Existing law requires a licensed covered facility, as defined, to disseminate to clients a notice, as specified, stating that California has public programs that provide immediate free or low-cost access to comprehensive family planning services, prenatal care, and abortion for eligible women. Existing law requires an unlicensed covered facility, as defined, to disseminate to clients a notice, as specified, stating that the facility is not licensed as a medical facility by the State of California and has no licensed medical provider. Existing law authorizes the Attorney General, city attorney, or county counsel to bring an action to impose a specified civil penalty against covered facilities that fail to comply with these requirements.

This bill would require a facility that offers abortion services to disseminate a notice to clients, as specified, providing the contact information telephone number for a specified organization and stating that pregnancy centers can provide women with services at no cost that include counseling, consultation, pregnancy tests, sexually transmitted disease or sexually transmitted infection (STD/STI) testing, ultrasound services, support groups, parenting programs, and material assistance.

Existing law requires a licensed covered facility, as defined, to disseminate to clients a notice, as specified, stating that California has public programs that provide immediate free or low-cost access to comprehensive family planning services, prenatal care, and abortion for eligible women. Existing law requires an unlicensed covered facility, as defined, to disseminate to clients a notice, as specified, stating that the facility is not licensed as a medical facility by the State of California and has no licensed medical provider. Existing law authorizes the Attorney General, city attorney, or county counsel to bring an action to impose a specified civil penalty against covered facilities that fail to comply with these requirements.

This bill would require a facility that offers abortion services to disseminate a notice to clients, as specified, providing the contact information for a specified organization and stating that pregnancy centers can provide women with services that include counseling, pregnancy tests, sexually transmitted disease or sexually transmitted infection (STD/STI) testing, ultrasound services, support groups, parenting programs, and material assistance.

Date of Hearing: April 19, 2016

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2775

Author:(Gallagher) – As Amended Ver:March 17, 2016

SUBJECT: Abortion services facilities: pregnancy center notice.

SUMMARY: Requires facilities that offer abortion services to disseminate a notice to clients providing a telephone number for a specific organization, and stating that non-profit pregnancy centers can provide a variety of specified services. Specifically, this bill:

1. Requires a facility that offers abortion services to disseminate to clients onsite the following notice:

"If you are considering continuing your pregnancy, nonprofit pregnancy centers can provide services at no cost to you, that may include consultation, pregnancy testing, ultrasound services, support groups, parenting programs, material assistance, and sexually transmitted disease or sexually transmitted infection (STD/STI) testing. To find a center near you, call 1-800-712-HELP."

1. Requires the facility to disseminate the notice in the primary threshold languages for Medi-Cal beneficiaries as determined by the Department of Health Care Services (DHCS) in which the facility is located.
2. Requires the onsite notice to be a sign at least 8.5 inches by 11 inches, written in no less than 36-point type, and to be posted conspicuously in the entrance of the facility and at least one additional area where clients wait to receive services.

EXISTING LAW:

1. Licenses and regulates clinics, including primary care clinics and specialty clinics such as surgical clinics, by the Department of Public Health (DPH).
2. Authorizes DPH to take various types of enforcement actions against a primary care clinic that has violated state law or regulation, including imposing fines, sanctions, civil or criminal penalties, and suspension or revocation of the clinic's license.
3. Establishes the California Reproductive Privacy Act, which provides that the state shall not deny or interfere with a women's right to choose or obtain an abortion prior to viability of the fetus, or when the abortion is necessary to protect the life or health of the woman, and makes legislative findings and declarations that every individual possesses a fundamental right of privacy with respect to personal reproductive decisions, and that every woman has the fundamental right to choose to bear a child or to choose and to obtain an abortion, as specified.
4. Enacts the Reproductive Freedom, Accountability, Comprehensive Care, and Transparency Act (Reproductive FACT Act).
5. Defines a “licensed covered facility,” for the purposes of the Reproductive FACT Act, as a licensed clinic or an intermittent clinic operating under a primary care clinic whose primary purpose is providing family planning or pregnancy-related services, and that satisfies two or more of the following:
   
   1. The facility offers obstetric ultrasounds, obstetric sonograms, or prenatal care to pregnant women;
   2. The facility provides, or offers counseling about, contraception or contraceptive methods;
   3. The facility offers pregnancy testing or pregnancy diagnosis;
   4. The facility advertises or solicits patrons with offers to provide prenatal sonography, pregnancy tests, or pregnancy options counseling.
   5. The facility offers abortion services; or,
   6. The facility has staff or volunteers who collect health information from clients.
      
