Assembly Health Committee

Oh, really? Okay, apologies.

Thank you, Madam Chair and members, for allowing me to present this important legislation. Assembly Bill 1591 addresses a critical shortage of doctors of podiatric medicine in California. Today, over half of our counties, especially rural, lack adequate podiatric care. At the same time, 23% of the current podiatric workforce is expected to retire within five years. And with only two podiatric medical schools, the pipeline is not keeping up. This matters because podiatrists play a key role in diabetes care, wound care, and preventing amputations. Without action, access will continue to decline. AB 1591 directs the Department of Healthcare Access and Information to create a statewide podiatric pipeline program between CSU and UC campuses and California's two podiatric medical schools. This will expand mentorships, internships, and clinical exposure opportunities, and it creates early or conditional admission pathways for students. This bill prioritizes students from rural, underserved, and unrepresented communities and includes reporting to ensure accountability and outcomes. This is a proven approach to grow California's podiatric healthcare workforce. This bill is supported by the California Podiatric Medical Association, and with no opposition it a smart investment into access prevention and workforce development With me here today is Dr Is it Cornelison and Dr Kierakosian to be my witnesses.

Thank you, Madam Chair and members of the committee. My name is Dr. Armand Kierakosian. I'm the current president of the California Podiatric Medical Association. I also serve as a residency director at the Department of Veterans Affairs in San Francisco, as well as a team podiatrist for the professional soccer teams, Bay FC, San Jose Earthquakes, and your Sacramento Republic FC as well. I would like to thank Assemblymember Rodriguez for introducing this important bill to strengthen the visibility and long-term viability of the podiatric profession. Podiatric medicine plays a vital role in our healthcare system, particularly in serving our aging population. Yet growth of the profession has not kept pace with increasing patient demand. That gap is exactly why I made it a personal priority to promote podiatric medicine in every level, beginning from high school levels to colleges and to clinical environments. I have personally sacrificed office hours, family functions to attend high schools, colleges for suture workshops, surgical workshops, as well as hosting Zoom talks with professional soccer players in promoting the field of podiatry, foreshadowing, and applying to podiatric medical schools. This challenge is too significant to address in isolation. By establishing a coordinated state-supported pathway to recruit and prepare undergraduate students for podiatric medical education, AB 1591 provides a meaningful solution to strengthen the pipeline and help ensure patients continue to receive the high-quality care they are entitled, particularly in high-needed populations such as veterans, diabetics, and underserved communities. Please support AB 1591. Thank you.

Well, thank you, Madam Chair and members of the committee. My name is Dr. Michael Cornelison. I am the current Executive Director of the California Podiatric Medical Association, and I've also been a practicing podiatrist in California for the past 26 years. I'm here today to speak on the importance of AB 1591 and how a strong, sustained workforce of doctors of podiatric medicine is essential to effective health care delivery in California. DPMs are uniquely qualified and suited to identify and manage the earliest signs of foot and ankle complications of systemic diseases, most notably those of diabetes. When left unrecognized and untreated, these can lead to devastating consequences, including deformities, amputations, and other debilitating outcomes that deprive patients of their quality of life, their independence, and potentially their lives themselves. An insufficient supply of enough new podiatrists in the state will result in a concomitant reduction in Californians' access to prevention and timely treatment of the earliest signs of life and limb-threatening complications of diabetes and other diseases. The inevitable outcome will be that these patients will be treated only after complications have taken their toll and will overburden our primary care providers, emergency rooms, and hospitals, and at a much greater expense. With the current trends in enrollment in the colleges of podiatric medicine in California and across the country, this is the path on which we are headed.

If I may respond.

Thank you. Share the concerns. As many of you know, I worked for 13 years with nurses making sure that they had a voice on the job and that the bottom line of hospitals was not getting in the way of patient care. So that's a critically important issue to me, and I know that we can find the right place to land to ensure that that's protected. But I have to push back a little bit on this notion that this inherently means that there will be corporate control of decision-making of physicians when we already have this model in every other public hospital setting. We have it in public hospitals, FQHCs, academic medical centers. It's already there. And I would also argue that even where it's not, for example, Kaiser that has its own medical group, I would say that there is a lot of corporate pressure on Kaiser physicians to perform a certain way. Right. So this is this is the challenge in health care, a challenge in health care. And I don't think that allowing hospitals that need to have a reliable supply of physicians is the thing that's going to push it over the edge for those physicians. And we're seeing increasingly, you know, there was a survey of physicians in 2011, 32% of them were saying that they wanted to be hospital employees. And now 2023, 68% are saying that they want to be hospital employees. And so it's just, it's, our laws have to kind of catch up with the times. And I feel like this one is a little bit antiquated in terms of where things are going with the workforce. and as you said, we work a lot in the health budget sub about our healthcare pipeline, about ensuring that we have the physicians that we need when we need them and where we need them and I in fact believe that this is an important way to be able to do that because physicians want, they don't wanna run their own business, they don't wanna have to worry about advertising and their own billing and invoices and all that kind of stuff, right? They want to go to work, they want to take care of patients, and they want to go home when they're done. And this is a way to do that. And so, you know, I'm confident on a number of the issues, especially that one, that we can get to a good place and we'll continue to work with the opposition, and you'll hear about how it goes.

I would still like to close.

I just will close with saying that, you know, we know that public health care district hospitals are often the only or the closest source of care for families and seniors in their communities. They should really have the same tools that other hospitals have to recruit physicians and keep their doors open. And that's really what AB 2311 is attempting to do to ensure these hospitals can continue serving the patients and have doctors that they need to be able to do it. So appreciate the discussion. Hear the concerns. We will continue working and looking forward to seeing you next time as we make progress. Appreciate an aye vote today. Thank you.

