO BE A BOND OR THERE
MAY NEED TO BE GENERAL FUND
RESOURCES. OR, IF WE'RE REALLY
LUCKY, THE, THE MCO TAX STARTS
PAYING AND DOING AN ADEQUATE JOB
OF DOING REIMBURSEMENT FOR
HEALTH CARE COSTS. AND THE
HOSPITALS WILL HAVE THE MONEY TO
DO IT THEMSELVES. AND SO BUT ONE
WAY OR ANOTHER, WE NEED DATA, WE
NEED INFORMATION. WE NEED TO
GIVE HCCI THAT OPPORTUNITY TO BE
ABLE TO MAKE SOME DECISIONS AND
TO DO IT IN A WAY THAT THAT
KEEPS THEIR FEET TO THE FIRE AND
THE PLAN THAT'S ENVISIONED IN
HERE IS HAS TO BE DETAILED
ENOUGH SO WE KNOW EXACTLY WHAT
THEIR PLAN IS. AND WHEN, WHEN'S
THE TRIGGER. AND THEN IF THEY
ASK FOR ANY ADDITIONAL TIME, IF
THEY ASK FOR THAT THREE YEAR
EXTENSION, THE LOCAL COMMUNITY
AND THE LOCAL UNIONS GET THE
INFORMATION OF WHY. WHY ARE THEY
ASKING FOR IT? AND AT THAT POINT
THEY CAN, LOBBY HCCI AND MAKE
PUBLIC COMMENTS AS PART OF THE
PROCESS AND SAY NO, THEY
SHOULDN'T GET ANY MORE TIME
BECAUSE THEY SHOULD HAVE THEY
SHOULD ALREADY HAVE DONE IT AND
GIVE GOOD DATA IN ORDER TO
ENSURE THAT. SO WHAT WE'RE
TRYING TO DO IS TO CREATE THIS
SYSTEM WHERE IT IT IS INEXORABLY
MOVING TOWARDS, US UNDERSTANDING
THAT, THAT IF SOMEONE SHOWS UP
HERE IN THE FUTURE AND THEY
HAVEN'T DONE WHAT THEIR PLAN
SAYS, AND THEY HAD THE RESOURCES
TO DO IT, THAT THE LEGISLATURE
HAS THE BACKBONE TO SAY, NO, NO,
YOU'VE HAD ALL THIS TIME, AND
WE'RE NOT GOING TO GIVE IT TO
YOU. BUT THAT'S A TOUGH THAT'S A
TOUGH CALL. WE GOT TO WE GOT TO
GET THE DATA BEFORE WE'RE GOING
TO BE. I THINK THE LEGISLATURE
WOULD BE WILLING TO DO THAT.
NOBODY WANTS TO SEE THEIR
HOSPITAL CLOSED. I THINK WE ALL
AGREE WITH YOU THERE. I
APPRECIATE THE COMMENTS. DO YOU
HAVE ADDITIONAL CLOSING REMARKS
OR I'LL I'LL USE THAT AS MY
CLOSING. THANK YOU SO MUCH.
SENATOR. DO WE HAVE A MOTION
MOVED BY WEBBER, SECONDED BY
AGUIAR-CURRY. THANK YOU. THE
MOTION IS DUE. PASS AS AMENDED
TO APPROPRIATIONS. PLEASE CALL
THE ROLL. BONTA. I BONTA I
WALDRON WALDEN I, I CURRY ANGER.
CURRY I ARAMBULA WENDY CARILLO
WENDY CARILLO I LARA HANEY WOULD
WOULD. AYE. JACKSON. JACKSON.
AYE. MCCARTY JO. PATTERSON. JO.
PATTERSON. AYE RODRIGUEZ.
SANCHEZ SANCHEZ. AYE. SANTIAGO.
SANTIAGO. I CHAVO. WEBER. WEBER.
AYE. THAT MEASURES OUT 10 TO 0.
THANK YOU. SENATOR. THANK YOU
VERY MUCH. MOVING ON TO ITEM. 15
SB 1354. WAHAB.
THANK YOU. SENATOR, WHENEVER
YOU'RE READY. THANK YOU. FEELS
LIKE I WAS HERE JUST YESTERDAY.
RIGHT. ALL RIGHT. CHAIR,
COLLEAGUES AND MEMBERS OF THE
PUBLIC, SB 1354 CODIFIES
REGULATIONS REGARDING SKILLED
NURSING FACILITIES AND PROTECTS
THE RIGHTS OF RESIDENTS,
REGARDLESS OF THEIR PAYMENT
SOURCE. SB 1354 ALSO REQUIRES
FACILITIES TO INFORM RESIDENTS
BEING TRANSFERRED OR DISCHARGED
THAT THEY MAY BE ELIGIBLE FOR
MEDI-CAL LONG TERM CARE PROGRAM
TO HELP PAY FOR THEIR STAY. FOR
DECADES, NURSING HOMES HAVE
FOUND WAYS OF DISCRIMINATING TO
REDUCE THEIR MEDI-CAL POPULATION
AND FREE BEDS UP TO MAKE SPACE
FOR MORE PRIVATE PAY OR MEDICARE
RESIDENTS. THIS DISCRIMINATION
FORCES LOW INCOME SENIORS TO
MOVE AWAY FROM FAMILY, FRIENDS
AND THEIR HEALTH CARE PROVIDERS
IN ORDER TO ACCESS A FACILITY
THAT WILL ACCEPT MEDI-CAL. SB
1354 WILL STRENGTHEN AND ENHANCE
THE RIGHTS OF RESIDENTS IN THEIR
FACILITIES AND PROTECT AGAINST
DISCRIMINATION BASED ON THEIR
PAYMENT SOURCE. I'D LIKE TO
INTRODUCE TWO WITNESSES. BLANCA
CASTRO, STATE LONG TERM CARE
OMBUDSMAN FROM THE OFFICE OF THE
STATE LONG TERM CARE OMBUDSMAN,
AND HELEN HALLDORSON, STAFF
ATTORNEY WITH THE CALIFORNIA
ADVOCATES FOR NURSING HOME
REFORM, OTHERWISE KNOWN AS
CANNOR. THANK YOU, THANK YOU.
EACH HAVE TWO MINUTES. PRESS THE
BUTTON. CAN YOU HEAR ME? GOOD
AFTERNOON. COMMITTEE MEMBERS. MY
NAME IS HELEN HALDERSON, AND I'M
A STAFF ATTORNEY AT CALIFORNIA
ADVOCATES FOR NURSING HOME
REFORM. A STATEWIDE NONPROFIT
ORGANIZATION WHICH ADVOCATES TO
IMPROVE THE QUALITY OF CARE IN
CALIFORNIA'S NURSING HOMES. AND
WE'RE PROUD TO CO-SPONSOR SB
1354. SB 1354 AIMS TO PUT AN END
TO MEDI-CAL DISCRIMINATION IN
NURSING HOMES THROUGH MINIMAL
CHANGES, WHICH REQUIRE
FACILITIES TO MAKE INFORMATION
MORE ACCESSIBLE AND DISCOURAGE
BAD ACTORS FROM ENGAGING IN
ILLEGAL AND DISCRIMINATORY
PRACTICES. IT'S IMPORTANT TO
NOTE THAT PARTICIPATION IN THE
MEDI-CAL PROGRAM IS COMPLETELY
VOLUNTARY. ABOUT 85% OF
CALIFORNIA FACILITIES CHOOSE TO
RECEIVE THESE PAYMENTS, AND WHEN
THEY DO, SIGN A PROVIDER
AGREEMENT AND COLLECT MEDI-CAL
FUNDS, THEY AGREE TO COMPLY WITH
FEDERAL AND STATE LAWS THAT
PROHIBIT DISCRIMINATION AGAINST
MEDI-CAL PARTICIPANTS. CANADA
RECEIVES HUNDREDS OF CALLS
ANNUALLY FROM CONSUMERS ACROSS
CALIFORNIA WHO REPORT MEDI-CAL
DISCRIMINATION AT THE POINT OF
PLACEMENT, OR WHEN THEIR SHORT
TERM MEDICARE STAY HAS ENDED AND
THEY NEED TO REMAIN IN A
FACILITY. DISCRIMINATION DURING
THE ADMISSIONS PROCESS IS FUELED
BY A POPULAR INDUSTRY MODEL
BUILT ON MAXIMIZING MORE
LUCRATIVE SHORT TERM MEDICARE
STAYS AND AVOIDING LONG TERM
MEDI-CAL RESIDENTS. FACILITIES
CAN BILL MEDICARE UP TO $1,000,
OR SOMETIMES $1,400 A DAY, AS
COMPARED TO MEDI-CAL RATES,
WHICH AVERAGE 250 TO $300 A DAY.
FAMILIES REPORT CALLING UP TO 20
NURSING HOMES TRYING TO FIND A
BED FOR THEIR LOVED ONE, ALL TO
BE TOLD THE SAME FALSE STORY
THAT THEY ARE SHORT TERM ONLY OR
THERE ARE NO LONG TERM BEDS
AVAILABLE. ANOTHER COMMON SOURCE
OF DISCRIMINATION IS AT THE
POINT WHEN MEDICARE COVERAGE
ENDS AND RESIDENTS SWITCH TO
MUCH LOWER MEDI-CAL RATES. MANY
FACILITIES USE THIS SWITCH AS AN
OPPORTUNITY TO MISINFORM
RESIDENTS OF THEIR RIGHTS TO
STAY, RESULTING IN PEOPLE BEING
FORCED INTO UNSAFE DISCHARGE
SITUATIONS SUCH AS A RECENT
CANCER CALLER WHO WAS
NON-AMBULATORY AND STILL HAD A
NEED FOR SKILLED NURSING. BUT
AFTER HIS MEDICARE DAYS WERE UP,
HE WAS DISCHARGED TO A SECOND
STORY MOTEL ROOM THAT COULD NOT
ACCOMMODATE HIS WHEELCHAIR. HE
WAS DISCHARGED TO THE MOTEL
WITHOUT NECESSARY FOLLOW UP CARE
AND LATER DIED. VULNERABLE
SENIORS WITH ONGOING NEEDS FOR
SKILLED NURSING SERVICES
ROUTINELY END UP DUMPED INTO
HOMELESS SHELTERS, MOTELS OR
HOMES WITH CLEARLY INADEQUATE
CARE AND SUPERVISION. FOR THESE
REASONS, WE REQUEST YOUR AYE
VOTE ON SB 1354. THANK YOU. TWO
MINUTES. GOOD AFTERNOON. GOOD
AFTERNOON, MADAM CHAIR BONTA AND
ESTEEMED MEMBERS OF THE ASSEMBLY
HEALTH COMMITTEE. MY NAME BLANCA
CASTRO, AND I AM THE LONG TERM
CARE OMBUDSMAN FOR CALIFORNIA. I
REPRESENT THE 35 LOCAL LONG TERM
CARE OMBUDSMAN PROGRAMS, AND WE
ARE A PROUD SPONSOR OF SB 1354.
WE WANT TO APPLAUD SENATOR WAHAB
FOR CHAMPIONING A CRITICAL
PROBLEM IN OUR STATE'S LONG TERM
CARE SYSTEM. I WISH WE DIDN'T
NEED THIS BILL, BUT
UNFORTUNATELY, WHILE THE FEDERAL
AND STATE LAWS CLEARLY STATE
DISCRIMINATION AGAINST MEDI-CAL
BENEFICIARIES IS ILLEGAL, IT
CONTINUES TO HAPPEN. SO I'M
GOING TO JUST SHARE A VERY BRIEF
STORY WITH THE COMMITTEE JUST TO
DEMONSTRATE HOW THIS IS
IMPACTING OUR ELDERS AND ADULTS
WITH DISABILITIES IN CALIFORNIA.
IN JUNE OF JUST LAST YEAR, ONE
OF THE LONG TERM CARE FACILITIES
, SKILLED NURSING FACILITIES IN
SAN DIEGO COUNTY, DECIDED TO
CLOSE DUE TO THE COST OF DOING
BUSINESS. THERE WERE 74
RESIDENTS WHO WERE GIVEN 60 DAYS
TO BE TRANSFERRED TO A NEW
NURSING HOME. ON SEPTEMBER 7TH,
THERE WERE 30 RESIDENTS THAT
WERE STILL UNABLE TO FIND
PLACEMENT. THE KIND OF RESPONSES
THAT WE RECEIVED ARE WE DON'T
ACCEPT CUSTODIAL CARE, WE ONLY
HAVE SHORT TERM AND WE DON'T
ACCEPT LONG TERM. WE DON'T HAVE
LONG TERM BEDS. ON SEPTEMBER
26TH, WE HAD FIVE REMAINING
RESIDENTS, ALL MEDI-CAL
BENEFICIARIES, ONE HEALTH PLAN
PAID A FACILITY ADDITIONAL MONEY
JUST TO GET THEIR MEMBER IN.
I'LL NEVER FORGET THE LAST
PERSON WE FINALLY WERE ABLE TO
PLACE. SHE HAS DEMENTIA, HER
HUSBAND IS IN DECLINING HEALTH
AND HE WAS TAKING A BUS TO GO
SEE HER EVERY DAY. SHE WAS GOING
TO HAVE TO GO TO RIVERSIDE
COUNTY BECAUSE WE WERE UNABLE TO
SECURE A BED. ON OCTOBER 11TH,
WE FINALLY RECEIVED THE NEWS
FROM HER CASE MANAGER FROM THE
HEALTH PLAN THAT SHE HAD SHARED
WITH HER HUSBAND. THE GOOD NEWS
HIS WIFE WOULD BE GOING TO A
LOCAL SNIFF AND HE CRIED HAPPY
TEARS. I ASKED FOR YOUR SUPPORT
OF SB 1354. THANK YOU. THANK
YOU. ANY OTHER WITNESSES IN
SUPPORT IN THE ROOM? YES. THANK
YOU FOR WAITING. FAITH LEE. WITH
ASIAN AMERICANS ADVANCINGJUSTICE
SOUTHERN CALIFORNIA. WE'RE IN
SUPPORT. THANK YOU. THANK YOU.
ARE THERE ANY PRIMARY WITNESSES
IN OPPOSITION?
I AM NOT A PRIMARY WITNESS IN
OPPOSITION. I DID WANT TO STATE
THAT LEADING EDGE CALIFORNIA HAS
REMOVED THEIR OPPOSITION AND
WANTED TO THANK THE AUTHOR FOR
HER MOST RECENT AMENDMENTS.
THANK YOU. THANK YOU. WITH THAT,
I'LL BRING IT BACK TO THE
COMMITTEE FOR QUESTION OR
COMMENT. DOCTOR, WOULD, FIRST OF
ALL, THANK YOU, SENATOR WAHAB,
FOR BRINGING THIS BILL FORWARD.
AND I, TOO, WISH IT WASN'T
NECESSARY, MY QUESTION IS, BY
PUTTING THIS INTO INTO LAW, IS
ARE THERE ANY PENALTIES
ASSOCIATED WITH A NURSING HOME
THAT WOULD, BE FOUND GUILTY OF
DISCRIMINATION OTHER THAN LEGAL
RECOURSE, WHICH WE KNOW WOULD BE
A CHALLENGE FOR SOMEONE WHO IS
IN A NURSING HOME, MAYBE EVEN
SOMEBODY WHO DOESN'T HAVE
SOMEONE WHICH IS WHY WE HAVE AN
OMBUDSMAN PROGRAM. SO IS THERE
ARE THERE ANY ANY REMEDIES, SAY
A STICK THAT HELPS PREVENT THIS
ACTIVITY BEYOND BEYOND WHAT WE
WOULD PUT INTO STATUTE.
CURRENTLY THERE ARE NO PENALTIES
ATTACHED TO THIS, TO THIS BILL.
WE NEED THIS BILL SO THAT WE CAN
DEMONSTRATE TO THE REGULATORY
AGENCIES, THE DEPARTMENT OF
PUBLIC HEALTH, DEPARTMENT OF
HEALTH CARE SERVICES, THAT THIS
IS HAPPENING BECAUSE THAT'S BEEN
ONE OF THEIR CHALLENGES. UNLESS
WE CAN PROVE THAT THIS THAT
THERE WAS AN OPEN BED AND THAT
WE WERE GIVEN INFORMATION THAT
WAS CONTRARY TO THAT, BASED ON
THE PERSON'S PAYMENT SOURCE,
THEY'RE UNABLE TO TAKE ANY
ACTION. SO OUR HOPE IS THAT THIS
WILL BE ABLE TO BUILD UP THAT
CASE, AND THEY WILL THEN BE ABLE
TO EFFECTIVELY ISSUE PENALTIES.
GREAT. WELL, THANK YOU, DOCTOR.
WOULD, AND ONCE AGAIN, THANK
YOU, SENATOR, FOR BRINGING THE
BILL FORWARD. AND, SHOULD THE
BILL MAKE IT OUT OF COMMITTEE
TODAY, IF YOU'RE ENTERTAINING
COAUTHORS, I'D LIKE TO BE
CONSIDERED ADDED. THANK YOU,
THANK YOU. I DON'T THINK THAT
THERE ARE ANY OTHER COMMENTS
FROM THE COMMITTEE. I WANT TO
THANK SENATOR WAHAB FOR BRINGING
THIS FORWARD. WE CONTINUE TO
SHARE, VERY COMMON CONCERN WITH
OUR SKILLED NURSING FACILITIES
AND THE FACT THAT WE ACTUALLY
DON'T HAVE WE'RE CAPACITY TO BE
ABLE TO SUPPORT, AND WE
CERTAINLY DON'T WANT THE ONES
THAT ARE AVAILABLE TO BE
DISCRIMINATING IN THIS WAY BASED
ON INCOME. SO VERY THOUGHTFUL,
BILL. THANK YOU FOR BRINGING IT
FORWARD WITH THAT. WOULD YOU
LIKE TO CLOSE? YES, I JUST WANT
TO HIGHLIGHT A LOT OF THE WORK
THAT I TRY TO DO IS GENUINELY
FOR THE MOST VULNERABLE
COMMUNITY MEMBERS. AND OUR
FASTEST GROWING POPULATION IS
OUR SENIORS. AND MANY OF US,
LIKE MYSELF, ARE STRUGGLING TO
EITHER CONSIDER BUYING A HOME,
PAYING OFF STUDENT DEBT, TAKING
CARE OF OUR AGING PARENTS, OR
STARTING OUR OWN FAMILY. AND I
THINK THAT WE DO NEED TO MAKE A
SIGNIFICANT INVESTMENT IN
SAFEGUARDING THE RIGHTS OF THE
VULNERABLE COMMUNITIES. BUT ALSO
INVESTING MORE FINANCIALLY, EVEN
IF IT IS A TOUGH BUDGET YEAR, SO
WITH THIS BILL, I DO APPRECIATE
THE COMMENTS, BUT I ALSO WANT TO
JUST RESPECTFULLY ASK FOR AN AYE
VOTE AND HOPEFULLY LOOKING
FORWARD TO WORKING TOGETHER ON
OTHER THINGS TOGETHER. THANK
YOU. WITH THAT, THE MOTION Ó,
WE NEED A MOTION. AND A SECOND
MOVED BY MOVED BY JACKSON,
SECONDED BY SANTIAGO. THANK YOU.
MOTION IS DUE. PASS TO
APPROPRIATIONS. PLEASE CALL THE
ROLL. BONTA I BONTA I WALDRON, I
CURRY ARAMBULA. WENDY CARILLO.
WENDY CARILLO I FLORA HANEY
WOULD WOULD. AYE. JACKSON
JACKSON. AYE. MCCARTY. JO.
PATTERSON RODRIGUEZ. SANCHEZ
SANTIAGO. SANTIAGO. I CHAVO.
WEBER WEBBER. AYE. THAT MEASURES
ON CALL. WE'LL MOVE ON TO OUR
NEXT ITEM, WHICH IS, ITEM SEVEN,
SB 966 BY WIENER. WHILE HE'S
COMING UP HERE, I WANT TO THANK,
DOCTORS JACKSON AND WOOD FOR
COMING TO SUBSTITUTE TODAY. IT'S
GREAT TO HAVE YOU HERE. I THINK
THIS IS THE MOST DOCS WE'VE HAD
IN THE IN THE ROOM. WHENEVER
YOU'RE READY, SENATOR.
