Senate Standing Committee on Health

The Senate Committee on Health will come to order. For everyone's awareness, one Bill was pulled from today's agenda. That's going to be file item 15, AB 1460. That now leaves us with 14 bills on the agenda. For on consent, we have our first author here who has two bills. Please kick us off with file item one, AB 56.

Thank you so much, Madam Chair and Senators. AB 56 is a critically important Bill to deal with the global mental health crisis that our young people are facing. As the mom of teens, I get to see every day how challenging it is for our kids to live in this new age of social media.

And and the Bill comes from the 2023 recommendation of US Surgeon General Vivek Murthy, who recommended that we put warning labels on social media just as we do cigarettes and other things that are addictive and cause harm.

And so this Bill puts into place a warning label on social media that will help to educate our youth around the negative mental health impacts of staying on social media for an extended period of time.

With me today in support of the Bill is Victoria Hinks, the mother of a beautiful daughter who is here to tell her story. And Anthony Liu, deputy Attorney General at the California Department of Justice. You'll see Holly Groschains is here from Common Sense Media for questions, if there are any.

Great. You have a total of five minutes. It's up to you how you want to distribute that time amongst each other.

Victoria Good Afternoon. I'm Victoria Hinks. But first, I want to thank Assemblymember Bauer-Kahan for authoring this critical Bill. It's so important and we desperately need it. And thank you so much to some of the other. It's good to see some of the other Committee Members that were in the Senate Judiciary Committee.

And thank you for your time and for having me here today. So I'm here to share my daughter Alexandra's story. This is Alexandra because she cannot. Alexandra, lovingly known as Owl by her friends and family Members, died by suicide almost a year ago, August 7, 2024. It's almost a year and she was only 16.

She was a kind, beautiful soul and full of life. She loved animals, especially our westie dog, Elsa. She loved sports, cross country, field hockey, skiing. She loved babies and little kids and looked forward to being a mom one day herself. She loved Hamilton, was always singing the songs and she loved anything pink.

But social media pulled her into a dark spiral. She was shown content about self harm and started believing she wasn't pretty enough without using beauty filters. She became hooked. Eating disorders, suicide, self harm, all that content was served up to her and she became hooked to doomscrolling for hours and becoming more isolated.

And we as parents were left with impossible choices. Do we not let her be on social media, having her feel like the outsider, not having any friends, or do we let her be on social media so she could feel connected to her peers in school? And we tried middle ground. Nothing worked. We tried everything to help.

Even therapy didn't help. And the parental controls were useless. She bypassed them all. And my husband, who's a very seasoned software engineer, set up all of the screen time limits, everything. She's very tech savvy. She got around all of that. And what worked for her at 13 didn't work for her at 16.

She became someone we did not recognize. Taking social media away from her was like taking drugs away from an addict. And finally, she used social media to find out the best way to kill herself. A question which was answered with great detail and encouragement.

It's unbelievable that you have to be 16 to drive, 18 to vote, 21 to drink, 25 to rent a car, but you can be any age and see anything online on the Internet. So instead of getting ready for her senior year of high school, I'm fighting for change for Owl and for California's kids.

This could be your kids. It could be your grandkids, your niece, your nephew. Social media does not discriminate. We are raising our kids in this unregulated social experiment that's going on. And our kids are the first generation of kids guinea pigs. You know, real warnings like AB 56 are so necessary.

And I think in 10 and 20 years, we're going to look back on this and we're going to ask ourselves, what were we thinking? We'll wonder how we allowed a whole generation of children to become test subjects in one of the most dangerous experiments of our time, social media.

Our kids again, were the first cohort raised entirely in a world of smartphones, algorithms, and addictive platforms. They were the guinea pigs, and we didn't protect them. These social media companies have a huge amount of intellectual horsepower and resources at their disposal. They could protect our kids and change the algorithms if they wanted to.

Our unwitting participants, our children if they wanted to. And I can't bring back my Owl baby, but I won't let her short life be in vain. I'm just here as a mom, like, appealing to other moms and dads. Please vote like a mom. Please support AB 56. And I really appreciate and I humbly ask for your support. Thank you.

Give about a minute and a half.

Thank you. Good morning. Good afternoon. My name is Anthony Liu. I'm the Deputy AG in the Office of Dutch Affairs for AG Bonta, who's a co sponsor of this Bill to ensure that parents, adolescents and the public are armed with clear information about the risks of social media for kids and teens.

We want to thank our author, Rebecca Bauer-Kahan for authoring the Bill and Victoria for sharing her story today, Common Sense Media for co sponsoring this legislation with us to protect California children.

As the author pointed out, the US Surgeon General's advisory warning in May 2023 detailed a lot of evidence identifying reasons for concern about social media usage by children and adolescents.

Page four of the Committee analysis reviews even more scientific evidence about the Association between frequent social media use and outcomes like sleep difficulties, attention problems, ADHD development, depressive symptoms in our youth. The AG is part of a bipartisan coalition of 42 attorney generals who sent a letter to Congress supporting the Surgeon General's advocacy for warning labels.

It's our responsibility to make sure consumers have access to information that may affect their health so that they can make the best choices for themselves and their families. Social media warning labels are an equitable, effective and transparent way to deliver public health information.

And by requiring warning labels on social media platforms, AB 56 provides families, children and others information about the risk of social media use. We thank you and ask for your aye vote today.

Thank you so much. Any Me Too's in support of this Bill, please step forward. Name, organization and your position.

David Bolland, Serving Family Values. We are in support. Thank you.

Dave, where's your cool hat?

Nice. Paul Hinks, I'm a dad. I strongly support. Thank you.

Shira Spector with Stone Advocacy. On behalf of the Children's Advocacy Institute at the University of San Diego Law. Thank you for bringing forward this Bill.

Good afternoon, Madam Chair and Members. Malik Bynum with the County Behavioral Health Directors Association in support.

Mikey Hothi, on behalf of Common Sense Media in support.

My name is Cheryl. I'm Owl's aunt and I ask for your support in this Bill.

Thank you.

Good afternoon. Angela Hill, California Medical Association, in support.

Thank you so much. Before we move on to opposition, Victoria, it takes a lot to come when a tragic incident has just recently happened. Thank you for bringing Owl with you. Thank you for being brave to do this during a really tough time that you're going through right now.

Thank you so much.

Opposition, please step forward.

Victoria, you can stay there. Gentlemen, you also have five minutes.

Okay. Thank you, Madam Chair and Members. Dylan Hoffman on behalf of TechNet in respectful opposition to AB 56. And first, I do want to say very clearly that our Member companies don't dispute that the youth mental health crisis is something that warrants serious discussion and real solutions.

Our companies recognize that we need to be a part of that conversation and have been at the forefront of designing better platforms, policies, tools for parents and youth to provide as safe and enjoyable experience as possible online. What we question is whether AB 56 is an effective solution to this problem. Our concern centers around a couple of things.

One, the efficacy of it the warning as proposed flattens an incredibly complex, nuanced and evolving issue to the point of overgeneralization.

The warning is inapplicable to adults, but it also tells minors nothing about what kinds of content, online behaviors or features could be risky, how they impact their mental health, or steps that they can take to protect themselves. Unfortunately, at best, we believe these labels will be ignored.

At worst, they'll create an annoyance and burden to users of all ages trying to access lawful speech. Which leads me to some of the constitutional issues with this Bill, which, while they may lie outside the jurisdiction jurisdiction of this Committee are still relevant.

Simply to say we believe this Bill is highly likely to be challenged in court and likely to be found unconstitutional. There's a significant likelihood that this Bill doesn't go into effect, and if it does, will do, we think, very little to solve this underlying problem.

With all that in mind, though, we're still willing to work on this Bill to avoid constitutional challenge and also ensure it provides useful, pertinent information to the users who need it most. And we look forward to continuing our dialogue with the author, their staff and this Committee, but respectfully oppose the Bill before us today. Thank you.

Good afternoon, Chair and Members. My name is Aodhan Downey. I'm speaking on behalf of the Computer and Communications Industry Association in respectful opposition to AB 56. While we support efforts to protect youth Online Similar to TechNet, this Bill raises serious constitutional and practical concerns.

AB 56 would require a government mandated warning label on social media platforms applied to all users regardless of age or content. That means adults and teens alike would face warnings even when accessing safe educational or supportive content. This approach is not narrowly tailored and could deter people from using platforms altogether or drive them to workarounds.

A one size fits all warning label misleads users and risks undermining trust. Finally, the Bill presents significant technical challenges for covered platforms and conflicts with data minimization principles. By requiring platforms to collect more user data than they otherwise would, it imposes unnecessary government mandated privacy risks on users.

We respectfully urge the Committee to pursue a more targeted and effective solution. Thank you.

Thank you. Do we have anyone in the room who want to record their Me Too in opposition?

Kelly LaRue for the California Chamber of Commerce In opposition.

Thank you. Seeing no one else bringing it back for any discussion. Senator Dr. Weber-Pierson

Thank you, Chair. I want to thank the author of this Bill for bringing forth this very important measure. Also want to thank the mother of Alexandria for being here, for allowing her life to be a life that will continue to impact society. We are all here because of what happened to her.

I think what is so frustrating for me, is that we have to do legislation around this at all. The reality is that these companies that have created these systems have some of the best and brightest in every imaginable field. Engineering, science, technology. They know what they're doing. They know how the human brain works.

They know how adolescent brain works. They know the developmental stage, how these young kids are at a very impressionable age. And they have targeted them and they prey on them.

And so although we are recognizing the consequences, I have no doubt that they knew this before because you do testing before you roll things out and you know exactly what you're doing. But let's just say that you didn't know.

You see that this has become a huge issue, and instead of working to fix it on your own, you choose to oppose measures to make it better. And I'm not talking to the individuals who are here, but I am speaking on the companies that you represent.

A part of your opposition is that you don't think it essentially goes far enough. It's not going to fix the problem. Then my question is, what have you done? Or what are you doing right now to fix it? You talk about the fact that it doesn't, It's just a warning sign, it's just a warning label.

It doesn't really tell people where to go to actually get help. You shouldn't need legislation to do it. You could fix it yourself. You can fix the problem that you've created, but instead you choose to try to put up these obstacles for financial reasons.

I just hope that at some point we all recognize that we must become good stewards for our communities and for our country. Otherwise, we will all perish. And with that, at the appropriate time Chair, I would like to move the Bill.

When we have quorum I'll entertain that motion. Any? Senator Rubio.

Thank you. I Also want to just take a moment to acknowledge the tragedy here. There's nothing we can say that can make it any better, but I know that what's happening to you has happened to many other parents. And I want to echo what my colleague just said, but in general, thank the author.

I have to share with you. I've been an educator for 20 years, and I remember being a vice principal at one point, point where I knew something was happening on the playground.

You just know when all the kids gather in the playground and they're giggling and, you know, we discovered that one of our students had put pictures of herself, fifth grade, I think it was 9 or 10 years old. And they were all sharing her pictures, inappropriate pictures.

And I say this because I know it's a different issue, but I don't think sometimes we realize the impact of platforms, social media, and what's happening with our kids. She thought it was something cute, put it on, and then all of a sudden her entire school is sharing these pictures.

And so it's a small piece of the puzzle, but I always think of this child. This was probably eight years ago. This person is probably 18 or 20 or so, and those images are going to stay there forever.

And I think of this individual when she goes for a job or this is going to come and haunt her. And so what's going to happen later, she may not be able to take the pressure of people sharing her images. And that's where the mental health issues kick in.

