Senate Standing Committee on Health

It's not our problem. Okay. The Senate Health Committee will come to order. And good afternoon. As we continue to welcome people in person, we're also continuing to adapt to people through our teleconference. We're going to allow six minutes for in person testimony per side. Individuals wishing to contact us via teleconference. The number is 877-226-8163 and the access code is 352-5905. We're going to cap the comments coming in on the telephone at 15 minutes.

Today we have 18 bills on our agenda, two of those bills on our proposed consent, starting with AB 420. Or those bills are AB 425 and AB 1239. And we are going to start with Assemblymember Aguia Curry. Welcome.

Madam Chair. And Senators. We all love someone who has struggled with or even died of cancer. I would have done just about anything to keep that from happening to my loved ones. HPV cancer rates are at 37,000 per year, and yet almost 60% of eligible teens have not received the HPV vaccination in California. Those numbers are much worse in small towns and communities of color.

HPV causes a range of cancers in both men and women, but we can only use preventative screening for a few of them. Other types remain undetected until they become a threat to a person's life. AB 659 will increase uptake of cancer preventing HPV vaccine by guaranteeing that the vaccine is completely covered by all public and private health plans.

This Bill as written will set the expectation that 8th graders be fully vaccinated against HPV, as well as an expectation for students entering UCS, CSUS and California Community Colleges. Parents of soon to be high school students will be notified at the beginning of 6th grade of the expectation for HPV vaccination, giving them ample time to learn about the vaccine and its benefits.

The notification will be done in the method already chosen by local school districts to communicate to students and parents and in the statistically prevalent languages of the school population. The opponents asked for me to consider the devastating effects of the pandemic on students from students being kept from in person learning and social activities, and on school districts who fear declining enrollment.

AB 659 has been amended to remove any enforcement by school districts and higher education institutions, so no student will be barred from school, college or universities. Then the opposition pivoted to claiming concerns of confusion created by the very notification of students and parents they'd requested. The Bill in its current form is endorsed by the California LGBTQ Legislative Caucus and is supported by a vast number of public health professionals and institutions and advocates, including the CMA, Planned Parenthood and the California Academy of Family Physicians.

The Freedom Angels removed their opposition when the enforcement was dropped. Madam Chair, my goal is to have every eligible child vaccinated against this life threatening virus. The Bill started off as a mandate, which is not confusing, but I listened to the concerns of the parents and compromised to remove enforcement. The Bill no longer mandates the vaccine for school attendance and will not contribute to declining enrollment. The default should be protecting our kids through this vaccination.

What no one can argue against is that a weaker notification will result in less children getting vaccinated and more people getting cancer. So I will, with great personal respect, ask for you to reconsider the proposed amendment to change expectation to recommendation in the Bill. Your staff has kindly offered to include more detail in the notification, which will further help me help educate parents on the vaccine. I appreciate that, and I look forward to working with you and them going forward for the perfect language.

Here with me today. In support are Dr. Jeffrey Klauser, clinical Professor of Medicine, infectious Diseases, population and Public Health Sciences from USC Geck School of Medicine, and Dr. Shapiro was a community physician at the AltaMed Health Services.

Okay, and just to say that I am the chair of the LGBTQ caucus and was supportive of it as a mandate. That's not how it came out, and I am supportive of the concept. I am not supportive of using the term expected because I don't think it's defined. I think we have recommendations and or mandates, but expected, I think, causes a lot of confusion. We've heard from both public health and the Department of Education. It's confusing and misleading. So I'm simply asking you to change that.

We are recommending that people get the vaccine. And I understand you have issues with that, but that's just to be clear for the public. That's where we are. Okay?

Can we get the first witness, please?

Good afternoon. My name is Dr. Jeffrey Klausner. I'm a Professor of Medicine, infectious Diseases, population and Public Health Sciences at the University of Southern California. I am also a former CDC medical officer and former deputy health officer for the City and County of San Francisco. I am testifying today as an individual and do not represent any prior or current affiliations. Today in California, about half of adolescents have completed HPV cancer vaccination.

That leaves about half of young Californians incompletely or fully unprotected against those cancer causing viruses. My own published research has shown with the current inadequate vaccination coverage in California, there will continue to be about 1350 new preventable cancers every year, at an annual cost to California of $52 million. With increased vaccination coverage, more cancers could be prevented, lives saved, and state healthcare costs reduced. Every day, two Californians die from vaccine preventable HPV related cancer. Additionally, there are important concerns on the issue of equity.

My research has shown that in some counties, the HPV vaccination completion is as low as 10 to 15%, while other counties reach 60% or more. The HPV cancer vaccine is very safe. In the 17 years since the FDA approval of the vaccine in 2006, safety concerns have never been validated in scientific studies. An overwhelming consensus of medical and public health experts in the US and globally agree that HPV vaccination is safe. HPV cancer vaccine is highly effective.

Studies have shown that the vaccine reduced precancerous lesions and abnormal cervical PAP smears. Most recently, a nationwide study in Sweden showed that HPV cancer vaccination reduced HPV related cancers by 88%. In countries like Australia where HPV cancer vaccination is routine, the number of cervical precancers and cancers have declined dramatically, such that by 2035, HPV related cancers may be eliminated. In Australia. I've also done research to show the benefit of school based Vaccination requirements in Virginia, Rhode Island, Hawaii, Washington and Puerto Rico.

In those places, school based entry requirements increase vaccination coverage from 50% to 80%, the target of the US healthy People 2030 recommendation. Lastly, I strongly support maintaining the language in the Bill that vaccination is expected of students as changing to recommended weakens the policy and might result in slower progress in reaching the state policy goal. I urge all of you to vote yes on AB 659 to help protect Californians from preventable cancers and reduce health disparities. Thank you.

Thank you. Next person, please.

It's an honor to be here with all of you. Good morning and good evening, chair and Members. My name is Dr. Ilan Shapiro. I am here to speak in support of the AB 659 on behalf of AltaMed Hair Services and myself as a community physician and most importantly, as a father. I serve as a participating physician and chief health correspondent and medical affairs officer for AltaMed.

AltaMed is one of the largest federal qualified health centers on the nation and we provide more help and most importantly to our base of 500,000 patients in California. It's important right now to understand that HPV is something that touches all of us, and one of the important things that we need to do is make sure that our future generations are protected and most importantly, our families have a better future than the one that we already have right now.

AltaMed has been exemplifying what actually community Members have been doing by moving forward with campaigns with COVID-19 vaccinations. We know right now that the communities are important and the educational component of it is key at the moment that we connect the dots and we give the opportunities to be protected against things that we can actually skip. Like cancer is extremely important for all of us. Preventing measures are a key aspect of creating a healthier future for our kids.

As a physician and most importantly as a father, I want my children to worry about math and social studies and not cancer. Each year, more than 46,000 people in the US. Are diagnosed with HPV related cancers. The HPV vaccine prevents around 90% of those cancers caused by HPV in both boys and girls. Having the opportunity and understanding that HPV is a common virus, that 75% of 15 to 24 year olds are exposed to HPV by that age is impressive.

As a father and as a physician, I want to give my community the best evidence based tools to be healthy. Why would it be important to protect at this age? Preteens produce more antibodies after two doses of HPV vaccines, while older teens require three doses. And this is important because that way we are actually preventing a lot of cancer. Protecting adolescents through HPV vaccinations before high school and before they are exposed to the virus takes advantage of the HPV natural vulnerabilities. Earlier is better.

Reducing barriers to this vaccine can lead to elimination of cancer among youth and young people. For example, and we already heard in Australia, they are projected by 2020.

Doctor, you need to wrap up. You're over six minutes now.

Sorry about that one. Most importantly right now, as a California physician and as a parent, I ask you for your help to do my job to protect the children from preventable diseases. I urge you to support AB 659.

Thank you very much. And we'll give the same amount of time. And just so I remember you said something and I just want to double check with you again before we go forward. You said the staff had provided language. I'm going to read this to you and see if this is what you'd be willing to accept. Okay. Yours is expected. This says this is what the policy notice would say going out to 6th graders.

The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommends the HPV vaccination at age 11 or 12, although vaccination can be started at age 9. ACIP also recommends vaccination for everyone through age 26, if not adequately vaccinated when younger. The CDC states that HPV vaccines are very safe. Scientific research shows the benefits of HPV vaccinations far outweigh the potential risks. Is that what you're willing to accept?

Can I address that in my close?

Certainly.

Okay.

Thank you.

All right, others speaking in support at this time. Would you come forward? And now it's just name and affiliation.

Would you make sure it goes to the hello Committee? I'm a governing board trustee. May I have 1 minute of your time in support of this?

Go ahead, please.

Oh, thank you.

Name and organization, That's all. This is everyone's speaking in support right now.

May I have 1 minute as a governing board trustee in support of this? Just a short statement then I'm going.

To allow that for the opposition as well.

All right, thank you.

Hello. My name is Kenneth Prado and I am a governing board trustee for Hemet Unified School District. And I'm here in my own capacity and not as a school board trustee. I believe strongly in precancer screenings and I support AB 695. If let me repeat, if you add the words not required for in person learning.

Okay, thank you very much.

Thank you, thank you.

Next person please.

Taylor Jackson on behalf of California Health Plus advocates in support. Thank you. Mehranna goneifer with Cbhn in support. Thank you, Holly Robeson with Planned Parenthood Affiliates of California in support. Thank you. Jessica Moran. With the California Dental Association in support. Thank you, Betsy Armstrong with the County Health Executives Association, representing local health departments in support. Thank you, madam. Chair Brandon Marchey, with the California Medical Association in support.

And also authorized to be in support for the American College of OBGYN's, District Nine. Thank you, Tyesha Watts with the California Academy of Family Physicians in support. Thank you, Kathy Mossberg of Central Access Health in support. Thank you. Madam Chair, Members, rand Martin, on behalf of the AIDS healthcare foundation in strong support. Thank you very much. Isabella Aragueta with the Health Officers Association of California in support.

Thank you very much. Okay, now we'll hear from those in opposition. Again, you'll be granted six.

Where are we at with time? It was like a little bit of extra on the first thing, and then the other gentleman had a little bit of time. Total time? You'll have six minutes and 30 seconds. Okay. All right. Are you the only one speaking in opposition today? No, there's going to be three of us. Okay. So you might want to keep track of that time.

Okay. Right. Sorry. Time has started, sir. Okay. We believe that all people should have the option of choice, especially when it comes to something that has the potential for serious side effects. The problem we have now with this Bill is that there is no language that will ensure people understand that they have an option. All the opposition has been asking for for months is that the author adds language in the notification to students and parents that clarifies that this public policy is not an enforced mandate. The author has refused.

Therefore, we believe that it is the intention of this Bill to lead students, parents, adults, children to believe that taking this vaccine is required in order to remain in school. Now, all vaccines are different, and the rate of injury varies depending on the vaccine. Gardasil Nine, the only HPV vaccine available, had three safety studies done by Merck Pharmaceuticals, the company that developed and manufactures this vaccine. Those studies evidenced an extremely high rate of severe adverse effect at 2.3%.

Now, you may have heard the phrase vaccine injury is one in a million. 2.3% would be 23,000 in a million, or to frame it differently, one in every 43 people. And these aren't minor side effects. The severe adverse effect is defined as death, life threatening condition, permanent injury, et cetera. In the 1980s, Congress set up a system to track postmarket experiences with vaccines called Vairs.

After the release of the Gardasil Nine vaccine, it quickly escalated to being the number one most reported vaccine to cause injury and death until the release of the COVID-19 vaccine. This vaccine was specifically developed to target HPV strains that cause cervical cancer. When Gardasil 9 was released in 2006. The cervical cancer rate in the US. Was 8.2 persons out of every 100,000 people. Since that time, the very lowest that statistic has become was in 2019, when it dropped to 7.5 persons out of 100,00 8.2 to 7.5.

The data shows that this vaccine is not safe, nor is it effective. And that is why if the author is going to allow people the choice by not kicking them out of school for not getting it, the least she could do is to ensure that people know they have that option. Thank you.

Thank you very much. Next person, please.

Can you hear me okay. My name is Catherine Swazo Robio. I'm a lifelong Californian and I oppose AB. 659. My daughter, Jennifer suffered a severe adverse reaction to the HPV vaccine Gardasil. As a teenager, Gardasil caused debilitating and devastating injuries. Jennifer was a high school athlete and honor student and had to drop out of school and has been disabled for over a decade. Jennifer is now 28 years old, and I am her full time caregiver. Gardasil has destroyed my daughter's life.

These injuries are real and they are devastating. Gardasil has been grossly mismarketed by its manufacturer, Merck. Merck oversold the efficacy of the vaccine and concealed safety risks. Merck's own literature states gardasil does not remove the needs for cervical cancer screening, does not treat HPV infection, does not protect against pre existing HPV infections, does not protect against HPV strains not covered by the vaccine, and may not fully protect each person who gets it. It is an expensive and optional Addon treatment.

It is important that the public is aware that the best way to prevent cervical cancer is a PAP smear. AP 659 uses language that is deceptive and intentionally misleading, and would lead the average Californian to believe that the state is mandating a cervical cancer vaccination for 8th grade through college students. The words public policy of the state and expected are coercive and misleading.

AB 659 needs to make clear that the vaccine is only a recommendation and not a mandate, and it needs to be expressly stated that students will not be denied access to education if they choose not to get the vaccine. My daughter and I met with the author of AB 659 and discussed the confusing and coercive language. We received a lot of pushback. When we asked why the language in the Bill implies that it is a mandate.

We were aggressively told by her chief staff that the Assembly Member will not be recommending the vaccine because she wants people to get vaccinated. It is inappropriate for the state to deliberately mislead the citizens of California by using deceptive and coercive language in this Bill. California should not be recommending a vaccine with serious side effects for a virus not transmitted in the classroom setting. Currently, there are hundreds of lawsuits in the United States, including California, against Merck for serious injuries caused by Gardasil.

