Assembly Standing Committee on Health

Good afternoon. We will call to order the assembly health committee on this Tuesday, March 24. Before we begin, I wanna make sure everyone understands our committee procedures to ensure we maintain order and a 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.

Rules of conduct by members on the 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 and support must be those accompanying the author or who otherwise have registered a support position with the committee, and the primary witnesses and 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 name, affiliation, and position.

All testimony comments are limited to the bill at hand. Some housekeeping items for today. I will note that the speaker has appointed two substitutes for today's hearing. Assembly member Rogers, substituting for assembly member Celeste Rodriguez, and assembly member Pacheco, substituting for assembly member Aarons. With that, we have, several items on consent.

The following bills are proposed for consent for today's hearing. Any member of the committee may remove a bill from the consent agenda. We have item number three, bill AB 1637 by Davies with a motion of do passed to emergency management. Item number four, ab 1648 by Michelle Rodriguez

with a

motion of do pass to appropriations. Item number five, AB 1672 by Solace with a motion of do pass as amended to appropriations. Item number 10, AB 2081 by Stephanie with a motion of do pass as amended to appropriations. Item number 11, AB 2194 by Valencia with a motion of do pass as amended to appropriations. Item number 12, AB 2233 by Ta with a motion of do pass to appropriations.

Item number 15, AB 2352 by Valencia with a motion of due pass to appropriations. And item number 17, AB 2571 b Flora with a motion of due pass to appropriations. Apologies. Item number three isAB 1637, not AB 1639.

With that correction, we will be hearing items in file item order with the exception of moving to item number 14, AB 2311 by Schiavo so that our committee member can have the ability to go on to, chair her committee.

Oh, really? Okay. Apologies. We will start with, item number one, AB 1591 by Michelle Rodriguez, and we will start as a subcommittee.

I think maybe press the button when.

Oh, sorry about that. Thank you, madam Chair and Members for allowing me to present this important legislation. Assembly Bill 1591 addresses a critical shortage of doctors of podiatric medicine in California. Today, over half of our counties especially rural lack adequate podiatric care. At the same time 23 percent of the current podiatric workforce is expected to retire within five years.

And with only two podiatric medical schools, the pipeline is not keeping up. This matters because podiatrist podiatrist play a key role in diabetes care, wound care, and preventing amputations. Without action, access will continue to decline. AB 1591 directs the Department of Health Care access and information to create a statewide podiatric pipeline program between CSU and UC campuses and California's two podiatric medical schools. This will expand mentorships, internships, and clinical exposure opportunities and it creates early or conditional admission pathways for students.

This Bill prior prioritizes students from rural, underserved, and unrepresented communities and includes reporting to ensure accountability and outcomes. This is a proven approach to grow California's podiatric health care workforce. This Bill is supported by the California Podiatric Medical Association and with no opposition, it's a smart investment into access, prevention, and workforce development. With me here today is doctor Is it Cora? Cora I'm sorry.

Cora Nelson and doctor Kerikosin to be my witnesses.

Thank you. You can go ahead and begin.

Thank you, madam Chair and Members of the Committee. My name is doctor Arman Karakosyan. I'm the current president of the California Podiatric Medical Association. I also serve as a residency director at the Department of Veterans Affairs in San Francisco as well as a team podiatrist for the professional soccer teams, Bay FC, San Jose Earthquakes, and your Sacramento Republic FC as well. I would like to thank assembly member Rodriguez for introducing this important Bill, to strengthen the visibility and, long term viability of the podiatric profession.

Podiatric medicine plays a vital role in our health care system, particularly in serving our aging population, yet growth of the profession has not kept pace with increasing patient demand. That gap is exactly why I made it a personal a priority to promote podiatric medicine in every level beginning from high school levels to colleges and to clinical environments.

I have personally sacrificed office hours, family functions to attend high schools, colleges for suture workshops, surgical workshops, as well as hosting Zoom talks with professional soccer players in promoting, the field of podiatry foreshadowing and applying to podiatric medical schools. This challenge is too significant to address in isolation by establishing coordinated state supported pathway to recruit and prepare undergraduate student for podiatric medical education.

AB fifteen ninety one provides a meaningful solution to strengthen the pipeline and help ensure patient continue to receive the high quality care they are entitled, particularly in hype needed populations such as veterans, diabetics, and underserved communities.

Please support AB 1591. Thank you.

Thank you so much. You'll have two minutes as well. Okay.

Well, thank you, madam Chair and Members of the Committee. My name is doctor Michael Cornelison. I am the current executive director of the California Podiatric Medical Association. I've also been a practicing podiatrist in California for the past 26 years. I'm here today to speak on the importance of AB 1591 and how a strong sustained workforce of doctors of podiatric medicine is essential to effective health care delivery in California.

DPMs are uniquely qualified and suited to identify and manage the earliest signs of foot and ankle complications of systemic diseases, most notably those of diabetes. When left unrecognized and untreated, these can lead to devastating consequences, including deformities, amputations, and other debilitating outcomes that deprive patients of their quality of life, their independence, and potentially their lives themselves.

An insufficient supply of enough new podiatrist in the state will result in a concomitant reduction in Californian's access to prevention and timely treatment of the earliest signs of life and limb threatening complications of diabetes and other diseases. The inevitable outcome will be that these patients will be treated only after complications have taken their toll and will overburden our primary care providers, emergency rooms, and hospitals, and at a much greater expense.

With the current trends in enrollment in the colleges of podiatric medicine in California and across the country, this is the path on which we are headed.

Passage of AB 1591 would play a major role in assuring that Californians will continue to have the axe access to the expert foot and ankle care they need now and in the future. I ask for an aye vote, and thank you for your consideration.

Thank you. With that, are there any others in the hearing room who would like to offer a me too in support of AB 1591?

Yes. Good afternoon, Madam Chair and Members of the Committee. My name is doctor Steven Wan. I'm a professor of pediatric medicine and surgery at Western University of Health Sciences in Pomona here in California, and I urge your support for 1591.

Thank you.

Good afternoon. Angela Hill with the California Medical Association in strong support.

Doctor Thomas Rambacher. I'm clinical practice podiatrist in Mission Viejo in Long Beach, California, and I support AB 1591.

Good afternoon. My name is doctor Heather Maguire. I'm in private practice in Ventura, California, and I also support AB 1591 and I ask for yours. Thank you.

My name is doctor Yasser Parupia. I am a practicing podiatrist here in Sacramento at Kaiser Permanente, and I support AB 1591.

Hello. I'm Renee Wu, doctor Renee Wu, from San Leandro, California in private practice in the Bay Area, and I request your support for AB 1591.

Good afternoon. I'm doctor Douglas Taylor. I'm from San Leandro, Harabedian County as well as Walnut Creek and Contra Costa County, and I also support AB 1592. And I ask for your support.

Hey. Good afternoon. Doctor David Pugach. I'm a diabetic foot specialist in Los Angeles at Cedars Sinai Medical Center and also serve as the president of the Los Angeles County Podiatric Medical Association and also urge your aye vote for AB 5091. Thank you.

Doctor John Haltmann, former executive director of the California Podiatric Medical Association. I was in private practice, retired at UCLA Medical Center, and my son who currently practices there urges your passage of AB 1592.

Thank you for that. Are there any witnesses who would like to testify in opposition to the Bill as primary witnesses? Any who would like to offer a me too in opposition? Seeing none in the hearing room, we'll turn it back to the committee for any comments or questions.

Noted. Thank you so much.

And no.

And Assemblymember Pacheco will move the Bill second the Bill at the appropriate time. Yes. Thank you for being here too. Thank you. Well, Assemblymember Rodriguez, thank you so much for bringing forward this Bill.

I think, you know that I care more about my feet than anyone, that can probably be here, and the only thing I care more about my feet is professional soccer. So I'm very thankful for your, for your of women's feet in particular, for, for bringing forward your witness in that with that. With that, would you like to close? And thank you so much for bringing forward this very thoughtful measure.

Thank you, and I respectfully ask for an aye vote.

Thank you. And at the time, with the motion in second, I'm sure that will be considered by this committee favorably. We will move on to item number well, we will move on to the member that is here. Item number seven, AB 2011 by Hart.

Thank you, Madam Chair and Members. It's good to be with you today, and I'm pleased to present AB 2011, a Bill to codify existing federal mental health parity standards into state law. Mental health and substance use disorders affect millions of Californians and are a growing health challenge. Last year, the Trump administration recklessly stopped enforcing federal protections that require insurers provide equal access to mental health and substance use disorder care as they do with traditional medicine.

Due to this order, access to care is at risk for many, and the state should take the lead in preserving protections.

Federal regulations require that health plans must collect data and conduct comparative analysis to demonstrate the treatment limitations are not more restrictive than those applied to medical or surgical benefits. These are limitations that are non quantitative, like requirements for prior authorization. California has continued enforcing these regulations through the Department of Insurance and Department of Managed Health Care, but the state's authority to do so could be revoked if federal rules are ultimately rescinded or weakened.

AB 2011 ensures protections and shrines protections in state law, so state regulators can continue to enforce parity requirements as they currently are no matter what changes occur at the federal level, especially during this administration. Many states like Colorado, Washington, Maryland, and Virginia have taken similar steps to prevent the Trump administration from undermining important health's access using the federal protections as the gold standard.

The Bill does not expand covered benefits, create any new mandates, or impose any new duties on regulators. The Department of Insurance estimates it will have zero fiscal cost to the state. At a time when our state is working to expand behavioral health, AB 2011 ensures that the promise of equal access becomes a reality for Californians.

Speaking in support of the Bill are Tara Gimbo Eastman with the Steinberg Institute and Miguel Bastidas, the chief deputy legislative director from the California Department of Insurance, and Katie Fisher from the Department of Insurance is also available to answer additional technical questions.

Thank you. Please go ahead. You'll have two minutes.

Good afternoon, Chair and Members. Tara Gimbo Eastman with the Steinberg Institute, a proud cosponsor of AB 2011. AB 2011 is a simple common sense Bill that protects California's access to mental health and substance use care by codifying the 2424 federal parity rule into state law. At its core, this Bill ensures that Californians don't lose critical protections if federal enforcement falters. Mental health parity has been federal law since 2008, but in practice enforcement has been inconsistent and often inadequate.

The biggest barriers we continue to see aren't about coverage on paper, but how plans operate in reality. Prior authorization barriers, overly restrictive medical necessity criteria, inadequate provider networks, and low reimbursement rates. The 2024 federal rule was a major step forward. It finally gave regulators clear, enforceable standards and data driven tools to actually measure compliance. Without these standards, parity exists on paper, but not always in practice.

AB 2011 simply codifies those federal standards into California law. It preserves the authority of DMHC and CDI to enforce parity and ensure those protections remain in place regardless of what happens at the federal level. This bill doesn't change the rules. It makes sure we don't lose them. AB 2011 ensures parity is real, enforceable, and protected for all Californians. Respectfully request your aye vote.

Good afternoon, Chair, Committee Members. My name is Miguel Bastidas. I'm the chief deputy legislative director for the California Department of Insurance here under the leadership of Assurance Commissioner Ricardo Olara. As a product cosponsor of AB 2011, commissioner Olara would like to thank Assemblymember Hart for his leadership in authoring this critical mental health and substance use disorder parity measure.