And so I do believe that it's time that we do better. There has to be a way. And I know that as educators, as a society, we try to encourage our kids not to do certain things, but at the end of the day, we have to figure it out. These precious lives are too important not to.

And it's easy that, you know, everyone's making money. There's algorithms, too, where they'll push our kids to go one direction or the other. There's certainly ways of getting information in front of our kids, so there's certainly a way to figure out how to make them safer.

And I know this is just a small piece of the puzzle, but I think it's an important piece. I think it's an important step towards trying to figure out how to, you know, provide some support to parents and warnings to our kids, our youth. This is, again, too important. It's not going to go away.

So we have to do better as legislators and making sure that we stay on top of it and that we mandate that these companies do better. And so I'm also very thankful for you. I believe I'm a co author already and I stand with you in the memory of your child. Thank you.

Madam Vice Chair.

Thank you. Well, first of all, I want to thank you for being here, for turning your pain into purpose. I cannot even imagine what it's like to lose a child.

And this is one of the hardest things about being a Legislator, too, is that being a Legislator and a mom is like, the mama bear in me is like, I'm going to take out anything that would try and harm my child and even change that in law or through policy. And I admire your courage.

I also take my role here on the Health Committee very seriously. And our responsibility to advance legislation that protects public health, especially when it comes to our youth, to mental health, to how social media impacts the mental health of our youth. Completely understand that.

But I also think that we have a responsibility to ensure that the policies are grounded in evidence and hold up constitutional scrutiny. And so my question to both the opposition and the AG's office, and I should have asked this in Judiciary. I'm sorry, but I know that there have been in the past lawsuits that-

In which these very, in which. Let me look for the language specifically, because I'm not an attorney, but. Okay, so the U.S. Supreme Court has held in cases like National Institute of Family and Life Advocates versus Becerra that the government cannot compel a private entity to speak government messages unless the regulation satisfies strict group scrutiny.

So I'm just concerned. Are we anticipating that? We're trying to do the right thing here, but are we going to end up in court on this issue?

Senator, do you mind if I begin? Is that okay? Okay. Thank you. So will we end up in court? Yes. I can tell you that every single social media Bill this Legislature has passed, the social media companies have sued us on. So I'm confident we will get sued on this.

There's lots of laws we pass that they sue us on. So I guess the question isn't do we end up in court? It's do we win? Do we end up prevailing and protecting our children? I don't actually have. Because it was an issue for Judiciary. I don't have the exact legal test.

Holly may have it and I can turn it over to her or the AG's office. But this is really akin to the speech that we are able to enforce on a cigarette warning label. And it's partially because of the deep governmental interest that we have here in protecting our children

that is so, I mean, I think bipartisan clear that that is a deep governmental interest, that we can overcome the compelled speech piece of it does have to be narrowly tailored. It has to be science backed. The warning label has been very- in

The Bill has been very carefully tailored to follow the research that has been published on the issue of social media warnings. The timing of the warning label at 3 hours is tied to research. That's when the research has shown that the mental health impacts start to really take effect.

And so it's all of those elements that will allow us to prevail on this. Of course, I can't predict what the courts will do, but give us a good chance of prevailing. And so I think it's really important that we take that chance.

And I've also said in other committees and I think I said this in Senate Judiciary. You know, I loved the age appropriate design Bill that was of a few years ago. I think you were serving in my house at the time when that Bill passed.

And that Bill would have created a set of parameters for youth when they used social media that were safer, less addictive. That were a lot of what I think Dr. Weber-Pierson was alluding to. Nothing would require legal action for that to be the case. Companies can do that today without us doing anything. They chose not to.

So we took that step that was overturned in the courts. So it is not in effect on First Amendment grounds. So this is a different approach. But I think that fundamentally, I'm a lawyer, I took an oath to uphold the Constitution and I will not bring you a Bill that I do not believe passes constitutional,

whether the courts agree with me or not. And you know, I think that I will keep fighting for our kids and I know all of us will because at the end of the day, we have to do something because the companies aren't choosing to take those steps.

Instead they're suing us when we try to take steps to protect our kids. And so I do hope that we get to a stage when that age appropriate design code becomes what they do out of choice. Because we all agree the health and safety of our kids is paramount to the mighty dollar.

But that's not where we are right now. And I don't know if Holly wants to chime in.

As the author indicated. As the author indicated, the test for a health information warning is that it is factual, non controversial and unduly burdensome and then advances a government interest. So we, as the author has indicated, have worked long and hard with the AG's office to make sure.

That this language is factual, non controversial, backed by the Surgeon General's advisory, and that it's not unduly burdensome.

So is it because we're taking the public health approach that this may get past that strict scrutiny?

Yes, it's a different test.

Would the opposition want to weigh in here or? Unless the AG's office had something to add through the chair.

I was just going to echo that. So the relevant test here is not strict scrutiny. It's more akin to commercial speech under the Zauderer standard, which Holly just outlined. And that standard does not require the warning label to be displayed only to young users that we mentioned in the warning.

The relevant test is the warning label just has to be purely factual and uncontroversial and not unduly burdensome. So that's not the strict screen standard.

And this is in a long line of product warnings on risky products that you see all the time for other kinds of products to warn parents and others folks, hey, you might want to think twice before giving this product to your child. That's not- There's a long line of cases in this vein. And so we're just driving down that road.

Yeah. And appreciate the question through the chair. I think there's obviously some disagreement that will play out in the courts as to whether this is commercial speech or not and which sort of tests.

Just to point out, though, there was a recent 9th Circuit case, X v. Bonta, which also dealt with whether or not a government requirement was considered commercial speech. So there is a question of whether Zauderer would apply or whether strict scrutiny would apply.

And I think, you know, obviously that's something for the lawyers to fight out in court. But just as a big picture item, I don't think anybody is disagreeing with the government's interest in sort of protecting our kids and protecting the citizens of California.

But I think it's fundamentally different to apply a product warning label to a cigarette than it is to speech. And that's what we're talking about here. That's why there are such serious and nuanced sort of concerns around the First Amendment is a cigarette is not the same as speech.

And I'm hard pressed to think of an example in which the government is warning these types of speech are potentially dangerous and this type of interaction with other people is potentially dangerous. And I think that's where this is going to sort of be one of the more novel cases.

But I think fundamentally we're not talking about a product, we're talking about speech. So. and just another sort of aside we've talked a lot about or I've mentioned that our companies are doing a lot of work to improve their products. Many of them are also voluntarily complying with the age appropriate design code.

So look, we're not doing nothing. It's not a sort of either or, but. And even in the face of constitutional challenges on some of these bills, we are trying to improve our products and constantly provide a better service.

And if I just may make one correction about what I'm doing here as the author is I don't believe I'm putting a warning on the speech. I believe I'm putting it on the product and the algorithm. I think that what is harming our children is not the speech, it's the algorithm that is addictive.

Drawing them in and keeping them there for so many hours.

Going to go back to Senator Rubio.

Well, and I know you just clarified you're actually joining here a product and then you said it's not the same putting a label on a cigarette box versus free speech. But you know, as life happens and things continue to evolve, you find that there are some limitations.

There's a reason why we cannot yell fire in a crowded, you know, restaurant or any but any other place where we may believe that there's a fire and then lives are harmed. Right. So in this particular case, we do have a situation where life is happening, technology is evolving.

At some point we're going to have to take this on. I'm sure at some point you could yell fire all day long. It didn't matter if someone was harmed or not. But there are some limitations eventually that we're going to have to contend with.

And technology is one of those fast moving things, trucks that are going to hit our kids and we're going to need to adjust. And this is one of those important issues. So I want to just highlight what you just said.

We hope that you want to do this and not be forced by policy or by going to court. I think it's something that you can do just because it's the right thing. So with that, thank you, madam.

Thank you so much, colleagues, for the robust conversation. And some of the comments aligned very much with what Dr. Weber-Pierson mentioned in the questioning.

Sir, you talked about it's not being expansive enough, but if the Assembly Member would have brought a Bill that had a long list like you had at the beginning of a Star Wars movie, you would have really, really opposed that because that would have covered the entire page of, let's say an Instagram or what have you.

This is two sentence, one sentence. It's one sentence that is at the bottom. Sure, I as a user, am I like, oh my God, 10 seconds? Absolutely. I'm going to be as a human being maybe a little bothered. Right. Because I even saw that most people were very impatient.

We want our web pages to load in half a second. I recognize that. But we also are not seeing enough work coming from the entities that you represent.

And it has been mentioned here that we wouldn't be here if there was some movement forward where now this Legislature has had to pass bills of saying in schools we're not going to have kids use their phones. We want to limit the age or, you know, the courts strike it down.

But we're trying to do our part here because your entities are not doing their fair share in helping because Owls isn't the only story out there. And there's endless amount predominantly girls who are suffering as a result of what we see on social media and them telling them that they're not not skinny enough, smart enough, beautiful enough.

So while the warning label is not the end all, even the Surgeon General's opinion said that this is not going to solve everything. It's what we have now.

Since you're suing us for everything else we're trying to do, it's its combination with Victoria and other parents who are going to try as hard as possible to address their kids doom scrolling. How I try to address that with my wife in her doom scrolling. But we are going to try with our loved ones.

But the assemblymember looked at the situation, saw that not enough work is being done here, and is putting her best foot forward as a lawyer, ensuring that we have our best fight in court, which is why we are going to be getting this vote out of Committee today. With that, you may close.

Thank you so much, Madam Chair. I just want to take this final opportunity that I get to spend with Victoria testifying Committee to thank her. Alexandra's life, like you said, you should be getting ready for school and being with her. And instead we're here talking about what we can do for other kids.

And I think that's the gift we can give to Alexandra in her memory is doing our best to ensure that we change the dynamic of what is happening with our children online, that we allow them to live the joyful childhood that every kid should have here in California and everywhere.

And so I want to thank Victoria again for her advocacy and the strength that I know everybody in this room so admires. Because I don't know how you do it, but you do it for other kids. And that is a gift to everybody.

And the opposition said that it is at best, I wrote it down, that at best the warning will be ignored. They said it was unnecessary. And I don't know how you sit and listen to even one child's story that ends in tragic death by suicide and say that. We need to do better for our kids.

And with that, I respectfully asked for your aye vote.

At the appropriate time we'll entertain that motion. Assembly Member, you have your next Bill. Fire item two, AB 432. Thank you again, Victoria and everyone else.

Now let's talk menopause. From teen mental health to menopause. These are the things we deal with. I know, right? You see, my legislation follows my life, Senator. So thank you, Madam Chair and Committee Members. And I am delighted to be presenting AB 432, the Menopause Equity Act.

This bill is really born out of, as I mentioned briefly, my own lived experience in trying to seek care during the perimenopausal transition and not getting the care that I needed. Living in the Bay Area in California, where you would think you had access to the best health care in the world.

I had to go to three doctors before anybody was able to help me by diagnosing and treating what for me was debilitating brain fog. I knew there was something wrong with my brain. I couldn't get the care I needed. And I finally did after three doctors. And so I thought we need to do better.

Over half the population is women. Everyone who lives long enough will go through the menopausal transition and we need the care we deserve. The portion of the Bill that's being heard here today relates to insurance coverage.

This is actually a fascinating part of the bill because what we found with the [unintelligible] analysis was that the front line medications, which is actually what I use, are covered, but for women who have higher risk and can't use the systemic estrogen that many women use but need to seek alternative therapies for whatever reason, often they're being denied.

