Senate Standing Committee on Health

The Senate Committee on Health will begin in ten seconds. The Senate Committee on Health will come to order. Good afternoon. We have 13 bills on the agenda for today with one of them on our proposed consent calendar. That is item four, SB 1186 by Sayarto with amends.

Seeing that we have no quorum, we will begin as a subcommittee until a quorum has been established. We will start with file item number one, SB 1377 by Senator Jones. You may begin when you're ready.

Thank you, madam chair and member that are here. Appreciate your promptness. And I think Senator Cortese may slip in with some opening remarks as well. But I'll go ahead and get started now, madam chair, if that's okay. Senate Bill 1377.

First of all, I would like to thank the chairwoman and the members of the committee, the staff, my coauthors on the bill, Senator Allen and Cortesi, for all of their quick work on coming up with something today that we can all be comfortable moving forward. So with that said, I will be accepting the amendments from the committee. Madam chair, on that note though, some of the comments today will be directed towards the original bill, but I I am accepting the commitments from, the committee.

The one thing, madam chair, I would like to make very clear to you, the committee, and the public is that this is not an anti vax bill. This bill does not call into question the efficacy of of childhood immunizations.

This bill puts doctors back in the driver's seat when it comes to care for our children where they have always belonged. Medical care should be administered by physicians, not enforced by health officers. Current law has created a system current law has has created a system that is not working for medically vulnerable children, their families, or the physicians who care for them.

In 2020, SB 276 placed some draconian rules and restrictions on our medical professionals when it comes to the issuance of medically necessary vaccine exemptions. With a raging and unprecedented global pandemic causing widespread fear, the legislature, human as its members are, overreacted a little bit in a number of areas.

Among them was a bill to limit the number of medically necessary vaccine exemptions of it a physician could issue without facing the threat of audit and third party investigation. We were scared. All of us were scared, but the legislature and certainly our governor went a little bit too far. Senate bill 1377 aims to return physician discretion to the doctor's office when it comes to medically vulnerable children who may not be healthy enough or may be predisposed to adverse reactions to receiving vaccinations.

And now we have a serious ongoing problem with the current medical exemption system.

When doctor Pan and others crafted and passed the current policy six years ago, there was a promise made in front of this committee that every child who legitimately needs a medical exemption will be able to get one. Unfortunately, that promise has failed to materialize. Instead, the threat of audit and lower arbitrary cap numbers have had a chilling effects to the point that doctors will not write exemptions even when needed for fear of unwarranted scrutiny.

Physician groups, hospital networks, and private practices have instituted policies that bar their employee physicians from writing them altogether. Worse, some even refuse to accept patients who have or need medical exemptions for risk of inviting the long arm of government investigators into their businesses.

Senate bill 1377 would resolve this problem by ensuring that doctors decide when a patient needs or doesn't need an exemption and that fraudulent actors can be rooted out through the medical board's already existing investigative and enforcement mechanisms. We trust our doctors and we give them wide wide spread discretion in all other aspects of medical care. And within those care provisions, we have safeguards to place to add in place to identify and deal with the bad actors.

This bill would allow those same mechanisms to protect our communities against bad actors who have violated their oath when it comes to the issuance of medical exemptions. The primary question this bill poses is do we, as California society, trust our physicians or not?

With that, I'd like to introduce, one of our co authors, Senator Dave Dave Cortese, along with our sponsors, Amy Bond from PERC and doctor Richard Fox, a pediatrician from Los Gatos. First, Senator Cortese.

Thank you. Thank you, madam chair. I'll be brief. Appreciate the opportunity as co author to co present, but again, I'll be brief. This is I think this is as narrow as the bill is and and rightfully so.

We've had discussions about that. It's still a remarkable beginning of a collaboration between members of the legislature and to some extent the end of conversations that have been going on for more than a year on a member to member basis and so forth. So we appreciate very much trying to get the discussion into the open in a way that's not problematic. It's not problematic from a public policy standpoint. And again, we've appreciated the chair's expert feedback and input on that.

I do wanna thank Senator Allen for his leadership in recognizing that the original policy put in place in part under his authorship might need to be revisited. And, you know, his work and his part in the conversations over the last year has been critical. I don't think I would have been willing to to come forward, you know, without having someone like him who was in the position of prior a prior author to to help guide along where we are today.

And hopefully, that's in a landing spot at least for today for this committee that you can support with an aye vote. The limits and audit requirements currently in place as the author of Senator Jones just said is really what's at issue here.

And the bill, we think, represents a narrow targeted reform, maybe a beginning of a a longer conversation. We'll see how the conversation goes in the legislature. And with that, as as the Senator said, we have witnesses. I think he already introduced them and I'll I'll defer to them at this time. Again, thank you to the chair.

Thank you. You all will have a total of five minutes. Okay.

Thank you, madam chair, and it's a pleasure to address the committee. I am Richard Fox. I'm a California licensed physician, a board certified pediatrician, been practicing for forty eight years, Also a California admitted attorney. Parents sometimes contact me seeking medical exemptions from the immunization requirements for school attendance. I decline.

I uniformly decline for several reasons. The first is that I know a number of pediatricians who have lost their medical licenses for writing such exemptions, including one who is a law client of mine. Such punishment is obviously intended not to correct but to deter doctors from writing such exemptions. In the law, we call this an in terrorem effect. It works.

I won't go anywhere near writing such exemptions even when they're appropriate because other than immunodeficiency and anaphylaxis, the criteria are too vague, arbitrary, and controversial. And the penalties for being wrong, investigation and loss of license, are too severe. Sometimes other doctors ask my legal advice about writing medical exemptions. My legal advice is simply don't ever write an exemption for any child. It's not worth the risk.

There are too many landmines with no clear guidelines and no safe harbors for medical exemptions in California, so you can always be second guessed. It's not worth the risk. Just send the patient to an infectious disease specialist at an academic medical center and let them take the risk. Taking that risk is a good way to ruin your career and end up financially ruined as well. Why would any sane doctor risk it?

Most California pediatricians work for large risk averse organizations. Why would those risk averse organizations let their doctors write immunization exemptions and expose the organization to costly investigation. Even though California law provides on paper for medical exemptions, the system for doing so simply does not work in too many cases. SB 1377 restores balance, the ability for physicians to practice individualized care, and ensures families with legitimate medical needs are not left without options.

It would be greatly improved with clear guidelines and safe harbors for doctors and eliminating the loss of licensure as a penalty.

I urge you to support SB 1377 with a less vote, yes vote and help restore that accessibility. Thank you very much for your attention.

Thank you. You have about two minutes left.

Thank you. Chairwoman and Senate Health Committee members, My name is Amy Baughn and I'm the president of PERC and the mother of four. As as the sponsor of SB 1377, I respectfully bring to your attention the serious and ongoing problems with California's current medical exemption systems and the negative impact on children. California's children are suffering right now. For seven long years, a minority group of our youngest demographic, medically vulnerable children, have suffered discrimination.

They are being denied equal access to education because valid medical exemptions are either unattainable, grandfathered exemptions are unrenewable, or the child is subject to retroactive revocations that debilitates them and their families with interruptive school removals with no solution in place to remedy the discrimination despite having legitimate medical needs. Over the past five years, over 4,000 children had exemptions revoked with 87.5 of the appeals with those exemptions being denied without distinguishing between form errors or medical reasons.

Children are denied and refused medical care from institutions and offices, and these problems are all interconnected. A child cannot obtain an exemption if the doctor's discretion is restricted. A doctor will not write the exemption if the audit system threatens punishment.

A family cannot protect the child if the exemption is later subject to revocation by an administrative panel. A simple change to one part of the law does not solve the broader problem because each part reinforces the other. Though this issue is severely stigmatized, reform is not only needed, it's necessary and incumbent upon all of us to ensure our children are not the victims of a poorly constructed system that effectually doesn't work for them. So the issue at hand is whether children can obtain legitimate medical needs.

Thank you

Okay. Well, thank you sincerely.

Thank you so much to, those who come to speak as lead witnesses in support. We will now open it up for anyone in the audience who would like to speak in support of this bill. Please just state your name, your organization, and your position only.

Hello. Tara Thornton, president, Freedom Angels Union, in strong support.

Thank you.

Hello. Denise Aguilar, vice president president of Freedom Angels Union in support.

Thank you.

David Bullock representing the Moms for Liberty California Legislative Committee. Thank you. In support.

Thank you.

Thank you.

Jessica Gavrra with Informed Policy Advocates in strong support of this bill. Thank you.

Hello. I'm doctor Azadeh Khatibi. I have a master's in public health and I'm in strong support of this bill.

Thank you.

Thank you.

My name is Kris Dukes. I'm with Informed Policy Advocates, and I support this bill.

I am Darrlene Alquiza, CEO of Informed Policy Advocates and strongly support the bill.

Thank you.

Thank you, madam chair. Tom Sheehy with the Sheehy strategy group here today on behalf of the informed policy advocates. We thank you for bringing this forward. We're here in support of SB 1377 and thank the author.

Thank you. Seeing no further individuals who would like to speak in support of this bill, we will now open it up to anyone who would like to speak as lead in opposition. If there are any witnesses that would like to speak lead in opposition, we will take two speakers. You may come here to the table.

And you have a combined five minutes.

Thank you.

Thank you. Good afternoon Madam Chair and committee members. I'm Doctor Dean Blumberg. I'm a pediatrician here in Sacramento.

I specialize in pediatric infectious diseases and I'm here to state my opposition to SB 1377 on behalf of the American Academy of Pediatrics in California representing over 5,000 board certified pediatricians and the California Medical Association representing over 40,000 physicians in California and the California Immunization Coalition, a non profit public private partnership dedicated to achieving and maintaining full immunization protection for all Californians.

The recent immunization legislation in California which is, already been mentioned, SB 276 and SB 277, they've successfully addressed the previous epidemic of fraudulent medical exemptions that threaten the health and safety of California's school children. These measures work valid medical exemptions are being issued and the majority of these medical exemptions are for true medical reasons. The American Academy of Pediatrics has clear guidance on when children should not receive routinely recommended immunizations.

In my practice as a sane doctor, I see patients that meet these conditions.

