Assembly Standing Committee on Health

Good afternoon and welcome to the Assembly Health Committee's hearing on Tuesday, January 13, 2026. Our agenda today consists of committee's two year Assembly bills. Before we begin, I want to make sure everyone understands our Committee procedures to ensure we maintain order and run a fair and efficient hearing.

With the go of hearing as much from the public within the limits of our time, we seek to protect the rights of all who participate in the legislative process so that we can have effective deliberation on the critical issues facing California.

Rules of Conduct include no Members of the public engaging in conduct that disrupts, disturbs or otherwise impedes the orderly conduct of this hearing. Engaging in personal attacks on Members of this Committee, author, staff or other witnesses Take talking or loud noises from the audience.

Please be aware that violations of these rules may subject you to removal or other enforcement processes. If you are providing witness testimony at this hearing. All witnesses will be testifying in person. Main support and opposition will be allowed to two main witnesses for a maximum of two minutes each.

As a reminder, primary witnesses in support must be those accompanying the author or who otherwise have registered a support position within the Committee, and the primary witness in opposition must have their opposition registered with the Committee per the instructions on our website. All other support and opposition can be stated at the standing mic.

When called upon to simply state your name, affiliation and position. All testimony comments are limited to the Bill at hand. Some housekeeping. There is a Republican vacancy on the Committee. Therefore, the speaker has appointed Assemblymember Gallagher to join us for today's hearing on consent. The following bills have been proposed for consent.

Any Members of the Committee may remove the Bill from consent. Those consent Items are item one, AB96 Jackson with a motion of do pass to Appropriations item number four, AB 1126 Patterson, with a motion of do pass to Appropriations and item number five, AB 1366 Flora with a motion of do pass to Appropriations.

With that, we will begin our hearing as a Subcommitee and we look forward to seeing the following authors. Jeff Gonzalez present his Bill. I also have one as well.

Given the short nature of this Committee hearing, I ask all Committee Members and authors to come to the hearing room so that we can conclude as soon as possible.

Mr. Gonzalez, please come forward. Yes. Thank you. Assembly Member. Please, whenever you're ready.

Do my best to do it with all of my breath. Good afternoon, Madam Chair. Members, I'm here to present AB 634, which would prohibit the manufacturing, distribution or sale of Ty Neptine in the State of California.

Before diving into this bill, I would like to Extend my sincere gratitude towards the chairs of both this Committee and the Committee on Judiciary and their respective staff who. Who worked tirelessly to get this bill ready for presentation today. AB 634 will prevent Californians from being exposed to tyneptine, a dangerous substance dubbed gas station heroin.

Gas station heroin is often sold over the counter at retail establishments such as gas stations, tobacco retailers and small markets with no age restrictions. This means that when children go to buy their favorite snacks, they also have access to gas station heroin.

Existing federal law does not explicitly approve or disapprove of this substance, and as it is marketed as a supplement, it currently enjoys a legal gray area.

While approved in some European and Asian countries to treat depression and anxiety or irritable bowel syndrome, this substance can produce both an opioid like high and an opioid like addiction when used recreationally. Multiple other states have already taken action against this substance, from placing it on a schedule to restricting its sale.

Amendments to this bill have switched the applicable penalties for a violation of the section from criminal to civil, which I believe is the correct course of action.

While we have made significant changes to this measure since introduction, we have also accepted amendments to be taken in the Judiciary Committee, which will narrow the scope of the bill to avoid implicating employees who do not have authority over what is being sold in stores.

Additionally, these amendments will provide for civil cost recovery to promote enforcement as as well as make a clarifying change to avoid a potential Commerce Clause violation. This measure has come very far since its introduction.

However, I would still like to commit to this Committee and its Members that my staff and I will work to ensure that employees are not inadvertently targeted by this bill.

In addition to ensuring that they are protected from any instance of employer retaliation in relation to this bill, we will also work to ensure that this substance can still be researched by accredited institutions, recognizing its potential legitimate medical use.

Soon, hopefully, will be joining me to testify in support of this measure Ryan Sherman, on behalf of the California Narcotics Officer Association. Since he's not here, as I think we were all running, I turn it back to you, madam.

