Senate Standing Committee on Health

The Senate Committee on Health will begin in ten seconds. The Senate Committee on Health will now come to order. Good afternoon. File item 21, AB 2343 by Assemblymember Patel has been pulled from today's agenda. That leaves us with 28 bills on the agenda with eight of them on our proposed consent calendar.

Item number four, AB 1696 by Assemblymember Stefani, File item seven, AB 1868 by Assemblymember Hadwick. File item 10, AB 2009 by Assembly Members Chen and Solache . File item 19, AB 2352 by Assemblymember Valencia. File item 22, AB 2348 by Assemblymember Bonta. File item 25, AB 2486 by Assemblymember Addis.

File item 27, AB 2562 by Assemblymember Dixon. And file item 28, AB 2598 by Assemblymember Krell. We will begin as a subcommittee until quorum has been established and our first author is here. So we will begin with file item number one, AB third three eighty seven by Assemblymember Alanis. If there are any other Assembly Members who wish to present their bills today, they can make it their way to 0 Street, Room 1200.

And you may begin when you are ready.

Thank you, madam Chair. Well, before I begin, I would like to thank you, madam Chair, and your committee staff for their time, their engagement, and thoughtful feedback throughout this process. I particularly appreciate the chair's commitment to ensuring that any policy we advance does not unintentionally further disadvantage lower income and underserved communities. Thank you for that.

While we may approach this issue from different perspectives, we share the same fundamental goal, protecting children and ensuring that every young athlete has the best possible chance of surviving a sudden cardiac emergency.

For that leadership and engagement, I sincerely thank you. AB 387 builds upon the foundation established by Nevaeh's youth sports act and seeks to address implementation challenges that have become apparent as youth sports organizations prepare to comply with the existing AD requirements. Under current law, youth sports organizations are responsible for ensuring AED access during practices and games.

However, many of these organizations, particularly those serving rural, low low income, and underserved communities, conduct their activities at public parks, recreation facilities, school athletic complexes, and other venues that may have already AEDs available on-site. AB 387 recognizes that reality and creates a shared responsibility framework between youth sports organizations and the facilities where athletic activities occur.

The bill requires collaboration between facilities and youth sports organizations to ensure AED access and encourages both parties to identify ways to share the cost associated with providing this life saving equipment. Importantly, the bill does not eliminate the responsibility of the youth sports organizations to ensure AED access. If a facility does not have an AED available, the youth sports organization remains responsible for ensuring access to an operate operating device during the practice or during a game.

I also wanna acknowledge the chair's concerns regarding affordability and the impact on disadvantaged communities. Those concerns are legitimate and deserve continued attention.

My office and I remain committed to exploring future funding opportunities, partnerships, and other avenues that can help expand AED availability while minimizing financial burdens on the communities that can least afford them. Throughout this process, my team and I have met extensively with youth sports organizations, cities, counties, park districts, school interests, and risk management organizations. Those conversations have resulted in a meaningful amendments to the bills, including clarifying responsibilities, strengthening collaboration requirements, and creating greater flexibility for facilities and youth sports organizations to work together towards compliance.

In that same spirit of collaboration, I would like to thank this commitment to the committee today.

Should AB 387 move forward, I will amend the bill and its next committee to remove the requirement that facility operators, procure an AD and instead require that any AED already installed at a facility be made accessible to the youth sports organizations during official practices and matches, as well as clarifying and strengthening the collaboration requirements between youth sports organizations and facility operators to ensure clear communication and coordination regarding AED availability.

Our work is not finished. There are still conversations to have and issues to resolve, and I remain fully committed to working with all interest parties to get this policy right. Our our children deserve nothing less. Should this bill move out of committee today, I remain fully committed to continuing these conversations and working towards a solution that addresses the concerns raised while preserving the bill's core public safety purpose.

At its core, AB 387 is about ensuring that when a child suffers sudden cardiac arrest, there is a realistic and practical pathway to life saving intervention.

This bill seeks to improve access to ADs, Strengthens Preparedness, and encourages collaborations among organizations and facilities that serve California's young athletes every day. And for those reasons, when the time is right, I respectfully ask for an Aye vote.

Thank you. Any lead witnesses? No. If there's anyone in the audience that would like to speak in support of this bill, please come to the microphone. State your name, your organization, and your position.

Good afternoon, Madam Chair. Greg Hurner on behalf of the Eric Pereta Save a Life Foundation, in full support of the bill and just note how this dovetails nicely with your efforts and our sponsorship of a bill to try and bring CPR AED education universally back to high school students. Thank you.

Thank you.

Good afternoon. David Bullock from the SFE Alliance in support.

Thank you.

Madam Chair, Members, Doug Houston representing California Park and Recreation Society. For the committee's edification, we are an opposed unless amend. We're gonna be transitioning to support if amended. Wanna reserve the right to continue work with the author, the legislature when the the the amendments are adopted. So thank you so much.

Thank you. If there's anyone in the audience who would like to speak and lead opposition to this bill, this is your time to come to the table. Thank you and you will have a collective of five minutes.

Good afternoon madam Chair and Members of the committee. Ethan Nagler here on behalf of the California Association of Recreation and Park Districts. CARPD is a statewide association representing 70 recreation and park districts that collectively own, operate and maintain more than 6,000,000 acres of parks and open space in California. I want to thank the author's office for working collaboratively with us over the past twelve months on this bill. Also wanna thank the committee staff for their significant work on the bill throughout this time.

We have been working closely with both the author's office and committee staff on amendments, and we look forward to seeing those amendments reflected in print. We remain opposed to the bill in print but anticipate removing our opposition as soon as those amendments are officially adopted. We share the author's goal of improving safety in youth sports. Thank you. I'm happy to answer any questions.

Good afternoon, Madam Chair and Members. Dorothy Johnson on behalf of the Association of California School Administrators representing 18,000 public education leaders statewide. We too are opposed as amended or opposed to the bill as in print. We look forward to reviewing the amendments, but do have serious remaining concerns despite the bill's laudable intent. Currently, schools provide AEDs in any building with greater than 200 person capacity, as well as AEDs for interscholastic or school based sports.

It's not clear to us how we can make school property and school facilities accessible to a private organization when they have a match or a practice. Also, regarding liability issues. The Good Samaritan protections, we understand applies to rendering of care, but we're not clear how that also applies to access to a device, and we're concerned that the public entity could be held liable for any concerns or problems or issues, in AU Sports Organization's effort to access a a publicly owned AED.

While this, committee's jurisdiction is not cost, schools also have limited cost recovery, that we have concerns about ongoing to make sure the AEDs are up and running and accessible. And we do believe this bill could have the unintended consequence of limiting these sports, facilities simply because there is no AED access.

So for these reasons, we remain opposed. Look forward to reviewing the amendments. Thank you.

Thank you. If there's anyone else that would like to register your opposition, this is your time to come forward. State your name, your organization, and your position.

Good afternoon, Chair and Members. Sasha Horwitz with the Los Angeles Unified School District. We're opposed for the reasons described by AXA. Thank you.

Hello. Caroline Grinder on behalf of the League of California Cities. Cal Cities has an opposed unless amended to the bill in print, but really appreciate the work of the author's staff and committee staff in the amendments. We look forward to reviewing those and hopefully removing our opposition the next committee. Thank you.

Good afternoon. Eric Lawyer on behalf of the California State Association of Counties. Very much appreciate the efforts by author, sponsor, and committee staff to work with us on our concerns. Looking forward to continued conversations but opposed today. Thank you.

Kelly Brooks on behalf of the Urban Counties of California. We appreciate all the work on the bill. We will be reviewing the amendments. We currently have an opposed position.

Sarah Dukett, on behalf of the Rural County Representative of California and the California Association of School Business Officials, align our comments with the schools concerned about the liability. Hopefully, we can work that out in the next Committee.

Good afternoon. Sharon Gonzales on behalf of the cities of Belmont, Corona, Santa Rosa, and Rancho Cucamonga opposed to the bill and print. I look forward to reviewing the amendments. Thank you.

Thank you. Alright. Seeing no one else who would like to speak from the audience. Well, first of all, I wanna thank Assemblymember for your focus and your dedication to this issue. It is extremely important.

You know, sudden cardiac arrest is not something that we think of happening to our youth, but it is. And more and more we're hearing stories about kids collapsing on fields, and the only reason why they were saved was because you had an AED ED device around. And so it is extremely important that that we have access to those, that our kids have access to those. At the same time, it is important that whatever we enact here at the state is not discriminatory, just in statute.

And the fact that we would require this, which could bump up fees, for our our youth sports would automatically make that some kids and families wouldn't be able to participate in it anymore.

We're dealing in a situation where the issue of affordability is something that we talk about a lot. And California is becoming less and less affordable for everyday Californians. Youth sports are so important. I mean, both of my boys have been have participated in youth sports. It not only shows you how to work together as a team, it gives you the ability to show your leadership skills.

And in this world where our kids are constantly on some sitting down on some device, This is another avenue for physical activity as we're dealing with issues of childhood obesity and diabetes and hypertension in in kids that we never thought they would have to deal with this stuff. But it also opens doors for many. Many who may not have ever thought about being able to go to college or having, you know, a profession maybe as a sports announcer or an athlete.

This is a way to open up doors. And so we have to make sure that we're looking out for their health in terms of their cardiac health, but also not closing the doors for some students, some youth, some families that would not be able to bear their burden of an extra $10, $15, $25.