As one of the regulators of the private health insurance market in California, it is critical that the department has clear, consistent, and enforceable statutory or regulatory guidance to ensure mental health and substance use order care parity.

The MPO 2024 rule does just that. The in 2024, the federal government updated its MPO regulation in response to changes added to via the Consolidated Appropriations Act of 2021 as well as in response to widespread deficiencies and insurer analysis. In 2024, and the MPO rule provided much needed clarity and was created under the extensive public rulemaking process.

Clear standards provided by the rule enables the department to more effectively determine whether insurers are restricting access to mental health and substance use disorder services compared to medical and surgical care. In 2023, none of the comparative analyses reviewed by the department were sufficient upon initial receipt even though the AMPIA had applied since 2014.

Many of the comparative analyses we received lacked essential information for proper evaluation. Without this information, we cannot determine if insurers apply NQTLs in compliance with MPIA. Clarifying these content requirements will help the department ensure ensure ensure that insurers apply NQTLs appropriately and consistently with the law. The temporary federal non enforcement request is just that only requesting does not lessen the importance of the rural substantive requirements or its guidance.

California has led in the past to codify federal standards to promote uniformity and protect consumers from inconsistencies and instability at the federal level.

This legislation simply codifies what is already good federal law. We cannot wait for the Federal Government government to resolve years long litigation while utilizing a less defined, vague, and outdated enforcement framework, which consumers, which hurts consumers' access to central services. On behalf of insurance commissioner, Ricardo Lara, I respectfully ask for your aye vote. Thank you.

Thank you. Are there others in the committee hearing room that would like to offer a me too in support of AB 2011?

Good afternoon. Lizzie Guansona here on behalf of two of the other cosponsors, California Academy of Child and Adolescent Psychiatry and the California State Association of Psychiatrists. Also asked to share support for the California Alliance of Children and Family Services, California Coalition for Behavioral Health, and the California Association of Local Behavioral Health Boards and Commissions. Thank you.

Angela Hill with the California Medical Association in support.

Katie Van Dines with Health Access California in support. Thank you.

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

Trent Murphy representing the California Association of Alcohol and Drug Program Executives in support. Thank you.

Natalie Pita on behalf of the California Academy of Family Physicians in support.

Kelly Brooks on behalf of The Urban Counties of California and The Rural County Representatives of California here in support.

Good afternoon. Tabarinde on behalf of the California Psychological Association in support. Thank you.

Thank you for that. Are there any primary witnesses in opposition who would like to come testify at this moment?

Thank you. You'll each have two minutes.

Good afternoon, Chair and Members. My name is Olga Shilo. I'm here on behalf of the California Association of Health Plans. While we share the legislature's commitment to mental health parity and ensuring meaningful access to mental health and substance use disorder services, we unfortunately must respectfully oppose AB 2011.

Health plans already are already required to cover medically necessary behavioral health treatment on par with medical and surgical care. AB 2011 attempts to codify an unsettled federal rule. The 2024 federal parity rule has been paused for review and at the same time is subject to ongoing litigation.

Despite this, mental health parity laws, including the ACA requirements, the 2013 federal rule, along with additional state protections remain in effect. Moving forward at the state level with premature legislative action while the federal framework is in flux risks locking California into requirements that may soon change or be invalidated, creating conflicting obligations and unnecessary disruption.

Additionally, AB 2011 imposes a highly burdensome compliance structure that may not actually improve access to care. Differences in access to behavioral health services are often driven by factors outside of plans' controls. This bill would hold plans accountable for those external challenges, diverting resources towards administrative compliance rather than patient care.

AB 2011 risks increasing cost and complexity without delivering meaningful improvements for patients. CAHP remains opposed... Sorry. CAHP remains committed to working with the author if the bill moves forward today. But at this time, we respectfully urge a no vote, and thank you for your consideration.

Thank you.

Madam Chair and Members. Steffanie Watkins on behalf of the Association of California Life and Health Insurance Companies. While we appreciate these discussions we've had with the Department of Insurance on this issue, as well as the ongoing efforts to ensure parity with respect to access to mental health and substance use disorder benefits, we do have significant concerns about adopting the federal 2024 parity rule into California law.

As was referenced earlier, in September 2024, the Department of Labor, Health and Human Services, and Treasury adopted an updated version of the 2013 federal MHPAEA parity regulations. Soon after, the risk industry filed a complaint challenging the 2024 final rules.

The litigation is centered around the fact that the material differences in access standard not only exceed the department statutory authority, but that the standard and new NQTL comparative analysis requirements are unconstitutionally vague.

Rather than respond to the complaint, the department asked the court to stay the case pending the department's review. In May 2025, the US Department of Justice announced that it will not enforce the 2025 for MHPAEA final rule while the administration considers whether to modify it.

Consistent with that position, the departments issued a formal non-enforcement policy. This action reflects the federal government's recognition that the 2024 final rule, including the material differences in access provisions and expanded comparative analysis obligations, raised serious statutory and legal concerns.

It should be noted that while the department did issue a non-enforcement order, it only applies to those portions of the 2024 final rule that are new in relation to the original 2013 final rule, which was adopted under the Obama administration.

With that being said, we have serious concerns that adopting AB 2011 in California statute will create significant legal and operational confusion, as it will codify parity requirements that are currently being challenged on the constitutional basis that they are vague and exceed the existing federal authority. The constitutional concerns that have been raised don't simply go away because we adopt this new standard into California law.

They remain an issue, especially if portions of the federal rule are invalidated or modified through ongoing federal litigation and or through administrative action. Unfortunately, if that were to happen, the bill would leave carriers facing conflicting obligations that will not improve consumer access to care.

Thank you. Thank you. Are there others in the room who would like to offer a me too in opposition to the measure? Seeing none. I will bring it back to committee for any questions or comments. Seeing none. Sorry, Assembly Member Hart. I'm going to ask that we stop to establish quorum.

[Roll Call]

We have a quorum. Thank you. In your closing perhaps, Assembly Member Hart, you would be great if you could address some of the concerns of the opposition. And with that, the Chair's recommendation is an aye on this, but please go ahead and close.

Thank you, Madam Chair. To clarify, the bill does not expand covered benefits. It does not create any new mandates, and it does not impose any new duties on regulators. The bill only codifies existing standards California already enforces to protect patient mental health and substance use disorder care.

The bill will protect most vulnerable Californians who could lose access to crucial mental health and substance use disorder care. We only received the letter in opposition on Friday, but happy to continue to work with those who have concerns to make sure that we protect Californians and ensure that they have access to the behavioral health services that they need. And I request, respectfully request an aye vote.

That was your close. Thank you. With that, Secretary, please call the roll. Oh, is there a motion? Thank you, Carrillo and Stefani. With that, Secretary, please call the roll.

The motion is do pass to Appropriations. [Roll Call]

That bill will remain on call. Thank you. Now we'll move to Assembly Member Schiavo, please. Item number 14, AB 2311. Thank you. Whenever you're ready.

Thank you, Madam Chair, and appreciate your accommodation so I can share something else elsewhere. So I'm very excited to present AB 2311 today, the Public Hospital Physician Stability Act. California's public Hospital Public Health Care District Hospitals, say that 10 times fast, are a critical lifeline serving some of our most diverse and underserved communities. And with the passage of HR one, we know that these hospitals are going to be even more critical in their support for our communities and their health care needs.

These hospitals are locally governed, publicly accountable, and often serve a higher share of medical patients than the state average.

However, they face a growing financial pressure, especially in the recent, actions around HR one. And at the same time, these hospitals are uniquely disadvantaged, and they are only they are the only public hospitals in California that cannot directly employ employ physicians. This restriction makes it harder for district hospitals to recruit and retain doctors, especially as physicians increasingly prefer stable employment with predictable salaries and benefits. Without the ability to directly hire physicians, many of these hospitals face worth worsening staff shortages and uncertainty in maintaining services.

AB 2311 simply allows public health care district hospitals to directly employ physicians just like other public hospitals, FQHCs, and academic medical centers already can.

This added flexibility will help hospitals compete in the health care labor market, stabilize their workforce, and ensure patients continue to receive timely care. As mentioned in the analysis, my office received amendments from the opposition last week, and we're having ongoing discussions in order to resolve some of their concerns. Ultimately, AB 2311 strengthens access to care and communities that depend on these hospitals the most.

Here to testify in support is Sarah Bridge with the Association for of California Health Care Districts and the sponsor of our Bill.

Thank you, Madam Chair and Members. Sarah Bridge on behalf of the Association of California Health Care Districts here as proud sponsors of Assembly Bill 2311. I wanna start by thanking the author, the committee, and the staff for their work on the Bill so far. As noted in the analysis and by the author, we received amendments late last week from the opposition or in ongoing discussions. We believe several of the concerns expressed will and can be addressed.

ACHG represents the 77 public health care districts across the state, 33 of which wholly own and operate their hospitals. However, the scope of the Bill is significantly more limited as over half of these hospitals already enjoy the ability to directly employ a physician by way of their critical access designation. AB twenty three eleven is simple. It closes a gap to ensure equity and access for millions of Californians.

As the author mentioned, academic medical institutions, designated public hospitals, and critical critical access hospitals, and federally qualified health centers can already directly employ.

This leaves 16 remaining public hospitals that are forced to compete with hospital systems and large foundation models without the same tools or resources. It has been highlighted that these exceptions are for rural areas only. I will note only one rural county operates a designated public hospital. The rest of these systems fall in urban areas. For the one to two hospitals that are resourced, they are pushed into foundation models to fill gaps.

These models require over 40 physicians across 10 specialties with independent administration. What does that mean? It means these are not cost effective models. We pride ourselves in California on working to address the cost of health care, and health care districts are committed to that goal. Yet, we are continually forced or offered solutions that drive up the cost of care or require our communities to simply go without.

Simply put, when the market of physicians is controlled by a select few large groups in the community, patients suffer, costs increase, and our public health care delivery systems fail. I wanna underscore that employment is a choice. Should a physician feel uncomfortable and wish to contract directly, the hospital will happily go that route. However, as trend shifts significantly and employment is more attractive, many do not wish to

engage in that contract model. Additionally, adequately staffing the services we need. The services needed include the while adequately staffing the services we need. The services needed include primary care, but typically include specialty OBGYN, cardiology, oncology, behavioral health. Thank you.

Thank you. Second witness.

Madam Chair and Members, thank you for allowing me to be here. My name is Chris Bjornberg. I'm the CEO of the Imperial Valley Healthcare District. And today, I'm here in strong support of AB 2311. As mentioned, Imperial Valley Healthcare District serves a community with significant health care needs and very high government payer mixes.

Like many public district hospitals, we face persistent and growing challenges in recruiting and retaining physicians, particularly in obstetrics, primary care, dermatology, and neurology, just to name a few. These are not optional services for our community. They are foundation to the access, to prevention for prevention, continuity of care, and quality of outcomes.

Today, we're unable to fill some of these key gaps because of California's long standing prohibition on direct care physician employment, and that leaves us without some of the tools necessary that many of our other, sister facilities have that, and we do not. The challenge grows more acute with h one with HR one and then also with the proposed HPSA withdrawal for our area in particular, even despite the reality that our region continues to experience severe provider shortages.

