Assembly Standing Committee on Health

Good afternoon, and welcome to the Assembly Health Committee's hearing on Tuesday, June 30. Before we begin, I wanna make sure everyone understands our committee procedures to to ensure we maintain order and run a fair and efficient hearing with the goal of hearing as much from the public within the limits of our time. We seek to protect the rights of all who participate in the legislative process so that we can have effective deliberation on the critical issues facing California.

The rules of conduct by members of the public include no engaging in conduct that disrupts, disturbs, or otherwise impedes the orderly conduct of this hearing, engaging in personal attacks of members of this committee, authors, staff, or other witnesses, talking or loud noises from the audience, please be aware that violations of these rules may subject you to removal or other enforcement processes. If you're providing witness testimony at this hearing, all witnesses will be testifying in person.

Main support and opposition will be allowed two main witnesses for a maximum of two minutes each. As a reminder, primary witnesses in support must be those accompanying the author or who otherwise have registered a support position within with the committee. And the primary witnesses in opposition must have their opposition registered with the committee per the instructions on our website. All other supports and opposition can be stated at the standing mic when called upon to simply state your name, affiliation, and position.

All testimony comments are limited to the bills at hand. I would like to note, we have a few interpreters by providing, who are providing American sign language interpretation for those attending today's hearing in support of SB 331 by Menjivar, the let California kids hear act. And I would just pause for a second and ask if the interpreter is in a location where those who need that interpretation are able to see unobstructed.

Assuming that they are and do not need to be relocated, as I'm looking out in the public hearing right now, I will continue on. I also ask that everyone in the audience help ensure the interpretation remains visible and accessible by avoiding disruptions, such as blocking the interpreter or obstructing the view of participants who are relying on the interpretation. For consent, the following bills have been proposed for consent today's at today's hearing.

Any member of the committee may remove the bill from consent calendar. Item number 14, SB 1447. Author is the Senate Health Committee with a motion of do pass to appropriations. With that, we do have our first, member or Senator who is able to present. We will begin with as a subcommittee with file item one, SB 331 by Menjivar. Whenever you are ready, Senator. Thank you.

Madam Chair, you know this bill very well. I-- this is my third time trying this bill, and last year, you and I tried together to increase the essential health benefits and we were able to pass those bills but we were roadblocked by the federal government who put a pause on approving them. This is the fourth time the legislature has attempted this coverage, and I think we're almost there.

Just couple-- just yesterday, the legislature passed and the governor signed the budget that assumes savings--should this bill pass--that assumes saving on shifting the coverage of individuals who need hearing aids away from the department's program--also known as the Hearing Aid Coverage for Children Program--and have the large plans cover this. With the budget assuming those savings, we just need this bill to get passed. We all have been hearing this conversation for the past four years.

In the state of California, a physician provider will tell you by law that your child was born hard of hearing or deaf, but that's as far as their responsibility goes. It is then on the parent to somehow figure out how to pay every couple years 3 to $6,000 as their baby's ears continue to grow if they want to provide hearing aids for their kids.

In 2021, the governor vetoed a bill saying that they would implement a program in the department to cover this. However, year after year, we're seeing that we're spending more money on the administration of the program instead of actually providing hearing aids for our kids, which is why for the past three years, we've been trying to rectify that situation and ensure that it's flipped, that we provide the services more than we pay for the administration.

The Let California Kids Hear campaign has been relentless, has persevered, has traveled here, has been wearing those shirts here in the Capitol year after year, and I wanna commend them for never giving up, for Michelle for never giving up on this, which is why I'm here once again to ensure that we allow--and then some more narrow version of the bill that we've introduced--to have mandated coverage for all health insurance plans, including those in the exchange, which was before and which was in limbo, to now just include the large plans. I will stop there and turn it over to my witnesses who I think does a more beautiful way of explaining why this is so important for our children.

Hi. My name is Marie, and I've been coming to Sacramento since 1st grade. Some of my fellow advocates here today have been coming here since they were babies and toddlers. Year after year, we've come back asking for the same exact thing, equal access to sound. Although I was born with hearing, I lost some of it after an illness.

Before my fourth birthday, my preschool teacher told my mom, Marie isn't the same confident little girl who walked into this classroom in September. She's removing herself from circle time and crying. She's losing language skills she once had. Something isn't right. The day I got hearing aids changed my life.

I danced around the house because I could hear my feet tapping on the floor. I was happy again. My parents carried guilt because, for months, I hadn't fully heard them say, I love you, or the bedtime stories they read to my brother and me. One night, they found themselves at a support group in LA. They were quickly humbled as mom after mom shared devastating financial decisions their families had to make.

The first three moms quit their jobs so their kids could qualify for Medi-Cal. The fourth said, I've got five kids. Our family isn't going down. He'll go without. Then my mom learned that kids were showing up at centers at age five unable to say their own names because they had never heard them.

That was the moment our advocacy journey began. I know what access to hearing aids has made possible in my life. Without them, I would not have had the same opportunities as my peers to learn to speak, attend mainstream school, and hear and connect with my peers and families. This bill will help 8,000 children. It'll provide access for 8,000 children's hearing aids.

While some families choose different ways to communicate, a family's-- a child's access to sound should never be dictated by their family's health plan. One of the first pictures of me in Sacramento was in front of the California For All sign outside of the Governor's Office wearing an oversized turquoise backpack. Vote to let California kids hear and include deaf and hard-of-hearing in California for all. Thank you.

Thank you. You'll have two minutes.

Thank you so much, Marie. It's such an inspiration to see you here. Thank you so much, Senator. Assembly Member Bonta and Health Committee, thank you so much for this opportunity. My name is Dylan Chan. I'm a Professor of Pediatric Otolaryngology at UC San Francisco. Our team at the children's hospitals in San Francisco and Oakland take care of about 2,000 children who are deaf and hard of hearing every year, and we've published nearly 100 articles on pediatric hearing health access outcomes and disparities.

One thousand children are born in California deaf and hard of hearing every single year. For these children, hearing aids are an absolute medical necessity. There's overwhelming evidence that failure to provide appropriate intervention for deaf and hard-of-hearing children causes permanent speech, language, cognitive, educational, and social-emotional deficits.

Because of this, pediatric hearing loss is considered a developmental emergency where every month without sound confers increased risk for permanent developmental delays. Despite this, only 14% of California children in large group plans have coverage for hearing aids. A pair of hearing aids costs $6,000 every few years. In our clinics, we see hardworking families who delay necessary treatment because they can't afford it or simply go without.

We also see the permanent speech and language delays that happen when these children don't get the hearing aids that they need. These preventable and permanent consequences are not only devastating for the child and the family; they cost society. It's estimated that a child who is deaf or hard of hearing without intervention costs about $1.9 million in special education and lost productivity.

We need to act now. A developmental emergency is unfolding for years and has been unfolding in California for every child who has gone without hearing aids because of inadequate coverage. Thirty-five states already have mandated coverage in large market or exchanges or both. Support of this bill is essential to provide California children equal access to hearing healthcare and enable them to thrive. Thank you so much.

Thank you so much. Are there-- press on the mic.

Thank you, Marie. I just want to thank you guys. Senator Menjivar, you have stood with us for so long, and we're really grateful and we're really grateful for both of you carrying the application--

Thank you.

--and for you guys standing with us every year and the legislature being with us every year. And Marie speaks better, so I thought I'd let her do the talking today, but thank you. We're so grateful to be here today.

Thank you. Are there others in the hearing room who would like to offer support for this measure?

Good afternoon. Bryant Miramontes with the California Teachers Association in support.

Good afternoon. Olivia Herrera, intern at Stone Advocacy, on behalf of the California Children's Hospital Association, in support. Thank you.

Christine Smith, Health Access California, in support.

Kasha Hunt with Political Solutions, here on behalf of the American Academy of Pediatrics and the California Children's Specialty Care Coalition, in support.

Angela Hill with the California Medical Association, in support.

Shamir Washington with California Care Kids, here in support. Thank you.

Alex Levy, parent, here in support and representing my four-year-old who has hearing loss and who benefits from hearing aids, and I can tell you that in addition to all the wonderful--

Thank you so much. Just a yes or aye support. Thank you so much.

Hi. Hi.

Hi.

Hi. Todd Jolly representing Sonoma County, my two boys who both benefited greatly from hearing aids, and I support.

Samuel Jain with Disability Rights California. Really appreciate the author's shift on this bill number. Proud support.

Nora Angeles with Children Now, in support, along with the 30 organizations in the analysis.

Hi. My name is Kimmy. I'm a deaf single mother with two deaf and hard-of-hearing children. I've been here since 2019, and I've testified in front of the Senate seven or eight years ago, and it's very important-- it's very important because of language deprivation and the school equal access--

Thank you. Just an aye support is sufficient.

Thank you.

I support--

--SB 331.

Thank you.

Hi. My name is Chloe, and I support Let California Kids Hear.

Thank you.

Hi. My name is Sophie. I'm 14 and I'm deaf. I support SB 331. Thank you.

Hi. My name's Avery. I'm hard of hearing, and I think it's time to let California kids hear.

I'm here for my sister, and let California kids hear.

Hi. My name is Caprice. I'm here for my daughter, Avery, and I'm in support of SB 331.

Hi. My name is Vicky, and I'm here as a grandparent, and I support the Let California Kids Hear. Thank you.

Hello. My name is Robert Schuler, grandfather of Avery. Please help. Thank you very much.

Hi. My name is Shelley, and I am Avery's grandma, and I think it's time to let California kids hear.

Thank you.

Hi. My name is Sofia Goldsby. This is my son, Sebastian Goldsby, who's eight years old, and we support. He's the example of what happens when you don't get access early.

Thank you. I think there's a request from the public to continue to sign while--are you--while people are up there. Okay, thank you.

My name is Lauren Jolly and this is my son, Owen Jolly. Please let California kids hear.

My name is Mateo, and it's time to let California kids hear.

Thank you, Mateo.

Hello. My name is Daniel Cabrera. I am a teacher, and I support the bill.

Hi. My name is Robin. I'm a hard-of-hearing medical student at Harvard Medical School, and I'm I'm in support of all medical students, and I support this bill.

My name is Johanna Wonderly. I'm parent to four hard-of-hearing children, and it's time to let California kids hear.

Hi. My name Carter. I'm hard of hearing. Let California kids hear.