We also don't want to close certain facilities. I know my kids, they you know, through our little league in my area, we practice at the school site. And I can easily see the schools saying, no, you can't have access to our facilities, especially on the weekends when no one is here. And therefore, because of this, you cannot you can no longer practice or play on some of these fields. And so it's a balance.

I appreciate what you've done. I recognize the fact that we still have another year to to get it right. And I would like to work with you next year to figure out how we can get this right because it is that important. But I do appreciate the amendments that you have taken today. It's an extremely important issue.

And I think once we get it right, we can really use this as a model for the rest of the country. And with that, if you'd like to close.

I would say you almost did my close right there. I completely agree with you. And obviously, we have the technology now to save lives, and and it's it's there. It's available. And when you can't get access to it, even knowing it's right there on the premises, those who have lost their children, it's just unfortunate.

To know that it was there, and if we can help further families from not experiencing that, then let's do it. So with that, when it's time, respectfully ask for an Aye vote.

Thank you.

When it when we have a quorum, we'll take it up.

Thank you.

Thank you.

Alright. I see Assemblymember Hart file item number 3AB1682. You may begin.

Good afternoon, Chair and Senators. Yes. I'm pleased to present AB 1682, a bill that would increase accessibility to scalp cooling for cancer patients who undergo chemotherapy. The California Cancer Registry reports that nearly two hundred thousand Californians are diagnosed with cancer annually with about thirty thousand of those cases involving breast cancer. For many cancer patients, chemotherapy is vital as it targets rapidly dividing cancer cells.

However, this affects healthy cells such as hair follicles, which leads to significant hair loss. Hair loss is one of the most visible and emotionally distressing side effects of chemotherapy. It affects a patient's confidence, mental health, and autonomy about when and how to disclose their diagnosis. To help combat this, scalp cooling is an evidence based treatment that is used for hair loss by cooling the scalp before, during, and after chemotherapy to limit the amount of medication that reaches hair follicles.

Although scalp cooling has been successful in reducing care chemotherapy induced hair loss, access remains limited by its cost, especially as coverage is inconsistent across private insurance and medical.

Patients are often required to pay out of pocket with cost ranging from 4 to $5,000 for a full course of treatment making it inaccessible for many. E b sixteen eighty two would remediate this by requiring California health plans and insurers to cover FDA cleared scalp cooling devices when prescribed by a provider. This bill ensures that scalp cooling is recognized as part of the oncology support services and expands access to an evidence based treatment that can reduce one of the most nuanced side effects of cancer care.

Speaking in support today are Alexa Meyer, a breast cancer survivor and founder of a survivor led community and apparel brand, and Lisa Roeb, clinical account manager at Paxman Scalp Cooling.

Thank you. You will have a combined total of five minutes. Great.

Good afternoon. My name is Alexa Meyer. I live in Concord and I'm honored to be speaking to you today in support of AB 1682. A week before my daughter's first birthday, a clogged duct from breastfeeding led me to schedule an early mammogram. Although that finding was benign, the mammogram ultimately led to the discovery of breast cancer at just 33 years old.

The day I heard the words, you have cancer, my world changed instantly. Of all the fears that came with my diagnosis, one of the things I worried about most was losing my hair during chemotherapy. To some people, hair may seem cosmetic. But for many cancer patients, losing your hair is the moment your diagnosis becomes real and visible to the world. It can affect your confidence, your identity, and your ability to show up as yourself in everyday life.

Fortunately, my treatment center offered access to a Paxman scalp cooling system. Over twelve consecutive weeks of chemotherapy, I spent roughly forty hours connected to the machine. It wasn't always comfortable, but that's a decision I would make again without hesitation. I saved nearly all of my hair throughout treatment, which I finished less than three months ago. While scalp cooling didn't change my diagnosis, it profoundly changed my treatment experience.

As a young mother, it helped me maintain a sense of normalcy for my family. It allowed me to look in the mirror and still recognize myself. During treatment, I built a community for breast cancer patients and survivors. Through that work, I've connected with hundreds of women across the country at every stage of the breast cancer journey. I've witnessed the devastating impact that hair loss can have on mental health, self esteem and recovery.

The emotional effects of hair loss can persist long after chemotherapy ends, making it more difficult for patients to reintegrate into their lives with confidence. I paid about $1,500 out of pocket for my scalp cooling treatment which was not covered by insurance. While I'm grateful I could do so, no one should have to choose between their financial well-being and access to supportive care that can meaningfully improve their quality of life. Cancer treatment is about more than just survival.

It's also about preserving dignity and confidence while patients fight for their future.

I can say with certainty that scalp cooling made one of the hardest seasons of my life more manageable. My experience should not be the exception. Thank you.

Good afternoon, Chair and Members of the committee. My name is Lisa Raub. I'm a breast cancer survivor, a mother, and a proud Californian. I'm here today because I had the great fortune of being able to preserve my hair with scalp cooling when I went through chemotherapy twelve years ago. When I heard the words, you have cancer, it wasn't the surgeries, the disfigurement, the pain, the nausea, or even facing my mortality that scared me.

Sorry. It was the idea of losing my hair. Not only for me, but because I knew that for my children seeing me without hair would be terrifying and traumatic. And I'm not alone. Studies have shown that for seventy five percent of cancer patients hair loss is the most feared side effect of chemotherapy and approximately ten percent of patients may decline treatment due to their fear of hair loss.

My experience led me to seek opportunities to help other patients facing the same diagnosis and for the past nine years, I have worked with hundreds of patients and clinicians at cancer centers across California to make FDA cleared mechanical scalp cooling available to them. I have seen the difference it can make for patients to be able to move through treatment with greater confidence and dignity.

However, this option is out of reach for many and far too many doctors tell me that cost is the barrier for their patients. The average patient out of pocket expense is $2,500 leaving it inaccessible for many Californians. In oncology, evidence based treatments that manage other side effects of chemotherapy are routinely covered.

Scalp cooling should be no different. Side effects management should never be determined by financial circumstances. In January of this year, the AMA recognized scalp cooling as a standard of care practice by issuing permanent Category one CPT codes for insurance coverage. AB 1682 aligns coverage with current clinical practice and helps ensure that access to this treatment is based on medical need rather than patient's ability to pay. Five other states have now enacted legislation requiring coverage for scalp cooling.

Californians and all Californians deserve to have access to this standard of care as well. Thank you so much for your consideration and support of AB 1682.

Thank you. If there's anyone else in the audience that would like to speak or register their support, please come to the microphone. State your name, your organization, and your position.

Christine Smith, Health Access California in support.

Gilbert Lara here on behalf of BioCom in support.

Brock Campbell from Lighthouse Baptist Church in Santa Maria in support.

Emily Campbell with Lighthouse Baptist Church in Santa Maria in support.

Kevin Guzman with the California Medical Association in support.

Mc Kay Carney on behalf of Cottage Health in support.

David Bullock of the Alliance in support.

Thank you. Seeing no others, I would like to register their support. If there's anyone in the audience who would like to speak as a primary lead in opposition, this is your time to come forward to the table. Seeing no one, if there's anyone that would like to register their opposition, this is your time to come to the microphone. State your name, your organization, and your position.

Seeing no one else, we will bring up I'll bring it back to the committee. Senator Menjivar.

Thank you, Madam Chair. As a Member, the I definitely wish our health coverage covered everything that an individual needs and not have to go through these barriers. But as the author of a previous, bill on essential health benefit, recognizing that a lot of often time, we pass these bills and if it exceeds it, we can't cover it and we have to go through the whole approval from the Federal Government.

So I'm just I'm still waiting to hear back if it's gonna go if it's gonna exceed our EHBs because I'm trying to be a little bit more mindful of of those bills that are gonna exceed it. Recognizing that it goes through the whole process.

But again, I wish it was up to us, right, we'd have all of these covered. So I just wanna make sure that you knew that.

Thank you. Appreciate that.

Seeing no further comments, really wanna thank you so much, Assembly Member Hart, for bringing this bill forward and really thank your witnesses for coming and sharing your very personal stories with us. You know, scalp cooling has been shown. It's evident based to show that it really does help, prevent hair loss at a time when it's so devastating for for individuals and their families. I appreciate the fact that you've brought this forward. I understand what Senator Menjivar is saying.

There's only so much that we should be adding on and the cost of premiums and things like that. But this is something that I think is is definitely important. And as people live longer and as we learn more about different things, unfortunately, more people will be touched by individuals and their families or in their close surroundings who have been diagnosed with things like breast cancer or have to undergo chemotherapy for other things as well.

And so I do think that this is a very important addition that we offer for, for patients and their families at this time. So I will let you close, and at the appropriate time, we'll take a motion on your bill.

Thank you. Well, thank you for your comments, and thank you very much for the witness's testimony. And, Senator Menjivar, thank you for your comments about the cost. That is an issue, obviously. But hearing the news of cancer diagnosis is one of the most difficult moments a person can face.

The treatment journey that follows is physically draining, emotionally challenging, financially, often disastrous for patients and their families. And as patients are focusing on fighting cancer, they deserve access to supportive care that helps preserve their dignity, confidence, and quality of life. For many, scalp cooling can make a meaningful difference during an incredibly difficult time. This bill helps ensure that access to the supportive care is not determined by a patient's ability to pay. It's a practical and compassionate step to support Californians undergoing chemotherapy.

And when you have a quorum, I respectfully ask for an Aye vote. Thank you.

