Assembly Health Committee

Good afternoon. We will call to order the hearing of the California State assembly health this Tuesday, March 17th. We will first establish quorum.

Here.

Here.

We have quorum. Before we begin, I want to make sure everyone understands our committee procedures to ensure we maintain order and run a

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. That being said, 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 are providing witness testimony at this hearing, all witnesses will be testifying in person. Main support and opposition will be allowed. Two main witnesses for a maximum of two minutes each. As a reminder, primary witnesses in support must be those accompanying the author or who otherwise have registered a support position with the committee. And the primary witnesses in opposition must have their opposition registered with the committee per the instructions on our website. All other support and opposition can be stated at this standing mic. When called upon to simply state your name, affiliation and position. All testimony comments are limited to the bill at hand. A couple of housekeeping items I would like to note. The speaker has appointed Assemblymember Rogers to substitute for Assemblymember Rodriguez for today's hearing.

Today we have the following items proposed for consent. Any member of the committee may remove a bill from the consent agenda. Those items include item number four, AB 1734, by Stephanie with a motion of due pass to higher education. Item number five with the motion of AB 1868 by Gallagher with a motion of due pass to appropriations. Item number seven, AB 1907, Addis, with a motion of due pass to appropriations, and item number eight, AB 1910, by burner with a motion of due pass to appropriations.

Because we do have quorum, I'm going to have us just vote quickly on the consent calendar

Seconded by Addis.

Bonta.

Banta I. Chen Addis. Addis I. Agarakuri. Agarakuri I. Ahrens Coloza. Carillo. Carrillo I. Gonzalez. Gonzalez I. Johnson. Johnson I. Patel, Patterson. Rogers. Rogers I. Sanchez, Chiavo. Sharp Collins. Sharp Collins. I. Stephanie. Stephanie I.

We will move on now to our first item on the agenda, which is item one. AB 1540 by Mark Gonzalez. 988 Suicide and Crisis Lifeline for LGBTQ youth. This is an urgency.

Motion by Addis. Seconded by Stephanie. Assembly member Gonzalez.

Thank you for the opportunity to present today. Thank you, Madam Chair. I also want to begin by accepting the committee's amendments and expressing my appreciation to the chair and the committee staff for working with my office on this bill. I also want to take a moment of personal privilege to thank the many colleagues, the members, the advocates, the providers and the stakeholders who have offered thoughtful feedback to this bill. I remain committed to continuing those conversations so that we can address implementation concerns and ensure that the program works the way that it's intended to. This bill represents meaningful progress, but we know that there is still work ahead. I look forward to continuing that work with our partners in the 988 space to make sure that the program can restart smoothly and effectively. But before we talk policy, I want to talk about something deeper. Every generation is tested by what it chooses to see and what it chooses to ignore. Sometimes the greatest danger to community isn't cruelty, it's indifference. It's seen warning signs flashing for our young people and deciding it's easier to argue than it is to act. Last year, national funding for the 98 LGBTQ Suicide Prevention Line was cut, shutting down a lifeline of thousands where young people relied in their darkest moments. AB 1540 is about restoring that lifeline. It reinstates the press 3 option with 98 system so that when someone reaches out in crisis, they can be connected to trained counselors who understand the unique challenges LGBTQ youth face. Because the reality is that LGBTQ youth attempt suicide at a far higher rate than their peers. Not because they are broken, but because too often the systems around them are. When young people, or when a young person is at their lowest point and finds the courage to ask for help, the worst thing that we can do is let that call go completely unanswered. Suicide prevention should never be political. It's a public health responsibility. And restoring this service means restoring something simple but powerful. The chance for someone on the other end of the line to say you're not alone. Stay with me. Sometimes the difference between tragedy and tomorrow is just one voice. Picking up that phone, AB 1540 helps to make sure that that voice is there. And today, to help us with that voice is Diva Shiv, a senior policy advocate for California alliance of Child and Family Services.

