Assembly Standing Committee on Health

Good afternoon. We'll call to order the Committee Hearing of Assembly Health today on April 23. Before we begin, I would like to make a statement on providing testimony at this hearing. Witnesses will be testifying in person. We allow two main witnesses for a maximum of two minutes each. We will take up item number three, AB 2075, Alvarez, as soon as we can, as first order if possible.

One of the witnesses has requested an ADA accommodation through the Rules Committee and will be testifying remotely. Item 12, AB 2467 Bauer-Kahan will be second on the agenda by prior agreement, should the author be here in time for AB 2200, which I know many of you are here for. We will allow 10 minutes each for support and opposition, then an additional 15 minutes for both support and opposition me-too testimony.

All me-too or additional testimony will be strictly limited to name, position and organization if you represent one. Also, we have as a special order business of the day today, AB 2200 Kalra, guaranteed healthcare for all, which will start at 3:00 and have a hard stop at 4:00. Vote only, we will have AB 2690, Lee is on the agenda and we will ensure that there is no presentation, witness testimony or discussion on this bill.

It is vote only. And on the consent calendar for the day, the following bills are proposed for consent for today's hearing, any members of the Committee may remove a bill from consent: item four AB 2101 Rodriguez, item nine AB 2348 Rodriguez with amendments, item 11 AB 2383 Wendy Carrillo with amendments, item 13 AB 2563 Essayli, item 19 AB 2726 Flora with amendments, item 20 AB 2756 Boerner, item 21 AB 2767 Santiago with amendments, item 24 AB 2843 Petrie Norris, item 30 AB 3156 Joe Patterson with amendments, item 32 HR 58 Jackson.

With that, I think we actually going to move to the author that is here. We will be operating as a subcommitee until we are able to establish quorum. And we will start with Assemblymember Ward, which is item number 25 AB 2893. Early bird catches the worm.

Thank you, Madam Chair. Got lucky this afternoon. I know you have a long schedule ahead of you, so I appreciate being here before you today. I want to start by thanking the Committee staff for their hard work on this bill. As California continues to navigate the mental health needs of our unhoused population, along with the state housing crisis, we've learned that these issues are often intertwined.

An option that has been working for people who find themselves in this position is recovery housing for which focuses on treatment, but not to the extent of clinical settings. Recovery housing allows flexibility and is stable enough to provide an environment where people can successfully progress out of their addiction. AB 2893 establishes a state certification process for recovery houses through the Department of Health Care Services.

This certification standardizes care and requirements for all recovery houses in California while also making it available as a tool the state can use to address treating our unhoused population. I acknowledge that this bill has been highly technical with further definition clarity needing to be addressed, and that's something that I can assure the Chair and Committee that I will continue to work with my sponsor and other organizations in the industry on.

We want this bill to be clear for implementation and with it, provide another tool that balances our state's substance abuse treatment needs and housing shortage. I have testifying in support of this bill, Jason Robison, the Chief Program Officer of SHARE Collaborative Housing, the sponsor of this bill.

Oh, thank you. There we go. Esteemed Committee Members, thank you for considering Assembly Bill 2893, which will create a certification process to bring recovery residences for people experiencing mental health and homelessness into California's continuum of housing options and homeless services. Recovery residences offer much-needed community supports and housing for California's most vulnerable citizens. As early as 2010, the National Health Institute has been emphasizing the importance of social support as a leading indicator of wellness for people experiencing mental health issues.

Studies have shown that the amount and quality of social supports account for 40 percent of whether or not people are okay. Recovery residences activate SAMHSA's four pillars of recovery: health, home, purpose, and community, using peer support to connect people to community where they develop broad, organic social networks that strengthen as people move forward in their goals.

AB 2893 seeks to define recovery residence modalities, abstinence based, non-abstinence based, and Housing First so that those recovery residences following Housing First protocols are eligible for referrals and funding through the state's Housing and Homeless Services Continuum, thereby vastly increasing options for housing and services. As California's peer workforce grows after the passage of SB 803, recovery residences are effective, efficient, and immediate solutions.

In LA County, they have accounted for ten percent of placements for people with mental health issues in recent years at a fraction of the cost as the total budget for LA County peer-run recovery residences is under two million. Their evidence-based practices yield outstanding outcomes, a 96 percent housing retention rate over four years, 57 percent employment rate, 62 percent of residents connected to non-subsidized housing, and 41 percent of people moving in within 24 hours. AB 2893 will create a standard certification process and scale these resources for people experiencing mental health and homelessness. Thank you.

Thank you. Go ahead. You'll have two minutes.

Only here to provide technical support. Thank you.

Thank you. Are there any other witnesses in support?

I'm Randy Hicks of Californians for Disability Rights. I just got a hold of this bill--

Just your name.

Okay. Randy Hicks with Californians for Disability Rights. We are not in support, but we will support if it has an accessibility piece in it for the ADA. Okay? Thank you.

Any other witnesses in support? Seeing none, any primary witnesses in opposition? Seeing none, any other witnesses in opposition? I'll bring it back to the Committee for any questions or comments. Mr. Ward, thank you for bringing forward this bill. I know that you are incredibly passionate and a leader in addressing the broader issue of the housing crisis that we all are experiencing.

And I know that you've kind of dived into this area that is certainly health related and that there's a lot still to be worked out in this legislation. I'm thankful that you'll continue to work with our Committee to do so as this bill moves forward, should it pass out of Committee, which I am recommending, and with that, you may close.

Thank you, Madam Chair. At the time that is appropriate, I would respectfully request an aye vote.

Thank you so much, Mr. Ward.

Thank you.

Okay, we are going to move on to Item 3, AB 2075 Alvarez. Assemblymember Alvarez, go ahead when you can.

Thank you, Madam Chair and Assembly Members of the Committee. Appreciate the opportunity to talk about Assembly Bill 2075, the Resident Access Protection Act. Chair, I'd like to first state that accepting the Committee amendments. Thank you very much for the work on behalf of your Committee staff on the Bill. And again, we're accepting the amendments as presented here.

Assembly Bill 2075 would provide residents of a long-term care facility with the right to in-person, on-site access to visitors during a public health emergency, as long as they follow the same safety protocols that are outlined by public health officials and required by staff.

We have learned many valuable lessons during the pandemic, and certainly since the pandemic, not least of which is that halting visitation rights for our loved ones in long-term care facilities has a major impact on their mental health and their physical well being.

For example, the Journal of American Medical Directors Association assessed the impact of the pandemic on the well being of nursing home residents in 2020, and found that long-stay residents had a 15% increase in depressive symptoms and a 150% increase in unplanned, substantial weight loss. Recognizing this, a former colleague of ours introduced Assembly Bill 2546. AB 2546 would have similarly established visitation rights in long-term care facilities during a public health emergency, as this Bill attempts to do.

But throughout that legislative process, the Bill was amended to create a working group to develop recommendations regarding the best visitation policies and practices for long-term care facilities during the public health emergency. It is based on that working group, which met five times over the course of six months, which included participants from advocacy groups, state agencies, facilities themselves, public health officials, and medical groups, that we come before you with this Bill.

In its published report of October of last year, the working group was clear in its takeaway, stated, quote, "it is essential for family and friends to have access to residents, including during a state of emergency." AB 2075 is a rare opportunity to pass legislation that has undergone a process that I think we all value, which is to be thorough and thoughtful and engage stakeholders before coming before you with legislative proposals.

The Legislature recognized the problem and established a working group with stakeholders, and numerous perspectives were part of that discussion to understand and ultimately produce the recommendations that we have in this Bill on how to solve a problem. As it relates to some of the concerns, I'm sympathetic to the view that we need to find a balance between public safety and ensuring that visitation rights are for residents are not impeded again.

To that end, we have included provisions to ensure flexibility for state and local authorities when handling public health emergencies by authorizing them to define how visitors can demonstrate that they are proficient enough in following safety protocols and to cap the amount of visitors that can visit simultaneously at a facility. Similarly, we added language that ensures facilities only provide personal protective equipment if it has been provided to them for the purpose of visitors. We also clarify that personal protective equipment is prioritized for staff.

Finally, through the Committee's amendments, we are also adding language to clarify that in the case of a public health emergency that requires an evacuation, visitation rights can be halted until the evacuation has been completed. Still, I'm fully committed to continuing to work on this language to ensure we are striking the right balance between the public health, safety and visitation rights, and I welcome other suggestions to that effect.

AB 2075 is essential to ensure that those of us that long loved ones in long-term care facilities don't ever have to go through what they went through during the pandemic. And with that, I'd like to introduce Tony Chicotel from the California Advocates for Nursing Home Reform to be our first witness.

Thank you. You'll have two minutes.

Good afternoon. Thanks for the opportunity to testify on behalf of AB 2075. Two years ago, I was here testifying a very similar Bill, to AB 2546. It was turned into a stakeholder workgroup and a lot of resident advocates and I were really heartened by the conversations that we had.

The Department of Aging did a really wonderful job facilitating the discussion, finding shared values among very different perspectives, and producing recommendations that balance resident access to the people who love them with the need to ensure that access does not endanger them. The workgroup's recommendations are the roadmap for AB 2075.

Residents are guaranteed access to the people who care for them best, while giving state and local public health officials the ability to impose any safety measures they feel are necessary to ensure resident safety, so long as they are no more stringent than what is required of facility staff. Last month, my father in law died in a nursing home, a really good one in Oakland called St. Paul's Towers.

It was sad, of course, but I was tremendously grateful that on the morning of the day that he died, I was able to spend some time with him alone and sit with him and tell him how much I loved him and how much he meant to me and the rest of our family.

It didn't dawn on me until last night, as I was thinking about being here today, that had this happened three or four years ago, I wouldn't have been able to spend that time with him. Saying goodbye is often a life's ultimate blessing, and it was denied to tens of thousands of California nursing home residents during COVID, who died while their loved ones were locked out, with so many important things left unsaid and unheard. AB 2075 says, let's never do that again. Thank you.

Thank you. And I'll remind everyone that we have a witness that will be participating telephonically, who's received an ADA accommodation from the Rules Committee.

Madam Chair. I'll introduce her. Hopefully she comes on the line. It's Nancy Stevens, a nursing home resident who was personally impacted by the curtailing of the visitation rights during the pandemic. Hopefully, Nancy is on the line.

Miss Stevens, if you can hear us, you can start your testimony whenever you're able.

Chair and Members. Kathy Mossberg with LeadingAge California in support.

Hi, I'm sorry for the interruption. My name is Nancy Stevens and I'm sorry for the miscommunication. But I'll just be giving my name, my organizations and my position.

I think you. You are one of the two primary witnesses.

My name is Nancy Stevens.

Go ahead, please go. You don't. You can offer a two minute testimony.

Hi. Yes, my name is Nancy Stevens. I'm so sorry for the miscommunication and interruption. I'll just be giving my name.

Okay, thank you so much. We will move to any other people who want to- witnesses in support, please.

Peter Hansel, advocacy volunteer for AARP California. AARP is in support of the bill.

Eden Rosales, representing Office of the State Long-Term Care Ombudsman. Proud co sponsors of this bill. In support.

Selena Coppi Hornback with the California Assisted Living Association in support.

Any primary witnesses in opposition? Please come forward. You'll have each two minutes. Please begin.

Thank you Chair and good afternoon. My name is Doctor Cameron Kaiser. I'm the deputy public health officer for the County of Solano, here on behalf of the Health Officers Association of California. We first want to express thanks to Assemblymember Alvarez for bringing AB 2075 forward. And we stand in full agreement that maintaining visitation and social connections for our most vulnerable is extremely important.

However, although we also appreciate the changes made in response to our concerns, Hoack's position remains opposed unless amended, in particular to the proposed final sentence of Section 1439.73, this chapter may not be otherwise suspended, superseded or modified. Such language, of course, often has unintended consequences. During an emergency, it is impossible to predict what steps may be necessary to take, and we never take lightly any step that impairs public activity lightly.

Although the bill says that visitors and residents may not be held to standards greater than that of staff, it also fails to recognize that staff may be trained in the use of personal protective equipment and are regulated by state agencies in a way that the public generally is not. Moreover, the clause isn't even necessary for this bill to achieve its aims. Health officer orders are always subject to judicial review and by codifying in statute the importance of visitation and personal interaction.

Without that language, the bill can still effectively express that they should be considered and properly weighed against public and personal risk. As would be appropriate during a public health crisis. As a public health professional.

Hello? Can anybody hear me? I'm unmuted on my end.

Do you want me to continue, Chair?

Please, go ahead--

I'm muted on my end.

You are not muted on your end, Ms. Stevens. We can hear you. Are you intending to offer testimony for two minutes? We are in the middle of opposition testimony. We're going to proceed with that. Apologies for the interruption.

Quite all right, Madam Chair. As a public health professional, and also as one of the millions of Americans who have lost family Members to COVID-19, including my own father, who died during the delta wave. I do ask that the tools which we've always responsibly used to protect the public be kept intact. We don't know what the next pandemic will potentially bring. And the bill, as written, will impair our ability to respond. I appreciate the Committee's consideration.

Thank you. Go ahead.

Madam Chair and Members, Betsy Armstrong with the County Health Executives Association. Regretfully here in an opposed unless amended position. The COVID-19 pandemic was unprecedented, and unprecedented actions were taken with the health and safety of Californians front of mind. Public health officials worked tirelessly to understand the virus and protect our communities under constantly changing conditions. Public health officials have been scrutinized, harassed, and even threatened for implementing public health measures that that we know saved lives.

Local health departments gained pragmatic and actionable experience during the pandemic. And have already begun implementing lessons learned. Local health departments have improved lines of communication. And have hired infection preventionists to work with these facilities to keep residents healthy and minimize the spread of disease. We absolutely acknowledge the value and importance of family and visitors to residents in these facilities. However, we must also be mindful of potential public health threats. That could potentially endanger residents, facility staff and our communities.

While we appreciate the engagement with the author's office and the proponents of this bill, unfortunately, we are unable to agree to amendments that do not align visitation in a public health emergency with public health guidance and measures. Public health guidance is tailored to the threat. It considers who is most vulnerable, the personal protective equipment, hospital beds, and other resource availability, including whether there's a vaccine to prevent the spread or medication to minimize the effects of the virus and evolves as the science evolves.

This is why we find it challenging to find an amendment that will always safely allow visitation during public health emergencies. And let me emphasize, we do not want to limit visitation as our 1st, 2nd, or 3rd choice. AB 2075 would leave public health with less tools to protect long term care facilities and our communities at large. When the next public health threat comes, it's not a matter of if, it's a matter of when.

It's for these reasons, we remain opposed unless amended to ensure visitation is done in accordance with public health orders and guidance. Thank you.

Thank you. Any other witnesses in opposition, please come forward. Seeing none, we'll bring it back to Committee for questions and comments. Doctor Weber.

Good afternoon. Thank you so much for bringing this bill forward and allowing for us to have a conversation around it. It is my understanding that prior to the pandemic, there was no stopping a visitation. Is that correct? That this is the first time that something like this has happened?

It was very, very rare. There were some isolated incidents where a norovirus would break out in a long term care facility and local public health officers would shut down access for days or maybe a week or so, but very rare, less than once a year.

Yeah. And I think that this was done around COVID because it was the unknown and we initially had no idea of how it was transmitted, who could get it. We had no vaccine. And so there was a need to not only protect the residents, but also the workers as well. And so.

Hi. Yes, I'm sorry-

Please go ahead. Doctor Weber.

With this bill pretty much kind of eliminating the ability for these facilities to have autonomy based on what's going on. Oh, my goodness.

The challenge is that once the speaker is kind of on, we cannot take them off until this item is no longer on the agenda. So, apologies for the intermittent interruptions. We'll just work through it. Thank you.

It's all right. So can we really believe that visitation can always be done safely under the threat of a public health threat?

So that is the intent, and that's why the legislation is written with stating that visitors must meet all of the requirements that are placed on staff that work at these facilities, so that they take the precautions that are required and follow the protocols as set forward by public health officials. So that's definitely what the intent is.

Right. And I think one of the things that the opposition just stated is that oftentimes, and what we saw was that those within the healthcare space had to learn certain techniques and make sure they knew how to mask and glove and gown accordingly, that someone who's not within the healthcare space would not necessarily know. So my question still remains. Do we believe that visitation can always be done safely under any public threat?