Vote no on AB. 669 this vaccine is dangerous, being intentionally mismarketed, and it is guaranteed to injure innocent Californians. Thank you.

Thank you very much. Next person, please. Give a little bit over a minute.

Good afternoon. My name is Karen Amagon. I lead standup California. I'm the Director of Operations for Freedom Keepers United. And I am the Health Rights Director for Voice for Choice advocacy, working alongside a consortium of organizations advocating for health rights. Thank you for the opportunity to give testimony, though. AB 659 has been amended several times, key amendments are needed to clarify the intent of AB 659 and remove potential unintended consequences.

Though the author has made it clear that this is a mandate without enforcement, if this Bill is not amended, there is a strong likelihood it will be enforced. There needs to be a clear statement that the HPV vaccine is not required to enroll or attend in person, public or private or public higher education.

If you have a state policy in which there is an expectation that pupils receive the HPV vaccine, the California Department of Education and or the California Department of Public Health could issue guidance in the form of FAQs or Q A on their website. Based on this guidance, the California School Boards Association could then put forward draft school board policies, send these school boards across the state who would adopt policies that have enforcement language in them. The notification should also only to wrap up okay.

In order to stay consistent with Section 120335 of Health and Safety Code, pupils on IEP should also be exempt, as well as pupils enrolled in independent study. For these reasons, we ask you to vote no. Thank you.

Thank you very much. Other people speaking in opposition now just name and affiliation.

Olivia MICOS, co founder of US for. Vaccine, oppose unless further amended. Paul Roby, Pasadena, California strongly oppose thank you. Corinne Whitlow, co founder of take a stand, Stanislaus. I also am a registered nurse with a national certification oncology, and I oppose unless amended. Thank you.

Hi, I'm Haley Page with mom army, and I oppose, unless amended. Thank you. This is all being filmed anyway. But I know, right? We all got to be on camera, right? Sure. We all need selfies, right? I don't know. I want to thank you. Senator Agnes. Okay, thank you. Thank you so much.

Thank you. And my name is Srinalatch, and I'm with California Parents Union and Educate Advocate, and we're obviously in strong opposition, but I want to thank you. Thank you very much. Next person, please. Thank you so much.

Good afternoon, Members. Kaisha Williams, on behalf of California Parents Union, a special interest group for parents, grandparents, teachers, and concerned citizens, we're in opposition to AB 659. Thank you so much. Thank you. Next person, please.

Good afternoon. I'm Stephanie degree. I'm a licensed registered pediatric nurse and also a representative for California Nurses United, and we oppose the Bill unless further amended to poll sections 4 and 6. Thank you.

Thank you very much. Good afternoon. Lisa Dispro, with informed parents of Contra Costa County in strong opposition of medical tyranny. Hi. David Bolog from the San Fernando Valley Senator Menjivar's, 20th district and speaking on behalf of San Fernando Valley parents and San Fernando Valley alliance in opposition. Thank you. Thank you.

Good afternoon. I'm Sophia Laurie with California Family Council, and we stand in opposition. Thank you. Hello, my name is Ruth, and I'm in opposition. Thank you. Good afternoon. Madam Chair. Tom Sheehy on behalf of Perk advocacy.

We came in opposed unless amended. If the Committee clarifies the Bill, as you mentioned, we would be pleased to remove our opposition. Thank you. Good afternoon, Chair Eggman and Committee Members. My name is Leah Jones. On behalf of a Voice for Choice advocacy, we graciously ask that this Bill please be amended or else opposed.

Thank you. Good afternoon. I'm Kara Butler, a parent in Contra Costa County and I thank you for amending and I request that you change the verbiage. Thank you. Thank you. Good afternoon. Sarah Martinez. I'm a mom of three students in Contra Costa County and I oppose AB 659 as is.

Thank you. My name is Darlene Al Khiza from Protection of the Educational Rights of Kids. Thank you, Madame Chair, for your considerations. That's all. Thank you very much. Good afternoon. My name is Max Bonill on behalf of Rebuild California and strong opposition.

Thank you. Good morning. My name is Jeanette Phelps, Sacramento County, and I oppose this Bill. Thank you. Hello. My name is Melissa Prado, Riverside County, and I oppose this Bill. Thank you.

My name is Beau King of Sacramento County, and I oppose this Bill. Thank you. Another double filmer. Okay, you're opposed. Hello, my name is Mrs. G and I'm here with my son today. That's sitting in the audience, and we both oppose this Bill as well as my daughters. Thank you very much. Thank you, Ms. G. Okay, seeing nobody else coming to the mic at this time, we'll go to our phone blinds now. And now it's for or against the Bill. Just name an affiliation and position, please. Moderator are there calls on the line?

Thank you. For support or opposition of AB 659, please press one, then zero at this time. And we will go to line 270. Line 70, you're open now. Thank you. Madam Chair and Members. This is Aaron Evans calling in support on behalf of NARAL Pro Choice California. Thank you.

Thank you very much.

Next caller, please, at line 278. Good afternoon, Madam Chair and Members of the California State Senate Health Committee. I'm calling on behalf of my husband, Daniel Mckinnon. Myself and millions of other people affiliated with the organization by the name of who Owns Your Body. Does the who own your body? If the who owns your body, then that makes you a slave organization, and that goes double for children and you pharma fascists.

Okay, thank you very much. Next caller, please. Thank you. Moderator next caller, line two former fascists aren't having it today. Line 225, you're open? Yes. Hi, can you hear me? Yes. Go ahead, please. Okay.

I thought I heard somebody say that the fascists don't have it or something. Please don't do those kind of comments. Okay, thank you very much. Next caller, please. I object. Thank you. Next caller. 266266.

Hi. My name is Raquel. I'm calling from the National Association of Social Workers California chapter and we support this Bill. Thank you. Thank you, next caller, please, line 273. Hi, good afternoon. My name is Dalia. I'm calling from West Covina Parents for Choice and we strongly oppose this Bill.

Thank you, next caller, please, line 275. Hi, I'm calling from on behalf of AB Parents for Education and we oppose this Bill. Thank you. Next caller, please, line 197. This is April Bean from Sacramento County and I'm with the California Parents Union and I oppose this Bill.

Thank you, line 285. This is Gabrielle Ingram, founder of Stand Up Sacramento County. We oppose unless amended. We would be happy to withdraw and. Support thank you, line 194. Hi, my name is Carrie Prentice, I'm the founder of California Rise Up, representing over 2000 families and I'm calling in opposition.

Thank you, thank you, line 267. Desiree Haradia calling on behalf of California Freedom Keepers in opposition. Thank you, line 257. Hi, my name is Veronica, I'm a constituent of Luke County vaccine injured since 2014. I post this Bill or unless amended.

Thank you, thank you, next caller. Line 227. Good afternoon, Quentin Levec on behalf of California Health Coalition. Is he in opposition? Thank you. Line 224. My name is Annette Pantoha, I'm a mom of three from Riverside and I oppose this Bill strongly with us.

Next caller, line 308. My name is China Begley from Yuba County and I oppose this Bill. Thank you. Hi, my name is Christina from Los Angeles County and mom of two and I oppose this Bill. Thank you. Align 239. Hi, Jennifer Kennedy, attorney, LA County and Pasadena Parents for Liberty in strong opposition.

Thank you, line 281. Nicole Malpi from LA County, a parent of two teenagers, strongly opposed. Thank you, line 234. Deanna Larson calling from Riverside County, healthcare worker and mother in strong opposition unless your wording gets moved around, so it's not so coercive. Thank you, next caller, line 264.

Hello, my name is Margaret Arator from Sacramento County calling in strong opposition. Thank you, thank you, next caller, please, line 219. My name is Colin Britton with California legislative voice in strong opposition unless amended.

Thank you, thank you, line 246. Hi. My name is Catherine Mcbride. Placer county and California Parents Union is strongly opposed as misleading and dangerous. Thank you very much. Next caller, please, line 297297. Hello, my name is Brianne Zamak, founder of Endured Moms Against Gardafell and mom of three and we strongly oppose this Bill.

Thank you, line 210. Hi, this is Anne Swedberg from Santa Cruz County and I strongly oppose that Bill. Thank you, line 212. Good afternoon, chair and Members, my name is Joni Greep. I am a mother of three, a registered nurse and a school board triskey calling in strong opposition.

Thank you, next color please, line 300. Yes, my name is Deborah King and. I'm in Sacramento County, and I'm a single mother of two, and I strongly oppose this despicable Bill. Thank you. Next color, please. Line 303. Hi, my name is Linda Rich from Plaster County. I strongly oppose AB 659 public schools will implode.

Thank you. Next color, line 262. Hello. This is Reina Shabesta. I am a school aged parent and school counselor. I am an Orange County parent, and I represent the group Newport Mesa Uncensored, and we strongly oppose this Bill. Thank you. Next caller, please.

Line 290. Hi. My name is Amber De LA Cruters, and I'm from Orange County, California. I'm in opposition unless amended. Thank you. Next caller, please. Line 268. Hi, I'm a parent of three daughters from Tahema County and strongly oppose this Bill. Thank you. Next caller, please. Line 188. Hi, I'm Michelle O'Brien from Orange County. I'm a mom, a grandma, and Member of Heritage Action and Perk. Unless amended. I oppose AB 659. Thank you.

Thank you. Next caller, please. Line 304. Good afternoon. My name is Anna Calderon from Orange County. I'm a retired second grade teacher and mom of autistic teen twin sons, and I am in strong opposition.

Thank you. Next caller, please. Line 302. My name is Veronica Solace. I'm calling from Santa Claus County, and I'm a mother of an autistic boy, and I strongly oppose this Bill. Thank you. Thank you. Next caller, please. Line 48. Hi. My name is Daniella Florence from Santa Barbara County, and I oppose this Bill.

Thank you. Next caller, please. Line 226. Hi. This is Nicole Corral from Ventura County. I'm a parent and educator, and I'm calling in strong opposition to this Bill. Thank you. Line 288. Good afternoon. My name is Shannon. I represent 235 families with California parents right to Act Now, and we strongly oppose.

Line 289. Amo Tito Perez De Sanoma. Siesto. Pasa De LA Cuela. Thank you. Next caller, please. Line 298. Yes, hi, my name is Margaret Williams, and I'm a parent of two children. I live in LA County, and on behalf of thousands of parents, we are opposing this Bill.

Thank you. Thank you. Next color, please. Line 255. Hi, this is Rachel Categon, founder of Natomas USD for Freedom, and we oppose AB 659, unless amended. Thank you. Thank you. Next color, please. Line 318.

Hi, my name is Kelly Ferrillis out of Potter County. I'm a mom of four, and I strongly oppose this Bill. Thank you. Next caller, please. Line 294. Hi, my name is Reina Solomon from Ventura County and I strongly oppose this Bill. Thank you. Next caller, please.

Line 314. Good afternoon. My name is Kobe and I'm calling on behalf of Tulare County Coalition for Freedom, also Blessings of Liberty, Mass, California. I represent two churches in opposition of this Bill. Thank you very much. Have a blessed day. Thank you. Next caller, please. Line 259. Hi. My name is Michael Keswick. I'm a UC Berkeley public health grad who was injured from Gartesville in 2006. I strongly oppose. Thank you. Next caller, please.

Line 326. Yes, Penny Harrington from San Diego County strongly opposed, but thank you for the incremental amendments. Thank you. Please. Line 325. My name is Christina Calderon, a mother of two, and I strongly oppose this Bill. Thank you. I think your sister called. Next caller, please.

Line 285. Hi, my name is Maggie Atkinson, mom of two from Riverside County, and I strongly oppose this Bill. Thank you. Next caller, line 230. Dixon Espandiari from the law firm of Wisner Bomb. We represent hundreds of young boys and girls who've been injured by gardasil in strong opposition, as it will mislead the public and is unwarranted. Thank you. Thank you.

Line 331. Have you picked up on it? The parents opposed this stuff. Thank you very much. Next caller, please. Line 337. My name is Natalie with Catholic Families for Freedom and Perk. Calling to oppose this Bill in strong opposition thank you.

Doesn't address Ross line. Thank you. Hi, my name is Anne Solomon. I'm a grandmother and a mother. And I strongly oppose this Bill because it definitely puts our children in much danger. Thank you. Thank you. Next caller, please. Line 350. Hi, good afternoon. My name is Jennifer Cardenas and I am in very strong opposition of this Bill. AB 659. Thank you.

Madam Chair. No further comments in queue at this time.

Thank you very much. And we did that in under 15 minutes. All right, now is the time we would bring it back to the Committee. Senator Wiener, you are reckoned.

Thank you very much, Madam Chair. First of all, I want to thank the author for not just this Bill, but her many year advocacy for prevention of HPV related cancers. I really just admire your work and I'm so appreciative of your just tenacity on this issue and also supporting smart public health measures such as vaccination.

And I strongly supported the original version of this Bill, the requirement to prevent cancer for kids so that they have a reduced risk, dramatically reduced risk of cancer for their entire lives. I wish that that were the version before the Committee today, and I would love to re amend it back. I know that's not possible given how the Legislature works, and I support the Bill in imprint, so I just wanted to sort of put that out there.

This is very real, and I just have CDC statistics in front of me. This is not like a tiny issue we have every year in the US. About nearly 40,000 HPV cancers, about almost 22,000 among women and almost 16,000 among men, because this is cervical cancer, maybe the most or among the most common, actually, it looks like back of the throat is even more common than cervical cancer.

But cervical cancer is a huge public health issue, but it's broader than that, and it affects both men and women. In addition, in terms of we know that this is an effective vaccine. It reduces the risk by about 90%. It's also a safe vaccine. I know we've heard some statistics today, but I'm looking at the National Cancer Institute site and the rate of I'll just read it. Reports of serious health issues after HPP vaccination were consistently rare, about 1.8 per 100,000 HPV vaccine doses, or 0%.

