Assembly Standing Committee on Health

Good afternoon. We're going to go ahead and get started with our hearing this afternoon. I was going to do it amended earlier, but I was reminded by my chief secretary that that would be a bad idea. So it's now 1:30, and we can actually officially begin. But before we begin, I'd like to make a statement regarding testimony, providing testimony at this hearing.

We seek to protect the rights of all who participate in legislative process so we can have an effective deliberation on the critical issues facing California. All witnesses will be testifying in person. We will allow two main witnesses for a maximum of three minutes each. Additional testimony will also be in person and limited to name, position and organization. If you represent one, all testimony comments are limited to the Bill at hand. Today we have one item as vote only.

Today we're voting on SB 326 for an amendment to the bill to add an urgency clause only. There will be no testimony taken. The Bill will be set for a full policy hearing in August, and that's when we will take testimony on the bill. We have a consent calendar day today. The following bills are proposed for consent for today's hearing, any Member of the Committee may remove a bill from consent. The bills proposed for consent are as follows item number eight, SB 10 by Senator Cortese.

Item number nine, SB 282 by Senator Eggman. Item number 10, SB 819 by Senator Eggman. Item number 15, SB 595 by Senator Roth. And item number 16, SB 67 by Senator Seyarto. So we do have a special order of business today. We're going to start with Senator Menjivar, who's going to present SB 635. And whenever you're ready, Senator, you and your witnesses come on up.

I will note that we do not have a quorum, so we'll be operating as a Subcommittee, and we're hopeful we get a quorum very soon. Hint hint. Members of the Committee, please come on down. Thank you, Senator. I believe we have someone who's going to be providing sign translation. Thank you. Okay, we are going to go ahead and get started. If she wants to come inside, you can come inside there. Okay, that's fine. Yeah. Okay. Thank you, Senator. You bet.

Thank you, Dr. Wood, Mr. Chair, Assembly Members. First, I want to take the time to thank the Committee staff for their work with my team on this Bill. I ask that the Committee adopt my author amendments, as stated in the Committee analysis on page eight, to delay the implementation to January 1, 2025. Currently, under California's Newborn Hearing Screening Program, hospitals are required to screen newborns for hearing loss once the child has been identified as deaf or hard of hearing.

However, there seems to exist a lack of access to essential hearing aids. You heard that right. As a new parent, you are told that your child is hard of hearing and left to scramble to figure out how to address this unique need. SB 635 the Let California Kids Hear Act three would improve access to hearing AIDS for youth.

Specifically, this Bill would require all private health insurance plans issued, amended, or renewed on or after January 1, 2025, to recover hearing aids and services for individuals under 21 years old. This will allow families to stay within their local networks by using their health insurance plans to access local providers. Because we're seeing numerous experts agree that pediatric hearing loss is a developmental emergency, requiring timely intervention to prevent permanent delays. Now, you may be asking why, if this is a developmental emergency, why hasn't something been done?

Well, previous legislation was attempted to rectify the situation, but instead, it was put aside to attempt to fix through DHCS. Fine. However, the Hearing Aid Coverage of Children program launched by the Department of Healthcare Services on July 1, 2021, has only provided hearing aids to 225 of the 7000 eligible children in the State of California. California is seeing only one in 10 families having some sort of coverage.

Additionally, few pediatric providers are participating in the program due to the historically low reimbursement rates and high administrative burdens, creating poor geographic coverage, segmented care and barriers that are difficult to overcome. That program is not working, so we must reroute through the legislative process. Over 30 states will or currently require, in the beginning of 2024, coverage for children hearing aids through commercial plans or the state exchange.

The State of Georgia was also in our situation, where they attempted the same way that we initially did, but they rerouted because it also wasn't working in their state. We should follow suit in ensuring that children are able to access hearing AIDS at an early stage in life. The lack of comprehensive coverage means care can be unaffordable and leave children without access to hearing aids and services that support their development.

Should a family decide to go with hearing aids, the Centers for Disease Control and Prevention show that outcomes are greater the earlier a child begins using hearing aids. Here with me today to testify Mr. Chair, with your permission, I'd like to turn to two of my witnesses. Michelle, a co chair and co founder of Let California, is kids here. And Dr. Daniela Carvalho with Rady Children's Hospital.

Please go ahead.

Hi, my name is Michelle Marciniak, and I'm the mom of a hard of hearing child and co founder of Let California Kids Hear and a co sponsor with Children Now of SB 635. Thank you to the 50 organizations who signed on and all the parents here today representing deaf and hard of hearing families in California.

Thank you, Senator Menjivar, Senator Portantino, Assembly Member Dr. Arambula, for their extraordinary leadership and the leaders committed to addressing this pediatric health equity issue that will enable children to hear and connect with their world. A prior version of the Bill in 2019 had unanimous approval in the Legislature, but was not signed into law. Instead, the Newsom Administration created the hearing aid coverage for Children program. Two years later, with 32 million budgeted, 225 of the estimated 7000 children in need have benefited.

There are no providers in Sacramento or Central Coast, and only one provider in Los Angeles. Kaiser, our largest health plan, does not participate in any state sponsored hearing aid programs and farms them out into the community. The State of Georgia ran a similar program. It failed, they course corrected, and they passed a mandate. We are asking for your renewed support to adopt the original solution a pediatric mandate to address the developmental emergency that has been unfolding for years in California.

The story that haunts me most is from a center director in Los Angeles about children showing up at the age of five, unable to say their name because they've never had access to sound. This shouldn't be happening in California. Here in California, only one in 10 health plans cover hearing aids. The health plans have yet to address this market failure dating back to the start of newborn hearing screening in 1998. There have been multiple attempts over the years.

When there is a market failure, especially involving children, leaders are called to step in and regulate. Now 32 states require health plans to cover hearing aids through the commercial mandate and or the state exchange to address what experts consider a developmental emergency. The misconception that a child's hearing aid requirement would violate federal age discrimination law does not hold and has been confirmed by HHS socio. By federal law, states have the flexibility to exceed the essential health benefits.

While there's potential for defray costs to include some of the most vulnerable children in the exchange, the current estimate is less than the annual cost of the HACCP program that's failing. These costs are not only devastating to the child and the family, they're costly to society. Over 30 years ago, the CDC estimated that the cost for every child that doesn't get early intervention is $1 million in special education, other medical complications, and unemployment.

Further, the state spends 400 million a year educating 16,000 deaf and hard of hearing children. The absence of an effective solution costing taxpayers hundreds of millions of dollars by failing to provide early intervention. The Bill is a better deployment of state resources supporting access to local pediatric providers in their medical home and will help 8000 children. Marie was supposed to say this today, and she was feeling a little sad that it's been taking so long, so I'm going to share her words.

This isn't a drill, it's an emergency. California's children and families have been waiting for years, and they can't wait any longer. Please let California kids hear.

Please, go ahead.

My name is Daniela Carvalho, pediatric otolaryngologist at Rady's Children's Hospital in San Diego and a Professor at the University of California in San Diego. I wanted to thank the Members of this Committee and thank the amazing leaders that are bringing forward SB 635. I'm here as a pediatric hearing loss specialist to explain to you why you need to support this Bill. By the end of my three minutes I hope you understand again that the pediatric hearing loss is a developmental emergency.

Our brains need sound stimulation early on to be able to create pathways that will develop spoken language, comprehension and speech. For this reason, 2007, the Joint Committee on Infant Hearing came out with a recommendation of the 136 model, screening children for hearing loss by one month of age, diagnosing hearing loss by three months, and treating them by six months of age. California does a wonderful job in diagnosing and screening children with hearing loss, but we fail miserably when it comes to treating them.

Unfortunately, the HACCP has not turned out to be the solution these children need. And there are still more than 7000 children in our state without hearing aids. These children without access to hearing aids will have significant delays in speech, academic delays and problems with social interaction and will likely be added to the already massive number of children with mental health problems in our state. Children with untreated hearing loss and with lack of language have a higher incidence of depression and suicidal ideation.

And the problem is that it takes years of speech therapy and special education to help children who do not have appropriate access to sounds and language. And most of the time the delays will continue despite all these interventions. You have no idea how disheartening it is to see a family in our clinic who finds out that they cannot provide their child with a hearing aid despite having insurance, as they know the devastating effects that this might have on their child's life.

We're keeping children with hearing loss in California hostage to greed. It is time that we do something for them. We can and we have to do better. The clock is ticking and it's unfortunately not in our kids' favor. It is time to let California kids hear. Thank you.

Thank you very much. Others in support, please come forward if you'd like, just your name and organization if you represent one.

Good afternoon, Chair and Members. Serette Kaminski with the Association of California School Administrators in support. Thank you.

Thank you.

Good afternoon. Sandra Poole. Western Center for Law and Poverty in support.

Thank you.

Vaneska Henon on behalf of the Nurse Family Partnership and Child First in support.

Thank you.

Tiffany Mok, CFT in support. Thank you.

Thank you.

Rebecca Gonzalez, National Association of Social Workers, California Chapter in support.

Thank you.

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

Thank you.

Good afternoon, Chairman and Members. Nick Brokaw here on behalf of the California Academy of Ideology in support, thank you.

Nancy Sager. I am the recently retired as the California Department of Education deaf and hard of hearing programs consultant. I represent California Hands & Voices, we support.

Thank you.

Dr. Christina Russo, I'm a pediatric audiologist at the USC Caruso Family Center for Childhood Communication in Los Angeles. We serve over 10 counties in California, and please let California kids hear. Thank you.

Thank you.

Brandon Marchy with the California Medical Association in support.

Thank you.

Samaya Nahara with the California Children's Specialty Care Coalition in support.

Thank you.

Hello. My name is Dr. Erin Noakes. I'm a pediatric and educational audiologist and also the parent of a deaf child who's starting college this fall at CSU Northridge. In part from early access to hearing aids and technology. I am in support. Thank you.

Thank you.

My name is Johanna Wonderley. I'm a military spouse who only has coverage when my husband's on active duty orders. I'm from Placer County, and I have four children who are hard of hearing, and I'm here in support.

Thank you.

Good afternoon, Chair and Members. Kathleen Soriano, on behalf of the Keck School of Medicine of the University of Southern California, pleased to support this Bill. Thank you.

Thank you.

Desiree Cruz on behalf of SELPA Administrators Association of California in support.

Thank you.

Alex Smith, Lodi, California. A mom of a son who's hard of hearing. He needs it to thrive in his safety and accessibility and to develop. I support.

Thank you.

Hello. My name is Tim Schuler from Lodi. I'm here in support of SB 635. This Bill means a whole lot to our family. Please let California kids hear. Thank you.

Hi. My name is Avery Schuler. Hi, my name is Avery Schuler, and I think kids in California should have hearing aids.

Thank you.

Hello. My name is Elijah Schuler. I'm from Lodi, California, and let California kids hear.

Thank you.

Hi, my name is Caprice Schuler. I'm from Lodi, California. I'm a parent of a heart of hearing kid that the DHS program did not work for us. So we're asking to please let California kids hear.

Thank you.

I'm Shelley Simas, I'm Avery Schuler's grandma who's been wearing hearing aids since she was two months old, and I'm here in support of this Bill.

Thank you.

I'm Chris, I'm the grandfather. I support the Bill. Thank you.

I'm Vicki Schuler, I'm from Petaluma, and my granddaughter is Avery Schuler, and I'm here to support the Bill. Please let California kids hear.

Thank you.

Hi. My name is Delaney Harrington Dummett. I'm a native Californian and local hard of hearing adult. I am also a graduate student at UC Davis, getting my doctorate and working in foster youth education. And I encourage you to let children who are like me be able to hear in this state. Thank you.

Thank you.

Good afternoon. Cherise Burns the Speech Language Pathology Audiology and Hearing Aid Dispenser Board's Assistant Executive Officer. We are sorry we missed the deadline for the support letters, but we support we're happy to support this and our licensees stand ready to support the children of California and this developmental emergency. Thank you.

Thank you.

Chair and Members, Kathleen Mossburg with the First 5 Association of California in support.

Thank you.

Hi, I'm Ellen Dietrich. I'm a mother of two deaf daughters and as you can see behind me, they'll say how well they've gotten the early intervention. They had two months and two weeks. They had hearing aids on. And I'm from Newport Beach.

Thank you.

Hi, I'm Maggie Dietrich, and since I had early intervention, it allowed me to have opportunities that I have to go to school and meet new friends. And I would love if the kids would have the same opportunities I had. So I support.

Thank you.

Hi, my name is Kate Dietrich and I was aided at two and a half weeks and because of that, I was able to have a lot of open opportunities. And so I hope that you help California kids hear.

Thank you.

Hi. My name is Kasey Cain. I am a mom of a deaf and hard of hearing child. I'm also the President of California Hands and Voices. We are here in support. I'm also an audiology student, so I am really pleased to support this all in and my children have something to say. Let kids hear. Let kids hear. Thank you.

Thank you.

Hi, I'm Brooke Phillips. I'm a pediatric audiologist in California for Let California Kids Hear. We've been fighting this battle for 25 years, so it's time to let California kids hear.

Thank you.

Hi. My name is Chloe. I'm eight years old. I'm hard of hearing. Let California kids hear.

Thank you.

Hi, my name is Sophie. I'm 11 and I'm deaf. Let California kids here.

Thank you.

Hi. My name is Kimmy Nguyen. I am a deaf single mother and you just met my two girls right now. Let California kids hear. Thank you.

Thank you.

Nora Lynn, with Children Now in support.

Thank you.

David Bolland, happy to support this Bill that is making the 20th Senate District very proud.

Thank you.

Nicole Pearson. In support of this Bill.

Thank you.

Hi, I'm Holly Gill, a para educator in special education and a grandmother of a hard of hearing child. Let California kids here.

Thank you.

Hi there. I'm Christina James, Rockland, California. I'm a mom to a six year old hard of hearing child who's here with me today. I'm also a former CBS 13 News anchor. So proud of this Bill and all that we're doing for our children. So please, let California kids hear. Thank you.

Thank you.

Hi, I'm Nikki Feinstein. I'm mom to Emory Feinstein here, who's a six year old hard of hearing little girl. Please let California kids hear.

Thank you.

I'm Emory Feinstein. Please let California kids hear. They need it.

Hi, I'm Raya Feinstein. I'm Emory Feinstein's big sister. And I think that California kids should hear.

Thank you.

Hello. My name is Courtney Hipskin. I am deaf, and I'm also a teacher of the deaf. And I've been using hearing aids since I was three months old, and it helped me tremendously. Please let California kids hear. Thank you.

Hey, I'm Zandy Feinstein, Emory Feinstein's dad. I support SB 635 and want California kids to hear.

Thank you.

Thank you.

Hello. My name is Robert Schuler from Petaluma, California. I'm grandfather of Avery Schuler, and I'm hoping that folks could help us let California Kids hear.

Thank you.

Hi, I'm Bethany Fletcher. I'm a public school teacher from Roseville, California. I'm a hard of hearing adult, and my son is a hard of hearing son. Obviously, we're asking for your support. Thank you.

Mr. Chair and Members. Brian Howe with the California Faculty Association. We don't have an official support position on it, but I will be recommending a support. I actually worked in this Bill as a young Senator Jack Scott Stafford, back in 2004. We were the first author to carry this Bill. So the fact that we're still trying, this is a travesty. I really hope this is a year that we get this through. Thank you so much.

Thank you.

Thank you.

Hello. Allie Snyder, mother. I support the Bill.

Thank you.

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

Thank you.

Mrs. G, a mother of three in support of the Bill. Thank you.

Thank you.

Nicole Young, mother of six. I support this Bill.

Thank you. Thank you very much. To all the witnesses in support. Is there opposition to the Bill? No one. We'll bring it back to the Committee. Questions or comments, anyone? Dr. Weber?

Good afternoon, Senator. Thank you very much for carrying this very important Bill. I want to give a special shout out to my colleague at Rady Children's, Dr. Carvalho, and I would just love at the appropriate time to be added as a co author. Thank you.

Thank you, Dr. Rubber. Absolutely.

Anyone else? Okay, so first I want to say thank you, Senator Menjivar, for bringing the Bill forward in my time as chair going back to 2016. This is now the fourth attempt. And the previous three times, I think we had unanimous support on this. And it always got hung in the first two times. Got hung up in Appropriations, once in the Assembly, once in the Senate.

And then, as you pointed out, in 2019, Assembly Member Bloom, who was the champion in all three of those cases, there was a deal struck with the Administration. And it appears that well, that it's not working. And so I applaud you for bringing this forward again, letting us have this policy discussion, letting us take a vote on this. And I fully support what you're doing. I supported this all along and want to see this get done.