Thank you so much. Assemblymember Gonzalez, I know that you have done an incredible amount of work on this. I think your presentation will stand alone should Ryan not be able to join with that.

If there are no others to testify and support, I will ask if there are any who would like to register me too, in support of this legislation. Please come forward to the microphone.

Seeing none, I will ask if there are any primary opposition witnesses who would like to speak in opposition to this bill or those who would like to offer a #MeToo. Seeing none, I will bring it back to the Committee for any questions or comments. Moved by Crell, seconded by Sanchez, and those will be considered.

While we give Mr. Sherman a couple more minutes, we can actually establish quorum in the Committee. Please call the roll.

[Roll Call]

We have a quorum. And now we will turn back to Assemblymember Gonzalez's presentation and hear a testimony in support.

Thank you. Good afternoon, Madam Chair Members. Ryan Sherman with the California Narcotic Officers Association. Please do support the bill and sponsor it as well.

Thankful for the Committee and their efforts to narrow this and be able to accomplish the goals of regulating and restricting Tianopin sales without all the other adverse effects that were talked about in previous iterations of this. So thank you very much for your work on this and look forward to supporting it and ask for an Aye vote.

Thank you.

Thank you so much. Hearing no other comments from the Committee at this time, I want to thank you, Assemblymember, for bringing forward this bill.

I know that it's on its way to Assembly Judiciary Committee, as you mentioned, and I understand that that Committee will be working on some amendments in their jurisdiction, not in ours, that improve the bill as it relates to enforcement and civil penalties.

I just want to appreciate you for bringing this forward, particularly recognizing that we need to ensure that retail clerks are julie placed in terms of their responsibility related to this. And at the end of the day, you had me at your headline.

And hello, if we can do anything to make sure that we are reducing the public health risks that come with distribution of this particular drug, California will be better off. So I'm thankful that you brought it forward with that. Secretary, please call the roll.

The motion is due pass to the Judiciary Committee. [Roll Call]

That bill is out of Committee. Thank you, Jeff Gonzalez.

Sanchez. Closest. We are now going to be hearing item number two, AB298 by Bonta.

Assembly Member. Please proceed when you're ready.

Good afternoon, Vice Chair Members. On January 1, with elimination of the ACA subsidies, families woke up to premiums that could put health care out of reach for many. By example, a family with two adults and two children in their household with incomes of 75,000 saw their premiums go from $3,612 to $6,708.

I'm proud to present AB 298 which will eliminate out of pocket costs for children's health care services. California families are struggling with the high cost of living and unexpected medical expenses can quickly strain a family's budget. Evidence shows that high cost sharing often deters families from seeking care and even kids care that a child might need.

AB 298 addresses financial barriers for children's health care by prohibiting cost sharing for children's health care services and large group commercial health plans, the source of health insurance for millions of California's children. In fact, more than half of California's children, 58% are covered as dependents through employment based coverage.

If a child is in a plan with a deductible, the family will have to pay thousands of dollars out of pocket before their plan pays for covered services with limited exceptions for free preventative care even after the deductible is met. Some families face a co payment of $40 or more per visit for a primary care visit.

Most pay between $35 and $45 for a specialist visit and some pay up to $60 or more for a visit. Studies have repeatedly shown out of pocket costs reduced access to care, especially for those with low incomes. Chronic illnesses. Peer reviewed literature is very clear.

High cost sharing at the point of services reduces low income children's use of healthcare services. For instance, one study found for low income families with higher cost sharing, nearly 32% delayed or avoided an office visit for their child with asthma compared to nearly 4% of those with lower cost sharing.

What we are doing here right now is not new. Medi Cal covers over a third of California's children and does not charge any out of pocket costs sharing for healthcare services. And we've already prohibited cost sharing and commercial plans for school based mental health services provided through the Children and Youth Behavioral Health Initiative fee schedule.

This Bill simply expands cost sharing prohibitions to more services making it easier for families to afford and access care for their children. And this certainly is the right moment for us to think about how we can reduce care, the cost of care for our families and those with children.

All children deserve access to health care and parents deserve peace of mind knowing the cost of their children's health care will be covered. This Bill will remove financial barriers and cost pressures when families seek health care for children, whether it's, well, child care or treatment for a medical condition.