Mr. Chair and members for the opportunity to present AB 2030, which would prohibit the sale of over-the-counter diet pills and supplements marketed for weight loss or for muscle building to individuals under the age of 18 years old. Before I begin, I want to clearly outline which products this bill does and does not cover. As our offices receive many questions regarding protein powers, powders, and creatine dietary supplements. First, this bill only applies to dietary supplements that are marketed or represented for the purpose of achieving weight loss or muscle building. This bill does not prohibit the sale of any specific supplement, including creatine, provided it is accurately labeled for what it is. Second, the bill only applies to dietary supplements not conventional food products that have an FDA nutrition facts label Most protein drinks and many protein powders are sold as food and would not be covered by this bill Third, nothing in this bill prohibits the sale of any dietary supplement to an adult. This bill only applies to minors. Adolescents face unique risks when it comes to dietary supplements marketed for weight loss and muscle building, particularly because of how heavily these products are promoted to young people and the well-documented harms these products cause. A study conducted by the Harvard-Teach Chan School of Public Health found that nearly one in 10 adolescents have used potentially harmful diet pills or significant similar products for weight loss in their lifetime, with use especially high among those with negative body image or those engaging with unhealthy weight control behaviors. Extensive research documents the dangers of these products. The American Academy of Pediatrics has been very clear. They strongly caution against teens using weight loss supplements. These products are not recommended by physicians but are widely available in pharmacies, grocery stores, specialty chains, and on the Internet. The use of these supplements for weight loss and muscle building is associated with mental health vulnerabilities, such as eating disorders and dysmorphic body disorders. Young people with a history of depression, body dissatisfaction, are at an elevated risk of using this category of supplements beyond levels recommended by the manufacturer. A study published by the National Library of Medicine highlighted how regular use of muscle-building supplements serves as a gateway to anabolic steroid use. Additionally, according to the American Academy of Pediatric recent guidelines, they discourage the use of sports supplements in athletes younger than 18 years old, emphasizing that a balanced diet is the best way for young people to get all the necessary nutrition they need. These supplements use deceptive claims to promote weight loss, often using public figures they know that are influential to youth like celebrities, influencers, or athletes. Young people are still developing cognitively and emotionally, which makes them particularly vulnerable to persuasive marketing. And as a result, they are less likely to critically assess messages that promote rapid weight loss or muscle gain. Empirical research supports this vulnerability. The systematic review published in Pediatrics, which is a journal by the American Association of Pediatrics, have found that the adolescents' critical reasoning abilities are not sufficiently developed to protect them from the influence of advertising, and that marketing exposure can significantly shape their attitudes and behaviors. Despite the American Academy of Pediatrics' recommendations against pediatric use of creatine and testosterone boosters, research suggests that many teenagers take these dietary supplements. The health risks associated with these products are well-documented and particularly concerning for young users. Weight loss and muscle building supplements have been linked to serious adverse events, including cardiovascular complications, liver damage, hospitalization. For example, the U.S. National Institute of Health reports increased cases of acute liver injury associated with dietary supplements, some of which require emergency transplantation or resultant death. In fact, thousands of emergency department visits every year in the United States are attributed to dietary supplements, with a disproportionate share involving young people using products for weight loss Dietary supplements are not regulated like pharmaceutical drugs Yet over the last decade more than 750 supplement brands have been found to be tainted with pharmaceutical drugs While the FDA identifies these tainted supplements less than half of these products were recalled. Unlike prescriptive medications, these products do not need to demonstrate safety or effectiveness before being sold, allowing potentially dangerous items to remain widely accessible. Diet terror supplements are not required to undergo rigorous pre-market testing in any population, including minors. Under the U.S. regulatory framework established by the Dietary Supplement Health and Education Act, manufacturers are not required to provide safety or efficacy before products are sold. And as a result, these supplements often enter the market without clinical trials, lacking evidence that they are safe or effective for any member of the general population, including minors. Public health research has emphasized that this regulatory gap leaves young people particularly vulnerable. A review published in Public Health Reports notes that dietary supplements marketed for weight loss and muscle building are frequently mislabeled or contain unsafe ingredients, and that regulatory controls are insufficient to ensure safety before sale. Experts and clinicians consistently caution against youth used precisely because of this lack of testing. Studies and clinical guidance emphasize that these products are not recommended for adolescents as their effects on developing bodies remain inadequately studied. But despite this, adolescents can easily purchase these products in stores or online without any age verification. This creates a situation in which minors have open access to substances that may pose serious health risks without adequate safeguards or accurate information. Given that these products have high rates of use among vulnerable youth, documented links to harmful behaviors and medical events, and no way to test these products are safe for children, restricting access for individuals under 18 is a reasonable and a necessary public health measure. Similar to how age limits are used to reduce harm for products like alcohol and tobacco, Limiting youth access to weight loss and muscle building supplements would help reduce preventable health risks during a critical stage of development. Dr. Jason Nagata, a pediatrician at UCSF's Benioff Children's Hospital and a faculty member at UCSF, specializes in adolescent eating disorders. He shared with our office stories about the countless youth in the Bay Area he has cared for who have used weight loss supplements, developing eating disorders, become critically ill, and require hospitalization. He shared that hospitalization for eating disorders has doubled at UCSF since 2020, and that weight loss supplements worsen health inequities and disproportionately affect people of color, low-income households, and those without health insurance. This is a pediatrician urging us to get these dangerous products out of the hands of our kids. AB 2030 would establish clear, enforceable age restrictions on the sale of over-the-counter diet pills and dietary supplements marketed for weight loss or muscle building. The bill creates meaningful safeguards to prevent youth by requiring age verification for in-store and for online purchases. By limiting access to these products for minors, this legislation can help reduce the development and severity of eating disorders of body dysmorphia and related mental health challenges among youth These conditions are known to contribute to long disparities in health outcomes such as depression anxiety and substance misuse This bill will also help mitigate the physical harms associated with poorly regulated supplements that can contain stimulants, adulterants, or unsafe ingredients linked to serious outcomes, such as cardiac events or severe liver injury. Just like existing age restrictions on other harmful products, AB 2030 provides a practical and immediate step to better protect California's youth from dangerous and misleading weight loss and muscle building supplements. Here to testify in support of AB 2030 is Naveen Radwan, founder of the Mira Foundation and also a parent of a child who almost lost her life from an eating disorder. and Izzy Mann, striped California youth team captain and student attending Occidental College.

Good afternoon, members of the committee. Thank you for the opportunity to testify. My name is Naveen Radwan. I'm from San Jose, and I'm a parent of a child who nearly died from an eating disorder nearly six years ago. I'm here today in strong support of AB 2030. Six years ago, my 15-year-old daughter was diagnosed with anorexia and entered a life-threatening spiral that nearly took her life several times over the course of a year. She still struggles today. Her obsessive and compulsive desire to be thin and reach abnormal body standards led her down a dangerous spiral. During that time, over-the-counter diet pills were readily available to her and helped exacerbate her illness. The toxic body image standards of our society have influenced our youth to try and chase an ideal that does not exist. This bill would help restrict the sale of these harmful over-the-counter diet pills and weight loss supplements to anyone under the age of 18. These products being readily available with no restrictions to children is putting our child's lives at risk. we have no choice but to make sure it cannot happen. For this reason, I urge you for the life of my child and every other child like her to vote in support of AB 2030. Thank you.

Good afternoon. Kelly McMillan on behalf of the American Academy of Pediatrics California in support.

Christopher Sanchez on behalf of the Consumer Federation of California in Support.