Hello, my name is Bridget McCarthy, and I'm here representing the American foundation for Suicide Prevention, which is the nation's largest public funder of suicide prevention research. We do support this bill, and I'm here to urge an I vote on AB 1540. But most importantly, I'm here as a mother. In September 2020, just 12 days after his 16th birthday, I lost my amazing son, Riley Chart, to suicide. His birthday balloons were still floating in his room. An image of a life just celebrated is one I cannot get out of my head. And it's there every single day. That is why I'm committed to preventing suicide. I have no agenda, and I'm simply here because it's the right thing to do. In California, suicide is the second leading cause of death for our youth. For children like Riley, who are part of the LGBTQ community, that risk is exponentially higher. They aren't just statistics. They are children looking for a place where they belong and a voice that understands them. And I have Riley buttons, if anybody would like one. After we lost Riley, we discovered that in the middle of his crisis, he reached out. He sent a text to a gay friend, hoping for a connection that never came back. Then we didn't have 988. We didn't have the press. Option three, a dedicated line where queer youth in distress can speak to somebody who truly understands their world. We know that a veteran crisis line looks after a fellow soldier. And if a veteran is in crisis, they're going to want to speak to somebody who understands their world. It's no different with LGBTQ youth. They need to know that the person on the other end of the line sees them for who they are. And we have to meet our children if we want to save them. Thank you.

There was a deferral of time.

Thank you. We will now move to hearing any support the measure. Craig Pulsar on behalf of Equality California

Malik Bynum on behalf of the County Behavioral Health Directors association and PROUD support. Thank you.

Good afternoon, Madam Chair. Olberth Franco here on behalf of the California Fire Chiefs association and support.

Kelly Brooks on behalf of the Santa

Good afternoon.

Good afternoon.

Social Workers California chapter. And strong support. Maydy Lowe with the California Behavioral Health Planning Council. Proudly support.

PROUD co sponsor of this Bill. In support.

Clifton Wilson on behalf of the California State association of Psychiatrists as well as the California Academy of Child and Adolescent Psychiatry Tree and then as well as the city of West Hollywood. All in support. Thank you.

And strong support. Thank you. Kathy Mossberg on behalf of the San Francisco AIDS Foundation.

Nora Angelis with Children Now. In support.

Angel Jaime with the Trans Latina Coalition. And strong support.

On behalf of cause I oppose AB 1540. My name is Johnny Skinner. I was a gay kid who was harmed by LGBT specific suicide prevention. As a teenager. I was on puberty blockers and estrogen. My physical development was arrested. I was IC isolated and bullied because my body stayed that of a child's. I was having thoughts of suicide because I didn't like anything about my body. My hatred of my body significantly worsened after I started sex rejecting interventions. The doctors told me I was supposed to be a girl, so I viewed my male body as defective. I was in crisis. So I called the Trevor Project because that's what LGBT influencers online told me. That's who you call. They were very nice at first, very affirming. But when I started talking about what was actually wrong, the side effects, the hormones, the blockers, my depression, they got very quiet. And then they hung up on me. A suicidal child. The world caved in and I cried myself to sleep that night. AB 1540 would root kids like me, kids in crisis, directly to organizations like the Trevor Project. An organization that believes children can be born wrong. An organization that doesn't want to hear about the harms of so gender affirming care. In fact, they deny the harms even exist. I know what it is to be a lonely gay kid reaching out in the dark for someone to help. That kid deserves real help and holistic care. That kid deserves to be told the truth, not an ideology. Don't send the next kid to the people who abandoned me. Please vote no on AB 1540.

Erin Friday, president of our duty, attorney mom and a kid who used to believe that she was trans. California is looking to create a dedicated routing option that directs youth to an LGBTQ provider through grants. This will direct the callers to Trevor project or similar. Using998. This bill is a direct attempt to do an end run around the prohibition of federal dollars being spent on the Trevor Project. But don't worry. When I was in D.C. last week speaking with the HHS, I made sure that they are aware of the games California is playing. The Trevor Project is not a suicide prevention organization. Its main focus is to target minors, promote secret social transitions, and provide chat rooms open to users ages 13 to 24 with no age verification. I know because I joined last year. I was able to join the Polyamory Club, where kids and adults set up meetups. The age regression club, where adults who like to pretend to be little kids can talk to depressed teenagers. One post was titled Looking for Little ones. I am 18, I just want to talk to someone while I'm regressing. I also have a Discord Member Gonzalez and this legislature made sure that all public school kids have the Trevor Project on their student IDs so that they can access this sexual chat rooms. This bill is another vehicle for the author's favorite fetish nonprofit. If the goal is truly suicide prevention, then 998suices and does so without incorporating sexual or fetish content. Thank you.

Good afternoon. David Bollog, SFB alliance and Neighbors for

Good afternoon. Carly Stelzer, on behalf of the California Behavioral Health association, not an official Opposed.

and appreciate the collaboration.

My name is Jean Chadbourne. I'm from Oakland, California. I'm a lifelong Democrat, mother of a gay son, and I'm here on behalf of Women Are Real Women's Declaration International, Women's Liberation Front and I strongly oppose this bill. Alisa Overholt, I'm here with Women Are

Oppose this bill.

