Assembly Standing Committee on Health

Good afternoon. We will call to order the hearing of the California State Assembly Health, this Tuesday, March 17. We will first establish quorum.

[Roll Call]

We have quorum. Before we begin, I wanna make sure everyone understands our committee procedures to ensure we maintain order and run a fair and efficient hearing with the goal 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. That being said, rules of conduct by members of the public include no engaging in conduct that disrupts, disturbs, or otherwise impedes the orderly conduct of this hearing, engaging in personal attacks of members of this committee, authors, staff, or other witnesses, 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 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 opposition with the with the committee. And the primary witnesses 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. A couple of housekeeping items. I would like to note that the speaker has appointed Assemblymember Rogers to substitute for Assemblymember Rodriguez for today's hearing. Welcome, Assembly Member Rogers. On consent today, we have the following items proposed for consent.

Any member of the committee may remove a bill from the consent agenda. Those items include item number four, AB 1734 by Stephanie with a motion of do pass to higher education. Item number five with a motion of, I AB 1868 by Gallagher with a motion of do pass to appropriations. Item number seven, AB 1907, Addis with a motion of do pass to appropriations. And item number eight, AB 1910 by Boener with a motion of do pass to appropriations.

With that, because we do have quorum, I'm going to have us just vote quickly on the consent calendar. Moved by Roger, seconded by Addis. Please call the roll.

[Roll Call]

The consent is out. We will move on now to our first item on the agenda which is item one a b 1540 by Mark Gonzalez 988 suicide and crisis lifeline for LGBTQ youth. This is an urgency.

Motion by Addis, seconded by Stefani. Assemblymember Gonzalez, please go ahead whenever you're ready.

Thank you, for the opportunity to present today. Thank you, Madam Chair. I also wanna begin by accepting the committee's, amendments and expressing my appreciation to the chair, and the committee staff for working with my office on this bill. I also wanna take a moment a moment of personal privilege to thank the many colleagues, the members, the advocates, the providers, and the stakeholders who have offered thoughtful, feedback to this bill. I remain committed to continuing those conversations so that we can address implementation concerns and ensure that the program works the way that it's intended to.

This bill represents meaningful progress, but we know that there is still work ahead. I look forward to continuing, that work with our partners in the 988 space and to make sure that the program can restart smoothly and effectively. But before we talk policy, I wanna talk about something deeper. Every generation is tested by what it chooses to see and what it chooses to ignore. Sometimes the greatest danger to community isn't cruelty, it's indifference.

It's seen warning signs flashing for our young people and deciding it's easier to argue than it is to act. Last year, national funding for the 98, LGBTQ plus suicide prevention line was cut, shutting down a lifeline of thousands where young people relied in their darkest moments. AB 1540 is about restoring that lifeline. It reinstates the press 3 option with 98 system so that when someone reaches out in crisis, they can be connected to trained counselors who understand the unique challenges LGBTQ plus youth face. Because the reality is that LGBTQ plus youth attempt suicide at a far higher rates than their peers, not because they are broken, but because too often the systems around them are.

When young people or when a young person is at their lowest point and finds the courage to ask for help, the worst thing that we can do is let that call go completely unanswered. Suicide prevention should never be political. It's a public health responsibility. And restoring this service means restoring something simple but powerful, the chance for someone on the other end of the line to say, you're not alone. Stay with me.

Sometimes the difference between tragedy and tomorrow is just one voice picking up that phone. AB 1540 helps to make sure that that voice is there. And today, to help us with that voice is Divya Shiv, a senior policy advocate for California Alliance of Child and Family Services.

Good afternoon, Chair Bonta and assemblymembers. My name is Divya Shiv, and I'm the senior policy advocate of behavioral health at the California Alliance of Child and Family Services, a proud cosponsor of this bill. I am here to answer questions about the bill, and I defer the rest of my time to Bridget.

Hello. My name is Bridget McCarthy, and I'm here representing the American Foundation for Suicide Prevention, which is the nation's largest public funder of suicide prevention research. We do support this bill, and I'm here to urge an aye vote on AB 1540. But most importantly, I'm here as a mother. In September 2020, just twelve days after his sixteenth birthday, I lost my amazing son, Riley Chart, to suicide.

His birthday balloons were still floating in his room. An image of a life just celebrated is one I cannot get out of my head, and it's there every single day. That is why I'm committed to preventing suicide. I have no agenda, and I'm simply here because it's the right thing to do. In California, suicide is the second leading cause of death for our youth.

For children like Riley, who are part of the LGBTQ plus community, that risk is exponentially higher. They aren't just statistics. They are children looking for a place where they belong, and a voice that understands them. And I have Riley buttons if anybody would like one. After we lost Riley, we discovered that in the middle of his crisis, he reached out.

He sent a text to a gay friend, hoping for a connection that never came. Back then, we didn't have 988. We didn't have the press option 3, a dedicated line where queer youth in distress can speak to somebody who truly understands their world. We know that a veteran crisis line looks after a fellow soldier. And if a veteran is in crisis, they're going to want to speak to somebody who understands their world.

It's no different with LGBTQ plus youth. We they need to know that the person on the other end of the line sees them for who they are, and we have to meet our children if we want to save them. Oh, I. Thank you.

You- You go ahead and finish your thought. There was a deferral of time.

Oh, thank you. Last year, the Federal Government cut the press nine crisis subnetwork, leaving thousands of queer and trans youth in California without specialized suicide prevention. We just passed AB 727 to put hotlines on school ID, but this is the next big step. This wasn't isn't just a niche option to press 3. It handled 73,000 calls from California alone from LGBTQ youth.

And the the suicide rates for trans youth are four times higher than that of their peers, and we cannot afford this gap. AB 1540 restores this lifeline and ensures our youth get the identity affirming care they need to stay safe. And when it comes to LGBTQ youth, words matter. There is no room for error here. For Riley and for every child still reaching out, I urge you to support AB 1540.

We must fund and implement- implement that press option 3 immediately. Let's make sure that the next time a child reaches out, someone who understands is there to pick up, and this legislation is the hand in the dark. Please say aye on 1540.

Thank you. We will now move to hearing any support on measure.

Craig Pulsipher on behalf of Equality California, proud cosponsor in support, also here on behalf of the California Psychological Association.

Good afternoon, Madam Chair and Members. Malik Bynum on behalf of the County Behavioral Health Directors Association in proud support. Thank you.

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

Good afternoon, Madam Chair. Obed Franco here on behalf of the California Fire Chiefs Association in support.

Good afternoon. John Skoglund with the County of Los Angeles in support.

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

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

Good afternoon. Trent Murphy with the California Association of Alcohol and Drug Programs in support.

Good afternoon. Binu Mukhamala with the National Association of Social Workers California Chapter in strong support.

Madi Lowe with the California Behavioral Health Planning Council, proudly support.

Romelle Antoine with the Sacramento LGBT Community Center, proud cosponsor of this bill, in support.

McLean Rozanski with the Alameda County Office of Education, in support.

Clifton Wilson on behalf of the California State Association of Psychiatrists as well as the California Academy of Child and Adolescent Psychiatry and then as well as the City of West Hollywood all in support. Thank you.

Hello. Sela Steiger on behalf of Lion Martin Community Health Services in strong support. Thank you.

Kathy Mossburg on behalf of the San Francisco AIDS Foundation in support.

Nora Angeles with Children Now in support.

Lauren Pulido with the American Foundation for Suicide Prevention and the Office of Lieutenant Governor's Transgender Advisory Council in strong support.

Angel Jaimes with the Trans Latina Coalition in strong support.

Thank you. We will now hear from, primary witnesses in opposition. You'll each have two minutes.

On behalf of CAUSE, I oppose AB 1540. My name is Johnny Skinner. I was a gay kid who was harmed by LGBT specific suicide prevention. As a teenager, I was on puberty blockers and estrogen. My physical development was arrested.