Good afternoon, Mr. Chair and members. Tatum Ackler with Samson Advisors on behalf of the Council for Responsible Nutrition, which has taken an opposed and less amended position on AB 2030. And let me start by thanking the author and his staff for very productive conversations to date. CRN is the leading trade association for the dietary supplement and functional food industry and has a history of working constructively with authors seeking to address this issue in the past, including with Assemblymember Christina Garcia, then chair of the California Legislative Women's Caucus through AB 1341 in 2022, and subsequently with Assemblymember Weber Pearson through AB 82 in 2024. And our engagement on those efforts was focused in great part on establishing a more balanced and targeted framework that does not bring unintended products within scope. Specifically by tying scope solely to labeling and marketing claims, AB 2030 would bring products within scope that have no connection to the bill's purpose. If you contrast that with AB 1341 by Assemblymember Garcia, which focused on products that may may contribute to specified health conditions as determined by the California Department of Public Health. In the end, we believe the approach in AB 1341, while imperfect, makes much more sense both for a public health and compliance standpoint than establishing a sales restriction based solely on what is contained on the label or advertisement. CRN appreciates the opportunity to raise our concerns here today, and we look forward to continuing the discussion.

Thank you for your testimony. Additional witnesses in opposition?

Mr. Chair and members, Anthony Molina on behalf of the Natural Products Association in opposition.

unless amended. Thank you. Do we have any questions from the committee? Mr. Rogers.

Bill's been moved. Thank you, Mr. Rogers. I always wondered why you were so jacked. Now I know.

First of all, Dr. Patel, I'm completely aligned with your comments. I take creatine. I don't find there to be a concern with anything that you said. Would love to incorporate those things. the comments I can wait for my to the end but even the comments by the opposition I don't see any reason why we can work together on all of these things none of these things sound like deal deal breakers and specifically I just want to to remind this the way the legislation is written right now it specifically towards things that are marketed for weight loss and muscle building which would not be the application that you speaking of

This one for Checo. Thank you. I just had a couple of questions. It appears that the opposing as amended, the individuals that are here for opposing as amended, it appears that their amendments seem to be reasonable. I'm hoping that you can work with the with the opposition as I'm calling them opposition. So that way we can perfect our bill, this bill, because I think it is important to protect our youth, especially when it comes to, you know, bills to for weight loss. I agree with you that, you know, our youth should not be focused on weight loss. But I'm hoping that I can get an agreement from you to work with the opposition to perfect this bill.

So I look forward to continued conversations, and I will be supporting your bill today. Thank you.

Good afternoon. It just came to me. To implement this, is there a cost that's going to be with this implementation of this policy? Oh, it's a freebie.

I don't know for sure I mean it does allow for attorney general enforcement so whether that's a cost a huge cost or not they would have to review the products and determine but one thing I would just point out again it seems like we've got a theme here going I forgot to point out that probably about

Well, I appreciate the robust dialogue and the comments, and I'm learning from everyone, and certainly the opposition.

With that, thank you so much, Assemblymember. We have a motion. We need a second. Thank you from Stephanie. Secretary please call the roll. The motion is due pass to the Judiciary Committee. Bonta? Aye. Bonta aye. Chen? Addis? Aye. Addis aye. Aguirre-Curri? Aye. Aguirre-Curri aye. Pacheco aye. Coloza? Carrillo? Aye. Carrillo aye. Gonzales? Johnson? Patel? Patel aye. Patterson? Rogers? Aye. Rogers aye. Sharp Collins Stephanie Stephanie I that measures on call thank you so much assemblymember we will now move to item number six maybe 1864 by Berman Thank you, Assemblymember, whenever you are ready. Assembly member, please press your button. Pacheco moves the bill. Seconded by Addis.

Good afternoon, Chair Bonta, Vice Chair Chen, and members of the committee. Thank you for the opportunity to testify before you today in strong support of AB 1864. My name is David Relman. I'm a professor of medicine and of microbiology and immunology at Stanford University, where I've authored more than 350 peer-reviewed papers. I've also had the honor of advising the federal government on biological risks, including at the White House, the Department of Defense, and the intelligence community. AB 1864 addresses a serious, urgent risk. The ability to order custom DNA sequences online enables highly impactful, innovative research. In my lab, we routinely use these services. But for more than 20 years, we've also known they can be misused to cause grievous harm. I was a founding member of the U.S. National Science Advisory Board for Biosecurity that issued a report on this topic in 2006. The genetic blueprints of dangerous viruses and toxins like smallpox, Ebola, and ricin are freely available online, and so are the procedures needed to recreate them in the laboratory. I tell my students I believe they'll face a human-made epidemic, or maybe even a pandemic, within their lifetimes. Fortunately, it's not too late to act. As we wrote back in 2006, companies can screen their orders to detect dangerous pathogens, and they can check to make sure those pathogens are going to legitimate researchers. Many companies already conduct rigorous screening voluntarily, but there is no legal requirement to do so anywhere in the world. This means that the DNA needed to create Ebola is less regulated than the penicillin at your pharmacy. That's what AB1864 is about, ensuring all gene synthesis companies meet the same basic requirements to protect Californians and the nation. I urge you to support this important initiative. Thank you.

Good afternoon, Madam Chair and members of the committee. Thank you for the opportunity to speak in support of AB 1864. My name is Ben Snyder, and I'm here today with ENCODE AI, a co-sponsor of the bill. ENCODE is a youth-led advocacy organization focused on advancing safe and responsible artificial intelligence development. Last year, we co-sponsored Senator Wiener's SB 53, a first-in-the-nation frontier AI transparency bill signed into law by Governor Newsom. One key risk SB53 addressed is the ability of AI systems to provide expert advice on creating biological weapons Last June the California report on frontier AI policy noted unclear but growing evidence that AI could enable biological attacks And the very companies building this technology warned that their systems, to quote open AI, are on the cusp of being able to meaningfully help novices create known biological threats. But guardrails on AI models are just one imperfect defense against a problem that long predates AI, as you heard from Dr. Relman. That's why AB 1864's gene synthesis screening requirements are so important. AB 1864 would align California law with federal guidelines to prevent misuse of benchtop synthesis equipment and gene fragments from dangerous pathogens, without restricting access for legitimate researchers. Screening has been recognized as industry best practice since 2009 and is supported by a wide range of scientific and industry leaders. Names like James Diggins, a senior executive at California-based gene synthesis firm Twist Bioscience, Dario Amadei, CEO of Anthropic, and David Baker, Nobel Prize-winning biochemist, have all spoken out about the importance of mandating or standardizing gene synthesis screening. Yet no jurisdiction has created a legal requirement to screen. I ask you to vote aye on AB 1864 and establish California as a global leader on this critical issue. Thank you.

That's an excellent question. Thank you, Dr. Patel. The bill points to this 2024 federal framework, which defines initially sequences of concern as those corresponding to regulated agents and pathogens. However, it includes a provision that goes into effect in October 2026, so it would be included in this bill if it were to pass, that instructs or requires providers to additionally make efforts to screen for known sequences that contribute to the pathogenicity of agents that are not regulated. So there is some provision there that's flexible, and certainly there are efforts underway internationally. So there is an international standards body that's working to define sequences of concern here that could take a sort of forward-looking perspective on this, and that would help shape the sort of international and industry best practices that companies might be expected to comply with. But this bill itself does not directly build in pathways to deal with those sorts of things.