6. Requires a licensed covered facility to disseminate to clients on site the following notice in English and in the primary threshold languages for Medi-Cal beneficiaries as determined by DHCS for the county in which the facility is located:
7. “California has public programs that provide immediate free or low-cost access to comprehensive family planning services (including all FDA-approved methods of contraception), prenatal care, and abortion for eligible women. To determine whether you qualify, contact the county social services office at [insert the telephone number].”
   
8. Permits the notice to be combined with other mandated disclosures, but requires it be disclosed through one of the following methods:
   
   1. A public notice posted in a conspicuous place where individuals wait that may be easily read by those seeking services from the facility. Requires the notice to be at least 8.5 inches by 11 inches and written in no less than 22-point type;
   2. A printed notice distributed to all clients in no less than 14-point type; or,
   3. A digital notice distributed to all clients that can be read at the time of check-in or arrival, in the same point type as other digital disclosures. Requires a printed notice be available for all clients who cannot or do not wish to receive the information in a digital format.
9. Defines an “unlicensed covered facility,” for the purposes of the Reproductive FACT Act, as a facility that is not licensed and does not have a licensed medical provider on staff or under contract who provides or directly supervises the provision of all of the services, whose primary purpose is providing pregnancy-related services, and that satisfies two or more of the following:
   1. The facility offers obstetric ultrasounds, obstetric sonograms, or prenatal care to pregnant women;
   2. The facility offers pregnancy testing or pregnancy diagnosis;
   3. The facility advertises or solicits patrons with offers to provide prenatal sonography, pregnancy tests, or pregnancy options counseling; or,
   4. The facility has staff or volunteers who collect health information from clients.
10. Requires an unlicensed covered facility to disseminate to clients on site and in any print and digital advertising materials including Internet Websites, the following notice in English and in the primary threshold languages for Medi-Cal beneficiaries as determined DHCS for the county in which the facility is located:

“This facility is not licensed as a medical facility by the State of California and has no licensed medical provider who provides or directly supervises the provision of services.”

1. Requires the onsite notice for unlicensed covered facilities to be a sign at least 8.5 inches by 11 inches and written in no less than 48-point type, and to be posted conspicuously in the entrance of the facility and at least one additional area where clients wait to receive services.
2. Requires the notice in the advertising material for unlicensed covered facilities to be clear and conspicuous. Defines “clear and conspicuous” to mean in larger point type than the surrounding text, or in contrasting type, font, or color to the surrounding text of the same size, or set off from the surrounding text of the same size by symbols or other marks that call attention to the language.
3. Specifies this bill does not apply to a clinic directly conducted, maintained, or operated by the United States or any of its departments, officers, or agencies; or, a licensed primary care clinic that is enrolled as a Medi-Cal provider and a provider in the Family Planning, Access, Care, and Treatment Program (FamilyPACT).
4. Makes covered facilities that fail to comply with the Reproductive FACT Act liable for a civil penalty of $500 for a first offense and $1,000 for each subsequent offense. Permits the Attorney General (AG), city attorney, or county counsel to bring an action to impose a civil penalty after:
   1. Providing the covered facility with reasonable notice of noncompliance, which informs the facility that it is subject to a civil penalty if it does not correct the violation within 30 days from the date the notice is sent to the facility; and,
   2. Verifying that the violation was not corrected within the 30-day period.
5. Requires any penalty resulting from an action brought by the AG to be deposited into the General Fund. Requires the penalty, if the action is brought by a city attorney, to be paid to the treasurer of the city in which the judgment is entered. Requires the penalty, if the action is brought by a county counsel, to be paid to the treasurer of the county in which the judgment is entered.