I was isolated and bullied because my body stayed that of a child's. I was having thoughts of suicide because I didn't like anything about my body. My hatred of my body significantly worsened after I started sex rejecting interventions. The doctors told me I was supposed to be a girl, so I viewed my male body as defective. I was in crisis, so I called the Trevor Project because that's what LGBT influencers online told me that's who you call.

They were very nice at first, very affirming, but when I started talking about what was actually wrong, the side effects, the hormones, the blockers, my depression, they got very quiet, and then they hung up on me, a suicidal child. The world caved in, and I cried myself to sleep that night. AB 1540 would root kids like me, kids in crisis, directly to organizations like the Trevor Project, an organization that believes children can be born wrong, an organization that doesn't want to hear about the harms of so called gender affirming care. In fact, they deny the harms even exist. I know what it is to be a lonely gay kid reaching out in the dark for someone to help.

That kid deserves real help and holistic care. That kid deserves to be told the truth, not an ideology. Don't send the next kid to the people who abandoned me. Please vote no on AB 1540.

Please go ahead.

Erin Friday, president of Our Duty, attorney, mom, and a kid who used to believe that she was trans. California is looking to create a dedicated routing option that directs youth to an LGBTQ pro- provider through grants. This will direct the callers to Trevor Project or similar using 998. This bill is a direct attempt to do an end run around the prohibition of federal dollars being spent on the Trevor Project. But don't worry.

When I was in DC last week speaking with the HHS, I made sure that they are aware of the games California is playing. The Trevor Project is not a suicide prevention organization. Its main focus is to target minors, promote secret social transitions, and provide chat rooms open to users ages 13 to 24 with no age verification. I know because I joined last year. I was able to join the Polyamory Club where kids and adults set up meetups.

The age regression club where adults who like to pretend to be little kids can talk to depressed teenagers. One post was- was titled looking for little ones. I am 18. I just wanna talk to someone while I'm regressing. I also have a Discord.

Member Gonzales and this legislature made sure that all public school kids have the Trevor Park Project on their student IDs so that they can access this sexual, chat rooms. This bill is another vehicle for the author's favorite fetish nonprofit. If the goal is truly suicide prevention, then 998 suffices and does so without incorporating sexual or fetish content. Thank you.

Thank you. We will now hear any me too's in opposition for the bill. Please come forward. State your name, affiliation, and your on the bill.

Good afternoon. David Bullock, SFP Alliance, and neighbors for the, neighbors of the 40th Assembly District for SANE legislation. We are opposed.

Good afternoon. Carli Stelzer on behalf of the California Behavioral Health Association. Not an official oppose. We had letters of concern. Just want to acknowledge that we're working with the authors and sponsors on that and appreciate the collaboration.

Bev Talbott from the Lesbian and Gay Courage Coalition. We strongly oppose funding a hotline that routes vulnerable youth into chat rooms with no age verification and onto Discord, a known source of child exploitation. Thank you.

My name is Jean Chadbourne. I'm from Oakland, California. I'm a lifelong Democrat, mother of a gay son, and I'm here on behalf of Women Are Real, Women's Declaration International, Women's Liberation Front, and I strongly oppose this bill.

Elisa Overholt. I'm here with Women Are Real, Women's Liberation Front. I oppose this bill.

Tish Hyman from Los Angeles, California. I'm here on behalf of Black Lesbians in Los Angeles, and I strongly oppose this bill.

My name is Matthew Ward. I strongly oppose this bill, and I am a school board member for Galt Elementary School District.

Meg Madden on behalf of CAUSE, Californians United for Sex Based Evidence in Policy and Law, and Women Are Real and Our Duty, as well as Amy Anderson and Heather McClure in opposition to AB 1540. Thank you.

Nicole Young, Placer County, Moms For Liberty, as well as Moms for Liberty California Legislative Committee. I represent over 12,000 parents and strong opposition.

Ariane Gehringer from Oakland, California on behalf of LGB, that is Lesbian, Gay, and Bisexual Alliance USA, the USA chapter of LGB International, and I oppose this bill.

Romy Mancini, former attorney for the ACLU Lesbian and Gay Rights Project and member of Our Duty and Women Are Real. I strongly oppose this bill.

I'm Barbara Walker from Alameda, California. I'm here with Women Are Real. I am the mom of three, and I'm the daughter of a mom who took her own life with dozens of suicide prevention cards in her pocket, and I strongly oppose this bill.

Sunil Vijay Sekhar from Pleasanton. I'm with the Democrats for Informed Approach to Gender, as well as Women's Liberation Front. I oppose this bill.

Lisa Smith, lifelong Democrat until two years ago, I strongly oppose this bill.

Michelle Connor, on behalf of the Frederick Douglass Foundation of California, we are in strong opposition and request a no vote.

Mallory Engel from Sacramento, California, and I oppose this bill.

My name is Leila Jane. I'm a detransitioner, and I'm here with CAUSE, and I oppose this bill.

My name is Greg Bird, vice president of the California Family Council in opposition. Thank you.

My name is Mariam Syed. I'm with Women Are Real, and California is in California is United for Sex Based Evidence in Policy and Law from Menlo Park, and I oppose this bill.

My name is Amanda Covetana from San Mateo County. I'm with Women Are Real, Women's Liberation Front, and lesbians advocating for a resilient future, and I strongly oppose this bill.

I'm Arian Adam Chacova, longtime San Francisco progressive Democrat and LGB activist, mother of a formerly trans identified son, co lead of the LGB Courage Coalition education team, cofounder of California Teachers Supporting Gender Nonconforming Youth, and member of Democrats for an Informed Approach to Gender, a veteran high school Spanish teacher, and a state council representative for CTA, and also a teen suicide survivor. I stand in strong opposition to this bill.

My name is Rachel Bordoli. I'm a registered Democrat, longtime San Francisco resident, member of Women Are Real, member of Democrats for an Informed Approach to Gender. As the mother of a gender nonconforming young Lesbian- young Lesbian and former supporter of the Trevor- Trevor Project, I stand in strong opposition to this bill.

Hi. My name is Beth Bourne. I'm from Davis, California. I've been working very closely with the Federal Trade Commission on this unfolding medical scandal where we're lying to children about their, healthy whole bodies. And I, strongly, urge you not to support this bill because-

Just to your position.

Thank you so much.

Oh, sorry.

A boy can't become a girl. A girl can't become a boy.

Please.

Leandra Wells with the California Family Council. And I oppose this bill. Thank you.

Thank you. We will bring it back now for any member questions or comments. Assemblymember, I- I would like to give you an opportunity to address the some of the concerns related to the- oh, Sharp-Collins had a question or comment.

It was just it was gonna be a comment. First off, I would like to thank the author for bringing forth this bill. I also would like to thank those that that were here to provide your story, your testimony. Thank you so much for that also. But what I wanted to say was that every day in California, the LGBTQ plus youth face extraordinary mental health challenges.

And tragically, too many lives are lost because they because of the the support they need is out is often delayed or is unavailable. This is about more than just access. To me, this bill is about equity, justice, and the accountability ensuring that our that our policies reflect the values of a state that protects all of its youth. California has a long history of leadership in mental health and suicide prevention, and this legislation to me is a bold step to continue that leadership where it is needed the most. Some may question timing, funding, or the logistics in regards to this particular measure, but let us be clear that no bureaucratic hesitation, no no debate over resources, and no outdated system can take precedence over the lives of all of our young people.

This bill is a statement that California refuses to leave its its most vulnerable youth behind and that the LGBTQ plus youth truly matter and that the state will take decisive action to actually protect them. This is not only a moral or social imperative, but it's also a political, imperative. So leaders in this state will be judged by whether they acted when lives were at stake. Well, lives are at stake. So it's it's our duty to do everything we can to actually protect those lives.

We have the tools. We have the knowledge, and I believe that we have the responsibility to act, and we must act now to save those lives. So with that statement, I will be supporting this measure today.