THANK YOU VERY MUCH, MADAM
CHAIR, COLLEAGUES, I'M HERE
TODAY TO PRESENT SENATE BILL
966, WHICH WILL REQUIRE THAT
PHARMACY BENEFIT MANAGERS OR
PBMS BE LICENSED UNDER THE
DEPARTMENT OF INSURANCE, WHICH
IS NOT THE CASE. NOW, THEY DON'T
HAVE TO BE LICENSED, AND WE'LL
ALSO PROVIDE GREATER
TRANSPARENCY AND, PROHIBIT
CERTAIN PRACTICES THAT ARE
DRIVING UP THE COST OF DRUGS AND
OF THE HEALTH CARE SYSTEM,
COLLEAGUES, IF YOU HAVE NOT SEEN
JUST IN THE LAST FEW DAYS, THERE
WERE MAJOR, EXPOSÉS IN BOTH THE
NEW YORK TIMES AND THE WALL
STREET JOURNAL, VERY ARTICLES
ABOUT HOW PBMS ARE, IN FACT,
DRIVING UP DRUG COSTS AND ARE
PUSHING COMMUNITY PHARMACIES OUT
AND ARE DOING ALL OF THIS IN A
WAY THAT HARMS, CONSUMERS, AND I
WOULD ENCOURAGE YOU, IF YOU
HAVEN'T SEEN IT, TO READ THESE
ARTICLES, BECAUSE THEY ARE
EXTREMELY POWERFUL, PBMS ARE THE
MIDDLEMEN OF THE HEALTH CARE
INDUSTRY, AND, THEY STARTED OUT,
DECADES AGO AS RATHER SMALL
ADMINISTRATIVE BODIES TO HELP
HEALTH PLANS NEGOTIATE, PUT
TOGETHER FORMULARIES, NEGOTIATE
DRUG PRICES, THEY'VE GROWN OVER
THE YEARS, PARTICULARLY OVER THE
LAST 6 OR 8 YEARS INTO ABSOLUTE
CORPORATE BEHEMOTHS THAT OWN
THEIR OWN, PHARMACIES, THAT,
FORCE OR STRONGLY ENCOURAGE
PEOPLE TO USE THEIR PHARMACIES
INSTEAD OF OTHER PHARMACIES,
THAT, TAKE, HAVE AN INCENTIVE TO
INCREASE THE COST OF DRUGS AND
TO FAVOR MORE EXPENSIVE DRUGS
OVER LOWER COST GENERIC DRUGS,
AND THEY HAVE DONE ALL THIS AND
TAKEN ON THIS MASSIVE ROLE IN
THE HEALTH CARE SYSTEM WITH
REMARKABLY LITTLE OVERSIGHT,
TRANSPARENCY OR REGULATION. I
WANT TO THANK, SOME MEMBER WOOD
FOR HIS WORK ON THIS ISSUE OVER
THE YEARS IN TERMS OF
TRANSPARENCY. AND WE'RE REALLY
BUILDING ON THAT WORK, TODAY,
THERE ARE OVER 60 PBMS IN THE
US. BUT A LARGE MAJORITY OF
PRESCRIPTION DRUG CLAIMS ARE
PROCESSED BY JUST THREE PBMS,
WHICH CONTROL OVER 80% OF THE
MARKET. PBMS, ENGAGE IN VARIOUS
PRACTICES WHICH ARE OUTLINED IN
THE ANALYSIS, THAT ARE NOT GOOD
FOR THE HEALTH CARE SYSTEM. FOR
EXAMPLE, HAVING A, MAKING MONEY
THROUGH REBATES, A PERCENTAGE OF
THE COST OF THE DRUGS. AND SO
THEY WILL HAVE AN INCENTIVE TO
HAVE A HIGHER PRICE PAID BY THE
HEALTH PLAN. AND THEN TO
NEGOTIATE THAT, THAT BE REDUCED,
AND THEN THE POCKET, A PORTION
OF THAT, REDUCTION, AND SO
AGAIN, IT'S JUST AN INCENTIVE TO
GO WITH THE HIGHER, COST, AS I
MENTIONED, THEY OWN THEIR OWN
PHARMACIES AND ENGAGE IN
PRACTICES. FOR EXAMPLE, BY
SAYING THAT YOU CAN GET A 90 DAY
SUPPLY IF YOU GET THE DRUG
THROUGH THEIR THEIR PHARMACY,
THROUGH MAIL ORDER. BUT IF YOU
DARE TO INSIST ON USING YOUR
NEIGHBORHOOD PHARMACY, YOU ONLY
GET A 30 DAY SUPPLY. SO MAKING
LIFE MORE DIFFICULT FOR THE
PATIENT AND CREATING AN
INCENTIVE TO USE THE PBMS
PHARMACY INSTEAD OF THE
COMMUNITY PHARMACY, THERE'S A
PRACTICE CALLED SPREAD PRICING,
WHICH MEANS THAT THEY GET PAID A
HIGHER AMOUNT BY THE HEALTH
PLAN, PAY A LOWER AMOUNT TO THE
COMMUNITY PHARMACY, AND POCKET
THE DIFFERENCE, AND AGAIN, ALL
OF THESE PRACTICES DRIVE UP,
COSTS ARE DONE WITH VERY LITTLE
TRANSPARENCY AND ARE HARMFUL TO
THE SYSTEM, SO, COLLEAGUES, THIS
BILL, IT'S TIME HAS COME. IT'S
TIME TO PUT REASONABLE
REGULATIONS ON PBMS, AND I
RESPECTFULLY ASK FOR YOUR AYE.
VOTE, WITH ME TODAY TO TESTIFY
IS DOCTOR CLINT HOPKINS.
PHARMACIST AND OWNER OF PUCCI'S
PHARMACY, A COMMUNITY PHARMACY
HERE IN SACRAMENTO. AND THEN,
PEDRO DEL COLLE, WHO IS A
PATIENT AT PUCCI'S PHARMACY. AND
THEN WE'RE ALSO JOINED FOR
TECHNICAL ASSISTANCE. IF
QUESTIONS COME UP BY RACHEL
BLUCHER, THE LEGAL COUNSEL FOR
THE CALIFORNIA PHARMACISTS
ASSOCIATION, ONE OF OUR
CO-SPONSORS. THANK YOU. YOU'LL
HAVE TWO MINUTES. AND FEEL FREE
TO REINTRODUCE. GOOD AFTERNOON,
MADAM CHAIR AND MEMBERS. I'M
DOCTOR CLINT HOPKINS, PHARMACIST
AND OWNER OF PUCCI'S PHARMACY,
INDEPENDENTLY OWNED HERE IN
SACRAMENTO SINCE 1930. AS
SENATOR, WIENER EXPRESSED, PBMS
NOW DOMINATE NOT ONLY THE
PHARMACY MARKET, BUT ALSO THE
HEALTH CARE MARKET AT LARGE.
THEY OWN HEALTH PLANS, THE
PHARMACY DOWN THE STREET, THE
SWITCH THAT PROCESSES OUR
CLAIMS, THE MAIL ORDER PHARMACY
TO WHICH THEY STEER OUR PATIENT
PATIENTS AND THEY DICTATE THE
CONTRACTS THAT UNDERPAY AND
FORCE PHARMACIES OUT OF
BUSINESS. ALLOWING THIS INDUSTRY
TO CONTINUE UNREGULATED IS A
DANGER TO ALL CONSUMERS AND ALL
HEALTH CARE PROVIDERS. IN RECENT
YEARS, PBMS HAVE BEGUN
PURCHASING PHYSICIAN PRACTICES
AND CLINICS. CONTRACTS WITH PBMS
ARE NOT NEGOTIABLE AND
UNPRECEDENTED IN ANY OTHER
INDUSTRY. OUR REQUEST TO
NEGOTIATE FOR FAIR REIMBURSEMENT
ARE DENIED. THESE TAKE IT OR
LEAVE IT CONTRACTS FORCE
PHARMACIES TO TURN PATIENTS AWAY
THAT WOULD PREFER TO GET THEIR
MEDICATIONS FROM A PHARMACIST
THAT THEY KNOW AND TRUST, THAN
FROM THEIR MAILBOX FOR THE
DRUGS. WE DO DISPENSE. PBMS
CONTINUE TO FIND WAYS TO SCAM
PHARMACIES AND CONSUMERS, USING
PRICES SUCH AS EFFECTIVE RATES
AND SPREAD PRICING. THANKS TO
RECENT FEDERAL LEGISLATION, THE
PBM PRACTICE OF CLAWBACKS ON
MEDICARE CLAIMS WAS STOPPED IN
2024, BUT NOW INSTEAD, WE ARE
SERVED WITH CONTRACTS WITH
UNSUSTAINABLE RATES, FORCING
PHARMACISTS TO AGAIN TURN AWAY
PATIENTS. PBMS DETERMINE WHICH
MEDS ARE ON FORMULARIES,
OFTENTIMES CHOOSING A DRUG THAT
COSTS THE PATIENT MORE. BUT THE
PBM PREFERS THE DRUG BECAUSE
THEY GET A LARGER MANUFACTURER
REBATE. THIS HIGH COST PAY TO
PLAY STRATEGY HAS RESULTED IN
SKYROCKETING COSTS OF BRAND NAME
MEDICATIONS, MAKING THEM
UNAFFORDABLE TO MANY PATIENTS. I
AM CERTAIN NO ONE IN THIS ROOM
CAN SAY THAT THEY HAVE RECEIVED
A REBATE CHECK FROM THEIR PBM.
PBMS JACK UP PRICES AND RETAIN
THOSE REBATES AS PROFITS. PBMS
AND THEIR LOBBYING GROUPS INSIST
THAT SPREAD PRICING IS IMPORTANT
TO EMPLOYERS. AS A BUSINESS
OWNER, I AM ALSO THE PURCHASER
OF HEALTH CARE FOR MY EMPLOYEES.
THERE ARE NO BENEFITS TO
MAINTAINING SPREAD PRICING
AGAIN, BECAUSE I'VE NEVER
RECEIVED ANY REBATE CHECK FROM A
PBM OR A HEALTH PLAN. MY COST TO
PURCHASE HEALTH CARE FOR MY
EMPLOYEES HAS ONLY GONE UP YEAR
OVER YEAR FOR DECADES. I WILL BE
MORE THAN HAPPY TO PROVIDE YOU
WITH EXAMPLES OF SPREAD PRICING
AND THE HARM DONE TO IT OR DONE
BY IT OUTSIDE OF THIS TESTIMONY,
WHICH I MUST DELIVER IN TWO
MINUTES OR LESS. REGARDING PBMS,
PLEASE TO MAINTAIN SPECIALTY
PHARMACIES, I RECENTLY HAD A
PATIENT WHO NEEDED A $14 A MONTH
PRESCRIPTION, A BOTTLE OF
GENERIC TRUVADA FOR HIV
PREVENTION, $14. I COULD NOT
FILL THAT PRESCRIPTION BECAUSE
THE PBM REFUSED TO ALLOW HIM TO
GET IT AT THE PHARMACY, BECAUSE
IT'S A SPECIALTY MEDICATION,
$14. HE CHECKED WITH HIS
EMPLOYER AND THEY KNEW NOTHING
OF THIS POLICY. EMPLOYERS DON'T
DEFINE THESE POLICIES. THE PBMS
DO FOR FAR TOO LONG, PBMS HAVE
OPERATED IN THE SHADOWS,
EXTRACTING EXORBITANT AMOUNTS OF
MONEY FROM THE SYSTEM THEY'VE
DESIGNED. PBMS ARE THE ONLY
ENTITY IN THE HEALTH CARE
CASCADE OPERATING UNLICENSED BY
THE STATE. WITHOUT LICENSURE,
PBMS WILL CONTINUE TO RUN AFOUL,
CAUSING PHARMACIES TO CLOSE
LOCAL JOBS TO BE LOST AND
PATIENTS TO LOSE ACCESS TO
HEALTH CARE IN THEIR
COMMUNITIES. THANK YOU. THANK
YOU. GOOD AFTERNOON, MADAM CHAIR
AND COMMITTEE. SO I'M ACTUALLY
JEFFREY COOK. DOCTOR. JEFFREY
COOK. OH, SORRY. THAT'S OKAY. NO
PROBLEM, SO, CHAIR, MEMBERS OF
THE COMMITTEE. MY NAME IS
JEFFREY COUCH. I TESTIFIED
REGARDING THIS BILL IN THE
SENATE HEALTH COMMITTEE ON APRIL
24TH. I ENCOURAGE YOU TO THE
COMMITTEE TO REVIEW THAT
TESTIMONY AS IT AS IT WAS
SUBMITTED TO THE PUBLIC RECORD
AND GIVEN IN PERSON. THE MAIN
THING I WANT THE COMMITTEE TO BE
AWARE OF REGARDING MY EXPERIENCE
WITH PHARMACY BENEFIT MANAGERS
IS THAT THEY DO HARM PATIENTS.
STRESS IS HARMFUL. THIS IS WELL
DOCUMENTED AND STUDIED.
ACCORDING TO THE AMERICAN
PSYCHOLOGICAL ASSOCIATION
REPORT, IN 2023, FINANCIAL
STRESS IS A LEADING CAUSE OF
STRESS, ESPECIALLY NOW IN THE
PRESENCE OF HIGH INFLATION. FOR
THE LAST TWO YEARS, AS I SEE IT,
THESE BUSINESSES WERE CREATED
FOR THE SOLE PURPOSE OF ACTING
AS INTERMEDIARIES BETWEEN
PHARMACIES, INSURERS, PATIENTS
AND DOCTORS UNDER THE GUISE OF
HELPING PATIENTS AND REDUCING
PRESCRIPTION DRUG DRUG COSTS.
HOWEVER, THEIR TRUE PURPOSE IS
TO EXTRACT EVER MORE PROFITS
FROM THE HEALTH CARE SYSTEM,
WITH PATIENTS PAYING THIS COST
THROUGH EVER INCREASING HEALTH
CARE PREMIUMS AND THROUGH POOR
HEALTH HEALTH OUTCOMES. THEY
ACCOMPLISH THIS BY DENYING
COVERAGE OF PRESCRIBED
MEDICATIONS, DELAYING COVERAGE
OF PRESCRIBED MEDICATIONS,
MAKING IT LESS LIKELY THAT
PATIENTS WILL GO THROUGH THE
PROCESS TO GET WHAT THEY NEED,
COMPLICATING AND DRAWING OUT THE
PROCESS OF REIMBURSEMENT FOR
PRIVATE COMMUNITY PHARMACIES,
EVEN CLAWING BACK MONEY FOR
MEDICATIONS THAT HAVE ALREADY
BEEN DISPENSED, THE LIST GOES
ON. I THINK IT HAS BECOME CLEAR
TO ANY REASONABLE PERSON THAT
OUR HEALTH CARE SYSTEM IS
FAILING, AND THAT THE PRIMARY
REASON IS NOT THE ACTUAL MEDICAL
CARE OR THE AVAILABILITY OF
MEDICATIONS TO TREAT MEDICAL
ISSUES. I PERSONALLY HAVE BEEN
BLESSED BY AMAZING DOCTORS,
PHARMACISTS, AND DRUGS THAT WORK
HARD TO KEEP ME ALIVE AND
HEALTHY, FOR THESE, I'M GRATEFUL
THE PROBLEM IS GREED AND PROFIT
EXTRACTION FROM HARD WORKING
AMERICANS. WE PAY MORE FOR LESS.
WE PAY MORE FOR LESS HEALTH CARE
THAN ANYWHERE ELSE IN THE WORLD
BY FAR. AS ALWAYS, WE JUST NEED
TO FOLLOW THE MONEY AND THE
INCENTIVES ARE VERY CLEAR. THESE
PBMS SHOULD NOT EVEN EXIST AT
ALL, IF YOU ASK ME. BUT TO LET
THEM CONTINUE TO OPERATE WITHOUT
ANY OVERSIGHT OR REGULATION IS
SIMPLY UNACCEPTABLE. THANK YOU
FOR YOUR, FOR YOUR TIME. AND I
ENCOURAGE AN AYE VOTE ON THIS
BILL. THANK YOU. YOU WANT TO
INTRODUCE YOURSELF FOR TECHNICAL
ASSISTANCE? YES. THANK YOU. YES.
THANK YOU. HI. RACHEL BLUE, ON
BEHALF OF THE CALIFORNIA
PHARMACIST ASSOCIATION, ONE OF
THE CO-SPONSORS, JUST HERE FOR
TECHNICAL ASSISTANCE. THANK YOU.
ARE THERE ANY OTHER WITNESSES
WHO WOULD LIKE TO TESTIFY IN
SUPPORT? DYLAN ELLIOTT, ON
BEHALF OF THE CALIFORNIA STATE
ASSOCIATION OF PSYCHIATRISTS IN
SUPPORT. ALEX KAHN, ON BEHALF OF
THE CALIFORNIA CHRONIC CARE
COALITION, A PROUD CO-SPONSOR,
AS WELL AS THE ALS ASSOCIATION
AND SUPPORT TIM MADDEN,
REPRESENTING THE CALIFORNIA
RHEUMATOLOGY ALLIANCE IN SUPPORT
. JENNIFER SNYDER, WITH CAPITAL
ADVOCACY ON BEHALF OF THE
CALIFORNIA LIFE SCIENCES AND THE
NATIONAL ASSOCIATION OF CHAIN
DRUG STORES IN SUPPORT. KATHY
MOSSBERG, ON BEHALF OF BOTH THE
SAN FRANCISCO AIDS FOUNDATION, A
PROUD CO-SPONSOR, AND APLA
HEALTH, BOTH IN SUPPORT. ARJUN
KRISHNA, ON BEHALF OF THE
CALIFORNIA MEDICAL ASSOCIATION,
WE'RE IN SUPPORT. THANK YOU,
MADAM CHAIR. MEGAN SUBERS, ON
BEHALF OF THE LOS ANGELES LGBT
CENTER CO-SPONSOR IN SUPPORT.
GOOD AFTERNOON. MOIRA TOP, ON
BEHALF OF BIOCOM CALIFORNIA, IN
SUPPORT. MADAM CHAIR MEMBERS,
RAND MARTIN, ON BEHALF OF THE
AIDS HEALTHCARE FOUNDATION,
WHICH OPERATES 14 COMMUNITY
PHARMACIES ACROSS THE STATE IN
VERY STRONG SUPPORT. THANK YOU.
MICHELLE RIVAS, CALIFORNIA
PHARMACISTS ASSOCIATION
CO-SPONSOR AND SUPPORT. FRED NÓ,
REPRESENTING PHRMA IN SUPPORT.
THANK YOU. GOOD AFTERNOON, MADAM
CHAIR AND COMMITTEE MEMBERS,
KATIE VAN DINES WITH HEALTH
ACCESS CALIFORNIA. WE'RE IN A
WIENER POSITION. WE HAVE BEEN IN
OPPOSING, AS AMENDED, POSITION,
BUT REALLY APPRECIATE THE AUTHOR
AND THE WORK OF THE SPONSORS AND
STAFF ON AMENDMENTS TO ADDRESS
OUR CONCERNS. WE'RE IN A
REVIEWING OUR POSITION POSITION
RIGHT NOW, BUT REALLY APPRECIATE
THE AUTHOR AND ALL OF THE WORK.
THANK YOU. THANK YOU. ARE THERE
ANY WITNESSES IN OPPOSITION?
YOU'LL EACH HAVE TWO MINUTES.
AND MEMBERS OF THE COMMITTEE. MY
NAME IS BILL HEAD WITH PCMA
HERE, RESPECTFULLY, IN
OPPOSITION TO SB 966, THE STATE
OF CALIFORNIA SPENDS BILLIONS OF
DOLLARS A YEAR ON PRESCRIPTION
DRUGS. OVER 300 MILLION,
PRESCRIPTIONS ARE FILLED EVERY
YEAR IN THE STATE. THAT'S A LOT
OF THAT'S A LOT OF MONEY AND
THAT'S A LOT OF PRESCRIPTIONS.