I follow the mainstream guidance and I issue medical exemptions for medical reasons. The California Department of Public Health also follows these guidance. The system works, trained medical professionals have not lost the ability to issue valid medical exemptions. SB 1377 would eliminate the current oversight and enforcement mechanisms that are working to ensure that medical exemptions are issued for true medical reasons. There's no reason to ignore the history and return to the days before the system was fixed.

The time when a few fringe practitioners were issuing loads of medical exemptions for non medical reasons. For physicians who are writing medical exemptions for valid reasons, they've nothing to fear about them being reviewed and validated. Similarly, if a physician is issuing invalid exemptions, it just doesn't make sense to me to increase the limit to 10 inappropriate exemptions from five. If they're issuing a bunch of inappropriate exemptions better to have the medical board review sooner rather than later.

Even a small decrease in immunization rates can lead to the return of highly infectious preventable diseases as the current measles resurgence illustrates.

The COVID pandemic led to decreases in vaccine rates nationwide and this has resulted in more measles cases being reported in The US in more than thirty years. And the vast majority of these infections are in those who are unvaccinated or with unknown vaccine status. And remember, measles is not just a fever and a rash. It may result in complications including pneumonia, inflammation of the brain, and even death. Now is not the time to eliminate the system that works and does not need fixing.

On behalf of American Academy of Pediatrics in California, the California Medical Association, and the California Immunization Coalition, I urge your no vote on SB 2, 1377. Thank you.

Thank you. You have about a minute and fifty seconds.

Thank you. Thank you, madam chair, members of the committee. Angela Hill with the California Medical Association. In the interest of time, I'll just go ahead and say, to begin that the California Medical Association did proudly cosponsor the framework that we're discussing here today to ensure that medical exemptions are rooted in clinical standards of care.

And moving to the, arguments that children who were originally exempted from the statewide review process and now require a new medical exemption can no longer find a doctor willing to submit an exemption.

We are unaware of any physicians that are unwilling to issue valid medical exemptions. Should this issue be true, we do think that this should be a conversation with the administration, CDPH, and the licensing boards, not through this bill today, unfortunately.

We thank the chair for her work to propose amendments that would aim to resolve our serious public health concerns with this approach as the bill is drafted, but we still have concerns by increasing the allowable revoked exemptions from five to 10 in a year, for those that previously had no medical exemption review because of the grandfathering language in SB 276.

Passing this bill today would insulate providers from referral and review that would need to have that by their licensing boards, and we think it gives validity to an argument that the system is broken when it is not. And for those reasons, we respectfully urge your no vote today.

Thank you.

Thank you. Still had a little bit of time left. Okay. At this moment,

Apologies, if I may, for the committee. We have provided a technical witness from CMA, Alicia Chance Sanchez, our chief strategy officer. Thank you.

Thank you. At this moment, we will have anyone else who's in the audience who would like to, speak in opposition to this bill. Please come to the mic, state your name, your organization, and your position. Thank you.

Thank you, Madam Chair. Ryan Spencer on behalf of the California Society of Pathologists, the California Radiological Society, the California Podiatric Medical Association, and the American College of OBGYN's District nine, all in opposition. Thank you.

Thank you very much. Vanessa Cajina with KP Public Affairs on behalf of the California Academy of Family Physicians here in opposition.

Thank you.

Thank you.

Thank you. Angela Pontus on behalf of Planned Parenthood Affiliates of California in opposition.

Thank you.

Good afternoon. McLane Rosanski with the Alameda County Office of Education in Opposition. We apologize for the late submission on our letter.

Thank you.

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

Good afternoon. Farrah McDaid Ting on behalf of the County Health Executives Association of California reviewing the amendments but opposed.

Thank you.

Good afternoon. Kamrynn Lawton with the California Immunization Coalition, and we respectfully urge a no.

Thank you.

Good afternoon, Chair and members. Carmen Nicole Cox with the Cox Firm for Law and Policy on behalf of the California Children's Hospital Association. Appreciate the amendments. We remain opposed. Thank you.

Thank you.

Doctor Haley MacNear. I'm a Sacramento OB/GYN in opposition to this bill.

Thank you.

Eric Dowdy with the California Dental Association in opposition.

Thank you. My name is Tao Lei. I am an OB/GYN in training and I'm in Opposition. Thank you.

Doctor. Kelly McHugh, Sacramento Area OB/GYN speaking in Opposition.

Thank you.

I am Patrice Trowbridge, also an OB/GYN in training and strong opposition.

Thank you.

Doctor Juliana Melo, Sacramento OB/GYN, also in opposition.

Thank you.

Doctor Shilpa Mathew also is practicing OB/GYN in Sacramento in strong opposition.

Thank you.

Kathy Mossberg on behalf of the Public Health Institute, opposed.

Thank you. Alright. Seeing no one else in the audience, moving to the mic to speak. I wanna acknowledge all the OB/GYNs out in the audience. I know they're here for their lobby day.

I will now bring it back to committee, Senator Menjivar.

Thank you, Madam Chair. I'll take the a stab here at the, start of this conversation here. So currently in California, we have a range between 93.7 to 97 percent in terms of vax rates of a variety of different vaccination rates. Correct me if I'm wrong, it's an a grade in the state of California. So I'm wondering what we're trying to fix if we already have one of the highest grading of vaccinations.

Why would we wanna do anything that could potentially lower the vaxx rates that we have in California? Senator, you know, one of your, supporters mentioned that our children are the victims of this system. But I would argue that victims of this, of this would be the kids who are actually dying from measles outbreaks that are actually occurring right now. Texas last year, I think, saw two kids die out of this who were unvaccinated. I think that is the ultimate definition of a victim.

You know, they're dying from a preventable disease. How do you outweigh given our our percentage of vaxx rates given the fact that, you know, California isn't immune to these outbreaks. We're seeing meso outbreaks. Shasta County has seen a huge rate, and ninety six percent of their cases are from unvaccinated kids. Why would we tamper with that?

That could increase our chances. Go back to what we saw in 2015, I think, in Disneyland with the outbreaks that occurred there. Overarching, why would we wanna change system?

A couple of things. Generally, this specific bill is very was originally very narrow narrowly tailored just to affect the few number of children in California that are medically at risk for receiving a vaccination, period. With the amendments that the chair has proposed, we're even tailoring it even more narrow now to impact only those children that currently have the vaccine exemption. So that they can continue as they progress through the school age into the next tier of either junior high or high school.

They can keep those those exemptions.

So I appreciate the chair's very diligent work on this. She's been very gracious in educating me on a lot of this. And so that's why the two coauthors, my, Senator Cortezi, Senator Allen, and myself were able to come to, what I believe some agreement with the chair on on where the bill is gonna is gonna do after today.

And it adds five more MEs. Right?

I believe that's correct. I wasn't sure that that was actually gonna get into the amendments, but I think the Sharon and I had discussed with the other two coauthors.

Confirming that is correct.

The amendments would allow for another five medical exemptions for those who had had exemptions in the past?

So again, it goes to currently the with the amendments to bill does if I'm if I and and I'm sure if I say this incorrectly, please please correct me. It doesn't give new medical exemptions to new people. It extends the ones that have already been issued.

So those who have it right now are unable to get renewed right now?

That is that is my understanding.

With the amendments that you took, those who haven't right now will be able to get renewed as they go to the next tier of education.

Correct.

So let me clarify because

Yeah. That

I don't generally like to speak before other members of the committee are able to speak.

Appreciate the authors, all of the authors coming to speak with me yesterday. This is a big issue, a big bill, and this is honestly not how it should be done, and we talked about it. This is not something that should have been dropped in on the very last day of language being dropped into a bill. This is not something that you have conversations with the committee and the chair about less than twenty four hours before the hearing.

From speaking with committee staff, they had heard about issues for people who had had medical exemptions finding difficulty getting doctors who had not already maximized on their five to give them an extension.

I informed this committee staff and the, the authors that if there was any potential amendments that I could potentially possibly in any kind of way put through, it would be this. Right. But this is not the right way of doing it. And had I not said that to you, I would not be supporting this. If there is an issue, this is not the way to handle it.

If there is an issue with the process, then what you do is you have hearings so that those who are in charge of the process can come before and present real data. I just heard something that 4,000 had been revoked. That's not true at all. According to CDPH, since this has gone into effect, 30,274 medical exemptions have been issued, 19,675 were reviewed by CDPH, only 2,869 were revoked.

This is why we have actual hearings with the people who are in charge and have the real data before we start moving on significant issues like this.

So since I'm talking, I guess I'll keep going.

Well, ma'am madam chair

I'll open it up.

I think it's entirely appropriate that you, yeah, I I I think your comments are

Well, I I usually like talk at the end. That's why I'm

I know. I know.

So but I'll just since I jumped in. You know, there was a statement about, at the begin when this bill initially went through or these policies initially went through that there was a promise made that every child could get an exemption, and I don't see where that promise has not been kept. And I was even thinking, you know, this doesn't even restrict only pediatricians or family practice providers. Anybody can give a medical exemption. I can give a medical exemption.

So to say that that promise has not been kept, I think, is a very false statement. Providers can choose whether or not they want to give an exemption, and the thought of having some kind of oversight does not deter physicians in any other way. When we write narcotic prescriptions, we are very much scrutinized. It goes into the Cures database. And if we have written too many, we are flagged.

But I don't think one surgical patient or any patient who needs narcotics to help with their chronic pain is complaining about the fact that they're unable to get their prescriptions, that because there's an oversight, now they won't do it. Oversight protects overdoses, people getting hooked on medications. Just like this oversight is actually protecting our children, not only those who are getting it, but that those who are around them in their schools and other places.

I believe that this is something if there is an issue that we need to have hearings on to figure out what the right method is if we need to move at all. Anecdotal stories, people coming up to you on the street, it does not give you a full picture of what's happening.

Because for every one provider that's saying, I don't feel comfortable, you've got 10 others that say it's working. So I I wanna I wanted to make that clear since I was, since it was being asked about the amendment. And even the number five, like, because it was less than twenty four hours, you just came up with that number. It's not anything rooted in actual data science facts, which is what I I like to move by.

Right.

And so in any other situation, outside of me having a conversation with you and Senator Cortese, I would not be supporting this bill. And so I don't want people to think that all of a sudden, this is something that I agree with because I think that the way in which we've gone about this is not the right method, and I can't even say for sure if we need to specifically change anything. But I know, Senator Valladares, you wanted to say something.

