Senate Standing Committee on Health

Okay, we have a member and an author already here, so we're going to get started. Good afternoon. The Senate continues to welcome the public in person and via our teleconference service, we'll allow six minutes of in-person testimony per side. Never feel obligated to use all that time. For individuals wishing to provide public comment via phone, today's participant number is 877-226-8163 and the access code is 736-2834 and just to say we will cap the phone testimony at 15 minutes. We have 12 bills on today's agenda.

Three of those bills are on our proposed consent calendar, SB 35, SB 694, and SB 815, with amendments. Two bills were pulled from today's Committee hearing agenda. That is SB 774 and SB 90. And I am being reminded that the third Bill on consent is SB 819. All right. Okay. So I see before us right now an author. So, Senator Seyarto, on SB 67, going to start the Committee as a Subcommitee and encourage all Health Committee Members to report to the Committee room.

There we go.

Please begin.

All right. Well, thank you so much, Honorable Chair and Members of the Committee. I suspect others will be here soon. I'm excited to be here today because I have a Bill before you that can be a lot of help in the public safety world.

My Bill, SB 67, will connect and further expand the critical data sharing between public health and safety departments, which at this very moment is needed to identify the needs for public resources to address the staggering numbers of drug ODs that we are experiencing these days. And let me be clear. The drug epidemic and recently, most recently, the fentanyl crisis and all of the add-ons that are going with it now have exponentially exploded throughout California and our communities.

In 2020 alone, California experienced nearly 4000 deaths just related to fentanyl alone, which is over two-thirds of all opioid overdoses in the state, primarily impacting Californians ages 15 to 24. The overdose detection mapping application, ODMAP, is a tool that will enable communities to develop tailored interventions that target specific areas that are high risk and hardest hit by overdoses.

With me here today to present AB 67 is Ashlee Zarou, who is the Federal Drug Intelligence Officer for Central Valley, California's High Identify Drug Trafficking Area, also known as HIDTA. So.

Thank you.

Thank you, Honorable Chair, Senator, Committee staff. I'm here to present ODMAP and its relevance to SB 67. So, as the Senator said, I'm part of the Central Valley, California's High Intensity Drug Trafficking Area, also known as HIDTA. I am the Drug Intelligence Officer for 15 counties. We bring together federal, state, local and tribal resources to disrupt and dismantle drug trafficking organizations across the United States. This program is within the Office of the National Drug Control Policy as part of the Executive office of the President.

It also houses the overdose response strategy, where myself and public health analysts bridge the gap between public health and public safety to provide strategies to communities on overdoses. As the Senator said, the Overdose Detection Mapping Application Program, also known as ODMAP, is a free, web-based, mobile-friendly software platform that shows where suspected fatal and non-fatal overdoses are occurring in near real-time.

ODMAP was established to provide these near real-time data points to public safety and public health agencies, for example, public health departments, hospitals with emergency departments, law enforcement, and health and human services, allowing these agencies to activate mobilized responses to overdoses throughout the state as quickly and practically as possible. ODMAP allows for the display of shared overdose data within and across jurisdictions to help agencies more accurately identify spikes and clusters within their communities. Furthermore, ODMAP is not available to the general public and the media.

Instead, it is only available to registered federal, state, local and tribal agencies serving the interests of public safety and public health as part of their official mandate. Now, with SB 67, coroners and medical examiners, in addition to licensed first responders, public and private hospitals and firefighters will be added to the data sharing network that again is only accessible through a permitted login and password. California currently has over 200 agencies who are currently logging overdoses.

However, the complicated and diverse web of reporting leads to a lack of cohesion in data sharing, removes the ability of real-time pattern identification, and leaves blind data spots in reporting from critical agencies like coroners and medical examiners. SB 67 will tie together the diverse web of reporting and uniformly house all data collected through these agencies, while at the same time bringing in agencies whose data is needed to further inform public health and safety on overdoses such as fentanyl.

As far as victim privacy, again, ODMAP is limited to only authorized personnel and scrubs all personal identifiable information, removing any and all privacy concerns. That is also highlighted in the legislative analysis and public policy association that you should have in front of you. Since there are only four required reporting fields, ODMAP is not used as a system of record. ODMAP provides public safety and public health agencies with the opportunity to respond to a crisis as it is occurring.

ODMAP facilitates the sharing of data with stakeholders to implement a range of rapid response activities. These activities range from spike alerts that are sent to neighboring communities and counties as early warning systems and can be put up on social media. It deploys overdose responses. Information from ODMAP grants ability to send out overdose outreach response teams to provide services and support to overdose of victims and surrounding communities. It also targets and secures resources.

The information from ODMAP can be used to target naloxone distribution and fentanyl test strips, prevention, education efforts and other treatment areas. While the data can be used also to support strategic planning and resource allocation to communities hit hardest by overdoses, with SB 67, we can bridge the gap between the data sharing gap between emergency medical services, first responders, firefighters, and now coroner and medical examiners.

Due to the unprecedented amount of Californians experiencing overdoses, especially from fentanyl, SB 67 grants another tool to help combat the drug epidemic that has only further exploded and allows for a collaborative effort between public health and public safety and better communication between all sectors of public service in California. Thank you.

Thank you very much. Any other witnesses on this Bill?

Madam Chair and Members, Paul Yoder, on behalf of the Fresno County Board of Supervisors, in support, urge your aye vote.

Thank you. Any others?

Madam Chair and Members, Tim Madden, representing the California Chapter of the American College of Emergency Physicians, in support.

Thank you very much. Anybody else speaking in support? Okay, anybody speaking in opposition to this Bill today? Seeing none. We'll go to the phone lines. Operator, are you there?

Hello, Madam Chair. Yes. If you wish to speak in support or opposition to this Bill, please press one, then zero at this time. Press one, then zero. And it appears that we have no one.

Thank you very much. Now would be the time we would bring it back to the Committee for questions, comments. We have no quorum yet, so we can't move the Bill. But when we do, Senator Dahle will be making that motion for you, it sounds like. And I appreciate your presenter because I had some questions on how would things be activated, but I heard things like you could send out an alert to say, "watch out in this area, there's more." You could distribute naloxone and testing strips.

Do you know if we've been able to see any positive outcomes in places that have this in place that they've been able to reduce the amount or be able to deploy? And has that been effective?

Many states across the US that have set up resources, such as posting the spike alerts online, like Facebook or Instagram, allowing law enforcement to carry more narcan in their patrol vehicles, things like that have started working across the United States that we've seen.

Okay, thank you very much. So just going forward, Senator, this might be something that you'd want to continue to keep tracking, about is it working and if so, how and what are some data points that we can really collect from that? And you said the amendments removed the opposition, so I'm assuming you're accepting set amendments.

Yes, I'm accepting the amendment.

Okay. Thank you very much. Would you like to close?

Sure, I'll close. Speaking from personal experience, one of the things we used to not have was real-time data to anticipate when we're having a big issue. We would have a bad batch of narcotics come into town, and we'd have one area where all of a sudden those squads were going time after time, and we would run out of our medication that we would order.

So this allows us to quickly identify when we have that kind of a problem and be able to respond to that with the resources that we need, including and up to moving resources down from other areas to cover the area until we get the situation under control. So with that, I would ask for an aye vote and appreciate your time today.

Thank you very much, Senator. Okay.

When the time comes.

Will do.

I see no other authors here. Senator Gonzalez, would you be interested in presenting now? I see you're presenting on the behalf of Senator Atkins. Thank you very much. And you're presenting SB 487 on behalf of Senator Atkins, is that correct?

I am. Thank you, Madam Chair and Members. I'm honored to present SB 487 on behalf of Pro Tem Atkins today. This bill is needed to help protect providers who provide abortion and gender-affirming care to people from out-of-state from additional sanctions. First off, Senator Atkins will be accepting the amendments as outlined on page seven of the analysis, and will be adding myself as well as Senators Ashby and Menjivar and Assembly Member Aguiar-Curry as coauthors.

We have worked hard to ensure reproductive health care is protected in California. Unfortunately, other states are not ensuring these same fundamental protections. The aftermath of the Dobbs decision overruling Roe not only eliminated 50 years of reproductive freedom, but it also encouraged states to enact their own bans and restrictions, unfortunately, with many passing laws to target providers. While many of the states with abortion bans do have limited exceptions, providers are becoming increasingly wary and discouraged from entering the reproductive health field.

We're also seeing some of the providers traveling to other states to provide abortion care services. So the purpose of SB 487 is to protect California health care providers who are willing to take risks by providing abortion care and gender-affirming care in other states from additional sanctions, as well as providers who provide those services in California from people out-of-state. This bill, in essence, would shield providers from retaliation and repercussions so that there is no disruption in their ability to perform abortion care in California, where abortion care is legal and enshrined in our state constitution.

SB 487 is narrowly crafted and in no way limits or restricts our current, usual concernment protections or the ability of the Medi-Cal program to terminate providers for other non-abortion health care reasons. To testify in support today of SB 487, we have Dr. Tanya Spirtos, President Elect of the California Medical Association and a practicing OB/GYN. We also have Molly Robson, Vice President of Government Affairs for Planned Parenthood Affiliates of California. Thank you, Madam Chair, and I respectfully ask for an aye vote.

Thank you. Dr, please go ahead.

Thank you. Thank you, Chair Eggman and the Members of this Committee for allowing me to present testimony today. My name is Dr. Tanya Spirtos. I am a board-certified obstetrician gynecologist practicing at Stanford Health Care. I'm here today representing the California Medical Association, who is cosponsoring Senate Bill 487.

SB 487 expands the protections of civil actions from another state's laws being applied to reproductive health care clinicians and ensures that California's providers can continue to care for patients without the fear of another state's laws interfering with their ability to serve California's Medi-Cal population. As a physician who provides reproductive health care services, I can say with certainty that the protections SB 487 provides are of utmost importance. As you all know, we have recently seen unprecedented legislation attacking reproductive rights and gender-affirming care.

Because of these laws, we are confident out-of-state patients will continue to seek care from California's providers. 29 percent of women in the United States of reproductive age are living in states where abortion is either unavailable or severely restricted. Half of the states are certain or likely to eventually enact abortion bans now that Roe versus Wade has been overturned. I see the effects of limiting access to abortion and other reproductive care and gender-affirming care.

Patients are forced to delay their care, travel hundreds or thousands of miles, face financial difficulties, and time away from work just to undergo a simple and safe medical procedure. However, there are more patients who do not have the ability to leave their state to seek care, and are ultimately forced to continue pregnancies that may be threats to their health and safety. Seven states have introduced legislation criminalizing a patient or a provider for performing or obtaining an abortion.

My patients come to me with a need for a service I can expertly provide. I will never interrogate my patients about their state of origin, and I know my colleagues treat their patients with the same respect. Out-of-state legislation like this puts our California providers at risk. Abortion care and gender-affirming care are essential care services. California has already done so much to be a safe haven and destination state for protecting reproductive freedom.

This legislation builds upon the state's achievements by expanding the protections for its abortion and gender-affirming care providers. I'm honored to serve my patients, but I can only continue to do this safely with the appropriate protections. Please allow my colleagues and I the peace of mind to focus on the patients sitting in front of us every day and to provide them with the quality care they deserve. Help us protect abortion access in California by voting yes on Senate Bill 487. Thank you for your attention.

Thank you very much. Ms. Robson.