FISCAL EFFECT: This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, pregnancy resource centers are a tremendous resource to pregnant women who need help and support. The author states that women who are deciding to keep their child deserve the opportunity to know about this resource, and this bill does not change how the current law is structured, but simply offers information on resources available in the community if a woman chooses to keep her baby. The author concludes, providing women with information about all their options and resources should be at the forefront of the California Health and Safety Code, and this bill seeks to make this a reality.
2. BACKGROUND.
   1. Unintended pregnancies. Almost half of all pregnancies in California are unintended. According to a 2014 Guttmacher Institute document titled “State Facts About Unintended Pregnancy: California,” an extensive body of research links births resulting from unintended or closely spaced pregnancies to adverse maternal and child health outcomes and myriad social and economic challenges. Economically disadvantaged women are disproportionately affected by unintended pregnancy and its consequences. In 2008, the unintended pregnancy rate among women with incomes lower than the federal poverty level (FPL), at 137 per 1,000, was more than five times as high as the rate among women with incomes greater than 200% FPL (26 per 1,000).
      
   2. Abortion data. According to a 2014 Guttmacher Institute document titled “State Facts About Unintended Pregnancy: California," contraceptive use is a key predictor of women's recourse to abortion. The very small group of American women who are at risk of experiencing an unintended pregnancy but are not using contraceptives account for more than half of all abortions. Many of these women did not think they would get pregnant or had concerns about contraceptive methods. The remainder of abortions occur among the much larger group of women who were using contraceptives in the month they became pregnant. Many of these women report difficulty using contraceptives consistently. According to the Guttmacher Institute, at current rates, about three in 10 American women will have had an abortion by the time she reaches age 45. Approximately, 58% of women having abortions are in their 20s; 61% have one or more children; 85% are unmarried; 69% are economically disadvantaged; and 73% report a religious affiliation. No racial or ethnic group makes up a majority: 36% of women obtaining abortions are white non-Hispanic; 30% are black non-Hispanic; 25% are Hispanic; and, 9% are of other racial backgrounds.

According to the Centers for Disease Control and Prevention (CDC), in 2012, 699,202 legal induced abortions were reported to CDC from 49 reporting areas. The abortion rate for 2012 was 13.2 abortions per 1,000 women aged 15 to 44 years, and the abortion ratio was 210 abortions per 1,000 live births. Compared with 2011, the total number and ratio of reported abortions for 2012 decreased 4%, and the abortion rate decreased 5%. Additionally, from 2003 to 2012, the number, rate, and ratio of reported abortions decreased 17%, 18%, and 14%, respectively. Given the large decreases in the total number, rate, and ratio of reported abortions from 2011 to 2012, in combination with decreases that occurred during 2008 to 2011, all three measures reached historic lows.

• 1. Crisis Pregnancy Centers (CPCs). CPCs are facilities, both licensed and unlicensed, which present themselves as comprehensive reproductive health centers, but are commonly affiliated with, or run by organizations whose stated goal is to prevent women from accessing abortions. A 2015 NARAL Pro-Choice America report on CPCs notes that the National Institute of Family and Life Advocates (an organization with over 1,300 CPC affiliates) states on its website that it is on the front line of the cultural battle over abortion, and its vision is to provide [CPCs] with legal resources and counsel, with the aim of developing a network of life-affirming ministries in every community across the nation in order to achieve an abortion-free America. The NARAL report also sent several researchers into CPCs to receive the counseling offered, and they widely reported that they were provided with inaccurate information, including only being given information regarding the risks of abortion, being told that many women commit suicide after having an abortion, and that abortions can cause breast cancer.