My name is Matthew Ward. I strongly oppose this bill and I am a school board member for Gauld Elementary School District.

and Law and Women are Real and

LGB International, and I oppose this bill.

I'm the daughter of a mom who

I'm with the Democrats for Informed Approach

Oppose this bill.

I strongly oppose this bill.

strong opposition and request a no vote.

My name is Layla Jane. I'm a D transitioner and I'm here with cause and I oppose this bill.

of the California Family Council.

My name is Mariam Syed. I'm with Women are Real and California is United for Sex Based Evidence in Policy and Law from Menlo park and

My name is Amanda Covetana from San Mateo County. I'm with Women are Real, Women's Liberation Front and Lesbians Advocating for a resilient future, and I strongly oppose this bill.

My name is Rachel Bordoli. I'm a registered Democrat, longtime San Francisco

supporter of the Trevor Project, I stand in strong opposition to this bill.

I've been working very closely with the

scandal where we're lying to children about

support this bill because just your position.

Please.

Thank you. We will bring it back now for any member questions or comments. Assemblymember, I would like to give you an opportunity to address some of the concerns related to the. Oh, Sharp Collins had a question or comment.

Thank you so much. And I want to thank Assemblymember Gonzalez for bringing forward this bill. This bill is attempting to simply restart a service that we already had available nationwide before the current federal administration ended it. Research is very clear that our LGBTQ people, and particularly our youth, are disproportionately higher, at higher risk of suicide, and at a time when their basic existence is being challenged, I can only imagine those feelings of anxiety and fear and the judgment that comes with that and how much it can be exacerbated. And I thank you always for bringing in the story of Riley into. Into our conversations around this. I want to also thank the opposition for your comments and your testimony as well. I want to appreciate our staff and your staff and you for always working with this committee. Assemblymember Gonzalez, you've indicated that you will accept those amendments that we've offered, and I'm proud to be a co author of this bill. With that, would you like to close?

I respectfully ask where I vote.

The motion is due. Passes amended to the Communications and Conveyance Committee. Bonta.

Fonta, I. Chen. Addis.

Addis, I. Aguiar. Curry. Ahrens. Coloza. Carrillo. Carillo I. Gonzalez. Gonzalez, I. Johnson. Johnson. No. Patel. Patterson. Patterson. No. Rogers. Rogers, I. Sanchez. Sanchez. No. Schiavo. Schiavo, I. Sharpe. Collins. Sharpe. Collins. I. Stephanie. Stephanie, I.

next item in file order, which is

All right.

Thank you. You'll have two minutes.

Thank you.

Thank you. We'll have anyone in the room in support of AB 1671 come to the mic please. David Bollog of the SFV alliance in support.

Thank you. We'll now move on to primary witnesses in opposition. Seeing none. If there are any members who would like to offer me too in opposition Seeing none. I will bring it back to the committee for any comments or questions. Seeing none. Please go ahead and close.

a lot of us care about as well.

Thank you. I will note for the committee that this committee has done extensive work over the years, as has the assembly, to ensure that our rural communities and our rural hospitals have the ability to be supported, including the provision of $50 million in one time MCO tax to help with seismic retrofits, another $300 million in loans to 17 facilities, many of them who are rural. Assemblymember Soria this year is carrying a bill introducing a refocus on the distressed hospital loan program. And we have certainly had an opportunity to have many of our critical access hospitals to hire physicians. And there is a bill this year to expand that to healthcare district hospitals as well. I want to just make sure that we are aware of the work that we have already done and that this committee continues to be focused on rural hospitals. And I know that. Majority Leader, you had a comment that you'd like to make.

Thank you. Oh, okay. We are going to offer Tangipa an opportunity to reclose with another comment coming from our.

A lot of people.

Seeing no other comments or questions from committee members, Assemblymember Thalangipal, would you like to close again?

worked to help a lot of people.

With that we have a motion and a second please call the roll.

That bill's out. Thank you. We're going to move on now to item number six, AB 1876 with Addis Healthcare coverage non discrimination. Move the bill second moved by our majority leader. Seconded by Rogers. Assemblymember Addis, whenever you're ready.

Thank you.

