Assembly Standing Committee on Health

Good afternoon. It is Tuesday, April 8, and we are convening the Assembly Health Committee. Welcome. Before we begin, I want to make sure everyone understands our Committee rules. To ensure we might, we must maintain order and run a fair and efficient hearing with the goal of a hearing as much hearing, as much as possible from the public.

Within the limits of our time. We seek to protect the rights of all who participate in the legislative process so that we can have effective deliberation on the critical issues facing California. Engaging in conduct that disrupts, disturbs or otherwise impedes the orderly conduct of this hearing.

Engaging in personal attacks of Members of this Committee, author, staff or other witnesses. Talking or loud noises from the audience will not be part of a rule of conduct that we will accept. Please be aware that violations of these rules may subject you to removal or other enforcement processes.

If you are providing witnesses testimony at this hearing, all witnesses will be testifying in person. Main support and opposition will be allowed two main witnesses for a maximum of two minutes each. Additional testimony will also be in person and limited to a name, position and organization. If you represent one.

All testimony comments are limited to the Bill at hand. The Consent Calendar has the following bills proposed for consent for today's hearing. Any Member of the Committee may remove a Bill from consent. Item number five, AB 440 Ramos with a motion as do pass as amended to Appropriations.

Item number six, AB517CREL with a motion of do pass to appropriations. Item number 10, AB641, Jeff Gonzalez with a motion of do pass as amended to appropriations. Item number 12, AB829 Sharpe Collins with a motion of do pass to Revenue and Taxation Committee. Item number 14, AB1003 Calderon with a motion of do pass to Emergency Management Committee.

We will start this hearing as a Subcommitee as we do not have quorum, and with that with our Committee author. Thank you, Assembly Member Maggie Krell, for being willing to present item 1, AB54, access to safe Abortion Care Act.

Good afternoon, Madam Chair and Members. First of all, I'd like to thank the Chair for her leadership on on this issue since we've been here and also to my co authors who are on this Committee, Assemblymember Aguiar-Curry, Assemblymember Stephanie and Assemblymember Sharpe Collins, who joined this Bill on our first day of work.

California is a leader in reproductive freedom and it's been a safe haven for individuals seeking care. However, threats at the federal level and restrictive abortion access across our country after and before even the overturning of Roe v.

Wade has reduced access for individuals seeking abortion, access to medication abortion plays an important role in reducing barriers and promoting equitable health care, particularly for those living in rural and underserved communities. Medication abortion is the most common form of abortion and this Bill is about protecting access to that.

Ensuring the integrity of the medication abortion supply chain process, from manufacturing to distribution to Administration of mifepristone and Misoprostol is essential to protecting care here in California for California patients. It's estimated that 60% of all abortions in the United States are done using medication abortion.

Medication abortion is proven to be safe and effective with a 0.4% risk of complications and a 0.00064% mortality rate. Just to put this in a little bit of perspective, right now maternal death rates are at 62% higher in states that are restricting access to abortion.

So AB54 reaffirms our state's commitment to safeguard our constitutional right to choose and obtain medication abortions by shielding manufacturers, distributors and authorized health care providers and others involved in the supply chain from civil and criminal liability. This is we already have a constitutional right to abortion in this state.

This is really a implementation bill to ensure that we have access to medication abortion in California no matter what. With me today are the sponsors of the bill, Tiffany Brokaw, on behalf of the Attorney General's Office, and Tyla Adams, representing Black Women for Wellness. Thank you.

Good afternoon, Madam Chair and Members of the Committee. I'm Tyla Adams, Reproductive Justice Manager at Black Women for Wellness Action Project. It's an honor to speak in support of AB54, especially as we approach Black Maternal Health Week, which nationally highlights the alarming inequities in Black maternal health.

For nearly 30 years, our organization has worked to improve the well being of Black women and girls. Rooted in the reproductive justice framework, we affirm the human right to control our bodies, lives and futures. This is only possible when everyone has access to the education, resources and support to make informed decisions.

Through this lens, equitable access to the full spectrum of reproductive health care, including medication abortion, is essential, not optional. Black women are disproportionately affected by barriers to reproductive care and suffer staggering rates of maternal mortality and morbidity. And these just aren't statistics.

They are lived realities of preventable harm, trauma and loss rooted in systemic racism, implicit bias and inequities in care. Ongoing attacks on abortion, especially medication abortion, only deepen these harms by creating more barriers to essential life saving health care. That's why access to the full spectrum of reproductive care, including abortion is not only vital, it is urgent.

We deserve the right to decide whether to continue a pregnancy and the resources to do so safely without dignity. AB54 matters because access matters. California led the country and enshrined abortion rights through Prop 1. But a right without access is no right at all. What good is choice when the options aren't affordable, available or culturally respectful?

AB54 is about more than policies about dignity is about ensuring black women and gender expansive people have the resources and autonomy to make informed decisions. And as relentless attacks on body autonomy occur across the nation, countless California must remain a leader in safeguarding reproductive freedom. Abortion is essential health care and it must remain accessible.

The power of meaningful change lies within this room. Collectively, our work is about more than fighting injustice. It's about building a future where individuals are empowered to control their health, bodies and destinies. As proud co sponsors of AB54, I respectfully urge your yes vote. Thank you for your time and thank you, Madam Chair, for your continued leadership.

Thank you, Assembly Member Crow and General Assembly General Attorney General Bonta, for championing this critically important issue.

Please go ahead. Thank you.

Good afternoon, Chair and Members Tiffany Brokaw, Deputy Attorney General and Legislative Advocate here on behalf of California Attorney General Rob Bonta, who is the proud sponsor of AB54. And we'd like to thank Assemblymember Krell for authoring this important piece of legislation.

AB54 would ensure continued access to medication abortion and shield providers and manufacturers from liability for transporting and administering such medication. Since the overturn of Roe V. Wade In 2022, abortion access has been under attack. Nationwide, 60% of abortions are done by using medication abortion. So. So it is crucial that we ensure continued access to this reproductive care.

And ensuring that continued access means maintaining the ability to transport and deliver medication abortion throughout the state. AB54 affirms that doing so is legal in California. And it shields providers, manufacturers, distributors, pharmacists and individuals from civil and criminal liability and professional discipline. AB54 is an important part in keeping California a safe haven for reproductive access.

I have here with me supervising Deputy Attorney General and head of our Reproductive Justice Unit, Carly Eisenberg, here to answer any technical questions you may have. And we respectfully ask for an aye vote.

Thank you. I will ask if there are any witnesses in support who would like to offer a me too. Please state your name, organization and position only.

Andy Liebenbaum, on behalf of the County of Los Angeles, in proud support.

Omar Altamimi with the California Pan Ethnic Health Network, in support.

Martin Radasovich on behalf of reproductive freedom for all California. Proud co sponsors of the bill.

Amy Chow with the California Teachers Association in support.

Catherine Squire on behalf of the California Commission on the Status of Women and Girls. Proud co sponsor.

Hi. Molly Mala on behalf of Planned Parenthood Affiliates of California co sponsor in strong support. Thank you.

Now we'll move to any primary witness. zero, hi.

I'm Annie Fisher on behalf of Indivisible California State Strong and we are strongly in support of this bill.

Stephanie Shaw on behalf of California Latinas for Reproductive Justice and support. Thank you.

Hello.

Thank you. Are there any primary witnesses in opposition? You'll have two minutes. Thank you.

Chair and Members. I'm Sophia Laurie, the outreach director at California Family Council. And we stand in opposition to AB54, a Bill that removes critical medical safeguards and promotes a dangerous and isolating practice. Sending abortion pills through the mail.

This Bill would reaffirm and expand the ability to mail mifepristone and misapristal the abortion pills without any requirement for in person medical evaluation or oversight. Sending abortion pills through the mail isn't safe. It's reckless and anti-woman.

The American Association of Pro Life Obgyns has warned that without an ultrasound, a woman cannot know if she's experiencing an ectopic pregnancy, a life threatening condition that the abortion pill cannot treat. A woman could be bleeding internally, believing it's just a side effect of the pills until it's too late. Coerced abortions are another serious danger.

When these pills are shipped to homes, abusers and traffickers can force women to take them against their will without a single medical professional to intervene. And the statistics don't lie. According to the FDA, between 2012 and 2017, there were 1,445 reports of adverse events from the abortion pill. 273 women were hospitalized.

182 suffered blood loss so severe they required transfusions. 103 women developed infections, including cases of sepsis. And most sobering of all, 22 women have died due to complications from the abortion pill regime. AB54 doesn't ensure safety. It shields recklessness. It tells women you're on your own. No Doctor, no advocate, no one to call. Did you know?

Even the manufacturer of mifepristone originally warned the FDA that without in person screening, the risk of fatal complications dramatically increases. Yet here we are, erasing the very safeguards that could save a woman's life. If you vote for this bill, you are not standing for women. You are surrendering them. Please do not trade real care for political ideology.

Vote no on AB54. Women deserve better.

Thank you. Are there any other witnesses in opposition who would like to offer a Me too please come forward. Seeing none we'll bring it back to the Committee for questions or comments. Seeing none move the Bill moved by Agar Curry.

We don't when the time comes seconded and when the time comes by Schiavo. Assembly Member, you may close.

I appreciate the sponsors and the supporters who are who are here and all of the folks who are working on the ground to make sure that people have access to abortion care here in California. I respectfully ask for your aye vote.

Thank you. Assemblymember. As abortion access is increasingly under attack, is it important? It is very important that we strengthen and clarify California law to ensure our healthcare providers can continue to provide critically needed care to our patients. This bill is very important.

I want to thank you for your leadership in this area and when the time comes I will be supporting this Bill and ask if I might be able to co author. If you're open to accepting co authors. That would be great. Thank you. Thank you. Thank you. We will move on to our next bill.

Assemblymember Crell can move on with her next Bill. Thank you for just staying at the podium over there. We're going to move on to item number eight. AB551 by crel thank you. Assembly Member.

Hi, good afternoon again. Assembly Bill 551 is a commitment to address gaps in reproductive care in in a state that has been a vocal champion of reproductive freedom. AB 551 establishes a pilot program to award grants and technical assistance to emergency departments to provide evidence-based and timely treatments around reproductive health care.

Right now, ER departments are carrying the ongoing burden of patients that have nowhere else to go and this is being exacerbated by the closure of maternity wards, the shortage of OBGYNs, and the flow of individuals from other states that have abortion bans in place.

Unfortunately, with this burden growing and many emergency departments not having the additional training needed, they're not able to provide for reproductive and sexual health care needs sufficiently.

With over 19 million women living in places that are considered contraception deserts or lack access to full scope reproductive health care, this bill will ensure that emergency departments are able to provide their patients with adequate, well-rounded care for all of their reproductive healthcare needs.

Today with me are Dr. Aimee Moulin and Dr. Anna Yap to elaborate further on the need for this measure through their practice and their experience. Thank you.