Thank you. Thank you so much, and thank you to your witnesses. We will now move to file item 16, AB 2093, Assemblymember Rebecca Bauer-Kahan. And if there are any other Assemblymembers who wish to have their bills heard and held today, I would recommend that you come down to 0 Street Room 1200. And Assemblymember, you may begin.

My patience paid off. I love it, madam Chair. Thank you. As many of you are aware, I'm happy to present AB 2093 as the Chair mentioned. And I wanna thank madam Chair, you, for our conversation, and the staff for their work on this bill and the conversations we've had.

I know this was, a later gut and amend, but, this bill is critically important.

As many of you know, in 2022, I authored and this legislature passed AB 988, exciting moment to really roll out the nine eighty eight system here in California and envision a future where we would have an entry point for Californians into a crisis care continuum that started with a 988 phone call, but allowed for someone to call through the 98 system someone to show up through our mobile crisis teams, and then eventually, hopefully, somewhere to go through the work we did on the bond.

And so now that we have twelve year term limits, it allows us to look back after a few years and see if the goals that we set out to achieve are working. And so this year, through the speaker's new oversight and accountability tool, the Assembly Health Committee in partnership with my office did an oversight of the nine eighty eight system, and we started to find things that, frankly, were not working as we had intended.

When we set up the program, for example, we gave, OES primary responsibility over the fee, which at the time made sense because we were setting up the phone system.

Technological question. But now years out, we are seeing that the coordination with mobile crisis and the role of HHS and other agencies is really critical, and maybe more coordination is needed there. In addition, we had required that the system be set up with interoperability between 911 and 988, which is critically important because we don't want Californians to ever 88. And if they call 988 and they need an ambulance, they should be able to get into the 911 system.

And if they call 911, what they really need is mental health crisis support.

They should be able to be given a warm handoff into the 988 system. And I had the privilege of visiting our call centers as part of this process, and then interoperability is very much not in place. And it turned out there was a difference in opinion about the definition of interoperability between me as the author and my intent and I think what the legislature understood and agency.

And so this bill also wants to really create that interoperability that I believe was always intended but has not come into fruition. So the bill does a few things.

It establishes clear statewide leadership and accountability. It improves that coordination. It integrates mobile crisis teams into the 988 system, and it creates a more sustainable funding process. And with that, I will turn it over to my witnesses to testify on the bill.

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

Good afternoon, Chair and members. My name is Tara Gamboa-Eastman, and I'm the director of government affairs for the Steinberg Institute, a proud cosponsor of both AB 988 and AB 2093. When the legislature passed AB 988 in 2022, California made a commitment to build a comprehensive behavioral health crisis response system, someone to call, someone to come, and somewhere to go. As implementation has moved forward, a number of challenges have emerged that cannot be solved administratively alone.

These issues have not been identified by any one stakeholder or in any one forum.

Over just the last six months, they have been discussed repeatedly in multiple budget hearings, an informational hearing, the AB 988 Policy Advisory Group, and most recently, the Assembly's May Oversight Hearing examining the performance of California's nine eighty eight system. The findings have been remarkably consistent, unclear statewide leadership and accountability, gaps in coordination between nine eighty eight, nine eleven, and mobile crisis teams, and funding processes that make it difficult to plan for future demand and system growth. AB 2,093 is reflective of those findings.

It is a targeted cleanup bill that responds directly to lessons learned during implementation and addresses problems that cannot be fully resolved without statutory changes. Most importantly, this is about building a system that works.

Every day, Californians rely on 988 during some of the most difficult moments of their lives, and the success of the broader crisis continuum depends on getting these foundational pieces right. AB 2,093 doesn't change the vision established in AB 988. It provides the governance, coordination, and planning tools needed to carry out the legislature's original intent and ensure California can fully deliver on the promise of someone to call, someone to come, and somewhere to go.

This bill has no opposition and I respectfully request your high vote. Thank you.

Good afternoon, Chair and members. My name is Narja Sohori Dillon. I'm the President of 90 Day California Crisis Center Consortium representing the state's 11 crisis centers. I'm also the Executive Director of Crisis Support Services of Alameda County. We run the nine eighty eight center in Oakland.

I'm here with strong support for AB 2 thousand and ninety three. Every day, California's nine eighty eight centers answer calls, texts and chats from people experiencing suicidal crisis, mental health emergencies, substance use concerns and emotional distress. We're often the first point of contact when someone reaches out for help. Over the last year, the demand for nine eighty eight services has grown by nearly 40%. This is exactly what we hoped would happen when California invested in building the system.

More Californias know about 988. They trust us and they're using it. But from the perspective of the centers operating the system, we're now reaching a point where implementation challenges must be addressed if we're going to deliver on the full promise of AB 988. As call centers, we need planning processes that are tied to actual demand and system needs. We need a seat at the table when statewide decisions are being made about how nine eighty eight operates.

We need clear accountability for implementation and we need ongoing collaboration between state agencies, crisis centers, counties, providers and people with lived experience as California continues building a comprehensive crisis continuum. The reality is that many of the most important implementations decisions are still ahead of us. California is working towards stronger integration with mobile crisis teams, improved coordination with nine eleven, expanded access to local resources and a more connected crisis response system.

The organizations answering nine eighty eight contacts every day have valuable operational expertise to contribute to those conversations. AB 2,093 helps ensure that expertise remains part of the process.

It creates a structure for continued collaboration, transparency and planning as California moves from building a nine eighty eight system to strengthening and improving it. The centers I represent have been doing this work for decades. We're proud of how far California has come and we believe AB 2093 is an important step toward ensuring the system continues to evolve and meet the needs of Californians in crisis. We respectfully ask for your aye vote. Thank you.

Thank you. If there's anyone else that would like to register their support for this bill please come to the microphone. State your name, your organization and your position only.

George Cruz on behalf of the California Behavioral Health Association. Proud to co sponsor of this bill and proud to co sponsor the original AB 988 and representing one quarter of all nine eighty eight call centers in strong support. Thank you.

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

Hi. Annie Thomas on behalf of the California Alliance of Child and Family Services in support.

Good afternoon. Lizzie Guansona here on behalf of the California State Association of Psychiatrists in support.

Jordan Curley on behalf of the Steinberg Institute. I've also been asked to offer support from CASRA, the Miles Hall Foundation, the, California Coalition for Behavioral Health, and Smart Justice.

Lauren, thank you at the Kennedy Forum, cosponsors of the original 988 bill in support.

Good afternoon. My name is Lex Olamio, and, I'm here in on behalf of LGBTQ plus Inclusivity, Visibility, and Empowerment or LIVE in support. Thank you.

Hello. Alondra Garcia Perez from the California Youth Empowerment Network, Kian in support.

Good afternoon. Anthony Guedebay Mena on behalf of cosponsors at Mental Health America of California, support.

I don't think there's opposition.

Sarah Webber with the Drug Policy Alliance in support.

Thank you. Not seeing anyone else who'd like to register their support. If there's anyone that would like to speak as lead opposition, this is your time to come forward to the table. Not seeing any movement. If anyone would like to register their opposition, please come forward to the table.

Not seeing anyone, we'll now bring it back to the committee. Vice Chair Valladares.

Thank you, madam Chair. Well, first of all, I was a a proud supporter of the first nine eighty eight bill many many moons ago. And I would like to see it, you know, move forward and actually function the way that I think we all intended it for it to to function. I do have some questions Can you can you

that are more on the The mic, sorry.

You better that are more on the technical side. And I was hoping do we have anyone from c CBHDA here?

I don't know.

Okay. So there were a there's some, I think, pretty valid concerns and amendments that were brought up at least in the analysis. And I was just curious to know if if you would be taking any of those. I think this is being dual referred. Is that is that That's

correct.

So if you could speak to the amendments or I could read through them, but I would appreciate some feedback on that.

Yeah. And I'll and so we are in conversations with them. They were a partner on the first ninety day that you, mentioned. And this really is a good to your point, this is a good governance bill. This is really a look back and did we do it right?

And I think that, honestly, we should do this more often with our legislation. And so we really are hoping that as many people come to the table as possible who want the system to work, and they are absolutely among those partners. At this point, that came in so recently. We haven't, had any opportunities. And I will say, I forgot to say in my opening remarks, so I'll clarify now that I've had conversations with the Chair.

And, this committee will absolutely be remaining a part of those conversations in figuring out how best to deal with the interagency operations, which is part of what was highlighted there. But if the Chair wouldn't mind if my sponsor might address it. Thank you.

Sure. Yes. Tara with

the Steinberg Institute. CBHDA's concerns largely seem, to be about including greater County conversation, which I think makes perfect sense as we continue the conversation, especially around mobile crisis team. In regards to the specific amendments, we are meeting with them tomorrow morning.

So I

think it'll be part of the next Committee's conversations, but not currently able to speak more specifically to their proposals.

Okay. So I mean, one of the things that and I would just I'm sure, you know, I know sometimes amendments come through at the last minute. I know, we're we're trying especially this time of year, we're trying to move things forward. And I do I mean, I think there's some some validity to some of their amendments requesting that the county behavioral health and agencies that are actually responsible for implementation of a lot of this be at the table when developing it.

So for me, I'm gonna support the bill.

I would like to see I just wanna make sure we're getting it right. So I'd like to see you continue to work with some of the I guess they're neutral. They're not they're not exactly in opposition. But thank you.

Thank you, madam vice Chair.

Seeing no further comments, wanna, thank the Assembly member for your dedication, on this. This is definitely one of the ones that you have really honed in and you're working on, you know, every year to make sure that we get it right. It is important that we do get it right. This is a very important system that we are trying to develop here in California. And, you know, we are all very well aware of the challenges with in our behavioral health space.

