Assembly Standing Committee on Health

Good afternoon, and welcome to the Assembly Health Committee's hearing on Tuesday, April 14. Before we begin, I want to make sure everyone understands our committee procedures to ensure we maintain order and run a fair and efficient hearing with the goal of hearing as much from the public within the limits of our time. We seek to protect the rights of all who participate in the legislative process so that we can have effective deliberation on the critical issues facing California.

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

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

As a reminder, primary witnesses in support must be those accompanying the author or who otherwise have registered a support position with the committee, and the primary witnesses in opposition must have their opposition registered with the committee per the instructions on our website.

All other supports and opposition can be stated at the standing mic when called upon to simply state your name, affiliation, and position. All testimony comments are limited to the bill at hand. For our housekeeping items, the Speaker has appointed Assembly Member Rogers to substitute for Assembly Member Celeste Rodriguez for today's hearing.

On the consent, the following bills are proposed for consent for today's hearing. Any Member of the Committee may remove a bill from the consent agenda. Item 12, AB 2348 by Bonta with a motion of do pass as amended to Appropriations. Item 13, AB 2368 by Bonta with a motion of do pass as amended to Appropriations.

Item number 14, AB 2442 by Patterson with a motion of do pass to Judiciary. Item number 15, AB 2486 by Addis with a motion of do pass to Appropriations. Item 16, AB 2562 by Dixon with a motion of do pass to Appropriations. Item 17, AB 2704 by Addis with a motion of do pass to Education. Item number 18, AB 2706 by Soria with a motion of do pass to Appropriations.

And item number 20, AB 2756 by Ahrens with a motion of do pass as amended to Appropriations. With that, we will start as a subcommittee and hear from the only author that is in the hearing room right now. And this is also item number two on the agenda, AB 1825 by Krell.

Hi. Good afternoon, members and Chair. I'm here today to present Assembly Bill 1825, which makes vital improvements and adds clarity to California's offenders with mental health disorders, OMHD program. I'd like to thank the committee staff for their excellent work on this bill, and I'm happy to accept the committee amendments.

As explained by the Department of Corrections and Rehabilitation, the OMHD program was created to provide a mechanism to detain and treat persons with severe mental health disorder who reached the end of their prison term but are still dangerous to others as a result of their mental health disorder.

To gain OMH declassification, CDCR and the Board of For All Hearings actually has to show that an individual meets all of these six factors, that the person has a severe mental health disorder, that the person used force, violence, or caused severe bodily injury in the commission of the crime for which they were sentenced.

That the severe mental disorder was the cause or an aggravating factor in the commission of the crime for which they were sentenced, that the person's severe mental disorder is not or cannot be kept in remission without treatment, that the incarcerated person had been in treatment for ninety days or more days within the year of parole or release.

And then finally, and this is the important one, that the incarcerated person, as a result of their severe mental health disorder, represents a substantial danger of physical harm to others. And the substantial danger of physical harm part has been you know, part of the reason for this bill because that's been difficult.

But once someone's diagnosed and designated as an OMHD, they must serve their parole at a state hospital and receive mental health treatment. If they can be safely and effectively treated in the community, the OMHD may be transitioned to the conditional release program, which is known as CONREP.

If the person disagrees with their classification, they can appeal. And if that fails, they can actually continue to appeal to superior court. If an individual is successful in their challenge, they must be released with an exit plan within thirty days directly into the community, and then they would they would not be transitioned into con rep. So they won't be receiving the treatment in the community if they successfully appeal.

So recent events reveal that there's been clear gaps in this process because of the, the way these court challenges can play out, and because of the, the vagueness of some of the terminology here. Specifically, the requirement of representing a substantial danger of physical harm has been interpreted that in a way that's allowed offenders who have severe conditions to successfully challenge their status in court and reenter society even though they still pose a serious risk to themselves and to others.

Furthermore, once those individuals are released via a superior court challenge, they don't have the structured pathway to effectively be in the community. They don't have the the mental health treatment. They don't have the resources that they would have if they had gotten that designation.

So Assembly Bill 1825 takes a multilayered approach, and it addresses these issues by requiring specific criteria to be evaluated when determining what constitutes a substantial danger of physical harm. And then it also defines more clearly what the exit plan is and expands Medi-Cal eligibility for this exit plan.

This ensures that those who need treatment receive it while prioritizing the safety of our communities. It also further ensures consistency in the OMHD program and makes certain that no individual is left behind in this.

With me today to testify in support is Doctor Aaron Meyer on behalf of the California State Association of Psychiatrists. Thank you, and I respectfully ask for your aye vote.

Thank you. You'll have two minutes.

Good afternoon, Chair Bonta, members of the committee. Again, my name is Aaron Meyer. I'm an associate clinical professor at the University of California, San Diego, speaking on behalf of the California State Association of Psychiatrists, proud sponsor of Assembly Bill 1825.

As a practicing psychiatrist, I see firsthand how fragile linkages are in California's public behavioral health system and what happens when they fail. Patients with the highest needs too often fall through the cracks, and these gaps are administrative, not clinical.

AB 1825 closes one of those gaps. Today, individuals classified as offenders with mental health disorders are treated differently based solely on where they are housed. Those in prisons and jails can access CalAIM's justice involved reentry services. Those in state hospitals cannot. The assumption has been that these individuals will return to custody before release, but that is not always what happens, and we've seen this play out.

When an OMHD classification is revoked by a superior court judge, that individual must be released within thirty days as Assembly Member Krell said. Those thirty days are critical. They are the window where coordination determines whether someone remains stabilized or deteriorates.

And we are talking about individuals with severe mental illness, often with a history of violence, whom the Department of State Hospitals has identified as being at higher risk of re offense when released directly into the community.

So AB 1825 ensures that during this window, care recommendations are communicated to the county behavioral health system responsible for supervision. It is a simple fix, but a consequential one. It aligns systems that should already be working together. It improves continuity of care, and it strengthens public safety. I respectfully ask for your aye vote on AB 1825.

Thank you. At this time, if there are any others in the room who would like to offer testimony in support, please offer name, affiliation, and position on the bill.

Thank you. Kim Stone with Stone Advocacy on behalf of the California District Attorneys Association in support. This bill promotes public health and public safety both. Thanks a lot.

Angela Hill with the California Medical Association in support.

Thank you. And now we will move to any primary witnesses in opposition.

Amer Rashid with the County Behavioral Health Directors Association of California. We had a concerns position. Appreciate the dialogue we've had with the author's office and sponsor and the amendments and committee today. Look forward to continued dialogue as we try to mitigate any future concerns. Thank you.

Thank you.

Good afternoon. Monica Porter Gilbert, Disability Rights California. We also registered a concerns position. We appreciate the committee's amendments and look forward to reviewing updated text.

Thank you. Any others offering Me too in opposition please come forward? Seeing none, I will bring it back to the committee for questions, comments. Assembly Member Stefani.

Thank you, Madam Chair. And I wanna thank the author for bringing this forward. I definitely support this legislation because we've seen in my district in San Francisco what happens when our systems actually fall short. There was a case, reported widely in the Chronicle of about Bill Gene Hobbs, which really shook the public confidence in our ability to protect the community. It's something I worked on when I was supervisor.

He had a long history of harassing women, served time in prison, and was placed in a state hospital for treatment, but only, after a short period, he was released. And soon after, he returned to the streets and started engaging in that same behavior. In this case, it really did leave a lot of people asking a very simple question.

How did could that happen, and how do we make sure it doesn't happen again? This bill is about learning from that moment and strengthening the system so that decisions affecting public safety are made carefully, consistently, and with the full picture in mind.

And because when someone has a documented pattern of threatening harmful behavior, which was in the case, that I worked on greatly in San Francisco, we really do have a responsibility to take those risks seriously.

We owe it to the public to make sure the right safeguards are in place and that releases are handled with the level of scrutiny and coordination that community safety demands. The Hobbs case made it clear that gaps in judgment or communication can have real consequences.

They are not abstract policy failures. They are felt by people who live in our neighborhoods and by the women who were targeted again and again after his release.

At the end of the day, this legislation is about restoring confidence that the system is working as it should. It is about accountability, public safety, and making sure we do better the next time. So I'm definitely an aye on this bill. Thank you so much.

Thank you. Seeing no other comments from committee, Assembly Member Krell, you may close.

Well, Assembly Member Stefani, thank you so much for your support on this bill and for bringing an an example of the of the policy failures, which really kinda crystallize what the need is here. Greatly appreciate your support. And to the rest of committee, I respectfully ask for your aye vote.

Thank you so much. And we will have that considered when we are not, no longer a subcommittee. Thank you. We are gonna move now to our other author in the room, Assembly Member Stephanie. Item number one, AB 1696 by Stefani regarding emergency services and care for nurse midwives.

Please go ahead whenever you're ready.

Thank you, Madam Chair and colleagues. Today, I'm presenting AB 1696. AB 1696 makes clear that nurse midwives do not require physician supervision when they are providing care within the well-defined scope of their existing license and training. Nurse midwives are highly trained advanced practice clinicians who provide comprehensive perinatal and reproductive healthcare. Many practice in hospitals as part of a collaborative care-- part of collaborative care teams, working closely with physicians, nurses, and other providers to deliver safe care for patients.

Their scope of practice is already clearly defined in law. It allows them to independently manage low-risk births, requires collaboration with physicians for certain conditions, and mandates the transfer of care when a patient's condition requires physician involvement. Those guardrails remain firmly in place, and this bill does not change them.

AB 1696 ensures that our laws reflect how care is delivered in hospitals today and allows care teams to work together without unnecessary administrative barriers that can slow down treatment or create confusion about roles and responsibilities. This is especially important at a time when California is facing real challenges in maternity care.

Hospitals across the state are closing labor and delivery units, and many communities are experiencing shortages of providers. In that environment, we need every qualified professional on the care team practicing to the full extent of their training so patients can receive timely and appropriate care. At its core, this bill supports collaborative team-based care and helps protect access to safe maternity services for California families.

I would also like to note that I'm committed to working with emergency room physicians to address their concerns as the bill moves forward. And with me testifying today is Kim Dau, Chair of the Certified Nurse Midwives Association Workforce Committee.

Thank you. Good afternoon, Chair Bonta and members of the committee. My name is Kim Dau, and I am a nurse midwife representing the California Nurse Midwives Association, and we're proud to be working with Assembly Member Stefani on AB 1696. This bill clarifies that nurse midwives may provide emergency services and care consistent with our existing scope of practice.

Emergency services and care is a defined term in the Health and Safety Code and commonly known as EMTALA care. It refers to the evaluation and treatment that hospitals must provide to anyone seeking care, regardless of their ability to pay. In obstetrics, this care often occurs in labor and delivery units, not just emergency rooms. Nurse midwives already provide this care within our scope and most commonly evaluating low-risk patients for labor. Importantly, most pregnant patients seeking EMTALA care are not experiencing true medical emergencies.

I'd like to provide an example of what this looks like on a daily basis. When I'm on labor and delivery for a hospital shift, I'm responsible for caring for the low-risk laboring patients, but I'm also responsible to see those who come to the unit for urgent care without an appointment, in other words, EMTALA care. Typically, most people come in because they're experiencing contractions or think that their bag of water broke.

Sometimes they're concerned that their baby isn't moving well or they could be postpartum, experiencing pain with breastfeeding. As a qualified provider, I would conduct a medical screening exam, determine the appropriate diagnosis and treatment plan for the patient. State and federal law require hospitals to evaluate and provide care in these EMTALA presentations, and this care is clearly within the nurse midwife scope of practice under the Business and Professions Code. However, the current Health and Safety Code imposes physician supervision requirements when care is classified as EMTALA care.

These requirements create unnecessary administrative barriers, limit nurse midwives from practicing at the top of our license, and according to the 2020 LAO analysis, are unlikely to improve safety or quality. In the example that I provided above, if anyone I saw for EMTALA care fell out of the low-risk category or was experiencing a medical emergency, the policies and procedures statutorily mandated by the Business and Professions Code would take effect, and I would transfer that care to a physician who would then lead the emergency services.