This comes for a lot of reasons, but some of it is a lack of understanding and a lack of research, as will surprise nobody in this room. We are under researched as women, especially aging women. And so we are not getting the care we need, nor are insurance companies covering it.

And so this bill would move the ball forward by ensuring that doctors have the ability to prescribe medications to patients as they see fit and those medications will be covered. With me here today in support of the bill is Lourdes Sayon in her own capacity. And Kat, how do you pronounce your last name? Canada, head of marketing and impact at Respin Health, will be reading written testimony from Halle Berry.

So I am not Halle Berry, unfortunately. Thank you for having me. I'm Kat Canada. As Assemblywoman Bauer-Kahan said, I am here today reading testimony on behalf of Academy Award winning actor, producer, entrepreneur and global women's health advocate Halle Berry. I found out I was in perimenopause at 54, abruptly, painfully and with no warning.

I was not prepared and did not receive the care I needed from my doctors. I was one of the millions of women who spent 4 and 5 years of their lives being misdiagnosed or not diagnosed at all. My doctors told me I was simply aging and that this is what happens to all women. Which is the point.

When I finally sat down with menopause specialists after weeks of waiting, hours of research and a huge price tag, I didn't even know the right questions to ask and walked away with even more confusion. If this is what it felt like for me, Halle Berry, with time, resources and access, what does it feel like for everyone else?

That experience was the beginning of my personal and professional commitment to transform midlife for women everywhere. We desperately need accurate information about menopause from our healthcare providers, including timely diagnosis and advanced preparation so we can enter this time of life with our best foot forward.

Menopause is not just a moment in time, it marks a major inflection point in a woman's long term health. After menopause, a woman's risk of cardiovascular disease, the leading cause of death for women, rises significantly.

Similarly, the hormonal changes during menopause are linked to an increased risk of cognitive decline in dementia, including Alzheimer's disease, which affects women at nearly twice the rate of men. Despite these known risks, most women are not informed about these changes and physicians are not trained to recognize menopause as a critical window for preventative care.

For too long, women have been left to navigate this stage without the support they need or deserve. I believe that AB 432 is a necessary step in the right direction. California women deserve to receive informed, compassionate menopause care that is covered by insurance.

Thank you, Assemblywoman Bauer, for your fearless leadership on AB 432, which truly paves the way to quality menopause care for all women while also providing support and enrichment to the doctors who care for them.

Substantial gains in health, financial stability and well being are possible. For these reasons and more I urge the Senate Health Committee to pass AB 432 this legislative season. Women cannot afford to wait any longer. Thank you.

Hi, Chair and Members. Hi, Chair and Members. I'm Lourdes Ayon, normally lobbyist here in this wonderful world of politics for San Diego Gas and Electric. Today, I'm here before you as a menopausal woman. Yes, I'm Lourdes Ayon, and I have menopause. I'm bloated, I'm tired. I don't even know why I'm here half the time to be honest. The brain fog is real and the tiredness is real. I hate it and I both love it, right?

Because this is this beautiful part of my life that I want to embrace and I want to feel good about. However, when I go to the doctor and I ask for the care that I need, I'm denied the medication that I needed. Compounding this is the fact that I do have an underlying condition. I do have a blood disorder that makes things a little bit more complicated. So my brain fog is twice the fun. I don't know.

What did I just say? I'm kidding. All right. So it really is tough, the brain fog. I want to be able to get on hormone replacement therapy and get everything that I need, but in a way that makes sense for me. Now, the doctors don't have the ability to think on their feet or to be able to treat me. They just try to give cookie cutter stuff. And when they do, the insurance companies don't cover it all. So they'll cover... Sorry.

They'll cover the progesterone and estrogen, but not the testosterone. Because on the other side, the pharmaceuticals have the appropriate dosage necessary for women. So, for example, they'll have a box full for men or for men or women that are transitioning or people that are transitioning. And this is supposed to be used for a month for a male. And because I am not male, I'm not allowed to coverage by insurance for this because the dosing is off. Whereas that box will last me a year.

They're saying we can't cover it for you, which makes absolutely no sense. I think it's a myopic view in which insurance companies look at treatment for women, yet there's treatment for men on the other side. So it feels to me unfair, burdensome, on top of the feeling that is already this, I don't know, other this pressure that menopause creates, I think, on the everyday life for women. So I wish that there was more coverage, appropriate coverage for women.

Thank you. Do you use this topic during your comedian stand up?

I do, actually. I talk about how being menopausal does create a different perspective in life. And it's quite funny, but it's also quite real. And like I said, it's very burdensome.

Gave us a little taste right now.

Okay. Oh, I was about to go into it.

Me toos in support of this bill, please step forward.

I was kind of hoping for the stand up a little bit. Kathy Van Osten representing American Association of University Women California in strong support.

Katherine Squire on behalf of the California Commission on the Status of Women and Girls in support.

Good afternoon, Madam Chair and Members. Nico Molina on behalf of Bayer in support. Thank you.

Good afternoon. Jessica Moran with Capitol Advocacy on behalf of California Life Sciences in support.

Good afternoon. Jorge Cruz on behalf of the California Behavioral Health Association in support.

Ben O'Brien. Already been said, California Life Science is in support as well.

Angela Hill, California Medical Association, in support.

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

Vanessa Cajina on behalf of the California Academy of Family Physicians. Very much appreciate the work that the author and the Committee Members have done on this bill. Removing our opposition and moving to neutral.

Thank you so much. Opposition. Ladies, come on up. We've spent the whole legislative session together this year. We're gonna make a chair for the health plans here. For health plans.

I know. I feel like we should have a table for the 50 year old ladies up here. I just joined the club this year, so. Madam Chair and Members. Steffanie Watkins on behalf of the Association of California Life and Health Insurance Companies. Regrettably, we are here today in opposition to AB 432, which mandates coverage without the use of utilization management tools for the evaluation and treatment of perimenopause and menopause as is deemed medically necessary.

Medical management practices such as utilization management are key tools used by health plans to ensure the patients receive the highest quality medical care. The imperative is to ensure that enrollees are getting the right care at the right time by the right provider. These practices are key to promoting safe, quality, and effective care for our members.

While we appreciate the author's intent to ensure women have access to coverage for menopausal symptoms, we feel this bill goes too far, as it opens the care model to dangerous levels of waste, fraud, and abuse. Specifically, our concerns are centered around the bill granting the treating provider unfettered authority to determine medical necessity while also limiting the ability of the plan to employ any utilization management tools.

Additionally, the coverage requirements outlined in the bill that require plans and insurers to cover a non-hormonal medication for each menopausal symptom and each formation and associated method is incredibly broad. That would include everything from expensive GLP-1 drugs for weight management to ketamine for treating depression to pain management drugs such as oxycodone for joint pain. Plans and insurers would be restricted under this bill from employing even the simplest oversight such as quantity limits.

Lastly, it should be noted that the bill is not limited to in network providers, and while most clinicians and physicians will be responsible and recommend the most effective treatment options, others will use this broad application and extreme latitude to monetize this critical care. The health plans are willing to partner in expanding medically necessary safe and effective coverage for people experiencing menopause.

We believe this is a path forward that we can be accessible for the medical coverage types. However, we believe this bill as written will drive up costs for consumers, increase the use of expensive brand name drugs, and ultimately increase the cost of health care for everyone. For those reasons, we remain opposed. We are looking forward to and we'll continue to have conversations if the bill moves forward today, but we do remain very concerned with the bill in print. Thank you.

Madam Chair and Members. Olga Shilo on behalf of the California Association of Health Plans. I align my remarks with those of my colleagues from ACLHIC and would like to offer our comments on AB 432. We appreciate the author's commitment to improving access to menopause care and recognize the importance of supporting those experiencing perimenopause and menopause.

However, we must respectfully oppose AB 432 at this time. We believe utilization management is an essential tool that ensures patients receive safe, appropriate, evidence based care. It also ensures provider accountability. It's not about denying care, but rather a critical safeguard against unnecessary, duplicative, and even harmful treatments.

Furthermore, it opens the door to fraud, waste, and abuse at a time when our healthcare system is already struggling with affordability. While it is incredibly important to maintain appropriate checks and balances in healthcare, we are continuously working to improve the authorization for care process and have offered amendments. As noted in the CHBRP analysis, health plans already cover a broad range of menopause treatment.

AB 432 unnecessarily expands those requirements in a way that encourages the use of high risk and costly medications. We are committed to a thoughtful and balanced approach to menopause care that maintains clinical oversight, prioritizes patient safety, and safeguards the affordability of care. Unfortunately, this bill does not offer these necessary guardrails. While we oppose AB 432 at this time, we remain committed to working with the author if the bill moves forward. Thank you.

And Madam Chair, I think I failed to accept the Committee amendments. As she was talking, I realized that.

Me toos in opposition, please step forward.

Thank you, Madam Chair. Tim Madden representing the California Chapter of the American College of Cardiology, the California Rheumatology Alliance, and the California Society of Plastic Surgeons. Apologize for the late letter, but we have removed our opposition and just wanted to thank the author as well as Senator Weber Pierson for their help on the CME provisions of the bill. Thank you.

Michaela Spencer on behalf of the American College of OBGYNs District 9. ACOG would especially like to thank the author for her recent amendments and proudly remove their opposition.

Okay, great. Thank you. Bringing it back for conversation. Senator Dr. Weber Pierson.

Thank you, Chair. First off, want to thank the author and also this Committee for working on the amendment dealing with CME. I think that was very important in order to try to create the best bill possible. Would love to be a co-author on this. Listening to the opposition, and I'm being very honest.

I was really focused on the CME portion. I understand what you're saying. There are some challenges around non-traditional hormonal replacement therapy. You know, many providers are comfortable with estrogen progesterone, but when you start getting into some of the other medications, testosterone compound medications, it does require a different kind of level of expertise.

Was very encouraged to hear that you are willing to work with the author to help figure out some language because this is an important bill and it is extremely important that, for patients who either can't take hormone replacement therapy, don't want to take hormone replacement therapy, have tried HRT traditional and it's not working and they need something else, that they are able to access it and not have to pay out of pocket for it.

And so I'm hopeful that you will work with the author so that we can pass and get a bill signed into law that will really be implementable and beneficial for the women in California. So I want to thank you for this bill. Look forward to you guys working together to really get some of those kinks out. Lourdes, I thank you so much for always being so open and honest about what you're going through and incorporating that into your into your routine.

But I think that's important because we all know you, we all love you. And to have you be so open and honest about the things that you are going through helps others, but also allows for those who will never go through this, our XY counterparts, to understand that it is a significant issue that impacts everyone. So thank you.

If I may just respond on that. Oh, I just wanted to say that I appreciate you making that point. That whereas I was making light of it, and I do make light of it in shows, there is also an element where women that are either going through menopause do come up to me and talk about how grateful they are at hearing this because they also feel at a loss. They feel alone. And so when somebody's talking about it in a way that's very kind of normalizing it, it brings that weight off. And then they themselves want to explore ways in which they could feel better. So I just want to point that out.

Thank you. And that's a perfect reason why we should work to ensure that we can get coverage. Because this is a normal process of life, of evolution. And so it shouldn't be incumbent on the individual to pay out of pocket to manage something that is normal, that the majority of XX individuals will go through. Thank you.