Well, I would say that that's definitely an opinion. Do we believe-I believe that it can. If we take the guidance that is given by the public health officials and that gets applied, if that guidance is not applied, then that would not be the case, but I think so.

Okay. I would probably disagree from a healthcare standpoint, but along those lines of guidance and ensuring that people are following the guidance, we have this continued discussion in this Committee and other committees dealing with workforce shortages, especially within, like, the healthcare space for this Committee. And so what if the staff at that facility is stretched to the point where they don't feel like they could safely monitor to ensure the safety of not only the visitors but the residents and themselves?

Yeah, I think this is, you're bringing up the point that I think perhaps the public health officials have, which maybe we don't have the solution on how to address that balance. And I'll be the first one to acknowledge that. I think this is an opportunity for us to weigh in on how much we think it's important to allow visitation versus restricted and just being. I think even the opposition said it. We have not found the language that strikes that balance entirely. And I don't know.

We'll continue to try to find that language. We have not come up with that language today.

Okay. Well, again, I do appreciate you bringing the bill forward.

And if the bill moves out of the Committee, I look forward to seeing what the final language would be, keeping in mind all of the different nuances, the things that the opposition has stated, some of the questions that I have said, and also keep in mind the workers themselves, because I remember during the pandemic, healthcare workers were oftentimes concerned about going into facilities, but at least they had the reassurance that those who lived there were not necessarily as exposed because you didn't have a bunch of people coming in and out from whoever being exposed to whatever.

So you also have to keep in mind the people that work there because you need those doors to stay open and you don't want the workers to not go to work because they're concerned about their own safety. So thank you so much again for bringing this forward. And I look forward to seeing what the final.

Thank you. And I don't know that this addresses those concerns that you raised, but this was a concern from another Committee Member who's not here today about quarantine. And in the early stages, when we didn't know what the right protocols were, there was quarantine in effect. And this bill would not supersede that. If that was a requirement, then you would not be allowed to have access if there was a quarantine order.

And so I would assume that during the process of trying to figure out what the right procedures and protocols would be, if it was that substantial of a health concern, there would be a quarantine order in place while that gets figured out. And then while that gets figured out, then the protocols and procedures would be put out and then they'd have to follow all of those protocols and procedures.

Again, I don't know that that actually answers your concern, but I think that does give us an opportunity to figure out what the right approach would be in order to allow visitation that is safe. Taking into consideration your other concern, which I think we need to, which is how stretch thin those who are healthcare providers and staff are during some of these very unique circumstances like we faced in COVID. Thank you.

Assemblymember Schiavo.

I want to thank the author for bringing this bill forward. I know I'm guessing the testimony that didn't happen was going to be incredibly compelling and I understand where you're coming from and completely respect it. And I know we haven't really got to talk about this bill. I'm going to be supporting it today, but reserve to see how the conversations go around this when it comes to the floor. I think that you're trying, I know that you're trying to strike a really important balance, right.

That being able to have access to family and loved ones is critical for people's health, actually. And we need to recognize that as someone who, I see a lot of nurses in the room, and I was working at CNA while we were in the middle of the pandemic, and it was terrifying, right. And it was terrifying for nurses. And we've seen that, you know, people wear masks or they don't, or they pull it down over their noes and it really doesn't work. Right.

So it's hard to have that kind of 100% trust that that would be able to be executed in a safe way, if they have the staff to make sure that it's executed in a safe way. And at the end of the day, you're trying to protect public health. Right. And the health of the patients. And so I look forward to continued conversations. I'm confident. I have so much respect for the author and know that you will work to find the right balance in this bill.

And so we'll, you know, be supporting it today on that, on that assumption. Thank you.

Well, I know, Mr. Alvarez, that this issue is deeply personal to you and I appreciate your passion for this issue and trying to, as Assemblymember Schiavo said, strike that right balance. I know that you'll continue to work on this Bill should it move forward, and we look forward to supporting it with an I vote recommendation today. Once we have a quorum, please go ahead and offer a close.

Just thank you for the thoughtful feedback. We've got some work ahead and obviously commit to doing that and appreciate again the Committee's work and appreciate the recommendation with the amendments. Thank you.

Thank you. Next we will be moving to file item number 12, AB 2467 Bauer-Kahan.

Good afternoon Madam Chair and Committee, and thank you so much for accommodating my religious needs today. I do really appreciate the Committee for that. Today I'm proud to present AB 2467 a bill that creates mandated healthcare coverage for those experiencing perimenopause and menopause-related symptoms. The bill was created in part due to conversations we had during the Select Committee on Reproductive Health, where we focused on menopausal care.

In the informational hearing, we talked about the lack of knowledge and research surrounding menopause and its appropriate treatments. For all the women in the room and watching who, like me, have talked to countless doctors and been given little to no information on how to handle perimenopause. We know that this is a little understood, little studied, little research, and little cared for part of our journey as women.

In a study by Bonafide on the state of menopause, only one third of women between the ages of 40 and 64 say their healthcare providers ever talk to them about what to expect while going through menopause. In comparison, issues affecting men of the same age, such as erectile dysfunction, are widely considered medically necessary and therefore covered by insurance. Doctors are working hastily to make sure that we are cared for and we're often not getting the care we need.

As one of the leading states in the nation for healthcare, we are letting half of our constituency down as they go through this life transition. Furthermore, race and ethnicity play another role in the range and severity of symptoms that people face. Research shows that white women experience hot flashes for an average of six and a half years, while black women an average of 10 years. Women reach the peak of their career while simultaneously combating menopause.

It is estimated there's a loss of $1.8 billion of productivity in the workplace during this time period. There are proven treatment options out there and women simply do not know they exist or they are not fully covered by our healthcare providers. We need to break down this stigma and bring menopause to the forefront by ensuring full equity in the healthcare space.

With me today to testify in support of this bill is Dr. Weston, who trains in the field of human sexuality, and Lourdes Ayon, who will speak to her own experience in this space.

You'll each have two minutes. Go ahead.

Thank you for having me. I'm going to speak underneath two hats today. As a person in her I'm 71, I've been through this particular set of circumstances, but also as a practice, a person in practice for 41 years. In 2002, the Women's Health Initiative was published and it changed treatment of menopause for more than 20 years. It frightened MDs away from prescribing hormone replacement therapy for menopausal women, which had been done since the 1970s.

In the Women's Health initiative study, oral estrogen was used instead of transdermal, which means three through the skin, and a type of progesterone was used that carried risks with it. The average age of women in the study was 63, not 50. When most women enter menopause, many were overweight and had been smokers. The population that was studied was flawed and the interpretations were flawed. And yet it rules the treatment today because MDs fear lawsuits.

The data will convince the already convinced the menopause experts who follow the data. Women are told to take supplements, eat yams or meditate, or sometimes they're put on antidepressants. There are two non-hormonal treatments for the small percentage of women who cannot use estrogen. Let me put it this way. I cannot read without my glasses. The treatment for that is eyeglasses. Not being told to try harder, have a better attitude.

At 71 now myself, I watch similar age women have their hormone treatment discontinued by their MDs. And there is a generation of women who have gone uninformed and untreated, and it still persists today. A recent article published on April 12, 10 days ago, it summarized much of what I'm saying today. One of the points that it makes is that for most women, continuing hormone replacement therapy after age 65 is safe and in fact, healthy, particularly for the cardiovascular system. I'm not a radical person.

I just know that when I have accidentally forgotten to replace my estrogen patch, my hot flashes return, my sleep is poor, and my mood is less calm. Occasionally, my husband will ask if I have remembered to switch my patch. If by chance I am a little bit cranky, it is usually because I have forgotten to switch my patch.

When asked about when I am going to stop my hormone replacement therapy, I answer that they can peel off my estrogen patch when I am laying in the coffin.

So entertaining although beyond two minutes. So please wrap up your comments.

Okay, I'll stop. I had one more paragraph.

I'll hear it later.

Good afternoon, Chair and Members. Thank you so much for having me here. Lourdes Ayon here representing myself. Usually you see me in the energy space as I work for Sempra. But today I'm here representing myself and all the women that are seeking access and treatment for menopausal symptoms. Now, for me, since I've turned 50, I've discovered this incredible sense of self. I feel much more confident about myself. I'm letting myself go gray. I'm really embracing this stage of my life.

In fact, I turned 51 last week, and I'm going to have a reverse quinceanera. Let's just do that all over again. I'm really enjoying this stage of my life. But with all this also comes some of the downsides. And the downside is the hormonal imbalance that comes from the drop of progesterone, estrogen, and testosterone in my body. Honestly, as Dr. Weston had explained, it's a crazy lack of sleep. There's brain fog. There's this really-- These mood fluctuations that I don't even recognize myself anymore.

I'm just kind of turning into the Hulk here at times. I don't even know why. And there's the inevitable drop in libido, which I think is really unfortunate as well. I went to my Doctor to address all these issues, and they mentioned, obviously, estrogen and progesterone and testosterone as a trio of the sex hormones that need to be, to be supplemented. When I went in and asked my insurance to cover, they covered the estrogen, no problem.

Gave me some trouble with progesterone and said they will not cover testosterone because I am not male. That was their reasoning for it. And when I went ahead and appealed it along with my doctor and did a peer-to-peer review where she presented scientific articles and information, they spoke to their doctors internally, and they came back and they said that it was not medically necessary. And so, thank you.

At time. I just want to mention that when I looked into paying out of pocket for testosterone monthly, it's $595 a month for a 30 day treatment of testosterone. And I think that it is unfair and a very myopic view of insurance companies and their pharmacies that they do not cover this for women who are especially low income and women of color. Thank you.

Thanks so much. Any witnesses in support?

If there are any witnesses in opposition who are going to be primary witnesses, please come forward.

Good afternoon. Barbara Morrow with Astellas Pharmaceuticals, in support.

Good afternoon. Craig Swaim with Bayer, in support.

Any primary witnesses in opposition?

Madam Chair and Members, Steffanie Watkins, on behalf of the Association of California Life and Health Insurance Companies, regrettably hear in opposition today. That being said, I would be remiss if I didn't recognize the work the author and sponsors and Committee have done on this issue, as well as acknowledge the amendments that are being proposed today to remove the reference to a specific brand name drug, which was certainly concerning.

Unfortunately, we still have some concerns with the remaining list of coverage requirements, specifically as it concerns the inclusion of bioidentical hormone treatment. While most of my members, as noted in the CHBRP analysis, cover the lion's share of drugs listed, bioidentical hormones are unique and that many are not FDA approved. As referenced in the CHBRP analysis, there's limited evidence that compound bioidentical hormones are effective treatment for menopause symptoms.

Use of compound identical hormones is only recommended for patients with an allergy to an active pharmaceutical ingredient or inactive ingredient of a drug product approved by the FDA, or documented requirement for a different dosage from those available. This is due to serious concerns about the safety, efficacy and standardization of these drugs, which are not regulated by the FDA. For these reasons, we would suggest bioidentical hormones be excluded from the list until there is more evidence to show their effectiveness.

With that being said, as if the Bill does move forward today, we look forward to having future conversations. I think all of my Members note the importance of coverage and access for women for these services, and with that, we look forward to future conversations. Thank you.

Any other witnesses in opposition?

Hi, Robert Boykin with the California Association of Health Plans. I'd like to align our comments with ACLHIC. Thank you for your time.

Thank you, Madam Chair, Jack Yanos, on behalf of America's Health Insurance Plans, align our comments with ACLHIC as well. Thank you.

I'll bring it back to the Committee for questions or comments. Doctor Weber.

So, good afternoon. Want to thank the author and those who came and speak in support of this very, very important Bill, and also to highlight the discrepancy within our healthcare system in terms of what we focus on and what we cover based on someone's gender. So thank you so much for that.

I do want to highlight, there was one part that just jumped out to me in this Bill, and you know, as an OB GYN, I have treated patients with menopause, but I also was very lucky to be at a healthcare facility prior to coming here where we actually had people that specialized, did fellowships or training in certain things.

And so, you know, I did PD Gyn, one of my colleagues actually focuses on menopause health, and she leads our menopause health program at UCSD and is actually a certified menopause provider through the North American Menopause Society. So I reached out to her because I remember a lot of the discussions that we would have around bioidentical hormones, and it can be somewhat confusing because bioidentical or biosimilar are supposed to be those that are just what our ovary would produce. Right?

And so there are some FDA approved ones that are supported by medicine and should definitely be covered. The concern comes in when you just have the broad bioidentical hormones, because it pulls in those that are not FDA approved. And it does include what was referred to as, like, some of the compounds, some of the creams, where there is no scientific evidence. The dose can vary based on where you go.

And in actuality, it may be a situation where you're getting too ow of a dose than what you should be getting, or at times, sometimes even too high of a dose, which could put you at increased risk for things like endometrial cancer, excuse me, uterine cancer. So what I would suggest, or I would recommend, is not to strike the bioidentical hormones, but just include FDA approved bioidentical hormones.

And so I will be supporting it today because it is just in concept, and I think that's just a small tweak. And I'm sorry I didn't get to you before, but this was, like, a last night, something I did last night, but I would just recommend that you change that to add FDA approved bioidentical hormones.

Thank you, Doctor Weber. I really appreciate you being here and all the feedback you provide on these bills. And I know we're doing a lot right now.

So I appreciate that we didn't get to all this before. And to be honest, the CHBRP analysis was the first place where that was raised for me. And I actually do want to express my gratitude to the CHBRP folks. They do such a good job, and I think their analyses are always really helpful. And so we are looking at that. We're working with the OB GYNs to figure out how to do this in a way that covers those that, for example, they can't.

The adhesive is something they're allergic to, so that everyone has the full range of options that are FDA approved. And so part of what's been complicated about this is that there isn't a great consensus because of the lack of training and what is menopausal and perimenopausal care, such that we felt like we had to list it out so that the things that OB GYNs are covered, but we're making sure we're focusing on that specific thing and addressing it. So I appreciate your feedback.

Seeing no other comments from the Committee, I want to sit on the Select Committee with you. And thank you so much, Chair, for having that Select Committee. It was also enlightening and thankfully, amusing. But the reality is that we are dealing with really devastating impacts of perimenopause and menopause not being addressed in the way that they should be.

And thank you to the witness to, for sharing your stories, both of you, for the impacts of not having our healthcare system really provide the necessary treatments that would enable us to be able to live full lives. I too am going to have a reverse quinceañera very shortly, and I'll be partying with you. With that, we still do not have quorum, but I ask that you close.

Thank you, Madam Chair and Committee, again for your support on this Bill. And you know, as I face down menopause myself, I think it is so critical that we have these conversations that we work for gender equity in the healthcare space and this is a huge step in the right direction, although much more is needed. And I know we will do that work together. So thank you. With that I respectfully ask for your aye vote when the time comes.

I just want to clarify that you'll be accepting the Committee amendments.

Yes. Thank you, Madam Chair.

Thank you.

We'll be moving on to item eight, AB 2271. Ortega? Please go up for-

Is it on? Can you hear me? Okay? Thank you, Madam Chair and Committee Members for the opportunity to present AB 2271 today and thank you to the Committee for their hard work on the analysis. AB 2271 is an urgent Bill that will help avoid a closure of a distressed hospital in my district.

Saint Rose Hospital is a distress safety net hospital in Hayward that treats mostly low-income Medi-Cal and Medicare patients. It has the only emergency room and maternity ward in the City of Hayward. Saint Rose's current financial situation is dire. The hospital will face bankruptcy and possible closure in the next six months if another entity does not acquire the hospital.

Alameda Health System, a public, state-created hospital system, is in the bidding process to buy Saint Rose, but requires financial assistance to do so, in the form of loan forgiveness. To aid AHS in acquiring Saint Rose and avoiding a closure, this Bill would forgive two of Saint Rose's loans, a loan for the distress hospital program, and construction finance loan. If Saint Rose were to close, more than 150,000 residents in my district would be left without a safety net hospital, an emergency room or a maternity ward.

Here testifying and support is James Jackson, CEO of Alameda Health System, and Michael Sorrell with Saint Rose Hospital.

Please go ahead. You'll each have two minutes.

Good afternoon. As Assemblymember Ortega said, Saint Rose is a standalone community hospital located in the City of Hayward that has served the residents of City of Hayward and surrounding community communities for more than 50 years. As a safety net healthcare provider, Saint Rose faces a number of financial challenges and is in significant financial distress.