I also want to note I have received outreach from some pediatric providers who are supportive of removing cost sharing but have a technical concern. They want to make sure that it doesn't impact provider payments from health plans. Now let me be clear.

This Bill is not intended to impact provider payments whatsoever and only deals with patient cost sharing. If a health plan has a contracted rate and cost sharing is limited, the plan or insurer is still obligated to pay the entire contracted rate to the provider.

And I'm committed to continuing conversations with any concerned providers and will work to clarify this point if needed. I also want to stress that although families win big with this Bill, the affordability is for families going away way up as their out of pocket costs go down.

I'm also cognizant that there is an impact to premiums for employers. Because of this, I will be exploring cost saving amendments in the Appropriations Committee, particularly as it relates to CalPERS.

With that, I have two phenomenal witnesses here, Christine Smith with Health Access and Nancy Netherland with Family Voices of California who are here in support and I respectfully request your aye vote after we hear their testimony and deliberate.

Good afternoon, I'm Christine Smith with Health Access California. We are proud to support AB 298 to prohibit out of pocket costs, including CO payments, coinsurance and deductibles for all covered health care services in large group plans provided to children under 21. This Bill addresses an affordability issue for families.

Anyone who has woken up in the middle of the night to find a toddler screaming in pain and holding their ear knows that a doctor's appointment is not optional. Depending on your plan, the copay for an appointment could be $45 to confirm the ear infection or with an additional copay for antibiotics.

None of these feel optional when your child is in pain, but unfortunately in these economic times, families are feeling the pressure to choose between a doctor's visit and other costs, including rent. Under current law, commercial health plans impose cost sharing at the point of care on most health care services provided to children.

58% of California children are covered as dependents under employer based coverage. Among those insured by their employers, 77% have plans that require a family based deductible to be met before their plan pays for covered services with exceptions for preventative care. This can be in the thousands of dollars.

Families should not have to think twice before getting health care for their children because of potential cost pressures to the family. This Bill will encourage timely screening, diagnosis and early intervention for all children and reduce overall financial strain for families. Thank you and we ask for your aye vote.

Good afternoon Chair Bonta and Members. I'm Nancy Netherland with Family Voices of California. We represent families of children living with special health needs. AB 298 will remove barriers to pediatric medical care by eliminating co pays for Californians under the age of 21. Today I will share stories of families who cannot afford those copays.

Currently, Jane's family has good insurance. Both parents work and their teenage daughters are covered under their employer's insurance. They did everything right and then their daughter got sick and now they're calculating whether one of them should quit their job so they can qualify for Medi Cal.

Jane's 15 year old daughter came home from a vacation unable to walk. It took six months and dozens of appointments to get a diagnosis. Orthopedist, surgeons, physical therapist $50 a copay. The diagnosis undetected hip dysplasia requiring specialized pediatric surgery, inpatient care, months of therapy and a wheelchair. Then two more surgeries. Some months co pays hit $6,000.

Jane and her husband determined that dropping one of their incomes to qualify for Medi Cal would actually make care affordable. Now their daughter faces needing surgery on her other hip and they face choosing whether one of them will quit working to afford her care. Maria's daughter has a rare genetic condition requiring weekly speech, occupational and physical therapy.

The volume of appointments forced Maria to reduce her work hours at $25 per visit. Three therapies weekly minimum meant $300 per month as well as a $5,000 deductible and up to $800 for Mr. With reduced income and mounting bills, she used her credit card accruing medical debt that she's still paying off.

We support AB 298's elimination of cost sharing barriers that force families to choose between their children's medical care and financial survival. We ask you to do the same. Thank you to Assemblymember Bonta for leading this effort.

At this time, we'll move to witnesses in support E2s. Please state your name, organization and position only.

Thank you. Chair and Members. Tim Madden representing the California Chapter of The American College of Emergency Physicians in support.

Good afternoon. Dylan Elliott on behalf of the California State Association of Psychiatrists as well as the California Academy of Child and Adolescent Psychiatry, both in support. Thank you.

Nora Angela is with Children Now in support and we look forward to working with the author and other stakeholders and to mitigate any unintended consequences for children's access to care. Thank you.

