Senate Standing Committee on Health

The Senate Committee on Health will come to order. Good afternoon, everyone. Two bills were pulled from today's hearing. That's going to be file item 4, which is AB539, and file item 11, which is AB1415, which means after all the consent items are pulled aside, we have five bills up for presentation today.

Shouldn't be too long of a day. We have three authors ready to go. We're going to start off with Assembly Member Pacheco, who has file item 1, AB 64. This is Assemblymember's first time in this Committee, in this room. Welcome. When you're ready. Assembly Member, the floor is yours.

Thank you. Good afternoon, Madam Chair and Members of the Committee. I am here to present Assembly Bill 64. This is my third introduction of the Bill, which reflects my sincere commitment to this policy, but my first time presenting in the Senate. So, I am excited to be here. First time here in this hearing room.

And you know, as the saying goes, third time's a charm, right? I want to thank the Committee staff for all their hard work on this Bill. I commit to making the amendments that have been shared with Members of the Committee, which address the County Clerk's implementation concerns.

For nearly four decades, California has been officially misspelling the names of residents on their most important documents. AB 64 will allow the inclusion of diacritical marks on vital records, such as birth certificates, death certificates, and marriage licenses, because people have a fundamental right to have their names recorded accurately.

Many states, including Texas, Illinois, Kansas, Hawaii, North Carolina, Oregon, Alaska, Utah, Arkansas, Delaware, and Maryland, allow diacritical marks. As the most populous and diverse state in the nation, California should be leading among these states, not lagging behind.

California included diacritical marks on vital records until the practice was discontinued in 1986 when English was declared our official language, diminishing the rich, multicultural heritage of so many residents. For 39 years, we've been asking Californians whose names include diacritical marks to accept the misspelling of their names on official records.

For seven years, one of our witnesses has been coming to Sacramento asking for the basic dignity of having his name spelled correctly. I am hopeful that Californians won't have to wait much longer. And with me today, I have two witnesses who can attest to the real impact this issue has on Californians.

I have here with me Martin Devlin and Jose Escobedo, who will be testifying in support of this Bill.

Thank you, Assemblymember. You two have a combined time of five minutes. It's up to you how you want to divide it.

Good afternoon. My name is Martin Davlin. I was born and raised in Ireland, but I immigrated to California in 2001 to pursue my career as a software engineer. I am proud to have made California my permanent home, as I see California as forward looking, innovative, and a place that respects its diverse population.

In April 2021, myself and my wife Katie were overjoyed at the birth of her first child. We did not decide on his name until after he was born, but we were already sure we wanted him to have an Irish Gaelic name. Giving him an Irish name was an important way to honour his heritage.

So, we decided on the name Dáithí. Dáithí is an old Irish name. It is spelled with a diacritic mark on—called a fada—on the last letter. In the Irish language, this diacritic mark is just as important as any letter.

I could not describe my absolute shock when we were informed that our chosen name was not allowed to be spelled correctly on his birth certificate. I was stunned. As we sat in the hospital, we immediately felt an implicit pressure to change his name to something else, one without a diacritic mark.

But why should we have been made to feel this way? I felt angry at the very notion that this very important decision, the name for my child, wasn't solely the decision of the parents to make without interference. Today, my child's name is spelled incorrectly on his birth certificate. Recently, we enrolled him in transitional kindergarten.

We were again compelled to spell his name incorrectly in the school enrolment system as it must match his birth certificate exactly. Presumably, we will repeatedly have to remind teachers of the correct spelling. This annoyance causes confusion for the child also.

The government should not be in the business of telling parents what cultural affiliation their children's names must conform to or how those names must be spelt. It is an artificial constraint and completely unnecessary. Also, it comes across as deeply disrespectful. Please pass AB 64 out of respect for California's diverse population. Thank you.

Good afternoon. My name is Jose Escobedo. Eight years ago, when I was just 12 years old, I sat in front of this very Committee in support of passage of Assemblymember Jose Medina's Bill, AB 82, that would have allowed the inclusion of diacritical marks on state documents.

When I first testified, I thought all it would take would be for a little kid to ask for his name to be spelled correctly. It seemed like a no brainer. But almost a decade later, here we are again, still fighting to make it happen.

I am now 21 years old and I'm a student at the University of Oregon, here testifying for Blanca Pacheco's Bill, AB 64. And by the way, I was really surprised when I found this out.

It turns out in Oregon, you're actually able to add an accent mark to your name on state documents, if you choose to do so. I've always been proud to be from California. It's a place that celebrates its diversity.

And that's why I think it's backwards that such a progressive and inclusive state would keep people like me from having our name spelled correctly. These accent marks represent my family, my culture, and my traditions. And ultimately, they represent me.

Still, you might ask, what's the big deal if an accent mark is not on the birth certificate or marriage license? And the accent mark itself is not a big deal. If your name should have an accent on it, you should just be able to add it. No big deal.

What's a big deal is how hard the California State government has fought to keep these diacritical marks off, and it is particularly hurtful and insensitive at a time when diversity and inclusion initiatives are being banned across the country. It's more important than ever that the State of California continues to advocate for many cultures of its residents.

And that includes allowing people to record their names correctly. While my name on my birth certificate doesn't have an accent, I'm hoping that with your help, on my marriage license, at least it will. I've been asking you to take action on this matter for now nine years, and all I've gotten from you is no way, Jose.

I thank you for your time and consideration.

Beautiful close. At this time, at this time, I'd like to welcome anybody in support of this Bill for a Me Too." Name, organization, and your position, please.

Good afternoon, Chair and Members. Karen Stout, here on behalf of Unidos U.S. We're in strong support.

Mark Gonzalez in strong support.

Please strike that from the meeting.

I'm Jodi Hernandez. I'm Jose's mom and I am in strong support. Awesome, thank you.

Seeing no one else. Oh, gonna give it a minute here.

My name is Joseph Hernandez. I'm a grandfather of Jose and I also support this Bill.

Thank you, sir.

Good luck, Jose.

I'm Matteo Escobedo. I'm his brother and I'm in strong support of this Bill as well.

Got strong family support behind you. Now is the time for any formal opposition on this Bill. Please step forward. Any "Me Toos" in opposition? Bringing it back to my colleagues here for any questions to the Assemblymember. Senator Durazo.

I just thank you very much. Both of you.

Jose, I'm glad that you were persistent and you've continued to come. I'm also sorry that you've had to come so often. I think third time's hopefully the triumph. That is my fair number as well.

And Assemblymember, I know you've had to take additional amendments to this and you're just looking to ensure that we change the story for Jose, for you and so many Californians that want their name to be just adequately spelled out. So, I want to thank you for your Bill. Senator.

I have an accent in my name too. Maria Elena, so it's over the "I". So, that's another reason. Thank you.

Assemblymember, you may close.

Thank you again for this opportunity for me to present this very important Bill. I've been working on this Bill really hard. I've been taking a lot of amendments and so, I respectfully ask for your "Aye" vote.

Thank you, Assemblymember. We don't have a quorum just yet. When we do, we'll entertain a motion. Thank you for your presentation. Thank you for coming up once again. Up next, we have File Item 2 with Assemblymember Zbur, for AB 309. Assemblymember, whenever you're ready, you may begin.

