Senate Standing Committee on Health

The Senate Committee on Health will come to order. Good afternoon, y' all. Having a late start, so if we can go through this as quickly and efficiently, efficiently as possible. One bill was pulled from today's hearing. That's file item 11, AB 1460. That's leaving us with 10 bills on the agenda, four of which are on consent.

We have our first author here with file item 1, AB 54. Assembly Member Krell, if you want to step on up and whenever you're ready, assembly member.

You may begin.

Good afternoon, Senators. I'm pleased to present you with Assembly Bill 54 today. Three years ago, just this week, Roe v. Wade was overturned.

Even though in California we enjoy a constitutional amendment guaranteeing the right to choice, this is still an important bill to put in place to make sure that we have a framework that works for patients to access medication abortion, specifically mifepristone and Misopristol, which are proven safe drugs for medication abortion.

60%, approximately, of abortions take place via medication abortion. And this simple bill just ensures and clarifies that no one can face any civil or criminal penalties for distributing, accessing, transporting, manufacturing, or using medication medication abortion drugs which are legal under current law and protected by the constitutional amendment.

Also, I appreciate the technical amendments brought on by the committee. I accept those amendments. And with me today is Deputy Attorney General Tiffany Brokaw and, from Planned Parenthood, Angela Pontes.

Thank you, ladies. You have a combined total minutes of five minutes.

Thanks. Good afternoon, chair and members. Tiffany Brokaw with the California Department of Justice here on behalf of Attorney General Rob Bonta, who is a proud co sponsor of AB 54. And we'd like to thank Assemblymember Krell for carrying this important piece of legislation.

AB 54 would ensure continued access to medication abortion by enshrining in California law that it is legal to transport and deliver this medication throughout the state. And it would shield providers, distributors, manufacturers, pharmacists, and individuals from doing so. Since the overturn of Roe v. Wade In 2022, abortion access has been under attack. There are emerging threats nationwide.

63% of abortions are done by using this medication, up 10% from 2020. Studies show that it is safe, it is effective, and it plays an important role in reducing barriers to health care. For these reasons, we would like to request an I vote.

And I have here with me Deputy Attorney General Erica Connolly to answer any technical questions you may have.

Thank you, chair and members. Angela Pontes, Senior Vice President of Government Affairs from Planned Parenthood Affiliates of California, representing the seven Planned Parenthood affiliates across the state, serving patients from every county through 115 community health centers. Here today in strong support of AB 54 as a proud co sponsor.

Restricting access to abortion care and specifically the drug mifepristone is a priority for the anti abortion movement and the federal government.

Though medication abortion has been used by millions of people for a quarter of a century and decades of research show that it is safe and effective, attacks on access and particularly the providers who offer this care persist.

AB 54 reassures Californians that their right to essential health care is and will remain protected by reaffirming the legality of abortion medications used and ensuring that the providers are shielded from harmful enforcement actions just for offering this care.

Any federal efforts to restrict access to medication, abortion providers, or the drugs and instruments that are used are a direct attack on our state's constitutional right to reproductive freedom. Thank you for your consideration of this policy. We ask for your I vote.

Thank you so much. Now's the time for any me toos in support of this bill.

Ryan Spencer on behalf of the California Medical Association and the American College of OBGYN's District 9 in support. Thank you.

Evelyn Wilson on behalf of California Reproductive Freedom for All. We strongly support AB 54. Thank you.

Kathy Mossberg, Essential Access Health. Co sponsor in support.

Craig Pulsipher on behalf of Equality California in support.

Good afternoon. Stephanie Estrada with California Latinas for Reproductive Justice. Proud co sponsor in support. Thank you.

Matty Hyatt, California Civil Liberties Advocacy in strong support.

Annie Chow with the California Teachers Association in support.

Thank you. Coming up for formal opposition.

Chair and members, my name is Greg Burt with the California Family Council and I'm here to urge you to reject AB 54. This bill is not about safety. This bill will shield the abortion industry that places politics above women's health. AB 54 protects manufacturers, distributors, and abortion providers from liability when mailing or admitting administering abortion pills, even retroactively to January 2020, regardless of the harm those actions may have caused.

You're being told these drugs are safe and effective, but a study in 2024 by the Ethics and Policy Center analyzing over 860,000 chemical abortion paints a very different picture.

More than 1 in 10 women suffer from serious complications including hemorrhaging, infection, and incomplete abortion requiring surgery. That's 22 times higher a complication rate than what the abortion pill label claims. Why such a discrepancy? Because the federal standards have been quietly eliminated. No in person examinations, no ultrasound to confirm gestational age, or to rule out ectopic pregnancies.

No required follow up care. AB 54 doubles down on this recklessness by shielding those responsible from civil or even criminal consequences. Even worse, emergency room data shows that over 80% of complications from abortion pills are misclassified as miscarriages. That's according to a study by the Charlotte Lozier Institute.

That's not just a health care crisis, it's a crisis of honesty. This bill enshrines that deception into law. Women deserve truth and transparency, not a legal firewall to protect the abortion industry. Please reject AB 54 and stand for health and safety of California's women. Thank you.

Any member of the public like to register a me too in opposition of this bill? Seeing none. We're going to bring it back to my colleagues for any questions or comments.

Move the Bill.

Once we have quorum, I'll entertain that motion. We currently do not. So assembly member, thank you for bringing this forward.

I recognize where this is coming from. This happened in New York. We want to prevent it and follow the other eight states that have done this kind of legislation. Please close.

I just want to thank all the advocates who came forward today in support of the bill and I respectfully ask for your I vote.

Once we have quorum, we'll entertain a motion. For now, assembly member thank you for your presentation. Assembly Member Patterson, you are up. I don't see any other member ahead of you. We're going to now do file item six, AB 536.

When you're ready, assembly member.

Great.

Great.

Great. Thank you, Madam Chair. Good afternoon, Madam Chair and Senators. First of all, I'd like to thank, thank everybody who had the opportunity to meet with and chat with about this bill, especially you, chair, for the many conversations we've had on this bill and the committee staff.

I know we spent a lot of time on this, probably an exorbitant amount of time. I'm here to present AB 536, a bill that has two goals: one: it ensures that despite litigation and federal challenges that Californians will retain colon cancer screening coverage, and two: seeks to increase the number of Californians that get screened for colorectal cancer, an issue that is near and dear to me and to many of our colleagues.

Current California law provides coverage for colorectal cancer screening without cost-sharing, mirroring the national requirements under the ACA. This coverage currently applies based on the federal clinical guidelines that unfortunately are both under threat of legal action and slow to historically incorporate innovations because of the length of time between reviews and updates.