Committee Members, Gilbert Laura with Biocomp California in support.

Good afternoon, Madam Chair. Members of the Committee, Awet Kidane proudly representing California Children's Hospital Association. Although we do not have a position, we are fully aligned with Madam Chair and in efforts of reducing pediatric access to care.

And in so doing, we look forward to working with Madam Chair and the small little tweaks as it relates to reimbursement rates. I fully have faith that we are aligned and I look forward to working with you.

Good afternoon. Kevin Guzman with the California Medical Association. Just going to echo the comments. We're in a supportive amended position. Appreciate the Chair speaking to some of those concerns. We look forward to partnering with her and appreciate her leadership on this. So thank you.

Thank you very much. Vanessa Kahina on behalf of the California Academy of Family Physicians in full alignment with Madam Chair as to cost sharing. Reductions for working families. We want to make sure that primary care is adequately incentivized and look forward to seeing the bill move forward.

Thank you, Madam Chair. Ryan Spencer with the California Podiatric Medical Association just like to line their comments. With those of the California Medical Association. Thank you very much for your help.

We will now move to main witnesses in opposition. Two minutes each. You may proceed.

There we go.

Good afternoon, Assembly Members, Alexis Rodriguez with the California Chamber of Commerce here testifying in respectful opposition to AB290. This bill would eliminate all cost sharing mechanisms such as co pays, deductibles, coinsurance for in network services provided to individuals under the age of 21 enrolled in a large group plan.

While well intended, AB298 will require employers to make difficult decisions about health insurance. I'm sorry, health care coverage. It's important to note that the businesses impacted by this bill are those with over 100 employees. These are not just large corporations. These are. These can be successful community businesses in your districts.

With that being said, Chipurp estimates this bill will increase total premiums by more than $710 million across the large care. Sorry, large group market and CalPERS. Many of California's businesses are already struggling to balance an ever changing Climate, tariffs, workforce needs.

If implemented, this will add another financial burden on these businesses as they'll need to find ways to offset this cost. This could look like reducing benefits, increasing employee cost sharing or other or reconsidering their coverage options, all of which could make health insurance less affordable and place a disproportionate burden on working families.

We ask that you carefully consider the broader economic implications of AB298. Shifting the cost to one segment of the population will increase healthcare costs to all consumers and employers. For those reasons we respectfully urgent a no vote. Thank you.

Stephanie Watkins on behalf of the Association of California Life and Health Insurance Companies. Also regrettably here in opposition. As my colleague mentioned, I think we are generally really concerned about the potential impact to the large group market. As was mentioned, this looks at adding another $710 million on top of other mandates that have been recently passed.

I think the Chibirp analysis also noted that the large group market has seen about a 26% increase over the last five years. And just to put that in real terms, what you're looking at is in a Milliman study they referenced for HMOs the average is $640 per Member per month whereas a PPO is $710.

So these are real impacts to employers who are going to ultimately have to make different decisions based on the decisions that are made here in the Legislature. I think our concern is that you will see employers choose to look towards the self insured market as an alternative option.

That means that all of the protections that are in the California marketplace and statute would not necessarily apply.

I think that's a really important piece to understand as well as While we absolutely appreciate the need to access and for children to access services, we'd also like to point out that under the Preventative Task Force all wellness baby visits vaccines are already included and at zero cost sharing.

To the degree that we want to have a more holistic larger conversation, I think we're welcome to having that.

I think we just have serious concerns about the potential impacts and making health care more unaffordable and having employers have to choose other options that might not benefit their employees, such as reducing the overall generosity of their existing benefits or shifting those costs to adults.

Instead of as you reduce the cost sharing on one side, the likelihood is you're going to see it increase on the other side and that's a serious concern. So for those reasons we are currently opposed to the bill.

Look forward to having future conversations with the Chair if this bill moves forward today and also just collaborating on the issue of affordability in General. Thank you.

We will now move to additional witnesses in opposition. Please state your name, organization and position.

Thank you. Madam Vice Chair. Jack Yanis, on behalf of America's Health Insurance Plans, respectfully opposed.

Good afternoon. Olga Shiloh with the California Association of Health Plans. We also are respectfully in opposition.