Thank you so much. And I wanna thank Assemblymember Gonzalez for bringing forward this bill. This bill is attempting to simply restart a service that we already had available nationwide before the current federal administration ended it. Research is very clear that our LGBTQ, people and particularly our youth are disproportionately higher at high risk of suicide. And at a time when their basic existence is being challenged, I can only imagine those feelings of anxiety and fear and the judgment that comes with that and how much it can be exacerbated.

And I thank you always for bringing in the story of Riley into- into our conversations around this. I wanna also thank the opposition for your comments and your testimony as well. I wanna appreciate our staff and, your staff and you for always working with this committee. Assemblymember Gonzalez, you've indicated that you will accept those amendments that we've offered, and I'm proud to be a coauthor of this bill. With that, would you like to close?

Yes. Thank you. Thank you, madam chair. Thank you to my colleagues for today, and thank you to everybody who came whether you were in opposition or you're in favor of the bill. It's important to be here because decisions are made by those who show up. I've read those opposition letters. I've heard the angry calls. I've I've received those hateful, voice mails. The ones claiming that this bill is about ideology or politics or some kind of an agenda. Let's be clear what this bill is actually about.

Very simple. A phone call. That's it. Just a phone call. A young person alone in their room staring at the ceiling at two in the morning wondering if anybody in the world understands them enough to keep them alive just for one more day or one more hour.

And when they finally find the courage to reach out, we should make sure that someone on the other end of that line knows how to help them, has the training, and the skill set to keep that individual alive. That's it. That's the bill. Not ideology, not politics, just the basic responsibility to keep our children alive. We are in the season of Lent right now, and I'd be remiss if I didn't mention that.

It's a season that asks people of faith to reflect on sacrifice, conscience, and what it means to stand with those who are suffering. And for me, that reflection is very simple. When a young person is in crisis, our job is not to interrogate them, debate them, or filter their pain through somebody else's politics. Our job is to answer the phone, answer that text, answer that cry for help. Because while some people are busy writing letters about ideology, there are kids out there right now just hoping somebody will answer that call.

AB 1540 makes sure that when they do call, someone understands them and is there, and they are ready to listen. And in a moment where a life hangs in the balance, that can be the difference between despair and tomorrow. Members, this should not be a partisan question. It's a moral one. I respectfully ask for an aye vote.

Thank you. With that, we've had a motion and a second. Secretary, please call the roll.

The motion is do pass as amended to the communications and conveyance committee. [roll call].

That bill is- will be on call. We're gonna move now to the next item in file order, which is item with the author here, item number 3, AB 1671, Tangipa. This motion by Chen, seconded by Sanchez.

Please go ahead whenever you're ready.

Alright. Well, happy Saint Patrick's Day, everybody. Good afternoon, Madam Chair and Members. I want to start off by saying thank you to the committee staff for their work on this bill, and we are happy to take the committee amendments. I am here today to present AB 1671 which creates the rural medical provider grant program to support health care professionals who provide care in rural communities across California.

Rural Californians face some of the most severe health care shortages in the state. Many residents must travel long distances just to see a doctor, dentist, or mental health professional. In some areas, patients delay or completely forego care because access simply does not exist. This lack of access leads to worse health outcomes, including higher mortality from preventable conditions as well as increased risk during pregnancy and medical emergencies. AB 1671 helps address this problem by creating a competitive grant program administered through the Office of Rural Health to support providers delivering medical services in rural areas.

Under the bill, eligible health care professionals including physicians, nurses, dentists, pharmacists, psychologists, physical therapists, and other licensed providers may apply annually for grants up to $10,000 to help offset operational costs associated with providing care in rural communities. Since introducing AB 1671 we have worked with committee staff and stakeholders to make several important amendments to strengthen the bill. The amendments clarify how grants funds may be used, including supporting workforce needs, equipment, operational costs, and other expenses that help sustain or expand medical services in rural communities. They also expand the list of eligible providers to include pharmacists and strengthen accountability by requiring proof of rural service and a description of how the funds will improve access to care. Lastly, the bill now requires the Office of Rural Health to measure program outcomes related to access to care and provide recruitment and retention in rural areas.

AB 1671 is a practical and targeted approach to improve health care access by helping the providers who are already serving these communities and encouraging others to practice there. Today, I have Andre with CSHP to testify in support.

Thank you. You'll have two minutes.

Thank you, chair and members of the committee, for the opportunity to speak today. My name is Andre Pieterse. I'm a pharmacist representing the California Society of Health System Pharmacists. I'm also a resident of one of our state's rural communities, communities that are struggling every day just to access basic in-person medical and pharmacy care. I'm here to voice strong support for AB 1671 which creates a rural medical services grant program.

In my professional role, I oversee medication therapy and clinical pharmacy services that are deeply interwoven with the work of physicians, nurse practitioners, mental health professionals, physical therapists, and many others listed in this bill. But in my personal life as a rural resident, I've seen the other side. Both myself and neighbors driving hours for routine provider visits, patients delaying care until they end up in the emergency room. Providers stretch so thin that burnout is not a possibility, it's a certainty. This bill provides small but meaningful grants up to $10,000 to the qualified providers who are actually on the ground delivering in person medical services, and it allows funding for exactly what rural practices struggle with most, workforce support, equipment, operational cost.

We lose providers because they simply could not sustain the financial or operational burden of practicing in remote areas. Even modest grant opportunities like this in AB1671 can be the difference between a medical or pharmacy service staying open or closing, or between a provider choosing to stay in a rural community rather than leaving for urban practice. But perhaps most importantly, AB 1671 honors the principle that zip code should never determine access to care. As someone who helps to manage clinical and pharmacy services at a system level and who experiences rural health care gaps at home, I can confidently say that this bill will save services, support providers, and improve health outcomes in some of the most medically underservice regions of California.

And I respectfully urge your aye vote. Thank you.

Thank you.

Thank you. We'll have anyone in the room in support of AB 1671 come to the mic, please?

David Bolog of the SFV Alliance in support.

Erin Friday in support.

Thank you. We'll now move on to primary witnesses in opposition. Seeing none, if there are any members who would like to offer an Me Too in opposition. Seeing none, I will bring it back to the committee for any comments or questions. Seeing none, please go ahead and close.

Well, thank you all for allowing me to present this again. This is a very simple bill to make sure that we're helping out some of the rural portions of Californians that a lot of us care about as well. So, thank you, and I respectfully ask for your aye vote.

Thank you. I will note for the committee that, this committee has done extensive work, over the years as has the assembly to ensure that our rural communities and our rural hospitals, have the ability to be supported, including a provision of $50 million in one-time MCO tax to help with seismic retrofits, another $300 million in loans to 17 facilities, many of them who are rural, and Assemblymember Soria this year is carrying a bill introducing a refocus on the Distressed Hospital Loan Program, and, we have certainly had an opportunity to have many of our critical access hospitals to hire physicians. And there is a bill this year to expand that to healthcare district hospitals as well. I want to just make sure that we are aware of the work that we have already done and that this committee continues to be focused on rural committee rural hospitals. And I know that majority leader you had a comment that you'd like to make.

Yeah. I do. Thank you very much. And thank you very much, mister Tangipa. I want to thank you for bringing the bill forward today. Specifically, I want to thank you for accepting the committee amendments. Thank you. And, to make telehealth eligible for grant funding under your bill. You know, we both knows how important telehealth is to our rural communities, and I have fought for that for years. And many of our constituents have to drive distances to access care, which is especially challenging for our working families.

So just consider the recent hike in gas prices we've seen over the past week. This makes it even harder for people in rural areas to afford the long drive to the doctor's office. We want our constituents to access health care without breaking the bank. Telehealth is affordable, an effective way for our rural communities to access care they would not otherwise receive. So, I'm preaching to the choir. I know it. But I want to thank you for your work on the bill.

Thank you. Oh, okay. We are going to offer Tangipa an opportunity to reclose with another comment coming from our Assemblymember Schiavo.