Hello. My name is Caitlyn. I've been coming here for my ear a lot, and I think that it's now time to let California kids hear.

My name is Cassie Wonderly, and let California kids hear.

My name is Cara Wonderly, and let California kids hear.

Tony Anderson, Association of Regional Center Agencies, in support.

I am Mary Tollner. I'm here for all the kids who have waited way too long for this. I'm supporting SB 331.

Hi. My name is Grace Tollner. I support Let California Kids Hear.

Hi. My name is Joy Kearns. I'm the Clinical Liaison for the Audiology Department at UCSF Benioff Children's Hospital Oakland. Please let California kids hear.

Hi. Florentina Di Gennaro in full support of this bill.

Hi. David Bolog of the SFV Alliance. It's not too often that we get to support one of Caroline's--excuse me--Senator Menjivar-- honorable Senator Menjivar's bill. We are in full support. Thank you.

Thank you. We will now move to any primary witnesses in opposition who are here. Seeing none, we will move to anyone in the hearing room who would just like to register their opposition. Seeing none, we can bring it back to the committee for any comments or questions. Assembly Member. Go ahead.

Thank you, Madam Chair. I just wanna thank the author for this, for her leadership-- her continued leadership from the yellow footsteps to the Capitol. I know what you're made of, and that's pure grit and a dragon slayer, and this is just another example of your great leadership. I'm proud to be a co-author along with you. One of the things that I will say about this is, we just have to make sure that not only this happens but we continue to advocate for our superheroes who are out there, so you can count me as part of your team.

Assembly Member Caloza.

Thank you so much, Chair, and thank you to the senator. Thank you to the witnesses and all the families, kiddos, and advocates who are in the audience voicing their support. I think this is a great bill and I think you've, you know, continued to elevate an issue that even though it's not made its way successfully through the process in past years, you didn't give up. You continued to fight for all of our children in California who who want to hear.

We hear you now, and I'm super proud to support this bill. I also represent the Children's Hospital of Los Angeles and know that, you know, this is much needed to continue to make California accessible to everyone, and would love to be added as a co-author, Senator. And somehow you just pick the bills with the cutest public comment, whether it was this one or your allergen bill, so kudos to you. Thank you, Senator.

I learned the trick, Assembly Member.

I see you. Yeah. Thank you.

Assembly Member Patel.

Thank you for bringing this very important bill forward. As a former trustee in a school district and as a PTA mom, bills such as these have been coming to us for support for many years and it's great to see it moving so far through the process this time around. I have written letters of support myself for similar bills in the past, and hopefully the governor will sign this one. Happy to give you an aye vote and would love to be a co-author as well.

Appreciate it.

Well, thank you, Senator, for bringing this forward. You and I had an opportunity to work on trying to make sure that this would be an essential health benefit along with many other benefits that we knew were absolutely critical. I think what stands apart between this and the other essential health benefits that we sought to introduce is that we have an advocacy group that has been at this for nearly a decade, sadly, and also astoundingly and inspiringly.

I wanna thank you all for making sure that California is able to put at the forefront our ability to ensure that our kids have the ability to hear, and that in so doing, parents and families aren't faced with crushing medical debt to be able to allow that to be a part of their developmental process. To be able to have hearing aids that actually grow with the child over time is something that is very different and distinct from other kind of equipment that we need and it does allow us to just be able to ensure our children have the ability to be able to connect with their families, with their communities, with their educational opportunities, and with life.

And so with that, I would love to be able to be a co-author on this bill as well. I just wanna say for the record for those in the back up in-- on the--I don't know where they are, 9th or 10th floor, wherever they are--this has been a very, very long journey for many advocates who want to do right by their children, and where California has the opportunity to push and to ensure that we are doing right by their folks is in this moment in time right now.

So I am very much hoping that the senator will be able to be a part of a signing ceremony where this one crosses the finish line after nearly a decade from way before many of us were actually in this legislature, have this happen for our children. And with that, Senator, please close.

I think that was a beautiful close, Madam Chair. Michelle has been the 121st legislator for the past 10 years. She has gone to D.C., she has met with the Governor's Office, she's met with probably every single legislator you can think of even before my time.

Her daughter has grown up in the legislature here from having to testify as a 1st grader to now a young lady. We have done our part, the legislators have done their part year after year, and I'm very hopeful that I think this year will be the year that we'll get it to the finish line. The program we've installed a couple years ago just isn't working how it's intended to be, so their money is there to shift around and I think it just now takes political will. I'm-- call me naive, but I think this might be the year that we'll get it to the finish line, and I welcome anybody for a co-author. I appreciate my brother for your wonderful words. Respectfully ask to let California kids hear.

And when we have a quorum, we will be able to consider this bill. Thank you, Marie. Thanks for speaking today. Thank you, Michelle. All right. Just so that we can have a motion and a second on the record, we have Ahrens first and Caloza second for consideration when the time comes. We are going to move on now to Item Number Four: SB 608 by Menjivar.

I'll get started as my witness come here. This bill you've also seen before.

Go ahead.

SB608 is the third year in attempt. I do not give up as you can see. On ensuring that individuals, young people have access to, be protected should they make that personal decision to be intimate at a at a younger age. While the bill was vetoed last year, we were able to get funding in the bill in the budget for this bill. So now we just need to pass the bill to use the money we've already allocated for or we've have set aside from last year's budget.

And in this year's budget, we were also able to get even more funding to help fulfill the requirements of SB 608 that is asking to that wants to bar school based health centers from making condoms available. We wanna make sure that they they have them available for grades seven to 12. We wanna make sure that when there is an educational or health program happening at the school that they make they are not prevented from providing, contraceptions, during those, educational, hearings or webinars.

And we wanna make sure that pharmacies and retailers are not asking for an ID because there is no state law requiring for ID to purchase contraceptive contraception at these locations. And we wanna make sure, while not in this health committee purview, we wanna make sure that the California Department of Education has the authority to monitor the already established California Healthy Youth Act.

With that, madam Chair, I'll turn over to my first witness in support.

Thanks. You'll have two minutes.

Good afternoon, Chair Bonta and Assembly members. My name is Joaquin Avalos, and I just completed my junior year at Da Vinci High School located in Hawthorne, California. I am here on behalf of hundreds of students who are in strong, strong support of Senate bill 608. I work hard to be healthy, and a part of that is to understand how SDIs work and how comprehensive sex education can help me and my friends become healthier.

Expanding access to condoms in schools and communities and actually implementing comprehensive sex education would support us to lead healthy lives.

California youth, and in particular, youth of color like myself and many of my high school peers, are disproportionately affected by the STI crisis. I know for a fact that students in my high school have experienced difficulties in the process of purchasing condoms. For example, some have been judged, some have been asked for ID, some have been shamed, and some even being harassed in the process.

Youth with low incomes are often left without the option to regularly use condoms to help protect their health and prevent unintended pregnancy from occurring just because of the cost. My peers and I need comprehensive sex education to make informed choices about our health and our lives.

You all are the leaders that can change this. California needs you to take more action. Senate bill 608 is a solution to this problem. California's youth deserves access. On behalf of students in California, I respectfully urge your aye vote.

Thank you very much for your time.

Thank you. You'll have two minutes.

Good afternoon, Assemblymember Bonta and committee members. My name is Jubilee Adams. I'm a UCSC student, and I've spent the past two years serving as a youth board member with the California School Based Health Alliance or CSHA, a cosponsor of SB 608. In high school, I accessed reproductive health services through my school based health center. The care and education I received there helped me make informed decisions that kept me healthy and focused on my future.

That access made a real difference, and not every student has it. The California Healthy Youth Act guarantees students the right to medically accurate sexual health education, but SB 608 is the necessary next step. CSHA supports 450 school based health centers and wellness centers in k through 12 schools in California. These centers provide comprehensive, confidential care to students facing barriers outside of school, such as cost, transportation, stigma, and lack of privacy.

For students in low income, immigrant, and LGBTQ plus communities, these barriers are even higher.

According to the CDC, twenty one percent of California high school students were sexually active in 2023, and fifty two percent of them did not use a condom during their last sexual encounter. Teens are often shamed or denied service when trying to purchase condoms or even asked for ID despite no age requirement existing. SB 608 addresses this directly and ensures that school based health centers can distribute free condoms as a proven harm reduction strategy.

Increasing access to condoms does not mean an increase in sexual activity. It increases safety.

Some high schools already provide free condoms. SB 608 ensures a fair uniform approach so that all students have the same opportunity to protect their health. Thank you all for your time, and I respectfully urge your aye vote.

Thank you so much. We are gonna move now to any of those in the hearing room who aren't in support of this measure with your name, affiliation, and position. We need the mic on.

Chair. Chair and members, Kathy Mossberg on behalf of Essential Access Health and Black Women for Wellness Action Fund, both cosponsors, as well as APLA Health and SFAF, San Francisco AIDS Foundation. Thank you. Thank you.

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

Ryan Spencer on behalf of the American College of OBGYN's District 9 in support.

Nicole Wertleman on behalf of the Children's Partnership in support.

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

Martin Rodasovich on behalf of Reproductive Freedom for All California in support.

Kasia Hunt with Political Solutions here on behalf of American Academy of Pediatrics in support.

Angela Hill with the California Medical Association in support.

Kelly Brooks on behalf of the board of supervisors, Santa Clara County in support.

Madam Chair and members, Dennis Cuevas Romero with the California Primary Care Association advocates in support.

Good afternoon. Karen Stout here on behalf of the California Nurse Midwives Association in support. Thank you.

Nora Angeles with Children Now in support.

Thank you. We are now going to move to any primary witnesses in opposition.

Thank you. We are now going to move to any primary witnesses in opposition.

Thanks. You'll have two minutes. You'll need to press the button so we can hear you.

Thanks. Chair members, my name is Greg Burt, and I'm with the California Family Council, and we're in opposition to this bill. First, parental authority. California law already gives parents a limited opt out from sex education. SB 608 builds a separate channel for handing out contraception entirely outside of that framework.

Under this bill, a seventh grader could obtain condoms at school with no parental notification at all. Parents are the constitutionally recognized primary decision makers for their children's health and moral formation, and courts have affirmed this for decades. This bill also strips the decision from local school districts. A community that believes handing condoms to 12 year olds is a bad idea can say so through its elected school board.

SB 608 takes that choice away and impose it imposes one answer on every district no matter what the local parents want.