Thank you, Assemblymember. The bill, as currently written, speaks to sequences that are a best hit to one of these known pathogens and does not have an exact hit to a non-worrisome non-pathogen. And so, no, there is no specific percent sequence similarity threshold. It is simply a screen for sequences that likely are associated with a pathogen and pathogen effects. But that would simply trigger a process that would then lead to a greater degree of scrutiny and presumably adjudication in an appropriate fashion. And certainly we've seen the technology with AI increase to the point where we can now throw in a DNA sequence and know what kind of protein structure we're going to get out of it. So it's very exciting to be able to put these types of tools together to help keep people safe. Thank you for bringing this bill forward.

Thank you for the questions. Thank you for the comments and encouragement to consider different both procedural and policy issues being raised. Happy to give consideration to the urgency clause request or suggestion, I guess. agree that this is an urgent issue. And so I can see the need for that. Appreciate the comments about, you know, how can we make sure that we somehow in the bill reference other, you know, lists or databases that are more living, breathing documents, because this is a constantly evolving kind of threat dynamic and want to make sure that we, you know, that our ability to react to that continues as well. So that's a great point. Appreciate the concerns raised by the opposition And, you know, these are industries and companies in or around my district and that I think are incredibly important to California and Californians and want to make sure that we don't have anything in the bill that unnecessarily delays their ability to do the life changing work that they're doing. We've had conversations with them. We've asked them to maybe give us some more specific examples of how this might either cause them to postpone the work that they're doing or make the cost of that work so unnecessarily burdensome. from our perspective. That should not happen. The cost should be de minimis. And there should really be no delay for a lot of the companies. There won't be any question about whether or not they are a legitimate customer of this synthesized DNA and RNA, but open to hearing from them about how specifics, how this might actually stop them from being able to do their work. So we'll continue having those conversations with them and make sure that the bill doesn't bring in unintended consequences from good actors, but that protects Californians from bad actors. I respectfully ask for your aye vote. Thank you.

Good afternoon, Madam Chair and members. I Dr Jeremy Sanchez board pediatrician in Sacramento with a Master of Public Health I pleased to speak in support of AB 2302 by Assemblymember Celeste Rodriguez While the FDA regulates aspects of infant formula, such as nutritional content and bacterial safety, it doesn't currently require routine manufacturer testing of toxic elements such as lead, arsenic, cadmium, and mercury. This gap matters. Even very low levels of these contaminants can harm infants whose developing nervous systems and higher absorption rates make them especially vulnerable. In the worst cases, these can lead to lifelong neurodevelopmental delays. In my practice, I care for many newborns whose families rely on formula as their primary source of nutrition, and they deserve to know that it is as safe as possible. In a 2025 analysis by Consumer Reports, nearly half of the formula tested had potentially harmful levels of at least one contaminant, including those in this bill. Three of the nation's largest formula manufacturers had products in both the best category with no or low levels of contaminants and the worst category with concerning levels of contaminants. This shows that manufacturers can make a formula without contaminants and are already doing it, but only for some of their products. Recently, California's attorney general reached settlements with two large formula manufacturers after lead was found in their products. AB 2302 builds on this progress by creating a consistent standard requiring testing and transparency for all manufacturers, not just a few. All babies deserve, excuse me, all babies deserve nutrition without harmful contaminants. As a pediatrician, I want to give parents full and clear information about the formula they feed their babies. I respectfully ask for your support of AB 2302. Thank you.