Thank you. Good afternoon. I'm Dr. Anna Yap, an emergency physician here in Sacramento. Let me tell you about a patient I'll never forget. She came to the ER with stomach pain and nausea, unaware she was pregnant. She hadn't had access to birth control or even a pregnancy test.

We diagnosed her with an ectopic pregnancy, a life threatening condition, and rushed her into treatment. This happens more than people realize. Over 360,000 pregnancies are discovered in ERs every year, and 44% of pregnancies in the US are unintended. For many, the emergency department is the only place they can go when something's wrong. We are the safety net.

We see people who have nowhere else to turn. But right now, we're not always prepared to meet the reproductive health needs. AB 551 changes that. It gives emergency departments the tools and training to provide basic care like contraception, counseling and referrals right when patients need it the most. It's also cost effective.

Contraception is far less expensive than the medical, emotional and systemic costs of unintended pregnancy. And like California Bridge did with addiction care in California in emergency rooms, this small investment will help us build sustainable, lasting change. In just a few years, as reproductive care is under attack across the country, California has the chance to lead.

AB 551 can be the blueprint that shows how to update, educate and empower clinicians already in practice and make emergency care truly comprehensive. Where California leads, others follow. And importantly, this bill doesn't force any hospital to do anything against its values. It simply ensures that when someone walks into our ER, we're always ready to help.

I urge your support for AB 551. Thank you.

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

Thank you. Aimee Moulin. I'm also an emergency physician here in Sacramento and I want to address the question that you all are probably thinking about, which is we are asking for money at a time of tight budgets when we are facing Medicaid cuts and it is exactly this moment when we need to invest in the emergency care system.

Emergency departments are a vital safety net that will become even more important in times of financial stress, particularly if the state is facing cuts to its Medicaid program, clinic closures, emergency departments become the only place and are the only place where health care is guaranteed and no one is turned away.

This is a critical investment that California can make in shoring up its emergency care system by providing critical access to reproductive health care to everyone in the state of California in a way that is efficient.

This bill would teach emergency departments and emergency physicians to do something new, which we have done before and that is provide full service, comprehensive reproductive health care to provide access to contraception, to provide definitive care for first trimester loss, and to provide definitive care for first trimester unwanted pregnancies.

This is efficient use of the emergency department because we can prevent potentially a second visit by providing that definitive care in the emergency departments. In times of stress for some patients, the emergency department is not the first stop, but the only stop.

And so I think at this moment it is really critical that we make this investment in our emergency departments and shore up the safety net. The access bridge model, the fellowship model, is a very efficient model of teaching and accelerating practice change in emergency departments. We did this previously by teaching California emergency departments to do addiction treatment.

This is a proven, scalable, smart investment that strengthens our safety net. I urge your support. Thank you.

Thank you. Any other witnesses in support, please come forward. State your name, affiliation and position on the bill.

Good afternoon. Omar Altamimi with the California Pan-Ethnic Health Network, in support.

Martin Radosevich on behalf of Reproductive Freedom For All California, co-sponsors.

Molly Maula on behalf of Planned Parenthood Affiliates of California, in support.

Tim Madden representing the California Chapter of the American College of Emergency Physicians, in support.

Tyla Adams, Reproductive Justice Program Manager on behalf of Black Women for Wellness, proud co-sponsors in strong support.

Lang Le from Asian Americans Advancing Justice Southern California, in strong support.

Good afternoon Chair and Members. Sosan Madanat, W Strategies here on behalf of the California Nurse-Midwives Association, in support. Thank you.

Good afternoon. Stephanie Estrada with Cruz Strategies on behalf of California Latinas for Reproductive Justice, in support. And on time. Thank you.

Thank you. Are there any primary witnesses in opposition? Any me-toos in opposition.

Move the bill.

Hi. Sophia Lorey with California Family Council, in opposition. Thank you.

Molly Sheahan with the California Catholic Conference, in opposition based on the reasons laid out in our letter. Thank you.

Thank you. We have a motion when appropriate from Majority Leader Aguiar-Curry, seconded by Schiavo. We'll bring it back now to the Committee for any comments or questions. Seeing none, Assemblymember, would you like to close?

I respectfully ask for your aye vote.

Thank you, Assemblymember. Many communities only access to health care is the emergency room, as was stated by your witness. And this bill builds on existing efforts to expand and improve access to reproductive health care and the quality of that care, which is critical at this point in time, especially now.

I want to thank you for bringing forward this bill and for bringing it forward for our committee's consideration when appropriate. Thank you. We're going to move now to item number three, AB 260 Aguiar-Curry.

When you're ready, Majority Leader. Thank you.

Great. Good afternoon, Madam Chair and Members of the Committee. Thank you, Madam Chair, for your Committee staff's work on this Bill. AB260 is an important proposal to protect safe and legal reproductive health health care here in California.

Access to reproductive health care, including abortion, continues to be under threat across the nation. Since the Dobbs decision, other states have been restricting or banning abortion care and people's ability to make decisions over their own bodies. In recent weeks, the Federal Government officials have publicly announced their intentions to reevaluate the approval of safe abortion medications.

They have already made cuts to critical funding for family planning in an effort to further restrict the ability of states to provide essential health care. So AB260 is in response to these very real threats. It protects access to medication abortion here in California.

Specifically mifepristone, a common and safe medication abortion drug that was first approved by the FDA in 2000. Medication abortion is safe and effective, and it's the best invasive option for abortion care. Based on decades of FDA research.

Access to the full scope of reproductive health care is critical for Californians and their health care providers so they can make decisions that are best for their health and the health of their families. It is especially true for people living in areas with few providers or those that have to travel long distances to get care.

This Bill also provides critical protections in California for medical professionals who are helping their patients to get health care as they need. Specifically, this Bill protects health care providers, pharmacy clinics and hospitals from disciplinary actions or licensing impacts that are legally providing mifepristone.

Following the passing of a similar policy in New York State, this Bill also allows reproductive health care providers names to be removed from medication abortion prescription labels. Health plans will be required to continue covering medication abortion, making sure this essential care remains affordable for those who need it.

This Bill also expands access to telehealth services, making sure more people, especially our folks in rural and underserved areas, have access to safe, reliable, remote health care Members. The Federal Government has already shown us it intends to roll back access in funding for reproductive health care. It's already happening.

It's more important than ever that we stand strong in protecting the rights of Californians and their health care providers. AB260 protects patients, providers and facilities while expanding access through telehealth. It reinforces California's constitutional right to make their own health care choices free from political or religious agendas.

This is a proactive step to make sure our people can keep accessing reproductive care regardless of changes at the federal level. Affirming access to reproductive health care not only secures a person's right to their own body, but fosters the health and well being of our communities across the state.

With me today to testify and support are Angela Pontes with Planned Parent Affiliates of California and Leah Koenig, a UCSF researcher with a focus on access to reproductive health services. Welcome.

Good afternoon. Angela Pontes, Senior Vice President of Government affairs at Planned Parenthood Affiliates of California, representing the seven Planned Parenthood affiliates operating 115 health centers across the state serving patients from every county here today in strong support of AB260 as a proud co sponsor, we know that restricting access to medication, abortion and specifically mifepristone is a priority for the anti abortion movement and the Federal Government.

Through proactive policy, AB260 safeguards existing access to medication abortion by protecting against federal interference with the current practice of medicine in California, including evidence based expansions established over the past decade that have made medication abortion more accessible and the preferred method for many patients.

Further, AB260 increases access to reproductive health care through telehealth, ensuring that the over 15 million medical beneficiaries, particularly those who already face barriers to care, can access the care that they need.

Any federal efforts to restrict medication, abortion and the drugs that are used are not only dangerous and cruel, but also a direct attack on our state's constitutional right to reproductive freedom. Thank you for your consideration of this important policy. We respectfully urge your support today.

Thank you.

Good afternoon. I'm Dr. Leah Koenig, an epidemiologist at the University of California, San Francisco. I'm here today to provide expert testimony as a private citizen and my views are not representative of the position of the University of California. My title and UC affiliation are for identification purposes only.

My research focuses on evaluating the safety and efficacy of medication abortion. Evidence consistently shows that medication abortion with mifepristone and misoprostol is highly effective and safe.

Its safety is supported by over 100 peer reviewed publications including 100,000 patients and by 25 years of use. Telehealth medication abortion is also extremely safe and effective and now accounts for 1 in 10 California abortions. Our recent study followed over 6,000 patients and found that telehealth abortion is just as safe and effective as in person care.

Nearly 98% of patients had complete abortions without needing any additional intervention and serious adverse events were exceeding exceedingly rare, occurring in only 1/4 of 1% of cases. Patients report high levels of satisfaction with telehealth citing convenience and privacy and reduced logistical barriers like transportation and childcare.

Asynchronous telehealth care conducted entirely via messaging is just as safe and effective as synchronous telehealth abortion involving video calls. In our study, patients who received asynchronous care were significantly more likely to report feeling cared for than than those who receive synchronous care. Because texting allows patients private and immediate contact with their providers.

Telehealth also makes it possible to access timely abortion care, especially among younger patients, those living on lower incomes, and those in rural areas. There is no scientific basis for restricting access to mifepristone. Limiting access to medication abortion will have harmful effects, especially for those with the most limited access to healthcare.

I urge the Committee to vote yes on AB260 so access to medication abortion can continue in California. Thank you.

Thank you. Any other witnesses in support? Please provide your name, organization and affiliation. Andy Liebenbaum, County of Los Angeles and proud support.

Omar Altamimi, California Pan Ethnic Health Network. In support.

Martin Radosevich, Reproductive Freedom For All California, co sponsors. Thank you.

Tiffany Brokaw here on behalf of Attorney General Rob Bonta, proud co sponsor. Thank you.

Michelle Rivas, California Pharmacists Association. In support.

Tyla Adams on behalf of Black Women for Wellness Action Project. Proud co sponsors and support.

Genesis Gonzalez on behalf of Lt. Governor Eleni Kounalakis as a proud co sponsor and support. Thank you.

Stephanie Strada on behalf of California Latinas for Reproductive Justice in support and also co sponsor. Thank you.

Molly Mallow on behalf of the American College of OBGYN's District 9, a co sponsor and strong support.

Ryan Souza on behalf of Essential Access Health and strong support. Thank you.

Sosan Madanat here on behalf of California Nurse Midwives Association in support. Thank you.

Thank you. Are there any witnesses in opposition? Any primary witnesses? You'll have two minutes. Thank you.

Hi, Chair Committee. I'm Sophia Lorey with California Family Council. And we weren't planning to originally be a primary witness in opposition, but after we were disrespectfully, the last Bill was moved by you. I want to make sure our voice is heard instead of us getting cut off.

And so there was a lot of, I think, misinformation spread in these testimonies when it comes to the abortion pill saying that it's safe. There's nothing safe when every single time it successfully works, a baby dies. That's the straight fact of it. We talked about mifepristone and misopristol. So let's talk about what mifepristone actually does?