So we don't have a quorum, so we can't make a motion on this. And I know that's probably confusing to the audience. We have 15 Members. We have to have eight here so that we can officially take and make a motion and a vote. And I apologize that we don't have that. So you could actually see that in play.

But I am very confident that when we have a quorum that this will get a very high threshold vote and hopefully a unanimous vote to move on to Assembly appropriations. I too would like to be added as a co author, if you'll have me.

Absolutely. Thank you so much.

With that, would you like to close?

Assembly Members, we can all agree that this current program is not working. I think usually I say third is the lucky number, but I'll take fourth as the lucky number at this time and I can feel that we'll get it all the way. I just want to give a great thank you as well to the witnesses and everybody who came out and voiced your support. With that, when appropriate, respectfully ask for an aye vote.

Thank you very much, Senator. Actually it's more like the 8th time, fourth in my tenure, but this is eight times. I'm shocked. And Mr. Ha, who had worked on this, goes back away. So we are one, two, three. We're one short of quorum. Gosh. It'd be really nice if another Assembly Member could make their way down here and we could get a quorum. But with that we will go ahead and move on to the next.

Thank you, Mr. Chair.

Thank you very much to the witnesses for coming and all the support.

Thank you. Thank you. Thank you.

Let you go. You got three more bills. It's like you're going to be here.

I'll be here for a little while, strap in.

Get comfortable. You got some water? You okay? All right. You need to refill, you just let us know. Okay? So. Item number two SB 11.

Perfect. May I proceed?

Absolutely.

Again, thank you so much Committee staff, Mr. Chair, for working with my team on this. I will be accepting the Committee's technical amendment to this Bill. We've all heard since the pandemic that our mental health illnesses have increased. The need for mental health services has increased. In 2021 there was a declaration of emergency with youth mental health in the cases we were seeing with anxiety, depression and so forth. My background is in social work.

I understand firsthand the need to better to remove barriers to mental health. Also, as a social worker, I recognize the hardship of going through becoming a social worker. Two years of unpaid work is a lot to ask for. And every single day here in my short seven months, in conversations we have, we talk about the workforce shortage. We talk about the need to put social workers everywhere in our Ers, in our community clinics, in our hospitals, in our schools.

But we're still having a bottleneck of that workforce. So my Bill is not to say it's going to solve the entire problem, but is one step closer to ensure that we're supporting the workforce. We're seeing, unfortunately, that the CSU systems are not maintaining a recommended ratio. Currently, the International Association of Counseling Services recommends that colleges and universities maintain a ratio of one full-time mental health professional to every 1,000 to 1,500 students, which I'm looking to codify with this Bill.

Additionally, SB 11 creates the CSU Mental Health Professionals Act, like I mentioned, to ensure that we're providing some incentive, some financial support to individuals who wish to be mental health therapists, as we're looking to embed them in almost every single thing we do here in the State of California. The short staffing of mental health service providers at the CSU has led to wake times of students seeing up to four to eight weeks.

I was a student before, and when I went into an intake, I was having a very difficult time. I did my intake, and I was told I can come back in three months for an appointment. I left there with a term that's called flooded, felt flooded, because I was told to release all the things that I wanted to seek mental health for, but was not unable to get an appointment shortly after to really dive into it.

In that moment, I felt that I didn't want to come back to seek services and maybe I'd figure out on my own to deal with the issues that I was going through. That's a situation that so many of our students are going through. And for me, I was able to turn to my VA health care service to get a mental health appointment sooner than what my school was offering me. Not everyone has that opportunity.

We are calling for social workers and other mental health professionals to be at every space. Therefore, we need to invest in this workforce. We're asking for this ratio because right now, what we're seeing in most CSUS, for examples, is a ratio that is unacceptable. CSULA has a ratio of 1000. I apologize. CSUN has a ratio of one to 1891. CSU dominguez Hills and CSU San Marcos. San Marcos is 1924. San Francisco has a ratio of one to 1897. Fullerton, similarly one to 1892.

These are the numbers that we need to ensure that we're addressing with that, Mr. Chair, I'd like to turn to my two witnesses in support. I have Karla Castillo, counselor at SF State, and Kimberly Rosenberger, Senior Government Relations Advocate.

Hello, Senators. Thank you for hearing about this Bill. My name is Karla Castillo, and I'm speaking to you on behalf of the California Faculty Association, the Counselors Committee. I'm in support of SB 11 and to support the 270 mental health counselors within the California State system. I have been working at San Francisco State for 17 years. I'm a tenured counselor faculty providing mental health services to students on my campus.

I also serve on the CFA Counselors Committee, and I do my best to represent mental health counselors statewide. I have the pleasure of meeting regularly with counselor colleagues from across the CSU system. And one thing I can say about mental health counselors is that they are the most empathetic, hardworking, and dedicated professionals. We all work really hard to help college students get through hard times, and we often engage in critical and very much life saving work.

Many of us go above and beyond our assigned roles to meet student needs. I, for example, started a scholarship about 11 years ago for undocumented students, and I fundraise every year by swimming from Alcatraz to raise scholarship funds. So many of my colleagues statewide also do amazing work, extra projects on their respective campuses. We do so because we want our students to be well mentally, physically, emotionally, so they could succeed in their efforts to complete their degree.

During my 17 years within the CSU system, I have seen some worrisome trends develop. Student mental health is declining, and counselors are asked to see more students and see them within less sessions. I've also seen the trends of eliminating permanent counselor positions, tenure track positions, and replacing them with counselors, working on temporary appointments, year to year contracts with less pay.

My colleagues are becoming tired and burnt out trying to help meet the needs of students within a system that is becoming less and less supportive of counselors and the work that we do. The worst part is seeing good counselors leave the CSU for a more reasonable workload, better pay, and more job security. Elsewhere, our counseling centers are left with less counselors, and the ones that stay have a bigger workload. While it won't solve everything, SB 11 will help address these problems.

Over half of the campuses in the CSU do not meet the 1500 to one faculty to student ratio required in SB 11. This Bill will help increase access to mental health counselors in the CSU and help support students succeed in college. SB 11 will create new incentives and funding for students who want to develop a career in mental health. California needs greater access to mental health professionals. I urge you to vote yes on SB 11. Thank you.

Thank you.

Thank you. Good afternoon, Mr. Chair Members. Kimberly Rosenberger with SEIU, California. While not as historic as your previous Bill, this is a Bill that we have brought for a number of years, and in that time we were urging to put this floor in. We have since faced a pandemic, so the urgency has only increased. We recognize the need. We think we're not just coming to you today, though, with a problem saying, we need this ratio.

We're also trying to bring a solution with the internship, because what's important about the students that are going to be these mental health counselors is they're still currently CSU students. And CSU students are twice as likely to be homeless than UC students. CSU's cornerstone is that they serve first generation. We know that this is a population that needs sometimes additional support and resources.

And so while we're trying to provide for that, on the end of ensuring there's enough mental health counselors, we're also trying to make sure that those that are interested in going into the field are supported and encouraged to give back to the community that supported them. I'll keep my comments brief, but be available for technical comment. I just really want to emphasize that the importance is only growing in the need for mental health services in a timely fashion at the CSU.

As noted, they're improving things, but the delay is too long, and we need to add some urgency to it, which is why we strongly support and sponsor this Bill. Thank you. And we urge your aye vote.

Okay, thank you. We only have two witnesses there for support. Okay, thank you. We do have a quorum, so I'm going to stop and take roll because it's really cool that we have a quorum right now. So, Madam Secretary, please call the Members to order.

Wood here. Waldron. Aguiar-Curry here. Arambula here. Boerner here. Wendy Carrillo here. Flora here. Vince Fong. Maienschein. McCarty. Joe Patterson. Rodriguez. Santiago here. Villapudua. Weber here.

So we do have a quorum. And a motion by Dr. Arambula. Second by Ms. Boerner, I believe. Thank you. So others in support of the Bill.

Priscilla Quiroz. Here. On behalf of the California State Association of Psychiatrists in support.

Thank you.

Rebecca Gonzalez, National Association of Social Workers, California Chapter. We represent professional social workers and also social work students, and we're very strongly in support of this Bill.

Thank you.

Afternoon, Mr. Chair and Members. Alyssa Yem, on behalf of the CSU Employees Union in strong support. Thank you.

Thank you.

Hello, Chair and Members. Anna Matthews with the Faculty Association of the California Community Colleges in support. Thank you.

Chair and Members, my name is Yusef Miller. I'm with Clean Earth 4 Kids and the North County Equity and Justice Coalition in full support.

Paul Simmons with the Depression Bipolar Support Alliance of California in support. And I'd like to thank the author for working with us.

David Bolog, Local 18 IBEW member in support.

Thank you. Very well. Is there opposition to the Bill? You come up to the table if you like.

Yeah. Push the button, please.

That would be a good place to start. Hi, good afternoon. I'm Maggie White with the California State University. We have an opposed, unless amended, position on the Bill. We'd like to thank the author's office sincerely. We've had several productive conversations about the Mental Health Professionals Act and how it would be implemented.

We're very enthusiastic about anything that would encourage folks to pursue this career path as a way of addressing the supply side of the supply and demand issue we often face when hiring counselors for our campuses. We do remain opposed to the ratio requirement in the Bill. There are a few reasons for that. One, we believe, fundamentally, that campus staffing and budget decisions should be left to our board of trustees.

We see this as an unfunded mandate that would cost at least $8 million per year in growing. Thirdly, we believe that the national standard is moving away from a ratio recommendation toward a more nuanced measure called the Clinical Load Index. That would take several factors, including utilization by students, into account when determining appropriate staffing levels. Just a quick example.

Despite great efforts to encourage students to seek care on campus, at one of our largest campuses, Sacramento State, only about four and a half percent of students even make contact with the Mental Health Counseling Office each semester. I would note that many of our students also do have health insurance and may be seeking services off campus. They may already be dialed in with a private provider.

I would also note that our average wait time for a non crisis appointment and I want to make a special point that students in crisis are seen on the same day. We take that extremely seriously. But for students who want to come in and just start seeing someone twice a month and when can I see someone? We have an average wait time of one to two weeks. Even at campuses where we do have those larger ratios are bigger campuses like Cal State, LA.

We completely agree with the author and the sponsors that two to three month wait times are absolutely unacceptable. I'd like to be very clear that we aren't satisfied with being stagnant with the care we're providing. We have decreased our ratio by 30% over the past four years, and we don't intend to stop that progress. But we do not believe that this ratio should be mandated by the state, particularly when we are making progress. Thank you for your time.

Thank you very much. Are there others in opposition? Okay. Seeing no one will bring it back to the Committee. Any questions or comments from the Committee? Dr. Weber?

A lot of doctors on this Committee.

There's a lot. My bad.

Thank you, Senator, once again for introducing this Bill. And I do have a question just to kind of piggyback off of something that the opposition said. As far as the metrics that are used, the one to 1500 students versus utilizing the clinical load index or having something in the Bill that would allow for flexibility.

If it looks like the clinical load index is a better indicator for the providers and for the patients, I. E. The students that they're serving that wouldn't necessarily require another Bill to come back and change it. I don't know if you had thought about that or been in any discussions.

I have thought about this. You heard from one of my witnesses that this is not the first attempt of know. It's been going for a couple of years and nothing has happened. We've seen no change from a CSU. The CLI index, the way I'm looking at it, is the way to provide adequate care and quality care versus the amount of Clinicians or the amount of Clinicians on campuses.

So while I do recognize the CLI should be taken into account when addressing the need of mental health services, but I think that deals with more of the quality of care and the actual needs of the campus versus the mental health needs versus the actual ratio of the campus. Additionally, I will note the first time that the CLI was introduced was in 2018 when surveys of mental health were nowhere comparable to what we're seeing in mental health rates right now.

So I would say that we should take that into consideration. One of the most recent reports in 2021 came out of ACLU California's action with the CSU Center to close the opportunity gap today and released and in the report that said that students, 83% of the students surveyed, saw no change post pandemic to address the increase of mental health needs.

So I would say that we've had some time without any mandate, without any racial mandate, and the CSUS have still yet to address the needs of the students. So I have taken into consideration but still yet feel strongly that this is the approach that needs to be taken.

Thank you so much. And I think I was asking because of the fact that we are seeing a significant spike in our mental needs of our students and also the severity of it. So there may be a situation at a college campus where a one to 1500 student ratio is just too much because of the amount of clinical severity that that particular therapist is having. And so the ability to look at that and say, okay, we actually probably need to decrease it for our campus.

Not necessarily because people may not necessarily be taking advantage of the service, but it may be to the point where the severity of the patients or the students that are coming through requires so much more time, energy and effort of our mental therapists that they actually need a smaller ratio. So that's what I was asking. That's why I was asking the question. Thank you. Though this is just the baseline.

We encourage them to reduce the numbers further it's one to 1000 to one to 1500. So we are already on the higher end and would recommend that those numbers be targeted at the lower end. And just to circle back to the earlier point, which I think the author addressed perfectly, I do just want to add on that these can work in tandem, so we're not opposed to it. As was highlighted, it's quality versus quantity.

But right now we're at a quantity issue that needs to be addressed before we can even see the light through the trees.

Thank you, Mr. McCarty. Yes. Thank you, Senator. Before the pandemic, this was a huge issue and I had bills on the money side. I want to ask CSU a question in a bit. Trying to redirect money from Prop . 63, the Mental Health Services Act, to student mental health a couple of years later, we did put ongoing money in the budget, which I'll get to in a second.

But even before the pandemic, the number one cause of death for young people at college was suicide and having to wait months. When you have an ailment, when you have a broken ankle or tooth problem, you go and see someone right away. The crisis, I want to see somebody come back in six weeks. It doesn't really work that way. That being said, I know this is a policy Bill.

We'll, of course go through the appropriations process, but it says here that the cost here is under this kind of mandate, this requirement that it would be less than $10 million. Is that accurate to CSU? And then I guess the flip is that the ongoing money we put to the system in the budget is way more than that. So why is that not sufficient to address what we're trying to accomplish here?

Thank you for the question. I will get this down. Thank you for the question, sir. Absolutely. See where you're going. So that $15 million ongoing in the budget is the reason we've been able to decrease our ratio by 30% over the past few years. That is being fully utilized by our campuses. We're very grateful for it. It's absolutely making a difference on our campuses.

The $8 million number is one that we've calculated based on our current population, to get to that one to 1500 number at the I believe there are eight campuses off the top of my head that are above that 1500 ratio.

Before the 15 million we put in there, the ratio was like one to 3000 or something.

I think one to 2146. In 2019, it was over 2000. We're now down system wide average one counselor per 1576 students. So we would need to hire, I think it's 57 counselors at a cost of 8 million per year, including benefits.

Okay, then how would we attempt to Fund this?

Two parts for the workforce place workforce portion of the Bill is my team has been having conversations with HKI to find existing pots there to be able to embed this under. And we've been having great conversations with HKI, and I know they've demonstrated their work to ensure that funding is available for the program.

We believe that the 15 million in funding and I was just recently looking at the most report CCUS have to provide an annual report of how that funding is being utilized of each campus is sufficient to cover this. We do recognize there are openings at different CSU hiring mental health therapists. I believe this could go in tandem to further incentivize, further recruitments, to fill those slots.

Very well. Anyone else seeing? No one. The Bill does enjoy due pass recommendation. Senator, would you like to close?

Thank you so much for engaging me on this. Know I said in the beginning, this isn't the end. This is not going to solve the entire problem. This is a step forward to ensure that we're incentivizing a workforce that is desperately needed in the State of California. And we're also providing the support to the helpers who help others. Correct. And also to the students who right now at this time, are going to school, working full time internship unpaid.

I think it's appropriate now to ensure we're investing in that generation and workforce with that. Respectfully ask for an aye vote.

Thank you very much, Senator. We have a motion by Dr. Arambula. A second by Ms.. Berner. Motion is due pass as amended to Appropriations. Madam Secretary, please call the roll.

Wood, aye. Waldron Aye. Aguir-Curry, Aye. Arambula. Boerner. Carrillo. Flora. Fong. Maienschein. McCarty, Aye. Patterson. Rodriguez. Santiago. Villapudua, Aye. Webber, Aye.

You have six votes. We'll leave the Bill on call. Okay, so we'll move on to your next Bill. While we're doing while we're waiting for a shift in your witnesses, I'm going to ask for can we entertain a motion for item number one, SB 635. So motion by Ms.. Aguiar Curry. A second by Dr. Weber. A motion is due pass as amended to Appropriations. Madam Secretary, please call the roll.