So AB 2311 may be the single most effective remaining mechanism available for us to attract physicians and keep our care local. Recruitment realities have also changed dramatically. Many newer early career physicians, particularly those from out of state, are reluctant to come to California and independently establish practices and navigate complex contracting, billing, and regulatory systems on their own. They did not go to medical school to become small business owners. They went to medical school to take care of patients.

AB 2311 allows us to meet those physicians where they are. It provides an employment op employment option that removes unnecessary administrative and financial barriers while allowing physicians to do what to who want to be independent practitioners to continue to practice that way. This Bill does not eliminate independent practice. It simply opens the door wider so physicians who want to focus on patient care stability and community service can do so in California. We respectfully ask you to, for a vote of aye.

Thank you for your testimony. Additional witnesses in support. Name, organization, and position only, please.

Good afternoon, Members. Connie Delgado on behalf of the District Hospital Leadership Forum in support.

Good afternoon. Christy Weese on behalf of the California Hospital Association in support.

Good afternoon, Chair and Members. Jim Wood on behalf of Washington Hospital District, Plumas Hospital District, Healthy Paloma Petaluma District and Foundation, Del Puerto Health Care District, Salinas Valley Hospital District, Antelope Valley Health Care District, Soledad Health Care District, Palomar Health Care District, El Camino Health Care District, Desert Health Care District, Fallbrook Healthcare Regional Healthcare District, all in support.

Good afternoon. Marcus Detweiler with the California Special Districts Association in support. Thank you.

Andrew Mendoza on behalf of the Alzheimer's Association in support.

Thank you very much. Key witnesses and opposition, please. You have two minutes.

Thank you. Good afternoon. On members of Health Assembly Committee, my name is Donaldo Hernandez, and I serve as a hospital based physician practicing on the Central Coast in internal medicine. I'm here on behalf of the California Medical Association to share our opposition unless amended position on AB 2311. California's long standing ban on corporate practice of medicine exist to protect patients over profits, and AB 2311 weakens that.

This proposal creates a board permanent exemption excuse me, broad permanent exemption to foundational safeguards that ensure medical decisions are made by physicians, not institutions with financial, political, and operational agendas. Bill attempts to see add safeguards that address these concerns, but we believe they're insufficient and unenforceable. Even without explicit directives, employed physicians are subject to powerful institutional pressures through compensation models, productivity targets, credentialing, and privileging that can and do influence clinical decisions.

By eroding physician autonomy, this bill creates new risk for allowing politics to influence critical care and treatments at a time when reproductive and gender affirming services face increased political pressure, weakened physician independence risks, allowing institutions and board level influence to shape access to care. AB 23 does not solve workforce problems it claims to address.

While proponents argue that allowing direct employment will improve recruitment and retention, there is no evidence that this exemption will bring new physicians and underserved communities. Further, failure of a hospital district to negotiate contracts does not warrant dismantling protections that date back nearly a century and are designed to ensure physicians remain accountable first and foremost to their patients. Hospital employment of physicians is also associated with higher cost, not better care.

Evidence shows that when hospitals employ physicians, it lends to higher prices, increased utilization, and no corresponding improvement in quality, all of which undermine our efforts to improve health care affordability for patients and the state. While the goal of creating consistency across hospital types is understandable, existing exemptions to hospital employment of physicians in the corporate bar is intentionally narrowing this Bill.

Thank you. Thank you for your time.

Thank you for your testimony. Second witness.

Thank you, Chair and Members. Tim Madden representing the California Chapter of the American College of Emergency Physicians. We are respectfully opposed to AB 2311. The ban on the corporate practice of medicine has been an important firewall to ensure emergency physicians provide what they feel is the best and most appropriate care for all patients.

Its purpose is to make sure that clinical decision making and treatment decisions are in the hands of physicians and other licensed health care providers rather than the hands of those responsible for the bottom line.

Hospitals face numerous financial challenges and decisions, especially in today's health care environment. Emergency physicians need to be shielded from the influence of these in order to provide the most appropriate care for all patients. In the increasing corporateization of health care, it is critical that emergency physicians are able to practice medicine to the benefits of their patients. For these reasons, we're opposed to AB 2311.

Thank you for your testimony. Other witnesses in opposition?

Thank you. Angela Hill with the California Medical Association with an opposed unless amended position and acknowledging we are working with the author's office. Thank you.

Ryan Spencer with the Conference Society of Pathologists, the California Orthopedic Association, and the California Radiological Society share the position previously stated by my colleague CMA. Thank you.

Thank you. Members, do we have any questions from DIAS? Senator Patel.

Thank you for bringing this Bill forward. I do have health care districts in my assembly district, and I watch things very carefully when it comes to providing high quality care for my constituents as well as throughout California. I also believe strongly in in leveling the playing field. That's very important to me, and I will be supportive of the Bill today. However, CMA raises some interesting concerns and so does so do the gentlemen representing emergency room physicians.

I would like to really make sure that we can protect physician decision making autonomy. The corporatization of the health care system is a concern of mine, and making sure that physicians do get to make the last and final and only call on how to treat a patient is very important to me, as well as making sure that existing physicians that are working within hospitals are not displaced or individually, hired staff.

So would really appreciate you continuing to work with CMA and the opposition to make sure that we are implementing this in the way that we desire, and not leaving patients behind. Thank you for continuing to work with the those organizations.

Thank you. Majority leader Curry.

I wanna thank the author for bringing the Bill forward, and I recognize how important it is to address the impacts of HR one in vulnerable, hospitals and Medi Cal patients. But at the same time, it's critical that California continues to protect our patients from corporate and institutional influence over medical, over medical decision making. So I just wanna make sure this Bill does not negatively affect the judgment of medical professionals, and I would like to see clear guard wells in place.

I also hope you'll continue to work on, with the opposition to ensure this Bill meets the goals without compromising the integrity of the medical professionals, and I too will be supporting your Bill today. I know you'll continue to work on this.

If not, you're gonna see me on the floor.

Assemblymember Addis.

Thank you so much, Chair. And thank you, Assemblymember, for bringing this forward. I'll echo these concerns. I actually was surprised to hear because I know you and I have talked a lot about access, and you're on the health budget sub where we're constantly talking about access. And our very first budget sub hearing this year was on physician access and how we can increase physician access across California.

So, I'm surprised to hear this level of opposition to the Bill and and also very concerned. I wanna support it support you now to get it out of committee. I can't commit to supporting it on the floor, knowing the concerns that have been raised here today. I think it's vital that our ER docs, that our physicians, our radiologists, or other specialists have control of those decisions.

I know, certainly, this committee has been a leader in terms of trying to put that control in the hands of physicians and making sure that they are in the lead and that whether it's private equity or anybody else is not getting in the way of that physician patient relationship and decision making and and and our ability to maintain medical care, which, you know, we've talked about a lot, but is disappearing quickly in California.

We already have a reduced physician to patient ratio compared to the rest of the nation, and so we already struggle with access. And then to take away decision making power is just a huge, huge concern of mine. So just hope that you're committed to working on this as it moves towards the floor and would like to be able to support it when it gets to the floor.

And, of course, I'm gonna support you to get it out of committee today, but very important issue to me to get right.

Are there other questions from the Committee?

If I may respond to the

Thank you. Share the concerns as many of you know. I worked for thirteen years with nurses making sure that they had a voice on the job and that the bottom line of hospitals was not getting in the way of patient care. So that's a critically important, issue to me, and I know that we can, you know, find the right place to land to ensure that that's protected.

But I have to push back a little bit on this notion that this inherently means that that, you know, there will be corporate control of decision making of physicians when we already have this model in every other, you know, public hospital setting.

Right? We have it in public hospitals, FQHCs, academic medical centers. It's already there. And and I would also argue that even where it's not, for example, Kaiser that has its own medical group, I would say that there is a lot of corporate pressure on Kaiser physicians to perform a certain way. Right?

So this is this is the challenge in health care, a challenge in health care, and I don't think that allowing hospitals that need to have a a reliable supply of physicians is the thing that's gonna push it over the edge for those physicians. And we're seeing increasingly you know, there was a a survey of physicians in 2011, 32% of them were saying that they wanted to be hospital employees. And now 2023, 68% are saying that they wanna be hospital employees.

And so it's just it's our laws have to kind of catch up with the times, and I feel like this one is a little bit antiquated in terms of where things are going with the workforce. And and and as you said, we work a lot in the health budget sub about our health care pipeline, about ensuring that we have the physicians, that we need when we need them and where we need them.

And I, in fact, believe that this is an important way to be able to do that because physicians want they don't wanna run their own business. They don't wanna have to worry about advertising and their own billing and all invoices and all that kind of stuff. Right? They wanna go to work. They wanna take care of patients, and they wanna go home when they're done.

And this is a way to do that. And so, you know, I'm confident on a number of the issues, especially that one that we can get to a a good place, and we'll continue to work with the opposition. And you'll hear about how it goes.

Would you like to close or would that be your close?

I would still like to close. Absolutely. Okay. Thank you. I I just will close with saying that, you know, we know that public health care district hospitals are often the only or the closest sort source of care for families and seniors in their communities.

They should really have the same tools that other hospitals have to recruit physicians and keep their doors open. That's really what AB 2311 is attempting to do to ensure these hospitals can continue serving the patients and have doctors that they need to be able to do it. So appreciate the discussion. Hear the concerns. We will continue working, and I'll look into looking forward to seeing you next time as we make progress.

Appreciate an aye vote today. Thank you.

Secretary, please call the roll. I apologize. There's been a motion. Is there a second? Seconded.

Secretary, please call the roll.

The motion is do passed to the Business and Professions Committee, Bonta. Chen. Addis. Aye.

Addis, aye. Aguiar-Curry. Aye. Aguiar-Curry, aye. Pacheco.

Aye. Pacheco, aye. Caloza. Carrillo. Aye.

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

Patel, aye. Patterson. Rogers. Aye. Rogers, aye. Sanchez. Schiavo.

Schiavo, aye. Sharp-Collins. Stefani. Stefani, aye.

Thank you very much. That Bill is out. Speaker Lowenthal, would you like to come to the dais? Item number eight, AB 2030. Thank you.

Thank you, mister chair and members, for the opportunity to present AB twenty thirty, which would prohibit the sale of over the counter diet pills and supplements marketed for weight loss or for muscle building to individuals under the age of 18 years old. Before I begin, I wanna clearly outline which products this bill does and does not cover as our office has received many questions regarding protein powders, powders, and creatine dietary supplements.

First, this bill only applies to dietary supplements that are marketed or represented for the purpose of achieving weight loss or muscle building. This bill does not prohibit the sale of any specific supplement, including creatine, provided it is accurately labeled for what it is. Second, the bill only applies to dietary supplements, not conventional food products that have an FDA mandated nutrition facts label.

Most protein drinks and many protein powders are sold as food and would not be covered by this bill. Third, nothing in this bill prohibits the sale of any dietary supplement to an adult. This bill only applies to minors. Adolescents face unique risks when it comes to dietary supplements marketed for weight loss and muscle building, particularly because of how heavily these products are promoted to young people and the well documented harms these products cause.