Thank you.

We respectfully ask for your aye vote. Thank you.

Thank you so much. Are there any others in the room who would like to offer support with a testimony in support?

Good afternoon, Madam Chair and members. Roxanne Gould, representing the California American Nurses Association of California and the Clinical Nurse Specialist Association, in support.

Good afternoon, Madam Chair and members. Jessica Moran, on behalf of the California Association for Nurse Practitioners, in support.

Thank you. Are there any in the room that would like to offer primary testimony in opposition? Please come forward. We're still in support, yes?

In support. Yes, ma'am. My name is Shannon Benson. I'm an ICU nurse with UNAC/UHCP, and I stand in support.

Thank you.

Zachary Pritchett, emergency room nurse with UNAC/UHCP, and we stand in support.

Thank you.

Colleen Basicio. I'm a labor and delivery registered nurse with UNAC/UHCP.

Carlada Calhoun, a chemical dependency nurse, here with UNAC/UHCP, in support.

Amanda Hixson, physical therapist with UNAC/UHCP, in support.

Hi. I'm Sophia Pak, oncology pharmacist, on behalf of UNAC/UHCP, in support.

Hi. My name is Jenny Masaoy, RN, with UNAC/UHCP, in support.

My name is Gigi Yanos. I'm an occupational therapist on behalf of UNAC/UHCP, in support.

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

Madam Chair, members, good afternoon. Elena Lopez-Gusman, on behalf of the California Chapter of the American College of Emergency Physicians. I first wanna thank the author's office and the sponsors for some very fruitful conversations, and I am hopeful that we can get to a shared common goal on this. Unfortunately, as the bill is in print today, we do need to register our opposition unless the bill is amended, but, again, expressing hope that we can get there together.

With me today, I have Dr. Alicia Gonzalez, who's a practicing emergency physician in Imperial County in California and also the treasurer of our organization to talk in more depth.

Thank you, Madam Chair and members. I first wanna say that I am a strong proponent of nurse midwives. In fact, with the Access Bridge Program that was founded here in California, I've been doing really amazing work throughout rural Illinois, helping emergency physicians alongside my midwife colleagues help us get ready for the unintended, impending, precipitous labors, et cetera, that show up in the ED, and I have learned a ton from my midwife colleagues in that process. So I have tremendous respect for what they do.

However, when we look at what the law states now, we believe that CNMs are able to practice without physician supervision in specifically low-risk pregnancy and delivery care, whereas patients show up to my emergency department with undifferentiated care, with symptoms that are not always what they seem and with things that are not obvious at all to the untrained eye at first.

And so that's actually what a medical screening exam is. The medical screening exam is the heart and soul of what emergency medicine is in general. Emergency physicians have undergone extensive training specifically to become experts in this nuanced process. It's actually precisely why our specialty was even formed was that we saw that it was a specialty and not the same as anybody else's medical training.

I have had women come to the emergency department in third trimester with what people thought was contractions, and it was actually appendicitis. Once, it was an obstructing kidney stone causing a severe infection. The Legislature recognized that CNM's value to patients is tremendous, and they did that when they passed SB 667 2023 and allowed them to practice independently again in these low-risk presentations.

But the Legislature did not intend for them to practice unsupervised in the emergency department where patients self-select to come to that environment because they themselves acknowledge something is troubling. We are, by definition, a high-risk environment, not a low-risk patient population.

So, again, we have deep appreciation for the job that certified nurse midwives do. We really, really do. But in the ED specifically, which is by definition high risk, the medical screening exam must be completed by an emergency trained specialist, and we can't support this bill in its current state unless we make it-- we adjust it to be consistent with the law from 2023 requiring physician supervision in the ED.

Thank you. Any others in the hearing room who would like to offer testimony as a MeToo in opposition? Seeing none, I will bring it back to the committee for any comments or questions.

Assembly Member Stefani, perhaps in your close, you might be able to address the notion that the opposition is raised around the need to make sure that there's still a team-based approach to provision of care in emergency departments and how that happens in the current context or within the context of your bill.

Madam Chair, if I can, I would like my witness to briefly touch on that, and then I will close.

Thank you.

Thank you for the opportunity to respond. So it's important to understand that what we're trying to do is only maintain the current scope of practice that is within the Business and Professions Code. The Business and Professions Code for nurse midwives already addresses the type of patients and specifically low-risk that we can care for. When a patient is determined to be of a higher risk, that patient is automatically transferred to physician care. That's what's in statute for Business and Professions.

I can understand the concern that in an emergency room, there are emergency situations that are typically beyond a midwifery scope of practice. However, in this case, emergency services and care is related to not just emergency room care, but also evaluation of labor. Evaluation of labor is part of EMTALA care and part of emergency services and care and the bread and butter of what we provide.

This is a specific section of code about EMTALA and mandating that these patients need to be seen and evaluated. If the patient were in labor and receiving care in a birth center, for example, the midwife could perform the exact same type of evaluation, but it's not under EMTALA because it's not in a hospital.

So I just wanna point out that the only reason that this is a question is not because of how the patient's presenting. The patient's not necessarily presenting with a medical emergency. The patient's presenting to rule out labor, and that, I don't believe, is a medical emergency.

Thank you, Madam Chair. I hope that explanation helped. Also, you know, CNMs are trained to screen for what is in their scope, as has been explained, and then refer care as needed. I remain committed to working with the opposition to make sure that we address their concerns. I don't think we're far apart. I think we just need to continue to move this bill forward so we can get there. So I respectfully ask for an aye vote at this time.

Thank you. And when we have a quorum, that will be considered. Thank you so much. We're going to move on now. I see the Chair of Human Services here, to item number five, AB 1949, Lee. I know Human Services is in the middle of their hearing as well.

Thank you, Madam Chair, and thank you for acknowledging we also have Human Services concurrently. Thank you, Chair and Members. I'm presenting AB 1949. I'd like to first acknowledge the committee staff for their thoughtful analysis and accept the committee amendments reflected on page three of the analysis.

I'm here today to present AB 1949, which will expand access to acupuncture for Medi-Cal patients, ensuring more Californians receive safe, effective pain management. Currently, Medi-Cal patients are restricted to two visits per month across a variety of outpatient services, forcing them to make hard choices between needed treatments.

These limitations create barriers to timely care and disrupt continuity of treatment for patients. AB 1949 addresses this problem by treating acupuncture as its own benefit, allowing patients access up to 24 acupuncture visits per year.

Acupuncture is an evidence based and cost effective treatment for managing chronic pain that can reduce dependency on opioids and other costly treatments. This bill will improve patient health outcomes and reduce use of higher cost services while maintaining responsible use of state resources. With me today in support, I have Lin Yang, licensed acupuncturist and member of the California Acupuncture Coalition.

Good afternoon, Chair Bonta and Assembly Health Committee Members. My name is Lin Yang. I'm a licensed acupuncturist and a former President of the California Acupuncture Coalition, the sponsor of AB 1949. I wanna thank Alex, Assembly Member Alex Lee for his leadership and his on this important issue.

Acupuncture is a safe, evidence based, and cost effective therapy that helps managing various conditions including chronic pain while reducing reliance on opioids and other high cost interventions and improve quality and function of life. However, in the current Medi-Cal policy, acupuncture is limited to a shared cap of just two visits per month across multiple therapies.

This is clinically inadequate and often prevents patients from accessing care at all. As a result, acupuncture exists on paper, but not in practice. More importantly, this policy does not reflect how acupuncture works. It is a time dosage dependent therapy that typically requires at least two visits per week to achieve meaningful and a sustained benefit.

When treatments are spaced too far apart, the effect is lost, the condition may linger indefinitely. Providing adequate acupuncture care reduces overall health care costs despite a modest initial increase in Medi-Cal spending, while limiting access increases medication use and downstream expenses. In short, acupuncture is effective and cost effective only when delivered at appropriate dosage.

AB 1949 offers a balanced solution by allowing providers to deliver care appropriately. It enables a substitution toward a safer, evidence based, lower cost of care and aligns with California's goals to reduce opioid use, improve outcomes, and control health care costs. I respectfully request your support for AB 1949. Thank you.

Thank you.

Good afternoon, Chair Bonta and Members. Thank you for the opportunity to testify. My name is Dr. Lili Qiao, and I serve as the Director of Integrative Medicine and North East Medical Services, where we provide comprehensive, culturally responsible care to diverse and underserved community across the Bay Area.

In our clinics, we care for many Medi-Cal patients, manage chronic pain, severe illness, and the side effect of the chemo treatments. For these patients, access to safe non pharmacologic options like acupuncture, it is an important part of the manage symptoms and improving their quality of life.

We see every day that acupuncture can help patients manage pain, nausea, neuropathy, and stress. It often allows patients to better tolerance to treatments and in many cases, reducing reliance on medications. However, access to acupuncture under Medi-Cal remains limited and inconsistent.

Clinically, acupuncture is typically delivered as a course of care over time. The current limitations under Medi-Cal can make it difficult to provide treatments at the frequency needed to achieve meaningful results for patients. Additionally, in practice, many patients benefit from more frequent visits, especially early in treatments.

And the current limitations can disrupt continuity of care. So AB 1949 would strengthen this benefit by ensuring Medi-Cal covers up to 24 acupuncture visits per year and removes the unnecessary utilization barriers while still allowing additional visits while medically necessary.

So for these patients we serve, many of whom already facing significant barriers to care, AB 1949 would mean more consistent access to a low risk and effective treatment options. It supports a more integrated patient centered approach to care and helps ensure that underserved communities are not left behind where it comes to access to these services. Thank you.

Thank you. We will now move to those in the hearing room who would like to offer testimony in support. Please come forward with your name, affiliation, and position on the bill.

Sydney Pon with North East Medical Services in strong support.

Paul Fox from North East Medical Services in strong support.

Jennifer Robles with Health Access California in support.

My name is Jingjiao Xia. I support.

I'm Jun Hu, local acupuncturist. Also, American Association of Chinese Medicine and Acupuncture members. So I have very strong support.

My name is.... I support the bill.

My name is Min Lei. I'm licensed acupuncturist in San Jose. I'm in support.

My name is Caiping Tang, licensed acupuncturist in Cupertino. I'm strongly support AB 1949.

My name is Yong Zhong Yu. I am licensed acupuncturist from San Jose. I am a representative Dr. Michelle Lau, the President of Council of Acupuncture and Oriental Medicine Associations and the American Alliance of American Alliance of Acupuncture. We strongly support AB 1949, and this bill is really smart. It will save the state's money overall and...

Thank you. That's... Support. Thank you.

Hello. My name is Chao Xing. I'm working at North East Medical Services in integrative medicals. I support AB 1949. Thank you.

I support AB 1949. Thank you.

I support AB 1949.

Good afternoon. I'm Association of Korean Acupuncture Group President, Dr. Bon Cho. I'm supporting AB 1949. Thank you.

Thank you.

My name is Huang Yu Yong. I support AB 1949.

Good afternoon. My name Chen Quan. I'm Chinese acupuncturist. Thank you.

Hi. My name is Chulong Xue, an acupuncturist in California and current Vice President of California Acupuncture Coalition. Myself and my association are very support in strong support of this bill. Thank you.

Good afternoon. This is Ivy on behalf of California University Silicon Valley, we provide master, PhD, doctorate degree in acupuncture program. I'm in support. Thank you.

My name is Xian Huang. I'm Chair of the Political Action of American Association of Chinese Medicine and Acupuncture. Our association and myself strong support bill 1949. Thank you.

I'm Yvonne Chen. I'm a licensed acupuncture from Walnut Creek. I'm here to support AB 1949.

Hi. My name is Meiya Zhang. I'm an acupuncture patient. I'm strong support this bill.

I'm Anna Liu. I'm California acupuncturist. I'm support.