AB 536 seeks to modernize current law by ensuring that every eligible Californian has access to the latest FDA approval screening test. We propose to do this by changing the coverage criteria to also include clinical guidelines developed by the American Cancer Society and those developed by the Federal Centers for Medicare and Medicaid Services.

The reason why: currently, eligible Californians covered by Medicare over 65 have access to new FDA approved blood tests for colorectal screenings. However, widespread access is limited.

We also believe that the ACS will be more nimble and incorporate innovation into the guidelines in a more timely manner than those federal guidelines I mentioned before, if they even continue to exist.

Medicare beneficiaries have had the access to this new test since it was approved by FDA almost one year ago because CMS was proactive in ensuring coverage. However, every other Californian between the ages of 45 and 64 do not have the same access.

AB 536 closes this disparity and and seeks to future-proof access to colorectal cancer screening innovation by allowing payers to consider other guidelines--other guideline body recommendations alongside those specified in current law. CRC is the third--colorectal cancer is the third leading cause of cancer death for women and men in California.

Seventy-five percent of those who die from it today are not up to date with the recommended screenings. Today, only 53% of eligible Californians are up to date with screening, despite a national goal of 80%. Senators, we can and should do better.

One of the factors why the screening rate is so low is that there have not been any innovation and the approved processes right now are quite invasive. I had a friend, when he was 40 years old, he was diagnosed--well, he was complaining of pains, you know, that he was having and he would go to the doctor, and at his age of 40 years old, nobody really, you know, they didn't really suspect. They said, 'hey, you know, eat more fiber, you know, do these things.'

And several months later, unfortunately, he was given his--finally approved for a colonoscopy actually, and he was diagnosed at that time with stage three colon cancer, and had it been diagnosed much earlier, especially through more simplistic means, you know, he would have had--probably would have gotten it sooner than he did and it wouldn't have been stage three.

Fortunately, he just celebrated his 50th birthday, so--but I spent a lot of time with him when he was going through treatment and we wish he never got to stage three. And that's why I'm doing this bill, honestly. Really has nothing to do with, you know, whatever, you know, around the bill. Really it's because I think that we need to ensure compliance. We need to ensure that people have more access and that the people are going to get the screenings of colon cancer, which a lot of people, frankly--I'm 43, going to be 45 before you know it.

Even though I'm a little bald man, still have very good looks and I'm hoping by the time I'm 45, I still continue to have those good looks, but the thing is, when I turn that age, I would love to have a screening and ensure that those continue to be in place despite threats to our system. So I just want to be really clear about what my motivations are on this bill.

This passed out of the Assembly unanimously--different House, of course, and last year it did pass out of the entire Legislature, although slightly different. We tried to address the governor's concerns. With me, I have Oliver Rocroi with Guardian Health. He's really here for technical questions, but with that, I'm happy to take any questions and when the time's right, I'll respectfully ask for your aye vote.

So no testimony, just technical questions?

No testimony.

Do we have any #MeToos in support of this bill? If you're new here, it's going to be name, organization, and your support #MeToo.

Chris Ward.

Would you like to record your #MeToo in support? Just your name, organization.

Patrick Foy with the California Clinical Laboratory Association, in support.

Thank you so much. Okay. Do we have any formal opposition to this bill?

Madam Chair, members, Stephanie Watkins, on behalf of the Association of California Life and Health Insurance Companies. Regrettably, we are here today in opposition to AB 536, which would expand the criteria for colorectal cancer screening tests and the health plans insurers must cover without cost sharing.

First and foremost, I'd like to thank the committee staff for their comprehensive and thoughtful analysis of this issue. It really highlights the concerns we have with respect to expanding for the purposes of colorectal cancer screening what is considered preventative and should be covered at zero cost-share.

While we appreciate the importance of cancer screenings and the value offers to our enrollees and insureds, we're very concerned that bill seeks to bypass the normal process set forth by the task force and create a statutory requirement that plans and insurers cover at zero cost, new tests, that application is still restricted.

As mentioned in the analysis, while the most recently developed blood tests have shown promise, they in no way have proven themselves be equal to a colonoscopy, which experts still point to as the gold standard.

Additionally, the bill opens up the broader conversation of if not--if this, then why not that, creating a new statutory standard for what should be covered at zero cost-share, should involve a broader policy discussion that goes beyond one disease or condition, especially one where there is a specific beneficiary.

For those reasons, we are strongly opposed to the measure as it's presented to you today. At this point, it's critical that we continue to support the important work that the task force provides and not undermine it by creating a statutory process which allows a specific group to bypass existing process. For those reasons, we respectfully ask a no vote.

Thank you so much for your testimony. If you'd like to record your #MeToo in opposition, please step forward.

Olga Shilo with the California Association of Health Plans. We're also in opposition. Thank you.

Thank you. Going to bring it back to our colleagues, and I'll start off with some comments here. Assembly Member, you and I are on the same page that cancer, all types of cancer, we need to do better in that space, right? I recognize and I do agree with you that there's more that can be invested in the preventative nature, and regular screening is really important and the two options that are recommended with A and B rating can sometimes be off-putting for individuals, but they are the gold standards.

And we tried, we worked back and forth and we just couldn't land on an amendment where we felt comfortable that we weren't just going to elevate one or two companies, and I do recognize this is a personal matter for you, so I'm in no way, shape, or form saying you're carrying the water for someone else.

I know this is personal for you, but my concern is getting ahead of the existing United States Preventive Services Task Force process or the American Cancer Society that also rates, which is why the American Cancer Society is not supporting this bill.

Current law states right now--and it's in the analysis--that nothing exists to prohibit a health plan from covering services in addition to those being recommended by the USPSTF. So that exists right now, but to pass a bill to just mandate a test that even does not prove to be effective in recognizing stage one is worrisome.

What I worry is that an individual is going to get a blood test and it does not detect about 87% of precancerous lesions, and they're going to say, 'well, I don't need to do a colonoscopy because I did a blood test and I'm fine.'

That can, in turn, have unintended consequences if people do this exam and think they don't have to do another--the gold standard. For those reasons, I cannot support your bill because, again, the recommended approach, the gold standards that are rated A and B do not include these exams. With that, I'd like to turn over to any--Madam Vice Chair.

So, first of all, I want to thank the author for bringing this bill forward and just let you know that, for the record, I am unapologetically pro early detection, early diagnosis, early intervention, whether it's for the autism community or the cancer community. Many of you know my story, but I'll repeat it.

My mom passed away from pancreatic cancer, and she was initially diagnosed on accident. It's one of the hardest forms of cancer to diagnose, and by the time symptoms appear, it's too late. And she went into remission for six years, and in hindsight, having those additional six years were truly a blessing.