Despite its best efforts and continued support from Alameda County and others, Saint Rose cannot and will not be able to achieve financial sustainability on its own and must become part of a larger health system. Absent an agreement for Saint Rose to become part of a larger health system, Saint Rose will not be able to withstand its ongoing losses and will be forced to make difficult decisions about the availability of services in the community and potential closure over the next several months.

This will obviously adversely affect patients and the overall healthcare safety net in Alameda County. Saint Rose sees approximately 28,000 patients in its emergency department each year and admits more than 3400 patients to its hospital for care each year. And the large, vast majority of those patients are low-income patients who qualify for Medi-Cal, and uninsured patients. Other area hospitals will not be able to absorb those patients if something was to happen to Saint Rose.

Saint Rose has been proactively looking at solutions, and last week, Saint Rose and Alameda Health System entered into a letter of intent to exclusively evaluate the opportunity for Saint Rose to become part of AHS over the next 90 days. And everyone's working to overcome any obstacles in that to prevent that from happening. One of those obstacles is Saint Rose's debt, which it's about $30 million insured by Cal Mortgage, and then the distressed hospital loan that was under the Distressed Hospital Loan Program.

Alameda Health System can't take on Saint Rose without that debt forgiveness. Thank you.

You'll have two minutes.

Thank you. Madam Chair, Committee Members, thank you for the opportunity to speak with you today. My name is James Jackson. I'm the CEO of the Alameda Health System. I come to you today representing the health system with a sincere appeal for your support of AB 2271. Assemblymember Ortega, I offer my sincerest gratitude for authoring this important Bill. This legislation is critical to safeguarding vital health care access for the residents of Hayward, California and the broader region.

Saint Rose Hospital is one of only three general, acute, disproportionate share hospitals in our county, and it stands as a beacon of care for our community. Today, Saint Rose confronts acute financial challenges, and I'm here today to urge you to prevent a hospital closure. I ask that you consider the ramifications of a potential closure of Saint Rose.

75% of Saint Rose's Hospital emergency room visits are senior citizens and/or low-income patients who qualify for Medicare and or Med-Cal, or they're indigent patients with no health care insurance at all. Saint Rose Hospital has the only emergency department in the City of Hayward, and the emergency department regularly operates at more than 100% of their standard capacity. If Saint Rose Hospital were to close, it would have a ripple effect throughout the county.

Already, the county's already-full emergency departments. Data shows that the neighboring hospitals would be overwhelmed if they saw the 10 to 15,000 more visits annually that would be anticipated. There's hope. The Alameda health system, appreciating the urgency of this situation, has embarked upon exclusive negotiations with Saint Rose Hospital.

Our overarching objective is resolute: to integrate Saint Rose Hospital into our safety net system, thereby preserving its indispensable services and ensuring the welfare of this community. As a safety net healthcare system in Alameda County, the Alameda Health System is devoted to serving the needs of all county residents, including the residents of the City of Hayward, and has the requisite operational and clinical strengths to assist Saint Rose Hospital in developing the programs, services, and efficiencies necessary to become more financially viable.

A formidable obstacle looms in our path and that's Saint Rose Hospital's outstanding capital debt. I appreciate that I'm at time, but I just wanted to acknowledge that by endorsing AB 2271 you are not merely enacting legislation, you're championing the health and welfare of our communities for posterity. Thank you very much.

Thank you. Any other witnesses in support? Any primary witnesses in opposition, or other opposition? Seeing none, I'll bring it back to the Committee. Any comments from the Committee? I will just offer. I know Alameda Health System very well. Assemblymember Ortega and I share that in common. And certainly I know that the struggles of Saint Rose have been ongoing, just because of the sheer fact of, as you stated, the payer mix is such that it primarily serves medically-uninsured patients and Medi-Cal elligible patients as well.

I know that Assemblymember Ortega is your biggest champion in this room for just taking the time to be able to move very swiftly. I want to thank the Committee for staff for operating so swiftly, to be able to get this Bill heard in time to be able to give you the necessary opportunity to save Saint Rose, and I know that any issues related to this potential merger will get examined more robustly as we move forward.

With that, I have an aye recommendation to pass out of Committee and once we have quorum, we will do that. Assemblymember Ortega, would you like to close?

I understand that we have a critical urgency throughout the state when it comes to distressed hospitals and I appreciate all of the Members today in hoping to earn your aye vote, so we cannot just save cent Rose from closing, but other distressed hospitals that provide healthy net resources for communities of color, our seniors, and our most distressed. Thank you so much and I respectfully ask for your aye vote

Thank you. We'll move on to Item 10. AB 2352 Irwin.

Is it working now? All right, thank you. I'm pleased to present AB 2352 which seeks to create a legal framework for psychiatric advanced directives, referred to as PADs, by adding on to the provisions related to advanced healthcare directives. In simple terms, PADs are documents completed by individuals who have behavioral health challenges. This allows them to continue to communicate preferences about interacting or caring for them during a future behavioral health crisis to first responders and healthcare providers.

Examples of information included in a pad include preferred De-escalation techniques or naming a trusted support person to serve as a healthcare advocate. This Bill has been crafted in collaboration with the project team behind the Mental Health Services Oversight and Accountability Commissions Innovative innovation project on PADs, which involves six different counties and one regional mental health authority. The innovation project's goal is to expand the use of PADs in their jurisdictions, preserve individual self-determination and improve positive outcomes for people at risk of involuntary care.

The goal of the legislation is to create a statute which bolsters individuals' confidence and ability to complete a pad and ensures first responders and behavioral health professionals that they have access to PADs in the moment when they can make a difference in an individual's care. I acknowledge that there's still work to be done adding language around access, and we're awaiting technical assistance from DOJ on what statutory language might be required to leverage CLETs or other digital systems to communicate with law enforcement.

I would like to thank the Committee staff, who has worked very diligently with my staff. I'd like to thank our sponsors and the opposition to identify amendments and refocus the Bill, bringing us closer to agreement.

I am accepting the Committee's amendments proposed on page 12, and now I would like to introduce two of my primary witnesses, Kiran Sahota, from the concepts forward consulting the project lead for the PADs Innovation Project, and Kendra Zoller, Deputy Director of Legislative Affairs of the Mental Health Services Oversight and Accountability Commission, who is here to share information about the Commission's role with the innovation project.

Thank you. Good afternoon, Madam Chair and Committee Members. Again, my name is Kiran Sahota and I'm the Lead Project Director for the Multi-County Psychiatric Advanced Directive Project, or what we call the PADS Project. Since the 1990s, mental health preferences have been hidden in the more common advanced healthcare directive.

For decades, psychiatric advanced directives remain an unknown tool for behavioral health crisis intervention, demonstrating the power of collaboration and ongoing participation of family members, the peer community, first responders, crisis teams, hospital staff, all participating in the project identified that creating a standalone PAD is indeed a crucial step in recognizing the gap in crisis services and addressing the specific needs of individuals with behavioral health conditions.

By providing a digital platform with standardized components, ensuring portability across different locations within California, and emphasizing voluntary participation and consent, you're not only promoting accessibility, but also empowering individuals to advocate for their own preferences and needs during a time of crisis. AB 2352 recognizes a standalone PAD as a document that reduces the stigma of behavioral health conditions condition, and it creates accessibility for all individuals, including the homeless or even those with a co-occurring condition.

This Bill also acknowledges the need for digital transformation and the role of trusted outreach workers and peer support specialists in facilitating and witnessing this document. The Bill will allow the use of a standalone PAD in a behavioral health crisis situation, expanding its use beyond a health care setting when a person may have lost decision-making capacities.

This is a crucial aspect that AB 2352 emphasizes, the importance of reducing recidivism of incarceration and hospitalization through personalized care and sensitivity, and underscoring the potential impact of a standalone PAD on improving outcomes for individuals experiencing a behavioral health crisis. The project looks forward to continued collaboration of our counties and stakeholders, and I thank you for your time and urge your support for AB 2352. Thank you.

Thank you. Two minutes.

Good afternoon. Kendra Zoller, on behalf of the Mental Health Services Oversight and Accountability Commission, appreciate the chance to be with you here today. The goals of this project are really simple and straightforward.

The intent is to capture the wishes and desires of an individual when they are not in a crisis and to be respectful of those desires and wishes when someone is in a crisis, as a strategy to reduce the likelihood of that crisis escalating and reduce law enforcement involvement and speed the pace at which we can provide services tailored to a person's individual needs.

The Commission saw this opportunity with the county several years ago to de-escalate crisis very early in the process, as outlined in the analysis. Implementing this goal is complicated, and we appreciate the work done by the author, sponsor, opponents, and the Committee staff. The Commission does not have a formal position because we meet on Thursday, but our Chair has authorized us to ask the Committee to move the Bill forward so we can continue to work with the stakeholders and address the issues.

We see this legislation as key to putting in place strategies to improve outcomes across the state, and we are committed to working with our partners and the author to move this Bill forward. Thank you, and happy to answer any questions.

Thank you. Any other witnesses in support?

Hello. My name is Rayshell Chambers, and I'm the co-Executive Director of a peer-run organization called Painted Brain, and we support this Bill.

Thank you. Any primary witnesses in opposition.

You'll have two minutes each.

Good afternoon, Madam Chair and Members. Miss Irwin. Deb Roth with Disability Rights California, with an opposed unless amended position. We appreciate the author's willingness to work with us, and I don't know that I've ever heard a shout out given to opponents in an author's presentation, so thank you for that very much. The Committee amendments, we think, are a big step in the right direction. DRC supports PADs. We co-sponsored legislation last year to establish PADs in California law.

A PAD is a form of an advance directive. It is still an advanced directive. It should be as enforceable as any other advanced directive. It should look as much as possible like any other advanced directive. One of the ways in which it could do that is by retaining the option to designate an agent for decision making. That's someone you would give power of attorney to.

For reasons we don't fully understand, the author is removing that, and you don't have that option if you do a standalone PAD, I'm assuming that if it's an integrated PAD, that would be. Then it would be kept. I'm not sure. Some people say PADs are different and that they don't count as much because they are preferences, and that's actually not fully accurate. A PAD contains instructions just like any other advance directive.

And in their simplest description, these instructions tell a healthcare provider, please follow my preferences whenever possible. If PADs don't have the same legitimacy as any other advanced health directive, what's going to make a healthcare provider pay attention to them? Thank you.

Good afternoon, Chair and Committee Members, Karen Vicari, Mental Health America of California, also proud co-sponsors last year of psychiatric advanced directives legislation. I want to thank the Committee, the Committee staff, the author, and the sponsors for working with us to address our concerns. In addition to the concerns mentioned by Disability Rights, we also believe that AB 2352 must account for a broad range of PAD sources, not just the innovation project's digital PAD.

While the innovation project's platform might be detailed, PADs can arise from multiple sources and will arise from multiple sources outside of these county-led PADs. Thus, PADs statute should be somewhat detailed. For instance, most states with PADs legislation include a form with specific mental health decisions. PAD statutes generally list specific information commonly included in a PAD, such as medication preferences, facility preferences, and preferred means of crisis intervention.

PAD statutes also generally address the issue of access, where a PAD is stored, who has access to it, and how to ensure it is found when a crisis arises. Also, regarding access, the Bill is silent on law enforcement. What do we expect law enforcement to do in a crisis if there's a PAD? And which parts do they have access to? Are they required to follow the PAD's instructions, and should you limit the information that law enforcement has access to?

Additionally, AB 2352 doesn't address what happens when a person is in crisis. The true value of a PAD is their use during crisis. With a mental health crisis, the determination of capacity is not as clear as with a medical crisis when a person may be unconscious or heading into surgery. A mental health crisis may have times when the person has capacity to make decisions and times when they don't.

AB 2352 is silent on the issue of who determines incapacity and how that determination is reversed when capacity is regained. Thank you. The healthcare advocate role should be clarified. That's our last point. And again, I just really want to thank the Committee for the Amendments and for their work on this and the sponsors and the author also and the Committee staff.

Yes, I wanted to thank them too. Thank you.

Always have time to be able to give shout outs to my awesome Committee staff. Thank you. Any other opposition in the room? I'll bring it back to the Committee. Miss Schiavo.

I just thank you for this Bill. I know it's a complicated issue. I wonder if you can just kind of respond to the opposition and let us know kind of how you're working with them going forward.

I will let my experts actually address that, but I do want to say that Disability Rights has been on the Advisory Committee for the pilot program, and we have been meeting with them in both of the committees. We've taken a lot of amendments and there's a lot of back and forth. So, we've all been acting in good faith.

Yes, and so I think part of the aspect of that is the innovations, and we are really looking at doing a system-wide change, and there are definitely some nuances that have to be worked through. One of the aspects is that of a crisis, and especially with law enforcement. My background also is in law enforcement and CIT.

And so knowing that we also have law enforcement on our Committee telling us we don't need all the information, we would like to know what is most pertinent in a crisis in a situation where I can help deescalate a situation. And so we are working with law enforcement as well and identifying exactly what parameters they would need. Same with healthcare and hospital settings.

And so making sure that the right amount of details go, plus offering full consent for the individual that is creating the pad so they can either opt to not provide information to law enforcement or hospitals, or they can opt to provide all of it. So those are some of the advantage of the digital aspect of PADs. And by no means are we wanting to take pads and the importance of mental health preferences out of advanced healthcare directive.

But one of the missing pieces in a crisis is what do we do in the moment? How do we deescalate? How do we prevent someone from going into a hospital or being incarcerated? So those are really those key components that we're looking at right now and working through with everyone.

Thank you.

Any other comments from Committee? Not seeing any. I want to thank the author for bringing forward this piece of legislation. I think you've hit into a very critical area for us to make sure that we get right in terms of advanced care directives, including our psychiatric advanced directives.

And I know that you have been diligently working with our Committee staff, and I know that our Committee staff will continue to be involved in moving this Bill should this Bill move forward and working on the amendments that really get to the intended goal of this. With that, we still do not have a quorum, but you are free to close.

Just when the time is right. I respectfully ask for your aye vote.

Thank you, Assembly Member Irwin.

Thank you.

We will move on to Assemblymember Berman. Item number 17, AB 2668. Please go ahead.

Good morning, colleagues. Good afternoon, colleagues. Whatever it is, colleagues. In the fall, I met with two high school students with alopecia who shared their stories about the critical role that wigs play in self-esteem and mental health, and they were the inspiration for AB 2668.

The lack of health insurance coverage for wigs means that Californians with medical hair loss are forced to pay out of their own pocket.

The cost of wigs depends on a number of factors, including length and the average cost, and this shocked me. The average cost is approximately $1,500. If patients cannot afford this cost, then they do not have access to a wig and the benefits it provides to remove this barrier.

AB 2668 would provide coverage for a wig for Californians experiencing permanent or temporary medical hair loss due to alopecia, chemotherapy, or other health conditions.

Importantly, this bill includes parameters which require a licensed provider to prescribe a wig for treatment, limit coverage to no more than one wig in a year, and cap the amount of coverage for a wig to $750.

I respectfully ask for your aye vote, and I am honored to be joined by Wendy Petka, parent of one of the high school students who convinced me to author this bill, and Adriana Zhang, representing California advocates for alopecia.

Thanks. You'll each have two minutes.

Good afternoon, Madam Chair, Committee Members, and supportive staff. My name is Wendy Petka, and I'm here today in place of my 17-year-old daughter, Miranda Huang, who wanted very much to be here herself to tell you her story.

But as you can appreciate, she's a senior in high school and our education doesn't let up. Even though they're seniors, we have good schools. This is her message, and I'm going to read it to you.

I was diagnosed with patchy alopecia areata at age 11 in 6th grade. And even then, I didn't truly understand the scope of my condition or the fact that there was no real treatment for it. To me, all alopecia meant was that my friends couldn't braid my hair anymore in class because they'd see my bald spots.

For background, alopecia areata is an autoimmune disease that encompasses different levels of hair loss, ranging from coin size pack patches that I have to complete hair loss across the body.

Given that I was diagnosed at such a young age, my confidence quickly plummeted as I began middle school, which, as we all know, is a horrible time. And I hated seeing myself in any photos. And I never truly embraced discussing my condition with my peers even now.