Where to start? The memory loss begins. Is that one? The fog. So I can completely understand how the author's life coincides with the policy. And that's just kind of been my experience, whether it's with the autism world, childcare, end of life with my mother, and now this stage of life that doesn't get enough light shined on it.

And it's also, I would be remiss if I didn't take this opportunity to say that look at what can happen, what happens in the policy world, in the health world, when women have parity in the Legislature. This is a big moment, I think, for women, and I'm happy to support this bill. But there's a next step, right?

We have to obviously ensure coverage of health, coverage of the treatments, but also work on reducing the cost and price of treatment for both our health plans and for women. So this is the very beginning. But it's amazing to see what can happen and what is happening because we have so many women in the Legislature now. Would like to move the bill when appropriate.

Thank you.

I was looking around the room. Tim killed it for us here. You know, I think, respectfully, the youngest Member here. I do appreciate my wiser colleagues introducing bill in preparation of when I get to that, to that age, into that status to prepare us. Since I know you and I have had conversations.

We're falling behind on a lot of things related to women. So thank you for that. But Steffanie, I had a question for you. You talked about the in network, and the amendments are to ensure that the, the physician is in contract with the plan. Tell me more how that doesn't land to ensure that we have...

And I think that would. I think there was some, I noticed the amendments or the suggestions, it wasn't clear whether or not those were going to be taken or not. So I mean obviously that's a piece of it for us as the in network. I mean part of the bill is it's rather broad to be honest with you, as you look at non-hormonal treatments and all of the things that have been discussed today. I mean from the brain fog to the weight gain to I mean the joint pain, which my husband told me was the cost of doing business in getting old. I mean all of those things.

I think as you look at without tying the clinical care guidelines and other things, there is some concern for us that like where does it begin and end and how do we ensure that people are getting access to to the right medications, ensuring that we have contracts with doctors, knows that we have relationships. That's a really key element to it. But something I think on that piece especially we'd like to continue to work with the author to see if we can narrow that provision and clarify.

And the goal of this Committee I think this year has always been to ensure that we can address as much of that as possible through the in network and also the utilization management for the non-FDA medication as well. So there's always an attempt to get at those. But also recognizing that even CHBRP mentioned that over 22,000 women are going to be are going to benefit if this bill would move forward.

That's such a compelling number and that number will continue to grow. Right. To ensure that we get that and some medication may never get FDA approved and those medications are helpful for a lot of individuals going through menopause. So again, I use this word trying to balance as much as possible with these bills. But thank you for the input. Assembly Member, you may close.

Yeah, thank you for highlighting the amendments because I do think I wanted to thank the Committee because by accepting those amendments I think we go a long way in addressing a lot of the opposition's concerns. And to be frank, the governor's veto message as well.

So really appreciate your partnership in helping navigate me through those what is complicated policy. I'll be honest with you, I'm not a health expert. And I think this bill is really important to move the ball forward for women. What we hear from the physicians we work with on this policy is that, you know, the estrogen patch is covered, but for women who need, you know, an estrogen gel because they have more localized needs, that's not covered.

And so even where it's FDA approved, doctors are having to navigate a complicated network of approvals and non-approvals for things that patients need and that will improve their lives and will allow us to go through this transition in a critical, critically positive way. It can be an amazing time in our life. I think I love what both Hallie said and Lourdes said about, you know, I'm excited about this time in my life.

Part of why I'm excited is I'm sleeping again and I feel great. And when I first went on hormone replacement therapy, nobody knew that. And I can't tell you how many of our colleagues said, God, you seem so much happier. What's going on? And I just chuckled to myself. I mean, for some women it really works. And I'm one of those women. And I hope that everybody will have the ability to find treatments that work.

And I know the physicians that work in this space, especially the limiting of the physicians and the FDA approval, you know, they are going to be looking out for their patients and they are going to be making sure their patients get the care they need. And in my experience in the healthcare system, it is my physicians who've ensured good care, not the plans. And so I'm glad we're putting a little bit more into the hands of our physicians. And with that, I respectfully ask for your aye vote.

Once we get quorum. Thank you. Assembly Member. We're moving on to file item four, Assembly Member Gonzalez, AB 554.

Hello. Thank you, Madam Chair. Thank you Members, I'm proud to present AB 554, the Prep or Prepare Act. In partnership with Assemblymember Matt Haney, I will accept the committee amendments this afternoon.

At a time when the Federal Government is actively working to roll back fundamental health care protections, California must continue to lead and AB 554 does just that. AB 554 protects and expands access to HIV prevention medications such as injectable PrEP, while also ensuring that small community based clinics receive streamlined reimbursements for the care that they are providing.

The bill will ensure more forms of PrEP, including the long acting injectable medication that has shown improved adherence and a reduction in HIV contractions, is available to patients across our great state. With me this afternoon to present, I have two witnesses that are testifying in support of AB 554.

Dr. Robert Bolan, is the Medical Director of Research and Education at Los Angeles LGBT Center and Craig Pulsipher, Legislative Director at Equality California. And for any technical assistance, Kayte Fisher with the California Department of Insurance. Take it away.

Good afternoon. Craig Pulsipher, on behalf of Equality California, proud co sponsor of AB 554, want to thank the Chair, committee staff for their work on this bill, the time and expertise that went into the proposed amendments.

Over the past several years, we've been proud to work with this committee and the legislature to expand access to highly effective HIV prevention medications commonly known as PrEP and PEP. In 2019, California became the first state in the nation to prohibit prior authorization and step therapy requirements for these drugs except in very limited circumstances.

We've since partnered with CDI and DMHC to ensure those protections are fully implemented alongside state and federal laws requiring health plans and insurers to cover preventive services like PrEP without cost sharing. But that progress is under threat and we have very real concerns that the current federal administration could take actions to undermine access to critical preventive services.

AB 554 is a straightforward response to clarify and strengthen the protections in existing law, helping to ensure that regardless of any future actions, Californians continue to have access to these essential HIV prevention tools.

First, the bill recognizes that several new injectable PrEP medications are in the pipeline, and the bill clarifies that injectable medications of different durations are not therapeutically equivalent and must be covered accordingly. Second, it codifies the existing requirement that non grandfathered plans and insurers cover PrEP without cost sharing and extends that requirement to grandfathered plans.

And finally, the bill includes a small but important change to improve reimbursement for injectable PrEP drugs by requiring these drugs to be covered under the prescription drug benefit in addition to the medical benefit, which you'll hear more about shortly. I just want to be clear.

The majority of health plans and insurers in California are already in compliance with AB 554 under existing federal and state law. So we expect the bill will have minimal immediate impact. But the bill takes important steps to shore up California's existing safeguards to ensure Californians have uninterrupted access to these critical HIV prevention tools. And I respectfully urge your aye vote.

Am I on? Okay. Right. My name is Dr. Robert Bolan, Medical Director of Research at the Los Angeles LGBT Center and together with my partners at UC San Diego and UCLA, I am a co principal investigator of an implementation science project funded by the California HIV Research Program to expedite the initiation of Long Acting Injectable HIV PrEP in Southern California.

We have formed a learning collaborative with 26 members who represent 21 diverse health care settings and pharmacies in Los Angeles, San Bernardino and Riverside counties. Young black or Hispanic men who have sex with men and transgender persons have lower uptake and persistence on oral PrEP regimens and have higher serial conversion rates than other groups.

Long Acting Injectable PrEP provides highly effective protection against HIV infection without daily pills. Cabotegravir, FDA approved in late 2021, must be injected every two months. Lenacapavir, just approved last month, must be injected every six months so insurers cover prescription drugs as either a pharmacy benefit or a medical benefit. Our experience at the LA LGBT Center is typical.

If LAI PrEP is a pharmacy benefit, approval is usually obtained within 10 minutes. If it is a medical benefit, approval, when secured, usually takes one to two weeks and requires up to four to five hours of office staff time per patient. Most importantly, delays or gaps in PrEP coverage are associated with new HIV infections.

Medi Cal and Medi Cal managed care plans cover LAI PrEP as a pharmacy benefit, while for most commercial plans it is a medical benefit. Thus, the insurer's choice of benefit category is arbitrary.

This bill will remove the most important barriers to delivering LAI prep in California and enable everyone who can benefit from PrEP to choose the most appropriate regimen for themselves. Thank you.

Thank you so much. Me too in support of this bill.

Good afternoon. Darby Kernan on behalf of San Francisco's AIDS Foundation, APLA Health and Essential Access Health in support of AB 554. Thank you.

Good afternoon. Madam Chair and Members. Mari Lopez with the California Nurses Association in support.

Good afternoon. I'm Katie Van Deynze with Health Access California and support. Thank you.

Lizzie Cootsona on behalf of the City of West Hollywood in support.

Miguel Bastidos here on behalf of California Insurance Commissioner Ricardo Lara, co sponsor of the bill in support.

Tiffany Mock on behalf of CFT, a union of educators and classified professionals in support. Thank you.

Kelly Brooks on behalf of the Santa Clara County Board of Supervisors here in support.

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

Betsy Armstrong on behalf of the County Health Executives Association representing local health departments in support.

Elise Borth on behalf of the California Community Foundation in strong support.

Gil Lara here on behalf of Biocom California in support.

Michaela Spencer on behalf of the American College of OB GYN's District 9 in support.

Lang Le on behalf of Asian Americans Advancing Justice Southern California in strong support.

Kelly Lou Densmore on behalf of the East Bay Community Law Center in support.

Kate Fremont, law student intern with the East Bay Community Law Center in support.

Isabel Cooper on behalf of the East Bay Community Law Center here in support.

Alex Kahn on behalf of Vive Healthcare in support.

Ellen Brittingham with Full Moon Strategies here on behalf of Alameda County in support. Thanks.

Shana Kirk, mental health advocate and LGBTQ advocate, on behalf of myself here in full support.

Thank you. Come on back. We're taking turns here.

Good afternoon. Matt Aiken, on behalf of the Association of California Life and Health Insurance Companies, we have a registered opposition on the bill in print. However, we are reviewing the committee amendments. Just want to thank the author, sponsors and committee for the work on the bill. And we look forward to future conversations if the bill does move forward today. Thank you.

Thank you.

Olga Shiloh with the California Association of Health Plans. We are opposed to the bill in print. We are also reviewing the amendments. And thank you for all the work that went into those. Thank you. Thank you.

I didn't say it, but that was opposition. Any me toos in opposition? Okay, bringing it back. Okay. Yes, bringing it back to us. Seeing no other questions. Thank you, Assemblymember, for taking the amendments to this bill. It's an important bill. I recognize, I recognize that.

And we just want to clarify and quantify provisions related to coverage for PrEP and PEP and expand those coverage requirements to the grandfather bills before ACA was passed. So I hope the Governor signs this one.

I know a similar version was not signed, so we were just trying to make sure we can give it its best shot to make it all the way to the governor's office. With that, please close.

Absolutely. Thank you to our folks who testified. And thank you, members and colleagues. AB 554 is about. Excuse me. AB 554 is about giving people real choices, equipping small clinics with the tools they need to protect lives, and ensuring that California continues to put public health over politics.

And this bill is also about access, especially communities of color who need to be able to go to clinics to get this medication. I respectfully ask for your aye vote and for your partnership in the fight to end the spread of HIV. Thank you.

And when appropriate, we will entertain a quorum. We are losing members.

Thank you.

Thank you.

Thank you all.

We will now move to File Item number three, AB 224, by Assemblymember Bonta, which will be presented by Chairman Menjivar. And you may begin whenever you are ready.