Thank you, Madam Chair. Members, I'm proud today to present AB309, 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 costs related to HIV treatment for just one person is over $326,000.

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 increasing rates of drug use, AB309 will ensure that our state maintains critical public health tools.

One removing the Sunset on the statute, which allows pharmacists to sell sterile syringes without requiring a prescription, and removing the sunset 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 research driven and effective HIV and hepatitis prevention and ensure that Californians continue to have access to sterile syringes with me today to testify in support of the bill is is Michelle Rivas on behalf of the California Pharmacists Association and Laura Thomas on behalf of the San Francisco AIDS foundation.

Ladies, you have five minutes. Thank you very much. Michelle Rivas with CPhA. CPhA is proud to serve as a co-sponsor of AB 309. We appreciate the opportunity to speak to you today.

AB 309 removes the Sunset on a vital public health provision allowing pharmacists to continue providing non prescription access to syringes, an important tool not only for disease prevention, but also for ensuring patients adhere to prescribed medication regimens.

Pharmacists play a critical role in supporting adherence by ensuring patients have access to the tools they need to administer medications such as insulin and hormone therapies. This is especially important for patients reliant on mail order pharmacies who may be left without survival. Syringes are for those traveling from out of state.

Without access to syringes, patients may delay or miss doses leading to poor health outcomes. Allowing pharmacists to provide syringes without a prescription ensures that patients stay on track with their therapies. In addition, this bill continues to support safe syringe access as a public health measure to prevent the spread of HIV and hepatitis B and C.

Pharmacists also offer guidance on syringe disposal and access to to drug treatment and testing services. This is not only sound public health policy but also fiscally prudent. For instance, the cost of treating hepatitis c is approximately $20,000. I'm just talking about the medications here with treatment for resistant variants reaching up to $100,000.

AB309 is a common sense measure that supports treatment adherence, protects public health and leverages pharmacists as trusted and accessible health care providers. We respectfully ask for your vote.

Thank you. Thank you. Senators. I'm Laura Thomas with the San Francisco AIDS Foundation. We are proud to be a co-sponsor of this bill as we were the previous iterations of this bill, because we understand that this is an essential element of HIV prevention.

The State of California has made great strides in reducing new HIV transmission as well as new Hep C transmissions and this initiative at pharmacy access to syringes is a core essential part of that. San Francisco AIDS foundation has operated syringe access and harm reduction programs for decades and we are proud to do that.

But we also know that the pharmacy syringe access is an essential component of the overall state strategy here. One of the reasons for that is that particularly in rural areas where there is less access to Healthcare programs and other harm reduction programs.

Pharmacies continue to be one of the most utilized sources of sterile syringes and other important health prevention activities. Syringe access as a component of HIV prevention has been heavily researched. It's very settled science at this point in time.

We know that these types of programs reduce syringe sharing, reduce HIV and hepatitis C transmission, they increase access to drug treatment. They make no. They do not increase drug use, they do not increase drug sales, they do not increase syringe litter.

And this is a particular issue, again, in terms of equity in access for rural areas where they may have access to a pharmacy, but they may not have access to a funded harm reduction program. So in the interest of helping California get to zero with new HIV transmissions, we ask for your support for this bill. Thank you.

Thank you so much.

Ladies, come on up for a me too. In support.

Clifton Wilson on behalf of the City and County of San Francisco, in support. Thank you.

Good afternoon. Glenn Baccus for Drug Policy Alliance co-sponsor. And on behalf of Smart Justice California in support.

Isabella Argueda with the Health Officers Association of California. We're a proud co-sponsor. Thank you.

Good afternoon. Symphoni Barbee on behalf of Planned Parenthood Affiliates of California in support.

Kelly Brooks on behalf of the Counties of Los Angeles and Santa Clara, here in support.

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

Kathy Mossberg, APLI Health in support.

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

Angie Minetti on behalf of the Steinberg Institute in support.

Craig Pulsar on behalf of Equality California in support.

George Paramthu on behalf of ACLU California Action in support. Thank you.

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

Dennis Cuevas Romero on behalf of the California Primary Care Association Advocates in support.

Now would like to turn over to any formal opposition, like to give testimony for any of those who would like to record a MeToo in opposition to this bill. Okay, bringing it back, Madam Vice Chair.

Well, thank you. Two things. One, why wouldn't we just extend the sunset rather than getting rid of it? What's the intent of.

I think basically we've got over, you know, this has been in place since 2004. So we actually have 20 years of experience with this program. There are numerous studies of it that show that it's effective, that it hasn't caused any harm, it hasn't, you know, caused increase in drug use.

So all of the issues that were raised as a concern we've Shown, I think over, I think 54 extensions now that this is a solid program and it doesn't cause any of the harms that people were worried about.

Okay.

And then I have a question in terms of accessibility because I'm just not understanding how it's not readily accessible to people because I just went on Amazon and I could buy 100 insulin syringes for $25. So I'm just not making the connection on is it, Are they accessible? Are they not accessible?

I'm going to let my experts respond to that question.

I don't know if there would be medical grade syringes that you're buying off of Amazon. I think that's probably where the issue lies. Got it. Okay. Thanks for that clarification.

Thank you, Senator.

Dr. Pearson. Thank you, Madam Chair. I want to thank the Assembly Member for bringing this bill forward. When I was reading through the letters of opposition, who I guess aren't here today, they mentioned something about, you know, it being taxpayer funded.

How is this something that people purchase when they come to the pharmacy, they ask the pharmacist and you purchase the syringe, or is there a special Fund? How is this funded?

Do you want to go ahead and answer that?

Thank you, Doctor for the question. Yes, they are purchased at the pharmacy. However, I think if there are syringes that are provided free of charge to a community Member that is through a harm reduction program. But if they go into a pharmacy, they are purchasing the syringes. Thank you.

Yeah, there's no cost to the state or the taxpayer for these programs. There are some other programs in the State of California, some that are funded through opioid settlement funds. Again, not a taxpayer cost, but for this, it's an individual, it's me walking into Walgreens to purchase my own syringes. And so there's no cost.

Thank you, Doctor. I was going to just bring up that point as well because I know that was flagged the opposition. But in fact, people are actually purchasing this. And since 2010-2012-2014-2019, study after study have proven that these are successful programs. In fact, we've compared these programs to other states, for example Florida, that don't have these programs.

And we've seen by and large that there's more syringes disposed inappropriately in states that don't have this program versus states that have these kind of programs. There hasn't been an increase of crime. These are the Walgreens, the cvs, these are pharmacies. These are regular, everyday entities that don't are not bringing additional crime to the community.

The removal of the sunset is just that. We don't have to come back and put energy into something that should just be in place since it's been in play for 21 years now. So with that Assembly Member, I'd like for you to close.

I think I'll rely on the Chair's closing as mine. So thank you very much and thank you for considering this bill today and want to thank the sponsors and the those that testified in support of the bill today.

Assemblymember, once we have a quorum we'll entertain a motion. But for now, thank you so much for your presentation.

Thank you very much.

Moving along. Assembly Member González, you have file item 5 with AB 543. Go ahead, Assembly Member.

Thank you, Madam Chair and Members. I am pleased to present this afternoon AB 543, which will ensure that people experiencing homelessness can access immediate life saving Medi-Cal services through street medicine providers without unnecessary delays or administrative barriers.