I have come to realize that hair is never just hair. It is important we wear it like clothes. It is part of our identity. And when it is taken from us, people can't ignore it.

Good afternoon. My name is Adriana Zhang. I am a current sophomore at Stanford University, but I am here proudly representing the California Advocates for alopecia, a co-sponsor of AB 2668. Four years ago, my sister knocked on my bedroom door at 06:00 a.m. In the morning asking for me to braid her hair.

Instead, they use it as a label and it hurts and consumes us. Assemblymembers, the mental health cost to young people with this disease is very real. I can attest this to this personally as her mom. This is why Miranda and I kindly ask you to support AB 2668. Thank you for your time.

Thank you. You'll have two minutes.

And admittedly, I looked at her really confused because I was diagnosed with alopecia areata since I was 10 years old. I completely lost my hair and my eyebrows two separate times in the past nine years.

And after some YouTube videos and after practicing on her, I eventually problem solved. And I bring that same problem solving here and why I'm in front of you all today. Wigs gave me the confidence to get through middle school to get out of my house and be able to talk to people without feeling judged.

However, the cost of wigs, as you have previously heard, is a large barrier, especially for patients where medications don't work.

It's important for them to have access to a wig, and it plays a crucial role in their role in their mental health. The cost of wigs are really high, but I believe that all people deserve to express their identity and culture regardless of their financial status. Compared to currently available medications, wigs are realistically the most affordable options for both patients and insurers.

So I know you all are problem solvers here today regarding mental health issues to financial equity, and I respectfully urge you to join eight other states in the United States in supporting 2668 wig access legislation. Thank you.

Thank you. Any other witnesses in support?

Faith Borges on behalf of the California Agents and Health Insurance Professionals in support.

Thank you, Madam Chair Members. Don Schinske, on behalf of the California Society of Dermatology and Dermatologic Surgery, in support.

Madam Chair Members Autumn Ogden-Smith with the American Cancer Society Cancer Action Network in strong support. Thank you.

Thank you. Any witnesses in opposition?

Good afternoon, Chair Members of the Committee. Robert Boykin with the California Association of Health Plans, regrettably in opposition to AB 2668. First, I would like to thank the author and her office for the open dialogue regarding this topic.

We understand and respect the author's intent with the bill. However, we are opposed due to the costs associated with the mandate. According to the California Health Benefits Review program, this bill will increase annual premiums by 29.5 million for all Californians.

It also exceeds the essential health benefits, leaving the state on the hook for the defrayed cost. As noted in the analysis, the Chair's Assembly Bill 2914 and Senate Bill 1290, introduced this year, conveys the Legislature's intent to review the California's EHB benchmark plan and establish a new benchmark plan for the 2027 plan year.

While we look forward to seeing that process and open dialogue take place in the interim, we feel that any new mandate should be held for the possible inclusion of a new benchmark plan. For the reasons stated, we respectfully ask for a no vote. Thank you for your time today.

Thank you. Any other witnesses in opposition?

Steffanie Watkins, on behalf of the Association of California Life Insurance Company, is also in opposition.

Jack Yanos, on behalf of America's Health Insurance Plans, respectfully opposed.

Seeing no other opposition, I'll bring it back to Committee. Go ahead.

To the witnesses. Thank you so much for your advocacy and testimony. The author thank you so much for your advocacy, and I'd love to be added as a co-author.

Thank you very much. Appreciate that.

Mr. Berman, I want to thank you for bringing forward this bill and quite frankly, for hearing the call from two school students that brought this to your attention. And thank you for representing your high schooler. And hopefully she's going to do well in her studies in her senior year.

So with that, with that, we. I will be recommending an aye vote for this to move out of Committee. Mr. Berman, would you like to close? You are both. Do you have something to say?

And thank you for not having senioritis, but really want to appreciate you all sharing your stories and also the solution that would help to address not only the physical treatments, but also the mental health concerns related to dealing and addressing alopecia.

Just real quick.

I wanted to be added on as a co-author. As someone who's had alopecia, I want to support it today and would like to be added as a co-author.

Go ahead.

Thank you, sir. Appreciate that.

Apologies. I thought you were pointing at them and they were saying no. Thank you so much. Mr. Berman, please close.

When the time comes, respectfully ask for aye vote. Really appreciate it. Thanks.

Thank you so much. We will move on to the next item.

All right, good luck today.

Thank you. We are still operating in file item order before our special order of business, which will begin as close to three as possible. That being said, item number 14 AB 2574 Valencia.

Thank you, Madam Chair. I will be brief to hopefully maybe squeeze in one more before 03:00 if possible. Buenos tares and Madam Chair and Members, I'd like to start by thanking the chair and her team for diligently working on AB 2574 and acknowledge my legislative assistant, Katie Guthrie for her work on this Bill. I'll be accepting the Committee amendments.

AB 2574 will require each organization that operates, conducts, owns or maintains a certified program or a licensed facility to disclose to the Department of Healthcare services whether a licensee, General partner, Director or officer of the licensee owns a recovery residence, has a financial interest in that recovery residence, or has a contractual relationship with a non certified or non licensed entity that provides professional services, addiction treatment, or recovery services to the clients of certified programs. A lot of information, but it needed to be stated.

This Bill will allow DHCs the authority to suspend or revoke the certification of a program or a license of a facility for failing to disclose this required information. AB 25407's goal is to provide a greater understanding of the financial relationships that license treatment facilities and certified programs have with the recovery residences within our communities. According to the California Human and Health Services data, there are 1801 licensed alcoholism and drug treatment facilities statewide.

Many of these facilities are concentrated in Southern California, with 331 residing within Orange County. The disclosure of this information will allow the Department to provide effective oversight and to take action against bad actors. With me to provide testimony is a Council Member from one of the cities I represent, Mister David Pentaloza from the City of Santa Ana and then Carolyn Grinder from the League of California Cities who is the sponsor of the Bill.

You each have two minutes. Please go ahead.

Thank you Madam Chair. Good afternoon honorable Chair Bonta and Members of the Committee. My name is David Pinalosa and I serve as the Council Member in the City of Santa Ana as well as the second Vice President of the League of California City's Orange County Division. I am here to speak in support of AB 2574. Santa Ana, as well as many other cities in Orange County, is home to many recovery residences.

Most of these facilities are located within residential neighborhoods as opposed to areas of the city where concentrations of medical facilities or other supportive services. The city understands that recovery residences provide a wide range of benefits to residents that are recovering from addiction. Unfortunately, there are instances when unlicensed facilities are operating under the radar as a recovery residence.

While the state law requires the Department of Healthcare Services to license and regulate drug abuse recovery and treatment facilities, it does not require DHCs to license recovery residences without the licensing of these facilities. It is impossible for state, city and and local municipalities to track where these facilities are located, the condition of the facilities, or complaints associated with the facilities. Additionally, the Department lacks data on the financial relationships a recovery residence has with a licensed treatment facility or certified programs.

This Bill will help DCHs provide better oversight and the ability to investigate these financial relationships between the recovery residences, treatment facilities and certified programs. It is for these reasons that I, on behalf of the City of Santa Ana, is in support of AB 2574 and I encourage the Committee to approve this measure. Thank you so much for your time.

Thank you. Two minutes. Good afternoon, chair Members. My name is Caroline Grinder and I'm here on behalf of the League of California Cities, which is proud to sponsor AB 2574. Residential recovery Housing provides a range of benefits to some of California's most vulnerable residents, and it's critical that their needs are prioritized over profits. That's why compliance with state licensing laws administered through the Department of Health Care Services is essential to safeguarding residents well being and maintaining quality care.

However, for too long, cities have struggled to work with the Department to ensure the bad actors are operating in their communities are held accountable, which has been to the detriment of those receiving care and the broader community. We believe AB 2574 is a step forward in addressing cases in which licensed facilities provide services to the residents of a sober living home, but the sober living home is not included within the facility's licensure.

Simply put, if residents of an unlicensed sober living home are receiving non medical services from a licensed facility, then the sober living home is an integral part of that facility and should be regulated by the state under the facility's license. This will help ensure that a recovery residence that's operated as a business with a licensed treatment facility is regulated like businesses and not residential homes.

As a number of drug and alcohol treatment facilities continues to rise in response to the state substance use crisis, the Department faces a major hurdle in monitoring and regulating these facilities. With billions in the pipeline for the behavioral health housing across the state, now more than ever, we need to re examine the oversight of these facilities and ensure that those receiving care and the surrounding communities are set up for success.

Over the last decade, Calcity has sponsored several legislative attempts to address concerns raised by cities related to transparency and accountability for these facilities. We're continuing to focus on enacting legislative solutions that safeguard every person's well being and careful we believe the transparency provided by AB 2574 is a step in the right direction to ensuring sober living homes that are providing services and should be licensed are on the department's radar so that we can ensure swift action.

For those reasons, we believe AB 2574 will help meet our shared goals of ensuring recovery. Housing meets standards for patients care, which is central to the effective treatment outcomes and community well being that we're all hoping for. We thank the Committee for all the work on the amendments, and we urge the Committee to pass this legislation. Thank you so much. Thank you. Any additional witnesses in support? Seeing none. We'll bring forward any witnesses in opposition? Seeing none. Back to Committee with that.

Mr. Valencia, thank you so much for bringing this Bill forward and for your work with my committee on amendments to address our concerns. I think we've struck inappropriate balance of bolstering oversight and enforcement without erecting barriers to this type of housing that is so incredibly crucial for our continuum of substance use disorder care. I know that you'll continue to work on this Bill as we move forward with that. Would you like to close?

Absolutely. Thank you, Madam Chair. Ensuring that folks are receiving the health care necessary is at the core of this Bill, and happy to continue those conversations. I would like to note that with the amendments that we accepted, the California Realtors Association is also removing their opposition. With that in closing, I appreciate your time and respectfully ask for a yes vote. Thank you.

Thank you. When we establish quorum, we will move that through. I'm going to. I know that Mister Zabur has a very quick Bill. I'm going to squeeze it in before we move to special order AB 20613 item number 15. Please go ahead whenever you're ready, Mr. Zbur.

Thank you, Madam Chair. Very appreciative of your squeezing us in. I'm the proud author of AB 20613 a Bill that creates a rare disease advisory council in California, otherwise known as RDAC.

The RDAC is created in the memory of Jacqueline Marie Zbur, my sister, who endured a three-year battle with ALS, also known as Lou Gehrig's disease, and frankly, inspired me to seek public office, in part to address the significant challenges people grappling with rare diseases are experiencing, as well as people grappling with a broken social safety net.

With over 10,000 rare diseases affecting one in 10 Californians, it's difficult for state policymakers and government officials to have an in depth understanding of the issues faced by persons affected by rare diseases and the resources needed to support them. The RDAC will be comprised of stakeholders across the rare disease community and will act as an advisory body to the Legislature, facilitating consultation with experts on rare diseases and developing policy recommendations with diverse membership and broad community support.

A California RDAC will serve as a valuable resource as our health care system evolves. Without an RDAC, California laws and regulations that affect the rare disease community will be developed without consultation of impacted stakeholders, leaving this vulnerable population at greater risk of poor health and public policy outcomes. The creation of this RDAC will have a fiscal impact, and I'm working with stakeholders to find alternatives to state funding to alleviate this issue.

Specifically, I'm in the process of conversations with UCLA, who has a rare disease center of excellence. The center offers world class doctors in all major specialties and brings together medical teams experiencing, diagnosing, and treating a rare, wide range of rare diseases and is interested potentially in hosting this endeavor. A strong RDAC can also help relieve burdens on the state by expeditionally delivering direct feedback, solutions and resources to policymakers with one community voice.

I appreciate the Committee's analysis of the Bill, and I agree to accept the Committee's amendments clarifying language related to the appointment of a secretary to the RDAC.

You know, my sister, in the final months and year of her life, would often call me at the end of the day just at a loss at, you know, she'd spend all day on the phone trying to figure out how to meet sort of her needs and always wondered why our social safety net was so broken, why people with rare diseases were left out, why she would have to, you know, she was in a wheelchair, was housebound, could not get out of the house without, without help and a van that allowed her to get out, you know, because of all the.

And she. And, you know, we had social service programs where she would literally have to go in and wait in line and spend all day to get. To get services that she needed. One of the last things she asked me before, probably about six months, is she basically said, Rick, I hope that you will run for office and really focus on people with rare diseases and people that need help and are experiencing just challenges with our broken social safety net.

So just as my sister knew that her efforts would, you know, not benefit her, you know, her experience is a siren alerting us to the deeply flawed public policy approach to addressing rare diseases. You know, rare diseases are rare, so people have very few opportunities to sort of be at the table, and public policy is made without them. And this, this council will partially alleviate that. I know. I respectfully ask for your aye vote when the time comes.

And with me today, I have Lindsay Viscara, who's the state public the state policy manager of the National Organization for Rare Disorders, sponsor of the Bill, and Michael Hu, the patient advocate, provide additional information to assist with questions.

Madam Chair Members, my name is Lindsey Viscara, and I'm the state policy manager at the National Organization for Rare Disorders, or NORD. I'm also a resident of California. I live up in Chico, and I'm a rare disease parent myself. Two of my three children have rare diseases. I'm so pleased to be here today in support of AB 20613 which would help establish a rare disease advisory council, or RDAC, in California.

For those not familiar with Nord, we're the leading independent advocacy organization in the United States, representing the more than 30 million people living with one of over 10,000 rare diseases in the United States. A rare disease is defined as any condition that affects fewer than 200,000 people. RDOCs vary in composition, in size, in housing, agency and duties, but they all have the common goal of giving rare disease patients and their families a unified voice in state government.

With an estimated one in 10 Americans living with a rare disease, it's critical that every health policy discussion, the rare disease community's unique perspective can be considered. Rare disease patients face unique challenges every day, from obtaining an accurate diagnosis and accessing medical specialists with knowledge of their condition to battling for fair insurance coverage of their treatment and care. I know that one firsthand.

California's RDAC would help address these issues by providing a forum for stakeholders across the rare disease community knowledgeable about the needs of rare disease patients and to help them to make recommendations to you to help the rare disease community. In addition to serving the rare disease community, the RDAC will help relieve some of the fiscal burden on the state by expeditiously delivering direct feedback, solutions and resources to California government decision makers with regard to drug costs, research, education, and the diagnosis and treatment of rare diseases.

To date, 28 states have established an RDAC. Our letter of support lists 27, but I'm thrilled to announce that Mississippi just signed the 28th into law just a couple of weeks ago. Thank you for your time, and I.

Urge your I vote Madam Chair and Committee Members, good afternoon. My name is Mike Hu, resident of Oakland, Member of the Coalition for California Rare Disease Advisory Council, RDAC. Thank you for the opportunity to speak with you in support of create and RDAC in California. I'm a father of two boys, Mudong and Mohua, who are 16 and 13 years old now. They're both affected by an ultra rare genetic disease called mucopolysaccharidosis, type two or mps two.

It's a systemic disease that affects every tissue and organ, which causes physical disabilities, developmental delays, and eventually leads to organ failures and deaths in the early adulthood. With only about 400 diagnosed patients in the entire country, virtually no one knows about the disease, including many of their doctors. During the past 13 years battling with the rare disease, my family have experienced the many challenges that the rare disease community face every single day.

From diagnostic odyssey to accessing proper medical care and therapies, battling insurance coverage, public school play placement, obtaining Regional Center support, just to name a few. As a rare disease family, we must educate everyone who come to interact with my boys and to advocate for every bit of resource and support they need. In our great State of California, it was estimated that one out of 10 individuals live with a rare disease.

Our goal is for the RDAC to raise awareness about rare disorders, provide valuable information, knowledge to policymakers, and to become a resource to individuals and families like ours, as well as to medical providers who support these patients. We hope California will join the 28 other states that have enacted RDACs to support and help give voice to the red disease patients and families. Thank you.

Thank you. Any other witnesses in support? Lynn Kinst, Executive Director of the Hemophilia Council of California and Strong Support. Thank you.

I'm Jennifer Campuser, the founder and Executive Director of the Necrotizing Enterocolitis Society. And on behalf of my son Micah, who died from a rare disease and babies like him, I'm in support.

Hi, I'm Kelly Goss, I'm managing Director of advocacy for the ALS Association, which is a Member of NORD, and we're in strong support.