Well, thank you for bringing this forward in the bipartisan fashion that you did. I think it was it's really important to note that this isn't a partisan fight. That this is this is what I believe is is a bit of a trust issue. And let me just say this here, vaccines save lives.

Full stop. They are essential to public health. But there are there really are rare, real cases where a child should not be vaccinated. And those families deserve a system that works for them, not against them. And I wanna be clear about what these amendments actually do from my understanding because there's been, you know, a lot of, a lot of different, variations.

This bill does not eliminate oversight. It restores existing law and still requires annual review of the immunization data with clinical review by a physician or by a nurse when there are real red flags, like schools that have below a 95% immunization rate or providers issuing high number of exemptions. And that's not no oversight. That's targeted oversight.

So the real question here is is a bit of balance and I can understand, from the chair how, especially on an issue so controversial, how we want data and we want time to review that data.

And those are great points to bring up. But we also if we create a system where every doctor feels second guessed, where liability increases, and there are families with legitimate medical needs, that can't access care, then we don't build trust. And there is a balance that needs to be struck. I do have a question for for doctor Fox. I was reading the support letters, the opposition letters, and I know the bill has changed, you know, pretty significantly.

But doctor Fox, can you the opponents were claiming that the bill does dismantle oversight. And can you also speak to the chair? It wasn't a question, but to her pointing out that this five came out of nowhere. How was that decided on or was I'm not sure if that was

if that's So I I I'm I'm sorry. I wanna so when I was saying the five, I'm not sure if you have the latest amendments because, again, this was a very last minute thing. And so when I said the five, it was the five that I came up with yesterday for the amendments. So I don't think that's something that doctor Fox could

Well, and I it said and or the author may be able to explain more. That was mine.

Okay. I came up with it out of thin air. You're the author of the five. Okay.

Okay. Chairwoman has adequately answered that.

That's what I was saying.

That part answered.

Why I was saying that this is something that really should be more data driven and not something that you just kinda pull out of the air.

Got it. So doctor Fox, if you'd like to weigh in a little bit about the still sent the reality of liability that doctors feel pressure.

If I understand your question, I understand this bill does not eliminate oversight, you know, quality control, that sort of thing.

What I'm asking for is to decrease the risk from the doctor's point of view of that oversight process by clear guidelines, safe harbors, and a more of a collegial educational process where if a doctor doesn't get an exemption exactly over the target, that they can get some feedback as opposed to an investigation where they have to hire a lawyer, take a, you know, a lot of money out of their pocket to fight and invest and audit an investigation or lose their license.

It's just too draconian as you said.

So to the opposition, are you aware of any, you know, stories from doctors who have had to go through this process and what that process looked like for them?

I can tell you that I read the newsletters that the medical board of California puts out that speaks to all the disciplinary action that's been performed by them and you can see the ones that have been performed for doctors who wrote, invalid excessive invalid medical exemptions. Some of them, have voluntarily surrendered their license. Some of the physicians have had remedial actions taken against them where they need to take course for documentation or other purposes so it varies depending on the offense.

I don't know the details of the individual doctors but I'm sure the medical board has that information.

I can give you that information. Okay. Since this was implemented, 26 have been this 26 physicians have been disciplined by the medical board. Two have surrendered their license, nine went on probation, six had public reprimand, and nine had public letters of reprimand. So only two no longer are licensed to practice here in the state of California since 2021.

And do we know how many that 26 of of those that were disciplined, how many went through an actual audit?

So, like I said before, there are over 30,000 medical exemptions that have been, issued since this when it took place. Over 19,000 were reviewed by CDPH. 28 a little over 2,800 have been revoked. 831 were appealed, and a 109 of those appeals were upheld.

And I think your questions are extremely valid, which also shows why just doing a bill like this without having the information, without having those sitting here at the table, like an informational hearing that we have, to answer those questions before we create a policy is extremely important.

So I'll just I'll close with this. It is my understanding that this bill is gonna be going to business and professions next where, you know, hopefully, someone from the medical board, will be there to answer questions. But it's an important conversation. It's a big conversation. I appreciate both your leadership and Senator Cortese's leadership and willingness to take this on.

I'll move the bill when it's appropriate. And let's continue to work on this together as well.

Thank you.

Thank you. Senator Padilla.

Thank you very much, madam chair. Just some kind of bring I was not personally present, but I was I'm monitoring some of the testimony, but I was here from another committee. So forgive me if some of my questions seem basic or redundant, but bringing it back to fundamental purpose of the bill. Either you or your primary, witnesses. What is the exigent, urgent, immediate community public health community public health concern issue that this bill addresses?

Not process, not scope of practice, not the process that allows for the obtaining or appealing of a medical exemption approval or denial. What is the urgent exigent pending public health community health issue that this bill seeks to address?

Senator Padilla, if if it's okay, I would like to answer that question in relation to the amendments that the chair has proposed and that I've agreed to accept because that's a different answer from the original language of the bill. Would that be okay?

Absolutely.

Okay. So the amendments that we're agreeing to accept, after discussions, very, good discussions with the chair and the two co authors, is the the children that have currently have medical exemptions as they age out of elementary school and into junior high school and junior high school to high school, they lose their exemption. So the chair has and that she educated me on that. With her amendments, the the committee's amendments, we're protecting those current medi, medical exemptions for vaccinations. It's that simple.

Okay. But the balance of the proposed language in the bill remains. Right? And

No. No. We're we we she's we've basically rewritten the bill between yesterday and today.

Alright. If I get clarity on pending

So again, this is what

And and while she's looking at her notes, I wanna say unequivocally that I agree with the chair that this needs to be a process and and there do need to be hearings. And that was something she brought up yesterday that both the co authors and I agree. And in retrospect, we should have started this conversation in January.

That's why I'm comfortable with where with the amendments today moving a much smaller bill forward that protects child protect children today that already have those exemptions, and then start this start the bigger conversation to address those other concerns that have come up.

Right. Okay. So this is what the amendment will say. This is what will trigger a review. Physicians and surgeons who have submitted more than five medical exemptions in a calendar year for children who do not have a medical exemption that was issued on or before 01/01/2020 or physicians and surgeons who have submitted more than five medical exemptions in a calendar year for children who do have a medical exemption that was issued on or before 01/01/2020.

That is, the bill. To Senator Valladares question, the five was just a five.

My understanding is the original five was just a five Right. Too. I mean, I I don't know that there was any public hearing on the original five.

Yeah.

So to your point.

Which is, again, why we should not necessarily be doing it this way, but but here we are. Oh, sorry. Senator Menjivar.

Thank you, madam chair. And on your point about the informational hearing, you know, to credit one of my constituents that's in me too supportive of this, she asked me for a hearing on this very topic last year. So I would say and when I when I was here, sorry. I would say that one of those requests were coming did come through.

But I do have a a question to CMA or I think the TA, if through the chair, if I can ask this question to the TA, and she might be best pos, poised to answer it.

In the perspective of the providers, what does it mean to have four more, MEs approved for each provider? And if I understand correctly, right now they get four. They do get to do four. If they do a fifth one, it gets flagged to CDPH. Correct?

Right. The fifth, exemption gets reviewed. Reviewed. That doesn't mean, however, that they are revoking the exemptions. They're just reviewing them to make sure that they align with the AAP standards.

And most of the exemptions that are reviewed continue to move through the process I mean, continue to be intact. It's when the exemption that's been submitted does not align with the standards that it would then be revoked.

So a provider, in theory, could do an endless amount of MEs, but they're just gonna be reviewed after the fourth one. And if they're all valid, they're all gonna get approved. Correct. Okay. So adding five more, in theory, doesn't you can you still get five you still get an endless amount if so long as you're okay with it being reviewed.

But now

It it I yeah.

Again, this is exactly why this should not happen this way. Should not happen this way. Conversation should be had.

While I recognize that, this is the only opportunity we have right now.

So so just as as we understand it, it would be saying that well, so after the review, if you then had five revocations. So there's a five for review, and then you can be approved for however many. But if you have five revocations, that is when there's a referral to the medical board. This, as we understand it, would be adding another five revocations.

Without being sent?

Correct.

Okay. So so that's and I guess I would say most physicians are not submitting more than five. There are some practices who have a patient population by virtue of the care that they're providing would be providing more than five, but many are providing less than five. So they're not ever having their exemptions reviewed. And that the physicians that we've talked to have not had issues with this process.

I think it's also important, if I may interject real quick, it's current exemptions. So the five may be even a mute point because we're not issuing new exemptions. These are extending current exemptions under the current amendments.

And to you, sir Senator, or to your I would like through the chair if I could ask the parent here. You and your your peers what you're hearing from providers. You know, CMA is sharing that what their members have not submitted any concerns of the program. You on the receiving end have a different perspective. So you're hearing concerns.

Yes.

But Providers are not providing another ME.

Yeah. I'm so so the the chilling effect and the fear that providers have is so severe related to the third party auditing. It's not that they don't care about their patients or that they're scared that they're doing something wrong. It's the third party review that triggers this chilling effect for them that they might lose their practice for an unfounded investigation.

And the thing that physicians are telling us too that they're so scared, they were unwilling to even send in letters of support for the bill, for SB 1377.

And that wasn't just a few, it was many. And it was an entire organizations that represent doctors and physicians and surgeons where, when we put out and ask for support, they were so scared to even send in letters.

Because what they said, the reason why, if I could share why, they said that if they sent a letter in in for support, they felt like that could potentially trigger some kind of target on their back and that just by sending in a letter, it could be sent to the medical board just because they support the bill. But in everyday practice, the physicians that we're hearing from as well, they won't this this is what our experience is. They won't write medical exemptions.

Some of my colleagues called about 800 doctors. This was a few years ago and asked if they would be willing to write a medical exemption for anaphylactic shock, which is one of the things that seems to qualify. And out of all 800, it was about 880, plus doctors, none of them were willing to write a medical exemption. So I think there's a category of of of they're unwilling for all these different reasons. They're scared.

And also there's a category of some that can't. And this is my understanding so correct me if I'm wrong but in the current law there are physicians that are completely disqualified from writing medical exemptions at all if they're on a list of either investigations or disciplinary action from the medical board. And so my understanding is that's a very, very large list of doctors that are automatically disqualified from writing exemptions at all just for that reason when it's completely unrelated to medical exemptions.

And so that was in the that was in the committee report as well.

