Assembly Standing Committee on Health

Good afternoon, and welcome to the Assembly Health Committee hearing on Tuesday, June 16. Before we begin, I wanna make sure everyone understands our committee procedures to ensure we maintain order and run a fair and efficient hearing with the goal of hearing as much from the public within the limits of our time. We seek to protect the rights of all who participate in the legislative process so that we can have effective deliberation on the critical issues facing California.

Rules of conduct by members of the public include no engaging in conduct that disrupts, disturbs, or otherwise impedes the orderly conduct of this hearing, engaging in personal attacks of members of this committee, authors, staff, or witnesses, talking or loud noises from the audience. Please be aware that violations of these rules may subject you to removal or other enforcement processes.

If you are providing witness testimony at this hearing, all witnesses will be testifying in person. Main support and opposition will be allowed two main witnesses for a maximum of two minutes each. As a reminder, primary witnesses and support must be those accompanying the author or who otherwise have registered a support position with the committee. And the primary witness in opposition must have their opposing opposition registered with the committee per the instructions on our website.

All other support and opposition can be stated at the standing mic when called upon to simply state your name, affiliation, and position.

All testimony comments are limited to the bill at hand. 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 number three, SB 1041 by Nilo with a motion of do pass to appropriations. Item number four, SB 1088 by Blake Spear with a motion of do pass as amended to judiciary.

And item number eight, HR 110 by Bonta with a motion of to be adopted. With that, we will begin with our as a subcommittee, and we will begin with our first item, item number one, SB 989 by Blakespear. Thank you so much, Senator. Whenever you're ready. I think you might have to press the button.

Thank you, Chair and colleagues. I'm pleased to author SB 989, which is sponsored by the California Professional Firefighters. This bill would expand access to CARE Court and help more Californians with schizophrenia spectrum and other psychotic disorders receive the care that they need.

CARE Court was created to provide a structured voluntary coordinated pathway to treatment for individuals with severe mental illness who are too often cycling through emergency rooms, jail, and repeated law enforcement encounters.

While early implementation shows promise, barriers in the current petition process are preventing the program from reaching many of the individuals it was designed to serve. The Newsom Administration originally estimated that between 7,000 and 12,000 people would qualify for CARE Court, but after a full year of implementation through the start of this year, January 2026, California courts had received only 3,817 CARE Court petitions.

So there was a prediction of 7 to 12,000, and there were only 3,800. This is clearly far short of the need. We know that first responders are often the first point of contact for individuals in crisis, but under current law, they must navigate a complex court filing process. They must obtain sensitive medical records, and they must appear in court to initiate a CARE Court petition.

First responders obviously have barriers to doing all parts of that. As a result, many individuals who would benefit from CARE Court are never connected to the program. SB 989 creates a more practical and effective pathway by allowing first responders to request that County Behavioral Health Agencies review and file CARE petitions on their behalf.

Counties are required to assess these requests within 30 business days and then determine whether to file a petition when eligibility criteria are met or likely to be met. Finally, the bill directs the Department of Health Care Services to develop a standardized referral form to provide guidance to first responders and to establish data-reporting requirements to improve transparency and program performance.

This approach reduces administrative burdens, better aligns responsibilities with expertise, and ensures that individuals in crisis are connected to care and not lost in the system. SB 989 builds on the promise of CARE Court by making it more accessible, more accountable, and more effective. And with me today in support, I'm honored to have Meagan Subers, on behalf of the California Professional Firefighters.

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

Thank you, Madam Chair, members. Meagan Subers, on behalf of the California Professional Firefighters, pleased to be a sponsor of the bill. CPF and our local affiliates have been leading and evolving a local response framework to improve patient care and outcomes for individuals who have been experiencing a mental health issue or a crisis. We've worked with this legislature to expand community paramedicine programs and mobile mental health units.

Our members are committed to this work because I hear again and again that they are often running 911 calls on the same individual in the community, transporting them to the hospital, understanding that they may not get the deeper level of care that they may need, and they're probably gonna have to respond on them again soon, and we see CARE as another tool for firefighters and other first responders to try to help make these connections to that deeper level of care.

I often hear from my members that they feel helpless sometimes when they can't make those connections in the community. I've been fortunate enough to sit on the HHS CARE Act Advisory Group, along with one of my local presidents from the City of San Jose, and through that work and engagement, we've heard from our members and learned several things about implementation across the state.

We have some examples of where CARE has been implemented in a fantastic manner with integrating the fire department, including Alameda City, Alameda County, and San Diego--so ironically, the two members that are here at the moment--but we've also heard from several other parts of the state where there have been challenges in integrating the fire department, getting the training and resources needed to the firefighters to do that work, and that is what this bill is focused on.

There's a general lack of information about how a firefighter may be able to complete the petition process, have access to that medical record information, and be able to show up to court as required under CARE. So that is what this bill is really focused on doing, as you heard from the author, creating that streamlined process.

We understand and respect there may be concerns from organizations about the underlying law of CARE, and I think we would just like to stress that if we thought the situation of trying to address the needs of this population was working prior to CARE, we wouldn't have CARE Act today, so we are focused on implementation and trying to make this program work, and for those reasons, we ask for your support today.

Thank you so much. Are there others in the hearing room who would like to offer their position on the bill? Please come forward.

Thank you. Good afternoon, Madam Chair, members. Dylan Elliott, on behalf of the California State Association of Psychiatrists, in support.

Leah Barros, on behalf of California Hospital Association, in support.

Alison Monroe, Alameda County Families Advocating for the Seriously Mentally Ill, in support.

Mary Ann Bernard. I am a member of FASMI, Families who Assist the Severely Mentally Ill, and here in Sacramento of NAMI. I am also a lawyer who used to represent mental hospitals in another state, as well as peace officers and firefighters, here in support.

Lauren Rettagliata, mother of a person with schizophrenia, and I represent families on the CARE Act working groups and NAMI Contra Costa County. Please approve this bill.

Elizabeth Kaino Hopper, Sacramento resident, member of NAMI Sacramento, volunteer on the helpline, and a parent of a person who qualifies for CARE Court; also, Chair of Family Advocates of Individuals for Seriously Mentally Ill, asking for support. Thank you.

Hi. I'm Dick Donnelly, Sacramento County resident. I'm the father of a young man who died last year for lack of interventions like are addressed under this bill. And I'm asking for your support. Thank you.

Ann Donnelly, the mother of a son that died that couldn't get help last year who was seriously mentally ill, and I ask for your support.

Mark Donnelly, the brother of that who died last year, and I support this bill.

Lawrence Abbott, San Leandro, brother of a beloved baby brother who died by not getting support.

Thank you. Are there any primary witnesses in opposition? Please come forward. Go ahead. You'll have two minutes.

Thank you, Chair and members. I'm Evan Fern with Disability Rights California. We are sympathetic to the concerns of first responders that some individuals are not getting connected with treatment. SB 989 would create a streamlined referral process for first responders to subject individuals to CARE Court. Funneling individuals into CARE Court is not the solution.

CARE Court is an unproven, costly, and coercive program. We continue to expand CARE Court without fully understanding if it's actually working. The numbers so far are not promising. The first CARE Court annual report tells us that 56.4% of people in CARE Court did not receive at least one ordered mental health service. 82.2% of people in a CARE Court did not receive at least one ordered social service or support.

And there were high indicators of unmet needs. Twenty-five percent of people still had criminal justice involvement, 21% had visited an emergency department, 20% had inpatient hospitalizations, and 20% experienced LPS holds. Despite not paying for services, the cost of CARE Court is astronomical. A report from the state legislature last year found that the program costs $713,000 per participant in Fiscal Year 2023-24.

That's more than the median cost of a single-family home in 35 California counties and more than 40 times the cost of full service partnership programs, which provide comprehensive services, including housing, food, case management, medical care, and mental health care.

CARE Court subjects individuals with disabilities to court-ordered treatment. It relies on the black robe effect, which is not backed by research. CARE Court is fear-based, not evidence-based. SB 989 would add yet another process, more complexity, and more cost to an unproven, coercive program. For these reasons, we ask you to oppose SB 989.

Thank you. Are there others in the hearing room who would like to register opposition for this measure? Please come forward.

Zeenat Yahya, on behalf of ACLU Cal Action, in respectful opposition.

Danny Thirakul with Mental Health America of California, Cal Voices, and the California Association of Mental Health Peer-Run Organizations, in opposition.

Simon Vu, on behalf of the California Behavioral Health Planning Council, in opposition.

Thank you. Seeing no other opposition, I'll bring it back to the committee for any comments or questions. Assembly Member Patel.