My name is Annie Zhang. I'm licensed acupuncturist in California. I'm ready to support AB 1949. Thank you.

Hi. My name is Joe Hao. I'm in support. Thank you.

My name is Amy. Support bill 1949.

My name is Emer. I support.

My name is Faye Yi, and I'm a patient and also a home caretaker, and I strongly support AB 1949.

Ryan McCarthy on behalf of Dongguk University Los Angeles, the Academy of Chinese Culture and Health Sciences, and the United Acupuncture Association in support.

We'll move on now to any primary witnesses in opposition. Please come forward for testimony. Seeing none. Any who would like to just offer a me too in opposition? Seeing none. I will bring it back to the committee for any comments or questions.

Certainly, Assembly Member Lee, I'm thankful that you're bringing forward this bill. I think it was very helpful to hear from your witnesses around the necessity to have enough dosage over time to be able to make sure that acupuncture is effective treatment.

As I know it is, having personally been provided with acupuncture for several years in a way that was very helpful to me and my family. I wanna thank you for bringing this bill forward. And certainly, my community in Oakland very much appreciates this as well. With that, would you like to close?

I wanna thank the Chair for your comments. I will be asking respectfully for your aye vote for this, but I do think it's important measure to elevate acupuncture. This is one of those issues. Medi-Cal reimbursement for acupuncture has been on the chopping block. Like, many things in the health budget, frankly, has been a chopping block consistently.

And I think it's one of those things to elevate to make sure that our patients on Medi-Cal understand the whole range of options out there, including other things, alternatives to opioids, and acupuncture is one of those really great, effective, cost effective, and health effective measures that we wanna show a spotlight on. And with that, I respectfully ask for your aye vote on this bill. Thank you.

Thank you. And when we have an opportunity, we will consider the bill, unless anybody wants to previously offer a motion in a second. Thank you, Majority Leader and Schiavo. We're gonna move on now to item number 10, AB 2330 by Boerner. Thank you, Assembly Member. Whenever you're ready.

Good afternoon, chair and members. I'd like to start by accepting the committee amendments and thanking all the stakeholders and the committee staff for working with us to help make sure this bill strikes the balance between safety and market implementation. I'm also committed to continue work continuing working on any other amendments that as this at as this bill makes its way through the process. With that being said, I'm pleased to introduce AB 2330, a bill that would create a distinct regulatory category for cold spas.

Restorative cold water immersion has become a cornerstone of athletic recovery and holistic wellness for many in our state.

However, the current opaque nature of regulation regarding cold plunges means spas might unintentionally be exposing their clients to unsafe environments. AB 2330 would establish a formal legal definition for cold plunges and baths, effectively distinguishing them from recreational swimming pools and hot tubs. This would help create a predictable business environment for wellness providers and ensure that all California consumers are protected by consistent health and safety standards. I respectfully ask for your aye vote on this measure.

With me to today to speak more on this bill is Cassie Lohse from the Health and Fitness Association.

And I said this earlier because she was my witness in a bill earlier. I've known two Cassies in my entire life until today, and now I know four. Oh. So she's one of the four. So Cassie.

Hi. Good afternoon, chair members. My name is Cassie Lohse for the record. I am the senior manager of state affairs at the Health and Fitness Association, and a proud sponsor of AB 2330. Thank you for the opportunity to be here today, first and foremost.

We represent more than 55,000 health and fitness businesses nationwide, 7,000 of which are right here in California. Our statewide members contribute nearly 3.3 billion dollars to adhere to the California economy and employ close to 64,000 workers. Many of our fitness facilities provide therapeutic cold plunge cold spa treatments to their members. Cold spas offer a range of well-established therapeutic benefits, including accelerated muscle recovery, reduced inflammation, a strengthened immune system, and enhanced systemic circulation.

Despite their increasing popularity, there is no established definition in the health code for cold spas.

This has led to uncertainty among local health of officers and whether to treat them as pools, hot tubs, or something unique. AB 2330 creates a distinct regulatory category for both in-ground and stand-alone cold spas, implementing modern safety standards that account for the unique operational needs while eliminating any regulatory gray area.

Establishing rigorous health and safety regulations will enhance protections for consumers and businesses alike. By codifying specific standards for construction, operation, disinfection, and usage, this legislation ensures that Californians can safely access therapeutic and research-backed benefits of cold water immersion. For these reasons, I respectfully ask for your aye votes, and thank you again for having us here.

Thank you. Are there any others who would like to offer a testimony in support?

Good afternoon. Steven Stenzler with Brownstein on behalf of the California Fitness Alliance in support. Thank you.

Hello. My name is Amanda Bloom, and I'm with the California Association of Environmental Health Administrators. The folks at the local level that enforce pool and spa code. We don't have a formal position but want to thank the author and sponsors for taking our amendments. Thank you.

Hi. My name is Angela Wild, on behalf of San Diego County, drowning prevention expert and water safety advocate in strong support. Thank you.

Thank you. We'll move on now to any primary witnesses in opposition. Any who would in the hearing room who would like to offer a me too? Seeing none, I will bring it back to committee for any questions or comments. Mr. Patterson.

Great. Thank you. As a connoisseur of recovery rooms on time to time, particularly cold plunges, you know, when I was reading the bill initially, I was thinking about prohibit prohibitions of basically every gym where the built in cold plunge might be in the same location as the built in sauna, for example, or or and, you know, so we had some communications with some of that proponents of the bill over the weekend, and I don't think this is the intent.

But I think the way the language is written right now, and I don't think it's your intent, feel free to respond is I'm concerned because having when I was on the city council and I saw how our chief building official at the time interpreted swimming pool regulations in particular, my reading of the bill made me feel like it opens up the door for a local building official to interpret it in such a way to where a cold plunge would need a separate enclosure from from the sauna.

So you might walk into a gym and see, you know, basically, like, two, two separate enclosures.

And I don't I know that's not your intent. Right? Yeah. So we'll talk we can talk more about this after this bill passed out of committee. I like what you guys are trying to do, but it, I just think it leaves too much latitude for the, frankly, the local building official to determine whether it should have a separate enclosure.

And it would be, you know, every building official would have a could have a different interpretation.

Point noted. We'll look at that and circle back with you, but I would appreciate your eye vote today.

I but we're on the same page. Right? Like, that's not your intent.

Everybody loves a cold plunge. Yes.

Okay. Good. Perfect. Perfect.

Not a gated one.

No gates for cold plunges.

Perfect. Alright.

Thank you. Any other questions or comments from the committee? I wanna thank Assemblymember Patterson for his question. I'm sure the author, as she always does, will continue to work on addressing any potential concerns. I also wanna thank the author for bringing forward this measure.

I think you again continue to advocate for our overall health and wellness in the state of California, and bringing this forward gives us an opportunity to make sure that we're providing necessary guardrails and definitions around a very, helpful, practice. With that, would you like to close?

Respectfully ask for your aye vote.

Thank you. Do I have any motion or a second on this?

Thank you. Assemblymember, Aguair-Curry and Rogers. We will take the vote up when we have a quorum. We're gonna move now to, majority leader, Aguair-Curry's item, item number six, AB 2000.

Whenever you're ready, majority leader.

Alright.

Thank you, madam chair and members. I wanna start by thanking the chair and the committee staff for their work on this bill. I will be accepting the committee amendments today, which promote affordability while protecting patients from disruptions to their care. AB 2000 addresses a growing issue in medication coverage, midyear formulary changes. Formularies are lists that show which medications insurance plans cover and what patients must pay.

Patients and doctors rely on these lists when choosing plans during open enrollment and making treatment decisions. But under current law, plans and Pharmacy Benefit Managers, or PBMs, can make changes to formularies in the middle of the year before patients can choose a new plan. They can remove drugs, raise costs, or add new restrictions that make it harder for patients to access the medications they need. The problem is patients can't switch plans until open enrollment the next year.

So, when coverage changes, patients may be forced to switch medications, pay more out of pocket, or lose access to their treatments altogether.

While plans and PBMs offer an exceptions process for patients to stay on their medications, this can be long and difficult for consumers, and plans can still deny these requests. Treatment delays threaten patient safety and well-being. They also create additional paperwork for providers who work hard to find the right medications for their patients and have to start this process from scratch. AB 2000 offers a clear solution.

It limits midyear changes to drug formularies, so patients don't face sudden changes to their medications or pay more out of pocket.

It also promotes greater transparency and predictability so Californians can make informed decisions about their health insurance upfront during open enrollment. The committee amendments promote affordability for consumers while strengthening patient protections. The amendments promote affordability by allowing for some midyear drug changes while still maintaining strong protections for patients. These include advanced notice, a clearer and faster exceptions process, reporting for transparency, and stronger enforcement with due process for plans.

With me today, I have Dr. Glenn Coogan on behalf of the California Academy of Family Physicians and Liz Helms with the Chronic Care Coalition.

You'll each have two minutes. Thank you.

Good afternoon, chair and members. My name is Dr. Glenn Coogan. I'm a family medicine physician. I'm the Program Director for a rural family medicine residency training program based out of a tribally federally qualified health center and a rural community hospital. I'm here on behalf of the California Academy of Family Physicians who is a proud cosponsor of AB 2000, the "Reliable Medication Coverage Act."

As a family physician, I see continuity of care as essential to keeping patients healthy. When a patient is stable on a medication, that stability reflects careful prescribing, ongoing monitoring, and trust that we've built over time. Health plans use formularies to determine coverage with tools like prior authorization and step therapy. While meant to control costs, they stand in the way of patients getting the medications they need, even when those medications are medically necessary. The problem arises when these rules change mid plan year.

Patients who are stable on a medication can be forced into nonmedical switching, moved off a treatment that's working, due to coverage changes, not clinical need or a decision I or my colleagues have made, and this is not just switching from brand to generic. It can mean being pushed to an entirely different drug within the same class.

An example patient of mine with asthma who was stable for years and took years for me to develop a relationship with to convince them to use their asthma medication, was forced to change their Single Maintenance and Reliever Therapy, or SMART Therapy, mid year to a different medication regimen that actually was two separate inhalers. This patient was confused with the change and clear—clinically—deteriorated with an unnecessary emergency department visit for an asthma exacerbation.

These disruptions can lead to worsening symptoms, treatment failure, and a higher health cost due to additional visits or complications. They also place a significant administrative burden on physicians and other clinicians in the healthcare system, taking away time from patient care. Continuity of care means keeping patients on plans and medications that work. AB 2,000 adds critical safeguards to limit these disruptions and protect patient care. Thank you for the opportunity to testify.

I respectfully urge your support and I'm happy to answer any questions.

Thank you.

Good afternoon and thank you, madam chair and members. My name is Liz Helms, and I'm President and CEO of the California Chronic Care Coalition, celebrating our twentieth year, which aims to improve the health of Californians with chronic and complex conditions. I'm here today to testify in very strong support of AB 2000, which protects patients from harmful midyear prescription drug changes that can disrupt care and jeopardize their health. I work with patients managing chronic and complex diseases that require consistent, carefully managed treatment.

For these patients, staying on the right medication is critical to maintaining their health and avoiding serious complications.

Reaching stability on a medication can take months or even years and trial and adjustment and trial and adjustment, but midyear formulary changes can disrupt, disrupt that stability. I've seen patients lose coverage for medications that were working well for them to be forced to switch to alternatives that may be less effective or cause side effects. While exceptions prospects exist, it's often slow and uncertain, leading to delays in care and added stress for patients.

It also creates more administrative work for physicians and providers and takes time away from patient care.

AB 2,000 helps providing more stability and predictability for prescription drug coverage. And at the same time, it still allows plans to make appropriate changes for safety and cost, including the use of generics and interchangeable biosimilars. This is a balanced approach that protects patients while supporting affordability. But I would be remiss if I did not mention that I was a part of the coalition that successfully fought for the passage of AB 974. I've been around for a long time.

All the way back in 1998, one of my first bills we were so excited to put patient protections in. This bill changed—it protect patients from being forced off medication, that they were stabilized. It's sad that we must be here again, a quarter of a century later, still fighting the same fight.