It chemically starves a preborn child of progesterone, causing the placenta to degenerate so that it can no longer provide oxygen nutrients to a child. And as you guys know, this is normally administered in the first 10 weeks of a pregnancy. So let's talk about what a baby looks like in the first 10 weeks of a pregnancy.

So by three weeks and one day, a baby's heartbeat can be detected. Between five to six weeks, the baby's lung and digestive system start forming and brain activity can be recorded. At nine weeks, the baby can suck their thumb, sigh, and stretch. At 10 weeks, a baby is about an inch and a quarter long.

All vital organs are in place and their teeth are starting to Harden and connect to the jawbone. When we use these abortion pills to kill those babies, there's nothing safe and effective about it. We can also go back to what the FDA has to say about these abortion pills.

Since 2000, 1,048 women have been hospitalized, 604 women have experienced blood loss requiring transfusions, and 414 women have experienced infections, all due to abortion medication. So every successful medication abortion ends in at least one person dead. Since 2000, 5.6 million unborn children have died from abortion medication. Since 2000, 28 women have died from abortion medication.

This is not misinformation. This comes directly from the US Food and Drug Administration. Protect women, do better, Stop giving them these harmful drugs. Thank you.

Are there any other witnesses who would like to offer me too in opposition? Seeing none, I'll bring it back to the Committee for questions or comments. Dr. Patel.

Thank you, Madam Chair, and thank you, Member, author. As principal co author of this Bill, I wanted to thank you for these important steps forward. You have demonstrated clear leadership in protecting access to reproductive health care. At a time when there's relentless attack across the country, we're not just facing legal uncertainty.

This is a deliberate national strategy to restrict access and roll back the rights of reproductive freedom. AB260 makes it clear that in California, we do not criminalize care, we don't turn our backs on science, and we will not allow federal overreach or out of state prosecutions to dictate our health and health care standards.

I do appreciate that this Bill updates Medi Cal to reflect how people actually access care, that we protect the pharmacists and the clinics from being caught in the crossfires of this kind of litigation. And it frankly aligns our state laws with California values and our Constitution.

Again, Assemblymember, thank you for authoring this Bill and bringing it forward today. My question to you with that preamble is what kind of message do you hope that this Bill sends not just to Californians, but to patients and providers across the country who are watching how states support the reproductive freedom of their residents?

As you may or may not know, I have been a proponent of access for all health care for all people across this entire nation. And rural communities have struggled more than anyone. And I always wanted to give opportunities of those that lived in those rural communities access to healthcare.

You know, years ago, we used to be able to think that you could just go to any Doctor that was down the street. But in our rural areas, it's just not that way. And so this Bill is really important to me because we are covering women as well as families in these decisions that we have to make.

This is a decision that I feel that the Federal Government has pushed us under the rug and we're here to fight and to make sure that Californians as well as others have the right to use stone. Sorry. Thank you.

Thank you. Thank you. Seeing no other comments or questions from the Committee, point of clarification that Committee Members have the ability procedurally to bring forward a motion at any time. Assemblymember, would you like to close?

I respectfully ask for your aye vote. It's important for all of us to realize that people need access and we have fought for this all along. And I continue will continue to do so. Thank you.

Move the Bill. Moved by Patel, seconded by Schiavo. When the time comes, we can review those motions. With that, we will move on to our next Bill in the queue. Item number four, AB309. Zbur.

Madam Chair, Members, I am proud today to present AB 309, which will support California's comprehensive strategy to prevent the spread of HIV and viral hepatitis by preserving existing laws that increase access to sterile syringes. After decreasing for almost 30 years, HIV diagnoses began increasing again in 2021 and 2022.

The sharing of used syringes remains the most common mode of transmission of hepatitis B and hepatitis C and the second most common mode of HIV transmission. These diseases are both potentially deadly and extremely costly. The estimated lifetime medical cost related to HIV treatment for just one person is $326,500.

After 20 years, extensive research and data collection has repeatedly proven that increased access to sterile syringes significantly lowers rates of transmission and saves lives without without increasing rates of drug use, AB 309 will ensure that our state maintains critical public health tools, first, removing the sunset date on the statute which allows pharmacists to sell syringes without requiring a prescription.

And two, removing the sunset date on the statute which clarifies that it is not a crime to possess sterile syringes and hypodermic needles for personal use. In doing so, this bill will reaffirm California's commitment to to research-driven and effective HIV and hepatitis prevention and ensure that Californians continue to have access to sterile syringes.

With me to testify in support of the bill is Michelle Rivas, on behalf of the California Pharmacists Association and Mr. Alex Kral, an epidemiologist from RTI with expertise in community-based research and syringe programs.

Thank you. You'll each have two minutes.

Thank you. Chair Bonta and Members of the Committee, Michelle Rivas with CPhA. The California Pharmacist Association is pleased to serve as a co-sponsor of AB 309 and appreciates the opportunity to address you today. Current law allows pharmacists to provide hypodermic needles and syringes without a prescriptions to adults, AB 309 proposes to eliminate the current sunset provision.

This is an essential component of the state's comprehensive public health strategy to prevent the transmission of HIV, hepatitis B and hepatitis C. For individuals struggling with addiction, the ability to purchase syringes at a community pharmacy provides a critical harm reduction resource.

Beyond reducing the spread of infectious disease, the access enables pharmacies to engage with individuals and offer information about drug counseling services, potentially guiding them towards recovery. I think that's an important component of this legislation is those counseling services that are required.

Additionally, it is not uncommon for patients receiving medications via mail order pharmacies to be left without the necessary syringes for administering treatments such as insulin, progesterone or home run therapy.

Ensuring that patients can obtain syringes without a prescription at a community pharmacy along with proper guidance on injection techniques is essential for their safety and adherence to prescribed treatments. We respectfully request your support of AB 309. Thank you.

Good afternoon, Chair and Committee. My name is Alex Kral. I'm a distinguished fellow in the Oakland Office of the Research Triangle Institute here in Oakland. And I received my Master's from Harvard and my PhD from UC Berkeley, both in epidemiology.

I've been conducting research in California now for three decades on drug use and infectious diseases specifically, published over 230 papers in peer reviewed journals, of which 90 of those are on HIV, 25 of them are on hepatitis and 9 are actually specifically on pharmacy sales of syringes and infectious diseases.

In fact, 20 years ago, I was part of the team that evaluated the pilot project for this. That was a California Department of Public Health evaluation, which is a five year study that we did at the time. And it basically-- we studied counties that had safe and legal access to syringes at pharmacies versus those that didn't.

And what we find, first of all, we found there was actually no negative effects of this. There was no differences in rates of drugs, drug use, drug sales or infectious diseases by the counties that we looked at.

And then second of all, we found that among the people who use drugs in those counties, the ones that had the pharmacy sales were much less likely to share syringes. So that's a really good thing. You know, nearly 5,000 Californians every year now still are getting HIV, but less than 400 of them are actually people injecting drugs.

And I think this is a big piece of this is both pharmacy sales as well as syringe service program sales that have been giving people access to sterile syringes. So our local studies, national studies and international studies, there have been hundreds of studies on this issue.

All of them show positive things regarding infectious diseases and no negative outcomes at this point. And so I also urge you to eliminate the sunset such that Californians can permanently benefit from this particular intervention. Thank you.

Thank you. Are there other witnesses in support? Please come forward, state your name, organization and position on the bill.

Aubrey Rodríguez with ACLU CA Action, in proud support.

Andi Liebenbaum, County of Los Angeles, in support.

Good afternoon. Glenn Backes for Drug Policy Alliance, proud co-sponsor.

Isabella Argueta with the Health Officers Association California, also a proud co-sponsor.

Angela Hill with the California Medical Association, in support.

Craig Pulsipher on behalf of Equality California, in support.

Good afternoon. Norma Palacios, and I'd like to read the name of the following organizations in support of AB 309: Maternal and Child Health Access, GLIDE Foundation, Hope in the Valley, National Harm Reduction Coalition, Ruby Income Programs, Citizens for Choice, HealthRIGHT 360, Needle Exchange Emergency Distribution, Being Alive and the GoVIA Project. Thank you.

Thank you Madam Chair. Jean Hurst here today on behalf of the Board of Supervisors of the County of Santa Clara, in support.

Farrah McDaid Ting on behalf of the County Health Executives Association of California, in support.

Maria Jose Vides here on behalf of the Vera Institute of Justice, in support.

Trent Murphy here representing the California Association of Alcohol and Drug Program Executives, in support. Thank you.

Ryan Souza on behalf of APLA Health and San Francisco AIDS foundation, in support.

Jorge Cruz with California Behavioral Health Association, in support.

Jen Chase on behalf of the University of California, in support.

Madam Chair and Members. Rand Martin on behalf of the AIDS Healthcare Foundation, in strong support of this bill. Thank you.

Tara Gamboa-Eastman with the Steinberg Institute, in support.

Molly Maula, Planned Parenthood Affiliates of California, in support.

Tim Madden representing the California Chapter of the American College of Emergency Physicians, in support.

And I'm Laura Thomas with the San Francisco AIDS Foundation, a co-sponsor in support.

Thank you. Before moving on, we are going to establish quorum. Secretary, please call the roll.

[Roll call]

Quorum is established. Are there any primary witnesses in opposition? Please come forward. Thank you. You'll have two minutes.

Good afternoon, Madam Chair, Members. Ryan Sherman with the California Narcotic Officers Association. Wanted to apologize for submitting our letter late. But I did want to pass along our association's concerns. California Narcotic Officers Association remains philosophically opposed to needle exchange and distribution programs. On a daily basis, our officers witness firsthand the devastation caused by narcotic addiction.

Making it easier for addicts to inject their deadly drugs makes no sense to us, those on the front line of this epidemic. Especially in light of overwhelming passage Prop 36, where voters demanded more accountability for drug offenders, not less. For these and the other reasons stated in our letter, we respectfully oppose AB 308.

Thank you. Are there any other witnesses who would like to offer me-toos in opposition? Seeing none, we will bring it back to the Committee for questions or comments. Moved by Arambula, seconded by Aguiar-Curry. Assemblymember, would you like to close?

Respectfully ask for your aye vote.

Thank you so much. I think for decades we know that we've been fighting with public health research that demonstrates that access to sterile syringes reduces HIV, engages people in treatment and does not increase crime in the surrounding areas. It's time our law acknowledges these successes and removes any uncertainty about future access.

And I want to thank you for bringing forth this bill. Secretary, please call the roll.

The motion is do pass to Appropriations. [Roll call]

That measure is on call, Assemblymember. Thank you.

Thank you very much.

We're going to move on now to item number seven, AB 536 Patterson.

Great. Thank you, Madam Chair, Members, great to be back with you again today. I'm here to present AB 536, which I also authored last year.