Good afternoon. Molly Robson with Planned Parenthood Affiliates of California. We represent the seven Planned Parenthood Affiliates in the state who operate over 100 health centers in California and provide over 1.3 million patient visits annually. Since the U.S. Supreme Court allowed Texas's SB 8 to remain in effect and overturned Roe versus Wade, abortion providers and their patients have faced an onslaught of new and unprecedented attacks on abortion, as you heard from Dr. Spirtos, including efforts to criminalize this safe and effective health care procedure.

Today, there are 13 states with full bans on abortion and five states that have implemented pre-viability bans. With the legal uncertainty, the one thing that is clear is that California must do everything we can to ensure that our providers in this state can continue to provide compassionate and comprehensive care, including abortion and gender-affirming care. We're seeing what happens when providers and patients are not protected.

Recently, an Idaho hospital announced they will close their maternity ward because providers may face steep consequences just for providing the standard of care. SB 487 ensures that providers are not punished for providing care to patients in line with their fundamental rights in this state. It protects patients in most need of affordable and accessible care by ensuring they can continue to receive it from trusted providers. With that, I respectfully ask for your support today. Thank you.

Thank you very much. Any other people speaking in support of this today, now just your name, position, and affiliation.

Madam Chair and Members, Tim Madden, representing the California Chapter of the American College of Emergency Physicians, in support.

Thank you.

Ryan Spencer with the American College of OB/GYNs. We are cosponsors on this measure in support.

Thank you.

Paul Yoder, on behalf of the California State Association of Psychiatrists, also in support.

Thank you.

Mari Lopez, California Nurses Association, in support.

Thank you.

Craig Pulsipher, Equality California, in support.

Thank you. Okay, seeing no one else, anybody speaking in opposition to this bill today, please come forward. Okay, seeing none, we'll go to the phone lines. Moderator, are you there?

Yes, Madam Chair. Thank you. For those who wish to speak in support or opposition to this bill, please press one then zero at this time. Press one then zero only one time, as if you press it a second time, you will be removed from the comments queue. Once again, please press one then zero. We'll now go to line 121. Line 121, your line is now open.

Go ahead, please.

Thank you, Madam Chair and Members. Taylor Jackson with California Health Plus Advocates, representing California's 1300 community health centers in strong support.

Thank you very much. Next caller, please.

We'll now go on to line 137. Your line is open.

Chair and Members, this is Erin Evans in support on behalf of NARAL Pro Choice California, as well as the California Nurse Midwives Association. Thank you.

Thank you very much. Next caller, please.

Just a moment. We're now going to go to line 171. Line 171, your line is now open.

Good afternoon, Chairwoman Eggman and Committee. My name is Leticia Zuniga, and I am a voter in the IE, and I support Bill SB 770. Thank you.

Thank you very much. Next caller, please.

There is no one else who signaled that they wish to speak.

Okay. And just a note, we are not hearing Bill 770 at this time. Okay, now is the time we come back to the Committee for questions. Comments? Okay. Seeing none, I'll just say thank you. Please thank Senator Atkins for bringing this bill forward. I happened to be at the airport recently, was talking to an OB/GYN whose wife wanted him to go practice in Mississippi because that's where they were from and they have such a need.

And he said, I can't even practice up to the standard of care in Mississippi, so I don't ethically feel like I can practice there. So I think we're going to be seeing that more and more around the country where providers don't feel like they can provide ethical care anymore with the severe limitations that are upon them. So, would you like to close, Senator?

I, too, want to thank Senator Atkins, Pro Tem Atkins for bringing this forward. Such an important bill, and I respectfully ask for your aye vote, Madam Chair.

Thank you very much. We don't have a quorum yet. We need one more. One more. Okay. When appropriate. Thank you very much. Okay.

Oh, Senator Portantino, I see you in the back on the phone. If you'd like to take a break and come on up. You have two bills before us today. We'll start the timer, sir. TikTok. TikTok.

Which one is up first?

First, you have 786 having to do with prescription drug pricing. I believe that's your 30...

And then we have...

340B program.

What's that?

We have autism up, if you'd like.

Sure. Yeah, I don't mind.

Let's start with.

Okay, that's 805 having to deal with qualified autism services and floor play. Floor time.

Floor time. Thank you. So, thank you, Madam Chair and Members; obviously, this is a bill that the committee has seen in the past. It's a subject matter where I think there's room to improve how we cover insurance for doctor-prescribed, medically necessary, evidence-based autism treatment. There's what I would call a flaw in current law that prescribes only one type of treatment.

And so what this bill seeks to do is offer parents and families the opportunity to seek other evidence-based treatment, clarify who's eligible to actually administer that treatment, and clarify the educational degrees necessary. It doesn't lessen any training. It just reclassify some training to make sure that we have enough healthcare professionals because, as you know, we can pass all the laws that we want to mandate all kinds of things.

If we don't have the healthcare providers to actually do it, it's not serving the public. And so this helps on both the provider side but also on the insurance side. And when you do have a quorum, I would respectfully ask for an aye vote.

Okay. And do you have people speaking in support today?

Yes, they're with the folders.

Okay.

Here comes the folder.

Well, the folders are coming, Senator, are you accepting the amendments?

I believe we're set. Yes, we're accepting the amendment. Yes.

All right.

This is the wrong folder, but that's okay. I just did the autism bill. All right. It's okay. I believe we're accepting the amendments.

You believe?

Yes.

You were supposed to be bringing a mock-up to the committee. This is 805. He asked to start with 805. Yes, we're supposed to bring a copy of them.

All in the folder.

Okay.

Which somehow, I think my staff and witnesses all got taken into a vortex.

Okay, well, is anybody here from the floor time coalition?

Yes, they're all with the folder. Thank you. I apologize.

So.

I cannot believe that they. Here they come. Come on up. Here's the mockup.

Here are the mockups. Thank you very much.

Yes. I would like to begin by taking the mockups that we're passing out to the committee, and then we do have witnesses who are in the elevator. We got the folder, but no witnesses. This should be a sitcom today.

Yeah. Okay, well. As we said, we've seen this bill. I think it's been vetoed three times so far, so we're all familiar with it for the most part. And I asked for some clarification on. We're talking about licensed assistance, and I didn't think those existed, and they don't. So we were changing that to associates and qualifying what that means to be an associate.

And I think that's important.

Clearly, I do, too.

Thank you.

And I'm glad we're in agreement on that. So, I think unless anyone has any questions. Do people have questions? Okay, then we'll just. Is there any opposition here today? Seeing no opposition. Anybody like to speak in support? Just in general. Seeing none. Anybody on the phone lines? Moderator?

Anyone wishing to speak in support or opposition, please press one, then zero. Press one, then zero. At this time, we have one person who signaled that they wish to speak. Just a moment please.

Okay. Seeing hearing none.

Madam Chair, we do apologize. I'm so sorry. Just another moment, please.

Okay. Committee seems to be moving too fast.

Hello?

Your line is open.

Okay, thank you. Good afternoon, Madam Chairwoman. I'm afraid I'm speaking out of order. I was waiting to speak on SD 70.

Okay, well, then we'll come back to you.

We'll take you.

No, we won't take you now. No, we won't. Thank you very much. Senator, would you like to close?

When life gives you lemons, make lemonade. I respectfully ask for an aye vote when appropriate.

Thank you very much. Okay, so how about. Let's move back now. Are you prepared for 786.

I am.

Okay, please proceed.

Thank you. Madam Chair and committee members, I want to start off by expressing my appreciation to the committee, both for their indulgence with the last embarrassing bill and for this important legislation. We're doing the diligent work that was put in by the sponsors. The staff is greatly appreciated. In 1992, Congress established the 340B drug pricing program to protect eligible hospitals, clinics, and others covered entities from rising prescription drug costs -

- by requiring pharmaceutical manufacturers to offer discounted outpatient drug prices. This program has allowed qualifying healthcare providers to treat more low-income and uninsured patients, thereby improving community health standards across the nation. Unfortunately, for for-profit pharmacy benefit managers, PBMs who negotiate rebates with manufacturers are increasingly looking for ways to misappropriate the 340B program benefits and make a profit. PBMs have blatantly discriminated against the hospitals and the safety net.

These safety net hospitals and rural critical access hospitals largely rely on contracts with community pharmacies, as many do not have in-house pharmacies. Yet, rather than focus on providing access to care for these patients, other things, other priorities get in the way. SB 786 will protect covered entities and the communities they serve by preventing PBMs from discriminating against qualified 340B entities.

Our office is continuing to engage in the conversation with all the stakeholders, and hopefully, if the bill gets out of committee today, we're going to continue to have those stakeholder meetings. With me today to testify in support of the bill is Laura Boudreau, Director of Operations for the AIDS Healthcare Foundation. Liz Oseguera, Assistant Director of Policy with the California Primary Care Association, would respectfully ask for an aye vote.

Thank you. Please go ahead,

Committee. I'm Laura Boudreau, Chief of Operations at AIDS Healthcare Foundation. We're a nonprofit. We provide care to over 55,000 people living with HIV nationwide, and in California, we treat about 9600 patients. We're the sponsors of Senate Bill 786, and I thank the committee for letting us talk about why it's so important. You heard a great summary from Senator Portantino. Just to hit the highlights, the goal is pretty straightforward.

I want to just give a quote from a congressman who's working on the issue at the federal level in the US Congress, who said a nice summary, pharmacy benefit managers have, quote, "...found a way to make money off of the 340B program by shaving off savings that Congress intended to go to safety net providers to support vulnerable patient populations." So that's it in a nutshell.

To give a little more context, PBMs, as you probably know, they're what we call they're middlemen in the whole healthcare industry. For those of us who have insurance, PBMs basically manage our prescription drug benefit, part of our insurance. The three big ones are CVS, Optum, and Express Scripts, among other things. For the purposes of this bill, the importance of PBMs are they determine how much a pharmacy is paid by a patient's insurance when the patient goes to the pharmacy.

Now, safety net providers, as Senator Portantino said, we have access to discounted drugs because we participate in the federal 340B discount program. And that discount is something that we get when we purchase drugs from the drug manufacturers, right? That's a matter between us, the wholesaler and the drug manufacturer. It's nothing to do with the PMBs at all. It's a discount we get when we go to purchase drugs from the drug manufacturers. After we purchase the discounted drugs, we can dispense them to eligible patients.

And if the patient has insurance, then these safety net providers, us included, we can realize a margin. And that's the difference between the cost of the drugs at the discount and what the insurance has agreed to pay. It's really important to understand that Congress intended for safety net providers to use this margin to, quote, "...reach more, to stretch scarce federal dollars, to reach more patients and to provide more services." But providers, we can't do that. If the PBM say, "Hey, you know what?

We're going to drastically reimburse your reimbursement because, you know what? You have access to this discount pricing. So we're not going to pay you like we'd pay the other pharmacy. We're going to really, really give you rock-bottom reimbursement." When PBMs do that, the upshot is they take the benefit of the 340B program, which is supposed to go to the community clinics, the FQHCs, the Ryan White providers, the dish hospitals, and it puts them into the pockets of the PBMs.

PBMs are now under fire in Congress and states and the press and FTC for a whole host of reasons. This bill is just aimed at one particular abuse and asking for reform. It's just basically asking that, please, California keeps the 340B benefits in the hands of the safety net providers and out of the pockets of the PBMs. 24 states have already enacted 340B antidiscrimination legislation, and there are eight pending bills as well. These states are red, they're blue, they're purple.