Thank you.

Thank you very much, and we support AB 2000. Thank you.

Thank you. Any others who would like to offer support?

Good afternoon, madam chair and members. I'm still Roxanne Gould on behalf of the American Nurses Association of California in support.

Angela Hill with the California Medical Association in support.

Ryan Spencer with the Crohn's and Colitis Foundation, proud cosponsors of the measure, and the California Rheumatology Alliance in support. Thank you.

Jennifer Snyder, on behalf of the California Life Sciences, in support.

Michelle Rivas, on behalf of the California Pharmacists Association, in support.

Katie Van Deynze with Health Access California. We were in a support if amended position. And with the committee amendments, we will be moving to a support. Thank you to the work of the committee and the author and the sponsors on this. Thank you.

We'll move on now to any primary witnesses in opposition. Please come forward.

Hello, Chair and members. Nick Louiseos, on behalf of the California Association of Health Plans, regrettably in opposition to Assembly Bill 2000. Our health plans do work hard to deliver enrollee access to medically necessary, safe, and affordable medications. Unfortunately, the in-print version of AB 2000 goes in the opposite direction by freezing drug formularies midyear. Freezing formularies midyear raises serious concerns.

It can compromise patient safety. It can increase cost for consumers, undermine affordability, and institute excessive regulatory burdens on our plans, including criminalizing clinical and fiscal management decisions that far exceeds standard regulatory oversight. Having said that, we understand that the bill is being significantly amended today, so we wanna thank the committee and the author for taking those amendments. Once the bill is in print, we will review those amendments with our members and let the author know if it results in any position change on our part.

According to the analysis, however, it does appear that the bill still contains penalties and enforcement actions against plans and insurance carriers if they violate the provisions of the bill.

This seems inappropriate, and we'd like to see more clarification on that language. In the meantime, we do respectfully oppose the bill and urge the legislature to support policies that actually lower prescription drug costs, which is one of the fastest, growing elements of the premium dollar for Californians and oppose costly mandates that drive up premiums for consumers. Thank you.

Thank you.

Madam chair, members, Steffanie Watkins on behalf of the Association of California Life and Health Insurance Companies here to today—regrettably in opposition to AB 2000. We do appreciate all the hard work with the author and the sponsors and the committee on the amendments. Unfortunately, we are in opposition. As was stated before, our members are committed to providing affordable high-quality care to millions of Californians.

While we share the goal of ensuring patient access, clinically appropriate medication, this legislation would fundamentally undermine our member's ability to ensure patient safety, respond to emerging clinical data, and managing the skyrocketing cost of prescription drugs. Many of the deep discount plans and insurers can achieve are possible when health plans and insurers adjust formula placement in response to competition, removing these tools functions as a de facto drug coverage mandate at a time when the prices charged by brand name drug makers continue to rise.

Health plans require flexibility to shield consumers from the full impact of these rising costs to preserve affordability. Ultimately, we are concerned about the potential rise in premiums and the impact on affordability and access for consumers.

For these reasons, we are opposed, but we do look forward to continuing the conversations with the author and sponsor if the bill does move forward today. Thank you.

Thank you. Any others in opposition, please register. Me too?

Madam chair, members, John Winger on behalf of America's Health Insurance Plans. Apologies. Our position didn't get reflected in the analysis. I guess I'm still working on the portal, but we do have an opposed position and thank the author and staff for all the conversations. Thank you.

Good afternoon, chair and members. Alison Ramey, here today on behalf of the Pharmaceutical Care Management Association opposed to the version in print, but look forward to reviewing the committee amendments, and thank you to the author for the engagement.

I'll bring it back to the committee now for any questions or comments. Chair leader, you can close.

By protecting consumers from changes to their medications after they've already committed to a health fund, this bill supports affordability and reliable access to health care. I hope that the opposition takes a chance to look at all the amendments that we have put through. I think it answers many of their questions that have been brought up. And that my door is an open, always been open, for visits with them to have these conversations, rather than having them here at the dais. Thank you very much.

Thank you.

I ask for your aye vote.

Thank you. We have a motion and a second? By Rogers. Seconded by Schiavo. We will take that vote when we have quorum.

Thank you.

Thank you very much.

We're gonna move on now to item number four, AB 1929 by Ortega.

Please go ahead whenever you're ready.

Thank you, Madam Chair and members of the committee for allowing me to present AB 1929 today, which is a Latino Caucus priority bill. I would like to begin by accepting the committee amendments. AB 1929 requires health plans to disclose all the investments they make with the subsidies and patient premiums they receive, including investment in for-profit prisons and immigrant detention centers.

An investigation by the United Nurses Association of California revealed that Kaiser, which has an investment portfolio of close to $6 billion, has significant investment in CoreCivic and GEO Group, the two largest private for-profit prison corporations in the country. We continue to hear horror stories coming from these detention centers that include the detention of pregnant people, children as young as two months old, persons with disabilities, and people with serious health conditions.

Detainees are denied medical care, given undrinkable water, and fed rotten food. The death toll in these facilities keep rising, tripling from 11 people in 2024 to 33 in 2025. The public deserves to know where their healthcare dollars are being spent and if they are being used against California values. That is what AB 1929 does. It's a sunshine law that requires transparency so that we can know where our resources are being spent.

Thank you. And with that, I have two witnesses here to testify: Joe Guzynski, Executive Director with UNAC, and Diana Escamilla, Policy Coordinator with the Central American Resource Center of California.

Thank you. You'll have two minutes each.

Good afternoon, Chair Bonta and the members of the Health Committee. My name is Joe Guzynski. I'm the Executive Director of the United Nurses Association of California/Union of Health Care Professionals, representing 40,000 registered nurses and healthcare professionals across California. UNAC/UHCP is proud to sponsor AB 1929 because it affirms a strong, simple principle. Health plans, many operating as nonprofits, carry an obligation to the public it serves.

The obligation is grounded in transparency. Nonprofit health plans benefit from a public trust, a trust reinforced by taxpayer support and expectations that its resources provide meaningful community benefit. With the trust, people deserve to know how those resources are being used. It is a matter of alignment between the values an organization claims to represent and the choices it makes with the dollars it spends. Although we recognize that taxpayers do not make direct investments and the choices make-- that they have a right to transparency, though, AB 1929 honors that right.

It ensures that investment choices and the values behind those choices are accessible and visible. Let me be clear. This is not about any one organization. This is about the right of help-- the right of patients to understand what those investments are.

That is the thing it is about is transparency. If a health plan, whether for-profit or nonprofit, chooses to do business in the State of California, transparency should be a fundamental condition. Patients should have a right to know how health benefits-- health plans invest their resources, particularly when those investments may conflict with their values or the well-being of their communities. People deserve that. Patients deserve it, employees deserve it, and the taxpayers of California deserve it.

Thank you.

Thank you. On behalf of the 40,000 healthcare professionals, respectfully ask for your aye.

Good afternoon, Madam Chair and members. My name is Diana Escamilla. I'm the Policy Coordinator with the Central American Research Center, CARESEN. We are the largest nonprofit that serves Central Americans in the country, and I'm here today as a proud co-sponsor and in strong support of AB 1929, a bill that will make appropriate disclosure so that Californians can make educated decisions when they are choosing a healthcare service plan.

CARESEN stands firmly against anyone, any system, or any company that benefits and profits from the detention of immigrants in private detention facilities who have a long history of violating human rights.

Our organization knows firsthand the inhumanity of these private detention centers because members of our legal team have gone inside these detention centers and met with clients and spoke with their families. The witnesses-- they have witnessed malnutrition, lack of proper hygiene, lack of medical care, and signs of physical abuse. Our legal team has seen these harms and have been told by our clients that their families have been victims of overcrowding in these detention centers.

These detention centers are solely designed to profit off immigrants. Under the Trump Administration, policies have been put in place to ensure profits from these detention centers are maximized.

For example, they have removed eligibility for bail hearings for the majority of those in detention, and they have significantly increased bail thresholds to make it impossible for those who have been granted bail to actually be released. It is clear that there's a lack of accountability from the federal government to hold these private detention centers and their investors accountable. It is our job to do so, and simple disclosures are a start.

Today, CARESEN urges your aye and vote for AB 1929 because our community deserves to know who is profiting from the violent apprehension of car washers, day laborers, street vendors, and all immigrants that are being racially profiled. Thank you.

Thank you. Are there others in the room who would like to offer support? Please come forward with your name, affiliation, and position on the bill.

Good afternoon, Madam Chair and members. Janice O'Malley with AFSCME California. We are proud co-sponsors. Thank you.

Good afternoon. Good afternoon, committee. I am Kelly Carrasco, representing Cal State Long Beach, the Department of Health and Human Services, and I am in support of Assembly Bill 1929. Thank you.

Good afternoon. I'm Sophia Pak, oncology pharmacist on behalf of UNAC/UHCP, in support.

Good afternoon. Colleen Basicio and on behalf of UNAC/UHCP, in full support. Thank you.

Carlada Calhoun, chemical dependency nurse in San Diego, on behalf of UNAC/UHCP, in support.

Hello. Shannon Benson, ICURN, here with UNAC/UHCP, in support.

Zachary Pritchett, emergency room nurse and patient in Los Angeles, on behalf of UNAC/UHCP, in strong support.

Amanda Hixson, physical therapist here in Sacramento with UNAC/UHCP, in support.

Jenny Masaoy, a RN, on behalf of UNAC/UHCP, in support.

Gigi Yanos, occupational therapist in Orange County, on behalf of UNAC/UHCP, in support.

Thank you. Now we'll move on to any primary witnesses in opposition. Please come forward. You'll each have two minutes. Thanks.

Madam Chair and members, Olga Shilo, here on behalf of the California Association of Health Plans, in respectful opposition to AB 1929. While we appreciate the goal of transparency, this bill is duplicative and ultimately it risks increasing cost for Californians without improving care. AB 1929 attempts to solve a problem that already has a solution.

Nonprofit health plans already disclosed extensive financial investment information through IRS Form 990, which is publicly available, in addition to comprehensive state and federal regulatory filings required of all licensed health plans.

Regulators have robust visibility into planned finances, and the public has meaningful insight into planned operations. This bill goes further by mandating public disclosure of highly sensitive investment information, raising concerns about confidentiality obligations, competitive harm, and legal exposure.

While some sectors may have disclosure requirements, AB 1929 imposes a far more aggressive standard, requiring detailed public reporting that is not consistently applied to other entities managing similar investments. Importantly, this approach is inconsistent with the longstanding California policy.

AB 1929 moves in the opposite direction, applying a more aggressive standard that even public pension funds may not be subject to. Finally, the proposed amendment defining material investment holdings makes the bill even more problematic. It relies on a vague, reasonable person standard with no clear thresholds or safe harbors. All of this comes at a cost. New reporting mandates increase administrative burdens and those costs ultimately show up in premiums. So for these reasons, we respectfully request a no vote.

Good afternoon, Chair and members. Alexis Rodriguez with the California Chamber of Commerce, here in opposition to AB 1929. First, I'd like to apologize for submitting our letter after the deadline and appreciate the Chair and the committee for allowing me to present today. Our concerns align closely with CAHP and believe that AB 1929 would create an uneven and anti-competitive regulatory movement or environment.

Health plans are already subject to extensive transparency reporting requirements, including publicly available IRS filings, quarterly financial disclosures, and, where applicable, federal ERISA reporting.

Together, these provide regulators the--and the public--with significant insight into planned finances and investments. AB 1929 would impose not only duplicative but overreaching requirements mandating public disclosure of sensitive investment information. This raises serious concern about competitive harm, particularly where confidentiality agreements are involved.

In 2005, the Legislature established a balanced framework through SB 439, enhancing transparency involving investment funds while safeguarding proprietary and insensitive information. The sponsors of that bill stated that without the protections of AB 439, they risk losing access to high-performing investment opportunities that have historically generated significant returns as private investment firms grow reluctant to work with public institutions due to concerns over disclosure and confidentiality of information.