AND EMPLOYERS AND ORGANIZATIONS
RELY ON PBMS TO MANAGE THAT,
PARTICULARLY MANAGE THE COST OF
THAT. PBMS ARE THE ONLY ENTITY
IN THE SUPPLY CHAIN THAT EXERT
ANY DOWNWARD PRESSURE WHATSOEVER
ON THE COST OF PRESCRIPTION
DRUGS, AND THAT'S WHY THEY HIRE
US. NOBODY IS REQUIRED TO HIRE
US. THEY DO SO VOLUNTARILY, AND
THEY DO SO TO MANAGE THOSE COSTS
. WE ARE NOT OPPOSED TO THE IDEA
OF BEING LICENSED BY THE STATE
OR TRANSPARENCY. WE THINK
EVERYBODY SHOULD BE TRANSPARENT.
WE SHOULDN'T GET EVERYBODY'S
CARDS, SHOULD BE ON THE TABLE.
WE WOULD HAVE LIKED TO HAVE MORE
TIME AND OPPORTUNITY TO HAVE
BEEN INVOLVED IN THE DRAFTING OF
THE TRANSPARENCY. WE THINK WE
WOULD HAVE BEEN ABLE TO MAKE
SOME SIGNIFICANT IMPROVEMENTS.
FOR EXAMPLE, THERE'S INFORMATION
THAT WE'RE REQUIRED TO REPORT
THAT WE SIMPLY DON'T HAVE
BECAUSE IT'S INFORMATION THAT
CEOS WHO CONTRACT ON BEHALF OF
PHARMACIES HAVE. SO WE THINK WE
COULD HAVE MADE IMPROVEMENTS ON
THAT. BUT BEYOND THE LICENSING
AND REPORTING, THERE ARE OTHER
PROVISIONS IN THE BILL THAT GO
FAR BEYOND THAT. AND THEY
RESTRICT AND TAKE AWAY MANY OF
THE TOOLS THAT OUR CLIENTS RELY
ON TO MANAGE THEIR DRUG BENEFITS
. WE COMPLETELY AGREE WITH THE
COMMITTEE ANALYSIS OR THE
QUESTION RAISED IN THE COMMITTEE
ANALYSIS. IF YOU'RE GOING TO
REQUIRE ALL THIS REPORTING AND
THERE'S A MASSIVE AMOUNT OF IT
DOESN'T IT MAKE SENSE FOR THE
STATE FIRST TO ANALYZE THAT
REPORTING, LOOK AT WHAT THE DATA
TELLS YOU AND THEN MAKE PUBLIC
POLICY DECISIONS. AND FINALLY,
WHERE IS THE CONSUMER ON THIS? I
THINK THERE'S AN ASSUMPTION THAT
PATIENTS WILL BENEFIT, BUT
THERE'S NOTHING IN THE BILL THAT
DIRECTLY BENEFITS PATIENTS ON
THE CONTRARY, THIS IS GOING TO
INCREASE COSTS. THERE'S ONE
PROVISION IN THE BILL THAT WOULD
ALLOW PHARMACIES TO CHARGE ANY
PRICE THEY WANT FOR DISPENSING
DRUGS. FOR THESE REASONS, WE
RESPECTFULLY ASK THAT YOU NOT
ADVANCE THE BILL. THANK YOU.
JOHN WINGER HERE FOR AMERICA'S
HEALTH INSURANCE PLANS, WHERE
THE NATIONAL TRADE ASSOCIATION
FOR HEALTH PLANS AND HAVE BEEN
WORKING ON PBM ISSUES, BOTH
NATIONALLY AND IN OTHER STATES.
SO I APPRECIATE THE TIME TO
SPEAK. AS I'VE STATED BEFORE,
HEALTH PLANS, OTHER
SOPHISTICATED PURCHASERS LIKE
LARGE BUSINESSES, SELF-INSURED
UNION TRUSTS, PUBLIC EMPLOYERS,
THEY ALL HIRE PBMS FOR THE SOLE
PURPOSE OF LOWERING THEIR
PRESCRIPTION DRUG SPEND, I THINK
MR. HEAD TOUCHED ON THAT A
LITTLE BIT. I THINK FROM OUR
PERSPECTIVE, WE ALSO AGREE THAT
TRANSPARENCY IS GOOD, THAT
LICENSING WOULD MAKE SENSE, BUT
I THINK AS THE BILL HAS EVOLVED,
THERE CONTINUES TO BE ISSUES IN
THE BILL THAT WE, THAT WE HAVE,
I THINK AFTER THE SENATE
HEARING, WE SAW THE BILL GOING
IN A MORE POSITIVE DIRECTION AND
THOUGHT WE WERE GOING TO BE ABLE
TO WORK OFF OF THAT.
UNFORTUNATELY, A PRETTY
SIGNIFICANT AMOUNT OF AMENDMENTS
HAVE BEEN PUT INTO THE BILL,
FROM TECHNICAL ASSISTANCE FROM
VARIOUS AGENCIES THAT WE THINK
COMPLETELY GOES IN THE OPPOSITE
DIRECTION AS IT RELATES TO COST.
AND, OUR ABILITY TO KEEP OUR
DRUG SPEND DOWN. SO THE BAN ON
SPREAD PRICING REMAINS IN THE
BILL. WE'VE CONTINUED TO OBJECT
TO THAT, A LOT OF PURCHASERS
PREFER TO USE SPREAD PRICING TO
GET A LEVEL OF PREDICTABILITY ON
THEIR DRUG SPEND THROUGHOUT THE
YEAR. IT ALSO PROTECTS THEM FROM
NEW DRUGS COMING TO MARKET IN
THE MIDDLE OF THE YEAR. THAT
COULD, COMPLETELY UPEND THEIR,
THEIR DRUG SPEND. AND SO IT
GIVES THEM A LITTLE BIT OF
PREDICTABILITY THROUGH THE YEAR.
IT SHIFTS A LITTLE BIT MORE OF
THE RISK TO THE, TO THE PBM.
THROUGH THAT COMPENSATION MODEL.
SO WE THINK THAT THAT'S
SOMETHING THAT SHOULD BE A
CHOICE FOR, PURCHASERS. AND SO
WE'VE CONTINUED TO OBJECT TO
THAT. BUT A LOT OF THE NEW
AMENDMENTS, DO ELIMINATE A LOT
OF THE, THE NETWORK, THE ABILITY
TO, TO CREATE NETWORKS. AND WE
THINK NOT BEING ABLE TO COMPETE
ON COST AND QUALITY IS GOING TO
DRIVE UP, OUR DRUG SPENDS AND SO
WE CONTINUE TO HAVE ISSUES WITH
THAT, TO MR. HEAD'S POINT, WE
THINK THE TRANSPARENCY STUFF
COULD BE CLEANED UP AS WELL, BUT
UNFORTUNATELY THE PROCESS HAS
BEEN A LITTLE BIT DIFFICULT SO
FAR. AND SO WE ARE OPPOSED.
THANK YOU. I WILL NOW ASK IF
THERE ARE ANY OTHER WITNESSES
THAT WOULD LIKE TO COME UP TO
THE MIC TO VOICE THEIR
OPPOSITION. PLEASE GIVE YOUR
NAME, ORGANIZATION AND YOUR
POSITION ONLY. GOOD AFTERNOON,
CHAIR AND MEMBERS, MARTIN
VENDIOLA ON BEHALF OF THE
CALIFORNIA STATE ASSOCIATION OF
ELECTRICAL WORKERS AND THE
WESTERN STATES COUNCIL OF SHEET
METAL WORKERS, IN OPPOSITION.
THANK YOU. GOOD AFTERNOON, MADAM
CHAIR. MEMBERS OF THE COMMITTEE,
JED HAMPTON WITH CALIFORNIA
ASSOCIATION OF HEALTH PLANS, IN
OPPOSITION. MADAM CHAIR, MEMBERS
STEPHANIE WATKINS, ON BEHALF OF
THE ASSOCIATION OF CALIFORNIA
LIFE AND HEALTH INSURANCE
COMPANIES, ALSO OPPOSED ANTHONY
BUTLER TORRES WITH THE
CALIFORNIA HISPANIC CHAMBER OF
COMMERCE AND OPPOSE. THANK YOU
VERY MUCH. I WILL NOW BRING IT
BACK TO MEMBERS OF THE
COMMITTEE. IF ANYONE HAS ANY
QUESTIONS, ASSEMBLY MEMBER
JACKSON, THANK YOU VERY MUCH,
MADAM CHAIR. I HAVEN'T HAD MUCH
TIME TO REALLY DIVE INTO THIS.
I'M JUST A GUEST TODAY. SO THE
FIRST THING IS. AND FOR THE
SPONSORS, THE ARGUMENT FROM THE
OPPOSITION IN TERMS OF, THE THAT
THE BILL WOULD INCREASE COST,
WHAT WHAT DO YOU HAVE TO SAY
ABOUT THAT? DO YOU AGREE WITH
THAT ASSESSMENT, NO, I THINK WE
DISAGREE WITH THAT ASSESSMENT.
WE BELIEVE THAT TRANSPARENCY AND
AN UNDERLYING LICENSING SCHEME
WOULD REALLY HELP TO SPREAD SOME
LIGHT ON WHAT HAS BEEN THUS FAR
DONE IN SHADOWS. THERE'S A LOT
OF INFORMATION THAT HAS BEEN PUT
OUT, INCLUDING FROM CMS AND
OTHER AGENCIES, ABOUT CONCERNS
ABOUT SOME OF THE PRACTICES. AND
WE'VE SEEN OTHER STATES REALIZE
SAVINGS FROM JUST THE SPREAD
PRICING BAN ALONE, ESPECIALLY IN
THE MEDICAID PROGRAM. SO WE
BELIEVE THAT THIS MUCH OF WHAT
THE BILL DOES IS CREATE A
LICENSING SCHEME THAT WOULD
ALLOW TRANSPARENCY AND BAND SOME
KIND OF WHAT WE WOULD CALL THE
MOST PROBLEMATIC PRACTICES THAT
HAVE BEEN BANNED THUS FAR IN
OTHER STATES. AND WE BELIEVE
THAT WILL HELP TO PUT SOME
PERSPECTIVE INTO WHAT THESE PBMS
ARE DOING, ALLOW TO SHINE A
LIGHT ON THEIR PRACTICES, AND
THEN ULTIMATELY SAVE THE STATE
DOLLARS OPPOSITION. WHY WHY
WOULD WHY WOULD YOU SAY THAT
THIS WOULD INCREASE COST, I
THINK FROM OUR PERSPECTIVE, WE
WEREN'T SPEAKING TO THE
TRANSPARENCY ASPECT OR THE
LICENSING ASPECT. WE WERE
TALKING ABOUT AS THE,
PROHIBITIONS IN THE BILL, A LOT
OF THERE'S A LOT OF PROHIBITIONS
ON HOW NETWORKS CAN BE FORMED.
AND SO FROM OUR PERSPECTIVE,
IT'S BASICALLY A DE FACTO ANY
WILLING PHARMACY. AND SO THE WAY
WE'RE READING THE BILL, YOU'RE
NOT GOING TO BE ABLE TO SET UP
INCENTIVE STRUCTURES INTO WHERE
YOU CAN DRIVE DOWN COSTS. AND SO
IF YOU CAN'T GUARANTEE A CERTAIN
AMOUNT OF VOLUME ON CERTAIN
DRUGS, THEN IT GETS MORE
EXPENSIVE FROM OUR SENATOR. YEAH
YEAH. I WANT TO BE VERY CLEAR
BECAUSE THIS IN THE IN SENATE
HEALTH, THIS WAS A TOPIC OF
DISCUSSION AND WE WERE VERY
CLEAR. AND WE EVEN MADE
CLARIFYING AMENDMENTS THAT THAT
THIS DOES NOT OVERRIDE NETWORKS.
THIS IS NOT IN ANY WILLING
PROVIDER OR ANY WILLING PHARMACY
SITUATION, NETWORKS ARE STILL
FULLY IN PLACE. BUT WHAT THEY
CANNOT DO IS WHAT THEY'RE DOING
NOW IS THAT SAYING WE'RE GOING
TO MAKE IT HARD OR IMPOSSIBLE
FOR YOU TO GO TO YOUR
NEIGHBORHOOD PHARMACY, WHETHER
IT'S A COMMUNITY PHARMACY OR
YOUR NEIGHBORHOOD WALGREENS OR
CVS, YOU HAVE TO GO TO OUR
PHARMACY ONLY, AND THAT, THAT SO
IT DOES PREVENT THEM FROM DOING
THAT, BUT IT DOESN'T TAKE IT
OUTSIDE OF THE NETWORK FOR YOUR
HEALTH COVERAGE IN ADDITION, IN
TERMS OF SOME OF THESE
PRACTICES, ONE OF THEM IS ABOUT
THE REBATES WHERE WHERE THEY GET
TO TAKE A PORTION, THEY GET A
CUT OF THE REBATE THAT THEY
NEGOTIATE FOR, FOR THE PAYER,
FOR THE HEALTH PLAN. AND WHAT
THAT DOES IS IT MEANS THE HIGHER
THE COST OF THE DRUG, THE HIGHER
THERE THE HIGHER THE REBATE,
BECAUSE IT'S BY PERCENTAGE AND
THE HIGHER THEIR CUT OF THE
REBATE. AND THAT'S WHY WE SEE
THAT THERE ARE, THERE ARE
SITUATIONS WHERE PEOPLE ARE
BASICALLY FORCED TO GET NAM NAME
BRAND AND, AND NOT GENERIC
INSULIN. YOU MIGHT ASK WHY ON
EARTH WOULD THAT EVER BE, AND
IT'S BECAUSE THAT MAKES THE PBMS
MORE MONEY BECAUSE GENERIC IS A
LOT CHEAPER. SO THE REBATES ARE
LOWER AND THEIR CUT OF THE
REBATES ARE LOWER. AND THAT'S
WHY THE BILL REQUIRES THAT THE
FULL REBATE, IF THERE'S GOING TO
BE A REBATE, PASS IT ALL THE WAY
THROUGH AND DON'T GET
COMPENSATED VIA CUT, BECAUSE
THAT CREATES AN INCENTIVE TO
DRIVE UP DRUG COSTS. YEAH. AND
THERE HAVE BEEN STUDIES THAT
HAVE SHOWN THAT I KNOW YOU
OBVIOUSLY YOU STILL HAVE MORE TO
SAY, BUT I ALSO, WHILE YOU'RE
THINKING ABOUT THOSE REMARKS, I
ALSO HAVE A QUITE AN ISSUE IN
TERMS OF WHAT BRINGS RED FLAGS
TO ME, IS EVEN LAST YEAR, I EVEN
, VISITED ONE OF MY LOCAL
INDEPENDENT PHARMACIES AND
TALKED ABOUT, HOW MUCH HOW MANY
INDEPENDENT PHARMACIES HAVE
CLOSED DOWN, BUT YET
UNDERSTANDING THAT WE ACTUALLY
NEED A GOOD AMOUNT OF
INDEPENDENT PHARMACIES IN TERMS
OF A COMMUNITY RESILIENCE
PERSPECTIVE, AS YOU KNOW, LARGER
PHARMACY CORPORATIONS SOMETIMES
MIGHT CLOSE DOWN. BUT THEN WHILE
THEY WERE OPERATIONAL, THEY
FORCED INDEPENDENTS TO CLOSE
DOWN. AND NOW THE COMMUNITY HAS
NO PHARMACIES. DO YOU HAVE YOU
HAVE YOU GUYS RECOGNIZED THE
HARM THAT, THAT, INDEPENDENT
PHARMACIES SAY THAT YOU HAVE
CREATED FOR THEM? NO, WE'RE
CERTAINLY SENSITIVE TO THAT
BECAUSE PHARMACIES, ALL
PHARMACIES ARE IMPORTANT, RIGHT?
BECAUSE THEY'RE NEEDED FOR THE
NETWORK. SO WE DO NOT WANT TO
SEE PHARMACIES CLOSE. AND WE
WISH, FRANKLY, THIS WOULD HAVE
BEEN A DISCUSSION FOCUSING ON
THE PLIGHT OF PHARMACIES. BUT
THIS GOES THIS DOESN'T EVEN
REALLY GET TO THAT PER SE. AND
IF I COULD GO BACK TO YOUR
EARLIER POINT ON THE COST
IMPACT, I, THE AUTHOR MAKES A
POINT ABOUT REBATES AND WHAT'S
HAPPENING WITH REBATES, BUT YOU
HAVE A TRANSPARENCY PROVISIONS
IN HERE, VERY COMPREHENSIVE
TRANSPARENCY AND REPORTING
THAT'S GOING TO GIVE THE STATE
THE DATA TO ANALYZE. SO DOESN'T
THAT PUT THE STATE IN A BETTER
POSITION TO DETERMINE WHAT IS
HAPPENING WITH THE REBATES? WHAT
IS WHERE IS THE MONEY GOING
PRIOR TO DECIDING WHAT PUBLIC
POLICY IS WITH RESPECT TO THOSE,
AND IN TERMS OF I WOULD POINT
OUT AND THIS MAY JUST BE A
MISUNDERSTANDING WITH THE AUTHOR
IN TERMS OF WHAT WAS FIXED.
THERE WAS THERE WAS ONE FIX MADE
IN TERMS OF CONDITIONS WITH
RESPECT TO PREFERRED PHARMACIES.
UNFORTUNATELY, THERE'S STILL
ANOTHER PROVISION THAT REMAINS.
AND AGAIN, THIS THIS MAY BE AN
OVERSIGHT OF SOME SORT, THAT
THAT SAYS PBMS CAN'T
DISCRIMINATE OR IMPLY APPLY
TERMS AND CONDITIONS TO
NONAFFILIATED PHARMACIES. SO
THAT MEANS A PHARMACY CAN CHARGE
WHATEVER IT WANTS AND CANNOT BE
DISCRIMINATED AGAINST. AND I
DON'T KNOW HOW THAT'S GOING TO
RESULT IN LOWER COSTS. I JUST
WANT TO MAKE THAT POINT. AND
AGAIN, IT MAY JUST BE A
SECTIONAL OVERSIGHT, BUT IT'S IT
BASICALLY THERE ARE ABOUT MAYBE
TEN, 12 STATES THAT HAVE ANY
WILLING PHARMACY, BUT THEY ALL
REQUIRE THAT THOSE PHARMACIES
ACCEPT THE TERMS AND CONDITIONS.
THIS BILL SPECIFICALLY SAYS WE
CAN IMPOSE TERMS AND CONDITIONS
ON THOSE PHARMACIES, AND THAT'S
WHERE WE THINK THE COST IS GOING
TO INCREASE. BUT WHAT IF ONE OF
YOUR TERMS AND CONDITIONS IS
THAT THE PHARMACISTS CAN'T
CHOOSE THE LESS COSTLY DRUG? SO
DO YOU HAVE TERMS AND CONDITIONS
THAT SAY THAT THE TERMS AND
CONDITIONS ARE PRIMARILY GOING
TO BE THE REIMBURSEMENT RATE,
THE QUALITY STANDARDS THAT THE
PHARMACY IS LICENSED, THE
PHARMACIST IS LICENSED, THOSE
TYPES OF THINGS. SO IF A
PHARMACIST SAYS IF I'M THE
PHARMACIST AND I HAVE A LOWER,
LOWER INCOME COMMUNITY AND
THERE'S A, YOU KNOW, POPULAR
NAME BRAND AND THERE'S A
GENERIC, YOU WON'T TELL ME THAT
I CAN'T GET THE USE THE GENERIC
FOR MY CUSTOMER, I'M NOT SURE I
FOLLOW THAT EXACTLY. THE IT'S
GOING TO BE WHATEVER IS ON THE
PLAN FORMULARY. BUT IF THE IF
YOU AS THE PHARMACIST HAVE A
DRUG THAT HAS, LET'S SAY THE
CASH PRICE IS $5, AND IF THEY
GET IT THROUGH THEIR HEALTH
COVERAGE, IT'S $10. THE PBM IS
ALWAYS GOING TO SAY CHARGE THE
$5, RIGHT? I THINK THE PROBLEM
COMES IN THAT THERE ARE
OCCASIONS BECAUSE THE PBM IS
ALWAYS GOING THE PBMS CONTRACT
IS WITH THE PLAN. AND SO
WHATEVER THE LOWEST NET COST TO
THE PLAN IS, IS WHAT THAT PBM IS
DRIVING FOR. I THINK THE RUB
COMES IN AND THEN HOW PLANS ARE
GOING TO STRUCTURE THEIR CO-PAYS
AND DEDUCTIBLES, WHICH THE PBM
HAS NO INVOLVEMENT IN. DOES THAT
MAKE DOES THAT DOES THAT MAKE
ANY SENSE? DOES THAT HELP YOU
UNDERSTAND. YEAH IT DOES YES.