This is a nonpartisan issue, so we urge the committee to please approve the bill in California. Thank you.

Thank you very much. Anybody else speaking in support of this bill today?

Hi, good afternoon. My name is Elizabeth Osiguera, and I am the Assistant Director of Policy for the California Primary Care Association, who represents more than 1240 community health centers throughout the state and 7.8 million people, which is one in five Californians and 1 and 3 medical patients. For community health centers, it wasn't until the 340B program was established in 92 that they were truly able to offer pharmacy services to their patients, given the high cost related to administering these services.

And thus, CPCA is proud to support SB 786. Community health centers are required by federal law and regulation to ensure that every penny of 340B savings is used to expand access to care for underserved patients.

CHCs: We invest 340B savings to pay for auxiliary services, such as paying for staff to extend pharmacy hours, providing anger management classes and substance use support groups, covering nonbillable services such as home visits, and paying for same-day access that allows patients to obtain a behavioral health visit on the same day they receive a primary care visit. And this is all accomplished again with 340B savings, which is outside of taxpayer dollars.

It's important to clarify that duplicate discounts do not exist under the private insured space, which is what this bill is tackling. What is at play here is private dollars in the form of rebates between PBMs and manufacturers. More specifically, manufacturers pay PBM rebates for drugs unless that drug is purchased under 340B program. And so discriminatory contracting practices happen when there is claims data from the 340B program shared with manufacturers. And then PBMs then lose their rebate in the 340B space.

And then they turn around and again put in these discriminatory practices against the covered entities, in this case, community health centers, which means that they're taking and pickpocketing the savings that belong to the safety net and retargeting them into the pockets of PBMs and manufacturers. And we've had pharmacy directors throughout the state, from rural north all the way to San Diego, say that they are impacted by these practices. And again, these practices include discriminatory practices for lowering reimbursement rates.

So when they're doing contracts, they would get less money because they're a 340B provider reclassifying a 340B covered entity-owned in-house pharmacy. So a pharmacy at the health center as a non standard retail pharmacy so that they could pay them less money.

If you could wrap up, please.

Yes.

So essentially because of all these pickpocketings, we really need the support of SB 786 and really ask for your aye vote. Thank you.

Thank you very much. And before we go to others speaking in support, but if you'd like to line up, you may, let's call for a quorum secretary. Could you please call the role.

[Roll Call]

Seven, a quorum is established. Thank you all very much. Please go ahead.

Madam Chair and members of the committee: Brandon Marchy with the California Medical Association in support. Thank you.

Next person, please.

Hi, Dr. Mona Patel, practicing pediatrician and in an FQHC and a safety net hospital, very important in support.

Thank you. Next person, please.

Ryan Spencer, on behalf of OCHIN, in support.

Thank you.

Mark Farouk, on behalf of the California Hospital Association, in support. Thank you.

Thank you very much. Okay, now's the time for people speaking in opposition to come forward again. Six minutes in total. Anyone speak in opposition today? Seeing none. Seeing one.

Hi, good afternoon. Jennifer Snyder, on behalf of the Biotechnology Innovation Organization, we have an opposed, unless amended, position on the bill. We've been talking with the author's office and the sponsors. Really, our concerns center around one small provision of the bill, which has to do with tracking of covered drugs and 340B drugs and how they're dispensed.

We hope, and we're continuing discussions to see how we can find solutions as to how you can possibly track those 340 covered drugs, how they're dispensed, maybe after point of sale. And so we look forward to continuing to work with the author, and we think he's committed to that. So thank you very much.

I have that question also, please. Next person.

Madam Chair and Members: Austin Heyworth, on behalf of PhRMA. While PhRMAhas not yet taken an official position on SB 786, we are working with Senator Portantino and the sponsor to come to an agreement on amendment language which would simply clarify two points: the definition of a specified pharmacy and that drug manufacturers can continue to be able to receive information on whether a drug was purchased through the 340B program so as to provide verification that a rebate or discount is not required to a PBM.

This ensures drug manufacturers who provide discounts upfront to clinics and hospitals are not then hit on the back end by a PBM. Since SB 786 is no longer a fiscal bill, there will not be a chance to amend this in the senate approach committee. So we're hopeful we can reach an agreement with the author so the bill will be amended before a vote on the Senate Floor.

Thank you.

Thank you very much. Next person, please.

Madam Chair, Bill Head with PCMA, the PBM Trade Association, and despite some of the disparaging remarks, we're actually neutral on this bill. And we do have a technical suggestion that we would like to work with the author on, but we are absolutely neutral. Thank you.

Thank you very much. Okay, anybody else is speaking and wanted in general support, come forward, please. Okay, opposition? I thought that was the opposition, so it was very mild opposition. Okay, let's go to the phone lines now. Operator, is there anybody on the phone line, wanting to speak in support and or opposition?

Thank you, madam. If you wish to speak in support or opposition to this bill, please press one, then zero at this time. Press one, then zero. We're going to go-pardon me. Line 180, please press one, then zero again.

Madam Chair, we apologize. We do have people who've queued up. One person dropped off, and we're going to go to line 180 now.

Good afternoon. My name is Phil Curtis. I represent APLA Health in Los Angeles. We're a federally qualified health center serving the LGBTQ population as well as people living with and at risk of HIV. And we support this legislation.

Thank you very much. Anybody else in the queue, Moderator?

There is no one.

Ok. Thank you very much. Now is the time we bring it back to the dais. Any members have any. Senator Dahle?

Thank you, Madam Chair. Thanks for letting me be in your committee. I just want to say to the Senator that our caucus hasn't opposed on this, and I got this packet about a couple of hours ago, but I have FQHDs in my district, and I also have had really horrible experiences with PBMs and our private pharmacies in the past where we were not able to know what the rebates were going to be before the drug was actually administered and sold. And then they came back and it really devastated our pharmacy. So I had a question. Maybe if that is one of the scenarios that happens to one of your witnesses, if that's okay, could you answer that for me as well, please?

Yeah, I mean, that's a clawback issue, which is one of the PBM reforms that are being asked for. Generally, it's not really an issue in this particular bill, but the idea that after the point of sale, PBMs do come back and they provide penalties or retroactive adjustments or whatever, they're devastating. And they're causing a lot of independent pharmacies to go out of business and creating pharmacy deserts.

Thank you. With those comments, I would be happy to move the bill.

Thank you very much. The bill has been moved by Senator Dahle. Anybody else? Senator Menjivar.

Thank you so much. Supportive of the bill. Just a quick question. I did read the letter of the opponent. Just wondering how the conversations are going on their specific on section the B 3 definition. I'm not sure if you had conversations with the opponents on this and what's the hesitancy?

Yeah, so both the sponsors and the opponents have been having ongoing conversations. My commitment to both sides is that the next conversation, I'm going to be in that room as well. So I can hear both sides articulate their concerns because it does seem isolated in the conversations that they're both saying similar things, which is why it's been a little bit interesting why we haven't been able to hit the sweet spot. I'm not promising you we will hit the sweet spot, but I am promising you that the next conversation will be a moderated conversation to try to get there.

Thank you. Would you like to close, Senator?

I respectfully ask for an aye vote.

Okay. And you are accepting the amendments on page seven. Thank you very much. Okay. We had a motion by Senator Dahle, and that is do pass as amended. Secretary, please call the roll.

[Roll Call]

Bill has six votes. We'll hold the roll open. Could we get a motion for the consent calendar? So moved by Senator Menjivar. Again, that's SB 35, SB 694, and SB 819. Secretary, please call the roll.

[Roll Call]

Seven, zero. We'll hold that the roll open. And we already had a motion on SB 67 by Senator Seyarto. Secretary, please call the roll. The motion is do pass is amended and rereferred to the Committee on Public Safety. Moved by Senator Dahle.

[Roll Call]

Seven, zero. That bill will also hold it open for absent members. And we also had, and as Senator Bradford makes his way to the podium, we also had a motion on Senator Atkins, SB 487 by Senator Menjivar. Secretary, please call the roll. That's item three. The motion is do pass and re-refer to the Committee on Appropriations. Do pass as amended and re-refer to the Committee on Appropriations.

[Roll Call]

It's five yeses, two noes. We'll hold the roll open. Welcome Senator Bradford on SB 873.

Thank you, Madam Chair. And I appreciate this opportunity to present 873, which will ensure patients are better able to afford to pay for medication by reforming the state's prescription drug rebate system to directly benefit patients. Patients shouldn't have to decide between paying rent and being able to afford their medicine. Currently, when a patient pays for a drug in the deductible phase or pays co-insurance at the pharmacy counter, the amount they must pay is based on full price of the drug.

Even if their health insurer or their PBM are paying a lower amount, they negotiate it with the manufacturer. In 2021, PBMs in the United States negotiated $236,000,000,000 in rebates overall, with none of that money going directly to the patient at the pharmacy counter. In California in 2021, the report from the Department of Managed Healthcare showed that health plans in the state received $1.7 billion in rebates, up from 1.4 in 2020 and up from $1.2 billion in 2019.

Because there's no transparency in the system, patients have no idea how much their medicine costs. If any rebate money goes to lowering their insurance premiums or lowering other out-of-pocket cost. With prior legislation, SB 17 and SB 315 only providing transparency to a portion of the system, SB 873 will add much-needed accountability and transparency. By sharing 90% of the rebate with the patients at the pharmacy counter, SB 873 will immediately lower prescription drug costs, helping Californians better access their medicines.

In January of 2022, California Health Benefits Review program report of a similar policy measure found that it is clearly possible for pharmacy software to be updated to share rebates at the point of sale as outlined in this bill. The software already allows for point-of-sale variations in pricing, cost-sharing amounts, benefit coverage, and formerly information. Other states are already doing this. So in 2021, West Virginia began passing 100% of the negotiated rebates to patients at the counter.

And we've seen national health insurers and their PBMs start to offer rebates to their patients as well. With me today in support of this bill is Dr. Le Ondra Clark Harvey, the executive director of California Access Coalition, the co-sponsor of this measure, and Erin Callahan, an individual living with diabetes and the chief operating officer of the Diabetes Patient Advocacy Coalition, another one of our sponsors of this bill. And at the appropriate time, and I'd ask you for your aye vote.

Dr. Clark Harvey, please go ahead.

Hello. Good afternoon, Dr. Eggman and committee members. I'm Le Ondra Clark Harvey, executive director of the California Access Coalition. Our mission is to bring industry representatives and patient advocates together to jointly create policy and advocate for patient access to behavioral health treatment. That is why the California Access Coalition is proud to co-sponsor SB 873 with the Diabetes Patient Advocacy Coalition and the Patient Pocket Protector Coalition to lower California patients' out-of-pocket costs for prescription drugs.

So we thank Senator Bradford, as well as nearly 50 organizations listed in support for working very hard to get this bill heard in Committee today. The current prescription drug rebate system was designed to help patients afford their medications, but it's changed and it now benefits health insurers and pharmacy benefit managers at the expense of patients. Right now, patients are being forced to pay more out of pocket for their medicines than ever before due to an increase in high deductible plans and the use of coinsurance.

Studies have shown that patients facing high costs are less likely to take medications as prescribed, more likely to abandon therapy, and more likely to delay or forego treatment, putting them at higher risk for emergency room visits, avoidable hospitalizations, and poor health outcomes in general. This foregoing of health care due to high costs is just untenable, and SB 873 provides a remedy, a solution that simply fixes the broken prescription drug rebate system. How?