I will now open it up to questions from Committee. Would the author like to close?

I just, I realize you're going to be working on some amendments on the bill, so I look forward to hearing that. Appreciate the fact that you're open to continuing the conversations with the Assembly Member and I look forward to supporting it now and let's see if we can get it across.

Move the bill.

We have a motion and a second and I see Assembly Member Krell would like to make a comment.

Yeah, I mean I'm concerned about the concerns the opposition raised and just the breadth of the bill. Overall, I completely agree with the goal. I think the goal is really important.

I'm wondering if you've considered whether this would shift costs to older Californians, if there's any other kind of limiters you're looking at in future amendments to try and mitigate costs on other folks.

So just to kind of frame the costs in a way that I think that we can all understand, the CHIBIRP analysis estimates that this would result in Approximately less than 1% increase in the commercial large group market and approximately 0.8% for CalPERS HMO plans. What that means for an employer. And I get it.

I was a small business owner. I had a company that I'd go to sleep every single night thinking about whether or not I could make payroll.

And when I decided to make sure that as an employer I could offer as robust health care package as I could, I would sit down with the actuarials and the estimates from Blue Shield and Kaiser and the host of them and I'd look at the Cadillac plan and I'd look at the at the plan that would be nothing for different types of my employees.

And I will say that if I was reviewing that plan and saw something that would create per to burp analysis in terms of the impacts on this and an $11.36 per Member per month impact on my employees to ensure that my workers would have the ability to have full coverage for their children and be able to not have to face down the crippling idea of medical debt that comes with deductibles or the other out of pocket expenses that our testimony referred to that can also be crippling.

And it would ensure that I could have a worker come to work the next day as opposed to wait till their kid gets a little sicker and ends up with pneumonia or some other kind of acute illness.

And having that worker miss two weeks instead of two hours to be able to take their child to the doctor, I would have taken that option right now.

We are in a moment right now where we have to deal with the trade offs that come with the, the crippling premiums that many of our California, many Californians will face.

I think as an employer and to respond to your question, Assemblymember, employers make decisions and they toggle between the types of benefits, the cost of those benefits for the entirety of their employee package. They will have to do this.

But to put this into perspective, it would be at a cost that is less than 1% that they are trying to make a decision around. I will be looking at, as I stated in my opening presentation, looking at amendments that will support some cost savings to the state of California, in particular as it relates to CalPERS.

And we will do our own toggling as we enter into appropriations to know that we are putting forward something that at the end of the day will save money for families who are struggling and making decisions about whether or to ensure that their child has the full care that they need in behavioral health and other things that aren't preventative care and all the things, the earaches in the middle of the night that keep our kids struggling.

And we will do whatever we can to make sure that we're putting that money in people's pockets right now when they need it most desperately. And we will certainly do that as we head into Appropriations as well as address the concerns that some of the providers have about the technical language to ensure that we.

That we ensure full reimbursement.

Thank you. I appreciate that. And I will vote for the bill to get out today. I'll continue to follow it closely and look forward to those amendments.

Thank you.

Do we have any other questions from Committee Members? Assemblymember, you may close.

Thank you. Members, this is a common sense bill that will improve affordability for California's families and help get every child in California the health care that they need and deserve. With that, I respectfully request your Aye vote.

We have a motion to Second. Secretary, please call the roll.

The motion is due pass to Appropriations Committee. [Roll Call]

The bill is on call. Thank you.

While we are waiting for our full complement of Committee Members to come down, we can vote on the consent calendar we have. We need a motion so moved by Gonzalez. Seconded by Sharp Collins. With that, please call the roll on consent.

[Roll Call]

Tthe consent is out. While we are we can do add ons now.

We can do add ons for item number three. AB634 Jeff Gonzalez.

[Roll Call]

That measure still out. We will take assemblymember Addis's add ons. On consent. Addis aye. Addis aye.

[Roll Call]

That measure is still out. Thank you.

We are waiting on one more two more Committee Members but that you are able to go. Mr. Patterson for add ons.

[Roll Call]

We will do add ons now for. Our consent and two items on consent.

[Roll Call]

Our Committee hearing is adjourned.