THANK YOU. I THINK IT HELPS ME
UNDERSTAND THAT WE HAVE A
CHALLENGE BECAUSE AS YOU'VE
STATED, THE PBMS RESPONSIBILITY
IS TO THE PLAN. I THINK SENATOR
WIENER'S BILL IS FOCUSED ON
ENSURING THAT OUR HEALTH CARE
SYSTEM IS RESPONSIBLE TO THE
INDIVIDUAL AND THE PERSON
SEEKING HEALTH CARE AS I'LL GO,
I'LL GO. WHAT? SORRY WOULD THEN
DOCTOR WOULD FIRST OF ALL, THANK
YOU, SENATOR WIENER, FOR,
CARRYING ON THE CHALLENGES OF
TRYING TO CREATE SOME
TRANSPARENCY AND SOME
RESPONSIBILITY AROUND THESE
ENTITIES, MY GUESS IS GOING TO
BE WE DON'T REALLY EVEN KNOW
BECAUSE THEY AREN'T LICENSED.
HOW MANY PBMS ARE ACTUALLY
OPERATING IN CALIFORNIA, WHO
THEY ARE, WHO THEY'RE SERVICING.
IS THAT IS THAT CORRECT, DOES
ANY CAN FROM THE SUPPORTERS?
YEAH ABSOLUTELY, YOU MAY KNOW OF
AB 315 THAT REQUIRED DMHC TO,
HAVE A LIST OF PLAN OF PBMS. BUT
AS YOU KNOW, THAT IS ONLY FOR
PBMS THAT CONTRACT WITH PLANS
THAT ARE LICENSED BY THE
DEPARTMENT OF MANAGED HEALTH
CARE. I HAVE BEEN LOOKING AT
THAT LIST QUITE OFTEN. IT SEEMS
TO ME IT'S NOT NECESSARILY
ALWAYS UP TO DATE. SO WE DO. IT
IS TRUE. WE AREN'T ENTIRELY SURE
OF EXACTLY HOW MANY PBMS ARE
OPERATING IN CALIFORNIA. I THINK
WHAT'S, YOU KNOW, CERTAINLY, YOU
KNOW, NINE, TEN YEARS AGO, WHEN
WE WERE BEGINNING TO LOOK AT
THIS, IF YOU WERE A PLANS, HAD
THEIR OWN PBMS, NOW THAT WE'RE
SEEING THAT SHIFT BACK WHERE
MORE PLANS ARE OPERATING THEIR
OWN PBMS AGAIN, AND SO I CAN NOW
I SEE WHY THE PLAN SOME OF THE
PLANS ARE IN OPPOSITION TO THE
BILL, YOU KNOW, ONE OF THE
CONCERNS THAT THAT I ALWAYS HAD
AND IS THAT, THE MIDDLE MAN
PORTION OF THIS IS, YOU KNOW, IT
REMINDS ME A LITTLE BIT OF THE
DIRE STRAITS SONG MONEY FOR
NOTHING. YES. YOU ARE PROVIDING
A SERVICE, BUT IT'S AT TIMES
FEELS VERY THE IT FEELS VERY
SELF-SERVING THERE. I COULD GIVE
YOU NUMEROUS EXAMPLES OF
OPPORTUNITIES, BECAUSE
OFTENTIMES THE PBM IS SETTING
THE FORMULARIES, OR OR
RESPONSIBLE IN GREAT PART FOR
HOW THE FORMULARIES ARE SET UP.
AND THAT MEANS THAT IT IS THE
PBMS INCENTIVE TO HAVE A AS MANY
HIGHER COST DRUGS AS POSSIBLE TO
GET THE HIGHEST REBATE POSSIBLE.
AND THERE ARE NUMEROUS EXAMPLES
OF DRUGS THAT ARE HIGHLY, HIGHLY
EFFICACIOUS THAT ARE LOWER COST,
WOULD NOT GIVE THE SAME REBATE
TO A PBM, AND THEREFORE THEY
DON'T MAKE IT ON THE FORMULARY.
SO WHO LOSES THERE? THE CONSUMER
LOSES THERE, AND THE PBM WINS
AND THE PHARMACIES DON'T BENEFIT
FROM THAT IN ANY WAY. AND SO I
DO YOU KNOW ANY ANY ADDITIONAL
TRANSPARENCY HERE. AND I AND I
DON'T KNOW WHERE YOUR REPORTING
IS GOING TO GO, BUT I HOPE SOME
OF THE REPORTING TRICKLES TO THE
OFFICE OF HEALTH CARE
AFFORDABILITY, FOR, DATA
ANALYSIS AND H H Kò AS WELL,
BECAUSE I THINK IT'S REALLY
GOING TO BE CRITICAL TO SEE HOW
THIS GOES. SO I COULD GO ON FOR
QUITE A WHILE. I WON'T I JUST
WANT TO SAY THANK YOU, SENATOR
WIENER, FOR, DOING THIS BILL. I,
I SIGNED ON AS A COAUTHOR, A
WHILE BACK. I'M HAPPY TO HAPPY
TO SUPPORT YOU AS WELL. AND AND
I THINK THIS IS, I THINK SOME OF
THIS IS REALLY, REALLY LONG
OVERDUE. ASSEMBLY MEMBER CARILLO
AND THEN DOCTOR WEBBER AND THEN
SANTIAGO. THANK YOU, MADAM
CHAIR. AND THANK YOU TO, THE
AUTHOR, THE SUPPORTERS AND THE
OPPOSITION FOR THE CONVERSATION.
I THINK, I'VE, I'VE SUPPORTED
AND HAVE COAUTHOR VARIOUS
VERSIONS OF THIS BILL IN MY,
TENURE IN THE LEGISLATURE. AND I
THINK WHAT OFTEN COMES OUT IS
JUST THERE'S SUCH A, A DEEP NEED
TO REFORM OUR HEALTH CARE
INDUSTRY IN GENERAL. RIGHT. AND
MAKING SURE THAT, THE CONSUMER,
THE PATIENT IS THE ONE RECEIVING
THE BENEFIT, THIS CONVERSATION,
THE PBM CONVERSATION HAS REACHED
A NATIONAL LEVEL. IT'S SOMETHING
THAT CONGRESS IS LOOKING AT, TOO
. AND WE'VE BEEN TRYING TO DO
SOMETHING IN CALIFORNIA FOR
QUITE SOME TIME, I, I UNDERSTAND
THE SENSITIVITY AROUND THE ISSUE
WITH THE HEALTH PLANS AND REALLY
PATIENT CARE AND PATIENT
ADVOCACY. AS SENATOR, YOU
MENTIONED, INSULIN COST IS THE
NUMBER ONE CONVERSATION ACROSS
THE COUNTRY RIGHT NOW. AND
PEOPLE HAVING TO RATION,
RECEIVING AND OBTAINING INSULIN
BECAUSE THEY CAN'T AFFORD IT.
AND SO I, I WILL BE SUPPORTING
THE BILL TODAY. I, I HAVE A
SLIGHT CONCERN IN TERMS OF THE
LANGUAGE OF THE BILL NOT GOING
DIRECTLY TO THE PATIENT. AND,
THE REBATES BEING PASSED ON TO
THE HEALTH PLANS. I'M NOT SURE
THE HEALTH PLANS ARE READY TO
LOOK AT THIS BILL AND SEE HOW
THEY'RE GOING TO FORMULATE IT OR
HOW THEY'RE GOING TO IMPLEMENT
IT, AND WHAT THE IMPACT IS GOING
TO BE TOWARDS THE PLANS
CURRENTLY IN PLACE. RIGHT. AND
SO IT'S AGAIN, I THINK WHAT
COMES UP IS THAT IT IS A LONG
TIME CONVERSATION IN THE MAKING
AND THAT WE ALL WANT TO SEE A
RESOLUTION THAT AT THE END OF
THE DAY, SERVICES THE PATIENTS,
ESPECIALLY THE PATIENTS, IN
LOWER INCOME COMMUNITIES. I HAVE
SEVERAL LARGE SCALE PHARMACIES
IN MY COMMUNITY THAT ARE
SHUTTING DOWN. THESE ARE RITE
AIDS, AND IT'S RELATED TO A LOT
OF THINGS, SOME OF WHICH HAVE TO
FINANCIAL, YOU KNOW, POSITIONS
OF THE COMPANY, SOME HAVE TO DO
WITH RETAIL CRIME. AND THE
CONSTANT SMASH AND GRABS IN
CERTAIN COMMUNITIES. BUT IT IS
CREATING, I THINK WE HAVE TWO
THAT ARE THAT ARE ONE THAT SHUT
DOWN, ANOTHER ONE THAT IS
SHUTTING DOWN, THAT'S CREATING,
PHARMACY DESERTS. AND THAT'S
SOMETHING THAT WE MAY
POTENTIALLY SEE MORE AND MORE
OF. AND SO I, I JUST WANT TO
AGAIN, JUST THIS IS AN ONGOING
CONVERSATION. THIS IS RELATED TO
A LARGER CONVERSATION ON OUR
OVERALL HEALTH CARE SYSTEM. BUT
IF THERE WAS A WAY TO PASS ON
THE, THE SAVINGS DIRECTLY TO THE
PATIENT, I THINK THAT'S A
POSITION THAT I WOULD FEEL THE
MOST COMFORTABLE IN. I'M NOT
SURE THAT, SUPPORTING THE BILL
NOW AND AS IT MOVES TOWARDS
POLICY COMMITTEE IN THE, IN THE
ASSEMBLY, YOU GET THERE. BUT I
THINK IT'S MOVED THE NEEDLE,
AGAIN YET IN ANOTHER YEAR ON
JUST HOW MUCH REFORM REALLY IS
NEEDED SO THAT THAT AT THE END
OF THE DAY, IT'S PATIENTS THAT
ARE GETTING THOSE, THOSE
SAVINGS. SO I JUST WANTED TO
AGAIN THANK YOU FOR YOUR
CONTINUED WORK. THANK YOU.
ASSEMBLY MEMBER. WELL, I WANT TO
ECHO WHAT HAS BEEN SAID BY MY
COLLEAGUES, AND JUST THANK YOU
FOR TAKING ON THIS, THIS
MONUMENTAL TASK OR CONTINUING
THE DISCUSSION THAT OTHERS, HAVE
STARTED SO LONG AGO. IT IS MIND
BOGGLING THAT WE HAVE SUCH A
HUGE PLAYER IN THE HEALTH CARE
SPACE THAT IS NOT LICENSED, THAT
WE HAVE VERY LITTLE INSIGHT INTO
, AND SO REALLY APPRECIATE, YOU
KNOW, THE LICENSURE AND THE
TRANSPARENCY PORTION OF THIS
BILL, KIND OF PIGGYBACKING ON
SOME OF THE THINGS THAT MY
COLLEAGUES HAVE HAVE MENTIONED.
YOU KNOW, AT THE END OF THE DAY,
WHAT WE WANT TO SEE IS A
DECREASE IN THE COST OF
PRESCRIPTION DRUGS. AND I'M
WONDERING, HOW ARE WE GOING TO
SEE THAT WITH THIS PARTICULAR
BILL, AS IS? WHAT IS IT THAT'S
GOING TO ULTIMATELY LEAD TO A
DECREASE IN THE COST FOR, YOU
KNOW, OUR CONSTITUENTS WHEN THEY
COME AND THEY ARE PAYING FOR THE
PRESCRIPTIONS THAT THEY SO
DESPERATELY NEED, YEAH. I MEAN,
A COUPLE OF THINGS. WE'VE YOU
KNOW, WE KNOW THAT THE PBMS ARE
RESPONSIBLE FOR THE FORMULARIES.
AND AS WE'VE DISCUSSED TODAY,
THERE'S AN INCENTIVE TO HAVE
HIGHER FAVOR, HIGHER COST DRUGS
BECAUSE IT INCREASES THE REBATES
AND THEIR AND THEIR PORTION OF
THE, OF THE REBATES, AND, YOU
KNOW, AND JUST THE WHOLE WAY
EVERYTHING IS STRUCTURED, IT
CREATES AN INCENTIVE TO INCREASE
THE COST SO THAT YOU CAN HAVE
MORE OF A REBATE SO THAT THEY
CAN GET MORE OF A CUT, OF THAT
REBATE. AND SO I'M NOT HERE TO
SAY THAT THIS IS GOING TO SOLVE
EVERY PROBLEM WITH THE COST OF
PRESCRIPTION DRUGS, BUT THIS IS
ONE ASPECT OF THE SYSTEM THAT IS
HELPING PUT UPWARD PRESSURE ON
THOSE COSTS. AND WE'VE SEEN
THERE HAVE BEEN STUDIES SHOWING
THAT ESPECIALLY THE REBATE
ASPECT OF COMPENSATION, DOES
THAT MISS BLUCHER, I DON'T KNOW
IF YOU WANT TO, YOU KNOW, I'LL
JUST ADD QUICKLY, THANK YOU,
SENATOR, THAT, ONE OF THE THINGS
THAT THE BILL DOES AND I WOULD
BE REMISS IF I DID NOT RESPOND
TO THE COMMENTS ABOUT THE ANY
WILLING PROVIDER LANGUAGE,
BECAUSE THE WAY THAT THIS BILL
IS DRAFTED IS IT REALLY LIMITS
THIS, THE RESTRICTION ON CONDUCT
AROUND CONTRACT PHARMACIES. SO
WE ARE NOT SAYING THAT PLANS AND
PBMS CANNOT SET UP NETWORKS.
WHAT WE'RE SAYING, IF THERE ARE
ADDITIONAL RESTRICTIONS ON
PHARMACIES THAT ARE AFFILIATED
VERSUS NONAFFILIATED. SO WITHIN
THE CHAIN OF OWNERSHIP OF PBMS,
PART OF A PBM THAT THE PBM
CANNOT GIVE THOSE PHARMACIES
MORE FAVORABLE CONDITIONS. SO
THAT I THINK IS THE LANGUAGE YOU
WERE REFERRING TO. SO LET ME
JUST ADDRESS THAT FIRST, BECAUSE
I COULDN'T HELP MYSELF. BUT
SECOND, I THINK THAT THAT IS ONE
ASPECT OF THE BILL THAT WE ARE
REALLY TRYING TO ADDRESS,
UNDERSTANDING, AND GETTING MORE
TRANSPARENCY AROUND THE CONTRACT
PROVISIONS THAT ARE PROVIDED VIA
THE VERTICALLY INTEGRATED PBMS.
THERE IS A LOT OF VERTICAL
INTEGRATION IN THE MARKET THAT
CHANGES SOME OF THE INCENTIVES
AROUND CONTRACTING. AND SO AGAIN
, HOPING THAT TRANSPARENCY AND
MORE INFORMATION WILL HELP US
SEE WHERE THERE ARE
OPPORTUNITIES TO REALLY DO MORE
TO SAVE CONSUMERS MONEY AND ALSO
TO HELP US SEE AND COMPARE
APPLES TO APPLES. WHAT SOME OF
THESE CONTRACTS LOOK LIKE AND
WHAT ARE THE SERVICES THAT
CERTAIN PBMS ARE PROVIDING OR
NOT PROVIDING? OKAY, SO IF I'M
TO UNDERSTAND THAT THIS BILL IN
ITSELF ISN'T REALLY GOING TO
START THE PROCESS OF DECREASING
COST, IT'S REALLY JUST TO ENSURE
LICENSURE AND PROVIDE MORE
TRANSPARENCY SO THAT WE HAVE
BETTER DIRECTION IN THE FUTURE.
I THINK REQUIRING 100% PASS
THROUGH OF THE REBATE ABSOLUTELY
WILL CREATE, A GOOD DYNAMIC FOR
LOWERING DRUG COSTS, THE WAY
THAT THE REBATE SYSTEM IS SET UP
NOW, CREATES A DIRECT INCENTIVE
FOR PBMS TO FAVOR HIGHER COST
DRUGS, TO HAVE HIGHER PRICES
WITH A, WITH MAKE THE PRICE
REALLY HIGH. SO YOU CAN THEN
HAVE A REALLY BIG REBATE AND GET
A PORTION OF THAT REBATE, SO THE
AND, AND THERE HAVE BEEN STUDIES
THAT HAVE SHOWN THAT THE REBATES
DO INCREASE, THE COST. SO I
THINK THERE ARE ASPECTS OF THIS
BILL, PARTICULARLY THAT ONE THAT
WILL HAVE AN IMMEDIATE IMPACT.
AND THAT'S WHY THERE'S
BIPARTISAN SUPPORT IN CONGRESS
FOR ADDRESSING THIS ISSUE. IT'S
WHY WE GOT A UNANIMOUS VOTE ON
THIS BILL IN THE SENATE. I THINK
A LOT OF DIFFERENT PEOPLE FROM
DIFFERENT POLITICAL PERSPECTIVES
HAVE SEEN THAT THIS IS GOING TO
BE BENEFICIAL TO THE SYSTEM.
RIGHT. SO YOU'RE THINKING THAT
THE PASS THROUGH MODEL, INSTEAD
OF THE SPREAD THAT IS CURRENTLY
BEING USED, WOULD HELP DECREASE
PRESCRIPTION COSTS? AND IS THAT
PASS THROUGH TO, ASSEMBLY MEMBER
CROW'S POINT? IS THAT PASS
THROUGH GOING TO THE ACTUAL
PATIENT OR IS IT GOING BACK TO
THE HEALTH PLAN. SO RIGHT NOW,
IF THE HEALTH PLAN IS PAYING FOR
IT, IT WOULD OFTEN GO BACK TO
THE HEALTH PLAN. BUT THE BILL
SAYS IT HAS TO GO TO EITHER THE
PATIENT OR THE OR WHOEVER'S
PAYING. AND SOMETIMES THERE ARE,
PATIENTS PAYING AS WELL AS WE
KNOW, ANOTHER QUESTION THAT CAME
UP IN MY DISCUSSION WITH, SOME
PEOPLE WHO SUPPORT THIS BILL,
THEY TALKED ABOUT THE ISSUE OF
DUTY OF CARE, AND THAT INSURANCE
INSURERS HAVE A DUTY OF CARE TO
PATIENTS. BUT OUR PBMS DON'T.