By correcting a regulatory oversight that has allowed prescription drug rebates paid by pharmaceutical manufacturers to go to health insurers and pharmacy benefit managers' profits, rather than to the consumers for which they are intended to help. So in 2021 alone, PBMs in the US negotiated $236,000,000,000 in rebates overall, with not a dime of that money going to offset the high cost of medications for patients at the pharmacy counter in California.

A 2021 report from the Department of Managed Healthcare showed that health plans in the state received 1.7 billion in rebates, up from 1.4 billion in 2020 and 1.2 billion in 2019. This bill is necessary to lowering prescription medications costs for all Californians, including the thousands of minority-owned small businesses and their employees who have high deductible health plans and face high out of pocket costs that make it difficult and often impossible for them to afford the medications they need to get and stay well. So let's do the right thing for California's patients today. Thank you.

Thank you very much. Next person, please.

Thank you. Good afternoon, Madam Chair and members of the committee. My name is Erin Callahan. I'm the chief operating officer of the Diabetes Patient Advocacy Coalition, or DPAC, a co-sponsor of SB 873. Like many Californians, I live with diabetes and have relied on insulin every minute of every day for the past 36 years just to stay alive. I'm honored to be here today to testify in support of SB 873 on behalf of DPAC as well as the Patient Pocket Protector Coalition.

As a voice for the diabetes community, DPAC knows all too well the challenges of the rising costs of prescription medications and the dangerous and sometimes tragic outcomes of rationing, which one in four insulin users report doing as a result of high cost. The Patient Pocket Protector Coalition brings together a diverse group of patient-professional advocates focused on addressing the financial toxicity of living with a chronic condition as an immediate step toward relief.

At the pharmacy counter, we are focused on PBM rebate reform to protect the pockets of patients burdened with the high cost of managing their health every single day. Annually, diabetes costs an estimated $39.5 billion in California. Californians living with diabetes are paying the brunt of that with medical expenses approximately 2.3 times higher than those who do not have diabetes.

As a result of the state's current rebate system, many insured Californians with chronic conditions are paying nearly double what their insurer and PBM are paying for life-saving and life-sustaining medications. It's past time to fix the financial burden placed on people living with diabetes and other chronic conditions. SB 873 is legislation to do so. Unfortunately, one of the main sources of pushback is related to health insurers falsely claiming that they use rebates to keep premiums down.

The statistical impact of passing through rebates to the patient would result in a less than 1% increase in premiums following West Virginia's implementation as Senator Bradford mentioned of a similar policy in 2021, rate filings have shown that health plans compliant with the policy showed no substantive change in premium costs for this year. In addition, opposition claims that this policy is not implementable.

Not only is this false, especially considering West Virginia but also several national PBMs have started sharing rebates with patients and why it is possible and simple to implement. And they know that it reduces patients' out-of-pocket costs, therefore improving medication adherence rates and overall health outcomes. A recent study by UFC also highlights the role rebates play in driving list prices and reducing or eliminating those rebates could result in lower list prices and reduced out-of-pocket costs for patients.

Through SB 873, we can decrease barriers to treatment access and simultaneously help to curb short and long-term complications of chronic conditions while lowering the cost of comorbidities, effectively saving patients and the state money. Thank you.

Thank you very much. Anybody else want to speak in support now come up and it's just name and organization, please.

Good afternoon. Paul Simmons with the Depression and Bipolar Support alliance, in support.

Good afternoon. Jamie Velasco on behalf of the Steinberg Institute, in support.

Madam Chair, members, Tim Madden, representing the California Rheumatology Alliance and the California Society of Plastic Surgeons, in support.

Thank you.

Jennifer Snyder, on behalf of the California Life Sciences, in support.

Ryan Spencer, on behalf of the California Podiatric Medical Association and the Crohn's and Colitis Foundation, both in support.

I'm Fred Noteware, representing PhRMA, in support.

Alex Khan, on behalf of the ALS Association and the California Chronic Care Coalition, in support.

Thank you very much. Okay, now people speaking in opposition. You are opposed now.

Senator Eggman and members of the committee. Good afternoon. My name is Bill head with PCMA, the PPM Trade Association. Thank you for the opportunity to testify today respectfully in opposition to SB 874, for the simple reason that while it will, in fact help some consumers, it will. A mandated point-of-sale rebate will harm all consumers. That is a fundamental issue. I think it's worth stepping back and thinking about where rebates came from.

The pharmaceutical industry petitioned Congress to create a safe harbor under the federal anti-kickback statute. They were granted that, and the reason the pharmaceutical industry sought that safe harbor is to move market share. So PBMs took advantage of that and have been negotiating with manufacturers for a number of years. And roughly 95% of the rebate dollars flow back to the employer or to the health plan.

They use that, obviously, to reduce premiums, copays, and what have you. In 2019, both the Department of Insurance and DMHC concluded, or reported, rather, that the rebates, in fact, did help drive down premium costs. Now, premiums may rise for other reasons, but the rebates had a positive effect on premiums. It's very important to note, too, that less than 20% of the drugs out there today actually have a rebate. Right? So the majority of drugs do not. And that's where the harm comes in.

The CMS three years ago proposed a rule that would require mandatory point of sale rebates for all Medicare beneficiaries. The Congressional Budget Office studied it and concluded that while, yes, some patients would have lower drug cost, all patients would have higher premiums.

Step back just a little bit. Your tie is caught on the microphone.

Oh, sorry. Let's see if I can raise it. A little bit, too. Actually, all patients would have higher premiums, and it would cost taxpayers $171,000,000,000 over 10 years. Congress then pulled back the rule, and using the money for other things, CHBRP, in this analysis of AB 933 last year, concluded it would raise premiums by $200 million. So, yes, some patients do benefit, but everybody pays a price for that.

I would also sort of point out somewhat what I believe to be sort of the disingenuous nature of this proposal, which is you heard the testimony that rebates caused the list price to go up. If that's the case, why doesn't pharma simply ask Congress to repeal the safe harbor, get rid of rebates, or better yet, lower the price of the drug?

But if all you're saying is that the rebate, instead of going here, is going here, you're acknowledging that the price is going to continue to rise and you're doing nothing really ultimately for patients. For these reasons, we respectfully ask the committee to vote no on this bill and not advance it. Thank you.

Thank you very much. Everybody else speaking in opposition. Now it's time to come forward. Name and affiliation.

Nick Louizos. Thank you, Madam Chair. Nick Louizos, on behalf of the California Association of Health Plans and we are regrettably opposed to this bill because we believe that the cost to employers, individuals, and employees far outweigh the benefits, the purported benefits of this piece of legislation.

This is most clearly demonstrated by the conclusions of the independent California Health Benefits Review program, which analyzed a substantially similar bill last year that indicated that premiums would increase as a result of this proposal by $200 million just in the first year. This cost is almost three times the purported benefit that will be experienced by a small percentage of consumers. In other words, all consumers will collectively pay more, so that some might pay less. It just simply doesn't pencil out.

There are other issues with this bill. It will lead to the prioritization of expensive brand-name drugs at the expense of other lower-cost alternatives like generics or other preferred brand-name drugs. And this is because, as previously mentioned, the rebates really only exist for a small percentage of expensive brand-name drugs. And there is no easy way to implement this bill.

Many times the health plan doesn't see the rebate right away, and so to try to initiate or enact a point-of-sale rebate will be very difficult. And our members already experience benefits by the collection of these rebates. When a plan can secure those rebates from the drug manufacturer, they do reduce the overall spending of the plan.

And so, for instance, in the 2021 report by the Department of Managed Healthcare in their annual healthcare drug cost transparency report, it clearly shows that health plans use drug manufacturer rebates to help mitigate the overall impact of high drug prices by reducing total health plan premiums by 2.1%. So then why would we want to interfere with the process by which we can lower overall costs in the healthcare system? Finally, we do believe that some work can be done on the issue of out-of-pocket costs.

We did support a bill last year by former Chair Senator Pan that would have leveraged state and federal funds to lower out-of-pocket costs for consumers. We're supporting a similar bill this year. That would be the way to do it so it doesn't impact consumer premiums. And then finally, with your indulgence, Madam Chair, we've heard this bill several times in the past. One thing that keeps getting repeated is that the consumers' out-of-pocket costs are based on the list price of the drug.

I have surveyed my Members repeatedly on that. They say that is not true. It is based on the negotiated price. I don't know what product is being cited here, but if the other side can inform us on that, we'd happily look into this. My plans don't think the DMHC would authorize a product of that nature. So just wanted to put that on record, too, and happy to discuss it. Thanks.

Thank you very much. And now just name an affiliation.

Madam Chair and members. John Wenger, on behalf of America's Health Insurance Plans, in opposition.

Thank you, John.

Steffanie Watkins on behalf of the Association of California Life and Health Insurance Companies, also opposed.

Preston Young from the California Chamber of Commerce, here in opposition.

Thank you very much. Anybody else speaking in opposition? Okay, how about people speaking in opposition? That was opposition. All right, let's go to the phone lines. Moderator, are you there?

I am. For those who wish to speak in support or opposition to this bill, please press one, then zero at this time. Press one, then zero. I'm going to go to line 185. Your line is now open.

Thank you, Chair and members.

Pardon me. Line 185, your line broke up. Please respond again.

Thank you. Madam Chair and M\members, Moira Topp. On behalf of Biocom California, in support.

Thank you. Next call.

Line 201, your line is now open. Line 201, your line is open.

Scott Suckow, on behalf of the liver coalition of San Diego, in support.

Line 184, your line is now open.

Thank you.

Good afternoon. My name is Maria Gutierrez of California's League of United Latin American Citizens, and we express our support for SB 873. Thank you.

Thank you.

Line 195. Your line is now open. Line 195. Your line is now open. Line 195. Please press one and zero again to rejoin the queue. We're now going to go to line 139. Line 139.

Yes. Hey, this is Lily Katanski. I'm with National Association of Social Workers California Chapter, and we're in support.

Thank you.

For callers wishing to comment, we do want to make you aware of the fact is, if you press one than zero a second time, you will be removed from the queue. We invite anyone that wishes to comment on this bill who has not commented to please press one, then zero at this time. And we have one additional person who signaled that they wish to speak. Just a moment, please. Thank you again for your patience. Just another moment. It's one more moment, please. We're now going to go to. I'm so sorry.

That's okay. Take a deep breath.

Okay. We have one additional person who signaled they wish to speak. Just a moment, please.

Thank you.

We're now going to go to line 20. Two. Pardon me. We're going to go to line 144. Your line is now open. 144. 144, your line is open. Go ahead, 144. And again, we apologize for any misunderstanding. Once again, for those who are calling in, please be aware if you press one and zero a second time, you will be removed from the queue. We're now completing with the queue. Please continue.

Thank you very much. Okay, now is the time we're going to bring it back to the committee. Questions? Comments? Okay, I'm supporting this bill today, but I do have. I mean, I kind of agree with the position. Let's maybe get rid of rebates and think about lowering the price of drugs the more we do these. I think the tripper was accurate and it's going to increase about 200 million for people. You'll be helping some, but everybody else will pay a little bit more. It's kind of the nature of our system right now, which is mostly unfortunate. But would you like to close or respond to the position about it's going to raise costs for others?