AB 1929 departs from that approach by imposing disclosure requirements that exceed even those applied to public pensions and pension funds. For these reasons, we respectfully urge a no vote today. Thank you.

Thank you. Any others in opposition, please come forward. Seeing none, I'll bring it back to the committee for any comments or questions. I do have a question, and this is to the opposition, primarily testimony. So I'm a bit confused because on the one hand, you said that this is duplicative, but on the other hand, you said that the extension of public disclosure of investment information would be something new that is being required. So which is it? Is it duplicative or is it burdensome?

It may be-- thank you. Appreciate the question. When it comes to duplicative, we're speaking to their already required, you know, disclosures that they have to comply with. And on top of that, when we say an additional, it builds on their already--as my colleague at Cal Chamber mentioned--the longstanding California policy of what the standard has been set in 2005.

Thank you. I'll accept that as a response. The other comment that I'm confused about from the opposition was the-- or I would just state that the potential chilling effect that this might have on private investment firms to have to participate in public disclosure. Last time I checked, private investment firms and the like were responsible for upwards of 30% of the mergers and acquisitions that were happening in the healthcare space.

That doesn't seem like there has been-- given the fact that there is already--supposedly, according to the testimony offered--public disclosure, it doesn't seem to have created any chilling effect in that regard.

I appreciate the question. I'm not prepared to respond to it, but we're happy to come back to your office and offer a response.

Thank you. And then final question, why would it be proprietary to have to disclose whether or not in the healthcare space an entity is investing in private detention centers that are locking up immigrants?

I can't speak to individual plans-- investments, but again, I'm happy to take it back to our team and respond to your office directly.

I appreciate that. I think you're gonna be hard-pressed to find a rational reason for why that disclosure somehow impedes on health plans' ability to be able to conduct their business. Assembly Member, seeing no other questions or comments, would you like to close?

I respectfully ask for your aye vote.

Moved by Aguiar-Curry; seconded by Carrillo. We have a quorum now-- oh, when we have a quorum. Thank you so much for your presentation, Assembly Member.

Thank you.

We're gonna move on now for the sake of our member who has to chair a committee, to item number 19 by Schiavo AB 2746. Whenever you're ready, assembly member.

Thank you so much, Madam Chair and members of the committee for the opportunity to present Assembly Bill 2,746 today. This is a simple bill with one goal to protect patients from financial harm associated with medical debt on medically focused credit cards. So the bill does just one thing. It defines medical credit card debt as medical debt. Thank you.

Thanks to the pro tem Limon, who authored SB 1061, medical debt in California is not reportable to credit agencies or included in credit reports, protecting patients. This way, people don't have to file for bankruptcy, lose out on housing, pay higher interest rates, or ruin their credit simply to access the care that they need. But current loopholes created when this part of the bill was actually taken out of that original bill, means that it doesn't classify medical credit cards as a medical debt.

This means anyone using a medical credit card like CareCredit, which is the largest that exists, do face the choice of ruining their credit or needing to file bankruptcy just to get health care treatment that they may need.

In fact, Consumer Financial Protections Bureau research and analysis real reveals that people with medical debt are penalized 10 to 20 points in their credit scores as as compared to those without medical debt, which can lead to, as I said, denial of housing, unfavorable loans, and in some cases, even lower paying jobs.

More than half of all Californians and three in four of people with low incomes say that they skipped or postponed care due to the cost of care in the past year. And those who skipped or postponed care, forty six percent of them say that they it made their conditions worse. So people are literally getting sicker and more serious health impacts because they cannot afford care.

No 1 should have to choose between their health or their own basic needs and a system that forces people to delay or skip care because the cost of the system is a system that's failing. We should keep in mind that three million Californians face losing their health insurance and health care because of the policy impacts and and health impacts related to HR 1.

The patients who are losing their health care coverage could mean they move even more to using these types of medical credit cards since so many so many people are gonna be struggling to pay for out of pocket care. So now is a time to close that legal loophole and protect patients before it gets too late. We know and have heard, you know, stories of people.

Even though it's illegal, people are still in situations in some of these medical offices where they are, you know, in the middle of receiving dental care and put kind of under a pressure cell situation to sign up for these credit cards or even under Anesthesia, which still is illegal, but unfortunately happens sometimes. And and there's no real enforcement of that law.

So patients will find out later that they signed up for a credit card. Sometimes they think it's a payment plan with their health care provider, and they can and it contains deferred interest provisions. This means that after a trial period, typically around a year, maybe eighteen months, that the patient has to pay their balance in full. And if they don't, the interest on their full amount that they ever charge to their account will be put back onto the credit card and charged.

And with the high interest rates that are associated with these credit cards, that can be crushing, crushing amounts of of money for people.

Let me be clear. As you hear from opposition pulling all the shots to kill this bill, including parking a billboard in my district office parking lot, nothing about this legislation will lead credit card companies to accessing patients' private medical information. The bill only defines what is or is not medical debt, which includes credit cards that specifically offer medical services. It allows for deferred interest purchases of those products.

Companies like CareCredit do not need personal medical information to know if a charge is related to a medical service so that they can classify medical debt.

Determining that is a simple yes or no question and can be handled by medical offices. They know who these providers are. They can also know just through who the provider is that charges those. So, if it's coming from a dentist office, it's pretty clear. We're following the lead of six other states that already have laws on the books that protect or prohibit reporting of medical credit card debt, including New York, Oregon, and Colorado.

There's clear and a simple road map here to help patients protect their financial futures and not allow medical debt to be ruining their lives. It's time that California joins them, and we have an opportunity to do that today with this bill. Here to testify in support is Caitlin Van Dines representing Health Access and Adrienne Paredes who is a senior staff attorney with Bay Area Legal Aid.

Thank you. Prior to that, we have been able to establish quorum, so we're gonna take the rolel.

[Roll Call]

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

Good afternoon, madam chair and members. I'm Katie Van Deynze with Health Access California, the statewide health care consumer advocacy coalition, and we strongly support AB 2746. Bill would ensure that when consumers have medical debt on their medical credit card, it does not harm their credit score. In 2024, California already banned medical debt from harming consumer credit with the principle that consumers don't have the control over if they need health care.

And as the author noted, medical debt is a poor indicator of credit.

However, this law has a dangerous loophole for consumers. If consumers owe their debt to a provider directly, it doesn't harm their credit. But if they pay for it on a medical credit card, it can harm their credit with real consequences. This bill closes that loophole, and it does so without putting consumer privacy at risk, counter to what opposition is claiming. We, in privacy groups, would not support the bill if it did.

Since 2024, the need for this bill has become even more dire. 70% of consumers say that health care costs are placing strain on their finances, and consumers are reducing spending on groceries and skipping meals because of health care costs. And this survey was d1 before we saw the we are seeing the impacts of HR 1 and the expiration of the Affordable Care Act subsidies.

Millions of Californians are gonna lose their health care coverage, and we already saw a 22% drop in enrollment for middle income Californians at Covered California. For consumers with no health insurance or consumers with really big deductibles, medical credit cards with promotional period look like a good option to pay off your medical debt.

These products are specifically being marketed to consumers for paying for what insurance does not cover in in medical offices and dentist offices. And dental insurance itself does not go very far, which makes the use of these products attractive, especially when marketed by providers. But if consumers cannot pay off the loan during the promotional period, they face huge interest rates on the whole loan. That is all the more reason why medical debt on your medical credit card should not be on your credit report.

Health care costs and medical debt are crushing Californian families, and we should call medical debt on your credit on your medical credit card what it is.

It's medical debt, and it does not belong to consumer credit reports. We respectfully ask your aye vote. Thank you.

Good afternoon, chair and committee members. My name is Adrian Paredes, and I am a senior staff attorney in the consumer unit of Bay Area Legal Aid. I am here to speak in support of AB 2746. Bay Legal represents low income Californians in seven Bay Area counties and sees 100 more consumers at pro se clinics each year. Medical credit cards and loans reported to credit reporting agencies causes huge problems for our clients, most critically, the denial of housing.

This is especially problematic because these are often unavoidable debts, not indicative of creditworthiness. And in our experience, these products are very prone to abuse. To highlight the issues, I'm going to share a couple of client stories. The names are changed for privacy. Frank is a disabled man on Social Security and Medi Cal.

He went to a dentist due to severe pain from a hole in his tooth. In the exam chair, the dentist informed him that they did not accept his insurance and that they would check if he qualified for a line of credit. Frank was later informed that he had been issued a $3,000 credit card with CareCredit. Frank was staying in an acquaintance's garage and looking for a habitable place to live.

He was unable to find housing due to the medical credit card on his credit reports and so had to stay in subpar living situation.

Another client, Mary, was signed up for a $20,000 proceed finance loan in the dentist chair despite being a disabled senior covered by Medi Cal. At this time, Mary was near the top of the waiting list for low income senior housing, so she continued to make payments each month out of her limited social security income so that she would not be denied housing based on bad credit. To afford this, Mary had to give up basic living necessities including food.

She was forced to rely on free pantries and cut out meals so that her credit would not be harmed. In my experience, these are not the exception but extremely common examples of the harm the reporting of these products can cause to low income people who are trying to get basic care. And for these reasons, we ask for your support on a B2746. Thank you.

Thank you. Any others in the hearing room who would like to offer a me too in support of this measure?

Good afternoon. Dani Kando Kaiser on behalf of the one of cosponsors, the California Low Income Consumer Coalition, also representing National Consumer Law Center Consumer Reports as well and strong support.

Good afternoon, madam chair and members. Christopher Sanchez with the Consumer Federation of California, proud to be a cosponsor.

Good afternoon, chair and members. Beth Velasquez SA California in support.

Good afternoon. Renee Bayardo representing Blood Cancer United in support.

Good afternoon. Linda Nguy with Western Center on Law and Poverty in support.

Helen Halderson with California Advocates for Nursing Home Reform in support.

Thank you. We will move on now to those in opposition as primary witnesses. Please come forward. You each have two minutes. Thank you.

You'll need to press the button.

Good afternoon, chair, members of the committee. Thank you for the opportunity to testify today. My name is Vanessa Lugo, and I am here on behalf of the California Bankers Association. CBA has significant concerns with AB 2746 because as drafted, the bill is unimplementable without granting financial institutions access to private medical information, which they do not have and are not permitted to obtain under current law.

At its core, AB 2746 attempts to expand the definition of medical debt to include obligations owed to third party lenders, such as credit card and installment loans.

However, lenders do not know what specific item, products, or services are purchased in any given transaction. They see only limited transaction data that identifies the merchant and location, the transaction date, the total amount of the purchase. They do not and cannot receive itemized transaction data to determine whether a charge was for a medical service, product, or device, whether it was for a medically necessary cosmetic surgery, or how much of a transaction, if any, qualifies as medical debt under the bill.

To comply with AB 2746, lenders would need access to sensitive medical data like diagnosis, procedures, and insurance details that is protected by law and not available to them, making it impractical to determine what can be reported to credit agencies. Giving lenders this kind of access would mark a major unprecedented shift in medical privacy.

Laws like California's confidential medical information act, HIPAA, and the FCRA limit sharing to specific health care related purposes, but AB 2746 would expand that flow of sensitive data to financial institutions. This is not theoretical. Under the Biden Administration, federal regulators addressed this issue in its January 2025 regulation five rulemaking. The CFPB found that debts to third party lenders can't reliably be identified as medical debt since they often mix medical and nonmedical charges, making any broader definition unworkable.

In summary, AB 2746 presents two insurmountable challenges. First, it is legally incompatible with existing state and federal privacy and credit reporting laws. For these reasons, CBA respectfully urges your opposition.

Good afternoon, madam chair and respected members of the Health Committee. My name is David Reid, and I serve as General Counsel to the Receivables Management Association International. RMAI is here to respectfully oppose AB 2746. Just two years ago, RMAI was before you in support of a definition of medical debt that was developed by the Biden Administration and the Federal Consumer Financial Protection Bureau. This was the definition that was enacted into law.