Senator Blakespear, I'd like to thank you for authoring this piece of legislation. As a representative from San Diego County, I've seen for the past several years how we've struggled to help make the CARE Court system work and know that there are still challenges within the system. And I wanna share appreciation for you trying to tackle some of those challenges to make sure that we get to the point where it is functioning how we would like it to function, how originally envisioned. So thank you for this very important work, and I would like to add on as a co-author.

Thank you. I also just wanna be clear, there were some technical amendments. Do you accept those? Great. Seeing other comments from the committee, we have, I think, a motion when it stands. Thank you. Motion and a second, Patel and our Majority Leader. I wanna thank you for bringing forward this bill. I think it is very clear that we are still in a state of really fully understanding the impacts and the implementation challenges with the CARE Act.

And so we are going to be looking forward to making sure that we're doing that more thoroughly next year, and at the same time, I also just wanna recognize the incredible asset that our firefighters are in particular in being able to help to provide first response in a way that is connected to individuals, and this is in keeping with allowing them to be able to have ability to participate in that particular process of ensuring an ability to review, and with that, I will be supporting the bill. I think that this is a balanced approach at the time and look forward to hearing more about how this proceeds over time. With that, would you like to close?

Yes. Thank you. Well, thank you for your comments, Chair, and I appreciate the supportive comments from other members of the committee. I just wanna address the issue of CARE Court being coercive because it's important to recognize that CARE Court is 100% voluntary, and so that means that people can stop participating at any time, and they stop intentionally, but also people stop participating because they're unable to participate.

Their grave disabilities have progressed to such an extent that they lack the insight to be able to participate or other means. And so, when you look at CARE Court, it has tremendous promise, and I spent several hours witnessing CARE Court a couple months ago, which was a lot to get organized because every person has to consent.

So I was in a courtroom in San Diego County, and my observation of the multiple people who we saw in the several hour period is that everybody was tremendously grateful by the support that was provided, and the feeling in the courtroom, there was a black robe effect in that important people cared about them.

And there were people who were from the county. It was in a courtroom setting, but it felt like a group therapy session. It wasn't being driven or directed in any way. It was checking in on the person, and one man played a song on the guitar that he'd written for us and another one talked a lot about his dog, and there-- so the reality is that people are accessing treatment and housing that they wouldn't be able to access otherwise by being part of CARE Court.

But it's also important to recognize that CARE Court is not serving anywhere near as many people as need help. So as I mentioned at the beginning, there were-- the estimate was that it would serve between 7 and 12,000 people, but actually, there were only 3,800 CARE petitions. And of the petitions, there were less than 1,000 that actually resulted in CARE plans.

So, you know, something that was supposed to have up to 12,000 people involved has under 1,000 after we have had one full calendar year of CARE Court. So the administrative barriers to entry associated with CARE Court and all of the safeguards and process around it is including the fact that first responders are the ones sometimes who have the most contact with people who have estrangement with their family members or other reasons that nobody's able to actually connect them to something, but first responders don't have access to medical records.

And so asking the county to be part of that process, having them evaluate and see if they could file actually something with CARE Court so that they could get involved in it--again, a voluntary process--you know, this is something that is not coercive, that is an opportunity that-- my observation was people are grateful for.

So I recognize that there's a philosophic resistance or opposition to CARE Court as a whole, as a concept, but the reality is we do have it in California, we are trying to get it off the ground in every county, and it is actually helping people who are involved. So figuring out more ways to have entrance points and then reducing the frictions that are at those entrance points so that people like our brave firefighters can help people access this care is just really important.

So, I'm grateful for the support of our first responders who are really looking at how we can make things better, and wanna thank the firefighters for that, and also, I wanna thank the committee and the staff for your involvement in helping the bill be better, and I thank you for your aye vote.

Thank you so much, and at the appropriate time, we will be able to consider it. And we have another author in the hearing room right now. So we will move to Item Number Five: SB 1089 by Richardson when she is ready.

Good afternoon, everyone.

Afternoon. You'll have to press the

I have the binder, but I don't have my talking points. So you're gonna test me on knowing my bill backwards and forwards, which I do. So I'm okay with it. Good afternoon, madam chair and members of the committee. I'm here to talk to you about SB 1089, which has to do with GLP ones.

And I'm first gonna tell you the amendments that we've agreed to accept from the committee, which is to essentially, strike the first portion of the bill, which has to do with including CalPERS. The CalPERS would offer GLP ones to state and other related employees. I do hope to bring that forward next year, some aspect of that of getting us to the point where health plans do actually offer to have GLP ones.

But I think based upon the chair's recommendation, we do have a very good portion in the bill which has to do with having the Department of Health and Human Services provide, or I should say, offer, GLP ones through their, distribution process. And with CalRx and HCAI to be able to have a system so Californians beyond people who are on health plans would be able to access it.

If I if you would indulge me because I don't think I've used three or five minutes, I do wanna tell you that I started taking GLP ones in August. I won't say the brand just because I don't wanna get in trouble of giving someone more advertisement than others. But I started in August of August of last year, and I have now lost approximately 50 pounds. When I began to take the GLP ones, I was diagnosed as being pre pre diabetic.

My mother had been diagnosed as being diabetic.

My father had been diagnosed as as being diabetic. And when you look at particularly within the black and brown community, diabetes is a very significant illness or diagnosis that people have. So at the point when I was aware that GLP ones were, potentially helpful for people who are diabetic and pre diabetic, of course, I sought to use them. Not because I wanted to get into a prom dress or go to the Grammys, but because I wanted to be healthy and I wanted to live.

And when I made the call, I got the prescription from my doctor.

And when I made the call to my health insurance as a state employee to Blue Shield, I was told that they didn't offer it to me. Even though I was one point off of everything of being diagnosed as diabetic. So since August, I started paying over $800 a month personally cash. And now, even though prices have dropped, I'm still paying over $450 a month.

And so the point the reason why this is so important that the Department of Health and Human Services, HCAI, and CalRx would offer a fair and affordable price to Californians is we shouldn't.

It is well documented, and I know we have a doctor in the audience as well. There's enough data now. It's well documented of the improvements that we're seeing of people taking GLP ones. And it is similar to a person taking insulin as a person taking high blood pressure medicine.

A person, if something is available to help you to be more healthy, to avoid core morbidities, which you see in the bill analysis before you, why would we want to wait till a person became diabetic to help them?

It is far cheaper and far less invasive and harmful to individuals not to have to have knee surgery, not to have gastro cancer, not to have so many of the things that we know GLP ones can be helpful with. So I respectfully request your support on s B1089.

I will be also submitting, amendments that in addition to the one that I'm accepting of the committee to remove, CalPERS, I would like to make sure anywhere where it references GLP ones that it references all of them because we have to make sure, for example, Kaiser today and Blue Shield may offer Ozempic, but they don't offer Wegovy, the weight management piece of it. So we wanna make sure, not only all GLP ones are being offered, but also, too, that future medications would be available.

In January, right now, there's a study going on, for a product, Retra, that actually has three of the components, not the two, which is the terrazeptide.

So we wanna make sure as our laws evolve that, HCAI and CalRx would have the flexibility to consider future products as well. And then the final thing is, because now the bill is restricted to CalRx HCAI alone, it's my hope that we would be able to change that from May to Shell because it's based upon if it's appropriated. So only if, even of of us passing this bill, it would still have to be appropriated in order for them to enact the process.

And so, of course, once we would appropriate the funds, we would certainly want them to do it. Right?

So with that, I respectfully, ask for your aye vote and I'm available for any questions on the bill.

Move the bill. Thank you. Moved by Aguirre Curry, seconded by Carrillo. Are there any primary witnesses in support please come forward?

Azimitu, Vanessa Cajina on behalf of the California Academy of Family Physicians here in support. Thank you.

Good afternoon. Alejandro Solis on behalf of CPCA Advocates in support. Thank you.

Dylan O'Hait on behalf of the California State Association of Psychiatrists in support. Thank you.

Good afternoon. Ben O'Brien with California Life Sciences in support.

Thank you. And are there any primary witnesses in opposition? Any of those who would like to register opposition in the hearing room? Seeing none, I can bring it back to the committee for any questions or comments. Assembly member Patel and then Assembly member Kolozar.

Thank you for bringing this Bill forward. I do have a couple questions for you as I'm trying to understand the CalRx process. I'm educating myself through your Bill. So if you don't mind me taking some liberties. We have done this with a couple other generic pharmaceuticals.

How has the process gone for those? And did you see any opportunity for improvement with GLP one inhibitors?