1. SUPPORT. Concerned Women for America (CWA) supports this bill and states that it attempts to balance the outrageous attack on pregnancy resource centers that occurred with the passage of AB 775 (Chiu and Burke), Chapter 700, Statutes of 2015. CWA also states that the people who work in pregnancy resource centers have a deep love and genuine concern for women and their babies, and the joy and hope that women experience through the care they receive at these centers make a challenging season of life so much more bearable and even a blessing. The California Right to Life Committee, Inc. supports this effort to provide pregnant girls and women with alternate resources when they are at abortion facilities, stating that this is a minimal measure to bring some equality to the recognition that women have choices when they are pregnant.
2. OPPOSITION. The American Academy of Pediatrics, California (AAP-CA) opposes this bill and states every year, nearly 42 million women around the world choose abortions, and nearly half of these procedures are unsafe. AAP-CA notes that women choose unsafe abortions for a number of reasons, including economic burdens and familial and societal pressures, and pregnant teens are even more vulnerable to these pressures. AAP-CA concludes that by requiring abortion clinics to post a notification encouraging women who want to continue their pregnancies to visit a CPC, this bill would represent an additional barrier to access to safe and legal abortions, and increase the risk that pregnant teens will resort to unsafe and illegal abortions.
   
   The California Family Health Council (CFHC), also in opposition, states because decisions around family planning and pregnancy are time sensitive, and care early in pregnancy is important, women need to receive accurate information about affordable health care options at the sites where they obtain care. CFHC contends that CPCs use misleading advertising to target women who may be pregnant to give them medically inaccurate information about abortion and contraception, and delay them from receiving the real medical care they need from health care professionals.
   
   Numerous other organization oppose this bill, including the American Congress of Obstetricians and Gynecologists, District IX, California, ACT for Women and Girls, California Women's Law Center, NARAL Pro-Choice California, and the National Council of Jewish Women, noting that the phone number abortion clinics would be required to post is Option Line, run by an umbrella organization for CPCs, the sole purpose of which is to prevent women from accessing abortions.
3. RELATED LEGISLATION.
   1. AB 2134 (Waldron) requires licensed clinics that perform abortions to post a notice advising clients that it may be possible to reverse the effects of the abortion pill. AB 2134 is currently pending in the Assembly Health Committee.
   2. AB 2081 (Grove) provides that a health care service plan is not required to include abortion as a covered benefit, and would prohibit the Director of the Department of Managed Health Care from denying, suspending, or revoking a plan's license, or otherwise sanction or discriminate against a health plan, if the health plan excludes coverage for abortions. AB 2081 failed passage in the Assembly Health Committee.
4. PREVIOUS LEGISLATION.
   1. AB 775 enacts the Reproductive FACT Act and requires clinics and other facilities that provide family planning or pregnancy-related services to provide specified notices to clients.
   2. AB 1254 (Grove) of 2015 was substantially similar to AB 2081. AB 1254 failed passage in the Assembly Health Committee.
      
   3. AB 2336 (Grove) of 2014 would have prohibited a person from performing, or attempting to perform an abortion if they know the pregnant woman is seeking the abortion on account of the gender of the unborn child. AB 2336 failed passage in the Assembly Health Committee.
   4. ACA 5 (Grove) of 2014 would have prohibited, except in the case of an emergency, a physician from performing an abortion on an unemancipated minor unless the physician has notified one of her parents, or a judge has granted the unemancipated minor a waiver of the notification requirement. ACA 5 failed passage in the Assembly Health Committee.
      

REGISTERED SUPPORT / OPPOSITION:
Support
California Catholic Conference, Inc.
Californians for Life
California Right to Life Committee, Inc.
Concerned Women for America
Six individuals
Opposition
ACT for Women and Girls
American Academy of Pediatrics
American Civil Liberties Union
American Congress of Obstetricians and Gynecologists, District IX, California
California Family Health Council
California Women's Law Center
Community Action Fund of Planned Parenthood of Orange and San Bernardino Counties
Law Students for Reproductive Justice
NARAL Pro-Choice California
National Council of Jewish Women
Physicians for Reproductive Health
Planned Parenthood Advocates Pasadena and San Gabriel Valley
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Affiliates of California
Planned Parenthood Mar Monte
Unite for Reproductive & Gender Equity

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097