The public record cuts public health record cuts against this bill too. The CDC's own youth youth risk behavior survey shows that early sexual initiation correlates with more partners in higher risk behavior. Teens who delay do better. SB 608 pushes the opposite direction by normalizing early sexual activity. And it treats condom access as if it were disease prevention when it's not.

The CDC is clear that condoms reduce, but do not eliminate the risk. And they are less effective against skin to skin infections like HPV, herpes, and Syphilis. California is in a congenital Syphilis epidemic right now. Handing condoms to minors without honestly communicating these limits creates a false sense of security. Abstinence remains the only method that is a 100% effective.

Honest policy should say so, and we urge you to invest instead in strengthening the parent child communication. We encourage you to oppose this bill. Thank you.

Thank you. You'll have two minutes.

My name is pastor Brandon Campbell, and I have served in Pastoral Ministry for twenty five years, fourteen of those as a youth pastor. Seven of them teaching in a private school. I am currently the senior pastor of the Faith Baptist Church and the Northern California director for the California Baptist for Biblical Values. I am in opposition to SB 608, this bill expanding condom access in schools and removing age barriers for non prescription contraceptives. But while intentioned, I believe it rests on a flawed premise that the solution to rising STD rates among youth is to make condoms more available and encourage them.

those as a youth pastor. Seven of them teaching in a private school. I am currently the senior pastor of the Faith Baptist Church and the Northern California director for the California Baptist for Biblical Values. I am in opposition to SB 608, this bill expanding condom access in schools and removing age barriers for non prescription contraceptives. But while intentioned, I believe it rests on a flawed premise that the solution to rising STD rates among youth is to make condoms more available and encourage them.

According to the CDC, condoms do not prevent the spread of all sexually transmitted diseases. For example, they offer limited or no protection against diseases like syphilis that are transmitted through skin to skin contact. Constant incorrect condom use does reduce the risk of some fluid transmitted infections, but it cannot provide absolute protection against any STD. Encouraging young people to participate in sexual activity with the promise of protection is not the answer. Instead, we should courageously promote the healthiest choice, abstinence from sexual activity until marriage.

This approach lines with both CDC statements, public health reality, and biblical values. As the Bible states in Hebrews thirteen four, marriage is honor bono in the bed undefiled. Our young people deserve better than risk reduction strategies that accept premature sexual activity as inevitable. They deserve a message of hope, self control, and the profound benefits of waiting. I urge you to reject SB 608 and prioritize policies that truly protect California's youth.

Thank you very much.

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

Hi. David Bullock, SFI Alliance representing parents and families in Senator Menjivar own 20th 10th Senate District in opposition. Thank you.

Christine Campbell, concerned parent in opposition.

Florentina Degenera representing Mom's Army, thousands of moms in California, also representing Church of God Tidings and Freedom Coalition opposition.

Thank you. I see no other opposition. I will bring it back to the committee for any comments or questions. Moved by Arons, seconded by Colosa. Senator, I wanna thank you for bringing forward this measure.

I know that this is also one that you've had to review and kind of reconsider over time. I think that you've sufficiently addressed the concerns that have been addressed in in the prior legislation. And with that, I will certainly be supporting this bill. I wanna thank everybody for offering their testimony, particularly the students who are coming from their schools to be able to share what they want to have happen in their schools. With that, would you like to close?

Y'all keep it short and simple. So just respectfully asking for an aye vote.

Thank you. And when we have quorum, we will be able to consider that. Okay. We are gonna move on now to item number seven, SB 971 by Senator Choi. Senator, we, at the Assembly, we just sit at the sit at the desk right there.

It's a different setup over here, I know. I think you might have to press the button so we can hear you.

Okay. Good afternoon, chairperson and all committee members. I would like to begin by accepting the committee's amendments, and I'm thankful for the collaboration on this measure. I'm proud to present Senate bill 971 of which would connect the California's growing older adult population with the community based interventions to achieve healthy aging outcomes.

SB 971 is geared toward individuals ages 60 and over for opportunities that allow them to remain connected, informed, independent, and engaged in their communities with respect to already existing local resources, including community colleges and the area agents agencies on aging.

While there are many programs for older adult education that are already going great great doing great work through classes and the curriculum. SB 971 incorporates engagement and implements localized support for seniors and the caregivers to achieve specific healthy aging outcomes. SB 971 encourages collaborative partnerships, opportunities between local government entities and the existing systems that are working toward the same goal of serving seniors. This bill has received bipartisan support without a single no vote.

With me today, I have, Mister Steve Lipson, with the California senior legislature who is sponsoring this bill.

Thank you.

Thank you. You'll have two minutes.

Good afternoon, Chair Bonta and committee members. My name is Steve Lipson. I serve as a senior Senator in the California senior legislature, a sponsor of SB 971. While the bill includes educational and enrichment activities, it is not primarily an education bill. It is a healthy aging bill designed to help older Californians remain connected, informed, engaged, and independent in their communities.

For example, a local partnership might offer technology assistance, social engagement activities, caregiver support, caregiver support resources, or other opportunities that promote healthy aging and community connection. These activities are not simply educational. They are preventive. Healthy, helping older adults avoid isolation, remain engaged, access technology, and recognize scams or practical strategies that help people remain independent and age in place longer. Equally important, SB 971 gives communities a recognized framework for bringing local partners together around shared healthy aging goals.

It resources in our communities is older adults themselves. These partnerships don't simply provide services to older adults. They create opportunities for older adults to continue contributing through volunteering, mentoring, and helping one another. That sense of purpose and connection is itself an important part of healthy aging. Participation is entirely voluntary and subject to available local resources and partnerships.

It is not a mandate. SB 971 gives communities another flexible way to bring local partners together so older Californians can remain healthy, connected, independent, and able to age in space in in place. That said, I respectfully ask for your iFO. Thank you.

Thank you. Are there others in support in the hearing room who'd like to register their support?

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

Darby Kernan on behalf of LeadingAge California in support. Thank you.

Thank you. Seeing no others in support, we'll move on to any primary witnesses in opposition. Seeing none, any in the hearing room who would like to register opposition? Seeing none, I will bring it back to the committee for any comments or questions. Senator, I wanna thank you for bringing forward this measure.

I think it's very much in keeping with what I know to be very important for the elders in my family and in our community, and I'm very grateful for this bill. Would you like to close?

Thank you, madam. I would like to thank my bipartisan group of colleagues who have coauthored the SB 971 showing our commitment to California. So although adults such as me, myself is included here, I respectfully ask for your aye vote for SB 971.

Thank you so much, Senator. Can we have a motion and a second? Moved by Colosa, seconded by Patel, and we will be able to vote on the bill when we have quorum. Thank you so much, Senator.

Thank you.

I appreciate your testimony. For those senators who might be monitoring or their staff, we have next up on the file item order, Umberg, Perez, Weber Pearson, Blake Spear, Allen, or Reyes. Alright. We are going to move forward with Senator Weber Pearson's slate of bills. So for those other senators, you can have a little bit of a moment because she'll be here for a while.

We will start with whichever you prefer. Item number five, SB 869 is the first in the order, which is regarding restaurant menus added sugar warnings. Whenever you're ready.

Good afternoon, Chair, madam Chair, and members. I'm here to present SB 869, a measure focused on transparency, consumer awareness, and public health, and we'll be accepting the committee amendments today. Excessive added sugar consumption is linked to obesity, which twenty nine percent of Californians have with three point five million Californians diagnosed with type two diabetes and nine million Californians prediabetic. In addition to these, excess sugar consumption can lead to heart disease and other chronic illnesses that continue to impact millions of Californians.

Sugary beverages remain one of the largest sources of added sugar in the American diet.

Yet many consumers do not realize how much sugar these drinks contain when ordering them at restaurants or drive thrus. AB 869 would require chain restaurants with 20 or more locations to place a clear added sugar warning icon next to beverages that contain extremely high levels of sugar. Specifically, beverages containing a 100% or more of the recommended daily value of added sugar in a single serving.

This bill would also require a brief factual statement explaining what the symbol means so consumers can make informed decisions at the point of purchase. Because the reality is that these decisions are often made quickly, on a menu board, out of counter, or on a phone app.

And consumers deserve information that is clear, visible, and easy to understand in those moments. SB 869 does not ban any product. It does not restrict consumer choice. It simply is a transparent information method so that Californians can make decisions that are best for them and their families. My staff and sponsors work with committee and opposition and attempt to come to a resolution around disclosure of added sugars on the menu.

Opposition wanted flexibility in providing this language similar to the allergens bill from last year. However, all language stating that the QR code or other digital disclosures would not refer that information to basically state that it was related to added sugars. It was just a nutritional thing. So this would effectively turn the bill into requiring just QR code on the menus. The goal of this bill is not to disclose nutritional information.

This bill is to inform consumers about added sugars. We decided to take some of the opposition amendments and increase the beverage sugar content requiring the icon from 25 grams to 50 grams of added sugar. This captures a lot less products. And while some restaurants had over 50% of the menu containing 25 grams or more of sugar, increasing 50 grams of sugar dropped it to about 25% of beverages. Other restaurants have even less.

This icon is meant to be simple and not overly burdensome. In conversations, it was brought up that a QR code could be done with a sticker on the menu that was a part of what was being done for allergens, but a sticker would suffice for the icon and statement, but it would still be very challenging for individuals to actually be able to easily get that information at the point of purchase.

When you go to a restaurant and you see the menu, you order from the menu, you rarely say, oh, let me take up my phone and look at this QR code and scroll through other information. This bill takes a practical and balanced approach by applying only to large chain restaurants that already standardized menu offerings across locations. This was specifically done to not burden our small mom and pop or community restaurants in our neighborhoods.

This is a very simple bill with a very simple goal, giving consumers better information about the beverages that they purchase every day. And although this is a very simple bill with a very simple goal, it can have significant impacts on someone's health. To me, this is one of my most important bills. And I'm so proud that I have today with me, Sarah Bachtor, a student advocate with the American Heart Association, and Christine Falabel representing the American Diabetes Association.

Additionally, we have Sarah Sosher with the Center for Science in the Public Interest for any technical questions.

And I respectfully ask for your aye vote at the appropriate time.

Thank you. You'll have two minutes.

Good afternoon, Chair and members of the committee. My name is Sarah Bauchter, and I was a student at Galileo High School, now incoming freshman at Cal Poly SLO, and a volunteer with the American Heart Association. I'd like to start off by saying thank you for the opportunity to speak today in support of Senate bill 869 and the importance of providing clear icons on menus to identify standard beverage menu items with high levels of added sugar.