As you recall, we are at risk of losing mandated coverage of colorectal cancer screenings in not only California, but really because of what's happening outside of this state and have nothing to do with it.

So just to keep it very short and sweet, what my Bill does is it makes sure that if litigation in Texas is successful, that we continue to cover colon cancer screenings here in California.

This has been a very important issue to me, as one of my friends in his 40s only survived and actually just recently celebrated his 50th birthday because of a screening that he was able to get. And unfortunately the Bill was vetoed last year.

But we've been working with the administration and have made changes to reflect those concerns and also appreciate the work of this Committee and the staff on helping to address those concerns as well. With me, I have Oliver Rocroi from Guardant Health to sponsor the Bill to discuss it.

Thank you, Assembly Member, Madam Chair, Members, good afternoon. Californians have had access to no cost preventative services for about 15 years, ever since the passage of the federal Affordable Care Act. During that time, coverage of preventative services has had a significant increase in the number of screenings that are completed and as a result, improved health outcomes.

For instance, between 2010 and 2016, eliminating the cost sharing was associated with a 17% drop in incidence rates for colorectal cancer. And especially for cancers like CRC where we know that catching and detecting them early can bend the curve on mortality, access to that screening is incredibly important.

Unfortunately, as the Assembly Member mentioned, adherence to recommended screening is fairly low. Today, 75% of the people that die of CRC are not up to date with the recommended screening. Simply put, AB 536 aims to protect the access that California enshrined when it codified the Affordable Care Act provisions into state law.

Those provisions, however, tie the recommended screenings to guidelines issued by a federal agency called the United States Preventative Services Task Force. And I will ask that you not ask me to say that fast, because I can't.

Those guidelines are currently being threatened by a court case as reference that is being heard in front of the Supreme Court on April 21st of this this year.

To remedy that AB 536 simply allows for other modal or for, excuse me, for other coverage criteria to be considered when allowing for access to screening. It does not expand access, it simply maintains and protects the access to colorectal cancer screening that Californians have enjoyed for almost two decades. So, happy to answer any questions. Thank the Assembly Member.

Thank you all for your time and worded your support.

Thank you. Is there any testimony in support? Are there any primary witnesses in opposition? The Bill has been seeing none. The Bill has been moved by Chen, seconded by Sanchez. I'll bring it back to the Committee for any comments or questions. Seeing none.

I want to thank Assembly Member Patterson for bringing forward this Bill once again to this Committee. I know that this is a very personal issue for you, and I appreciate your commitment to ensuring that all Californians have access to these critical preventive cancer screenings.

I've shared with you in the past that this is also a very personal issue to me as well. I thank you for your leadership and I want to highlight again that our California Health Benefits Review Program determined that yet again this Bill does not change or expand benefit coverage.

And I hope we can see this, that this gets through, fully through, the finish line this year. Thank you, Assembly Member. With that, Secretary, please call the roll. Oh, sorry. Assembly Member, would you like to close?

That was an amazing close. So with that, I ask for an aye vote.

Please call the roll.

[ROLL CALL]

That measures out, thank you. We'll move on now to item number 11.

Thank you, Madam Chair and Members. AB 804 sets the state on a path to providing housing support services as a covered medical benefit. It requires California's Department of Health Care Services to seek federal approval for this benefit no later than March 31, 2026.

AB 804 Wicks. Whenever you're ready, assembly member.

This will ensure California more equitably and consistently provides housing support services while maximizing federal matching funds after the current CalAim waiver expires. Without stable housing, health care treatment is often ineffective. In fact, acute care costs for unhoused patients continually increase as long as they remain homeless, regardless of the quality of treatment.

AB 804 addresses this health care gap with wraparound services to keep people safer and healthier. While I recognize the potential state cost, I've submitted an accompanying budget ask and want to emphasize that these supportive housing services a vital health care investment that could avoid future costs to our government of more than $46,000 per year per person.

This cost saving and life saving support can be the difference between thousands of Californians returning to homelessness or remaining safely housed. Here to speak with me in support is Divya Shiv with Housing California. And here to answer any technical questions is Sharon Rapport with the Corporation for Supportive Housing.

Thank you. You'll each have two minutes. Good afternoon assembly members and Chair Bonta. My name is Divya Shiv and I'm the senior policy advocate of homelessness policy at Housing California, a statewide nonprofit organization focused on affordable housing and ending homelessness. And we are proud sponsors of this bill. Homelessness and health are deeply intertwined.

Homelessness not only creates new health problems and exacerbates existing ones, but it makes it more difficult for an individual to recover from health conditions when they don't have stable housing. For example, a survey of unhoused individuals found that 38% of people experiencing homelessness visited emergency rooms and 21% were hospitalized over a six month period.

Fortunately, California can address this critical issue through AB 804. AB 804 would require the Department of Healthcare Services to seek federal approval of a Medi Cal benefit for housing support services which are currently provided through the CalAim waiver and include necessary services to help people navigate the housing system, move into housing and stay stably housed.

In fact, multiple studies over the last 30 years find that these services allow people to exit homelessness, decrease hospital admissions and avoid significant healthcare costs. However, because these services are provided under a CalAim waiver, the state does not receive additional federal funding.

In addition, while CalAim has offered much needed resources for these services, these managed care funded services are inconsistently administered, underfunded and often time limited. Making these services of benefit will improve health and housing stability for Medi Cal enrollees who are experiencing homelessness.

AB 804 is critical to improving health outcomes and reducing homelessness for Californians and it would allow California to take advantage of a federal match of up to 90%. For these reasons, I commend Assemblymember Wicks for authoring this bill and I urge your aye vote, thank you.

Sharon Rapport with the Corporation for Supportive Housing, also proud co sponsor and I'm here just to answer any questions you may have. Thank you.

Thank you. Are there any other witnesses in support who would like to offer me to Please come forward. State your name, organization and position.

Sandra Pool, Western center on Law and Poverty. Proud co sponsor and support.

Nora Angelouz with Children Now in support.

Christine Smith, Health Access California in support.

Aubrey Rodriguez, with the ACLU California Action in proud support.

Tara Gambo Eastman with the Steinberg Institute in support.

Justin Yotta with the California Housing Partnership in support.

Norma Palacios with the Drug Policy alliance in support.

Hi, my name is Jacob Neiman with the Association of Regional Center Agencies and we are in support of this bill.

Move the Bill moved by Aguiar-Curry, seconded by Arambula. Are there any primary witnesses? In opposition. Any me toos in opposition. Echo, echo, echo. With that I'll bring it back to the Committee for any comments or questions.

Hello. Shana England with the California Community foundation in support.

Assemblymember Addis, I just, I want to thank the author for your leadership in the housing realm and in the health budget. Sub Yesterday we heard about the emergency rental assistance under Medi Cal and just the prompt promise of that. And I think this really builds on the promise of being able to get Medi Cal waivers.

I'm incredibly hopeful that the Federal Government will see fit and will agree that this is important and that we can get bipartisan support at the federal level to 1 not cut Medicaid and 2 provide the waiver for these really important programs. And so thank you for your leadership on this.

Assemblymember Chiavo.

I want to thank you for bringing this Bill forward. I co founded an organization working on homelessness and I did outreach into communities where people cannot keep appointments or get a job or get on their feet in any way, shape or form if they don't have access to housing.

And so it's so critical and fundamental to people being able to be healthy, to be safe. We know that living on the streets is also much more dangerous and that many are victims of violence while they're on the streets.

And so I would be happy to co author this if you'll have me and really grateful for your leadership on this issue.

And I wonder if you could talk about also a little bit does this there was a big report in LA about how effective protection program had been that helps people prevent homelessness and that when they're given assistance, if they're on the verge of homelessness, that 9090% of them stay housed.

And so this I I assume that this could help folks who are, you know, currently experiencing homelessness but also could help on the prevention side of moving into homelessness. Is that true?

Yeah. Thank you first and foremost for your work establishing the organization that you were just speaking of.

And yeah there is a lot of compelling data that shows a little bit of assistance can go a long way to stopping people from entering homelessness, which then saves taxpayers in the long run on healthcare costs and all other sorts of costs.

And as noted in the analysis, this makes Medi Cal beneficiary eligible for housing support services if they're at risk of experiencing homelessness. So we want to make sure we stop that before it happens because we see so much more unintended consequences once folks end up on the streets.

As you mentioned and would love to have you as a co author. Assembly Member Stefani.

Thank you, Chair. I want to thank the author for bringing this very thoughtful bill forward. I think it's a common sense solution to supporting our vulnerable populations and addressing our homelessness crisis. I just want to thank you and I'm proud to be a co author.

Thank you. This bill will transition housing support services from an optional community support to a permanent medical benefit. This bill really speaks to that critical link between housing and health. I want to thank Assembly Member Wicks for championing always housing and health and recognizing that they are go in tandem.

I also want to note that this is a very cost effective bill as it will allow us to be able to make sure that we're fully taking advantage of Medi Cal, assuming that we are able to have that.

But for our whole system, we need to make sure that we're providing solutions for the homelessness crisis that we continue to struggle with. With that Assembly Member, would you like to close?

Just appreciate the comments from you, Madam Chair and Members of the Committee would ask that we join nine other states, including states like Arizona, North Dakota, Washington and others who already do this and take advantage of our federal matching funds and respectfully ask for an aye vote. Thank you.

Secretary. We have a motion and a second by Aguiar-Curry. Seconded by Arambula. Secretary, please call the roll.

The motion is due pass to Appropriations. Bonta. Aye.

Banta aye. Chen. Addis. Addis aye. Aguiar Curry. Aguiar-Curry aye. Arambula. Carrillo. Carillo aye. Flora Gonzalez. Krell. Krell aye. Patel. Rodriguez. Sanchez. Sanchez. No. Schiavo. Schiavo, Aye. Sharpe-Collins. Stefani. Stefani aye.

That measure is on call. Thank you. We'll move on now to item number nine. AB 594 by Solace. Whenever you're ready, Assembly Member, please press the button.

Still the new guy around here.

There you go.

Thank you, Madam Chair and committee members. I am presenting AB 594 in partnership with the California Department of Insurance and Commissioner Ricardo Lara. AB 594 builds upon AB 1823, a bill passed by this body in 2022 by addressing an unforeseen gap and providing necessary protections for students who are navigating college-providing health insurance.

Specifically, this bill will allow students to withdraw from their coverage when no longer enrolled in the school, thereby preventing unnecessary charges. Additionally, AB 594 would require schools to inform their students on any year-to-year increases to the premiums.

These protections already exist in consumers in the broader insurance market and this bill provide a similar level of protection. This bill is necessary to ensure that we do not charge students for a service they do not qualify for and to maintain transparency for them as they navigate a unique form of coverage.

My office and I remain committed to working with the stakeholders to addressing any concerns. With me today to testify in support, representing the Department of Insurance is Miguel Bastidas, and student with firsthand experience in this issue, Apollo Rydzik.