Diane Nugent, representing the Hemophilia and sickle cell centers throughout the 13 western states, especially California. We are in strong support.

Thank you. Thank you. Any witnesses in opposition? Seeing none, I'll bring it back to the Committee for any questions. Seeing none, I'll just offer a comment. I just wanted to say just a lot of respect for the author. I know you've been a champion for your sister. Really appreciate that. Thank you, Mister Zbur. I want to thank you, Assemblymember Zbur, for bringing forward this Bill.

I want to acknowledge that this Bill is named for your sister, Jacqueline Marie Zebra, who endured a three year battle with ALS and thankful that something potentially beautiful can come from, I'm sure, that very painful experience. The Rare Disease Advisory Council created by this Bill will serve as a resource to state government in making sound policy to serve Californians with rare diseases. And thank you for being a champion of this Bill, would you like to close?

I respectfully ask for your vote. Thank you very much.

Thank you so much. We will now move to our special order of business, AB 2200. Item number one. As Assemblymember Cholera is coming up to the presentation table, I want to just remind everyone that we are going to allow 10 minutes each for support and opposition. Then an additional 15 minutes for both support and opposition. For me too testimony, all me too testimony or additional testimony will strictly be limited to name, position and organization.

We will now move to our special order of business, AB 2200, item one. It's Mister Kalra. As Assembly Member Kalra is coming to the presentation table, I want to just remind everyone that we are going to allow ten minutes each for support and opposition then an additional 15 minutes for both support and opposition for me too testimony. All me too testimony or additional testimony will strictly be limited to name, position, and organization if you represent one.

We will start the special order of business at 3:10 and end it at 410. Assembly Member Kalra, you can begin.

Thank you so much Madam Chair. I would first like to recognize that the thorough Committee analysis and accept the proposed amendments. And I really appreciate the hard work and many hours put into this by the Committee staff and by you, Madam Chair, as well.

Assembly Bill 2200 the California Guaranteed Health Care for All Act is the policy framework for a single-payer healthcare system driven by quality of care, not profits, that is efficient, not weighed down by administrative waste, and that builds a thriving healthcare network upon a foundation of equity. The last time this Committee passed out a policy bill on single payer, the world was still healing from a global pandemic that exposed serious vulnerabilities and inequities in our current system.

It was during this once-in-a-generation moment that many questioned our status quo system. A system that incomprehensibly ties access to healthcare to employment. A system that thoroughly that, through costly co-pays and deductibles, cruelly forces people to ration the care they need. A system that pays the most among high income countries for some of the worst health outcomes. A system that allows thousands to die and millions to go bankrupt every year. So where are we now?

According to our recent 2023 health survey, nearly two-thirds of Californians are worried about unexpected medical bills and affording out of pocket costs. The average cost of family premiums for job-based coverage climbed 7% to nearly $24,000 per year in 2024. Last year, 46% of us adult workers with job-based coverage reported having difficulty affording their health care. That's millions of workers and their families. And over half of workers have a large deductible. What does that mean for practical purposes?

That means that they're choosing whether they can afford to actually access the healthcare they supposedly have or not. Healthcare affordability is a top issue for Californians, and many are unable to afford the high cost of care or fear of losing their coverage in an economic downturn. Even with the expansion in Medi-Cal, 2.6 million in California will remain uninsured.

As many on this Committee know too well, we have some of the worst health disparities, and vulnerable populations face greater risk and less access to safety net programs. Black Californians have the highest rates of infant mortality. People of color in California are 20% more likely to have asthma and 10% more likely to be diabetic. The hospital death rate among racial and ethnic categories is practically 10% higher across the board compared to White Californians. Millions of Californians live in areas with acute shortages of healthcare professionals.

More than one-in-five Californians live in a primary care shortage area and more than one-in-four live in a mental health care shortage area. We hear about hospital closures on the regular, every day in rural communities and in urban communities. It's for these reasons and a refusal to accept our status quo that I bring AB 2200 for your consideration. AB 2200 would enact a comprehensive framework of governance, benefits, program standards, and healthcare cost controls for a single-payer healthcare coverage system in California.

This system would be called CalCare and it will be available to all California residents. CalCare is designed to cover all medically necessary and appropriate care as determined by a patient's treating healthcare provider or integrated team and consistent with the patient's best interests.

Californians will have access to comprehensive healthcare coverage, including and not limited to all primary and preventative care, hospital and outpatient services, prescription drugs, dental, vision, audiology, reproductive health services, maternity and newborn care, gender-affirming care, long-term services and supports, mental health and substance abuse treatment, laboratory and diagnostic services, and ambulatory services.

At its core, CalCare is a simplified public payment system for quality care to our healthcare providers that will set fair rates based on Medicare, but can be adjusted to attract a certain optimal result or ensure adequate reimbursement for services rendered. Instead of hospitals barely getting by or charging consumers unattainable prices, CalCare would negotiate global budget for institutional providers like hospitals, facilities and clinics so we can actually fund what should be a public good.

Healthcare providers will have the ability to appeal the CalCare Board for an alternative rate or make adjustment on their budgets in a transparent manner. Finally, the global operating budgets for hospitals, clinics, and other institutional providers include funding for graduate medical education. We have made amendments to the last version of CalCare. Specifically, we added a public retirement benefits advisory panel, Office of Health Equity, more detail on special project budget towards rural and medically underserved areas, fee for time payment models and emphasis on care coordination and prevention.

We're also taking special attention at addressing our healthcare workforce shortage and retention in a number of ways. For example, a main tenant of CalCare's methodology is maintaining an optimal workforce to deliver quality and equitable healthcare. AB 2200 has provisions to increase payment rates in areas that have provider shortages.

The CalCare Board will be able to increase payment rates to improve the availability and accessibility of healthcare and CalCare includes a special projects budget to be used to increase payment rates to improve the availability and accessibility of healthcare services in rural and medically underserved areas. Up to 1% of the entire budget will be dedicated to programs providing healthcare, workforce education, recruitment and retention, and there will be a CalCare health workforce group that will continue to identify efforts to improve workforce and address issues of attrition.

Special projects in CalCare will fund the construction, renovation or staffing of healthcare facilities in rural or other underserved communities. It will also prioritize those projects that address the health inequities that pervade today. Full equity in our health system will only be achieved through a single-payer system of guaranteed healthcare for all.

The Office of Health Equity now in CalCare will support the board through data collection, analysis and recommendations on issues that include barriers to care and access, equitable distribution of healthcare services, discrimination in healthcare settings, and more. Study after study has shown that a single-payer healthcare system with comprehensive coverage for all would produce massive savings on healthcare costs. As a result, California could provide better healthcare coverage to all and do so for less money than our current system.

By simplifying our healthcare system, CalCare would save billions in administrative costs. By directly negotiating prescription drug prices and provider payments on a statewide basis, CalCare would be able to lower prices for drugs and healthcare services, resulting in substantial savings overall also in the billions.

The Governor's Healthy California for All Commission found that under a single-payer model, with no copays or other cost sharing, and with benefits that include long-term supports and services for all, California would save between $32 and $213 billion over 10 years compared to our current system. Opponents will say California can't afford to sustain this system, but the Commission also found a higher rate of growth in spending to our current system.

And under a single-payer system, the gap of funding needed is $16 billion less than what California has already paid for employer contributions, premiums and out-of-pocket expenses that our status quo requires us to pay. The reality the reality is that CalCare is not only good for California businesses, it is good for California businesses who are being pummeled with year over year insurance premiums premium increases with no ability to negotiate or push for some sense of moderation.

The Commission conducted polling that found that 65% of Californians with low incomes and 72% of Californians of color with low incomes support a proposal to replace all Medicare, Medi-Cal, Covered California, and private job-based insurance plans with a single statewide government program that would cover healthcare for all people who live in California, regardless of income. CalCare will save lives. The Commission reported a universal health care system would save an estimated 4,000 lives every year in this state.

Inevitably, someone will ask how we will pay for CalCare, especially in today's budget climate. AB 2200 is the policy framework and a policy bill that's needed to engage the Federal Government on a consolidated waiver, and there would need to be a fiscal analysis on what funding will be needed to fully transition and implement it.

This may take years, but we should and must act now and make progress on the policy, or we don't even get to any point of discussing how we can create real cost savings for Californians.

Members, we have an opportunity to set the stage for universal, affordable, equitable healthcare justice for all in California and be a model for the nation on what a progressive alternative to our fragmented, profit-driven status quo would look like. Imagine for a moment how California would have fared under a single-payer universal healthcare system during the COVID-19 pandemic. People that immediately lost their jobs will still have their healthcare. Hospitals would not need to worry about a pay source.

The state would be better coordinated on providing access to vulnerable communities and directing critical healthcare services like PPE and vaccines. And most importantly, lives would have been saved. One published study examined the potential benefits nationwide and estimated that the United States would have saved 212,000 lives in 2020 alone, and that $106 billion of medical expenses associated with COVID-19 hospitalizations could have been averted. CalCare is not just a healthcare justice bill. It's a racial justice bill. It's an economic justice bill. It's a gender justice bill.

It's about affirming the fundamental right to healthcare, a right that should never, ever be contingent on your job, on your wealth, or where you live or where you were born. With me to provide supporting testimony is Michelle Gutierrez Vo, an RN and President of California Nurses Association, Carmen Comsti, Policy Specialist with the California Nurse Association and Ishmael Amendariz, President of the Oakland Educators Association and representative on behalf of the California Teachers Association.

Thank you. And just as a reminder, you will all collectively have 10 minutes.

Can you hear me? I'm Michelle Gutierrez-Vo. I'm a President of the mighty California Nurses Association and I've been a registered nurse for over 26 years, representing over 100,000 RNs across the state. CNA is a proud sponsor of AB 2200. As a nurse in an adult family medicine outpatient clinic in Fremont, I witness preventable health care tragedies every single day that result from our profit-driven system of insurance.

Patients forego the medication and care they need simply because they cannot afford it. Meanwhile, health plan middlemen deny care to boost corporate bottom lines. I cannot tell you how many times a day, I work five days a week in the last 23 years at Kaiser as a charge nurse of the clinic.

I cannot tell you how many times a day I have to beg my patients who work two to three jobs just to pay for healthcare insurance they have no intentions of using unless they are dying. I would like for you to take a pause and remember that statement, because I don't want to waste today unless we move forward. They are counting on us.

As the COVID pandemic ruthlessly demonstrated, high health care costs and poor health outcomes persist because access to an insurance plan is not the same as guaranteed health care for all. Our current profit-driven system is deeply inefficient, unaffordable and unsustainable for California and our patients. It is designed to squeeze every dollar and cent from our health. As a nurse, I have a professional duty to ensure that my patients receive the care, therapeutic care, they need.

This is why union nurses advocate for universal guaranteed health care for all under a single-payer system. The Legislature must act with urgency to pass Cal Care because any delay will be paid through the health and lives of our patients. We must act now. CalCare would establish a single standard of care for all Californians, regardless of income, regardless of employment or immigration status, and regardless of whether an insurance company thinks we are profitable. Everyone gets the same high-quality care. Everybody in, nobody out.

Study after study has shown that a single-payer system like CalCare is the only solution that would allow everyone to get the care they need while reducing healthcare spending overall. With CalCare, California would save lives and save tens of billions each year. This savings would go towards providing comprehensive care to all. In other words, CalCare would control costs without resorting to care rationing. Importantly, CalCare would not only save money, but it would improve their lives and practice of nurses like me and doctors like you.

We'd spend less time and resources navigating insurance and have more time for our patients, resulting in better care. For our union members, CalCare takes healthcare off the bargaining table permanently. This gives us more bargaining strength to win better working conditions, safe staffing and other protections on the shop floor. This is why CalCare has the endorsement of dozens of California unions, which represent over 2.3 million union members across the state. As union nurses, we understand that CalCare is an act of solidarity.

By placing every person in California into one system, in solidarity with one another, we would come closer to achieving health equity. It is my duty as a nurse to advocate for my patients and end suffering under our tiered system of care. Health care must be treated as a human right, not a commodity. We urge you to vote in support of CalCare today so we can begin to heal our broken healthcare system. Thank you so much for your time.

Good afternoon, Chair Bonta and Committee Members. I'm Carmen Comsti, Lead Regulatory Policy Specialist with the California Nurses Association. Since last session, we've worked diligently to incorporate feedback from legislators and stakeholders, and we want to thank you again for your time today. And I want to touch on some key components. CalCare is ultimately a reinvestment of our healthcare dollars into care.

Instead of ballooning prices, administrative complexity, and corporate profiteering on savings, the Healthy California for all Commission also found that it would save $40 billion each year on insurance administration alone. And when it comes to receiving care, cow care eliminates insurance barriers and financial barriers to care. CalCare creates one network of providers spanning the state where care would be free at the point of service. With CalCare, we would get more, pay less, and provide comprehensive benefits and high-quality care to everyone.

This framework importantly establishes the policy legislation required under federal law to begin negotiating federal waivers needed to incorporate public programs into CalCare. For provider reimbursements. CalCare aligns payments closer to cost and uses our bulk purchasing power to win fairer prices for everyone. For rural and underserved areas, payment rates would be adjusted upwards to ensure that they have the resources they need to stay open.

By stabilizing funding for hospitals and clinics throughout the state, we can finally combat the epidemic of healthcare closures in rural and less affluent areas and for communities of color, which leads us to a really important point of CalCare. It creates the framework to begin dismantling the structural racism and structural health inequities that our current system is built upon.

A new Office of Health Equity would identify distributional gaps in our healthcare infrastructure, and it would develop programs to address disparities in rural and medically underserved areas, including programs to meet the cultural and linguistic needs of all patients. Savings from the illumination of insurance administration and profiteering could be used for additional staff, extended office hours, or hospital renovation and construction, and to boost healthcare staffing and other resources.

The Bill includes provisions on healthcare workforce recruitment and retention. Programs and funding would be available to build a diverse workforce pipeline and to keep nurses and other healthcare workers in good, safe jobs with safe staffing levels while they care for patients. Passing CalCare's policy legislation today is important, is an important first step that California needs to take on the path towards implementing guaranteed health care for all as a right. Thank you.

Good afternoon, Madam Chair and Committee. My name is Ishmael Armendariz and I am speaking on behalf of the California Teachers Association. And I am a very proud special education teacher and President of the Oakland Education Association, 3,000 members strong. I'm here to talk about how CalCare will improve education in California. I want to just make a couple of points, so we bargain healthcare. This year we were collectively bargaining with our district and with Kaiser.

And Kaiser came with a 25% increase to our healthcare in one year. Now imagine this. They came with their slides. The first slide said, one, you have a lot of women, you employ a lot of women. The second slide said, your birth rates have gone up, which cost money. Then the third slide said, you employ a lot of people of color and they're expensive to employ. Because of this, your rates are going up 25%. That is money that is coming out of our classrooms.

Money that is intended to retain teachers and to keep teachers in our already systems that's driving us out. So, by taking healthcare off the bargaining table, that would allow us to invest into our classrooms, to retain teachers, because teachers are leaving the classroom. We can invest in teachers. We can invest in services such as counselors, social workers, nurses. But more importantly, it ensures that every single teacher and every single student and every family that comes into our classroom has access to high-quality healthcare.

And that is why we support this. So I urge you to support the Bill, to vote for the Bill. And I urge you to stand with California nurses and stand with California teachers, and let's get this done. Thank you.

Thank you. We'll now have primary opposition come forward.

You'll collectively have 10 minutes.

Thank you, Madam Chair and Members, Nick Luizos with the California Association of Health Plans CAP represents 40 plus state licensed health plans in the State of California, delivering high quality and coordinated care to approximately 27 million Californians. Our members operate in all markets, individual, employer and public programs like Medi Cal.

CAP also supported the managed care organization tax last year, which is a tax on our Members and our consumers, more specifically your constituents, to invest more money in the Medi Cal program to improve rates for providers and improve the delivery system. CAP is part of a coalition that is strongly opposed to AB 2200.

Our coalition consists of doctors, hospitals, employers and others that are strongly opposed to this Bill because it is too costly, eliminates choice, thrashes our existing delivery system, and ignores the hard work that we have done in California and the hard work that we are still doing overall.