Things have just gotten even worse after COVID. And, you know, we're really trying to figure out how we can bring a system up to where it should have already been You know, long, long, long time ago. With this particular bill, kind of to the vice chair's point, this was a gut and amend, which always shortens the time frame.

And so committee staff was not able to do as much with this bill as we would have liked to to have said, yes, this is good from a health perspective to get it out. But recognizing that this is an important issue to get right, we're gonna go ahead and let it out with, as the Assembly member say stated, the commitment that our staff will continue to work with your staff and your sponsors as you move into the next committee.

So that whatever bill lands on the floor and then back on the Assembly is one that is a little bit better hashed out than maybe what we have today. But really wanna appreciate your commitment to this issue. And with that, you may close.

Thank you, madam Chair. I really appreciate, sort of what was highlighted today, which was the bipartisanship of this effort and how it matters to every community across the state because we all experience this every day. And, just wanna express immense gratitude to the people who answer these calls every day and save the lives of the Californians who need it. They are the heart of this system. And with that, I respectfully ask your aye vote.

Thank you. And at the appropriate time, we will take it.

Thank you.

Okay. I see, file item number six, AB 1843, Assemblymember El Haware. And you may begin whenever you are ready.

Good afternoon, madam Chair and members. I am proud to present AB 1843, a bill that removes unnecessary administrative barriers and ensures Californians can access life saving hepatitis c treatment without delay. Hepatitis c is a serious but curable disease. We're seeing nearly fifteen hundred deaths each year in California, even though treatment today cures over ninety five percent of cases in as little as eight to twelve weeks. The problem is not the treatment, it's the access.

Right now, too many people face delays because of prior authorization, unnecessary testing, and insurance requirements that don't improve care, but just slow it down. AB 1843 aligns health plans with current medical guidelines and removes those barriers to patients so patients can get treated when they need it. When treatment is delayed, people get sicker, and something that could have been cured becomes much harder to treat.

According to the CHBURP analysis, the bill's impact on monthly premiums is negligible at most between 2 tenths of a cent excuse me, 2 hundredths of a cent and 1 tenth of a cent per member. This bill also builds on the progress we've already made.

Medi Cal eliminated prior authorization for hepatitis C treatment in 2024. AV eighteen forty three extends that approach more broadly, so more Californians can benefit. And this matters most for the communities disproportionately impacted, including people of color, people experiencing homelessness, LGBTQ plus individuals, and people who struggle with substance abuse who already face barriers to care. Expanding access not only saves lives, but it also reduces long term health care long term health care costs by preventing more serious and expensive conditions down the line.

No one should suffer from a disease that is curable.

Testifying with me today is Heather Lopez, lead caseworker at project h HCV Connect and Jonathan Frochsweig, director of health justice policy with San Francisco AIDS Foundation.

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

Good afternoon. Is this all? My name is Heather Lopez and I'm the recent master of public health graduate from USC. I currently serve as a lead caseworker for project HTV Connect, a Los Angeles based program that links residents' security of hepatitis c treatment. Hepatitis C is a significant public health communicable disease problem.

It currently affects about four hundred thousand Californians. And in our program, we see that two thirds of our residents remain untreated. And a major barrier to treatment that we see is prior authorization. I spent hours talking to our untreated California residents.

I sit on the phone with them and hear their stories of how some have lived with the virus for more than twenty years, putting off getting treatment due to financial constraints, constant appointments to the next and next test, and who are overwhelmed by the system and the requirements they know they will inevitably face.

I know how thankful they are for our help. Our residents want to be treated. As a caseworker, I can get them to their appointment and in the door to the doctor's office. And the physician I work with wants to and is ready to treat them immediately. However, it is the inevitable next pro authorization step that gets in all of our way.

In our work, we've seen that these insurance imposed requirements can mandate dangerous and unnecessary procedures. These include liver biopsies where one in twenty patients might be at risk for life threatening bleeding and costly genotype testing which can run patients hundreds of dollars out of pocket even though leading medications are pan genotypic and can work regardless of the genotype. Beyond the patient burden already, prior authorizations exhaust our medical teams.

My colleagues spend up to thirteen hours per case chasing faxes, labs, providers, and patients fighting for a prior authorization approval. With your support and I vote on this important bill, we can align with evidence based care and share health equity and get our Californians secure.

Thank you.

Thank you. You may begin.

Again, my name is Jonathan Froxwijk. I'm the director of health justice policy for San Francisco AIDS Foundation, which is a cosponsor of this legislation. As providers of hepatitis c treatment, we at San Francisco AIDS Foundation see firsthand the transformative impact that accessing a hepatitis c cure can have on a person's life. Unfortunately, many insurance companies in California prevent people living with hepatitis c from getting cured by requiring prior authorization for these drugs.

Requiring prior authorization for hep C treatment conflicts with the definitive medical guidelines on hepatitis C in The US, which recommend timely treatment for almost all people living with the disease.

Many insurers also request information or procedures that are not recommended, but are costly and dangerous, like liver biopsies. These insurance company hoops often result in people living with hep c not getting cured. About two thirds of people who have private insurance and are diagnosed with hep c don't start treatment within a year. PA is one reason why.

AB 1843 addresses this issue by first prohibiting insurers from requiring PA for most hep c treatment drugs, and second, requiring that insurers PA processes align with medical guidelines.

Treating hepatitis c saves the health care system money. This is just common sense. The cost of a single eight to twelve week course of medication is much lower than the cost of treating a lifetime of complications like cirrhosis and liver failure. The CHBURP analysis of AB 1843 found that for every person cured of hep c, the health care system saves $7,650 every year. The analysis also found that the bill would have a negligible impact on health insurance premiums.

Given this cost effectiveness, we strongly encourage you to advance AB 1843. Thank you for your consideration, and I'm happy to answer any questions.

Thank you. If there's anyone else in the audience that would like to register their support, please come to the microphone, state your name, your organization, and your position.

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

Thank you.

Good afternoon. Jessica Brand on behalf

of the California Life Sciences in support.

Thank you.

Christine Smith, Health Access California in support.

Thank you.

Scott Zuko with Liver Coalition of San Diego and the Eliminate Hepatitis C of San Diego County in support.

Thank you.

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

Thank you.

Isabela Argueta with the Health Officers Association of California in support.

Thank you.

Ryan, Susan on behalf of APLA Health in support. Thank you.

Sarah Webber with the Drug Policy Alliance in support.

Thank you.

Good afternoon. Laura O'Connor. As a Californian family member whose, sister passed away from Hep C, I'm in strong support of this bill. Her untimely death is due to delays in insurance and multiple different kinds of medications and hospitals, but it was very much part of this. So, thank you very much, Assembly Member.

Thank you.

Madam Chair and members, Rand Martin on behalf of the AIDS Healthcare Foundation in strong support of this bill. Thank you.

Thank you.

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

Thank you. Seeing no one else who would like to register their support, we'll now open it up to anyone that would like to speak as lead opposition to this bill. Please come to the table.

Thank you. Seeing no one else who would like to register their support, we'll now open it up to anyone that would like to speak as lead opposition to this bill. Please come to the table.

You have a combined total of five minutes. Thank you.

Thank you. Cassie Heckman on behalf of the California Association of Health Plans. While we appreciate the author's intent for AB 1843 today, we have significant policy concerns and must respectfully oppose it. AB 1843 prohibits plans from conducting prior authorization, or PA, on drugs used to treat hepatitis C. Just last year, the legislature passed SB306, which established a comprehensive regulatory process that evaluates use of prior authorization by health plans.

This is a real time regulation. Health plans will start submitting PA data to regulators next month. And as you know, regulators will review this data, then identify and publish a list of services that are approved more than 90% of the time. And on 01/01/2028 health plans will no longer require PA for those identified services. However, as a part of the SB306 process, it was determined and considered whether specialty drugs, particularly tier three and tier four, should be exempt.

Ultimately it was determined these medications should remain subject to PA, a decision that reflected the significant costs associated with these drugs and an understanding of the role PA can play in ensuring enrollees receive appropriate treatment for an affordable price. Therefore, we are concerned that AB1843 would deviate from the recent and deliberate policy decision to maintain U M safeguards for higher cost specialty medications. I'd also be remiss if I didn't also note the prescription drug prices have increased by more than 70% since 2017.

In the case of prescription drug mandates, CAP will continue to encourage thorough review of prescription drug costs, which remain a major driver of healthcare expenditures. And since health plans already cover drugs used to treat FC, we unfortunately oppose any mandate that prevents us from designing a formulary that preserves affordability and access for our enrollees.

For these reasons we respectfully oppose and want to thank the author and sponsors for their continued conversations.

Sorry. Good afternoon, Chair members. Matt Akin with the Association of California Life and Health Insurance Companies, also respectfully in opposition to AB 1843. In the interest of time, I would just like to align my comments with my colleague at Cap and just very quickly reiterate that we are concerned that this bill would broadly eliminate PA for an entire class of drugs, removing an important tool used to ensure safe, evidence based, and cost effective care.

We are also concerned that establishing drug specific coverage mandates into statute limits plans abilities to adapt to evolving clinical guidelines.

I wanna thank the author and sponsors for their continued engagement on this bill, and we look forward to future conversations as the bill moves forward today. Thank you.

Thank you. If there's anyone else that would like to register their opposition to the bill, this is your time to come forward to the microphone, state your name, your organization, and your position. Seeing no one, we'll bring it back to Senator Caballero.