But when she went into remission, she had, you know, signs and symptoms where she should have had a diagnosis and she didn't, and I believe that whether it's colon cancer, whether it's pancreatic cancer, if we can offer people opportunities to test and raise awareness, then we should do it.

You know, when my mom was diagnosed with cancer, I became eligible for genetic testing, and I went and got my genetic testing and my markers are good. I'm not supposedly susceptible. However, I need to do yearly screenings, and if there is a more modern test available, you bet your life I'm going to be taking it.

And we should be offering this to all people, including the people you're advocating for today, Assemblyman, so I will be supporting this because it's a small, very small token of hope, of life we could be giving to, if even just one person. To me, that's worth it, and that's why I'm supporting this bill.

Senator Dr. Weber Pierson.

Thank you, chair. Want to thank the Assembly Member for bringing this bill forward. You know, really sorry to hear about your friend being diagnosed at such a very, very young age. Very happy that he's still alive and doing well and those things were caught.

I think, you know, this bill, had it been in place, would not have impacted your friend because what you're talking about is the screening method versus the timing of screening recommendations.

So he was too young to be within the recommended screening time, regardless of if it was a colonoscopy or a blood test or a stool test or whatever. That being said, I have to align my comments with the chair.

I'm concerned about expanding it to other entities that may not do the the vigorous amount of research that we have with those that are currently recommended and that would be not only a cost to the health care system, but also a cost to the patient because he or she may--he or she--excuse me--may end up undergoing unnecessary procedures or having the stress of getting or being worried about something that's not actually there, and so for that, I will not, I cannot support your bill today, but definitely appreciate the conversation. Thank you.

Seeing no other questions, Assembly Member, you may close.

Great. Well, thank you for the conversation. You know, on this bill, just a couple--to address a couple of the comments--and appreciate the opportunity to do that at my close--you know, I think there, there are some, I think, you know, fortunately we're, we have the ability to have the task force out there right now to make these recommendations, but there is concern about--because of litigation occurring in Texas--that that task force may cease to exist.

And as a Republican myself, I can say that, you know, the Administration has actually talked about this organization no longer existing anymore, so we have to take it upon our own hands to ensure any screening continues to be covered, required coverage in California.

Now, I would say, in respect to the blood test, I think the importance to that is Medicare covers it already and I think that that's indicative, I think, of how important it is to have--how important it is to have available for people who are seeking screenings.

And I think that decision--and not saying anybody would disagree--but with the low--with only 53% of Californians getting screened, because, as you know, the screenings are quite invasive. Either you, you know, use the restroom and you ship it in or you, you get a colonoscopy.

If we can improve the 53% by getting more people to screen via blood and new technology, I think that's ultimately a good thing and a goal that we should all be reaching out to. So, you know, I've had--this has been a great opportunity to work on.

I think you're right about whether or not my friend--if this--any screenings, the law right now is 45. I think we're starting to see that maybe that should be reconsidered in the future, but that's a much broader conversation. I just actually heard a story today about somebody in their 30s, actually. So, you know, it's really disappointing.

But again, this bill is really twofold. One is to ensure no matter what happens, we take our own destiny in our own hands and ensure that coverage continues to exist. The second one is by bringing that 53% up to the national goal of 80%, and so that's my intentions with this bill and with that, I respectfully ask for an aye vote.

Assembly Member, we still don't have quorum. Once we do, we'll entertain a motion. Thank you so much for your presentation. Assembly Member Dr. Jackson, you are up next for File Item Two: AB 220.

Thank you very much, Madam Chair. Committee Members, AB 220, which would require a health facility that provides sub acute care services to submit either form DHCS6200 or 6200A with a treatment authorization request when seeking authorization for subacute care services. It would also prohibit a medical managed care plan from developing or using its own criteria to substantiate medical necessity for subacute care.

I have taken the committee's amendments and I've appreciated. Appreciative of the work of the committee. I respectfully ask for your I vote.

Do you have any witnesses with you, assembly member?

No.

Okay. And just confirming those were your own amendments. No committee amendments came from us.

Sounds good.

Okay, great. Any me toos in support?

Good afternoon, Madam Chair and members. Connie Delgado, on behalf of the District Hospital Leadership Forum in support.

Ryan Spencer on behalf of the California Medical Association in support.

Thank you.

Mark Farouk on behalf of the California Hospital Association, in support.

Thank you.

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

Thank you. Is there any formal opposition? I'm sure it shouldn't have any. Okay, bringing it back. Any comments, questions? Okay, no.

Assembly member, thank you so much for bringing this bill forward. I think it's very imperative and ensure that we streamline and remove children, especially out of acute hospitals, make room for other beds, for other patients in those beds, put them in the right kind of care.

This is an issue that's been brought up to me a couple years ago. So I want to thank you for that, for this bill. I'd love to be added as a co author to your legislation. With that, you may close.

I respectfully ask for an I vote.

Great. When we have quorum, we'll. I'll entertain the motion. I thought I saw. Yes, I did. Assembly Member Ortega for file item 5, AB 499, you are up.

Assembly member, when you're ready.

Thank you, Madam Chair and members, for allowing me to present AB 499 today. The Robert F. Kennedy Farm Workers Medical Plan provides medical benefits to about 6,000 farmworkers and their families. Only 4% of the plan's budget is overhead. 96% of the RFK plan's budget goes directly to providing medical care benefits to its beneficiaries and their dependents.

The California Endowment estimates that the plan saves the state's general fund about $11 million annually in Medi-Cal expenditures. Last year, the plan needed to. The plan needed to deplete millions in its reserves to pay for life savings of. I'm sorry.

Last year, the plan needed to deplete millions in its reserves to pay for saving the life of a farm worker's son who needed a rare stem cell transplant. Currently, the RFK plan is reimbursed by the states for claim that exceeds $70,000. AB 499 simply lowers that amount to $50,000 to help keep the plant operational.

The bill, however, does not raise the existing annual $3 million limit on reimbursements by the state. Today I have a witness for technical question questions, Mercedes Martinez, administrator for the RFK Medical Plan.

Good afternoon. Mercedes Martinez, Plan Administrator for the RFK Medical Plan in support. AB 499 allows farm workers and their employers continue to both contribute financially to their own health while saving $11 million in California's medical budget and do so even when the plan experiences the occasional acute episode of care like we have experienced most recently with a young person who needed a life saving stem cell transplant.

We are pleased to have worked with Stanford University Children's Hospital and share with you that we were able to save the young person's life. With a medical plan as basic as ours, AB 499 helps keep the RFK farmworkers medical plan solvent by adjusting the state reimbursement trigger while still maintaining the existing $3 million annual cap on state support.