Wood, aye. Waldron Aye. Aguir-Curry, Aye. Arambula. Boerner. Carrillo. Flora. Fong. Maienschein. McCarty, Aye. Patterson. Rodriguez. Santiago. Villapudua, Aye. Webber, Aye.

Six votes. And then we'll do this really quickly. The consent calendar. Item number eight, SB 10, a motion by Ms.. Agar Curry, second by Ms.. Waldron on the consent calendar, item number eight, SB 10 by Senator Cortesi. Item number nine SB 282 by Senator Eggman. Item number 10 SB 819 by Senator Eggman. Item number 15 SB 595 by Senator Roth. And item number 16 SB 67 by Senator Sayarto. Madam Secretary, please call the roll.

Wood, aye. Waldron Aye. Aguir-Curry, Aye. Arambula. Boerner. Carrillo. Flora. Fong. Maienschein. McCarty, Aye. Patterson. Rodriguez. Santiago. Villapudua, Aye. Webber, Aye.

That's six also. So okay, now we are all caught up and it's a good feeling. So please go ahead, Senator.

Thank you, Mr. Chair, Committee Members. My third Bill that you're about to hear right now is to deal with an STI epidemic. We're seeing in the State of California, and honestly nationwide right now, we're seeing youth, especially youth of color, are disproportionately being represented of those who have an STI. Right now, youth or Tay individuals make up about 50% of individuals with STI.

My Bill is looking to address that remove barriers for individuals, high school individuals, to obtain condoms and to make it easier to obtain the HPV vaccine should you wish to. Specifically, this Bill will expand access to condoms by requiring public and charter high schools to make condoms readily available for students for free.

Bar high schools from prohibiting condom distribution in the context of an educational or public health program, for example, sex education or a community partner that comes into the class into the school to put on a health fair. It would prohibit pharmacies and retailers from asking proof of age, requesting an ID when individual wants to purchase condoms. There is no state law right now that requires proof of being 18 years old to purchase these items, but it's happening.

And finally, we want to ensure there is a no wrong door for the HPV vaccine. And we're asking to require family packed programs to cover vaccines. HPV vaccine for young individuals ages 12 to eight. Given that this is the leading STI, like I mentioned, we're experiencing a public health crisis of STIs, and youth are disproportionately impacted in this. We need the youth, should they make that decision, to be prepared and ready with prevention tools when they are sexually active.

Our teens are being like I briefly alluded to when looking to purchase condoms, are being asked to provide proof that they're 18 being sent away. Now, this isn't deterring them from practicing sex. This is actually pushing them to practice unsafe sex. And when someone makes that personal decision to be sexually engaged, we want them to be prepared with all the tools necessary to protect themselves. I'm proud to have this Bill be a youth driven Bill.

We are listening to them as we continue and move this Bill forward. This isn't a new system that we're looking to implement. Condom availability programs, or Caps, have been around since the 90s. We see them in LA, we see them in the Bay Area. But what we're seeing is that in the rural areas, the rural areas have one of the highest Sci numbers across the State of California.

And we want to close that equity gap, ensuring that all high schools across all our geographic areas provide this resource. So, with that, I'd like to turn to my witnesses. First, Kim Robinson, the community liaison with Black Women for Wellness, followed by Sylvia Castillo, the Director of government affairs at Essential Access Health.

Good afternoon and thank you, Mr. Chairman and Committee Members. My name, as stated, is Kim Robinson. I'm the community liaison with Black Women for Wellness and Black Women for Wellness Action Project. We're a statewide reproductive justice, community based organization committed to improving the overall health status and well being of Black women and girls. I'm reading this testimony on behalf of my colleague, Lanell Stuhler, who serves as program lead for Black Women for Wellness.

Get Smart before You Get Sexy program, our comprehensive sex education program dedicated to eliminating health disparities that's present in our communities. Black Women for Wellness Action Project is proud to co sponsor SB 541, the Youth Health, Equity and Safety Act, because it's a huge step in eliminating health disparities and it remove barriers that limit youth access to critical resources.

This Bill will advance health equity, improve health outcomes, and support safer sex behaviors among teens by requiring that California public and charter schools make internal and external condoms readily available to students, prohibiting retailers from asking for ID for condom purchases, and increasing access to HPV vaccine. As program lead for Get Smart, a large portion of my work is to train peer educators from high schools across LA County to lead comprehensive sex ed workshops in schools and in communities.

We educate around 1500 to 3000 youth and young adults between the ages of 12 and 30 years of age on sexual health topics like consent, body image, sexually transmitted infections, birth control, and gender identity and expression, to name a few. Last week, after hosting an event on health advocacy, one of the peer educators that attends King Drew Medical Magnet High School thanked me for doing this work.

She said that before going to Get Smart, she had not received any sex ed in school and considered herself to be clueless. She when her and her boyfriend wanted to take things further, neither of them knew where to get condoms for or who to ask. She said she supports bills like SB 541 because she recalls the fear and stigma she felt after experiencing a pregnancy scare and not feeling like she had anyone to talk to or whether to go for help.

She wished her school provided sexual education and made sure that condoms were accessible so that she and her partner would be equipped to make better decisions for themselves.

Get Smart our mission is to ensure youth have the knowledge and tools to make the most informed decisions about their health. The advantages and mobilizing resources is where I implore you all to vote yes on SB 541.

Good afternoon, Mr. Chairman and Committee Members. My name is Sylvia Castillo, and I'm the Director of government and community affairs at Essential Access Health. We advance health equity and champion and promote quality sexual and reproductive health care for all. And we're proud co sponsors of SB 541. We work in close partnership with the state county health departments, community providers, and other stakeholders statewide to increase access to sexual and reproductive health care, including STI, prevention, testing and treatment.

As the Senator mentioned, the STI epidemic in California and across the nation has reached crisis levels. This past April, the CDC released the most recent data on nationwide STI rates, which is from 2021, and the picture the data paints is not pretty. Across the board, STI rates have continued to rise. There was 1.6 million cases of Chlamydia reported in 2021. Syphilis cases saw the steepest rise, with 28.6 increase from 2020 to 2021.

And youth continued to be disproportionately impacted, with LGBTQ plus and youth of color facing the most significant inequities in 2021, youth accounted for more than 50% of STIs. In 2018, the CDC estimated that STIs cost the US. Healthcare system approximately 16 billion in direct lifetime medical costs. About 36% of that costs accounted for care provided to youth ages 15 to 24.

Since most STIs are asymptomatic, they're often left undetected and can pose serious life threatening health problems later in life, it is estimated that 80% of sexually active people in the US. Will get HPV at some point in their lives. This is why youth in particular need and deserve equitable access to the HPV vaccine to protect their health and safety.

The vaccine is a vital tool to reduce incidences of HPV related cancers, and while nearly 80% of California teens received the first of three doses the HPV vaccine in 2020 was, the vast majority do not complete the full vaccination series, leaving them without maximum protective care. Reproductive health advocates were thrilled when the California Family Pack program began covering the HPV vaccine for beneficiaries ages 19 and older.

Thanks to the great work of the Department of Healthcare Services in securing the federal matching funds to support the added benefit. Now it's time our state takes the final step to close the HPV vaccine coverage gap under FPAC for teens ages 12 to 18. We urge you to vote yes on this Bill. Thank you.

Thank you very much. Others in support, please. Just your name and organization. If you represent one.

Tiffany mock on behalf of CFT. In support thank you.

Thank you, Brian Spencer, American College of OBGYN's, District Nine in support. Thank you.

Kathy Mossberg on behalf of the San Francisco AIDS Foundation and APLA Health. In support.

Thank you.

Priscilla Kuros, here on behalf of the California Faculty Association. In support, thank you.

Sumayana Aharan on behalf of the Alameda County Board of Supervisors. In support, thank you.

Molly Robson with Planned Parenthood Affiliates of California in support.

Thank you.

Taylor Jackson with California Health Plus advocates in support.

Thank you.

Greg Polsfer on behalf of Equality California. In support, thank you.

Rand Martin on behalf of the AIDS Healthcare Foundation. In strong support, thank you. Thank you,

Noah Bartelt To, on behalf. Of ACLU California action in support. Thank you.

Thank you, Karen Stout, on behalf of the Narrow Pro Choice California and the California Nurse Members Association in support.

Thank you very much. Is there opposition to the Bill? So please come forward.

Chair Members. My name is Greg Burt with the California Family Council. For the last decade or more, this legislative body has been pushing condoms as a solution to sexually transmitted infections spreading among our youth. And each time that rate rose, you insisted kids just needed easier access to condoms and information about safe sex at younger and younger ages. That was the whole argument surrounding the California Healthy Youth Act, passed in 2015, which mandated comprehensive sex ed in every school district.

And now you have an SDI epidemic on your hands. The act isn't working. According to the California Department of Health, SDIs are at epidemic levels in 2020. A report showed a 320% increase in Syphilis over the past 10 years. Gonorrhea is up 190%. How much do you really trust condoms to protect kids? Did you know condoms don't protect people from all SDIs? Such as herpes genitala warts, Syphilis and monkey pox, which can spread by skin to skin contact?

Don't you think it's time to reassess your health policy on this issue? Don't you think it's time to tell young people the truth? That those with the most fulfilling and healthy sex lives are those who treat sex as a special and intimate act to be shared in a monogamous, committed marriage? I'm not encouraging you to shame people, but to hold up abstinence till marriage as a noble ideal. Something beautiful to pursue, not something to laugh at and mock as unrealistic.

Why not put together a messaging campaign for youth to make marriage cool again? Honor it, praise it. STDs cannot survive in a culture that idealizes waiting for sex until marriage. But it does thrive in a hookup culture, which you have more or less encouraged, where sex is meaningless and done for fun with multiple partners. I know it's hard to change course when you're so convinced you are doing the right thing. But ask yourself, how many young people are you willing to sacrifice?

What SDI infection rates are you willing to tolerate before you're willing to look at different options? Please vote no. Thank you.

Thank you. Are there others in opposition? No one will bring it back to the Committee. Questions or comments from the Committee? I'm sorry? Is there other opposition? zero, sorry. Please. Too quick, I guess. Sorry.

Ali Snyder in opposition. Thank you.

Thank you.

Nicole young opposition. Thank you.

Ms. G, a parent of three, and I opposed this Bill. And there was things that my kids were learning about sex ed that, as a grown woman of 50, that they were going to know before I did. So no. Thank you.

Thank you. Just your name and position on the Bill, please.

Nicole Pearson, in opposition. Thank you.

Thank you.

Max Bonilla, Opposition.

Thank you.

Cheyenne Kenny, in opposition.

Thank you.

Elizabeth Kenny opposition.

Thank you. Anyone else? Okay, now we'll bring it back to the Committee. Any questions or comments from the Committee? Dr. Weber?

Senator, once again, I want to thank you for bringing forward this Bill. It is very much necessary. As an OBGYN who specializes in pediatric and adolescent gynecology, it is not lost to me that the highest rates of STI are within our 15 to 24 year olds. And so we need to not only educate them, but make sure that we are arming them with the tools to protect themselves as well and to the opposition.

I think one of the reasons why we have moved away from abstinence based teaching is that research has shown that it doesn't work. Not only do children not do that, but actually it increases teen pregnancy rates, which would then also increase STI rates. And so thank you very much for bringing this Bill forward and for focusing on evidence based research, which will decrease the amount of STIs that our teens are having. Thank you.

Thank you, Dr. Robert.

Thank you. Anyone else seeing? No one. The Bill does enjoy a due pass recommendation. Senator, would you like to close?

I appreciate the support, Mr. Chair. With that, I just respectfully ask for an Aye vote.

Thank you very much. Is there a motion on the Bill? So we have a motion by Ms.. Aguiar-Curry. A second by Dr. Weber. The motion is do pass to Appropriations. Madam Secretary, please call the roll.

Wood, Aye. Waldron. Aguiar-Curry, Aye. Arambula. Boerner. Carrillo, Aye. Flora. Fong. Maienschien. McCarty, Aye. Patterson. Rodriguez. Santiago. Viapudua. Weber, Aye.

You have five votes. We'll leave the roll open. We'll leave the Bill on call. Excuse me. And that will go to your next Bill.

Thank you.

Thank you.

One more, Assembly, Members. One more.

Water. Okay. Are you doing okay, then?

Okay. All right.

We're doing good here.

I think this is my last one in Health Committee for the year. So see you again after next year. I want to again thank Mr. Chair. You and I have had conversations on this. The committee has had several meetings with my team on this. I want to thank you all for your diligent work on getting to a place we can move forward, hopefully. I will be accepting the committee amendments as described on page nine of the committee analysis.

SB 729 would require large group health plans to provide coverage for fertility care, including treatment for infertility and IVF. We're seeing that one in eight opposite-sex couples will be struggling with infertility, and that ratio does not even include any of the unique family-building challenges faced by myself and my family and the rest of the LGBTQ-plus couples. Data from the Pew Research Center indicates that a full third of Americans have used fertility health services or know someone who has.

I definitely know several of my friends who have. Yet right now, the safest and most reliable methods of fertility care remain out of reach for most Californians because it's really expensive. Current law mandates only that health insurance offer coverage for treatment of infertility, but it does not require that all plans actually provide coverage. Additionally, current law requires invasive standards of proof in order to access care.

For example, you have to prove that you have completed a year of heterosexual relations without contraception, which are standards that me and the rest of the LGBTQ, most of the LGBTQ couples, are often unable to meet. Worse yet, the law explicitly excludes any coverage of IVF, even though that's the most reliable treatment with up to 77% of success rate. For Californians struggling with infertility, the very existence of the family they hope to build can depend on income alone.

Now, I recognize that this bill is again not something that is if should this pass and gets a signature where we stop, there is so much room to move on, to grow on, but this is a way to ensure the conversation gets started. But I know you in this committee have heard this bill before from one of your colleagues in the other house. So the conversation has started. I'm looking to ensure that it continues going.

We want to ensure that we're increasing access to care, help reduce inequities in health and economic status, and bring the law up to date on medical advancements in IVF and its uses. As a reproductive freedom state, California still has significant work to do. I will always be the first person at the front line to protect someone's right to choose to have a child, but I'm always going to be at the front line as well to help an individual have a child should they wish to as well. 14 other states have already passed IVF insurance laws and we must catch up to continue to earn our designation at reproductive freedom state.

To that I'd like to turn over to Mallory Casperson, the CEO, co-founder of Cactus Cancer Society, who brings firsthand experience, followed by Dr. Ruben Alvero, a professor of obstetrics and gynecology at Stanford University.

Hello, my name is Mallory Casperson, and I live in Berkeley, California, with my husband Brett, our three and a half year old son, Tennyson, and our rescue dog, Lulu. When I was 24 years old, two months after my mother passed away from a brain tumor, I was diagnosed with Hodgkin's lymphoma. I was engaged to be married in a master's program in aerospace engineering, mourning my mom and suddenly facing a life-threatening diagnosis. I underwent months of chemotherapy treatment and was deemed cancer-free.

But long term side effects caused me to leave my PhD program. I spent a year talking with other young survivors and ultimately founded a nonprofit to support them called Cactus Cancer Society. When I was first diagnosed with cancer, I entered treatment quickly and did not undergo fertility preservation. I was young, and the treatment I underwent on a clinical trial was relatively low-risk to my fertility.

Eight years later, and more than after more than 18 months of actively trying, I had my son. When he was one years old, my spouse and I started trying for another child, but I noticed hardened lymph nodes in my neck. Just shy of my 10-year cancer-free anniversary, my cancer had returned. I was now 34 years old and terrified that I would die with a husband and a baby at home, I decided again to immediately start chemotherapy. Now, after two cancer diagnoses 10 years apart, my ability to conceive has been severely compromised. I chose not.

Thanks. I chose not to preserve my fertility in order to expedite my life saving treatments and am now paying for costly IVF treatments. This is full service. With very limited fertility coverage. Through my experience and through my work, I know how painful and difficult it is to lose your fertility because of cancer. Young people facing cancer want to live, but surviving is not enough. We want to lead active and productive lives, and many of us want to have children.

My son is rambunctious, and he loves Legos, and I'm beyond lucky to have him. But I want to have another child. SB 729 would help those who now, because of SB 600, were able to undergo fertility preservation, realize the promise of their carefully stored materials, and it would also help patients like me, who couldn't preserve by providing for the medical interventions they need after surviving cancer.

We already face daunting obstacles to realizing the dream of a family, the risk of recurrence, the challenge of long-term physical and emotional side effects, the possibility of dying too young, the burden of having to pay the substantial out-of-pocket cost of IVF, which are not feasible for many, does not need to be included in this list.