AND I THINK THAT KIND OF
PIGGYBACKS OFF OF WHAT CHAIR WAS
SAYING, THAT AT THE END OF THE
DAY, WE SHOULD BE FOCUSING ON
THE PATIENT, IS THERE ANY
LANGUAGE IN HERE THAT WOULD
ACTUALLY CREATE THAT DUTY OF
CARE THAT IF THERE'S A CONFLICT,
THAT THE DUTY ALWAYS FALLS TO
PROTECTING THE PATIENT FIRST? I
THINK SO, YEAH. SO AS OF RIGHT
NOW, THERE IS CLEAR LANGUAGE
THAT SAYS THE DUTY OF CARE IS
FROM THE PBM TO THE PLAN. AND WE
ACTUALLY WORK WITH HEALTH ACCESS
TO HAVE SOME ADDITIONAL LANGUAGE
THAT WOULD MAKE CLEAR THAT IT IS
THE PLAN OF THE ENROLLEE. WE ARE
WORKING ON ADDITIONAL AMENDMENTS
TO THAT DUTY OF CARE TO MAKE
CLEAR THAT IN THE CASE, YOU
KNOW, TO ADDRESS THIS ISSUE
AROUND VERTICAL INTEGRATION,
WHEN YOU MIGHT HAVE A PBM WHO IS
MORE ALIGNED WITH THE PLAN, HOW
DO YOU ENSURE THAT THE
INCENTIVES ARE THERE TO ACTUALLY
PROTECT THE CONSUMER AND THEN
THE SECOND THING I'LL JUST ADD
IS WE STARTED WITH SOME VERY
BROAD LANGUAGE AROUND DUTY OF
CARE INITIALLY, AND I THINK
THROUGH THE SENATE WHERE THAT
LANGUAGE WAS LIMITED A LITTLE
BIT, RECOGNIZING SOME OF THE
ISSUES AROUND CONTRACTUAL
PROVISIONS AND LIMITATIONS
AROUND DUTY OF CARE. SO THAT WAS
THE CURRENT LANGUAGE IS IN
RESPONSE TO THOSE CONCERNS FROM
FROM THE SENATE HEALTH
COMMITTEE. SO WITH THE CONFLICT
THAT IS POTENTIALLY THERE AND
STILL WORKING ON LANGUAGE, WILL
THAT BE RESOLVED PRIOR TO THIS
BILL HITTING THE FLOOR? YES, I
WE ABSOLUTELY WILL LIKE TO
RESOLVE IT. AS AS WAS MENTIONED,
WE ARE WORKING VERY CLOSELY AND
WE'RE GRATEFUL TO RECEIVE,
TECHNICAL AMENDMENTS FROM THE
DEPARTMENT OF JUSTICE AND THE
DEPARTMENT OF INSURANCE AS THEY
WERE LOOKING AT THIS. SO WE
CERTAINLY WANT TO MAKE SURE
WE'RE WORKING WITH THOSE
ENTITIES AS WELL AS THE AUTHOR,
TO WORK ON THAT LANGUAGE, BUT
THAT'S DEFINITELY A PRIORITY. WE
DON'T WANT THERE TO BE, ANY,
CONFUSION ABOUT ULTIMATELY WHERE
THAT DUTY SHOULD LIE. OKAY. AND
THEN MY FINAL QUESTION IS WHEN
WE'RE TALKING ABOUT THIS PASS
THROUGH, ARE WE REFERRING TO THE
LIST PRICE OF THE MEDICATION OR
THE NET PRICE OR THE NET PRICE
OF THE MEDICATION OR THE LIST
PRICE? I'M NOT SURE IT'S THE
FORMULARY PRICE. I MEAN, IN
TERMS OF THE REBATES, YEAH, IT'S
THE FORMULARY PRICE. DO YOU HAVE
A DIFFERENT ANSWER? I SAW YOU
SMILING. OKAY I DON'T HAVE A
DIFFERENT ANSWER. BUT I THINK
THAT THIS REALLY ILLUSTRATES
THAT THERE'S IT'S SO COMPLICATED
AND THERE'S SO MANY DIFFERENT
SITUATIONS THAT AND THERE'S NO
TRANSPARENCY THAT IN ORDER TO BE
ABLE TO GO ANYWHERE, YOU HAVE TO
GET MORE INFORMATION ABOUT
WHAT'S ACTUALLY HAPPENING,
BECAUSE IT'S ALL IN THE SHADOWS
RIGHT NOW. THAT'S ALL. THERE IS
A DIFFERENCE BETWEEN THE LIST
PRICE I UNDERSTAND. YEAH, YEAH.
BUT I'M JUST THAT THAT WAS
THAT'S WHY I WAS SMILING BECAUSE
I'M LIKE, WHY IS IT SO
COMPLICATED? ALL RIGHT. WELL
ONCE AGAIN, SENATOR, THANK YOU
SO MUCH FOR BRINGING THIS BILL
FORWARD. AND THANK YOU TO
EVERYONE WHO'S COME TO, TO
ENGAGE IN THIS VERY ENGAGING AND
IMPORTANT CONVERSATION. THANK
YOU. A COUPLE OF MORE COMMENTS
OR QUESTIONS. WE'LL GO WITH,
SANTIAGO, THEN VICE CHAIR, THEN
MR. PATTERSON. THANK YOU, MADAM
CHAIR. AND I THINK, I APPRECIATE
THE WORK THAT YOU'VE DONE
BECAUSE THE COMMITTEE'S WORK
OVER THE YEARS HAS BEEN TO TRY
TO REDUCE THE COST OF THE
CONSUMER, IN DIFFERENT WAYS FROM
JUST EVERY STEP OF THE PROCESS.
WHEN SOMEBODY IS INJURED OR GOES
IN THE HOSPITAL OR OR, OR
SCHEDULED, SCHEDULED, VISITS,
AND IT'S A FOR ME, IT'S TO TAKE
A LOOK AT THIS. AND HOW DO YOU
DRIVE THE COST LOWEST TO THE
CONSUMER. AND CERTAINLY THERE IS
SOME CONCERN WHEN HEARING THAT A
NAME BRAND COULD BE GIVEN AS
OPPOSED TO A GENERIC BRAND
DRIVING UP THE COST AND, AND
THE, DRIVING UP THE COST,
BECAUSE THE REBATE IS MUCH
HIGHER, SO I GOT TO SAY TWO
QUICK QUESTIONS AND JUST A TIME
I'LL SPEED A LITTLE BIT QUICKLY
THROUGH THEM. AND, YOU KNOW, ONE
OF THEM IS TO THE OPPONENTS OF
EXPLAIN TO ME HOW YOU OR I THINK
I AT LEAST I HEARD THAT, THAT
SPREAD PRICING IS POTENTIALLY
THE LOWEST COST TO THE CONSUMER,
THAT'S ONE. AND IF THAT'S THE
CASE AND JUST THOUGHTS, I'M NOT
SAYING YOU'RE NOT SUGGESTING
ANYBODY TAKE THIS, BUT DOES IT
MAKE SENSE THEN THAT MAYBE EVEN
ENTERTAIN A CONVERSATION ABOUT
HAVING BOTH INSIDE OF THE BILL,
IF THE INTEREST IS TO DRIVE THE
LOWEST COST, TO THE CONSUMER?
BECAUSE I AM A LITTLE, A LITTLE
CONFUSED ON THAT, BECAUSE
EVERYTHING THAT'S BEEN
PRESENTED, THIS BILL DOES MAKE A
LOT OF SENSE AS TO WHY TO PASS
THIS BILL. AND I'M SUPPORTIVE
TODAY. SO I WANT TO BE VERY
CLEAR ABOUT THAT, BECAUSE AT THE
END OF THE DAY, YOU WANT TO MAKE
THE LEAST AMOUNT, SORRY, THE
DECREASE, THE COST ON ALL
PHARMACEUTICALS, NO MATTER WHAT
THEY MAY BE. AND SOME OF THE
STUFF THAT'S BEEN SAID IS
CONCERNING. ABSOLUTELY. SO MAYBE
JUST THOSE TWO QUICK QUESTIONS,
MAYBE THE PROPONENTS WILL SAY,
OKAY, WELL THEN WHAT IF PRICE
SPREADING? LET'S SAY, COULD BE
THE LOWEST COST TO THE CONSUMER,
I'M NOT SUGGESTING THIS BILL,
BUT COULD BOTH OR MAYBE IN THIS
BILL, COULD THEY BOTH COEXIST
THEN IN THE INTEREST OF DRIVING.
BUT I FIRST WANT TO GET CLARITY
ON THE ON THE SPREAD PRICING
BECAUSE YOU'RE SAYING THAT AT
LEAST I HEARD SAYING THAT THAT'S
THE BEST PRICE FOR THE CONSUMER.
EXPLAIN TO ME WHY YOU THINK THAT
MIGHT BE THE CASE. BECAUSE WHAT
I'M HEARING IS VERY DIFFERENT.
YEAH. AND IF I, IF I COULD
ASSEMBLYMEMBER I JUST WANT TO
I'LL LET MY COLLEAGUE TALK ABOUT
THE SPREAD. BUT IN TERMS OF THE
REBATES, IT'S IMPORTANT TO BEAR
IN MIND THAT LESS THAN 10% OF
DRUGS HAVE REBATES. REBATES
DON'T EXIST WHEN THERE'S A
GENERIC EQUIVALENT, AND
CALIFORNIA HAS MANDATORY GENERIC
SUBSTITUTION. SO, THAT'S NOT
GOING TO BE THE CASE, BUT
REBATES AREN'T AS PREVALENT AS I
THINK PEOPLE ASSUME THEY ARE.
BUT YEAH, I THINK ON ON SPREAD
PRICING, WHAT WE WERE SAYING IS
THAT FOR THE PAYER, THEY LIKE TO
HAVE THAT OPTION. IT'S AN OPTION
FOR COMPENSATION. AND HOW YOU'RE
PAYING THE PBM FOR ITS SERVICES.
AND SO WITH 100% PASS THROUGH,
THE PAYER IS TAKING ON ALL OF
THE RISK AND ALL THE VOLATILITY
OF WHAT YOU'RE GOING TO GET IN
REBATES THROUGHOUT THE YEAR. YOU
DON'T ALWAYS KNOW WHAT THAT'S
GOING TO BE. YOU COULD HAVE A
DRUG COME TO MARKET HALFWAY
THROUGH THE YEAR. THAT'S
ASTRONOMICALLY HIGH, WHICH WE
CONTINUE TO SEE WITH A LOT OF
SPECIALTY DRUGS. AND SO WITH THE
SPREAD PRICING, THE PBM TAKES ON
MORE OF THAT RISK AND YOU HAVE
MORE OF A PREDICTABLE DRUG
SPEND. AND SO FOR CERTAIN
PAYERS, THEY WANT TO KNOW WHAT
THEIR DRUG SPEND IS. AND STICK
TO THAT. AND SO IT'S MORE OF A
SHIFTING OF RISK. IT DOESN'T
CHANGE ANYTHING IN REGARDS TO
THE ACTUAL REBATE AND THE PBM
TRYING TO DRIVE DOWN THE LOWEST
COST. AND THEN THOSE REBATES GO
BACK TO THE PREMIUM DOLLAR AND
TRY TO KEEP THAT PREMIUM DOLLAR
LOW. SB 17 REPORT SHOWED THAT
REBATES REDUCE OUR PREMIUMS BY
1.7 TO 2. A YEAR. AND SO THAT'S
WHERE THE SAVINGS KIND OF COMES
IN THERE. BUT IT'S REALLY SPREAD
IS REALLY JUST A, A CHOICE ON
HOW YOU'RE GOING TO PAY THE PBM
FOR ITS SERVICES AND HOW MUCH
RISK YOU WANT TO TAKE ON. A LOT
OF THE BIGGER PAYERS WILL WILL
TAKE ON 100% PASS THROUGH
BECAUSE THEY CAN THEY CAN GO
WITH THAT VOLATILITY, SOME OF
THE SMALLER ONES, THEY WANT A
LITTLE BIT MORE OF THAT OF THAT
PREDICTABILITY. MAY I FOLLOW UP
ON THAT. BUT IN TERMS OF SPREAD.
SO IT WOULDN'T JUST BUT HOW DOES
THAT IMPACT THE CONSUMER THOUGH.
SO I THINK I KNOW MR. HAGAN, I
THINK FOR THE SMALLER PAYERS IT
HELPS THE CONSUMER IN THE FORM
OF MORE STABLE, PREDICTABLE
PREMIUMS IN THE PREMIUM DOLLAR,
BECAUSE THAT THEY'RE CHOOSING
THAT MODEL TO KEEP THEIR KEEP
THEIR DRUG SPEND. STABLE AND
PREDICTABLE FOR THE YEAR, WHICH
KEEPS YOUR PREMIUM PREDICTABLE
FOR THE YEAR. AND YOU'RE NOT
SUBJECT TO AS MUCH VOLATILITY.
AND SO IT'S A MUCH BETTER
BENEFIT DESIGN FOR THOSE PAYERS,
NOT EVERYBODY CHOOSES SPREAD,
AND IF WE WANT TO REQUIRE THAT
THERE BE AN THAT YOU CAN'T ONLY
OFFER SPREAD, YOU HAVE TO OFFER
SOMETHING, ANOTHER MODEL, THEN
THAT'S FINE. YOU NEED TO OFFER
OPTIONS. BUT FOR SOME PAYERS
IT'S GOING TO BE BETTER FOR SOME
PAYERS IT'S THEY'D RATHER TAKE
ON THAT RISK AND HAVE MORE
REBATE. AND IF I COULD JUST
SPEAK, EXCUSE ME TO THE LARGER
ISSUE, WHICH IS WE ARE NOT
OPPOSED TO LICENSING AND
TRANSPARENCY. LET ME MAKE THAT
CLEAR. WE DON'T OPPOSE THOSE.
WHAT WE WHAT WE ARE CONCERNED IS
WHAT WAS RAISED IN THE COMMITTEE
ANALYSIS, WHICH IS YOU'RE MAKING
POLICY CHOICES BASED ON DATA
THAT HASN'T EVEN BEEN SUBMITTED,
LET ALONE ANALYZED. I THINK IT
WOULD GET TO YOUR QUESTION TO
HAVE DO I GET THE INFORMATION,
ANALYZE IT, AND REPORT BACK TO
YOU. AND BECAUSE DON'T TAKE OUR
WORD FOR IT, LET THE DATA SPEAK
FOR ITSELF. BUT WE'RE PUTTING
THE CART BEFORE THE HORSE IN
TERMS OF RESTRICTING WHAT OTHER
ENTITIES IN THE SUPPLY CHAIN CAN
DO OR NOT DO. BUT YOU HAVEN'T
EVEN RECEIVED AN ANALYZE THE
DATA YET. SO I THINK IT'S A IT'S
A GOOD QUESTION. SO LET'S FIND
OUT WHAT THE DATA TELLS US. VICE
CHAIR WALDRON. MIKE, I KNOW
WE'VE ALL PRETTY MUCH SAID A LOT
OF THE SAME THINGS, AND WE'VE
BEEN SAYING IT THROUGH THE
YEARS, I AM A COAUTHOR ON THIS
BILL, IT'S JUST BEEN KIND OF AN
ONGOING CHALLENGE, AND IT IS ONE
OF THE MORE DIFFICULT ISSUES WE
FACED. I'VE SAT ON HEALTH
COMMITTEE, I THINK, ABOUT SIX
YEARS AND IT DOESN'T REALLY GET
ANY MORE, STRAIGHTFORWARD AS WE
DIVE INTO DIVE INTO THIS ISSUE.
BUT, YOU KNOW, WE'VE SEEN IN THE
PBM INDUSTRY, THE MERGERS, THE
ACQUISITIONS RESULTING IN PBMS
HAVING A MAJOR IMPACT ON THE
HEALTH CARE MARKETPLACE IN
GENERAL BY THEIR LARGE PRESENCE,
BUT THE LACK OF ACCOUNTABILITY
WE'VE ALL BEEN BRINGING IT UP,
YOU KNOW, HAS BEEN THE ISSUE.
WE'RE TRYING TO GET AT THAT, AS
THE SENATOR MENTIONED, THE
CURRENT PBM COMPENSATION HAS
CREATED NEGATIVE ISSUES WITH THE
INCENTIVES, THE WAY THEY ARE IN
THE SYSTEM, AND IT'S IMPORTANT
THAT THIS BILL WILL HELP PATIENT
ACCESS AND HELP THEM TO AFFORD
THEIR MEDICATIONS. SO THAT'S WHY
I'M A COAUTHOR. AND I WANT TO
THANK YOU FOR BRINGING IT
FORWARD. I KNOW IT'S
CHALLENGING. WE MAY NEED TO WORK
KINKS OUT AS IF IT DOES GET
THROUGH THE PROCESS, BUT, WE
NEED TO, YOU KNOW, DEAL WITH THE
ISSUES. SO THANK YOU. MR.
PATTERSON. THANK YOU. APPRECIATE
IT. I THINK I SAID THIS LAST
WEEK IN PRIVACY, SENATOR, THAT
YOU ALWAYS BRING THE SMALL
TOPICS, LAST WEEK IT WAS
REGULATING AI, AND NOW IT'S,
PBMS. SO, I MENTIONED THAT
WORKING ON SOME AMENDMENTS, OR
CONSIDERING CHANGES AND THINGS
LIKE THAT. AND I THOUGHT THAT
THAT WAS GOOD BECAUSE, I'M GOING
TO SEE THIS AGAIN, I THINK IN
JUST A FEW DAYS IN JUDICIARY
COMMITTEE, IF IT PASSES OUT OF
THIS COMMITTEE. AND I WAS
WONDERING, WILL THERE BE
AMENDMENTS FOR THAT COMMITTEE OR
WILL THIS MOVE FORWARD? I THINK
OUR NEXT AMENDMENTS WILL BE AN
APPROACH. OKAY. OR IT'S A LITTLE
UNCLEAR RIGHT NOW. AND I WANT TO
BE CLEAR, THESE AMENDMENTS ARE
THIS IS TECHNICAL TIGHTENING
WITH A BILL THAT'S COMPLEXITY.
YOU'RE ALWAYS FROM BEGINNING TO
END GOING TO BE, TIGHTENING THE
LANGUAGE. AND AND WE ALSO AND
I'M, ALSO I WANT TO SAY IN TERMS
OF A COMMENT MADE EARLIER, I'M
ALWAYS OF THE VIEW THAT IF, IF,
IF, IF, YOU KNOW, IF, IF THERE'S
INFORMATION BEING DEMANDED IN
HERE THAT IS PHYSICALLY
IMPOSSIBLE FOR THE PBMS TO
PROVIDE, THEY NEED TO TELL US
THAT. AND WE'RE HAPPY TO TAKE A
LOOK AT THAT, AND THAT'S, THAT'S
MY YOU KNOW, STYLE, IF THAT'S
ACTUALLY TRUE. SO BUT IT'S NOT
IT'S MORE TECHNICAL TIGHTENING
UP KIND OF AMENDMENTS. OKAY.
GREAT AND I DON'T KNOW IF IT'LL
BE IN PRIVACY OR IN A PROCESS IF
IT GETS OUT OF PRIVACY AND IF IT
GETS OUT OF THIS COMMITTEE. I'M
SORRY I SAID PRIVACY. YEAH.
PRIVACY ON THE BRAIN AFTER YOUR
COMMENTS. YES. JUDICIARY. SORRY
YOU KNOW, I THINK ONE THING,
KEEP IN MIND THAT I DON'T KNOW
IF IS MENTIONED IS THAT I
BELIEVE ONE OF THE REASONS WHY
PBMS WERE STARTED IN THE FIRST
PLACE WAS TO HELP NEGOTIATE
LOWER PRICES FOR, FOR PEOPLE,
YOU KNOW, THROUGH THE JUST
THROUGH THE WITH THE
PHARMACEUTICAL COMPANIES AND
THINGS LIKE THAT. AND I THINK
THAT GOAL IS, IS A GOOD THING,
BUT WHEN I, NOBODY OUTSIDE OF
BEING A PHARMACY OR PHARMACY,
YOU KNOW, IN THE PHARMACEUTICAL
WORLD HAS ANY IDEA WHAT A PBM
IS, AND I JUST HAPPENED TO BE
HAVING A DRINK WITH A FRIEND AND
DINNER WITH A FRIEND, IN
ROSEVILLE, WHEN I GOT ON THIS
COMMITTEE AND I HAD NEVER HEARD
WHAT A PBM WAS. AND YOU LEARN A
LOT IN 18 MONTHS, BY THE WAY.
BUT I ASKED HIM HIS WIFE HAPPENS
TO OWN AN INDEPENDENT PHARMACY
AND I JUST ASKED HIM ONE DAY I
SAID, HEY, CAN YOU TELL ME, WHAT
DO YOU THINK OF PBMS? AND, THE
WORST THING TO TALK ABOUT OVER
DINNER WITH A FRIEND, BY THE
WAY, AND I RECEIVED AN EXPLETIVE
LACED, RESPONSE. THIS IS A
SPOUSE, BY THE WAY, OF,
INDEPENDENT PHARMACISTS. AND SO
THAT WAS KIND OF LIKE MY FIRST,
YOU KNOW, LIKE, WOW. BUT
OBVIOUSLY YOU LEARN MORE OVER
TIME AND YOU LEARN, HEY, PBMS.