Yeah. No. So I again, this is why we need to have the people who actually have the information here in front of us and from the departments. I've already went through the numbers of those who were on probation, those who had, public reprimand, those who had a public letter of reprimand, and the two that had to surrender their license.

So I I think we're getting into areas where we don't actually have data nor the experts to back what is being said. Senator Naveed? Can

would you mind, both from CMA and Doctor. Fox, can you clarify that when when you reach, issuing five exemptions, your an audit or review, whichever you you wanna call it, is triggered. Is it just a review of those five, exemptions or is it a review of your entire patient portfolio?

Yeah. That's a good question.

Doctor Fox then CMA.

Well, I can speak to that very briefly because I just don't do it. It's never come up for me. I don't do one much less five.

So I can read from what is current statute. Clinically trained immunization department staff member who is either physician or surgeon or registered nurse shall review all medical exemptions. Okay. Just the exemption.

So I can read from what is current statute. Clinically trained immunization department staff member who is either physician or surgeon or registered nurse shall review all medical exemptions. Okay. Just the exemption.

Okay. Seeing no further questions or debate, senators. Okay. Senator Padilla.

I would just note. Madam chair, sorry. I think I've seen the distinction in the language on the amends, and there is a narrowing of that process. And then without to perhaps the chair's broader points, a sufficiency of data to justify that in terms of its operational impact. So that's it. Second, I just note, I don't hear an answer to the primary question here because ultimately, at the end of the day, this is about community public health and all the unique attributes therein, and there is a reason why these constructs are carefully put together.

There may be another a number of other elements your bill seeks to address. They some of them may be legitimate. In my view, from a community health impact standpoint, I don't see it. So I'm not gonna be able to be supportive of the bill today, but I wanted to put that in the record and I appreciate your work. Thank you, Madam Chair.

Thank you. Seeing no further discussion or debate, Senator Jones, would you like to close?

I'll close after Senator Cortese.

Let me just, first of all, say that I agree with everything the chair has advised today and has advised the same things to us yesterday in terms of having an oversight hearing and or informational hearing, structure hearing to get into this broader issue and even the issues that are before us today with an appropriate deep dive. I will say that the data that's needed to support these amendments is common sense because this was initiated in the middle of the pandemic.

The number five according to one of the co authors is one of our current colleagues was relatively randomly come up with. That was before 2020. It's now 2026.

You have families coming into physicians where an older child, older than one who wasn't even born yet during the pandemic, are coming forward and saying I need an immunization renewal for my child who received one from before, and now I need another one for the baby that was born in the meantime. And we have a system that's so constraining that if that doctor is already at this low triggering number of five is essentially gonna send those those patients away in many cases.

I don't think that's anecdotal. I don't think that's without data. I think that's basic actuarial information that we all know on a common sense basis day to day.

It's not as if we have suddenly stop propagating more children. I've seen that right here in the legislature among our own colleagues. Where do they go if doctors are unwilling to surpass the threshold? So this I thought the chair's recommendation was absolutely spot on, which said, look, that kind of situation shouldn't happen. The five should not should not essentially be counted twice for a child who's already received a medical exemption.

And unless we're gonna go back and call out all those approved medical exemptions, those should continue to move on. And those five should not restrict the next child in that family from getting an exemption at all if it's needed on a medical basis. How many is that? I don't know. But I have a nephew that has a condition that one of the witnesses described.

I would not want him to be in that situation of essentially having a mandated vaccination to go to school that might kill him. And so I do think that's an urgency Senator Padilla, and I don't know what greater urgency there could be than making sure that for the sake of the 97% that can have exemptions, that two or three percent risk their lives. That's to me the ultimate urgency. Thank you.

Thank you. And I think we've kinda parsed this. There's a bright line between the original language and the new language based on the leadership of the Chairwoman, and her scientific expertise. And, I'll add political expertise as well, to get us to the point where we are today, where I believe we have a bill, that I'm comfortable moving forward.

I hope the chair is still comfortable moving forward. And we've got a long process. I joked if it's okay that I with her that I she wants to do an oversight hearing. I joked that I'm termed out, and she said it doesn't matter. I'm still coming.

I think we've got a lot of work to do. I think the bill is narrowly tailored enough today that we should all be comfortable moving it forward and looking forward to the amendments being accepted and then having the conversation in business and professions next week. Thank you very much. Ask for an aye vote.

Thank you. Seeing that we have no quorum, we will move on this bill when we do have a quorum present. Do wanna reiterate that my support is only because I had a conversation with you and I gave you. Not that I think this is the right way in which we should be moving.

I appreciate that. Welcome.

Now we will now move to file item number eight, 995, by Senator Perez.

Well, alright. Good afternoon everyone. It's nice to see you Madam Chair and members of this committee. I would like to start off by confirming my acceptance of the committee amendments and thank the chair and staff for working to make SB 1089 a true valued benefit to the state employees and ultimately to all Californians. Today, I want to have a frank conversation about weight.

Chronic weight disease is a serious problem in The United States. Of the 39.5 million people in California, approximately 24.5 million adults between the ages of 18 and 64 years old living in California suffer from some sort of weight issue. Being over a healthy weight comes with many challenges such as precursors to cardiovascular diseases, diabetes, neurological disorders, chronic respiratory diseases, and digestive disorders. Additionally, chronic weight disease extends beyond the need to lose pounds.

It can also contribute to 13 types of cancers.

Some of which are colon and rectal cancer, gallbladder, renal cell carcinoma of the kidney. I may need the chair to help me with some of these, words. Liver, ovarian, and also thyroid cancer. In addition to types of cancers that a person, suffering with chronic weight disease may experience, there's also significant over two hundred core morbidity conditions that also apply. Things like high blood pressure, heart disease, susceptible to strokes, fatty liver disease, diseases of the gallbladder and the pancreas, and kidney disease.

This one I may need help with madam chair. Glucan gain, a peptide GLP one receptor and antagonist are a class of drugs such as semiglutide and trizepatide that mimic a natural gut hormone. Stated more simply, like my language, GLP ones can work to stimulate the insulin secretion, thereby suppressing an appetite and delaying gastric emptying to promote significant weight loss. Let me say it even more simply. What that means is not feeling hungry and not feeling hungry most of the time.

GLP ones are demonstrating more and more the capacity to improve the health in a variety of areas even beyond weight loss. Recent studies have shown they can help with cognitive and behavioral health, lowering risk of heart attacks, stroke, liver disease, and potential benefits against dementia and Alzheimer's. Chronic weight management can be related to a reduced labor participation in terms of earnings, increased early mortality, absenteeism, disability, and healthcare costs exceeding $1,000,000,000 and a 2.6% reduction in California's gross domestic product.

Barriers to the reduction, maintenance, or elimination of chronic weight disease come down to ultimately access and cost. So why did SB 1089 need to take this approach?

Frankly, I met with health plans. I brought forward a bill last year and the health plans essentially told me they provide medications and services that employers require. So, CalPERS is the largest pub largest public pension fund and manages health benefits for more than 1,500,000 public employees. As the largest purchaser of public employee health benefits in California, the program provides coverage to over 1,200 public agencies and schools.

For this reason, SB 1089 would support and encourage and actually require that CalPERS would offer, not require of every, health plan, but actually offer that they would have available similar to if a person needed vision.

Person may pay more to have VSP. A person may pay more to have dental. A person may choose to pay more for long term health care. This is something giving the individual, the worker, the opportunity to choose based upon their health program whether this would be something they would want to pay a little bit more for to improve their livelihood. Recently, a federal executive order was authorized by the most favored nation prescription drug pricing.

California can lead by offering competitive pricing through CalRx at an affordable price. This would allow CalPERS, the largest state employer, and 29% of California adults to receive reduced costs and employees would be thereby more productive and creating a workforce savings. Now, I'm gonna speak a little more personally. I think it's important in the work that we do that we speak truths. And I think since I'm working on this particular bill, it's important that I tell a little of my story.

My entire life I was never thin. I always participated in sports, very aggressive sports all of my life despite intense, regimens, playing basketball in college, trying out for the Olympics, and being in the top 20 guards in the nation. Weight was always something that was on my mind. After having both my mother and father, diagnosed with diabetes, I began to think a little more seriously about what the relations to weight meant.

It was only after my mother was diagnosed with esophageal cancer and going down to weights of one fifteen that she was now removed from not having diabetes.

So clearly, there was some correlation to her weight and how that related to also her vulnerability with diabetes. My physician, I had, subsequent tests. My normal annual exam, which has now become more like two years instead of one year. I'm working to do better, doctor Weber. I promise.

My physician conducted the various tests and said yes, based upon my numbers, based upon my BMI, my blood, I'm gonna get an updated test results and personally present it to the chair, hopefully before our summer recess to show her my results. But I'm happy, well let me before I get to the end point. So my, physician recommended that I would have a prescription of Zepbound.

My insurance company denied it and said that they didn't cover that prescription and they would not reserve would would not reimburse for Zepbound or any other GLP-1. So I was stuck on my own.

Here I had a pre diagnosis of potentially being susceptible to diabetes based upon my results, my test results. And I had a choice to either continue to gain more weight, which is what was happening. Or, to wait until I became actually diabetic to then be qualified to have this medication. So what happened, my physician prescribed Zepbound. So I had a choice of either paying cash, which is what a lot of people unfortunately are stuck doing.

That cost has been in the excess of over $1,000 a month. Or I could choose to purchase a compound. And compounds, I don't want to get in a debate with the compound people. So I will shy away from that. But, most feel that it's probably better if you could afford, the brand that that would be better, based upon, how the medications are combined and the, pharmacies being regulated and all of that.

So because based upon money, I chose to spend over $600 a month on a compound. Most people cannot afford $600 a month. We're talking about that's that's like paying for a car. And in some cases, people that's actually paying for their rent. So prices have gone down a little bit, not enough.

I now pay direct, for the brand, and I'm still paying over $450 a month. It's not fair, in my opinion, that individuals who receive Medi Cal or other, insurances had the opportunity to have a prescription at a lower price, approximately $249 and half of that was covered by their insurance. So now we're talking about paying a $125, and individuals who had the same situation would have to pay more. And oftentimes choose that they could not receive the medication.

So what is SB 1080, 1089 about?