On behalf of young cancer survivors like me and all Californians who are facing or may one day face infertility, I respectfully ask that you support SB 729 to bring more equitable and comprehensive infertility coverage to all Californians who need it. Thank you.

Thank you very much.

Good afternoon, members. My name is Dr. Ruben Alvero and I am a professor and division director of reproductive endocrinology and infertility at Stanford University and Stanford Medical School. I'm also a retired US Army colonel with a 27-year career with a significant portion of that time serving the fertility needs of active duty service members and their partners. Infertility is indeed a disease not unlike diabetes and cancer and profoundly affects the quality of life of those affected, including one in seven Californians of reproductive age.

Both the World Health Organization and the American Medical Association have long held this view, citing the millions of people worldwide who are impacted by this condition. And quality of care unequivocally has been shown to be effective in treating the condition in most cases. Unfortunately, there's unequal access to quality fertility care, since even in the most affluent country in the world, only 14 states have some mandate for insurance coverage. Unfortunately, California is not one of those states.

Prior to coming to California, I practiced in Rhode Island, which has a mandate, and I had the privilege of caring for fishermen, for bus drivers, for teachers, for cops, for firemen, and just every member of the community that you can think of. At Walter Reed, I cared for all ranks equally, including enlisted, non-commissioned officers, company grade, field grade, and even general officers, all without regard to cost.

As a native Spanish speaker, I am used to serving the Hispanic community, and usually, about a third of my patients are Spanish-speaking. Sadly, given the absence of a mandate in California, I speak very little Spanish in my clinic these days. Fertility costs have been shown to be cost-effective in multiple journals and in the states with a mandate. Estimates for the price of a single birth generally range from $25,000 to $30,000 per live birth, which is exceptionally good in the cost-effectiveness world.

Additionally, mandates have been shown to incentivize the use of safer approaches, such as transferring only a single embryo. This improves outcomes and reduces costs. When you practice in these mandated settings, individuals can focus on their reproductive journey rather than being distracted and worried about what their treatments will cost. Absence of coverage encourages dangerous practices, which increase multiple pregnancies, which have significant costs for the medical system and also for the state.

Fertility services are considered the standard of care in any community and are part of a continuum from prepregnancy to neonatal care. California should join those states and medical systems that have chosen to do the right thing. I ask that you support Senate Bill 729. Thank you.

Thank you very much. Others in support, please.

Hello, Karen Stout on behalf of NARAL Pro-Choice California, proud sponsor of the bill, as well as the California Nurse-Midwives Association, in strong support.

Thank you.

Hi. Joyce Reinecke on behalf of the Alliance for Fertility Preservation and here on behalf of RESOLVE: The National Infertility Association, supporting the bill. Thank you.

Thank you.

Rebecca Gonzalez, National Association of Social Workers, California Chapter, in support.

Thank you.

Craig Pulsipher on behalf of Equality California, proud co-sponsor in strong support.

Thank you.

Jennifer Robles with Health Access California, in support.

Thank you.

Beth Malinowski, the SCIU California, in support.

Thank you.

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

Thank you.

Alice Kessler, on behalf of the Academy of California Adoption ART, Assisted Reproductive Technology Lawyers, in support.

Thank you.

Noah Bartelt on behalf of ACLU California action in support.

Thank you.

Molly Robson with Planned Parenthood Affiliates of California, in support.

Thank you.

Josephine Figueroa, on behalf of Insurance Commissioner Ricardo Lara, proud co-sponsor, in support.

Thank you. Is there opposition to the bill? We have two witnesses.

Hello, my name is Allie Snyder, mother of two. No one has the right to buy a baby. SB 729 redefines infertility to a person's inability to reproduce either as an individual or with their partner without medical intervention. This is obviously insane. Humans need two gametes to reproduce, sperm and eggs. Individuals have only one or the other, so no one can reproduce without a person of the opposite sex. Under SB 729, everyone will be considered infertile and eligible for surrogacy.

California obviously doesn't care about women. After all, it houses convicted rapists in women's prisons under SB 132. Still, it should be noted, destitute women's bodies will be broken by the increased demand for babies. Let's be explicit in who will be eligible for a baby. I'll focus on two protected characteristics, age and disability. The state Legislature thinks kids as young as 12 can emancipate themselves under AB 665. Does it follow they're mature enough to have a baby? How about the elderly?

Using IVF, Dr. Sahakian helped a woman give birth to twins at age 67. She died of cancer a year later, leaving her twins orphans. How about someone with a disability, such as an acute mental illness? Maybe an autogynophile with a breastfeeding fetish? Propagandists say these men are loving parents, just nursing their infants. But these very same men post pictures of themselves enjoying nipple clamps and masturbating while using breast pumps. There's a word for men who force children to suck on them. It is not mother.

Babies are blessings, too many of whom already suffered the primal trauma of losing their mother. They need loving families. SB 729 will make California complicit in this trauma, complicit in buying babies, and potentially complicit in giving them to predators. Vote no on SB 729.

Thank you Mr. Chair and committee members. No mike. There you go. Better? All right. Preston Young from the California Chamber of Commerce, here today in opposition to SB 729. As I've said in previous committee hearings and made clear, it is not a policy issue for us. That is not why we're here today in opposition. It's the unintended consequences that come along with SB 729 that we're concerned about. Notably, the costs associated with SB 729 if this bill goes into effect, is the reason for our opposition today.

Now, the California Health Benefits Review Program conducted an analysis of SB 729, and they determined that if the bill went into effect with the way it appears in print today, it would increase premiums for California employers and employees over $330,000,000. I appreciate the author and the committee's work on this. I appreciate the amendments that have been agreed to. And putting a cap on the IVF treatment is a step in the right direction.

However, this is still an extremely large expense for California's employers and employees. When we look at this in isolation, I understand it seems like it's something that is worth it. It seems like policy that we should implement because it is going towards individuals starting a family. However, we have to put this into context. Healthcare affordability as a whole right now is increasing every year. Additional mandates will be passed through by this Legislature, which will increase costs.

Additionally, there's inflationary pressures in the economy right now, pharmaceutical cost increases, and point of care cost increases. Furthermore, to put it in greater context, over the last five years, the average premium for family coverage in employer-sponsored plans has increased 20%. In 2022, the average annual premiums for California employer-sponsored family healthcare coverage reached $22,463. Workers, on average, paid $6,106 towards the cost of that coverage. So, as I said at the beginning, we need to keep this in context. I understand the policy. I understand what is being driven towards here, the unintended consequences that we're concerned about. And I thank you very much for your time and your consideration.

Okay, thank you very much. Others in opposition.

Mr. Chair and members of the committee, Jedd Hampton with the California Association of Health Plans, here regrettably in opposition. I would line my comments with Mr. Young's comments. We are concerned about the cost of this particular mandate. Thank you.

Thank you.

Mr. Chair and members, John Wenger on behalf of America's Health Insurance Plans, would also align our comments with the Chamber related to the costs.

Thank you.

Steffanie Watkins on behalf of the Association of California Life and Health Insurance Companies. We'd echo my colleague's comments with the Chamber. Thank you.

Thank you.

Nicole Young, Placer County. Opposed.

Thank you.

Nicole Pearson, in strong opposition.

Thank you.

Max Bonilla, in strong opposition.

Thank you.

Cheyenne Kenny, in opposition.

Thank you.

Elizabeth Kenny, opposition.

Thank you.

Greg Burt with the California Family Council in opposition.

Thank you.

Mrs. G and I oppose.

Thank you. Anyone else? Okay, seeing no one, and bring it back to the committee. Questions or comments? Dr. Weber.

I first want to thank both of your witnesses, but specifically the patient, for relaying your story. I, too have a family member who was diagnosed with non-Hodgkin's lymphoma when he was 19. That was almost a little over 20 years ago. Unfortunately, there was no thought or consideration to future fertility, and the thought was to go straight to chemotherapy. And he was hit with some very strong chemotherapy and is unfortunately infertile at this point. So thank you very much for sharing your story.

Infertility to my fellow colleague is a disease, and I know it's been taken out of this bill, but it is, and it is a condition that we should treat and give as much focus and attention to as we do other diseases or conditions. There are a couple of things that people said. One, Senator, I think you said you wanted to reduce inequities within the healthcare system.

And my fellow physician talked about the fact that in certain states and in certain areas where you practice, you were able to give care for every member of the community and not have unequal access. My concern with this bill is that it does not give equal access to everyone. And Senator, you and I have talked about this. It explicitly eliminates the people who need it the most, and that's our patients on Medi-Cal.

And there are times because these treatments are so expensive that people with insurance have to decide between using the money for a down payment of a home or pay for these treatments. But when we look at our most vulnerable in the Medi-Cal population, that's not even an option for them because they don't have money for either one. And although we say, okay, we'll work here, we'll chip slowly at this until we can get to a point where we cover everyone.

One of the things that we have noticed is that those are the people that are often left behind first. We will eventually get to you. We will make sure that we're working on education in this space, and eventually, we'll get over to this area to improve educational outcomes for people in other areas. We will deal with environmental issues over here and then eventually come over and work with you all.

We will make sure that we have the best and the brightest and the biggest hospitals over in this area that take commercial insurance. And over here, we'll get to you at some point. And all that has done is created continued disparity between the haves and the haves not. I believe that this is something that should be covered for everyone.

And if we're going to start someplace, I believe that we should start at a place for those that need it the most, that do not have the ability to choose between paying for a down payment on a house or a down payment on a car or this particular treatment. And so this bill, as it stands to me, sets up inequities between the haves and the have-nots, who will get covered based on your insurance and who won't get covered because you happen to be on Medi-Cal. And for that for this particular bill, as is, for that reason, I cannot support it. We talked about my background. I did my OBGYN residency at Cook County Hospital in Chicago.

And when it came to issues of family planning, if someone had had their tubes tied and they didn't have insurance and they had to come and see us at Cook County, the only option that we had for them was to actually do surgery, open them up and re anastomose their tubes. If they had insurance and they had had their tubes tied and they wanted to now have a baby, they had the ability to go across the street to rush and get IVF.

That bothered me back then, 20 years ago. And I felt that way when I read this bill. So I really applaud your effort for continuing the conversation. I hope that you continue down this road and not forget the people who, regardless of what community, because we have minorities that are on Medi-Cal, we have LGBTQ plus people who are on Medi-Cal. We have a wide variety of our patient population that is on Medi-Cal that do deserve to have the best healthcare options. Just like those with commercial insurance. So I hope that you continue the conversation, and when that bill comes forward, I would gratefully support it. But this particular bill I cannot support today. Thank you.

Any other members? Okay, seeing no one. The bill enjoys a do pass recommendation. Senator, would you like to close?

Thank you, Mr. Chair, I'll address a couple of things. If you look at probably not my legislative package this year has to do with uplifting our most vulnerable individuals. You describe two demographics that make up who I am, Dr. Weber, LGBTQ, minority. Medi-Cal recipients make up my family. I am no stranger to ensuring that whatever we pass is helping. I don't know if the motion sensor.

It's impressive.

Is going to be reaching every single individual. At the same time, I'm also, as Chair of Budget Sub one in the Senate of Health and Human Services, have dived in into all the money into this budget deficit. And I was realistic in seeing what I can move forward, if that. The bill from your colleagues, I believe last year, two years ago, didn't make it out of the first House. This is the furthest this kind of bill has gone.

And I know that this is no way a one-and-done, but to say that because not everyone can get it right now, to not support it, it's going to be hard for me to agree with that, but I would always say yes to providing services to every single individual. To the expense, CHBRP made their analysis, but I would note that their number also includes postpartum services that are already covered by the State of California. So that large number includes from pregnancy to postpartum.

There has been another review from an industry leader in fertility data analytics that shows that it will be a 0.72 cent per member per month to cover the 9 million insurance plan enrollees with insurance subject to these requirements. Additionally, a 2021 Mercer survey of more than 450 employers nationwide found that 97% of those employers offering infertility coverage, even those with IVF, only saw, did not experience increases in their medical cost. And these are from the states that already offer this kind of care.

This is a needed, much-needed first step in the right direction to ensure individuals like you heard of my first witness to ensure individuals like me that even with a Senate pay, it's still very expensive for me and my wife to go through IVF. It's a step in the right direction. And if you allow me to move in that right direction, moving it out of this committee, I do promise, like I shared with Dr. Weber, that I won't stop here. I will ensure that every single individual gets covered for infertility. With that, I respectfully ask for your aye vote.

Thank you very much, Senator. Is there a motion? There's a motion by Ms. Aguiar-Curry. A second by Ms. Carrillo. The motion is do pass as amended to Appropriations. Madam Secretary, please call the roll.

Wood. Aye. Wood, aye. Waldron. Waldron, aye. Aguiar-Curry. Aguiar-Curry, aye. Arambula. Boerner. Wendy Carrillo. Wendy Carrillo, aye. Flora. Vince Fong. Maienschein. McCarty. Joe Patterson. Rodriguez. Rodriguez, aye. Santiago. Villapudua. Weber. Weber, not voting.

You have five votes. We'll leave the bill on call.

Thank you for spending the afternoon with me.

Thank you, Senator. Senator Ashby, come on up. Thank you, Senator. Welcome.

All right. It's my goal to be not quite as spicy as my colleague, Senator Menjivar. Let's see if I can get you one that's a little simpler to get through and keep the lights on while we're moving. All right. Thank you, Mr. Chair.

I'm here today to present to you SB 408. I want to begin by thanking your Committee staff. Lisa Murawski is a superstar. Her and her team have helped us make this Bill a little bit better on its way through your Committee, and we're very grateful for that. I'm accepting those Committee amendments. They help to clarify some technical changes and allow for some flexibility with these regional health teams I'm going to tell you a little bit about, which is what SB 408 seeks to do:

Create 10 regional health teams across the state that will go directly to youth in crisis and their families to provide diagnostic assessment, direct care and support. These regional health teams will focus on being trauma informed and addressing needs that cross systems of care. So our goal here is to bring together folks in the lives of these young people that are working in their education, but also occupational therapy, mental health, of course, their physical health doctors, and any substance issues they may have.

As well, these regional health teams will prioritize referrals from child welfare and from probation and from tribes. The regional health teams can also help youth at risk. We want to prevent them from ever entering the foster care system. This is an effort to go back in time and work with families who are at risk of entering our system and hopefully get them the resources and they need across multi jurisdictions to support the family from ever entering the system.

Another thing that I love about this Bill is that it is the first time that the child is not the only person who would receive help in the family. The child is the impetus for the help. But if there is a parent or a grandparent or an older sibling or someone else in the home who's in need of mental health services, substance abuse support, in order for that family to stay stable, the regional health teams would take a holistic approach and a whole family approach to serving these families. SB 408 is pretty simple.

It seeks to meet highly traumatized foster youth where they're at, or hopefully before they become foster youth, and provide trauma informed services to reduce the harms that are happening in the lives of these kiddos. I have with me some superstars. I love to take these two with me. I'm sure you all already know them, but the head of the Child Welfare Directors Association, Kathy Senderling, and Daniel Sanchez, who leads the Probation Officer Association, are both with me today to witnesses. Great.

Thank you, Mr. Chair and Members. Kathy Senderling, with the County Welfare Directors, CWDA. We're pleased to sponsor SB 408 along with the Chief probation officers. Around 10 years ago, when the continuum of care reform was enacted for the foster care and child welfare system, it did some great, amazing things. And one thing that it didn't do was really focus on those youth with the most complex needs across multiple systems.

So we're talking youth that may have an intellectual or developmental disability or delay educational needs, behavioral health needs, and that sort of thing across more than one system. And about 40% or so of our youth in care are not in managed care medical, they're in fee for service. They're one of the sort of remaining groups, one of the only remaining groups that's not a mandatory managed care group.

And so they're not going to be receiving the benefits of the Enhanced Care Management Program under the new Cal Aim initiative that's getting going now. And so what we found is that a lack of coordination across the different organizations, and especially as well with the healthcare needs really results in them just not getting the care as quickly as they need or as comprehensively as they need. Other states have used this type of approach.

We've actually tried it in some different ways with different populations and seen some good success as well. And so SB 408 would allow us to do up to 10 of these regional health teams. I really want to thank as well the staff, both the Health Committee and Human Services for working so well together. They definitely helped us improve the Bill through this process. Urge your aye vote and I'm very happy to answer questions.

Great, thank you.

Good afternoon, chair and Members. Danielle Sanchez on behalf of the Chief Probation Officers of California. Very pleased to be a co sponsor of this important effort. As was stated, a number of years ago, CCR took place and certainly resulted in a much greater focus on supporting children and youth in family based settings. Also has been said though there are significant areas for youth with complex trauma and those with physical, behavioral and related needs without restating. Kind of what the Bill does.