Thank you, madam Chair. I appreciate you bringing this this this bill. Let me let me ask the the opposition, something because I Aye, I get processes and I understand processes. And Aye, I'm I'm a big believer that they're really critically important. You set up a process, you utilize it, and it and, it it achieves the goals for which the process was set up.

The challenge is is that we're talking about, a, disease that if not treated can result in death as we hear we heard, or a much more serious condition. And I wonder if your cost benefit analysis or your cost analysis whether the increase in a medical care after the fact or if a denial is achieved, if that's part of the analysis that's done.

Because I you know, I'm a big believer in prevention and the more we can get to the root of of what is causing our obesity, high blood pressure, hypertension, and and and the diabetes, the the diseases frankly, the diseases of excess in our in our society, the The more we're going to get a control over the very issue you're talking about which are prescription drugs that are driving up the cost of healthcare. So I wonder if you could address that particular issue.

Yeah. I would just say, you know, the context of AB 1843, I don't think our plans have done an analysis or a cost benefit analysis of, you know, further treatment being more cost effective than the particular cost of the drug. I will say this is an issue that health plans face regularly, which is the cost of prescription drugs. So, you know, it's not specific to this bill or specific to this disease.

It's just something that we have to consider when designing our formularies and, having negotiations.

I understand. Okay, thank you very much. I appreciate that.

Seeing no further comments, I want to thank you Assemblymember for, bringing this bill forward. It is a it's a it's a tough issue because it's not like these medications aren't covered, by insurance companies. It's it's just where they're tiered and so sometimes you do have prior authorization or you do have step therapy. And the other issue for me is the the entire SB306 process, that that was something that we just passed. It was negotiated.

These, Tier three and Tier four drugs were not included in that, primarily around the issue of cost. I'm assuming I was not in the room, I was not the author, but, understanding that getting the whole prior authorization bill through was something that was years in the making. And this does kind of seem to go around it or undo it a little bit.

And so understand the opposition's concern about opening this would then allow for a wide variety of other kind of medications in these tiers to be able to kind of skirt the process that we all agreed to last year. But definitely appreciate you bringing this bill forward.

And with that, we'll let you close.

I really appreciate you bringing up the piece about SB 306.

And definitely for us, it's not about skirting around the process, just recognizing the negligible cost, recognizing that it won't impact the broader framework, and knowing that this is just has such a high, rate of curing a disease that is really like, we know when someone has hepatitis c, when they go to the doctor, to have to go through another process of having to prove that they need these drugs, we recognize just is really, causing more harm.

So really appreciate your consideration and, respectfully ask for your aye vote.

Thank you, and thank you to your witnesses. Once we get a quorum, we will take it up. Thank you. We will now move back to file item two, AB 1629, Assembly Member Haney. And you may begin when you're ready.

Thank you,

Chair, and members. I wanna start by thanking you and your staff, for their work on the bill and accept the committee amendments. AB 1629 will help prevent patients from paying large upfront costs for out of network dental care by requiring insurers to pay dentists directly when a patient chooses to assign their benefits. Every month, millions of Californians pay their monthly dental insurance bill, but never get the care that they're entitled to. California has over 35,000 active dentists.

The issue isn't a lack of dentists. It's that some insurance companies may narrowly exclude in network services, pushing patients to seek out of network care. Despite patients already obtaining assignment of benefits, non contracting providers may exclude from receiving direct payments with insurance insurance companies. 28 states have implemented assignment of benefits legislation that requires insurers to reimburse dentists directly, and California is behind.

These restrictions force patients to travel long distances for care or pay the full out of pocket cost due to inadequate provider networks and restrictive insurance policies.

In most cases, patients would have to pay the cost upfront and wait for prolonged periods to get reimbursed. Patients should not have to choose between paying large upfront costs or delaying dental care, care that can mean the difference between prevention and serious long term health consequences.

AB 1629 will end this limbo by requiring insurers to reimburse dentists with a written assignment of benefits regardless of their contracting status rather than require patients to pay out of high out of pocket costs upfront and wait prolonged periods for reimbursement. It will also require insurance companies to report network adequacy data, which measures whether a health plan has enough in network dentists in the right locations.

We've had productive conversations with opposition and other stakeholders and have taken significant amendments along the way with this bill, including I think ones that we work very closely with you and your staff on and which we appreciate.

And, and with me in support of the bill to testify is Eric Dowdy from the California Dental Association and Shelby, Aravelo, a patient advocate coordinator.

Thank you. You have a combined total of five minutes.

Thank you, doctor Weber Pearson and members of the committee. Eric Dowdy with the California Dental Association. I'm proud to be sponsoring AB 1629. Too many Californians are paying for dental coverage they can't actually use. AB 1629 makes practical, targeted improvements to change that.

First, it strengthens network adequacy oversight to ensure that dental plans have enough dentists and patients to find in network dentists. And second, AB 1629 requires plans to honor a patient's assignment of benefits request. When a patient chooses an out of network dentist, the insurer would send payment directly to the dental office, not the patient. Without AOB, patients must pay the full cost of treatment out of pocket and then wait to be reimbursed. For working families.

That financial barrier makes their coverage effectively worthless. Assignment of benefits is not a new concept. As the Assemblymember said, '28 other states already have this requirement in place and dental plans, including Delta Dental, already comply where it's required and in some locations comply voluntarily where it's not. Importantly, states with assignment of benefits laws have not experienced shrinking dental networks or rising premiums. In many cases, we've seen just the opposite.

We appreciate the Committee's work on the amendments to be adopted today, which improve cost transparency and establish exceptionally strong disclosure requirements to protect patients, and we appreciate the long conversations with Committee staff on the bill and remain committed to pursuing additional transparency and plan accountability as a key part of dental insurance reform. For these reasons, we respectfully ask for your nigh vote.

Good afternoon, chairperson and members of the committee. My name is Shelby Arevalo, and I'm the founder of the National Dental Advocacy Program, a California founded nonprofit organization dedicated to helping patients navigate barriers to accessing dental care. Today, we serve patients across California and throughout The United States. I have spent more than sixteen years in dentistry, beginning chairside as a dental assistant and advancing through management, billing, and coding.

Today, I serve as a board certified patient advocate working directly with patients, families, and providers navigating a healthcare system that is often confusing, overwhelming, and difficult to access.

Through this work, I see firsthand the barriers patients face when simply trying to obtain dental care. Many patients, particularly those in rural communities, those with disabilities, complex medical conditions, or severe dental anxiety struggle to find an in network provider able to meet their needs. When they finally locate a qualified dentist who can provide treatment, they're often met with another barrier, the inability to assign their insurance benefits directly to that provider.

I have worked with patients suffering from severe infections, patients requiring sedation, and patients who have spent months searching for care. In many cases, they they they call dozens of offices before finding a provider who can help them.

Yet, even after finding treatment, some are required to pay the entire cost upfront and wait for reimbursement because their dental plan refuses to honor their assignment of benefits request. For many families, that financial burden is simply impossible. Patients should not be penalized for seeking care from a provider who can meet their needs, especially when network limitations leave them with few practical options. Assignment of benefits is not about providers. It's about patient choice, access to care, and removing unnecessary financial barriers that delay treatment.

AB 1629 also helps address concerns surrounding network adequacy by ensuring regulators have a more complete picture of the provider network patients rely on. Access to care begins with accurate accountability. Every meaningful improvement in healthcare starts when patients have a seat at the table. AB 1629 represents an important step toward improving access, transparency, and fairness for the patients we serve. Thank you for your time and consideration.

I respectfully ask for your vote in favor of AB 1629.

If there's anyone else in the audience that would like to register their support for this bill, please come to the microphone, state your name, your organization, and your position.

Good afternoon, Chair. Jasmine Asher representing the California Association of Orthodontists. We are in support.

Thank you.

Thank you.

Madam Chair and members, Janice O'Malley with AFSCME California in support.

Thank you.

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

Thank you.

Kevin Guzman with the California Medical Association in support.

Thank you.

Good afternoon, Chair and members. Jennifer Tannehill with Erin Reed and Associates on behalf of the California Dental Hygienists Association also in support.

Thank you. Seeing no further individuals wishing to register their support, if there's anyone in the audience that would like to speak as lead opposition, please come to the table, stay and you will have a combined total of five minutes.

Chair Pearson, members of the committee, my name is Sierra Feldman on behalf of Delta Dental of California in respectful opposition to AB 1629. While we do appreciate that and acknowledge the amendments that have been proposed, we remain significantly concerned about the impact this bill will have to patients. We want strong networks. We want as big of networks as possible. But when dental networks weaken, patients lose access to in network care resulting in higher out of pocket costs.

Strong dental networks are essential to patient access and affordability and plans want to partner with providers. But network participation is a two way partnership. Dentists agree to negotiated fees and consumer protections in exchange for this direct payment and patient volume. And direct payment is a key driver of network participation. AB 1629 is mandating that we extend the benefit of direct payment to non contracted dentists without them agreeing to consumer protections or negotiated fees.

This undermines network participation, pushing patients out of network where care is more expensive and the protections are weaker. The risk to networks is not theoretical. In our assessment, states with similar policies have seen declines in network participation. And in California, even a modest decline could translate into hundreds of million dollars of increased out of pocket costs to patients. And this is a cost borne by patients, not dental plans.