As a high school student and like many of us, I'm busy, burnt out, and I like to alleviate some of that stress by hanging out with my friends and ordering smoothies or coffee after school or over the weekend, sometimes both. When I order, I'm not sitting there googling nutrition facts, scanning QR codes, or giving staff an extra task of giving me calorie information.

I look at the menu, pick whatever sounds the most appetizing, and keep it moving. And to be honest, I'm ordering enough to satisfy my craving, which is about a medium. And if I'm really feeling it, I'll get the harge. It wasn't until learning about this bill in school and seeing examples of nutrition information and drinks that I realized just how much added sugar was in my usual drink.

I was shocked and I had no idea that I was starting my day with almost all the sugar I should be having for an entire day.

If that information had been right there on the menu when I had ordered, I would have made a different choice or at the very least, I would be more mindful about the rest of the sugar I eat that day. I also know that my peers want this information and want to be more cautious of their sugar consumption as well. I learned through further research that too much added sugar is linked to serious health issues like heart disease, type two diabetes, and obesity.

As a first generation person going to school in my family, I have high expectations of myself. I hope to become a cardiologist in the future for a multitude of reasons.

My biggest reasons, however, is to help the future. As a cardiologist, I'd rather have fewer patients coming in or at the very least, older patients for natural reasons than have multiple patients coming in as young children and young adults for diseases that shouldn't be their burden to carry so early on in life. I like to think that you all want that for our children as well.

Thank you.

Icons are easy to see and understand. My own mother who has had to learn English on her own oh, didn't have the easiest time asking for sugar and content and drinks, and it's not realistic. We respectfully ask for your aye vote on SB869 so that not only young people like me, but all Californians can start our days informed and end our days as healthy as possible. Thank you.

Thank you. You'll have two minutes.

Good afternoon, madam Chair and members of the committee. Thank you for taking the time to hear about such an important issue today. My name is Christine Harabedian I lead state government affairs for the American Diabetes Association. I'm here today to speak in support of Senate bill 869. For too long, we've asked people to make better choices without giving them the tools or the truth that they need to actually do that.

Sugary beverages are one of the clearest examples of this gap. They're marketed as refreshing, energizing, and even healthy. But what's often missing is simple, honest transparency about how these drinks impact our bodies, especially for communities already facing higher rates of chronic conditions like type two diabetes and obesity. That's where Senate Bill 869 comes in. This bill is not about taking choices away.

It's about making those choices real and transparent. Currently, there are no mandates for restaurants to label added sugar, the most detrimental sugar to our health and well-being, even though the dietary guidelines for Americans recommend a limiting added sugar to less than fifty grams per day for most adults. Transparency levels the playing field. It replaces confusion with clarity and empowers people to make decisions that align with their health goals. We know that small daily choices add up.

A single beverage may not seem like much, but over time, it can significantly impact someone's health trajectory. Studies show that adding just one twelve ounce sugary drink daily increases for developing type two diabetes by twenty six percent. Liquid sugar without any fiber is especially dangerous for health insulin resistance, weight gain, and health complications. Senate bill 869 is a step toward respect for consumers, for families, and for communities. It acknowledges that people can make good decisions when they're given honest information.

We support Senate bill 869 and ask for your aye vote. Thank you very much.

Thank you. Any in the hearing room who would also like to register support for this measure, please come forward. Name, affiliation, position on the bill.

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

Angela Hill with the California Medical Association in support.

Good afternoon. Alex Khan with the California Chronic Care Coalition in support.

Sarah Sorscher, Center for Science in the Public Interest in support.

Kathy Mossberg, Public Health Institute in support.

Kasia Hunt with Political Solutions here on behalf of the California Dental Association and the American Academy of Pediatrics in support.

Jonathan Clay on behalf of Scripps Health in support.

Britney Lemon, epidemiologist at UC Davis in support.

Tim Madden, representing the California chapter of the American College of Cardiology in strong support.

Kennel Jack Gray with the Weidman Group on behalf of the California Chiropractic Association in support. Thank you.

Hello. Andrea Gill, PhD candidate in the department of nutrition at UC Davis in support.

Ali Raimold, behavioral scientist at UC Davis in support.

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

You need to press the button.

Thank you. Good afternoon, madam Chair and members. I am Pat Joyce with KP Public Affairs here on behalf of the California Restaurant Association who's opposed unless amended to SBA 69, which mandates on many warning symbols and labeling for certain sugar sweetened beverages. The CRA greatly appreciates the author's dedication and strong interest in these issues. And while a deal seemed very close to the end of last week, we still believe we're very close to achieving a mean a meaningful compromise on the issue.

CRA has been an industry leader on menu disclosure issues in the state capital for a long time. And here again, we're not objecting to the disclosure itself. Restaurants in the scope of SB 869 are already required to have a series of on menu nutritional labels. The CRA then Senator Alex Padilla achieved the first in the nation on menu labeling law for calories and nutritional information for both food and drink including sugar.

The groundbreaking policy was later adopted at the national level is now across all 50 states.

In 2018, CRA again stepped up working on legislation that removed sugar sweetened beverages as the default beverage for kids meals. As this committee deliberated and the governor Newsom signed additional new menu labeling disclosures for allergens just last year. Now, we find ourselves with that new menu labeling law barely having the ink dry on it and taking effect tomorrow, July 1, and we already are facing another menu labeling mandate here today.

It proposes a very rigid and prescriptive set of on menu labeling mandates for certain drinks that exceed sugar thresholds. Menu labeling laws are expensive as menus, menu boards, and other menu resources are forced to be changed out, and actual menu items get crowded out given the limited real estate of menus and menu boards.

These force increasingly frequent changes to menus and menu boards drive up cost significantly. And unfortunately, those costs fall on the guests. Eight six nine imposes rigid and costly disclosure requirements for eating establishments as those mandate mandated disclosures would be required on physical menus as opposed to a more flexible and less expensive disclosure approach that would better address guest needs in the different formats and concepts captured by the bill. In fact, last year's restaurant allergen disclosure law established a set of my time is up.

I can hear.

Let me just close with this. The disclosure sorry. So obviously, the concern from the author is, how will the guest draw their attention to these additional resources off menu?

And to address that, we've expressed to the author's office, the Chair, and the committee staff that we are willing to consider ways that a restaurant could flag those off menus in some way, possibly with clear and conspicuous notices in the restaurant or the concise on menu statement or symbols alerting guests to additional resources, including for added sugar. So hoping to get a compromise and I'll I'll close and that's why we're gonna oppose a non submitted position. Thank you.

Thank you.

Forward.

Thank you, Madam Chair. Jack Yanos on behalf of California Fuels Convenience Alliance, we'll align our comments with the restaurants. Thank you.

Good afternoon. Shari McHugh representing the American Beverage Association. We have concerns with the bill, and we look forward to continue continuing to work with the author to see if those concerns can be addressed. Thank you.

Thank you. I will bring it back to the committee now. Seeing no other opposition, Assembly member Aguiar Curry.

I wanna thank the Senator for bringing this bill forward, and I'll be supporting it today. But I did have a question about QR codes. Can you just clarify for me, please?

And I will

Yep.

Turn it over to one of my witnesses. Oh, I'm sorry? Oh, is the technical witness here?

You're bringing up a technical witness?

Yes.

Yes. Sarah Sorscher, Center for Science in the Public Interest. I'd be happy to answer any questions you have about QR codes. Is there anything specific you want me to talk about?

I was just wondering why they wouldn't be used in trying to find out a solution for this or to make sure the public's aware. Thank you.

Yeah. I think the issue is that consumers are already really struggling with a food environment that is stacked against them when it comes to health. So we did a study in 2021 showing that, for example, most small sized beverages exceed the daily value for added sugars, so it's a very distorted environment.

And the problem with the QR codes is that they sort of hide the information about what you're getting behind this technological this technical device, that a number of consumers don't have access to.

We know the elderly. We know children. We know people in rural areas may not have be able to use a smartphone to inform purchasing decisions. And so it just puts in additional barriers to accessing the information, and that's the concern.

What we've seen from the studies also is that, really to be effective, the warning labels need to be conspicuous, they need to be clear, they need to be accessible, and QR codes just don't provide that.

Thank you. Because when I go and try to do the menu thing, I never know what I'm ordering. So, anyway, thank you for clarifying.

Yes. Yeah. And I know that's a thank you, Assemblymember Aguiar Curry for answer for asking that question. I know that that is one of the things that we continue to work out with opposition. As I stated at the beginning, the information should be very clear at the point of cert, at point of purchase.

I can only speak for myself. I'm not whipping out my phone. I'm not looking, trying to look through a bunch of different things. Many of these QR codes will take you to the nutritional information, which I agree, that CRA has worked and you can find, that if you dig deep enough. But the information that oftentimes they will reveal is the total amount of sugar, not the added amount of sugar.

There is a difference, and there is a difference in terms of the impacts to your health. And so you can go and you can look and you can see if you are savvy enough to have a phone or go on their website. Many of them will have the total amount of sugar, but this is really focused on added sugars because that is what has been linked to diabetes, heart disease, Alzheimer's, obesity.

And, you know, it's this is a very a very simple bill, but like I said, it can have significant impacts, not on one's health but also on our health care system in general. Think about the amount of money that we are spending to treat these preventable conditions that end up being very chronic long term conditions that we can treat by allowing people to have better choices when they're purchasing drinks, which we all do every single day.

Any other questions? Assemblymember Ahrens and then Patel.

Thank you, Senator, for your leadership on this issue. I know that I agree with you on the need to address the high sugar content in our beverages. And you know, there's not any one bill that's going to solve the epidemic and the crisis facing our country, certainly. I know that I also know that, you know, the opposition comments are really resonating with me, and I know that you've, you know through discussions have been trying to get there. I think you were almost there at one point.

I know you're gonna continue to try. I will be extending a courtesy aye vote today and like to move the bill at the appropriate time. But would just like to see if we can continue to have you all talking so that we, you know, strike that right balance to try and do that. Because I do, I do understand the, you know, the concerns of trying to make this right, and we ultimately want people to make those right decisions. I think transparency is always important.

How we are going about it and how we are striking the balance with with industry and and proper transparency, I think, is very important. But I also trust your leadership on this issue, Doctor Weber Pierson.