I think from probation's perspective, we really see this through the lens of both serving probation foster youth that we work with, but also making sure that we're really limiting disruptions and preserving their placements. That really is the goal of this. And by bringing together kind of multisystem approaches and making sure that the coordination is there for these particular subset of youth, we believe is going to be a very important and needed step again to preserving families and to supporting youth in a more holistic and coordinated way. So for those reasons, we ask for your support today. Thank you.

Thank you very much. Others in support.

Erin Niemela, representing Casa. Also in support.

Thank you.

Nicole Wordleman, on behalf of San Bernardino County and the Children's Partnership in support.

Thank you.

Priscilla Quiroz on behalf of the City of Santa Monica and the following counties Kern, Fresno and Humboldt, all in support.

Thank you.

Tiffany Whiten with SEIU California, in support. Thank you.

Thank you.

Samayan Hart. With the Alameda County Board of Supervisors in support.

Thank you.

Kelly Brooks, on behalf of the Urban Counties of California, the Rural County Representatives of California and the Boards of Supervisors of Los Angeles, Santa Clara, Riverside, and Ventura, all in support.

Thank you.

Geoff Neill, representing Contra Costa County. Also in support.

Thank you. Thank you very much. Is there opposition to the Bill? Seeing none. Bring it back to the Committee. Questions or comments from the Committee? Seeing none. The Bill does enjoy a do pass recommendation. Senator, would you like to close?

I just appreciate your time and your hard work. This is a tough Committee you guys are working really hard on. I appreciate all of your effort. Ask for an aye vote.

Thank you. Thank you very much. Do we have a motion on the Bill? Motion by Dr. Weber. A second by Mr. Rodriguez. The motion is do pass as amended to Appropriations. Madam Secretary, please call the roll.

Wood? Aye. Wood, aye. Waldron? Aye. Waldron, aye. Aguiar-Curry? Arambula? Beerner? Wendy Carrillo? Aye. Wendy Carrillo, aye. Flora? Vince Fong? Aye. Vince Fong, aye. Maienschein? McCarty? Joe Patterson? Rodriguez? Aye. Rodriguez, aye. Santiago? Villapudua? Weber? Aye. Weber, aye.

You have six votes. We'll leave the Bill on call. Thank you very much. Thank you.

And if there are any Senators who have a Bill before the Committee, we do have an opening at the table, although we can do now item number 21, SB 326, which was Senator Eggman. This is not a Bill for a hearing today. The vote is to amend the Bill to add an urgency clause. Can I entertain a motion to do that? A motion by Dr. Weber. A second by Mr. Rodriguez. The motion is amend and re refer to the Health Committee. Madam Secretary, please call the roll.

Wood? Aye. Wood, aye. Waldron? Waldron. Aye. Aguiar-Curry? Arambula? Boerner?Wendy Carrillo? Aye. Wendy Carrillo, aye. Flora? Vince Fong? Aye. Vince Fong, aye. Maienschein? McCarty? Joe Patterson? Rodriguez? Aye. Rodriguez, aye. Santiago? Villapudua? Weber? Aye. Weber, aye.

That has six. So we will leave that on call. And now we will wait patiently for Senators.

Thank you. Let's start then. Yeah, SB 717. That's all right. I want to start out by thanking the Committee for their work on tightening this Bill. I think we made an important compromise in the amendments that you all see before you here today.

We'll get into it, but essentially this involves a prison to street pipeline that we're seeing play out daily to the detriment not just of those who are in the carceral system, but also those who end up on the streets after and their neighbors and the community around them. When you're declared incompetent to stand trial and you've been convicted, you've been charged with a misdemeanor during the pendency of that trial. Now you can spend that time receiving mental health services.

However, if your charge is dismissed, there is currently no requirement that county or public defenders or the behavioral health system or really anybody tries to keep offering you services and stays in contact with you. And what ends up happening is that hundreds, if not thousands of people now in California who are incompetent to stand trial, may have severe mental health disorders, are simply just back on the street, no housing, nobody health treatment. And this is a disservice to them and our whole system.

We've been encouraged by some recent activity at the Department of Health Care Services looking at earlier interventions in the prison system. But we feel like this builds a really important safety net measure to make sure that at least at the county level, when folks are released or dismissed, that they're going to have some kind of contact for that initial period post release. And the amendments that I mentioned willfully make that very intense up front.

If you lose track of somebody in the first couple of weeks or as this Bill puts out there in the first 60 days, going to be very hard to find them again and serve them. We had 180 day period originally in this Bill. We've truncated that, but hopefully made those initial weeks very intensive. So there are going to be multiple contacts, we hope, and an attempt to get people into housing and services.

They can obviously still decline those services and people will have the right still to do so. They are not compelled, but we ought to try. So I wanted to happy to answer any questions, but trying to fill a really important hole right now between our justice system and our health care system. And I want to recognize that the concerns from AFSCME and some of the county behavioral health directors around shortages, we share some of those concerns.

We don't think this is going to be unduly burdensome from a workforce perspective and we're obviously pursuing that on budget fronts as well. But I feel like this is what those systems are designed to do. We just want to empower them to make it work. And so with me here today, I have Paul Simmons, the Executive Director of the Depression and Bipolar Support Alliance, as well as Le Ondra Clark Harvey, who's the CEO of the California Council of Community Behavioral Health Agencies.

There we go. Good afternoon. Thanks for allowing me to speak with you today. The Depression and Bipolar Support Alliance is the leading peer directed national organization focusing on the two most prevalent mental health conditions, depression and bipolar disorder, as well as other numerous other conditions in the mental health space, such as anxiety disorder, PTSD, et cetera. As the Senator mentioned, SB 717 would require a county behavioral health department to maintain contact for really just 60 days I think it should be longer. And offer mental health treatment to an individual charged with a misdemeanor who's been found incompetent.

We find ourselves in a particularly difficult time for those with mood disorders and mental health challenges. More and more peers, those with personal lived experience, like myself, are being marginalized, even criminalized, and end up in a cycle of forced treatment and incarceration without getting the help they really need.

A program to ensure that people receive the follow up that they need, particularly when they are so ill or in such a crisis mode that they are pronounced incompetent to stand trial seems fairly obvious, yet there seems to be no real system in place to address this. SB 717 requiring 60 days of contact with these individuals is a good Kickstart to ensure continuity of care with 60 days, I hope it's a good Kickstart. Once individuals start reconnecting with services.

I think it's going to be a real good benefit and encourage them, once they have those contacts, to continue on. So those first 60 days is really when it matters the most. The involvement of community based organizations in the process could both enhance the effectiveness of the program by providing more points of contact for the patient, but also making this minimal burden even lighter for the county behavioral health departments.

Anyone found incompetent to stand trial should already be receiving a substantial amount of mental health services, and hopefully this Bill will do more to ensure this. I think it's the best practice to maintain contact as long as possible, or certainly at least until the individual's mental health recovery is well on its way. We support this Bill strongly. Thank you.

Thank you very much.

Thank you, chair and Members. I'm Dr. Le Ondra Clark Harvey, a psychologist and the CEO of CBHA. Our Members represent mental health and substance use disorder agencies across the state that serve over 1 million individuals. So we understand that individuals found incompetent to stand trial on misdemeanor charges often fall through the cracks, receiving little to no behavioral health support. This lack of assistance can exacerbate their mental health conditions, putting them at further risk for Criminal Justice Involvement, increased personal suffering.

I saw this firsthand when working with this population at the state hospital in Wisconsin years ago, it wasn't odd to see the same individuals cycle through the system. By requiring county behavioral health departments to maintain contact with these individuals, SB 1717 can increase access and support to help prevent further deterioration of their mental health and substance abuse disorders and reduce the likelihood of recidivism.

We firmly believe that primary and secondary prevention can help individuals who have contact with the justice systems achieve recovery and become contributing Members of their communities. Thank you.

Thank you very much. Others in support, please. No one. Is there opposition to the Bill?

Good afternoon. Lisa Gardiner with the County Behavioral Health Directors Association. We represent the leaders of the public behavioral health safety net in 58 counties and two cities. We share the author's concern for this population and recognize that they could benefit definitely from behavioral health services, but we remain opposed unless amended on the measure.

Thank you to the author for the recent amendments, which narrow the amount of time required to track these clients, but we continue to find the 60 day time frame unduly burdensome at a time when we are facing a catastrophic workforce crisis. We believe this Bill would require the hiring of multiple additional staff per county and under. Medical outreach and engagement are not reimbursable services.

In addition, the prescriptiveness of the language around the outreach, which requires making concerted efforts to maintain contact at a minimum of twice a week for the first three weeks, really overrides the important and careful clinical judgment and expertise that our professionals bring to engagement with this difficult population. As the author and the analysis has noted, the Administration is in the process of implementing a justice involved medical initiative, a 90 day jail inreach program.

This is the first of its kind in the country, and in our initial discussions with the Administration, this program, which is set to start in April of 2024, we understand the goal is also to serve those with misdemeanor ists. So we believe it makes a great deal of sense to concentrate on upfront outreach of this population. So thank you very much.

Thank you.

Thank you. Mr. Chair, Members of the Committee, Alia Griffing with the American Federation of State County Municipal Employees appreciate the author's comments, and he did mention that we have concerns about the impact to the existing workforce currently highly understaffed. So we do have that concern, as mentioned, and look forward to working with the author moving forward. Thank you.

Okay, thank you. See, no one else will bring back to the Committee questions or comments from the Committee.

I want to thank you for bringing the Bill forward. We are always talking about how we need to get timely intervention, especially for people who need it right at that moment where they're facing either incarceration or future recidivism. And that's one of the things we always try to prevent and try to break that cycle. So I am supportive of the Bill.

I, too, support what you're trying to do. Senator, we had a discussion about this, and I have a much better understanding for what you're trying to do. And I guess as I start thinking about workforce challenges, we're talking about kind of a revolving door here. We've got people that are continued to repeat through the cycle.

And I can't help but think that if we took a more proactive approach to contacting them, it would alleviate potential additional work that would have to be done by people who are already having to work hard. So I see this as a positive impact. And contact doesn't necessarily mean you have to physically see them. Contact might mean a telephone contact, just a touching base. And I just have a hard time thinking that that's going to be that difficult unless you physically can't reach them.

And so I apply what you're trying to do here, I understand it. I support what you're doing, and the Bill does enjoy I do pass recommendation. So would you like to close?

Thank you for that, Mr. Chair, and for getting into details here on this. We think that that sort of relentless, abundant care up front at those crisis moments is just desperately needed. And right now, people are being released from a very unjust carceral system into an equally unjust life on the streets. And that just can't stand so big resource issues to solve.

Want to work closely with the counties and behavioral health directors, so we're going to keep doing that moving forward, but really appreciate your consideration and respectfully ask for your aye vote.

Thank you very much, Senator. Is there a motion? Can I entertain a motion? Move the I'm sorry, was that you, Ms. Waldron? Moving the Bill and a second from Ms.. Carrillo. Thank you. So, motion is do pass to, just I'm hearing things all over the place here today, so I'm also apparently seeing things that aren't there. So anyway, a motion is do pass to Appropriations. Madam Secretary, please call the roll.

Wood? Aye. Wood, aye. Waldron. Aye. Waldron, aye. Aguiar-Curry? Arambula? Boerner? Wendy Carrillo? Aye. Wendy Carrillo, aye. Flora? Vince Fong? Aye. Vince Fong, aye. Maienschein? McCarty? Joe Patterson? Rodriguez? Santiago? Villapudua? Aye. Villapudua, aye. Weber? Aye. Weber, aye.

That's six votes. We'll leave that Bill on call and you have another Bill, SB 779.

Yes. Thank you, Mr. Chair. I want to accept at the outset the Committee amendments referenced on page 11. And thank again, the Committee for their Engagement and thoughtful amendment dialogue. This Bill is really an effort to increase accountability, quality and transparency in health care care by updating annual data reporting for licensed primary care clinics. We know that community clinics and the licensed primary care clinics that they often operate under are in very tough environments, reaching populations that are often impossible to reach.

And the work is hard. The intake is hard. We know that it's not the traditional intake that you may face when you go to the Doctor's office and fill out that form. Often, folks at the clinics have to help people even fill out that documentation. And sometimes it may be the people we were just talking about who may be incompetent to stand trial and back on the street, or may have a psychotic affective disorder or bipolar disorder, other issues that make serving them very difficult.

So we don't want to complicate that relationship or add any undue stress. But we also know that we need critically quality and workforce data as well as patient data when they want to submit it to make sure we're serving populations as best we can. And so as we're sort of embracing primary care and clinic work and upping the budgets there and trying to sort of catch up with this broken social safety net, we don't want to delay that care.

We want to make sure there's quality and equity in this outreach. And currently, Department of Healthcare Access and Information is annually collecting a lot of this data, making public financial utilization, labor and patient demographic information from licensed primary care clinics. However, these current reports don't provide the level of detail we think is needed to enable the state to look at the healthcare policy questions, assess trends, anticipate workforce shortages. We need to be able to spot crises before they start.

We need to know where the gaps are in service for populations. We want to help community clinics do their jobs better, and we think this data is going to help empower them to do so. And I sincerely appreciate their concerns and the burdens they've got just for delivering care out there. But we think this Bill is not unduly duplicative and hopefully will earn your eye vote. I've got Beth Malinowski here with SEIU, as well as one of our local leaders from SEIU as well. So thank you.

Chair. Members. Beth Malinowski here today with SEIU California. On behalf of our 700,000 Members, SEIU California is a proud sponsor of SB 779, and we're grateful for Senator Stern for his leadership. As the Senators noted, we're also deeply appreciative of Committee staff working with us to continue to refine the Bill.

I want to align myself with the remarks made by Senator Stern and respectfully ask for your I vote today available to answer any technical questions, and now have the privilege of handing it over to one of our SEIU leaders, Joseph Torres Vazquez, medical assistant at Watts Healthcare in Los Angeles and a Member of SCIU Local 721 to share a bit more about why SB 779 matters to our workforce.

Good afternoon, Committee Chair Wood and Members of the Committee. My name is Joseph Torres Vasquez, and I'm a medical assistant in the Pediatrics Department at Watts Healthcare. I started working in healthcare because I feel passionate about helping people, especially in my community, Watts. Working in a clinic, mine is really fulfilling because I know that I'm helping my community. I am especially proud of part in enrolling parents and their children in our Healthy Steps program from Zero to Three.

This program helps guide parents on how to best support their babies early developmental stages, making sure that all families, including the low-income, Black, Latino and immigrant families that make up the majority of our patients, have the care and support that they need, and creates a brighter future for our generation. I want to continue and build a career in the healthcare field, but to be honest, I don't know if I will continue to do so. I don't know how much longer I am going to stay.

A lot of clinic workers are quite quitting. They find themselves in the same position, wondering if they can keep going with the way things are. Medical assistants like myself are getting paid $18 an hour and we get taxed as well. So that basically comes out to like around $15 an hour. Our wages are so low and we find ourselves exhausted and stretched beyond our limits due to our community.

Clinics receive millions in taxpayer dollars, but reporting requirements for how they spend this money to ensure that clinics have enough staff and whether they are investing in workforce development don't exist in our state for the first time. SB 779 would guarantee that the Primary Care Annual Utilization Report brings together information on finances and clinic workforce with information on quality of care.

SB 779 updates reporting requirements so that the clinics have to provide information on how they are creating a pipeline for their workers for long term careers in healthcare. It makes it so that lawmakers and the public know that the clinics are doing the support workers with job trainings and education. Without healthcare workers, our clinics won't thrive, and without our clinics, our patients have no other places to go.

SB 779 will help us seek how deep the problems go when it comes to staffing, patient care, workforce development, and as well as information on clinic mergers and acquisitions. I urge you to vote yes on SB 779 to strengthen our clinics, help the communities that rely on them, and to stand with clinic workers and our patients. Thank you.

Thank you very much. Others in support?

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

Thank you. And just name and organization if you represent one, please.

Connie Taylor Smith. UHW, Healthcare Justice. I stand in support.

Thank you.

Marnae Maldonado from San Diego with San Ysidro Health. I stand in support.

Thank you.

Sharon Brooks Boyd, retired from SEIU-UHW, and as a patient that advocates a healthcare system, I stand in support.

Thank you.

Gloria Bridget, HealthRIGHT 360 Statewide. I stand in support.

Thank you.

Trina Marie Yuso. Desert Regional Medical Center Palm Springs, SEIU-UHW and San Diego Clinic--Clinics--I stand in support.

Thank you.