I'd like to thank the Chair and Committee staff for their thoughtful work on this bill, and I will be accepting the Committee amendments. California's homelessness crisis has reached record levels, with over 187,000 individuals unhoused, two thirds of them unsheltered.

Homeless individuals face far worse health outcomes, including high rates of chronic illness, disability, and a 12 year shorter life expectancy. While 70% of unhoused people are enrolled in Medi-Cal people, fewer than 10% can access care from their assigned primary care provider compared to over 80% of the general population.

Street medicine providers are often the only accessible care, but are blocked from ordering basic services like x-rays, medications, or specifically referrals because they're not listed as the patient's assigned provider. This leads to worsening conditions, preventable emergency room visits, and higher costs, both human and financial. To address these issues, AB 543 makes three key reforms.

One, it establishes presumptive eligibility for people experiencing homelessness, allowing street medicine providers to immediately enroll and treat patients. Two, it removes network barriers so that the street medicine providers can directly order medically necessary services for their patients. And lastly, creates a homelessness identifier, Medi-Cal, and public assistance systems to improve data sharing, care coordination, and access to critical services.

Without these changes, people are left to risk their health or or face dangerously delays waiting for care. With me this afternoon representing 175 organizations from 35 counties to testify in support of AB 543 are Brett Feldman, director and co-founder of USC Street Medicine, and José Luis González, vice president of clinical services and medical director at Healthcare in Action. Take it away.

Chair Menjivar, Vice Chair Valladares, and Member of the Committee, thank you for the opportunity to testify today. My name is Dr. José Luis González. I am a primary care physician, board certified in internal medicine and addiction medicine. I am the vice president and medical director of Healthcare In Action.

Healthcare in Action, or HIA, is California's largest street medicine organization, consisting of 22 teams spanning across six counties. We provide social support, including enhanced care management and community supports to the unhoused population, as well as provide primary care, addiction and mental health services to unhoused individuals.

HIA uses mobile vans to provide services to patients wherever they reside, including streets, tents, personal vehicles, and encampments. I am privileged to testify today on behalf of HIA in support of AB 543. This bill improves access to Medi-Cal coverage and services for unhoused individuals.

AB 543 would allow street medicine providers to provide services to unhoused patients regardless of their primary care provider or IPA assignment, directly refer unhoused patients to specialists, and order necessary medical equipment such as wheelchairs and wound care supplies.

These changes are important because unhoused patients have difficulty accessing their primary care provider due to lack of reliable phone service and transportation. In contrast, street medicine providers meet patients where they are, both physically and emotionally. I want to share a short story of a patient I met in an RV in San Diego.

Mr. Gardner was referred to us by an outreach organization due to chronic bilateral lower extremity wounds. As I began changing his dressing, I asked him his story and how things had gone so bad, primarily to distract him, partially to distract him from his pain. His wounds had been there over had been there for over a year.

He explained to me that he had no idea how to get to his PCP to refer him to wound care nor who his PCP was, so he managed the best he could. Six months later, his wounds were so bad he was hospitalized. Upon discharge, the hospital placed an order for wound care. However, the care team would not see him in his RV because it did not have a fixed address. As I looked up, I noticed tears trickling down his face, not because of the pain, but because he was finally receiving the care he had been seeking all this time.

Mind you, this is a gentleman with full scope Medi-Cal insurance. AB 543 would have allowed him to get these services much sooner. Thank you for this opportunity to testify. I will now turn to my colleague Brett Feldman to share some additional examples of how AB 543 will help our unhoused patients.

Great. Thank you very much. My name is Brett Feldman. I'm the director of street medicine at the University of Southern California and vice chair of the International Street Medicine Institute. I've been practicing street medicine for almost 20 years. I would like to share what I've witnessed are the consequences to strict network assignment within or strict PCP assignment within our managed care networks.

Tomorrow I will go to the streets as I always do, and we'll see a young lady who suffers from what seems to be seizures. Because I'm not her assigned PCP, I'm not able to order the EEG or the neurology referral that she needs. But I have to treat her as if she has that official diagnosis anyway because if I don't, the postictal phase will leave her dazed and confused and at risk for being raped, as she has been for the past three years before we met. I'll also see another gentleman, and we've been working together. His hypertension's controlled.

His bipolar disorder is controlled. I even have him on medication assisted therapy, and he stopped using methamphetamines. And yet, when he sustained a hand fracture while working as an electrician, because I was not his PCP, I was unable to order him a simple x-ray or a referral to orthopedic surgeon, leaving him with a permanent disability and unable to work. And then I will also see an older gentleman who suffers from urinary incontinence.

And the indignity of only having two pairs of pants, nowhere to wash them, and no bathroom to go in. Because I'm not his PCP, I'm not able to order the diagnostic testing he needs or an urology referral to find out why he's having this incontinence, which could be related to cancer. I also can't order briefs because they're considered durable medical equipment. AB 543 solves this by allowing street medicine providers to order medically necessary services for the people we serve, regardless of PCP assignment.

Thank you so much for your testimony. Is there anyone in the room who would like to record their me too in support of this bill?

Thank you very much. Vanessa Cajina on behalf of the California Academy of Family Physicians, letter forthcoming. Proud to be in support.

Clifton Wilson on behalf of the California State Association of Psychiatrists as well as the City and County of San Francisco, both in support. Thank you.

Good afternoon. Whitney Francis with the Western Center on Law and Poverty in strong support.

Good Afternoon. Kelsey Avery with SCAN. Healthcare in Action is a proud member organization of SCAN, and we are in support.

Nicette Short on behalf of Adventist Health in support.

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

Symphoni Barbee on behalf of Planned Parenthood Affiliates of California in support.

Tyler Aguilar on behalf of the University of Southern California, co-sponsor in support.

Glenn Backes for Drug Policy Alliance, Smart Justice California in support.

Geoff Neill representing the County of San Diego, also in support.

Chair and Members, Jael Dantas with Full Moon Strategies on behalf of Alameda County in support.

Vanessa Gonzalez with the California Hospital Association in support.

Good afternoon. Amer Rashid with the County Behavioral Health Directors Association in support. Thank you.

Good afternoon. Angie Manetti with the Steinberg Institute. Thank you.

Good afternoon. Danielle Bradley with the California State Association of Counties in support.

Thank you so much. Do we have any formal opposition? Any me toos?

Dennis Cuevas-Romero with the California Primary Care Association Advocates and also here on behalf of the County Community Clinic Association of Los Angeles County. Really just want to say thank you to the author, his staff, and Committee staff. We're going to be removing our opposed unless amended positions. So really appreciate the work. Thank you.

Thank you so much. Bringing it back to my colleagues for any questions. Ms. Senator Vice Chair.

More rather a comment than a question. I just want to thank the author for working so closely with the opposition to try and get this to be the best bill possible, and I'll be supporting it. And just wanted to acknowledge that you've worked really hard on it.

Thank you so much for working with us here and taking these amendments. You know, we wanted to make sure that the bill would be able to move forward should something happen on the federal side and make sure that we have those protections and also make sure that there's a plan in place right between the MCPs, the providers to make sure you're doing it aligned and you're able to provide the services necessary. Thank you for bringing your testimony, your lived experiences. Assembly Member, I try to do that in one breath like you did with your presentation. But you may close now.