Thank you so much. This bill is the companion bill to a bill that I Have that this Committee heard in my SB 62. It's related to the essential health benefits. Both health chairs introduced a companion bill at the beginning of this legislative session.

And should the Federal Government approve our request to enhance essential health benefits to include hearing aids for adults and children, durable medical equipment and fertility coverage, these two bills would codify those coverages in statute. Would like to turn over to my witness for their testimony. Thank you. You have a total of five minutes.

Thank you. Christine Smith with Health Access California. We're pleased to support this bill which as we heard comes after a year long process to solicit stakeholder feedback on potential updates to our state's benchmark plan. Health Access is pleased to support this bill and believes the new required benefit would provide significant benefit to consumers in California.

Health Access was part of the process in developing the original EHB standards in 2014. At that time, we knew not everything consumers wanted or even needed was included. But it was the most comprehensive benefit package we could develop under the rules that applied then.

In the decades since the rules have changed, we have seen that California can lead the way in higher standards of care and we have the opportunity to provide a more extensive benefit package. This bill includes a hearing exam and hearing aids every three years, ensuring fewer Californians will go without hearing due to lack of coverage.

AB 224 also includes coverage of durable medical equipment such as wheelchairs and oxygen equipment. With coverage that is often limited and faced with out of pocket costs of up to $50,000. Many people currently go without these devices or obtain inferior ones that risk their health and safety. Finally, this bill would also require infertility coverage, including Ivf.

This will have a significant equity impact on the LGBT community, LGBTQ community and others facing fertility challenges and reaffirms California's commitment to reproductive rights and access. Health Access appreciates the careful consideration of the range of benefits to include in our new state benchmark plan. And we ask for your aye vote on this bill. Thank you.

Thank you. There any others in the audience that would like to give a me too and support on AB 224, please come to the mic. State your name, your organization and your position.

Good afternoon. Sandra Poole on behalf of Western center on Law and Poverty in support. Thank you.

Good afternoon. Raymond Contreras with Lighthouse Public affairs on behalf of reproductive freedom for all Californians. Support. Thank you.

Thank you. Darby Kernan on behalf of Essential Access Health and support. Thank you.

Nora Angeles with Children Now in support. Thank you.

Good afternoon. Nick Broca here on behalf of the California Academy of Audiology and support.

Thank you. Good afternoon. Beth Malinowski, the SAO California in support.

Thank you. All right, we will now move to opposition. Is there anyone in the audience that would like to see speak in opposition on this bill? Amy? 224. Not seeing anyone. Is there anyone that would like to give a me to in opposition on this bill? Not seeing anyone. We'll come back to the Committee for questions, comments.

When appropriate, respectfully asking for an aye vote.

Thank you. Thank you so much. We will now move to File item number 7 AB 682 by Assemblymember Ortega.

Not seeing any. Okay. Senator Manavar, would you like to close.

If there are any other Assembly Members that would like to present their bill and help, this would be a good time to come down.

Thank you, Madam Chair and Senators for the opportunity to present AB 682 today. I would like to begin by accepting the Committee amendments and thank you to the Committee for their work. The purpose of health insurance is to pay for health care when it is needed.

Yet today, Californians face a bureaucratic system where unnecessarily complex processes discourage patients from pursuing the care they need. Too often, insurance claim denials rob patients of life saving treatments and timely health care.

This Bill mandates transparency and accountability by requiring health care plans to publicly disclose detailed claim denial data, including reasons, outcomes of appeals and frequency of denials.

This Bill provides the data needed to understand the scope and the extent of health insurance denials, empowering consumers to make informed choices and providing lawmakers and stakeholders crucial information that we can use to support future health care policy today.

Testifying with me is Raina Prato, and also to answer any technical questions is Carmen Comste with the California Nurses Association.

Good afternoon. Good afternoon and thank you to the chair and the Members of the Committee. My name is Raina Prato. My pronouns are she, they, and. I live in Los Angeles. Every day, health care insurers deny claims and interrupt doctors recommended treatment, including my own.

I have an autoimmune disease and I'm covered through a private health plan I purchased through Covered California. Initially, my rheumatologist prescribed me humira, which worked perfectly for my needs. It allows me to be mobile, have no joint pain or inflamed skin, and keeps my immune system from attacking itself. It makes my embarrassing skin issues go away.

It allows me to walk my dog and live a full life. My insurer initially made me go to a dermatologist to get this prescription, but starting in December, they denied this medication despite my Doctor's advocacy. The plan then forced me to change to biosimilars three different times in three months.

Almost every time I refill my prescription, they delay prior authorization or outright deny it, even for the exact same medicine that I had been receiving. This adds hours of phone calls that myself or my doctors have to handle because I don't know what prescriptions will ultimately be covered and what the CO pays will be.

I'm forced to ration my meds and take them half as often because I don't know when I'm going to get them again. The biosimilars aren't as effective for me and I fear my disease is needlessly progressing.

Without disclosure of health insurance denial information, I have no way of knowing whether my plan or others will persistently deny my treatment. It's embarrassing, exhausting and I grieve the life I could live, the contributions to a better society I could make if I just had this one medication at the regular dose.

I need please support AB682 to bring much needed transparency to ensurers claim denial practices like mine. Thank you.

Very briefly, thank you to Assemblymember Ortega for authoring this Bill. Thank you to the Chair and thank you to Committee staff for working diligently on this Bill. And with us with the California Nurses Association. We're proud to co sponsor and we urge your aye vote. Thank you. Thank you so much. MeToo is in support of this Bill.

Please step forward.

Katie Van Dynes with Apple Access California and support. All right, thank you. Thank you.

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

Dylan Elliott on behalf of the California State Association of Psychiatrists in support. Good afternoon, Brian. Mayor Montez with AFSCME California in support.

Good afternoon. Kaylyn Dean with the California Hospital Association in strong support.

Angela Pontus with Planned Parenthood Affiliates of California and support.

Colette Madden with the California Society of Plastic Surgeons and the California Chapter of the American College of Cardiology and Sport. Thank you. Nick, it's your turn.

Now's the time for opposition.

Thank you, Madam Chair Members Nick Louiseos on behalf of the California Association of Health Plans. I'll be brief. You know, extensive amendments are going into the Bill today and so we just recently saw those and we're still evaluating those. But I want to thank the author, staff and the sponsor.

You know, we had a couple of really good conversations about our concerns related to this Bill. Just taking a step back. We know prior authorization is a major concern of policymakers this year. Nationally.

The industry's gotten together and released a set of principles related to prior auth one of which relates to transparency in data reporting at the same time that Biden Administration Administration released some prior authorization reporting regulations that will apply to Medicare Advantage plans and the plans that operate at the federally run exchanges.

And what we were asking for in our opposing less amended letter was that we conform to those federal reporting requirements so that number one it reduces the administrative burden on our Members.

And then policymakers have a streamlined and consistent I should say set of data that they can use to evaluate what's going on with respect to authorization for care. And so it looks like a lot of that language is going into the Bill as a result of the amendments.

However, there are still portions of the original Bill that are still in there. So we're still looking at those pieces to make sure that either results in a position change for us or we might need to knock on the author's door and have further discussion with the sponsors about any further clarifications to the Bill.

So I'm unable to remove our opposition today. But we appreciate the amendments and we'll be closely looking at them. Thank you.

Thank you so much. Me too. Is in opposition.

Stephanie Watkins, on behalf of the Association of California Life and Health Insurance Companies also opposed unless amended. But look forward to having future conversations as we evaluate the amendments. Thank you. Thank you so much.

Bringing it back. Got nothing as a Member. Thank you so much. We've been working on this Bill to the sponsors. Thank you so much.

We were looking to align the the reporting requirements to what exists now so that we can have an equitable approach to review what is already being captured now and compare both on the medical markets and commercial in respect to prior authorization. It's important data that does need to be submitted.

You know, going back to your story of example, even the opposition mentioned that the Legislature, the Members have had a keen interest in this topic this whole year. I know it's top of mind for a lot of individuals to try to get to a solution with that. Please close.

Yeah just again want to thank your staff and the opponents are correct. We did take some amendments where we are adopting the language that is currently being used with the federal requirements. And of course my door is always open. You're free to knock at any time and we'll continue to work with you on these concerns.

With that, I respectfully ask for your aye vote maybe don't knock the next month.

I don't know when we have a quorum Assembly Member. We'll entertain that. Asking for any other authors to come on down. We have no Assembly Member, authors or my own colleagues to establish a quorum. But until we do that, Madam Vice Chair has the floor.

Thank you, Madam Chair. Since we don't have any authors here, I would like to take a moment to recognize and thank someone whose insight and service has helped shape California, Tim Conagan. Well, this is his final Committee hearing. He won't officially retire until the end of this year.

Tim has served the Republican Caucus for over two decades, serving at least eight vice chairs for Senate Health Committee. I know I'm his favorite. Before joining the Legislature, Tim worked for U.S. Senator John Seymour and Congressman Wally Herger. Here on the Health Committee, Tim has been more than just a consultant.

He's been a trusted guide through some of the most complex and consequential policy debates we face. His work has touched countless issues that affect the everyday lives of Californians. Tim brings not only sharp policy insight, but warmth, humility and a generous spirit.

Whether working with Members, staff or stakeholders, he always leads with respect and a quiet sense of humor that keeps us grounded outside of these chambers. Tim is a proud husband to Mary, a retired nurse practitioner from Kaiser, and a devoted father to their two daughters.

And one of his only flaws is that he's also a Die Hard 49ers and Giants fan. And if you ever seen him behind the wheel of his convertible Porsche, top down, you know he also enjoys the open road as much as a good policy debate.

Tim, the impact that you have had here on this Committee, on the capitol and on 40 million Californians is lasting. Your work has made this institution stronger, more thoughtful and better prepared to serve Californians. On behalf of the Republican Caucus, this Committee and the California State Senate, thank you for your years of service and leadership.

We wish you and Mary nothing but joy, good health and many top down drives in your next chapter.

Thank you so much. My advice, thank you so much for that recognition. The Senate Committee on Health will take a brief recess.

All right. Senate Health Committee is back in session. Back in business. Assembly Member Soria, you have five file item 98849. Floor is yours. Great.

Good afternoon, Chairwoman and Members. I'd like to start by accepting the Committee's amendments which revise the definition of sensitive examination so that it includes the pubic and groin region, rather than referring to deep vein thrombosis. And I want to thank the chair and the Committee staff for their work on this Bill.

AB849 requires healthcare facilities to provide trained chaperones for ultrasound examination of sensitive areas and establishes the facility's responsibility to educate chaperones on how to identify and intervene against abusive behavior. Under current law, health facilities in California are not required to offer chaperones for any sensitive examinations.

Many facilities have established their own internal policies for when and if chaperones are required or suggested, but the specific details vary widely. Even in facilities that have formal policies, chaperones are not always provided with instruction on what to look out for and what to do if they witness something concerning.

I was personally moved to author this Bill after hearing the horrific stories of women from my district who came forward to share their accounts of an ultrasound technician preying on them while they were most vulnerable and who is now on trial for his alleged crimes.

Over a period of years, at least 10 women have reported being sexually abused by this man under the guise of medically necessary ultrasound examinations.

In several cases, chaperones were present, but they later testified that they received no training on issues as fundamental as where to stand, what to look out for, and what to do if they noticed something was wrong.