Moved by Carrillo, seconded by Sanchez. Please go ahead. You'll have two minutes.

Okay, thank you. Good afternoon, Chair, committee members. My name is Miguel Bastidas, and I am the Chief Deputy Legislative Director for the California Department of Insurance, here under the leadership of Insurance Commissioner Ricardo Lara. As a proud sponsor of AB 594, Insurance Commissioner Ricardo Lara would like to thank Assembly Member Solache for his leadership in authoring this important measure.

Student health insurance is a very specific form of health insurance offered by universities and colleges to their students. CDI is the sole regulator of these products. In 2022, CDI sponsored AB 1823, which codified federal ACA requirements that apply to student health into state law and clarify that student health insurance is a form of individual coverage consistent with the ACA.

Much of the state law governing student health insurance went into full effect in 2024 and during that first year, the department discovered a few areas where the law could be improved. The first area that CDI identified affected students billed for coverage they no longer needed or were ineligible to utilize when they withdrew from enrollment or were no longer students. This practice is fundamentally unfair. Students shouldn't be on the hook for to continue premium payments when they are no longer students.

In addition to this bill would create transparency for it by seeking to have those students in the university notified of rate change. Finally, the department needs better tools should the insurer fail to comply with this statute. That is why we added explicit enforcement authority including penalties for non-compliance. On behalf of Insurance Commissioner Ricardo Lara, I respectfully ask for your aye vote, and with me today is Apollo Rydzik, who who will continue to share his experience as the former student. Thank you.

Good afternoon, Chair and committee members. My name is Apollo Rydzik. As a former low-income college student who personally understands the burden of student debt, I am honored to testify in support of AB 594. I was a PhD student at Stanford University for three years.

Due to personal circumstances, I went on a leave of absence from my graduate program. When I returned in the fall of 2023, I enrolled in Stanford Student Health Insurance, Cardinal Care/Aetna. I enrolled because I was turning 26 in December, making me ineligible for my parents' employer-provided insurance.

While I was a student, I received a fellowship that covered my student health insurance premium. After fall quarter, I received an employment offer from the Department of Public Health. I promptly requested to permanently withdraw from Stanford which was approved the same day, immediately terminating my time as a student. Nevertheless, Stanford continued charging me for Cardinal Care.

To date, I have a total of $4,752 in health insurance fees for the quarters I was not enrolled in Stanford. During this time, I was employed at CDPH and received coverage from Kaiser. Furthermore, I was informed that my account would be sent to a collections agency if I did not pay the charges.

I reached out to Stanford Student Health Insurance Office where I spoke with the Student Health Insurance Manager who told me that Cardinal Care is an annual plan, that I would remain enrolled through the end of the year, and applicable fees would apply.

In summary, although I am not a student, I am required by current Stanford policy to pay nine months of student health insurance premiums. I received a final notification from Stanford in January of this year stating that my account would be sent to a debt collector.

My student health insurance debt is a source of significant financial stress in an already precarious economic period. I and other students have only one choice: pay or risk credit score damage, lofty interest payments, and potential legal action. Given significant increases in student debt, never before has it been more critical to protect students from unnecessary fees. Our socioeconomic context, in addition to my personal experience is why I support AB 594. Respectfully ask for your aye vote. Thank you.

Thank you. Are there any other witnesses in support who would like to offer #MeToos? Are there any primary witnesses in opposition? Any others who would like to offer #MeToo in opposition? Seeing none, I'll bring it back to the committee for questions or comments.

Assembly Member Solache, I want to thank you for bringing forward this bill along with Insurance Commissioner Lara and to your witness for being able to just share so compellingly why this bill is so necessary. We shouldn't be creating pathways towards debt when we have options to be able to make sure that our students, when covered, don't have to pay for services that they're not using as as you stated. With that, if you are accepting co-authors, I would love to be considered and added as a co-author on this bill. With that Assembly Member, would you like to close?

Madam Chair, thank you for offering to co-author. As you mentioned, just a very important issue. Just as a personal privilege, as a former student leader who fought for the CSU and the 400,000 plus students as a student leader, this is a full circle for me to come back and advocate for our students and continue advocating for our students in higher education spaces. So thank you, and I ask for your support in this, in this bill. Thank you.

Thank you for your leadership, Assembly Member. Secretary, we have a motion of Carrillo, seconded by Sanchez. Secretary, please call the roll.

The motion is do pass to Appropriations. [Roll Call].

That measure's out. Thank you.

Thank you so much.

We are going to move on now to the consent calendar. Can I have a motion for the consent calendar? Moved by Aguiar=Curry, seconded by Stephanie.

[Roll Call]

The consent calendar is out of Committee. Assembly member Stephanie. We are moving on to item number 13 AB 836 by Stephanie. Moved by Krell, Seconded by Chen. Assembly Member, please move. Go ahead.

Thank you, Madam Chair. Members, Today I'm presenting AB 836, the midwifery workforce Training Act. I think we all know that California is facing a reproductive and maternity care crisis. A severe shortage of maternal health providers is one of the top three factors driving this crisis.

Statewide, midwifery care has been shown to have excellent clinical outcomes, reduced disparities and lower health care costs. But it is vastly underutilized. California currently has no licensed midwife programs and only one nurse midwifery program accepting students. Certified nurse midwives and licensed midwives collectively attend approximately 14% of the births in California.

Targeted investment to grow this workforce could help address shortages across the state. AB 836 directs the state to conduct a comprehensive landscape analysis of midwifery education in California, mapping out what exists, what's missing, and how we can grow a diverse, high quality pipeline of culturally competent providers.

This Bill will also explore barriers to program development and clinical placements and identify strategies to build sustainable, cost effective midwifery education programs across the state. Investing in midwifery isn't just about numbers. It's about ensuring every Californian has access to safe, responsive and equitable care during pregnancy and birth.

I'm joined today by Holly Smith and Liz Donnelly from the Certified Nurse Midwives Association to speak in support of the Bill. Thank you. I'll have two minutes.

Here we go. All right, sorry. Thank you. Chair and Committee for this opportunity to speak in support of AB836, which seeks to address the barriers to growing California's maternity and reproductive health care workforce.

I am Holly Smith, a nurse midwife with 25 years experience and the Legislative Coordinator for the California Nurse Midwives Association, the primary sponsor of this Bill. My background includes clinical midwifery, abortion care, public health and policy, and for the last 11 years I have focused on advancing midwifery access and improving maternal health outcomes in California.

As the author said, California faces a severe shortage of essential maternity care providers, compounded by closures of maternity units statewide and a projected shortage of 1,100 OB GYNs by 2030. This crisis is acutely felt in underserved and rural communities, exacerbating existing inequities. Research shows that midwifery care improves birth outcomes.

Countries with better birth and infant outcomes in California have invested heavily in midwives recognizing their capacity to serve most reproductive age individual. Yet California faces significant challenges in building a strong midwifery workforce, partly due to gaps about gaps in knowledge about expanding educational programs to meet the needs of Californians.

AB 836 builds on the 2021 Midwifery Workforce Training act, which funded active midwifery education programs in California and is the foundation for two new programs. However, at this moment, there's only one actively enrolling nurse midwifery program in the state.

AB 836 will look at national and statewide data to analyze costs, diversify team based training models, identify trends, address barriers for students, and determine factors to increase clinical placements.

This will enable a strategic expansion of both nurse midwifery and licensed midwifery education programs, leading to many more high quality maternal and reproductive health care providers in areas of the state that need it most. Can California has a history of commissioning studies to improve nursing and medical education specifically to address workforce shortages.

However, there have been no such studies focused on midwifery education in California. This proposed analysis is vital for making informed decisions to address the workforce needs in specific areas and underserved communities, and importantly, to identify essential conditions for maximum impact statewide. Thank you. And I urge your aye vote.

Thank you.

Liz is just here for technical support in case there's any.

Great. Wonderful. Are there any additional witnesses in support? Please come forward. State your name, position and affiliation.

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

Good afternoon. Chair and Members Pat Wahlen on behalf of United Nurses Association of California in support.

Shannon Olivieri Hovis with Essential Access Health in support.

Tyla Adams on behalf of Black Women for Wellness Action Project and strong support.

Molly Mallow on behalf of Planned Parenthood affiliates of California in support.

Megan Bochum on behalf of California Association of Licensed Midwives in Support.

Thank you. Are there any primary witnesses in opposition, or me toos in opposition? Seeing none. I'll bring it back to the Committee for any comments or questions. Thank you. Assembly member Schiavo.

I just want to thank the author for bringing this forward. My daughter was born with a midwife and my mom had my two brothers with midwives. And I know it can be a really wonderful experience. And so I think it's an important resource.

And also we know that it really expands access to, you know, caring support that is needed in our communities throughout the state. And so appreciate this Bill and happy to support.

Certainly, in the name of nurse midwife Debbie Sabelli, who delivered my first child, I want to thank you for bringing this forward and really being able to create a pathway and a workforce that we so desperately need right now so that we can continue to have safe birthing options statewide.

With that Assembly Member, would you like to close? Thank you for those comments and I respect. Respectfully ask for your aye vote. Thank you. We have a motion from Crell, seconded by Chen. Please call the roll.

[Roll Call]

That Bill is out. Thank you so much. Assembly member, we are going to move on now to item number 16 AB 1418 by Schiavo.

Thank you Madam Chair and Committee Members for the opportunity to present AB 1418, which is a bill that will enhance the understanding of our healthcare workforce trends across the state. California has long recognized the value of data driven decision making in healthcare.

An existing law requires the Department of Healthcare Access and Information to maintain Central Research and Data Center, a vital resource that collects, analyzes and shares data to the healthcare workforce and educational systems.

This center has been instrumental in ensuring that our healthcare policies are grounded in real world insights and thanks to this data, we've been able to make informed decisions that support and strengthen our healthcare workforce.

AB 1418 builds on this strong foundation by introducing a new reporting requirement that addresses a key issue trends in healthcare coverage for all employees who are eligible for healthcare benefits in California and by gaining a clearer picture of who has access to healthcare coverage and who may be falling through the cracks, we can make meaningful steps to close the gap and create a more equitable system.

Today I have Dr. Nakasi-Nakase Hagiha and my sponsor Beth Malinowski with SEIU here to support and testify in this measure.

Thank you.

Good afternoon Chair and Members. My name is Dr. Neki Saharit. I am here today as a proud Member of SEIUCIR, SEIU, the Committee of Interns and Residents. After completing my General Psychiatry residency in the UC system, I am now starting a new program, a new fellowship in Psychiatry at a county based academic hospital.

Today I'll be sharing how current law regarding healthcare coverage for new hires impacts Californians like me and the negative ripple effect it has on our communities.

As you may know, in order to become a practicing physician in the United States, once we graduate from medical school, we must undergo our specialty training in what is called residency, and these programs last anywhere from three to seven years, depending on your specialty and oftentimes with additional fellowship training for our subspecialties.