Well, when you look at the overall cost, you're talking about about 0.3% of an increase. When you look at it in his aggregate, and true enough, that means something in people's pockets, but at the same time, why should the sickest of Californians subsidize the most healthiest people? And this is what we're just trying to bring some kind of balance here where folks can afford their drugs.

At the early part of this year, we heard about a young man who was suffering from diabetes, and he rationed his insulin, unbeknownst to his parents. And we know what happened there. He died. And no one should have to make a decision between paying your rent and buying medicine. And this is all we're trying to do, is make health medicine accessible to as many people as possible. Is this a perfect bill?

No, but I think it's something where we always take pride in being the leaders in California. Well, there's five other states that are already doing it, and it's working. And you haven't had upheaval or major impact to the industry. So I just think, with all due respect, we should give it a shot here in California. And I respectfully ask for your aye vote.

Thank you very much. Is there a motion on this bill? Moved by Senator Gonzalez. Secretary, please call the roll. It is do pass and re-referred to the Committee on Appropriations.

[Roll Call]

Five, zero. We'll hold that roll open.

Thank you, Madam Chair and members.

Okay. Also, we had a motion on SB 85. Portantino, forget who made that motion.

I don't think we did a motion because we didn't. Is there a motion for SB 805 by Senator Portantino? Okay, Senator Dahle made that motion despite having a no from his party. He stepped out. zero, that's a different one. Okay. All right, he's in line. He's in line with the party. And do pass, as amended, and rerefer to the Committee on Human Services. Secretary, please call the role.

[Roll Call]

That is eight to zero. We'll hold the roll open. Okay, we are going to. People may recall we had heard a Bill last week by Senator Nguyen, SB 625. The motion was do passed as amended, and re referred to the Committee on Judiciary. And at this time, due to reconsideration, we're going to open the roll. Secretary, please call the roll. Do we need another motion? Okay, do we have a motion for today's? Senator Dahle makes the motion. All right.

He's a motioner, and it is do pass as amended and rerefer to the Committee on Judiciary. Secretary, please call the roll.

[Roll Call]

That is 6-1. Hold it open for absent Members. Okay, so we'll hold that open, but so far, the Bill fails again. It's open. It's open. I said it was open. All right. We are looking for Senator Lamone. Her Wiener is here. How about Senator Wiener? SB 770. We still need Limone. Come on down. Come.

Senator Wiener, nice to see you. SB 770 and you are accepting the amendments, clarifying the legislative intent language?

Yes, we are accepting the amendment.

Thank you, sir.

Thank you, Madam Chair.

Please proceed.

And thank you, Madam Chair, for your Committee working with us. We appreciate it. Colleagues, I'm here to present Senate Bill 770, which takes a tangible step on a concrete timeline toward creating a system of guaranteed health care for all Californians to provide better care at lower cost with a unified financing system by doing the following directing the Secretary of Health and Human Services to pursue waiver discussions with the federal Center for Medicare and Medicaid Services to facilitate the creation of a unified healthcare financing system requiring the secretary to establish a waiver development workgroup of diverse healthcare system stakeholders appointed by the Governor, the speaker, and the pro tem requiring the secretary to provide quarterly reports to the chairs of the Assembly and Senate Health Committees on the status and outcomes of waiver discussions with the Federal Government and the progress of the workgroup and requiring the secretary to submit a complete set of recommendations regarding the elements to be included in a formal waiver application no later than June 1 of next year.

Colleagues, we have a large coalition behind this Bill of major labor organizations, healthcare advocates and antipoverty organizations, some of the most respected organizations in the State of California. The fragmentation in our current healthcare system leads to massive, massive inequities, from highly varying health plan eligibility requirements to the continued lack of effective oversight of health plans.

As we see every single week in this Committee and this is harming California residents, these shortcomings result in severe and sometimes lethal gaps in medically necessary health coverage and disproportionately impact historically and systematically marginalized communities. California has taken important steps to expand access to health care for all, most recently with Senator De Rosso's work spearheading expansion of Medi Cal coverage for people regardless of immigration status.

But the state has also recognized that the status quo of healthcare financing is not working and that innovative solutions must be explored. The 2019 Budget act charged the Healthy California for all Commission with developing a plan that includes options for advancing a health care delivery system in California to provide better care that costs less through a unified financing system, including, but not limited to, a single payer financing system for all California residents.

In the Commission's final report, it summarizes the characteristics of what that system would be that all California residents would be entitled to receive a standard package of healthcare services that this package could include long term care support services, which would relieve huge, crushing burdens that are currently falling on millions of families in the state. Entitlement will not vary by age, employment status, disability status, income, immigration status or other characteristics.

Finally, moving away from the completely broken system of basing whether you have healthcare coverage on your current employment, it's an absurd system that was created in this country after World War II, and looking back on it, it's just shocking that we ever allowed that system to come into place. And then distinctions among Medicare, Medicare, employer sponsored insurance and individual market coverage would be eliminated with a unified financing system.

The report estimates that universal coverage through a unified financing system would save 4000 or more lives annually, and finds that, quote, absent a shift to unified financing, California will incur an additional $500 billion in medical costs over the next decade. I want to acknowledge the opposition to this Bill, colleagues, I view the support and opposition of this Bill as a little bit like a temporary family feud. Sometimes family Members and coalition partners have disagreements and have arguments and disputes. Sometimes those pour out into public.

And that's just the nature of human existence and of democracy. This is a coalition that I think is temporarily having a disagreement. My hope is that we can eventually come back together because we all share the same goal. SB 770 will be a tangible step forward and I respectfully ask for your I vote. With me today to testify is Mike Casey with Unite here and Dr. Jeff Fraser, Md. And I respectfully ask for your I vote.

Thank you, Senator. Mr. Casey.

Good afternoon. My name is Mike Casey with the Hospitality Workers Union Unite here. I've been a union organizer for 40 years, and in that time, I've watched health care costs consume an ever growing portion of working people's income. Universal health care is taken for granted in other countries, but in America, health care costs are strangling people's ability to pay rent, put food on the table, and live the lives they want to.

I'm here to appeal to you to finally get the ball rolling on fixing this crisis. When I first started organizing restaurant and hotel workers, health benefits cost 10 cents out of every dollar that workers bargain with their employers. Today, that number is closer to $0.30. If premiums had just gone up at the rate of inflation over the last 20 years, a typical union dishwasher or room cleaner in San Francisco could have had $200,000 more into their wages or pension contributions.

Trade unions from other countries have asked me in disbelief, when you don't have guaranteed health care, how can you fight for anything else? I've lost count of the number of strikes and lockouts that were motivated by the question of who's going to pay for health coverage. I talk to employers almost every day who are hard pressed to hire workers because insurance prices limit what they can pay in wages. And it doesn't have to be this way.

I spent a lot of time bargaining contracts in Canada, where each province has its own Medicare for all system. Unions bargain for healthcare benefits, too. However, they cover things that the healthcare system doesn't like private hospital rooms or dental coverage. But the cost is a non issue, amounting to just a few cents increase each year. I'd add that a room cleaner in Vancouver pays less in taxes than one in California does.

I focused on the economic toll our healthcare system has taken, but let me take a word about the human costs. The Healthy California Commission found a unifying financing system in California a Senator Wiener said could save 4000 lives per year. I saw the reality of that firsthand during 2020, when 95% of hospitality workers were laid off and I personally witnessed the termination of health coverage for tens of thousands of families at the height of the pandemic.

I can't imagine a clearer call to change what we're doing. I understand CESB 770 doesn't in itself create a Medicare for all system, but it will hold this state accountable to moving on the Commission's recommendations on a timeline that matches the urgency of the crisis. There are countless decision points that go into deciding how and when the California designs a unified financing system.

We need clarity as to what the Federal Government is prepared to go along with so this Legislature can craft a Bill that has the greatest chance of success. Please pass SB 770. Thank you.

Thank you very much. Do you have a second?

Yes, Dr. Fraser.

Dr. Fraser.

Good afternoon, Madam Chair. Members of the Committee, thank you for allowing me to provide some witness testimony. My name is Jeff Fraser and I'm a retired neurologist. From 1991 to 2020, I worked as a staff neurologist at Santa Clara Valley Medical Center, a large public hospital in Silicon Valley. I served as the Department chair for five of those years. I have seen the inequities and the follies of our current healthcare system, and I have personally dealt with the problem of physician burnout.

These concerns have led me to research and write a book arguing that a single payer, notforprofit healthcare system with universal coverage will provide the necessary foundation for solving the burnout problem. SB 770 lays out a path to achieve these necessary reforms. I firmly believe that without such reforms, the burnout problem will only worsen and the physician shortage crisis will snowball when physicians encounter patients who have treatable medical conditions but who lack the means to get proper treatment, they experience profound moral injury.

Our patients commonly face delays or insurmountable barriers to getting appropriate care due to the fact that they were uninsured or underinsured. People with seizure disorders, for example, would routinely show up in our emergency room because they had had a seizure after running out of their medications. Why did they run out? Because having lost their job and their employer sponsored insurance, or having recently arrived from another county without insurance, they were unable to access our overwhelmed neurology clinic in a timely manner.

A healthcare system that cannot reliably provide the simple service of refilling a life saving medication is absurd. By addressing the tragedy of unmet health needs, SB 770 gives doctors hope that California's state policymakers will address their plight and, most importantly, the plight of their patients. Doctors also shoulder the burden, the exasperating administrative burdens heaped upon them by multiple growing bureaucracies. We are obliged to clutter up our patient encounter notes with redundant or irrelevant information so that billing departments can maximize charges to third party payers. We struggle to navigate various prior authorization processes.

Doctor, if you could wrap up, please.

Which are often cryptic or quibbling in nature, and most of us have come to see them as nothing more than devices to discourage, delay, or deny appropriate care.

Thank you. Thank you very much. Now, people just speaking in support. Just name and affiliation.

Good afternoon. Tom Brandon with the California Conference of Machinists in support. Thank you.

Ellen Carroll with the Executive Committee of Healthcare for all California. Thank you.

Thank you.

In support.

Julie Nielsen with the National Union of Healthcare Workers in Support.

Thank you.

Stephen Vernon, founding Director of therapists for Single Payer, Vice Chair of physicians for National Health program, California. Proud Members of the Healthy California Now Coalition.

Thank you.

Patricia Chadwick, California alliance of Retired Americans in support.

Thank you.

Alfredo Calderon, local two. United here support.

Thank you.

I'm Danielle Guzman. I support thank you.

Maria Mata, housekeeper w San Francisco Hotel. And I support.

Thank you.

Yolanda Carmona Locoto United.

Thank you.

My name is Kamucha Kim. I'm private dining server from the San Francisco Hotel, San Francisco. United here. I support. Thank you.

Hi, my name is Lassanta Rana Singh from unity, a local two. I support this field.

Thank you.

Diana Douglas with health access, California, in support.

Thank you.

Gordon Miller, Central Contra Costa County, California Alliance for Retired Americans in support.

Thank you. Windsor Young, California Alliance for Retired Americans. I am in support. Thank you.

Madam Chair Members. Bryce Doherty, on behalf of the California Academy of Family Physicians, in support.

Thank you.

Good afternoon. Irene, GA with courage, California here to express our strong support for SB 770.

Thank you.

Afternoon. Carolyn Bowden, Healthy California Coalition. Healthy California now coalition in strong support.

Thank you.