Today, we are back, but this time in opposition to a bill that is trying to change the Biden Administration definition of medical debt to a definition that no other state has adopted. This bill would broaden the definition to include any credit card that allows for deferred interest purchases of a medical service, product, or device. Examples of deferred interest credit cards include Best Buy, Wayfair, Home Depot, the Tractor Supply Company, and CareCredit.

It might surprise you to know that these are also examples of credit cards that can be used to buy medical products and devices. Whether it is health monitoring devices at Best Buy, livestock vaccines at the Tractor Supply Company, senior and disabled accessibility products at Home Depot, lift chairs at Wayfair, or a treadmill using CareCredit, the fact is that no one, not even the issuer, knows what purchases on a credit card would qualify as a medical product or device.

Simply stated, AB 2746 is unimplementable. If adopted, one of several outcomes is foreseeable, including the issuers no longer offering deferred interest credit cards to California or reducing the availability of these types of cards to California residents. Either outcome would be disastrous for consumers. Please support consumers by voting no on AB 2746.

Thank you.

Thank you. Are there others in the hearing room that would like to offer opposition?

Madam chair, members of the committee, Randy Pollack, on behalf of the Consumer Data Industry Association, in opposition.

Scott Govenar, on behalf of the California Financial Services Association and the American Financial Services Association, in opposition.

Hi, madam chair and members. Megan Murray with the White Home Group on behalf of California Chiropractic Association. Regretfully in opposition.

Chloe King with Political Solutions, on behalf of the California Dental Association and the California Society of Dermatology and Dermatological Surgery, in opposition. Thank you.

Jessica Moran on behalf of the Association of Dental Support Organizations, in opposition. Thank you.

Aaron Brenna with Cruise Strategies, on behalf of Encore Capital, in opposition.

Thank you. Seeing no other opposition, I will bring it back to the committee for any comments or questions. Assemblymember Rogers.

Thank you so much, chair. My question first is for the opposition. I heard multiple times, and it appears in the analysis that you're trying to argue that SB 1061 has a requirement that the medical debt be deemed medically necessary. But the staff analysis clearly states that they could not find anything in SB 1061 that could be interpreted that way. So, could you please point to where in SB 1061 you are drawing that requirement?

I could read it too if you'd like. Yeah. Says, "the opposition also argues that SB 1061 required medical debt to be deemed medically necessary, and they do not have the ability to determine what purchases were medically necessary without violating state and federal medical privacy laws. This seems to be the underpinning of most of your opposition. While they are able to easily determine—while they are able to easily determine at which merchant..."

I think that's enough reading, Assemblymember Rogers. Hopefully the opposition has come prepared to answer your response—to provide a response to your question.

I'll—can get back to you on that. I—that was not the reason for RMAI's opposition. RMAI's opposition was related to the deferred interest.

Okay. Alright. So, I do have to say I find that fairly concerning that you don't come equipped with an answer when it is clearly called out in the analysis that the whole underpinning for why you think this bill is unworkable doesn't actually exist according to committee staff. And it seems as though the solution that the assembly member is offering that you could code based on where the actual transaction is taking place may actually be a workable solution.

You know what doctor's offices are versus a Walmart, as the analysis calls out.

Actually, I, I can respond to that.

Yeah, please.

The reason why you cannot do that is because, for example, at dentist offices, you have medically necessary procedures. You have also optional vanity procedures.

Right. So, if there's no requirement in SB 1061, as is called out, for it to be medically necessary, again, sidestepping entirely having to pace through what is medically necessary and what is not medically necessary at a medical facility seems to be the entire underpinning of your opposition.

SB 1061, is that the Limon bill?

Yes.

Okay. Again, RMEI has never made that position, so I can't speak to the, the consultant's analysis on medically necessary. I'd have to look at the—SB 1061 to be able to respond to that.

Okay.

Yeah. I would too.

Okay. Well, I'm gonna support your bill today. I appreciate you bringing it forward. I wish that there was the ability to have more of a nuanced discussion about the merits of the bill, as, as the discussion currently sits, it's hard for assembly members, especially hearing the horror stories of folks at a medically fragile moment being pushed into signing up for these, not to feel like there's an industry that's taking advantage of and trading it on the trust that patients have with their medical providers.

And the strides that have been made to try to protect people from the impacts of medical debt on their credit history, I think, have been notable and laudable.

And without being able to have a discussion about the main underpinning of the opposition's argument, I'm happy to support the bill, and we'll see how this moves forward. Thank you.

And I just wanna clarify for the sake of perhaps getting an actual response, that existing law ensures that any service, drug, medication, product, or device sold, offered, or provided to a patient by licensed people or facilities is defined as a, as a, a medical service, product, or device that is eligible for a deferred interest or purchase for, or purchases, with the exception of cosmetic surgery. Assemblymember Sharp-Collins.

Thank you. Thank you to the assemblymember for bringing forth this bill. I have some concerns in regards to the opposition's responses. Number one, when you're looking at CareCredit, first of all, I'm, I'm a person who views CareCredit. Okay?

And the fact that—thank you for pointing out. The deferred payments, when you do not pay that off within the eighteen months, here we are thinking, imma speak for myself thinking that I've made strides into paying this off and then get hit with a huge bill now, because all that interest has been tacked back on. So, now I'm back to paying a lot more interest instead of it going to my principal, but thinking that I've made strides.

But the way that it's marketed for CareCredit is all medical.

Literally, you go into a weight loss clinic, you go to the, to the veterinarian, it's all health. Right? It's all medical. So, when you go to your to your CareCredit site and it tells you that this can be used for doctor's visits, veterinary, dentists, specialists, select retail purchases, and so much more. But when you go to the retail purchases, it is specified in there on what it can be, meaning select health, wellness, and personal care.

So, it tells you that it can only be used for vitamins, prescription, vision, medical supplies, these types of things. So, that marketing is still towards all medical. Not only is it towards the medical side of things, but then, when you continue to look at this, the, the card itself is—it definitely accrues a lot of debt.

In my personal opinion, it is medical debt, whether it's from you utilizing it for your pet, for care for your pet, or utilizing it whether, like I said, it was for, for weight loss performance, injections, your, your eye, your eyeglass care, all the above. I believe that this is a problem.

I really appreciate you bringing forth this bill because if you've never had a CareCredit credit card, then in my personal opinion, you cannot really speak to the issues that CareCredit credit cards can cause on not only on your personal credit, but on your financial stability because the darn bills be about $400 or $500, and then your payment derangement is only about three months until you can figure that stuff out, and now you have additional stuff put on your credit. So, yes, I'm speaking from experience.

So, I really appreciate you bringing forth this bill. It is a medical debt, and it needs to be rectified as soon as possible, especially with the hits coming down the pipeline. More and more people are gonna be kinda shifting to another way to pay for stuff. And if this is gonna offer a way to pay for your medication, pay for diapers, pay for whatever it is that's listed on your sites in regards to what it's for is all medical purposes.

You could talk about Home Depot. You could talk about everything else, but on this card, on that site, it's all medical purposes.

By the way, can I be a co author? Thank you.

Thank you. Assemblymember Patterson.

Great. Thank you. Well, that was very educational to me. I have not had a CareCredit card, and so, naturally, I'm gonna speak about it. Anyways, no, but, you know, I didn't support the underlying policy. So, you know, the, the Senator Limon bill, don't tell her. But, you know, so I'm not gonna be supporting this bill today, but it, it you know, Assemblymember Sharp-Collins brought up an interesting point just in terms of, you know, people who are getting a credit card purposely for medical expenses versus people who are, like, putting, you know, a, a cost on their just sort of normal run of the mill credit card, you know, and, but this bill does apply to, to both types of debt. Basically, like, if I put a, a, a filling on my Chase card?

No. We're really trying to capture with this medical credit cards, and we are open to language that, you know, further clarifies that. And, you know, some of the—some of the solutions that we've talked about is just only including, from medical charges from medical providers to just make sure that it's very clear. So, we're open to, you know, to making sure that that's clear. But the intent of this bill and how we've written it is really around just medical credit cards, medical debt.

Okay. Thank you.

Thank you. Assemblymember.

Thank you very much for bringing this bill forward. I'm gonna support your bill today because we're in a health committee and we're gonna talk about health. And so, it's really important that we support this so you have the opportunity to go over to Banking or Finance, wherever else, because I think there's some real issues here. And then, hopefully, that can get clarified and rectified at the next hearing. So, thank you very much and I'll be supporting your bill today.

Thank you. Seeing no other comments, Assemblymember, would you like to close.

Thank you. I really appreciate the points that were made today. I appreciate you co-authoring and, and sharing your personal experience. Every person I've talked to, and there's a little bit of smoke and mirrors by the opposition starting to say that these aren't medical credit cards. But like you said, everything on their website is talking about medical care.

They can see if things are coming in from a medical provider or merchant. And, and we know, you know, with what is coming down the pike, related to HR 1 and people really, really struggling when it comes to being able to pay for health care, that this is something that people are going even more be forced into taking up.

And, you know, the decision on the the original bill was made to exclude medical debt from credit reports because there's an understanding that this is not indicative of your ability to pay regular debt. Right? You can't control if you break a leg or have a huge, you know, health care incident happen, which has enormous cost sometimes associated with it, that sometimes you can't pay for, and that's not necessarily reflective with how responsible you are typically with debt.

And so, I appreciate that California has really had the leadership to make sure that that's excluded. This was included in that bill originally and then taken out at the last minute, before it got to the final vote. And so, that's why we brought it forward because we feel like these, you know, these are even more so going to be an issue for folks in the in the near future because of the threats of HR 1.

And, you know, it shouldn't be that health care is a privilege for those who can afford it, and it shouldn't be based on the size of your wallet. It really needs to be something that everyone can can take advantage of and not end up not getting into housing because they they took care of their health.

Thank you so much, and appreciate an aye vote.

Thank you. And I would also like to be added as a co author. Appreciate your bringing forward this very important legislation. As you said, as, as many people are going to need to be figuring out how to pay for the overwhelming medical expenses that they will face, as a result of where we are in our protection of health care.

With that, Secretary, we need a motion in a second. Moved by Aguiar-Curry, seconded by Sharp-Collins. With that, Secretary, please call the roll.

[Roll Call]

That bill is on call. Thank you. Our next item up is item number 7, AB 2082 by Jeff Gonzales, and I've handed over the gavel to Assemblymember Johnson.

Good afternoon, Assemblymember Gonzales. You may begin whenever you're ready.

Good afternoon, madam chair and esteemed colleagues, members. I'm proud to present AB 2082, the Rural Farmworker Women's Health Act of 2026. A bill grounded in dignity, health, and respect for the women who help feed not only our state and nation, but those around the world. Across California, more than a 100,000 women work in our agricultural sector. Many in rural regions like the Inland Empire, Central Valley.

These women are essential to planting, harvesting, and processing the food that sustains California and communities across the country. Yet despite the critical role they play, many of these women face barriers to something as basic as women's health. Agricultural work often happens in remote rural areas far from stores, pharmacies, or health facilities. Many farmworker women spend long hours in the fields, sometimes with limited transportation and little opportunity to leave their worksites during the day.

And when you combine distance, cost, and long workdays, the result can be heartbreaking.

Two in five farmworker women reports being unable to afford basic feminine hygiene products. Think about that for a- for a moment. Two in five women are doing the physically demanding work that keeps food on our tables cannot re- cannot reliably access basic health supplies. When these products are unavailable, some women resort to unsafe alternatives, rags, paper, or other materials simply to get through the workday. That puts them at risk of infection and other health complications.

But beyond the health risks, it also affects something equally important, their dignity.