Mi nombre es Paula Carillo, y vengo de Modesto. Y vengo apoyar las 779. Yo soy paciente de la Golden Valley. Gracias.

Gracias. Thank you.

Good afternoon. My name is Alicia, and I'm from Los Angeles, and I'm here to support the 779.

Thank you.

Hi, good afternoon. My name is Maria Mercado. I'm coming right here because I'm San Ysidro Health Center, the medical assistant CNA, and this is I'm coming today for support. This is at 779. Thank you.

Thank you.

Good afternoon. My name is Miria, and I work. At the Watts Health Center for three years. I am also an SEIU 721 Member, and I'm here to support the 779.

Thank you.

Good afternoon. My name is Judith Valenzuela. I'm from San Diego. San Ysidro Health Centers. I'm a CNA, and I'm here to support the 779 standing for support.

Thank you.

My name is Francisco Bodello Hernandez. I'm a clinic courier at Saluta Lahente in Watsonville, California. I'm a Member of SCIU 521, and I strongly urge you to please vote yes on SB 779. Thank you.

Thank you.

Tiffany Mok, representing CFT, a union of educators and classified professionals in support. Thank you.

Thank you.

Hi, good afternoon. Deborah Barrios. I'm a nurse at Zuckerberg San Francisco General Hospital. I'm also a Member of SEIU 1021. I stand here in support. Thank you.

Thank you.

Good afternoon. My name is Jessica Orantes. I'm a medical assistant at Highland Hospital in Oakland, and I stand in support.

Thank you.

Good afternoon. I am Brandon Dawkins. I am a health worker with the San Francisco Department of Public Health and a Member of SEIU Local 1021, and I, too, support SB 779.

Thank you.

Hello, I'm Shelley Butler. I work at Watts Healthcare. I'm here to ask for your support for SB 779. Thank you. Have a good day.

Thank you.

Hi, I'm Diana Morales, registered nurse. I work with Borrego and I ask for your support and yes on SB 779. Thank you.

Thank you.

I'm sorry. Navani Saxton come from an Inland Empire, and I also do support for the SB 779.

Thank you.

Hi, I'm Katie Templeton. I'm from Hollywood, California, LA LGBT center. We stand in support. Thank you.

Thank you.

My name is Vaughn Cotton. I am a well spaced patient standing in support for 779. Thank you.

Thank you.

Hi. My name is Geneva Henry. I did CNA for 30 years at Piedmont Garden, Healthcare Justice for UCW 799. I'm supporting.

Thank you. Anyone else seeing? No one. Is there opposition to the Bill?

Good afternoon, Mr. Chair and Members. Dennis Cuevas-Romero with the California-Health Plus Advocates. We are the c[4] arm of the California Primary Care Association. We represent nearly 1,300 health centers in the State of California, providing care for over 7.7 million patients in the state. We appreciate the Committee's hard work on the amendments. Also appreciate the author and sponsor for the continued dialogue on the bill.

We will be bringing the proposed amendments to our legislative Committee on Thursday for potential reconsideration of our position. In the meantime, do want to just express a couple ongoing concerns. The author and sponsors do argue that the bill is intended to address a gap with the increase of intermittent sites and the lack of data that has not followed.

We agree with that assessment, and that's why we've provided proposed amendments to try to address that concern, to try to make sure that the data follows the rise in intermittent clinics. Again, we agree with that, and we do believe that there is a need for increased data. The concern with this bill is that we don't really see the specific data points that are remaining in the bill, the new data that is really getting to the heart of increasing patient care, and that's, I think, the most problematic issue for our Members.

We certainly appreciate the delayed implementation because that will help our Members implement the bill if the bill is passed and signed into law, and we do appreciate the continued dialogue that we'll have with the authors and sponsors, but those are some of the remaining concerns.

The last thing I do want to mention is with the expansion of health care for all for the 26 to 49 population on Gen One, our health centers are going to take on the lion's share of those members and the concern from our health centers is that without any additional funding to help support this, they may have to move staff to meet the requirements of this bill instead of providing additional support for patient care because the author and sponsors I know we share the goal of providing better, more timely access and patient care, and we hope to continue that dialogue moving forward. Thank you for your time.

Okay, thank you very much. Anyone else in opposition?

Martin Pineda on behalf of Calexico Warner Center and La Cooperativa Campesina in opposition.

Thank you.

Brandon Marchy with the California Medical Association in an oppose unless amended position. We'll take the amendments back in review. Thank you.

Thank you.

Dominic Di Mare here on behalf of Health Center Partners. Not sure why we didn't show up on the analysis, so I'll figure that out, but Senator Stern will not be surprised that we are opposed unless amended and we'll be taking the amendments back to our legislative Committee as well. Thank you.

Good afternoon, Chair and Members. Alejandro Solis on behalf of Los Amigos de La Comunidad in opposition, and as a proxy for California Human Development Center for Employment and Training, Center of LA, Opportunity Center, Farmworkers Institute of Education and Leadership, Inland Coalition for Immigrant Justice, and San Diego Regional Chamber of Commerce, all in opposition. Thank you.

Thank you.

Libby Sanchez on behalf of AltaMed, an oppose unless amended position echoing the comments of my colleague at CPCA.

Thank you. Anyone else? Seeing no one, bring it back to the Committee. Any questions or comments from the Committee? Dr. Weber?

Thank you, Senator Stern, for bringing this bill forward. I think you have, on one point, kind of highlighted an area that we do need more data from some of our intermittent clinics. I do echo the concerns from the opposition with the expansion of the data requirements. As I was reading through the bill, the Doctor came out of me, and it's just like, more paperwork, more paperwork, more paperwork, but how does this translate into better patient outcomes and improved access to care?

And so understanding that these clinics that we're referring to, these are our community clinics that are really our safety nets for our communities. These are the clinics that are ensuring that our most underserved patients in our communities are getting at least the primary care, at least that first step in the door. There are many people here from San Ysidro Health, and although it's not necessarily in my clinic, I understand the impactful role that they play within San Diego County.

And so when I was reading it, I said, 'well, who is going to be the person that will be collecting all of this data and putting it together in a report?' And is this taking away from someone who could be providing patient care when at the end of the day, some of these things--I don't see how it translates into better patient care, better patient outcomes, better patient access like mergers and acquisitions.

I don't understand how collecting that data translates into lower hypertension rates or lower diabetes rates and things like that, and so although I do believe that some of these clinics for which we're not getting any data from, we do need patient demographic data, we do need worker data. We need the data that we're getting from some of these other hospitals and clinics that are currently required.

I'm not sure if the extensive expansion is going to translate into better patient outcomes, and so that's really kind of where I'm having difficulty, because personnel has to come from somewhere, and if we're removing it from current patient care, then I want to at least say, at the end of the day, it's going to improve patient outcomes, and I'm not sure if all of this data does that, but I do want to thank you for shedding this light that we're not reporting on all of our clinics as we should be.

I'm going to continue to look at this, but I just wanted to kind of let you know my appreciation on one part, but also my concerns with some of the others. So thank you.

Okay, thank you. Anyone else? Mr. Villapudua.

Thank you to the Chair. Thank you, Senator, for bringing this up. One of my jobs when I first came up here, so I'm a former county supervisor, so I see it from when it hits at the county level and my clinics are closed. They're done. It's another issue, but one that upsets me the most, right, because these are folks that are in my district that sometimes they don't have means of transportation and you're closing these clinics in our district.

We're fearing that more and more and hearing that more and more, and I also have heard from employees, county employees, that it just seems like when government gets involved, we're asking them to do more with less. They're wearing many--you guys, I saw all the SEIU members here, they're wearing so many different hats and we're asking them to collect more and more data. I'm going to be voting for this today, but I just want to make sure that the data that we're asking our employees to do, that it's going to be--to make sure that our community is served well.

Our community is for folks that--I'm thinking of my district and probably your district, that we're serving them and giving them the best, not trying to close those clinics, not trying to close those hospitals because it just seems like when we're forcing that, we're forcing our workers to do more and they're doing the max that they can.

It just seems like we keep--the government gets involved in asking for more and more data. I hear it. They're like, I'd rather them do deal with the patient, work with the constituent instead of us keep asking them to, hey, can you--because I know sometimes they say, 'well, we're doing it' because it equals dollars, right?

Okay, well, coming here, I'm fighting hard to make sure that we don't add another hat to that worker. So I appreciate the bill and I will be supporting it today. Thank you.

Thank you, Ms. Carrillo.

Thank you, Mr. Chair. I want to thank the members of SEIU 721 and others that came up from various different parts of the state to address the importance and the concerns related to this particular piece of policy. Senator, thank you for your hard work on this. We've done a lot of work in the last few years, myself included, in authoring legislation that empowers the workforce at community clinics and at federally qualified health care centers, but I do want to echo the sentiments of my colleagues who have expressed some concerns in my district.

Community clinics saved thousands of lives amid pandemic. We were one of the hardest districts hit in all of LA County, and it was also incredibly challenging to even try to address issues with the Administration on COVID testing, COVID vaccines. If you don't have an iPhone, you couldn't even get access to making an appointment.

And so I just want to thank our community clinics as well in particular, and some of our hardest hit communities who were at the forefront of the pandemic and, who again, saved thousands of lives. I do believe that the concerns raised are important and need to be addressed, so I will be supporting the bill today but I do hope that you take into account some of the conversations and potential amendments that are being requested and asked to ensure that, one: we're doing the very best we can on transparency and accountability, but also patient care.

Community clinics, as mentioned, are really the forefront of so many of the most vulnerable communities across California and I don't think any of us want to be in a position of making their work harder, but certainly want to figure out a way in which we achieve transparency, accountability, worker shortages, expansion of a workforce that we know is already very understaffed and underserved across the state, but I do hope that you take some of the considerations and the amendments as it moves forward into Assembly Appropriations and before it gets to the floor vote. Thank you.

Senator, thank you for bringing the bill forward. I do support the bill. I guess I would point out that with OHCA, the Office of Health Care Affordability, in time, some of this data is going to be collected, so I don't believe we're really asking for a lot of new data. A lot of this information is already available out there. It's just a matter of packaging it in a way that's understandable.

So we talk about transparency and understanding, things like the finances and workforce and how they're paid and all of that. I think that's important in the long run to the efficient operation to ensure that the workforce is well compensated so they can provide the care that's necessary for people. So I appreciate you bringing forward the bill. It is at its heart, a data and transparency bill, and I think that's important. I've always been driven by that and I just thank you for bringing it forward and with that, would you like to close?

Yeah, thank you, Mr. Chair, and I'll just in my close respond to the thoughtful comments, especially, not just from you, but from the Committee Members. We're not looking to add further to the burden facing community clinic workers, those who administer it, the doctors themselves. In fact, in some of these cases, we don't actually think it takes a new piece of paper.

Some of the questions around patient demographic issues--say, gender, sexual orientation--those were some of the ones brought up as something that for the clinics, they were uncomfortable or at least expressed some discomfort with asking for that kind of information from the patient that maybe that would cause a rift or some sort of pushback or unwillingness to even show up at all. We want to make clear here that it's not mandatory that you go collect that data. It'll be a box to check.

So you're going to have to just like--you check name, you have to put race. You don't have to check the box, but there's the checkbox there. So adding a couple of checkboxes, we don't think at least on that issue will be too burdensome, but we did clarify that the clinics will be held harmless if the patient doesn't want to submit that kind of information around gender, sexual orientation, things like that.

We are hoping that the Association and some of the major clinics out there take a good hard look at the timelines we've put out here because we do want to make it sync up with some of the broader new data requirements, and so, to the extent that they're writing down on paper right now about their workforce, which is sort of the feedback, some of the feedback we got when you're going through your worker evaluation or hiring folks and you're taking note, literally of who your workforce is, a lot of that's written down right now.

May not be then integrated into the database itself. There should be a pretty low cost, simple way to get the tech and the database part sorted, but we know that may take a little time, so hopefully pushing that out to 25 and then 26 for new reporting requirements will help give them a little bit of that breathing room. But look, this bill has been--I'm sensitive about it too because this is the lifeline in my district. You go out to places like Reseda, Canoga Park, this is life and death for a lot of people out there, these clinics. So I'm grateful to the work they do as well.

I just think this is going to help strengthen us all and again, not have surprises in this space on the M&A question and sort of that broader financial trends like why is that useful? And I think it's a valid conversation and debate to get into, but at least my thinking, so you know where we're coming from, is to say, 'if there are going to be broader financial trends in the industry and we know--say there could be closures in a particular area or because of consolidation, there's going to be sort of fiscal pressure on this network versus that network.'

That's the idea that if we have that kind of information, we can see crises coming before they start. It's not intended to be a sort of disruptive or burdensome data request. It's more to say, 'let's not fly blind here when we're trying to deliver more community care.'

So we hope that kind of gets us a little purview into what to expect. Obviously can't be perfect about this stuff, but I hope you can appreciate just the good faith efforts we're making, and we're going to keep working with opposition to try to dig in here and see if we can land this thing with an outcome that works for all, and with that, I respectfully ask for your aye vote.

Thank you very much, Senator. Is there a motion for the bill? Motion by Mr. Villapudua. Second by Ms. Carrillo. Motion is 'do pass as amended to appropriations.' Madam Secretary, please call the roll.

Wood? Aye. Wood, aye. Waldron? No. Waldron, no. Aguiar-Curry? Arambula? Boerner? Wendy Carrillo? Aye. Wendy Carrillo, aye. Flora? Vince Fong? Maienschein? McCarty? Joe Patterson? No. Joe Patterson, no. Rodriguez? Santiago? Villapudua? Aye. Villapudua, aye. Weber? Aye. Weber, aye.

The vote is four/two. We'll leave the bill on call. Thank you. Next up is Senator Limon. How about start by pushing the button?

Ding.

Thank you.

Thank you, Mr. Chair and Members. I'd like to start by thanking the Chair and Committee Staff for your work on this measure. I accept the Committee amendments as outlined in the analysis. SB 496 ensures health care coverage of biomarker testing by health plans, health insurance policies, and the Medi-Cal program. Precision medicine is improving patient outcomes by using their own genes or proteins, also known as biomarkers, to prevent, diagnose, or treat diseases.

According to last year's Sharpr analysis, biomarker testing is broadly covered by the California Essential Health Benefits Plan, therefore, this bill would not require coverage of a new state benefit mandate. However, in a 2021 survey, 66 percent of oncology providers provided that insurance coverage is a barrier to biomarker testing. This bill will improve access to biomarker testing to help patients treat their disease, slow disease reoccurrence or progression, and lead to a better quality of life.

With me today to testify in support of the bill, we have Autumn Ogden-Smith with the American Cancer Society-Action Network, and Jen Chase with the University of California Office of the President.

Hello, Chair and Members. Autumn Ogden-Smith with the American Cancer Society-Cancer Action Network. Here is a proud co-sponsor. Insurance coverage for biomarkers is failing to keep pace with innovations and advancements in treatment. SB 496 will ensure timely access to appropriate biomarker testing, with help achieve better health outcomes, improve quality of life, and reduce costs by connecting patients to the right treatment at the right time. This bill, this language has been passed in 13 other states, inclusive of Illinois, Arizona, Texas, Alabama, Rhode Island and Louisiana.

We thank the Committee for all their hard work in helping us address Department concerns. We feel we're well on our way to a signature this year, and for these reasons, I ask for an aye vote.

Thank you.

Good afternoon, Chair and Members. Jen Chase with the University of California. We are proud co-sponsors of SB 496 and also wanted to thank the Committee Staff for all their hard work over the past few weeks on the bill. UC is a leader in cancer care, and our five cancer centers are focused on addressing health disparities and promoting health equity in cancer diagnosis and care. Research shows that there are racial and socioeconomic inequalities in biomarker testing and target therapy utilization across different cancer types, and one of these barriers is variability in how health plans cover biomarker testing.

SB 496 will require health plans to cover biomarker testing using the same coverage criteria, which will increase our access to precision medicine, which is an initiative we're working on very hard at the University of California, and so we respectfully ask for your aye vote on SB 496.

Great. Thank you. Others in support?

Good afternoon. Kristi Foy here on behalf of the California Clinical Laboratory Association in strong support.

Thank you.

Ryan Spencer, the Crohn's & Colitis Foundation, in support.

Thank you.

Mr. Chair and Members, Adam Keigwin on behalf of Natera and as a patient who utilizes this test. In support.

Thank you.

Sumaya Nahar on behalf of the Children's Specialty Care Coalition in support. Thank you.

Thank you.

Good afternoon. Moira Topp, on behalf of Biocom California, in support.

Thank you.

Conor Sweeney with the Susan G. Komen foundation in support. Thank you.

Thank you.