Thank you. Hello, Chair Bonta and Assembly members. My name is Angel Jaime. My pronouns are they he and I am the Statewide Policy Initiatives Organizer at the Trans Latina Coalition. I am here to advocate for AB 1876, which would strengthen and clarify federal nondiscrimination protections under section 1557 of the Affordable Care act into California state law. This piece of legislation is incredibly crucial at this moment when these protections are vulnerable in the federal legislation, particularly given executive order 14187. It directed the Secretary of Health and Human Services to revisit the legality of Section 1557 of the Affordable Care Act. These developments have had already very devastating effects for tgi, transgender, gender expansive and intersex access to care both in and outside of California. At the Trans Latina Coalition, specifically, our patient navigation program supports Our patient navigation program supports people in understanding and challenging coverage denials, navigating the appeals process and advocating for themselves amid the inconsistent implementation of federal policies that too often result in discriminatory practices. In the past year, we have witnessed community members who lost coverage for gender affirming care due to policy changes, as well as those who were told services they had already been approved for were no longer covered. We have also supported clients who had to call multiple providers across the county when programs were closing in mostly rural and suburban areas through 1876. California has the opportunity and responsibility to ensure that these protections are clear and strengthen for vulnerable communities across the state. Ensuring that California is explicit is particularly vital in this moment. And with this, we respectfully request your I vote on AB 1876. Thank you.

Good afternoon Chair Bonta and members. My name is Lauren Polito and I am here today as a lifelong Californian, a member of the Lieutenant Governor's Transgender Advisory Council and a member of the LGBTQ community in strong support of AB 1876. I know California has the capability and has a long history of attempts at being a safe haven for LGBTQ individuals and marginalized community communities. At a time when protections at the federal level are being redefined, rolled back or dismissed, it is more important than ever that California continues to strengthen protections against discriminations in health care for many transgender, gender diverse and intersex people. Access to medically necessary care is becoming increasingly uncertain. Across the country we are seeing rollbacks in gender affirming care services and clinics. These changes disproportionately affect young people and those living in suburban and rural areas where access to specialized care is already limited. When services are restricted or removed from networks, the impact is immediate. People lose access to providers, appointments get canceled and the care that once was available suddenly becomes out of reach. I have personally seen how insurance barriers and shifting policies can relay or prevent care. Changes in coverage rules, denials of service, or sudden policy changes can force people to postpone procedures or move surgery dates after months or even years of planning. This is something that I have seen with many people that I care about and many of your constituents and this causes mental health distress and furthering unnecessary stress. And in some cases, providers preemptively comply with shifting policies outside of fear or uncertainty, like when consent ages for policies change and people suddenly have to move or cancel their appointments that they have

These disruptions are not abstract and they are not abstract policy debates.

health stability, well being. California has led, long led the nation in protecting vulnerable communities and at this moment we must continue to stand strong against federal attacks on health care providers and systems that provide care for trans and gender diverse people.

Craig Pulsar on behalf of Equality California, PROUD co sponsor and strong support

Symphony Barbee on behalf of the ACLU

Malik Bynum on

Carly Stelzer with the California Behavioral Health

Clifton Wilson, on behalf of the California State association of Psychiatrists, in support, thank you.

Bridget McCarthy, mother of a trans child, in strong support.

and strong support, thank you.

American association of University Women California, in support,

On behalf of our duty, I oppose AB 1876. I'm Johnny Skinner, a D transitioner and I was a gay kid who was harmed by so called gender affirming care. I was a very feminine boy. Everyone around me made it clear that that was not okay. I was called slurs. Males mocked me. From the time I was five, I knew I was different and didn't like it. I just wanted to be normal and loved. When I was 12, I found trans influencers online who looked like me. As kids they said, change your body and your life gets better. And I thought, that's my way out. At 13, my doctors told my mom she had a daughter, not a son. He told her 60% of trans kids kill themselves if they don't undergo sex. Rejecting, intervent. That wasn't true, but my mom loved me and followed the doctor's advice. The doctor told me I was too feminine to find love as a man and that gay men don't want someone like me. That I needed to change my body if I wanted to find a husband. I was put on estrogen and blockers at the age of 13 and my body fell apart. Nipple leakage, brain fog, chest pain, depression. I was urinating blood and had ulcers in my bladder and was too weak to attend school. When I told my doctor how sick I was, he looked at me and said, welcome to womanhood. What they were doing has a name. It's called Transing the Gay Away. And there's nothing wrong with being gay. This bill forces insurance companies to fund this cruel homophobia. It continues the lie that some children are born in the wrong body. Vote no.

Thank you. I will ask if there are any in opposition to please come forward now to state your name, affiliation and position on the bill.

Bev Talbott, San Francisco, Democrat with the Lesbian and Gay Courage Coalition. We strongly oppose forcing insurers to cover treatments that yield no proven benefits and cause known irreversible harm. Vote no.