I wanted to thank you for this bill. As you know, I am from your district. I have family, friends, loved ones in your district. And I just wanted to share a story about one person in your district, my brother's best friend, who my dad actually trained him as an electrician.

And he worked for my dad a little bit. He has become a union electrician, got a good union job, which I was very excited about. He has six kids. His wife's homeschooling them. So having that union he recently, as happens in construction, lost his job and, is on the verge of losing health care for him and his whole family.

And I know how important health care is in our rural communities and how difficult it can be to access. My mom is working on, you know, addressing some of her own health issues there in Sonora. And so, I hope that your work to support health care in rural communities goes far beyond this bill. Because when in other committees you say that taking away health care from millions of people is closing a loophole, people's lives are on the line. And so maybe I take it a little more personally because I know people in your district who are being hurt by this a lot of people there's a lot of poor people in your district.

A lot of people I know who struggle in your district. And so, I am willing to support this bill today. But I urge you to think about the impact that this is going to have on our friend Ross and his six kids and the families that are going to be profoundly impacted by the loss of the MCO tax and MediCal in your district as well.

Seeing no other comments or questions from committee members, assembly member Tangipa, would you like to close again?

Yes. And I I do actually want to really take this time to make sure that I am thanking, all of the committee staff, Madam Chair, your staff as well, and your comments again, and the Majority Leader as well. I believe that type of collaboration was what was needed to make this bill even better to make sure that we're addressing those same individuals in Sonora and in a lot of the rural portions of California. So, again, as we all understand that the times are changing right now, I want to do what's best to make sure that I'm working with everybody and anybody within the parameters that we have to make sure that we're prioritizing the needs of Californians. I think the amendments that we've accepted only make this bill a whole lot better.

And I actually ask everybody to look at where are ways that we can make sure that we're partnering too. And to Assemblymember Schiavo, your father was an amazing man and worked to help a lot of people, and so I appreciate your comments on that too, as we really do try to prioritize those who need it most. And so, I respectfully ask for your aye vote. Thank you.

With that, we have a motion and a second. Please call the roll.

The motion is do passes amended to appropriations. Bonta

Aye.

Bonta, aye. Chen.

Aye.

Chen, aye. Addis.

Aye.

Addis, aye. Aguiar-Curry. Aguiar-Curry, aye.

Arons. Kalozah, Carrillo.

Carrillo, aye. Gonzales. Gonzales, aye. Johnson, Johnson, aye.

Patel. Patterson. Patterson, aye. Rogers. Rogers, aye. Sanchez. Sanchez, aye. Schiavo. Schiavo, aye. Sharp-Collins. Stefani, Stefani, aye.

That bill's out. Thank you. We're going to move on now to item number 6, AB 1876 with Addis, "Health Care Coverage Non-Discrimination".

Move the bill.

Second.

Moved by our Majority Leader, seconded by Rogers. Assembly member Addis, whenever you're ready.

Thank you, madam chair and members. Appreciate the motion and the second, so I will try to tighten up my talking points for you. But today, we're here to present AB1876 the Fair Care for All Act that would codify federal nondiscrimination protections to ensure that no individual is excluded from health care coverage or services based on a protected class. And the gist of this is that these protections are currently codified in federal law under the Affordable Care Act. Nonetheless, the current presidential administration is trying to attack and roll back those discrimination protections.

So as California often does, we feel it's important to codify those protections into state law to make sure that we are as protective as we can possibly be against the discrimination, based on a number of factors that include race, color, or national origin, age, disability, or sex. And the bill also updates some definitions that I'm happy to get into should the committee have a need for that. With me today to testify are Angel Jaimes, Statewide Policy Initiatives organizer with the Trans Latine Coalition, and then Lauren Pulido, youth advocate, and member of Lieutenant Governor's Trans Transgender Advisory Council.

Thank you. You'll each have two minutes.

Thank you. Hello, Chair Bonta and Assembly members. My name is Angel Jaimez. My pronouns are they/he, and I am the statewide policy initiatives organizer at the Trans Latin@ Coalition. I am here to advocate for AB 1876 which would strengthen and clarify federal nondiscrimination protections under Section 1557 of the Affordable Care Act into, California state law.

This piece of legislation is incredibly crucial at this moment when these protections are vulnerable in the federal legislation, particularly given executive order 14187. It directed the Secretary of Health and Human Services to revisit the legality of Section 1557 of the Affordable Care Act. These developments have had already very devastating effects for TGI, transgender, gender expansive, and intersex access to care both in and outside of California. The Trans Latin@ Coalition, specifically, our patient navigation program supports people in understanding and challenging, coverage denials, navigating the appeals process, and advocating for themselves amid the inconsistent implementation of federal policies that too often result in discriminatory practices. In the past year, we have witnessed community members who lost coverage for gender affirming care due to policy changes as well as those who were told, services they had already been approved for were no longer covered.

We have also supported clients who had to call multiple providers across the county when programs were closing in mostly rural and suburban areas. Through 1876, California has the opportunity and responsibility to ensure that these protections are clear and strengthened for vulnerable communities across the state. Ensuring that California is explicit is particularly vital in this moment. And with this, we respectfully request your aye vote on AB 1876. Thank you.

Thank you. Please go ahead.

Good afternoon, Chair Bonta and members. My name is Lauren Pulido, and I am here today as a lifelong Californian, a member of the Lieutenant Governor's Transgender Advisory Council, and a member of the LGBTQ plus community in strong support of AB 1876. I know California has the capability and has a long history of attempts at being a safe haven for LGBTQ individuals and marginalized communities. At a time when protections at the federal level are being redefined, rolled back, or dismissed, it is more important than ever that California continues to strengthen protections against discriminations in health care. For many transgender, gender diverse, and intersex people, access to medically-necessary care is becoming increasingly uncertain. Across the country, we are seeing rollbacks in gender affirming care services and clinics.

These changes disproportionately affect young people and those living in suburban and rural areas, where access to specialized care is already limited. When services are restricted or removed from networks, the impact is immediate. People lose access to providers, appointments get canceled, and the care that once was available suddenly becomes out of reach. I have personally seen how insurance barriers and shifting policies can relay or prevent care. Changes in coverage rules, denials of service, or sudden policy changes can force people to postpone procedures or move surgery dates after months or even years of planning.

This is something that I have seen with many people that I care about and many of your constituents. And this causes mental health distress and furthering unnecessary stress. And in some cases, providers preemptively comply with shifting policies outside of fear and or uncertainty. Like, when consent ages for policies change and people suddenly have to move or cancel their appointments that they've already previously prepared for. These disruptions are not abstract, and they are not abstract policy debates.

They are real barriers that affect people's health, stability, well-being. And California has long led the nation in protecting vulnerable communities. And at this moment, we must continue to stand strong against federal attacks on health care providers and systems that provide care for trans and gender-diverse people.

Thank you. We'll move on now to all those in support of the measure. Please come forward.

Craig Polster on behalf of Equality California, proud cosponsor and strong support.

Angela Pontus on behalf of Planned Parenthood Affiliates of California, proud cosponsor in support.

Symphoni Barbee on behalf of the ACLU Cal Action in support.

Malik Bynum on behalf of the County Behavioral Health Directors Association in support. Thank you.

Carli Stelzer with the California Behavioral Health Association in support.

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

Katie Van Deynze on behalf of Health Access California and the Western Center on Law and Poverty in support. Thank you.

Bridget McCarthy, mother of a trans child in strong support.

Kathy Mossberg, San Francisco AIDS Foundation in support.

Salas Tiger, Lyon Martin Community Health Services in strong support. Thank you.

Yesenia Robancho with End Child Poverty in California in strong support.

Kathy Van Austin on behalf of the American Association of University Women California in support.

Thank you. We will move now to primary witnesses in opposition. You'll each have two minutes. Please go ahead.

On behalf of our duty, I oppose AB 1876. I'm Jonni Skinner, a de-transitioner, and I was a gay kid who was harmed by so called gender affirming care. I was a very feminine boy. Everyone around me made it clear that that was not okay. I was called slurs.