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

Thank you.

Chair and Members, Dean Talley with the California Manufacturers & Technology Association. Strong support.

Thank you.

Brandon Marchy with the California Medical Association in support.

Thank you.

John Wenger, on behalf of the Advanced Medical Technology Association in support.

Thank you. Is there opposition to the bill? Seeing none. We'll bring it back to the dwindling Committee. Are there questions? Yes, Ms. Waldron.

Thank you, Mr. Chair. Just a comment. I've toured several facilities that do whole genome sequencing and it's really amazing, and we talk about individualized care and actually, if we could do such a thing over time, we're going to save money. Patients won't have to undergo treatments that they don't need. It's really a way to do as someone is under treatment to make sure the monitoring is more of an exact science, so to speak, that they're actually getting what they need and is supported by scientific evidence, so I support your bill.

Thank you. Anyone else? Seeing no one. The bill does enjoy do pass recommendation. Would you like to close?

I respectfully ask for an aye vote.

Okay. Thank you. Is there a motion for the bill? A motion by Ms. Waldron. A second by Mr. Villapudua. Motion is 'do pass as amended to Appropriations.' Madam Secretary, please call the roll.

Wood? Aye. Wood, aye. Waldron? Aye. Waldron, aye. Aguiar-Curry? Arambula? Boerner? Wendy Carrillo? Flora? Vince Fong? Maienschein? McCarty? Joe Patterson? Aye. Joe Patterson, aye. Rodriguez? Santiago? Villapudua? Aye. Villapudua, aye. Weber?

You have four. We'll leave that Bill on call. Thank you. It's a busy day out there, so Members are all over the place seeing Senator Bradford. Senator, you have SB 873.

Thank you, Mr. Chair and Members. I'm here to present SB 876, which will ensure patients are better able to afford their medication by reforming the state's prescription drug rebate system to directly benefit patients. Currently, when a patient pays for a drug in the deductible phase or pays coinsurance. I'm sorry at the pharmacy counter, the amount they must pay is based on the full price of the drug. Even if their health insurer and pharmacy benefit managers or PBMs are paying a lower amount, they negotiate it with the manufacturer. In 2021 alone, PBMs in the United States negotiated $236,000,000,000 in rebates overall, with none of that money going to offset the high cost of medication to the patient at the pharmacy counter. In California in 2021 report from the Department of Managed Healthcare showed that health plans in the state received 1.7 billion in rebates, up to 1.4 billion in 2020 and up to 1.2 billion in 2019. Because there is no transparency in the system, patients have no idea how much, if any, rebate money goes to lowering insurance premiums or lowering other out of pocket costs to the patient. With prior legislation only providing transparency to a portion of the system, SB 873 will add much needed accountability and transparency. By sharing 90% of the rebate with the patient at the pharmacy counter, SB 873 will immediately lower prescription drug costs, helping California's better access their medicines. A January 2022 California Health Benefits Review Program report of a similar policy measure found that it is possible for pharmacy software to be updated to share rebates at the point of sale as outlined in this Bill. The software already allows for point of sale variations in prices, cost sharing amounts, benefit coverage, and formally information. Let's not forget that other states already are beginning to implement a program similar to SB 873. In 2021, West Virginia began passing 100% of the negotiated rebates to patients at the counter, and we've seen national health insurers and other PBMs start to offer rebates to their patients as well. I want to address the decision to not accept the Committee's amendments and Senate Bill 873. My constituents are profoundly impacted by chronic diseases and health inequities, and it is my responsibility to implement solutions that address these disparities and ensure equitable access to affordable health care. Healthcare affordability is central in improving the lives of individuals and families across our state. The suggested amendments replace this Bill with a study, and while I'm a big proponent of more data, I believe we already know what is needed here. The California Health Benefits Review Program has conducted its financial assessment, and we have several other states to base our efforts on. SB 873, as written, provides an opportunity to alleviate financial burdens and make vital medications more accessible. Furthermore, representing an area where disenfranchisement is a pressing issue, every bit of savings that can be obtained through this veil holds immense importance. We must seize every opportunity to uplift our communities and enhance their quality of life. National pharmacy benefit managers have already adopted similar practices, and states like West Virginia and Arkansas have successfully passed similar legislation. It is vital that this Bill receives the attention and discussion it deserves, and it has the potential of positively impact the lives of countless Californians. With me today. In support is Dr. Leandra Clark Harvey psychologist and Executive Director of the California Access Coalition and Asher Lisec, Vice President of the Western Region of State Advocacy for Pharma. I respectfully ask for your I vote.

Okay, thank you. Please go ahead.

Good afternoon. The Access Coalition joins our co sponsors at the Diabetes Patient Advocacy Coalition and the Patient Pocket Protector Coalition to lower California's patients out of Pocket Cost for Prescription Drugs. In 2020, I received a phone call that no one wants to go. I was told that I had an early breast cancer diagnosis. I have my doctorate, I worked in hospitals, and I'm a professional advocate. I was also stuck with a high deductible plan through my husband's health insurance. I was hit with thousands of dollars of medical bills after I had my double mastectomy. And a few months later, my mother revealed that she too was diagnosed with breast cancer. But hers is stage four. How did it get to stage four? Because she managed her diabetes treatment for years. She knew the high cost of medications, and she was terrified of the extra cost of cancer medication and treatment that wouldn't be covered by her health plan. So she waited until she was old enough to get Medicare to pursue her treatment. After debilitating chemo, radiation, and double mastectomy, a suspicious mass resurfaced during her reconstruction phase. My mother is hospitalized as I speak. The current prescription drug rebate system was designed to help patients afford their medications, but it has changed, and it now benefits health insurers and pharmacy benefit managers at the expense of patients. Studies have shown that patients facing high costs are less likely to take their medications as prescribed, more likely to abandon therapy, and more likely to delay or forego treatment, putting them at higher risk for expensive emergency room visits, avoidable hospitalizations, and poorer health outcomes. This is the story of my mother. This foregoing of health care due to high costs is untenable, and SB 873 provides a remedy, a solution that fixes the broken prescription drug rebate system. Is it a silver bullet? No. But is it an important step in the right direction? And despite what the opposition will assert, other states have successfully implemented this policy. This Bill will benefit thousands of small businesses and their employees who have high deductible health plans and face high out of pocket costs that make it difficult and often impossible for them to afford the medications they need to get and stay well. Members, your legislative colleagues have introduced this measure multiple times, and this is the second time that we have been heard in this Committee. So thank you, sincerely, Chairman Wood, for letting me share my story, my mother's story, and so many other patients and coalition Members who don't have an opportunity to speak before you today. Whether it is $5, $50 or $500 that are saved at the pharmacy counter, every dollar counts when you're a patient in need. Thank you.

Thank you.

Chairman Wood, Members of the Committee, thank you for having me here today. As Senator Bradford stated, in 2017, the Department of Managed Healthcare started measuring, in part rebates. And since 2017, they have found out that rebates have gone up 81.6%. That's a growth of around 13% a year. The good news in that is that we have seen the net cost of prescription drugs. So the cost of a prescription drug, minus the rebate stay very steady over the last several years because of the increase in Rebates. Unfortunately, the rebate system has also created some perverse incentives, and really it needs to be fixed. One of those perverse incentives that the Senate Finance Committee recently found in Congress is that PBMs and health plans will actually incentivize a higher cost drug because a drug rebate is based off a percentage of the list price, and then they are retaining the percentage of the rebate they receive. And that's not going to consumers. This means that health insurance formularies are increasingly excluding lower list price option drugs in favor of the higher list price higher rebate drugs. Making matters worse, consumers are not benefiting from the rebates when they're paying in the deductible phase and in coinsurance. And I will fully acknowledge this Bill does not fix the entire system. But what it will do is make sure that patients and California consumers will benefit from the negotiation that's happening between the manufacturers and the health plans when they go to the pharmacy counter. And for those reasons, I respect ask for your support.

Okay. Thank you. Others in support.

Good afternoon. Tara Gamboa Eastman with the Steinberg Institute. In support.

Thank you.

Jennifer Snyder with the California Life Sciences in support.

Thank you.

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

Thank you.

Tim Madden representing the California Rheumatology Alliance. In support.

Thank you.

Paul Simmons with the Depression and Bipolar Support Alliance of California. In support.

Thank you.

Matthew Burke, a type one diabetic living in Davis, solely in support.

Thank you.

Dean Talley with the California Manufacturers and Technology Association. In support.

Thank you.

Missy Johnson, on behalf of the California Pharmacists Association. In support.

Thank you.

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

Thank you

Moira Tap, on behalf of Biocom California. In support.

Thank you.

Kathleen Soriano on behalf of the Keck Medicine of the University of Southern California. In support.

Thank you. Opposition.

Dr. Wood and Members of the Committee. My name is Bill Head with PCMA, the PBM Trade Association, here in opposition to SB 873. I think it is important to remember that this proposal has come before the Committee, I think in the last four or five years and been rejected because of the cost impact. And let's consider the source for a minute. Not to be too disparaging, but this has been a pharma proposal for all those years. So this is the industry that creates patent tickets that limit the ability of generic drugs to come to market. When they are able to come to market, they often do pay for delay. That's where a pharmaceutical company will pay a generic manufacturer money not to come to market. But yet they want you to support this policy when it does absolutely nothing to lower the cost of prescription drugs. Bear in mind that 90% of drugs dispensed are generic drugs. So that 10%, of the 10% that are brand drugs, less than 20% of that 10% actually have rebates. So the vast majority of drugs do not come with rebates. This proposal was considered under the previous Administration to do for Medicare and what the Congressional Budget Office came to, this is our conclusion, this is CBO said that, yes, for some Medicare beneficiaries they would pay lower cost for drugs, but for all Medicare beneficiaries they would experience a cost increase to the tune of $171,000,000,000 over 10 years. Also, CBO estimated that the pharmaceutical manufacturers would keep the money that they would otherwise given a rebate and increase drug costs by $137,000,000,000 over 10 years. Rebates were the creation of the pharmaceutical industry. If there's a problem with them, they should fix it and stop offering rebates and instead just lower the cost of the drug. This notion that there's an incentive to have higher cost rebate drugs on the formulary is a falsehood. A PBM is always going to go with the lowest net cost drug to the health plan, whether it has a rebate or it's discounted to that price. Otherwise, the plant is going to go shop somewhere else, because the plant is only interested in what is the lowest cost net that they will pay for a particular drug. So this is nothing more than really a shell game. In the past, we've heard the pharmaceutical industry say that rebates add to the list price. Well, if that's the case, they're basically saying we expect the list price to continue to rise because we're not doing anything about that. We're going to continue the rebate system and continue to have our prices increase. So for these reasons, we respectfully ask a no vote on this Bill. Thank you.

Thank you.

Thank you, Mr. Chair and Members, Nick Louizos on behalf of the California Association of Health Plans, in opposition to SB 873. Regrettably, the cost to employers, employees, and individuals far outweigh the purported benefits of this Bill. Members, $200 million, $200 million is the premium increase that is estimated by the independent analysis of the California Health Benefits Review Program of the first year impact to premium payers. So this is the cost that individuals and employers in your district will be paying in the first year of implementation of this Bill. That cost is almost three times the purported benefit that will be experienced by a small percentage of consumers. In other words, consumers will collectively pay more so that some might pay less. And this simply does not pencil out. So, setting aside the cost for a minute, this is bad public policy for a number of other reasons. This will lead to a prioritization of the use of expensive brand name drugs at the expense of lower cost alternatives. And Members, what this Bill does, it removes the ability of my Member health plans to collect a drug rebate and apply that across all premium payers in order to mitigate the cost of premiums to your constituents. And despite the statement that there's no transparency in drug costs, quite the contrary, there's a significant amount of transparency in the State of California with respect to drug costs. In fact, SB 17, which passed a number of years ago and was supported by our industry, applied transparency to both the health plans and the pharmaceutical companies. That was opposed by the pharmaceutical companies. Indeed, they took it to court even, and my understanding is that they lost on that issue. So the law moves forward. But one of the things that the Transparency Report pointed out in its latest edition, the 2021 Department of Managed Healthcare Drug Cost Transparency Report, it clearly shows that health plans use drug manufacturer rebates to help mitigate the overall impact of high drug prices by reducing total health plan premiums by 2.1%. And so we're perplexed as to why we would propose or pass a law that eliminates that option of the health plans to be able to apply the drug rebate across premium payers. It's what our health plan clients want, and we just think it's bad public policy to remove that option for our Members. So why would we want to interfere with that? It makes a little sense from our perspective. So finally, I would just say CAP has supported other legislation in the past to reduce the share of cost. In fact, the budget that was just passed recently will enact a program at Covered California to reduce the share of cost for enrollees there. And it will do so in a way that will not increase premiums. And we need to look at innovative solutions like that and not bills like this. Thank you.

Thank you very much. Others in opposition.

Chair Members, John Winger on behalf of America's Health Insurance Plans, in opposition.

Thank you.

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

Thank you. Okay, seeing no one else will bring it back. Committee questions or comments from the Committee. Dr. Weber.

Thank you, Senator and those who have spoken support and in opposition. I do have a couple of questions and some concerns. I will be supporting the Bill today because all of this information, the analysis kind of came out a little late and I was not able to give the opposition opportunity to answer some of the questions, nor the supporters. But one of the things that struck me as I was reading through the analysis is that when they were referring to rebates, that's done in secret. So how are we to know when someone goes to point of sale purchase, how much they should be receiving a discount for?

So that is true that the negotiation happens between the PBM and the manufacturer and that information is not public. What the Bill says is at least 90% of rebates have to be passed through at the point of sale. So the PBM and the health plan could choose to pass through 100% or they could calculate it down to 90%. As far as how you would know whether you got the benefit of the rebate, the consumer would see their Bill go down in their deductible phase for one. And then two, the Department of Insurance and the Department of Managed Healthcare would have the ability to go in and look at the books and make sure that rebates were being passed through.

And Doctor, can I just ask, maybe the broader point you're getting at is that in terms of the rebate, the current system now there is transparency between the PBM and the client, if that's what you're getting at. And it's not unusual at all for the client, I'm sure CalPERS has this provision. They have audit provisions so that they can audit what rebate they're getting and compared in the grand scheme of things so that information is known, but it is proprietary between the client and what the PBM is negotiated with the manufacturer. If that's what you're getting at.

Go ahead.

I was just going to say, yeah, what you're hearing is correct. It is proprietary information. I mean, it is reported on aggregate. So the health plans, unlike others in the healthcare sector, go through rate review. And as part of that process, the aggregate rebates are reported to the Department of Managed Healthcare. But I think one of the things that we're all kind of pretending here is that the rebate process happens in real time and for the most part it doesn't. So the health plans are going to be asked as a part of this Bill to front a rebate that they may not have. And so my understanding and Bill might be able to clarify this, is that when rebates negotiate, it's contingent. A lot of times it's contingent on volume. So the drug company is not giving a rebate because they're being altruistic. They're providing a rebate with the understanding they've done some sort of estimate. I don't know how it works technically, but they've done some sort of estimate about volume and market penetration within the health plans enrollees before the rebate is issued, and that could take six months to a year. So a lot of times the reason clients don't want this is because they don't know if it's going to materialize in the amount or at all. So you're basically kind of operating under some assumptions here.

It could be more than a year, it can be two years to get the rebate dollars themselves.

Right. And I guess that is a part of my question. Like, if we don't really exactly know the amount of the rebate, then how are we going to provide that discount to the patient, client, whatever, at the point of purchase? Because it does seem to be, at least from everything I've read, something that's retroactive. And even I think in the Bill it states that, hey, if you didn't get all your money after the audit has been done, we'll give you more money, but if we gave you too much, then you don't have to give it back. So that tells me that we're not really quite sure exactly how much to give to that particular individual at the point of purchase. Okay, I guess that question was answered. So my other question is, from everything I've read, these rebates are on our brand name products, not on our generic. And so when we are talking about a potential increase in the amount of people who are getting brand name versus generic drugs, how is this Bill going to lower the overall cost of our healthcare system?

Dr. Weber, I can start. Thank you for the question. I think one of the things I saw in the analysis was that there would be a perverse incentive to prefer brand name drugs. And I think that quite the opposite is going to happen right now. If you look at the insulin marketplace, for instance, generic insulin came to market, but none of the large three PBMs wanted to put generic insulin on their formulary. They excluded it. So it was the brand name prescription drug that was more expensive, that came with a rebate with a net cost that was lower, that ultimately got favored. And so I think if we see this Bill move forward, the perverse incentive to keep the brand name medicine on the formulary longer is actually going to go away. And so to us, it's very important to keep the generic dispensing rate high and keep a healthy generic marketplace. So we don't see like, what we have with insulin, where there isn't uptick in the generic marketplace for insulin.