So this is a safe and effective vaccine. No vaccine is perfect, but this is a good one. I will also just say on a very personal front, I'm of the age where there was no HPV vaccine when I was a kid. It was approved for men when I was 39 years old. So I was well past the time when it was recommended. And so I did not have HPV protection. I was recently diagnosed with HPV related precancer, and I'm going to be fine. I got treatment.

I'll have to be monitored for a while. And it's not the most pleasant treatment in the world, but it's all going to be good. And I just happened to get screened for it for unrelated reasons. And fortunately, they found it and were able to treat it. I really wish that when I was a boy, that they had had the HPV vaccine and knowing my family, we would have gotten it. And there was a very high probability that I would have avoided having HPV related precancer.

And so when we talk about the health of our kids and it's not just about the health of the kids, it's about their health for the rest of their lives, because this isn't a situation that they can just get it at any point in their lives. We know that it's by far and away most effective if they get it, if they receive the vaccine as a teenager.

And if they don't, then they are being basically the lifetime risk of HPV related cancer is being inflicted on them for the rest of their lives. And I think it makes all the sense in the world for people to receive this vaccine at the age specified in the Bill. And again, I think this is just incredibly important. It's an incredibly important public health issue. And I'm happy to support the Bill today and happy to move the Bill at the appropriate time.

Thank you very much. Other Members wishing to speak. Senator Grove.

Thank you, Madam Chair. I do apologize to the author that I am bouncing between two committees rules and where the Senate Pro Tem is at and governor's confirmations in here. So I did miss a large part of the testimony, but I did want to note, number one, just and I know you've read the analysis, but the analysis in the Bill actually says, sorry let me pull it up again.

That the CDE, the California Department of Education, because of the way the wording in the Bill, it actually sounds like a mandate. But it's not a mandate.

Correct. It's not a mandate.

It is not a mandate. So when you read the language, I'm going to address that you weren't here, but I will address that in my.

Clothes, in your so so, and I apologize. But in the language itself, the California Department of Education says the Bill is misleading and may indicate to many that HPV vaccine is required to enter 8th grade. And they think that would be a confusing thing for parents. And I understood, and correct me if I'm wrong, Madam Chair, but I understood that the Committee or you had amendments. So are we taking those amendments to clarify the language or the author?

Thank you. Senator Grove. We have requested that the author take amendments that changes expected to recommended.

We have a statement written up. The Center for Disease and Control Prevention CDC Advisory Committee on Immunization practices recommends the HPV vaccination at age 11 or 12, although vaccination can start at the age 9. Also vaccinations for everyone through age of 26, if not adequately vaccinated when younger. The CDC states that HPV vaccines are very safe. Scientific research shows the benefits of the HPV vaccination far outweighs the potential risks. We've asked the author to take the amendment.

Right.

So far the author has been unwilling and my recommendation will be an aye. If the author takes the amendment without it, I have a none recommendation, but I will be voting no.

Thank you for that clarification again. I just needed to be caught up to speed. So I apologize for going over all that again. I do happen to agree with the chair. I think the word expected, if you look it up in the dictionary, sounds more like a mandate than recommended. That sounds like it's okay for the parent to make the decision on their child. I realize this isn't like measles mumps chickenpox. It's not like they can go to school and infect someone else.

But this should really be a parent decision or an adult child, or an adult after the age of 18 to what, 26 or whatever the number is. So I do agree with the Chair's recommendation for the amendments. But you're not taking those amendments.

I'll address it in my close.

Okay. Thank you.

Welcome. Thank you. No, thank you for your comments.

Okay. Any other Members wishing to speak at this time? 12. And just to say, this is one of the questions I had, because we were saying if a parent chooses not to for a child and that child is unprotected. But in California we have said that children at the age of 12 can voluntarily get themselves vaccinated.

Yeah, okay. Just to clarify that.

Okay, I'm sorry, can you clarify that, Madam? Chair, can you clarify it one more time?

12. Like is that in this Bill or in. Every vaccination we have system wide system.

Well, every sort of STI related vaccine is 12. That was 10 or 12 years ago. So for hepatitis B, for HPV, I imagine monkey pox will qualify at some point. And that is absolutely true. But of course, as we talked about a lot when we tried to lower last year all the vaccine age of consent for all vaccines, many, many, I think a large majority of kids are not going to get vaccinated on their own. They're going to do it via their parents.

Thank you. Okay, so seeing we've exhausted the conversation up here, and you and I have had many talks and we are friends, we have a lot of respect for you. I have children. They have all the vaccinations they're supposed to have at the age appropriate. I was with you with the mandate. I believe expected is a confusing language and it should be recommend or mandate. We're at the point where we are saying recommend. Would you like to close?

I sure would. First of all, I want to thank Senator Wiener for sharing your story. Takes a lot to do this. Thank you. AB 659 will result in an uptick in HPV vaccination at the ideal age range for the vaccine. The question is how much? This Bill does not mandate or enforce vaccination similar to the long standing hepatitis B vaccine required for 7th graders most of you likely don't even know about.

Hep B requirement exists because it has caused none of the horrors claimed by the opponents of this Bill. This Bill ensures proper communication with students and parents in locally prevalent languages. This Bill also removes all cost barriers to getting HPV vaccine, regardless of health insurance status. I've been working on this proposal for five years. During that time, over 203,000 Americans have developed HPV related cancer and more than 35,000 people have died from as a result.

Colleagues remember the loved ones who got the terrifying news that they had cancer. And I know for me, I would have done almost anything to prevent it. And that's why I'm here today fighting for the Bill as I brought it to the Committee, I want California to do its part in protecting our youth from cancer. Madam Chair, I understand that you insist on amending the Bill language from expected to recommended. And with tremendous regret I will accept and ask for your aye vote.

We have got the request today and we would like to continue to work on it. Thank you.

Okay, so my understanding then is you are willing to take recommend. Okay, thank you very much. Okay, so the we have a motion by Senator Wiener and the motion is do pass as amended and refer to the Committee on Education. Yes, we do not have a quorum yet. When we do, we will take the roll call.

Great.

Thank you very much appreciate all your comments.

Okay.

Thank you very much.

Yes. Well, good afternoon, Madam Chair and Members of the Committee. Thank you to the Committee Chair and Staff for the thoughtful conversations leading up to this hearing and I accept the amendment. I'm here to present AB 85, which will require health plans and insurers to include coverage for social determinants of health screening and access to community health workers.

Social determinants of health are commonly defined as the conditions in which people are born, grow, work, live, and age, in which a wider set of forces and system shapes the conditions of daily life and affect health functions and quality of life outcomes and risk. The determinants are things like safe housing, education, food access, transportation, and economic stability. Social determinants of health screening tools and clinical practice help to identify the social and economic risk of patients that may be previously unknown to health providers.

Ideally, that information leads to health care teams linking patients to community resources or discussions about changing patient treatment plans to mitigate the social needs to improve the overall health outcomes. One survey conducted by the American Academy of Family Physicians indicated that family physicians want to help address their patients' need, but face many barriers in offering the support that they need. AB 85 helps address these gaps in the health care by requiring coverage and reimbursement of social determinants of health screening and access to community health workers.

It also makes screening a covered benefit for medical beneficiaries. This bill also requires the Department of Healthcare Access and Information to convene a working group to create a standardized model and procedures for connecting patients with community resources, to access the need for centralized list of accredited community providers, and to determine gaps in research to inform policy. Here with me to speak in support of AB 85 are Catrina Reyes, the Vice President of Advocacy and Policy, and Dr. Scrubb.

Thank you. Ms. Reyes, please.

Thank you, Chair and Committee Members. My name is Catrina Reyes, and I'm the Vice President of Advocacy and Policy for the California Academy of Family Physicians, the proud sponsors of AB 85. I would like to thank Assembly Member Weber for introducing this critical bill that will make a real impact on health outcomes, health equity, and health care costs. As you know, social determinants of health are a growing cause of health care inequity, resulting in worsening health outcomes and increasing health care costs.

AB 85 seeks to identify social determinants of health and intervene earlier by requiring health plans and insurers to provide coverage for social determinants of health screenings and to provide adequate access to community health workers, promotores, community health representatives, or social workers. The impact of social need on health is well documented. Studies have found that food insecure individuals are 20 percent more likely to report that they have hypertension and 30 percent more likely to report that they have hyperlipidemia than their food secure counterparts.

Substandard housing conditions such as poor ventilation, pest infestation, and water leaks are directly associated with respiratory diseases and asthma. In 2000, a study attributed social factors as the direct cause of death. Taking the first steps in addressing social determinants of health through screenings and closing the referral gaps to community resources will result in better health outcomes and lower costs. In 2015, two of the most commonly treated conditions among the top five percent of health spenders were hypertension and hyperlipidemia, and both were linked to unmet social needs.

Other conditions for which at least 25 percent of persons in the top five percent of health spenders were treated include mental health disorders, heart disease, COPD or asthma, diabetes, and trauma related disorders, all of which have been linked or exacerbated by social and economic conditions. By addressing the social needs of high health care spenders, particularly through community health worker intervention, we can improve chronic disease control, mental health, quality of care, and hospitalizations, and thus lower health care costs.

A study on the expenditure reductions associated with the Social Service Referral Program found a ten percent reduction in health care costs equating to more than 2,400 in annual savings per person. Another study, conducted by the University of Pennsylvania on the Return on Investment of Community Health Worker Interventions for the Medicaid Program, found that just one team of community health workers serving 330 patients would prevent 295 bed days, yielding a savings of over 700,000 dollars.

AB 85 will improve health outcomes and health equity and reduce health care costs, and it is for these reasons that we urge an aye vote on AB 85. I'm happy to answer any questions the Committee may have. Thank you.

Thank you very much. Next person in support, please.

Thank you to the Chair and Committee Members. My name is Adia Scrubb and I am a family medicine physician from Oakland, California, currently working in Fairfield. I learned early on from my mentors in medicine that a community physician must also reach beyond the clinic walls to make an impact. I ask you to vote yes on AB 85 because it will ensure that health care providers have the resources to better understand factors impacting our patients' health both inside and outside of the clinic.

Screening for the social determinants of health is critical to developing a treatment plan that's best for my patients. If I am informed that a patient doesn't have reliable transportation, then I try to select medicines that require less follow up and monitoring. If I am informed that an unhoused, diabetic patient doesn't have access to refrigeration to keep insulin, then I have to maximize treatment with oral medications.

However, there is a need to do more than just screen because there are obstacles outside of the clinic that interfere with a patient's ability to complete treatment. This bill will provide the linkage between the health care team and community resources through community health workers or social workers. They can ensure that patients are receiving the direct assistance they need to access food, transportation, housing, and health care. I recall having a patient with extremely elevated blood pressure readings every time she came into the clinic.

She later shared with me that she was living alone with no access to transportation. This left her with no other option than to eat high salt, frozen meals because it was easy for her to keep for extended periods of time. A community health worker would have been able to help her with transportation vouchers and resources to food banks that might deliver. My family medicine colleague had difficulties with getting an unhoused patient a much needed surgery because he did not have an address where he could be discharged to after the surgery.

A social worker would have been able to assist the patient with navigating and obtaining at least some type of temporary housing to be able to move forward with surgery. With that, I respectfully ask for you to vote yes on AB 85. Thank you.

Thank you very much. Others speaking in support, now is the time just to come forward with your name, position, and affiliation.

Libby Sanchez on behalf of AltaMed in support.

Thank you.

Marana Gonifer with CBCN; co-sponsor in strong support.

Thank you.

Taylor Jackson with California-Health Plus Advocates representing 1,300 community health centers, here as a proud co-sponsor.

Thank you.

Jennifer Robles with Health Access California in support.

Thank you.

Megan Chung with the Steinberg Institute in support.

Thank you.

Madam Chair and Members, Bryce Docherty on behalf of the American Academy of Pediatrics California, and OCHIN, and their subsidiary, the California Telehealth Network, in support.

Thank you.

Chair and Members, Chris Zgraggen with Aprea & Micheli on behalf of Children's Choice Dental Care in support. Thank you.

Brandon Marchy with the California Medical Association in support.

Ryan Spencer on behalf of the American College of OB-GYNs, District Nine, and the Crohn's & Colitis Foundation in support.

Thank you.

Stephen Cutie with California Life Sciences in support.

Thank you.

Yareli Magallon on behalf of Children's Specialty Care Coalition in support.

Thank you.

Molly Robson with Planned Parenthood Affiliates of California in support.

Thank you.

Isabella Argueta with the Health Officers Association of California in support.

Thank you.

Karen Stout on behalf of the Black Leadership Council. We are co-sponsors in strong support.

Thank you.

Corrin Whitlow. I'm a licensed registered nurse in support.

Thank you.

Stephanie Daigre, also a licensed registered pediatric nurse in support. Thank you.

Taneicia Herring on behalf of the California Hawaii NAACP in strong support.

Thank you very much. Okay, now's the time for folks speaking in opposition to this bill to come forward.

Good afternoon, Madam Chair and Members of the Committee. Jedd Hampton with the California Association of Health Plans, regrettably here in opposition to AB 85. First of all, we want to thank the author and her staff. We've been talking with them and working them very closely, and we just really appreciate that they're working with us on this bill. We're certainly appreciative and supportive of the intent of this bill, and wholeheartedly--excuse me--agree that social determinants of health are significant drivers of health disparities and a critical component of determining health outcomes.

In fact, commercial health plans are already in the process of building out their networks to ensure that we can capture and reimburse for the required social determinants of health screenings that are part of the NCQA Health Equity Accreditation which is set to go live January 1, 2026. So we're certainly appreciative and supportive of the intent of this bill.