So we'll move at the appropriate time, but would love to see the continued conversations as it moves closer to the floor so that we can perhaps come to a resolution soon.

Thank you.

Thank you.

Thank you.

Thank you. Assemblymember Patel.

Thank you, Doctor Senator Akilah Weber Pierson for bringing this bill forward. Clearly, you have been very passionate about this. I have come to learn that you have been, very active in this area even on social media. I tend not to follow a lot of social media, but, it's come to my attention that this is such a passionate issue for you, I think, as a physician, as a parent, as someone who cares about their community.

As a scientist and a mom, I have also noticed how much added sugar there is in the beverages that our young people consume to the point where I don't think they even realize how much sugar is in their drinks.

And one thing we do know is that we get increasingly desensitized to sugar consumption as we consume more sugar. So we may not even realize how much sugar we're slowly creeping up on consuming added sugar. And with that in mind, I also want to give a nod to those who are running businesses and trying to keep costs low and keep costs low to consumers.

And we'll be supporting this bill today, but wanna make sure that you're able to keep working with those in this, the chain restaurant community to make sure that it's implementable, that it's operational on the ground. I know that we keep bringing these bills forward with nutritional guidelines and warnings on our menu items that are very important to protect consumers.

But at the same time, yeah, sure, it may be crowding out the actual menu description and the font gets smaller and smaller and it becomes harder to read as we try to figure all of it out. And with the QR code specifically, I also tend to not bring out my phone at a restaurant. And in fact, my children, we have a rule that we don't have phones at the table, and that's even phones at the table at a restaurant.

And so when we see restaurants that have their menu option as a QR code, sometimes it's like, oh, man, we gotta get out our phones. So I want to acknowledge that, yes, there are barriers and some of them are by choice and some of them are by a lack of ability of being able to access that QR code.

But with that in mind, I'm definitely interested in making sure that there's appropriate runways and ramps for businesses to implement that we don't annually come to them with these massive menu changes. And that it doesn't become problematic for them to to communicate that to consumers. So thank you for bringing this bill forward and trying to care take care of the health and well-being of all of Californians.

Thank you, Senator, for bringing this forward. I will say, that I've had an opportunity to speak with opposition and hear, as well some of the concerns and to certainly, receive the testimony offered today. I also know that we are in a sugar crisis that you started talking, and I started to push all these little snackies that I have up here, the candies, knowing that I had already consumed my sugar for the day, allowable sugar for the day.

I think a couple things to just really note in terms of the way in which you've amended this bill. The first is, having the icon only apply for a threshold not from 50% to a 100% of the daily value of sugar, which we heard from your testimony can be received from one sugary drink consumed in a day.

And we know that we are struggling with issues related to tooth decay, type two diabetes, heart disease, and I'm sure many others that are serious concerns for us. We also know that this type of legislation was moved forward in places like New York City, and we know that this does have an impact. I wanna acknowledge that on our chain restaurants and eateries.

I would hope one thing that we might consider to address the concern of having to comply year over year, is that we perhaps move into a preventative posture in all aspects of our business, enterprises. And so I think last year, we were focused on allergens, which was critically important.

This year, the Senator has brought before us a bill related to added sugars. In those conversations that I had with opposition, we talked about the likelihood that perhaps trans fats might be something that people focus on, and we know that we have moved many legislation piece of legislation around ultra processed food.

So I think for me, that means that we are now in the legislature focused on, what we have consumers put in their bodies and that we need to be able to create a regulatory framework that allows us to do that.

So I would encourage, those who are wanting to make sure that they have their business concerns, have some pattern of certainty to recognize the label on the wall that is coming your way and perhaps move more into a space of helping to make sure that we are providing the necessary messaging to keep our consumers healthier in the State of California.

And perhaps it might just be one overhaul that might be voluntarily taken on as opposed to being compliance oriented around this on the timetable that we're focused on.

With that, Senator, would you like to close?

Well, I wanna thank you, Committee Chair and your committee again for working with us with this bill. I wanna thank you all for the conversations today. I love your suggestion. I would love to not have to do legislation, and to have, you know, the people in our restaurants to really work as partners with their consumers to ensure that what they are taking in is as healthy or at least allow them to have the information.

As you stated this, you know, I wanted California to be the first in the nation to do this, but, unfortunately, we're not because New York has already done this and without a QR code.

And they have been able to adjust so that their residents can have that transparency and make those decisions for themselves. We passed an allergen bill last year, which was extremely important. Over twice as many people in California have diabetes or are prediabetic as those who have actual food allergens.

And so, yes, it was important, but this is also extremely important because of not only who it impacts, but as was stated, our kids are just drinking up these sugary drinks, and so it's also about who will be impacted in the future. And with that, I respectfully ask for an aye vote at the appropriate time on SB 869. Thank you.

Thank you. We actually can establish quorum if you give us a minute to call roll.

[quorum]

We have a quorum. And on this measure, we have a motion. Can I get a second by Aguiar Curry. Please call the roll.

The motion is do pass as amended to the Appropriations Committee.

[roll call]

That measure's on call. Thank you, Senator. We're gonna move now. I'll excuse these witnesses for this measure. We're gonna move on to another of Senator Weber Pierson's bills.

Item number 6, SB 950. Regarding health coverage and dementia.

Whenever you're ready, Senator.

Thank you. Good afternoon again. I am presenting SB 950, which will ensure timely access to FDA approved medically necessary treatments for Californians with early onset Alzheimer's disease.

I wanna thank the committee staff for working with our office, and I accept the committee amendments which remove the explicit parameters around the coverage. Alzheimer's disease is a chronic and irreversible neurological condition that affects over seven million people nationally with 12% residing here in California.

Alzheimer's disease, while often thought of as a condition of aging, reflects broader disparities in our public health care system. Women, those with lower income, communities of color face disproportionate elevated risk, higher diagnostic race, and poor outcomes once living with the disease.

For many years, little could be done to slow or stop the disease once it was diagnosed, but that reality began to change with the development of an FDA approval of medications that meaningfully slow the clinical decline of early Alzheimer's disease.

These innovative medical breakthroughs that remove the plaques responsible for the disease progression finally provide families precious time, hope, and memories they deserve. These treatments are generally covered by MediCare, MediCal, and CalPERS, which together covers a significant share of Californians living with Alzheimer's.

However, coverage is less consistent in the commercial market where enrollees can be subject to plan by plan determinations and utilization management. As identified in the JURB analysis, coverage of both disease modifying and symptomatic treatments is not universal across commercial plans.

SB 950 reaffirms our goal to have universal and equitable access to these treatments when medically necessary. Timely and easy access is an important, especially because there are no FDA approved disease modifying therapies for later stage Alzheimer's.

One extra denial, one more phone call, one failed medication, one extra month of waiting for a decision can be a huge barrier and the difference between receiving life changing treatment and losing that opportunity altogether.

SB 950 specifically ensures that all enrollees on commercial plans regulated by the state can access medically necessary, FDA approved treatments for Alzheimer's disease. It prohibits inappropriate rerouting of medically necessary treatment, preserves utilization management and prior authorization process, and establishes Alzheimer's as an exigent circumstance to ensure expeditious coverage determination process.

SB 950 help alleviates pressure from our families, caregivers, and health care system while navigating a very complex and time sensitive disease.

Alzheimer is a fourth leading cause of death in California, and families deserve clarity, consistency, and timely care. Today, I'm joined by Andrew Mendoza with the Alzheimer's Association and Andrew Cope, an advocate who will share his personal experience with Alzheimer's disease.

Thank you.

Andrew Mendoza, on behalf of the Alzheimer's Association, proud sponsor of SB 950. Thank you, Madam Chair, members of the committee, and staff for your work to advance this important measure. We appreciate what Senator Weber Pierson prioritizing early intervention strategies to improve brain health.

SB 950 clarifies existing law to ensure that people living with Alzheimer's disease have coverage for the treatment plan that their doctor deems medically necessary, and it streamlines access by removing unnecessary barriers to care.

The disease modifying treatments approved by the FDA present a paradigm shift for those contending with an Alzheimer's diagnosis.

These therapies and lifestyle interventions provide proactive measures to delay cognitive and functional decline. California recognized the importance of providing coverage for biomarker testing, which helps many assess the risk for Alzheimer's disease. These developments encourage early detection and diagnosis.

Treatment is the natural next step for an early intervention strategy. Unfortunately, issues in our health care delivery system often delay someone for receiving a diagnosis from primary care and the lack of specialist delay confirmation.

They very well could exit their eligibility window for treatment during that time. Moreover, co occurring conditions, the lack of infusion sites and qualified providers, or the cost incurred from the necessary tests in addition to lacking insurance coverage can all be prohibited for someone seeking access to care.

Most of, most of the most people with Alzheimer's disease are 65 and on MediCare, which minimizes the affected population to those with early onset or diagnosed prior to 65, which represents less than one percent of those with Alzheimer's disease in California.

However, the access that SB 950 would provide can make a meaningful difference in the lives of individuals continuing with the diagnosis at a young age as it affords time to create plans and cherish family.

This bill is an important measure here for assuring in a new era for the treatment of Alzheimer's disease, and we appreciate Senator Weber Pierson for meeting the moment and closing the gap in coverage that would otherwise be a significant and consequence if left unaddressed.

Thank you for your consideration. I'm respectfully asking for your aye vote at the appropriate time, and I will now turn it over to our advocate, Andrew Cope, to share his experience receiving in the diagnosis of early onset Alzheimer's disease.

Thank you. You'll have two minutes.

Hi. My name is Andrew Cope. I'm 56 years old, and I'm from Menlo Park, California. As Andrew mentioned, I'm here today because I'm also living with Alzheimer's disease. My journey began when a genetic test revealed I had the double APOE four genotype, which if you're unfamiliar, has the highest incidence of Alzheimer's and the highest incidence of early onset.

That test sent me on a year long journey that started with my primary care physician, and then I waited six months to get an appointment with a neurologist. And then I waited an additional three months to get the PET scan, which revealed my diagnosis. It was a year of anxiety, worry, uncertainty. I had no idea how much quality time I have left with my wife and two children. However, as has been mentioned here, I'm an incredibly lucky person to be born when I was.

Medical research right now is making life changing progress for people like me. There's now a very simple blood test that reveals the pathology for Alzheimer's and as is mentioned, there are two therapies, two infusion therapies that are approved that are proven to slow the progression of the disease. And there are clinical trials, one of which I'm going to be joining, that are pushing the progress even further. So it's giving people like me true optimism and hope.