The RFK medical Plan is a joint labor management Taft Hartley plan for farm workers. The UFW and contributing agricultural employers deliver basic medical care to farm workers and their families at an affordable cost while keeping our administrative much lower than any other medical plan that we know of.

The plan is self funded, self insured, that is subject to a collective bargaining agreement between the UFW and agricultural employers and, as Assemblywoman Ortega mentioned, it supports over 6,000 Californians, including approximately 2,000 children. With recent changes in California law, there's a reasonable expectation the number of farmworkers covered by UFW collective bargaining agreements will grow.

That growth will increase the RFK's generated state medical savings from the current $11 million annually. Thank you for your consideration.

Now is the time for me toos in support of this bill.

Good afternoon. Esperanza Ross on behalf of the United Farm Workers in support. Thank you.

Ryan Spencer on behalf of the California Medical Association in support.

Okay, I don't think there should be any formal opposition. Any me toos in opposition of this bill? Colleagues, questions? Madam Vice Chair.

Hi. Thank you so much. So I'm just. I just have a few, I guess, technical questions. One, through the chair, why the 20,000? How did the $20,000, lowering it by $20,000 come to fruition? Why that specific number?

And two, are you concerned that by lowering the threshold you'd have more claims, thus needing more than $3 million annually?

No, we would never need more than $3 million annually. When we see a trend of care kind of toward the middle cost, then it just allows us to maybe add a few cases that would have not been initially included at the $70,000 threshold, but it's never more than 3 million.

And then the $20,000 marker, where did that?

So that's reducing it from 70 to 50. And that's what I was saying with the middle stream of type of care. So that just allows us to add some additional cases with a different dollar threshold of care.

So the majority of cases are below? Are already above, I should say.

The majority of the cases are above. Okay.

Okay. Okay, thank you.

And to clarify, you can't ever go above 3 million, right? Because that's what we passed.

Yeah, that's correct. Can never go above that.

It'd be capped at that. Any other questions on this? Assembly member, you may close.

Respectfully ask for an I vote.

We're zooming through. Thank you so much.

When we have a quorum, we'll entertain a motion. Assembly member, thank you for the presentation. Thank you. All right, we have two bills left. Assembly member. Madam Chair, come on up. You have file item 10, AB 1415.

Thank you, chair and committee members. Let me start by accepting the committee amendments and thanking the chair and staff for all of their work on this piece of legislation. The amendments of the committee remove health systems from the bill and focus the bill on transparency. This is important because AB 1415 is really about one thing: affordability, and we won't be able to understand why healthcare costs are rising so much if we don't have accurate and complete data to assess.

Today, a family living on the median income of $85,000 a year is asked to pay over $10,000 annually for their family's share of healthcare premiums and median deductibles, and 41% of adults have healthcare debt, often forgoing food, basic necessities, and spending down savings to manage that debt, yet many feel like the quality of their healthcare is decreasing.

In response to this crisis, in 2022, the Legislature and the governor stood up the Office of Health Care Affordability with an aim of lowering costs, improving outcomes, and supporting healthcare, the healthcare workforce.

Currently, OHCA has three primary responsibilities: setting and enforcing spending targets, monitoring system performance, and assessing market consolidation. To do this, OHCA collects, analyzes, and publicly reports data on total healthcare expenditures and enforces spending targets set by the Healthcare Affordability Board.

AB 1415 does two things: first, it provides OHCA the ability to collect information from private equity and hedge funds when they take over doctor's offices or other healthcare providers to OHCA's merger review. This is very critical information to have because private equity acquisitions of healthcare providers in California totaled $4.31 billion between 2019 and 2023, which is a third of all healthcare deals.

The second thing AB 1415 does is add management service organizations, or MSOs, to the list of entities that must report to OHCA regarding their involvement in healthcare transactions. MSOs help provide a variety of nonclinical services like billing and information service technology.

Despite their nonclinical focus, MSOs can nonetheless have a significant impact on the healthcare market functioning, patient care, and prices. They are on the business side of healthcare delivery, but they still impact clinical care. We want to make sure that management--physician organizations are being bought up by private equity, if they are, which is then limiting how doctors provide care like shorter appointment times and increasing prices.

I want to be clear about one thing that this bill does not do. This bill does not add MSOs to the list of healthcare providers who are subject to cost targets. They must simply report to OHCA to allow OHCA to better assess the effect they have on healthcare costs and quality. Families across the state are grappling with the increasing cost of healthcare and aren't receiving the quality of care they deserve.

This bill ensures that OHCA has the full picture of the cost drivers in our healthcare system and provides the needed authority over private equity and healthcare entities impacting costs and care in the system. With me today in support are Kaitlin Van Deynze from the Health Access and Beth Malinowski from SEIU.

Kaitlin, give me one second. We're going to establish quorum since we have it. Secretary, please call the roll.

[Roll Call].

We have quorum. Ladies, you have five minutes total.

Hi. Good afternoon, Madam Chair and Senators. I'm Katie Van Deynze with Health Access California. We are proud to sponsor AB 1415 by Assembly Member Bonta. We worked with Dr. Wood and the Legislature to establish the Office of Health Care Affordability in 2022 to address the rising healthcare costs facing consumers.

And because robust research has shown that healthcare mergers drive higher costs, OHCA, as the author noted, is importantly charged with assessing mergers' impact on consumers' access and affordability. And OHCA does this through reviewing mergers in producing reports on the impacts on consumers.

OHCA does not have the authority to approve or deny mergers, but if needed, they can refer to the Attorney General for action under their existing authority. While OHCA can look at a private equity merger right now, they don't have the authority to collect information from private equity and so we're missing a really important part of that transaction and AB 1415 ensures that that information can be collected from private equity and hedge funds and management services organizations.

When OHCA was passed, we didn't have a full picture and understanding of how prevalent private equity is already in our healthcare system. A third of all healthcare deals in the last three years have been private equity acquisitions in healthcare, and private equity is focused on aggressively pursuing a short-term profit and often leaving a hospital or a nursing home in a worse condition than they found it. During their tenure, research has shown that private equity deals can lead to price increases, dangerous impacts on quality, and risks for access to care and loss of services.

Last year, Massachusetts saw this on a large scale when formerly private equity-owned Steward Health Care filed for bankruptcy, leading to hospital closures across three states, and in this case, the private equity owner left the system with $800 million in profit while the system was financially struggling, leading to worse patient care and hospital closures even before the bankruptcy filing.