Well, I would probably need I'll give you my perspective, but of course, the governor and the administration and the department could give a I will ask them and make sure to follow any answer to you. But as I understand it, some of the products currently that CalRx is providing is for example insulin. That was the most popular 1. And originally the thought was that California, we could produce, insulin and do it at a much cheaper price.

And as has been told to me, that ended up being I think more complicated than expected.

And so they ended up forming a partnership which is what the current legislation provides to be able to get that product and to be able to offer it. And so our Bill is consistent with that, that CalRx would be able to because the manufacturers currently have a patent, they would be partnering with the manufacturers to provide the product. However, it's my understanding the manufacturers do have the ability to also produce generics

as well. So patent would expire then potentially, other providers could seek to produce the product. I will say though, what was encouraging that I learned a few weeks ago is that the Carpenters Union for example, in Las Vegas has a major pharmacy that they provide products to their members at a significant reduction price. So I'm hoping that this Bill would also afford HCAI, CalRx to consider potentially working with entities such as.

The carpenters or directly with the manufacturers to distribute the product. I will say for my experience with Zepbound, Zepbound what they do, I buy direct from oh, I wasn't supposed to say the name. They buy direct from the manufacturer. The manufacturer then offers that I could receive the product through the mail. Through the mail is using a I believe, pharmacy company named Gift Health, and they are the ones who distribute the product.

However, if you have it where you pick it up, they utilize locations such as Walmart, Costco, whoever, where they use that distributions system, meaning a big store that provides a pharmacy. Yeah. So how has it worked? I believe it's important that we include some dollars that would be required to set up the proper distribution center. But given the fact that, for example, carpenters and others are currently distributing the product other than directly the manufacturer, I think it's very possible.

And in my initial question to the governor of his willingness to include GLP ones with CalRx, he was very positively open to that given your approval.

Okay. So another question. As I think about legal frameworks, does your Bill have any provision for any liability? Who would assume the liability if there was any contamination of product or any something that happens with it along the way? Is that now does that stay with the manufacturer who we're contracted with?

That is

Or is that up to CalRx to figure out?

You know, that is an excellent question that I do not know the answer to, but I will find it out. I would assume, however, it would be similar to any medication situation. I remember I'm trying to remember what the drug was, aspirin or something that people were contaminating and Tylenol. The manufacturer Tylenol, maybe. And I believe the manufacturer had to pull the products and all of that.

But I don't believe the distributor was responsible. I think actually the manufacturer pulled the products and had to check that their products were safe and so on. So I assume something similar would be in effect.

And I would assume also, remember, that any issues related to liability would be very well spelled out in whatever Yeah. Contract agreement that they had between these parties.

Perfect. Thank you. Thank you for your questions.

Assembly member Caloza.

Thank you, Madam Chair. Thank you, Senator first and foremost for sharing your story and how you have used GLP 1 to fight being prediabetic. That's also very common being Filipino. Many people in my community are also prediabetic. 1 of the questions that I had was really around kinda like the age limit. Is there an age limit for who would be eligible for these treatments?

So as the Bill would go as of today. A doctor does need to prescribe the medication. You can't just go and say hey, you know, go to CalRx and I wanna order a GLP 1. It still requires a doctor's prescription. And so the doctors then follow the current guidelines. I believe currently, I don't believe doctors are able to prescribe you know, younger than teenagers at this point.

But, I believe there are discussions in the industry about whether that would be appropriate because there are some young children who are actually diabetic, born diabetic frankly. And so but it's my understanding the current rules that apply for a prescription for a GLP 1 would apply, which as I know it today not to include children. But I do believe there's an interest in that and but that would be something the food and drug, you know, association would have to determine.

Thank you for sharing that. And and like I mentioned, I really appreciated hearing your story and just your focus on prevention of long term health outcomes for some of these very serious chronic health issues and would love to be added as a co author if you have. Thank you.

Thank you. I would say you're 1 of our softball players, and we had softball practice a year ago. And for the first time in my life, I've been an athlete. I've tried out for the Olympics in 1980. Now, I'm dating myself. But for the first time in my life, when our coach said, run from the 1 gate to the other, I couldn't run.

And I was shocked. I just you know, I could barely do more than a brisk walk, and I said, that's it enough. And so I'm looking forward to seeing you out on the baseball field. I'm not running a sprint yet, but at least I'm not falling out either. But it really I can tell a tremendous difference just in not feeling heavy, feeling lighter, feeling healthier.

Just so many things that really weight has a huge impact on beyond, you know, your physical appearance. It really is about the health. Thank you.

Thank you for sharing that, your personal story and your journey, your health journey. I think, very much appreciated, Senator. We are going to be with a motion and a second on this Bill, going to be considering it.

I just wanted to clarify to committee members that what you have in print represents the committee's amendments as previously discussed, and those are what we are going to be making a motion for with a motion as amended to appropriations and have discussed with the author the consideration for the additional amendments that she may made after this hearing as it moves towards appropriations or in other committees. With that, we still don't have a quorum.

Would you like to close Senator?

As a Senator, I respectfully ask for an aye vote.

Thank you. Thank you.

Thank you all. Have a good day.

We're gonna move on now to item number seven SB 1309 by Rubio. Hi, Senator. Whenever you're ready.

Thank you so much. Thank you, madam chair, members of this committee. I appreciate the opportunity to present SB 1309 to the stop lung cancer early act, which will increase access to life saving care by eliminating out of pocket cost for medically appropriate lung cancer screenings. I'm accepting the committee amendments that were offered, and it's noted in the analysis. This bill makes an essential change.

It will remove financial barriers preventing patients from accessing life saving follow-up care. As studies show, preventative care is the best way to keep people healthy, so expanded access to necessary screenings will save thousands of lives. We see its success to the lives safe when we decrease cost of screening for breast cancer, cervical cancer, and colorectal cancer. Lung cancer is California's deadliest cancer right now, killing over ten thousand Californians every year. However, our screening rates are very low.

They're under ten percent where whereas other cancer rates are above seventy percent, and cost are the main cause of avoidance for a lot of families. And the reason why people just avoid altogether until it's too late, and we know that families are struggling with high cost of of pretty much everything, and we don't want them to have to make that decision about their health care. I have heard stories of families not sharing with other family members because they don't want to put them in that situation.

So this bill would help in that regard. We want people to have the access.

And for example, veterans are far less likely to follow go to a follow-up appointment as it also disproportionately affects people of color. And bottom line, it's difference between life and death for some of some patients. Less than a quarter of lung cancer cases are diagnosed at stage one when survival rates are at their highest. Around half are diagnosed at stage four when survival rates are at their lowest, but the cost of care is at its highest.

By removing barriers, we increase early detection, improve survival rates, and reduce long term long term I'm sorry, long term health care costs associated with late stage lung cancer treatments.

SB 1309 is a targeted evidence based early detection update to existing policies. One that aligns lung cancer screening with other covered preventative services and family members will stay quiet often as mentioned because they don't wanna put this burden on their family members and this is an easy way to save lives. I'm gonna turn it over to my witnesses, Denise Lee and Laura LaRose, if I may.

Move the bill.

Moved by Aguiar-Curry. Second. Seconded by the vice chair. Please go ahead whenever you're ready.

Good afternoon, Chair Bonta and members. My name is Laura LaRose. I'm a hematology oncology nurse practitioner in California with more than sixteen years of experience caring for cancer patients. I'm here today on behalf of the American Cancer Society Cancer Action Network in strong support of SB 1309, the Stop Lung Cancer Early Act. Lung cancer remains the leading cause of cancer death, but we know early detection can make a meaningful difference.

When lung cancer is found earlier, patients often have more treatment options and a better chance at survival. Unfortunately, too many patients, the barrier is not just getting their first screening scan. The barrier often comes after that initial scan when the follow-up is needed to determine whether a finding is cancer. This may include a low dose CT scan, a PET CT, a biopsy, or a consultation with a specialist.

In my clinical experience, even when patients understand the importance of follow-up care, cost sharing can create hesitation or delay For someone already worried about a possible cancer diagnosis, an unexpected bill can be enough to postpone care.

Those delays matter. SB 1309 addresses this gap by removing out of pocket costs for lung cancer screening and medically necessary follow-up services when recommended by a provider. This is important because screening only works if patients can move from an abnormal result to the right follow-up care without delay. This bill helps ensure that when a patient is eligible for lung cancer screening or when their provider determines follow-up care is medical medically necessary, cost sharing does not stand in the way.

SB 1309 is a practical step to support early detection, improve access, and help ensure patients are not forced to choose between timely diagnostic care and what they can afford.