In network dentists cannot charge more than the negotiated fee, whereas out of network dentists can charge their full charges. AB 1629 would allow non contract dentists to receive direct payment from a plan while still billing patients for the remaining balance. If assignment of benefits is expanded, it is critical that providers who receive direct payment from a plan accept that payment as payment in full aside from any cross sharing.

Allowing providers to bill a patient after a plan's payment continues to shift the higher out of pocket cost to patients. Plans are committed to working with providers but ultimately as written this bill still continues to weaken networks limiting access to in network care, stripping negotiated protections and driving up out of network costs.

For these reasons we respectfully urge your no vote. Thank you.

Good afternoon madam Chair and members. Christy Weese on behalf of the California Association of Dental Plans. We are opposed to the bill in print. We received the amendments last night and are reviewing them with our association members and are working through that process today as we speak. We want to acknowledge that the hard work of the committee and these amendments do go a long way towards removing the association's concerns particularly the removal of the language requiring predetermination that was particularly problematic for our plan members.

I think the the most important thing for the associations members is to make sure that our plan members understand you know when they're going out of network right what the implications of that are, what the costs are, what benefits they may not be receiving from their plan and just really to make sure that our plan members understand their benefits and are using them as much as possible. So we're we're still opposed at this time but really appreciate how far the bill has come. Thank you.

Thank you. If there's anyone else in the audience that would like to register their opposition, this is your time to come to the microphone. State your name, your organization, and your position.

Alexis Rodriguez with the California Chamber of Commerce in opposition. Thank you.

Thank you.

Olga Shiloh with the California Association of Helplands also in opposition. Thank you. Thank you.

Matt Akin with the Association of California Life and Health Insurance Companies also respectfully in opposition.

Thank you. Seeing no further individuals that would like to register their opposition, we'll bring it back to committee members. Well, I would like to thank you Assemblymember Haney for bringing this bill forward, for allowing for us to engage in this conversation. It's it's not the easiest issue. We've had some pretty tough negotiations, but really appreciate your staff, the sponsors, the health staff, and being able to get us to the place that we are today.

And with that, I'd like for you to close.

Thank you. I appreciate it. And thank you, madam Chair, and to to your staff. As you said, there was a lot of great work done on this bill under your direction, and I really do appreciate everyone who's participated including the opposition. We we do have amendments that I think address some some of the concerns, and I know that the conversations will will be ongoing hopefully as this bill moves forward and very much respectfully ask for your aye vote.

Absolutely. At the appropriate time, we will. And just wanna clarify that the amendments because, again, this was a tough negotiation, but they will have to be adopted in business and professions and not in this committee because of timing.

So Absolutely. Alright.

Thank you.

Yeah. Thank you.

We will now move to file item number five, AB 2540 by Assemblymember Stefani. And you may begin whenever you are ready.

Thank you, madam Chair and, colleagues. Today, I'm presenting AB 2540, which is the Community College Student Right to Access Act. And first, I wanna start by thanking the committee staff for their hard work and partnership with my office, as well as the community colleges for their thoughtful engagement throughout this process. I will be accepting the amendments we have agreed to, which will be taken in the next committee. So thank you so much for that.

Four years ago today, the United States Supreme Court overturned Roe v Wade. With one decision, the court stripped away a constitutional right that millions of Americans had relied on for nearly half a century. It was a devastating step backward for reproductive freedom. California responded by reaffirming our commitment to reproductive health care. California has long said that access to care should not depend on who you are, where you live, or how much money you have.

But today, that is exactly what happens for many college students in our state. Imagine two students living in the same community. One attends a UC or CSU, the other attends a community college. Both are working towards a degree. Both may be balancing jobs, family responsibilities, and the pressures of school.

Both need access to reproductive health care. But only the student at the UC or CSU is guaranteed access to medication abortion services through their campus health system. The other student at the community college may have to navigate transportation barriers, take time off for work, find a provider miles away, which we've heard stories of, or simply go without care altogether. And the reality is the student facing those barriers is often the student who can least afford them.

Community college students are among the most diverse students in California.

They are more likely to be low income, more likely to be first generation college students, more likely to be working while attending school, and more likely to be balancing family and caregiving responsibilities. These students are doing everything we ask of them. They are pursuing an education, building a future, and strengthening our workforce. Yet when it comes to access to reproductive health care, we are not treating them the same as students attending four year institutions. That disparity is what AB 2540 is solving for.

This bill expands equitable access to medication abortion services for students attending community colleges by requiring colleges with existing student health centers to provide these services. And let me be clear. Reproductive health care is essential health care. Access to that care should not depend on whether a student attends a UC, a c a CSU, or a community college. This bill allows services to be provided through existing campus health centers, through telehealth, through contracted providers, or community partnerships.

It also improves transparency by requiring colleges to publish information about available services so students know where they can turn for care. Reproductive health care. And with me today in support

for California support is Alicia Nagpal, who is with the Student Senate for California Community Colleges, and doctor Pana Lassi, a family medic medicine physician who has provided primary and abortion care for over thirty years.

is Alicia Nagpal, who is with the Student Senate

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

Good afternoon, Chair Webber Pearson and members of this committee. My name is Alicia Nachbaum, and I sit here as behalf on as the vice president of legislative affairs for the student senate for the California Community Colleges, the official voice of 2,200,000 students across California. I am also here not just as a student leader, but as someone personally impacted by reproductive health challenges. Our support for this bill is grounded in distribution of clear and comprehensive information for available reproductive and sexual health resources, which AB 2540 establishes.

AB 2,540 is an effort to provide equity when it comes to reproductive healthcare to some of our most vulnerable populations.

While students at the UC and CSU campuses already have access to medicated abortion services through SB 24 in 2019, community college students do not. They are more likely to be low income, working, and place bound. Students in remote areas such as the Far North often don't have the same access to services that students in urban regions may have. Students who are struggling to make ends meet may not have reliable health care.

With this discrepancy, students in the CCC system are disproportionately affected and cannot access timely reproductive health care.

Instead, they may be forced to miss class, delay their education or drop out entirely. Barriers to care become barriers to college completion. This matters for most of this matters most for the students who are already navigating the greatest challenges. Foster youth and documented students, students of color and first generation students who have the least margin of disruption in their lives. Access to these resources expands on the equity work that should be strived for in healthcare and in higher education.

This bill ensures that students are well informed about services and how to access them. The bill means timely, affordable care. It means privacy, dignity, and autonomy when students seek support. And it affirms a simple truth. Community college students deserve the same standard of care as any other student in California.

AB 2,540 affirms a simple truth. Us community college students deserve the same standard of care. We respectfully urge your aye vote. Thank you.

Hello.

Hello. Hi. I'm my name is doctor Pana Lassi, and I'm a family medicine physician who has provided primary care and abortion care for over thirty years. I'm also the very proud mother of a daughter who just finished a fabulous culinary program at our local community college. Many of my daughter's classmates and friends come from immigrant and low income families and worked part time or full time while going to school.

If we truly believe in reproductive freedom, justice, and equity in California, then we must pass this bill. I wanna stress how safe early medication abortion is. A recent study in the journal, contraception, shows that staying pregnant was 35 times deadlier than having an abortion. The major complication rate is less than half a percent, and the mortality rate is zero point six per hundred thousand procedures. For comparison, the mortality rate for a colonoscopy is approximately three per hundred thousand procedures, five times higher.

I understand that the idea of providing medication abortion might feel daunting to people who have not been active in reproductive health care recently, but it is very doable. My family practice clinic started offering medication abortions in 2003, twenty three years ago, so I have firsthand experience. I also help Sonoma State implement medication abortion services after SB 24 and have consulted with many other clinics about adding abortion care to their practices. What has been universally true is that it feels scary before starting.

But after implement implementation, providers reflect that it's really not medically or technically difficult at all.

Routine ultrasounds and follow ups are no longer required. And if providers have questions, they can call the California state funded UCSF reproductive health hotline for immediate free help. There are also free on call services to help patients after hours. The benefit to students is enormous. By not having to delay care and interrupt their studies because they can get what they need from trusted providers right on campus.

I know that everyone working in the community college system is committed to providing the best education and health care to their students and I strongly encourage a yes vote on AB 2540. Thank you very much.

Thank you. If there's anyone else in the audience that would like to register their support, please come forward, state your name, your organization and your position.

Chair members, Austin Webster, with W Strategies on behalf of the Student Senate for California Community Colleges, also here just to answer questions.

Thank you.

Thank you, Chair members. Angela Pontus on behalf of Planned Parenthood Affiliates of California in support.

Thank you.

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

Thank you.

Lizzie Guasona here on behalf of Training and Early Abortion for Comprehensive Health Care or Teach, in support.

Thank you.

Good afternoon. Georgia Apostolatis on behalf of Lieutenant Governor Eleni Gunalakis in support. Thank you. Thank you.

Good afternoon. Adam Cagle on behalf of California LULAC in support.

Thank you.

Christine Smith, Halifax is California in support.

Thank you.

Martin Rudasovich on behalf of Reproductive Freedom for All California cosponsors.

Thank you.

Good afternoon. Isla Bravo on behalf of URGE and California Latinas for Reproductive Justice. Proud cosponsors in support.

Thank you.

Hello. Alana Laddesa on behalf of the American Nurses Association of California in support.

Thank you.

Hi. Kim Robinson, with Black Women for Wellness Action Project and also, giving AME two for Access Reproductive Health, in support and also co sponsors.

Thank you. Seeing no one else that would like to register their support, if you would like to speak as lead opposition, this is your time to come to the table. Just two witnesses to speak as lead opposition. Thank you. And you both will have a combined total of five minutes.