A study conducted by the Harvard teach Chan School of Public Health found that nearly one in ten adolescents have used potentially harmful diet pills or significant similar products for weight loss in their lifetime, with use especially high among those with negative body image or those engaging with unhealthy weight control behaviors.

Extensive research documents the dangers of these products. The American Academy of Pediatrics has been very clear. They strongly caution against teams using weight loss supplements. These products are not recommended by physicians but are widely available in pharmacies, grocery stores, specialty chains, and on the Internet. The use of these supplements for weight loss and muscle building is associated with mental health vulnerabilities, such as eating disorders and dysmorphic body disorders.

Young people with a history of depression, body dissatisfaction are at an elevated risk of using this category of supplements beyond levels recommended by the manufacturer. A study published by the National Library of Medicine highlighted how regular use of muscle building supplements serves as a gateway to anabolic steroid use.

Additionally, according to the American Academy of Pediatric recent guidelines, they discourage the use of sports supplements in athletes younger than 18 years old, emphasizing that a balanced diet is the best way for young people to get all the necessary nutrition they need. These supplements use deceptive claims to promote weight loss, often using public figures they know that are influential to youth like celebrities, influencers, or athletes. Young people are still developing cognitively and emotionally, which makes them particularly vulnerable to persuasive pervasive marketing.

And as a result, they are less likely to critically assess messages that promote rapid weight loss or muscle gain. Empirical research supports this vulnerability. The systematic review published in pediatrics, which is a journal by the American Association of Pediatrics, have found that the adolescents' critical reasoning abilities are not sufficiently developed to protect them from the influence of advertising and that marketing exposure can significantly shape their attitudes and behaviors.

Despite the American Academy of Pediatrics' recommendations against pediatric use of creatine and testosterone boosters, research suggests that many teenagers take these dietary supplements. The health risks associated with these products are well documented and particularly concerning for young users.

Weight loss and muscle building supplements have been linked to serious adverse events, including cardiovascular complications, liver damage, hospitalization. For example, the US National Institute of Health reports increased cases of acute liver injury associated with dietary supplements, some of which require emergency transplantation or result in death. In fact, thousands of emergency department visits every year in The United States are attributed to dietary supplements with the disproportionate share involving young people using products for weight loss. Dietary supplements are not regulated like pharmaceutical drugs.

Yet over the last decade, more than 750 supplement brands have been found to be tainted with pharmaceutical drugs.

While the FDA identifies these tainted supplements, less than half of these products were recalled. Unlike prescription medications, these products do not need to demonstrate safety or effectiveness before being sold, allowing potentially dangerous items to remain widely accessible. Dietary supplements are not required to undergo rigorous premarket testing in any population, including minors. Under The US regulatory framework established by the dietary supplement health and education act, manufacturers are not required to provide safety or efficacy before products are sold.

And as a result, these supplements often enter the market without clinical trials, lacking evidence that they are safe or effective for any member of the general population, including minors.

Public health research has emphasized that this regulatory gap leaves young people particularly vulnerable. A review published in public health reports notes that dietary dietary supplements marketed for weight loss and muscle building are frequently mislabeled or contain unsafe ingredients and that regulatory controls are insufficient to ensure safety before sale. Experts and clinicians consistently caution against youth use precisely because of this lack of testing. Studies and clinical guidance emphasize that these products are not recommended for adolescents as their effects on developing bodies remain inadequately studied.

But despite this, adolescents can easily purchase these products in stores or online without any age verification.

This creates a situation which minors have open access to substances that may pose serious health risks without adequate safeguards or accurate information. Given that these products have high rates of use among vulnerable youth, documented links to harmful behaviors and medical events, and no way to test these products are safe for children, restricting access for individuals 18 is a reasonable and a necessary public health measure.

Similar to how age limits are used to reduce harmful products like alcohol and tobacco, limiting youth access to weight loss and muscle building supplements would help reduce preventable health risks during a critical stage of development. Doctor Jason Negata, a pediatrician at UCSF's Benioff Children's Hospital and a faculty member at UCSF, specializes in adolescent eating disorders.

He shared with our office stories about the countless youth in the Bay Area he has cared for who have used weight loss supplements, developing eating disorders, become critically ill, and require hospitalization.

He shared that hospitalization for eating disorders has doubled since UCFF at UCSF since 2020 and that weight loss supplements worsen health inequities and disproportionately affect people of color, low income households, and those without health insurance. This is a pediatrician urging us to get these dangerous products out of the hands of our kids. AB 2030 would establish clear, enforceable age restrictions on the sale of over the counter diet pills and dietary supplements marketed for weight loss or muscle building.

The bill creates meaningful safeguards to prevent youth by requiring age verification for in store and for online purchases. By limiting access to these products for minors, this legislation can help reduce the development and severity of eating disorders, of body dysmorphia, and related mental health challenges among youth.

These conditions are known to contribute to long term disparities in health outcomes, such as depression, anxiety, and substance misuse. This bill will also help mitigate the physical harms associated with poorly regulated supplements that can contain stimulants, adulterants, or unsafe ingredients linked to serious outcomes, such as cardiac events or severe liver injury. Just like existing age restrictions on other harmful products, AB 2030 provides a practical and immediate step to better protect California's youth from dangerous and misleading weight loss and muscle building supplements.

Here to testify in support of AB 2030 is Navin Radwan, founder of the Mira Foundation and also a parent of a child who almost lost her life from an eating disorder, and Izzy Mann, striped California youth team captain and student attending Occidental College.

Good afternoon, members of the committee, and thank you for the opportunity to speak with you today. My name is Izzy Mann, and I'm a college student from Pasadena attending Occidental College and the California captain for the strategic training initiative for the prevention of eating disorders at the Harvard TH Chan School of Public Health. And I'm here in strong support of AB twenty thirty. I'm here not only as an advocate, but as someone who has personally struggled with an eating disorder.

And I know firsthand how easily accessible and deceptive these products are.

That experience is what drives my work, and is what brings me here today. However, my story is not unique and the science confirms it. These products are not reviewed by the FDA before they reach store shelves. Meaning, minors can easily purchase supplements that may contain banned drugs, toxic chemicals, or heavy metals. These products send over 23,000 people to the emergency room every year.

And youth who use them experience severe medical injuries at three times the rate of those taking ordinary vitamins. Because of these risks, the American Academy of Pediatrics strongly cautions against adolescent use. AB 2030 is a common sense safeguard. It doesn't ban these products. It simply ensures they are not sold to minors.

I wish this bill had existed when I was younger, which is why I urge this committee to vote yes on AB 2030 to give today's youth the protection I didn't have. Thank you for your time and your leadership on protecting the health of California's youth.

Good afternoon, members of the committee. Thank you for the opportunity to testify. My name is Naveen Radwan. I'm from San Jose, and I'm a parent of a child who nearly died from an eating six years ago. I'm here today in strong support of AB 2030.

Six years ago, my 15 year old daughter was diagnosed with anorexia and entered a life threatening spiral that nearly took her life several times over the course of a year. She still struggles today. Her obsessive and compulsive desire to be thin and reach abnormal body standards lever down let her down a dangerous spiral. During that time, over the counter diet pills were readily available to her and helped exacerbate her illness.

The toxic body image standards of our society have influenced our youth to try and chase chase an ideal that does not exist.

This bill would help restrict the sale of these harmful over the counter diet pills and weight loss supplements to anyone under the age of 18. These products being readily available with no restrictions to children is putting our child's lives at risk and is something we have no choice but to make sure make sure cannot happen. For this reason, I urge you for the life of my child and every other child like her to vote in support of AB 2030. Thank you.

Thank you for your testimony. Other witnesses in support?

Good afternoon. Kelly McMillan on behalf of the American Academy of Pediatrics California in support.

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

Christopher Sanchez on behalf of the Consumer Federation of California in support.

Do we have our key witnesses in opposition?

Good afternoon, Mr. Chair and Members. Tatum Ackler with Samson Advisors on behalf of the Council for Responsible Nutrition, which has taken an opposed unless amended position on AB 2030. And let me start by thanking the author and his staff for very productive conversations to date.

CRN is the leading trade association for the dietary supplement and functional food industry and has a history of working constructively with authors seeking to address this issue in the past, including with Assembly Member Cristina Garcia, then Chair of the California Legislative Women's Caucus, through AB 1341 in 2022, and subsequently with Assembly Member Weber Pierson through AB 82 in 2024.

And our engagement on those efforts was focused in great part on establishing a more balanced and targeted framework that does not bring unintended products within scope. Specifically, by tying scope solely to labeling and marketing claims, AB 2030 would bring products within scope that have no connection to the bill's purpose.

If you contrast that with AB 1341 by Assembly Member Garcia, which focused on products that may contribute to specified health conditions as determined by the California of Department of Public Health.

In the end, we believe the approach in AB 1341, while imperfect, makes much more sense both for a public health and compliance standpoint than establishing a sales restriction based solely on what is contained on the label or advertisement. CRN appreciates the opportunity to raise our concerns here today, and we look forward to continuing the discussion.

Mr. Vice Chair and Members. Trent Smith on behalf of the Consumer Healthcare Products Association. We've adopted an opposed unless amended position. Let me be very clear, we are not opposed to the element of the bill requiring proof of age at purchase, whether that be in a store or online.

The other, the elements of the bill that we do have a problem with are the secondary verification of age upon delivery. So if you purchase it online, then having to show another proof of age upon delivery, we think that's a barrier for many people who are buying these products legally. There are computer and technology systems that can verify age electronically at the point of sale, and so we think that's a better model.

We are also opposed to the standards in the bill for retailers on where they must store and keep these products, either in a locked case or behind the pharmacy counter. We believe the retailers know their products well, and if they are a threat to be stolen, that they will figure that out and lock them up themselves.

Also, the portion of the bill near the end, which would expose a retailer or seller to enforcement allows the Attorney General to actually shall consider the ingredients and list several ingredients. Those ingredients are also included in thousands of other over the counter drug products and supplements.

So if the bill was just limited to products that are marketed and label as weight loss or muscle building products, then we would remove our opposition. We've shared all of these with both committee and the author and would appreciate his consideration. Look forward to working with him.

Thank you for your testimony. Additional witnesses in opposition?

Mr. Chair and Members. Carlos Gutierrez here on behalf of the California Grocers Association in opposition.

Mr. Chair and Members. Anthony Molina on behalf of the Natural Products Association in opposition. Thank you.

Good afternoon. Jacob Brint on behalf of the California Retailers Association in respectful opposition unless amended.

Thank you. Do we have any questions from the committee? Mr. Rogers.

Not a question, but I wanted to thank the author for bringing this forward. In the space of the things that you would never guess about Assembly Members, one of my degrees is actually in personal training. I worked my way through college, NASM and ACE certified, working in gyms, working a split shift.

Which is why Assembly Member Pacheco can never get me to lift a weight at 6am ever again. This was a huge issue almost twenty years ago when I was working in the industry. It's only become a bigger issue with social media and health influencers peddling their thirty second reels. I'd love to be added as a co-author, if you'd have me. And with that, I'll move the bill.

Bill's been moved. Thank you, Mr. Rogers. I always wondered why you were so jacked. Now I know. Assembly Member Patel.

Thank you for bringing this bill forward, Mr. Lowenthal. Definitely, having just served eight years as a school board trustee, we've seen the transition come forward. I do have a concern around creatine. It is my understanding, through cursory background information, that it, there are some correlations with creatine being used in concussion protection.