For these reasons, I respectfully ask for your aye vote on SB 1309.

Thank you. You'll have two minutes.

Good afternoon, madam chair Bonta and members of the Assembly Health Committee. My name is Denise Lee, and I'm honored to be here today in support of SB 1309, the stop lung lung cancer early act. I'm a seven year lung cancer survivor, and I can say without hesitation that early detection saved my life. Without it, I would not be here today. Several years ago, I learned about the American Lung Association's Saved by the Scan campaign.

That message encouraged me to talk to my doctor about lung cancer screening. I followed through and received a low dose CT scan. That screening found my lung cancer at an early stage, stage 1B, before I had symptoms and while I was still treatable. Because my cancer was caught early, I had treatment options. I received treatment, continued my career as a criminal defense attorney, remained active in my community.

And today, I'm able to be here and share my experience with you. Had my cancer been discovered later, my outcome most certainly could would have been very different. Unfortunately, though, too many Californians never get that same opportunity. Even when an initial lung cancer screening is covered by insurance, patients who receive an abnormal result are often faced with high out of pocket cost and, excuse me, for the follow-up test needed to determine whether they have cancer.

Those costs can range from hundreds to thousands of dollars creating a significant financial burden.

When someone hears the words, we found something concerning on your scan, their focus should be on getting answers and receiving care, not worrying about how they will pay for the next test. For many families, especially those already struggling financially, these costs become a barrier that delays diagnosis and treatment. For lung cancer, that delay can mean the difference between finding cancer early when treatment is most effective and finding it too late.

Senate bill 1309 addresses this problem by eliminating cost sharing for medically necessary follow-up diagnostic testing after an abnormal lung cancer screening result. Senate bill 1309 helps ensure that patients can complete the entire screening process and re receive timely care without financial barriers.

As someone whose life was saved because lung cancer was detected early, I urge you to give more Californians the same opportunity I had and by supporting SB 1309. I respectfully ask for your aye vote on Senate bill 1309 so more lives can be saved through early detection. Thank you for your time and consideration.

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

Good afternoon, madam chair. Megan Murray with the Weideman Group on behalf of Southern California Breathe and strong support. Thank you.

Good afternoon. Jennifer Tannehill with, Aaron Reed and Associates on behalf of the California Society for Respiratory Care also in support.

Ben O'Brien with California Life Sciences in support.

Thank you, madam chair. Megan Soopers on behalf of the California Professional Firefighters in support.

Christine Smith, Health Access California in support.

Sarah Nocido on behalf of the California Chronic Care Coalition, in support.

Vanessa Cajina on behalf of the California Academy of Family Physicians, here in support.

Gilbert Laurie here on behalf of Biocom in support.

Angela Hill with the California Medical Association in support.

Kisa Bruce with the American Lung Association and proud cosponsor here in support.

Akil Shaikh of a junior in Mira Loma High School. I strongly support.

Heather Beckham, the daughter of a mother who didn't get caught her lung cancer early enough, and I lost her twelve weeks later, and strong support so that other families have more time.

Kenneth Wilkerson on behalf of the American Cancer Society Cancer Action Network, proud cosponsor in support.

Thank you. We will move on now to any primary witnesses in opposition. Please come forward. Seeing some.

Thank you. You'll each have two minutes.

Thank you, chair and member- chair and members, Olga Shilo on behalf of the California Association Health Plans. We share the author's goal of improving early detection of lung cancer and we agreed that no patient should face barriers to necessary care. And as we were reviewing the true burp analysis, one data point really stood out to us. Only about 16.8% of eligible individuals received an initial lung cancer screening even though those screenings are already covered without cost sharing.

At the same time, screening rates for other cancers are much higher.

The gap is important because it suggests that some of the barriers of the biggest barriers to early detection may be emerging earlier before a patient ever reaches follow-up diagnostics. From what we've seen, those challenges include things like awareness, figuring out who's eligible, and making sure providers are able to identify and engage patients, at the right time. We've also heard the point of, that removing cost sharing can help patients follow through on care and we absolutely agree that follow-up services do really matter.

But it raises the question of where policy changes have the greatest impact. SB 1309 focuses on follow-up services which come later in the process.

It's less clear whether that's where the biggest gap is given how low initial screening rates still are. So while the bill may help some patients access follow-up care, it doesn't necessarily adjust how- why so many eligible patients are never getting screened in the first place. We think there's also an opportunity to focus on getting more people into that screening pathway through outreach, clear eligibility criteria, and provider support.

We look forward to working with the author and the committee on such approaches, but at this time, we respectfully oppose 1309. Thank you.

Good afternoon, chair and members. Matt Akin with the Association of California Life and Health Insurance Companies. In the interest of time, I would like to align my comments with my colleague, CAHP, and sincerely appreciate the author's commitment to improving early detection of lung cancer. We share the goal of ensuring patients receive timely life saving care. As we consider ways to improve early detection, it is worth noting that lung cancer screenings for eligible populations are already covered without cost sharing under state and federal law.

SB 1309 would go beyond that requirement by extending the prohibition on cost sharing to follow-up diagnostic services, which are covered today, but are generally subject to cost sharing. While we support efforts to reduce barriers to care, we are concerned that this approach does not directly address the primary challenge in early detection. As stated by my colleague, screen rates remain low, 16.8% among eligible individuals, and nearly seventy percent of lung cancer cases are diagnosed at a late stage.

At the same time, this bill was estimated to increase premiums by $28,000,000. Given the existing coverage requirements and the challenge of getting more eligible individual screened, we are concerned this bill can increase costs without meaningfully impacting early detection outcomes.

For this reason, without meaningfully impacting early detection outcomes. For this reason, we are respectfully opposed, but we look forward to future conversations as the bill moves forward today. Thank you.

Thank you. Are there others in- in the hearing room who would like to register opposition? Please come forward. Seeing none, I will bring it back to committee for any comments or questions.

Thank you, Senator for bringing this bill forward. Truly appreciate it. It's about access, delays. Those are words that I hear from a really good friend of mine that's very ill with lung cancer. The delays in the way that the family's had has been painful to say the least.

I- I'm honored that you're bringing this forward, that we can help other families so they don't have to go through it as you did. And I'd like to be a co author today.

Thank you.

So noted. I wanna thank you for bringing this forward, Senator. I do think that the opposition raises a concern that we also had just on the ability to recognize that we needed to increase the number of people from their primary screening who are actually from the sixteen percent that it is right now to our higher rate.

And so we are definitely supportive of this bill as it moves forward, but would ask that you consider the ways in which we also need to increase the number of people who are getting primary screenings, because sixteen percent is largely, the reason why we had such a robust show of support, for this legislation and, you know, that many people, including the majority leader's friend and, people that you care deeply about, are suffering.

So, right now, so, with that and perhaps in your closing, you could address that and, appreciate you bringing this measure forward.

Thank you. I- I do wanna acknowledge what they said. I mean, I think we could do it all. Education, absolutely. Outreach, absolutely.

I think that what we're trying to- to get at, I think all of us are in- in agreement and the call and ask to save lives. And so I will consider what you're saying and how else we can reach that and increase the 16%.

But but at this point, again, I know based on stories that I've heard personally and and based on the majority leader story, there is a lot of families that even when they're told that they have something there, they've something was found, they will not go. Again, financially, it's a challenge and this is just meant to capture that group of folks that will just stay home and not tell their families and continue to. They rather get sick than put the burden on their families.

I know not recognizing that later on it will be a problem but reducing barriers is key. Bottom line, if we can save one life with this bill, I think it's worth it. But I will I can acknowledge what they said and really work on other ways to improve diagnostics earlier.

Thank you. And we do have a- a motion and a second. Motion by Aguiar-Curry, seconded by Chen already. We're going to take a moment to establish quorum so that we can vote on this measure.

Thank you.

[quorum is called].

We have a quorum, and now to vote on item number seven, SB 1309 by Rubio with the motion of do pass as amended to appropriations. Please call the roll.

[roll call].

That measure's out. We're gonna move on now to Item Number Six: SB 1284 by Smallwood-Cuevas.

Good afternoon, Madam Chair and colleagues. I am proud to be with you here today, and I'm-- my heart is a little heavy, so I'm gonna make it through this presentation, and I wanna thank all of you for your hard work, many of you on the front lines of making sure that the state of California holds true to its promise that healthcare is for all, that it is a right, and that as we are facing HR 1, that we stand up against Trump by protecting our most vulnerable Californians who rely on this health and safety net.

