Senate Standing Committee on Health

Seven of those bills are on our proposed consent agenda. And those bills are AB 283, AB 289 AB 317 with amendments AB 1241, AB 387 AB 1233 AB 1467. Okay, I think we'll get started. We'll be starting as a Subcommittee, of course, but I see our first author here, Dr. Akilah Weber is here. She also had two bills on consent and we'll be presenting AB 17 One for us today. Welcome.

Thank you. Good afternoon, Madam Chair and Members. I am here today to present AB 1701. I want to begin by stating that I accept the Committee amendments and want to thank the chair and Committee staff for the work on my Bill. AB 1701 will provide equity within the distribution of funds already allocated to the California Department of Public Health for the Black Infant Health Program by allowing both counties and cities with their own health departments to apply for the funds.

In 2018, the State of California recognized a statewide gap in the Black infant mortality rate and established the Perinatal Equity Initiative, also known as the PEI, within the Department of Public Health. The expanded scope of interventions provided under the Black Infant Health Program with the goal of helping women have healthy babies. PEI supports evidence-based strategies in reducing racial health disparities among black women, like home visitation programs and fatherhood initiative.

Current law states that the CDPH can only allocate these PEI funding to county health departments with BIH programs, leaving cities with their own health departments without direct access to this additional funding. Expanding access means helping California's effort to address racial disparities and infant mortality even further by promoting specific interventions designed to improve outcomes for black mothers and infants. This Bill allows for all black infant health programs to be eligible to apply for these funds to help more expected families. With me. Here to testify in support is Joe Saenz, Deputy Director of Policy with the County Health Executives Association of California. Welcome. You may begin.

Thank you, Madam Chair and Members. My name is Joe Saenz. On behalf of the County Health Executives Association of, California, representing the local health departments, we are proud sponsors of AB 1701. Supporters of AB 1701.

As this Bill will decrease barriers for African American women and birthing people to access the Black infant health program for the purpose of eliminating the disproportionate rate of African American infant mortality that is more than twice that of their white and Hispanic counterparts. Studies consistently highlight the alarming disparity between Black babies and their counterparts from other racial and ethnic backgrounds, regardless of socioeconomic status.

The BIH program aims to tackle the root causes of this disparity by providing comprehensive support to Black mothers and birthing people and families, focusing on preconception health prenatal care, and postpartum support. By doing so, it empowers Black women and birthing people with the knowledge, resources, and support necessary to ensure healthier pregnancies, safer deliveries, and improved infant health outcomes. Also, the program recognizes the complex interplay between physical health and social determinants of health.

This includes addressing issues such as systemic racism, poverty, limited access to health care, and inadequate social support networks. By providing culturally sensitive services and connecting families with community resources, the BIH program addresses structural barriers in order to improve health outcomes. The program emphasizes cultural competence and inclusivity.

By recognizing the unique needs and experiences of Black families and acknowledging the historical and ongoing racial disparities in our society, the program fosters a sense of community and support by creating spaces for women and birthing people to connect, share experiences, and access emotional support. This program plays a vital role in promoting equity, justice, and the well-being of Black communities in California.

AB 1701 strengthens the reach of the program by allowing California's three city health departments to apply for funding, as would their County Health Department counterparts. And for these reasons, we support this measure. Thank you.

Thank you very much. Any other people speaking in support? Please.

Madam Chair, Members, Amy Brown on behalf of the City of Long Beach, one of the cities that has its own Public Health Department, thank the author for running this Bill. Ask for your aye vote. Thank you. Mr. Spencer.

Ryan Spencer on behalf of the American College of OBGYN's, District Nine, in support. Thank you.

Anybody else? Okay. Is there anybody speaking in opposition to this Bill today? Seeing none. Are there any callers on the line? Do we know? Open up the line for callers speaking for or against AB 1701. Moderator, are you there for your support?

Yes. If you're in support or opposition of AB 1701, you may press one and then zero. Again, that's one and then zero. If you're in support or opposition, we do have one in queue. One moment while we gather their line number. Okay, and again, this is for AB 1701. Thank you. And we'll go to line 31. Your line is open.

Good afternoon. Sumaya Nahar on behalf of the March of Dimes in support of AB 1701. Thank you very much. Next caller. Thank you. One moment for that line number. Again. We are on AB 1701. For support or opposition, you may press one and then zero.

And we will go to line 33. Your line is open.

Hi, Josefina Ramirez Natsuna, with Children Now in strong support of this Bill.

Thank you and Madam Chair, we have no further support or opposition. Thank you.