However, some of our remaining concerns are addressed somewhat in the Committee Analysis around the evaluations and what tools are acceptable and how this requirement will interface with the Medi-Cal version of the screening program under Population Health Management, so we believe that those requirements should align as closely as possible, so we're avoiding any sort of duplication or additional work. So, again, supportive of the intent of this bill. We have just some of those remaining concerns, and again, we'd like to thank the author and her staff for working with us on this bill.

Thank you very much. Next person, please.

Steffanie Watkins on behalf of the Association of California Life & Health Insurance Companies. We too are opposed for the same reasons. We look forward to continuing those conversations. I think the overall goal is making sure that this is done in the most effective and thoughtful process so that we get the services to the right people. Thank you.

Thank you very much.

John Wenger on behalf of America's Health Insurance Plans. Just echo the comments of CAHP and ACLHIC.

Thank you very much. Anybody else just want to speak in general? Opposition? Come forward at this point. Name and affiliation? Seeing none, we'll go to the phone lines. Moderator, do we have any lines on, phones on the line? People on the line?

Yes. For support or opposition of AB 85, please press one then zero at this time. And we will go to line 295. 295, you're open. No response. Line 364. I'm sorry, 374.

Hi. My name is Linda, I'm in Lincoln, California, and I oppose this bill.

Thank you. Next caller, please.

Line 206.

Nicole Wordelman on behalf of the Children's Partnership in support.

Thank you. Next caller, please.

Line 233.

Sandra Poole on behalf of Western Center On Law & Poverty in support.

Thank you.

Line 384.

Good afternoon, Madam Chair and Members. Alex Khan on behalf of the California Chronic Care Coalition in strong support.

Thank you. Next caller, please.

Line 363. Line 363, you're open. No response. Line 387.

Good afternoon. Kelly Hitt on behalf of Sutter Health in support. Thank you.

Thank you.

Line 266.

Hi. Raquel with the National Association of Social Workers, California Chapter, in support of this bill. Thank you.

Thank you.

Line 378.

Keller, Sacramento County, and I oppose this bill.

Thank you.

And Madam Chair, no further comments in queue.

Thank you very much. Now would be the time we'd bring it back to Committee, and just to say something--the amendments, and I fully supportive of this concept. We've moved to this with the CalAIM and really acknowledge this. As a professor of social works, one of the things I taught all the time is we need to have the social and physical environment in order for anybody to reach their full potential. This makes total sense, but those tools are still being processed, so we've asked HCAI to put together a working group to be able to standardize some of this as we continue to customize it so we can really get the care to the right people at the right time. And you are accepting those amendments?

I am accepting them.

Okay. Any other questions, comments from the Committee Members? Okay, would you like to close Assembly Member?

I just thank the Committee and respectfully ask for your aye vote.

Okay, thank you very much. Important bill, and we'll do that when we get a quorum. Thank you very much. And you have another one before us today?

I do.

Dealing with Medi-Cal reimbursements for abortion services.

Yes. So I'm here to present AB 576, which updates the medical guidelines for abortion medication. Medication abortion is safe and effective method of terminating a pregnancy and is preferred by many people who obtain abortions. Since the US Food and Drug Administration first approved the drug for medication abortion in 2000, its use has grown substantially, and in 2021, half of abortions in the United States were medication abortion. Currently, Medi-Cal only covers medication abortion for up to 70 days gestation.

Yet a 2019 study demonstrated that medication abortion for pregnancies between 71 and 77 days was safe and effective as a regimen is for 64 to 70 days. There are over 8 million women eligible for medical in this state who have more limitations on their access to the abortion pill than those in the private insurance market.

For those reasons, AB 576 would require the Department of Healthcare Services by March 1, 2024, to review and update Medi-Cal coverage policies for medication abortion to align with current evidence-based clinical guidelines. After initial view, the Bill would require the Department to update its Medi-Cal coverage policies for medication abortion as needed to align with clinical guidelines. This Bill would also require the Department to allow for flexibility of providers to exercise their clinical judgment when services are performed.

By extending the time that a pregnant individual can receive abortion medication under Medi-Cal, we are allowing families to make the family decision planning that is most appropriate for their life. This Bill is sponsored by Essential Access Health, the National Health Law Program, NARAL Pro Choice, California and Planned Parenthood Affiliates of California. Here to testify with me today is Molly Robson with Planned Parenthood Affiliates of California and Dr. Upadhyay. Hopefully I said that right. Professor of Obstetrics and Gynecology and Reproductive Sciences at UC San Francisco.

Thank you very much. Could say your own name there? Go ahead.

Yes, thank you. Good afternoon, Chair Eggman and Members. I am Dr. Ushma Upadhyay, Professor and Public Health Scientist at University of California, San Francisco. I'm here today in support of Assembly Bill 576, which requires DHCS to update their billing policy for medication abortion to reflect evidence-based research, clinical guidelines, and the discretion of the clinical provider. Medication abortion has taken on a pivotal role in abortion care in the wake of the Dobbs Supreme Court decision.

It now makes up well over half of all abortions nationally. For a long time, medical policy required two ultrasounds for reimbursement. I analyzed Medi-Cal data on over 11,000 medication abortion patients, and found that they were routinely required to make return visits for post-abortion ultrasound when most providers across the rest of the country had long stopped requiring this unnecessary, in-person follow up visit.

Patients too often receive the care that will be reimbursed rather than the care that they actually need, based on the best medical evidence. Additionally, studies show that medication abortion is extremely safe and effective through the first trimester up to 12 weeks of pregnancy, and this is endorsed by the World Health Organization guidelines. Yet Medi-Cal reimburses only up to 10 weeks of pregnancy. A new UCSF study found that over one third of abortion providers across the country currently offer medication abortion care beyond 10 weeks.

With an additional dose of misoprostol, a medication abortion between 9 and 12 weeks is just as effective as earlier in pregnancy. Science is continually evolving, and I want Medi-Cal Members to avail of the latest evidence-based care. I am proud to be here in support of AB 576 and respectfully urge your support on this Bill today. Thank you.

Thank you very much, Doctor. Next person, Ms. Robson.

Good afternoon. Molly Robson with Planned Parenthood Affiliates of California. We represent the seven affiliates in the state who offer sexual and reproductive health care through over 110 health centers in California. Medication abortion is a preferred method for ending a pregnancy. It has been for the last two decades. And at Planned Parenthood health centers, more than 70% of patients seeking an abortion end up receiving a medication abortion.

By extending the window in which medication abortion would be available just to be in line with clinical guidelines, an additional 10% of Planned Parenthood patients would be able to choose medication versus being kind of forced into an in-clinic procedural abortion. So this Bill really will address unnecessary barriers to care and address kind of equity gaps in coverage between Medi-Cal and private insurance. So as such, would respectfully request your support on this Bill today. Thank you.

Thank you very much. Okay, now's the time just for people speaking in general support to come forward. Name and affiliation, and we assume you're speaking in support.

Taylor Jackson, with California Health Plus Advocates, here in strong support.

Tiffany Matthews, on behalf of Attorney General Rob Bonta, in support.

Taisha Watts, with the California Academy of Family Physicians, in support.

Brandon Marchi, with the California Medical Association, in support.

Hello, Genesis Gonzalez, on behalf of Lieutenant Governor Eleni Kounalakis, in support. Thank you.

Brian Spencer, American College of OBGYNs, District Nine, in support.

Kathy Mossberg, proud co-sponsor, Essential Access Health, in support.

Karen Lang, on behalf of the City and County of San Francisco, in support.

Karen Stout, on behalf of NARAL Pro Choice California, proud sponsor of the Bill, as well as the California Nurse Midwife's Association, in strong support.

Thank you.

Diaz Grubb, family medicine physician, representing myself, in support.

Thank you.

Mari Lopez, California Nurses Association, in support.

Thank you very much. Okay, now those speaking in opposition to the Bill may come forward at this point.

Committee Members. I'm Sophia Lorey and I'm with California Family Council. AB 576 would require taxpayers Medi-Cal funding to fully reimburse providers for medication abortions up to 77 days gestation, whereas it currently covers 70 days. The FDA has granted approval for the use of abortion medication up to 70 days of gestation. It is important to note, regarding AB 576, that the FDA does not approve the Administration or consumption of abortion medication after 70 days of gestation. Let's walk through what abortion medication does.

A medical abortion is done by taking two pills, mifepristone and misoprostol. Mifepristone chemically starves a pre-born child of progesterone, which causes the placenta to degenerate so that it can no longer provide oxygen and nutrients to the child. The woman then takes misoprostol within 24 to 48 hours, causing severe cramping, contractions and often heavy bleeding to expel the dead baby out of a woman's uterus, usually on her own, sitting over a toilet.

Through this Bill, Medi-Cal will be forced to pay for abortion medication up to 11 weeks of a pregnancy. So let's walk through what the first 11 weeks of a pregnancy looks like. By three weeks and one day, a baby's heartbeat can be detected. Between five to six weeks, the baby's lung and digestive system start forming and brain activity can be recorded. At nine weeks, the baby can suck their thumb, sigh, and stretch. At 10 weeks, a baby is about an inch and a quarter long.

All vital organs are in place, and their teeth are starting to harden and connect to their jawbone. Every successful medication abortion ends in at least one person dead. Since 2000, 5.6 million unborn children have died from abortion medication. Since 2000, 28 women have died from abortion medication. This is not misinformation. This comes directly from the US. Food and Drug Administration. The FDA has also reported that since 2000, 1048 women have been hospitalized, 604 women have experienced blood loss requiring transfusions, and 414 women have experienced infections, all due to abortion medication.

And while I do not have time to dive into this, I do want to note that currently there is a case before federal court which could lead to the court ordering the FDA to withdraw these dangerous chemical abortion drugs from the market.

Due to the current case and the physical harm that abortion medication causes to women, taxpayers' Medi-Cal funding to fully reimburse providers for medication abortions should not exist at all, let alone be increased to 77 days gestation. I urge a no vote on AP 576. Thank you.

Thank you. Anybody else speaking in opposition to this Bill today? Anybody just want to say no to this Bill today? Okay, seeing none, bring it back to the Committee. I think we have no comments. Dr. Weber, would you--oh, telephone, telephone. Thank you. Let's go to the telephone lines. Do we have any callers?

Thank you. Yes. For support or opposition of AB 576, please press one then zero at this time. Go to line 363.

Go ahead, please.

363, you're open. No response.

Okay.

Line 392.

Yes. My name is Wendy Palacici. I'm a mother and an aunt to be, and I strongly oppose this Bill.

Thank you.

Line 398.

Hi. My name is Raquel. I'm with the National Association of Social Workers California Chapter, and I strongly support this Bill.

Thank you. Next caller.

Line 285.

Gabrielle Ingram, founder of Stand Up Sacramento County, strongly oppose this Bill.

Thank you.

Line 303.

Linda Rich, Placer County. I strongly oppose AB 659.

Okay, we're not there anymore. Thank you. Next caller, please.

Line 378.

Heather Keller from Sacramento County, oppose this Bill.

Thank you, next caller, line 396.

Angel Shannon, representing LA County, and I oppose this Bill.

Thank you. Next caller, please.

Line 203.

San Bernardino County, and I oppose the Bill.

Excuse me, sir, which Bill are you opposing?

576.

Okay, thank you. Next caller, please.

Okay, one moment, please. We go to line 363.

My name is Andrea Hedstrom, and my affiliation is a mother of four who has had two mifepristone, misoprostol abortions, and I am pro choice and I oppose this Bill.

Thank you very much. Next caller, please.

Line 303.

One moment, please. Line 400.

Yes, hi. My name is Margaret Boyles, and I am from Los Angeles County, and I oppose this bill as the abortion is life threatening--

Thank you very much. Next caller, please.

Okay, line 303.

Hi. Linda Rich, Placer County. I'm sorry, I had the wrong number. I oppose AB 576. Thank you.

Thank you. Next caller, please.

Madam Chair, no further comments in queue at this time.

Thank you very much. Now would be the time to bring it back to the Committee. Seeing nobody wishing to comment, Dr. Weber, would you like to close?

Every single day matters when making such a major decision, and the decision should not be dependent on whether an individual has the funds to cover this medication. I respectfully ask for your aye vote. Thank you.

Okay, thank you very much. This does enjoy a do pass recommendation and we'll--when we get a quorum. Thank you.

Thank you.

Thank you. All right, Dr. Wood, you are up next. AB 242, which enjoys a do pass and re-refer to the Committee on Appropriations. Welcome. Getting rid of some sunsets, although I love sunsets. They're so pretty.

Like sunrises, too.

Yeah.

So, thank you, Madam Chair and Members. AB 242 eliminates the five-year sunset on a prior bill of mine, AB 2024, which allows federally certified critical access hospitals to employ physicians and be able to bill for their professional services. Critical access hospitals are often referred to as frontier hospitals because most of them are located in remote, rural areas. There are 34 such hospitals in the state, and they all have 25 or fewer beds. While these hospitals are small, they provide critical services and value to their communities.

Without these hospitals, people would have to drive many miles before reaching another hospital. One of the issues I continue to hear throughout my district is how difficult it is to recruit physicians. Six of these hospitals are in my district. It's important to point out that a continued sunset creates uncertainty to physicians who may be seeking employment and whether the length of employment could end abruptly by a sunset.

Having been a health care provider myself, I understand the concerns of the medical community about whether allowing hospitals to employ physicians will change the nature of the physician's clinical decision. However, the opportunity for these hospitals to hire physicians has now been piloted two times with no negative feedback, and the medical board is neutral on the bill.

AB 242 is a modest bill; provides a limited exemption for those hospitals most at risk of closing their doors if they can't figure out a way to address their physician staffing needs. In support of the measure today is Sarah Bridges with the California Association of Healthcare Districts. I respectfully ask for an aye vote.