So I am disappointed today, but I am not discouraged. But I am disappointed that once again, as California faces difficult choices, too many are willing to ask working families, our most vulnerable families, our families that are being terrorized by ICE in particular, our seniors, our children, our babies, the poor, to carry the burden while some of the wealthiest interests in our state contribute nothing.

Just had a briefing with the Controller, which was really eye-opening about how the state utilizes its resources, and she just completed an amazing audit, and I suggest everyone get a chance to be briefed on it. In the audit, $286 billion is spent on healthcare by the state of California.

Imagine what we could do, how many senior centers, parks, transit we could do if we could figure out a way to generate revenue to take some of the pressure off of our General Fund to provide basic healthcare to the most neediest. This is why my constituents sometimes scratch their head and ask me, what are you all thinking? Here we are, the shiny state on the hill, and we are, in fact, doing a lot of what this administration is doing to us: denying basic care.

And we know the estimate of 1.3 million to 3 million Californians are gonna be heard. And I just wanna say, again, this conversation takes courage, but we have to face it when we are spending so many resources on healthcare and subsidizing some of the wealthiest industries in the world who do not provide healthcare to their low-wage employees who, even though they work full-time, still qualify for Medi-Cal. And it's not to attack corporations, because we need strong business.

Strong businesses means strong workers. Strong workers means strong communities. We all know the intersectionality of this. But this is a moment where we all have to roll up our sleeves and not fight but see the bigger picture. If we can deal with the 286 billion we're spending on healthcare, that means more resources for everyone so we are not choosing between things like R&D tax credits and healthcare for our families. This is an all-hands-on-deck situation.

And I wanna say that the people of California have stepped up. As we expanded healthcare ACA, we all enrolled, we all got in the game to make sure everyone was insured, and we saw the reduction in some of the cost. But now we are going to be looking at incredible increases in healthcare above what we're already spending because so many Californians now will have to go to the emergency room.

Nearly one in five California jobs is held by a Medi-Cal enrollee, representing more than 20 billion in public spending tied to the workforce. That means taxpayers are subsidizing gaps in employer-provided coverage even as large corporations remain highly profitable. Under existing law, large employers are already required to offer affordable coverage.

Hell, our small businesses are required to offer healthcare. When full-time workers still rely on Medi-Cal, it signals a gap between what is required on paper and what is affordable in reality. And without transparency, taxpayers cannot see where their dollars are going or why costs keep rising.

SB 1284 does not assign blame. It provides transparency so policymakers and the public can understand what is driving costs. In my district, I hear from workers because the majority of jobs created in my district--and I am the heart and soul of Los Angeles-Downtown LA, South LA, Culver City--the overarching message is when we do things right, like go to work, we still fall behind.

Their stories reflect a broader affordability crisis where our essential workers cannot afford healthcare, even while contributing to our economy every day. Meanwhile, some of the largest corporations continue to report strong profits while relying on the taxpayers, the taxpayers to fund public programs that support their workforce.

That also puts responsible employers--and we know there are many; we have many responsible employers in the state of California who do provide healthcare for their workers--it puts them at a competitive disadvantage. This raises a fundamental question about fairness. At a time of budget strain and rising costs, is it fair for taxpayers to subsidize corporate labor costs?

There have been polls and research that says across the entire spectrum of California--Independents, Republicans, Democrats--that fairness is the most important principle and that everyone should pay their fair share.

SB 1284 responds with a simple solution: transparency and accountability. It requires the Department of Health Care Services to publish the names of large employers with workers enrolled in Medi-Cal along with the estimated costs to taxpayers, taxpayers who are asking us for relief. They're asking us to help them make ends meet when a carton of eggs is at $8.99. Over 70% of voters support requiring large corporations to take responsibility for their workers' healthcare instead of shifting the cost to them.

That support is bipartisan, as I mentioned. SB 1284 is a measured step, because without transparency, nothing changes, and we have a plan put forward by the Senate, made actionable by members of the Assembly to make fairness the priority and strengthening the ways in which we generate revenues to help with California's healthcare crisis and our fiscal price. With me to testify today is Nancy Mendoza, organizer for UFCW Local 5, and Christine Smith with Health Access.

Thank you. You'll each have two minutes.

Hello. Thank you for your time. Good afternoon. My name is Nancy Mendoza, and I am an organizer at UFC Local 5 and a former Safeway employee in Redwood City. I have talked to many retail and grocery workers over my career, and I can tell you that one of the top issues I hear about is the cost is healthcare.

One worker I talked to told me that she had a co-pay of-- she paid monthly 280 on her health insurance monthly, and she had to go to the emergency room. Her co-pay was $300, and she wasn't the only one. There's many of those workers, nonunion. Other union workers I talked to are making minimum wage. Their hours get constantly cut and they simply can't afford the insurance that their employer may provide.

Many of them won't even go to the doctors because they don't have the money to pay or co-pay and can't pay the high medical bills. How can they afford healthcare when their hours get cut on week to one week? And something that happens a lot, there's no stability with their wages and hours. I spoke to workers who can-- who was working for the same employer for 29 years and was still making a minimum wage and unable to afford healthcare.

Twenty-nine years still making minimum wage, $16.90 in San Rafael. What is clear that many of employers are trying to shift cost to healthcare to taxpayers and workers who can least afford it. All employers need to pay their fair share. I was a Safeway employee for 30 years, and as a union worker, I never had to hesitate to go to the doctors for myself or for my daughter because I knew I had great insurance. Just having that peace of mind was so invaluable.

HR 1 has created an urgency to revisit corporate accountability and healthcare coverage. This will give us a deeper understanding of the dynamics of healthcare coverage and employment by producing a much-needed annual report to the legislature of employers with employees on Medi-Cal. I strongly urge you to support SB 1284. Thank you.

Thank you. You'll have two minutes.

Good afternoon, Madam Chair and committee members. My name is Christine Smith with Health Access California, and we're proud to support SB 1284 to require the Department of Health Care Services to prepare an annual report to the state for employers who are paying low wages and gaming the system to keep their workers reliant on Medi-Cal rather than providing coverage. According to a January 2025 report by the California Health Care Foundation, nearly 20% of all California workers were enrolled in Medi-Cal in 2023.

California's Medi-Cal program currently provides coverage to nearly 15 million Californians, including children, older adults, people with disabilities, and working families. Medi-Cal ensures that millions of Californians can see a doctor, fill a prescription, or get behavioral health care when they need it.

Now under HR 1, passed by Congress last July, this population is at risk of losing access to healthcare. The cuts included threaten to unravel years of progress on healthcare coverage and affordability in a matter of months. Up to 2 million Californians are expected to lose healthcare coverage due to the devastating Medi-Cal cuts in HR 1, and 217,000 California jobs are at risk. HR 1 also includes work requirements that further threaten the healthcare of Medi-cal enrollees.

When people who depend on Medi-Cal lose their coverage, they lose access to life-saving medications, in-home care, dependable emergency room care, and other vital services. The report included in this bill will be critical to understand how many employers are relying on California taxpayers to fund healthcare for their employees and their dependents, and as a result, the impacts on our state budget.

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

Thank you. We will now move to any who want to register support in the hearing room for this measure. Please come forward.

Good afternoon. Beth Malinowski, on behalf of SEIU California, proud co-sponsors of this bill, and also want to register strong support from our fellow corresponders at EPIC, End Poverty in California. Thank you.

Mariko Yoshihara, on behalf of UFCW Western States Council, proud co-sponsor, in strong support.

Good afternoon. Jessica Hay with AFSCME California, in support.

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

Good afternoon, Madam Chair and members of the committee. Ivan Fernandez, on behalf of the California Federation of Labor Unions, in support.

Good afternoon, Madam Chair and members. Tasia Stevens, on behalf of UDW / AFSCME Local 3930, in strong support.

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

Moved by Aguiar-Curry, seconded by Addis. Thank you so much. We are gonna now move to primary witnesses in opposition. Seeing none, I will bring it back to the committee for any comments or questions. Assembly Member Addis.

Thank you much, so much, Senator. I really appreciate you bringing this forward. I know you've been working on it for a very long time because I've been in many conversations with you and other members on this kind of concept, and, as you know, it's my second year as the Chair on the Assembly side of the Health Budget Subcommittee, and last year was just probably one of the most difficult times of my time in the legislature grappling with what we're facing.

We didn't really know yet what was coming with HR 1 and Congress and the lack of reopening the Covered California subsidies and then the kind of disappointing proposals coming out of the Governor's Office. Last year, we ended up doing a lot of work. I think this year, we made a ton of progress, but through all of that, you know, have always thought about the what-ifs of this kind of a proposal and if we had more money in the system so that we weren't making these difficult kinds of choices.