Okay. Thank you very much. So now's the time we bring it back to the Committee. Could I ask, is there a method so people aren't double dipping and that there's coordination between the city and the county? Because we know some people will live in the city and county and some people will just live in the county.

Right. No, that's a great question. And this actually only applies to actually two cities right now, Long Beach and Pasadena, because the other city that does not have a county health Department is Berkeley, and they don't have one of these programs at this. So, you know, the County of Los Angeles can definitely make sure that they're not giving funds to the City of Long Beach or Pasadena since they have their own individual health county.

Those counties and I'm aware that there are multiple counties in LA County or multiple cities, but the county will not serve the same?

If they if Long Beach and they're here and Pasadena, because they have their own health Department, they can apply and get those funds directly. The other cities have a county-wide health Department, so they couldn't apply for it. So, for example, City of San Diego could not apply because their Health Department is a county Health Department.

No, I understand, like, say Stockton had their own we don't would the people and San Joaquin County is a big county, right. We have Lodi, we have then. And they're all in the county, but they're not all in Stockton. So if Stockton were to get it, then the county funds there would be more for Tracy and Lodi, and Stockton would not then the services wouldn't be provided by that person.

Right the county would not then go and give it to that. Okay. All right.

Any other questions? Okay. I don't think we have a quorum yet, but noted, when we do have a quorum, that Bill is moved by Senator Gonzalez. Would you like to close Assemblymember?

Yes. I just want to thank you all questions closing. This is a very simple Bill that makes funding distribution more equitable for the Black Infant Health programs. And when you have a quorum available, I respectfully ask for an aye vote.

Thank you very much. We look forward to a quorum shortly. Thank you. All right. I see Assemblymember Addis here. Tricky first thing to get a Bill passes to get through the gate. You'd think, I'd never been here before in this room, but thank you, honorable Chair and Members of the Committee.

I want to thank our witnesses that are here with us today, as well as this Committee staff and my own staff who have worked hard on this Bill. I'm here because residential care facilities, or RCF, are an incredibly important part of our state's healthcare system, supplying housing and care to people over the age of 60. And these facilities are generally seen as an intermediary between independent living and 24-hour supervised care. So they provide personal care, assistance, room and board, among other services to seniors.

I do want to point out by 2030, California is expected to have 10.8 million individuals over the age of 60, which is the qualifying age for RCF care. And by 2060 it's estimated that 30% of California's overall state population will be age 60 or over. So the silver tsunami is coming as they say, and that will make RCFEs all the more important as our demographics continue to shift. That said, residential care facilities for the elderly have faced huge challenges.

There's existing staffing challenges, then there was the COVID Pandemic and for smaller RCFEs for nonprofits, it's been a struggle for these businesses to get up and running and to stay running. So AB 839, which I'm asking for your support on today, would open up lower-interest and tax-exempt financing via the California Health Facilities Financing Authority. We've had extended conversations with CHFFA and our legislative council. We have some minor amendments that will be taking in the Senate Human Resources Committee.

And so the Bill is a modest change that would open up financing to nonprofit RCFEs and allow them to then invest those funds into an area of dire need for the State of California. And we've got a couple witnesses that I'd like to have come forward and turn over to them for their testimony. First supporter, please.

Thank you, Madam Chair Members, Amber King with LeadingAge California representing nonprofit providers serving the full continuum of care for older adults outside of the hospital setting, including RCFEs, skill nursing facilities, life plan communities, home and community-based care, affordable housing, and home and hospice care. We're proud to sponsor AB 839 to allow our CFEs, or commonly referred to as assisted living facilities, regardless of their connection to a skilled nursing facility, to take advantage of the CHFFA financing and the tax-exempt bond program.

As the author mentioned, the older adult population in the State of California is rapidly changing. And with that, the delivery of care and how older adults are wishing to age is also evolving. Independence and dignity are key drivers of that change. While skilled nursing facilities are critical component of the healthcare delivery system, we are seeing more and more of our members downsizing their skilled care to increase their capacity for assisted living and memory care.

In particular, as older adults are choosing to receive care and stay in their homes for as long as possible and delaying moving to the more clinical setting. In addition, AB 839 furthers the goal of the Master Plan for Aging. Goal one housing for all Ages and stages which aims to allow older adults to choose the way they live in the communities that are age, disability, and dementia friendly.

AB 839 will lower the borrowing costs to create more nonprofit assisted living and memory care to meet the needs of our growing older adult population. With that, I'd urge your aye vote. Thank you. Thank you very much. Next person, please.