On other occasions, the ultrasound technician was allowed to dismiss the chaperone midway through the examination, leaving no third party to observe or intervene. And of course, there were also cases where no chaperone was present, nor was the patient ever offered to have one provided.

These profound betrayals of the sacred trust that patients place in those who are supposed to heal and care for them can have devastating and lasting consequences.

One of the women who was allegedly preyed on by the ultrasound tech in my district was so deeply traumatized that she could not bring herself to go back to her city's only hospital to receive treatment for an underlying health issue, and so she died. As a result.

AB 849 requires a patient to be provided notice that a trained chaperone is available upon request to be present for an ultrasound examination of certain sensitive areas.

It further requires that staff who may serve as medical chaperones must be educated by their facility on Appropriate techniques to observe the examination, when and how to intervene when they identify concerning acts and the procedures to report any inappropriate behavior.

AB849 provides vital safeguards during highly vulnerable examinations to protect patients and ensures that the relationship between patients and medical providers is one of trust and transparency that promotes healing and safety. This bill's current form is the result of a long and productive stakeholder process.

We have taken many amendments requested by stakeholders to improve the Bill throughout the process, and I'm committed to taking further amendments to improve implementation of the Bill, particularly to address what happens when a chaperone is unavailable.

Here with me to testify in support of AB849 is Celly Gonzalez, a survivor of the abuses at the in Los from Los Banos, here to tell her story.

Sally, you'll have five minutes, okay?

Okay.

Good afternoon, Chair and Members. My name is Sally Gonzalez. Back In May of 2020, I had gone to Sutter Health Memorial hospital emergency room for lower abdominal pain. That had lasted several days, so a vaginal ultrasound was ordered. Instead of getting help, I was sexually assaulted by the ultrasound tech.

My mind was racing and I began questioning myself. I was frozen, unable to utter a sound. All I could do was search with my eyes for the female chaperone who was in the room, hoping she'd notice what he was doing to me.

But she was facing away from me, from me and the ultrasound tech, entirely engaged in her phone and completely oblivious to what was happening. Later, I learned that in that hospital, chaperones aren't required to receive any actual training on what to do or to look out for other than being physically present in the room.

They had no responsibility. Chaperones like herself need to receive proper training so that they know where to stand and what to look out for. They need to have knowledge of proper procedure for these types of ultrasounds.

If the chaperone in my room had been given proper training or any training at all, maybe she could have helped me and stopped him.

And if the man who assaulted me knew she was trained to notice and prevent acts like his, maybe he wouldn't have felt like he could have gotten away with it with violating myself and others like me. I know we can't always stop men like him from violating women like myself.

But what we can do is, is make sure we aren't alone and are protected during these vulnerable moments. For these reasons, I strongly urge your aye vote on AB849. Thank you, Sally.

I'm so sorry that happened to you. Hopefully this bill, once it gets out, prevents that from Happening again to anybody. That's a hope. Thank you. #MeToo. Is in support of this bill. Do we have any formal opposition?

There we go. There we go. I'm new here.

Yeah, I've never seen you.

Thank you, Madam Chair. Members, Ryan Spencer, on behalf of the California Radiological Society and the California Medical Association, with respectful opposition unless amended to AB849. I want to begin by emphasizing that opposing legislation, particularly on an issue as important as this, is never a position we take lightly.

Every patient, regardless of sexual orientation or gender identity, deserves to feel safe, respected and comfortable in all medical settings, especially during sensitive examinations. We fully support the intent of AB849 and recognize the critical need for trained medical chaperones to help ensure that patient dignity and safety are upheld.

Our concerns lie not in the goal of this legislation, but rather in the mechanics, as the author mentioned, of its implementation. There's currently a lack of alignment across California's healthcare systems regarding what qualifies as a quote, sensitive examination.

Operational challenges also remain, such as how to comply with provisions during times of staffing shortages, which the similarma mentioned we likely addressed. Additionally, there are other logistical issues that require further refinement to ensure the bill's successful and equitable application.

To be clear, this bill, as the author said, has come a long way since its introduction and we commend the author's thoughtful efforts to incorporate feedback and address our concerns.

We believe continued collaboration is central and we welcome the opportunity to keep working together toward a solution that meets the needs of patients while respecting the operational realities of our healthcare providers. Thank you for your time and consideration.

Good afternoon. Vanessa Gonzalez with the California Hospital Association here with an opposing unless amended position. First off, I'd like to start by thanking the author as well as the Committee staff for working with us to address our concerns, and particularly the author for taking a number of amendments to help address our concern.

And the bill is definitely moving in the right direction. Hospital's number one priority is to care for patients and we fully share the goal of protecting patients and staff and making sure they feel safe and supported at all times, especially during a sensitive exam.

Many hospitals already provide chaperones when possible, in accordance with their own policies and available resources. Our main concern with the Bill as currently in print is really related to the staffing challenges and concerns that hospitals won't have enough chaperones to help meet the demand for chaperones.

As one example, a medium sized hospital in the Central Valley reports that they around 17,000 sensitive ultrasounds and they only have a limited number of staff to help serve as medical chaperones. And in more urban areas, that number goes up to around 52,000 sensitive ultrasounds per year.

At the same time, hospitals are also navigating a difficult environment and are facing major financial pressures, in particular due to HR1 and the federal Medicaid cuts, as well as spending caps recently set by the Office of Healthcare Affordability.

So while hospitals will try to meet this requirement, it's going to be really difficult for hospitals to bring on staff without impacting other services that they provide.

But again, really appreciate the authors continue continuing to work with us, especially on that amendment that would give providers some flexibility when a shop round is not immediately available, as well as a number of other technical and clarifying amendments to help address our concerns.

Appreciate the author's continued engagement and happy to continue the discussions should this bill move forward. Thank you.

Thank you so much, you two. Me too's in opposition. Okay. See? None. I'm going to bring it back. Senator, Dr. Weber Pierson.

Thank you Chair. I am so very sorry about what happened to you. It should not have happened to you or anyone else in that matter.

But thank you so much for coming here today and sharing your story and helping the Assembly Member kind of highlight the fact that we do need to implement some kind of change in our system and in the way in which we examine our patients. I guess the question is what kind of change do we need to implement?

Understand the issue with staffing from Cha. I know I always have chaperones with me and I just use my ma. But I am fortunate to do that. And I know many people are not able to because MAs oftentimes are dealing with multiple providers. I'm fortunate to have just one that focuses on me.

But one of the things that I was questioning or confused about is that this medical chaperone needs to be appropriately trained. What training do you foresee? Because I've never heard of a training course for chaperones.

That's a great question, Senator. And I think what our attempt is to provide the Cha and the other providers that are going to be the ones that have to implement this to come up with training that is appropriate to prevent this. I think that we have to figure that out.

I think those are the conversations that we've been having to ensure that the end goal is to prevent any types of situations, as we've heard, not just in my district, but I think what we've heard even happening in Los Angeles and other hospital settings where, you know, women were also experiencing similar sexual assault.

So I guess one concern I have with that is I'm not sure if there are any specific training guidelines, any specific, you know, this is what you need to do in order to qualify as a chaperone. I've never seen it. We've never needed it.

And so if it's kind of hospital specific or clinic specific, that's not necessarily something that's standard. I guess I was just trying because it doesn't lay anything out and it doesn't really talk about any specific guidelines to look towards to ensure that everyone that gets trained is available.

And then for training, how does that interact with the flow of clinics? Because I can have somebody there that's working the clinic that may not necessarily be trained as a chaperone, but then I have to wait for the trained chaperone, just like I have to, you know, for surgical consents, wait for the trained translator. So I'm just.

That.

That is a great question. I think that obviously I don't have the expertise in terms of what are the things that chaperone would need to be trained on specifically. But I think that that's what the Bill is trying to attempt to do is to address the lack thereof of anything being right now, even in statute, that requires.

And there's inconsistency. Right. Even across what hospitals and these medical facilities currently have. Some have some internal policies and some don't. And so this Bill is attempting to begin to develop that framework so that the goal is, again, to protect, you know, patients from experiencing these types of things.

Yeah. So I think for me, it needs to be a little clearer. And I know we don't oftentimes like to be prescriptive, but I can have a hospital or a clinic and say that the training that I did, we should just say that you have to be in the room. Right.

That would not have helped your situation because a person was in the room, but they weren't actually paying attention. You know, you mentioned that they need to know where to stand, like, you know, all of those things. None of that is kind of laid out here.

And so I'm not sure if what we have here is going to get the result that you're actually looking for, but appreciate the ability to at least start the dialogue on something that is important.

Thank you. Yeah. And, you know, I again, we've been working with stakeholders, and so I'm happy to, you know, consider anything if there's specific language that would be included.

I don't know if it's appropriate for it to be in statute or if it needs to be, you know, through other guidelines that I know, obviously in the medical field, and depending on what type of medical, I guess, position, there's different guidelines in terms of standards of care and so forth.

So I don't know if it's appropriate to be in statute specifically, or we point to something that needs to be developed and used as a standard, as a whole.

Vice Chair.

Thank you.

Thank you, Madam Chair. So my question is for the opposition. I just would like a better understanding of what the current chaperone process looks like or is, does it vary across provider? And also, are we concerned at all that.

And it may not even apply, but if a patient wants to bring their own chaperone, would they not be qualified to now be in the room with the patient and do we create liability? I'm just trying to understand the process.

Yeah, thank you for the question. So right now, most the majority of our hospitals have medical chaperone or would offer medical chaperones and let patients know that a medical chaperone will be available upon request. However, this does vary. It can be different from facility to facility.

But if a patient does request a medical chaperone, the hospital would try their best to find someone to serve as that medical chaperone.

So, I mean, it's not just someone. It has to be someone specific. Right. So would it be a nurse, someone with some type of certificate or. It varies.

It varies across different providers. You know, some may use a nurse, some may use clinical staff, some may use non clinical staff, but it varies. Right now.

Okay. May I? Yeah. I think one thing we're trying to reconcile is just that I think there are some questions of what to do if the patient's incapacitated, what to do if it's a minor. These are discussions that we promised to have with the author after this hearing to continue the dialogue.

I think one of the issues that we're facing is even the definition, what qualifies as a, since the exam varies from facility to facility, and so every facility does handle this a little bit differently. And so these are exactly the type of your concerns, exactly the type of discussions that we're having ongoing with the author's office.

In situations where, say, a child comes in and their parent is their chaperone, do they qualify and meet the requirements of state law? We don't know yet.

But, you know, some could say that they should, but maybe some go, no, you still need to have another medical chaperone in the room if the patient wants to, because it is up to the patient. To decide if they want to have a medical chaperone or not. Ultimately they make the decision, which we support.

Okay.

So there is a clear need for this Bill. I understand what you're trying to get at, but I think there's some details that still need to be worked out. I'm going to abstain from the vote today, but my objective is as this gets closer to where we need it to be, I'd love to support it.

Ryan, what do you do now when a minor gets a sensitive area observed or treated just because it seems like that this will create uncertainty? I'm just wondering what's the approach now?

Usually when it's a minor, the parent would be in the room, but sometimes if it's emancipated minor, I don't know.

A regular minor, non emancipated minor.

I'm afraid to answer that question, to be honest, without really knowing, without having one of my Clinicians in the room that actually experiences this issue.

Just because you're saying this would create uncertainty but you're unaware of what the current role is now. So I'm just trying to.