I think I'll certainly personally stand behind what we all voted on last night in terms of this budget, but it would be so much better if we weren't in that position. It would be so much better if we weren't making the kinds of choices that we're making, and so I just wanna commend you for your stick-to-itiveness on this kind of policy.

I also wanna commend our Health Policy Chair who has done a lot of work on a similar policy, and really appreciate the fortitude from both of you in terms of pushing this conversation. And so I'm very glad to support today and just wanna say thank you for all the hard work.

Thank you, Assembly Member. Assembly Member Schiavo.

I wanted to thank you for this bill too. I think this is really so, so important and for, you know, as someone similar to you who's come out of working with workers for 20 years before getting this job, I've heard the many stories of how, you know, stores like Walmart teach people how to sign up for Medi-Cal and public assistance because workers are just not making enough to survive in some-- you know, some of these places. And we've called it corporate welfare in other spaces.

And so, I think to have an accounting of this and really know where we stand and who's really taking advantage of this and where the workers in need are gives us a lot of information to be able to figure out kind of where to go with policy in the future as well, and I think this will be very interesting to see the results of. Thank you. Happy to support.

Well, thank you. Seeing no other comments from the committee, I will make some. I wanna thank the author for bringing this forward and just want to kind of raise for the committee's awareness that we will, in the next coming days, vote on the AB 177, SB 177, which directs the Department of Finance to essentially enact some recommendations to be able to create the Fair Share for Big Corporations Act pursuant to which DOF would be required by March 1, 2027 to present some proposals in order for us to be able to enact that. That is in our budget.

We are going to be considering that in the next-- a little bit. I will say that the senator's bill is absolutely essential in order for us to be able to move forward with that moment when the DOF would come back with whatever recommendations they need. To be very clear, this plainly allows for us to do a couple of things that have been the counter arguments, if you will, to why we were not able to fully consider Fair Share, I believe, this year.

The first is that it gives us the very important data that we need for the largest 100 employers to ensure that we are detailing those 100 employers, how many employees they have, and their status of whether or not of enrollment in Medi-Cal, kind of an essential building block in terms of analysis for being able to move forward with any implementation as quickly as possible when we are able to consider what the DOF brings forward by March 1, 2027.

And secondarily, it also make sure that we are protecting our workers in the establishment of a Fair Share Plan, ensuring that we have the ability to install anti-discrimination measures that would not unduly harm any employee who is on Medi-Cal for their employer.

Those two main arguments are really the ones that I've heard the most over the last two years working on similar legislation to have the Assembly really think about making sure--Senate, the legislature, and this administration--think about how we can generate the revenue that we need, that that should be dedicated for the purpose of healthcare infrastructure and Medi-Cal.

So I wanna commend the author for bringing this forward, for having the foresight to put together legislation that will ensure that when we are prepared to move towards implementation around this, we have the tools at the ready to do it and we're not further delayed by another year of analysis in its consideration. I would love to be considered as a co-author on this measure if you will have me, Senator.

And with that, everybody has heard me talk about the importance of making sure that we are having everybody in the state of California pay their fair share for insurance that everybody can have the right to healthcare. It is-- healthcare is a human right, and we need to do better.

And we've created a situation for ourselves where we have tied our healthcare to our employment and we've tied our healthcare infrastructure to the existence of Medi-Cal, and those two things are creating a strain on people being able to get the care that they rightly deserve. And with that, I'm thankful that you've brought this forward, Senator. Would you like to close?

Well, I just wanna thank you, Madam Chair, again for all of your work and for your comments and proud and happy to add you as a co-author and for all of the members who spoke today. You know, this is about healthcare, but it's also about our economy. Healthcare sector is what's helped us weather this very dangerous time that we've faced from the federal administration, and it's unfortunate that whatever is to come because of HR 1 that that economic stabilizing force is going to be harmed.

And so the sooner we can figure out ways to generate revenues that create fairness in our system that helps us not have to spend more than half of our budget on Health and Human Services, the sooner we can get to a more fiscal stability in our economy and be able to do the work that California needs to do the work to do moving forward and to continue to be the leader that we are. So I'm grateful for your commitment, I'm grateful for all of your consideration and discussion and time on this issue, and I respectfully ask for your aye vote.

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

The motion is do pass to the Labor and Employment Committee. [Roll call].

That bill's out. Thank you so much, Senator. We're going to move on now to Item Number Two. Oops. Oh. Nope, nope, nope.

Item number nine, SCR 7 by Niello, permanent standard time. Whenever you're ready, senator. You'll have to press the button.

Thank you, madam chair. As you said, I'm presenting SCR 7 relating to the well known health benefits of permanent standard time. Now, this subject lists a lot of opinions. Most people are tired of changing the time every six months or so. As I put it, everybody, almost everybody agrees to ditch the switch.

It's just a question of which switch to ditch. I did not get that from Dr. Seuss. I made it up myself. But this is not a policy bill. It is speaking in favor of standard time because of the unquestioned health benefits of standard time.

The discussion- This discussion is about biology, not personal preference. Regardless of what your personal preference is, the fact is that standard time is better for your health. Medical study after medical study shows that when we make the switch to daylight saving time, heart attack, strokes, car accidents, and medical errors go up. In addition, it has a negative effect on our youth.

This house, this legislature decided a few years ago that the majority were in favor of more sleep for our students when we moved the start time for school back.

Daylight saving time forces- forces them to rise in the dark further disrupting disrupting their natural sleep. This is not beneficial for their health or their studies in school. We know we perform better when we sleep well at night, and having daylight expo- exposure closer to when we wake up better aligns us with the natural harmony of the Earth and our circadian rhythm.

All of these medical reasons are why the California Medical Association, the California Sleep Society, the American Academy of Sleep Medicine, the National Sleep Foundation, Sleep Research Society, and the Society for Research on Biological Rhythms advise standard time as the best for our health. Today, I hope you will join me in recognizing the health benefits of permanent standard time by giving your aye vote to SCR 7.

Here to testify on behalf of the bill is Angela Hill with the California Medical Association.

Thank you. Moved by Ahrens, second by Chen.

Good afternoon, madam chair and members. My name is Angela Hill. I'm with the California Medical Association, and CMA does strongly support establishing a permanent standard time as a public health issue. As the senator mentioned, there is growing scientific evidence that shows that the twice yearly transition between standard time and daylight saving times does disrupt our natural circadian rhythms, and it does carry real consequences for health and safety. As mentioned, those can include heart attack, strokes, medical errors, collisions. And these aren't just inconveniences.

They are preventable public health harms that do affect millions of Californians every year, maintaining a stable year round, standard time better aligns with the human biology, and it supports healthy sleep cycles. And for physicians, protecting healthy sleep is a foundational preventative health strategy just like promoting nutrition and physical activity. We do thank Senator Niello, his attention to this issue, and we respectfully ask for your aye vote.

Thank you. Are there any others in the hearing room who would like to register support? Seeing none, we'll move to any primary witnesses in opposition or those in the hearing room who would like to register opposition. Seeing none, I will bring it back to the committee for any comments or questions. Assembly- Assembly member Aguiar-Curry.

Senator Niello, by chance, will you be serving donuts again after you get this bill? If you get this across the assembly floor?

My- My clever staff member who is here with me, who's also responsible for the wonderful decorations that change on our office door from time to time, I'm sure we'll think of something very clever.

Thank you. Well, we have a motion and a second. Thank you, senator, for bringing forth this measure. Please call- oh would you like to close?

Yeah. I would like to add that there would have been additional testimony and additional me too's, but most of the people that belong to these organizations are at a national conference discussing the sleep benefits of daylight of standard time. With that, I respectfully ask an aye vote.

We could have streamlined live for them. Here we go. Please call the roll.

The motion is to be adopted. [Roll Call].

That resolution passes. Thank you so much.

Thank you all very much.

Take care.

Alright.

I'm gonna go get my sleep.

Oh, I will be shortly following you. Community members, we will take care of business now while we wait for our last author to come back to the Hearing Room, and we will begin with a consent calendar. We need a motion and a second. Motioned by Addis, seconded by Agaracari. With that, please call the roll.

[Roll Call]

The consent is out. We'll move on to item number one, SB 989 with a motion of do pass as amended to judiciary. We have a motion and a second. Please call the roll.

[Roll Call]

That bill's out. We will move on to item number five, SB 1089 by Richardson with the motion and a second with with the motion of do pass as amended to public employment and retirement. Please call the roll.