Males mocked me. From the time I was five, I knew I was different and didn't like it. I just wanted to be normal and loved. When I was 12, I found trans influencers online who looked like me as kids. They said change your body and your life gets better, And I thought that's my way out.

At 13, my doctors told my mom she had a daughter, not a son. He told her sixty percent of trans kids kill themselves if they don't undergo sex rejecting interventions. That wasn't true. But my mom loved me and followed the doctor's advice. The doctor told me I was too feminine to find love as a man and that gay men don't want someone like me, that I needed to change my body if I wanted to find a husband.

I was put on estrogen and blockers at the age of 13, and my body fell apart. Nipple leakage, brain fog, chest pain, depression. I was urinating blood and had ulcers in my bladder and was too weak to attend school. When I told my doctor how sick I was, he looked at me and said, welcome to womanhood. What they were doing has a name.

It's called "transing the gay away", and there's nothing wrong with being gay. This bill forces insurance companies to fund this cruel homophobia. It continues the lie that some children are born in the wrong body. Vote no.

I'm here on behalf of CAUSE, and I oppose this bill. My name is Leila, and I'm a de-transitioner, one's one of tens of thousands. I am not rare. I was just in DC for de-trans awareness day with over 70 other de-transitioners. Our stories are all very similar.

Childhoods filled with abuse, mental health issues, Internalized Homophobia, and insecurities. Finding transgenderism online, being affirmed by therapists, doctors promising us that sex rejecting interventions will cure our problems. I was on puberty blockers, cross sex hormones, and a few weeks after I turned 13, my breasts were amputated because my mother was told that I would kill myself if she didn't consent to the procedure. I became extremely suicidal after I was pumped with drugs and affirmed by all the trusted adults in my life that everything about my body was wrong. This bill will criminalize insurance carriers if they refuse to cover the horrors that happened to Jonni and me.

It ignores that other countries have stopped this barbarism. The UK, Sweden, Finland, Norway, Denmark, Italy, Chile, Brazil, and even part of Australia. Even the American Medical Association is pulling back. More than 40 pediatric gender clinics have closed. The American Society of Plastic Surgeons states, and I quote, "there is insufficient evidence demonstrating a favorable risk benefit ratio for the pathway of gender related endocrine and surgical interventions in children and adolescents".

Yet here in California, this legislature continues to force the sterilization of children and adults, removal of their body parts, and creation of lifelong medical patients. Vote no.

Thank you. I will, ask if there are any in opposition to please come forward now to state your name, affiliation, and position on the bill.

Erin Friday, president of Our Duty, mother of a daughter who used to believe that she was a boy. Lifelong Democrat until the Democrats forgot what sex meant.

Ev Taubut, San Francisco Democrat with a Lesbian and Gay Courage Coalition, we strongly oppose forcing insurers to cover treatments that yield no proven benefits and cause known irreversible harm. Vote no.

Alisa Overholt. I'm from San Mateo County, a member of Women Are Real and Women's Liberation Front, a member of the LGB community, oppose this bill.

My name is Jean Chadbourne. I'm from Oakland, California, a mother of a gay son, a teacher, a lifelong Democrat. I'm here on behalf of Women Are Real, Women's Liberation Front, Women's Declaration International, and I strongly oppose this bill.

My name is Mariam Syed. I'm with COREs and Women Are Real, and I strongly oppose this bill.

Amanda Covitana, lifelong Democrat and Lesbian here with Women Are Real, Women's Liberation Front, and Lesbians Advocating for a Resilient Future, strongly oppose.

Mary Anne Gehringer, lifelong Oakland resident, part of LGB, that is Lesbian, Gay, and Bisexual Alliance USA, part of LGB International, and I strongly oppose this bill.

My name is Barbara Walker from Alameda, California, and I'm here with Women Are Real. And I am in support of de-transitioners and gender nonconforming youth, and I strongly oppose this bill.

My name is Sunil Wijayasekara from Pleasanton, California. I'm with Democrats for an Informed Approach to Gender and the Women's Liberation Front. I strongly oppose this bill.

Meg Madden, on behalf of CAUSE Californians United for Sex-Based Evidence in Policy and Law, and Women are Real, both nonpartisan organizations without religious affiliation, as well as Our Duty and Amy Anderson and Heather McClure in opposition to AB 1876. Thank you.

Nicole Young, Placer County Moms for Liberty as well as the Placer County Coalition for Sane People. We are against this bill.

Arian Adam Chakova, longtime progressive Democrat from San Francisco, mother of a teen boy who used to believe that puberty blockers and cross sex hormones were an appropriate response to his teenage angst. I am also the cofounder of the California Teachers Supporting Gender Non-Conforming Youth and a believer in the human right of puberty and sexual function and gender nonconformity. I strongly oppose this bill.

Lisa Smith, daughter of a gay father. I strongly oppose this bill. It's time to listen to our children.

Thank you so much for your affiliation position.

Rachel Bordoli, a San Francisco based, registered Democrat, member of Women Are Real, member of Democrats for an Informed Approach to Gender. As the mother of a gender nonconforming young lesbian and believer that children cannot be born in the wrong body, I stand in strong opposition to this bill.

My name is Romy Mancini. I'm a former attorney for the ACLU Lesbian and Gay Rights Project, a resident of San Francisco. On behalf of Women Are Real and Our Duty, I strongly oppose this bill.

Rochelle Connor, on behalf of thousands of women's and families in California for the Concerned Women for America, we strongly oppose this bill.

Mallory Engel on behalf of Concerned Women for America and Young Women for America, I oppose this bill.

Leandra Wells, policy engagement coordinator for California Family Council. I oppose this bill.

Greg Burt with the California Family Council in strong opposition. Thank you.

David Bolog representing the Facts Law Truth Justice Law Firm, Taxpayer Oversights for Parents and Students, LOCA, meaning leave our kids alone, the Neighbors of the 40th Assembly District for Sane Legislation, and SFE Alliance. We are an opposition.

Hi. My name is Tish Hyman, cofounder of There Are No Trans Kids, Just Children Being Abused by Crazy Pedophile Adults, and whoever supports this should be ashamed of themselves. I completely oppose this bill.

Hi. My name is Beth Born. I represent the people, who have gone undercover to be approved for top surgery, which is a double mastectomy and fallible-

Affiliation, please.

I'm a school board member for Galt Elementary School District, and I oppose this bill. Thank you.

Thank you. We will now bring it back to the dais for any comments or questions. Assemblymember Gonzalez?

Thank you, madam chair. Thank you to the author and TransLatin Coalition from my district for being here today. AB 1876 isn't about creating something new. It's about drawing a clean line in the sand. In California, dignity is not up for debate and health care is not conditional.

This bill simply says what should have always been said and known; is undeniable that you cannot deny someone care first simply for who they are. While others try to roll back rights, we choose to reaffirm them loudly and unapologetically. AB 1876 is not just a policy. It's a promise. And in California, we keep them. Thank you again to the author for bringing this forward.

Assemblymember Rogers.

Thanks so much, Chair. I just want to thank the author for reframing and recentering this discussion where it belongs, and that's between an individual and their health team. Taking the politics out of it, not having politicians determine what options are available to folks, but making sure that they have a suite of options that they can figure out what works best for them, what works best for their family, and what works best with their care team. So, I'm proud to support the bill. Thank you.

Assemblymember Patterson.

Great. Thank you. Just so I understand, this legislation requires no copayment of, gender transition treatment. Is that correct?

This legislation really doesn't do anything in terms of adding new requirements or changing requirements when it comes to treatment. It's just about nondiscrimination. So, lifting, from the ACA, the, nondiscrimination protections that are in place and putting those into state law.

And to clarify, Assemblymember, there's no requirements of any kind of copay from health insurers.

Okay. You know, the reason why I asked those questions is, I don't think it would be unfair to describe California's law or at least a part of this bill that would be different than the ACA in terms of how we define sex and sexual orientation than maybe other states. And maybe that's something that California desires to do. I think one issue that I always have with this, because there are pieces of the bill that talk about exclusions and prohibitions for policies around gender transition or gender affirming care. And I think that's why there are a lot of questions and about that.