Thank you very much. Ms. Bridges.

Thank you. Thank you, Madam Chair and Members. Sarah Bridge on behalf of the Association of California Healthcare Districts, here in proud support of Assembly Bill 242. District hospitals make up over half of the critical access hospitals in the State of California. As the Assembly Member mentioned, these hospitals with the critical access designation are some of the most rural and remote in this state, with 25 or fewer beds making them the sum of the smallest.

Specifically, AB 242 makes the pilot program established in 2016, allowing these critical access hospitals to directly employ physicians permanent. Without this bill, come January 1, 2024, hospitals that have utilized this program will have to transition their employed physicians to the contracted model, which most certainly will result in the loss of those physicians. Rural, critical access hospitals have an incredibly difficult time recruiting and retaining physicians to their areas. This is for a number of reasons, including location, lack of other facilities, and high Medi-Cal and Medicare numbers.

This pilot program has produced exceptionally strong retention, allowed facilities to recruit young physicians coming out of residency and fellowship, and has shown no signs of impacting a physician's ability to make clinically appropriate decisions for their patients. Notably, the Tahoe Forest Healthcare System, a district hospital located in Truckee, has successfully recruited 54 physicians under this pilot programs to their region of the state, something that would not have been possible without the employment model.

Those hospitals that have not yet used this tool cite their number one concern is the pilot program and the unwillingness of doctors to enjoy an employment model under the threat of the looming sunset. I want to thank Dr. Wood for his leadership in this area and it is without a doubt that AB 242 will preserve access to care in rural California. It is for those reasons we respectfully ask for your aye vote. Thank you.

Thank you very much. Others speaking in support, come forward at this time.

Good afternoon, Madam Chair and Members. Connie Delgado on behalf of the District Hospital Leadership Forum in support.

Thank you.

Heidi Hannaman on behalf of the California Special Districts Association in support. Thank you.

Thank you.

Good afternoon, Chair and Committee Members. Vanessa Gonzalez with the California Hospital Association in support. Thank you.

Thank you very much. Those speaking in opposition, now would be the time to come forward.

Madam Chair, Members of the Committee, Brandon Marchy with the California Medical Association. Very happy to be changing up my spiel for this bill, and on this subject, we greatly appreciate the conversations that we have had, the very productive conversations we have had with the author on this topic.

We are still in an oppose unless amended position, but having those conversations, and hopefully, as the report comes out in July, the next couple of days, we look forward to removing our opposition soon.

Thank you very much, Mr. Marchy. Any others speaking in opposition today, come forward. If not, let us pause for a moment while we call the roll.

Senators Eggman? Here. Eggman, here. Nguyen? Here. Nguyen, here. Glazer? Gonzalez? Grove? Here. Grove, here. Hurtado? Limon? Here. Limon, here. Menjivar? Here. Menjivar, here. Roth? Here. Roth, here. Rubio? Wahab? Wiener? Present. Wiener, present.

That's seven; we have a quorum. Thank you. All right. Now we're bringing it back to the Members. Questions, comments for Dr. Wood? Oh, phone calls. You forget about the phone calls. They don't do them in the Assembly anymore.

No, we don't.

Okay, let's go to the phone lines. Do we have any callers on the line?

Yes. Support or opposition of AB 242, please press one and zero. We'll go to line 387. Your line is open. No response from that line. Line 405, please go ahead.

Yes, my name is Linda in Lincoln and I oppose this bill.

Okay, thank you. Next caller, please.

Go to line 363.

Hi. My name is Andrea Hedstrom and I oppose this Wood bill, abort the government-

Thank you very much. Next caller, please.

Madam Chair, no further comments in queue at this time.

Thank you very much. Now would be the time we would bring it back to the Committee. Senator Grove.

Thank you, Madam Chair. I just want to thank the author for bringing this bill forward as somebody who represents rural communities, and having a model where medical providers, doctors don't have to put up a shingle in a small community, but can have a place in the hospital to operate, to provide services, especially to--I represent 70 percent of the Medi-Cal population.

Takes a special doctor to get paid less than what they're putting out and I appreciate the bill, and I look forward to moving it at the appropriate time.

Thank you. Others? Okay. Would you like to close, sir?

I just respectfully ask for an aye vote. Thank you.

Okay. I think it's a good bill. Important issue. How many critical access hospitals do you have in your district?

Six of the 34 are in my district.

Okay. All right. Okay, we have a motion by Senator Grove. Secretary, if you could please call the roll. The motion is 'do pass and re-refer to the Committee on Appropriations.'

Senators Eggman? Aye. Eggman, aye. Nguyen? Aye. Nguyen, aye. Glazer? Gonzalez? Grove? Aye. Grove, aye. Hurtado? Limon? Aye. Limon, aye. Menjivar? Aye. Menjivar, aye. Roth? Aye. Roth, aye. Rubio? Wahab? Wiener? Aye. Wiener, aye. That's seven.

That's seven; we'll hold the roll open for absent Members. Thank you very much.

Madam Chair, I do have a bill I was asked to present for Assembly Member Wicks. Do you want me to come back?

No, go ahead, sir.

Go ahead, sir.

Okay. Thank you. Thank you very much. Madam Chair, I'm here to present AB 1048 for Assembly Member Wicks.

Okay.

First, I want to accept the Committee's amendments. This is not my statement, so it doesn't sound like me at all, but it's really good.

Okay. Alright. You like it. Alright.

Alright. Thank you.

And it does enjoy a do pass.

Oh, good. Okay, let me see if I can shorten it then. Even in a state that has embraced the Affordable Care Act, dental insurance plans have operated with much less oversight and regulation than full service health plans. Regulatory exemptions have allowed dental plans to restrict patient benefits with arbitrary waiting periods, deny coverage of preexisting conditions, and increase patient premiums without increasing benefits.

These exemptions critically hurt patients denied coverage due to or prevented from receiving meaningful value for their dental premiums. Especially important as out of pocket expenses for dental services are continually rising, 16% alone in 2021. And a new California Healthcare Foundation survey found 38% Californians have a family member who skipped dental care last year due to high cost. Actually, 50%, almost 40... 50% of medical patients skipped for the same, very same reason.

So, as amended, AB 1048 will establish essential patient protections and create accountability through prohibiting large group dental plans from implementing arbitrary waiting periods on patients, prohibiting dental plans from denying claims related to pre-existing conditions, and requiring an annual review of dental plan premium rates. I think at this point I will ask we have a couple of witnesses in support here today. Dr. Stephanie Sandretti, the former Chair of the Government Affairs Council for the California Dental Association, and Jessica Moran, Legislative Advocate for the California Dental Association.

Thank you. Thank you, Dr. Wood. Good afternoon, Chair and Members. My name is Dr. Stephanie Sandretti. I'm here today speaking on behalf of the California Dental Association and our 27,000 members throughout the state in support of AB 1048. As the owner of two dental practices here in the Sacramento area, I regularly have come across countless patient stories of those who choose to forego dental care.

Welcome.

Even when they have dental insurance, patients often find themselves in situations where they're unable to cover the out of pocket cost of care or have claims denied by their dental insurance. For example, dental insurance plans can impose waiting periods on patients in which they will not cover services such as fillings, root canals, deep cleanings, or crowns for 6 to 12 months upon gaining coverage, despite the patients paying for their monthly premiums. When I see a patient for a comprehensive exam and diagnosed gum disease, it is incredibly disheartening.

When we find out that the patient will not have coverage for up to a year for that treatment. This will lead to permanent damage to their gum and bone. AB 1048 would prohibit dental insurance plans from imposing waiting periods on enrollees in the large group market. Dental insurance plans can also deny claims for enrollees with preexisting conditions. This is when a dental plan will not cover bridges, partial dentures, or implants for a tooth that was lost before an enrollee started coverage with that specific plan.

For example, I had a patient who had an existing bridge. She developed decay underneath it. We replaced the bridge with a new one, and the insurance denied that replacement because she had a missing tooth clause under her plan. It was difficult for us to collect money from that because we had estimated that the insurance would cover. But despite that missing tooth clause, it was denied. AB 1048 would prohibit dental insurance plans from denying claims due to preexisting conditions.

These prohibitions in coverage beg the question as to what value dental insurance actually provides to enrollees if they will not cover dental procedures when they are most needed. AB 1048 would also require dental insurance plans to go through a premium rate review process, just like any other types of insurances, including medical, homeowners, and pet insurance. It's long overdue for dental plans to be held accountable and to ensure consumers are receiving value for the premium dollars they pay.

As healthcare providers, our ultimate goal is to provide quality care to all of our patients. If dental plans can deny coverage for arbitrary reasons, how can we possibly provide this necessary care? We know how integral oral health is to overall physical health, and AB 1048 is an important step in ensuring dental insurance provides real value to our Californians. I respectfully ask for your aye vote today. Thank you.

Thank you very much. Next person and support, please.

Good afternoon, Chair and Members. Jessica Moran with the California Dental Association, here today as the sponsors of AB 1048. This is an important bill that aims to make dental insurance more real for consumers that are already paying their monthly premiums. We understand that those who are in the small individual group market are more sensitive to premium increases, which is why we took the amendment in Assembly Health to narrow the waiting period provision to only apply to large group plans.

Contrary to what the opposition claims, the large group market does not operate the same way the individual and small group market does. You cannot enter the large group market, gain dental coverages, and then drop coverage because your coverage is tied to your employer, and your employer has to have over 100 employees to provide large group products. So the widespread bipartisan support that AB 1048 received in the Assembly is proof that dental insurance reform is needed. We shouldn't continue to allow dental insurance plans to operate with minimum patient protections and oversight. I urge your aye vote today. Thank you.

Thank you very much. Next person, please, in support. Now just name an affiliation.

Thank you, Madam Chair and Members. My name is Fred Noteware, representing the Association of Dental Support Organizations in support. Thank you.

Thank you, Fred.

Good afternoon, Chair and Members, Janice O'Malley with AFSCME California in support.

Thank you.

Good afternoon, Chair and Members. Jessica Hay with the California School Employees Association in support.

Thank you.

Taylor Jackson with California Health Plus Advocates, representing California's Community Health Centers, here in support.

Thank you.

Thank you, Chair and Members, Chris Zgraggen with Aprea and Micheli on behalf of Children's Choice Dental Care in support.

Thank you.

Good afternoon, Chair and Members. Jose Torres with Health Access California in support.

Thank you, Jose.

Good afternoon, Chair and Members. Jennifer Tannehill on behalf of the California Dental Hygienist Association in support.

Thank you.

Mari Lopez, California Nurses Association, in support.

Thank you very much. Okay, now we'll go to anybody speaking in opposition to this bill today.

Madam Chair, Senators. Dean Grafilo with Capital Advocacy on behalf of the California Association of Dental Plans in opposition to the bill. We object to the supporters' description of the dental coverage market as the Wild West. As the Committee analysis says, all these products are regulated by DMHC and CDI. The fact is that dental coverage is a very different product from medical coverage. It is not mandatory coverage, and so when employers offer it, it is a voluntary benefit that they seek to provide.

And as a result, they are very cost sensitive. Our position is based on the fact that SB 1048 limits the ability of plans to control costs and prevent adverse selection. This will increase the cost of coverage to employers. We do not believe the rate review provisions are necessary, given the existing role of CDI and DMHC. We respectfully request your no vote. Thank you.

Thank you very much. Dr. Wood, is Ms. Wicks accepting the amendments?

Yes, absolutely.

Chair and Members. Kathy Mossburg, representing Delta Dental. Just want to associate myself with the comments made by the representative CADP. We do remain opposed. Thank you.

Thank you very much. Anybody else?

John Wenger on behalf of America's Health Insurance Plans. We do still have an opposed position.

Thank you very much. Okay, let's go to the phone lines now.

Thank you. For support or opposition of AB 1048, please press one, then zero. Go to line 235. 235.

Good afternoon, Chair and Members. Faith Borges on behalf of the California Associate... Excuse me. California Agents and Health Insurance Professionals, respectfully opposed.

Thank you. Next caller, please.

Line 233.

Sandra Poole, Western Center on Law and Poverty in support.

Thank you. Next caller, please.

Line 203.

In San Bernardino County. I support.

Thank you. Next caller.

One moment, please, for the next line. Line 409. One moment, please. 409, you're open now.

Nora Lynn on behalf of Children Now in support.

Thank you.

Okay. And Madam Chair, no further comments in queue.

Okay, bringing it back to the Committee. Senator Wiener.

I know this isn't your bill, but it's in spirit your bill, Doctor. I was actually really excited when I saw this bill because, with all respect to the opposition, dental insurance is absolutely the Wild West. And I think which stems from the fact that as a society, we've always treated oral health as somehow optional or a luxury, as opposed to what we know, which is that oral health is absolutely central to overall health.

You know this better than most, that if you have poor oral health, that impacts so many other aspects of your health, in addition to being potentially very painful, making it harder to eat, and creating social challenges for people, and yet we really treat it like a luxury. And a big swath of society doesn't even have dental insurance at all. And even if you have good dental insurance, it's always bad. It doesn't cover nearly as much as it should. There's huge potential out of pockets.

It hits a limit very very quickly. People have to pay out of pocket or just not get medically necessary dental care. In addition, I want to say I have Delta Dental CalPERS through the state. I'm guessing that that is probably among the best dental plans. I mean, compared to other dental plans, it's CalPERS, et cetera.

And in addition to always having a lot of out of pockets, my dentist recently told me that he and many, many other dentists he knows are all going out of network for Delta Dental because Delta Dental is slashing its reimbursement. So all these dentists are going out of network, and that means that, as someone who has Delta Dental, I and many other people are going to have to pay in advance and then go and do the paperwork to get reimbursed.