Are there others in the hearing room who would like to offer support as a Me Too? Please come forward. Nora Angeles with Children Now, proud sponsor of AB 2302. Three other organizations wanted me to list their support are Green Challenge, Clean Water Action, and Breast Cancer Prevention Partners. Thank you. Christopher Sanchez on behalf of the Consumer Federation of California in support. Sarah Diaz with the California WIC Association in support. Good afternoon, April Robinson with the Voice for Choice Advocacy in support. Hello, Susan Little with the Environmental Working Group in support. Thank you. We will now move to opposition. Are there any primary witnesses in opposition who would like to offer some testimony? Thank you. We'll each have two minutes. Thank you. Good afternoon, Madam Chair. Missy Johnson on behalf of the Infant Nutritional Council of America, Inca, as it's known. And by the way, we're all for babies. I have a baby. I had a baby. I have a grandbaby, so we all support babies. Inca represents several leading domestic manufacturers of infant formula, which is already the most highly regulated food in the U.S. supply chain. Infant formula is regulated in a way that baby foods under – It's regulated under federal law in a way that baby food currently isn't. And the industry currently tests for heavy metals under various international standards as a part of our longstanding commitment to provide safe infant formula products. As the results of those tests show, our products comply with heavy metal standards established by the European Safety Authority, the European Commission, Joint FAO slash WHO Expert Committee on Food Additives and Codex. While we appreciate the intent of this bill, this proposal overlooks important differences between infant formula and the baby foods that are currently regulated by California law. AB 2302 mirrors those requirements for baby food, but we have FDA-mandated controls that those products are not currently subject to. For example, there are current FDA regulations that help guard against high levels of heavy metals in infant formula. The FDA's infant formula good manufacturing practices and regulations established under the Food Safety Modernization Act requires that manufacturers conduct hazard analysis and establish risk-based preventative controls, including raw material hazards such as potential for heavy metal contamination. The FDA recently announced its intent to set formula-specific action levels as a part of Operation Stork Speed, an effort that we support. HHS also announced that it will publish a report in April on heavy metals which is a precursor to federal action on setting levels Infant formula manufacturers must follow sanitary controls that are required by the FDA to prevent contamination of infant formula during manufacturing. The FDA inspects facilities that make infant formulas on a routine basis, including unannounced surprise inspections. The FDA has specific requirements for infant formula labels. The information on the labels that is most helpful caregivers includes directions for preparation and use, and the labels are also required to provide information that is truthful and not misleading. We are concerned that AB 2302 would require infant formula to bear a statement about toxic element testing. The word toxic is not only inaccurate as it relates to trace levels of heavy metals in infant formula, but potentially alarming for parents. Again, the FDA has stated that heavy metals in formula did not indicate a public health concern. Absent such a demonstrated concern, requiring formulas to bear the word toxic might mislead parents and caregivers into thinking that these products are unsafe. Thank you. Sorry. And I also have with me Craig Filner of Inca to answer any questions, technical questions that the committee may have. Thank you. We'll have two minutes. Thanks. I don't have much to add. I'll just make a couple comments, and then we could maybe move to some questions if y'all have them. It's been raised today about a Consumer Reports piece. I think it's a great example of how talking about heavy metal, especially with new moms and dads, because people are very anxious, All the formulas of our members in the CR report were testing under European standards, but they were considered concerning or elevated in the article, but they were all under European standards, which is the strict standards that we all test under. Also, just real quick, I just want to, for an analysis here, I want to just highlight something. What we're talking about for infant formula is trace amounts of heavy metals in infant formula. To visualize it, it's like one grain of sand in a pile of 730 pounds of sand. And so I just want to highlight one more thing. It was talked about that FDA hasn't set levels yet. We do think they're going to issue a report in April. That's the precursor for that. But also, unlike baby food, we have regulations that we test our ingredients right when it comes to the facility. And so there's a big difference between baby food, which is treated just like a food in the grocery store, and infant formula that has pre-market approval. And with that, I'll answer any questions. I thank you for your time. Thank you. Others in opposition in the room would like to offer a Me Too in opposition on this measure? Seeing none, I can bring it back to committee for any questions or comments. Assemblymember Sharp Collins. Thank you. Permission to share a photo? Please. This is baby Valentina. Oh. and because of her and also her mother i will be supporting this bill today because i believe we need to do better for health of our children infant formula is a needed product to support babies and mothers in the beginning of their developmental stages and as we know families are balancing other variables during early childhood and so they they should not have to have the added weight of toxic material seeping in into the baby's nutrition you know when we talk about a mother breastfeeding and other options we always make sure that they are educated on what not to put into their body to make sure that the kids can be properly nurtured. So our state has a long history of holding industries accountable, and this should be no different, especially as we are talking about food for our future leaders. So accountability, in my opinion, is not optional. It is the responsibility. So transparency must be our top priority, and California families deserve to trust us and know that we're fighting for their health. And so I would like to thank the assembly member for bringing this bill forward and granting permission to share that this is the beautiful soul. That's also part of the reason why this bill has been pushed forward to make sure that she has proper nutrition. So with that, I am supporting the bill. Thank you, Assemblymember. Assemblymember Dr. Patel. I do have a few technical questions that I'm going to ask. One of them is with the FDA thresholds imminently coming out, we are currently using European standards, which arguably tend to be more protective than stateside standards. Is that correct? Correct. And so then when we look at what's currently being done, are you saying that the formula undergoes more rigorous testing now than baby food standards? I really can't speak to baby food because they're just not a member of ours and I'm not that versed in it. But with respect to infant formula, absolutely. It's a pre-market approved product. It's more scrutinized than any other product in the grocery store. And I just want to paint a quick picture. Under the current program that California has with testing and reporting of heavy metals and baby food, a mom or dad can be in a grocery store and they can maybe scan a QR code. Maybe they can if they can understand the parts per million parts per billion, understand that if they're if it makes them anxious, they can put it down because there's so many options. Once you get through an older infant into a baby, what I'm trying to just show concern with today is with respect to infant formula, which is the sole source of nutrition other than breast milk. If a mom or a dad is in a store and they're trying to figure out parts per billion, parts per million, and they don't quite know what it means, but maybe they just found out for the first time that heavy metals is actually in infant formula. It's also breast milk, by the way. It's omnipresent. It's in the animals. It's in the water. It's in the land. They might find out for the first time they're at that store, and it might make them really anxious. We don't want them to put down the can and Google homemade recipes or go grab some almond milk or something like that. And so that's the that's the scenario I'm trying to articulate. So I appreciate the question. Thank you for that. To our witnesses in support of this measure, do you have a response to that? Carly Clemens with Children Now. I would say that we trust parents and caregivers to be the experts on their own family, and they are capable of understanding information when presented to them. And these QR codes would not simply direct to a number with no context As the language currently stands it would also include a link to the FDA website for additional guidance So currently though the FDA doesn have guidance around allowable amounts though. So would it point to the European standards for now? The FDA does have the Closer to Zero program, which sets levels for other products, and there is context around those levels. So it would not simply be one part cadmium per billion. there would be levels for other products that would at least provide some context. And I would just say as well that parents are already afraid. There were headlines