And I would love to hear a response to that. Just to give an example of why I think actually this bill could be discriminatory, actually, I'm going to start talking about this this year. Somebody's got to talk about it. But if a person transitioning to male wants to get on testosterone treatment, that's between them and their doctor and should be covered and so on and so forth. Yet, if you're a male who's wanting to keep their testosterone levels up, you have to basically be near dead to get coverage from your provider.

And I think that's a problem. There are a lot of guidelines around that. So, I think that's something that we need to take into account. But going back to the items about gender affirming care, I'm just curious if you're saying your bill doesn't touch that. Is that?

If I understood your question correctly before, it was around copays. And this bill is simply taking the federal nondiscrimination provisions of the ACA and codifying those provisions into state laws. So, this bill really doesn't do anything around co pays.

Okay. Again, it does prohibit denial or limiting health care services sought for purpose of gender transition or other gender affirming care that the Health Care Service plan would otherwise cover if the denial limitation is based on an individual sex assigned at birth. So that is definitely different than the ACA.

So this bill is really around nondiscrimination. So, the bill is focused on not discriminating against people based on their gender/ gender identity. So those pieces around gender and gender identity are in this bill. But it's really taking those nondiscrimination pieces, codifying them into California state law. Is that? I genuinely want to answer questions.

No. I I know you're not trying to be evasive to me. I just-

I don't know if I'm understanding you.

You know, I don't know. We're putting this in the law. I would assume the proposal is to put this in the laws because the federal definition of nondiscrimination does not include gender affirming care.

So please.

May I?

Madam Chair, please.

Just to clarify, I think, where Assemblymember Addis is, talking about is one that we have laws on the books already with Bostock v Clayton County. It's in our analysis if you'd like to read that. And she's specifically talking about, making sure that the ACA is transposed, as a federal statute, is transposed into state law. The reference that you are making is actually not law, Assemblymember Patterson. It's executive order 14187 which, is an executive order.

It's not a statute, and is something that, is highly discriminatory. It is the policy of The United States that it will not fund, sponsor, promote, assist, or support the or support the so-called transition of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life altering procedures. That is an executive order of the Trump administration and President Trump, which is a different thing than whether or not it is in statute.

Well, thank you. I was reading from the bill that the proposal is to put this into statute, which is why I'm going to be voting no on this bill. Thank you.

Any other questions or comments? Thank you. Assemblymember Addis, I want to thank you and your staff for and the sponsors for bringing this bill forward at a time now more than ever, especially given the executive order that is hanging out there and the incredible destruction of the ACA, it is very important to note that California will stand ready to protect the law that requires plans and insurers to cover medically necessary care for transgender, gender diverse, and intersex people. Our state has nondiscrimination protections on the books to ensure that all Californians can access the care that they need without discrimination. I think it's very important to note that as well.

And this bill is really attempting to strengthen and reaffirm those existing protections by codifying federal nondiscrimination standards into law across our constitution and by statute in the ACA. I want to thank you for bringing forward this bill. My recommendation on this bill is an I, and I would ask to be added as a coauthor if when the opportunity is appropriate. With that, would you like to close?

Thank you, Madam Chair, and I appreciate the, the comments and questions. I think one of the most important things that has been said, and it was actually, set up here today, is that there's nothing wrong with being gay. And I might just add to that. There's nothing wrong with being trans. There's nothing wrong with being cis.

There's nothing wrong with being a certain race or color or having a certain national origin or being of a certain age or having a certain disability or being a certain sex. And that's really just what this bill is doing as saying there's nothing wrong with any of these things, and insurance should not be discriminating against people for being any of those things. And we want to codify that into California law because we do believe in treating people fairly and equitably in California. And it's very important that regardless of who someone is, they're not discriminated against when they go to get health care or through their insurance plan. So, with that, I want to respectfully ask for your aye vote.

Thank you. And now we will ask to call for a vote on the on the bill. We have a motion and a second. Secretary, please call the roll.

Bonta.

Aye.

The motion is do passed to judiciary. Bonta.

Aye.

Bonta, aye. Chen. Chen, no. Addis.

Aye.

Addis, aye. Aguiar-Curry? Aguiar-Curry, aye. Ahrens? Caloza? Caloza, aye. Carrillo? Aye. Gonzales?

Aye.

Gonzales, aye. Johnson? Johnson, no. Patel? Patterson? Patterson, no. Rogers?

Rogers, aye. Sanchez? Sanchez, no. Schiavo? Schiavo, aye, Sharp-Collins. Sharp-Collins, aye, Stefani? Stefani, aye.

Aye.

That bill is out. I just want to clarify for those who testified in support and opposition. We were already at the stage of Assemblymember Addis' close, which means that there is no testimony to be offered after that time and there was no question or comment offered directly to either the support or opposition. So, I just wanted to clarify that for you. I saw your hand raised and I'm sorry I had to not acknowledge that.

Thank you. With that, the bill is out, and thank you very much, Assemblymember Addis. We're going to move now, back to file item two, AB 1629 by Haney, dental coverage.

Please go ahead. Thank you.

Thank you, Madam Chair and Members. AB 1629 will prevent insurers from shifting financial burdens onto patients by requiring dental plans to send payments directly to dentists rather than forcing patients to cover large upfront costs. Every month, millions of Californians pay their monthly dental insurance bill, but never get the care that they are entitled to. California ranks among the worst in the nation for children's dental health, placing 47th out of 51 states in a national assessment of pediatric dental disease rates. California has over 35,000 active dentists, which is the most in the nation.

The issue isn't a lack of dentists. It's that many of the dentists aren't in the insurance networks because insurance companies, some insurance companies, may keep their network smaller to maximize profits and force patients to go out of network. Many families are forced to travel long distances for care or pay high out of pocket costs due to inadequate provider networks and restrictive insurance policies. Small insurance networks and restrictive policies force many families to choose between traveling long distances for care or paying high out of pocket costs. In many cases, patients pay the full cost of dental care upfront and wait for reimbursement from their insurer, leaving families to choose between paying thousands of dollars or delay needed dental care.

AB 1629 will require insurance payments to go directly to dentists, preventing patients from facing large upfront costs. We also require insurance companies to report network adequacy data, which measures whether a health plan has enough in-network dentists in the right locations. By requiring dental plans to pay out the assignment of benefits request, it stops families from needing to pay out of pocket for care while waiting for reimbursements. We've had productive conversations with the opposition. This bill was changed and narrowed from a prior version last year, and we're looking forward to reviewing any proposed amendments.

With me to testify in support of the bill is Shelby Arevalo, a patient advocate coordinator, and Eric Dowdy on behalf of the California Dental Association.

Thank you. You'll each have two minutes. Please, let's hear from the support.

Chair Bonta, members of the committee, my name is Eric Doughty with the California Dental Association. We're here to proudly sponsor AB 1629. Many patients cannot easily use the dental coverage they already pay for. AB 1629 makes two improvements to address this issue. First, it requires increased reporting on provider network data so regulators can more accurately assess whether networks meet policy policyholders' needs.

Nearly half of Californians with commercial dental products have a self-insured plans regulated by the federal law. These plans are not included in the state's assessment of network adequacy despite the large overlap in providers. This hinders Californians' ability to determine whether a state regulated plan has enough in network dentists and specialists for patients to access care. Second, AB 1629 requires plans to honor a patient's assignment of benefits request ensuring that when a patient receives care from an out of network dentist, the insurer sends the payments directly to the dental office rather than the patient. Without assignment of benefits, many plans send reimbursement to the patient instead of the provider, which often requires patients to front the entire cost of treatment and wait for reimbursement.