Thank you. Madam Chair and Members. I am Jenna Magan, partner at the law firm of Orrick, Herrington & Sutcliffe here. In support of AB 839, I've worked on tax-exempt nonprofit financings for over 30 years.

I would like to describe why allowing RCFEs to access tax-exempt financing is valuable. Being able to borrow on a tax-exempt basis through an issuer such as CHFFA results in lower borrowing costs for nonprofit organizations, including RCFEs. Because the interest paid on tax-exempt debt is exempt from federal income tax as well as California income taxes, the investor requires a lower interest rate to produce the same after-tax result as taxable debt would produce.

This reduces the borrowing costs for RCFEs when they decide to finance new facilities or make improvements to existing facilities. One of the main benefits to borrowers to use is that CHFFA can hold a statewide public hearing and the state treasurer can provide the approval that is required under federal tax law as a condition to issuing tax-exempt bonds.

And if issuers other than CHFFA are used to issue tax-exempt bonds, then separate public hearings and separate approvals have to be obtained from each governing body of each local jurisdiction in which the project is located. And holding these multiple public hearings and obtaining multiple public approvals is a time-consuming and expensive process. So for these reasons, I urge your aye vote on this important measure. Thank you.

Senators. Eggman. Here. Eggman? Here. Nguyen. Glazer? Glazer? Here. Gonzalez? Gonzalez? Here. Grove. Hurtado. Limon? Limon? Here. Menjivar? Menjivar? Here. Roth? Roth? Here. Rubio. Present. Rubio? Present. Wahob? Wiener? Wiener? Here.

Thank you very much. And let's take a pause here to call the roll. I believe we have a quorum here. Now, Secretary, if you could call the roll.

A sharp bunch here today at Cinema. Member we're coming off Nonprofit of the Year, so aye think that's resonating with the Committee. Okay, anybody else speaking in support of this measure? Anybody speaking in opposition? See? None. Let's go to the phone lines. Moderator is there anybody speaking in support or opposition of AB 839? Sharp indeed. Thank you.

If you're in support or opposition of AB 839, you may press one and then zero again. That is one and then zero if you're in opposition or support of AB 839. We do have one. One moment, please. Line 29. Your line is open.

Thank you. My name is Pat McGinnis. I'm the Executive Director of California Advocates for Nursing Home Reform and I'm here to oppose AB 839. I want to make it clear that we are not opposed to having this Chafa being available for freestanding, nonprofit residential care facilities. What we are opposed to is opening up this Fund for continuing care retirement communities, the majority of which have millions of dollars in Reserve funds. They recently most of them. We have about 79 non-profit CCRCs in California. I've watched the fees, care fees, monthly care fees go up to 8% to 10% over the past few years for residents.

These residents in CCRCs, the majority of whom live in independent living, not in assisted living, they have invested their life savings into these CCRCs. And I guarantee you, any money saved through investment, through Chafa will not be passed on to the residents. The California Health Facilities Financing Authority was created to be the state's vehicle for providing financial assistance to public and nonprofit healthcare providers.

It's to make help eligible and credit worthy providers reduce their cost of capital, promote important California health access, health improvement, and cost containment objectives. I don't know of a nonprofit CCRC that accepts medical number one. Secondly, CCRCs are not healthcare providers. The overwhelming majority are in independent living units of the residents and those facilities. Just changing the definition is not going to make them healthcare providers.

While they're required to include some licensed skilled nursing beds on the premises, depending on the contract, most of them do not accept MediCal, even in their skilled nursing units. Finally, I just say that it does not promote health access, health improvement, or cost containment. It will, however, expand the profits of all these already profitable companies, regardless of whether they are listed as a non-profit or a for-profit.

And again, we support independent freestanding RCFEs having access to this fund, but we do not support having CCRCs having such access. I think it's a betrayal of what the CHFFA stands for. Thank you.

Okay, thank you very much. Any other callers in there?

We have no further callers in queue.

Okay, thank you very much. At this time, we'd bring it back to the Committee. Any questions? Comments? Okay, we have a motion on that Bill.

I will just say, and I don't know if the industry knows, and I apologize for not knowing. I did legislation on this earlier, just on Rcfes with some of the issues they were having with abuses being reported and the follow-up was very slow. We had people moving and then changing names. Does the industry know? Have we?

I know a lot of this goes through the Human Service Committee and not through the Health Committee, but I'm just wondering the status right now on complaints and follow-throughs on those.

Thank you. Madam Chair Amber King with LeadingAge, California. I do not know the answer to that, but we can work with your staff and get it back to you. I'd like to get an update on that. Okay, thank you very much.