And I would just wanna make sure that as we look towards implementation, that we're making sure that we're not getting into a space where use in those ways, in those limited ways, would not be prohibited or made more difficult.

It's not a prescription medication. So it's not something that a doctor would prescribe. It's a nutritional supplement or can be found through diet. Just so just wanna make sure that we are keeping open the opportunity for research medicine to keep making progress on how things can be useful even as a supplement.

If I may, Mr. Chair, respond. First of all, Dr. Patel, I'm completely aligned with your comments. I take creatine. I don't find there to be a concern with anything that you said. We'd love to incorporate those things. The comments, I could wait for my till the end. But even the comments by the opposition, I don't see any reason why we can't work together on all of these things.

None of these things sound like deal breakers. And, specifically, I just wanna remind, this, the way the legislation is written right now, it's specifically towards things that are marketed for weight loss and muscle building, which would not be the application that you're speaking of.

Thank you. Other questions? Assembly Member Pacheco.

Thank you. I just had a couple of questions. It appears that the opposed unless amended, the individuals that are here for opposed unless amended, it appears that their amendments seem to be reasonable. I'm hoping that you can work with the, with the opposition as of calling them opposition. So that way, we can perfect our bill, this bill.

Because I think it is important to protect our youth, especially when it comes to, you know, pills to for weight loss. I agree with you that, you know, our youth should not be focused on weight loss. But I'm hoping that I can get an agreement from you to work with the opposition to perfect this bill.

Assembly Member, I'm aligned with you. As a matter of fact, we would have done that, but the opposition comments got to us past the deadline. Actually, the amendments that have been suggested to the, our office were received after the deadline, so could not be incorporated for this hearing.

And that makes sense. So I look forward to continued conversations, and I will be supporting your bill today. Thank you.

Other questions? Madam Leader.

Good afternoon. It just came to me. It's to implement this, is there a cost that's gonna be with this implementation of this policy? Oh, it's a freebie. Yeah.

So far. We'll check in with the Department of Finance on that. But, no, I don't believe that this can gonna be fiscal under any circumstances.

Okay. I just was curious.

If I might, Mr. Vice Chair.

Sure. If a member of the opposition would like to...

Yeah. I don't know for sure. I mean, it does allow for Attorney General enforcement. So whether that's a cost, a huge cost or not, they would have to, I guess, review the products and determine what. But you know, one thing I would just point out again, it seems like we've got a theme here going.

I forgot to point out that probably about twenty years ago, the legislature adopted a model that we, I think, have all been describing for cough medicine, liquid cough medicine that minors were purchasing to consume in large quantities to to get a high.

And we were part of a policy that was adopted as state law to restrict that to require ID at point of purchase, and that policy has worked very well. In fact, you very very rarely hear of that sort of activity now, and we think that would be a good model to follow in this and probably would have the same outcomes that the author and the sponsors have put forth.

Thank you. Any other questions from committee? Mr. Speaker, would you like to close?

Well, I appreciate the robust dialogue and the comments, and I'm learning from everyone and certainly the opposition. And I especially would like to acknowledge the witnesses that came to testify today. You know, coming to talk about your personal story is an incredible act of vulnerability, especially on camera in front of the state of California.

But it are those voices that we need to listen to and guide us. And we should start from a place, a conservative place. We shouldn't start with the floodgates completely open because any disastrous outcomes deserves our analysis and whether or not we should be changing. So I just don't think we should be allowing kids to...

be human guinea pigs in these products, waiting until something bad happens to react. We should be proactive and start from a place of protection. These products need to be safe and effective before they are tested in real time on our kids, and I respectfully ask for your aye vote on ab 2030.

Thank you. With that, thank you so much, assembly member. We have a motion. We need a second. Thank you from Stephanie.

Secretary, please call the roll.

The motion is do passed to the Judiciary Committee. Bonta.

Aye.

Bonta, I. Chen. Addis.

Addis, I. Agaracuri. Aye. Agaracuri, I. Pacheco. Aye.

Aye.

Pacheco, I. Colosa. Carrillo?

Aye

Carrillo, Aye, Gonzales?

Johnson? Patel? Patel, Aye, Patterson? Rogers? I.

Rogers, Aye, Sanchez? Schiavo? Sharp Collins, Stephanie, Stephanie, Aye.

That measure is on call. Thank you so much, assembly member. We will now move to item number six, a b eighteen sixty four by Berman.

That measure is on call. Thank you so much, assembly member. We will now move to item number six, a b eighteen sixty four by Berman.

Thank you, assembly member, whenever you're ready. Assembly member, please press your button.

Pacheco moves the bill. Second. Seconded by Addis.

Thank you very much. This morning, I was in your role telling people to press the microphone button. AB 1864 would protect Californians against the threat of bioterrorism by establishing safeguards to prevent the misuse of gene synthesis technology to endanger public health. California has long led the nation in biotechnology innovation, including gene synthesis, the process of using chemicals and specialized equipment to build artificial DNA or RNA sequences from scratch.

Unfortunately, today in California, a bad actor can order online the genetic sequence of a dangerous pathogen or toxin such as smallpox or Ebola and have it delivered through the mail without any verification.

While creating a live virus or engineered bacterium used to require specialized expertise, recent advancements of artificial intelligence have lowered the technical barriers to make and spread a dangerous pathogen threatening the health and safety of all Californians. Recognizing this threat to public health, in September 2024, the White House developed a framework for screening gene synthesis orders. However, this current framework is entirely voluntary is entirely voluntary, and there is no way to verify that providers and manufacturers are in compliance.

AB 1864 would require providers of synthetic genes and manufacturers of gene synthesis equipment operating in California to screen orders for dangerous pathogen sequences and verify customer legitimacy. To ensure compliance, producers and manufacturers that violate the framework will be subject to a civil penalty of up to $1,000 per violation enforceable by the attorney general.

AB 1864 would also authorize the California Department of Public Health to update these regulations only if the federal government issues new guidelines that better protect Californians without overly burdening industry. California cannot and should not wait for a public health crisis or bioterrorism attack. AB 1864 is a proactive and common sense approach to standardize federally recognized best practices in order to keep Californians safe. I respectfully ask for your aye vote.

And here with me are doctor David Relman, professor of microbiology and immunology at Stanford University, and Ben Snyder, policy adviser for ENCODE.

Thank you. You'll each have two minutes.

Good afternoon, chair Bonta, vice chair Chen, and members of the committee. Thank you for the opportunity to testify before you today in strong support of AB 1864. My name is David Relman. I'm a professor of medicine and of microbiology and immunology at Stanford University where I've authored more than 350 peer reviewed papers. I've also had the honor of advising the Federal Government on biological risks, including at the White House, the Department of Defense, and the intelligence community.

AB 1864 addresses a serious urgent risk. The ability to order custom DNA sequences online enables highly impactful innovative research. In my lab, we routinely use these services. But for more than twenty years, we've also known they can be misused to cause grievous harm. I was a founding member of the US National Science Advisory Board for Biosecurity that issued a report on this topic in 2006.

The genetic blueprints of dangerous viruses and toxins like smallpox, Ebola, and ricin are freely available online, and so are the procedures needed to recreate them in the laboratory. I tell my students, I believe they'll face a human made epidemic or maybe even a pandemic within their lifetimes. Fortunately, it's not too late to act. As we wrote back in 2006, companies can screen their orders to detect dangerous pathogens, and they can check to make sure those pathogens are going to legitimate researchers.

Many companies already conduct rigorous screening voluntarily, but there is no legal requirement to do so anywhere in the world.

This means that the DNA needed to create Ebola is less regulated than the penicillin at your pharmacy. That's what AB 1864 is about, ensuring all gene synthesis companies meet the same basic requirements to protect Californians and the nation. I urge you to support this important initiative. Thank you.

Thank you.

Good afternoon, madam chair and members of the committee. Thank you for the opportunity to speak in support of AB 1864. My name is Ben Snyder, and I'm here today with encode AI, a cosponsor of the bill. ENCODE is a youth led advocacy organization focused on advancing safe and responsible artificial intelligence development. Last year, we cosponsored Senator Wiener's SB 53, a first in the nation frontier AI transparency bill signed into law by governor Newsom.

One key risk SB 53 addressed is the ability of AI systems to provide expert level advice on creating biological weapons. Last June, the California report on Frontier AI policy noted unclear but growing evidence that AI could enable biological attacks. And the very companies building this technology warn that their systems, to quote OpenAI, are on the cusp of being able to meaningfully help novices create known biological threats.

But guardrails on AI models are just one imperfect defense against a problem that long predates AI, as you heard from doctor Rehlman. That's why AB 1864 gene synthesis screening requirements are so important.

AB 1864 would align California law with federal guidelines to prevent misuse of benchtop synthesis equipment and gene fragments from dangerous pathogens without restricting access for legitimate researchers. Screening has been recognized as industry best practice since 2009 and is supported by a wide range of scientific and industry leaders.

Names like James Diggins, a senior executive at California based gene synthesis firm, Twist Bioscience, Dario Amede, CEO of Anthropic, and David Baker, Nobel Prize winning biochemist, have all spoken out about the importance of mandating or standardizing gene synthesis screening. Yet, no jurisdiction has created a legal requirement to screen. I ask you to vote aye on AB 1864 and establish California as a global leader on this critical issue.

Thank you.

Thank you. Are there any others in the hearing room who would offer, Me Too in support?

Thank you, madam chair, members. Doug Subers on behalf of the Secure AI project. Please take responsibility and support. Thanks.

Kevin Guzman with the California Medical Association in support.

Thank you. Are there any primary witnesses in opposition? Are there any who would like to testify?

Madam chair, members, Dean Grafila with Capital Advocacy here on behalf of the California Life Sciences to express concern on AB 1864. First, I'd like to thank mister Berman for his time meeting with us as well as, his continued openness, working with the life sciences community. We agree with strengthening California's biosecurity. However, as the bill currently written, concerned about how it could, in fact, create operational challenges, disrupt supply chains, as well as add compliance burdens without fully realizing and strengthening California's biosecurity.

Look forward to continuing working with the author, his staff, and the committee to help ensure amendments make the bill effective and workable.

Thank you.

Thank you. Any others in opposition who would like to offer, Me too in opposition? Seeing none, I will bring it back to the committee for any comments or questions.

Hl.

Hi. Thank you for bringing this bill forward. I find it very intriguing and, the challenge that you're trying to address very realistic. So really appreciate you working to bring this bill forward. I have two kind of technical questions.

One in the, technical language of the bill, for our, witnesses today. Sorry, Mark, Assemblymember Berman. I'm assuming that

I'm glad they're here.

You will not be answering these questions. I'm assuming that the bill language is for currently known pathogens or biologically, biological weapons, what are we doing about those that are not yet known?

That's an excellent question. Thank you, doctor Patel. The bill points to this 2024 federal framework, which defines initially sequences of concern as those corresponding to regulated agents and pathogens. However, it includes a provision that goes into effect in October 2026, so it would be included in this bill if it were to pass that instructs or or requires providers to additionally make efforts to screen for known path known sequences that contribute to the pathogenicity of of of agents that are not regulated.

So there is some provision there that's flexible.