Real, Women's Liberation Front, Women's Declaration International,

I'm with Cause and Women Are Real and I strongly oppose the spill. Amanda Covetana, lifelong Democrat and lesbian, here with Women Are Real, Women's Liberation Front and lesbians advocating for a resilient future. Strongly oppose.

lgb, that is Lesbian, Gay and Bisexual

I'm with Democrats for an Informed Approach

I strongly oppose this bill.

Arian Adam Chacova, Longtime progressive Democrat from San Francisco, mother of a teen boy who used to believe that puberty blockers and cross sex hormones were an appropriate response to his teenage angst. I am also the co founder of the Teachers California Teachers supporting Gender Non Conforming Youth and a believer in the human right of puberty and sexual function and gender nonconformity. I strongly oppose this bill. Lisa Smith, Daughter of a gay Father

Rachel Bordoli San Francisco based Registered Democrat,

Democrats for an Informed Approach to Gender

My name is Romy Mancini. I'm a former attorney for the ACLU Lesbian and Gay Rights Project, a resident of San Francisco. On behalf of Women Are Real and Our Duty, I strongly oppose this bill.

women's and families in California for the

Mallory Engel on behalf of Concerned Women for America and Young Women for America, I oppose this bill. Leandra Wells, Policy Engagement Coordinator for California Family Council I oppose this bill.

David Bollog representing the Fax Law Truth

and students loca meaning leave our kids

the neighbors of the 40th assembly

Hi, my name is Tish Hyman, co founder of There Are no Trans Kids,

I completely oppose this bill.

which is a double mastectomy.

Board and I'm a school board member for Gaulde Elementary School District and I oppose this bill. Thank you.

Thank you to the author and translaten coalition from my district for being here today. AB 1876 isn't about creating something new. It's about drawing a clean line in the sand. In California, dignity is not up for debate and healthcare is not conditional. This bill simply says what should have always been said and known is undeniable. That you cannot deny someone care first simply for who they are. While others try to roll back rights, we choose to reaffirm them loudly and unapologetically. AB 1876 is not just a policy, it's a promise. And in California, we keep them. Thank you again to the author for bringing this forward.

thanks so much. Chair I just want to thank the

And that's between an individual and their

it, not having politicians determine what options are available to folks, but making sure that they have a suite of options that they can figure out what works

their family and what works best with their care team.

Thank you.

This legislation really doesn't do anything in terms of adding new requirements or changing requirements when it comes to treatment. It's just about non discrimination. So lifting from the ACA the non discrimination protections that are in place and putting those into state law.

Okay. You know, the reason why I asked those questions is, you know, I think our, I mean I don't think it would be unfair to describe California's law or at least a part of this bill that would be different than the ACA in terms of how we define sex and sexual orientation than maybe other states. And maybe that's something that we, you know, that California desires to do. I think, you know, one issue that I always have with this because there are pieces of the bill that talk about, you know, exclusions and prohibitions for, for policies around gender transition or gender affirming care. And I think that's why? There are a lot of questions about that. And I think, you know, obviously would, would love to hear your response to that. I think, you know, my. Just to give an example of, of why I think actually this bill could be discriminatory, actually. And this is not. Look, I'm gonna start talking about this this year. Somebody's gotta talk about it. But if a person transitioning to male wants to get on testosterone treatment, that's between there and their doctor and should be covered and so on and so forth. Yet if you're a male who's, you know, wanting to keep their testosterone levels up, you have to basically be near dead to get coverage from your provider. And I think that's, that's a problem. There are a lot of guidelines around that. So I think that that's something that we need to take into account. But going back to the items about gender affirming care, I'm just curious if you're saying your bill doesn't touch that. Is that

Okay. It does prohibit denial or limiting healthcare services sought for purpose of gender transition or other gender affirming care that the healthcare service plan would otherwise cover if the denial limitation is based on an individual's sex assigned at birth. So that is definitely different than the aca.

Sure.

I just, I don't know if I'm understanding.

Madam Chair, please, just to clarify, I think where Assemblymember Addis is talking about is one that we have laws on the books already with Bostock v. Clayton County. It's in our analysis. If you'd like to read that. And she's specifically talking about making sure that the ACA is transposed as a federal statute, is transposed into state law. The reference that you are making is actually not law. Assemblymember Patterson. It's executive order 14187, which is an executive order. It's not a statute and is something that is highly discriminatory. It is the policy of the United States that it will not fund, sponsor, promote, assist or support the so called transition of a child from one sex to another. And it will rigorously enforce all laws that prohibit or limit these destructive and life altering procedures. That is an executive order of, of the Trump administration and President Trump, which is a different thing than whether or not it is in statute.