And one of the reasons they're going out of network is Delta Dental won't even tell the dentist how much they're going to reimburse in advance. So they're stuck basically trying to collect from the patient after the fact. So it's a really bad situation, and it is the Wild West, and it's long past due that we start putting some of these regulations in place, because dental insurance should not be treated differently than other forms of health insurance. And so I'm happy to move this bill.

Thank you. Senator Grove, followed by Senator Limon.

Thank you. Thank you, Madam Chair. Surprise. I disagree with my colleague from San Francisco. Just saying.

That's okay.

I know it's not your bill, but I do have a couple of questions. So it's just top five major plans. It doesn't cover, like, poor Medi-Cal recipients that don't have dental coverage, so Medi-Cal wouldn't be mandated to provide this service.

Actually, the Medi-Cal program is completely independent, so it's administered by Delta Dental, but it is completely independent, so the benefits have been established by the state.

I understand that, but your bill wouldn't require or, your bill... The bill you're presenting here today wouldn't require that service to be provided to Medi-Cal patients?

No.

Thank you. Through the chair. Do you have a comment on my question?

Did I mess up already?

No, I'm here to answer any questions also.

Okay. You run up there, so I ask. So the next question I have is, I think what I heard from the plans themselves is that they're opposed to it because there has to be some type of prior coverage or some type of coverage mechanism prior to getting dental work.

And so I guess my question is, is there anything in the bill that would prevent someone from enrolling in some major medical program, paying two months, getting thousands upon thousands of dollars worth of dental care, and then canceling their policy? Is there anything in that requires them to have 12 months prior coverage, 6 months prior coverage or anything like that.

Actually, there isn't. This bill has now been narrowed to large group plans. So that would mean you take a job with somebody to get dental insurance and then leave the job after a couple of months. I'm not sure that many people would go through that, but I guess it's a possibility. But it's because it has been narrowed to cover just large group plans.

Okay. Alright, well, I appreciate that. And I hadn't had a chance to look at the amendments, but I understand they're just technical. Is that true?

I hope so.

I'm sorry.

This is clarification of rate.

Kind of fun, actually. I kind of know the bill, and...

You're kind of a dentist.

I'm kind of still a licensed dentist here in California.

I just wanted to make sure they were just clarifying technical amendments and nothing greater that I missed...

On rate reviews.

So the amendments for this Committee are technical. The amendment that Dr. Wood is referencing to narrow the waiting periods, that was taken in Assembly Health.

Oh, it was?

We did that.

You did that. Okay. And eliminate the waiting periods. And is there a waiting period at all, or it's completely eliminated.

So with the amendments taken in Assembly Health, it would eliminate waiting periods in the large group market, so those who are receiving their benefits through their employer in the large group.

So at the same time their health care goes into effect, their dental care goes into effect.

Yes.

Thank you. Thank you, ma'am. Chair, should I ask you that question?

I guess I just might note, some employers have a waiting period for people to be eligible for plans anyway.

Yes. And this would comply with that waiting period for those individuals to be eligible, like their regular health insurance.

They wouldn't get a dental plan just without qualifying for the other benefits that the employer would be offering during a specific time frame.

Okay. No, I appreciate you responding. Thank you, sir.

Parity between teeth and noes. Okay. Senator Limon.

Thank you. This is an interesting conversation because I just recently, I think, in the last two months, received a notice from my dentist letting me know that my dental insurance plan was now going to be out of network. And so while we know that there's such importance with health, with dental health, and it also relates to overall health for many, for all, but also particularly for communities who don't have access. So I think having a more comprehensive medical insurance I think makes sense.

We know there's a lot to do, and I think of my former school board days and what we did to have volunteer dentists in our schools because it was so key to overall health. And while this only applies to the larger groups, I still think it's very worthwhile, and I think it is part of a broader conversation of how we align the benefits, particularly in light of, I think, what so many are experiencing that do have coverage.

And that coverage is inconsistent depending on where you live. And also has its own challenges that your average patient might not be able to navigate on their own without some broader standards statewide. So I'm grateful that this bill is coming forward. Do understand the concerns of the health plans, but certainly think that there is much to gain if we are able to have a more comprehensive way to align it with medical.

Thank you. And I will echo some of those same comments. I try to be sympathetic to the plans. I understand that there's always new things. But I also stand on the side of, as a social worker too, trying to work with students about how do you care for kids. One of the biggest risk factors is having a messed up mouth that then just continues to keep that child in trouble, not raising their hand, getting, I mean, it's just incredible social determinants of health live in our mouths. So I'm also a supporter. We had a motion by Senator Wiener. Would you like to close, sir?

Thank you, Madam Chair. And to Senator Grove. I would love it if the Medi-Cal program was as comprehensive as some other plans are. Yet here we are. Some of these private plans are not as comprehensive as I think they should be. Imagine a child born with a cleft lip or a cleft palate, and often that involves missing teeth. There is medical care available for the treatment of the cleft lip and cleft palate.

But under most dental plans, the replacement of a tooth that was never there would be considered a preexisting condition, and that child would not be able to get the restorative functional treatment that they need to eat, chew, smile, and those kinds of things. And I just think fundamentally, that's unfair. And I think when I was practicing, I think the biggest frustration I ever had was this pre-existing condition, a missing tooth exclusion that just made it really difficult to provide comprehensive care to people. And I just think it's unfair, and I hope that we can change that going forward.

Thank you. Okay, Secretary, please call the roll, and this is a do pass is amended and re-referred to the Committee on Appropriations.

Senators Eggman? Aye. Eggman, aye. Nguyen. Aye. Nguyen, aye. Glazer? Aye. Glazer, aye Gonzalez? Grove? Grove, aye. Hurtado? Limon? Limon, aye. Menjivar? Roth? Aye. Roth, aye. Rubio? Wahab? Wahab, aye. Wiener? Aye. Wiener, aye.

That's eight to zero. We'll hold the roll open. Thank you very much, Dr. Wood. Mr. Gabriel, you are up next with 418, food product safety.

Thank you very much, Madam Chair and Members. I want to start today by accepting the amendments to delay implementation until 2027 to permit the industry time to reformulate and make the necessary supply chain adjustments. Want to thank you and your staff for their thoughtful help and assistance. With that, I want to thank the opposition, particularly the Consumer Healthcare Products Association, for working with us on the implementation date delay and appreciate their thoughtful collaboration.

I am pleased today to present AB 418, which would help to protect kids, families, and consumers in the State of California by banning the use of five toxic chemicals with well-documented risks of harm, including cancer, reproductive issues, and developmental and behavioral issues in kids. As I've discussed with many of you, these chemicals are all currently banned in the 27 nations of the European Union. They are also banned in different permutations and combinations in many other jurisdictions around the globe; countries including the UK, Canada, Brazil, India, China, Nigeria, South Korea, Israel, Qatar, and so on.

We've also seen that many major brands and corporations here in the United States have moved away from using these chemicals, including some of our most iconic brands and corporations. So, Coke, Pepsi, Gatorade, Papa John's, Dunkin' Donuts, Panera, Whole Foods, Kroger, and others have moved away from the use of these chemicals.

One thing I do want to make clear here is that we are not looking to pull any items off the shelf, and in fact, I would vote against a bill that I thought was going to ban Skittles. The idea of this here is simply to have these manufacturers, have these companies do what they are already doing in Europe and so many other places around the globe, which is make minor modifications to their recipes and we know that these companies can do that because in fact they're already doing so.

And Senator Limon was generous enough to bring me a package of Skittles back from Denmark on a recent visit there, and I assure you I tasted them, we tasted them in my office. They were delicious. My staff actually took them away from me because I was eating too many of them and we wanted to use them as a prop, but we know that the industry is capable of making these modifications.

So the backdrop of all of this for me--because I had a question when I first looked at this and this is not an area in which I've done a lot of work--was why is the United States an outlier here? Why is it that so many other jurisdictions, so many other nations, so many corporations and manufacturers moved away from these chemicals and yet the FDA has not done so?

And what I found was actually very disturbing to me, that there are major flaws in the FDA regulatory process. One of them is the 'generally recognized as safe' or GRAS loophole to the fact that approximately 99 percent of new chemicals that have gone into our food supply have either been grandfathered in or have not received independent, meaningful review by the FDA. The FDA operates differently than other federal agencies.

So example, where the EPA reviews chemicals every 15 years, re-reviews them because our understanding of human physiology, of science, new data comes into account, that does not happen at the FDA in the way that it does at other agencies.

And so we've ended up in this situation, this very bizarre situation where we are lagging behind the rest of the world and I think the best example of this is that one of the chemicals in this bill, red dye No. 3, has been banned by the FDA for use in cosmetics since 1990 and yet is still allowed in our food supply, and I think that tells you everything you need to know about how incoherent the system is.

I don't think it takes a PhD in molecular biology to understand that doesn't make a lot of sense, that if something is a type 2 carcinogen, too dangerous to put on our faces, and yet it's put in a lot of products that are primarily targeted towards our young people. So we have focused on these five chemicals because we believe that there is strong science to support that, but also because for each of these chemicals, there are readily available alternatives, and again, the industry doesn't have to guess what those alternatives are.

It is already using them in many products here in the United States and certainly in other products in jurisdictions around the world. So we're very proud to have assembled a coalition of consumer protection, public health, anti-cancer, environmental groups that are behind this. Most recently secured the support of former Governor Arnold Schwarzenegger, who I think made the excellent point that this is not a partisan issue, this is simply common sense.

He had his team look into the science behind this, and I think they were very persuaded that this is a common sense step forward to protect kids and families in the State of California. So appreciate the work of the Committee, happy to accept the amendments, and would respectfully request your aye vote. And with me today to testify are two witnesses, and so we have with us from the Environmental Working Group, Susan Little, and also I'm very grateful that Dr. Richard Jackson has joined us.

He is a pediatrician, a professor emeritus at the Fielding School of Public Health at UCLA where he was the Department Chair in environmental health science, has served in many leadership positions within the California Department of Health, including as--the highest is the State Health Officer under Governor Schwarzenegger. For nine years, he was the Director of the CDC's National Center for Environmental Health.

He received the Presidential Distinguished Service Award from President George W. Bush, and most recently was elected to the National Academy of Medicine and the National Academy of Sciences, putting him in a very, very small group of the most distinguished experts on this issue. So thank you for your consideration and respectfully request your aye vote.

Thank you, Assembly Member. Doctor, please.

Madam Chair, Members of the Senate Committee, it's a pleasure to be with you. Because I'm a pediatrician, I'm going to focus on children, and one of the fundamental tenets of pediatrics is that children are not little adults. They eat, drink, and breathe three times as much as an adult does for every pound of body weight, and insults that occur to them early in life, as you know, stay with them potentially for their entire lives. They carry that damage all the way along.

As I read this bill, and I learned more about it, I was shocked that these chemicals are unnecessary, they're not proven to be safe in most situations, and there are safer substitutes. If they make a sugar tablet shine, we don't really need it. Every mother teaches a child the prettiest food is not necessarily the healthiest ones for you to be eating.

And moms and dads should not have to be biochemists and epidemiologists to go shopping to figure out what is best to give their children. My long career in public health, I've learned the American approach to public health threats is a combination of neglect and panic, and too often we suffer from this neglect, and FDA is in part guilty of this with the 50 years they've been sitting on some of these chemicals.

In fact, if the FAA operated the way the FDA did, not one of you would get on an airplane at this point. Our health protection agencies need to be nimble, smart, and decisive because California is one-ninth of all the births in the United States. We sent the federal budget 280,000,000,000 dollars last year, which was more money than Texas, Florida, and New York sent to the federal government. Don't you think we owe much better oversight?

But in fact, the real leadership on pesticides has come from California. The real leadership on air pollution and water pollutants. I work with Lloyd Connelly and many others on these issues--have come from California. And sometimes, California has to step up and show the leadership when the Feds are dragging their feet. So as a pediatrician, a public health doc, and a grandfather, my granddaughter is here, Senator Glazer, from Walnut Creek.

I want to ask you to make decisions about how we can make our food safer for all of our grandchildren. Thank you very much.

Thank you. Next witness, please.

Thank you. I'm Susan Little. I'm with the Environmental Working Group. Today we ask you to support AB 418 and remove five toxic chemicals from food products sold in California. All five are banned in nearly all foods sold in the European Union's 27 nations and many other nations around the world. Unfortunately, the Food and Drug Administration's process for addressing food chemical risk is deeply broken.

A recent FDA commissioned report, which we provided to your staff, found the agency's food safety program is plagued by turmoil, infighting, and bias against action. In fact, the FDA does little to keep food chemicals safe. Food and chemical companies, not the FDA, perform the safety assessments of 99 percent of new food chemicals placed on the market over the last 20 years.

Even when the FDA does approve chemicals and new science later identifies serious health harms linked to that chemical, the FDA does not have to re-review it. And if citizen groups petition the FDA--such as Environmental Working Group has--to re-review a chemical, the FDA is slow to act, if at all. It has not substantively responded to a petition filed in the 1990s, for example. Consequently, many chemicals, including most of those listed in AB 418, have not been assessed in decades.

Potassium bromate for instance, a carcinogen, has not been reassessed since 1973, even though it was listed as a Prop 65 chemical in 1990. Propylparaben can harm the hormone system, but has not been reviewed by the FDA since 1972. And the list goes on. Have you heard about red 3? BVO, which harms the nervous system has never been allowed in the EU food, but remains in store brand sodas sold across the United States.

In the absence of constructive federal regulation, it's up to states to follow the lead of other nations and ban the worst of the worst chemicals in the food supply. AB 418 will do this and we urge your aye vote. Thank you.

Thank you very much. Other speaking in support, now just name and affiliation.

Good afternoon, Madam Chair and Members. Libby Sanchez, here today on behalf of three of our coalition partners, Center for Community Action and Environmental Justice, Center for Food Safety, and Social Eco Education, in strong support. Thank you.