And and, certainly, there are efforts underway internationally. So there's there is an international standards body that's working to define sequences of concern here that could take a sort of forward looking perspective on this, and that would help shape the sort of international and industry best practices, that companies might be expected to, to comply with. But this this bill itself does not directly build in pathways to to deal with those sorts of things.

Okay. So I I think that we would like to to make sure that we are keeping it as a living, breathing type of legislation. I don't know how that's done. I'm a freshman here. But that would be a concern to me as a former research scientist.

Still one in my own head. The second question, I think, relates to what percentage accuracy or alignment are you looking at? Do you have a threshold that the sequence has to align by a certain percentage threshold? And if not, is that something that you would recommend putting in there?

Thank you, assembly member. The bill as currently written speaks to sequences that are a best hit to one of these known pathogens and does not have an exact hit to a non worrisome, nonpathogen. And so, no, there is no specific percent sequence similarity threshold. It is simply a screen for sequences that likely are associated with a pathogen and pathogen effects, but that would simply trigger a process that would then lead to a greater degree of scrutiny and presumably adjudication in an appropriate fashion.

And certainly, we've seen the technology with AI increase to the point where we can now throw in a DNA sequence and know what kind of protein structure we're gonna get out of it. So it's very exciting to be able to put these types of tools together to help keep people safe. Thank you for bringing this bill forward.

Thank you. Assembly member, we did have a request from a committee member for your consideration to potentially treat this as a bill that would require urgency. I would have that be something to contemplate as you move this bill forward for sure.

Also wanted to just perhaps in your closing to give you an opportunity to address the, the trade offs of our public health safety, in a very scary time right now with advancements in technology that would allow someone to be able to use gene gene synthesis in a way that would be harmful for our overall public health and safety, against the operational challenges and additional compliance burden that was outlined by the opposition.

Do they note it on both points?

Please feel free to close.

Thank you for the questions. Thank you for the comments and and encouragement to consider different both procedural and and policy issues being raised. Happy to give consideration to the urgency clause request or suggestion, I guess. Agree that this is an urgent issue. And so I can see the the need for that.

Appreciate the comments about, you know, how can we make sure that we somehow in the bill reference other, you know, lists or or databases that are more living, breathing documents because this is a constantly evolving kind of threat dynamic and and wanna make sure that we, you know, that that our ability to react to that continues as well. So that's a great point.

Appreciate the concerns raised by the opposition and, you know, these are industries and and companies in or or around my district and that I think are incredibly important to California and Californians, and wanna make sure that we don't have anything in the bill that, unnecessarily, delays their ability, to do the the life changing work that they're doing. We've had conversations with them.

We've we've asked them to maybe give us some more specific examples of of how this might, either cause them to postpone the work that they're doing or make the cost of that work so unnecessarily burdensome from our perspective.

That should not happen. The the cost should be de minimis, and there should really be no delay for for a lot of the companies. A lot of the that, you know, there won't be any question about whether or not they are a legitimate customer of this synthesized DNA and RNA. But open to hearing from them about how, you know, specifics, how this might actually, stop them from being able to do their work.

So we'll continue having those conversations with them and make sure that the bill doesn't bring in unintended consequences from good actors, but that protects Californians from bad actors.

Respect to ask for your aye vote.

Thank you. We have a motion by Pacheco, seconded by Addis. Secretary, please call the roll.

The motion is do passed to the Judiciary Committee. Bonta?

Aye.

Bonta, aye. Chen?

Aye.

Chen, I. Addis. Addis, I. Agaracari.

Pacheco. Colosa. Carrillo. Carrillo. I.

Gonzales. Johnson. Johnson, I. Patel. Patel, I.

Paterson. Rogers, Aye, Sanchez. Sanchez, Aye, Chiavo, Sharp Collins, Stephanie. Stephanie, I.

That measures out. Thank you so much, assembly member. We'll move on now to item number 16, AB 2457 by Connolly. Whenever you're ready, assembly member.

Good afternoon, madam chair, members. Proud to present AB 2457, which would which would improve the lengthy credentialing process for physicians by requiring Medi Cal managed care plans to adopt a standardized credentialing form. This bill will also establish firm deadlines for the credentialing process requiring that a Medi Cal managed care plan has ninety days to review a credentialing application. This will eliminate the delay in physicians receiving a response to their credentialing application.

AB 2457 builds upon AB 1041 by Assemblymember Bennett, which established the use of the Council for Affordable Quality Healthcare or CAQH credentialing form by commercial health plans.

Currently, doctors must have their Medi Cal managed care provider credentialing application approved prior to treating Medi Cal patients. While there are important safety measures within the credentialing process, there are a number of a significant number of administrative burdens and unnecessary delays. It is common for an applicant to wait anywhere between ninety to a hundred and eighty days between submitting their credentialing application and receiving a decision or response.

While physicians wait for a decision, they are unable to see Medi Cal patients, depriving vulnerable patients of access to health care. By streamlining a credentialing process across the Medi Cal managed networks, we will reduce unnecessary paperwork and allow physicians to care for their patients in a timely manner.

At a time where we are seeing severe federal cuts to health care, it is critical to ensure access to health care for underserved Californians in rural and low income areas. Every Californian deserves speedy access to quality health care. And this bill offers a solution to the redundancies within the current credentialing process. With me to testify today is Dr. Join Luh with the Physician Association in California and Bill Barcelona, executive vice president of America's Physician Groups.

Thank you so much. You'll each have two minutes.

Good afternoon, chair and members. My name is Dr. Join Luh. I'm a radiation oncologist in private practice in Eureka, Humboldt County. Like many rural areas, we face persistent shortages of health care providers and have a very high medical population. Our small three person clinic is deeply embedded in our community.

When a patient calls our office, they don't get routed to a call center or an AI chatbot. They get a human being, and they hear from me directly. My ability to provide personal responsive care and remain closely connected to my community is why I've practiced here for nearly nineteen years. Unfortunately, the timely care I strive to provide can be disrupted by factors outside my control.

When my practice changed its name, we were required to recredential with Medi Cal before we could credential with its managed care organizations.

The recredentialing process was confusing and often duplicative. We couldn't find Medi Cal staff to help us. When physicians are delayed in joining Medi Cal managed care networks, patients may wait longer for treatment or travel hours outside their community. When low income rural Californians are facing cancer or other serious illnesses, delays in care should not be acceptable. Fortunately, AB 2457 is a practical fix that builds on the success of AB 1041 from last year.

It expands the standardized credentialing application and process to Medi Cal managed care plans. It doesn't compromise quality. It simply allows physicians to serve patients without getting hung up on multiple applications and processes. Streamlining credentialing for Medi Cal managed care plans will allow physicians to join networks more quickly and start seeing Medi Cal patients sooner. For patients, it means shorter wait times, fewer delays in diagnosis and treatment, and better access to care closer to home.

I urge your support of AB 2457. Let's remove needless barriers and help providers care for all patients in a more timely fashion. Thank you.

Thank you. Are there others in the hearing room who would like to offer a me too in support of AB 2457? Oh, I'm so sorry. Yeah.

I think we have one more time.

Well, thank you. Thank you, madam chair and members. Bill Barcelona on behalf of America's Physician Groups, cosponsor of AB 2457. APG represents physician organizations in California's delegated model, caring for approximately 6,000,000 medical beneficiaries through medical groups and IPAs responsible for care delivery and network performance. We support AB 2457 because it addresses a core barrier, fragmented and duplicative provider credentialing.

Oh, sorry.

California requires providers to enroll through the state's PAVE system, which verifies licensure, ownership, and program integrity. But after clearing that process, providers must still complete separate and duplicative credentialing requirements across multiple Medi Cal plans. In a delegated environment, that sometimes means that the same provider is processed multiple times across plans with inconsistent requirements and timelines. As a result, even fully enrolled providers can wait months before they're able to see a medical patient.

AB 2457 streamlines the transition from state enrollment to plan credentialing by reducing duplication and delay, helping qualified providers enter Medi Cal networks more quickly.

For our delegated physician organizations responsible for network adequacy and access, this alignment is critical. It allows us to onboard providers more efficiently and focus on delivering care, not navigating redundant administrative processes. And for those reasons, APG respectfully urges your aye vote. Thank you.

Thank you. My apologies, mister Barcelona. And with that, we will move to the me too's.

Madam chair, members, Tim Madden representing the California chapter of the American College of Emergency Physicians in support.

Natalie Eloe on behalf of 360 Behavioral Health in strong support.

Dennis Cuevas Romero with the California Primary Care Association Advocates in strong support. Thank you.

Jessica Rountree representing Community Autism Services in strong support.

Missy Johnson on behalf of the California Association for Applied Behavior Analysis in support.

Dr. Lauren Phillips on behalf of Blue Sprig Pediatrics in strong support.

Good afternoon. Anthony Butler Torres with the California Hispanic Chambers of Commerce in support. Thank you.

Brindy Quintana, on behalf of the Central Valley Latino Mayors and Elected Officials Coalition, as well as Cisse Puede, Kings County, Fresno County, Tulare County, Kern County, Madera County, and the, Yemen societies in Central California and Northern California. Thank you.

Nora Kennetti, on behalf of the Multicultural Business Alliance and Latino Business Association, we strongly support AB 2457.

Good afternoon. Esther Flores with the California Farmworker Foundation in strong support.

Good afternoon. Michael Saragosa on behalf of National Action Network Sacramento and Hispanic 100 in support.

Thank you so much. Now we will move to primary witnesses in opposition or others who would just like to offer a me too in opposition to the measure.

Like to move the bill.

Thank you, doctor Patel, seconded by Kate Sanchez. Sorry. With that, we have a motion and a second. Assemblymember, would you like to close?

Thank you so much.

Sorry. Any other questions or comments from the committee? No?

Respectfully ask for an aye vote.

There we go. The easiest question to answer. Thank you so much. With that, chair's recommendation is an aye on this measure. Please call the roll secretary.

The motion is do passed to appropriations. Bonta?

Bonta, aye. Chen?

Aye.

Chen, aye. Addis?

Aye.

Addis, aye. Aguiar-Curry? Pacheco? Caloza? Carrillo?

Aye.

Aye.

Johnson, Aye. Patel?

Aye.

Carrillo, Aye. Gonzalez? Johnson?

Aye.

Patel, Aye. Patterson? Rogers?

Rogers, Aye. Sanchez?

Sanchez, Aye. Schiavo? Sharp-Collins? Stefani?

Aye.

Aye.

Aye.

Stefani, aye.

That measure's out. Thank you so much, Assembly Member. We're gonna move now to item number 13, AB 2302 by Celeste Rodriguez, presented by Addis.

Thank you, Madam Chair and Committee Members and staff. I am proud to present AB 2302 on behalf of Assembly Member Celeste Rodriguez. The Assemblywoman does accept the committee amendments and thanks the committee for its work.

AB 2302 addresses a critical gap in California law by requiring brand and infant formula manufacturers to test for toxic elements such as lead and arsenic and to make those test results publicly available on their websites. The bill is fundamentally about ensuring accountability, safety, and transparency in the products that our infants rely on.

Transparency leads to safer industry practices, while accountability assures our communities that we are actively responding to concerns around infant formula safety. We know that AB 2302 would empower parents and caregivers by ensuring that testing is conducted on the formula they use, providing them with the information they need to make informed choices.