Any other questions or comments? Thank you, Assemblymember Addis. I want to thank you and your staff for, and the sponsors for bringing this bill forward at a time now more than ever, especially given the Executive order that is hanging out there and the incredible destruction of the aca. It is very important to note that California will stand ready to protect the law that requires plans and insurers to cover medically necessary care for transgender, gender diverse and intersex people. Our state has non discrimination protections on the books to ensure that all Californians can access the care that they need without discrimination. I think it's very important to note that as well. And this bill is really attempting to strengthen and reaffirm those existing protections by codifying federal non discrimination standards into law across our Constitution and by statute in the aca. I want to thank you for bringing forward this bill. My recommendation on this bill is an aye. And I would ask to be added as a co author when the opportunity is appropriate with that. Would you like to close?

Thank you. And now we will ask to call for a vote on the. On the bill. We have a motion and a second secretary, please call the roll.

Aye.

Aye.

Aye.

That bill is out.

Thank you, Madam chair and members. AB 1629 will prevent insurers from shifting financial burdens onto patients by requiring dental plans to send payments directly to dentists rather than forcing patients to cover large upfront costs. Every month, millions of Californians pay their monthly dental insurance bill, but never get the care that they are entitled to. California ranks among the worst in the nation for children's dental health, placing 47th out of 51 states in a national assessment of pediatric dental disease rates. California has over 35,000 active dentists, which is the most in the nation. The issue isn't a lack of dentists. It's that many of the dentists aren't in the insurance networks because insurance companies. Some insurance companies may keep their network smaller to maximize profits and force patients to go out of network. Many families are forced to travel long distances for care or pay high out of pocket costs due to inadequate provider networks and restrictive insurance policies. Small insurance networks and restrictive policies force many families to choose between traveling long distances for care or paying high out of pocket costs. In many cases, patients pay the full cost of dental care up front and wait for reimbursement from their insurer, leaving families to choose between paying thousands of dollars to or delay needed dental care. AB 1629 will require insurance companies to go directly to dentists Insurance payments to go directly to dentists, preventing patients from facing large upfront costs will also require insurance companies to report network adequacy data which measures whether a health plan has enough in network dentists in the right locations. By requiring dental plans to pay out of out the assignment of benefits requests, it stops families from needing to pay out of pocket for care while waiting for reimbursements. We've had productive conversations with the opposition. This bill was was changed and narrowed from a prior version last year and we're looking forward to reviewing any proposed amendments. With me to testify in support of the bill is Shelby Arevalo, a patient Advocate Coordinator, and Eric Doughty on behalf of the California Dental Association.

bonte members of the committee. My name is Eric Doughty with the California Dental Association. We're here to proudly sponsor AB 1629. Many patients cannot easily use the dental coverage they already pay for. AB 1629 makes two practical improvements to address this issue. First, it requires increasing increased reporting on provider network data so regulators can more accurately assess whether networks meet policyholders needs. Nearly half of Californians with commercial dental products have self insured plans regulated by federal law. These plans are not included in the state's assessment of network adequacy despite the large overlap in providers. This hinders Californians ability to determine whether a state regulated plan has enough in network dentists and specialists for patients to access care. Second, AB 1629 requires plans to honor a patient's assignment of benefits request, ensuring that when a patient receives care from an out of network dentist, the insurer sends the payments directly to the dental office rather than the patient without assignment of benefits. Many plans send reimbursement to the patient instead of the provider, which often requires patients to front the entire cost of treatment and wait for reimbursement. For many families that makes their coverage effectively unusable. As the analysis notes, AB 1629 does not expand consumers ability to access out of network providers. However, this bill would give consumers greater transparency into cost implications of going out of network compared to current law. Assignment of benefits laws are not new and already exist in 31 states. Dental plans across the country, including Delta Dental, already comply in states where this is mandated. States with assignment of benefit laws have not seen dental networks shrink or premiums increase. In fact, in many cases, we've seen the opposite. For this reason, we respectfully asked for