I want to end it this way, a little bit different. But look, I want to thank the Members, the staff, and everybody here who came together, and thank you to the folks who pulled off their opposition on that piece because we did amend it. Earlier this year, I had the honor to walk alongside the individuals that you see here. But we walked the sunlit sidewalks of Los Angeles side by side with the heroic USC street medicine teams in my district in Pico Union MacArthur Park. I saw courage in the eyes of an elder individual who feared that they would never walk again.

And I watched hope bloom on the face of a young man when a simple bandage became his lifeline. Those moments, born of compassion and carried on the breath of sí se puede remind me that every life is sacred. Every neighbor is a precious jewel in California's crown. AB 543 ignites a beacon of hope across our state that reaches out to the unhoused before bureaucracy can say wait. That removal of network walls that block life saving services. This bill is not just policy, it's a promise.

A covenant of mercy that unfolds with each x-ray ordered under the curb, each prescription handed over without delay, each wound dressed under the open sky. Today we have that power to rewrite destiny for thousands of Californians living without shelter, ensuring that they are not invisible, not forgotten, and never left behind. And in doing so, we answer the call of our better angels and shine a light so bright that even in the darkest night and every encampment transforms into the morning. So thank you, and I respectfully ask for your aye vote.

Thank you, Assembly Member. We'll entertain a motion once we have quorum. Thank you for your presentation.

Thank you, Madam Chair.

Assembly Member Papan, you're up with file item 7, AB 787. We're moving along, moving along.

Good afternoon, Madam Chair. I don't know if I can be as poetic as Assembly Member Gonzalez, but I'll do my best. So I want to first start--are you ready for me? I'd like to first start by saying I will accept the committee's amendments which are, number one: to clarify the directory statement requirements, number two: adjust the response time for the plans, and three: apply the bill's directory statement provisions to dental plans in addition to the medical plans captured by the bill.

I'd like you all just to take a moment, if you would, and imagine being sick, in pain, or struggling with your mental health and spending hours calling doctors offices to get an appointment only to find that the person is out of network, not accepting new patients, or worse, not even practicing anymore.

This negative experience isn't just frustrating, it's a crisis. Studies show that nearly half of provider directory listings are inaccurate, with some plans reaching error rates as high as 98%. Patients pay for insurance expecting access to care, not to go on a wild goose chase.

This problem hits hardest for vulnerable communities, people with disabilities, low-income families, communities of color, and those seeking mental health care who already face serious barriers. Inaccurate directories can lead to surprise bills, coerced out-of-network care, and financial harm for patients who did everything right. AB 787 offers a simple but powerful fix.

First, it requires health plans to inform patients that they can request help finding in-network care and explain the rights--the patient's rights--for out-of-network care. Number two, it mandates fast action.

Plans must acknowledge the request for help within one business day and provide a list of available providers to patients within two business days for urgent requests and five business days for non-urgent requests. The patient gets to determine the urgency--thanks to the amendments of the--requested amendments of the chair--the patient gets to determine the urgency of their needs, giving them the agency to receive timely assistance when needed while allowing the plans more flexibility when possible.

The result? Quicker care and a healthcare system that actually works when people need it most. AB 787 ensures patients can get the care they're paying for accurately, fairly, and without delay.

With me to testify today is Kate Van Deynze, who is the Senior Policy and Legislative Advocate for Health Access California, and Sara Sorokin, Associate Member of the National Union of Health Care Workers. So we'll take it away to Katie first.

Hi. Good afternoon, Senators. I'm Katie Van Deynze with Health Access California. We're proud to support AB 787. We support this bill because it'll ensure that consumers know that they can reach out to their health plans for help to find a provider within the provider directory and receive listings in a timely manner and that are accepting new patients.

Health Access California co-sponsored the law back in 2015 to establish the provider directory requirements, ensuring updates to the provider directory listings and verification of that information. However, unfortunately, we found that there are large numbers of inaccuracies in these directories, causing barriers to care for consumers, and while these directories are meant to help facilitate care, it has been left on the consumer and some providers to try to help find a provider that the consumer can access to address their health needs.

In one case, a consumer seeking help had to call 73 doctors and found that some had retired, some weren't accepting their insurance, some of their phone numbers were disconnected, and some had even passed away.

Again, this should not be on the consumer to have to find the provider and navigate and wade through these listings, and this bill will ensure that we can reduce this access barrier and we think that we really need to have both accurate directories and ensure that consumers know that they can call their health plan for support. We really appreciate the Assembly Member for her work on this bill, and we respectfully request your support. Thank you.

As a licensed marriage and family therapist who has worked in various healthcare settings, I have frequently observed patients struggle to find available mental health clinicians on provider directories given to them by their health plan. Provider directories are notoriously inaccurate, especially for mental health clinicians.

Patients struggling with symptoms of panic, social anxiety, depression, post-traumatic stress, psychosis, and more are expected to call through these highly inaccurate lists, even though their symptoms and distress make it incredibly difficult to do so.

When I was employed in the UC system at a student counseling center, we would call through health plan provider lists for students in order to sift through inaccurate lists and help connect students to needed mental health care, but looking back, I see how this constitutes the shifting of the responsibilities of private health plans onto the public sphere and taxpayer.

While employed as a triage and crisis therapist at Kaiser, I took calls every day from patients unable to find available therapists on the list given to them by the Kaiser contractor, Carelon, formerly Beacon Value Options.

Patients with means would resort to paying out-of-pocket for care when unable to get connected to an in-network provider, and patients without means who are disproportionately people of color and low-income populations would either experience significant delays in getting connected to needed care or go without care altogether.

Delayed or denied care risks worsening mental health symptoms, the development of comorbidities, the need for more intensive and expensive care, not to mention the cost to individuals, families, and communities caused by unaddressed mental health needs such as interference with functioning and family roles, problems functioning at work, and increased disability and need for public assistance.

Delayed and denied care can also lead to suicide attempts. When employed at Kaiser, I rarely provided coverage for emergency mental health assessments in the Emergency Department, but one of the few times I did so, I assessed a young patient who attempted suicide after calling through an extensive list of in-network mental health therapists without success.

If health plans were required to provide patients with assistance getting connected to in-network care instead of just giving patients a provider list filled with inaccuracies, more patients would access the mental health care they need and pay for with their health premiums. Health care saves lives and health plans can and should do more to connect their patients to care. Thank you.

Thank you so much. #MeToos in support of this bill.

Eric Dowdy with the California Dental Association and with the amendments that include dental. We're proud to support.

Clifton Wilson, on behalf the of California State Association of Psychiatrists, in support. Thank you.

Whitney Francis with the Western Center on Law and Poverty, in support.

Kevin Guzman with the California Medical Association, in support.

Jessica Gott, on behalf of the California Alliance of Child and Family Services, in support.

Angie Manetti, on behalf of the Steinberg Institute, in support.

Thank you. Former opposition, please join us.

Let me get that for you.

Sorry.

It's the least you can do, open the door for you.

I'll get the gate for you.

Gentlemen, five minutes.