And this legislation builds on California's leadership. We have already taken action to hold baby food manufacturers accountable where federal protections have fallen short. So today with us are Dr. Jeremy Sanchez, Pediatric Chief Resident from UC Davis, and Diana Welsh, Vice President for Learning Disabilities Association of California. And I'll turn it over to the doctor and then Diana.

Good afternoon, Madam Chair and Members. I'm Dr. Jeremy Sanchez, board certified pediatrician in Sacramento with a master of public health. I'm pleased to speak in support of AB 2302 by Assembly Member Celeste Rodriguez. While the FDA regulates aspects of infant formula, such as nutritional content and bacterial safety, it doesn't currently require routine manufacturer testing of toxic elements such as lead, arsenic, cadmium, and mercury. This gap matters.

Even very low levels of these contaminants can harm infants whose developing nervous systems and higher absorption rates make them especially vulnerable. In the worst cases, these can lead to lifelong neurodevelopmental delays. In my practice, I care for many newborns whose families rely on formula as their primary source of nutrition, and they deserve to know that it is as safe as possible.

In a 2025 analysis by Consumer Reports, nearly half of the formula tested had potentially harmful levels of at least one contaminant, including those in this bill. Three of the nation's largest formula manufacturers had products in both the best category with no or low levels of contaminants and the worst category with concerning levels of contaminants.

This shows that manufacturers can make formula without contaminants and are already doing it, but only for some of their products. Recently, California's Attorney General reached settlements with two large formula manufacturers after lead was found in their products. AB 2302 builds on this progress by creating a consistent standard requiring testing and transparency for all manufacturers, not just a few.

All babies deserve... Excuse me, all babies deserve nutrition without harmful contaminants. As a pediatrician, I want to give parents full and clear information about the formula they feed their babies. I respectfully ask for your support of AB 2302. Thank you.

Good afternoon, Madam Chair and Members of the Committee. Thank you for allowing me to be here today. My name is Diana Welsh, and I'm the Vice President for the Learning Disabilities Association of California. LDA provides support, education, and advocacy for people of all ages with learning disabilities, their families, and professionals.

LDA's Healthy Children Project works to eliminate preventable causes of neurological disabilities, including those caused by harmful heavy metals. In the US, one in six children have a learning or developmental disability. It costs about three times as much to educate a special needs student in our state, roughly 27,000 per year per student.

While there are multiple factors that contribute to these disabilities, Project TENDR, which stands for Targeting Environmental Neurodevelopmental Risks, includes more than 50 leading scientists, states that toxic chemicals contribute to the high prevalence of these neurodevelopmental disorders in children.

And the good news is that these causes are preventable. As a special education teacher, I've worked with a lot of students with special needs, including learning and attention disabilities and autism. Every classroom in these yearbooks that I brought with me from my school have students with some kind of a learning difference or a disability.

The students in the special k, special education pre k classes are all students with impairments. I've seen my students doubting their own worth because they learn differently than other kids or their parents blaming themselves for their child's difficulties.

While we can't know if heavy metals contributed to these students' disabilities, we do know that heavy metals are toxic even at low levels, especially for infants, and can permanently impair brain function. And while we can't control our genes, we can prevent some of these exposures, and formula is a great place to start.

The FDA has not set safety levels for heavy metals in infant formula, despite LDA and other partners pushing for this over the last decade. LDA asks you to support this bill, which will finally help parents and caregivers get critical information they need to make informed decisions. Thank you. And please vote yes for AB 2302.

Thank you. Are there others in the hearing room who would like to offer support as a me too? Please come forward.

Nora Angeles with Children Now, proud sponsor of AB 2302. Three other organizations wanted me to list their support, Our Green Challenge, Clean Water Action, and Breast Cancer Prevention Partners. Thank you.

Christopher Sanchez on behalf of the Consumer Federation of California in support.

Sarah Diaz with the California WIC Association in support.

Good afternoon. April Robinson with A Voice for Choice Advocacy in support.

Hello. Susan Little with the Environmental Working Group in support.

Thank you. We will now move to opposition. Are there any primary witnesses in opposition who would like to offer some testimony?

Thank you, madam chair and members. Thank you for the opportunity to be here with you all today. I wanna start by saying that I'm happy to accept the committee amendments. My team has had thoughtful, productive conversation with the opposition, and I want you to know that I hear those concerns, and I'm committed to continuing the dialogue as this bill moves forward. At the end of the day, though, this is about people.

Every single person who walks into an emergency room, no matter who they are, no matter what they have in their pocket, they are seen and they are treated. That's not policy. That's just who we are. But here's the reality that we don't always say out loud. Emergency rooms across California are seeing nearly 15,000,000 visits a year.

About one in five of those patients has no insurance. Changes to the Medi Cal as a result of HR1 are estimated to drastically increase the number of uninsured on its, own in seven years implementation period. So when someone can't pay, who fills the gap? That's where the Maddy EMS Fund comes in. It's quiet but critical lifeline that helps keep emergency care afloat, keeping doctors on shift, ambulances on the road, and trauma care available for our kids through the Ritchie's Fund.

And it's funded in a simple, modest way, just a small add on to court fines, nothing extravagant, but the impact is life saving. AB 1607 is straightforward. It doesn't expand the program. It doesn't reinvent the wheel. It just gives us more time, more time to keep this lifeline in place, more time to make sure our emergency rooms don't fall further behind, more time to protect access to care when people need it most.

Because without it, we're asking for a strain system to do even more with less, fewer positions, longer wait times, and higher costs that ultimately hit us all. And right now, again, to reiterate, with millions of Californians at risk of losing their health care insurance, we know what's coming. More people will turn to emergency rooms as their only option. So this moment matters. This bill is about being ready.

It's about making sure that when someone calls 911 on the worst day of their life, we're not debating whether we can afford to show up. We just do. This afternoon, primary witnesses in support, to highlight the impact of the bill is Elena Lopez Guzman, executive director of the American College of American Physicians emergency physicians, excuse me, California chapter, and John Polad, regional executive director of Sierra Sacramento Valley EMD Agency.

Thank you. Good afternoon, madam chair and members. Elena Lopez Guzman on behalf of the California chapter of the American College of Emergency Physicians. About 21 years ago, then Senator Richard Aralcon introduced SB 57, the predecessor to this bill. He had lost his three year old son as a result of a traffic accident.

And at that point in time in LA County, six hospitals and emergency departments had closed over the prior fourteen months. He was quoted in the LA Times as saying, everyone knows that emergency services and trauma care centers are slipping away. This is my effort to get dollars into the system and save some additional sites from going under. Here we are twenty years later on the precipice of another catastrophe in the emergency care safety net.

Last April, RAND published a report on the challenges that EDs are facing nationwide.

According to RAND, and I quote, the viability of emergency care as we know it is at risk. To preserve emergency care quality and coverage, policy action is needed on multiple fronts, end quote. That study was published before the passage of HR one. I don't need to tell this committee what we're facing in California as a result of the cuts from HR 1. Billions of dollars to the hospital based health care delivery system will be gone.

Two million people will lose their health care insurance. Underserved and underprivileged folks who will have nowhere to go but the emergency department. My members are proud to stand on the line, the last line of defense, and not ask questions about whether people can afford to pay when they walk in the door and provide the coverage. But that coverage is predicated on there being some funding from some place, as the author mentioned.

And the funding, while it is tied to a particular individual's visit, doesn't affect the care that the patient gets.

It affects all of us the same. When we walk in the door, we're treated based on the severity of the condition, not based I heard the beep. Not based on whether or not we can pay. And so if only one doctor can be there, that affects us all.

Appreciate the passage.

Thank you.

Hello, chair Bonta and assembly members. My name is John Poland, regional executive director of the Sierra Sacramento Valley EMS Agency, a local EMS agency serving 10 Northern California counties. I'm here speaking on behalf of the Emergency Medical Services Administrators Association of California, representing all 34 local EMS agencies covering all 58 California counties.

As already mentioned, in 1987, the legislature concluded that EMS providers, including physicians and surgeons and hospitals, as part of the requirement to provide emergency medical care to all patients regardless of their ability to pay for higher costs for their services, but often received only partial or no payment for patients. As a result, the legislature enacted a series of laws to compensate EMS providers, physicians, surgeons, and hospitals for patients who cannot pay for their medical care.

California law authorizes counties to establish a MADI EMS fund to reimburse physicians, surgeons, and hospitals for the cost of uncompensated emergency care and for other essential EMS system purposes. It has also authorizes counties to establish a Ritchie's Fund as part of their MATI EMS Fund to provide funding for pediatric trauma centers throughout the county. If no pediatric trauma centers exist, the funding must be used to improve access to and coordination of pediatric trauma and emergency services in the county.

Expenditures from the Ritchie Fund are limited to reimbursement to physicians, surgeons, and hospitals for the cost of uncompensated pediatric care. The Maddy EMS Fund and Ritchie's Fund are funded through revenues generated from local penalty assessments on fines and forfeitures for various criminal offenses and motor vehicle violations.

The revenue generated also includes a portion of traffic school fees collected by the courts and forwarded to the counties. The regional authorization for the additional penalty assessment was previously extended through 01/01/2017, and again until 01/01/2027. EMS is a vital component of California's health care safety net.

At a time when EMS providers are having to reduce or cease providing essential services, Hospitals are closing at a significant risk of closing and uncompensated care, and the impacts of HR one is an imperative that current sources of EMS system funding be maintained.

Thank you. Are there others in support of this measure? Please come forward.

Madam chair, members, Awet Kidane with Lane Hansen Lane Hansen, Jiro Kidani, representing the California Children's Hospital Association. Strong support. Thank the author.

Good afternoon. Christy Weese, Capital Advocacy on behalf of the California Hospital Association in support.

Good afternoon. Kelly McMillan on behalf of the American Academy of Pediatrics California and the Children's Specialty Care Coalition.

Clifton Wilson on behalf of the Napa County Board of Supervisors in support. Thank you.

Justin Paddock on behalf of Yolo County in support.

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

Kevin Guzman on behalf of the California Medical Association in support.

Thank you. Are there any primary witnesses in opposition? Are there any me too's in opposition that would like to register? Seeing none, I will bring it back to the committee for any questions or comments.

Second.

Moved by Rogers, seconded by Pacheco, our subs. Get that one. Assembly member and majority leader, Aguiar-Curry.

Thank you for bringing this bill forward. I know these works on these bills are so important. But I just wanna remind everybody, the Maddie M EMS Fund provides critical support to our emergency rooms across the state and especially in rural areas like my district. That said, I understand the concern that this that the way this is funded

may be

regressive and appreciate the chair's amendment to extend the sunset for just ten additional years. I'm not gonna lie. I have a problem with the ten years. Because since many of this on this dais will not be here in ten years, I wanna make sure that it can continues. And so, miss assembly member Gonzales, when you're out of here in ten years, can you make sure that you up this again?

Because it would be a shame that it wasn't. So if I had it my way, I wouldn't want a sunset on it, but I'm not in charge.

From your lips to god dearest, I'm here in ten years. Yes. Absolutely. And thank you.

I'll be supporting your bill today.

Thank you for your comments.