It's about that I started Zepbound on, August 15. And dating to April 11, I've lost 42 pounds and thirty three weeks. That's averaging 1.27 pounds per week. So this was not SB 289 is not about me getting a prom dress or going to the Academy Awards or just wanting to look cute in a bathing suit. This was about, even though I would like to do all of those things, I must admit.

This is frankly about people who have difficulty in suppressing an appetite despite tremendous exercise are still unable to suppress their diet to the point of being able to, when you're full, feel full. And that is now what happens with me. When I eat, I actually feel full and I stop eating. Whereas before, if you're not feeling that I'm full at that point, sometimes you've still eaten until you're really to the point that you're full.

So I respectfully ask for your aye vote for SB 1089.

We have accepted the committee's amendments gladly, and we look forward to offering at least four state employees to begin to have the same right as anybody else would have to medication to help them. But what we've also done in this bill is we have said to assist with CalRx that they would then begin to partner with manufacturers, whether it's generic or the brand, to be able to offer ultimately on their discretion whether this medication would be available to all Californians.

I would say as a member of the budget committee, I have put in a budget request for funding for CalRx that they could in fact do the process of being able to offer GLP ones to not only state employees but ultimately all Californians if they so choose. So with that, I respectfully ask for your aye vote.

Thank you. And your witness has a total of five minutes.

Thank you so much Madam Chair, Madam Vice Chair, members of the committee. My name is Cher Gonzalez, and I have the great honor and privilege to represent the American Diabetes Association. We are in support of SB 1089. We are not the sponsors of the bill, but we are in strong support and we are, of course, grateful to the esteemed author. The bill ensures that California state and local government employees have access to GLP-1 medications.

Treatments that represent one of the most effective tools we have to prevent and manage type two diabetes. These are not cosmetic weight loss drugs. They improve insulin sensitivity, reduce blood glucose, support healthy weight loss, and cut the risk of developing type two diabetes by as much as sixty percent in people with prediabetes. California has a diabetes crisis. More than 3.5 million adults already live with diabetes, and another 10 million adults in California live with prediabetes.

The toll is enormous. Over 40,000,000,000 a year in healthcare costs and lost productivity. Prevention is our best chance to reverse this trend. And GLP Medicaid GLP-1 medications allow us to intervene before diabetes develops. Yet, too many Californians who could benefit cannot access these treatments because insurers exclude or severely restrict coverage.

That inequity worsens health disparities, especially in communities of color and among lower income families who are already hardest hit by diabetes. By requiring coverage for GLP-1 medications, SB 1089 will save lives, reduce health care costs, and move us to true health equity. The science is clear. When people can access proven prevention tools, we prevent disease, not just treat it.

On behalf of the American Diabetes Association, I urge your aye vote on SB 1089 to give more Californians a fair chance to stop type two diabetes before it starts.

Thank you.

Thank you. If there's anyone else that would like to speak in support of this bill, please come to the microphone. State your name, your organization, and your position. Thank you.

Madam chair, members, Tim Madden representing the California Chapter of the American College of Cardiology and the California Rheumatology Alliance in support. Thank you.

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

Thank you.

Maryal Concepcion family physician. I stand in support. Thank you.

Seeing no one else coming to speak in support, if there's anyone in the audience that would like to speak in lead opposition, this is your time to come forward. Seeing no one, if there's anyone who would like to do a me too on opposition, you can come to the microphone. Please state your name, your organization, and your position. Seeing no one, we'll now bring it back to the committee. Senator Valladares.

Thank you for your leadership on this. I also wanna say happy birthday to you and to my daughter who share the same birthday. And I'm happy to move the bill when it's appropriate.

Thank you.

Senator Menjivar.

Senator, just to add that, last Thursday during budgets up there in health and human services, I asked a question to HCAI's director Landsberg on what else CalRx was gonna be looking at. And she mentioned GLP-1. So I think, you know, we are already the department is investigating this as a potential of another treatment that we can invest in to make it more affordable to people. So hopefully get some good news out of that soon.

Yes. And hopefully, SB 1089 will push them a little in that direction.

Thank you. Senator Smallwood-Cuevas.

I also want to thank the author for bringing this bill back. I believe in the science of GLP-1. I'm a living experience of it, and I feel so much better. I've had so many of my relatives pass away from complications of diabetes, and I really appreciated the witness's comments. And for me, I think about, you know, fast forward thirty years from now.

I feel that we have the tools to save people's lives today. And this is, an in an invention, an American contribution that is going to save people's lives and also save the state money down the line as we are able to treat people through this medication. And they won't develop these complications that are far more costlier, down the line. So yes, this is an important bill. It's a it's a revenue bill because we will save money as we invest in this treatment for many Californians.

So thank you for being brave enough to bring this bill forward and I look forward to voting for it today.

Thank you.

Thank you. Seeing no further, questions or comments, Senator, would you like to close?

Yes. One I'd like to say that, one of the senators here on the dais, I won't point the individual out. We were practicing for softball. And for the first time in my life, the, the the trainer, that we had said, you know, you need to run from here to the fence. And it was probably at least, I'd say probably about a 150 feet.

And for the first time in my life, I went to run and I could not run. And that was I said, this is ridiculous. I mean, I've always been athletic. And so I think it really spoke to sometimes you just have to get to the point that you say enough is enough. The problem is I was blessed enough that I could figure out how to scrounge up, you know, $500 a month.

But most Californians cannot do that. And we should not be in the position where people can't run a 100 feet or can't, you know, bend over without, you know, pains in their sides or whatever it is. People should all have the opportunity to be better. And this is proving people can do better. I did have one member who had a couple questions who's not here yet, but for the record I wanted to answer.

Are GLP-1s a lifetime medication? It was said to me as my physician, GLP-1s are just like anything else, blood pressure, whatever, in order to continue to suppress, the appetite. Yes. It probably is a lifetime commitment. And more people need to be honest about that.

Do you have to stay at the same level? You know, ten, twelve point five or 15? No. But certainly, it is a lifetime commitment. And I think, last year some of the insurance plans had expressed if they make this investment and offer this medication and have this cost, are people just gonna drop off, you know, two years later and then come back with the same situation.

So we do need to do a better job of making sure people understand that this really is a ongoing commitment. And the other question was asked, are there any side effects with GLP-1s? People, it is in their own medications. They note digestive issues, dizziness, fatigue, headaches, nausea, and a word I think you probably don't want me to say that starts with a D. But, you can guess what I'm saying.

We have a doctor. She's so sweet when I say these words. She's like, yeah, yeah. I've been there, done that. I would say for myself, one time in now, what, six, seven months, I had a little allergic reaction and that was I went to an environment that was a lot hotter, geologically, a place that was hotter.

And I had changed the levels, and since then I have not had any rashes. Every once in a while, I may be off schedule by one day than my normal everyday. I know I'm sharing probably TMI. But my point is is I want people to get to the point that we can be comfortable about saying what people are experiencing and that they can get better. And that's the bottom line.

So with that, I urge and aye vote on SB 1089.

Thank you so much, Senator Richardson. The motion has occurred by Senator Valladeres. The motion is do passed and we refer to the committee on labor, public employment, and retirement. Assistant, please call the roll.

Aye.

Senators Weber Pierson?

Weber Pierson, aye. Valladares?

Valladares, aye. Caballero, Durazo, Gonzalez, Grove, Menjivar.

Aye.

Aye.

Menjivar, aye.

Aye.

Padilla?

Padilla, aye. Perez, Rubio. Smallwood Cuevas.

Aye.

Smallwood Cuevas, aye.

Thank you. That vote has five. We will place that on call. I do see, Senator Stern in the audience, so we will go to file item number five, SB 1221. And you may begin whenever you are ready.

Okay. Thank you Madam chair. Switch gears here to a major Mental Health and Public Safety issue that is affecting not a huge number of Californians, but a very critical population that we need to be looking after. SB 1221 deals with a type of conservatorship called a Murphy's Conservatorship. And this is specifically for people who have, committed serious and violent crimes, like murder, rape, arson with injury, but that those crimes are related to a mental health disorder that they suffer from.

This bill seeks to address what we feel is now a gap and uncertainty in law that both the support and a very welcome and collaborative opposition both identifies a serious issue. Decision called In re Lerke, where the courts ruled that these conservatives who were previously under the wardship of the state could not be detained even temporarily while awaiting placement in Department of State Hospitals. The alternative to this is that these individuals are simply going to have their cases dismissed and released.

Now, we're talking about out of a total number, say, of mental health patients. Take for example, in LA County, we've got about 6,200 mental health patients.

And right now, 76% of those are Murphy's Conservatives. So about less than 1% of the population. I think overall within Department of State Hospitals, we're talking about 15% or less. So not a huge number of people, but a very important group of people that, desperately need care. I wanna really appreciate not just the chair, but the committee, the great Reyes, for digging into the details of this bill and really addressing, I think, some of the central concerns from the opposition.

I was reading through the California Behavioral Health Director Association's opposition letter, and before after talking in them before the hearing, and some of their central concerns is that we're gonna reach into the broader LPS process and try to get into conservatorships writ large. Committee has a very important amendment that we're accepting, that will clarify that this bill is only about these Murphy's conservatives, that we're not trying to impact the broader LPS population.

Likewise, the committee also has a important amendment that we're taking today, to address, this issue that, we don't necessarily want, there are limited state beds in the state hospitals, and we don't want to necessarily have these conservatives cut the line of other LPS conservatives waiting because we know we just simply do not have enough behavioral health beds in this state period.

I think it's a little outside of this bill issue, but there it that is an outstanding budget challenge and a resource challenge that I wanna try to remedy this year, for our county behavioral health directors and for our department state hospitals.

But here before us today, I think what we're trying to do is really improve the identification of who is awaiting these beds to make sure that they have access to treatment and that not to insert, say, the DAs into all LPS proceedings and give that sort of criminal dimension to what is really a health issue.

But specifically in these Murphy's processes to make sure that there aren't sort of abuses of discretion and that there are dismissals because of this In re Lerke, decision that send these people back to the streets, where they will very likely either do harm to themselves, do harm to others, or be victimized out there. These are individuals that are currently deemed dangerous by the court. That is why they are Murphy's Conservatives.

And so I think it's a problem that both the opposition and the support acknowledge. It is a hard one to solve.

It is not just gonna take this bill. It is gonna take resources too. So I would respectfully ask for your aye vote and I look forward to the conversation and again, appreciate the chair and accept all the amendments.