Members, no woman should have to choose between her health and her livelihood. And yet today, while California has broad strategies addressing women's health, there is no dedicated statewide program specifically focused on feminine hygiene product access in rural farmworker communities. The gap is what AB 2082 seeks to close. AB 2082 directs the State Department of Public Health to partner with trusted local nonprofits, organizations that already serve farmworker communities to provide free feminine hygiene products in rural and agricultural areas.

These programs will prioritize communities with the highest rates of poverty, ensuring resources go exactly where they are most needed.

This approach is thoughtful and practical. By working with trusted community partners, we ensure culturally competent outreach, efficient distribution, and real results, not bureaucracy. But beyond the policy details, this bill is about people. It's about the farmworker mother who wakes before sunrise to work the field so her children can have a bright future. It's about the young women working long hours in the heat, doing physically demanding labor while managing a basic biological need with limited resources.

It's about ensuring that women who sustain California agriculture and themselves supported with the basic health supplies they need. Members, feminine hygiene products are not a luxury. They are an essential health they are essential health items, and access to them should not depend on your type of employment, income level, or priority to a store. AB 2082 is modest, targeted solution to a very real problem.

It strengthens public health, supports working women, and affirms the dignity of farm workers who are the backbone of California's agricultural success.

This bill was born in my district from the- from the women who work tirelessly in my district. They came up two years ago and- and said, we need help. We need a voice. And that's- that's honestly where it began. And in understanding when they show up at 2AM and there's no gas stations, there's nothing to- to help them, they needed someone to speak for them and that's why we're here today.

And it's for those reasons, I respectfully ask for your aye vote on AB 2082. Besides me- Beside me is Angela Cardenas, a representative of the Inland Congregations United for Change, the sponsor of this crucial measure.

Madam chair and distinguished members of this assembly, my name is Angela Cardenas, and I'm a community organizer with Inland Congregations United for Change, ICUC. Through the listening campaigns with farmer- farmerworker women in the Coachella Valley, we indent- identify a crucial

and urgent need addressed by AB 2082, the Rural Farmworker Women's Health Act of 2026. More than a 100,000 women work in California's agriculture sector, many in rural and remote areas far from stores, pharmacies, and health clinics. These women sustain our food system,

yet one and four can not afford basic menstrual products. Some are forced to use unsafe alternatives, increasing the risk of infection and other health issues. Barriers go beyond cost. Access to trained menstrual health support. This is nearly nonexistent.

Menstruation remains stigmatized, leading to fear and misinformation and unsafe working conditions. While other women in California benefit from laws ensuring access to menstrual products, farmworker women are often left behind. AB 2082 helps close that gap. This bill would require the State Department of Public Health to provide free menstrual products to women in rural and agriculture communities, prioritizing high poverty areas and partnering with trusted local nonprofits for effective outreach.

I respectfully ask for your support of AB 2082 to advance menstrual equity, protect health, and recognize the dignity of farmworker woman.

Thank you.

Thank you. We'll move to others in support.

Thank you, Madam Chair. Ryan Spencer on behalf of the American College of OBGYN's District 9 in support.

Hi. Jennifer Snyder on behalf of the California Life Sciences in support.

Crystal Quinns on behalf of the California Commission on the Status of Women and Girls in support.

Ozzie Dolan, member of in the Congregational Center for Change in Student Pacific High School in support.

[speaker presents in Spanish].

My name is Angelica. I go to- with ICUC. I go to San Bernardino High School and I'm in strong support with this.

My name is Jada Rodriguez and I'm a youth leader at ICUC and I'm a student at Royal Valley High School and I strongly support AB 2082.

Apologies. Ryan Spencer, behalf of the California Medical Association, also in support. Thank you.

We now have, any witnesses in opposition? Any me too's? Alright. We'll bring it back to the committee for questions, comments, or a motion. We have a motion and a second.

Mister Gonzales, would you like to close?

Members at its heart, AB 2082 is about dignity. The women who harvest our food and sustain California's agricultural economy should never have to work long days in the fields without access to basic health necessities. Yet today, too many farmworker women face that reality and are forced to improvise, risk their health, and endure unnecessary hardships simply because essential products are out of reach.

This bill offers a practical compassionate solution by partnering with trusted community organizations to ensure feminine hygiene products reach the women who need them most, especially in the rural communities too often overlooked. Supporting farmworker women means supporting the backbone of our agricultural workforce.

It means recognizing their humanity, their health, and their dignity. I respectfully ask for your aye vote.

Alright. Thank you. We have a motion to second. So secretary, will you please call roll?

The motion is do passed to appropriations. [roll call].

That bill is out. Thank you. Alright. We're gonna go a little bit out of order just to allow a colleague to present. We're gonna go to file item number 11, AB 2343. Assemblymember Patel? Sure. Alright. So while Assemblymember Patel's making her way down there, we're gonna take a moment to catch up and do some voting. Starting with item one, AB 1696. I need a motion. Is there a motion? Are you sure? Okay. Alright. Secretary, can you please call the roll?

[Roll Call]

Now thank you for your patience. Assemblymember Patel will move it back to file item 11, assembly bill twenty three forty three. Thank you.

I certainly appreciate this committee's patience. Thank you, madam chair and colleagues. I appreciate this opportunity to present AB 2343, and thank you to the chair and committee staff for their work with my office on this bill. I will be accepting the committee's amendments. Nearly three million Californians have a substance abuse disorder, yet eighty one percent of who need treatment do not receive it.

Among those who go without care, thirty nine percent do not know where to find a treatment, and thirty six percent cannot find a program that meets their needs. These are not shortages in treatment capacity. They are barriers to access and navigation. Patients and families must families lack a trusted unbiased source to identify and compare and verify available programs.

To close this gap, DHCS partnered with an independent nonprofit to create the treatment atlas, a free directory that allows Californians to search licensed programs by location, insurance, services, population served, and patient ratings.

Because only licensed facilities can appear on this platform, it also helps patients verify that they are choosing a legitimate provider. But participation is voluntary, leaving the directory incomplete and undermining the accessibility it was built to provide. That gap is especially consequential given the continued presence of unlicensed operators who actively market to vulnerable patients. And a 2024 state auditor review found enforcement actions can take months to resolve. A complete directory gives patients a faster, more reliable way to verify that a provider is legitimate.

AB 2343 requires private substance use disorder programs and facilities to participate in DHCS's designated directory. Every patient can compare their options and confirm their choice, their chosen facility is operating legally. Registration can take less than an hour and is designed to be administratively straightforward. The infrastructure to provide care for Californians exists. This bill ensures patients can readily access it.

With me today are Lisa Scott and Patty Vargas to testify on behalf of the bill. Also with me is Lisa Kugler for any technical questions. And with that, I've presented my bill and would love to have your support.

Good afternoon. My name is Lisa Scott. Our son, Travis Scott came to us when he was 20 years old to express that he needed help with his addiction. We knew he had a problem, but we didn't really understand the depth of it. He was addicted to heroin.

We immediately got on the phone and called our insurance company in which they gave us a list of care centers and facilities. We made other phone calls. We spent hours trying to find help with no luck. The only place that was willing to help us wanted $30,000 upfront in which we did not have. I told them we didn't have the money and their solution was to go to our parents.

Well, that wasn't a solution. So we got in the car with our son and we drove to every place we could find from Camino to Sacramento, stopping, begging for help. At this particular time, the people that can provide the help, they didn't have enough room to take more patients. Midday, my son was going through severe withdrawals. I begged him to let me take him to the hospital.

He thought if he went to the hospital that he would be arrested. So instead, I gave him money so that he could go buy drugs on the street, so that he could cope enough to get back in the car, and we kept looking. At the end of the day, we found a doctor who was able to prescribe Suboxone for him.

He didn't give him any other treatment, just the Suboxone, and his advice to us was to go to church or go to AA, which were not options for my son. The Suboxone works and my husband my husband.

My son stayed clean for five years in which he relapsed. Five years later, we went through the same nightmare. He got clean again. In about three months after he had gotten off the Suboxone, not having any tools, not having any counseling, not knowing how to really deal with the problem of addiction, he relapsed. He was living the best life.

He was two months away from marrying the woman of his dreams. He had just gotten his third promotion at work in a month. But he put his fiancee on the plane so that she could go buy her wedding dress with her mom, and he decided to try it one more time. It was laced with fentanyl, and he died instantly. Access to proper care for addiction is imperative for recovery, And to have recovery is the only way that you will survive this horrible disease.

Thank you.

Thank you.

My name is Patty Vargas. My son, Joel, started using substances at 15. Like many parents, we had no experience with this world and didn't understand what was ahead. When we realized that his meth and heroin use wasn't just a phase, we did what many families do. We searched online for rehab.

We didn't know what to look for, what questions to ask, or what quality care even meant. We were scared and trying to act fast. The first program that came up in the search looked professional, answered immediately, and spoke to us with urgency and compassion. They told us time was of the essence and that money should not stand in the way of saving our son. We should look at it as investing in his life.

We didn't know how much this system relies on marketing and not transparency. Some treatment providers exploit your fear to sell you hope. Hope that they hold the silver bullet to return your child to the person they used to be. We were not given clear information about outcomes, about what treatment actually included, or about what would happen after those twenty eight days. We took out a second mortgage and paid $48,000 for a twenty eight day program.

We showed up for every family session holding on to hope, but there was little focus on long term recovery and no meaningful plan for aftercare. In the final week, we asked what came next. They suggested we write another $48,000 check for another twenty eight days. We were unable to do that, so they handed us a list of sober living homes and literally said, good luck. Joel relapsed within two days, and he died in 2017.

Families in crisis should not have to navigate a system that is this confusing, this expensive, and this vague. We need transparency, accountability, and real guidance so that desperation is not exploited and families have a fair chance to make informed safe decisions. Thank you.

Thank you so much, and we're so sorry for your loss. Are there any additional witnesses in support? Please go ahead and come up to the mic.

Good afternoon. Trent Murphy with the California Association of Alcohol and Drug Program Executives. We had originally submitted concerns to the committee. And with the amendments, we can now support the bill. I wanna thank the author's office and the sponsor's for for working with us on this.

Thank you.

Thank you. Is there any primary opposition in the room? Any opposed me too's? Alright. I'll bring it back to the author.

Thank you.

Are there any questions from the committee?

Alright. Go ahead.

In this complex health care, time in our lives, it's very important we provide clear guidance to our families in crisis seeking care. I respectfully ask your aye vote on this bill.

We have a motion.

move by Stephanie, seconded by Carrillo. Let's go ahead and call the roll.

It's a

The motion is do passes amended to appropriations. Bonta, Chen, Addis, Agaracuri, Aarons, Colosa, Carrillo? Aye. Carrillo, aye. Gonzales, Johnson, Patel?

Patel, aye. Patterson? Patterson, aye. Rogers?

Aye.

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

Thank you, Assemblymember. We'll leave the bill on call. Assemblymember Gabriel, go ahead and come on up. We'll do item number three AB 1915. Alright.

Assemblymember, feel free to begin whenever.

Alright. Thank you very much, mister chair, and good afternoon, colleagues. I am pleased today to present AB 1915, a measure that will support California's neighborhood restaurants by cutting red tape and modernizing outdated regulations. Neighborhood restaurants are the backbone of communities across California and appoint one of the most diverse workforces in our state, but too many are continuing to struggle. After enduring unprecedented challenges during the pandemic, these beloved small businesses are now grappling with major challenges from inflation and other cost pressures.

AB 1915 will support California's neighborhood restaurants by modernizing California's food facility code to reflect the realities of how small businesses operate, amend outdated facility requirements around restrooms, ventilation, and equipment, and create a streamlined permitting pathway to allow qualified contractors to self-certify routine equipment installations, making it less expensive to own and operate a restaurant. This bill was written in strong partnership with small business leaders to address these issues head-on.

And so doing this bill will help to keep our beloved neighborhood restaurants afloat and assist them on the long road back to recovery. This bill is supported by a robust coalition that includes the Los Angeles County Business Federation, the California Association of Environmental Health Administrators, the California Restaurant Association, and local restaurants and business councils. It has no registered opposition.