Members, it makes zero sense to replace our current healthcare system with a costly, untested new system that would hurt patient care, especially when we're making strides on affordability and are so close to achieving universal coverage in the State of California. Thanks to actions by this Governor and the state Legislature, California is closer than ever to achieving universal health care for all since Covered California's first open enrollment period in 2013, California's uninsured rate has fallen fallen from 17.2% to just 6.5%.

Nearly 1.8 million people enrolled in Covered California plans during the most recent open enrollment period. That is a record number of health insurance signups in in the state. With new policies beginning in 2024, virtually all Californians will have access to health coverage and we continue to make strides in making healthcare more affordable for Low and middle income Californians. New subsidies provided under the American Rescue Plan have significantly improved access to affordable health care for all covered.

California is also in the process of implementing cost sharing reduction subsidies for people that Covered California. Currently, two thirds of Covered California's customers are eligible for comprehensive coverage at a cost of less than $10 per month. Additionally, the Office of Healthcare Affordability is on the verge of setting a statewide spending target in healthcare that will encompass virtually all sectors. CAP supports a workable, multi year spending target as well as the overall mission of the Office of Healthcare Affordability.

Members one thing that you hear from the supporters of this Bill is that Californians are opposed to or believe that we should completely change over our existing healthcare system. And we have found that Californians are satisfied with their health care that they receive for themselves and their families today and actually want to build on the progress that we've made under the Affordable Care Act and not start over with the new healthcare system.

And yet today we're considering a massive, costly and untested system that would destroy the progress that we've made thus far. Recent LAO Legislative Analyst Office analysis of this Bill, or single payer, I should say, not the specific Bill. Single payer legislation in the past pegged the annual cost of single payer at roughly $500 billion annually. That is more than twice the typical state budget, and we don't have a funding plan associated with this Bill, and we'll hear more about that later.

Almost half of the funding, roughly $200 billion annually, would require a waiver from the Federal Government in the form of congressional action. Even if granted, this could be revoked by a later Congress, leaving California's single payer system if it is enacted with a massive budgetary shortfall. The other half of the funding, around $250 billion, would be paid for by taxpayers in the form of higher taxes on jobs, income, services, and more.

If the congressional waiver does not happen or gets revoked, the taxes would need to be doubled roughly. Californians by and large oppose the tax increases that would be necessary for a single payer system and access to quality health care. One of the other things, excuse me, that you hear from the supporters of this Bill is that other countries have enacted some sort of single payer paradise in other countries.

But if you really look at the evidence, access to quality healthcare has suffered tremendously in other single payer systems. According to some studies of the medium wait time in Canada, a country with a single payer system between a referral for a General practitioner to a specialist procedure is 27.7 weeks. That's in contrast to the wait time in the United States, which is under 30 days, about 26 days.

Also, Britain's National Healthcare Service is in crisis as it deals with the lack of facilities and equipment cost increases and an exodus of healthcare providers in that system. Indeed, some providers that are just starting out in the British healthcare system are paid less than baristas and fast food workers in that country. I don't know how you would be able to sustain a workforce necessary to keep the system going. Members, as you know, California is facing a massive budget deficit.

Our priority should be safeguarding the existing programs and services that we have in place now, not passing legislation. For a $500 billion health care system that has never been tested, single payer would force all 39 million Californians out of their existing coverage, including Medicare, employer based coverage and Covered California plans, into an untested system with no ability to opt out, Californians oppose single payer that offers no ability to opt out or to choose private coverage.

They oppose a single payer system that eliminates Medicare as an option for seniors. Californians want the right to choose private coverage instead. Single payer could eliminate patients, will eliminate patients choice of coverage and could endanger their choice of physicians, hospitals, and other providers. California would lose doctors to other states, leading to longer wait times and reduce access to care. And then, Members, I'll close with this.

SB 770 was legislation that was passed last year and that is initiating a process to explore the necessary federal waivers for a single payer system. Passing full legislation is not only premature, but highly questionable at this time. For this, and for budgetary reasons, and until whether we know a waiver is even possible, the State of California, we shouldn't be considering this Bill. So, you know, I think that's a good place for me to stop, and I'll pass it over to Preston from Cal Chamber. Thank you.

We're opposed to this Bill, and we urge you to vote now.

All right, thank you. Madam Chair Members Preston Young from the California Chamber of Commerce here today in opposition to AB 2200. First, I just want to make it abundantly clear, we completely agree that every Californian is entitled to receive affordable and accessible health care. However, affordable healthcare coverage is different than a government run bureaucracy propped up by monumental tax increases. If we're going to talk about single payer, then we also have to talk about how it's going to be funded. Unfortunately, AB 2200 doesn't do that.

Everyone can agree the proposals contained within this Bill will require taxing Californians hundreds of billions of dollars every single year. This is completely contrary to affordable health care. This unsustainable tax burden falls directly on the shoulders of California's employers, which is why we're here today in opposition. First, let's talk about costs. A piece of legislation of this magnitude and complexity should contain a funding mechanism.

However, we don't have the benefit of seeing such a proposal today, so we're left to guess at how this will be paid for. It's indisputable. AB 2200 will increase taxes for California's employers and employees by hundreds of billions of dollars every single year. The Healthy California for all Commission indicated that California's total health expenditures in 2022 were $517 billion. That's about one 7th of our gross state product. According to the Office of Healthcare Affordability, California's per capita healthcare spending in 2020 was $10,299.

Even assuming federal funding stays in place, AB 2200 would require a significant tax contribution per each Californian to even partially approach these figures. That needs to be kept in context. California already has the highest gas tax rate in the country, the highest sales tax rate in the country, the highest personal income tax rate in the country, the 8th highest corporate tax rate in the country, and I think we can all agree that we have a housing affordability crisis now.

AB 22100's implementation would require layering the biggest tax increases in state history, not once, but year after year onto struggling Californians so the state can reinvent and take over one of the most complex systems that exists in our society. Also, the last iteration of this Bill included a proposed payroll tax, which I assume will be on the table again. This is worth mentioning since our state's Unemployment Insurance Fund is insolvent and increased payroll taxes are already being assessed on our state's employers.

Furthermore, if the Bill were implemented, the tax increases wouldn't be static. They would have to annually grow with healthcare costs year after year, meaning the enormous tax increases would have an unremitted pace of growth. Vermont enacted a single payer Bill in 2011, but that was derailed when the state realized at risk economic shock if they instituted the 11 and a half percent payroll tax that they planned, along with a personal income tax rate increase.

Vermont's Governor at the time, Governor Shumlin, stated, and I quote, what I learned the hard way is it isn't just about reforming the broken payment system. Public financing will not work until you get costs under control. Also worth mentioning, single payer healthcare will cost nearly double our state budget. This idea can't be paid for in surplus years. Now we're having this conversation when the states facing a $38 to $73 billion deficit. Next, we oppose AB 2200 because it will drive employment elsewhere.

AB 2200 will eradicate freedom of choice for consumers while heavily taxing employers who expand in California. Since this would be a state system and not nationalized health care, employers and employees will be free to leave so they could choose their own private health care rather than being forced to participate in a state bureaucracy. They'll leave to avoid the highest taxes in the country, and employers will leave to avoid enormous gross receipts taxes and payroll taxes while being able to expand elsewhere.

This exodus will punish remaining Californians with higher taxes in order to offset the funding shortfall. Last California is approaching your universal health care coverage, rendering AB 2200 on.

Please wrap up your comments.

Yes, thank you so much. We oppose AB 2200 for these reasons. We ask for no vote today.

Thank you I'm going to bring it back to the Committee for questions or comments. I'm going to bring it back to the Committee for questions or comments to be able to allow some Members to be able to offer insight.

Assembly Member Schiavo, thank you and my apologies. I am presenting six bills today. I gotta go chair a Committee shortly. But I did want to ask some questions and make some comments, and I have some questions for the sponsor. But first I wanted to ask opposition. If you could just clarify, you were talking about the $500 billion. Is that out of the study that was commissioned by the Healthy California for all Commission by UC Berkeley Labor Center.

That was the Legislative Analyst Office analysis of the prior single payer Bill.

Right. So I think where that number is coming from, and I just hope that we can clarify that here, is actually stating what the cost of healthcare will be over 10 years if we do nothing. That's the current cost of healthcare. So that is not necessarily the cost of implementing a single payer, Bill. That is the cost that we are already going to be paying for healthcare. And that study was based on from 2020 to 2030.

So that 10 year, we're kind of in the middle of it and maybe an update would be a good idea, but. Right, but I think that they're referencing it. You know, that same study said that we would actually save $152 billion over that 10 year period. Nearly every study that has looked at single payer has said that we will save money. It's not really debated at this point. It will save money. It will cover everyone. Those are the basic tenets of single payer.

And we know that and we see that happen in other countries. And while you quote wait times in other countries, which I would dispute, we have wait times here. As someone with decent health insurance, I have had to wait months. When my insurance calls me and says I need to come in, they don't even have an appointment for me and they're telling me I need to go in. And we have people who can't afford to use their insurance and they're waiting until they die.

We are the only country where people go bankrupt. And it is the number one reason for bankruptcy is medical bankruptcy every year, year after year, since I can remember working on this issue, which has been over 15 years, so we don't have that in other countries. And I understand concerns around the budget right now.

I would have really loved for this to pass when it was 1400 and when we had a budget surplus of billions of dollars, been able to set aside money to really start this program, because hopefully we would see the fruition of those savings coming in years going forward that we actually really need right now. But, you know, to say that we want to continue to tweak around the edges, I think is short sighted.

And anyone that I talk to in healthcare sees a fiscal cliff ahead of us that we cannot afford. Our healthcare system is unaffordable and we know that we have to make a change. This is the only one that saves money and covers everyone, prevents death and prevents bankruptcy. And if people want to go figure out how much they could save, there's a convenient calculator on Healthy California website, the Healthy California Coalition website, that actually can help people calculate those dollars.

When it comes to business, there's a phenomenal documentary called Fix it, and it's a series and the first one really focuses on what businesses would save. You know, I'm a small business owner. I come from a family of small business owners. My parents and their small business would pay for health insurance for my dad's one employee before they paid for it for our family. We know that covering the cost of health insurance for businesses, especially small businesses, is crushing it. Is crushing them.

And so when you look at this issue for businesses, I think that this is actually a huge benefit for them and something that they are desperately looking for change and improvement on. And it's one of the reasons that we have huge businesses like Amazon trying to create their own healthcare system because they are so frustrated with the high cost of healthcare. Right. You know, I do have some questions that I wanna ask the sponsors and better understand some of the thinking on the Bill as well.

And I know that AB 2200 directs the State Administration to apply for federal waivers and it does not in any way constrain what the Governor negotiates with the Federal Government. And as a result of those negotiations will be applied by Calcare governing board, who will have complete authority to design and implement the program. I know in the last iteration in 1400, the program would come back to the Legislature at a point it looks like that's taken out in this iteration of the Bill.

And I just wanted to better understand the lower involvement from the Legislature and what the thinking is there.

Thank you, Assembly Member Schiavo. And we really appreciate your ongoing life's work on single payer. And you know, I think one of the points on the question of federal waivers, because this Bill is focusing on the policy Bill and we've taken the ACA with the financing and put that aside for now, we really wanted to focus on the policy legislation.

So that there wasn't any confusion about, you know, the Legislature acting on a financing plan, because the plan is to be able to speak to that in the years to come after we get the policy legislation moving forward and just, you know, so that everyone is clear with the federal waivers. Congress doesn't have anything to do with federal waivers.

It is a process that has been outlined in the Affordable Care Act with the Department of US Department of Health and Human Services, and they have very strict regulations that include a requirement that a Bill has to be passed, a policy legislation has to be passed before it can actually start to consider a federal waiver. And, you know, a number of points that Assembly Member Chavo pointed out.

I just wanted to clarify that the savings that the Healthy California for all Commission found that it was very specific. It's the closest study that we have on the Bill that we have before us today on AB 2200, where it includes no copays and long-term care for all. And the range just depends on how much the UC Berkeley labor Center had estimated in terms of the increase in inflation generally.

So depending on how much inflation happens, we'll save either between 30 billion to 200 billion plus.

So, yeah, and I just want to mention the legislative, the legislative authority. So that amendment or that text you're referring to was an amendment that was taken the last iteration when there was a separate ACA. Legislative authority will certainly be attached, particularly the financing component of it, when it does get to that at some later stage.

But that being said, like, there is definitely a fine balance of making sure that the calcare board's powered versus having to come back to the Legislature for too much and encumbering kind of the daily operations of calcare being effective, but definitely open to more suggestions and thoughts on it. And we can give you more background on why that was done back when on the earlier iteration in context of the ACA. And we'd more than happy to get back to you on that.

Thank you. Yeah, I mean, I would love to work more closely. I haven't had an opportunity to do that. I have not had an opportunity to be a co author. So hopefully that can change. But I have to go chair a Committee in 10 minutes, and I know other people have questions. I just want to make just one more comment.

So as someone who worked at CNA for 13 years, I see friends here who I've been in the trenches with on this issue and have deep, deep, incredible respect for the work in holding the line on this issue and moving it forward for decades, for decades and also the staff who have worked really hard for many years. I've been there. I've been up.

I have a picture of me with my daughter sleeping on the sofa while I was working on getting ready for a previous iteration of this Bill until two in the morning on a regular basis. And so I know how much work is going into this. And at the same time, you know, it's been decades and it's kind of the same, it's the same approach, and I hope that this will get across the finish line this time.

But if it doesn't, I really hope that there is an honest reflection on whether or not this is the right strategy. I think that there really needs to be an honest discussion around the approach that is happening right now. I have serious concerns. We've had many years to bring together people to find resolution to big issues like the Gan limit and Prop 98. I have not heard about progress that's happening there.

I hope there is, and happy for you to answer that, but I'll have to leave and I'll watch it later. I see a lot of division in the movement, and I don't think we can win divided, and I think that it's a big, complicated issue and you need a lot of people at the table in a real way to be able to push this over the top. That's how we see big policy happen in Sacramento, and I don't see that.

And so I will be supporting it today as I have supported it for many, many years. I really, really hope that those things change. I really do. And I think that I'll leave it at that. Thank you very much.

Thank you, Assembly Member Schiavo. We are going to just make sure that we are ensuring that we have a robust conversation and also balancing the fact that we have still a very long remainder of the agenda. We are going to go with Doctor Weber and then Mister Jones Sawyer and then Mister Patterson.

Thank you, chair. And seeing the time. And after talking with your chair, I will keep my questions very, very limited because I do want to give others the opportunity, and I also want to make sure that those who came here have the opportunity to speak. So first, I want to start by thanking the author and the sponsors. I have the utmost respect for the author of this Bill.

And, you know, what you have done once again, or what you all have done once again, is to highlight it. A significant issue within our healthcare system, not only here in California, but within the United States. Yes, health care is a right, but it is not affordable. And there are so many issues so many obstacles, so many barriers for patients to get the care that they deserve, for providers to be able to provide the care that they should.

And, you know, like I've said to many people who have come to talk to me about this, this is, in my opinion, something that should be discussed and passed at a federal level. It should not be something that California is trying to do alone, but it is something that we should have throughout the country. I am a little confused as to what would happen if this Bill were to be passed as is, but we don't have time for me to really go into that.

So my concerns, this Bill has a lot of holes in it. There's a lot of unanswered questions. And this is a very, very important issue. We're talking about the healthcare for all Californians, current and in the future. I read the Bill in its entirety, all 70 plus pages. And so I'm just going to focus on a few concerns. I'm not going to talk about the grant waivers. Other people have talked about it. I've talked about that before. I'm not going to talk about taxes for people.

I'm sure other people might talk about that. One of my concerns is the calcare board. This Bill gives this board tremendous authority. Now. They will receive state and hopefully federal money. However, it is a, quote, independent entity not affiliated with any agency or Department.

If you look through the Bill, if you read the Bill or even just read the analysis, the things that this particular calcare board is over, which is the financial structure, the provider institution contracts, building maintenance, employee staffing, creating employment structure, negotiating prices for not only drugs, but devices and negotiating provider agreements, I mean, any and everything, this board is over.

And despite the fact that it's going to be using state funds, federal funds, there's no significant oversight or accountability or a place for the Legislature to input in this board, in this Bill as is. And I think that might have been one of the things that Assemblymember Schiavo was getting at. You know, one of the, one of my concerns is that in the Bill, we passed this. Right.