Thank you. You have a combined of five minutes for your testimony today.

Give it a shot. There you go.

May it please the Chair and members of the committee. I'm Matthew Greco on behalf of the one of the cosponsors, the San Diego County District Attorney's Office. I'm also a 30 year prosecutor and the author of the California Criminal Mental Health Manual. Of the over 1,100 conservatives in San Diego County, there are less than 30 Murphy conservatorships. These are convicted murderers and alleged murderers, attempted murderers, arsonists, and rapists.

The worst of the worst. At the time of the In re Lerke decision, San Diego had five murderers, and a sexual assault defendant all waiting for their designated placement to become available at the Department of State Hospitals. And lo and behold, in San Diego as in many other counties throughout the state, the public conservator was forced to scramble to find placement outside of a local detention facility.

Courts were forced to quickly identify alternative placements for high risk individuals, often without clear statutory guidance or without meaningful input from individuals responsible for public safety, the public or the victim or their families. The practical effect of lurking has been a profound statewide chaos.

Prosecutors, were required to litigate the placement of individuals and yet, as that was occurring, these proceedings frequently occurred without clear authority for the district's attorneys to participate in this rush process. Despite their responsibility legislatively, to protect the the public and represent victims' interest. Victims and their families were left without a voice in in proceedings that directly impacted their cases, leaving the victims feeling revictimized. SB 1221 directly addresses these challenges through targeted reforms.

The bill ensures that determination of grave disability and dangerousness are evaluated based on an individual's condition outside of a controlled treatment or custodial setting.

It also explicitly authorizes, access to conservatorship investigation materials to ensure meaningful participation in hearings as an advocate for public safety ensuring that courts receive a complete, informed perspective when making placement decisions. SB 1221 ensures that victims' voices are represented in decisions that directly affect their safety, protects the public, and protects the defendants that suffer from severe mental disorder and are placed in Murphy conservatorships.

Thank you. You have about two minutes remaining.

Afternoon, Chair Doctor Weber Pierson, members of the committee. Aaron Meyer, Associate Clinical Professor of Psychiatry at University of California, San Diego, speaking on behalf of the California State Association of Psychiatrists in support of Senate bill 1221. Great disability cannot be determined by a snapshot. A point in time assessment in a structured setting tells you very little about whether a person could survive safely in the community.

In those settings, basic needs are already met. So the real question is what happens outside? A proper determination requires a longitudinal view and that same flaw where dangerousness and grave disability is determined in a in a structured setting applies to people who may be in administrative segregation where they have limited opportunity to act violently. A housing decision designed to manage risk should not be used as evidence that risk no longer exists. These violence determinations are necessary because Murphy conservatorships are different.

They're different than LPS. They're not just about treatment. They explicitly require consideration of public safety and the conservatorship investigator is not required in their report to address public safety at all. Even the California public guardian has recognized this in their legislative platform that other agencies with a public safety lens would be better for these determinations. So we have also troubling examples of abusive discretion where decisions to exclude individuals from Murphy conservatorships were based on narrow interpretations of mental illness.

The nature of the offense or or even cost. So that's not a clinical standard and it's not a public safety standard. So SB 1221 introduces a necessary check and brings an additional appropriate voice into a process that is too often closed to scrutiny. It aligns decision making with clinical reality and statutory intent. This is a targeted common sense fix and I respectfully ask for your aye vote.

Thank you. If there's anyone else in the audience that would like to speak in support of this bill, please come to the mic. State your name, your organization, and your position.

Madam Chair, Members, Dan Felizzatto on behalf of the Los Angeles District Attorney's Office in support. I've also been asked to, state the support for the Crime Victims Alliance and the California District Attorneys Association.

Thank you. Seeing no one else wishing to speak in support, if there's anyone in the audience that would like to speak as a lead in opposition, this is your time to come forward to the table.

Good afternoon. You will both have a total of five minutes combined. Thank you.

Thank you, chair and senators, for the opportunity to speak to you today. My name is Amer Rashid, director of legislative affairs for the County Behavioral Health Directors Association of California, representing the leaders of the public behavioral health agencies that serve the mental health and substance use disorder needs of California's Medi Cal, uninsured, and underinsured populations. CBHTA respectfully stands in opposition to SB 1220, 1221.

We greatly appreciate the amendments discussed here in committee today and look forward to our continued dialogue with the author's office on the language in order to continue to mitigate our concerns. However, CBHDA remains concerned with the impact of including DAs in what is inherently a civil court process under LPS.

We appreciate the committee's proposed amendments to narrow the focus of the bill to apply more narrowly to Murphy's Conservatees. However, the entire premise of Murphy's LPS conservatorship is that the individual in question is too sick to even engage in a criminal court process. We also remain concerned regarding the concept of bed prioritization at the state hospitals. Counties are very aware of the challenges with finding suitable treatment options for, Murphy's conservatees at the local level.

And this bill will not change the array of options, but rather, arbitrarily restrict our ability to manage the flow of patients.

CBHDA is also concerned about the unintended impact of policy changes brought by, brought about by recent law suits. But we are concerned that this bill would only add to those challenges rather than resolve them. As our cons, it is out of concern of these unintended consequences that we will continue to work with the author's office once these amendments, and thank you all for your time today.

Thank you.

Good afternoon, chair doctor Weber Pearson and members. I'm Evan Fern, public policy advocate with Disability Rights California here in opposition to SB 1221. We appreciate the committee's work on proposed amendments. We look forward to reviewing the updated text, but our current understanding of the proposed committee amendments does not change our position. Changing California's bed prioritization structure would be disruptive and a misuse of resources.

Counties recently and carefully collaborated with the Department of State Hospitals and the California Mental Health Services Authority to develop the current allocation system. Counties are not equipped to handle this great of a shift at this time. Without first putting in place adequate supports to transition people to less restrictive placements, there's a real risk that LPS conservatees would fall back into cycles of homelessness, disengagement from services, and law enforcement contact. SB 1221 would inappropriately turn a civil proceeding into a quasi criminal proceeding.

The bill would give district attorneys unprecedented power over conservatorship proceedings, including access to highly sensitive and private medical records and reports.

If people are afraid that what they disclose in a conservatorship investigation could be used against them in court, they won't talk. This bill would also grant district attorneys power to challenge placing a conservatee in a less restrictive setting. The Americans with Disabilities Act requires people with disabilities to be served in the least restrictive setting appropriate to their needs. District attorneys, respectfully, are not qualified to opine on the appropriateness of various treatment settings.

The law already states that place, placement in a less restrictive setting won't be approved if it would pose a threat to public safety.

SB 1221 would also disproportionately impact people of color.

The bill would have the greatest impact on people who are in our state's institutions and people who are currently or at risk of becoming unhoused. People in both of these groups are disproportionately likely to be people of color. A recent UCLA study concluded that reliance on conservatorships as a means to secure both long term shelter and mental health treatment is a signal of systemic gaps in California's safety net systems of care.

Rather than continuing to cycle people through carceral systems, we must prioritize and fully fund services that break cycles and lead to stability. For these reasons, we respectfully request your no vote on SB 1221.

Thank you. If there's anyone else in the audience that would like to register a Me too in opposition, please come to the microphone. State your name, your position, and your organization. Just a moment.

You can today? Uh-huh.

Meron Agonafer with CAL voices in strong opposition. Thank you. Oh.

Zeenat Yahya with ACLU Cal Action in opposition. Thank you.

Move to the bill.

Seeing no further individuals wishing to speak, I'll bring it back to the committee if there are any questions.

The bill has been moved by Senator Valladares. And, I don't see any questions from the committee. I want to thank the Senator for bringing this bill forward. You know, I understand that this is a significant issue after we've had, you know, conversations of significant issue in your area, in the LA area. And so, there are still some some significant outstanding issues with this bill.

But some of which are not necessarily the purview of this committee. So, agree with the opposition with the concern of having the DA involved in any part of the conservatorship. But that's not really a part of the Health Committee and so didn't really touch too much except to narrow it to say this bill is about Murphy conservatorship, so let's not do it for all conservatorships. And with the bed prioritization, completely understand it's not a mandate.

It's just letting them know that they have the ability to to do this.

The only other thing that I would suggest, because you and I have had many conversations about this and even, you know, ways in which we can potentially fund more or find more money for the counties to be able to have more beds and more resources. We had talked about improving the data collection because as as we were trying to figure things out, it's there. It's just not in one easily recognizable concise place.

And so as you're moving the bill, if you're able to move the bill forward, I would suggest thinking about ways in which you can also include a way to capture the data to see how many of these individuals, you know, in one place aren't able to get beds, how many are waiting, how many are now being switched over to Murphy conservatorships, all of these things

In one particular place. So that at the end of the day, you don't have staff trying to find it at the last minute.

Okay.

But really appreciate the conversations that we've been having and, the bill has been moved, so you may close.

I agree.

Okay. Thank you, madam chair. And I will commit to you, getting that data in a sort of published format that's gonna be more easily accessible. It's something we we definitely plan to try to ascertain. You know, there's some of the most recent data we have as you as you mentioned does show LA with with a a larger number of individuals that are awaiting placement.

I will say, you know, I I've I've always sort of in my mind, especially with people suffering from severe mental illness, we've been trying to seek the most the least restrictive means necessary and try to find alternatives to carceral care. I think that all that always should be, the first priority, especially in, like, misdemeanor populations. In in this in this particular circumstance, we're talking about very serious and violent crimes and a much smaller set of populations.

So while I'm I'm extra sensitive to some of the the issues raised by disability rights about trying to find the least restrictive means possible. The law works a little differently with these Murphy's cases.

And so I I know this is tough stuff and no one likes the idea of someone to be held in any kind of locked setting, in a locked psychiatric facility. These are places that you don't wanna see anyone end up. But because they've committed serious crimes, there there's you're really left with no choice in these particular circumstances. This doesn't mean that the restoration process doesn't continue. This doesn't mean we don't try to give people a second chance.

And in fact, there's really exciting work going on in the LA County Jails to to the center from South LA.

We took a tour down there with Smart Justice last year with some of the leadership to look at what they call the fifth step down in in the Twin Towers where we're actually trying to make that jail setting not a place of suicide and of horror and sort of, you know, locking people up and and and treating them, in a way that was having, serious, serious, problems within our jail system.