And the criteria that's established for this is the same as establishes for hospitals. And of course, nobody wants the big mega ones who could be labeled as nonprofit, although we have that same issue with hospitals and we've been able to find our way forward with that. I guess I'll just say not everybody over 62 is moving right into it. Okay, would you like to close Assemblymember?

All due respect, I ask for your aye vote.

So why don't we--can we get a motion on the consent calendar? Moved by Senator Limon. Measures on consent are AB 283, AB 289, AB 317, AB 1241, AB 387, AB 1233, AB 1467. Secretary, call the roll.

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

Nine eyes. We'll hold that item open. So now we have a full Committee, and we're just looking for Assembly Member Berman. Okay, let's vote. Let's take a vote. Thank you all. Got a lot of helpers. So let's now, we had a motion by Senator Limon--Senator Gonzalez on Weber: AB 1701, Black Infant Health, California Perinatal Equity Initiative. If Secretary could call the roll, that is 'do pass as amended.'

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

Nine ayes. We'll hold that measure open. Still looking for Mr. B-E-R-M-A-N. Berman. Welcome. You can come in.

Respectfully ask for aye vote.

Move it. Yeah. All right. Welcome, Assembly Member with AB 948. You've got the floor.

Thank you, Chair and Senators. I won't hold the floor for long. I would like to begin by thanking Committee staff for their work on this bill. I will be accepting the Committee's amendments described in the analysis. Since 2017, Californians have been protected from rising prescription drug costs with a 250 dollar copay cap for a 30 day supply of medication, but that consumer protection is set to expire next year. AB 948 would make the existing copay cap permanent. Please join me in supporting it. Respectfully ask for your aye vote.

All right, then. Anybody speaking in support today?

Yes.

Hello. Chair Eggman, Committee Members, my name is Marguerite Casillas. I'm a volunteer with the National Multiple Sclerosis Society, and I have been living with MS since 2003. With MS, it's critical to start medication as early as possible and to take it consistently. MS medications are expensive, but they are powerful. They help to reduce relapses and delay the progression of disability.

Before the copay cap, many people were forced to pay their entire annual out-of-pocket maximum in the first month of each year, which is thousands of dollars before insurance would cover any of the cost. This is a significant cost for most people and out of reach for many. Without a copay cap, people may skip or delay taking their medication.

In a recent national study by the MS Society, 40 percent of people with MS reported that they had altered the use of their medication due to cost, either delaying or skipping treatment. This could lead to progression of disability and ultimately the inability to work. People with MS and other chronic conditions depend on the copay cap to keep their costs reasonable so they can afford their medications and stay healthy. AB 948 will give those of us with serious illnesses peace of mind when it comes to paying for our essential medications. Thank you.

Thank you. Thank you for sharing with us. Next person, please.

Good afternoon, Chair and Senators. I'm Katie Van Deynze, a policy and legislative advocate with Health Access California, and we're the sponsor of AB 948. I'm here for any questions and respectfully ask for your aye vote. Thank you.

Thank you very much. Anybody else speaking in support now? Welcome, Mr. Madden.

Madam Chair and Members, Tim Madden representing the California Rheumatology Alliance, the California Chapter of the American College of Cardiology, and the California Society of Plastic Surgeons all in support.

Thank you very much.

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

Thank you. Mr. Spencer.

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

Thank you.

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

Afternoon, Madam Chair, Members. I'm Stewart Ferry with the National Multiple Sclerosis Society in support.

Thank you very much. Anybody speaking in opposition to this bill today? Seeing none, we'll go to the phone lines. Moderator, is anybody on the phone lines speaking for or against AB 948?

Thank you. If you're in support or opposition of AB 948, you may press one and then zero. Again, that is one and then zero if you're in support or opposition of AB 948. We will go to line 30. Your line is open.

Good afternoon. Rebecca Gonzales with the National Association of Social Workers, California Chapter in support.

Thank you. Next caller.

Thank you. Line 35, your line is open.

Hello. Seth Bramble calling with the California Teachers Association. We are in support.

Thank you. Next caller.

Line 32, your line is open.

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

Thank you. Next caller, please.

Line 40, your line is open.

Good afternoon. Rebecca Marcus representing CALPIRG in support.

Thank you. Next caller, please.

Line 36, your line is open.

Thank you, Madam Chair. This is Adam Zarrin from the Leukemia and Lymphoma Society in support.

Thank you. Next caller, please.

Thank you, and Madam Chair, we have no further support or opposition in queue.