But if we have rebates that are only going to brand name, and now this money is going to decrease what the individual has to pay. To me, it seems like more people would be prescribing and giving away brand names, thus disincentivizing our generic medications and disincentivizing companies to actually create generic medications.

Just to clarify, too, it's only going to brands who have competitors in the same therapeutic class. So it's a subsection of brand drugs, not all brand drugs. So a source, source brand drug that has no competition, the price is unlimited. Right. They're not going to offer rebate because they don't have to. They have the entire market. So it's only for that subsection that is competing in the same therapeutic class. And that's our concern, too, because what are we doing about those people? So you are helping a small segment of the population at the expense of the entire population.

Thank you. So again, how are we thinking this is going to lower overall health care cost?

Well, I think first and foremost, it's going to lower cost for consumers and then what we are hoping that we see is that the generic marketplace stays strong and that we continue to see generics come to market and get on formulary. Because when they are on formulary, when you prescribe an insulin to a patient, then the pharmacist will automatically substitute to the lower price generic first. But if it's not on formulary, if it's not covered, then they won't make that formulary switch or substitution at the pharmacy.

Well, Senator Bradford, I really appreciate you bringing this Bill forward. I definitely appreciate the conversation. I do think that there may be some concerns or some further discussions that I do need to have on both sides. But for today, I will be supporting it to let it continue to go, and I look forward to my future conversations on this particular Bill. Thank you.

Any other comment, questions? Mr. Patterson.

Thank you. Yeah, I, you know, I was listening to some of the comments and it's always interesting having friends on different sides of a particular issue, which is, I think, pretty much every Bill in this Committee. But I don't want to get in a position where we're talking about this particular group does bad things and so on and so forth. I think everybody provides a critical role in the delivery of healthcare services. When I initially thought of this Bill, I see a lot of issues, just generally when it comes to how healthcare, being the new guy, how healthcare is delivered in terms of PBMs and rebates. And it's all very complicated. And so my initial impression of this Bill was I'm supportive of the concept, but I do feel like we need to take a step back. There have been other pieces of legislation on PBMs and all sorts of things like that that you really need to and I know there have been informational hearings in the past that I wasn't here, neither was a third of the Legislature was here to really do a deep dive into all of this. But that said, when you look at the intricacies of the legislation, we don't know exactly how it's going to implement, but I do philosophically believe that the patients should benefit it from the rebates. And I think that's the intent of them. I think that's always been the intent of them. So I am interested in supporting this measure, but also very cautiously, because I think it's biting off a piece of really a problem that we have to address more globally or have a better understanding and make some more detailed decisions on. So I think it's kind of incomplete. It's, again, a small piece of something we need to discuss. But I'm willing to support this today, and hopefully if it went out as it is and is approved on the floor, I'd be comfortable with it. But I do think ongoing, we really have to consider all of these issues more globally, not just pharmaceuticals or any particular piece, because it's very complicated. I read picture books to get a better understanding of the healthcare delivery system, and so the more pictures and less words is good for me. But I do think, again, we should eventually take another step back. So many of us are new here, and so we're trying to really learn on the fly. And I mean, so many of you have really come into my office and tried to educate me on a very complex issue. And I appreciate that. And I just go back to the whole point, is I am supportive of the concept, and so that's why I'm going to be supporting this measure today. Thanks.

Anyone else? Ms. Carrillo?

Thank you, Mr. Chair. And I want to thank the author for bringing this very important piece of legislation forward. I was the co author of AB 2942 in 2022 by the Member, the previous Member from Anaheim. I want to also thank the opposition in terms of the conversations and ongoing potential negotiations related to the Bill. This is a national conversation related to health care and ensuring that the benefits of any costs actually go towards the consumer. And it's a very complicated issue and one that certainly needs to be tackled. I want to thank the Chair for allowing the presentation and ensuring that the Members have the ability to vote. The previous version of the Bill did not get a hearing, so I think this is a step forward and certainly a conversation worth having and trying to figure out how do we best ensure that at the end of the day, everyday people, the 40 million people across California actually receive some of the benefits of those cost saving measures. So I will be supporting this Bill and look forward to the continued conversations. Thank you.

Anyone else? Okay, the guest is back to me. So let me begin by saying this is the fifth time this proposal has been before the Legislature since 2021. I've been the chair of this Committee since 2016, so I've been here the whole time. Prescription drugs are too expensive. Period. Exclamation point. And I've worked really hard in my time in the Legislature to address this, but this is not the answer. I know there are specific populations disproportionately, many people of color with underlying chronic conditions who are hardest hit by these ever escalating prescription drug costs and my compassion for them is real. But this is a Band Aid to a much larger problem. And it may benefit some patients to save money at the pharmacy counter only to have the potential to increase the cost of health care to everyone in the form of higher premiums. Those savings, for some will translate to costs, higher costs for everyone. Even those people who are getting that benefit at the counter will see a higher premium in their health care. Rebates at the point of sale, I believe, incentivizes the use of high cost, expensive brand drugs. While specialty drugs account for only 1.6% of all drugs dispensed, they account for 62.9% of the spending on prescription drugs. 1.6% of the drug pool, 62%, 63%, of the overall cost. Jabur points out that this Bill will actually increase total net premiums expenditures by $130,000,000 in the commercial market, $30 million in Covered California. I think the top number is actually closer to $200 million total. So if we're serious about addressing prescription drug pricing, we need to fix the manufacturer, the PBM, and the formulary process that are causing these ever increasing prices. There needs to be more accountability and transparency. But this proposal, in my opinion, is cost shifting, and it's unsustainable. And I want to ask some questions, but as you can tell, I'm not supporting this here today. But I have some specific questions because I think it's an important topic. The reason I proposed a study was not to kill the conversation. The reason I proposed a study is that this is really complicated, and there are many players. I find myself those two guys over there don't usually look at me as supporters. Okay? The other side, the pharma, certainly doesn't look me at me as a supporter. I hope consumers look at me as a supporter, because that's what we've been trying to do for a long, long time. So early on in the statement, Senator, you said there's states that are doing this, West Virginia in particular. Okay. There's a difference in what's going on in West Virginia. They treat copays and coinsurance differently. The money actually saved doesn't go back to the patient in a rebate. It goes back into premium savings, which is actually what PBM rebates are designed to do. They're designed to go back and help to spread out and reduce premium for everyone. So what's going on in West Virginia is completely different than what you're proposing here. The other thing is that in West Virginia they have the ability to regulate PBMs. And we don't have that in California. We cannot regulate PBMs. We tried to get there. I had a Bill, AB 315. I got to know the PBM industry up close and personal, and it wasn't pretty. And what we got out of that was some transparency. And we understand the PBM industry better. And it's been a while. And maybe it's time to step back and take another shot at that, quite frankly, because I am concerned that the overall increase potential for increases in drugs costs is there. There is nothing in the Bill that incentivizes drug manufacturers to keep their prices down. If the prices were lower, we wouldn't need rebates. And there's no incentive to prevent the companies from increasing the cost of drugs. So in 2022, 42% of drugs had a wholesale acquisition cost of between $1000 and $5,000, $1000 and $5,000 25% of new drugs were $10,000 or more. That kind of trend is grossly unsustainable. And I feel like this is a wolf in sheep's clothing. This, on the surface, looks like it's a great way to help some consumers. And it is. But the bigger picture is that I think the drug companies get more money, the consumers pay more in premiums, and I don't see how it's sustainable. I don't know what's going on in Arkansas except that I know that Arkansas is patterned after West Virginia. I don't know if and maybe someone over here knows what their program looks like, but it is clearly not what we have here, what we're looking at in this particular Bill. So my purpose for a study and asking for a study was so that we can actually dig into this again, really dig into this and figure out why and how we can actually approach this from a system wide level. Because I think this is really a Band Aid. It really is about the cost and the price of drugs. It's the price of drugs, period. There's nothing to keep that from going up. Rebates, as we heard in the current system, are about helping to reduce premiums. That's how it's cycled back. And as I said, that's the West Virginia plan. It doesn't go directly to the patient. I wonder if we're looking at 90% of the rebate going back to the patient. And this is supposedly a trade secret. Aren't we creating a situation where you can kind of reverse engineer and figure out what the rebate is? I don't know. It certainly sounds like it. I mean, 90% to 100%, probably pretty closely figure out what the rebate is, the drug company and you're going to be able to figure it out. The competitors are going to be able to figure it out. And suddenly there's going to be an escalation there talking about pay for delay that came up where Pharma was incentivizing generic companies to slow down the production of a generic drug. We did that Bill, and they're trying to do that at the federal level now, too. The policy you're putting forward here has been tried at the federal level and they pulled back because it's too expensive. They realized that they can't do it. Just for me, it's just the wrong approach. I've been in the Legislature nine years. This is my 9th year, been eight years as the chair of this Committee. I've worked on so many policies have gone after every entity in the healthcare space to try to improve life for patients. And I don't believe this one does it. I can't support your Bill today. Would you like to close?

Thank you. Mr. Chairman, I have the utmost respect for your comments and your concern as it relates to this matter. And I want to thank you for the conversation that we've had. You express your concerns and it's duly noted and respected. But at the same time, we do know the poorest and the sickest individuals here in California, across this country, pays the most for health care. Many times when they can't even afford it, sacrificing and not having medicines just to keep lights on and things of this nature. This is an opportunity to try something new and see if in fact we can direct those discounts to the patient. As you clearly stated, it's the big companies who control this industry and this does not address that. But I think it's worth a try. And this is not the fourth time, as the opponent said, that this Bill has come before this Committee. Yes, this Bill has been introduced four times, and I'm thanking you for allowing this hearing. This is only the second time this Bill has even been granted a hearing in health. So I appreciate that and it's not gone unnoticed, but I think it's an opportunity for us to again try something. When you talk about $200 million costs, when you spread that out over all subscribers, we're talking about 0.1%. We're talking about pennies on the dollars at the end of the day. And yes, does that impact folks? Yes, but it's pennies on the dollars. We subsidize or poor folks subsidize so many other things. Let's talk about solar and all the other renewable products that they never benefit from, but no one seems to be concerned about them subsidizing this. This provides a more of a direct benefit by bringing allowing folks to afford medicine and having it to treat the sickest Californians and give them a chance at living a healthy life. So I'm just here asking for this opportunity. Is it perfect? No. And as I stated, it's still much work to be done. And I respect both Dr. Weber and yourself, who are healthcare professionals. But I, too, come from a healthcare family as well, and I know the cost of medicine, and we have to find a way to bring it down. I wish this Bill fixed all those things that are wrong and impacting the medical industry today. It doesn't, but I think it's an opportunity to take a shot. It's more than Arkansas and West Virginia. Who's doing this? States like Nevada, Maine and Vermont are also looking at similar programs like this. So I think the time has come. We often say know, so goes California, so goes the nation. I think we have opportunity to prove everybody wrong and fix this industry and try something new. So I respect last for Ivo.

So we have a motion by Mr. Flora. A second by Ms. Carrillo. Madam Secretary, please call the roll. A motion is due. Pass to appropriations. Wood no.

Wood no. Waldron. Waldron. Aye Aguirre curry. Arambula Berner. Wendy Carrillo. Wendy Carrio. Aye. Flora. Flora. Aye Vince Fong. Vince Fong. Aye. Mainshine Mccarty. Joe Patterson. Joe Patterson. Aye. Rodriguez. Santiago. Via Poudois. Via Pudois. Aye. Weber. Weber. Aye.

Your Bill has seven votes. We'll leave the Bill on call.

Mr.Chair and Committee Member.

Mr. Becker. Senator Becker.

Good afternoon, Chair and Members. I'm here today to present SB 570. This bill would restore a pregnant person's ability, in consultation with their doctor, to utilize all available prenatal screening services. This will allow them to make the most informed decisions about their health and the health of their newborn as possible. Specifically, this bill prohibits the state from limiting access to genetic screening through rule, regulation, or contract when genetic screening is recommended or ordered by a pregnant individual's prenatal provider.

While the fix proposed in the bill is simple, making sure pregnant Californians maintain a choice in accessing in their prenatal screening options and have those screenings covered by insurance or medical, the same as it was before. This change, we believe, is absolutely essential to address unfortunate access issues that recent CDPH changes have created. Unfortunately, in late 2022, CDPH implemented major changes that limit the state's prenatal screening program to testing for just Trisomy 21, Trisomy 18, and Trisomy 13.

If pregnant individuals wish to access the additional screening they previously would have enjoyed as recommended by their provider, they must now undergo a complicated and confusing two path process of screening. We believe this unnecessary new barrier means the vast majority of pregnant people will not have access to full panel screening and the important information it provides. This is about medical care being decided by medical care providers rather than an arbitrary line in the sand.

And lastly, I did amend the bill to remove reference to microdeletions at the recommendation of the Committee. And I appreciate and thank the Committee for working with me on that matter. And with me I have two witnesses today, Libby Sanchez and Ryan Spencer.

Good afternoon, Mr. Chair and Committee Members. Libby Sanchez here on behalf of Natera. SB 570 seeks to address inherent flaws in the CDPH PNS program and to solidify the right of pregnant individuals to access prenatal screening tests as ordered by their prenatal treaters. During the short time the changes to the PNS program were administered, post-adoption of the emergency regulations, but prior to the injunction. So for about a 12-week period. There was a dramatic reduction in uptake rate in the black, brown and Medi-Cal populations.

The irony of this is that it was these exact populations that CDPH had been concerned were not accessing important prenatal screening at as high a rate as other populations. And that CDPH had intended, the whole purpose of the changes to the program to achieve, to address those disparities in access and uptake rates. In other words, the access and equity concerns providers, geneticists, parents and others raised with the Department, when the Department was first publicly unveiling its limited version of the changes to the program, all came to fruition.

While the court decisions upholding the injunction now stand and will until and unless the Department chooses to appeal. The court decisions do not provide adequate and consistent access to prenatal screening pregnant individuals need. The only thing that can do so, ensure that consistent access and adequate access, is for the Legislature to provide the direction pursuant to this measure. As highlighted in the committee's very good analysis... And we do appreciate so much the work of the Committee consultant on this...

There is a serious disconnect between what the Department says doctors, patients, and labs can and cannot do under the program and what doctors, patients, and labs actually can do. Case in point is the representation by the Department that pregnant individuals could simply opt out and secure PNS screenings elsewhere.

While that in fact is the case under the court ruling, it was not the case under the changes to the program as administered by the Department pre-injunction, as non-contracting labs were precluded from administering PNS tests. There were no, and continues to be no code for the non PNS screening, sex chromosomes, and microdeletions, which comprise the full panel of traditional panel ordered by OBGYNs. And there's no reimbursement mechanism. In other words, the Department's "pregnant individuals can opt out and get the full panel elsewhere," neglected to mention the fact that there was nowhere else to go and no way to get it paid for.

Finally, I'd like to address concerns regarding the false positives. False positives are no more common with the current generation of PNS screening than they were with the prior generations of screening that have been administered for 40 years. That doesn't mean false positives aren't problematic, but they are not as problematic as false negatives, the numbers of which are far lower in this generation of testing.

As mentioned in the analysis, the purpose of PNS screening is to reduce the number of more invasive follow up tests required. This generation of screening does exactly that by ensuring the smallest number of pregnant individuals have to rely on more invasive diagnostic screening. The problem with the CDPH program and the need for this measure is that when providers order the full panel for their patients, it is because it's in the patient's best interest to be fully informed. Thank you.

Thank you, Mr. Chair Ryan Spencer on behalf of the American College of OBGYN's, District Nine, and I'll be brief. Our support of SB 570 is based on a very fundamental issue for ACOG in the House of Medicine, governmental interference with medical decisions and the patient and physician relationship. Shared decision making involves discussion of the benefits and risks of all available testing and treatment options in the context of a patient's values and priorities.

The physicians ordering the screening and testing should, along with the patient, decide which screening or test is appropriate for the individual. Their decision should be based on science and clinical guidance and not contingent on government regulation. Restrictions or limitations on what tests may be performed and who may perform the test interfere with this vital patient physician relationship, and the government should not place barriers that could impede access to this care. For these reasons, ACOG supports the bill and asks for your aye vote. Thank you.

Thank you. Others in support?

Hello. Kristi Foy on behalf of the California Clinical Laboratory Association, in strong support, thank you.

Mr. Chair Members, Adam Keigwin on behalf of BillionToOne, in support.

Thank you.

Molly Robson with Planned Parenthood Affiliates of California, in support.

Thank you.