For many families, that makes their coverage effectively unusable. As the analysis notes, 1629 does not expand consumers' ability to access out of network providers. However, this bill would give consumers greater transparency into cost implications of going out of network compared to current law. Assignment of benefits laws are not new and already exist in 31 states. Dental plans across the country, including Delta Dental, already comply in states where this is mandated.

States with the assignment of benefit laws have not seen dental network shrink or premiums increase. In fact, in many cases, we've seen the opposite. For this reason, we respectfully ask for an aye vote.

Move the bill.

Moved by Aguiar-Curry, seconded by LaShae Sharp-Collins. We'll hear the second testimony.

Good afternoon, chair and members of the committee. My name is Shelby Arevalo, and I'm the founder of the National Dental Advocacy Program, a nationwide nonprofit starting in California, and we're dedicated to bridging the gap between patients and dental providers. I've spent more than sixteen years in dentistry. Today, I serve as a board-certified patient advocate working directly with patients and providers who are trying to navigate a health care system that is often confusing, overwhelming, and at times, unsafe. Through this work, I see firsthand the barriers patients face when they simply try to access care.

Many patients, especially those in rural communities or those with complex medical or behavioral needs, cannot always find in a network a provider who can treat them. When they finally find a dentist willing and qualified to provide that care, insurance policies around assignment of benefits often create an unnecessary barrier that makes treatment harder to access and harder to afford. I've seen patients in severe pain resort to emergency rooms because they could not find an in-network provider nearby. I have followed cases where dental infections became medical emergencies simply because treatment was delayed. I've worked with patients requiring sedation due to severe dental anxiety who called dozens of offices without finding an in-network provider able to meet their needs. And when they finally find the right provider, assignment of benefit restrictions means the dentist may not be paid directly, leaving patients responsible for large upfront costs that simply they cannot afford.

So, when a patient chooses their provider and agrees to assign their benefits to that provider, there should be nothing standing in the way of that decision regardless of network status. Assignment of benefits is about patient choice, continuing of care, and removing unnecessary financial barriers that delay treatment. The current system places a strain on both patients and providers, and it ultimately restricts access to care. This bill is an important step towards restoring fairness, improving access for vulnerable populations, and allowing patients to receive care from the providers they trust without unnecessary administrative barriers. Thank you for your time.

Thank you. All those in support who are in the room to offer a "me too", please come forward to state your name, affiliation, and position on the bill.

Gary Cooper representing UAPD, Union of American Physicians and Dentists. We have decided to take a support and a cosponsor position on the bill. Thank you.

Good afternoon, Madam Chair and Members. Janice O'Malley with AFSCME California in support.

Hello. I'm Dr. Guy Acheson representing the California Academy of General Dentistry, and we strongly support this bill. Thank you.

Hello. Michelle Rivas on behalf of the California Association of Oral and Maxillofacial Surgeons in support.

Bill Oskott on behalf of the California Association of Orthodontists in support.

Thank you. We will now move to opposition on the bill with primary witnesses. You'll have two minutes each.

Thank you. Chair Bonta, members of the committee, my name is Sierra Feldman. I'm here on behalf of Delta Dental of California in respectful opposition to AB 1629. Our concern is patient impact. When networks weaken, patients lose access to in network care, negotiated rates, and protection from balance billing, resulting in higher and less predictable out of pocket costs.

Strong networks are essential to patient access and affordability, and dental plans want to partner with providers. But participation in a dental network is a two-way partnership. Dentists agree to negotiated fees and consumer protections in exchange for direct payment and patient volume. Direct payment is one of the primary reasons dentists to choose to stay in network or join a network. AB 1629 would extend direct payment to non-contracted dentists without requiring them to accept negotiated rates or consumer protections.

This predictably does reduce network participation, pushing more patients out of network where costs are higher. This has real consequences for patients. In network dentists are prohibited from balance billing beyond the negotiated fees, whereas out of network dentists are not. AB 1629 would allow non contracted dentists to receive direct payments while still balance billing them for their full amount. States with similar policies have seen a 7% decline in network participation.

In California, even a modest decline could increase patient out of pocket costs by hundreds of millions of dollars. AB 1629 makes it more likely that patients will be pushed out of network, lose negotiated fee protections, and face higher out of pocket costs. For these reasons, we respectfully urge a no vote. Thank you.

Madam Chair, Matt Bach representing California Association of Dental Plans. Start by thanking the author and the sponsors. We have had constructive conversations with them, but, unfortunately, we are still opposed. You just heard about the AOB concerns, but also there is network reporting, that is duplicative. I think the committee analysis does a good job of noting.

So, the way the bill is structured, an HMO is regulated by DMHC, a PPO typically regulated by DOI. Your line of business, that is your regulator, and you provide information to your regulator. This bill would have us provide information to both regulators. So, I may be an HMO product, but I'm now having to, provide all of that information to DOI, which, again, they have no jurisdiction or they're not regulating me. The bill also, if I'm a MediCal provider, providing the insurance in the MediCal market, again, I have to provide that information to these two regulators that may not regulate me.

And then finally, ERISA plans, which are federally regulated plans, and these departments have no jurisdiction over that. This bill would also have us supply that information to the departments. Again, they do not have the oversight. So, we're kind of perplexed by that, provision, and it certainly would add cost, and it's duplicative to what we do now. We certainly have significant network adequacy requirements in law today.

We have time and distance standards in time in place today. There are audit provisions that these regulators can audit our networks. So there's a lot of provisions under current law, intended to ensure our networks are adequate. So, on that provision, the association is opposed but we do certainly look forward to working with you going forward.

Thank you. Are there any in the room who would like to offer a "me too" in opposition? Please come forward to state your name, affiliation, and position on the bill.

Thank you, Chair. Kassidy Heckman on behalf of the California Association of Health Plans in respectful opposition.

Stephanie Watkins on behalf of the Association of California Life and Health Association, also in respectful opposition.

Thank you. We'll move now to questions or comments from committee. Assemblymember Gonzalez.

Just want to thank the author for bringing this bill forward. Dental is always often the first thing that's cut. For me growing up, dental insurance was a luxury, not a necessity. I actually did not get my first dental plan until I became an employee of the state legislature in 2009. And so, I just want to thank the author for bringing this forward.

Many friends had to go to Mexico and others and find other alternatives to dental work, and so this is a step in the right direction, especially as we face cuts on the HR-1 docket. And so I just want to thank the author again for bringing this forward.

Assembly member Addis.

I want to thank the assemblymember and sponsors for bringing this forward. I think I supported and coauthored similarly last year and, wanted to ask to be a coauthor on this. I think particularly along the Central Coast and many other regions of our states where our health care access is, we consider it a health care access desert, really, but it's also becoming a dental care access desert, and so bills like this are critically important. Thank you.

Thanks. Assembly member Patterson.

Thank you. Question, because last year, I laid off the bill and getting closer. But so right now, under this bill, if this bill were to become law, you go into a dentist that isn't contracted with the plan, they need to give you an estimate of what your out of pocket cost would be right then and there, but also show you, obviously, what the insurance coverage that you pay for would pay. Am I understanding that correctly?

Yes. Exactly.

For the opposition, I understood your concern. For Delta Dental, they're one of the opposition letters in here that's not yours, so maybe you won't really have a comment about it. But it seems to leave the in the thought that there would be no incentive to sign up with insurance companies anymore, or the dentist too, because they could receive payment for out of network. But I kind of feel like the incentive is still there because, I mean, the first thing I go to is I say, hey. Look. I'm going to go to who's covered. Right?

Like, in my area, I'm fortunate to have of a lot of dentists, even on my own street, which is good when your kid chips their tooth, by the way. But I was just wondering if you can kind of explain that a little bit because I do kind of feel like if I want to go see somebody out of network, maybe a friend, I have I do actually have a friend who's out of network, and I kind of know that upfront what my costs are going to be. He doesn't lose the incentive to want to sign up with Delta Dental to ensure coverage. Right?