Okay, thank you. Now's the time we'd bring it back to the Committee for questions, comments. Senator Wiener.

First, I'm happy to move the bill. I really want to thank the author for moving this legislation forward. This all started when the author's predecessor, Rich Gordon, authored the very first cap. We had never had a cap on copays before. You could literally be charged 1,000 dollars a month as a copay. Just absolutely horrible, and so Mr. Gordon fixed that. I wish it were lower than 250, but 250 is certainly better than what we were seeing before.

I authored an extension years ago, wanted to remove the sunset entirely, but we were ultimately forced to put a new sunset. I hate repeat sunsets. I think it's a waste of time, so I'm glad we're finally getting rid of the sunset entirely. So thank you for doing this. It just is very maddening that people who have insurance can still be priced out of accessing health care. It's not acceptable. It's not what people purchase insurance for, and this helps fix that, so thank you.

Thank you very much, Senator. And he moved that bill. Anybody else wanting to speak on this? Okay. Would you like to close, sir?

Anytime I'm building on something that Assembly Member Gordon and Senator Wiener have done, then I know I'm in a good place. Respectfully ask for your aye vote.

There you go. Then the secretary will call the roll. The motion is 'do pass as amended and re-refer to the Committee on Appropriations.'

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

That bill has nine to zero. We'll hold it open for the absent Members. Congratulations, and I will note that our language says to repeal the date because I hate to give sunsets a bad word, you know what I mean? Like those sunsets are negative. I don't want to get rid of sunsets. Okay, so, yeah, so we don't want to get rid of them. Let's say 'repeal date.' Repeal date.

Okay, so we are still looking for Senator Wahab and Grove and Hurtado, but the rest of you good senators are excused. Okay, to be kind and open hearted, let us start since Ms. Grove has arrived. On the consent calendar, it was moved, and that's AB 283, AB 289, AB 317, AB 1241, AB 387, AB 1233, AB 1467. Secretary, could you call the roll?

Senators Grove.

Thank you, Madam Chair, for your continued graciousness in my absence as I was in rules. I vote aye.

Grove, aye.

That is now 10 to zero. We'll still hold it open for the absent member, Senator Wahab. Now going in file order, AB 1701 from Assemblymember Weber and that is do pass as amended. Senator Grove.

Aye.

All right, moving on. Grove, aye. Moving on measures heard in file order, AB 839 Addis and that is do pass and re-refer to the Committee on Human Services. Secretary.

Grove. Aye. Grove, aye.

AB 980, 948. And that is do pass as amended, and re-refer to the Committee on Appropriations. Secretary.

Senator Grove. Aye. Grove, aye.

That is 10 to zero. We'll hold it open one more time. And we thank the senator for coming to committee. So we're just looking for Senator Wahab and Senator Hurtado. Welcome. And we have measures on consent. So for the consent calendar, secretary could call the roll.

Senator Hurtado. Aye. Hurtado, aye.

That is 10, 11. That is 11 to zero. That the consent calendar is out. We'll hold the rolls open a few more minutes and then moving on. AB 171 Weber that is do pass as amended. Secretary.

Senator Hurtado. Aye. Hurtado, aye.

Okay, we'll hold the roll open. AB 839 Assemblymember Addis that's do pass and rer-efer to the Committee on Human Services. Secretary.

Senator Hurtado. Aye. Hurtado, aye.

And AB 948 Berman, do pass as amended and re-refer to the Committee on Appropriations. Secretary.

Senator Hurtado. Aye. Hurtado, aye.

All right, that is 11 to zero. We will hold that open for a remaining member. And thank you, Senator. Thank you. Concludes that concludes your job for today. Not all of it. Okay, here we go. Measures on consent for today AB 283 Patterson, AB 289 Holden, AB 317 Weber, AB 1241 Weber, AB 387 Aguiar-Curry, AB 1233 Waldron, AB 1467. Secretary please call the roll.

Senator Wahab. Aye. Wahab, aye. Twelve, zero.

That's 12, zero. That measure passes. Close the rolls. Moving on AB 171 Weber, do pass as amended. Secretary.

Senator Wahab. Aye. Wahab, aye.

12, zero. That measure is out. AB 839 Addis, do pass and re-refer to the Committee on Human Services.

Senator Wahab. Aye. Wahab, aye.

That is also 12 to zero. That measure is out. And AB 948 Berman, do pass as amended, and re-refer to the Committee on Appropriations. Secretary.

Senator Wahab. Aye. Wahab, aye.

That's 12. Again, that measure is out. And that concludes this Senate Committee on Health.