These treatments that we referenced, they've been shown to reduce the plaque progression growth in the brain by as much as 30%.

So I ask each one of you to sort of take a moment and imagine somebody important to you, whether it's a family member or a very close friend, and maybe they have a diagnosis like mine, and now you tell them that you're gonna be able to give them months, years, or maybe a decade of life to live and plan. That's absolutely priceless.

I'm here as a volunteer because, this disease face is changing in real time, and more and more people are going to look like me that are living with this disease. And I feel it's my responsibility to do something positive for anybody else who is facing this disease and to the millions of people who never had the chance. Everybody in this room right now has a chance to make a difference in this pivotal moment.

You can do it for me. You can do it for people that are important to you. You can do it for all of California. So I really urge you to pass SB 950 and be on the right side of history on this one. Thank you for your time and thank you for your consideration.

Very much appreciated.

Thank you. Others in the hearing room who would like to register support? please come forward.

I'm Howard Posner, volunteer advocate with the Alzheimer's Association. I support the bill.

Good afternoon. My name is Lisa Bishop. I'm a volunteer advocate with the Alzheimer's Association, and I support SB 950.

Hello. Kylie Oshioka, also volunteer advocate with the Alzheimer's Association, in support.

Hi. Veronica Mead with the Alzheimer's Association in support of SB 950.

Lynette Blumhardt, volunteer advocate with the Alzheimer's Association. I'm here in support of SB 950.

Cloyce Dickerson, Board member, Northern California Alzheimer's Association in support.

Good afternoon. Darby Kernan on behalf of LeadingAge California in support.

Good afternoon. Sandra Poole on behalf of Western Center on Law and Poverty in support.

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

Alex Kahn with the California Chronic Care Coalition in support.

Jessica Hayes with AFSCME California in support.

Thank you. Are there any primary witnesses in opposition? Please come forward.

You'll have two minutes each.

Thank you. Kassidy Heckmann on behalf of the California Association of Health Plans. Wanna start by thanking the author, her staff, and the sponsor for continued conversations on this bill. Regrettably, we are still opposed to it today. As outlined in our letter, one of our primary concerns is the ban on step therapy.

Thank you.

While the bill states that if FDA, if the FDA has approved one or more types of treatment for Alzheimer's disease, that health plan does not have to cover all types of treatment without step therapy. It specifies this as conditional on a plan covering at least one anti amyloid without step therapy. We appreciate the intent behind this language.

However, there are currently only two anti amyloids that are FDA approved, both brand name, and they cost between $26,000 and $32,000. We believe this language will limit plans from offering enrollees a therapeutically equivalent and more affordable alternative when they eventually come to market.

Additionally, we are concerned about the requirement that health plans cover all FDA approved drugs for the treatment of Alzheimer's disease and dementia. As the analysis notes, health plans already cover all medically necessary drugs, including anti amyloids. However, we have concerns the language can unintentionally prevent plans from updating their formularies as new data emerges and from designing products that are both affordable and appropriate.

Finally, we are concerned with the recent amendment that requires anti amyloids and other Alzheimer's drugs to be treated as exigent circumstances.

A 24 hour review is an incredibly short timeline for an entire class of drugs, specifically ones like anti amyloids that are new to market and are required to be used under strict guidelines and supervision.

For these reasons, we remain respectfully opposed. Thank you.

Good afternoon, Chair members. Matt Akin with the Association of California Life and Health Insurance Companies, also in respectful opposition to SB 950. I just wanna first say we sincerely appreciate the author's intent and goal of improving care for individuals living with Alzheimer's and dementia. I'd like to align my comments with my colleague and briefly highlight one additional concern we do have with the bill.

As my colleague noted, the bill would significantly limit plan's ability to use step therapy for FDA approved Alzheimer's treatments, requiring that at least one anti amyloid therapy be available without it.

We are concerned that the efficacy of these drugs has not been strongly proven. As CHBRP noted, there is some evidence that disease modifying medications are effective at slowing cognitive decline, but the effects generally fell below minimum clinically important difference thresholds. CHBRP also noted that there is not enough research to determine whether amyloid plaque reduction improves health outcomes.

Given the evolving clinical evidence and the potential for side effects with some of these medications, we believe plan should maintain the ability to apply evidence based utilization management tools, such as step therapy.

For these reasons, we respectfully oppose the bill, but we'd like to sincerely thank the author and sponsors for their engagement so far, and we do look forward to future conversations if it moves forward today. Thank you.

Thank you. Any others in the hearing room who would like to offer opposition?

Seeing none, I will bring it back to committee for any comments or questions. Assembly member Stefani and then Patel.

Thank you. I just wanna thank the Senator for bringing this forward. I had a dad pass away. My dad just passed away April 29 this year after suffering from Lewy body dementia for eight and a half years. And I was just saying to my daughter the other day that I wish I had been able to do more at the early stages in 2016 and 2017.

And the suffering that my family went through, that he went through, the health care, the hurdles, it's traumatic. And with all due respect to the opposition, I think these are just the same tired arguments we hear about what we need to be doing for Alzheimer's and dementia. And I wanna thank the Alzheimer's Association and the witness for bravely sharing your story.

When I told my daughter I wish there was more I can do, I'm glad I get to be here today and vote aye on your bill. So thank you.

Assembly member Patel.

Thank you, Senator for bringing this bill forward. It's very important we have our patients have access to life saving therapeutics. And anything that can improve quality of life is is certainly worth looking into. I do have one question, specifically from what the oppo brought up about the designation as an exigent condition. Can you address concerns around that?

Yes. We're making it exigent circumstance because these medications have a limited eligibility window. They're only available for people that are in the early stage of Alzheimer's. Something that was mentioned in the, in the presentation is that they this is specifically also targeting the insurance insured population that is living with early onset.

So that's diagnosed younger than 65, but the treatments are available for people that are in the early stage before they move into the mild to moderate, aspects of Alzheimer's disease when they're going to need either more assistance with their activities of daily living or they will need higher levels of care at a long term care facility.

So, essentially, that is why we're making that circumstance exigent instead of the normal.

Thank you for explaining that. That's something I didn't have a quite a good grasp on understanding. So these therapeutics a follow-up question, maybe even two. So these therapeutics are such that they have to be used at the very early stages. Are they then able to continue to be used for the duration of the condition?

That is something that we are still finding out. Essentially, there is a subcutaneous maintenance dose for Lekembe, which is one of the anti amyloid therapies, so that would continue on. There is a notion that you'll be able to stop Consumla at a certain point, but I don't think that we're there yet to say that for sure. But they are not essentially to carry over to those other stages. Those other stages are where the symptomatic medications are generally used.

Okay. Thank you for that explanation.

Yeah. So I think I'm sorry. The think of these medications on the very, very front end to try to prevent the progression. Once you get to a certain point, the medications are used to treat the symptoms. And so that's also one of the reasons why we're not going with the step therapy because the step therapy will make you do the symptom treatment first, fail before you can do this.

But you really need this first if you're able to be diagnosed at a, at the early stage.

So it's almost like treating two different kinds of diseases or disease profiles?

Yeah. It's targeting different things.

This is targeting the formation of the amyloid plaques versus the other medications that target the symptoms of Alzheimer's.

Thank you for that. I'd like to move the bill.

Thank you. Assemblymember Patel, a second by Stefani.

Senator, I wanna thank you for bringing forward this measure. And again, I wanna thank, as well, thank the testimony provided. It's, this is certainly something that I feel very personally having two members of my family who suffered from Alzheimer's and dementia and were taken from us too long.

I think to Assembly member Stefani's point and very loving commentary, when people have dementia and Alzheimer's, they are with us for a very, very long time often, but physically so. And we have to recognize that we are dealing with people who are not able to be their full selves. And that creates other kind of quite frankly health concerns and puts people into acute health care needs and creates much more cost to the consumer, the family, and to our overall health care system.

I think you've put forward a very strong argument for why we need to make sure that we are treating this particular opportunity for effective delivery of care sooner and to classify it with exigent circumstances. Very helpful explanation with that.

Senator, would you like to close?

Yes. Once again, wanna thank you, Chair and the committee. Really wanna thank my the sponsors, the Alzheimer's Association, but my witness in particular, for coming and being so vulnerable and sharing your story. Wanna acknowledge, Assembly member Stefani. Thank you so much, and I'm sorry for your loss.

I didn't know, but thank you for, for sharing that because, it highlights how widespread these conditions are and how they impact families and communities. And, you know, the treatments that we're talking about today. Unfortunately, were not there with a cure.

So this is not going to cure, but it can provide something incredibly meaningful that may have otherwise not felt possible. More time, a better quality of life, new found memories with loved ones that can be passed down for generations. Those things are invaluable.

And as we look ahead, these medical discoveries are just the beginning. We know that we have ongoing research and innovation to move us closer to expanding access, improving lives, and one day, achieving a future that is free from Alzheimer's disease. And with that, I respectfully ask for an aye vote on SB 950. Thank you.

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

The motion is do pass as amended to the Appropriations Committee.

[roll call]

That measure's on call, Senator. We are going to pause from the rest of your, slate of bills to move to item number two, SB490 by Umberg regarding alcohol and drug programs. Thank you, Senator. Whenever you're ready.

Thank you, madam Chair. And a special thank you to Senator Weber Pearson for your accommodation. Very much appreciate that. Madam Chair and members, I'm here to present SB490. Thank you to you personally, madam Chair, and also to Logan Hess for your continuing help with Umburg bills.

We'll be accepting committee's amendments. I'm happy to present SB490, which was established timelines for the Department of Health Care Services, DHCS, to investigate allegations of licensed treatment at unlicensed sober living homes if DHCS cannot meet the timelines. SB490 would authorize counties to request approval to conduct site visits and enforce compliance with existing state licensing requirements. The challenge of unlicensed sober living homes is particularly acute in Orange County, but it is a statewide phenomenon and is a statewide concern.

And it's a concern because DHCS doesn't frankly have the resources to be able to do the kinds of site inspections that we would hope or audits.

A recent state audit revealed significant shortcomings in DHCS' oversight of unlicensed treatment facilities. The audit found that DHCS has not consistently investigated allegations of unlicensed facilities providing or advertising treatment services. So there are many examples. There are many examples where there's been a complaint, an initial take take a look see and and no follow-up.