THE INTENT OF THEM, IF WE CAN
KIND OF GET THAT GOAL GOING
AGAIN IS A GOOD THING. AND I
THINK, YOU KNOW, THAT'S WHAT WE
WANT TO SEE HAPPEN. BUT I DO
HAVE A COUPLE MORE QUESTIONS, I
HAD A QUESTION SPECIFICALLY ON
THE DEPARTMENT OF INSURANCE. WHY
THAT WAS THE AVENUE. YEAH. SO
THE ORIGINAL VERSION OF THE BILL
HAD THE BOARD OF PHARMACY AS THE
REGULATORY BODY. THAT THAT, DID
NOT, LAND THE BEST, WHEN AS WAS
MOVING THROUGH THE SENATE AND I
THINK THERE WERE MEMBERS WHO HAD
WHO WERE NOT ENTHUSIASTIC ABOUT
THAT BEING THE BOARD OF PHARMACY
BEING THE OVERSIGHT BODY AND
THAT'S WHEN WE MOVED IT TO THE
DEPARTMENT OF INSURANCE. THE
DEPARTMENT OF MANAGED HEALTH
CARE HAS, SHALL WE SAY, A LOT ON
ITS PLATE. AND, I, I REALLY WANT
TO MAKE SURE THAT THIS LAW GETS,
ENFORCED AND SO THERE'S NEVER A
PERFECT AGENCY TO CHOOSE. WE
THINK, UNDER THE CIRCUMSTANCES,
DEPARTMENT OF INSURANCE IS THE
BEST CHOICE, SO JUST FOR
CONSIDERATION AS THIS BILL MOVES
FORWARD, IS, YOU KNOW, MY
CONSTITUENCY IS OBVIOUSLY A LOT.
I THINK OUR FAIR PLAN ENROLLMENT
HAS GONE FROM 9000 HOUSEHOLDS TO
40. SOME THOUSAND HOUSEHOLDS.
AND WE HAVE A MAJOR, AS YOU KNOW
, INSURANCE CRISIS. AND SO I DO
GET I PERSONALLY WANT THEM TO
FOCUS ON INSURANCE ISSUES, YOU
KNOW, SO THAT'S JUST MY PERSONAL
PREFERENCE. I UNDERSTAND DMHC,
YOU KNOW, I MEAN, WE'VE ALL HAD
OUR INTERACTIONS WITH THEM. SO I
UNDERSTAND YOUR PERSPECTIVE.
IT'S JUST I DO HAVE SOME
CONCERNS THERE, ONE MORE THING
ON THE, THE SPREAD PRICING, I
NOTICED A LOT OF THE TRADES AND
OTHER GROUPS WERE CONCERNED
ABOUT THE PROHIBITION OF SPREAD
PRICING. IT'S BEEN ASKED TO ASK
A FEW TIMES, BUT I WAS WONDERING
IF I DON'T KNOW IF THIS WAS
ANSWERED DIRECTLY, BUT HAVE YOU
CONSIDERED GIVING AN OFFER?
WHOEVER THE REGULATOR IS GIVING
THEM THE OPTION OF DETERMINING
IF THEY REALLY WANT TO LIMIT
THAT, BECAUSE I UNDERSTAND ON
ITS FACE SPREAD PRICING IS
SOUNDS TERRIBLE, LIKE A TERRIBLE
PRACTICE, AND I UNDERSTAND
WANTING THE PROHIBITION, BUT I
DON'T ACTUALLY KNOW WITHOUT THE
DATA. IF THAT'S SOMETHING WE
SHOULD RESTRICT RIGHT OFF THE
BAT. AND SO, I PERSONALLY, I, I
THINK THE LEGISLATURE SOMETIMES
DEFERS TO TOO MANY POLICY
CHOICES TO, AGENCIES. THAT'S MY
PERSONAL OPINION. AND WE SEE HOW
THAT SOMETIMES PLAYS OUT IN NOT
THE BEST WAYS. I THINK WE HAVE
AN ISSUE THAT'S BEFORE US, IT'S
A THIS IS A WELL KNOWN, ISSUE
SPREAD PRICING. AND I THANK YOU
FOR ACKNOWLEDGING THAT IT, THAT
IT SOUNDS REALLY BAD BECAUSE IT
IS REALLY PROBLEMATIC FOR THE IT
JUST, YOU KNOW, WHEN YOU JUST
LOOK AT THE BASICS OF IT, AND I
THINK IT DOES MAKE SENSE TO, TO
MOVE AWAY FROM THAT. SO NOT THAT
I'M ASKING YOU, AND MAYBE IF THE
OPPOSITION WANTS TO RESPOND TO
THAT, BUT WHY WOULD, THESE
GROUPS, THE TRADES IN
PARTICULAR, I READ THEIR
LETTERS, BUT WHY WOULD THEY
SUPPORT KEEPING SPREAD PRICING?
THAT OPTION THERE I, I, I, YOU
KNOW, I DON'T WANT TO SPEAK FOR,
FOR, FOR THE TRADES OR SPECULATE
IN, IN ANY WAY. THEY'RE ENTITLED
TO THEIR POSITION AND I RESPECT
THEIR POSITION. I JUST DISAGREE,
AS DOES THE HUGE COALITION
BEHIND THIS BILL, OKAY. GREAT
THANK YOU. I THINK, YOU ARE
DEFINITELY HEARING FROM THIS
COMMITTEE AT LARGE THAT WE ARE
DEEPLY CONCERNED WITH THE COST
TO CONSUMER AND THE PATIENT AND
THE ROLE THAT PBMS HAVE IN, I
BELIEVE INCREASING THE COST OF
PRESCRIPTION DRUGS FOR OUR
CONSUMERS AND PATIENTS AND VERY
THANKFUL TO THE AUTHOR FOR
BRINGING FORWARD THIS BILL. I
THINK ONE OF THE WE'VE TALKED
ABOUT THIS, MORE EXTENSIVELY.
I'M TO HAVE SOME CONCERNS ABOUT
CDI BEING THE REGULATORY AGENCY,
AT THIS POINT. AND I KNOW THAT
YOU WILL CAN WE HEAR AND
UNDERSTAND YOUR POSITION ABOUT
WHY, WHY YOU SELECTED CDI? I
KNOW THAT THAT WILL BE FURTHER
CONVERSATIONS AROUND THAT MOVING
FORWARD, I THINK WE DO HAVE
EVIDENCE BASED ON THE ADOPTION
OF, OF REGULATORY SCHEME IN
OTHER STATES TO BE ABLE TO GUIDE
US AROUND, BEING ABLE TO MOVE
FORWARD. FOR THE STATE OF
CALIFORNIA AT THIS POINT, I KNOW
THAT YOU WE'VE LOOKED AT OTHER
MODELS AND ONE OF THE ASSETS OF
HAVING THAT IS THAT WE KNOW THAT
OTHER STATES HAVE PERHAPS BEEN A
LITTLE LESS, PRESCRIPTIVE, IF
YOU WILL, THAN THIS LEGISLATION.
SEEKS TO BE. BUT WE DO NEED TO
MOVE FORWARD IN MAKING A CHANGE
NOW AND REALLY APPRECIATE YOU,
SENATOR WIENER. TAKING ON YET
ANOTHER INCREDIBLY IMPORTANT
CONCERN FOR THE STATE OF
CALIFORNIA. WOULD YOU LIKE TO
CLOSE? I THANK YOU VERY MUCH,
MADAM CHAIR. I VERY MUCH
APPRECIATE THOSE. REMARKS, YOU
KNOW, IN THE END, WE HAVE A HUGE
SEGMENT, A HUGE PLAYER IN THE
HEALTH CARE INDUSTRY THAT IS,
VERY, VERY MINIMALLY, IF AT ALL.
REGULATED AND OVERSEEN. WE HAVE
AN OPPORTUNITY TO DO THAT TODAY
AND ALSO TO ADDRESS SOME, VERY
PROBLEMATIC, PRACTICES. AND I
RESPECTFULLY ASK FOR AN AYE
VOTE. THANK YOU. THE MOTION IS
DUE. PASS TO JUDICIARY. LET ME
JUST CLEAR. YES. DO PASS TO
JEWISH JUDICIARY MOVED BY
ARAMBULA, SECONDED BY RODRIGUEZ.
SECRETARY, PLEASE CALL THE ROLL
TO AYE ONTO. AYE. WALDEN. WALDEN
AYE. AGUIAR-CURRY ARAMBULA.
ARAMBULA. AYE. WENDY. CARILLO.
WENDY. CARILLO. AYE FLORA.
HANEY. WOULD. WOULD AYE.
JACKSON. JACKSON. AYE MCCARTY.
JOE. PATTERSON. JOE. PATTERSON.
AYE RODRIGUEZ. RODRIGUEZ. AYE.
SANCHEZ SANTIAGO. SANTIAGO. AYE
WEBER. OKAY. THAT MEASURES OUT 9
TO 0. THANK YOU. THANK YOU VERY
MUCH. WE'RE GOING TO MOVE ON NOW
TO ITEM 16 SB 1423. DOLLY.
THANK YOU. SENATOR. YOU'VE
GOTTEN AN EARFUL OF OUR
DELIBERATIONS TODAY. YOUR,
PLEASE PUT ON THE MIC, BUT YOU
WERE THE FIRST PERSON WHO I
DIDN'T EVEN REALIZE THAT IT WAS.
YOU WEREN'T USING IT. HOW'S
THAT? GOOD MORNING, CHAIR AND
MEMBERS. I'M HERE TO PRESENT SB
1423. I WANT TO THANK THE CHAIR
FOR THE WORK IN THE COMMITTEE. I
WILL BE ACCEPTING THE
AMENDMENTS, TO THE TO THE BILL.
THE GROUP WOULD, THE BILL WOULD
ACCEPT THE COMMITTEE AMENDMENTS
TO CHANGE THE BILL TO A STUDY
BILL. THE GROUP WOULD INCLUDE
VARIOUS STAKEHOLDERS AND WOULD
LOOK INTO THE EXISTING MEDI-CAL
REIMBURSEMENT METHODOLOGIES AND
HOW THOSE METHODOLOGIES CAN
IMPROVE THE TO INCREASE THE
FINANCIAL VIABILITY OF CRITICAL
ACCESS HOSPITALS, THE STUDY
GROUP WOULD REPORT BACK TO THE
LEGISLATURE BY MARCH 31ST, 2026.
THE STUDY GROUP DOES CONTINUE
THE NECESSARY CONSERVATION CON
CONVERSATIONS TO ENSURE THE
CRITICAL ACCESS HOSPITALS REMAIN
OPEN, BUT THERE IS A DESPERATE
NEED FOR IMMEDIATE RELIEF.
UNFORTUNATELY, THE STUDY GROUP
DOES NOT PROVIDE THE IMMEDIATE
RELIEF. THE LACK OF FUNDING AND
THE VERY LATE PREVIOUS UNKNOWN
POLICY CONCERNS STALLED THE
PROGRESS OF THIS BILL. I JUST
WANT TO STATE, THIS BILL CAME TO
ME, FROM A DISTRICT HOSPITAL IN
MY IN MY DISTRICT, AND WE JUST
WANT TO GIVE A LITTLE BIT OF
HISTORY. WE INTRODUCED IT
FEBRUARY 16TH. IT WAS AMENDED
APRIL 8TH, BY THE HOSPITAL
ASSOCIATION AMENDMENTS PASSED
OUT OF SENATE HEALTH 11 TO 0,
AMENDED ON APRIL 29TH. ADDED IN
SOME OPT IN, SOME LANGUAGE.
AMENDED MAY 16TH. SENATE
APPROPRIATIONS. UPON
APPROPRIATIONS PASSED OUT OF THE
APPROPRIATION COMMITTEE ON MAY
16TH. THEN WE GOT OPPOSITION.
LATE IN SOME CONCERNS SUBMITTED.
SO WE'VE HAD TO TURN THIS BILL
INTO A STUDY BILL,
UNFORTUNATELY, SO IT IS A STUDY
BILL I HAVE WITH ME TODAY.
DARREN. BETTY, WHO BROUGHT THE
BILL TO ME FROM PLUMAS DISTRICT
HOSPITAL, HE HAS SOME COMMENTS
AND THEN WE'LL TAKE IT. I
RESPECTFULLY ASK FOR AN AYE
VOTE. THANK YOU. YOU'LL EACH
HAVE TWO MINUTES. THANK YOU.
CHAIR BONTA AND COMMITTEE
MEMBERS, FOR THE OPPORTUNITY TO
TESTIFY BEFORE YOU TODAY. MY
NAME IS DARREN BEATTY AND I AM
THE CHIEF OPERATING OFFICER FOR
PLYMOUTH DISTRICT HOSPITAL. IT
HAS BECOME INCREASINGLY APPARENT
THAT THE LONG TERM FINANCIAL
SUSTAINABILITY OF CALIFORNIA'S
CRITICAL ACCESS HOSPITALS
REMAINS DOUBTFUL. THESE
HOSPITALS SERVE AS THE SOLE
PROVIDERS OF CARE TO RURAL AND
UNDERSERVED COMMUNITIES
THROUGHOUT THE STATE. THEY
PRESERVE ACCESS TO CARE AMIDST
CALIFORNIA'S NATURAL WONDERS,
WHERE LARGE POPULATIONS
RECREATE. ADDITIONALLY, THEY ARE
OFTEN THE LARGEST DRIVER OF
ECONOMIC ACTIVITY AND THE
PRIMARY SOURCE OF EMPLOYMENT IN
THESE REGIONS. THE INTRODUCTION
OF SB 1423 INITIATED A DEEP DIVE
INTO THE COMPLEX INNER WORKINGS
OF HEALTH CARE FINANCING AMONG
THE IMPACTED HOSPITALS.
UNSURPRISINGLY, WE DISCOVERED
THAT AN UNEVEN PATCHWORK OF
FUNDING MECHANISMS THAT REFLECT
MULTIPLE PREVIOUS ATTEMPTS TO
ACHIEVE EQUITY IN THE FIELD THAT
STATUS QUO MUST CHANGE. IF
EQUITY IS OUR DESIRED OUTCOME,
WE ENDORSE THE FORMATION OF A
RURAL HOSPITAL ADVISORY GROUP AS
OUTLINED IN THE MOST RECENT
AMENDMENT OF THIS BILL. THIS
INITIATIVE IS CRUCIAL FOR
ENSURING THE FINANCIAL VIABILITY
AND CONTINUED OPERATION OF
CRITICAL ACCESS HOSPITALS. THE
LEGISLATIVE LANGUAGE REPRESENTS
A PROACTIVE AND STRATEGIC
APPROACH TO ESTABLISHING A
RELIABLE FUNDING FRAMEWORK FOR
THE MOST VULNERABLE HOSPITALS IN
THE STATE, ALLOWING THEM TO
PROVIDE ESSENTIAL LIFE
SUSTAINING SERVICES WITHOUT THE
PERPETUAL FEAR OF IMMINENT
CLOSURE CLOUDING EVERY DECISION.
AGAIN, I THANK SENATOR DALLI AND
THE CALIFORNIA HOSPITAL
ASSOCIATION FOR ELEVATING THIS
ISSUE ON OUR BEHALF. WITH THAT,
I RESPECTFULLY REQUEST YOUR AYE
VOTE. THANK YOU, THANK YOU,
THANK YOU. GOOD AFTERNOON. MARK
FAROOQ, ON BEHALF OF THE
CALIFORNIA HOSPITAL ASSOCIATION,
PROUD TO SPONSOR THIS BILL.
FIRST, I WANT TO THANK THE
AUTHOR OF THE BILL FOR HIS
STEADFAST SUPPORT AND ENGAGEMENT
WITH RURAL HOSPITALS AND
CONTINUING TO MOVE THIS ISSUE
ALONG. I ALSO WANT TO THANK THE
CHAIR OF THE COMMITTEE AND YOUR
STAFF FOR YOUR WORK IN
TIGHTENING UP THIS LANGUAGE
RELATED TO THIS STAKEHOLDER
PROCESS, CRITICAL ACCESS
HOSPITALS ARE FOUNDATIONAL
INSTITUTIONS IN OUR RURAL
COMMUNITIES, BUT THEY'RE ALSO
FOUNDATIONAL INSTITUTIONS FOR
ALL OF CALIFORNIA. THE CLOSURE
OF ONE OF THESE HOSPITALS
INCREASES THE MEDIAN TRAVEL
DISTANCE TO ACCESS INPATIENT
SERVICES BY 20 MILES FOR
SPECIALIZED SERVICES SUCH AS
SUBSTANCE ABUSE TREATMENT. THAT
DISTANCE INCREASES BY ALMOST 40
MILES. AND THESE DISTANCES IN
RURAL COMMUNITIES EQUAL HOURS,
NOT MINUTES. RURAL HEALTH CARE
FACES A CRISIS AS THESE
HOSPITALS FACE SIGNIFICANT
FINANCIAL STRESS AS THE
PERCENTAGE OF RURAL HOSPITALS
THAT LOSE MONEY EVERY DAY CARING
FOR PATIENTS HAS INCREASED TO
WELL OVER 50. THE EXISTING
STRUCTURE IS NOT SUSTAINABLE,
AND IT IS RURAL COMMUNITIES THAT
WILL SUFFER. SB 1423 IS AMENDED,
WILL BRING STAKEHOLDERS TO THE
TABLE WITH DHCS TO CONVENE
REGULAR STAKEHOLDER MEETINGS TO
MAKE RECOMMENDATIONS TO IMPROVE
THE LONG TERM FINANCIAL
STABILITY OF CRITICAL ACCESS
HOSPITALS. C.H.A AGAIN IS PROUD
TO SPONSOR THIS BILL TO PROTECT
AND ENHANCE ACCESS TO RURAL
HEALTH CARE. THANK YOU, THANK
YOU. ARE THERE ANY OTHERS IN
SUPPORT? MADAM CHAIR MEMBERS,
CARLOS GUTIERREZ HERE ON BEHALF
OF THE CALIFORNIA FRESH FRUIT
ASSOCIATION, IN SUPPORT. NASET
SHORT ON BEHALF OF ADVENTIST
HEALTH IN SUPPORT. CONNIE
DELGADO ON BEHALF OF THE
DISTRICT HOSPITAL LEADERSHIP
FORUM AND SUPPORT. MOVED BY
RODRIGUEZ. SECONDED BY SANCHEZ.
ARE THERE ANY OTHER ARE THERE
ANY TESTIMONY IN OPPOSITION?
SEEING NONE, I'LL BRING IT BACK
TO THE COMMITTEE. DOCTOR, WOULD
YOU MIGHT GUESS I MIGHT HAVE A
COMMENT OR TWO ON THIS. SO FIRST
OF ALL, THANK YOU. SENATOR
DAWLEY. I YOUR DISTRICT AND MY
DISTRICT HAVE A LOT OF
SIMILARITIES, WITH REGARDS TO
THIS, THIS ISSUE. I HAVE SIX
CRITICAL ACCESS HOSPITALS IN MY
DISTRICT. I DON'T KNOW HOW MANY
YOU HAVE, BUT IT'S A PRETTY BIG
NUMBER WHEN YOU LOOK AT THE
AUTHORS AND THE COAUTHORS OF
THIS BILL, IT'S IT IS REALLY
RURAL CALIFORNIA. HERE THAT,
THAT THAT IS AFFECTED. SO I KNOW
THAT HOSPITAL FINANCING IS
REALLY COMPLICATED. I KNOW THAT,
CRITICAL ACCESS HOSPITALS GET
DIFFERENT KIND OF FINANCING FROM
THE FEDERAL GOVERNMENT. THERE
ARE ENHANCEMENTS THERE, BUT I
ALSO KNOW THAT EVEN WITH THAT,
THERE ARE TREMENDOUS STRUGGLES
TO MAINTAIN. SOME OF IT IS
CHALLENGES AROUND SEISMIC
THINGS. WE'RE GRAPPLING,
GRAPPLING WITH HERE EARLIER
TODAY. SO, SO I, I APPRECIATE,
YOUR HOSPITAL EXECUTIVE COMING,
BRINGING THIS IDEA TO YOU AND IF
YOU'D HAVE ANOTHER COAUTHOR, WE
CAN GET HOLLYWOOD BACK TOGETHER
AND, INSIDE JOKE. BUT I'D LOVE
TO SUPPORT YOU ON THIS. I THINK
IT'S I THINK IT'S A REALLY
IMPORTANT STEP. AND I HOPE THAT
THE INFORMATION, ACTUALLY LEADS
TO SOME CHANGES, AND I THINK
INFORMATION. I'M VERY DATA
DRIVEN MYSELF. SO INFORMATION I
THINK IS REALLY IMPORTANT. AND
I'M HAPPY TO SUPPORT YOU ON
THIS. THANK YOU. THANK YOU. I
BELIEVE THAT, HAD WE THE TIMING
WORKED OUT, THIS WOULD HAVE BEEN
A CONSENT ITEM. CERTAINLY REALLY
APPRECIATE YOU, SENATOR DALI,
FOR BRINGING THIS FORWARD. AND
KNOW THAT OUR COLLEAGUE
COUNTERPART REPRESENTING THE
DISTRICT IS ALSO HAS BEEN SUCH A
CHAMPION FOR OUR RURAL HOSPITALS
AND HAVING ACCESS FOR CRITICAL
CARE HOSPITALS IS ESSENTIAL.