Residency is not optional and because of the match, we are assigned to one singular program which we go to, and the institution that houses your residency program is effectively your employer. So we have very little say in who our employer is or even what state, state or city we're working in.

You might be surprised to learn that as a resident I am facing a major challenge right now in affording my own health care because of employment practices that force people, including doctors, to cover their own health care costs when first starting their jobs.

I was born and raised in the Riverside area and I grew up seeing what it was like to live in a place that was one of the most medically underserved regions in the entire state.

So I've always understood that access to affordable health care is something every one of us deserves, and it's what drove me into medicine to begin with. I found that there are many misconceptions about what it means to be a resident physician, especially in the financial sense.

Like many of my neighbors when I was growing up, most of my fellow doctors and I depended on Medi Cal for our own health care when we were medical students. People are often surprised to learn that throughout our residencies, our salaries amount to essentially minimum wage.

Once you factor in the fact that we work on average 80 hours a week, that makes it almost impossible. That's almost a decade of our lives.

That makes it almost impossible for resident physicians to find affordable housing, especially if we've had to move to a new city or a state, which is often the case when it comes to match.

When you also consider that each physician begins their residency with hundreds of thousands of dollars in educational debt that oftentimes prevent them from choosing primary care specialties, you understand what a challenge this becomes.

And it becomes clear how unrealistic it is to expect new hires like me who are already struggling to afford our basic necessities to also foot the Bill for healthcare coverage.

Thank you. Can you wrap up your comments?

Because of my prior coverage, I was able to rely on a COBRA plan at a cost of $700 a month, which is one third of my rent. And so right now, this is a huge difficulty that we are facing in having to have COBRA.

So that's why I'm asking for your support of AB 1418 so Californians can join the workforce and do their jobs. Thank you.

Thank you. Beth Malnowski, the SEI California.

Sorry, Beth Malnowski, the SEI CA. Proud sponsors of this bill. Thank you for your consideration today and. Happy to answer any technical questions you might have.

Thank you. Are there any other witnesses in support would like to offer? Me too?

Tim Shea from SEIU CIR and strong support.

Hi, I'm Annie Huang. I'm an emergency medicine physician on behalf. Of CIR SEIU in support.

Christine Smith, Help access California and support.

Are there any primary witnesses in opposition or Me too is in opposition seeing none. I will bring it back to the Committee for any questions or comments. Bill is being moved by Aguiar-Curry. Seconded by Chen. Assemblymember. I want to thank you for bringing forward this bill.

I've had an opportunity actually to spend a good amount of time with the residents and it's been very helpful to me to just know I will never get over the statistic of 80 hours a week working for minimum wage as our healthcare workforce is so incredibly strapped.

So I just want to thank you for bringing for this bill. I think we know that KFF at one point was actually collecting this survey data and has since stopped.

And so we do necessary, we do need to get to the bottom of what kind of employer waiting periods there are in this moment in time when we need to be able to have more people entering into medicine and becoming physicians in the healthcare workforce. And so with that, would you like to close?

Just thank you very much for the consideration. It's as someone who worked with nurses for 13 years, it was always shocking to me to learn about, you know, healthcare workers not having health care themselves when they're the ones providing it to our communities.

I think this, you know, helps us take a step forward in figuring out how we can address that in a real way and bring relief to the folks that we rely on to make sure that our communities are healthy. So respectfully request an aye vote. Thank you.

Thank you. As a motion by Aguiar-Curry. Seconded by Chen. Secretary, please call the roll.

The motion is due pass to Appropriations. Bonta.

Aye.

Banta. Aye. Chen. Chen aye. Addis. Addis aye. Aguiar-Curry.

Aye.

Aguiar-Curry aye. Arambula. Carillo. Carillo aye. Flora. Gonzalez. Gonzalez aye. Krell. Krell aye. Patel. Rodriguez. Sanchez. Schiavo. Schiavo aye. Sharpe-Collins. Stefani. Stefani aye.

That bill is out. Thank you. We'll move on now to Item Number 17: AB 1500 by Schiavo.

Thank you, Madam Chair and members of the committee for the opportunity to present AB 1500. Threats to reproductive health, including abortion care access, are ever increasing under the new Federal Administration. One of the first actions taken by the Administration was the removal of evidence-based and medically accurate sexual and reproductive health information from federal websites.

Just last week, we saw the Administration freeze tens of millions of dollars in Title X funding, which provides people with low incomes access to important healthcare services like birth control, cancer screenings, and STI testing and treatment. Due to the Administration's actions, seven states, including California, are not receiving any federal family planning dollars.

In addition to these new threats, there's a stunning lack of public information on existing state policies. According to a 2024 Kaiser Family Foundation Women's Health study, less than half of reproductive-age women know what the abortion policies are of their state, even in states like California, where abortion is generally available.

In response to the overturning of Roe v. Wade, abortion.ca.gov was created by Senator Caballero's SB 1142 in order to share timely and accurate information about abortion access in California, providing linkages to time-sensitive care and combating disinformation.

In light of the unprecedented deletion of medical research and health guidance, abortion.ca.gov should be used to preserve the research and guidance that we need to guide our medical providers.

AB 1500 will require that abortion.ca.gov be expanded to maintain--and maintained by a nonprofit organization with the expertise to ensure that that website is regularly updated with content that is responsive to the rapidly changing sexual and reproductive health landscape.

This site has an essential role to play as California's central repository for reproductive health guidelines and resources for both providers and the public. Here to speak on AB 1500 is Shannon Olivieri Hovis, Vice President of Public Affairs at Essential Access Health, and Alena Chavez, Program Manager at TEACH.

Thanks. You'll each have two minutes.

Good afternoon, Chair and members. Shannon Olivieri Hovis with Essential Access Health, a proud sponsor of AB 1500. For decades, Essential Access has been a trusted partner of federal and state agencies, distributing public funds and administering sexual and reproductive health programs in partnership with robust networks of providers and community-based organizations.

Essential Access has been California's Title X federal family planning program grantee for 55 years and is also proud to be the program administrator of three state abortion access grant programs. We serve on the California Future of Abortion Council Steering Committee and are grateful for the work of this committee to protect and advance reproductive equity.

AB 1500 will build on the initial success of abortion.ca.gov to ensure that the website is maintained and updated in a manner responsive to a rapidly changing sexual and reproductive health landscape and in partnership with content experts and communities who face systemic barriers to comprehensive care.

The site must continue to connect people seeking abortion care to providers and counter abortion misinformation and disinformation that have surged since Roe v. Wade was overturned. Emerging federal threats are expected to worsen the national abortion access landscape, embolden and empower fake clinics, and result in further proliferation of disinformation that harms public health by delaying access to time-sensitive care.

Already, scientific and inclusive sexual and reproductive health information, including clinical practice guidelines, data, research, have been removed and altered from federal websites, making these sites no longer trustworthy for evidence-based, unbiased information.

While many organizations quickly tried to download and post compromised information amidst widespread alarm, California can step in to serve as a trusted actor and central repository. Finally, AB 1500 recognizes the state imperative to increase public awareness about abortion.gov as a vital resource, and I will stop there. Thank you.

Perfect ending. Thank you. Go ahead.

Good afternoon, Chair and members. My name is Alena Chavez with TEACH, Training in Early Abortion for Comprehensive Healthcare, a proud co-sponsor of AB 1500. TEACH cultivates the next generation of diverse reproductive health champions through abortion training, mentorship, and curriculum development.

Our work empowers abortion providers and advances reproductive freedom in California and nationwide. AB 1500 will require the abortion.ca.gov website is maintained and updated to ensure patients and providers have access to accurate information for care.

Working with learners, existing healthcare providers, and members of my community in the Central Valley, I witnessed firsthand the responsibility and need for California to be clear about what is accurate for patients seeking care and for clinicians providing that care.

In this age of medical disinformation from the federal level and from local crisis pregnancy centers or fake clinics, having a website where both patients and providers have access to medically accurate information and resources is critical to ensuring access to sexual and reproductive healthcare for all Californians.

I am proudly from the San Joaquin Valley and have witnessed the devastating effects that a lack of knowledge and information has on my community. Tulare County has one of the highest teen pregnancy rates in California, with no access to an abortion provider for miles and only fake clinics spreading disinformation and withholding information about comprehensive sexual and reproductive healthcare.

Further, healthcare workforce shortages can be tied to a lack of accurate resources and information for clinicians who want to provide this essential healthcare to their patients. Our learners and providers who are so fiercely dedicated to their work and their communities deserve a resource hub that has medically accurate and scientific information--sorry--and medically accurate and scientific evidence-based information so they can continue to advance access to comprehensive reproductive healthcare throughout our state. Thank you so much for your time.

Thank you. Are there any others in support who would like to offer a #MeToo? Please come forward. Name, affiliation, and position.

Martin Radosevich, on behalf of Reproductive Freedom for all California, in support.

Angela Hill with the California Medical Association, in support.

Sosin Madinat, on behalf of the California Nurse Midwives Association, in support.

Tyla Adams, on behalf of Black Women for Wellness Action Project, in strong support.

Molly Maula for the American College of OB/GYN's District 9, a co-sponsor in strong support and Planned Parenthood Affiliates of California, in support.

Thank you. Are there any primary witnesses in opposition? Please come forward. Thank you. You'll have two minutes.

Thank you. Good afternoon, Chair Bonta and members of the committee. My name is Molly Sheehan, here with the California Catholic Conference. Haven't had a chance to get our letter in, but I just wanted to express our concern with this bill. The reality is that abortion.ca.gov exists, it has information there already, it's not going away.

Our concern is really with the coercive impact that a lot of these bills have on the realities of women. Right now in California, we have a website, abortion.ca.gov. There is no endometriosis.ca.gov, there is no womenshealth.ca.gov. The only resources that are provided on that website are resources for abortion.

And this makes it really difficult for moms who want to welcome their children, who want to carry to term, and are not able to find the resources that they need to be able to find a healthcare provider. We talk frequently in this committee about how there are five counties that don't have an OB/GYN.

We talk about how the average age of OB/GYNs is 59 years old, that one in four California women receives inadequate prenatal care. Yet prenatal care is not listed on this website, nor would it be. We know that 46 maternity wards--actually, it's more than that--52 have closed since 2012.

You know, rural California counties are struggling to support moms that want to welcome their children, and maternity--excuse me--maternal mortality has doubled in California. So all these realities say that whatever your view of abortion--obviously we're opposed to abortion--but whatever your view of abortion, women do need support in order to welcome the children that they hope to have, and the lack of support for them makes it very difficult, and providing abortion resources without providing the needs of these moms is reproductive coercion.

So we continue to raise this issue. We believe that California is failing at the reproductive healthcare that women need. There's over 400 abortion providers in California, facilities that provide abortion.