These are all reasons why AB 1415 is needed to ensure that everyone can fully understand the impacts of these mergers before they happen, and importantly, as the author noted, this bill includes management services organizations in these merger reviews because they're now a big part of the day-to-day in our healthcare and the finances, and we want to make sure that OHCA can look at the data about MSOs.

And as the author noted, we're increasingly seeing private equity-backed MSOs in our system and we want to make sure we can look at those mergers as well. Together, this bill will ensure that there's increased transparency over these increasingly complex mergers in our system and we can look out for the impacts on access to care for consumers. Thank you, and respectfully ask for your aye vote.

Good afternoon, chair and members. Beth Malinowski, the SEIU California, also here in proud support of AB 1415. SEIU California proudly worked with Health Access and a broad coalition of consumer, labor, and small business organizations to really stand up the Office of Health Care Affordability, and we've continued to engage actively in the work of the office to date and are deeply proud of the work.

As we reflect on that work, similar to our clients' health access, we've noticed, right, areas of refinement, things that we've learned in the past few years, and that's really where this bill comes into play.

As Katie spoke to, private equity is leading into greater consolidation, picked in quality, service reductions, closures, and OHCA needs to be able to fully review these mergers and transactions, but today, they cannot see both sides of that private equity transaction as Katie spoke to, and as she outlined, these transactions come with the greatest risks for our workforce and for our communities.

If we allow transactions to go forward without this full knowledge, it will be too late, and so again, really looking to make sure we're understanding here impacts to our workforce and our communities.

We also very much appreciate the additional work being done here for inclusion of management service organizations, those MSOs, to make sure that we've got that merge review and data collection happening on that end as well, and so with that, again, thank you all for your support today and hoping to move this bill forward. Thank you.

Thank you so much. Anyone like to record their #MeToo in support of this bill? Please step forward.

Thank you, Madam Chair and members and staff. Mitch Steiger with CFT, a Union of Educators and Classified Professionals, also in support.

Thank you.

David Berger, California Department of Justice, on behalf of Attorney General Rob Bonta, in support.

Thank you.

Keith Coolidge, on behalf of AARP California, in support.

Thank you. Formal opposition, please step forward.

Good afternoon, chair and members. Mark Farouk, on behalf of the California Hospital Association, representing 400 hospitals and health systems in California. I first want to acknowledge the amendments and thank the author and the committee staff. The amendments do go a significant, long way to address many of our concerns.

Unfortunately, we still remain opposed due to several other provisions of the bill. I will start by saying part of our overall opposition is the Office of Health Care Affordability has not yet provided a report to the Legislature to demonstrate where its existing authority is lacking.

For example, hospitals are already subject to significant spending caps that will impact the delivery of care. We believe it would be appropriate for an analysis of those impacts, of those existing spending caps on the healthcare delivery system before further expanding OHCA's authority.

Another issue is we believe that the current language of the bill related to reviewing transactions could jeopardize critical partnerships and the ability to rescue an organization. As amended, it would still expand OHCA's review of healthcare transactions that could delay or derail the very partnerships needed to save distressed providers or the ability of a provider to sell assets as part of a recovery plan.

Furthermore, we believe the bill would create unnecessary delays in the reopening of a closed facility as that transaction would need to go through the OHCA review process.

And finally, just briefly, I do want to frame some of the background of this issue that we currently know, as we all do--and I think we all agree that it's very problematic--that at the federal level, there are significant cuts being contemplated to the Medicaid system that will impact healthcare in our state.

I think we would respectfully ask that as you consider this legislation, that you consider the impacts of those pending cuts to California's healthcare system. For those reasons, we remain opposed. Thank you.

#MeToos in opposition, please step forward.

Good afternoon, Madam Chair, members. Ahwad Kidani, representing the California Children's Hospital Association, respectfully oppose, aligning our comments with our colleagues at the Hospital Association. Thank you.

Good afternoon. Megan Loper, on behalf of the United Hospital Association; also would align our comments with those of CHA. Thank you.

Thank you.

Nicette Short, on behalf of Adventist Health, Loma Linda University Health, Rady Children's Hospital, the Alliance of Catholic Health Care, and St. Agnes Medical Center, in opposition, but appreciate the amendments and are taking a look at them. Thank you.

Thank you.

Good afternoon. Jen Chase, on behalf of the University of California, also in opposition, but appreciate the amendments are continuing to review. Thanks.

Good afternoon, Madam Chair and members. Connie Delgado, on behalf of Newport Healthcare. We appreciate the amendments. We'll be reviewing those as soon as they come into print. Thank you.

Thank you.

Good afternoon. Shaun T. Flanigan, on behalf of Tennant Health, in opposition.

Thank you.

Fred Noteware, representing Stanford Healthcare, in opposition. Thank you.

Thank you.

Good afternoon, Madam Chair and members. Alfredo Medina, here on behalf of Manatt Phillips--with Manatt, Phelps, & Phillips, here on behalf of Cedars-Sinai and Cottage Health. We'd like to thank the author for the amendments and look forward to working with her to address our outstanding issues as they relate to the definition of MSLs, which currently drafted, we believe still includes health systems. Thank you.

Thank you.

Thank you, chair and members. Chris Scroggin with Capital Advocacy, on behalf of the American Investment Council, in oppose unless amended.

Thank you so much.

Sumaya Nahar, on behalf of Memorial Care Health System, in opposition.

Thank you. Bringing it back for discussion. Dr. Weber Pierson.

Thank you, chair. I want to thank the author for this bill so that we could have this conversation and discussion and also for the amendments that you've taken. I want to once again make myself very clear. I am not happy with what OHCA is doing, what they have done.

I think that it has been rushed, I think all of the data points have not been included, and I am concerned about the fact that at the end of the day, patients will suffer because of some arbitrary--what I view as arbitrary--spending targets at this point.

That being said, with the original bill, prior to the amendments, I would not have supported it because I did not think that they needed to have any further purview over something like the health systems when I'm concerned with what they currently have purview over, but with removal--and I do want to state that I will be supporting it today, but there are a couple of things that I need clarified prior to it coming to the floor.

The definition of MSO, ensuring that that does not include health systems, because again, if that's included, this isn't something that I would support OHCA having purview over at this point, and also ensuring that their ability to look into mergers and acquisitions, which is extremely important because those things oftentimes in the past have caused a reduction in access to services because these are businesses coming in, looking at the bottom dollar, which is finances.

So we do need some more transparency and some light in that area. However, looking at what's happening at the federal government level, but even outside of that, the fact that many of our hospitals, especially in rural areas, are struggling anyway, the ability for them to review this information should not cause any unnecessary delay in that happening.