For the recommendation of the state auditors report, SB490 institutes a timeline to assign a complaint to an analyst within ten days, complete investigations within a hundred and twenty days, issue violation notices within ten days of completing the investigation, and conduct mandatory follow-up site visits to ensure unlawful services have been stopped.

If this is the gravamen of the bill. If DHCS fails to meet these timelines, then counties can work with DHCS to enforce licensure laws and protect public health and safety. With me testifying in support of the bill are Anaheim City Council member, Kristin Moss, and found who is also founder and director of the National Patient Brokering and Prevention Initiative. I'm sorry. I've got that confused.

Founder and director of the National Patient Brokering Prevention Initiative, Sequoia Thiesen. So thank you very much. Back to you, madam Chair.

Thank you, Senator. You each have two minutes.

Thank you. Good afternoon, Chair Bonta and committee members. I'm Kristen Maas, City Council member for the city of Anaheim. On behalf of Anaheim, thank you for this important opportunity to offer input on the topic for our city in all of California. Like other cities, Anaheim provides a frontline perspective on this issue.

Recovery treatment in many forms plays a vital role in our city as it does across our state. The challenge of substance abuse disorder brings real impacts on people, families, and neighborhoods. Anaheim is supportive of community care facilities. We estimate our city is home to more than a 150 facilities of many varieties. We share a belief that recovery is most effective in the right setting and with the best help possible, but we also know that there are challenges.

As a city, we are limited in our ability to regulate treatment or as a city, we're limited in our ability to, regulate treatment facilities or group homes. That makes California's rule and your consideration of this proposed legislation so important. Recovery is only as strong as the support someone receives. There are many great operators whose work changes lives, but we also know of horror stories. Stories of billing exploitation, client cycling, disruptive operations, unlicensed treatment, and ultimately failed recovery.

Undermining recovery in one case undermines treatment and supportive recovery as a whole. What is being proposed is enhanced oversight in a reasonable incremental way. SB 490 embraces the state auditors' recommendations for investigating unlicensed treatment. It would bring partnership with counties to do site visits and ensure licensing. This would allow the state to leverage local support and to better respond to violations, ensure compliance, and to protect the health and safety of those in treatment.

The proposal would strengthen state oversight backed by local governments. It is critical for all of us to ensure that recovery meets the highest standards, brings better outcomes, and supports healthier communities. Thank you for your consideration on this proposal. On behalf of the city of Anaheim, I extend our city's appreciation for your support of enhanced recovery outcomes and a stronger treatment system. Thank you.

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

Thank you.

My name is Sequoia Thiessen. I'm the founder and director of the National Patient Brokering and National Patient Brokering Prevention Initiative and a UC Berkeley student. I support SB490 because from my perspective as both a survivor and someone who works on this issue every day, California's oversight of fraudulent and unlicensed treatment centers has not kept pace with the reality on the ground. I founded this organization because after surviving this industry and then researching it, I realized that exploitation is not the exception.

It has unfortunately become the norm.

When people are entering treatment, they are in their most vulnerable. These become more than licensing violations because they create environments where serious harm can go unchecked. When oversight fails, there are serious consequences. I have witnessed patients, including myself, be subjected to conditions akin to human trafficking. Because of the lack of oversight, there is immeasurable exploitation going on here in California, including kidnapping, rape, coercion, and both labor and sex exploitation.

The people exploiting this system count on enforcement gaps and delays. They want to delay these consequences so that they can continue commodifying people's health and sobriety. SB 490 also acknowledges that many fraudulent rehab act or actors own more than one facility, and they often move patients between facilities to avoid oversight and accountability.

In practice, this mirrors human trafficking because patients are brought from all over The United States and being coerced with housing, food, and medical income or medical care to generate income for these unlicensed facilities. It is not uncommon for patients to be brokered across 50 plus facility over a number of years.

This bill will help close an important gap within collaboration and trust building as well. One of the main reasons victims struggle to come forward in this industry is because they are typically come coming from backgrounds that have fractured trust with the state. This bill tells patients that you care about the conditions they are subjected to while in treatment and that their reports will not go uninvestigated. Thank you.

Thank you for that testimony. We will hear from anybody else in the hearing room who would like to offer support for the measure.

Good afternoon. Sylvia Solis Shaw here on behalf of the City of Beverly Hills in support. Thank you.

Cassidy Heckman on behalf of the California Association of Health Plans in support.

Good afternoon. Olivia Herrera, intern at Stone Advocacy on behalf of the California District Attorneys Association in support. Thank you.

Good afternoon. Kendra Begley on behalf of the city of Carlsbad and the city of Thousand Oaks in support.

Stephanie Watkins on behalf of the Association of California Life and Health Insurance Companies also in support.

Thank you. Are there any primary witnesses in opposition? Thanks. You all have two minutes.

Thank you, Chair and members, for the opportunity to speak to you today. My name is Amara Sheehy, the director of legislative affairs for for the County Behavioral Health Directors Association of California, representing the leaders of the public behavior health agencies that serve the mental health and substance use disorder needs of California's Medi Cal uninsured and underinsured populations. CBHDA respectfully stands in opposition to SB 490.

SB 490, as is in print, instructs the Department of Health Care Services and potentially county behavioral health agencies to investigate sober living homes providing unlicensed substance use disorder treatment, an activity those centers should not be engaged in and one that the department already has jurisdiction to investigate. The issue that the author discusses are rooted in private sober living facilities, which advertise detoxification services or other unlicensed residential SUD treatment and are not contracted or under the jurisdiction of county behavior health in any way.

SB 490's proposed timeline for DHCS to complete investigations for facilities engaged in unlicensed residential SUD treatment in conjunction with the proposed option for county behavioral health department to instead perform the function of investigating those private entities in which they have no jurisdiction over, represents a significant liability risk and a potential unfunded workload increase for county behavioral health agencies.

It's for that reason that we thank the committee for the proposed amendments in the analysis, which take the bill to a more appropriate step in assisting in the aims to ensuring that the investigations of these entities engaged in inappropriate unlicensed SUD treatment are happening in a thorough and timely manner through DHCS, the appropriate jurisdiction and oversight authority of these facilities.

However, with these proposed amendments, there still seem to be a number of technical concerns, which will result in unnecessary burdens to some of the counties that we hope to continue to engage in discussion with the author's office on in order to mitigate for. And it is for those reasons that CBHD at this time respectfully opposes SB 490 and thank the Chair and members for the time today.

Thank you. Any others in the hearing room with position of opposition to the bill? Seeing none, I will bring it back to the committee for any comments or questions. Assembly member Patel.

Thank you for bringing this bill forward. Certainly, it's an important thing to take on these, unlicensed behavioral health mental health clinics, especially for behavioral subs or substance abuse disorders. Want to ask if you could address some of the concerns raised by the opposition here from our county behavioral health folks.

Sure. I I think that's correct. In an ideal world, there would be adequate resources, adequate capacity at DHCS to be able to timely investigate abuses. But that's not the world in which we live. And so as a consequence, cities and counties, some counties, but particular cities and neighborhoods have said, we need to do something about this.

And if DHCS doesn't have the capacity, where do we turn? I understand that the counties don't want additional workload, and, indeed, they don't have to do anything. We're simply telling them, hey. Here's what's going on. Please investigate.

Please take action. So, if if they don't want to, they don't have to. There's no mandate in this bill. There's no consequence. There's no penalty.

But, in order to address the the violations and the challenges that exist, we need to do something. And it's a good matter of public policy that we basically, we empower localities to actually do site visits and investigate. But as a practical reality, if DHCS stops it, they can stop it. In other words, they can stop any investigation. They can stop any further process with respect to the sober living homes.

K. Thank you for that.

Seeing

Assembly member.

I wanna thank you for this bill too. I mean, I think at the end of the day, if we don't if there's no one with eyes on situations and if there's no one checking, then there are literally no checks on what people are doing. And especially, you know, when you're talking about people who are in a vulnerable state and in a really difficult time in their life where they could be taken advantage of, it's it's really unconscionable.

And there's been some terrible horror stories about what is happening in some of these centers. And and so, you know, unfortunately, until we get to the point where we as a state can fund the kind of oversight and investigation that needs to be done, I think that we should certainly not stand in the way of localities being able to being able to, you know, look into the sober living facilities themselves.

So I'm happy to support it today, happy to move the bill, and would love to be added as a coauthor if you'll have me.

Alright. Thank you very much.

Thank you.

She said. So right. Thank you.

What she

said as you're close, sir?

Closed. Yeah. That's my

Appreciate it.

Thank you, madam Chair.

With that, I think we have a a motion. Oh, Assembly member?

Yeah. One follow-up. I do after processing this a little more, seeing that this is not a mandate and it's an option for localities to pursue investigation, I do feel like it's okay and I would like to add on as a co author as well.

Thank you.

Thank you very much. Thank you.

Can you also second that one?

And I will second it.

Thank you. Senator has already closed. Please call the roll.

The motion is do pass as amended to the Appropriations Committee. Bonta.

Aye.

Bonta, Aye. Sanchez, Addis, Agaracuri, Arons, Colosa, Carrillo Carrillo, Aye. Jeff Gonzalez. Jeff Gonzalez, Aye. Mark Gonzalez, Johnson.

Johnson, Aye. Patel. Patel, Aye. Patterson. Rodriguez.

Schiavo. Schiavo, Aye. Sharp Collins. Stephanie.

That measure's on call. Thank you so much, Senator.

Thank you, madam Chair. Thank you, Assemblymember Schiavo. Thank you, Assemblymember Patel, and all the other members. Thank you.

Thank you. We're gonna move back to our file item number nine, s B1037 by Weber Pearson for one of three bills that she still has to be heard. Go go ahead. Item number nine, s B1037.

Thank you. Thank you, madam Chair. I wanna thank you and your staff for the work on this bill. I accept the amendments described in the analysis and that are reflected in the mock up. The focus of this bill, SB 1037, is affordability of state regulated commercial health insurance.

This bill with the amendments requires health plans and insurers to demonstrate where the premium rate growth meets the cost growth target established by OCA. If the rate growth will exceed the cost target, the plan must indicate why and what steps it will take to address it and reconcile this with any relevant analysis published by OCA.

SB 1037 codifies the federal definition from the Affordable Care Act of, quote, unreasonable rate increase, end quote, which is a determination state regulators are currently authorized to declare when reviewing health insurance rate. This bill also requires regulators to consider specific revenue indicators when determining if a rate increase is unreasonable, but not in a way that conflicts with the financial solvency of the plan.