It's available through telehealth and on our college campuses and in numerous other ways, but the prenatal care that moms need, the support for postpartum mental health, the support for endometriosis care, for PCOS, for the things that women need for their comprehensive reproductive healthcare, is not being provided, and so I just want to raise that parity issue and say for these reasons, we would oppose this bill and encourage those things to be addressed for women. Thank you.

Thank you. Are there any others in opposition who would like to offer a #MeToo?

Sophia Lorey with California Family Council, in opposition to this bill. Thank you.

Thank you. I will bring it back to committee now for questions or comments? Moved by Addis; seconded by Aguiar-Curry. Assembly Member, I just want to give you an opportunity to be able to respond to the testimony provided.

I, I fundamentally believe that we need to have more access in all aspects of women's healthcare and reproductive healthcare and agree in that regard with the opposition and the comments and would like your thoughts on that as well.

Thank you, Madam Chair. Yeah, I mean, obviously that is the work of this committee and it's the work that we do day-in and day-out. We've seen multiple bills here today to address some of those disparities, and the opposition hasn't gotten up and raise their support to expand access in different ways or support to prevent, you know, death and illness on other issues that were here before us today.

So, you know, I appreciate their broad, you know, understanding of how we need to prioritize health right now, and I agree with all of that, and I think this is one piece of the puzzle, and you, you know, more specifically, this bill is very broad and open and really leaves a lot of space to determine what kind of information needs to be posted on the website when it comes to, you know, sexual and reproductive health and that whole landscape.

We know that, you know, family planning and basic family planning information and health data was deleted from our federal CDC websites. Basic information for families who are trying to have children and plan a family was deleted, and that is information that we need to make sure is on our website as well.

So, you know, I think this, this website is even more needed because we need to make sure that people have medically accurate information so that care can be provided in a safe way, and so it goes much beyond the abortion.ca.gov.

Also, one other point I will make is endometriosis is not being--you know, care for endometriosis is not being overturned by the Supreme Court. There is no national attack on care for endometriosis, and so if that were to happen, I'm sure we would do the same things, but right now, what we are seeing happening is really specific to abortion care.

We need to make sure that people have medically accurate information and know where they can get safe and effective care if they need it, and information about what is--what their legal rights are and all of those other pieces that are rapidly disappearing around the country, and California will continue to be a backstop to protect women here.

Thank you. Can we treat that as your close? Thank you so much. With that, we have a motion by Addis, seconded by Aguiar-Curry. Secretary, please call the roll.

The motion is do pass to Appropriations. [Roll Call].

Thank you. That measures out of this Committee. Thank you so much. We're going to move on now to item number 15, AB 1037. Elhawary as she's getting set up. Members of the Committee, we are one bill away after this one from being able to complete our hearing for the day.

So please come forward so you can make sure to vote. Assemblymember, whenever you're ready.

Good afternoon, Madam Chair and Members. I'd like to start by accepting the Committee amendments and thank the Committee for working with my office on this important bill. I am here to present AB 1037, which updates substance use disorder laws to reflect what actually works. Evidence based compassionate care that meets people where they are.

California is moving forward in how we treat behavioral health. We've passed big reforms and created new ways to reach more people. But some of our laws haven't kept up. They still carry outdated language and barriers that do real harm. I represent skid row.

I see what happens when systems fail people, when treatment is out of reach, when stigma is written into law, and when the only door left open is jail or death. Just last year, my cousin, who was like a brother to me, passed away of an accidental fentanyl overdose after struggling with cocaine addiction for years.

Ashamed of asking for help. Too ashamed to ask for help. Excuse me. AB 1037 helps remove barriers. Excuse me. AB 1037 helps to remove those barriers. It gets rid of language that shames people, whether they're just starting to seek help. Excuse me.

Updates policies to reflect current best practices and make sure our laws support healing and not punishment. People don't need more judgment. They need care, services and a path forward. Whether they're just starting to seek help or have been trying to get support for years.

The fact that this Bill touches so many parts of statute shows how broken and inconsistent the system is. We have a real opportunity to bring clarity, compassion and consistency to how we treat substance use in this state. With me today is Dr. Gary Tsai, Director of LA County's Substance Abuse Prevention and Control Program, to testify and support.

Thank you. Thank you, Chair. Thank you. Members, My name is Dr. Gary Tsai. I'm the Director of the Substance Abuse Prevention and Control with Los Angeles County Department of Public Health.

I'm a physician board certified in psychiatry and Addiction medicine, and I'm someone with lived experience with a family Member who has had challenges navigating our behavioral health system. My agency oversees a full spectrum of substance use prevention, harm reduction, treatment and recovery services for the residents of Los Angeles County.

And as we continue to face the worst overdose crisis in history, research has shown that 2/3 of people in the United States have been impacted by addiction in some way. In LA, we've launched the Reaching 95% initiative designed to increase access to services for people with substance use disorders.

Studies have found that we're only reaching about 5% of people with these conditions, with the other 95% of people with substance use disorders indicating that they either do not want services or do not think that they need those services. These numbers are not unique to Los Angeles. They're mirrored across the state and across the nation.

We know that we have to do better, and to do better, we have to fundamentally take a different approach to care by ensuring that programs are designed not just for the 5% of people who are knocking on our treatment doors, but for the 95% of people with substance use disorders who are not.

Today, across California, an individual cannot be admitted into residential or any kind of outpatient substance use treatment if they've consumed a substance over the past 24 hours. If they relapse, they could be removed from care.

Similarly, for the millions of people who are not yet ready to fully abstain from substances, providers like myself, like my staff, are barred from discussing ways that people can minimize their harms from substances. This just say no approach may work for some, but it certainly doesn't work for the vast majority. And these policy barriers are counterproductive.

People who have consumed a substance within the past 24 hours, who are seeking help, and who are interested in lowering their risk from substances are exactly the individuals that we need to be engaging in substance use treatment and care.

Nowhere else in healthcare do we ask someone to address the symptoms of their condition before they're able to access care. We don't ask individuals with diabetes to get their blood sugar below 200 before they're eligible for treatment.

We accept them wherever they are in terms of their diabetes journey, and if they eat donuts in the morning, they're allowed to continue treatment. AB 1037 redoubles efforts on proven interventions so that programs and providers can focus on serving the needs of the clients that we treat.

This Legislature previously mandated that all residential substance use treatment facilities either directly offer or effectively refer individuals for evidence based treatments such as medications for addiction treatment or mat. This was a very important step, but there are still procedural bottlenecks. AB 1037 addresses these by increasing access to these evidence based interventions and streamlining these procedural hurdles.

This will increase access to evidence based interventions such as MAT in these residential substance use treatment settings. And lastly, Naloxone was approved for over the counter use in 2023.

We're going to need you to wrap up your comments please.

In closing, the Various components of AB1037 address long standing barriers and we appreciate your support and I vote for AB 1037.

Thank you. Are there any others in support?

Andy Liebenbaum County of Los Angeles sponsor and strong support. Thank you very much.

Malik Bynum with the County Behavioral Health Directors Association and strong support and I want to express our thanks to the. Author and our LA County partners for the leadership on this. Thank you.

Aubrey Rodriguez on behalf of ACLU California Action and proud and strong support. Thank you.

Trent Murphy with the California. Association of. Alcohol and Drug Program Executives and support thank you.

Chair and Members Kathy Mossberg with the San Francisco AIDS foundation in support.

Nora Palacios with the Drug Policy alliance in. Support.

Jorge Cruz with the California Behavioral Health Association in support.

Farrah McDade Ting. On behalf of the County Health Executives Association of California in support.

Madison Whittemore on behalf of Steinberg Institute in support.

Good afternoon. Angela Hill with the California Medical Association in support thank you.

Are there any primary witnesses in opposition? Please come forward.

Madam Chair and the rest of the Committee, Sheriff Jeff Lykoff, El Dorado County Please excuse my overdress today, but I just came directly from a memorial service to honor fallen officer Marysville PD Fallen officer Asma Rodarte, who was killed in line of duty while serving a narcotic search warrant. I want to be clear.

AB 1037 is not about public health. It's about public endangerment. If this legislation passes, it will continue to victimize the communities throughout the state by green lighting the distribution of hypodermic needles, meth pipes, crank pipes and other drug paraphernalia with no regard for the families who live and work there.

In doing so, we prioritize the needs of a few at the expense of the many by placing the comfort of drug users above the safety and well being of our greater California communities. Public libraries, parks and other community spaces are already suffering under the weight of this failed harm reduction experiment. AB 1037 will only make it worse.

Just this year, El Dorado county experienced over 28 wildland fires linked to the unhoused population, many of whom are battling addiction. Thankfully, these fires were contained, but we may not be so lucky or fortunate the next time. We know that cooking illegal narcotics often involves open flames, especially among individuals experiencing homelessness and addiction.

These flames are incredibly dangerous in fire prone areas like ours. Yet the state provides nearly everything needed for this process. Foil, pipes, metallic instruments and other materials. The only thing left out of the kit is the torch. Why would we supply tools that enable high risk activity in our most vulnerable environments? That's not a public health solution.

It's a public safety hazard and it puts entire communities at risk. At a time when the opioid and fentanyl epidemic is claiming thousands of lives across California, the last thing our state should be doing is softening this message around illegal drug use. This bill abandons prevention, abandons accountability, and abandons clarity.

It sends a dangerous and misleading message, especially to our youth, that illegal drug use is somehow acceptable or even state sanctioned. That is not harm reduction, that is harm enrichment. Law enforcement will be stretched thinner and more time spent responding to overdoses, fires and disturbances and less time helping those who truly need protection.

Let me remind you, voters have spoken. Prop 36 emphasized accountability. It demanded balance. AB 1037 undermines those reforms and takes us backwards. We should support recovery. We should show compassion, but we cannot sacrifice public safety to do it.

AB 1037 is a step too far and I urge our leaders to reject it for the safety of our families, our communities and California's future. So I sincerely ask for your no vote on this bill. Thank you.

Thank you.

Briefly, Madam Chair, Ryan Sherman with California Narcotic Officers Association. I want to align our comments with the sheriff's and then just make a brief statement. CNOA opposes AB 1037 because it abandons California's emphasis on the importance of prevention and a consistent message that illegal drug use is not acceptable.

And that softening this message at a time of crisis is the last thing that we believe the state should be doing. For those reasons and the reasons in our belated letter, we respectfully request a no vote. Thank you.

Thank you. Are there any others in opposition who would like to come forward at this time? Seeing none, I will bring it back to the Committee for any questions or comments. Moved -Moved by Addis. Seconded by Arambula Assemblymember Krell. Put your mic on, please.

Sure. I was just going to comment. Thanks to the author for bringing this Bill forward and for all her work on it. I initially shared some of the concerns that the sheriff brought up today, I think with the amendments, at least for me, those concerns have been alleviated.

I agree that voters passed Proposition 36 for more accountability, but I think that we wanted to. I don't think we wanted to create more felons. I think we wanted to create less drug addicts. I think that that's what this bill is about, bringing people into treatment, allowing them to stay there.