Good afternoon, Chair and members of the Committee. My name is Shelby Arevalo and I'm the founder of the National Dental Advocacy Program, a nationwide nonprofit starting in California, and we're dedicated to bridging the gap between patients and dental providers. I've spent more than 16 years in dentistry. Today I serve as a board certified patient advocate, working directly with patients and providers who are trying to navigate a healthcare system that is often confusing, overwhelming, and at times unsafe. Through this work, I see firsthand the barriers patients face when they simply try to access care. Many patients, especially those in rural communities or those with complex medical or behavioral needs, cannot always find an in network provider who can treat them. When they finally find a dentist willing and qualified to provide that care, insurance policies around assignment of benefits often create an unnecessary barrier that makes treatment harder to access and harder to afford. I've seen patients in severe pain resort to emergency rooms because they could not find an in network provider nearby. I have followed cases where dental infections became medical emergencies simply because treatment was delayed. I've worked with patients requiring sedation due to severe dental anxiety who called dozens of offices without finding an in network provider able to meet their needs. And when they finally find the right provider, assignment of benefit restrictions mean the dentist may not be paid directly, leaving patients responsible for large upfront costs that simply they cannot afford. So when a patient chooses their provider and agrees to assign their benefits to that provider, there should be nothing standing in the way of that decision. Regardless of network status, assignment of benefits is about patient choice, continuity of care, and removing unnecessary financial barriers that delay treatment. The current system places a strain on both patients and providers and it ultimately restricts access to care. This bill is an important step towards restoring fairness, improving access for vulnerable populations and allowing patients to receive care from the providers they trust without unnecessary administrative barriers. Thank you for your time.

Gary Cooper representing UAPD Unit of American Physicians and Dentists.

and a co sponsor position on the bill. Thank you.

General Dentistry and We strongly support this bill. Thank you.

association of Oral and Maxillofacial Surgeons and support.

Thank you. We will now move to opposition on the bill with primary witnesses. You'll have two minutes each.

Madam Chair. Matt Back representing California association of Dental Plans. Start by thanking the author and the sponsors. We have had constructive conversations with them, but unfortunately we are still opposed. You just heard about the AOB concerns, but also there is network reporting that is duplicative. I think the committee analysis does a good job of noting. So the way the bill is structured there are certain. So an HMO is regulated by dmhc, a PPO typically regulated by doi. We obviously your line of business, that is your regulator and you provide information to your regulator. This bill would have us provide information to both regulators. So I might be an HMO product, but I'm now having to provide all of that information to doi, which again they have no jurisdiction or they're not regulating me. The bill also If I'm a Medi Cal provider providing the insurance in the Medi Cal market, again, I have to provide that information to these two regulators that may not regulate me. And then finally, ERISA plans, which are federally regulated plans, and these departments have no jurisdiction over that. This bill would also have us supply that information to the departments. Again, they do not have the oversight. So we're kind of perplexed by that provision. And it certainly would add cost and it's duplicative to what we do now. We certainly have significant network adequacy requirements in law today. We have time and distance standards in place today. There are audit provisions that, you know, that these regulators can audit our networks. So there's a lot of provisions under current law intended to ensure our networks are adequate. So on that provision, the association is opposed. And but we do certainly look forward to working with you going forward.

Thank you. Chair Cassidy Heckman on behalf of the

author for bringing this bill forward. Dental is always often the first thing that's cut. For me, growing up, dental insurance was a luxury, not a necessity. I actually did not get my first dental plan until I became a employee of the state legislature in 2009. And so I just want to thank the author for bringing this forward. Many friends had to go to Mexico and others and find other alternatives to dental work. And so this is a step in the right direction, especially as we face cuts on the HR1 docket. And so I just want to thank the author again for bringing this forward.

assembly member and sponsors for bringing this forward. I think I supported and co authored similarly last year and wanted to ask to be a co author on this. I think particularly along the Central coast and many other regions of our states where healthcare access is, we consider it a healthcare access desert, really, but it's also becoming a dental care access desert. And so bills like this are critically important. Thank you.

Question. Because last year I laid off the bill and getting closer. But if you so right now, under this bill, if this bill were to become law, you go into a dentist that doesn't have, you know, isn't contracted with the plan, they need to give you an estimate of what your out of pocket costs would be right then and there, including, but also show you obviously what the insurance coverage that you pay for would pay. Am I understanding that correctly? Yeah, I see.

Okay. For the opposition, I understood your concern for Delta Dental. One of the opposition letters in here, that's not yours, so maybe you won't really have a comment about it, but. It seems to leave the, in, you know, the, the thought that, you know, there would be no incentive to sign up with an insurance company, insurance companies anymore because, or the dentists to, because they could receive payment for out of network. But I kind of feel like the incentive is still there because, you know, I mean, the first thing I go to is I say, hey, look, I'm going to go to who's covered, right? Like in my area I'm fortunate to have a lot of, a lot of dentists even on my own street, you know, which is good when your kid chips their tooth, by the way. But, but I was just wondering if you can kind of explain that a little bit because I do kind of feel like if, if I want to go see somebody out of network, maybe a friend, I have, I do actually have a friend who's out of network and I kind of know that up front what my costs are going to be. He doesn't lose the incentive to want to sign up with Delta Dental to, to ensure coverage. Right. Or.