VERY MUCH APPRECIATE YOU
BRINGING FORWARD THIS BILL, WITH
THAT, WE HAVE A MOTION AND A
SECOND. AND WOULD YOU LIKE TO
CLOSE? WELL THANK YOU, CHAIR AND
MEMBERS, I JUST WANT TO SAY
THAT, I'M SOMEWHAT FRUSTRATED,
TO BE HONEST WITH YOU, I, I'VE
BEEN CHAMPIONING FOR, RURAL
HOSPITALS FOR A LONG TIME AND
JUST WHERE I LIVE, MANY OF YOU
WHO'VE BEEN TO OUR HOME, AND IN
SOME CASES, IT'S 100 MILES TO
HAVE A BABY. AND IT'S VERY, IN
FACT, MY BEST FRIEND, HIM AND
HIS WIFE DELIVERED THEIR
GRANDCHILD ON THE SIDE OF THE
ROAD BECAUSE THEY WERE ON THEIR
WAY TO THE HOSPITAL, AND
THANKFULLY, EVERYTHING WAS
GREAT, BUT WE STARTED THIS WITH,
YOU KNOW, TRYING TO GET SOME
PARITY IN MEDI-CAL REIMBURSEMENT
RATES, QUITE FRANKLY, IS OUR
GOAL, BUT REALIZED WHEN WE GOT
OVER TO THE ASSEMBLY THAT THERE
WAS SOME DIFFERENCES IN HOW
HOSPITALS AND DISTRICT HOSPITALS
WORK TOGETHER. SO HOPEFULLY THIS
STUDY WILL FLESH THAT OUT. AND
AT SOME POINT, WE CAN ACTUALLY
COME BACK AND DO SOME
LEGISLATION THAT ACTUALLY HELPS
DRIVE UP THAT MEDI-CAL RATE AND
KEEPS THESE HOSPITALS IN, IN
SERVICE. QUITE FRANKLY, THAT'S
THE GOAL. SO APPRECIATE YOUR
WORK, AND RESPECTFULLY ASK FOR
AN AYE VOTE. ABSOLUTELY. THE
MOTION IS DUE. PASS AS AMENDED,
TO APPROPRIATIONS. SECRETARY,
PLEASE CALL THE ROLL. BONTA AYE.
AYE. WALDEN. WALDEN AYE.
AGUIAR-CURRY ARAMBULA. ARAMBULA
AYE. WENDY. CARILLO. WENDY.
CARILLO. AYE. LARA LARA. AYE.
HANEY WOULD. WOULD. AYE JACKSON.
MCCARTY JOE. PATTERSON. JOE.
PATTERSON. AYE RODRIGUEZ.
RODRIGUEZ. AYE. SANCHEZ SANCHEZ.
AYE. SANTIAGO CHAVO. WEBER.
MEASURES OUT NINE ZERO. THANK
YOU SO MUCH. ITEM FOR SB 803 BY
BECKER HAS BEEN PULLED. WE'RE
MOVING ON TO BY AUTHOR. WE'RE
MOVING ON TO ITEM NINE SB 1061
BY LIMÓN, WHICH WILL BE OUR LAST
ITEM FOR THE HEARING. GOOD
AFTERNOON, CHAIR AND MEMBERS. SB
1061 WILL REMOVE MEDICAL DEBT
FROM CONSUMER CREDIT REPORTS,
PROVIDING RELIEF TO MILLIONS OF
CALIFORNIANS WHOSE CREDIT SCORES
ARE UNNECESSARILY HARMED BY
DEBT. WE ALL KNOW THAT OUR
HEALTH IS NOT SOMETHING THAT ANY
OF US CAN TAKE FOR GRANTED. WE
ALSO KNOW THAT MEDICAL DEBT
DISPROPORTIONATELY IMPACTS LOW
INCOME PEOPLE, BLACK AND LATINO
COMMUNITIES, AND YOUNG PEOPLE,
ALL OF WHOM ARE LESS LIKELY TO
HAVE SAVINGS OR OTHER WEALTH TO
ABSORB THE FINANCIAL BURDEN OF
DEBT. IN ADDITION TO BEING
NONDISCRIMINATORY,
NON-DISCRETIONARY, AND OUTSIDE
OF THE CONTROL OF A PATIENT.
MEDICAL DEBT THAT IS REPORTED TO
CREDIT AGENCIES IS OFTEN
INACCURATE, WHETHER DUE TO
BILLING ERRORS, MISTAKES, OR
MISTAKES WITH REIMBURSEMENTS OR
ONGOING DISPUTES WITH INSURANCE
PLANS. WHEN A CONSUMER DISCOVERS
MEDICAL DEBT ON THEIR CREDIT
REPORT, THEY MAY NOT KNOW WHY IT
IS THERE OR WHO TO CONTACT TO
VERIFY THAT THE AMOUNT THAT THEY
ALLEGEDLY OWE IS REAL AND
ACCURATE FOR MEDICAL DEBT
ASSIGNED TO THIRD PARTY
COLLECTORS, OR SOLD TO DEBT
BUYERS, THE CONSUMER MAY NOT
KNOW THE ACTUAL HEALTH CARE
PROVIDER OR MEDICAL DEBT
SERVICES. THIS PROCESS OF
DETERMINING WHETHER AN ALLEGED
MEDICAL DEBT IS ACCURATELY
REPORTED CAN BE TIME CONSUMING
AND FRUSTRATING. CONSUMERS GO
FROM CREDIT BUREAU TO DEBT
COLLECTOR TO HEALTH CARE
PROVIDER TO INSURANCE COMPANY
SEEKING TO FIGURE OUT WHETHER A
MISTAKE HAS BEEN MADE AND WHO IS
RESPONSIBLE FOR FIXING IT. ON
TOP OF THESE CHALLENGES, MEDICAL
DEBT IS LESS PREDICTIVE OF A
CONSUMER'S WILLINGNESS AND
ABILITY TO PAY FUTURE CREDIT
OBLIGATIONS THAN OTHER FORMS OF
CONSUMER DEBT. SOME LENDERS AND
CREDIT SCORING MODELS HAVE COME
TO REALIZE THAT FALSE SIGNALS
THAT MEDICAL DEBT CAN SEND,
LEADING THEM TO REMOVE MEDICAL
DEBT FROM THEIR RISK SCORING
SYSTEM. THIS BILL PROHIBITS
MEDICAL DEBT FROM BEING REPORTED
TO CREDIT AGENCIES, BUT IT DOES
NOT FORGIVE THE DEBT. THIS BILL
DOES NOT RELIEVE MANY OF THE
BURDENS ASSOCIATED WITH MEDICAL
DEBT. THIS BILL DOES NOT FORGIVE
DEBT, NOR DOES IT RESTRICT
COLLECTION PRACTICES RELATED TO
MEDICAL DEBT, SUCH AS CONTINUOUS
OUTREACH BY DEBT COLLECTORS.
WHILE THIS BILL DOES NOT SOLVE
ALL OF THE PROBLEMS WITH MEDICAL
DEBT, IT IS A START REMOVING
REMOVING MEDICAL DEBT FROM
CREDIT REPORTS WILL GIVE A
CONSUMERS A BETTER CHANCE TO
RESTORE THEIR FINANCIAL HEALTH.
TESTIFYING IN SUPPORT OF THE
BILL TODAY IS SHELLEY ERKKI, WHO
WILL SHARE HER PERSPECTIVE WITH
MEDICAL DEBT, SHOWING UP ON
CREDIT REPORT, AS WELL AS
ELEANOR BLUM FROM THE CALIFORNIA
DEPARTMENT OF JUSTICE AND FORMER
COUNSEL AT THE CONSUMER
FINANCIAL PROTECTION BUREAU.
THANK YOU. YOU'LL EACH HAVE TWO
MINUTES, GOOD AFTERNOON. MY NAME
IS SHELLEY ERKKI, AND I'M A
MIDDLE SCHOOL TEACHER IN SANTA
MONICA. I'M HERE TO SHARE WITH
YOU THE CASCADING WAYS IN WHICH
MEDICAL DEBT ON MY CREDIT REPORT
HAS IMPACTED ME. SEVEN YEARS
AGO, I WENT IN FOR A NECESSARY
ABDOMINAL SURGERY. I HAVE WHAT
IS CONSIDERED VERY GOOD UNION
NEGOTIATED INSURANCE. THANKS TO
OUR BARGAINING TEAM. HOWEVER, I
STILL GOT A SURPRISE BILL FOR
ALMOST $16,000 POST-SURGERY AT
THE TIME, I WAS VERY MUCH LIVING
PAYCHECK TO PAYCHECK. DESPITE
THAT, MY CREDIT WAS GOOD. I
NEVER MISSED A RENT, UTILITY, OR
SCHOOL LOAN PAYMENT AND ANY
CREDIT CARD DEBT FROM MY YOUNGER
YEARS HAD BEEN COMPLETELY PAID
OFF YEARS BEFORE THAT, 16,000 I
OWED CAUSED EXTREME FINANCIAL
AND EMOTIONAL STRESS. THERE WERE
HOURS AND HOURS AND HOURS ON THE
PHONE TO TRY TO FIND A
RESOLUTION. I STRUGGLED TO PAY
THE RESULTING MEDICAL BILLS AND
OTHER BILLS ADDED INTEREST, AND
LATE FEES MADE MY FINANCIAL
SITUATION WORSE. I COULDN'T GET
APPROVED FOR A CREDIT CARD THAT
I NEEDED. I WAS I COULDN'T GET A
LOAN FOR GRAD SCHOOL, WHICH KEPT
ME FROM GETTING AN ADVANCED
DEGREE TO ADVANCED ON THE PAY
SCALE IN MY SCHOOL DISTRICT.
THAT IMPACTED MY CALSTRS, AS
WELL AS MY 403 B CONTRIBUTIONS.
I WAS STUCK IN AN APARTMENT WITH
ABUSIVE LANDLORD BECAUSE I
FEARED I WOULD NOT PASS A CREDIT
CHECK FOR A NEW PLACE WHEN I
NEEDED TO BUY A CAR. THE DAMAGED
CREDIT FROM THE MEDICAL DEBT
PREVENTED ME FROM GETTING A LOW
INTEREST LOAN, CAUSING ME MORE
MONTHLY PAYMENTS. MEDICAL DEBT
NOT ONLY DAMAGED MY ONCE GOOD
CREDIT, IT IMPACTED MY MENTAL
AND PHYSICAL HEALTH AS WELL.
I'VE BECOME VERY AVERSE TO
ACCESSING REGULAR HEALTHCARE
BECAUSE I FEAR ANOTHER SURPRISE
BILL WILL LEAD TO MORE CREDIT
DAMAGE, I'M NOT UNIQUE. MILLIONS
HAVE SIMILAR STORIES, SOME FAR
WORSE. MANY, FAR WORSE. BUT I
WANT TO MAKE THE POINT THAT
PEOPLE WITH MEDICAL DEBT ARE NOT
NECESSARILY IRRESPONSIBLE.
THEY'RE INDIVIDUALS WHO HAVE
BEEN THRUST INTO AN UNTENABLE
FINANCIAL SITUATION, NOT OF
THEIR OWN MAKING. SO I'M ASKING
PLEASE SUPPORT SB 1061 SO
CALIFORNIANS MAY GET SOME SMALL
MEASURE OF RELIEF IN THIS
SITUATION. THANK YOU, THANK YOU.
YOU'LL HAVE TWO MINUTES. GOOD
AFTERNOON, MR. CHAIR AND
COMMITTEE MEMBERS. MY NAME IS
ELEANOR BLUM, AND I'M A SPECIAL
ASSISTANT ATTORNEY GENERAL FOR
ECONOMIC JUSTICE IN THE
CALIFORNIA ATTORNEY GENERAL'S
OFFICE. ATTORNEY GENERAL BONTA
IS PLEASED TO CO-SPONSOR SENATE
BILL 1061 TO BRING AN END TO
PUTTING MEDICAL DEBT ON CONSUMER
CREDIT REPORTS ON BEHALF OF THE
ATTORNEY GENERAL, I WANT TO
THANK SENATOR LIMÓN AND OUR
COALITION OF CONSUMER AND HEALTH
ADVOCACY ORGANIZATIONS FOR
LEADING ON THIS IMPORTANT
LEGISLATION TO PROTECT
CALIFORNIANS FROM THE HARMFUL
IMPACTS OF MEDICAL DEBT
BURDENING CONSUMER CREDIT
REPORTS, ESPECIALLY THE LOW
INCOME AND MARGINALIZED
COMMUNITIES THAT ARE MOST
IMPACTED BY THIS PERVASIVE
PROBLEM. MEDICAL DEBT APPEARING
ON CONSUMER CREDIT REPORTS CAN
DESTROY CREDIT WORTHINESS
BURDENS CONSUMERS THROUGHOUT
THEIR FINANCIAL LIVES. MEDICAL
DEBT IS NOT A GOOD PREDICTOR OF
A CONSUMER'S LIKELIHOOD OF
PAYING A DEBT NEEDLESSLY
DIMINISHING THE ABILITY OF
PEOPLE WITH MEDICAL DEBT TO
CARRY OUT THE REST OF THEIR
FINANCIAL LIVES. THIS DEBT OFTEN
COMES FROM UNEXPECTED,
UNPLANNED, AND UNAVOIDABLE
CIRCUMSTANCES UNRELATED TO
GENERAL FINANCIAL WELL-BEING AND
CAN HAPPEN TO ANYONE. MEDICAL
DEBT INCREASES THE RISK OF
HOMELESSNESS OR BEING FORCED TO
LIVE IN SUBSTANDARD HOUSING. IT
CREATES BARRIERS TO FINDING
EMPLOYMENT, AS EMPLOYERS OFTEN
USE CREDIT REPORTS AS THE BASIS
FOR HIRING DECISIONS. WE KNOW
THAT PEOPLE ARE DELAYING OR
SKIPPING ESSENTIAL MEDICAL
TREATMENT OUT OF A FEAR OF
ACCUMULATING MEDICAL DEBT. A NOT
UNREASONABLE FEAR GIVEN THE HIGH
COST OF HEALTH CARE. SKIPPING
THIS CARE, OF COURSE, ONLY LEADS
TO WORSE HEALTH OUTCOMES.
CALIFORNIA FAMILIES THAT SHOULD
NOT BE FORCED TO SUFFER FROM THE
HARMFUL OR UNNECESSARY IMPACTS
RESULTING FROM MEDICAL DEBT,
DAMAGING THEIR CREDIT. SENATE
BILL 1061 ENACTS A VERY
STRAIGHTFORWARD SOLUTION TO THIS
PROBLEM BY PROHIBITING MEDICAL
DEBT FROM BEING REPORTED TO
CONSUMER CREDIT REPORTING
AGENCIES. IF ENACTED, CALIFORNIA
WOULD JOIN COLORADO AND NEW
YORK, WHICH ALREADY HAVE LAWS IN
PLACE AND A HANDFUL OF SISTER
STATES THAT ENACTED LAWS THIS
YEAR TO A MORE JUST AND RATIONAL
APPROACH TO ADDRESSING MEDICAL
DEBT. ATTORNEY GENERAL BONTA IS
PLEASED TO STAND WITH THE BROAD
COALITION AND URGES YOUR SUPPORT
FOR SENATE BILL 1061. THANK YOU.
MOVED BY ARAMBULA SECONDED BY
RODRIGUEZ. OTHERS IN SUPPORT,
PLEASE COME FORWARD. GOOD
AFTERNOON, DANNY KENDALL KAISER,
ON BEHALF OF TWO OF THE
CO-SPONSORS OF THE BILL, THE
CALIFORNIA LOW INCOME CONSUMER
COALITION AND THE NATIONAL
CONSUMER LAW CENTER. THANK YOU.
MARCHESE, ON BEHALF OF THE
COUNTY OF LOS ANGELES IN
SUPPORT, THANK YOU. GOOD
EVENING, JANICE O'MALLEY WITH
AFSCME CALIFORNIA AND SUPPORT.
THANK YOU. K¾T ÓRDENES WITH
HEALTH ACCESS CALIFORNIA. WE'RE
PROUD CO-SPONSOR. THANK YOU.
BRIAN LEAHY, AARP VOLUNTEER. I'M
ON BEHALF OF OUR 3.2 MILLION
CALIFORNIA MEMBERS IN SUPPORT.
HELLO. RACHEL BHAGWAT, ACLU
CALIFORNIA ACTION AND SUPPORT
KELLY BROOKS ON BEHALF OF THE
SANTA CLARA COUNTY BOARD OF
SUPERVISORS IN SUPPORT REBECCA
MARCUS ON BEHALF OF ONE OF THE
BILL'S CO-SPONSORS, CALPIRG, AS
WELL AS THE CONSUMER PROTECTION
POLICY CENTER AT THE UNIVERSITY
OF SAN DIEGO SCHOOL OF LAW IN
SUPPORT BETH MALINOWSKI, SEIU
CALIFORNIA, IN SUPPORT.
CHRISTOPHER SANCHEZ, ON BEHALF
OF THE CONSUMER FEDERATION OF
CALIFORNIA, IN SUPPORT. ADAM
ZARIN, THE LEUKEMIA LYMPHOMA
SOCIETY IN SUPPORT. NIHAR SAJJU,
ON BEHALF OF THE WESTERN CENTER
ON LAW AND POVERTY AND SUPPORT.
MARTY LOPEZ, CALIFORNIA NURSES
ASSOCIATION CO-SPONSOR. THANK
YOU. ARE THERE ANY WITNESSES IN
OPPOSITION?
PLEASE PRESS YOUR BUTTON. YOU'LL
EACH HAVE TWO MINUTES. THANK
YOU. GOOD EVENING, MADAM CHAIR.
AND MEMBERS. MELANIE CUEVAS WITH
THE CALIFORNIA BANKERS
ASSOCIATION. WE ARE IN OPPOSE
UNLESS AMENDED POSITION, I WILL
START BY SAYING THAT WE'RE NOT
OPPOSED TO THE CORE GOAL HERE.
AND IN FACT, WE AGREE WITH THE
AUTHOR AND THE PROPONENTS THAT
MEDICAL DEBTS ARE UNLIKE OTHER
TYPES OF DEBT. THEY ARE
EMERGENCY, UNPLANNED, ONE TIME
SCENARIOS, USUALLY IN A STATE OF
DURESS. YOU'RE DEALING WITH
INSURANCE, WHICH IS OFTEN
COMPLICATED AND CONFUSING AS
WELL. OUR CONCERNS COME IN
BECAUSE THE MEASURE ISN'T
LIMITED TO THOSE TYPES OF DEBT.