I note that one of the amendments took out the prohibition on 24 hours clean and sober for certain facilities. I think that's a step in the right direction. And also another amendment changed the part about syringe distribution. So I think that also addresses some of the concerns that the sheriff addressed.

I'm going to be voting for this bill. I appreciate you bringing it forward and I look forward to continuing to work with you on these issues.

Thank you. I want to acknowledge County Sheriff. Thank you for coming forward and for recognizing the loss of our officer. It's very much appreciated that you've come from, from the memorial service that I know that many of us would have liked to be at as well.

So thank you for being here and testifying and I also want to thank the author for bringing forward this bill.

We in the last couple of years have really focused on issues related to public safety and the impacts related to drug use on public safety as well as how health oriented approach to being able to figure that out. And Assemblymember, you've presented a very comprehensive bill with several different components to it.

I think I want to appreciate the fact that you continue to work with our Committee to get this to a place that it would be able to be supported by all of our Committee Members as Assembly Member, as Assembly Member Crell indicated. And I will be supporting this Bill as well.

Know that there's some additional work that we will continue to do on this and know that this is a passion area. I also want to acknowledge and appreciate that you started out your own authorship statement with expressing the loss of a loved one as well.

So I know that this is coming from a very real and personal place for you. And with that I want to give you an opportunity to close after I ask you have you accepted the Committee's amendments. Thank you. Let's put your mic on.

I'm so loud I didn't even notice. AB 1037 is about meeting people with dignity and care, especially those who've been pushed to the margins for far too long. Let's build a system that saves lives, not one that waits until it's too late. I respectfully ask for your aye vote. Thank you.

Thank you. The motion is from Addis and Arembula. Secretary, please call the roll motion is.

Due Pass is amended to the Judiciary Committee. Bonta.

Bonta. aye. Chen. Chen. No. Addis. Addis. aye Aguiar-Curry. Aguiar-Curry. aye. Arambula. Arambula. aye. Carrillo. Carrillo. aye Flora. Flora. Flora. No. Gonzalez. Gonzalez. aye. krell. Aye. krell. aye. Patel. Patel. aye. Rodriguez. Sanchez. Sanchez. No. Schiavo. Sharpe-Collins. Stefani. Stefani. aye.

Aye.

That measures out thank you so much. We are going to move on now to item number two, AB 55. Vice Chair Chen.

Madam Chair, at your pleasure.

Thank you, Vice Chair and members. AB 55 will streamline licensing requirements for alternative birth centers or ABCs, increasing access to maternity care and creating additional birthing options where they are needed the most by removing the requirement that all ABCs must be a comprehensive perinatal service provider.

Current law mandates that an alternative birthing center must be a comprehensive perinatal service provider, which requires them to be Medi-Cal providers. This requirement is very burdensome to our alternative birth centers that do not serve Medi-Cal patients and significantly delays the licensure process.

Furthermore, birth center owners who intend to serve Medi-Cal patients report that the CPSP requirement unnecessarily duplicates practices already included in the midwifery model of care that exceeds CPSP standards currently. Of note, hospitals are not required to be CPSP providers as a condition of licensure.

Alternative birthing centers provide maternity care for birthing people specializing in childbirth geared to care for low-risk patients in an environment that is less restrictive or medicalized and more homelike than a hospital.

Alternative birth centers provide excellent outcomes for birthing people and infants, including reduced preterm and low birth weight rates, decreased C-section rates, increased breastfeeding rates, and over $2,000 in cost savings to Medicaid for every birth when compared to typical care.

When maternity wards close, alternative birth centers that are no longer within 30 minutes of a maternity ward lose their licensure status and new birth centers cannot acquire the license in those poorly resourced areas as long as a maternity hospital is not nearby.

Furthermore, with the closure of maternity wards across the state, prenatal and postpartum care providers typically disappear from those areas as well. This impacts rural communities as well as urban and suburban.

This bill also removes the difficult requirement that an alternative birth center must meet a 30-minute time and distance requirement from a hospital--from hospital to birth centers, but maintains a very strict standard for eligibility for alternative birth centers--only the lowest risk patients give birth in alternative birth centers--and adds additional requirements for transfer plans that are already required for home births.

This bill is co-sponsored by the Western Center on Law and Poverty, the American Association of Birth Centers, the California Chapter, Black Women for Wellness Action Project, California Black Women's Health Project, California Association of Licensed Midwives, and the California Nurse-Midwives Association.

Testifying in support with me today are Sandra Poole from the Western Center on Law and Poverty and Holly Smith with the California Nurse-Midwives Association.

Good afternoon, Chair and members. Sandra Poole, Western Center on Law and Poverty. We are proud to support and co-sponsor AB 55, the Freedom to Birth Act, and believe it will play a vital role in improving access to care in light of the current maternity crisis in California.

During the pandemic, demand for out-of-hospital maternity care increased dramatically and continues to remain high today. According to the CDC, home births increased by 21% overall, while the rate of home births for Black and Hispanic women increased by 38 and 30% respectively.

In California, the capacity for birth centers to accommodate this demand has been significantly restrained by unnecessary, ineffective, and obstructive statutory constraints. Data collected in California has found that among people who have previously given birth in a hospital have interest in receiving future care from a midwife or in a birth center, and this was highest among Black women.

At the same time, not only do they experience significantly higher rates of maternal mortality and morbidity, but Black women in California giving birth in hospital settings report significantly higher incidence of discrimination, disrespect, and lack of communication from providers.

The proposals in AB 55 to streamline requirements for licensing ABCs do so without compromising the safety of a birthing person or child, and by passing AB 55, policymakers have an opportunity to restore the rights of pregnant and birthing people to make informed and autonomous decisions in choosing their birth settings and providers. I would like to thank Assembly Member Bonta for her leadership on this very important bill and ask for your support.

Chair and committee, thank you again for the opportunity to address you regarding AB 55 and midwifery and birth center access, and big thank you to the Chair for carrying this bill as well. Again, I am the Legislative Coordinator for the California Nurse-Midwives Association, a co-sponsor of this bill.

On behalf of CNMA and our other co-sponsors, we appreciate the Legislature's continued support for advancing midwifery care in California in recent years. All of your actions recognize the potential of this workforce to improve birth outcomes in the state. However, we face significant regulatory barriers that impede access to community midwifery care.

A primary obstacle lies in the licensing requirements for freestanding birth centers. These requirements are unnecessary, hindering the establishment of new centers and creating substantial burdens for existing ones. For example, a birth center in the Bay Area experienced a four-year delay in licensure. This is compared to the 12 to 18-month timeframe for hospital licensing.

Licensure is crucial for financial sustainability. It enables reimbursement by Medi-Cal and other payers for facility fees which cover essential operational costs of the clinic. Sadly, over 20 freestanding birth centers have closed in the past three years across the state, compounding the fact that maternity units are also closing at a rapid clip.

And every time a community birth center closes, it reverberates through the community because they aren't just sites of birth; they are sites for prenatal care, postpartum care, contraceptive care, and comprehensive reproductive and sexual healthcare. This bill proposes technical changes to modernize language and removes that CPSP requirement as well as the time-distance requirement.

These changes are essential. To illustrate, until recently, licensed midwives couldn't even be CPSP providers, creating a near impossible barrier for their birth centers to receive CPSP status and therefore licensure. CPSP was created in 1987 to improve outcomes, especially for low-income people receiving standard prenatal care and birthing in hospitals.

While it was an innovation then, CPSP standards are now a minimum level of expected wraparound care and something already included in the midwifery model of care. Additionally, a 2023 auditor report--

If you could you please conclude your statement?

All right.

Thank you.

So, given the concerning trend of maternity unit closures in California, the time-distance rule for freestanding birth centers effectively guarantees the closure of even more vital sites for safe births. Other states that have better birth outcomes and better midwifery integration do not have these time-distance standards and achieve hospital-level outcomes nonetheless. Removing these barriers will create a viable pathway to licensure and sustainability, and respectfully request your aye vote.

Thank you so much. Do we have other witnesses in support? Please line up.

Martin Radosevich, on behalf of Reproductive Freedom For All California, in support.

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

Pat Whalen, on behalf of UNAC/UHCP, in support.

Shannon Olivieri Hovis with Essential Access Health, in support.

Christine Smith, Health Access California, in support.

Lan Lee, on behalf of Asian Americans Advancing Justice, Southern California, in support.

Good afternoon, Madam Chair. Tyla Adams, representative of Black Women for Wellness Action Project, proud co-sponsors, in strong support.

Maria Flores, here on behalf of Hispanas Organized for Political Equality with strong support.

Kathy Mossburg, on behalf of the Local Health Plans of California, in support.

Molly Sheehan with the California Catholic Conference, in strong support. Thank you.

Annie Fisher with Indivisible California StateStrong, strong support.

Good afternoon, Mr. Chair and members. Jonathan Muñoz, on behalf of First Five California, in strong support, and we thank the author for her leadership on this.

Omar Altamimi with the California Pan-Ethnic Health Network, in support.

Megan Bochum, on behalf of California Association of Licensed Midwives, in support.

Angela Pontes, on behalf of Planned Parenthood Affiliates of California, in support.

Do we have a key witness in opposition? Seeing none. Do we have any #MeToos for opposition? With that, I'll take it back to the committee. Members, we have any questions? Seeing none. Madam Chair, would you like to close?

Thank you so much. We are at a critical time. We are at a critical time where we need to make sure that we have every opportunity to be able to bring our beautiful babies into this world. Currently, 12 counties, most of them rural, do not have any hospitals delivering babies. These are places where we've had the closure of many facilities, alternative birth centers. Marysville, Rocklin, San Francisco, Sonora have facilities right now, but San Diego, Sacramento, Corona, Santa Rosa, Marin do not.

We want an opportunity to make sure that everyone has this opportunity to deliver in a place that is safe for particularly low-risk births and provide the kind of access to care that we know every Californian deserves. With that, I respectfully request your aye vote.

Thank you, Madam Chair. I've been told that we wanted to ensure that you would accept all the committee's amendments?

I will consider it. Yes, I will.

Thank you, Madam Chair. Secretary, please call roll.

The motion is do pass as amended to Appropriations. [Roll Call].

That bill is out. Thank you, Madam Chair.

Thank you. We have heard all bills now, so we will just register our votes for all of the bills and we will begin with the consent calendar. Secretary, please call the roll.

[Roll Call]

The consent calendar is still out. We'll move on now to item number one. AB54. Krell. It needs a motion. zero. Motioned by Aguiar Curry. Seconded by Schiavo.

[Roll Call]

That measures out. We did item two, AB55 Bonta. So we will move on to AB item number three. AB260, Aguiar Curry for add ons. Oh. With a motion from Patel and seconded By Schiavo. This is our first vote.

[Roll Call]

Item number three. AB260.