I would definitely be interested in the conflicting studies. Like there's conflicting studies on everything. But I'll read them both. But I kind of, I don't, I mean, tell me where I'm wrong. I don't know if I really agree with that or, you know, again, I'm just a politician up here. But if somebody's in network and I go there and they tell me, hey, this is your cleaning is covered today because you're in network. But if I go to an out of dentist, out of network person and they say like, well, we're only getting 50 bucks, but we charge 100 bucks, I think the incentive is pretty clear to go to the person who's in network.

Yeah, but you're saying it's not incentive enough to know that the patients are actually going to look for the in network person.

Yeah. Okay. I'm just curious, is the patients.

Oh, no problem.

Patients are very dedicated to their dentist and their hygienist. They want to stay with them. In fact, studies show even more than your medical because you go twice a year if possible. So if your dentist drops your network, you're still likely to stay with them versus going and trying to find an in network dentist.

Does supporters have any responses to that?

So I just beg to differ with the opposition.

Assemblymember Chiavo.

Yeah, no, that's Shelby. So as an advocate, I work closely with patients. They are, I would say, more insurance driven now more than ever, but especially when it comes to our children. Right. There are a lot of dentists that are dropping the network specifically with delta dental because of the fee structure, honestly. And so it does make it harder when the network doesn't allow direct payment for that allowance, it doesn't go to the provider. So yes, patients have to pay their full fee, which that's going to be with any out of network provider, any out of network insurance. The fee doesn't change regardless of the insurance. But if the doctor is in network, then there's a contracted rate which is discounted. So the patient does have, you know, the influence to see in a network provider for that discounted rate. But yes, if they, if the patient sees an out of network provider, there is no payment to be sent to the, to the dentist. So the patient is forced to pay out of pocket and the insurance doesn't allow for the payment to go to the dentist, even if they select it on the claim, even if the patient signs saying, yes, you can send payment to my doctor, they will not send it to the doctor. Specifically, Delta dental.

May I?

shouldn't happen in terms of if a delta dental dentist is making you pay up front, that's not the way it is. So I'm going to have to look into that and then perhaps contact your office because that would only should only happen if it's out of network. Even if you have delta dental, you were to go to out of network dentist, then that's when that upfront payment can happen. I will say when you go out of network, from what we've heard from providers, is yes, sometimes providers will require a patient to pay up front, but sometimes they don't. It's the provider's decision. They can sometimes just collect the amount that would be the patient's responsibility no matter what and then wait for the patient to submit a claim and get the difference from their dental insurance. So each provider handles an out of network claim differently in terms of less providers. That's happening throughout California and nationwide. And some are dropping Delta Dental, but many are just going insurance independence completely. It's a trend that we're seeing across the state and across California where they're not, or excuse me, the nation, where they're not just dropping a single plan, they're actually dropping all insurances. And there's plenty of data on that that I'd be happy to provide as well.

Thank you. I just wanted to make a comment to concur with the assembly member from Southern California. And I know I said this in the hearing last year, but you know, we were, I think we had Delta Dental for 25 years and all of a sudden nobody was willing to take Delta Dental anymore. And so we're actually forced to be out of network, which causes a huge, huge burden to families. And I think that' syou know whether this bill exactly is going to rectify all of that or not. I do hope that I said it last year in the hearing. Now you're hearing from two of us here. I really do hope that Delta would be working to rectify that situation because it's one of the reasons that healthcare is out of reach, particularly in my district, is that you can't find somebody to take your insurance anymore. And so it's a massive problem. Actually, I would never want anyone to think it's just the assembly member's daughter because I think it's happening to majority of people in California.

Seeing no other questions or comments, Assemblymember, would you like to close?

Thank you. The chair's recommendation is an aye. Secretary Police color roll.

Aye.

Aye.

Not voting.

Thank you very much. We are going to go back now to continue our business. That ends the hearing on all of the bills on the agenda today. So we will just move forward with taking votes starting with the consent calendar.

Consent is still out. Moving on to AB 1540. Item number one. Mark Gonzalez. We're going to lift the call. Called the roll.

Aye.

That bill's out. Thank you. Item number two. AB 1629. We can move on to the next item number three. AB 1671. Tongueipa.

Aye.

That's is still out. We'll move on to item number four. Oh, sorry, that's gone. Consent. Item number six. AB 1876.

Abrans. Aaron's. Aye.

On AB 1876. Patel. Patel. Aye.

Sharp. Collins, Sharpe. Collins I

Sharpe, Collins, Sharpe, Collins I.