And the only thing that prohibits it from actually going into effect is it says a Bill would prohibit specific provisions from becoming operative until the secretary of California, the secretary of California Health and Human Services give written notice to the secretary of the Senate and the chief Clerk of the Assembly that the Trust Fund has the revenues, and then the California Human Services Agency will be required to publish a copy. That's it. It doesn't say anything about once all of these things are figured out.

It's coming back to the Legislature so that we know exactly what we would be implementing. There's nothing in here that necessarily states that if calcare implements a policy, it's got to come back to us. And I think we know of another Commission that legislators continuously complain about that has all of this authority to go out here and increase prices, and we have no say yet. We're the ones that represent.

So I'm concerned about the significant authority that you've given to the calcare board with no other input from the Legislature. The other thing I discussed this last week on a Bill, by giving providers the ability to essentially decide what they want to do for their patient, putting it in our hands, you discard evidence based methodology, you discard best practice guidelines, and you essentially decide what practitioners want to do for their patients. Right.

And that is very scary because remembering what happened in COVID, just because I have an MD behind my name does not mean that I am practicing evidence based medicine. And we saw that with providers saying, don't get vaccines, take this weird medicine, right. That nobody says is correct. But I'm the provider, and I think that's what's best.

It also allows for continued discrimination within our healthcare system because I as a provider can choose to give you a certain medication or choose to treat you a certain way. But another patient that walks through my door who looks different, who may come from a different background, a different gender, whatever, I can impose my biases in my decision. Where now when you have, you have standards, practice, you know, standards of how we practice evidence based approach. If you start to veer, there are checkpoints. Right.

And it may even be the insurance companies that time that say, we're not going to cover this medication. It's also expensive because when you eliminate that step therapy that says I can choose to, as a, as a surgeon, you come in with pelvic pain. I don't necessarily have to work you up. I can just go straight to a diagnostic laparoscopy. I don't have to go through the steps to say, let me try nsaids. Let me see if hormonal therapy works.

Let me try another thing before I take you for the more expensive procedure. So concerned about that. I've talked about this also many times around this issue, allowing California to continue to be competitive, to get providers to come here. I am concerned with the way in which this Bill is structured that we create a system where we would no longer be competitive to get providers nor to maintain the providers that we have, especially around specialty care.

There's a section in the Bill that explicitly states there shall be a presumption that Medicare fee for services for reimbursement constitute reasonable fee for service. Which is interesting when just in February of this year, the Ama published an article that says, quote, what doctors wish patients knew about the Medicare physician payment system. And it highlighted the fact that Medicare rates have not kept up with inflation. And actually when you adjust for inflation, Medicare physician pay over the last 23 years has been cut by 30%.

So we are coming out of the box going to provide our providers less money and think that they're going to come or stay in practice here in California. We already have a provider shortage and if we don't do this correctly, we'll just worsen that. We are also removing individual autonomy, which if someone, one of the things that jumped out at me is that if a person was eligible for an income related subsidy, right. And they decided, I don't want, I don't want it.

I don't want to apply for this in the Bill. They have to, they have to apply for it. And if they do not, then they will lose their calcare coverage. Right. If they haven't applied or provided the information within 60 days, it's gone.

And so I'm just, I'm very concerned about some of the things, the way in which the, that are actually in the Bill, not the concept we have got to fix our healthcare system, but the things that are currently in the Bill are very, very concerning. And the fact that if this passes as written, it doesn't come back to us at all. All of these things are done. All of these things are implemented. Let's say the money gets there.

A letter is just sent stating the money is there, calcare is off and running. And so, you know, I think that there is a lot more work to be done. Definitely appreciate your persistence with this and the sponsors persistence with this, but I think that this is so important that if we're able to do it, we need to do it in a manner that will actually help Californians and not ultimately end up harming them. So thank you.

If I might.

I'm sure I'm actually going to have, well, I'm going to establish quorum right now. My apologies. Secretary, please call the roll.

[Roll Call]

We will continue with Committee Members questions and comments. I'll move to Assemblymember Joan Sawyer and then go back to you before Mister Patterson asks this question.

Okay. And then maybe I can move this along by asking Mister Carragher to answer these three questions, maybe in your summary or immediately after. And maybe we can bring this down to a level that people who are listening, hopefully can possibly understand from a consumer or just from people who have to use these. As you all know, or you may not know, I'm someone that has lifetime life insurance, I mean health insurance with the City of Los Angeles.

At one time I had double insurance with both the State of California and the City of Los Angeles. Many of you have seen me hobble around this building and other buildings with a knee problem, a knee problem that I've been working through with Kaiser for the last six months. So, I don't know where you got your specialist, you can get to people in 29 days. And it wasn't until this pain got to a 10 plus level that I finally have gotten.

And this is someone that has health insurance. I finally got somebody to tell me that hopefully within two weeks they can tell me when they can do the surgery and I have health insurance. Let me say this again, I'm supposed to have one of the better health insurance. And every Member on this Committee, every Member in building, every lobbyist have seen me struggle, struggle for over six months with this malady.

I just hope whatever we're doing will not increase the level of care that is needed for individuals because you'll lose me in a minute if that is the case. This, the reason I'm going to go ahead and move this along and do the due to motion is that I want to continue this because right now is not working for me.

And in two weeks when I visit my doctors and they tell me another six months I will lose it and they will be calling LAPD on my ass because I can't take it anymore. So that's one for me. I need to know that. And this is just for anybody out there that's listening, they just need to know whether or not this is going to improve their health, quality of care once, whatever we do, once this is done.

Two, many of you know, I have a mother who will be turning 88 on Thursday is her birthday. She just, we just brought her back from the hospital. For seniors out there. I'm worried about their quality of care right now. I pay additional insurance for her so that she doesn't have to lose her home, she doesn't have to.

We don't have to go into debt to pay for her because she has diabetes, she's on dialysis, she has heart problems, and she's probably in a hospital once a month with some kind of emergency care. And if you think about that, just the dialysis alone could be catastrophic if we had to come out of us out of pocket. And so for those seniors who have ongoing medical maladies, we need to make sure we take care of them first.

Yes, this is a nice esoteric discussion, and budgets and big, but at the end of the day, I don't care. We got to take care of them. And the additional money that I pay for Medi Cal and Medicare comes to like $600 a month. And I have insurance, so I pay another $1000 a month for me and my mother so that we can have medical coverage on top of what the City of Los Angeles already puts in. So that's a real concern.

And then lastly, when my mother first got sick, I remember getting her credit card Bill and it had close to $12,000 on it. I said, Ma, what the heck is going on? And it was for prescription drugs. It was for about 100 pills, my lord, at dollar 120 each or more $1000. I mean, it was ridiculous, the amount of money. It wasn't until we were able to get her into ObaMacare at that time, that's how long it goes.

That cost would have been incurred for her for the last 10 years. So prescription drugs and that cost is just as debilitating for people out there, whether you're poor or whether you've worked a long time and you have insurance. If I have to put out a whole lot of money going forward on prescription drugs, that is a nonstarter.

And so if you can answer those questions, because those really, I think, important questions to seniors, to people who work every day and the people who have to have prescription drugs, they need to know that if we move forward with this, that the quality of life will not go down even more so, because we make this happen.

Before. Any response, I heard a motion. Do I have a second? Doctor Ramula. Thank you.

And I said he could answer it.

I'll let you respond.

Would you prefer if others go? And then I should give one response.

Mister Patterson, that would be great. Thank you.

Great. Thank you. First of all, please, for the love of God, don't make Mister Joan Sawyer grumpy next week or in a couple weeks. Appreciate the chair for giving me some time here. I do want to take a moment to, well, first of all, make everyone a little mad, I think. But I think a lot of this comes from the elephant in the room.

Only been on this Committee for a year, but it seems like a daily occurrence, whether it's in this Committee or just whether it's with my conversations with doctors or hospitals or, you know, the frustrations essentially getting paid. And, you know, I just think it's, for example, just the other day there was opposition on a Bill to oppose substance, somebody dying of an overdose. And we're going to try to get back to them in 72 hours in order for the Doctor to provide that medicine.

I have opposition on my Bill today that would simply continue existing coverage of, make sure colorectal cancer screenings are covered if some questions are brought in because of some litigation in some other state. So I think we have to get serious as a, you know, really together.

I mean, I want to work with everybody to make sure that, you know, they're, when people have health insurance and when the providers are providing that, that service, that we know that it's going to be paid because, I mean, it is a constant. I put together a medical advisory group of all sorts of people, and we couldn't even get past agenda item number one because a lot of frustrations from all my constituents that are in the medical field, and it's something we really have to address.

But I do have a lot of concerns about government run healthcare. And I'm not just saying that out of some philosophical view, but, like, right now I'm dealing with an issue where individuals who actually had private insurance or we're on Tricare that are being forced onto Medi Cal and their doctors, there are no doctors that cover their specialty, developmental disabilities.

And despite lots of work with the Department and things like that, I mean, we just can't, I mean, they're losing their coverage right now despite the fact that they have insurance and they want to stay on their insurance. And I thought that was all going to be solved. You know, speaking of Obamacare, I thought that was all going to be figured out there, but I actually don't. That is a problem of a government mandated system, and they really just want to keep their private insurance.

And so, you know, obviously, we've had conversations here about the costs and things like that. You know, obviously going to need some details. I do think the chamber brought up a good point about what businesses, if there's some Runway, a couple of years, three years, you know, before we really know the expenses or what it's going to cost, you know, I think they're going to start thinking like, hey, what's my long term gain in three years from now?

You know, maybe I should leave this state now so I don't have to participate in this expense if they don't know it, if they don't know those questions, the answers to those questions in advance. So obviously, I mean, it's probably no surprise to you I'm not going to support this today, but you're always bringing the small item issues before the Legislature. So thanks for doing that. And please just don't make Mister Jones Sawyer mad.

I'm going to have Wendy Carillo ask the last or make the last comment from Committee and then we'll give it back over to you for any comments.

Thank you, Madam Chair. And I feel it necessary to also give a disclaimer on behalf of my colleague from South LA who will not get law enforcement involved in his situations moving forward. But I do agree with a lot of his sentiment. I think a lot of us have personal experiences when it comes to lack of quality of healthcare, lack of insufficient quality health care over, like, incredibly burdensome costs associated with healthcare.

A lot of folks in my community of Assembly District 52, which includes East Los Angeles, northeast LA, rely on the emergency room, and that's already incredibly costly. A lot of community clinics are becoming less and less available in our community. Less and less doctors and nurses, affordability of healthcare. All of these things are true. And I really just want to bring into the space a gentleman that we lost Addie Barkin, who has been at the front lines of Medicare for all for many years.

And while we may discuss issues related to healthcare at disproportionate ages, Addie was 39 when we lost him and we lost him to ALS. And he was a family. He was a family man, husband, father, and a staunch advocate for healthcare. And we know in this movement so many people that we continue to lose because of just an inability to receive healthcare in time or preventative.

I want to thank the author for all of his diligence and hard work and having the meetings necessary at the federal level to get California, get the federal waiver to even begin this conversation as to what it would look like. And I think it's important that we recognize all the work that's being done across the state and across the country. I completely, you know, want to say, respect the opposition and their point of view.

At some point in all of our lives, regardless of who we work for, how much money we make, or, you know, where we are in life, we will know someone that is impacted by the lack of healthcare coverage or good quality healthcare. And we will know someone that is going to go bankrupt because of their high cost of bills.

We know someone that's going to lose their home, lose their livelihood, lose their job, lose everything they have because they are trying to live their life with a disease, an illness, a family Member going through cancer. We've heard the stories, and there are millions of them across the country. I want to thank the advocates that are here, some I know are here from Los Angeles and various other places across California for their continued advocacy.

Some constituents of mine who are in the room or are watching back home and couldn't make the trip up here. It takes effort to come up here and have 30 seconds or 10 seconds of testimony and to really commit any free time that you have to fight for healthcare and not only fight it for yourself and for your families, but fight it for every person across the State of California, because that's who you're fighting for and that's who the nurses are fighting for.

So I'm proud to be a joint author, proud to continue to support the policy in a variety of different ways for the past few years, continue to put pressure on the Federal Government to really move forward with the promises that they were, that were made during campaigns and promises that were made here. To the 40 million people that call California home, nothing is ever perfect. I think the conversations related to healthcare in the state are critical.

We know that the State of California is coming with more and more double seniors at the same time, lack of, again, as I'll mention, lack of professional healthcare personnel to take care of our communities, the more that we work on. This, I think gives us in a better space and more and more people are supportive of the work that is being done. There's a lot of work to be done, but I think we're headed in the right direction.

And while I think policy committees are always hard, it's always harder to present and sit with your opposition and try to come to common ground and try to really tell the stories of everyday people who are suffering and who really want us to do what's right for them. And so I'm happy to be supportive of the Bill and continue to move the conversation forward. Thank you.

Thank you, Madam Chair. And I'll try to answer some of the questions very quickly. Appreciate Senator Carrillo for longstanding support and for her comments today as to Doctor Weber, who made some excellent points. One of the points that she made was she believes it should be passed at the federal level. The ACA waiver process was created so that states could move forward with a variety of programs, including potentially a single payer program.

So it's been set up in a manner for states to take the lead, to be the ones that move forward with it. It's the same way that many other countries. Canada is an example that started at the state level. And actually, each state has their own program that the Federal Government helps to Fund. And so that's the reason why we lead as a state on the policy.

One of the questions she raised, also a good one, in terms of giving doctors, nurses the autonomy to make that decision, the decisions in the operating room or in the hospital room, really the reason why that's in there is that we don't want algorithms to override the best judgments of those that are actually caring for our patients. Now, can we tighten up the language?

Because we definitely want an evidence base and more than happy to work with Doctor Weber to ensure that language makes it very clear that we still want to make sure that they're using best practices, evidence based practices. What we don't want to have is some algorithm or some, or what we see nowadays, an insurance company telling a Doctor that they can't do what they see as medically fit in terms of calcare board having too much power.

Look, this Bill is the policy Bill, and I want to make that very clear. This is the policy Bill on how the actual operation of calcare would function. And as was mentioned earlier, there are many other steps that have to be in place, including the funding of a system that the Legislature would have to approve and give authority to, and release those funds to the board. So there's plenty of opportunity, and our intention is to have legislative authority through that process.

What we don't want to have, and this is that balancing act, as every year you have to go back to the Legislature to change something, do this and the other. We need the board, the calculator, to be able to operate independently, because it is a system that's going to require that level of attention, but it does not remove legislative authority or the relationship between the Legislature and the calcare board.

But more than happy to look at language that would better satisfy some of our colleagues if they think there needs to be more language in the policy Bill that makes that very clear, that the Legislature is not completely cut out of the operation of Calcaretta board in terms of, especially the financing aspect of it, to Senator Patterson. I appreciate his comments. The reality is that when we talk about businesses, businesses are being fleeced right now. They're being completely fleeced.

And they have very little control over how much they're being charged or how much their rates are going up year over year.

If we can relieve them of that obligation, if we can relieve them of that and have them have something that's a fraction of that, which is what would happen under a single payer program, we would actually make it more competitive for businesses to be in California, especially knowing that now they can get rid of all their administrative costs, of having to worry about their employees healthcare, which is enormous cost on businesses.

And let's keep in mind that Californians right now, including California businesses, are paying the highest healthcare taxes in the world. They're just not called taxes. They're called premiums and they're called co pays. They're called administrative costs. So we can play the game of, zero, you're going to be taxed. Let's be real. We have the most expensive system in the world, and we do not have the best outcomes.

To some of Reginald Jones Sawyer's points these wait times, and let me tell you this, my father's right there in the front row. I take care of him. He's on Medicare. I take him to his appointments. I know how long it takes to get an appointment. I know how much he pays out of pocket. I know he has to have Medicare advantage, which was, again, a privatization of our Medicare system. And we're lucky that he can afford to do that.

If he can't afford to do it, guess how long his wait time is going to be? Forever. I really appreciate the comments from Jonah Sawyer. Absolutely. The goal is to make sure everyone has access to high quality care. And the reality is we can do better than Medicare. We can provide long term care. We can provide vision and dental. My dad has spent $6,000 for hearing aids. He has to pay thousands for dental work.

That's a reality of what people are going through, and you're lucky if you're the ones that can afford it. Those are my answers to those questions.