Dr. Jamie Congdon, a pediatrician from San Francisco, in support.

Thank you.

C. T. Weber, a Legislative Analyst from California Peace and Freedom Party. We're in support. We do have some questions on the Bill, and we'd like to talk to staff.

Thank you.

Mark Dahlman, healthcare for all California in support thank you.

Deborah Dahlman, in support on behalf of Sonoma County Working Group for Healthcare for all physicians for a national health program, Healthcare for all California in solidarity and coalition with Healthy California now.

Thank you.

Amber Gotam, pediatrician from SF in support.

Thank you.

Dr. Sarah Bourne, pediatrician in San Francisco.

In support thank you. Okay, now we'll hear from the other side of the family feud.

Thank you, Madam Chair. Thanks, Committee Members. I'm Carmen Comste, lead regulatory policy specialist with the California Nurses Association, in respectful opposition, representing over 100,000 strong union registered nurses throughout the state. CNA has championed single payer healthcare legislation for decades, and we are grateful again for Senator Weiner's longstanding support for single payer. CNA, however, opposes SB 770 because it is unnecessary and unfortunately would sidetrack California from achieving our goal of single payer health care.

First, the Bill would unnecessarily duplicate, not complement, the work of the Healthy California for all Commission, which I proudly served on as a Commissioner. The Commission expended extensive financial and human resources to develop a roadmap on unified financing for two and a half years. CalHHS policy experts, stakeholders, patient advocates, and representatives from the Legislature, including former chair of this Committee, Dr. Pan.

We analyzed the range of issues on unified financing, including system design, benefits, community engagement, financial analyses, among many issues, and we issued our final report to the Legislature and the Governor last April. The Commission held lengthy discussions on federal healthcare waivers, and calhs secured outside legal counsel to analyze the issue for our final report. In short, the Commission has already completed the work of the bill's proposed waiver workgroup.

Concerningly, this Bill would hand over decisions on restructuring our health care system to an unaccountable work group and to nonbinding informal discussions between Cal HHS and federal HHS. But the law on federal waivers makes clear that SB 770s approach puts the cart before the horse for California to even apply for a consolidated federal waiver. Section 1332 of the Affordable Care Act requires that we enact legislation establishing the underlying program. The Federal Government cannot negotiate on a program that does not yet exist.

Thus, the only way to get federal HHS to the negotiating table on federal waivers is for the Legislature to first pass a Bill enacting a single payer system. Finally, it is troubling to CNA that this Bill concerns unified financing and not single payer. The Commission's discussions made clear that a unified financing system includes a multipayer system of health insurance, which falls far short of single payer.

Without clear instruction from the Legislature in a Bill establishing single payer, this calhs and a waiver workgroup may pursue something that is not single payer in any way if the Legislature is committed to tangibly moving forward on single payer. CNA urges the passage of a Bill establishing single payer, and we urge a no vote on SB 770.

Okay, thank you very much. Next person, please.

Thank you, Senators, for this opportunity to speak to you. My name is Cheng Sim Lim. I'm an immigrant and a film curator. I'm also a two time cancer survivor who's been in enough hospitals as a patient to volunteer my time and energy the last seven years to organize for single payer healthcare in California. Today, I represent healthcare for us in Los Angeles to say our organization strongly opposes SB 770 and calls in this Committee to vote it down.

The single payer activists I work alongside include young and old BIPOC LGBTQ immigrants, folks who are insured, uninsured, and those on Medical and Medicare. We are diverse but united in wanting single payer. We reject SB 770 because it is not a single payer Bill. It's a let's have more discussions and more study of the waiver process Bill with loophole language to preserve insurance company profiteering off healthcare in California.

Furthermore, as Ms. Comstey has pointed out, SB 770 runs counter to the ACA's section 1332 requirement that states must enact healthcare legislation first before they can apply for a consolidated waiver. Those of us organizing for single payer in our communities do not need more legislation to talk and study how to do waivers. We've been there and done that, most recently from 2020 to 2022, when we set through two and a half years of the Healthy California for all Commission.

You could wrap up waste taxpayers dollars on setting up another Commission like body. SB 770 also has a timeline that gives cover for legislators to say they cannot pass actual single payer calcare in the Assembly by May 2024 because they have to wait for waiver reports due later in June or even 2028. We don't need SB 770 to delay legislative action on calculus.

Thank you. Thank you very much. Thank you very much. Next person, please. And you've got less than a minute.

Thank you, Madam Chair Members. Nick Luizos with the California Association of Health Plans opposed to the Bill from the opposite direction. California already has the authority to seek a waiver on this. We don't believe California should exercise that authority for this particular issue. But this Bill requires a state to seek authority that it doesn't need to trigger a massive change to a new health care system that most Californians don't want.

It'll lead to government run health care, the elimination of Medicare, $500 billion in a new health care program that needs $300 million in taxes on businesses and individuals. We've made tremendous progress. Most Californians want us to build upon the current progress that we've made through the Affordable Care Act. They don't want to see a complete change of our health care system. Thank you.

Thank you very much. Other speaker in opposition now to come forward and just name an affiliation.

Faith Borges. On behalf of California agents and health insurance professionals. Opposed for the reasons outlined by Cap. Thank you.

Thank you.

Stephanie Watkins. On behalf of the Association of California Life and Health Insurance Companies. Also opposed.

Preston Young from the California Chamber of. Commerce here in opposition.

Thank you.

Megan Shumway, retired nurse, in opposition.

Thank you.

Madeline Mabry. On behalf of CNA, in opposition.

Thank you.

Wayne Chapman. On behalf of CNA. Strong support for single payer healthcare. Opposed to SB 77.

Thank you.

Gary Fitzgerald. I'm here on behalf of the me, myself and I foundation. And I'm opposed to this. SB 77.

Thank you to all three of you, sir.

Shirley Toy, CNA Member and also representing the Wellstone Progressive Democratic Club.

Thank you.

Jennifer Mueller, self employed. Opposed.

Thank you.

Greg Miller, retired nurse and Member of California Nurses Association retirees. And also the Santa Clara County single payer Healthcare Coalition, both of which are in opposition.

Pamela Rouse, retired RN with CNA and I'm an opposition.

Hello, I am Brian Sithner and I'm with Wellstone progressive demiliocrats of Sacramento. And I strongly opposed. SB 770.

Thank you,

Victoria Hall Ariane. Opposed to 770.

Thank you. Okay, seeing nobody else approaching the mic, let's go to the phones, please. Operator, are you there?

I am. Thank you, Madam Chair. For those of you who have not spoken with an operator and wish to comment on this Bill, please press one, then zero at this time. We're going to go to line 135. Good afternoon.

This is Sandra Poole. On behalf of Western center on law and poverty and support.

Thank you.

Line 173. Line 173, your line is open.

Hi, yeah, hi. My name is Lynn Heidi Copper from one payer state, and I think that a lot of people.

Thank you very much. Next caller, please. Next caller, please, just your name and.

190, your line is open.

Good afternoon, Chairwoman, Committee. I'm Hilda, and I live in Alameda, and I am here supporting SB 770. Thank you.

Thank you very much. Next call.

Line 176, this is Terry Winter representing the healthcare role work group in Sonoma County, and we rise support of the 770.

Thank you.

Line 150, your line is open. Line 150, your line is open.

Hi, my name is Jeff Green. I'm with Inland Equity Community Land Trust and we are in support of 770 and single payer in General.

Thank you very much. Next caller, please.

Line 181. Line 181, your line is open. Line 223, your line is open.

Thank you. Next caller, please.

Line 224, your line is open.

Hello, everyone. Maribel Nunes with Inland Equity Community land Trust, Inland Equity Partnership. I know we have a lot of coalition partners. Lulac Riverside Latino roundtable that support SB 670. Thank you much.

Line 228.

Good afternoon, Madam Chairwoman. I appreciate the Committee hearing. My 1 minute statement. My name is Laurie Stevens.

No, just name and affiliation, ma'am. Name and position? Are you for it or against it? Laurie Stevens, are you for the Bill or against the Bill?

For the Bill. And I had a 1 minute.

Thank you very much.

Line color 93, your line is open.

Yes, hi, my name is Betty Toto. I am from Medicare for all everywhere. I'm also an elected Member, County Committee Member of Los Angeles County Democratic Party, and I oppose without amendment.

Thank you very much. Next caller, please.

Line 175, your line is open.

Hello, my name is Maureen Cruz, registered nurse, formerly of La County Department of Health Services, co chair of Healthcare for Us Los Angeles, and Member of DSA Los Angeles Healthcare Justice Committee. Strongly in opposition to this Bill.

Thank you.

Next color. Line 203, your line is open.

Hi, I'm Sherry Roberts. I'm a health insurance agent in Southern California serving families and seniors, and I strongly oppose SB 770.

Thank you. Next caller please.

Line 191.

Good afternoon. Marissa Wu, on behalf of UAW 5810 in support.

Thank you. Next caller please.

Line 146. Hi, good afternoon, Chairwoman Eggman. My name is Bruce Mcclain and I'm representing Duke County Healthcare Coalition, DBA north state Medicare for all. We rise in support of SB 770. Thank you.

Thank you very much. Next caller, please.

Line 209. Hello, this is Eddie Kurtz with business leaders for healthcare transformation rising in strong support of SB 770.

Thank you.

Next caller, please, line 158.

Good afternoon, Madam Chair and Committee. My name is Georgia Brewer. I'm associate Director of California one care. We strongly support SB 770. Thank you.

Next caller, line 155. My name is Art Persico. San Francisco Gray Panthers, California Alliance for Retired Americans Healthy California now in support of SB 770.

Thank you.

Thank you.

Next caller, please, line 227. Harry Baker, healthcare for all. California in strong support of 770. Thank you.

Thank you.

Next caller, please, line 124. Line 124, your line is open. Line 157. Your line is open.

Good afternoon. My name is Pam Rood, representing the California Alliance for Retired Americans and the National Union of Healthcare Workers in strong support of SB 770. Thank you.

Thank you. Next. caller, please,

line 131.

Your line is now open.

Hi, good afternoon. My name is Vanessa Rhodes. I'm a resident in Hayward, California, and a mother of two. I rise in strong support of SB 770, thank you.

Thank you. Next caller, please.

Line 217

James G. Khan, health economist, the University of California, San Francisco, in strong support.

Thank you. Next caller, please.

Line 165.

Good afternoon. My name is Beverly Arias, and I'm here representing IE Votes. We rise in support of SB 770. Thank you.

Thank you. Next caller, please.

Line 196.

Sandy Newman, Health Care For All. I rise in very strong support for SB 770.

Thank you very much. Next caller, please.

Line 216.

Hi, Elizabeth Underhill, Los Angeles, opposed to SB 770.

Thank you. Next caller, please.

Line 171.

Good afternoon, Chairwoman and committee. My name is Leticia Zuniga, and I'm here representing IE Vote. I rise in support of SB 770.

Thank you. Next caller, please.

Line 162.

Good afternoon. Chairwoman, Eggman, and committee. My name is Maria Galvan, and I'm here representing Inland Empire Vote. We rise in support of SB 770, thank you.

Thank you. Next caller, please.

Line 202.

Hi, I'm Gina Viola, California employer representing Trade Show Temps, strongly opposing 770 in the delayable gift of childcare.

Thank you.

Line 204.

Thank you. Next caller, please. 204. Hello.