[Roll Call]

That measure is still out. Item number nine, we just dispensed with. So we will do item number six, for add ons, SB 1284 by Smallwood Cuevas.

[Roll Call]

We've done everything we can possibly do aside from hearing the last bill of the agenda. Item number two, SB 995 by Senator Perez. Hello, Senator. Thank you so much.

We are going to hear item number two, SB 995 by Perez.

Thank you, and thank you for your patience, Madam Chair. Good afternoon. I'm presenting SB 995, the Masooma Khan Justice Act, which establishes a statewide inspection and compliance framework for large and involuntary residential facilities in California, including privately operated detention facilities using existing state inspection authority and enforcement tools. These facilities house thousands of people who depend on them for shelter, food, medical care, and basic safety.

Because individuals in these settings cannot freely leave, the state has a responsibility to ensure that conditions are safe, humane, and consistent with basic health and safety standards.

Yet, across this country, inside private immigration detention centers, people are being denied their basic rights. The California Attorney General recently released the Department of Justice's fifth report and found conditions in these facilities to be cruel, inhumane, and unacceptable, citing issues such as undercooked food, limited access to clean drinking water, inadequate and delayed medical care, and six deaths in less than a year. The consequences are devastating. Last year alone, thirty two people died in ICE custody, the deadliest year in decades.

Regardless of where one stands in immigration policy, there should be agreement on this.

No human being should be subjected to inhumane treatment, no corporation should profit from human suffering, and no system should operate without accountability. And yet, accountability is exactly what is missing. Currently, California's inspection authority applies only to counties, and three of the four counties, with this authority have not conducted any inspections. In practice, that means many of these facilities operate with little to no meaningful oversight. Recent reporting has underscored the consequences of the gap.

Advocates have also exposed the human reality inside these facilities. At Otay Mesa, detainees have resorted to writing messages on small hygiene bottles, weighing them down with rocks, and throwing them over fences, hoping someone on the outside will hear them. Recently, about 20 migrants detained in the Adelanto ICE Processing Center's Desert View Annex Detention Center have begun a hunger strike, protesting what they describe as inhumane conditions and medical neglect by GEO Group.

They are demanding adequate medical and mental health care, nutritious food, and accountability for recent deaths, among other reforms. This bill is named after Masooma Khan, a 64 year old resident of Altadena.

She survived the Eaton fire, only to be detained by federal immigration agents during a routine immigration check-in appointment, and transferred to the California City Detention Facility in Kern County. Masooma has lived in the United States with her husband and daughter, both American citizens, for several decades. She has no criminal record. Yet, she was held in a cold facility without warm clothing, without proper food, and without access to the medication she needed. Her story reflects a broader failure.

SB 995 is grounded in a simple principle. If detention facilities operate in California, they must meet California standards for safety, dignity, and human rights. To achieve that, SB 995 creates a uniform statewide system for inspecting and enforcing standards in large and voluntary residential facilities, including private detention centers. It designates the California Department of Public Health as the lead coordinating agency working in partnership with fire, environmental, water quality, and workplace safety regulators to ensure a comprehensive approach to oversight.

The bill requires facility operators to grant reasonable access to inspectors and maintain records demonstrating compliance.

It establishes a tiered enforcement framework that ties penalties to the severity of violations. And finally, the bill ensures transparency and accountability by requiring inspection findings to be documented and reported to the legislature within thirty days. This bill is sponsored by the Mexican American Legal Defense Educational Fund or MALDEF, CHIRA, Public Counsel, South Asian Network, and is supported by over 37 organizations. It has received unanimous bipartisan support on the Senate floor, and at the appropriate time, I ask for your aye vote.

Do you have witnesses who are gonna speak?

Good afternoon, Chair and members. Ronald Coleman Baeza here on behalf of CHIRLA. SB 995 is a straightforward exercise of California's core police powers, which seeks to regulate only one thing, health and safety conditions in large involuntary residential settings. CHIRLA's impact litigation team currently represents clients in Adelanto detention facility. Clients often reference deplorable health and safety conditions.

Detainees are often given raw or uncooked food. Medical neglect is often rampant. Individuals with chronic pain are given Tylenol if they're lucky. Individuals with diabetes aren't given food that meets their nutritional standards and either have to forego food or eat very little. The lack of basic health and safety standards has no place in any facility within California's borders, and it must be addressed.

This bill is constitutional for three reasons. First, it is neutral and generally applicable law. It applies to any facility that meets objective criteria, regardless of who operates it or why individuals are there. It expressly includes multiple categories of noncriminal facilities, which is exactly the kind of comparative framework that courts approve. Second, it regulates conditions, not government operations.

This bill is explicit. It does not regulate detention decisions, security procedures, or custody determinations. Instead, it focuses on traditional public health concerns, things like air quality, sanitation, fire safety, infectious diseases, or worker safety, areas where states have long exercised this police power. Lastly, it fully complies with the doctrine of intergovernmental immunity. Enforcement runs against the operator, not against the government, and inspections must not unreasonably interfere with any security functions.

For these reasons, we respectfully ask for your aye vote. Thank you.

Thank you. I'll have two minutes.

Good afternoon, Madam Chair and members. Kaho Maeda with Public Counsel, a legal services nonprofit organization based in Los Angeles. We are proud to be one of the cosponsors of SB 995 and ask that you support the bill. We first thank Senator Perez for sponsoring this important bill, which would allow for stronger oversight of private and involuntary residential facilities, including immigration detention centers.

As Senator Perez explained, the bill allows the state to inspect facilities and impose fines and penalties for violations when facilities fail to meet basic health and safety standards.

As an organization that serves the Los Angeles community, we have represented far too many clients who have been placed in dire and inhumane conditions by private detention centers, which are failing to provide critical medical care, packing more than 60 people in one cell, refusing to respect religious dietary restrictions, providing spoiled food and unsanitary water, and intentionally subjecting detained individuals to freezing temperatures without adequate clothing.

Currently, there is very limited oversight of these centers, and they do not face consequences for these conditions despite the many lives they've endangered and some even lost. These experiences, including that of Masooma Khan, whom the bill is named after, are what inspired Senator Perez to sponsor this bill. Our organization secured Masooma's release from California City Detention Center last year. She was denied safe food and water as well as critical medications and basic medical care for her chronic asthma, high blood pressure, glaucoma, and other serious conditions.

She did not see a doctor until almost two weeks after her detention. Masooma and her family made repeated requests for her medications. And thanks to their persistent advocacy, she was finally given some, but not all of her medications. Due to public and legal advocacy, Masooma was thankfully released, but many of our community members still face the same inhumane conditions today, and SB 995 can provide necessary safeguards.

We ask that you support SB 995 to increase oversight of involuntary residential facilities and help protect our community members.

Thank you.

Thank you. Are there others in the hearing room who would like to register support? Please come forward.

Cal Westlow with the California Community Foundation in support.

Good afternoon, Madam Chair and members. Usama Muqaddam on behalf of the Council on American-Islamic Relations California in strong support.

Good afternoon, Chair and members. Carol Gonzalez on behalf of Inclusive Action for the City in support. Thank you.

Good afternoon. Zenith Yaya on behalf of ACLU Cal Action in support.

Vanessa Cajina on behalf of the California Academy of Family Physicians and in support.

Good afternoon. Joanna Vega Garcia on behalf of NextGen California in support.

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

Good afternoon, Chair and members. Elmer Lozardo on behalf of the California Federation of Labor Unions in support.

Thank you. Are there any in the hearing room who would like to offer primary opposition to this measure? Please come forward. Thank you. You'll have two minutes.

You'll have to press the button.

Thank you. Good afternoon, Chair and members. Danielle Sanchez on behalf of the Chief Probation Officers of California, in respectful oppose unless amended to this bill today. I do wanna note that our opposition is very specific to the definitional aspect of the bill and

the inclusion specifically portion of county juvenile facilities in the definition. We have had, early and ongoing discussions with the author's office and have provided amendments to seek to address our opposition in total. But, as reflected in the bill's findings and declaration section, and it was shared by, I think, some of the sponsors, that the bill has noted that it's intended not to regulate detention operations, security procedures, or other things, that are kind of local governmental, agency duties.

Consistent with the above, amendments were taken on April 6 to exclude state prisons and county jails. Further amendments were taken on May 14 to further exclude a portion of county juvenile facilities, the juvenile halls, camps, and ranches.

But what has been expressly included and kept in the bill are secure youth treatment facilities, which are also county governmentally operated facilities that is essentially, the what has been created as a result of DJJ closure and the realignment of state youth to counties. And so the current version of the bill, now excludes, from the definition, all governmental, facilities, state, local, adult, again, except for this one county secure youth treatment facility.