So we'll be supporting it today, but once it gets to the floor, want to make sure that there are no unnecessary delays in these mergers going forward, especially when we're talking about distressed hospitals and providers and ensuring that MSO definition does not include health system, but I really want to thank you for the amendments that you have taken and that you continue to work on this bill to make sure that it is the best in this current circumstance, but thank you.

Senator Rubio.

Thank you, Madam Chair, and you know, I want to thank you for this information. I know I met with most of you in my office, and I do also want to state some of my concerns.

You know, I will be supporting the bill, and I'm thankful that you've worked towards trying to mitigate some of the concerns of the hospitals, but I don't want to belabor the point and repeat everything that Senator Akilah Weber said, but, you know, when I think of distressed hospitals in our communities and that there have been a few that have gone under, that gives me pause in the sense that when a hospital needs help and we're delaying their ability to find someone that can help out, that's the impact to our communities.

That's a reduction in quality health care that we keep fighting for in this committee, but when I met with you, one of the things that I struggle with when we put caps--and that is--that we--right now there's so much that we're dealing with when we talk about the cuts from the federal government.

We don't know what that's going to look like and then we still see what's happening, and I'm sure right now in all of our communities, a lot of folks are not going to get care because they're afraid of, you know, there's going to be a raid in the hospitals, and so we're just going to see a disruption for a little while, and I'm also very cautious of understanding what that impact is to the hospitals.

If we truly want healthcare, quality healthcare, then we have to do what we can to partner with them and find out how we can make sure that we don't end up hurting those very communities that we want to help.

I did--again, I have most of the conversations with you in my office, and I keep saying when we look at caps, I also want it to be an ongoing conversation because a lot of the times healthcare goes up not necessarily because of what the hospitals are doing, but a lot of the policies that we implement in this dais, and so we end up increasing the cost, and yet we penalize them for increasing their own costs.

So it's kind of a give and take. I think at the end of the day, my, my--what's first and foremost in my presence is my community. How do we make sure that hospitals remain open, how do we make sure that they have access to care, and how do we make sure that we're not breaking a system that's already stressed?

So just wanted to put all my concerns out here because I'm not necessarily 100% in agreement, but I did tell the author that I will support it and I appreciate the information that was brought to my office, but with all the concerns that I just heard from my colleague Akilah Weber, as well as what I've stated, it's, it should be an ongoing conversation, but I think we're almost there and the amendments helped out a lot, but I still have concerns and just moving forward to see if we can continue the conversations. Thank you.

Senator Padilla.

Thank you very much, Madam Chair, and to the author, thank you for your work and for the progress on working with the stakeholders with respect to the amendments, and I would echo some of the comments of my colleagues with respect to being careful that we craft definitions carefully and not sweep up in that somebody's ability to apply that definition to systems in a way that could cause other unrelated issues.

I think the level of scrutiny here, particularly articulating the ability to obtain the appropriate information and data, is critical to oversight. I think as much as timeliness is important, as we look at this market trend of these private equity acquisitions and mergers have some benefits in some circumstances. I think there are also ample data to seem to indicate that these market trends, where there's acquisition and sales within a certain time frame, contribute directly to incremental cost to healthcare services and in some cases access.

So I think that going after providing that discrete authority and making sure that you have the right ability to obtain data for appropriate oversight, this level of scrutiny is important. We have to get it right. For those reasons, I'll be supporting the bill, but I do appreciate the work and would encourage the author to continue that work in refining the bill. Thank you, Madam Chair.

Senator Limón.

Thank you. Thank you to the author. We had multiple conversations here over the weekend recently and I really appreciate you just listening and also helping walk through and working with the amendments to craft something that was going to work for lots of different parts of the state and also lots of different healthcare systems that don't always deliver in the same way.

I think the amendments have gone a long way and I want to recognize you because that was a lot of work to try to, you know, figure out how to bring folks to a place where, you know, it better worked.

I'm going to echo the voices on the MSOs, and I'm going to give an example in particular to, to one in the district who is a healthcare provider and also provides billing services, UM, payer contracting to the foundation, 1206[l] side of it, and something like that could potentially get incorporated without clear definition.

They are a health, you know, health system, and we would like for that to be clear, and so I'm hoping that there could be perhaps some more, you know, along with the intention of what we're trying to do, but also some more clarity so that something like that couldn't get picked up outside of this, but I do want to thank you for it, and I will be supporting the bill today. Thank you.

Senator Durazo.

Yeah, I just want to ask the author a couple of things have been raised about the impact of the federal government's cuts and then also reference to distressed hospitals. Could you respond to that because I actually didn't see it from that point of view. I mean, I know the federal cuts, of course, could have an impact, but how distressed hospitals would be impacted, could you please respond to that?

Absolutely. Thanks for the question, Senator. So I think we're all incredibly concerned about the cuts that we know are looming from the federal government and the impact that it will have on our healthcare systems.

I think the bottom line to that is that it is going to impact how much we are able to support our Medicaid and Medicare systems, our safety net systems, and all of those will impact our overall--our healthcare providers will create a lot of anxiety and real need within our healthcare system overall.

So I am very sensitive to that looming as a part of this. I will argue that one of the things that we are going to need to do very quickly given these healthcare cuts is make sure that we, in California, are able to manage affordability overall, which makes the work that OHCA does even more critical.

I think the piece around the distressed hospitals, I fully understand HCAI sits--OHCA sits within HCAI and so HCAI is constantly, very closely monitoring distressed hospitals while they are heading towards distress and then managing, managing the ability for them to not become distressed, and so it's very important that we can recognize that those two offices are existing and talking to each other very, very consistently, which gives me hope.

I think the other thing is that OHCA does have the ability to expedite review related to any of these processes. In the instance of a distressed hospital, which is important to note overall so that we don't have this situation where there needs to be a quick closure like we experienced with Madera Hospital recently or, or others and reopening, and where there needs to be an infusion of cash in order to be able to do that, private equity may get involved in that. OHCA does have the ability to expedite the process around that particular transaction. I think that's very important to outline.

The overall review process, I think I just want to note and certainly hear the concern around not wanting to have any unnecessary delays or reviews associated with, with particularly our distressed hospitals or entities. Typically, OHCA has at least 90 days before needs a requirement--a private equity fund has to notice OHCA 90 days before entering into any agreement.

So there's advance notice there. If conditions are met, such as affecting the state's ability to meet cost growth targets, OHCA will conduct another CMIR. That's kind of a look at the overall market impact, and OHCA has 45 days to complete that initial review.