Thank you, chair and members. Nick Louizos, on behalf of the California Association of Health Plans. You know, first I want to state that, you know, we've had some, you know, pretty good conversations with the author and her staff, and so we've appreciated the back and forth and we certainly share the goal of making sure that provider directories are as accurate as possible for health plan enrollees.

Unfortunately, we do have an opposed unless amended position on the bill. Now, we're digesting some of the amendments that are just going into the bill. I think some of those are an attempt to address some of our timeline and other concerns, but other amendments that appear to be going into the bill create new administrative burdens on our health plans, and so we're still evaluating those and we're still in opposition to the bill but definitely want to, you know, continue the conversation with the author and her staff.

You know, our issues around feasibility of response times, the, you know, confirmation that providers are accepting new patients, and the print versus online directories are certainly some challenges.

They're different and so there's some challenges with both of those, particularly the printed directories, but you know, just stepping back, our main message point on this bill and other provider directory related bills is that they lack an element of shared responsibility.

Our provider directories, our members' provider directories, I should say, are only as accurate it as the information that's given to the plan by the providers, so when their information changes or whether they're accepting new patients or not, it's really incumbent upon the providers to share that information with the health plans or else the directories are not going to be accurate.

Now, there are checkpoints in the process and our plans check with their network providers, but sometimes there's no response, and so again, our message is that if there's a way to add an element of shared responsibility to the debate, I think we'd have a more productive conversation and actual accurate directory. So with that, we're opposed unless amended, but look forward to continuing the discussion related to this bill. Thank you.

Thank you, chair. Matt Back, representing the California Association of Dental Plans. As the author noted, the bill has been expanded to include dental for all provisions of the bill. We're disappointed in that, obviously.

We were actually having some constructive conversations about getting dental exempted from the bill because to date, we haven't seen any information, any data, anything concrete. There really hasn't been any discussion about dental until today. So without that data to prove that we're doing something wrong, it's a bit perplexing while we're being added into the bill with all of these provisions which will certainly add cost to the dental market, which I will remind folks, is not a mandated product.

So employers are providing dental voluntarily. It is a very competitive market. We have premiums less than $10 a month. A robust PPO might be 50 or 60. A bill like this will certainly add cost which could jeopardize coverage and access for folks with dental. So today, we have a robust process for our directory. Twice a year we have to update that directory. We send out notices. The law is very prescriptive in the way that works.

We have 30 days or they have 30 days to respond. We are allowed three times to contact them. If they don't contact us, we have to suppress them. There are some plans who go for the fourth time, but like my colleague said, I mean, we're only as accurate as the information we get.

This bill will have us--if an enrollee calls--which by the way, we handled that today. If an enrollee calls, we give them real-time information. We're asking for where they live. We're providing information about dentists to them on the phone. If they want it printed, we'll certainly mail it to them. This will have us contact the dentist in real time.

If you live in LA or San Diego, Orange County, you could have 50 to 100 providers in your area. This bill would say we have to call those 50 or 100, or at least a subset of those, find out within a day or two if they're accepting patients.

These are providers who sometimes don't contact us in 90 days and now we are going to be mandated to respond within a day or two to the enrollee if they deem it an urgent matter. If it's not urgent, it's five days.

So now we're given four extra days or four, probably business days, maybe five, to contact the folks again when we've tried three times, twice a year. We do believe our directories are accurate. Again, we haven't been given any information to tell us otherwise so we're obviously disappointed that the bill applies to us, and for those reasons, we're opposed.

#MeToo's in opposition.

Madam Chair Member Stephanie Watkins, on behalf of The Association of California Life and Health Insurance Companies, also opposed unless amended.

Thank you. Seeing no one else going to bring it back. But I want to first start off that I do recognize, and I think it's valid the opposition's concerns because, and I shared this with the author, we're asking someone to be successful when they don't hold the sole responsibility in their ability to be successful.

It is valid that if you're dependent on someone else to be successful, and we're only asking one entity, it is a little bit uneven. And that was the Committee's approach to try to extend a little bit more within negotiating with the author where she felt some comfortable means to move forward with it.

And that's why we landed with the five for non-urgent. I did share with the author the concerns of providers sometimes don't pick up, don't have the capacity to pick up. They're providing services to our patients.

And then even if the list we provide to a consumer, a provider could be accepting a patient today and tomorrow not be accepting any new patients. I do recognize that it's a valid, valid concern.

But the goal, I know at the end of the day is to ensure that we as consumers have an ability to turn to our health plans and find out if our providers are available and taking partners. So it's between a rock and a hard place. So I just want to recognize that these are valid points.

We're just also trying to balance them with the ability for a consumer to have access to up to date information.

Want to, you know, thank the author for bringing this bill forward and want to thank the chair for her comments. You know, this is a tough one for me because it is extremely important that patients have a way to figure out where they can go for care, who is accepting new patients.

But as I'm listening to the opposition, I completely understand what you're saying. And as a provider, I know how busy I get with seeing patients, answering questions from my chart and lab results and this and that. And so, you know, something that may come through that request.

We need to know if you're still seeing this kind of patient may not necessarily be on the top of my agenda for the day when I have so many other things that are pressing. I don't know what the answer is. I don't know if this is the right answer.

And whatever we pass or implement, I want it to be successful and actually something that would improve. And I don't know if putting this onus, you know, on the insurance companies or the healthcare providers or the health, you know, the healthcare insurance companies is the. I don't know if that's the right answer.

And I don't know if we get the outcome that we're looking for because I don't know if they could give us that information accurately and on time. I just don't know. So I'm kind of. I'm kind of like you. I'm kind of stuck with this, with this particular bill. I think it's a just cause.

I'm just not sure if this is gonna get us to where. Where you're looking for us to go and where we should go.

See, no other question. Senator Durazo, I assume are you going.

To refer or respond to the issues that have been raised by opposition? Yeah, I mean, well, we certainly have with respect to the amendments, so that the carriers certainly have more time in order to respond because we recognize that it is an additional onus on the carriers.

I would submit that, you know, they certainly have a bit more bargaining power as it relates to the providers that they are contracting with than your average enrollee who's just calling, calling. And I myself have been in that position and I've got enough savvy that I can know, handle the phone pretty well. And I struggled.

So it is difficult to. When you're paying your premiums and you're expecting that there will be providers that are available through your particular carrier, the carrier should certainly help you find that provider within those constraints. We have tried to try to make it that you have additional time to respond.

You can put in a disclaimer in your response that says this may not be accurate. It was accurate today, but as the healthcare plans have pointed out, two days from now it might not be accurate. It may be that that provider just can't take a single more patient.

So we put in there that this is only valid or accurate for this day or so when we were able to confirm that X provider is in fact taking new patients and they're in your network.

So we've tried to allow flexibility in respect to the responses so that the carrier isn't going to be held, you know, an absolute perfect standard.

But certainly we can do better than where we are now with 50% of the directories being not accurate and some upwards of 98% that makes it awfully difficult on the enrollees that aren't feeling well. So we're working to try to make it manageable for folks. We don't want to put too much onus.

And I can Certainly sympathize with Dr. Weber, who is a provider who, like she said, she's busy with her patients. She may not have that time to go, oh my God, I'm still going to accept X, Y and Z new patients.