But in fact, having people who have much more serious sentences, people actually on death row, embed with those groups that are seriously mentally ill. And these mental health assistants, y'all should look it up. There's a guy named Craigen Armstrong who's literally he's sentenced for life and has found new purpose taking care of these individuals all day.

So it's not just a a warden or or a PO, or even a clinical psychiatrist, but that you actually have peer based support, in the system. And we've seen huge results of people graduating out of these, forensic inpatient care and the sort of most most restrictive settings and finding new pathways for them to to get the care they so desperately need, to to find ways to not do forced medication and find ways for them to actually build social relationships.

And so I don't wanna give, such a a dark and and grave outlook on what the future can be for this population, but I know that they cannot just be dismissed on to the streets and let go because we'll be abandoning our duty to them. And so for that reason and for the reason that, you know, everyone else in the community deserves a right to live safely, and and not subject to to this kind of of threat from from our neglect in the mental health system.

I would respectfully ask for your aye vote and, I I commit to you to to continue to work on this with both the opposition and to find some solutions here.

So thank you.

Thank you. The motion by Senator Valladares is do pass as amended and re referred to the committee on rules. Assistant, please call the roll.

Senators Weber Pierson.

Aye.

Weber Pierson, aye. Valladares.

Valladares, aye. Caballero, Durazo, Gonzalez, Grove, Menjivar, Padilla?

Aye.

Padilla, Aye. Perez, Rubio, Smallwood Cuevas.

Aye.

That's 3-0. We'll place that on call. We will now move to file item 10. SB 1284 by Senator Smallwood Cuevas.

Okay. We will actually go to file item 11, SB 1323 by Senator Rubio. File item 10, SB 1323 by Senator Rubio.

I think I was waiting for one more witness that went outside. But we'll get going.

You may begin.

Thank you, Madam Chair and members of this committee. I'm proud to present SB 1323, which is a Patient Protection and Dignity Measure that strengthens existing laws for individuals receiving medical care while in immigration custody.

ThiS Bill clarifies and reinforces the fundamental right that should always be upheld. At its core, SB 1323 is about ensuring humane treatment, transparency, and account accountability in a medical setting. Under current law, health care facilities must limit immigration enforcement access to non non public areas. However, existing statute does not address the communication rights of a patient when they're in immigration custody. As a result, detained individuals may be isolated and unable to notify family members during a medical crisis.

Reports indicate that some individuals in custody have been denied communication with loved ones, have delayed care especially extreme cases when they're dying. SB 1323 requires health care facilities to inform staff and volunteers on how to respond to requests from individuals in immigration custody and allow patients to notify a family member or loved one of their location and condition.

SB 1323 ensures communication is timely, consistent across facilities, and ensures that no one receiving medical care in California is cut off from their loved ones simply because they're in ICE custody. One particular case in my district was a man who had had a heart attack last year. He had high blood pressure.

And when he was taken in, family struggled to locate him to ensure that he had his medication. Months later, he was able to communicate that he had never, gotten his medication and his condition had worsened. These are a few small, cases that are often highlighted, but we've known of other very serious cases where people are shot. They're dying, and family members don't get to to see them, don't get to talk to them until it's too late.

With me today, as a witness, joining me is Hector Pereyra on behalf of the Inland Coalition for Immigrant Justice.

I know we have also Jeannette Zanipatin on behalf of Coalition for Humane Immigration Rights who will be speaking on behalf of this bill. Thank you.

Thank you. You both will have a combined of five minutes.

Good afternoon, Chair Weber Pierson, members of the committee. My name is Hector Pereyra. I'm the Political Manager for the Inland Coalition for Immigrant Justice. We are a regional coalition of a little bit over 40 organizations, that serve the immigrants in San Bernardino and Riverside County. We provide legal services, community organizing, policy advocacy, but we also manage the rapid response hotline for the Inland Empire, which gives us a direct view into the fear and violence that our communities are facing on a daily basis.

We've seen the sharp escalation in violence, including an incident last August in San Bernardino where federal agents fired three unprovoked shots into a family's vehicle. Similar incidents are happening across California. A farm worker in Camarillo died after being chased by federal agents. A peaceful protester in Santa Ana was permanently blinded. And just this month, a man in Patterson in Northern California was shot seven times by ICE agents.

These are only a fraction of the harms caused by excessive force. And these harms aren't isolated to incidents of arrest. The harm, these individuals face continue when they are sent to detention centers across the state notorious for their inhumane living conditions and their egregious records of human rights violations.

Through our work around the Adelanto Ice Processing Center, we've documented four in custody deaths due to systemic medical neglect since the beginning of this administration, contributing to the over thirty deaths nationally, the deadliest record since DHS was created. Many more individuals suffer from untreated injuries sustained during their arrest and chronic conditions.

And let me be clear, this medical neglect is purposeful and intentionally cruel. We've worked with detained individuals, that have been hospitalized because of their pleas for medical treatment are disregarded until they are in urgent emergency conditions, life threatening conditions. When they are hospitalized, federal agents intimidate hospital staff into blacking out their information, a practice that is used for some criminal detainees, but not at all required for civil immigrant detainees. Federal agents monitor private medical interactions and restrict access to families and legal counsel.

In one case, one of our partners had a hospitalized client who was told that if they hinted to their family members where they were receiving treatment, they would be completely cut off from their families and not allowed to make any more calls.

In another case, a family was only notified when their loved one was on their death bed. And they received the call to rush to the hospital to say their final goodbyes even though the individual had been hospitalized for days. This state must do everything in its power to protect against these abuses and ensure detainees have the right to contact their loved ones when they are hospitalized and in critical conditions. And this is the bare minimum. By supporting 1323, you are supporting basic human dignity.

And for these reasons, I respectfully request your aye vote.

Thank you. You have about two minutes left.

Okay. Jeannette Zanipatin. I'm the director of policy and advocacy for the Coalition for Humane Immigrant Rights. I'm here to testify in support of this bill. This is a really straightforward measure.

It really does provide, it does help strengthen both existing privacy protections by clarifying that individuals in ICE custody retain their rights while receiving medical care. This is a critically important, measure as my colleague here mentioned. We have seen ICE enforcement activities take a a dark turn in California. They have become a lot more violent. Just recently, I met with an individual who was arrested.

And before our rapid responders were able to document what had happened, they had shoved him in the back of an SUV face first. And so this individual was critically injured. Fortunately for him, he or unfortunately for him, he is a kidney dialysis patient and so he was released from within a day. However, in another instance, we also represented an individual or gentleman, in his immigration case and he was also under ICE custody at UCLA Harbor Medical Center.

In this instance, the Federal Government did not have a warrant for his arrest nor was he, issued what we called a notice to appear or had any court order to have him in civil immigration detention while at the hospital.

His family tried to call and see if he was there. Yet the hospital would not allow neither his family or immigration council to see the patient, although he had suffered a catastrophic injury as a result of the of his arrest. The family was not given information about their loved one despite, again making several calls and several organizations had to intervene in order to have the patient, to allow the patient to have access to legal immigration counsel while at the hospital.

And after much targeted advocacy that we did from, several organizations, they did allow the family to finally have family visitation with the patient. But that was also taken away pretty quickly without any justification.

The hospital decided that they just all of a sudden, it would no longer allow his family to see the patient, which was extremely devastating for him. In this instance again, this person was under quasi civil immigration detention. And you know, again there there was no civil detainer or anything of that nature. So in these circumstances, you know, what we're really asking for is for patients to be able to have their families notified for treatment plans to be created.

And the gentleman that I just spoke of, we did work hard with the hospital to have a treatment plan.

He was gonna be released whether he was gonna be released to his family or whether he was gonna be released to DHS and ICE. He would still need a treatment plan, yet the hospital would not do that. And so for these reasons, we just think there needs to be more transparency and uniformity in California. Thank you.

Thank you. If there's anyone else in the audience that would like to speak in support of this bill, please come to the microphone, state your name, your organization, and your position. Seeing none, if there's anyone that would like to speak as a lead witness in opposition to this bill, this is your time to come forward. Seeing none, if anyone would like to give a me too in opposition to this bill, please come to the microphone. State your name, your organization, and your position.

Hi. Kelly McMillan on behalf of the California Dental Association. We're opposed unless amended as reflected in the analysis, and we look forward to working with the author.

Thank you. Seeing no further, individuals wishing to speak, we'll bring it back to the committee. Don't see anyone on the committee with any questions or comments. Senator Rubio, would you like to close?

Thank you. You know as you just heard these are not isolated incidents. They keep happening over and over again. And because I know this may be perceived as an immigration issue, I wanna remind, you know those listening that, US citizens have been detained as well. There was a young lady who was shot, US citizen who was not allowed to notify her parents.

So this could be anyone's mother, daughter, father. And at the very least, we need to ensure that the treatment is humane. No matter who you are, let's start there. But it has the violence has been escalating, the treatment and the isolation. And, we know based on some stories that, you know, a lot of, families are now, having to deal with mental health issues and the detainees because of that isolation.

And I don't think it's good for anyone to leave families destroyed, you know, reallyncrying over the loved one. I think we need to do better as human beings, as legislators. I think it's our responsibility to ensure that the care that patients receive in the hospital is, you know with the utmost respect and allowing them to communicate with their families, I think, would help alleviate some of the issues that we're seeing now. With that, I respectfully ask for an aye vote. Thank you.

Thank you, Senator. If anyone would like to move the bill?

So moved.

Moved by Senator Smallwood Cuevas. The motion is do pass and re refer to the committee on judiciary.

Assistant, please call the roll.

Senators Weber Pierson?

Aye.

Weber Pierson, aye. Valladares?

No.

Valladares, no. Caballero? Durazo? Gonzales? Grove? Menjivar? Padilla? Perez? Rubio?

Aye.

Rubio, aye. Smallwood Cuevas?

Smallwood Cuevas, aye.

Aye.

3-1 on call.

3-1, we'll place that on call.

Thank you.

We will now go to file item number 9, SB 1284 by Senator Smallwood Cuevas. As she is walking, if there is anyone else who needs to present, I would suggest that you come down now. Thank you. You may begin.