And if it's determined that a CMIR is actually required, OHCA must complete the CMIR within 90 days. So OHCA's involvement in that is not multiple years. It's within the scope of a quarter for the most part, which I think can stand to be looked at for sure, but I think in the case of distressed hospitals in particular, there is an opportunity to expedite that.

Great. Thank you. Madam Chair, thank you so much for bringing that point up. I was going to share that there is an expedited process that exists right now that should there be a transaction that is going to be impacted to a distressed hospital, there's ability to fast-track that so it does not impact that transaction.

Can you address--because it's been brought up and it wasn't our intent as we drafted the amendments on when we narrowed down the MSO--is it your intent to include health systems in the definition of MSOs?

No, I think we worked really hard to acknowledge that there was still work that needed to be done around inclusion of health systems at this time, so it is certainly the intent that we are going to make sure that the language hits the right chord to ensure that there's no conflation of an MSO or a health system with an MSO as we've defined it, and I'm certain that we'll be able to get that language.

Perfect. Yeah, because we were in agreement that--yeah--that we didn't want to include that in there, and I was trying to look back and trying to figure out maybe how someone can construe that definition as that.

And slowing the growth of healthcare costs is a huge responsibility of OHCA, but equally as important is to ensuring that we have access to healthcare, especially in our underserved populations, and we were trying to balance that, which is why it was important for us in agreement to remove the definition of healthcare systems as a cost target. We wanted to make sure that wasn't impacting access to healthcare.

And I think the amendments that the author took to narrow this bill down to really just focus on private equity, hedge funds, and then redefine or narrow MSO was trying to get at that balance there, so I want to thank you for your collaboration on this bill.

I know there's some outstanding concerns still from my colleagues, but we've gotten to a place where we felt that we were able to balance the needs of access to hospitals and so forth, the impact that could be coming from the federal government, but also the need to get some responsibility, some accountability here.

Now, there is outstanding concerns on OHCA, and I think I've also shared some of those concerns in sub three regarding those cost targets and the data points, and I think they advanced them two years before the actual deadline. Was this fast-track too fast? Did we not put enough thought into it?

But those are outside concerns that should be dealt with outside of this bill. This bill stands on its own dealing with this specific topic, which is why I recommended an aye vote with these amendments. Madam Chair, you may now close.

Thank you. I want to appreciate the really critical analysis that many of the committee members have done and certainly our chair, to make sure that we could move this bill to a place where you would have something viable to consider as we move this forward.

I certainly take to heart the concerns that have been raised by committee members and will seek to ensure that we have clarity around those concerns prior to it hitting the floor, should it be so fortunate to do so, and I just want to echo the broader concerns. OHCA was stood up in 2022.

That's a blink of an eye in the way of state agencies and it hasn't been without its bumps and bruises, and should I be so fortunate to continue in this role or just certainly as a Legislator, I will certainly commit to making sure that we're taking a very hard look at OHCA's process and ensuring that it doesn't create any unintended consequences.

I've heard things about the review process, the need to clarify what technical assistance looks like, and quite frankly, feels like to hospitals in partnership to make sure that they have the ability to continue to provide the service that they need, and those are all things, as the chair said, that are outside of the scope of this bill, but are certainly areas of concern and growth that we can ensure the people of California.

At the end of the day, affordability is something that we all have committed to be focused on in this year and we know that particularly, private equity's engagement in our healthcare system is something that we have to be incredibly mindful of and we can't be outpaced in terms of their ability to buy up and participate in our healthcare system and our ability to have oversight that's much needed to ensure that we have a healthy and affordable California. With that, I respectfully request your aye vote.

Thank you. Can I entertain a motion? Moved by Senator Durazo. Motion in front of us is do pass as amended and re-refer to the Committee on Appropriations. Please call the roll.

[Roll Call].

With the current vote count of 7-0, we're going to put that back on call. Thank you so much. Our last item for presentation today is going to be for file item 8, AB 1103. Assemblymember Ward, when you're ready, the show is yours. Little squirmy over here. This is our last bill for presentation.

For any members missing, please come on down. We'll be voting after summit Assemblymember.

Well, thank you, Madam Chair and senators. First, I'd like to start off by accepting the committee amendments. And I want to thank the staff for their very hard work on this bill. AB 1103 expedites the state's review and approval of federally sanctioned drug, clinical tri - sorry, drug trials and clinical research, administering Schedule 1 and 2 controlled substances to human and animal subjects in California. This approval is granted through the Research Advisory Panel of California, better known as RAPC, which is housed within the Department of Justice.

Now, the Federal Controlled Substance Act requires all medical and scientific research with controlled substances in the United States to be reviewed and approved by the FDA and registered by the DEA before it may commence.

The current RAPC approval process requires taking action by a majority vote at a regularly scheduled bimonthly meeting of the full panel membership, which can delay the commencement of urgently needed research by up to 60 days and potentially longer. In cases where researchers submit incomplete and or premature applications without the requisite federal approvals.

Elite AB 1103 seeks to alleviate these avoidable delays by codifying an expedited approval process while ensuring that California retains rhapsody as a backstop to federal oversight so that all controlled substance research conducted in California always complies with state law and policy.

The expedited review process responds to concerns voiced by California's research community over the state's approval process delaying the commencement of vital clinical research in California and the effect of these delays on the ability of California institutions to compete for research investment and talent.

With me today here to testify are Khurshid Khoja with VETS and retired Navy SEAL Master Chief Tarj Shavrat, who served in the United States Navy. And when the time comes, I respectfully request your aye vote.

Gentlemen, you have a total of five minutes. Whoever wants to start?

Good afternoon, Madam Chair and members. In the 25 years I was in uniform, I deployed to combat zones from Desert Storm, Afghanistan and Iraq. I would return from these deployments with hyper vigilance, anxiety, brain fog and irritability. I took unnecessary risks, and I abused alcohol. I was not okay. My family life was not okay.

I experienced the loss of many of my friends to combat casualties, which again led to excess alcohol use. I would get a call in the middle of the night informing me that dozens of my teammates had died in a helicopter that was shot down. The pain is indescribable.

I experienced traumatic brain injuries and blast injuries from massive explosive forces throughout my career. After an altercation with my son, I'd had enough of my own attitude. I went to the VA mental health care facility and reached out for help.

The psychiatrists at the VA were very helpful with the initial triage and getting me out of the trenches. I did the therapy. I took the pills. I was prescribed a total of 5 pharmaceuticals for mood, depression and sleep. These pills had serious side effects that negatively affected me.

On one occasion my body seized up and I was lying there paralyzed and had to call 911 on my cell. The side effects were terrible. I did not feel human. After this incident I decided to get off the VA, prescribed medications and find a better solution. VETS was recommended to me by a close friend.