And so we recognize that it can be difficult with respect to the providers for sure, but we're hopeful that the strength of the carrier can help intercede with the enrollee and help you get accurate information a bit faster.

Senator, Durazo. Yes, yeah, I'm not going to get. Into a back and forth and all that response back and forth. But is there, do you not agree or do you disagree with what's being forward, putting forward what is being put. Forward here as a problem? Do you agree or do you think.

That it's not a problem and therefor, what's being asked is too much? I'm trying to get a sense of how far and I'm not talking about negotiating, I just want to get a. Sense of how far off you all are.

So we believe that the directories could be more accurate and that more work needs to be done in that direction. I think our primary message point is that it's a two way street. We need to work with our provider partners and they need to work with us to make sure that they're as accurate as possible, conceptually speaking.

When this bill was introduced, we had a discussion internally. You know, the idea of additional disclosure in and of itself is not conceptually an issue for us. It's whether it's going to be administratively burdensome and how that's going to work out procedurally.

And I think my colleague Matt here explained some of the difficulties with the precise language in the bill that we've pointed out to the author. But to your point.

Yeah, I mean, if we could work better with our provider partners to have more accurate directories, that's kind of the missing element in this debate from our perspective.

If I may. So, I mean, I have to agree, right. We're never going to have a directory that's 100% accurate. It's just impossible. We have thousands, tens of thousands of dentists in our network. So it's never going to be perfect. But I don't know if this is the solution. Right.

I mean, we are going to have to be calling dental offices constantly. If we get just 10 people in LA that call within a two or three week period, we're calling the same hundred providers every time the enrollee calls. Because the bill is so prescriptive in you have two days or five days.

So these Dentists are going to be getting calls constantly, if just 10 or 20 in a month. And we're talking, I mean, Obviously we have 30 million plus people under dental coverage, so it's just going to be extremely difficult. And I would argue again, we haven't been told.

None of the conversation has been about dental to this point. It's been all about medical. So I'm not sure there is as much of a problem with the dental directories. Certainly there's been no information provided to us to justify that. So that's why we were working through an exemption.

And now actually the bill applies more to us than it did as of two days ago.

And to that point, you know, I'll carry that as the chair. That, that was important for me just to have equity across all types of services for our consumers. I just didn't want to have a carve out.

I mean, that's why I, I asked the author to take that amendment to ensure that there was no exemptions to that.

Well, it seems to me, Madam Chair. And the authors, that something more could. Be done, as you're saying. But there's got to be a better. Response from you all as to how much better. What's it going to take to be better? I'm seeing really a big gap here. But yet it seems like something that.

Has to be addressed and either you. Address it or this is the result.

Thank you, ma' am. You know, I think, you know, what assignment you might be witnessing is, you know, some of the concerns that I brought up to you as well. I did.

And you're hearing some hesitations from the members here that you might maybe want to absorb before it gets to the next, before it gets to the next Committee approves or on the floor that there is a problem.

We recognize there's a problem and we tried to tweak it as much as we could, but with still some reservation that is this going to get us to the point that we need to get. Senator Rubio, thank you.

I mean, certainly sometimes when we come to these committees, there's conversations like these that really highlight some issues that are not necessarily obvious when we're talking to, you know, the member of the opposition.

And what strikes me is something that I hear often from providers and that's, you know, the amount of time they're spending with paperwork or documenting so much, nobody's fault. But I think if I could blame us, I think there's a lot of mandates that come out of this building.

And, you know, I do hear from smaller providers how they're just so consumed with the paperwork, the documentation on another issue, not this per se. Right. And then you add this on top of that.

And I do think of like your medical, I'm sorry, dental providers that perhaps, you know, you're right, people are calling and I'm just thinking exactly along the lines that Senator Durazo was kind of stating. Clearly there's a problem.

And the problem is that, you know, it's cumbersome on someone that wants to get services to not find that appropriate person. So we know the system is broken, there's something there. But just mandating more, it feels like, are we going to solve the problem? And I think that's what Dr. Alika Weber was alluding to.

Is that going to solve the problem or are we going to find ourselves with yet two more problems?

I do think that it is something that I again, I talk to people on both sides that I want to support in the sense that I know that there's a problem here, but I'm not necessarily convinced that this will solve what we're trying to solve. And I don't want to disadvantage.

Ditch the, the author to not help you pass it and see we can continue to, to have a conversation. And, and I do hear the chair, you know, that you added the, the dental Association just because you want to be equitable, which, you know, we don't want to disadvantage some folks and some other folks not.

But I do think there is something broken. I do think it needs to be addressed, but it may need a lot more time to see we can get those two sites to figure out what can be done.

Because I think at the end of the day, consumers, as you know, people trying to find services are the ones that lose. And you're right. When you have to navigate a system of health care, you know, for us more well versed individuals, we can navigate that.

But for someone that doesn't speak English and you have a slew of other reasons why they cannot figure out the system, I think that we have to do better. So like I said, I'm going to support it because I do think that the system is broken. But I'm not convinced you're there yet.

And so I would just ask that you figure out if we can sit down and have further conversations before it comes to the floor, if I can get that commitment. I know it's hard when people are asked to take commitments here.

And I never do this, to be honest with you, never really have unless I tell you in advance. But there's a lot of valid points that were brought up, which I'm struggling with. So. So I will just leave it at that and hope that you continue to sit down and see we can come up with something better.

Okay. Thank you, Dr. Weber Pierson.

Thank you, Chair. And then I just realized that this applies for all appointments, all types. Right. Not specific. Right. And then you've carved out like urgent emergent versus just routine. Correct.

But even in those situations, I think that there's, I think there's a lot of work that needs to be done on this bill because to say, oh, I need to have just my routine OBGYN visit and I need to find an OBGYN. Like, do they need to do that in five days? Probably not. Right.

If it's not urgent emergent, but it's another kind of like in between, then maybe it does need five days. I'm saying doing a better tiered system of specialty, of the urgency, urgent emergent. You know, we're doing this now within the surgical realm as how we need to schedule our procedures.

I think there's four different tiers that they have that could also cut down on the burdensome nature. Because now we're not talking about either two or five days. It could be 2,5,15,30. Right. And we do that even with appointments, you know, urgent versus non urgent.

And when someone needs to, you know, with your third next available option. So I think that there's a little bit more digging that you need to do if you're going to expand it to all appointments, because not all appointments are the same, not all diagnoses are the same.

I think if it passes out of Committee and you go back and you start figuring out how you can strengthen it to make it better so it's not so burdensome and that people are actually able to get the information that they need to get in an appropriate amount of time for the provider and the diagnosis that they have and also give those providers, you know, enough time to be able to get back to you.

Because even five days for something that the physician you don't necessarily feel is the top of your list, and you've got a ton of patients, a ton of charts, a ton. I mean, it's a lot. It's a lot to try to put.

And then if you, you know, companies come back and they say, well, if you don't do this, then we're going to drop you, then that's a whole other aspect that we don't want to have to deal with within the healthcare profession, because it's challenging for us as providers, but it's even more challenging for patients because then they lose access.

So if it passes, I would just really urge you to think of a different way of kind of determining the urgency, emergent, different specialties, time frame that individuals would be able to get that information because not everyone is the same. So that's what I would recommend.