Well, I haven't seen that letter. Removing direct payment and giving it to non-contracted dentists does remove the incentive for joining a network. So one primary reasons that dentists join a network is for that direct payment. It makes it easier for their administrative side and then also the patient volume. If they already have the patient volume, they get direct payment through assignment of benefits now. It does remove the incentive for them to join or stay in a network.

So that's why our analysis has shown that in states that do mandate AOB, there is a drop in network participation. I know there's perhaps conflicting studies, but that's what our data has shown.

I would definitely be interested in the conflicting studies. Like, there's conflicting studies on everything, but I'll read them both. But I kind of I don't I mean, tell me where I'm wrong. I don't know if I really agree with that or, you know, again, I'm just a politician up here. But if I'm if somebody's in network and I go there and they tell me, "Hey, this is your cleaning is covered today because you're in network."

But if I go to an out of network person and they say, like, well, we're only getting $50, but we charge a $100. I think the incentive is pretty clear to go to the person who's in network.

For patients, yes. But for out of network providers, they're more likely to not join a network. So, actually, this is where the patient impact is. As dental plans, including Delta Dental loses dentists from our network, patients now have less options to go in network. They're being more forced to go out of network, having that balance billing higher having that higher out of pocket cost.

So, patients do have a choice. Some have more of a choice right now. The concern is because of the drop in network participation in those states with AOB mandates, the same would be in California, you're having less choice to go in network. And in fact, I'll add that we have, several anecdotes from dentists that have left our network and rejoined. We always interview them.

"Why are you leaving? Why are you rejoining?" One of the primary reasons for rejoining network is the direct payment. So, we do have that dentist saying that it is an incentive for them to stay and join a dental network.

Yeah. But you're saying it's not incentive enough to know that the patients are actually gonna look for the in network person.

Correct. Yeah.

Okay. Does I'm just curious as to that.

Oh, no problem. Go ahead.

Oh, I'm so sorry.

Patients are very dedicated to their dentist and their hygienist. They want to stay with them. In fact, studies show even more than your medical because you go twice a year if possible. So, if your dentist drops your network, you're still likely to stay with them versus going and trying to find an in-network dentist.

Okay. The supporters have any responses to that?

Yeah. Eric Doughty with CD. I think I would just comment. I think the major driver of being in a network, direct payment definitely is one of those. I think rates probably are higher among that. So I don't know that any of the data we've seen have shown that, you know, the assignment of benefits piece actually increases network. So I could just beg to differ with the opposition.

Yeah. I'm gonna lay off again, take the bold position of laying off again today. And but I would like to read both of those conflicting studies, you know, should it get to the floor. I can make that determination. So thank you very much.

Assemblymember Schiavo.

This is all anecdotal, not based on conflicting research. So I have been finding it very hard. I have Delta Dental as do some other people in the room here. And I've been finding it very hard to find a dentist here in Sacramento that takes it, especially for my kid. And, also, some who do are having us now pay up front and get reimbursed by Delta Dental as well.

So can you, I'm just trying to understand if that interacts with this bill or this issue at all. And I see a nodding head over on the end.

So yeah. This is Shelbey. So as an advocate, I work closely with patients. They are, I would say, more insurance driven now more than ever, but especially when it comes to our children.

Right? There's there are a lot of dentists that are dropping the network specifically with Delta Dental because of the fee structure, honestly. And so, it does make it harder when the network doesn't allow for direct payment for that allowance. It doesn't go to the provider. So, yes, patients have to pay their full fee, which that's going to be with any out of network provider, any out of network insurance.

The fee doesn't change regardless of the insurance, but if the doctor is in network, then there's a contracted rate which is discounted. So, the patient does have, you know, the influence to see an in-network provider for that discounted rate. But, yes, if the if the patient sees an out-of-network provider, there is no payment to be sent to the dentist. So, the patient is forced to pay out of pocket, and the insurance doesn't allow for the payment to go to the dentist even if they select it on the claim. Even if the patient signs saying, yes, you can send payment to my doctor, they will not send it to the doctor, specifically Delta Dental.

Thank you.

May I?

You wanna hear the response?

That shouldn't happen in terms of a Delta Dental dentist is making you pay up front. That's not the way it is. So, I'm going to have to look into that and then perhaps contact your office because that should only happen if it's out of network. Even if you have Delta Dental, you were to go to out of network dentist, then that's when that upfront payment can happen. I will say when you go out of network, from what we've heard from providers is, yes, sometimes providers will require a patient to pay upfront, but sometimes they don't.

It's the provider's decision. They can sometimes just collect the amount that would be the patient's responsibility no matter what and then wait for the patient to submit a claim and get the difference from their dental insurance. So, each provider handles an out of network claim differently. In terms of less providers, that's happening throughout California nationwide. And some are dropping Delta Dental, but many are just going insurance independent completely.

It's a trend that we're seeing across the state and across California where they're not or excuse me, the nation, where they're not just dropping a single plan. They're actually dropping all insurances. And there's plenty of data on that that I'd be happy to provide as well.

Thank you. Assemblymember Addis.

Thank you. I just wanted to make a comment to concur with the assembly member from Southern California. And I know I said this in the hearing last year, but, you know, we were I think we had Delta Dental for 25 years, and then all of a sudden, nobody was willing to take Delta Dental anymore. And so, we're actually forced to be out of network, which causes a huge, huge burden to families. And I think whether this bill exactly is going to rectify all of that or not, I do hope that I said it last year in the hearing.

Now you're hearing from two of us here. I really do hope that Delta would be working to rectify that situation, because it's one of the reasons that health care is out of reach, particularly in my district, is that you can't find somebody to take your insurance anymore. And so, it's a massive problem, actually. I would never want anyone to think it's just the assembly member's daughter because I think it's happening to majority of people in California.

Thank you for your comments, Assemblymember. It is certainly something that we're looking at. And I said at the beginning, and I just want to hone in on it. We do feel that our it is a partnership with providers, and we're always working to get them in network. And we continue to do that knowing that there are dental deserts.

There are regulations in place that if you cannot find a provider, that you can already go out of network at in network rates. So, there are protections in place that help with these situations. This bill, we just feel would exacerbate more dentists choosing to go out of network and wouldn't help the strong networks that patients rely on. Thank you.

Seeing no other questions or comments, assembly member, would you like to close?

Yes. Thank you, members for your questions and comments. And thank you, chair, and to your staff for working with us again on this bill. We'll continue to be in in conversation, for sure with the opposition. And, you know, I think that as has been identified, this is an important issue that across our state, our constituents, and even our members are experiencing, and it will help to protect consumers and improve, access to dental care. And with that respect, your respectfully ask for your aye vote.

Thank you. The chair's recommendation is an aye. Secretary, please call the roll.

Bonta, aye, Chen. Addis.

The motion is do passed to appropriations. Bonta.

Aye.

Aye.

Addis, aye. Aguiar-Curry. Aguiar-Curry, aye. Ahrens. Ahrens, aye, Caloza. Caloza, aye, Carrillo. Carrillo, aye, Gonzales. Gonzales, aye, Johnson.

Not voting.

Patel. Patel, aye, Patterson. Rogers. Rogers, aye. Sanchez. Schiavo. Schiavo, aye, Sharp-Collins. Stefani. Stefani, aye.

That bill's out. Thank you very much. We're gonna go back now to continue our business that ends the hearing on all of the bills on the agenda today. So we will just move forward with taking votes starting with the consent calendar.

[Roll Call]

Consent is still out. Moving on to a b 1540 item number one, Mark Gonzales. We're gonna lift the call. Call the roll.

[Roll Call]

That bills out. Thank you. Item number two, AB1629. We can move on to the next item number three, a B1671 tangipa.

[Roll Call]

That's it's still out. We'll move on to item number four. Oh, sorry. That's gone consent. Item number 6, AB1876 Addis.

[Roll Call]

That, item is still out. We will hold the roll for any last votes.

For item two, AB1629 Haney, please call

[Roll Call]

That measure is still out. Item number three, Tangipa AB1671.

[Roll Call]

Thank you. That measure is out. And we are adjourned.