Thank you very much.

Madam Chair and Members, Duncan Mcfetridge representing Food Safe. Strong support.

Thank you.

Good afternoon. Roxanne Gould, representing the American Nurses Association of California, in support.

Thank you.

Thank you, Chair and Members. My name is Noah Whitley, speaking on behalf of the Breast Cancer Prevention Partners in strong support.

Thank you.

Good afternoon. Matt Lege with SEIU California in support.

Thank you.

Ryan Spencer, American College of OB-GYNs, District Nine, in support.

Thank you.

David Bolog, San Fernando Valley resident, wishing Assembly Member Gabriel will turn his red light from red to green, in support.

Thank you. Okay, seeing no other people speaking in support right now, we'll go to opposition now. Folks, come forward.

Madam Chair and Members, Peter Kellison. Our client is the National Confectioners Association. The lead witness who was supposed to be here to present testimony was unable to make it to California due to inclement weather and so I am standing in. I want to be very clear that I will do my best to convey their testimony, but I lack the expertise to answer questions or to respond. The National Confectioners Association, NCA, represents candy manufacturers across the nation, including many in California.

Its members prioritize food safety and ensure that all ingredients used comply with FDA requirements and are safe for consumption. They would like to address two underlying arguments that are behind AB 418. The first is that the FDA is not actively regulating the safety of food additives. The FDA consistently reviews additives and is currently evaluating three of the five additives mentioned in the bill.

For example, the FDA recently completed studies on brominated vegetable oil, BVO, and announced its intention to propose a rule by the end of this year to ban it. The FDA is also reviewing titanium oxide and red No. 3, actively seeking data and comments on their safety as color additives. The FDA has previously examined titanium oxide in 2021 and red No. 3 in 2019, and continuously assesses the safety of these ingredients in the drug approval process.

Separately, the California Department of Public Health is also conducting a review of red No. 3 to determine if warning statements should be required. The other issue that they wish to address is the belief that if a substance is banned in the EU, it should also be banned in the U.S. They believe that this is a nuanced statement, and in fact, the EU permits the use of red No. 3 in both cosmetics and food, as the analysis points out, such as cocktail and candied cherries.

Although the U.S. allows broader uses, the EU has determined that red No. 3 is safe for consumption of food. The interpretation of scientific studies can differ, as exemplified by the FDA's denial of red No. 3 approval in cosmetics in 1990 based on a rodent study, while the EU in 2012 reviewed the same study in additional literature, concluding that red No. 3 does not pose a carcinogenic risk and is permissible in EU cosmetics. So different perspectives on the relevance of studies also exist.

FDA disagreed with the EU's ban on titanium oxide because it was based on studies not applicable to food grade titanium oxide. Lastly, I'd like to address the misperception that there are existing replacements for titanium oxide in red No. 3 in the U.S. There are not. FDA approval is required for all color additives, including natural color additives with approximately 40 approved additives. No suitable substitute exists for current use of titanium oxide in red No. 3.

In conclusion, these complex matters involve the expertise of toxicologists, food scientists, chemists, and biochemists, and the authority to make such decisions should remain with the FDA. By ensuring a consistent approach that aligns with the FDA's science-based deliberative process, it is the hope to preserve the core purpose of the FDA and essential to maintain a balance and avoid creating a precedent where individual states make individual determinations that may conflict with the process. For these reasons, they're in opposition to the bill. Thank you.

Thank you very much. Anybody else speaking in opposition to this bill, just now name and affiliation.

Madam Chair and Members, Anthony Molina on behalf of the Consumer Brands Association in opposition. Thank you.

Thank you.

Chair and Members, Dean Talley with the California Manufacturers and Technology Association. Opposed.

Thank you.

Good afternoon. Leticia Garcia with the California Grocers Association, also opposed.

Hi. Mc Kay Carney on behalf of the International Association of Color Manufacturers Respectfully in opposition. Thank you.

Thank you.

Madam Chair, Russell Noack on behalf of the American Chemistry Council. Opposed.

Thank you.

Margie Lie with Samson Advisors on behalf of the California League of Food Producers and the Council for Responsible Nutrition in opposition.

Thank you.

Madam Chair and Members, Don Gilbert on behalf of the Consumer Healthcare Products Association. We're removing our opposition in light of our successful negotiations with the author. Thank you.

Thank you very much, Don. Okay, let's go to the phone lines. Now's the time for people in support and/or opposition. Simply state your name, affiliation, and position. Thank you. Moderator, are there any calls?

Yes. For support or opposition of AB 418, please press one then zero at this time. And we will go to line 418. Please go ahead.

Priscilla Quiroz calling on behalf of the National Stewardship Action Council in support of AB 418. Thank you.

Thank you. Next caller, please.

Line 419, please go ahead.

Good afternoon, Madam Chair. Adam Regele on behalf of the California Chamber of Commerce. Appreciate the amendments. Currently have an opposed position. Thank you.

Thank you. Next caller, please.

Line 274.

Good afternoon. This is Jim Lindburg on behalf of the Friends Committee on Legislation of California in support. Thank you.

Thank you. Next caller, please.

Line 251.

John Bottorff with CleanEarth4Kids.org in strong support of AB 418.

Thank you. Next caller, please.

Line 406.

Good afternoon, Chair and Members. Ryan Allain on behalf of the California Retailers Association in opposition. Thank you.

Thank you. Next caller, please.

Line 424.

Hi. Gabriella Ingram in support. Thank you.

Thank you. Next caller, please.

Line 247.

This is Kian Schulman, Director of Poison Free Malibu, in strong support.

Thank you, next caller.

Line 427. Yes, 427.

Yes, this is Natalie Boust on behalf of the California Business Roundtable in opposition.

Thank you. Next caller, please.

Line 422.

Hi. This is Elsa with CalHEART in support of AB 418.

Thank you. Next caller, please.

Line 421.

Good afternoon. This is Quintin Levesque on behalf of California Health Coalition Advocacy in support.

Thank you, next caller.

Line 240. 240.

Hi. This is Polly Marshall on behalf of Breast Cancer Over Time in strong support.

Thank you.

Line 415.

Jack Yanos on behalf of the California Fuels & Convenience Alliance in opposition.

Thank you.

Line 303.

Linda Rich, Plaster County, in strong support.

Thank you very much. Next caller, please.

Okay, Madam Chair. No further comments in queue at this time.

Thank you very much. This is the time we'll bring it back to the Committee for Senator Roth, followed by Senator Glazer.

Thank you. Thank you, Madam Chair. Thank the author. I'm very impressed with your presentation and your thoughtful analysis in the way that you've structured your bill. It's a difficult bill. Obviously, there's a lot of opposition and of course, I think all of us up here are reticent to cause a disruption in the marketplace.

I'm pleased that you provided an on-ramp to allow the supply chain to even out and the shelves to take care of themselves before as the alternative formulas are developed, an alternative product is put out in the marketplace, and it seems to me that at least with four out of the five food chemicals, that sufficient safety issues have been identified by these various issues, even though they're various studies, even though they're conflicts, to justify requiring the ban and the utilization of alternative food chemicals in these various products. So, obviously, I'm going to support the bill, as I indicated to you previously.

As the bill moves forward, however, to the extent it moves to some other Committee besides this one, with the fifth food chemical, this titanium dioxide, in looking at it again, it appears, obviously, that there's this European study but there are other studies, at least one or more, that seem to provide a conflicting opinion as to whether titanium oxide causes the problem that the Europeans believe that it does.

And while we have no control over the Federal Food and Drug Administration at all, we do have a California Department of Public Health. And so as the bill moves out of this Committee, perhaps you would consider asking the CDPH to take a look at titanium dioxide and the studies that exist and provide us, as a Legislature, some idea as to whether there is sufficient cause to believe that despite the conflict in the studies, that there is a danger with the continued use of titanium dioxide.

Your option, just a suggestion as we move forward. I will be supporting your bill, and thank you for the effort.

Thank you very much.

Thank you, Senator Roth. Senator Glazer, and then Senator Grove.

Thank you. I appreciate the thoughtfulness in the bill and the challenge that we have, though, of trying to ask, you know, we're not experts. Conflicting studies. There's always the politics of these choices that we face. We always have a bill or two every year that says, 'This is a bad chemical. Ban it.' And then the dilemma of reviewing the studies, understanding we have processes for some of these to have them examined more objectively.

All that gets me to my question that I wanted to ask the author and perhaps the opponents, which is that, all things being equal, if there is an alternative, then that gets me to the place of, 'well, I'm not making a political choice. There's an alternative.' So I wanted to ask the author to speak to this issue of suitable substitutes. I thought I heard the testimony from Mr. Kellison a moment ago that said there are none and I wanted to give you a chance to speak to that and perhaps have him come up and defend his point as well.

Yeah, thank you very much, Senator, and I think what I understood from the opposition, and they can correct me if I'm wrong, is that they were saying that there's no suitable alternative for one of the chemicals for titanium dioxide. I think we'd respectfully suggest that that's not the case. There's a number of substitutes on the market. Calcium carbonate can be used as a substitute. There's a number of manufacturers that have developed proprietary blends as a substitute, and the other thing that I think maybe is helpful to understand or take a step back and understand what titanium dioxide does.

So it scatters light to create very vibrant white. So I would be willing to bet a lot of money that there is titanium dioxide in the paint on these walls. It's often found in paint because it creates vibrant colors, and the manufacturers are using it to create vibrant colors in their products.

And what we have found is that actually one of the substitutes for titanium dioxide, and I don't mean this goodly, is food. So I'll give you an example. Dunkin' Donuts was putting titanium dioxide, mixing it in with the powdered sugar on their powdered sugar donuts, to make them more vibrant. Because of health concerns, they simply removed the titanium dioxide. They still have powdered sugar donuts. They still sell a lot of them. There's been no disruption to the market.

Papa John's Pizza was mixing titanium dioxide in on their cheese pizzas to make it a little more vibrant, to make the cheese look better. They realized that actually, you can just use cheese. You can still sell a lot of pizzas, and you don't need the ingredients. So I would actually push back on the suggestion that there are no substitutes out there in three ways. One, we know there are: calcium carbonate and the proprietary blends and others.

Two, you've seen companies just successfully transition to food ingredients as substitutes, and three, we don't have to guess for each of these companies, and none of these companies will actually have to guess about what alternative they might use because they are already using alternative recipes in Europe. Right? So Skittles already knows what the alternative recipe is.

All of these candy companies that are manufacturing products here in the United States and here in Europe, they already know what the alternative is because they're using it, and they have contracts to use it, and they have supply chains to use it, and they're using it in the products in Europe, and nothing that I'm aware of has come off the shelves as a result of that ban.

Thank you. And through the Chair, could we ask the opposition to come and defend their claim?

Mr. Kellison, do you feel defendable?

As I said in my opening statement, I do lack technical expertise, given the last minute notice here. My understanding is that for this product, there is approval for limited use, not widespread use, and as far as frozen pizza goes, as has been conveyed to me, that is typically an American product rather than an EU product, and that is the extent of my information.

Thank you.

Thank you.

Did you want to hear from the proponent at all?

No, I think the author gave a very compelling statement, and I think it was pretty convincing to me. I do think we--you know, no one wants to do these things haphazardly, and I think we take the right of the marketplace to kind of do their thing with some appreciation for that challenge, but if there are alternatives, for me at least, this doesn't become the dramatic decision that it might have been at first blush, that this is a much more narrow in scope, this bill, with alternatives that seem to not be as scary as one might have thought from the start anyway. Thank you.

Thank you, Senator Grove.

Thank you. Thank you, Madam Chair. First, I'd like to thank you for spending time with me. You absolutely have your facts together around this bill, and you spent a lot of time on it, and I heard your personal story of what that purpose was. I agree with my colleagues that spoke. I believe it's a battle of the experts. I'm not an expert. I don't think anybody on the dais is in this field, so I think it is a battle of the experts.

One of the compelling statements that you made to me is that red dye No. 3 has been removed from a cosmetics, but still allowed in our food. So why--can you give me the explanation you gave me when we had a conversation on the phone why the FDA has removed red dye No. 3 from cosmetics, but not from our food?

I think there was some indication when they removed it from cosmetics that they were going to take action to remove it from food, which they should be required to do under federal law with the Delaney Clause, but they never got around to doing it, and I think that's one of the frustrations here. The opposition is saying, 'well, let the FDA take care of this,' but we've been waiting for 33 years for them to remove it from food, and they have not gotten around to it.

And very recently, as noted in page four of the analysis, FDA leadership actually put out a statement saying that they want to do better in the food safety area but to do that, they would need more personnel, more funding, and more legal authority from Congress, but they don't actually have all of the legal authority they need right now to do the best job in protecting us in food safety. So I think you'd have to ask the FDA why they haven't done that, but the facts are there. It's very clear, it's undisputed that it was removed from cosmetics in 1990 and they have not removed it from our food supply.

Thank you. And with the other one, the titanium dioxide, that one that is brought up, and you said it's just like an enhancer for white color. It's the color white. So I'm just curious again, and this is kind of a silly question, what's milk going to look like? Because it's in milk. So, like, what's milk going to look like? Is it going to look yellow? Are we going to have to educate the public? I'm just curious.

I bet if we asked our parents and grandparents, they tell us that milk probably looked fine and they were able to drink it and everybody did fine before they put titanium dioxide in it.

Yeah, I know it's a silly question, but I was just curious about--I don't know. That's why I asked. The other thing that I have about that particular titanium dioxide is that it's my understanding that there's not a replacement for that for Pepsi, correct?

Pepsi and sodas.

Pepsi and sodas?

Beverages, is that correct?