Vice Chair, thank you. I can completely relate to needing to find a Doctor quickly, a physician quickly. Really short story here. I had a impacted gallbladder long time ago, a few years ago and two weeks to have that diagnosed, found out what it was.

I didn't have a primary care physician so I needed to make, I think I make six or seven calls and I, I was like, my pain was at like a 10. I was not going to go another day with keeping my gallbladder in my body and needed to be removed. And that was frustrating.

And so I can completely understand the need for this. However, I have some serious concerns because you would be making it very onerous on the health plan to provide this information.

But the missing component is the provider, is the Doctor, what in this bill addresses that component because they have to work together or you're still not going to have accurate information. So I would suppose to the sponsors if they could weigh in on that.

Well, you as the enrollee, you contract with the provider, excuse me, the healthcare plan. And they are the ones that are enrolling all of the providers.

So the reason why we took the TAC that we did is because it's really almost boiling down to can you get what you're paying for, which is access to a provider and who are you paying for that equation? You're paying the plans.

And so what this bill does is it asks the plans, can you keep somewhat current the information that lists the providers? I like you, I needed surgery. I had to find a primary just to get over hurdle number one to get a surgery. So Dr. Rover's point is well taken.

But it was still relatively urgent, even though I just needed to get a provider and your average physical to get to the next step. But I was suffering all along the way. I also, in my search for just an OBGYN was the woman that had delivered our child at that time.

It was 15 years before and she'd been out of the practice of medicine for 10 years and she was still listed on my healthcare plans directory. Certainly we can do better than 10 years.

So I recognize, and this is maybe a more roundabout way of answering your question, but I think I can address some of the other items that have been raised as well. There will be an additional burden, no question. But we are falling down and we can do better.

And this bill doesn't ask for perfection, not by any stretch, but it does come into the equation of healthcare plan provider and patient to give that patient that's hurting like you were and I was, some assistance with finding the provider because you're contracting and you're paying the healthcare plan. That was where I thought.

And they're maintaining the list. That's where I thought was a reasonable place to go to ask for some assistance on those lists. That's all we're suggesting.

And I recognize there is additional burden, and I don't want to make it overly oppressive, which is why we have taken some amendments and we will continue to talk to see if we can work within reason so that we're not overburdening providers.

But at the same time, we're getting to people like you and me who need some care pretty readily. So.

But in the bill through the chair, there's currently no directive to the provider side.

There is not.

So I'm just. You're correct. There's a huge disconnect for me because I'm not a provider. However, I would imagine that you don't necessarily know when your patient list is going to be full. And so you could still be listed as a provider with your plan, but you may not be taking more patients.

So I think that's a really important missing component here, which is why I want to. I understand what you're trying to accomplish. I can't get to support today, but I would hope that you would continue to work on this missing piece.

And if I may, through the chair, and you're right, the providers are not in here and they do contract with the healthcare plans. So I would submit that there is something in that link between those two that could be addressed as well. And I don't disagree with you. This was just.

I was looking at what was happening to the enrollees and how they could expect more from their plan. But what transpires between the plans and the providers and what sort of requirement. We heard from the dental plans that they can't get providers to respond to them.

Then we heard from providers that were so busy it really is hard to respond to the plans. So everybody's going to be burdened a bit. I'm not going to dispute that. But we got enrollees that have some needs.

Senator Rubio, this question is for the provider. And I'm sorry, you guys know the background. I don't. And how things work. The plan. Sorry. And it goes to what we're saying here.

See, I don't know how it works, but when I hear the good summary Member here stating how someone had dropped off 15 years and there was still. I mean, is there any way that we can put that burden on those that leave the profession or not practicing to share that information in an timely manner?

Is there any requirements you guys have? I mean, I don't know. That's why I want you to enlighten me on that.

I mean, we've advocated for that, you know, in the context of other bills that have been introduced in the past and, you know, haven't been able to get over the line on that. I mean, there are, you know, ideas that could be, you know, resurrected and discussed, you know, within the context of any provider directory bill.

You know, the plans do go out. There's annual verification, there's federal requirements that the plans verify every 90 days in the large group market that the directories are accurate. So they make available to the providers various means to help us update those directories. The problem is that they don't always respond.

And so there's no direct requirement on them to do so. And so we would love to have that debate if the door is open for that. But you want to do it in a way that's thoughtful. We don't want to create too much provider abrasion at the same time.

That's a term of art in the industry because, you know, we do have to have adequate networks and we have to have good relationships with our providers. But they do have to have some skin in the game as well.

Well, and that's my point, because it almost feels like you're in a relationship. It's not going to work unless both of you are helping each other be successful. And I venture to say that there's benefit on both sides. So if they're not being responsive, I do see that that's a problem. They need to figure out how to.

And if there's any way that we can again, tweak. I don't want to also create policy right here on the dais, but there has to be an incentive for them to want to stay current and help you get there. There is an incentive. Well, you know, and again, they. They do get business.

But my point is that if you're chasing and chasing, it almost feels like we're putting something on you that. That it takes two to tangle, so to speak. And if they're not, if Both of you guys are not working.

And I'm not in plain or saying that they're not, but clearly, right, you're talking about, you know, the federal requirement and everything you have to do to chase the information. And if you're not getting it, I feel then there has to be something on the other side. So I just wanted to. I wanted to understand it.

But thank you for sharing all those requirements.

Thank you, Nick. I mean, it's in the analysis. But Nick, what is. What can you do if a provider does not respond to provide up to date information?

I think there in the original provider directory bill, there's something to the effect of being able to impact their. The reimbursement rate. But our plans are very hesitant to take that approach because again, in a meet and network, we have to have adequate networks.

So I think, you know, if we could talk about, you know, some alternative approach that's less onerous. I mean, and, you know, it was an approach that was definitely, you know, something that we appreciated that the Legislature thought of.

But, you know, it's one that I don't think has been activated very often because, you know, we have to have, you know, the doctors available for our enrollees. So we'll have. I mean, there's another provider directory bill. There's this bill. I mean, we'll have further discussions about this.

But I think it's crucial that it needs that it be addressed at some point in order for these directories to.

Be better before we move forward. Let's establish quorum.

[Roll Call]

A quorum is present. Have a quorum at 8. Do we have any other comments or questions to the Assembly Member? If not. Assembly Member, Robust discussion. You've heard some concerns, some hesitations, you may close.

I thank you for the robust discussion. So I'll be brief. I respectfully request, and I vote. Let's do right by the enrollees at this point. Okay.

Can I get a motion on file? Item 7 AB787, moved by Senator Durazo. Senator Durazo. Secretary, please call the roll. The motion in front of us is do passes amended and we refer to the Committee on Appropriations.

[Roll Call]

As a Member that currently has a vote count of seven to zero. We're going to put it on call for the rest of the members. Thank you so much. Chair, we have our final presentation for any remaining Committee Members, if you can join us. This is our last bill. Assembly Member closes out with your fresh haircut.

I just saw him yesterday. He didn't have a new haircut yesterday.

Thank you so much, Madam Chair. My fans like the high fade, so good evening or good afternoon. I'm here to present AB 1326, which would establish the legal right for individuals to wear a mask in public spaces.