So, I reached out to them, and they immediately got me scheduled to attend a treatment in Mexico. I went to Mexico a very broken man. I returned very focused, and all of my anxieties had gone. The process in Mexico involved me taking ibogaine, the root of the iboga plant from Gabon in Africa.

I experienced clarity on many issues that had plagued me and was relieved of the negative brain fog and the hypervigilance. This one treatment was able to erase these negative feelings. I've been 100% alcohol and medication free for the past eight years. I do not have any desires to use drugs or alcohol and no feelings of harming myself.

This treatment changed my life for the better immediately. I've experienced zero secondary side effects other than the positive ones. I have real confidence that I will never drink again, and I know that this treatment had an impact on this. Suicide is devastating. Our veteran community and the special operations community is not immune.

We have lost some exceptional patriots to this issue. I had suicidal ideations prior to the treatment and know how desperate these veterans must have been to take their own lives. It breaks my heart into pieces. California is where I grew up. I served in the SEAL teams that are trained and headquartered in California.

Yet I had to leave this country in order to get the help that I needed. That ain't right. This treatment can and has saved lives by allowing research on this medication. It is another tool to stand in the way of suicide and get these guys real help.

I hope that you will all vote yay on this bill and help get this through so that we can have this for our veterans and for the rest of the people that need it that are out there. Thank you very much.

Good afternoon, Madam Chair and distinguished committee members. I'm Khurshid Khoja, the Director of Public Policy and Legal Counsel for VETS, a tax exempt veterans charity and the sponsor of AB 1103. I'm here at the request of Dr. Jennifer Mitchell, chair of the Research Advisory Panel of California who could not join us today.

As you know, RAPC is a long standing state panel tasked with evaluating controlled substance research.

It predates the Federal Controlled Substances act by two years and yet the statutes mandating RAPC approvals have never been updated to account for either changes in the way such research is regulated or to account for subsequent state laws that affect how and when the panel can meet.

The lack of updated statutory language governing RAPC previously caused the panel to stop meeting for almost a year, halting nearly 100 research studies within the state, many of which impacted veteran care and mental health.

I'm here today because AB 1103 is an opportunity to update and improve RAPC to ensure that controlled substance research within our state is reviewed and approved expeditiously and to remove unnecessary bottlenecks to the availability of life saving therapies for veterans and other Californians this Bill would create an expedited review process for qualified studies and enable panel Members to continue performing candid scientific reviews of research applications without exposing panel Members to potential conflicts of interest.

AB 1103 represents nearly two years of outreach and effort by vets, Dr. Mitchell and her fellow panel Members of RAPC, as well as numerous stakeholders in the medical, scientific and research communities that enthusiastically support this Bill. Finally, I'll note this Bill has no opposition. Thank you for your consideration.

Thank you so much. Coming up for me too, in support of this bill.

Thank you, Madam Chair and member. Dylan Elliott on behalf of the City and County of San Francisco and the California State Association of Psychiatrists in support. Thanks.

Ray Naroposta on behalf of Drug Policy Alliance and support

Also, on behalf of my previous legatee.

Ryan Spencer on behalf of the California Medical Association and support.

Thank you.

Maddie Hyatt, California Civil Liberties Advocacy and strong support. And I don't usually get personal, but I have a strong military background. Not myself, but my family. Both grandfathers, World War II, my uncle Vietnam and PTSD issues galore. Iraq. I got lots of family members, so.

Gilbert Lara on behalf of Biocom California in support.

Hello. Nicole Redler on behalf of compassionate veterans 501c3 in support.

Pam Lopez on behalf of California NORML in support.

Jen Chase on behalf of the University of California. We don't have a position on the bill but wanted to thank the author and sponsors and the committee for working with us on the amendments. Thanks.

Any like you mentioned, no formal opposition, I think. Okay. No. Any me toos in opposition of the bill? Bringing it back. And those were author amendments that were asked for the committee to take. So, no committee amendments. Any questions from the - from our colleagues. Okay. All right; was moved by Senator Padilla. Assemblymember. You may close.

Thank you. Senators, I would respectfully request your aye vote.

Great. Motion in front of us is do pass as amended and refer to the Committee on Judiciary. Secretary, please call the roll.

[Roll Call].

Assemblymember, that currently has a vote count of 8-0, but we're going to put it on call because we're missing some members. Thank you so much. Thank you for your presentation. Thank you for your service, sir. Okay, we are. We will now consider the bills on the consent calendar.

Those are going to be Items file number three, AB424. File number four, AB440. File number seven, AB960. And file item nine, AB1357. Can I get a motion so moved Moved by Senator Richardson to slow. Madam Vice Chair. She was quick.

[Roll call]

Consent Calendar currently has a vote count 8 to 0. Putting it back on call. Missing some colleagues. Please come on down. Let's go through the roll on file. Item one, AB54. Can I get a motion moved by Senator Dr. Wilbur Pearson? Motion is due, passed as amended and re. Refer to the Committee and Judiciary.

Please call the roll.

[Roll call]

On a vote count of seven to zero, we're going to put that back on call. File item two, AB220. Can I get a motion move by Senator Dr. Weber? Pearson. Motion is due. Passing. We refer to the Committee on Appropriations. Please call the roll. Senator Menjevar.

[Roll call]

I'm going to put that back on call. Currently has a vote count of 8 to 0. File item 5, AB499. Motion. Can I get a motion moved by Senator Durazzo? Motion is due. Pass and refer to the Committee on Appropriations. Can I give you a Doctor?

[Roll call]

Putting it back on call. With the current vote count of 8 to 0. File item 6. AB536. Chair having a none. Reco, please. I need a motion move by the Vice Chair. Motion is due. Pass and we refer to the Committee on Appropriations. Please call the roll.

[Roll call]

Current vote count of seven to one. We're going to put that item back on call. Please call the absent Members on file number eight. Grove found number eight.

Then I gotta flip the page.

[Roll call]

That bill is out with 11 to 0. Please call the absent Members on file, item 10.

[Roll call]

That bill is out with the vote count of 9 to 2. Please call the absent Members on the consent calendar.

[Roll call]

The consent calendar is out with the vote count of 11 to 0. Please call the absent Members and file item 1.

[Roll call]

That bill is out with the vote count of nine to one. Please call the absent Members on file, item two.

[Roll call]

That bill is out with the vote count 11 and 0. Please call the absent Members on file, item 5.

[Roll call]

That ill is out with the vote count of nine to zero. Please call the absent Members on file, item six.

[Roll call]

That bill is out with the vote count of 8 to 1. That concludes all the business for the Senate Committee on Health. We are adjourned.