THE DEFINITION OF MEDICAL DEBT
IN THIS BILL ALSO INCLUDES
CREDIT CARD PRODUCTS, AS WELL AS
SECURED DEBTS, WHICH ARE MORE
REFLECTIVE OF A CONSUMER'S
GENERAL FINANCIAL STANDING AND
ARE NOT THOSE DURESS ONE TIME
SITUATIONS, WE'VE HAD MANY
CONVERSATIONS WITH THE AUTHOR'S
OFFICE, AND I THINK THAT WE ARE
AT A FUNDAMENTAL DISAGREEMENT
ABOUT WHAT THE DEFINITION OF
MEDICAL DEBT SHOULD BE. WE
BELIEVE THAT IT SHOULD BE THOSE
DEBTS OWED DIRECTLY TO A
FACILITY OR TO OR TO A PROVIDER,
AND SO AT THIS TIME, WE REMAIN
OPPOSED. AND I KNOW THAT CREDIT
CARDS AND SECURED DEBTS AREN'T
THE MAIN PURVIEW OF HEALTH
COMMITTEE. SO I'LL STOP MY
TESTIMONY THERE. BUT I'M HAPPY
TO ANSWER QUESTIONS. THANK YOU.
YOU'LL HAVE TWO MINUTES. CHAIR,
VICE CHAIR WALDRON AND MEMBERS
OF THE HEALTH COMMITTEE. MY NAME
IS DAVID REED, AND I SERVE AS
GENERAL COUNSEL TO THE
RECEIVABLES MANAGEMENT
ASSOCIATION. INTERNATIONAL RBI
IS A NONPROFIT TRADE ASSOCIATION
WHICH REPRESENTS BANKS, CREDIT
UNIONS, COLLECTION AGENCIES,
DEBT BUYING COMPANIES AND
COLLECTION LAW FIRMS. OUR MAY I
IS IN OPPOSITION TO SB 1061 AS
CURRENTLY DRAFTED. RMI AGREES
WITH THE AUTHORS POSITION THAT
MEDICAL DEBT SHOULD BE TREATED
DIFFERENTLY FROM OTHER ASSET
CLASSES DUE TO THE UNIQUE NATURE
OF THE DEBT. SIMPLY PUT, PEOPLE
DO NOT CHOOSE TO GET SICK, NOR
DO THEY CHOOSE TO GET IN AN
ACCIDENT. RMI HAS BEEN
CONSISTENT IN ITS OPPOSITION FOR
ONE SINGLE REASON THE OVERLY
BROAD DEFINITION OF MEDICAL
DEBT. I THINK WE CAN ALL AGREE
THAT DEBT OWED TO A HOSPITAL,
MEDICAL CLINIC OR MEDICAL
PROVIDER IS CLEARLY MEDICAL DEBT
. THIS IS THE POSITION TAKEN NOT
ONLY BY THE FINANCIAL SERVICES
INDUSTRY, BUT ALSO THE FEDERAL
CONSUMER, FINANCIAL PROTECTION
BUREAU, IN ITS JUNE 11TH
PROPOSED RULE TO BAN MEDICAL
BILLS FROM CREDIT REPORTS.
HOWEVER, THIS BILL APPLIES TO A
MUCH BROADER DEFINITION OF
MEDICAL DEBT, WHICH PULLS IN
OTHER TYPES OF FINANCIAL
PRODUCTS, INCLUDING SOME CREDIT
CARDS, GENERAL PURPOSE LINES OF
CREDIT, AND SECURED DEBT. THE
CFPB SPENT TWO YEARS ANALYZING
THE CHALLENGES RELATED TO
MEDICAL DEBT FOR ITS RULEMAKING,
AND CONSIDERED A BROADER
DEFINITION SIMILAR TO SB 1061,
BUT CONCLUDED IT WAS NOT
FEASIBLE AND FOCUSED EXCLUSIVELY
ON DEBT OWED TO A HOSPITAL
CLINIC, OR MEDICAL PROVIDER. WE
ASKED THE STATE OF CALIFORNIA TO
DO THE SAME. HOWEVER, IF THIS IS
NOT POSSIBLE, RMI IS REQUESTING
GREATER EXEMPTIONS IN THE BILL
TO COVER GENERAL PURPOSE CREDIT
CARDS. GENERAL PURPOSE LINES OF
CREDIT, GENERAL PURPOSE CLOSED
END LOANS AND SECURED DEBT. WE
ALSO REQUEST THAT THE DEBT
VOIDING PROVISION CONTAINED IN
THE BILL FOR REPORTING DEBT TO A
CREDIT REPORTING AGENCY CONTAIN
A PROVISION WHERE THE REPORTING
ENTITY CAN SEEK TO CORRECT AN
ERROR WITHIN 15 DAYS OF CONSUMER
NOTICE. FOR THESE REASONS, RMI
REMAINS IN OPPOSITION. IF THESE
CONCERNS ARE ADDRESSED, RMI WILL
CHANGE ITS POSITION TO SUPPORT.
THANK YOU. ANY OTHER WITNESSES
IN OPPOSITION? PLEASE COME
FORWARD. HI, MARK, ON BEHALF OF
THE CALIFORNIA HOSPITAL
ASSOCIATION, WE'RE OPPOSED
UNLESS AMENDED. BUT WE'VE BEEN
HAVING DISCUSSIONS WITH THE
AUTHOR. WE'RE SIGNIFICANTLY
CLOSE TO BEING ABLE TO REMOVE
OUR OPPOSITION. THANK YOU.
INDIRA MCDONALD HERE ON BEHALF
OF THE CALIFORNIA MORTGAGE
BANKERS ASSOCIATION,
RESPECTFULLY OPPOSE, UNLESS
AMENDED, AND APPRECIATE THE
CONTINUED TALKS WITH THE AUTHOR.
THANK YOU. I'LL BRING IT BACK TO
THE COMMITTEE FOR COMMENT OR
QUESTION. I'LL CERTAINLY BEGIN.
SENATOR YOU HANDED US ALL A
DOCUMENT, I THINK, THAT SPEAKS
TO THE SOME OF THE OPPOSITION'S
CONCERNS ABOUT THE BROADENING OF
THE CHARACTERIZATION OF MEDICAL
DEBTS AND WOULD LOVE FOR YOU TO,
KIND OF WALK US THROUGH CARE
CREDIT CARDS AND THE IMPACT ON
THEM AND WHERE THEY FIT INTO
YOUR BILL. PLEASE PUT YOUR MIC
ON. ALL RIGHT. WHAT YOU'VE BEEN
HANDED IS INFORMATION ABOUT THE
CARE CREDIT CARD. SO JUST TO BE
CLEAR, THIS DOES NOT APPLY TO
REGULAR, CREDIT CARDS. THEY HAVE
TO BE CARDS THAT ARE MARKETED
FOR MEDICAL PURPOSES. SO IF A
CARD ADVERTISES, NO MATTER WHAT
IT IS, CARE CARD, OTHERS IF THEY
SAY, HEY, THIS IS ABOUT MEDICAL
DEBT, THEN THIS APPLIES CARE,
THE CARE CREDIT CARD IS ONE
SPECIFIC FOR THAT. AND SO WE
JUST WANTED TO SHOW FOLKS THE
PARAMETERS OF WHAT IT SAYS THAT
YOU CAN OR CANNOT USE THE CARD
FOR. AND SO YOU WILL SEE HERE
THAT IT HAS A PARAMETERS RELATED
TO MEDICAL CARE. AND SO IF THERE
ARE DISPUTES ABOUT THAT, IF
SOMEONE IS USING A MEDICAL CARD
FOR SOMETHING THAT IS NOT
ALLOWED, THAT SHOULDN'T BE USED,
THAT IS A DIFFERENT LEVEL OF
DISPUTE. BUT THAT IS THE CARD
ISSUERS, PROBLEM ESSENTIALLY,
BUT WE WANTED TO MAKE SURE THAT
YOU ALL HAD THIS. WE ALSO WANTED
TO MAKE SURE THAT YOU
UNDERSTOOD, EVEN IN THIS AREA,
WHERE THIS CARD IS, WHERE YOU'RE
ABLE TO USE THIS CARD, SO IT IS
NOT EVERYWHERE ALL THE TIME, ANY
PLACE, THERE ARE JUST HERE IN
SACRAMENTO, WHICH WAS A BIG AREA
FOR OUR STATE, LIMITED PLACES
WHERE YOU CAN ACTUALLY USE THIS.
AND SO WE ALSO GAVE YOU SOME
BACKGROUND. IT'S JUST BEEN A BIG
TOPIC OF CONVERSATION, AND WE
WANTED YOU ALL TO HAVE MORE
INFORMATION ABOUT WHAT A CARE,
CARD IS AND WHAT IT IS USED FOR
IN LIGHT OF THE OPPOSITION'S
COMMENTS. THANK YOU. I WANT TO
SAY I VERY MUCH APPRECIATE THIS,
BILL. I KNOW THAT YOU, HAVE BEEN
VERY FOCUSED ON BANKING AND
FINANCE OVER ON THE SENATE SIDE
AND BRING THAT OVER HERE. HERE
WE HAVE A SITUATION WHERE, TO Ã
REALLY APPRECIATE THE TESTIMONY
OFFERED BY THE WITNESS, WHERE
SOMEBODY CAN HAVE AN INCREDIBLY
CHALLENGED TIME IF THEY'RE IF
THEY RECEIVE A MEDICAL DEBT
BECAUSE OF SOMETHING THAT THEY
COULD NOT PREVENT OR, OR EVEN
PREDICT FOR THE MOST PART, AND
KNOW THAT I'M REALLY CONCERNED
ABOUT THESE, CARE CREDIT CARDS,
AND THEY'RE PLACED IN MEDICAL
OFFICES. THEY'RE AVAILABLE.
SOMEONE STRUGGLING, THEY GO TO
USE THIS, CREDIT CARD, AND THE
IMPACT OF THAT WILL MEAN THAT
THEY END UP BEING IN A VERY
VULNERABLE POSITION AND THEN
HAVE THE ABILITY TO ACCESS THIS
CARD AND IF THEY ARE UNABLE TO
MEET THE INCREDIBLE DEMANDS OF A
$16,000 UNEXPECTED PAYMENTS,
THEY CAN HAVE THEIR CREDIT. LIFE
RUINED, SO VERY CONCERNED, VERY
THANKFUL FOR YOU BRINGING
FORWARD THIS BILL. IF YOU WANT
TO ADDRESS ANY OF THE
OPPOSITION'S CONCERNS IN YOUR
CLOSING, PLEASE GO AHEAD. THANK
YOU. AND I APPRECIATE THE
HEARING. I WILL SAY THAT
UNSECURED DEBT, WE JUST TOOK
MORE AMENDMENTS IN ASSEMBLY
JUDICI, TO ALSO FURTHER NARROW
THE SECURED DEBT. SO THIS ISN'T
ABOUT SECURE DEBT. I THINK THAT
THAT'S, YOU KNOW, REALLY, REALLY
IMPORTANT TO NOTICE COMMENTS
HAVE BEEN MADE ABOUT ALIGNING
WITH THE CFPB. THE CFPB HAS A
LETTER OF SUPPORT FOR THE
POSITION FOR THIS BILL AS IS. SO
WE BELIEVE THAT THEY ARE
PERFECTLY FINE WITH, CALIFORNIA
MOVING IN THIS DIRECTION. AND,
YOU KNOW, I THINK IT'S ALSO JUST
A REMINDER, THE GOAL OF THIS
BILL IS ABOUT, ENSURING THAT
WHEN YOU HAVE MEDICAL DEBT, IT
DOES NOT GET REPORTED TO A
CREDIT REPORTING AGENCY TO RUIN
YOUR CREDIT. THIS IS WHAT THIS
IS ABOUT. IT DOESN'T SAY YOU GET
A PASS AND NOT PAYING THIS, YOU
STILL HAVE TO PAY IT. BUT
RUINING YOUR CREDIT SCORE HAS
OTHER CONSEQUENCES. AND MANY OF
US, WHETHER YOU'RE A PRIVATE,
YOU HAVE PRIVATE INSURANCE OR
WHETHER YOU DON'T HAVE PRIVATE
INSURANCE, KNOW WHAT IT'S LIKE
TO HAVE TO PICK UP THE PHONE AND
CALL AND SAY, HEY, THERE'S AN
ERROR IN THIS BILLING STATEMENT,
AND I NEED MORE TIME, AND WE
NEED TO FIGURE OUT WHY THAT IT
WAS CODED WRONG OR WHY SOMETHING
DIDN'T HAPPEN. SO INSTEAD OF
THAT MOMENT BEING USED TO GO AND
SAY, HEY, CREDIT REPORTING
AGENCIES, THIS PERSON HASN'T
PAID THEIR DEBT, IT IS NOW GOING
TO BE A TIME WHERE THAT CAN BE
FIGURED OUT. BETWEEN THE
CONSUMER, THE PATIENT AND THE
ENTITY. AND SO FOR ME, THIS IS
WHY IT'S IMPORTANT TO BRING THIS
FORWARD, YOU KNOW, JUST LIKE
I'VE BEEN ON THE HEALTH
COMMITTEE, BOTH IN THE ASSEMBLY
AND THE SENATE FOR EIGHT YEARS,
ALSO IN BANKING AND FINANCE. AND
THIS IS ONE OF THOSE RARE PLACES
WHERE THEY MEET. THIS IS ABOUT
CONSUMER PROTECTIONS FOR THE
PATIENTS. AND SO WITH THAT, I
RESPECTFULLY ASK FOR AN AYE VOTE
. THANK YOU. I THINK WE HAVE A
MOTION AND A SECOND ON THIS. THE
MOTION IS DUE PASS TO BANKING
AND FINANCE SECRETARY. PLEASE
CALL THE ROLL BONTA I BONTA. AYE
WALDEN AGUIAR-CURRY AGUIAR-CURRY
AYE. ARAMBULA ARAMBULA AYE.
WENDY CARILLO. LARA. LARA. NOT
VOTING. HANEY. HANEY. I WOULD.
WOOD. AYE. JACKSON. JACKSON. AYE
MCCARTY. MCCARTY. AYE. JOE.
PATTERSON Tê. PATTERSON. NÓ.
RODRIGUEZ RODRIGUEZ. AYE.
SANCHEZ. SANCHEZ. NO SANTIAGO.
SZABO SZABO. AYE. WEBER. THE
VOTE IS 9 TO 2. THAT MEASURES
OUT. THANK YOU SO MUCH. WE'VE
HEARD NOW ALL OF THE BILLS THAT
WERE BEING PRESENTED FOR THE
COMMITTEE. SO WE WILL BACK GO
BACK TO TWO VOTES ADD ONS AND
ANY ON CALL MEASURES. WE'LL
START WITH THE CONSENT CALENDAR.
MOVED BY AGUIAR-CURRY SECONDED
BY DOCTOR WOULD PLEASE CALL THE
ROLL ONTO AYE ONTO AYE. WALDRON
AGUIAR-CURRY. AGUIAR-CURRY. AYE.
ARAMBULA ARAMBULA. AYE. WENDY
CARRILLO. LARA. LARA. AYE HANEY.
HANEY I WOULD, I WOULD AYE.
JACKSON. JACKSON. AYE. MCCARTY.
MCCARTY I PATTERSON. JOE.
PATTERSON. AYE. RODRIGUEZ
RODRIGUEZ. RODRIGUEZ. AYE
SANCHEZ. SANCHEZ. AYE. SANTIAGO.
CHAU. CHAU. VÚI. WEBBER.
WALDRON. WALDEN AYE. WENDY.
CARRILLO. WENDY CARRILLO. AYE.
THE CONSENT CALENDAR IS OUT 14
TO 0. MOVING ON TO ITEM SIX. SB
954. WE NEED A MOTION AND A
SECOND MOVED BY ARAMBULA,
SECONDED BY AGUIAR-CURRY. PLEASE
CALL THE ROLL. MOTION IS DUE
PASSED TO APPROPRIATIONS. BONTA
I BONTA. AYE. WALDEN. WALDEN I
AGUIAR-CURRY AGUIAR-CURRY. AYE.
ARAMBULA. ARAMBULA. AYE. WENDY.
CARRILLO WENDY. CARRILLO. AYE.
FLORA LARA. AYE. HANEY HANEY I
WOULD WOULD. AYE. JACKSON.
JACKSON. AYE. MCCARTY MCCARTY.
AYE. JO. PATTERSON. JO
PATTERSON. NO. RODRIGUEZ
RODRIGUEZ. AYE. SANCHEZ SANCHEZ.
NO. SANTIAGO CHABOT. CHAU. AYE.
WEBBER. SANTIAGO. SANTIAGO. AYE.
13 AND TWO. YEA I JUST DIDN'T
READ THAT. MEASURE IS OUT. 13 TO
2. AND THE LEFT PART OF THE DAIS
IS STARTING TO DECOMPOSE. OVER
THERE, WE WILL MOVE ON TO ITEM
WHERE WE WHERE ITEM SEVEN SB 966
WIENER. THE MOTION IS DUE. PASS
TO JUDICIARY. IT'S ALREADY
PASSED. WE NEED ADD ONS FOR THIS
MEASURE. AGUIAR-CURRY
AGUIAR-CURRY. AYE. LARA LARA.
AYE HANEY. HANEY. AYE. MCCARTY
MCCARTY. AYE. SANCHEZ. SANCHEZ.
NOT VOTING. CHAVO. CHAVO AYE.
WEBBER. 14 ZERO THAT MEASURES
NOW AT 14 TO 0. MOVING ON TO
ITEM NINE SB 1061 LIMÓN FOR ADD
ONS. WALDRON ITEM NINE ALDER NOT
VOTING WENDY CARRILLO. WENDY.
CARRILLO. AYE SANTIAGO.
SANTIAGO. AYE. WEBBER. 1102 THAT
MEASURES NOW 11 TO 2. MOVING ON
TO ITEM 11 FOR ADD ONS. SB 1238
EGGMAN ARAMBULA ARAMBULA. AYE.
WENDY CARRILLO WENDY. CARRILLO
AYE. HANEY. HANEY. AYE JACKSON.
JACKSON. AYE. MCCARTY MCCARTY.
AYE. SANCHEZ SANCHEZ. AYE.
SANTIAGO SANTIAGO. AYE THAT
MEASURES NOW 16 TO 0. ITEM 15,
SB 1354 IS ON CALL. WE'RE
LIFTING THE CALL. WALDRON ITEM
15, SB 1354 WALDRON. AYE. AGA.
CURRY AGUIAR-CURRY. AYE.
ARAMBULA. ARAMBULA AYE. FLORA
LARA AYE. HANEY HANEY. AYE.
MCCARTY MCCARTY. AYE. JO.
PATTERSON. JO PATTERSON. AYE.
RODRIGUEZ. RODRIGUEZ. AYE
SANCHEZ. SANCHEZ. AYE. CHAVO
CHAVO. AYE 16 ZERO. THAT
MEASURES OUT 16 TO 0. ITEM 16 SB
1430 1423. DOLLY FOR ADD ONS.
EDGAR CURRY. AGUIAR-CURRY AYE.
HANEY HANEY. AYE. JACKSON
JACKSON. AYE. MCCARTY. MCCARTY.
AYE SANTIAGO. SANTIAGO. AYE.
CHAVO CHAVO. AYE WEBBER. 15 ZERO
THAT MEASURES NOW AT 15 TO 0.
ITEM 17 SB 1432. CABALLERO
ARAMBULA. LARA. LARA. AYE HANEY.
HANEY. AYE. MCCARTY MCCARTY.
AYE. RODRIGUEZ. CHAVO. CHAVO.
AYE. 14. THAT MEASURES NOW AT 14
TO 0.
WE'RE GOING TO DO AD ON ON
CONSENT FOR SANTIAGO. ON CONSENT
CALENDAR. SANTIAGO AYE.
COMMITTEE MEMBERS, OUR HEARING
FOR JUNE 24TH OF THE HEALTH
COMMITTEE IS GOING TO BE
ADJOURNED. I WANT TO ALSO SAY
THAT WE WILL NOT HAVE A HEALTH
COMMITTEE MEETING. AS IT STANDS
NOW, NEXT WEEK. SO THIS
CONCLUDES OUR HEARINGS FOR THIS
LEGISLATIVE SESSION. THANK YOU.
THANK YOU TO OUR INCREDIBLE
STAFF, COMMITTEE STAFF FOR THEIR
WORK TO GET US TO THIS POINT.
THANK YOU. SO MUCH.