Well, thank you. I wanna note, assembly member, that this bill is actually gonna go to, public safety after this, and I'm sure that they will address the source of the funding of this very important, bill to ensure that we have funding in our EMS fund. With that, would you like to close?

Thank Thank you, madam chair and members. Illness doesn't ask for your insurance card. A stroke doesn't pause for payday, and our doctors can't wait. Every second counts. When someone calls 911, they don't care about paperwork.

A child in trauma doesn't wait for a billing cycle. Every heartbeat, every breath, every second matters. AB 1607 keeps that lifeline strong. This fund is small, but it keeps emergency rooms open, ambulances rolling, and lives on track. It's a lifeline we can't afford to lose.

I respectfully ask for your aye vote.

Thank you. We have a motion and a second. Please call the roll.

The motion is do pass as amended to public safety. Bonta?

Aye.

Bonta, Aye, Chen. Chen, Aye, Addis. Agaracore oh, Addis, Aye, Agaracore, Aye, Agaracore, Aye, Pacheco, Aye, Pacheco, Aye, Colosa Colosa, Aye, Carrillo, Gonzales, Gonzales, Aye, Johnson, Johnson, Aye, Patel. Patel, Aye, Patterson. Patterson, Aye, Rogers.

Rogers, Aye, Sanchez. Sanchez, Aye, Chiavo. Sharp Collins. Stephanie. Stephanie, Aye.

That measures out. Thank you. We are gonna now hear item number nine, ab 2066 by Celestia Rodriguez. I will be presenting and handing over the gavel to our vice chair, Chen.

Thank you very much, Madam Chair. Your pleasure.

Thank you, Committee Members. I'm presenting AB 2066 on behalf of Assembly Member Celeste Rodriguez. The Assembly Member would like to thank the committee for their work on this bill. AB 2066 recognizes pregnancy as a qualifying life event, allowing individuals to enroll in or adjust their health insurance when they need it most.

This will ensure pregnant people have timely access to the care and coverage essential for a healthy pregnancy. Under current California law, individuals can enroll in or make changes to their health insurance only after experiencing a qualifying or triggering life event.

These include when a person gains a dependent such as the birth of a child, gets married, or adopts a child. Enrollment in health plans is restricted to set periods. Without a qualifying event, individuals must wait until the next annual enrollment window to sign up or make changes. Access to prenatal care cannot wait.

Research has shown that timely access to prenatal care results in better outcomes for both the mother and the child. When antiquated enrollment rules delay timely access to prenatal care, the consequences can include preventable risks for both the pregnant individual and the child.

Today, we will hear in support of AB 2066 from Dr. Neel Arant, certified nurse midwife and member of the United Nurses Association of California Union of Healthcare Professionals.

The bill has been moved and seconded. Thank you. Key witness, at your pleasure.

Good afternoon, Chair Bonta and Members of the Committee. My name is Neel Arant. I'm a member of the United Nurses Associations of California, Union of Healthcare Professionals, and I have worked as a certified nurse midwife for the past 24 years.

I also hold a PhD in international health with a focus on perinatal HIV, hepatitis, and other infectious diseases. I am here in support of AB 2066, and I am also a constituent of Chair Bonta's. Throughout my career, I have worked across a wide range of health care settings, from caring for uninsured populations to Medicaid patients to those with private insurance.

I have also practiced in Australia where universal access to health care is guaranteed and outcomes are among the best in the world. Currently, individuals who become pregnant outside of Covered California's annual open enrollment period or who experience gaps while transitioning between coverage types during the perinatal period often have no pathway to obtain timely insurance coverage.

This creates a critical and dangerous gap in care. AB 2066 will rectify this, closing these gaps. Timely access to prenatal care allows us to diagnose and treat infections, identify ectopic pregnancy, risks for preterm birth, and manage conditions such as diabetes and hypertensive disorders that can have serious long term consequences for both parent and baby if left untreated, as well as ensuring that people are enrolled in postpartum care.

Without insurance, patients delay care, miss critical screenings, and often present later in pregnancy with more severe and preventable complications. These gaps in care are what lead the United States to rank fifty fifth in quality of maternity care in the world, which is abominable.

In fact, 80% of the maternal deaths in the United States were preventable. Members of our black, American Indian, Alaska Native, and Asian Pacific Islander communities are two to five times more likely to die from pregnancy related complications than their white counterparts. These gaps...

Thank you. If you could please start wrapping up, ma'am. Thank you, doctor.

Sorry. These gaps disproportionately affect Californians who are already experiencing health disparities, further exacerbating existing inequality. Thank you.

Any others in support?

Hi. Kelly Mac Millan on behalf of American Academy of Pediatrics California in support.

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

Ryan Spencer of behalf of the American College of OBGYNs District 9 in support.

Natalie Pita on behalf of the California Academy of Family Physicians in support.

Kevin Guzman with the California Medical Association in support.

Emily Mmeje, UNAC/UHCP, and also RN family nurse practitioner in strong support. Thank you.

Thank you. Do we have any witnesses in opposition? Seeing none. Oh, I apologize.

Good afternoon, Chair and Members. Matt Akin here on behalf of the Association of California Life and Health Insurance Companies, regrettably here today in opposition to Assembly Bill 2066. While we sincerely appreciate the intent of the bill, we have significant concerns about its potential impact on the health insurance market.

AB 2066 would make pregnancy a triggering event for enrolling in or changing health plan. Currently, special enrollment periods are limited to broad qualifying life events, such as marriage, relocation, family expansion, or losing employer sponsored coverage. These rules are specifically designed to maintain market stability without tying access to coverage to a specific medical condition.

This bill would move California toward condition based enrollment, favoring certain conditions over others, and setting a precedent the Governor raised concerns about when vetoing similar legislation last year. The key part of keeping coverage affordable is encouraging people to maintain insurance even when they do not have an immediate medical need.

In its current form, this bill risks undermining that goal by allowing coverage to be delayed until it is needed. For these reasons, we respectfully oppose the bill, but we do look forward to continued dialogue with the author and staff if it does move forward today. Thank you very much.

Vice Chair and Members. Olga Shilo on behalf of the California Association of Health Plans. I'd like to align my remarks with those of my colleague from ACLHIC and share our perspective, particularly on the cost. We sincerely appreciate the intent behind AB 2066 to enhance access to maternal health coverage.

But we do want to highlight findings from the state's independent analyst, CHBRP, which looked at a nearly identical proposal last year. Their analysis found this policy would increase health care spending by about 70 million annually statewide.

And for consumers, that translates to roughly a $2 per member per month increase in premiums in the individual market. That may not sound like a lot, but those costs don't just affect one group. They do spread across all enrollees.

And at a time when affordability is already a major concern, even a small increase like this start to add up to and compound over time. CHBRP also point out to a broader dynamic. When people can wait to enroll until they know they'll need care, such as during pregnancy, it increases adverse selection. And it ultimately puts upward pressure on premiums for everyone.

California system is really designed to encourage continuous coverage, not just enrollment at the point of need. This bill shifts that balance and introduces new cost pressures into the market. For those reasons, we respectfully remain opposed, but we look forward to continuing the conversation. Thank you.

Thank you very much. Do we have other folks in opposition in the audience? Seeing none. I'm gonna take this back to committee. Assembly Member Rogers.

Thank you so much, Mr. Vice Chair. With all due respect to the opposition, my wife had a change of life circumstances when she married me, which was disruptive, but not nearly as disruptive as when she got pregnant. I can promise you.

I would love to be added as a co-author. I think that when we talk about maternal health, it doesn't even just start with the pregnancy. The data is very clear that access to care prior to conception has huge outcomes for both the mother and the child.

And that if we are serious about supporting families in this state, this is a very minor tweak that can be made to have a better outcome for folks. So with that, I'd be more than happy to support the bill, and I hope our colleague is watching from home.

Assembly Member Patel.

Thank you for bringing this bill forward. And I continue to be surprised that pregnancy is not already a life changing qualifying event for health insurance. I think many families that knowingly are family planning already are on the insurance that covers and meets their needs because they want to be ready and prepared for when that happens.

But for those who were not expecting pregnancy, now all of a sudden find themselves pregnant, it is absolutely a qualifying event. And we know from history from something as basic as addressing cleft lip and cleft palate with vitamin b in prenatals.

We know that there are cost saving measures that will come out of families, mothers, expecting mothers being able to access prenatal care at a quality and level which will help improve outcomes for children as they grow.

So did the CHBRP analysis have anything, any, the previous year's one, did it have any extrapolation on possible cost savings for increasing the access to prenatal care?

Thank you. I think at this point, we know the CHBRP analysis actually was referenced to a Wahab bill from the Senate last year that actually was quite a bit more extensive just on the opposition's point around the cost. And we assume that the actual cost given the limitation to just looking at the eligibility for pregnancy would be significantly lower.

In response to your question specifically, Assembly Member, there is strong evidence that maternity services will improve outcomes for infants and mothers. And we know that there is significant preventative savings when mothers or those who might be go from being uninsured to insured.

Which this legislation would allow to be able to happen and also we know that there are significant cost savings when we have prenatal care a part of what a mother is able to offer their fetus in throughout the process.

So we don't have in the CHBRP analysis anything that speaks to that, but I think we know for sure that there are significant savings and better health outcomes for children when they're able to receive prenatal care.

I certainly agree with that. I mean, I don't have a fine point on those numbers, but it's not hard to imagine that there's gonna be significant cost savings long term. With that, I would love to be added as a co-author. My team has sent Assembly Member Rodriguez an email, and we hope that this bill progresses. Thank you.

Thank you. Assembly Member Addis.

Thank you so much. And thank you, Madam Chair, for presenting this bill. And thank you, Assembly Member Rodriguez, for bringing two important bills forward today. I just think this is a wild conversation. I'm astounded we're having this conversation.

And I was, did a little Google search. And, actually, pregnancy used to be a preexisting condition where insurance companies could just deny you coverage up until the 2010s. We've made huge growth in the last fifteen years. I'm astounded that we would be not just very easily making this easier for pregnant women.

But one piece of data I wanted to bring up is that birth rates are declining across the US, and birth rates are declining in California in specific. And when we look at the population data, it's actually very precarious because our number, our percentage of people 65 and above is increasing drastically.

The percentage of working age people who are about 20 to 64 is somewhat stagnant, somewhat the same. But the percentage of people 0 to 18 is drastically declining. And the number one reason people say that they're not having children is cost. It's wholly to do with the economy, and people wanna be able to grow their families.

It benefits our state and our nation to grow our families. So to have any kind of opposition on this bill, I'm just I'm really surprised. I find it totally wild actually sitting here listening to any kind of opposition on this. So obviously I support the bill. And thank you, Madam Chair, for presenting it on behalf of Assembly Member Rodriguez.

Assembly Member Stefani.

Thank you. Yes. I perked up as well because I'm absolutely confounded by this discussion. I just don't understand how being pregnant can be compared to anything else or any other specific medical condition. It's the only one specific medical condition that can bring life into this world. So I don't, I am, I am baffled by this conversation. And I just want to thank the author for bringing this forward, and I would love to be added as a co-author. Thank you.

Assembly Member Pacheco, then Leader Curry.

Could I also... Sorry. Sorry, Chair. May I also ask to be added as a co-author? Thank you.