Joe Partis, CLU, serving families and seniors in Sacramento and all of California opposed to SB 770.

Thank you. Next caller, please.

Line 181. Line 181. Your line is now open.

Hello? Can you hear me?

We certainly can. Go ahead, please.

Hi, Jenny Chang, elected board member of the California Democratic Party, in strong support.

Thank you.

Madam Chair. There is no one else who signal that they wish to speak.

Thank you very much. Okay, now's the time. We're going to bring it back to the dais. Any questions? Comments? Senator Roth? Senator Menjivar, after.

Thank you, Madam Chair. Just a comment. As the author knows, I've had serious concerns about these various single payer proposals in the past. Haven't quite decided what to do. I continue to have some very serious concerns about the proposals.

My concerns relate to the potential impact of the various single payer proposals on our Medicare seniors, on our military retiree Tricare recipients, and our military veterans in the VA healthcare system, among others.

But having said that, as I indicated to the author, I have a great deal of respect for him as an author, and I intend to vote to allow him to move forward with this bill and the proposed working group at this point.

Thank you, Senator Menjivar.

Thank you, General. I echo some of those sentiments. But my question here is, I know you've been having some conversations with opposition around some friendly amendments in the timeline, I can understand that. It seems like we're just pushing it more and more back.

I'm wondering how those conversations are going as the states, I think you said June would be the current date. Are you open to changing that date?

So right now the bill requires a report by June 1 of next year. We received a request to amend that and make it January 1. The problem with that is that's the date that the bill would go into effect under the constitution. So that seems potentially unworkable.

We're always happy to have discussions about details like timetables, but that's where we are now. There's nothing magical about June 1. So we're open to that conversation.

Thank you. Would you be open to a friendly amendment today?

Not today. I'd have to consult with my sponsors and have those conversations.

We don't nursery amend from the dais, but those conversations can be ongoing, and I appreciate you taking the shot. Okay. Anybody else wishing to speak at this time? Okay. Senator Wahab?

Senator, I do appreciate you bringing this forward. I did just want to ask a couple of questions in particular. I believe that we are hearing that this, and I just want you to clarify this, if you will, that SB 770 could delay the progress on calcare until as late as 2028.

And then we obviously know, as the general stated earlier, that people can't wait. So do you have any comments in regards to that?

Yeah. So the 2028 argument, respectfully to the opposition, is a red herring because that's when the bill sunsets. But the report is required before that next year, in fact. And so that just simply went everything legally sunsets.

But in terms of delay, I want to be clear. I've co-authored, there have been two single payer bills since I've been in the legislature. I've been a co-author of both of them. I've been very on the record where I am on single pay.

I voted for it on the floor of the senate. I would have voted for it last year had it come over from the assembly. So I would not do anything that I thought would delay single payer. It's obviously a very hard issue, and those bills are very hard. I hope something passes next year. I'll be supporting that and hoping that that'll happen and we'll see how that goes. I want to be very clear about one thing.

There's been some suggestion, actually explicit statement that this requires the request for the formal application for a waiver before we even have a single payer bill. Passed into law. And that's not what the bill requires. The bill requires consultation with the feds so that we can start crafting what the scope of that waiver would be.

And that actually, frankly, will inform the legislative process for the single payer bill if it's able to advance, because then we know in advance what it would take to get that waiver. And so I think the two dovetail nicely.

Okay. So if passed, SB 770 would establish a working group to have informal conversations with the Federal Government about waivers to capture federal funds for a single payer system.

That's correct. One of the things, it's a tangible step to make sure that the administration is doing this. And I'm not criticizing the administration, but we want to make sure we're keeping this on track.

And these conversations are technically already happening. Correct?

There are always conversations happening. This is a more structured way of requiring that it move forward. I know Mr. Culra has had conversations with the US Department of Health and Human Services. There are always conversations. This is a structured way and it's a legislature.

And if the governor signs it, the governor going on record saying that we are going to do this, we're going to have these conversations, we're going to figure out the scope and the structure of a waiver application.

Okay. And then according to Health Care California For All we're hearing that an informal working group won't be able to make any actual progress on single payer or reform our healthcare system. Would you like to touch on that?

I don't agree with that. Respectfully, I strongly disagree with that. And if you look at the coalition behind this bill, this is not what we would call flimsy coalition. These are some of the largest and most progressive labor unions in the State of California. They're respected health organizations like Health Access.

They're respected anti poverty organizations like the Western Center. There's the Courage campaign, a diverse set of labor unions that don't always agree with each other, that have come together on this.

And so this is a strong and respected coalition. And this coalition would not have come together and put this level of effort into this if they thought that this working group and this bill wouldn't do.

And, you know, I will tell you, Senator, I do appreciate any effort to kind of fix our system, if you will. I do just want to highlight that I am a strong supporter of CNA's continued effort for a just healthcare system, in particular in California.

I do believe that they have always been kind of on the righteous side of the argument and obviously putting patience before profits. But out of courtesy for continued conversation, I'm just asking, you will potentially continue conversations with the opposition, correct?

Absolutely.

Okay. And the goal is to potentially make this bill better for all people with a priority of patients first.

Yeah. And as I said at the beginning, we all support opposition. The health plans have their own perspective. I respect that. I disagree with them. But in terms of CNA and its allies in opposition and the supporters of this bill, we all want to get to the same place.

And as I described it in my opening, it's a temporary family feud that I hope everyone can come back know. Assemblymember Kawara and I, we have a great relationship.

We've spoken about this, and we want to try to hopefully heal the rift at some point. But for now, it's a bit of a disagreement. But it's not a disagreement as to the final goal. It's how we get there.

Definitely similar to yourself. We seem to love to carry the more difficult bills and it requires a lot of conversation. And so I will reserve my right on the floor because I would like to see the final product.

I will be supporting this out of committee just to give you the courtesy to continue to move it on through the legislature. I am hoping that you continue conversations with CNA and other stakeholders, but I trust that we will have hopefully something better than what we have today. So thank you.

Thank you.

Thank you. Anybody else? Okay. And I will say, I have never had the opportunity to vote for one on any floor I've been on. That's my first time serving on a Health Committee. I also share some of the concerns as the general with Medicare and with veterans groups.

But certainly the longer any of us look at healthcare, the more we realize something needs to be done. Every week we see bills trying to cap costs, and then it's like a whack a mole.

You cap it one place and it pops up somewhere else, which is just not the way we want to go about delivering our health care system. But I do believe this is a way to keep moving it forward and having these conversations.

And the administration is always involved in waiver conversations, so they need to be at the table and make sure that California is at that table to be able to have those conversations. So is there a motion on this bill? Moved by Senator Menjivar.

Senator, would you like to close?

I think we've collectively closed, and I respectfully ask for an aye vote.

Thank you to the collective close. And aye will say aye don't think the health plans are against healthy people. Okay. Secretary, please call the roll.

Senators Eggman.

And the motion is do pass as amended and referred to the committee on appropriations.

[Roll Call]

Scott Limo. Thank you, Madam Chair.

7-2. We have two loud voices, and we will leave that roll open for now. And now it's going to turn it over to Senator Limon, who's going to present her own bill. And she's also presenting for Senator Stern this week.

And Members, on behalf of Senator Stern, who is at home with a new baby, I'm presenting SB 717, which will require a county behavioral health department to maintain contact for 180 days and offer mental health services to an individual charged with a misdemeanor, who has been found incompetent to stand trial and who is not receiving court directed services. California is facing a behavioral health crisis.

An estimated 63% of adults with mental illness receive no mental health treatment, according to the Substance Abuse and Mental Health Services Administration. As a result, vulnerable individuals are left with minimal support. In the California court system, if a judge believes that a defendant is not mentally competent to understand court proceedings, they can order a separate hearing to determine if the defendant is incompetent.

If the person is found to be mentally incompetent to stand trial for a misdemeanor, existing law authorizes the court to either grant diversion for a period of one year and then refer to the defendant to treatment or dismiss the charge. However, in the current system, those who have cases dismissed are not required by law to engage in community mental health services or programming. These individuals are more challenging to engage since any treatment is voluntary and many find themselves uninterested in services at the time of dismissal.

SB 717 expands on the efforts to keep those experiencing severe mental challenges out of our justice system and in treatment. The bill uses this critical opportunity to intervene and ensure that incompetent defendants are offered mental health resources to help them achieve wellness, reduce rates of recidivism, and avoid the cycle of incarceration.

To testify in support of the bill is Paul Simmons, the Executive Director of the Depression and Bipolar Support Alliance, and Le Ondra Clark Harvey, the Chief Executive Officer of the California Council of Community Behavioral Health Agencies.

Thank you very much. Go ahead.

Good afternoon again. Oops. Yes. I'm Paul Simmons with the Depression and Bipolar Support Alliance of California, and thank you for the opportunity to meet with you this afternoon and to express our support for Senator Stern's bill. Depression and Bipolar Support Alliance, our DBSA, we love the acronyms, is the leading peer directed national organization focusing on the two most prevalent mental health conditions, depression and bipolar disorder, as well as numerous other conditions that are co occurring with them.

SB 717 would require a county behavioral health department to main contact for 180 days with and offer mental health services to an individual charged with a misdemeanor who has been found incompetent to stand trial. We find ourselves in a particularly difficult time for those with mood disorders and mental health challenges.

More and more peers, those with personal lived experience of mental health conditions, are being marginalized, even criminalized, and end up in a cycle of forced treatment and incarceration without getting the help that they need to recover. I personally know a number of people who have been released from either criminal justice system or forced treatment and basically dumped on the streets and they are never contacted again.

And they end up all the worse for the supposed treatment that they got and a program to ensure that people receive the follow up that they need, particularly when they're so ill that they are pronounced incompetent to stand trial, seems fairly obvious, yet there seems to be no system really in place to ensure this. SB 717, requiring 180 days of contact is a good start to ensure continuity of care.

Along with that, of course, is having a system of care to take care of these people when they do in fact get referred. Anyone found incompetent to stand trial should already be receiving substantial mental health services, and hopefully this bill will do more to ensure this. DBSA California wholeheartedly supports this bill and thanks Senator Stern for his initiative. Thank you.

Thank you very much. Dr. Le Ondra Clark Harvey.

Hi. I'll be quick. Dr. Le Ondra Clark Harvey, psychologist and CEO of CBHA. We understand that individuals found IST on misdemeanor charges often fall through the cracks, receiving little to no mental health support. This lack of assistance can exacerbate their mental health conditions, putting them at risk for further criminal justice involvement and increase personal suffering.

I saw this firsthand when I worked with this population in a state hospital in Wisconsin years ago, and it wasn't odd to see the same individuals cycle through over and over again. It was quite sad. By requiring county behavioral health departments to maintain contact with these individuals for 180 days, SB 17 can increase access and support to help prevent further deterioration of their mental health and reduce the likelihood of recidivism.

We firmly believe that primary and secondary prevention can help individuals who have contact with the justice system achieve recovery and become contributing members of their communities. And for these reasons, we urge your support. Thank you.

Thank you. Others speaking in support? Now just name and position. Seeing no one approaching the mic. Opposition?

Good afternoon. Lisa Gardiner with the County Behavioral Health Directors Association. We represent the leaders of the public behavioral health safety net in 58 counties and two cities.