The soda one was BVO is the chemical that's most relevant. Brominated vegetable oil, and so Coke and Pepsi and Gatorade, all the major brands stopped using BVO a number of years ago, and that's the one that the FDA has now indicated that actually we're right and that they're thinking that they're going to get around to banning it. Again, they've been making noise about banning BVO for several decades now. So the industry has already moved. It's mostly now in a number of store bought brands.

It's an emulsifier in citrus beverages. You might find it in Sprite or something like that to keep the flavor from all going to the top. You know, all of these companies: Coke, Pepsi, Gatorade figured out how to make their products without BVO, and so it's mostly in these off brands that are still out there, and, you know, again, I think Coke is doing fine. Pepsi is doing fine. All of these major companies are doing fine without using BVO.

And just on a short comment, the reason why I asked you about that titanium dioxide is because on a quick Google search after I heard that Pepsi and Coke said there was not a replacement for it, on a quick Google search in 2014, it says Pepsi and Coke insist they are not using titanium dioxide in SoBe or Powerade drinks. So I don't know. Again, that data, it's a battle of the experts, I guess you would say. I thank you.

I do, I thank you. I think the headline is going to be that California is banning Skittles. I thank my colleague from Santa Barbara for bringing Skittles from the European Union. I do have a huge concern with the fact that if we do this here in California, just like if we mandate certain vehicles or whatever we mandate here in California, being a large market, the rest of the nation's going to have to follow suit. So goes California, so goes the nation because I don't think manufacturers are going to produce one product for California and one product for the rest of the nation.

As I shared with you, I got nine grandkids--ten is due anytime now, right? So I got nine grandkids, and the tenth one is on the way, and I have concerns about this, and I have concerns about red dye No. 3, specifically after what you told me about not having it--having it being banned in makeup. And I looked that up, and you're telling the truth. It was banned by the FDA.

It doesn't serve to lie up on there when you're presenting.

Well, you know, I've been in the building since 2010. I did look that up, and you're right. The FDA did say that you couldn't use that in makeup, and so if you can't put it on your face, why can you ingest it? There is a very strong oppose on the analysis. I'm going to lay off the bill because I don't want to vote no on it, but I am concerned about overriding the FDA.

I do have that concern as far as I think the federal government has a place. The state government has a place, but I want you to know you make a very compelling argument, and being one of the most conservative Members in this body, you have me this close to a yes, and you have your facts and your data down. I mean, I checked it and you're right.

Well, I appreciate the thoughtful consideration and really grateful for you for making time to have a conversation. I will confess, this is, as I mentioned, not an area that I normally legislate in. You probably haven't seen me in Health Committee often. I was a little hesitant to wade into this, but when the proponents came to me and I started to do my own research here, and come into perspective really as a parent, right, as a parent of three young kids, and it kind of blew my mind, what I discovered, right?

And these things, I mean, again, it doesn't take someone with a PhD in neuroscience to say, 'Wait a minute, it's banned in cosmetics. You can't put it on your face, but you can ingest it.' These things that just don't make any sense and I think it's just, as Governor Schwarzenegger said, 'This is not partisan. This is just some common sense.'

There was a comment made by the proponents. I think the lady who had come up, she said that a lot of the food additives are approved by the food companies themselves instead of the FDA and, you know, when I looked up the Pepsi thing, what was interesting to me is that it's still allowed by the FDA. This titanium dioxide is still allowed by the FDA, but yet the largest Pepsi-Cola and Coke have removed it from their products because they feel it's hazardous. So, again, validating your point. So thank you. Sorry.

That's a lot of validation for that. A lot of validation for not voting. Senator Nguyen. No validates.

Thank you.

I don't even think that's funny.

Assembly Member, my colleague from Riverside, I agree with him. I think going back to the titanium dioxide, I mean, FDA has generally recognized it as being safe, and so, you know, as mentioned, we are not experts up here, and I hope that you would consider moving forward, is asking the California Department of Public Health to look at that because it is the battle of the experts.

One says it's safe, one says it isn't, but generally everything with food and drug in the United States, we look to the FDA, and so I do have concerns that if this is not--is it safe or is it not safe because I remember way back when they started talking about MSG in the Asian culture, at least the Vietnamese community, they use a lot of MSGs back then, but when it came out that it could cause cancer and everything, it just went away and they looked for other alternatives for the Vietnamese food and so it's very rare you get any MSG in Vietnamese food these days.

If they do, they would disclose it at that restaurant that, 'hey, we do have some MSG.' So I think, though, that's the confusion. Maybe the Pepsi or the Coca-Cola, maybe it's not maybe sodas but they do have other product. They have actually a lot of products, not just sodas. Maybe it's in the orange juice or something. I don't know.

So I think that, you know, if you go forward, it's really helpful to get some of these where we can get our own Department for Public Health to give us their expertise on it because they have experts to look at it.

Yeah. Thank you. No, I think that's an interesting idea, and I appreciate it. I think one thing just to add on the titanium dioxide that Dr. Jackson explained to me as we were talking about this before, nobody thinks it's safe. It's just a question of how unsafe is it, right, and where do you draw the line and do we believe it's really unsafe or really, really unsafe?

And as a parent, knowing, I think, to Senator Glazer's point that there are all these alternatives out there, I'd rather have my kid--it doesn't sit well with me, the notion that kids in Italy and France and Bulgaria and Romania and Sweden and Finland and all these other countries are more protected than my kids are, and so ultimately, I would like knowing that there's alternative, knowing that there's no harm to the industry. I think we'd be better off doing everything we can to protect kids and families.

Thank you, Assembly Member, and I will also say we were prepared to really take some blows to this bill and then we met with you, and you are very compelling, and I know you really do have all your facts and everything in a row and so we do have a do pass. I will say that I had a major processor in my district come forward on the titanium dioxide also.

So I'd also just like to tag on with Senator Roth about checking in with Public Health a little bit just to see. You know, I don't like bans, but I also don't think food should be bright and shiny. So would you like to close?

Just really want to thank you all for the engagement, for the opportunity to have a conversation, and would respectfully request an aye vote.

Thank you very much. Do we have a motion? Senator Limon moves the bill. Secretary, if you'd call the roll, and it is 'do pass as amended and re-refer to the Committee on Environmental Quality.'

Senators Eggman? Aye. Eggman, aye. Nguyen? Glazer? Aye. Glazer, aye. Gonzalez? Grove? Hurtado? Limon? Aye. Limon, aye. Menjivar? Aye. Menjivar, aye. Roth? Aye. Roth, aye. Rubio? Wahab? Aye. Wahab, aye. Wiener? Aye. Wiener, aye.

Those seven votes; we'll hold the roll open. Assembly Member Bryan. Senator Grove, which county has the most dairy in the State of California?

Tulare County, ma'am.

Where do you represent?

Tulare County.

What color is that milk when it comes out of those cows?

White.

Okay. All right. Assembly Member Bryan, you are recognized.

I'd like to inform the Chair there is a workplace conduct unit where Senators--when we feel offended.

Giving your district props.

Well, thank you, Madam Chair and colleagues, I have a bright and shiny Bill for you today. I'm here to present AB 424, a Bill that would direct the California Department of Public Health to establish a registry for people with ALS or Lou Gehrig's disease in the State of California. Current law requires CDPH to establish and maintain a registry for Parkinson's disease and allows the Department discretion to expand the registry to other diseases such as ALS, but it does not require it.

The average life expectancy for somebody who is diagnosed with ALS is 2 to 5 years. A recent study showed that the prevalence of ALS is expected to grow by 69% by 2040. Yet there's still a severe lack of information, research, treatment and investment. We don't know why this disease is more prevalent in men. We don't know why this disease impacts our veterans at a significantly disproportionate rate. We don't know where folks who are disproportionately impacted by this disease are in California.

We can't make the meaningful investments that we need to in research and resources and cures/treatments. This Bill left the Assembly floor with all 80 votes. So I won't waste too much more of your time and respectfully ask for an aye votete.

Thank you very much. First person. Speaking in support, Mr. Noteworth.

Thank you, Madam Chair. Members. My name is Fred Notewear and I represent the Golden West chapter of the ALS Association and we're the sponsors of the Bill introduced by Mr. Brian and. The Bill makes certain that the California Department of Public Health will add ALS into their existing California Neuro Disease Registry program. The ALS registry will allow us to fully understand where Californians with ALS reside so that no person is left behind.

We're hopeful the registry will identify these patients living in underresourced areas, for example, so we can bring care to them. Risk factors remain confounding and it is unclear if or when there may be ALS hotspots in our state that could provide critical clues and understanding of the mysteries behind the disease. It is thought that unlocking ALS will also help the science behind other neurodegenerative diseases like Parkinson's and Alzheimer's.

As the author said, sadly, most people with ALS die within 2 to 5 years of diagnosis and there is a compelling reason to underscore the urgency attached to bringing an ALS registry online. With the largest ALS population in the country, it is our hope to confirm and prioritize a California ALS registry. And I think the good news here is that there's a tremendous amount of support in this building and the Administration for people who have this disease. It's horrible. So we respectfully urge you right about and thank you so much.

Thank you very much. Others speaking in support now it's the time just to come forward with name and affiliation. Seeing none. Anybody speaking in opposition to this Bill today? Seeing none. We'll go to the phone lines. Any callers on the line at this time?

We have no callers in queue.

Okay, now it's time to bring it back to Committee. And I'll just say I'm very supportive of this Bill. ALS is a terrible disease. I just lost a friend last week with ALS male, active. And as we all know, we lost a dear Capitol community friend last year. Also very fit, young, active. It's a tragedy and we need to find out more. Senator Grove.

Thank you, Madam Chair. I want to thank the author for bringing this forward. I think it's an excellent Bill and I echo my colleagues comments about the Capitol person that we lost last year, the Capitol Member of our family. We've lost people in my district and it happens very quickly. Very quickly. I have a very strong rancher friend. He's no longer with us but. I.

Think it was in January we saw him and he looked just normal like he's lifting 100 pound bells of hay. And then we saw him in June. He was in a wheelchair and could hardly move and feed himself and it's a very sad disease and he was a United States military veteran. So thank you for bringing this Bill forward. I appreciate it and I'd move the Bill when appropriate.

Thank you.

Senator Glazer yeah thank you Chair and I appreciate the testimony on this and personalizing it. There's some real meaning in doing that and I'll recognize in my support today Tim Davis who was a former staffer here in the Capitol, longtime staffer who passed away from this. And I'm happy to invoke his name in support of this Bill.

Cliff Blake Bailey would you like to close? Assembly Member.

Yeah. No I think you are all channeling the spirit of what we're trying to do here. I want to bring up my co authors on this measure, Assembly Member Rick Zabur and Assembly Member Diane Dixon bipartisan coalition much like those of you up here. Last weekend I spent it with my cousin Chris. Chris was an EMT at 30 years old working late night shifts when he was diagnosed with ALS. He's coming up on his fifth year. He is needing full time care at this point.

He speaks with his eyes. When I got to the Legislature I thought, zero we've got 100 billion dollar surplus. We need to do something for folks with ALS. How do we make the meaningful investments that we need to make? And I found out very quickly that we are so far behind that we don't even have a registry to help us decide and think through critically using data and evidence where and how to make the investments we need to make.

And that is unfortunate because we won't always have the surpluses of yesteryear. And so starting here at the foundation it gives us something we can all build on and we can build on it together. Again, I respectfully ask for your aye vote.

Senators Eggman. Aye. Eggman? Aye. Min? Aye. Min. Aye Glazer? Aye. Glazer Aye Gonzalez. Grove. Grove. Aye Hurtado Limon. Menjivar. Aye. Menjivar Aye Roth. Aye. Roth? Aye. Rubio? Wahab. Wahab. Aye Weiner. Aye. Weiner?

Thank you very much. I was able to help get a couple million last year for an ALS site in Sacramento because there's only one in San Francisco, in LA and not one at UC Davis. So we got a satellite hooked up. Okay. We have a motion by Senator Grove secretary if you could call the role motion by Senator Grove and that is to pass and refer to the Committee on Appropriations.

Aye. Thank you. We'll hold that roll open for absolute Members. Thank you. Ms. Schiavo, now on AB 464, enjoying a do pass and re refer to the Committee on Transportation having to do with records.

Thank you. And I have to say, you have such a pleasant voice as the chair, this is the first time I've been in the Committee. So thank you so much. Madam Chair and Members, I am very happy to present AB 6464. And you may not know, but I co founded an organization addressing homelessness in the San Fernando Valley.

And what became now has the largest homeless outreach program in the West Valley, where I personally did a lot of outreach to encampments myself every Sunday for over a year. And the number one thing that people asked for after housing and food was an ID, was vital records, things that they needed to be able to get on their feet. And so AB 464 really is to address that need.

And given the burdens of living in such unstable circumstances, it can be really challenging to recover vital documents such as personal identification, driver's licenses and other paperwork when an individual is seeking employment, applying for services, or applying for rental. Housing identification documents of this sort are, in most cases a requirement. Estimates are more than 150,000 Californians are homeless, with 72% of those unsheltered and with the highest unsheltered population in the state.

AB 464 will reduce administrative barriers for low income individuals seeking employment, housing, health care and more. And it does so by exempting individuals, based on their qualifications for certain public assistance, from having to pay any fee otherwise required for copies of vital records or for a California State ID or driver's license and driver's license renewal.

Additionally, beginning on July 1, 2027, AB 464 exempts a person who is experiencing homelessness from paying a fee for a driver's license and would require the determinations of eligibility to be made by a governmental or nonprofit entity. Happy to share that this Bill has received bipartisan support on the Assembly side. And also, hopefully, we'll get the same here and looking forward to working together to make sure that we can help folks have the tools that they need to get on their feet.

Thank you very much. Okay, anybody speaking in support of this Bill today, time to come forward.

David Bologna for 20 in support. Thank you. Thank you very much. David. Kim Lewis, representing a Spiranet in the California Coalition for Youth and Support.