Hi. Good afternoon, Chair members. My name is Michelle Barclay representing Health Services Association California Community Colleges, HSA CCC. We have a we have an opposed position on the bill at this time, but anticipate removing opposition based on amendments discussed this week. To be clear, HSA CCC strongly supports students' access to comprehensive reproductive health care, including abortion.

We appreciate the author, committee sponsors, and the chancellor's office for the continued collaboration and thoughtful work on recent amendments on this on AB 2540. We especially value the added flexibility allowing colleges to partner with outside providers. This is an important step that recognizes campuses may support students through a mix of on-site services, telehealth, and community partnerships. We want to highlight a few practical considerations. Each model brings different operational needs.

On-site care may require new clinical staffing and infrastructure. Telehealth still requires, still relies on campus coordination and oversight. Community partnerships can be effective, but provider availability varies widely by the region. Community college health centers are already operating at or near capacity and are designed for short term care, implementing multiple service pathways simultaneously, while we'll take careful planning and support. Sustainable ongoing funding will be essential to ensure colleges can expand access while maintaining core services it's it's core services students depend on.

HSACC is committed to continuing to work collaboratively with the author authors and stakeholders to help ensure this bill is both student centered and implementable. Thank you for your consideration. Thank you.

Good afternoon, Chair and members. My name is Megan Pannell, and I am a current community college student at Folsom Lake College. I'm here today in opposition of AB 2540, which promotes and expands access to abortion drugs on community college campuses. While I have never been pregnant nor do I have any children of my own, I have worked in public education and watched friends juggle school and parenthood.

The stress of going to school for a degree alone is a lot, and to be able to handle that while also being a parent is something I have always admired in others.

It shows how strong people can be while also showing their children that nothing is impossible. Instead of promoting abortion and choosing to end a life out of convenience, we should be giving college students resources to help them. For example, providing them with options for adoption if they choose they aren't ready to be a parent, offering childcare centers on campus so that they can attend class while their child is well cared for cared for.

My mother was sexually assaulted at a young age and got pregnant with me. Rather than telling someone, she chose to hide her pregnancy because she wanted me to wanted to give me the ultimate gift of life.

She knew there was a chance that someone would try to pressure her into abortion. She's my inspiration to fight for the millions of beautiful children who have no voice. Time or circumstance should not dictate the value of life. Did I deserve to die for the crimes of my father? California does not impose capital punishment.

If we do not punish criminals with death, why should an innocent child receive a death sentence because of the circumstances of his or her conception? Why are we so quick to end a life out of convenience instead of offering resources for the mother and her child? Young women with unplanned pregnancy should be encouraged to have their children instead of making abortion an option women feel pressured into because that's the only option offered for an unplanned pregnancy.

From someone who is happy to be alive, I respectfully urge a no vote on AB 2540.

Thank you. If there's anyone else in the audience that would like to register their opposition, please come and state your name, your organization, and your position

only. Good afternoon. David Bullock on behalf of the SFV Alliance. We are in opposition. Thank you.

Thank you.

My name is Leandra Wells with the California Family Council. I completed my degree three weeks after my baby boy is boy was born. We we respectfully oppose this bill. Thank you.

James Delcourt, Living Well Medical Clinic, Grass Valley, stand opposed.

Thank you.

Good afternoon. Justin Selnick on behalf of the California Community College Chancellor's Office. We don't have an official position, but we are supportive of the intent. And we are aligned with the concerns of the Health Services Association and the excuse me, and the community college CEOs. But as as our witness spoke, there have been amendments that are pending that will hopefully remove our concerns going forward.

Thank you. Seeing no further individuals that would like to register their opposition support or tween position, we'll bring it back to the committee. Okay. Wanna thank, Assemblymember, Stefani for bringing this bill forward. It is extremely important that we, as a reproductive states, a state believes in allowing for people to have all options of what they want to do with their bodies, that we do work on getting this right.

Also, understanding though the challenges of our community colleges. Community colleges are not UCs. They're not CSUs. They don't have the same resources, and not all community colleges are the same. Some are very large, and some are very, very small and and are very limited in terms of resources.

And I think sometimes when people think, oh, well, you can do telehealth and they've never actually done telehealth, they don't understand some of the intricacies and some of the modernization that you must have, the infrastructure that you must have in order to, be able to do something like a telehealth. And so I really appreciate you, agreeing to these amendments.

I think that it does address a lot of the opposition's concerns, but at the same time, still allowing for disclosure on all campuses about what, options are available, and also allowing for those community colleges that do have the ability to do this, to to continue or to provide the service for the students. And with that, you may close.

Thank you, madam Chair. And, yes, I do wanna thank the community colleges for working with us on this bill. This is not to add any burdens to their already overstressed system. We wanna make sure that we are working with them, and that's why we have accepted the amendments and will continue to work and address those remaining concerns. But, you know, this bill is about equity.

It's about dignity. It's about making certain that we have reproductive, health care access, to all those students who need it, and I thank you, for your consideration. I respectfully ask for an aye vote.

Thank you. And at the appropriate time, whenever we establish quorum, we will do that. Alright. We will now move to file item eight, AB 1929 by Assemblymember Ortega. And you may begin when you are ready.

Thank you, madam Chair. I'm also chairing my own committee, so I'm actually gonna make my comments very brief to allow my witnesses to make their comments. Thank you for allowing me to present AB 1929 today, which is a Latino caucus priority bill. AB 1929 requires health plans participate on the covered California health care exchange to disclose all the investments they make with the subsidies and patient premiums they receive, including investments for in for profit prisons and immigration detention centers.

AB 1929 is a sunshine law ensuring that the public knows which health plans are investing in the well-being of their communities and which are profiting from destroying them.

Here to testify with me today is Joe Gudzinski, executive director of UNAC, and Christopher Sanchez on behalf of Central American Resource Center of California.

Thank you. You have a combined total of five minutes. Thank you and good afternoon.

Thank you and good afternoon, Chair Weber Pearson and members of the Health Committee. My name is Joe Gudzinski. I'm the Executive Director of the United Nurses Association of California, Union of Healthcare Professionals or UNACUACP. We represent approximately 41,000 registered nurses and healthcare professionals across California. UNACUACP is a proud sponsor of AB 1929 because it affirms a simple principle.

Health core organizations, many operating as nonprofits, carry an obligation to the public they serve. That obligation is grounded in transparency. Transparency must be a fundamental condition doing business with the state of California. Nonprofit health plans benefit from a public trust reinforced by taxpayer support and the expectation that its resources provide meaningful community benefit. With that trust, health care organizations have an obligation to provide the public with a clear understanding of how they are putting those resources to use.

This is not about restricting the rights of health care systems to decide how they invest. This is about the taxpayers' right to transparency. AB1929 honors that right. It ensures that investment choices and the values behind those choices are accessible and visible. People deserve to know when a health care system's investments conflict with the values or well-being of the communities they serve or when they conflict with the values that the organization claims to represent.

Patients deserve this. Employees deserve this. The taxpayers of California deserve this. Behalf of the 41,000 health care professionals we represent, we respectfully ask for your aye vote.

Good afternoon, madam Chair and members. Christopher Sanchez with the Mesa Verde Group here on behalf of the Central American Resource Center, CARESN, the largest Central American immigrant rights organization in the country, here today as a proud cosponsor in strong support of AB 1929, a bill that would make appropriate disclosure so Californians can make educated decisions whether choose choosing a health care plan.

Cadizance stands firmly against anyone, any system, or any company benefiting and profiting from the detention of immigrants and private detention facilities who have a long history of human rights violations. Our organization knows firsthand the inhumane conditions of these private detention centers because we represent individuals and and their families who are in these centers, and members of our legal service team have gone inside these detention centers to service the clients.

They have witnessed signs of malnutrition, lack of proper hygiene, lack of medical care, and signs of physical abuse.

Our clients have told us about significant overcrowding, and there have been countless reports of deaths that are based on violence and lack of medical treatment in these facilities. These detention centers are solely designed for profit for of immigrants. And under the Trump administration, these policies have been implemented to ensure that there is no due process immigrant proceedings resulting in forever detention to maximize profits for these private detention companies.

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's our job to do so and simply just to have simple disclosures.

Today, Kaida Center is your eye vote.

Thank you. If there's anyone else in the audience that would like to register their support for this bill, please come forward. State your name, your organization,

California. We are proud cosponsors. Thank you.

Thank you.

Hello. My name is Elizabeth Dubs. I'm a nurse midwife, and I'm a supporter of it.

I'm also a UNAC member.

Thank you.

Thank you.

Hello. Camille Stone, certified nurse midwife. I am in support of this.

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

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

And you will have a combined total of five minutes.

Good afternoon Chair members, Olga Shilo on behalf of the California Association of Health Plans in opposition to AB1929. AB1929

a fundamental mismatch by assigning responsibilities to Covered California that is not designed or equipped to carry out. It is not clear what gap this bill fills or why Covered California should be tasked with filling it. Furthermore, Covered California is not a health plan regulator. Neither does it have the expertise or the filings or adjudicate compliance. This bill would effectively require it to do all three.

creates

It also places the exchange in a position of posting and explaining complex Non Healthcare Financial disclosures to consumer at a time when its core mission is enrollment and retention. Covered California has raised concerns that this could confuse or even discourage consumers from signing up for coverage. The exchange already operates in a challenging environment and has just 11 participating carriers today. We should focus on stabilizing and strengthening that market, not adding new requirements that could make, participation less attractive.