Zero, if there isn't. Well, again, it depends on the facility. They some have policies, as the simmer Member said, that they should have a medical chaperone in those facilities that don't require that policy. I'm not, I don't know what they would do in that particular case.

Okay. I mean even in the Bill, I know the back and forth with the Senator and she left the Bill, talks about what should go in the training now. I mean how to drape a patient, how to appropriately absorb intervention techniques, the importance of neutrality, reporting procedures and how to report any inappropriate behaviors.

So I think while you weren't super prescriptive, you did. You are asking for specific things to ensure that observer is not facing another wall and they're actually facing the patient. Now on the staffing issue, we weren't able to land. We were trying to land how to address the staffing issue for hospitals.

And you know the author has committed. I'm not going to put words in your mouth, but. Right. You have committed to continue working on the staffing issue. I know people come after nine to five. Can we change the appointment without causing some pain or undo, I think there's a phrase for it onto the patient.

I know you will continue working on that. But the issue that not all hospitals and not all medical clinics have an individual that are appropriately responding or know how to intervene is a real issue. I myself have a Bill related to women incarcerated.

Exactly to this point because women continue to be unfortunately assaulted in very sensitive times when they're vulnerable. So we have to intervene. You've heard some concerns, Assemblymember, from my Committee Members. I know you're going to still work on this to land this.

The intent, of course is important to address, but I would encourage you to continue working with the opposition on those small details.

Yeah. And so, you know, I want to thank the opposition for the work that.

We use this as your clothes.

Yeah. Thank you. Thank you, Chairwoman. I do first thank obviously the comments made by you and then also the questions raised by Senator Dr. Weber Person and obviously have appreciated the time that we spent with opposition.

I think from day one we've been very open to figuring out how we craft a Bill that will mitigate any unintended consequences. But keeping front and center in mind that we want to protect our patients because one is one too many. And so that's what the Bill intends to do.

And so my commitment is to continue making, you know, taking every opportunity to fix and mitigate as much as possible, but to get something out that will ensure that our patients or patients are protected at the end of the day. So with that, I'd respectfully ask for.

An item when we have more Members. We'll entertain that. Thank you so much for your presentation. Thank you. We're going to be moving on to file item 5, AB592. So Member Gabriel is here.

Thank you very much. Good afternoon, Madam Chair and colleagues. I am pleased today to present AB 592, a measure that will support California's neighborhood restaurants by ensuring that outdoor dining remains a viable option for restaurants across the state.

I want to start by thanking the Chair and the Committee for their thoughtful work on this bill and confirm that I will be accepting Committee amendments today that will allow restaurants to operate with an open kitchen concept if the restaurant develops an integrative pest management and risk mitigated plan approved by the local enforcement agency.

And again, I want to thank you, Madam Chair, to you and your Committee for the thoughtful work here. Neighborhood restaurants are the backbone of communities across California, but too many are continuing to struggle. After enduring unprecedented challenges during the pandemic, these beloved small businesses are now grappling with major challenges from inflation and other other cost pressures.

AB 592 will support California's restaurants by reducing red tape and enabling restaurants to leverage our state's exceptional climate. In particular, this bill will extend the regulatory flexibility granted under two bills that I authored, AB 61 in 2021 and AB 1217 in 2023, which allowed for greater outdoor and patio dining.

Additionally, AB 592 will cut red tape around open kitchens. With this flexibility, restaurants can create a more inviting and open air atmosphere as part of the overall dining experience. And so doing, this bill will help keep our beloved neighborhood restaurants afloat and assist them on the long road back to recovery.

This bill is supported by a robust coalition that includes the Los Angeles County Business Federation, VICA, Public Counsel, the California Travel Association, local restaurants and hospitality coalitions, business councils, and chambers of commerce from across California. I'm very pleased to have with me today to testify in support of the bill Brittney Valles, an entrepreneur from Los Angeles, and Brian Kellerman, Chief Food Safety Officer at Kellerman Consulting. Thank you, and respectfully request an aye vote.

You will have a total of five minutes each. It's up to you how you distribute it.

Good afternoon. My name is Brittney Valles. I am a small business advocate, a mom, and a former restaurant owner. My restaurant, Guerrilla Tacos, started as a food truck 12 years ago and we evolved into a brick and mortar. Like many restaurant owners, independent restaurant owners, I poured everything I had into the restaurant. Savings, dragged my family into the business often, and I really wanted to build something meaningful.

But on January 31st of this year, after 13 years of serving our community, I closed the doors to my restaurant after 13 really long, hard fought years. Today I am here in strong support of AB 592, a bill that can make the difference between survival and closure for restaurants across California. Covid era flexibilities were created to keep restaurants alive in an extremely difficult economy. If it wasn't for outdoor dining, my restaurant would have closed five years ago.

We were able to add 52 extra seats and people loved the outdoor patio. And during this extremely, extremely difficult time, my restaurant actually was thriving. Between skyrocketing inflation, rising labor costs, and an ever growing list of regulatory burdens, it has become nearly impossible for small, independently owned restaurants to keep up with larger chains.

I believe every customer deserves to feel confident with the food that they eat and that it is safely prepared and that health and safety standards should always be followed. But there must be room for flexibility, especially for the smallest operators who don't always have the financial resources that larger chains do. Creating extra regulation disincentivizes street vending entrepreneurs like Guerrilla Tacos was to move into brick and mortars.

Outdoor dining and open kitchens should not only be prevalent in wealthy, capital backed restaurants. Everyone across California should be able to open their doors on a beautiful California day. This bill helps level the playing field for small independent operators, not just large restaurants with huge legal teams.

AB 592 simply recognizes that smart, localized flexibility can help restaurants remain compliant without being crushed by red tape. It empowers us to innovate, to adjust to our unique environments, and to make decisions that work for our customers and our staff while still maintaining safe and healthy operations.

Although I may have been forced to close my restaurant, I am here because I really believe in the power of neighborhood restaurants and because I know what they mean for the communities and our economy and, of course, to our culture. So for that reason, I'm super excited about AB 592, and I respectfully ask for an aye vote. Thank you.

Madam Chair and Members of the Senate Health Committee. My name is Brian Kellerman, and I am the owner and Chief Food Safety Officer at Kellerman Consulting. I'm a registered Process Authority with the Association of Food and Drug Officials, as well as an internationally recognized consultant for food safety and quality management systems. And I am pleased to be here in support of AB 592.

I've personally worked with over 500 retail and wholesale food businesses and created accepted food safety programs to international, national, and state standards, including numerous food safety plans accepted here by the California Department of Public Health. With this background, I am here to acknowledge any restaurant that chooses to an open kitchen design and has open windows and doors during hours of operation would continue to implement safe and hygienic practices for food safety.

The food code used here in California and the science behind it focus on proper temperature controls of food, using clean contact surfaces, and enforcing ServSafe... Excuse me. ServSafe compliant hygiene. This bill does not make any changes to current food safety and hygienic standards.

To assure that applicable restaurants prepare safe food, restaurants choosing to have open kitchens and open windows and doors would be required to develop an integrated pest management and risk mitigation plan consisting of risk assessment, control procedures, monitoring, training, and record keeping. These are industry best practices, and I am proud to eat in any restaurant that operates in this manner.

I firmly believe we can and should allow these neighborhood restaurants to open their doors and windows during service and continue to operate safely while allowing California's beautiful climate to truly transform our dining experience. Thank you, and I'm happy to answer any questions.

Any me toos in support of this bill?

Chair and Members. Marlon Lara from the California Restaurant Association in support. Thank you.

Good afternoon, Chair and Members. Norlyn Asprec registering support for the following restaurants and organizations. Bavel, Bestia, HiHo, Jon & Vinny's, Matsu, Rossoblu, Rustic Canyon, Saffy's, Steadfast LA, Superfine Playa, Sushi Nozawa, and UOVO. Thank you.

Good afternoon, Madam Chair and Members. Dylan Hoffman on behalf of the City of Los Angeles in support.

Good afternoon, Chair and Members. Ross Buckley on behalf of Sacramento Mayor Kevin McCarty in support.

Eddie Navarrette with the Independent Hospitality Coalition. Also asked to voice the support for Found Oyster, Great White, Nativo, HomeState, Stir Crazy, Captain's Table, the Lonely Oyster, Cole's French Dip, Broad Street Oyster, Townhouse Bar, Menotti's Coffee, Skyduster, Holdfast, Liberties of Dublin, Heirloom LA, Traxx Restaurant, and El Chucho. Thank you.

This is making me hungry. Kelli L'Heureux with Resilient Advocacy on behalf of the California Chamber of Commerce in support. Thank you.

Griselda Chavez with the Mesa Verde Group on behalf of Inclusive Action for the City in support. Thank you.

Formal opposition, please step forward. Ma'am, you will have five minutes.

Thank you. Good afternoon, Chair and Members. My name is Amanda Bloom and I'm the Executive Director of the California Association of Environmental Health Administrators. We represent the directors of California's 62 local environmental health departments, which are responsible for ensuring restaurant food safety.

We are currently in an opposed unless amended position on AB 592, with our concerns focused on the enclosed kitchens portion of the bill. Environmental health aims to keep Californians safe from food contaminants and illness. For vulnerable populations such as the very old, the very young, and those with underlying conditions, foodborne illness can lead to severe dehydration, hospitalization, and even death.

A key pillar of food safety is the careful handling and preparation of foods which are easily contaminated or especially prone to spreading foodborne illness. Current law requires that these foods be prepared in enclosed kitchens, which serve to restrict rodents, flies, cockroaches, birds, and dust from entering areas where these foods are prepared.

Other foods which do not carry the same level of risk can be prepared in open spaces. If you've watched your pizza being cooked in a wood burning stove or enjoyed a custom made drink in an open air coastal bar, you've seen these safeguards in action. These safeguards are not arbitrary, they are science based and they were reaffirmed by the FDA and a restaurant Industry working group in 2022.

California restaurants can already offer a wide range of open air dining and interactive cooking experiences, like the one the author and the sponsors have described, while still protecting the public, especially our most vulnerable residents, from foodborne illness. As noted, several Committee amendments have been taken today or offered today.

They removed some of our food safety concerns, and we'll be looking at them more closely moving forward. We thank the Committee staff, the sponsors, and the author's office for the numerous conversations we've had about this bill. We remain committed to working with the author's office to build a bill that maintains important safeguards. And we also remain committed to our strong working partnership with the restaurant industry, working to support safe and vibrant dining experiences. Thank you for your time.

Me toos in opposition, please step forward.

Chair and Members. Isabella Argueta with the Health Officers Association of California. We're aligned with the Environmental Health Administrators in an opposed unless amended position. Thank you.

Thank you so much. Coming back. I'll kick this off. We worked up to the wire on this one, I think about 30 minutes ago, a couple hours ago, came to an agreement. Thank you so much for working back and forth with me on the concerns from the local environmental health agencies.

You know, part of our responsibility here at the Health Chair is to collaborate with our partners on the local level who are held responsible in ensuring that we are kept safe and everything we eat and so forth. I'm comfortable for now with where we landed with ensuring that a plan is put together and you have the final say on approving that plan.

But with the additional amendments, recognizing that the approval or denial has to be on a reasonable ground. That is not a biased denial, that there's proof as to why it should be denied because of lack of pest mitigation and so forth, not just because we just want to deny open dining.

I want to also point out, ma'am, to your point, you talked about we want these not to just be in affluent areas. They're in no areas right now. So there's no, it's not about parity because it doesn't exist in California. And I want to make sure that as we're moving forward into a new model in California, that there are guardrails in place since this will be drastically different.