last year where children were hospitalized in 12 states with botulism because of infant formula. Several years ago, two babies died because of infant formula or bacteria in infant formula. And we know that infant formula is regulated closely for microbial contamination. Parents deserve the information they need to feel good about the decisions they're making. And we trust them to be able to make those decisions for their own families. One clarifying question around that. I probably have a couple more if you don't mind. One of them is when we look at those parts per billion, we don't have a, as a society, it's really hard to extrapolate of what is a safe, allowable amount without something actually being put there. Even when I get a blood draw, for example, and I see iron levels or calcium levels in my own blood, If not for that beautiful little chart that pops up that says you are in the appropriate range, I wouldn't have a good understanding of that. So I want to empower our consumers to be able to be empowered with that information. The specific information that the QR code is tied to, is that for that exact batch? It is, yes. Okay. And I would say as well, as Dr. Sanchez noted in the Consumer Reports analysis, there were formula products that had no or low level of contaminant. And I think that this would give formula manufacturers the opportunity to highlight that for parents, that when they did this testing, there are formulas that do not have levels of concern. So while seeing that there are levels of concern could scare people, that is not true for all formula products. And I would say as well, while there were outliers in the Consumer Reports results, one of the most egregious outliers was that there was a formula that had twice the level of arsenic that the FDA allows in bottled drinking water. So while we cannot make these Apple storages comparisons for some of these levels, I think that is one that speaks to the concerns here. And certainly that raises the question of powdered formula and the sourcing of water that people use to reconstitute their powdered formula. And knowing that maybe the powdered formula level might come in below the threshold, and the water may independently come in below the threshold, but in combination it might raise to a level of concern. And so I just want to make sure that as we're moving forward with keeping babies safe and making sure that they have the best chance developmentally to thrive in California, that is ultimately my goal. I want to make sure that we're giving our consumers information that they can also digest and understand and empower them. I'm a big champion of general public science literacy. I think we need to increase the awareness for our residents out there to understand what these metals can do, what other toxins can do in the environment. So appreciate that you have this belief that consumers will know what to do with that information. I think we need to continue to educate our consumers as well. Thank you. Thank you. Assemblymember Schiavo. I wanted to thank the author wherever she may be for this bill taking care of a baby a cute baby and you know as a mom and I remember being a first time mom it's terrifying. You want to really make sure that your kid is safe. I think that it's really important that we have these protective practices, and we know that manufacturers are able to do it, are able to create formula safely, and we want to make sure that that is all formulas. I would say I also agree around the concern of parents being able to parse that information and understand it, right? Because I think that a lot of times we're putting a lot on parents to understand a lot of things. And, you know, I look at things that are about parts per billion and parts per million quite a bit because of the burning landfill in my district. And if you don't know what is a safe level of benzene, is it parts per million or parts per billion and how many, then you can get very easily alarmed if it's on the wrong scale. And so I would just say, I hope maybe there can be some kind of clarifying language to make sure that that's made explicitly clear that the safe levels are really clearly stated and supplied to parents so that they can very easily and quickly. Because if you're a new mom shopping in the store, scanning a QR code, trying to figure out what's safe, making it really easily understandable and clear and legible, I think is really critical to make sure that they have the information they need to make safe choices for their babies. So thank you so much for your work on this, and I'm happy to support today. Can I respond briefly? Did you have a response? Sure. Yeah. I would just say, And, you know, what we're trying to caution about today is when moms and dads are making decisions, normally, my kids are older now, but like when moms come to a decision to go to infant formula, either they're not able to breastfeed or maybe they're going back to work or for whatever reason, maybe they've adopted a child. That usually doesn't come lightly. And so what we're cautioning about is as the sole source of nutrition, other than breast milk, that we make that process the easiest for moms and dads that we can make it. And I can unequivocally tell you that our members test under the International European Union Standard. So I just wanted to let everybody know that while the U.S. FDA is going to set standards this year, for years now we have been – our members have been testing under European standards, which are the strictest in the world. So thank you so much. Thank you. Assemblymember Patterson. Great. Thank you. So just to clarify, because, you know, like many in other committees, this bill currently, even with the committee amendments, doesn't have some kind of like scale of whatever the number would mean. The heavy, you know, parts per million or whatever doesn't have that currently written into this bill. Is that correct? That is correct. And I think it's worth mentioning that we will be aligning the bill language with the current FDA guidance that we hope is forthcoming very soon to the extent possible. But to answer your question, yes, that's currently stands. Okay Yeah I mean you know I like the concept of the bill You know think uh you know all my all my kids were uh on formula um you know and by the way there like an entire society out there that basically shames women who, uh, use formula. And I think that's shameful. Um, but, um, but anyways, you know, I, I think breastfeeding is just great, you know, for if that's possible, But anyways, all of that tirade aside, I have – I just bought this ring here, this Aura ring, and I have an Apple Watch, and it provides me with a lot of data about my health that I really have no idea how to interpret. it, you know, and so I think that that's my concern, you know, with the bill as written right now is I definitely I spent a lot of time, you know, researching fumes coming out of mattresses, whether that was like, going to cause SIDS, you know, and I spent up countless nights thinking about that exact issue, because I didn't really know how to interpret whatever data was coming out of whatever conspiracy theories I was reading that day. But that's how important my kids are, you know. So I think, you know, this bill, I think, does kind of set up for crazy people like me that can't really interpret the data, you know. And so I kind of support where the bill is going. I just am going to lay off today because I think it's not currently setting up the parents, I think, for anything other than concern, to be honest with you. Can I comment briefly? Sure. You asked about what the language says in the bill. One thing that Missy talked about was the requirement that we label our products with, say, toxic elements. Click here. As we all know, given that it's omnipresent, there are trace amounts of heavy metals in infant formula. But as a lot of folks know, the toxicity of a particular element is the duration that you're exposed to it and the level that you're exposed to it. So, and Missy also talked about how we have to be truthful in our labeling. So that's one of the big concerns that we have, too, is that we do not believe the trace amounts that we account for and we test under is a toxic element. Appreciate that. I want to also just recognize that Consumer Reports just tested 41 types of formula, and they found that half had potentially harmful levels of contaminants. I think it's also very important to note that half of them had low or no levels of concerning chemicals. So when we talk about single source of nutrition, there are at least 20 products out there that have the ability to not be tagged with having potentially harmful levels of contaminants. So there are many options available for individuals, and I want to appreciate the proponents' testimony in that regard. I also want to just acknowledge that we had in the Me Too's for support, the WIC Association come up and offer a Me Too in support. I can't imagine any other organization or entity that probably sees more new mothers and addresses their concerns around providing nutritional opportunities for their children than WIC in that regard. And it carries a great amount of weight for me that they also were in support of this legislation and kind of belies the notion that new mothers are so scared that they might be scared out of giving their children some options when there are apparently 20 options available to be able to provide care for them I want to acknowledge and say hello to our Assemblymember Celeste Rodriguez and Valentina, and thank you Assemblymember Sharp Collins for bringing Valentina into this conversation, because as a new mother, Assemblymember Rodriguez is