Thank you. We are going to now move to me toos, just as a reminder, because we are over the time that we allotted for this special order of business, we are going to cap me, too, at 15 minutes. And if you are in support or opposition, you should be lining up now. Wherever we get after 15 minutes is where we are going to stop. The secretary is going to start the clock. Thank you.

Thank you, Brian. Ha with the California Faculty Association. We stand in strong solidarity with the nurses, and we applaud the author for carrying this very important Bill.

Thank you, Madam Chair Members. Tim Taylor with the National Federation of Independent Business, in opposition. Thank you.

Annie Chao at the California Teachers Association, in support.

In the name of my niece, Alicia Bates, who was killed because of medical apartheid. As a Member of Black Lives Matter Los Angeles and Black Lives Matter California, I stand in strong solidarity with the Bill and I thank the Assembly Member for bringing the Bill forward. It could have saved my.

As a person who has fought for single payer for over 35 years with Black Lives Matter's grassroots and the Fannie Lou Hamer Institute, we firmly support this Bill.

You, Dylan Elliott, on behalf of Shasta County, regretfully opposed.

Rayn Hicks, California's disability rights and a disability advocate and strong support.

Dean Talley with the California Manufacturers and Technology Association respectfully opposed.

Thank you, Madam Chair. Tom Sheehy, representing the California Landscape Contractors Association, in opposition.

My name is Heather Ablog. I've been a nurse for 23 years, 17 of which at Kaiser and Sacramento in the emergency room. I absolutely, positively support AB 2200. Thank you. Nadine Pebru Kane. We support the American Federation of I 'm going to screw this up. It's ask me and I'm nervous and I'm sorry, but it's also, it's council 57 and the retirees Chapter 57 and 35,000 Members strong. Thank you.

Dan Plonsi, math teacher, on behalf of my students who have had their education derailed and is a Member of Berkeley Federation of Teachers, which has passed a resolution in strong support. Good afternoon. Johan Cardenas with the California Panignek Health Network and we support. We support in concept. Thank you.

Tina Rufo, 35 plus year union nurse with California Nurses Association, in strong support.

Hi, my name is Melody Mendenhall. I'm an oncology nurse practitioner from Los Angeles. I come out in strong support of this Bill.

Honorable chair and Members, Amy Hindsheik representing unite here, local 11 and their 32,000 Members in strong support. Thank you. Brittany Clark, on behalf of California School Employees Association and strong support.

Madam Chair Members Rand Martin, on behalf of the AIDS Healthcare foundation, which is also a managed care plan, in strong support. Thank you.

For Charlton Butte County Hucker Coalition and strong support as well.

Hi, I'm Will Toparoff, 28 year nurse practitioner working in HIV primary care. I'm here in strong support of AB 2200. Thank you.

Dr. New and charity Members, Jessica Moran with California Dental Association in opposition. Thank you. Jane Kim, California Director of Working Families Party. This is our top priority and we are in strong support. Also. Former San Francisco supervisor and visual support. Hi, I'm Jenny Osgood with the Sacramento chapter of the Democratic Socialists of America. And we are in strong support.

Hello, my name is William White. I speak on my own behalf. As a working class 26 year old person, I would rather see the Legislature enact a system, new system with some problems.

Organization support or opposition?

Please support strong support. Thank you.

Aliyah Griffin with the American Federation of State County Municipal Employees and support and content. Thank you.

Good afternoon. Tim Valderrama with the Weidemann group on behalf of Blue Shield of California, in opposition.

I'm Jelika Gonzalez, on behalf of Kaiser Permanente.

In opposition, Chang Sim Lim, board Member.

Healthcare for us and also representing Asian Pacific Islanders for Calcare and strong support. Caroline O'Riordan, founder, Hollywood for Calcare. In strong support.

Jonathan Karf, I sit on the board of directors of the California Factory Association. That's not only endorsed it, but urge a strong support.

Jennifer Snyder with capital advocacy on behalf of the California Life Sciences, in opposition, Julie Nielsen with the National Union of Healthcare Workers in Healthy California. Now, per our letter, in support.

Good afternoon. Mark Farouk on behalf of the California Hospital Association, in opposition, Madam Chair Members. Yvonne Fernandez, California Labor Federation, in support.

Annalee Augustine on behalf of the Family Business Association of. California. Opposed.

Thank you.

Mitch Steiger with CFT, a union of educators and classified professionals.

Also in strong support.

I'm Robin Sunbeam from Mendocino County. I represent not only the Democratic Central Committee and the Inland Mendocino Democratic Club, but also the Mendocino Women's political coalition, and they are all in strong support. Kelly Brooks on behalf of the Santa Clara County Board of Supervisors and Support.

Rachel Bhagwat, ACLU California action, in support.

Mckinley Thompson Morley on behalf of the City of Sacramento, in support.

Sandra Pool on behalf of Western center on Law and Poverty and support.

Savannah Jorgensen on behalf of the Lutheran Office of Public Policy, California and strong Support.

Simon Hyatt, working families Party of California, Central Valley chapter. In strong support.

Simon Ann Marie Garcia, a medi Cal recipient who had to become poor to be one. But it's through Kaiser, and I feel so. No, they've been. Man, I'm sorry. I'm just lucky, that's all. It makes me sad that I had to be poor to get better health care than I got before from work. We have to start somewhere. I want this to go.

Peggy Elwell, on behalf of the South Bay Progressive alliance, in enthusiastic support.

Katie Van dynes with Health Access California. In support. Thank you.

Good afternoon. Alex Kahn, on behalf of UCAN, a regional coalition of chambers of Commerce and the California Builders alliance, and respectful opposition.

Catherine Gale, principal at Katharine Gale Consulting small business support.

Nelson Tam, delegate at the California Democratic Party and officer of the Children's Caucus, in strong support. Good afternoon. Jesse Gonzalez, California Working Families Party, San Francisco, in strong support. Good afternoon.

Matt Akin with the Association of California Life and Health Insurance Companies, in opposition.

Good afternoon. Sherry Mchugh, representing the California Correctional Peace Officers Association, benefit trust Fund and NAFA California, and respectful opposition.

Thank you, Madam Chair of Members, John Norwood, on behalf of the Independent Insurance Agents Association, thank you. In opposition.

Patricia Johnson, I'm a RN, former CNA Member. I'm on the board of Wellstone. Progressive Democrats of Sacramento, strong support.

Hi, Robert Copeland, DSA second Amendment Member and California alliance, retired Americans Member, strong support.

Karen Gale, retired Sacramentan. Strong support.

Christopher Sanchez, representing the Consumer Federation of California in support.

My name is Case Fritz, co chair of the Sacramento Democratic Socialists of America, and we voted to support this Bill.

Megan Shumway, retired obstetric and public health nurse and retired CHTP Deputy Director and strong support.

Derek Grafte, board President, Mount Pleasant Elementary School district, representing myself, in strong support.

Susan Tapadisto, President of the American River Democrats. We strongly support AB 2200.

Sally Gwen Satterlee, Anarin, for many years. Tarnit, I was going to do this. Yeah, very strong support for the California Nurse Association and Santa Cruz Verni of 2000 people. I'm representing Santa Cruz for Bernie and then of course, all the nurses. Thank you.

Seth Reed with Reed government relations, representing military Officers Association of America, California Council of Chapters opposed.

SEIU 2015. Strong support.

My name is Celia Copeland, SEIU local of 2015. Strong support.

Brandon Marche with the California Medical Association, in opposition.

My name is Doctor Flojon Cofer. I am the senior Director of policy with public health advocates and we are in strong support. Thank you.

Julian Kennedy, California Hispanic Chambers of Commerce, respectfully, in opposition. Thomas Cronin, local resident and strong support of AB 2200. Thank you.

Martha Kuhl, RN for over 40 years, pediatric oncology nurse at Children's Hospital Oakland. Strong support. California Nurses Association. Shirley Toy, nurse for over 44 years. DNA Member, strong support.

Paty Estevez, California Nurses Association, a mighty, mighty nurse, in full support.

Joe Donahue, registered nurse since late 1970s, so that's 40 some years. Still a Member of California Nurses Association, Progressive Democrats of America, Monterey area chapter. Strong support, please.

Greg Miller, I'm a retired RN and worked as a hospital staff nurse for 35 years. Strong support. And also a Member of the Santa Clara County Single Payer Healthcare Commission. Which also is strongly support.

Faith board just on behalf of California agents and health insurance professionals in opposition.

Hi Connie Chu with California Working Families Party, Bay Area and I support.

Hanna Carpolo SEIU, 2015 Longtime IHSS home care worker and chair of the Alameda County Public Authority for in home Support service strongly support this Bill. Thank you.

Thank you, Madam Chair Jacquianos on behalf of America's health insurance plans and elephants health respectfully opposed. Also asked to register opposition on behalf of Cigna. Thank you.

I will bring it back for comment before I allow a brief close from assemblymember Kalra I want to thank you, assemblymember Kara, for your continued commitment to making sure that every Californian has affordable, quality healthcare and for your commitment to continue to work on this Bill and this framework. Each time this proposal comes forward to the Legislature, we get incrementally closer to achieving health care as a right that all Californians deserve.

This Bill seeks to address what is wrong with our current system, a healthcare system that is expensive and unequal depending upon insurance type. We've made enormous strides since the implementation of the ACA, where the uninsured rate has fallen and consumers protections have made healthcare more accessible. Still, barriers exist in healthcare delays and increased premiums and out of pocket costs. And in fact, we sit here as a Health Committee week after week hearing legislation that attempts to try to fix this frankenstein of a system.

In this agenda alone, we are seeking to make sure that we have coverage for menopause, that we have newborn screening programs available to everyone, that we can ensure that our clinics are adequately covered in supporting controlled substances, that our distressed hospitals are not closed when they need to with St. Rose Hospital, that we ensure we have financial solvency for our different boards, that we ensure that we have awareness around abortion services in the way that we need to, and we go on and on and on human milk with aspects of our healthcare system that continue to not serve every californian.

I know that you have been in this struggle for a very long time, and I want to thank each and every advocate who took time to come here to the State of California and in this hearing room to contribute your voice to what we need to ensure moves forward. We know that this is just a framework that you are starting with, and we know that you purposely separated the framework from and the policy discussion from how we would Fund that.

And I think that was a smart way for us to go because it provides an opportunity for us to take a real hard look at some of the policy components. And I think you heard from Committee Members, some aspects of this policy framework that still need significant work for us to be able to move forward. And I know that you will take heed with those aspects and continue to work on those should this Bill be able to move forward. I support this Bill today.

I supported Assembly Bill 1400. I respectfully ask to be a co author at this time on this Bill. And I know that you will continue, as I do, to support every californian in this conversation to ensure that we have adequate healthcare for everybody that is affordable. I want to thank you for your work and know that we will continue with all proponents and stakeholders throughout our healthcare system to move towards a better California with this legislation. So with that, we were optimistic.

In our count, we did not actually have quorum with eight. We need nine. So we are going to establish quorum and refer back and vote on this Bill. But I will give you just a short two minute close.

Well, thank you so much, Madam Chair, for your longtime support of health justice and for being so gracious and giving me credit when there's folks behind me that have been in this fight way longer than I have. And I would simply say that I'm so grateful to my colleagues, to those on the Health Committee. I know many of you have been fighting in so many different ways to increase access. But the reality is we know our system is broken. It's unsustainable.

And the reality is that with the most expensive system in the world, we have to ask the question, who's paying for it now and how are they paying for it? We're paying for it out of our paychecks. We're paying for it out of gathering all of our life savings. We're paying for it by making choices over food versus medication versus housing. We're paying for it with lives lost in the streets.

We're paying for it with the highest number of those entering into homelessness, being seniors because they get into a medical emergency and they lose their home because they can't pay their debts. The reality is that we know there's a better way. We know there's a better way because not only do other places do it, but every legitimate study has shown that we have the most convoluted, expensive, and unjust and immoral system that you could possibly create. We can do better.

And the reality is that we know a state is going to lead and be the first one to do this. It must be California. California is the one that can do it. Because we have a large enough gdp, we can make it happen. And ultimately, it's not going to be easy. I do really appreciate the feedback, especially on the policy components of this. Doctor Weber, Samaritan, we're going to take all that into account and keep moving it forward.

But the reality is that it does seem like we keep on repeating ourselves by bringing this Bill forward and forward, but the reality is also that we're not going to stop. And Nelson Mandela once said, it always seems impossible until it's done. And the reality is that we together cannot stop because people are dying. And we know that every single year we have a system that is profiting the very few while the masses suffer.

And so I urge support of this Bill when there's a motion for it. I'm so grateful to the chair, I'm so grateful for the co authors, our sponsors, and everyone here in support, and everyone around the state in support. I'd be so grateful for your

aye vote thank you. That concludes our special order of business right now. And thank you so much assemblymember Kara, for presenting AB 2200. We will move on now to Mister Wallace, item number 23. AB 2789.

Ready for me, please?

Go ahead when you're ready, Mr. Wallis.

Good afternoon Madam Chair and Members. I have an equally controversial bill. I'm here today to present Assembly Bill 2789. This bill will create a one stop shop website to guide new married individuals on how to change their name.

Our state was the birthplace of technological innovation, and we don't currently have an easy to follow free online resource to help people change their last names. As a result of this deficit, many individuals are purchasing name change kits that can cost upwards of $100.

With the cost of living going up, I believe it's important that we provide a free government resource to solve this issue, especially when we have an interest in keeping data accurate for our government agencies. The state courts currently have an online how to guide which isn't comprehensive.

Under my bill, the website will include a list of all agencies that must be notified, including federal agencies such as the Social Security Administration, the Department of State, the California State agencies, including the Department of Motor Vehicles, the Department of Public Health, and licensing agencies such as the state bar and Department of Consumer Affairs.

Government should make life easier, not more convoluted, and changing a name after marriage should be simple, not a burden. AB 2789 will simplify the name change process by providing transparent information that is easily accessible in one place.

Thanks so much. Are there any other witnesses in supports? Any in opposition? Bring it back to the Committee for comments. Seeing none. Mr. Wallis, I want to thank you for bringing forward this bill.

I know that our Committee has been working with you and know that there are ways that we can certainly strengthen an opportunity for this to happen and appreciate you bringing for this bill. We will vote on it as we can. Please feel free to close.

Thank you, Madam Chair, and thank you to the Committee staff for working with us on this bill. Just respectfully ask for an aye vote when the opportunity comes.

Thank you. We're going to move forward with the authors who are in the room moving to item number two, AB 2064. Joan Sawyer and I will make a call out to authors who are viewing the screen right now. Please come down. We're trying to move in file order and would love for Committee Members to come so that we can establish quorum.

Thank you, Madam Chair. I present AB 2064, which will establish the Community Violence Intervention grant program. This bill is among the 14 priority bill identified by the California Legislative Black Caucus as part of the reparations package.

This bill, which would be administered by the California Health and Human Services Agency, would ensure funding for community driven solutions to decrease violence in our schools and neighborhoods, as opposed to the continuation of incarceration.

These funds would be secured through an appropriation of the savings from any future prison closure within the state. By using funds for these preventative programs, we reduce incarceration even further and focus on finding solutions to crime beyond the incarceration of our most vulnerable and underserved populations.

AB 2064 allows for true rehabilitation, for putting an emphasis on the community and victims impacted, giving them a voice in reducing monetary expenditures accrued on imprisonment which has not been shown to reduce recidivism. Thank you. And respectfully ask for your aye vote.

Thank you so much. Any additional support?

Samantha. Samantha Johnson, on behalf of the Greater Sacramento Urban League, in support.

Thank you. Any witnesses in opposition? Seeing none. Bring it back to the Committee for comment. I will offer comments. I want to thank you, Assemblymember Jones-Sawyer, for bringing forward this bill. We know that this is a part of the reparations task force recommendations and supported by the California Legislative Black Caucus.

We know that this is, well, I personally know that this is something that you have been working on for a very long time and that you endeavor to ensure that California has an opportunity to create legitimate pathways for violence intervention through youth development and really want to support your continued effort in this regard. So with that, when we have the opportunity, we shall vote, but please feel free to close.

Thank you. And one of the unique things about this is that this is based on opportunities that we may have from savings from closing prisons that are empty, that no longer at the end of their useful life.