I I it's important to note that county juvenile facilities, including SYTFs, are already subject to inspection by the board of state and community correction as well as extensive oversight from local public health, fire marshals, and many others. There's an important state framework for inspections. We certainly believe in the importance of public health inspections and the broader kind of transparency around services and care for those in our custody.

But because there's an existing framework, adding duplication and layering a new one, we are concerned actually does more harm than good in carrying out the the state framework that has been established right now through the board of state and community corrections and our local public health, officers.

So for those reasons, we're concerned that this bill kind of adds a new process on top of what already exists, and and certainly could create disruption, confusion, and also does not seem to align with the fact that other entities, governmental entities, have already been excluded from the bill. So for those reasons, we are opposed unless amended.

Are there any others in the hearing room who would like to offer or register opposition to this measure? Seeing none, I will bring it back to the committee for any questions. I will start out with just a kind of a direct response to the opposition or query around the opposition. So I fully understand the perspective that you are offering. I think it's important to note that this bill is applicable on it on its face to public entities, including those that are in the state.

We know that juvenile detention centers have been found to be in grave violation of of the health and safety code and and others in terms of of kind of human rights violations for our juvenile youth. So can you so that part, we are going to have to, not be aligned in your concerns. I think it's very fair that this is a group that has some additional oversight.

Can you speak to any, ways in which we could have alignment the existing pattern of review or around safety conditions with the existing reviews that are that already happened.

Yeah. I I appreciate it through the chair. So because those frameworks already exist and, again, understanding, you know, the legislature's desire as is ours to have those processes in place for review inspections, We really believe that those those mechanisms exist and and are working. I think it's difficult when you add new frameworks that run concurrent to that that oftentimes, right, if you have duplicative directives or different things happening, the goal is to obviously reconcile those things and get have meaningful conversations and get things addressed.

And so right now, as the bill currently stands, it's unclear how all of those pieces would in fact work together that wouldn't inadvertently, again, have unintended consequences to impede the very thing, I think, being sought from this committee and and from probation as well.

And so we certainly welcome those conversations. But, again, because this framework exists and it seems to be a recognition as to why all other governmental entities, state and local, were excluded except for this one category of facilities, that that kind of further complicates how you would address it via different, state frameworks.

Yeah. I'm not sure about that last part being of a valid concern. But I do think that as I understand the bill that we right now essentially require or would authorize and require DPH to essentially outline their, oversight prioritization and the considerations with that. And I'm sure that we could have DPH take into consideration making sure that level of alignment is there, so that we don't unduly burden or somehow misdirect efforts.

So I I think I I want to just state clearly that I am very much in support of this bill as it's written.

I know that there was another measure that was coming from the Senate with Senator Caballero. I understand that they have been that both measures have been worked to be able to work in together in a very seamless way and have removed duplicative areas in those two measures. So thank you, Senator, for bringing for this measure. I think it's absolutely critical that we ensure that we are providing levels of health and safety safety for all of our detention facilities.

And and certainly, we are concerned with ones that are not at the level of security that we know given the number of deaths that we were seeing, particularly in our private detention centers that are holding our immigrant community members.

And I also know that we have an ongoing issue and concern with what is happening in our juvenile detention facilities as well. So I know that there are others who would like to make comment on this bill, but I wanna thank you for bringing forward this measure. And I'd like to be asked asked to serve as a coauthor on this bill as well.

Thank you.

Thank you. Assemblymember Rodriguez.

I wanna thank the author for bringing this critical measure forward. Everything that we continue to hear is so disturbing and unacceptable. And what you're doing today is showcasing how we're able in California to utilize every tool in our toolbox to protect the health and safety of every Californian. I would also ask to serve as a coauthor and look forward to supporting this measure today.

Assemblymember Addis.

Thank you so much, Madam Chair, and thank you to the author. I'd love to be added as a coauthor as well. And just wanna applaud your work in this area in particular. I know you worked on these issues last year as well and appreciate it.

It's probably these issues with ICE are probably and detention facilities are one of the things I hear about the most from my community in terms of the highest level of concern around what we're able to do and, people really feeling helpless if, there's federal, you know, federal regulation and how that interacts with state regulation.

So I wanna appreciate your witness testimony around how this is constitutional and, just your perspective that we can take action at the state level, that there are things within our power. And then also really appreciate that you've crafted this so it's not just about immigration detention facilities, but really that this should apply to any kind of detention facility. Particularly, I think the youth facilities are important and are vital.

That's one area that this legislature has done a lot of work on is to try to make sure that we're caring for our children and that they're not in situations where they might experience abuse and so appreciate that this would be covering children as well. So, thank you.

And obviously, I'll be supporting the bill.

Yeah. Assembly member Gonzales and then and then Patel.

Thank you to the author. I know we participated in a press conference together where I am the coauthor, and I did meet the family. We did hear about these conditions. So I just wanna thank you again for bringing this forward, and to my colleagues who've also joined on today as coauthors. This is extremely important. So just thank you for leading the charge on that.

Wanna thank the author for bringing this very important measure forward to make sure that those who are in government custody have their care, well-being, safety, and health taken care of. I do wanna express some, a question first before I get into any concerns. Can you help me understand the component about the secure youth, treatment facilities? What, currently are the inspection requirements and how would this overlay or overlap with, what's currently in law?

Yeah. So, part of the reason why Secure Youth Treatment Facilities or SYTFs as they're referred to or or, continue to be included is because these are locations that house youth for extended periods of time in secure settings, and they are much closer in their operation and in their definition to other long term and voluntary residential facilities that are addressed in this bill. And so that's why this bill is intended not to just apply towards those, private operations that have contracts with the Federal Government.

This applies to any state and local facilities that fall under that definition, which is why they've been captured. One of the things we did include in the bill and let me see if I can bring up the section number.

It's 19998.3. It was language to state that this if there is any sort of duplicative language that the State Department of Public Health has the ability to, to basically determine whether or not there is duplicative language so that they they can make that determination.

And so we recognize that there are some laws in place that regulate these facilities as well as some of the other places that we ended up excluding from the bill, and wanted to make note of that. So, as was mentioned by the Chair, we wanna give the Department of Public Health really the ability and the flexibility to decide how they want to do enforcement and how they want to provide oversight to these types of locations.

Okay. So just to clarify, so the process by which you were able to exclude some other government detention facilities didn't apply to secure youth treatment facilities.

Yes. Because juvenile halls, camps, and ranches are they don't fall under the same definition that secure youth treatment facilities would because these are locations that house youth for an extended period of time, and also are providing, health support as well, which is also what we have our detention facilities doing too. And so, we need to continue to capture locations that fall under those kinds of definitions. We cannot, because of the supremacy clause, target federal locations. Right?

And so we need to make sure that we're including all of those locations that fall under that definition. And so they happen to fall under that definition and are very close in the way that they operate to private detention facilities.

Thank you. Thank you for that ex explanation. I think I have a better understanding about how those remain still within your provision, what you're proposing, and how the departments can prioritize inspection to make sure there isn't any duplication of effort or conflicting effort put through. Thank you. We certainly wanna protect the health and well-being of people in custody.

Thank you. I don't see any more, comments from the days or questions. So, Senator, please feel free to close.

As I mentioned before, you know, it it, it certainly was really powerful to see the, Senate approve this bill heading out the Senate floor with a unanimous bipartisan vote. I think it really speaks to the timeliness of this issue and and really the human rights component of this. Right? Anybody, any individual that is, in a facility that is being operated by, the government, even if it is a private contractor working on behalf of the government, needs to abide by our public safety and public health standards.

And I think that that's something that we can all agree to regardless of party, and it is something that's so critical and that is part of the reason why we brought this bill forward.

I respectfully request an aye vote.

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

The motion is do passed to the Judiciary Committee.

[Roll Call]

That bill's out. Thank you so much, Senator. K. All bills are out. So we are now going to just complete some add ons for any who want to add on to any of our votes.

We'll begin with the consent calendar.

[Roll Call]

Item number 1, SB989, Blake Spear.

[Roll Call]

Item number 2, SB995 by Perez for add ons. We have everyone. Item number five, s B1089 by Richardson for add ons.

[Roll Call]

Item number six, s B1284 by Smallwood Quivis for add ons.

[Roll Call]

oh, we did this. Sorry. Item number 7, s B13O9 by Rubio for add ons. Everyone's there. And finally, item number nine, SCR 7 by Niello for add ons.

[Roll Call]

That measures out still. And with that, we are adjourned.