And you've talked about eating in these open spaces, I would like to hear what those spaces were because we asked for examples and we did not get examples of what those places look like now. And the examples we were given were of restaurants that have the same model that we have here in California.

So all because of that, the lack of examples that we didn't get and the last us coming up to the wire, I am recommending an aye vote on this. And I know that the author will continue working with the opposition on it. But for right now, we're comfortable where we're at. Any other questions or comments? Assembly Member, you may close.

Yeah. Let me just, first of all, thank you, Madam Chair. Super appreciate your willingness to dive in here and your thoughtful and sensitive approach to this, and want to thank the consultant as well. We were working last night and this morning. But I do share your concerns and I do think we can do two things at once.

I do think that we can address and be very mindful of the health and safety. And I know that the comments from the opposition are coming in the best sense and from the best place of wanting to protect diners and protect people. And I will say when I did the first version of this bill during COVID, part of the motivation was to protect health and safety, right, to allow people to eat outdoors.

But we have also heard really loud and clear from so many folks in the hospitality industry, in the restaurant industry that there's just too much red tape. And we know that so many beloved neighborhood restaurants are dying. It's one of the most diverse workforces in the state.

And we want to make sure that we can help these beloved small businesses businesses succeed. So we think that there's a way to pare back some red tape here, but in a smart way, in a thoughtful way, in a way that still protects health and safety. And so at the appropriate time, we just respect an aye vote from everyone on your Committee. But again, thank you for your engagement here.

Thank you so much, Assembly Member. Thank you for everybody joining us. Once we have quorum, we'll get you a motion, sir.

Assembly Member, come on up. We are now on file, item 12, AB 1312. We have after this two more bills. Colleagues, if you want to come on down to Senate Health Committee or any other authority Member, please proceed.

Thank you so much. Madam Chair and Senators grateful for the opportunity to present AB 1312 today. And I will be accepting Committee amendments which include delaying implementation, revising presumptive eligibility categories and allowing hospitals to income verify. And it also deletes the screening requirement for patients who owe $500.

And we've discussed process to continue the conversation about making sure we don't lose folks who could really benefit and be helped by this when they need it. So look forward to continuing those conversations and some other clarifying changes. So grateful to staff and the Committee for their work on this.

You know, as I'm sure you all discuss on a regular basis, as we do in our Assembly Health Committee, we have some of the highest costs in the country for inpatient hospital care costs that force a third or half of patients to skip or delay care when they need it.

And one time acute medical events such as a single hospital visit or treatment for an accident are the most common cause of medical debt. Medical debt continues to have 75% of adults with health care debt say the bills are from one time or short term medical expenses in their debt.

And those who choose treatment rightfully fear that the visit to a hospital will put them into thousands of dollars of medical debt and at risk of their ability to afford basic needs like rent or food.

It continues to be medical debt continues to be the main cause of bankruptcy and today it is more than one in three Californians who reported having medical debt were in 2023. So we know that this disproportionately also impacts communities of color, low income folks.

A national survey by the Urban Institute found that nearly 3/4 of adults with past due medical debt owe some or all of it to hospitals. And so this is making going to the hospital or emergency rooms a financial decision instead of a health decision, which is what it should be.

Hospital financial assistance or charity care is supposed to help alleviate these burdens. Really was a program that was created out of coming from a very generous gift of saying hospitals can be tax free. They save millions and millions and millions of dollars because of this tax free status.

And there was a commitment made that you need to provide charity care and take for the neediest in our communities as a way to make up for that and fill a community need. And so patients still can encounter roadbloc lacking information and help that they need when they're seeking financial assistance and threatening their access to care.

Excuse me. We cannot let patients continue to fall through the cracks. California needs to join other states in requiring patients to be proactively screened for financial assistance before being saddled with medical debt they can't pay.

AB 1312 will require hospitals to screen patients for financial assistance and automatically apply for free and discounted prior to the billing for financially qualified patients.

Patients who are experiencing homelessness or are enrolled in means tested assistance programs would automatically be eligible for financial assistance and patients who are uninsured, covered by Medi Cal in cost sharing or enrolled in Covered California will be screened before billing.

With these amendments, we have delayed implementation to July 2027 to give hospitals time to operate, operationalize, operationalize this process and we have also included an opt out provision to address other concerns from the hospitals and we continue to work with them on this Bill. Similar policies have already been implemented by many hospitals in California.

However, it's not a standard process and we need to ensure that patients are not who are the most at risk of falling into medical debt are proactively screened instead. Some patients are never told about financial assistance nor are they offered accessible resources to assist with the filling out of applications.

So this Bill would better implement the existing law and standardize presumptive eligibility practices and give more patients the opportunity to utilize financial assistance programs they're entitled to, preventing them from falling into debt. With me today to testify is Monica Padilla, mother and patient advocate and Celine Betancourt, senior in policy manager at California Pan Ethnic Health Network.

Chair and Members of the Committee. My name is Monica Padilla and I'm a proud mom of a brave little girl named Vera. In 2022 she was diagnosed with leukemia and today I'm so happy to say that she's 6 years old and full of energy. But unfortunately, the road to this point in time has not been easy.

My daughter just finished her cancer battle nine months ago and we are so grateful to make this transition but getting back on our feet has been hard. When Vera, my husband and I had had health insurance provided by our employers but soon we had to stop working.

I had a baby, I had a six month old and I had a three year old fighting cancer. We were told on day one of her diagnosis that she would fight for two and a half years.

Overnight we went from two incomes to finding out we didn't qualify for any family leave due to having a baby six months prior. When we first got to the hospital, I wasn't thinking about Money. I was just thinking about my daughter's life. I just want her to survive.

And I'm willing to do everything and anything to make that happen. But when we asked a social worker about financial assistance, she let me know that we wouldn't qualify, but that our family should in fact, start a GoFundMe to support our income loss.

It was heartbreaking, not just because of the bills, but because it felt like no one really understood what we were going through or what we were going to have to go through over the course of two and a half years.

Months later, after struggling to keep up with bills and our jobs and asking for extension and forgiveness, I tried again to find help at the hospital. I was really desperate, and I googled and I found that there was in fact, a financial assistance program available buried in the website of our hospital. And I applied for help.

I wasn't really too sure if I did it right. It took me hours to finish. And after copious form fields, they let me know that my application would be reviewed.

When the hospital social worker, when we saw her at the next clinic appointment, which just happened to be within the next couple weeks, she came up to me and she said, I'm so sorry. I didn't realize that you guys were struggling. And I thought, how does she not know that we're struggling?

She sees us here every single week, multiple times a week for my daughter's chemo infusions. She let me know that if we would have kind of just tried a little bit harder in the beginning, that we probably would have qualified from day one.

It was really shocking to know that we were spending this much time in the hospital, sometimes more than we were at home. And no one knew that we were in this much.

After I polled all of the cancer moms in the pediatric floor because I was so anxious to let everyone else know who was in the same battle with us, many of them on medi Cal. None of them knew or were aware of this financial assistance program available at our hospital. That's why I support AB 1312.

Our story could have been different if hospitals had checked from the start to see if we qualified for financial help. We could have focused on bears treatment instead of worrying about bills. AB 1312 will ensure families like mine don't slip through the cracks. When you're fighting for your child's life, you shouldn't have to fight for help.

Please support AB 1312. Thank you.

Good afternoon, chair and Members of the Committee, Celine Bettencourt with the California Pan Ethnic Health Network. CPEN is a proud co sponsor supporting AB 1312 Monica's experience is an unfortunate example of the burden placed on California families. Medical debt is the largest source of consumer debt that disproportionately impacts communities of color and patients with low incomes.

CPEN analyzed UCLH's data using a conservative methodology, and we estimate that Californians collectively owe $10 billion in medical debt. Further, according to UCLA Center for Health policy research, in 2023, over 1 million Californians couldn't afford basic necessities because of medical debt, the vast majority with incomes below 400% of the federal poverty level.

However, families are often unable to benefit from the financial assistance laws they are entitled to unless they can overcome these various administrative burdens to access it. The burden is still on the patient to learn about and initiate an application for financial help, all while they are recovering or helping a loved one recover from hospital care.

In fact, A national survey by $4 found that 65% of eligible patients didn't apply for financial assistance because they didn't know it existed. Instead of getting the financial help they need, California patients feel pressured to put medical debt on their personal credit cards or borrow money from friends and family. To pay their bills.

AB 1312 ensures that California's financial assistance laws are working as they should be for the patients that need it most by asking hospitals to proactively screen patients likely to qualify and determine eligibility for financial assistance before they receive a Bill. This is a best practice we're already seeing across the country and right here in California.

Yet we lack any standard, standardization or fair practice guidelines on who should be screened and when they should be screened. AB 1312, as it will be amended, clarifies and addresses hospitals operational concerns regarding income verification while still setting reasonable criteria.

For these reasons we humbly ask for your aye vote on this and thank you as a Member of Shelby for her leadership on this issue. Perfect. Thank you so much.

Please support if you'd like to record. Your Me too and support.

Good afternoon Madam Chair and Committee Andy Liebenbaum, county. Of Los Angeles we had a support. If amended the amendment is delaying implementation. I imagine that in the next couple of days we will be taking away that condition and fully supporting the Bill.

Great. Thank you.

Adam Zarin, co sponsor and then in support for the Leukemia Lymphoma Society Omar Altamimi with California Pan Ethnic Health Network and Rising Communities as Pratt co sponsors and then also MeToo's in support for Ari Asian Resources Inc. And the Southeast Asian Resource Action Center. Thank you.

Katie Van Dynes with Health Access California proud, co sponsor and also recording support. For the National Consumer Law center and. The California Low Income Consumer Coalition. Thank you.

Thank you.

Good afternoon. Michelle Johnston, National Multiple Sclerosis Society in support. Thank you.

Good afternoon. Johan Cardenas with the Having Our say. Coalition and strong support.

Brian Mayor Montes Fasmi, California in support.

Katie Jennings on behalf of the Children's Partnership in support. Thank you.

Good afternoon. Beth Malnowski, the SA Californian support.

Good afternoon. Lanle from Asian Americans Advancing Justice, Southern California and strong support.

Sandra Poole, on behalf of Western center on Law and Poverty and support. Thank you so much. Opposition. Vanessa.

Have five minutes.

Good afternoon. Vanessa Gonzalez with the California Hospital Association here with an opposed unless amended position. First, I like to thank the chair and the committee staff for all their hard work on this bill and working with us to address our concerns.

While we're still reviewing the comm, the Committee amendments the author agreed to take today, they do appear to address our remaining concerns and we look forward to seeing the language in print. Currently, all hospitals in California are required to provide financial assistance to patients, whether they're private, public, not for profit.

All hospitals in California provide assistance and current law also requires hospitals to provide multiple notices to patients to inform them of that available financial assistance. However, we absolutely share the goal of making sure that patients get the financial assistance that they need.

And we believe that this new screening process will help more patients get access to that financial assistance. Our concerns with this bill, however, have really been focused on making sure that hospitals can make accurate eligibility determinations, especially at a time when they're facing historic Medicaid cuts due to HR1 and a projected tripling of uncompensated care.

We also want to ensure that hospitals can operationalize this new screening process and that it aligns with information that they have access to and that it is consistent with existing laws and requirements. That said, we're encouraged with the committee amendments and we look forward to reviewing the final language. Thank you.