bringing this forward as an item that she cares deeply about for all mothers in the state of California. And with that, Assemblymember Addis, thank you so much for being willing to present on this bill. Would you like to close? Thank you so much, Madam Chair. I know that the author is committed to continuing the conversation around concerns raised by opposition. I think this is maybe Valentina's first time on TV, but I don't think it's going to be her last. She has big shoes to fill as she follows in her mother's footsteps. But I think the legislature and this committee have made it clear that we support protective measures to ensure that what we're giving to our babies is healthy and is going to help them develop. And so with that, on behalf of Assemblymember Rodriguez, I respectfully request your aye vote. Thank you. This needs a motion and a second. Moved by Aguirre-Curray. Seconded by Gonzalez. The motion is due pass as amended to the Environmental Safety and Toxic Materials Committee. Bonta? Aye. Bonta, aye. Chen? Addis? Aye. Addis, aye. Aguiar Curry. Aguiar Curry, aye. Pacheco. Pacheco, aye. Coloza. Carrillo. Gonzalez. Gonzalez, aye. Johnson. Patel. Patel, aye. Patterson. Rogers. Aye. Rogers, aye. Sanchez. Aye. Sanchez, aye. Chiavo. Chiavo, aye. Sharp Collins. Sharp Collins, aye. Stephanie. Stephanie, aye. That measures out. Thank you so much on behalf of Assemblymember Rodriguez, Assemblymember Addis. We are going to move on now to item number two, AB 1607 by Mark Gonzalez. Whenever you're ready, Assemblymember. Thank you, Madam Chair and members. Thank you for the opportunity to be here with you all today. I want to start by saying that I'm happy to accept the committee amendments. My team has had thoughtful, productive conversations with the opposition, and I want you to know that I hear those concerns and I'm committed to continuing the dialogue as this bill moves forward. At the end of the day, though, this is about people. single person who walks into an emergency room, no matter who they are, no matter what they have in their pocket, they are seen and they are treated. That's not policy. That's just who we are. But here's the reality that we don't always say it out loud. Emergency rooms across California are seeing nearly 15 million visits a year. About one in five of those patients has no insurance. Changes to the Medi-Cal as a result of HR1 are estimated to drastically increase the number of uninsured on its own in seven years implementation period. So when someone can pay who fills the gap That where the MADI fund comes in It quiet but critical lifeline that helps keep emergency care afloat keeping doctors on shift ambulances on the road and trauma care available for our kids through the Richies Fund And it's funded in a simple, modest way, just a small add-on to court fines. Nothing extravagant, but the impact is life-saving. AB 1607 is straightforward. It doesn't expand the program. It doesn't reinvent the wheel. It just gives us more time. More time to keep this lifeline in place. more time to make sure our emergency rooms don't fall further behind, more time to protect access to care when people need it most. Because without it, we're asking for a strained system to do even more with less, fewer physicians, longer wait times, and higher costs that ultimately hit us all. Right now, again, to reiterate, with millions of Californians at risk of losing their health care insurance, we know what's coming. More people will turn to emergency rooms as their only option. So this moment matters. This bill is about being ready. It's about making sure that when someone calls 911 on the worst day of their life, we're not debating whether we can afford to show up. We just do. This afternoon, primary witnesses in support. To highlight the impact of the bill is Elena Lopez-Guzman, Executive Director of the American College of American Physicians, Emergency Physicians, excuse me, California Chapter, and John Polad, Regional Executive Director of Sierra Sacramento Valley EMD Agency. Thank you. Good afternoon, Madam Chair and members, Elena Lopez-Gussman, on behalf of the California Chapter of the American College of Emergency Physicians. About 21 years ago, then-Senator Richard Aralcon introduced SB57, the predecessor to this bill. He had lost his three-year-old son as a result of a traffic accident. And at that point in time in L.A. County, six hospitals and emergency departments had closed over the prior 14 months. He was quoted in the LA Times as saying, everyone knows that emergency services and trauma care centers are slipping away. This is my effort to get dollars into the system and save some additional sites from going under. Here we are 20 years later on the precipice of another catastrophe in the emergency care safety net. Last April, Rand published a report on the challenges that EDs are facing nationwide. According to Rand, and I quote, the viability of emergency care as we know it is at risk. To preserve emergency care quality and coverage, policy action is needed on multiple fronts, end quote. That study was published before the passage of H.R.1. I don't need to tell this committee what we're facing in California as a result of the cuts from H.R.1. Billions of dollars to the hospital-based health care delivery system will be gone. 2 million people will lose their health care insurance. Underserved and underprivileged folks who will have nowhere to go but the emergency department. My members are proud to stand on the last line of defense and not ask questions about whether people can afford to pay when they walk in the door and provide the coverage. But that coverage is predicated on there being some funding from someplace, as the author mentioned. and the funding, while it is tied to a particular individual's visit, doesn't affect the care that the patient gets. It affects all of us the same. When we walk in the door, we're treated based on the severity of the condition, not based, I heard the beep, not based on whether or not we can pay, and so if only one doctor can be there, that affects us all. Appreciate the passage. Hello, Chair Bonta and Assembly members. My name is I'm Paulin, Regional Executive Director of the Sierra Sacramento Valley EMS Agency, a local EMS agency serving 10 Northern California counties. I'm here speaking on behalf of the Emergency Medical Services Administrators Association of California, representing all 34 local EMS agencies covering all 58 California counties. As already mentioned, in 1987, the legislature concluded that EMS providers, including physicians and surgeons and hospitals, as part of the requirement to provide emergency medical care to all patients, regardless of their ability to pay, bore higher costs for their services, but often received only partial or no payment for patients. As a result, the legislature enacted a series of laws to compensate EMS providers, physicians, surgeons, and hospitals for patients who cannot pay for their medical care. California law authorizes counties to establish a MADI-EMS fund to reimburse physicians, surgeons, and hospitals for the cost of uncompensated emergency care and for other essential EMS system purposes. It also authorizes counties to establish a Ritchie's fund as part of their MADI-EMS fund to provide funding for pediatric trauma centers throughout the county. If no pediatric trauma centers exist, the funding must be used to improve access to and coordination of pediatric trauma and emergency services in the county. Expenditures from the Ritchie Fund are limited to reimbursement to physicians, surgeons, and hospitals for the cost of uncompensated pediatric care. The Maddie EMS Fund and Ritchie's Fund are funded through revenues generated from local penalty assessments on fines and forfeitures for various criminal offenses and motor vehicle violations. The revenue generated also includes a portion of traffic school fees collected by the courts and forwarded to the counties. The regional authorization for the additional penalty assessment was previously extended through January 1st of 2017 and again until January 1st of 2027. EMS is a vital component of California's health care safety net. at a time when EMS providers are having to reduce or cease providing essential services. Hospitals are closing at a significant risk of closing and uncompensated care, and the impacts of H.R. 1 is an imperative that current sources of EMS system funding be maintained. Thank you. Thank you. Are there others in support of this measure? Please come forward. Madam Chair, members, Awa Kidani with Lang Hanson, Lang Hanson, Jeroe Kidani, representing the California Children's Hospital Association. Strong support. Thank the author. Good afternoon. Christy Weiss, Capital Advocacy, on behalf of the California Hospital Association, in support. Good afternoon. Kelly Macmillan on behalf of the American Academy of Pediatrics California and the Children's Specialty Care Coalition. Clifton Wilson on behalf of the Napa County Board of Supervisors in support. Thank you. Justin Paddock on behalf of Yolo County in support. Farrah McDade-Ting on behalf of the County Health Executives Association of California in support. Kevin Guzman on behalf of the California Medical Association. Thank you. Are there any primary witnesses in opposition? Are there any Me Too's in opposition that would like to register? Seeing none, I will bring it back to the committee for any questions or comments. Moved by Rogers, seconded by Pacheco, our subs. Get that one. Assemblymember, Majority Leader, Agi Akari. Thank you for bringing this bill forward I know these works on these bills are so important but I just want to remind everybody the MAD fund provides critical support to our