Thank you Madam Chair. I am very thankful to the committee chair and staff for all of their diligent and hard work on this bill. I will be accepting all of the committee amendments. And that includes the increase the employer threshold from 50 to 100, designate the State Department of Healthcare Services as the entity responsible for preparing the report and privacy protections for enrolled employees and clarifying that MediCal is intended to function as a public safety net, and as the payer of last resort.

So with that, I'm proud to present SB 1284, which ensures that billion dollar corporations do not shift their labor cost onto the taxpayers.

More than 3,000,000 working Californias rely on MediCal. Not because they are unemployed, but because their wages are too low or employer coverage is unaffordable. Nearly 1 in 5 California jobs is held by a MediCal Enrollee. That represents more than 20,000,000,000 in public spending connected to the workforce. Medi Cal was designed to be a safety net and a last resort.

And we know how difficult it is to maintain that safety net. But when wages do not keep pace and coverage is out of reach, MediCal fills the gap. And the taxpayers bear the cost. I want to address a point raised, by the opposition in this bill. This bill does not assume that every employer with workers on medical is acting in bad faith.

But under existing law, large employers those with 50 or more full time employees are already required to offer health care that meets minimum value and affordability standards. And we know many of our businesses are doing that, large and small. When significant numbers of full time workers still rely on MediCal, it raises legitimate questions about whether coverage is truly affordable or accessible in practice. SB 1284 does not assign blame. It simply provides transparency.

So policy makers and the public can better understand where the gaps remain. And without that transparency, we cannot have an honest conversation about what is driving these costs or how to address them. In my district, I hear from workers who are doing everything right and still falling behind. And I represent, cities in a county where the fastest growing jobs being created, unfortunately, are low wage jobs.

And so one of the workers I had the chance to learn about and meet is Diego, a resident of LA County of over 35 years.

He and his wife, both work and they clean houses. And he lives with chronic rheumatoid arthritis where severe knee pain and diabetes is constant. At the start of this year, he lost his full medical coverage and was left with emergency only care. Now he cannot access regular doctor visits and must pay out of pocket for medications he depends on. Despite working and paying taxes for decades, Diego and his wife are barely able to cover rent.

He told us he fears that if he needs surgery, he simply won't be able to get care. His story is not unique. It reflects a broader pattern where hardworking Californians many inessential jobs, cannot afford basic health care while the companies they work for remain highly profitable. That also puts responsible employers who do do the right thing, who do provide care, health care for their workers at a competitive disadvantage.

This raises a fundamental question about fairness and sustainability as we grapple with the impacts of HR 1 and our health care costs here in California.

At a time where we are facing real budget crises with these federal threats that weaken our MediCal system, families are struggling to get by. We have to ask, is it fair or sustainable for taxpayers to subsidize the labor cost of billion dollar corporations? A 2026 report found that at many of the nation's largest low wage employers, a family of three still qualifies for MediCal, even on a full time salary while CEO pay averages about 900 times that of the median worker.

California cannot afford to look away with corporations that drain the very programs we are fighting to protect. If public dollars are being used to support a company's workforce, the public has the right to know.

SB 1284 brings transparency and accountability to this issue by requiring the Department of Health Care Services to publish the names of large employers with workers enrolled in Medi Cal, along with the estimated annual cost the program associated with those employees. The data creates accountability, transparency, and Californians are demanding it. Over 70% of voters, and there have been recent surveys done, support requiring large corporations to take responsibility for their workers' health care instead of shifting the cost to taxpayers. That support is Bipartisan, Democrats, Independents, and Republicans.

Voters across the aisle see this for what it is, a matter of fairness. SB 1284 responds to that call in a measured way. It simply brings transparency to how public dollars are being used because without transparency, we know nothing changes. With me today to testify is Beth Malinowski with the SEIU California and Christine Smith with health care I'm sorry, with health access.

Thank you. You're both recognized for a total of five minutes.

Chair and members, good afternoon. Beth Malinowski of SEIU California. As a union of eligibility workers, a union of healthcare workers, long term care workers, and a union of low wage workers, we proudly cosponsor SB 1284. As our author shared, for too long, working people have relied on MediCal for care. Why?

Because of poverty wages, because employers have not offered affordable comprehensive coverage, because workers have been held to part time hours just out of reach of employer sponsored benefits. Fast forward to 2025, the Trump administration and GOP led Congress was quick to create a false narrative that our nation's MedicAid program was caring for the lazy, the unproductive, the unworthy. We know better in California. With HR 1 linking work and Medicaid, we must now recognize that employers have long relied on public benefits to care for their workforce.

Here are some of the facts.

Nearly 4 in 5 Californians in poverty live in families with at least one working adult. Half of adult workers living in poverty are employed full time. Only 34% of low wage workers receive employer sponsored coverage. And as a result of this, nearly two in three non disabled, non elderly adult enrolled in medical work.

Now, as California is saddled with the herculean task of implementing work requirements, worker occurrence that we know from past experiments in other states are not going to increase the availability of good paying jobs, are not going to increase the number of people working, but will increase the burden on states and individuals to prove work, ultimately leading to fewer people in care.

We know we need to do a better job understanding the interplay of work and MediCal. A part of our responsibility to administer a state's MedicAid program, we need to look at the data at the employer level and understand the trends. With this information reported to legislature, the body will be best positioned to hold employers accountable to address underlying policies impacting these trends. And at the end of the day, make sure we have a MediCal program designed, administered, and financially supported in the best way possible.

With that, respectfully ask for your aye vote today. Thank you.

Thank you.

Good afternoon, Madam Chair and Committee members. My name is Christine Smith with Health Access California, and we're proud to support SB 1284. According to a January 2025, report by the California Healthcare Foundation, nearly 20% of all California workers were enrolled in MediCal in 2023. California's medical program currently provides coverage to nearly 15,000,000 Californians, including children, older adults, people with disabilities, and working families.

In 2014, California expanded MediCal to include adults ages 19 to 64 without dependent children with incomes below 138% of the federal poverty line.

MediCal enroll- Medi Cal ensures that millions of Californians can see a doctor, fill a prescription, or get behavioral health care when they need it. Now under HR 1 passed by Congress last July, this population is at risk of losing access to care. The cuts included in HR 1 threatened to unravel years of progress on health care coverage and affordability.

Up to 2,000,000 Californians are expected to lose health care coverage due to devastating medical cuts and 217,000 California jobs are at risk. HR 1 also includes the work requirements that for further threaten the health care medical enrollees.

Data analyzed by KFF and reported by the UC Berkeley Labor Center demonstrates that most medical members who can work are already working. When people who depend on MediCal lose their coverage, they lose access to life saving medications, in home care, dependable emergency room care, and other vital services. This report will be critical to understand how many employers are relying on California taxpayers to fund health care for their employees and their dependents, and as a result, the impacts on the state budget.

When families lose access to preventative care, like routine checkups, cancer screenings, blood tests, addiction treatment. We lose our freedom to stay healthy, keep our jobs, and maintain our economic independence.

We need to address health care funding gaps to ensure a stable economy and protect our quality of life. We respectfully ask for your aye vote.

Thank you. If there's anyone else in the audience that would like to come and speak and support and give a me too, please state your name, your organization, and your position.

Madam Chair, Member. Sarah Flock, California Federation of Labor Unions. We're proud to cosponsor this measure. Thank you.

Mariko Yoshihara on behalf of UFCW Western States Council in support.

Good afternoon, chair and members. Connor Gusman on behalf of Teamsters California in support.

Hello, Ines. GRACE End Child Poverty here in support.

Thank you, madam chair and members. Meagan Subers on behalf of the California Professional Firefighters in support.

Chloe Hermosillo with the California Immigrant Policy Center in support.

Thank you. If there's anyone in the audience that would like to speak as lead opposition to this bill, this is the time to come forward to the table.

Thank you. You have a total of five minutes for your presentation.

Good afternoon, madam chair and honorable members of the committee. I'm Andrea Lynch, and I'm here on behalf of the California Chamber of Commerce. We apologize for the late notification, but we received new information regarding this bill, and we're required to take a position on this bill. SB 1284 would require DHS DHCS to re report Medi Cal enrollment data identified by employer name, effectively creating a government run public, public shaming registry built on incomplete de decontextualized information.

The bill's premise that any employer with workers on Medi Cal is offloading its obligations onto taxpayers taxpayers is simply unfounded.

Medi Cal Enrollment reflects a wide range of factors, including workers who voluntarily prefer Medi Cal over employer coverage, part time or seasonal employees who are not eligible for benefits, and new hires still in waiting periods for benefits. Listing an employer's name next to an enrollment account with without any of this context implies that employers are responsible and exposes good faith employers to unfair public scrutiny, litigation, and reputational harm.

SB 1284 treats employers as the sole architects of a problem shaped by market forces, state and federal policy, and individual worker worker choice and decisions beyond any employer's control. And for these and other reasons, we respectfully oppose SB 1284. Thank you.

Thank you. If anyone else in the audience would like to come and speak in opposition, this is your time to come forward to the microphone. State your name, your organization, and your position. Saying none, we'll bring it back to the committee. If anyone in the committee, Senator Padilla.

Thank you, Madam Chair. Just thank the author for bringing the bill, the sponsors. I think there's an important dynamic we're beginning to realize here in this data as it affects availability of coverage. I won't overly characterize it here madam chair but I certainly would if it was appropriate. So I appreciate the the ability to address this issue.

This data is important. It'll be the first steps or what I hope will be another steps to address this phenomenon that does not help people who work hard or employed, being shuffled off to be under the the state's benefit program. So appreciate the author. I'm happy to move the bill at the right time.

Thank you. Senator Gonzalez.

I too just wanna say thank you to the author for bringing this forward in a in a time where Medi Cal and people's, health care benefits are being cut and, you know, not understanding, you know, which, employers are doing what and feeling like, you know, we've got no answers. This is an opportunity for us to be able to, you know, get some more, information, but actually do something for people.

And and that is ensure that they have health care access, which is ultimate, the reason why we're all here and got elected. Right? So I appreciate you and I appreciate your, witnesses for coming forward too.

Thank you.

Senator Perez. Also wanna express my support and thank the author for bringing this forward. I think this bill is just asking for a report. Right? And I think that's one of the most fundamental and basic things we can get do is get accurate data on this issue.

I've certainly seen a bunch of independent non profit organizations try to assess this, but I do think it's incumbent on us as the state to come up with our own numbers and to assess this issue. So thank you.