Currently, there is no codified right to wear masks, despite their proven effectiveness in reducing illness and protecting against poor air quality. Without an explicit legal right, local ordinances could ban masks and leave those who wear masks subject to stigma and discrimination.

This would also reduce protections for immunocompromised individuals and other vulnerable people in public spaces, such as businesses, schools and transit centers. AB 1326 affirms the right for vulnerable individuals to protect their health in public, making communities safer.

I also want to mention I've had some great conversations with some of my Senate colleagues and I'm going to continue to work in Senate Judiciary to clarify different types of health masks that are protected, because I understand that some of our Senators are getting into the mask business. With Me today is Dr.

Cameron Kaiser from the Health Officers Association of California, here to testify.

Thank you, Chair and Members. My name is Dr. Cameron Kaiser. I'm the Deputy Health Officer for the County of Solano, and I'm appearing on behalf of the Health Officers Association of California in strong support of AB 1326.

Many Californians today, based on solid medical principles and reputable studies, wear masks to protect themselves and their loved ones with deficient immune systems from airborne disease, to help reduce their exposure to dust and wildfire smoke, and also to keep healthy while in frontline jobs working with the public. I know because I'm one of them.

I have a very poor track record myself with respiratory illness, and my masking has helped to make me more productive and reduce those episodes of illness which I used to struggle with in the past. My wife also wears one to help keep me healthy.

Masking is one part of how we reduce our risk and are still able to do our daily activities. Just as this would be the case for anyone with disabilities or chronic diseases, it would put them at greater risk of complications than all those who just want to avoid exposure.

This bill doesn't change public health rules or impose any order or requirement other than to respect our needs. It is a simple protection for those of us who now rely on this basic preventive health measure. And it requires no unreasonable accommodations from anyone else.

AB 1326 enables Californians to care for themselves and also for their vulnerable friends and family. We urge your strong support. Thank you.

Thank you. Do we have any me toos in support of this bill? Any formal opposition? Anyone want to record a me too in opposition of this bill? Colleagues coming back to us. Senator Dr. Weber Pearson.

Thank you, Madam Chair. Really want to thank the Assembly Member for agreeing to take some amendments in judiciary. It's not only potentially problematic with some of the other bills that have recently been introduced, but we also want to make sure that we in statute are doing what is most effective.

And one of the things that we learned during COVID is that the surgical masks, your N95s are the ones that are more effective, not necessarily your cloth mask or whatever other kind of thing you may put over your face. So really appreciate your willingness to continue to work on this bill to make it the best bill possible.

Thank you. Thank you.

Yeah, thank you. I want to echo that, and I support this bill and I appreciate you doing it. I was actually, you know, to me. If someone wants to wear a mask to protect themselves from illness, they should be able to do that.

And it's unfortunate that we need a bill to say that, but I guess we do. So I support this, and I do. Appreciate the willingness to focus the bill. On the effective masks.

You know, and, you know, we do have this other bill around law enforcement, which has a blanket exemption for people who are wearing medical masks to protect themselves from getting sick, as opposed to wearing, like, a ski mask trying to arrest someone when you can't even see their face.

But I think this is a really important bill and I appreciate you doing it. Thank you, Senator.

Vice Chair. So I didn't realize that this was a problem, to be honest with you. Are there instances where people are not allowed to wear masks?

Yes, well, several businesses have been reported to deny entry or deny individuals from entering their businesses if they are wearing medical masks. And so this would sort of codify that, right? From a personal experience. When my twin brother was terminally ill with cancer, he faced that personally during COVID.

So why not? I mean, I do have concerns. You know, I have a background in my younger years in law prevention. And given the increase in smash and grabs that we've seen and retail theft. Does this just create an avenue or an opportunity for people who want to go to businesses with the intent of stealing?

Does it give them a right to do that under a disguise, a mask? Does it open that up?

I think that. And I can certainly let my witness speak to that, but I think that is those who are wishing to cause havoc in our community and do smash and grabs are going to do them regardless of whether this bill is passed or not with that intention. This is specifically looking for medical purposes, a medical mask.

And just to clarify that that is the comments that were made earlier to really. And that's the legislative intent of why I brought this bill forward is to address the medical concerns regarding the right.

To wear masks, so long as it's tied to a medical reason you're allowed to.

That's. Well, I would. That's my. The purpose of this bill is the legal right to wear a mask for. And codifying that different types of health masks should be protected and to wear.

Okay, thank you. Thank you

Senator Rubio.

Thank you. You know, this is seems like a simple bill and common sense, but it isn't. You know, and I've seen children being shamed for wearing masks, and I don't necessarily think even has to do with medical conditions. Sometimes, again, it has to be a protective mask.

But, you know, sometimes people are worried. They're concerned. They have loved ones. You know, there's reasons, you know, they have loved ones who have a compromised immune system. And so I think that right exists and it should exist.

But we're getting into some territories where we're far removed from the pandemic and people are being shamed for either wearing it. And I think that should be someone's choice and someone's choice alone. I mean, you know, we see videos from, like, those ring cameras where, you know, you have thieves stealing regardless.

And I agree with you, that's going to continue to happen. And there were ski mask and everything they need to do to commit those crimes. But we're just talking about these medical masks. Correct? That will help at least protect that basic right. If someone's afraid.

And I know there's a lot of people that still walk around afraid, you know, not so long ago, we went on a Senate delegation to Japan, and years years later, after they've had, like, all these viruses, they're wearing it everywhere and no one seems to flinch. That's just a norm that they've established for those that are afraid.

And I think that it seems simple, but I've Seen children being shamed for wearing masks. And I think we need to now put it in statute because it's getting worse and worse. And so I want to thank you for it. I appreciate it.

And I'm sure all those that have families that are, you know, immune compromised will also appreciate it. Thank you. Thank you, Senator.

Seeing no other comments, it was moved by Senator Wiener as a Member. You may close.

Respectfully ask for your aye vote.

Thank you so much. Secretary, please call the roll. The motion in front of us is due. Pass. And we refer to the Committee on Judiciary.

[Roll Call]

The Bill is out with the vote count of 8 to 0.

Thank you so much, Assemblymember. Can I get a—moved by the Vice Chair. Give me a second here. Items Number 3, AB 618. Item File Number 6, AB 594. File Item 8, AB 894. File Item 9, AB 951, is on the consent calendar. Our Senator Valladares has made a motion. Secretary, please call the roll.

[Roll Call]

On a 10 to 0, consent calendar is adopted. Can I get a motion for File Item 1, AB 64? Moved by Senator Durazo. Motion in front of us is do pass as amended and we refer to the Committee on Appropriations. Please call the roll.

[Roll Call]

Vote is out on a vote count of 10 to 0. On File Item 2, can I entertain a motion? Moved by Senator Richardson. Motion in front of us is do pass and we refer the Committee on Business, Professions, and Economic Development. Please call the roll.

[Roll Call]

Can I get a motion on File Item 5? Motion in front of—okay, can I get a motion first? File Item 5? Senator Durazo moves File Item 5. Motion in front of us is do pass as amended and we refer to the Committee and appropriations. Please call the roll.

[Roll Call]

On a vote count of 10-0, that Bill is out. Can you open the roll on File Item 7, please?

[Roll Call]

That Bill is out with 8 to 0. That concludes the business of the day. Senate Committee on Health has adjourned.