We respectfully have an opposed, unless amended, position on this legislation. We share the author's concern for a population that could benefit from voluntarily engaging in treatment and services, but we see significant challenges with implementation. Many of these individuals are homeless, lack contact information, phones, a permanent address. So we believe it would require additional staff per county to conduct very time-consuming outreach and engagement. This outreach and engagement is not reimbursable under MediCal.

And in addition, we are facing at this time, as many people know, a catastrophic workforce crisis. In addition, a proportion of these individuals will be privately insured, and SB 717 has no mechanism for reimbursement for providing taxpayer funded services to a privately insured population. We think a positive first place to start would be ensuring that each of these individuals are notified by the court of their eligibility for behavioral treatment services, depending on their insurance provider, at the time of their dismissal from the court system.

That could be followed up, we think, by a second notification. We look forward to continued discussions with the author on how best to reach this population, which we also agree could benefit from treatment and services. Thank you very much.

Thank you very much. Other speaking in opposition? Okay, let's go to the phone lines. Moderator, those speaking for and against now, just name and affiliation.

If you wish to speak in support or opposition of this bill, press one and zero. And once again, for your comments, please press one, then zero. We have no one to signal that they wish to speak.

Thank you very much. Now is the time that we bring it back to the dais. Senator Roth.

Thank you, Madam Chair. I certainly support the bill's intent and the concept. The key is to have a system, as the witness indicated, in a workforce to support services and treatment. And as you well know, we all well know, many counties have limited capacity in terms of facilities and an even more severe shortage of behavioral health workers to provide the services and treatment. So from my perspective, a program with no money is no program at all. I'll be voting aye on the bill.

But we're going to have to work, those of us on the dais and those of us under the dome, we're going to have to work awfully hard to increase funding both for behavioral health infrastructure in our 58 counties and even more diligently to increase the supply and the pipeline of behavioral health workers.

Thank you. Senator Rubio.

Thank you, Madam Chair. And I don't disagree with General Roth. However, I do think it's an important step to take. This is a population that otherwise are out on the street and we don't have a solution for. So I really wholeheartedly, strongly support this one. In fact, I reached out to the office. I want to be a co-author. Just that we need some type of solution. And having this bill in place is the first step.

And working on everything that General Roth just stated is the other important part. But I think it's important to have it in place and figure this out. This is a population that continues to fall through the cracks and we need to do something, be proactive in trying to reach that vulnerable population. So I also will be supporting the bill. Thank you.

Thank you. Sergeant Menjivar.

In another world. To the workforce issue, these are individuals are having approximately 15 contacts with county individuals, with law enforcement, with the courts, where we're also shorting workforce theirs. But that's approximately 15 times versus interacting with one entity, perhaps just one time, addressing the workforce shortage and other entities.

I think this is a good way to address both workforce shortages, to also address the need to get these individual services, because then also as a state, we're going to be spending more money on these individuals who then go to Department of DSH. DSH, yes. So I'm very supportive of this and I'll send the author my support as well. Thank you so much for stepping in for him.

Thank you. It's a surprise to me that these folks don't have contact already. Right. You'd think these are somebody who has committed a crime, a misdemeanor, has not been found not competent to stand trial. And then we just say, go on ahead. And then we wonder why people cycle through and through and through. I do think the argument about private insurance has merit, and I think we should be able to figure out a way for some bridge to be able to happen. And I also wonder as it comes online if some of these folks will be eligible for care court.

I think a lot of the bills that we have passed and are working on passing this year hopefully will address some of these issues. I think we all are trying to address the very serious issues we see on multiple levels. Would you like to close? There's been a motion by Senator Dahle and would you like to close?

I respectfully ask for an aye vote.

Thank you very much. And this is do pass and re-referred to the Committee on Appropriation. Secretary, please call the roll.

[Roll Call]

[Roll Call]

11-0. That bill is out. The roll is closed. Let's move on to your own bill. Last bill we'll be hearing today, SB 496.

Thank you Chair and members, I'd like to start off by accepting the amendments listed in the analysis. SB 496 makes necessary changes in the law to ensure healthcare coverage of biomarker testing by the health plants, health insurance policies and the medical program.

Precision medicine is improving patient outcomes by using their own genes or proteins, biomarkers to prevent diagnoses or treat a disease. Biomarker testing can be performed for cancer including prostate, ovarian, breast and lung cancer, Alzheimer's disease, rheumatoid arthritis, type two diabetes. The list goes on.

According to last year's Chaperp analysis, biomarker testing is broadly covered by the California's essential health plan benefits. Therefore, this bill would not require coverage of a new state mandate benefit mandate. However, in practice, patients continue to face barriers in accessing the testing.

In 2021, a survey by the American Society, 66% of oncology providers reported that insurance coverage for biomarker testing is a barrier to biomarker testing.

This bill will improve access to biomarker testing to help patients treat their disease, slow disease, reoccurrence or progression, and lead to a better quality of life. With me today to testify in support of the bill, we have Autumn Ogden-Smith with the American Cancer Society and also Jen Chase with the University of California, office of the president.

First supporter, please.

Chair and members, Autumn Ogden-Smith with the American Cancer Society Cancer Action Network here is a proud co-sponsor. Senate Bill 496 will ensure timely access to appropriate biomarker testing and will result in better health outcomes, advance health equity and reduce costs by connecting all patients to the most effective treatments.

This language has been passed in seven other states, including Arkansas, Arizona, Illinois, Kentucky, Louisiana, New Mexico and Rhode Island, with Maryland and Georgia awaiting a signature. Currently, this was passed unanimously by the legislature last year, and we ask that you support us again today as we work with the administration to resolve those issues. Thank you.

Thank you very much. Next supporter please.

Jen Chase with the University of California. We are proud co-sponsor and ask for your support today. Thanks.

Thank you.

Madam Chair, Members of the Committee. Brandon Marchy, with the California Medical Association, in support.

Madam Chair. Jackie Yanis. On behalf of the Advanced Medical Technology Association, in support.

Ryan Spencer. On behalf of the Crohn's and Colitis Foundation, in support. Thank you.

Adam Keigwin. On behalf of Natera, in support. And I happen to take this test every three to four months, so I personally ask for your support as well. Thanks.

Thank you.

Madam Chair, members. Bryce Docherty. On behalf of the California Academy of Family Physicians, in support. Thank you.

On behalf of the Association of California Life and Health Insurance Companies, we'd first like to thank the committee, the sponsors, the senator, for all the work that she's done and it's been done on this bill. We have an opposed, unless amended position.

Thank you.

Jennifer Snyder. On behalf of City of Hope and the California Life Sciences, in support.

Thank you very much. Now's the time for opposition. Is it you, Stephanie, or Nick? Come on.

Wow. We interchange quite a bit. Thank you, Madam Chair. Stephanie Watkins. On the behalf of the Association of California Life and Health Insurance Companies. We first would like to thank the committee, the sponsors, the senator for all the work she has done on this bill. We have an opposed until amended position.

These most recent amendments we are taking back to our members. But we are incredibly thankful for the changes that have been made. We understand there may be other amendments based on the administration. We hope to keep an open dialogue on those as the bill moves forward. Thank you.

Thank you very much. Other speaker in opposition.

Good afternoon, Madam Chair, Members of the Committee. Robert Boykin with California Association of Health Plans. We have an opposing unless amended position on the current version of SB 496.

While biomarker testing is a promising new field and certainly useful in areas for which the benefit is supported by medical literature, its use requires careful oversight and consideration when determining its appropriateness and necessity.

Regrettably, we are concerned that this measure, as currently drafted, includes coverage for testing that is beyond the current standard of care. We understand that the amendments are being taken. Thank you so much.

Today, they include language that we seek. We'll have our members look it over and after that we'll report back to committee and to the senator's office if there is a change in our position. Thank you for your time today and look forward to work with you as this bill moves forward. Thank you.

Madam Chair, members. John Winger. On behalf of America's Health Insurance Plans, we're listed as opposed. I forgot to update our letter. Apologies. We are opposed unless amended as well. Thank you.

Thank you very much. Okay. Seeing no one else approaching the mic. Moderator, you want to do it one more time?

Thank you, Madam Chair. For those who wish to speak in support or opposition of this bill, please press one, then zero. Press one, then zero. And we're going to go to line 163.

In support. This is Christy Foy. On behalf of the California Clinical Laboratory Association, again, in strong support. Thank you.

Thank you.

Line 242.

Thank you, Madam Chair and members. Laure Clark on behalf of Biocom California, in strong support.

Thank you very much.

Line 244.

Thank you, Madam Chair and members Alex Khan, on behalf of California Chronic Care Coalition, in support.

Thank you.

There is no one else.

Thank you very much. Okay, bringing it back to the committee. Hello, committee. Okay, the bill has been moved. Senator Limon, would you like to close? I'll just say thank you for working with the committee. We appreciate it and look forward to it going forward.

Thank you. I respectfully ask for an aye vote.

All right. And the motion by Senator Wiener is do pass as amended. And we'll refer to the Committee on Appropriations. Secretary, please call the roll.

[Roll Call]

11-0. That bill is out. The roll is closed. Secretary, let's go through the roll again, starting with the consent calendar.

[Roll Call]

11-0. That the consent calendar is passed. Next.

SB 67 by Senator Seyarto, having to do with controlled substance overdosing reporting. Secretary, please call the roll.

Senators Glazer? Glazer, aye. Limon? Limon, aye. Hurtado? Rubio? Rubio, aye. Wahab? Wahab, aye.

11-0 that Bill is out. Next, we move to Senator Atkins, SB 487.

Senators Glazer? Glazer, aye. Hurtado? Limon? Limon, aye. Rubio? Rubio, aye. Wahab? Wahab, aye. Nine to two.

Nine to two that Bill gets out and close the roll. I think, 786 by Senator Portantino, the Chair, voting aye. Secretary, please call the roll.

Senators Nguyen? Glazer? Hurtado? Limon? Limon, aye. Rubio? Rubio, aye. Wahab? Wahab, aye.

SB 805. Portantino, that bill's out. We're not going to call it again.

And I know Glazer did not vote correct. I have nine.

For the last time. On SB 786, The vote is 9-0, and that Bill is out. And the roll is closed.

Okay, everybody, let's just keep breathing. We're going to get through this. We're on number seven, 805. Which is also by Senator Portantino. Do pass, as amended and re-refer to the Committee on Human Services. The Chair voted aye. Secretary, please call the roll.

Senators Glazer? Glazer, aye. Hurtado? Limon? Limon, aye. Wahab? Wahab, aye.

11-0. Bill is out. The roll is closed. Now moving on to issue number eight, SB 873 by Bradford. The motion was do passed. We referred to the Committee on Appropriations, with the Chair voting aye. Secretary, please open the roll.

Senators Nguyen? Dahle? Glazer? Glazer, no. Hurtado? Limon? Limon, aye. Wahab?Wahab, aye. Wiener? Wiener, aye.

8-1. That's enough to get the Bill out, and we'll close the roll. Now we go to vote only, SB 625 Nguyen. Secretary open the roll.

Senators Glazer? Glazer, aye. Gonzalez? Hurtado? Limon? Wahab?

7-1. That Bill gets out, the roll is closed. All right, thank you, Members.

We're going to open the roll one more time on SB 770. Secretary, please call the roll.

Senators Glazer? Hurtado? Rubio?

7-2. That's enough to get the Bill out, and we'll close the roll. Senators, thank you all very much. Thank you to the staff. Thank you to the moderator.

Thank you, Madam Chair.

This meeting is adjourned.