With the amendments, this bill will require regulations in consultation with OCA to be reevaluated as a part of the rate review process if the insurer's rate meets the ACA affordability standard benchmark for an individual and for a family of four with household income at 200, 400, and 600% of the federal poverty level.

The findings of the evaluation will be will be reported as required under existing law at a public meeting on health insurance rates. With the loss of federal enhanced premium tax credits, many covered California enrollees have experienced an average of a 97% increase in monthly health care insurance premiums. As predicted, almost 400,000 Californians canceled or terminated their coverage California coverage covered California coverage. Cancellations were highest among middle income Californians and people of color.

Those who are still covered have moved to higher deductible plans with lower premiums, but a higher cost sharing when services are needed.

This will aims to add health insurance rate reviews and affordability focus. With me today to testify are Caitlin Van Steyn from Health Access California and Benjamin Eckert Eckert from NUHW. Thank you.

Thank you. You'll each have two minutes.

Good afternoon, madam Chair and members. Katie Van Dines for Health Access California. We're strongly in support of SB 1037 as amended that will evaluate the impact of proposed rate increases on affordability. And detail how health plans will show the benefits of the office of health care affordability, cost growth targets, and their rates. The most common question we get about the office of health care affordability is when will my health care cost be less because of OCA?

Then in fact, the UC Labor Center says that if we have these targets three years ago, premiums of family coverage would have been $5,800 less over those three years. The bill requires that the health plan and insurers explain in the rate review process how the OCA targets will be affecting health care costs they are asking consumers and employers to pay.

And as the Senator noted, we'll see if they're going to meet those targets, and if not, what proactive steps are being taken and what are those cost drivers leading to those increases. Health SB 1037 will help us ensure the savings and the cost of targets are realized in consumer premiums.

And to affordable to evaluate how affordable rates are, the under this bill, the departments will consult with OCA and look at that through an affordability standard and look at that based on different Californians' incomes.

We think this is a really important measure and really appreciate this in this bill. And with that, I respectfully ask for your aye vote on SB 1037. Thank you. Thanks.

Good afternoon, Chair and members. My name is Benjamin Eichert, and I'm the public policy director for the National Union of Healthcare Workers here in strong support of SB 1037. NUHW represents frontline caregivers across California, including, 4,500 mental health clinicians at Kaiser Permanente, and we often hear how unaffordable care has become for the patients our members serve. SB 1037 sharpens what plans must show in rate review, including how OCA's cost growth targets reach the premiums people pay and add something new.

If a plan will miss the target, it has to tell regulators, explain what's driving the higher costs and what it's doing to fix it.

We strongly support OCA's all in approach. We also support measuring whether rates are truly affordable year over year as a share of people's income. The piece we most, wanna speak to is letting regulators weigh excessive financial capacity. The analysis before you shows excess reserves at full service plans topped $94,000,000,000 in 2024. These reserves are largely funded by California consumers who have paid the increasing rates whether individually or as businesses burdened with higher premiums.

They've also been paid by workers who did not get a wage increase because instead, that money was diverted to maintain increasingly costly health care benefits. When a tax exempt plan sits on such large reserves and still wants a rate increase, regulators should be able to ask, are the rates too high or should that money be going into care? Often the answer is both. We're grateful to the author for advancing this important issue. For the patients our members serve, I respectfully ask for your aye vote.

Thank you. Any others in the hearing room who would like to offer support for the measure?

Megan Loper on behalf of the California Hospital Association in support.

Thank you. Are there any primary witnesses in opposition?

Thank you. Are there any primary witnesses in opposition?

Thank you. You'll each have two minutes.

Thank you. Chair members, Olga Shiloh with the California Association of Health Plans. Regrettably, we remain opposed to, SB 1037. We all agree that affordability is one of the biggest challenges facing Californians today. It's why health plans support policies that address the underlining underlying drivers of health care costs and oppose proposals to make coverage more expensive.

The reality is that premiums are not set arbitrarily. They are certified by actuaries, reviewed by state regulators, subject to public scrutiny, and can be deemed unreasonable. Health plans are already required to spend the vast majority of premium dollars on medical care with access funds returned to consumers through rebates. California has some of the strongest consumer protections and transparent transparency requirements in the country. The issue we're we're facing is not a lack of oversight.

The issue is that the underlying cost of care continue to rise. Hospital costs have increased by more than 265% over the last five years, and pharmaceutical costs have risen by more than 70%. In addition to these pressures, the legislature had just approved and the governor signed a new MCO tax that places a $1,500,000,000 tax on commercial coverage. Given that action, it's difficult to reconcile the affordability goals of SB 1037 with the reality that health insurance will now bear additional costs.

S B 1037 adds new regulatory requirements without addressing the factors that are actually driving premiums higher.

Help hints want to be part of the solution, but meaningful affordability gains will come from addressing the cost of care itself. For these reason reasons, we respectfully oppose ten thirty seven. Thank you.

Thank you. Madam Chair

and members, Stephanie Watkins on behalf of the Association of California Life and Health Insurance Companies, regrettably here in opposition to the bill today. We do appreciate the early conversations that we had with the author, the sponsor, and staff. Unfortunately, as my colleague mentioned, we share the legislature's goal of ensuring all Californians have access to comprehensive affordable health care. Unfortunately, as drafted, SB 1037 introduces a new and subjective rate review process.

More specifically, while we understand the desire to delink existing definition of unreasonable rate increases from the Federal Affordability Care Act in order to reflect California specific market, the framework proposed in this bill creates significant implementation challenges.

As it's currently drafted, ten thirty seven introduces numerous new terms that have a potential to make the process not only confusing, but potentially inconsistent across regulatory bodies. We're concerned that the lack of certainty regarding compliance will lead to significant regulatory confusion as well as increased cost to the system. The bill also appears to combine the function of the office of health care affordability, application health care cost targets with DMHC and CDI's rate review process, which are fundamentally distinct.

Additionally, while we appreciate the interest of considering affordability and the analysis that references the actual premium impact, we are confused about whether or not there are true deficiencies within the current process. If the argument is that there are there is additional information necessary to determine something to be unreasonable or reasonable, we certainly wanna have those conversations going forward.

But if this is an an exercise in looking at affordability disconnected from the actual functional rate inputs that create a reasonable or unreasonable rate, we're not sure that this actually benefits the consumer rather than just add its additional cost to the system. So for those reasons, we remain opposed to the bill, but certainly do look forward to continuing conversations if it moves forward today. Thank you.

Thank you. Are there others in the hearing room who would like to offer opposition to this measure? Seeing none, I will bring it back to committee for any comments or questions. Assembly Murshiavo.

I wanna thank the author for this bill. I think, you know, as was stated, and this is something that I saw for workers for many, many years that they will go to the bargaining table. And after COVID, I mean, there are some unions, hotel workers, for example, who got zero wage increases because everything went to health care. And so it's something that we don't think about all the time about the downward pressure on wages that health care actually has.

But because health benefits are taking up so much of the money that is on the table, it's a huge, huge detriment and is one of the, you the biggest cost that is really keeping workers behind in the state and in the nation.

And, you know, as the impacts of HR 1 are felt and the cuts to our health care and subsidies have disappeared, we know that people are really struggling. You know, some people in my district have talked about paying more for their health insurance than they do for their mortgage.

And so, you know, I think having daylight on this and having more transparency for us to inform us as policymakers to be able to make decisions that make sense and how we best can support folks and and policies that need to be changed, I think, is really, you know, critical for the work that we do. And, really grateful for your leadership on this and happy to move the bill.

Thank you. We have a motion Seconded by Patel. Senator, I wanna thank you also for bringing for this bill. I did, just want to, have you address the opposition's concerns around the kind of conflation, if you will, between the rate review process and the impact of cost targets, which are outlined as something that is pretty, seminal to this to this measure.

Thank you, madam Chair. I think the having the rate review process and the office of health care affordability, cost growth targets work together is essential to the rates being, those benefits being realized for consumers. And because, I think, to what, like, what the opposition said, like, the office of health care affordability has the all in approach around, there's cost growth targets for health plans, large physician organizations, and hospitals.

To see the benefits of all that, the slowing of the of the increases in costs, we wanna make sure that all of those benefits are are realized on the rate side so that if we're seeing that the health plan isn't gonna meet the the cost growth target or there's gonna be big increases in rates.

We now have this data on cost drivers at OCA to be able to reconcile and check against and see what are the actual drivers of what is being proposed in the rate on the rate side.

I know I've heard on from the opposition arguments around, while the the rate regulation is looking forward, it's looking at proposed rates, whereas the office of health care affordability is looking backwards. We're looking at spending from the previous years and then doing enforcement over the next couple years after the actual, enforceable year.

I think we can do both, and it's important that we can do both so that we can see moving forward what are the cost drivers, but also are looking backward with the data we have from the previous years to inform all of those decisions and what we can do to try to actually see those benefits and bring down the rising cost of care for Californians.

Thank you. Senator, would you like to close?

I wanna thank you and your committee staff once again. You know, eight out of 10 Californians say that health care affordability is a top priority. This bill and my next two bills will be specifically addressing that. You know, we can all agree that health insurance is extremely expensive, and health insurance premium growth is surpassing medium household income and cost of living.

SB 1037 connects the work of OCA with regulated reviews of health insurance premium rates and respectfully ask for an aye vote on this bill.

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

The motion is do passes amended to the Appropriations Committee. Vonta.

Aye.

Vonta, aye. Sanchez, Addis, Agarakuri, Aarons, Koloza, Carrillo? Aye. Carrillo, aye. Jeff Gonzales?

Jeff Gonzales, no. Mark Gonzales? Johnson? Johnson, no. Patel?

Aye. Patel, aye, Patterson? Patterson, no. Rodriguez? Shievo?

Shievo, Aye. Sharp Collins? Stephanie?

That measure's on call, Senator. Thank you. We're gonna move on now to item number 10, SB 1094 by Weber Pierson.

Okay. Thank you. Thank you, Chair, committee members, committee staff for all of your work on this bill. I will be accepting amendments to require plans and insurers to notify providers about this bill and that beginning 01/01/2027, their patients who are on a reference biologic will be eligible for pharmacy substitution of biosimilars on the formularies listing the patients and the possible substitutions.