Finally, as the committee analysis notes, much of this information is already publicly available through existing reporting frameworks.

For these reasons, we respectfully ask for a no vote. Thank you.

Madam Chair and members, Stephanie Watkins on behalf of the Association of California Life and Health Insurance Company. I echo many of my colleagues' comments. We do represent, the major health insurers that are regulated under CDI.

Just like to note, and I think it's addressed in the analysis that much of this information, I think that the author and sponsor we're initially seeking is provided through annual and quarterly disclosures that are required as a part of the, National Insurance Commissioner's Model law that they are publicly available and provided to CDI and just to give you some examples these include real estate, mortgage loans, bonds and stocks, alternative investments that include disclosures for non traditional assets such as private equity, hedge funds, joint ventures and mineral rights, short term investments and cash and cash equivalents.

So much of this information is already provided and we're a little confused as to during this specific time when affordability is at the forefront of everyone's mind if it's the best use of resources to add additional administrative burden and cost to the health care system that doesn't necessarily fill a gap but is feels very duplicative of what's already provided.

So for those reasons we are opposed to the bill but if it doesn't move forward we look forward to having continued conversations. Thank you.

Thank you. If there's anyone else in the audience that would like to register their opposition this is your time to come forward. State your name, your organization, and your position only. Thank you.

Alexis Rodriguez with the California Chamber of Commerce in opposition.

Thank you. Seeing no further individuals that would like to register their opposition, we'll bring it back to committee. Vice Chair Villadares?

Thank you. Thank you, Madam Chair. I have major concerns with this bill. You know, health care is is personal and families don't buy insurance because they care about what stocks or funds their insurer owns. They buy insurance because they wanna know when their child gets sick.

They want they want coverage when their spouse needs surgery or when a loved one is diagnosed with cancer that the care is gonna be there. And this bill moves us away from that mission, from my perspective. California already regulates insurers to ensure that they are financially sound and that they're able to pay claims. But this isn't about protecting patients. It's about publicly exposing and scrutinizing lawful investment decisions so that they can become targets in political debates.

And for me, that's a dangerous precedent. Today, health insurers, tomorrow, banks, more nonprofits, you name it. But if there's fraud, let's investigate it. If there's mismanagement, let's stop it. But government should not be in the business of politicizing investment portfolios.

And at a time when Californians are struggling with the cost of care, we should be focused on lowering premiums, increasing access, and improving patient outcomes, not creating new bureaucracy. So my question is, how does this bill improve access and how does this bill make health care more affordable at a time when we're raising taxes to cover health care for Californians? How does this accomplish that? To the sponsors.

What what I would say To answer your question, what this bill does as far as when we talk about access, it's access to information for the consumer.

I'm talking about access to care, to medical care. How does it improve it?

Well, for the consumer who's seeking to make judgments about the community in which they live and health care is part of this to provide insurance for their family, I've been on the exchange. I understand what it provides and it does provide, you know, there's a lot of personal information that's given from the patient here.

And what this bill does is it says that when it relates to investment, which has a huge impact on the community, investments in fossil fuels, investments in things that deal with mental health, predatory lending, investments that have everything to do with health care. As a consumer, I would like to know, and that's what this bill seeks to do is in a transparent way of not having to go through a whole bunch of forms.

I would have no idea where to get the information that was listed before.

It's all over the place. So what the bill does is it's it's from a consumer point of view. It says, let's make the revenue that I pay and the revenue that these insurance companies achieve. Let's see where they're investing in that situation.

So the answer is it doesn't improve it. I'm talking about the person that is trying to get a doctor's appointment. I'm talking about so it does not improve

I would I would concede that it's not

So to the to to the opposition, does this does anything in this bill improve access to care?

Oh, sorry. I mean, from our perspective, no. I think it increases administrative costs, which therefore increase the general premiums that rate payers pay and ultimately then makes health health care less affordable. And I would say that while I appreciate the fact that not all consumers necessarily know that they can access CDI, to the degree this information is publicly available, those within the advocacy community do know and can make that publicly known to the people that they work with.

I mean at the end of the day, all of this is quarterly and annually reported to CDI.

It's publicly available and it's quite comprehensive to the degree that you want to do the investigation on who's investing and where. I think that's an important key element that our community can access and provide to those who are interested but adding additional administrative costs at a time when enhanced subsidies are gone, people are really struggling. I don't think it brings more to the consumer. I think it it's just an additional administrative cost in a duplicative process. I mean that's that's from our perspective.

I'm just generally frustrated right now that we are trying so hard to find dollars to pay for care. And at a time when we we are raising significant taxes for families this year to pay for for to to pay for access to care. And for access to care to care to undocumented immigrants too. That's what we're doing this year. We're we're we're here addressing or presenting bills that I think make it even more political.

And so I can't get to support on this because I have a fundamental opposition to what I think it's it's going to do. And my priority is making health care more accessible for every Californian and making it less expensive because people are struggling to pay for prescriptions, to pay for premiums and then we're raising taxes. So I'll end with that.

Thank you. Not seeing any other Senator that would wish to speak. Wanna thank you Assembly member for bringing this bill forward. It is important to have information to know, you know, who's investing what and where. I do have some concerns though because that information, although maybe not in one consolidated place, is already available.

And where we are right now, we have to weigh the cost of consolidating all that information that's already out there against the cost that will that the patients will have with the increase in their premiums because of the increase in the administrative burden. I don't I don't personally think that it is going to improve health outcomes. I don't personally think that it's going to improve access to healthcare.

And, you know, there was, technical assistance from Covered California which on June 19, which really states that this is far outside of their role as an Affordable Care Act marketplace. You know, they even say it's unclear what information consumers would obtain that's not currently available through public filings.

The fact that they themselves don't have any experience with forms, 5,500 for any employee benefit plan. I'm just really concerned that we would be putting more cost on patients and not getting significant returns. Understand the purpose of the bill. Understand the fact that people should know. But I'm just wondering at this time, is it worth us increasing their premiums?

And when you're looking at patients that are uncovered California, I mean, everybody's struggling right now, but they're definitely struggling and we've seen some people have to drop their tears in order to keep their insurance at this time. So I'm just not sure if what we would get from consolidating all of this information is worth the cost to those families. And for some of them, they may end up having to remove off of insurance completely. But definitely understand and appreciate you bringing this forward.

And with that, I know you have a committee, so you can close.

Thank you. And I appreciate the author's comments and the opposition. I definitely, you know, agreed to take a look at some of the comments that have been made in terms of the regulatory authority and willing to take amendments as it relates to that because I do not want it to be a burden.

It's about transparency and ensuring that we as premium payers, you know, you talked about increased premiums and access to health care, We should also have a right to know where our dollars are being invested and if in fact they are being invested in detention centers that are hurting our communities and our babies and our mothers.

And if we wanna talk about health cuts and political, we should also acknowledge that a lot of the reasons that we're having to make these cuts is because the big beautiful bill cut $799,000,000 in health care access to give tax breaks for billionaires.

So we should really look about both issues, not just one if we're gonna talk about health care access and why we're having to make these difficult decisions. With that, I respectfully ask for your Ibook.

Thank you. And when we get a quorum, we will take that bill out. We are now, going to go down to file item 23, AB 2651. Wanna thank, Assembly Member Harabedian for allowing Assembly Okay. Well we will hold off on that and go to file item 11 AB 2030 from Assemblymember

Lowenthal.

And you may begin when you're ready.

Thank you madam Chair and members for the opportunity to present AB 2030. This will prohibit the sale of over the counter diet pills and supplemental supplements marketed for weight loss or muscle building to individuals 18. I wanna begin by clearly outlining outlining which products this bill does and does not cover. First, the bill only applies to dietary supplements that are marketed or represented for the purpose of achieving weight loss or muscle building.

This bill does not prohibit the sale of any specific supplement including creatine provided it is accurately labeled for what it is.

And second, the bill only applies to dietary supplements not conventional food products that have an FDA mandated nutrition facts label. Most protein drinks and many protein powders are sold as food and would not be covered by this bill. And third, nothing in this bill prohibits the sale of dietary supplements to an adult. This bill only applies to minors.

Adolescents face unique risk when it comes to dietary supplements marketed for weight loss and muscle building particularly because of how heavily these products are promoted to young people and the well documented harms these products cause.

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

Young people with a history of depression and body dissatisfaction are at an elevated risk of using this category of supplements beyond levels recommended by the manufacturer.

Additionally, according to the American Academy of Pediatrics recent guidelines, they discourage the use of sports supplements in athletes younger than eighteen eight 18 years old emphasizing that a balanced diet is the way for young people to get all the necessary nutrition that they need. The health risks associated with these products are well documented and particularly concerning for younger users. Weight loss and muscle building supplements have been linked to serious adverse events including cardiovascular complications, liver disease, hospitalization.

Dietary supplements are not regulated like pharmaceutical drugs yet over the last decade decade more than 750 supplement brands have been found to be tainted with pharmaceutical drugs. While the FDA identified these tainted supplements, less than half of these products were recalled.

Unlike prescription medications, these products do not need to demonstrate safety or effectiveness before being sold, allowing potentially dangerous items to remain widely accessible. Experts and Clinicians consistently caution against youth use precisely because of this lack of testing. Studies and clinical guidance emphasize that these products are not recommended for adolescents as their effects on the developing bodies remain inadequately studied. Yet despite this, adolescents can easily purchase these products in stores or online without any age verification.