Very pleased to have with me today to testify in support of the bill, Eddie Navarrete on behalf of the Independent Hospitality Coalition, and Britney Valles, an entrepreneur from Los Angeles. Thank you, and respectfully request your aye vote.

Thank you. And we'll allow two minutes for the supporters.

Thank you. Good afternoon. My name is Eddie Navarrette, president of the Independent Hospitality Coalition representing a network of small business businesses across LA County. Our industry is not stabilizing. It is contracting.

In Los Angeles, more than 84% of restaurants reported declining businesses last year, with many operators experiencing revenue losses between 30 to 80% due to economic shocks, declining tourism, and reduced consumer spending. At the same time, the cost of doing business continues to rise across the board, including food, labor, insurance, and rent, all increasing faster than revenue, creating sustained pressure that small businesses are struggling to absorb. AB 1915 directly addresses a piece of pressure that we actually have the ability to fix.

It removes a hidden cost embedded in outdated building and health codes, requirements that no longer reflect how businesses operate today, but still drive thousands, and, in many cases, tens of thousands of dollars in unnecessary expenses. This bill allows simple like for like equipment replacements such as an ice machine or a stove to be replaced without months of delay, eliminates construction triggers that, like additional restrooms or ventilation systems where there is no measurable impact to public health.

It updates the food code to reflect modern operations, including temperature monitoring, practical hand practical handwashing standards, and flexibility for smaller or older spaces. Although some of these minor technical changes these are technical changes. These are real cost drivers that determine whether a small business can open, reinvest, or stay in business.

AB 1915 is also the result of meaningful collaboration with health officials and regulators to identify where the code can evolve in a way that maintains safety while reducing unnecessary cost and delay, creating clear standards, improving consistency, and allowing enforcement to focus on real risks. At a time when vacancies are rising, small businesses are closing, and our local economies are under significant strain.

This bill provides a practical and immediate way to reduce the cost of doing business and support the businesses our communities depend on. On behalf of the Independent Hospitality Coalition and the small business community we represent, we respectfully ask for your aye vote.

My name is Brittney Valles. I am the executive director of the Independent Hospitality Coalition and a seasoned restaurant owner, and I am really excited to be here to advocate for AB 1915, a bill that would be a major game-changer. The restaurant industry, as we all probably know, is a famously tough one no matter where you are. In California, it is much tougher.

And though I appreciate the street cred that being a restaurant owner in California provides me, I enthusiastically welcome anything that makes it easier.

I want to, share a story to illustrate just how necessary the changes in AB 1915 would be in that effort. So at one of my cafes during a routine health inspection, the health inspector noticed that we didn't have a wipeable surface above our espresso machine, and he doesn't under didn't understand how we got through previous inspections without it. Keep in mind that our ceilings were over 20 feet high, and they were not getting a lot of action.

But regardless, after being open for three years, we had to close until that issue was addressed. I then began the grueling process of working with two local departments, the Health Department and building and safety.

We couldn't afford the experts that would have helped to streamline this process, so Aye, a professional Taco lady, had to figure it all out on my own. The process was so incredibly stressful, and every single person that I spoke to gave me contradicting information. It was very complicated, and it took over four weeks. I felt insane and frustrated, and all of my mental energy was focused on this issue, taking me away from my other restaurants and not even considering how to grow my businesses.

For over four weeks, my staff didn't work, my business brought in no revenue, and our customers became frustrated.

Once everything was approved, the actual work of what needed to be done took less than half a day and cost less than 1,000 dollars. The cost of the lengthy process was a whole another story. Not only did I lose out, but my staff, unfortunately, had no certainty of when they would go back to work. During my time in this industry, I have many, many, many stories like this.

I need you to wrap up, please.

Yeah. But I only have two minutes. So, I I just wanna illustrate the importance of restaurants and the joy that they provide and how much AB 1915 would make changes to keep restaurants open and send a message in that effort.

Thank you so much. Do we have any other witnesses in support?

Good afternoon. Marlon Lara with the California Restaurant Association. We're in support. Thank you very much.

Amanda Bloom with the California Association of Environmental Health Administrators in strong support.

Naylea Ayala with the Mesa Verde Group on behalf of the Inclusive Action for the City, and also a proud sponsor. Thank you.

Now we will hear from primary opposition, if there is any. Seeing none. If there are any me toos in the hearing room that would like to offer opposition? Seeing none. I will bring it back to the committee for any comments or questions. Assembly Member Carrillo moves the bill, seconded by Stefani, and González has a comment.

Just wanna thank the author. Britney, I know for a long time, and I believe that restaurant was in our in my district. And thank you for all your work and your advocacy. Many folks on this bill are also from my district as well, Inclusive Action for the City. And I just wanna thank the author for bringing this forward. I'd love to be added as a co-author as well. Thank you.

Thank you. Seeing no other comments from committee. Assembly Member, would you like to close?

Yeah. Thank you very much, Madam Chair. I just wanna I think Britney's story beautifully illustrates what we're trying to do here. We think there's a way that we can cut red tape, that we can support small businesses, we can support workers, and we can do without compromising safety. And so on behalf of restaurant owners like her, I would respectfully request an aye vote. Thank you.

Thank you so much. This has a motion in a second, so we will call the roll.

Motion is do pass to the Business and Professions Committee. [Roll Call]

That measure is on call. We're going to move now to your second bill, item number nine, AB 2244 by Gabriel, California certified food standard. Whenever you're ready. Thank you.

Alright. Thank you, madam chair and colleagues. I wanna begin by thanking the committee for their work on this bill, and I'm pleased to accept the committee amendments. I am also pleased today to present AB 2244, legislations designed to empower Californians to make better informed and healthier choices by increasing transparency around ultra processed foods.

In recent years, doctors and scientists have increasingly warned us about the negative health consequences of ultra processed foods, which have been linked to serious health harms, including cancer, cardiovascular disease, diabetes, metabolic disorders, reproductive harm, and neurobehavioral issues in children.

These products are often filled with harmful additives and specifically engineered to interfere with our brain signals in ways that contribute to food addiction. In recent years, California has emerged as a national leader in addressing these growing health risks. We began three years ago by banning the most dangerous additives, selecting chemicals where the industry couldn't credibly push back. We then moved to limit additives in our school foods and then to restrict ultra processed foods in our schools.

Last year, governor Newsom signed into law the Real Food Healthy Kids Act, legislation that established a framework to phase out dangerous ultra processed foods from California schools.

It was a historic win for our kids and for public health, and it passed with overwhelming bipartisan support. I'm proud of California's leadership over the past three years. We've shifted the national conversation, sparked FDA action, inspired similar legislation in more than 30 other states. Despite this progress, more work is needed to protect our kids and to improve public health. And so now it's time to address ultra processed foods in our grocery stores.

In particular, as consumers continue to face real challenges in identifying healthier products, Ingredient lists are often long, technical, and incomplete, leaving families without clear accessible tools to distinguish between minimally processed and highly processed few foods. Our view is that parents shouldn't need a PhD in chemistry to understand what they're feeding their kids, and that's why he we have introduced this bill. It would establish a voluntary seal that food manufacturers could place on products that meet clear science based standards for not being ultra processed.

Modeled after the successful and widely recognized USDA organic label, the seal would provide consumers with a simple, trustworthy way to identify healthier options with a quick glance. AB 2244 is a voluntary common sense approach that will enable consumers to quickly compare products and empower them to make better informed choices.

The bill also will allow manufacturers to highlight healthier products and rewards companies that are doing the right thing. In so doing, this bill will address the dangers of ultra processed foods, but in a way that strengthens consumer choice, drives innovation, and promotes healthier options across the food supply without banning any products. I also want to acknowledge that we have had productive conversations with opposition and other stakeholders.

We are happy to accept the amendments today, and we are committed to continuing to work collaboratively with all parties to produce the strongest possible bill. Like our work last year on AB 1264, our hope is that we can turn opposition into support and work together in a spirit of cooperation to provide customers with the information they want and deserve.

Finally, I wanna thank the many medical researchers and public health advocates who have worked in close partnership with us on this bill. I'm proud that it's supported by a coalition that includes the California Medical Association, the American Diabetes Association, the Crohn's and Colitis Foundation, the United Nurses of California, and so many more.

I'm pleased to have with me today to testify in support of this bill, Alyssa Moran, the deputy director of the Center for Food and Nutrition Policy at the University of Pennsylvania, and pediatrician and president of Children's Medical Alliance, doctor Ravindikaara. Thank you, and respectfully request your aye vote.

Thank you. You'll each have two minutes.

Thank you to the chair and members of the committee. My name is Alyssa Moran, and I'm the deputy director of the Center for Food and Nutrition Policy at the University of Pennsylvania. I spent two decades working with patients, policymakers, and academics to design impactful nutrition policies. This bill is an effective practical approach to helping people avoid ultra processed foods. Consumers need better information.

Most people want to limit ultra processed foods, but struggle to identify them. Parents view ultra processed foods as one of the three biggest threats to their children's health, yet most find it more confusing to identify an ultra processed food than to file their taxes. Even experts are unable to reliably identify these foods without significant training. This proposed California certified label solves this problem. It's simple.

It's on the front of food packages, and it clearly identifies which foods are not ultra processed. Research consistently shows that simple front of package labels like these help people identify and purchase healthier products. They can even be used by kids. But people need a label they can trust, and industry back labels have been unreliable. Many non ultra processed food labels are already starting to flood the market, including labels supported by the food industry.

Consumers are skeptical of industry back claims in part because ultra processed food companies have a history of misleading the public. For example, in 2009, the food industry implemented a smart choices label to identify healthier items. The label appeared on Froot Loops, Cookie Crisp cereal, and Fudgsicles. By contrast, most people recognize and trust government certified labels like the USDA organic seal. This is why a California certified label is critical for delivering objective science based information that consumers can trust.

Importantly, this proposal is not overly restrictive and leaves both consumers and retailers with plenty of choices. There are already tens of thousands of products that would qualify for the label, and the average supermarket has close to a thousand products displayed prominently outside of the center aisles. People want to be able to find healthier foods, and this bill empowers them to do so. Thank you.

Good afternoon, everybody. Thank you for letting me be here and giving me the opportunity to speak on behalf of the American Academy of Pediatrics and the Children's Medical Alliance about the clinical importance of AB 1264. As pediatricians, we don't see numbers. We see kids. We see how diet shapes their health, their behavior, and their futures.

And we're not just talking about calories, we're talking about consequences. Ultra processed foods are fueling a surge in chronic conditions among children, obesity, type two diabetes, and even mental health challenges like anxiety and depression. These aren't distant threats. They're showing up in our exam rooms every day. The science is clear.

Studies published by The Lancet shows a fifty percent increase in cardiovascular disease among people who consume ultra processed foods. And the data from the CDC and NIH confirmed that even short term exposures can lead to overeating, weight gain, behavioral issues, especially in school age children. Yet today, nearly two thirds of the calories that our children consume come from ultra processed foods in these products. Many of the many are served in school cafeterias, places that should nourish children, not expose them to preventable harm.

Yet today, A B yet today, AB 1264 offers a thoughtful phase solution.

It defines ultra processed foods, directs the state to identify the worst offenders, and gives schools time to remove them. This approach aligns with the American Academy of Pediatrics. Core message, children deserve access to real nutritious food that supports physical and emotional cognitive development. Schools should be safe havens, not sources of chronic disease. Let's give our children a foundation that they deserve.

Beforehand, I must give my heart heartfelt thanks to Assemblyman Gabriel for his leadership and unwavering commitment to children and health. His work is on this bill has values that we all share. These are things that children should have in a fair shot for their healthy future.

Thank you. Are there others in the room who would like to register support? Madam chair, Bernadette Del Caro, a sponsor with Environmental Working Group. Thank you.

Ryan Spencer with the oh my god. With the Crohn's and Colitis Foundation and the Calvary Podiatric Medical Association in support.