emergency rooms across the state and especially in rural areas like my district. That said, I understand the concern that the way this is funded may be regressive and appreciate the chair's amendment to extend the sunset for just 10 additional years. I'm not going to lie, I have a problem with the 10 years because since many of us on this dais will not be here in 10 years, I want to make sure that it continues. And so Assemblymember Gonzalez, when you're out of here in 10 years, can you make sure that you up this again? Because it would be a shame that it wasn't. So if I had it my way, I wouldn't want a sunset on it, but I'm not in charge. From your lips to God, dear, I'm here in 10 years, yes. Absolutely, and thank you. I'll be supporting your bill today. Thank you for your comments. Well, thank you. I want to note, Assemblymember, that this bill is actually going to go to public safety after this, and I'm sure that they will address the source of the funding of this very important bill to ensure that we have funding in our EMS fund. With that, would you like to close? Thank you, Madam Chair and members. Illness doesn't ask for your insurance card. A stroke doesn't pause for payday, and our doctors can't wait. Every second counts. When someone calls 911, they don't care about paperwork. A child in trauma doesn't wait for a billing cycle. Every heartbeat, every breath, every second matters. AB 1607 keeps that lifeline strong. This fund is small, but it keeps emergency rooms open, ambulances rolling, and lives on track. It's a lifeline we can't afford to lose. I respectfully ask for your aye vote. Thank you. We have a motion and a second. Please call the roll. The motion is due pass as amended to public safety. Bonta? Aye. Bonta, aye. Chen? Aye. Chen, aye. Addis? Aye. Addis, aye. Aguiar Curry? Aye. Aguiar Curry, aye. Pacheco? Aye. Pacheco, aye. Coloza? Coloza, aye. Carrillo? Gonzalez? Gonzalez, aye. Johnson? Johnson, aye. Patel? Patel, aye. Patterson? Patterson, aye. Rogers? Aye. Rogers, aye. Sanchez. Sanchez, aye. Chiavo. Sharp, Collins. Stephanie. Stephanie, aye. That measures out. Thank you. We are going to now hear item number nine, AB 2066 by Celeste Rodriguez. I will be presenting and handing over the gavel to our vice chair, Chen. Thank you. Thank you very much, Madam Chair. Your pleasure. Thank you, committee members. I'm presenting AB 2066 on behalf of Assemblymember Celeste Rodriguez. The Assemblymember would like to thank the committee for their work on this bill. AB 2066 recognizes pregnancy as a qualifying life event, allowing individuals to enroll in or adjust their health insurance when they need it most. This will ensure pregnant people have timely access to the care and coverage essential for a healthy pregnancy. Under current California law individuals can enroll in or make changes to their health insurance only after experiencing a qualifying or triggering life event These include when a person gains a dependence such as the birth of a child gets married or adopts a child Enrollment in health plans is restricted to set periods. Without a qualifying event, individuals must wait until the next annual enrollment window to sign up or make changes. Access to prenatal care cannot wait. Research has shown that timely access to prenatal care results in better outcomes for both the mother and the child. When antiquated enrollment rules delay timely access to prenatal care, the consequences can include preventable risks for both the pregnant individual and the child. Today, we will hear in support of AB 2066 from Dr. Neal Arendt, certified nurse midwife and member of the United Nurses Association of California, Union of Healthcare Professionals. Move the bill. The bill has been moved and seconded. Thank you. Key witness, at your pleasure. Good afternoon, Chair Bonta and members of the committee. My name is Neal A. Rant. I'm a member of the United Nurses Associations of California, Union of Healthcare Professionals, and I have worked as a certified nurse midwife for the past 24 years. I also hold a PhD in international health with a focus on perinatal HIV, hepatitis, and other infectious diseases. I am here in support of AB 2066, and I am also a constituent of Chirapontas. Throughout my career, I have worked across a wide range of health care settings, from caring for uninsured populations to Medicaid patients to those with private insurance. I have also practiced in Australia, where universal access to health care is guaranteed and outcomes are among the best in the world. Currently, individuals who become pregnant outside of Covered California's annual open enrollment period or who experience gaps while transitioning between coverage types during the perinatal period often have no pathway to obtain timely insurance coverage. This creates a critical and dangerous gap in care. AB 2066 will rectify this, closing these gaps. Timely access to prenatal care allows us to diagnose and treat infections, identify ectopic pregnancy, risks for preterm birth, and manage conditions such as diabetes and hypertensive disorders that can have serious long-term consequences for both parent and baby if left untreated, as well as ensuring that people are enrolled in postpartum care. Without insurance, patients delay care, miss critical screenings, and often present later in pregnancy with more severe and preventable complications. These gaps in care are what lead the United States to rank 55th in quality of maternity care in the world, which is abominable. In fact, 80% of the maternal deaths in the United States were preventable. Members of our Black, American Indian, Alaska Native, and Asian Pacific Islander communities are two to five times more likely to die from pregnancy-related complications than their white counterparts. Thank you. If you could please start wrapping up, ma'am. Oh, yes. Thank you, Doctor. Sorry. These gaps disproportionately affect Californians who are already experiencing health disparities, further exacerbating existing inequalities. Thank you Any others in support Hi, Kelly Macmillan on behalf of American Academy of Pediatrics, California, in support. Good afternoon, Mr. Chair and members. Janice O'Malley with AFSCME, California, in support. Thank you. Ryan Spencer-Path, the American College of OBGYNs, District 9, in support. Natalie Pita on behalf of the California Academy of Family Physicians in support. Kevin Guzman with the California Medical Association in support. Emily Majey of UNAC-USCP and also RN Family Nurse Practitioner in strong support. Thank you. Thank you. Do we have any witnesses in opposition? Seeing none. Oh, I apologize. Good afternoon, Chair and members. Matt Akin here on behalf of the Association of California Life and Health Insurance Companies, regrettably here today in opposition to Assembly Bill 2066. While we sincerely appreciate the intent of the bill, we have significant concerns about its potential impact on the health insurance market. AB 2066 would make pregnancy a triggering event for enrolling in or changing a health plan. Currently, special enrollment periods are limited to broad qualifying life events, such as marriage, relocation, family expansion, or losing employer-sponsored coverage. These rules are specifically designed to maintain market stability without tying access to coverage to a specific medical condition. This bill would move California toward condition-based enrollment, favoring certain conditions over others, and setting a precedent the governor raised concerns about when vetoing similar legislation last year. The key part of keeping coverage affordable is encouraging people to maintain insurance even when they do not have an immediate medical need. In its current form, this bill risks undermining that goal by allowing coverage to be delayed until it is needed. For these reasons, we respectfully oppose the bill, but we do look forward to continue dialogue with the author and staff if it does move forward today. Thank you very much. Vice Chair and members, Olga Shiloh on behalf of the California Association of Health Plans. I'd like to align my remarks with those of my colleague from ACLIC and share our perspective, particularly on the cost. We sincerely appreciate the intent behind AB 2066 to enhance access to maternal health coverage, But we do want to highlight findings from the state's independent analyst, Chiburb, which looked at a nearly identical proposal last year. Their analysis found this policy would increase health care spending by about $70 million annually statewide. And for consumers, that translates to roughly a $2 per member per month increase in premiums in the individual market. That may not sound like a lot, but those costs don't just affect one group. They do spread across all enrollees. And at a time when affordability is already a major concern, even a small increase like this start to add up and compound over time. Chip Rupp also pointed out to a broader dynamic, when people can wait to enroll until they know they'll need care, such as during pregnancy, it increases adverse selection. And it ultimately puts upward pressure on premiums for everyone. California's system is really designed to encourage continuous coverage. not just enrollment at the point of need. This bill shifts that balance and introduces new cost pressures into the market. For those reasons, we respectfully remain opposed, but we look forward to continuing Thank you. Thank you very much. Do we have other folks in opposition in the audience? Seeing none, I'm going to take us back to committee. Assemblymember Rogers. Thank you so much, Mr. Vice Chair. With all due respect to the opposition, my wife had a change of life circumstances when she married me, which was disruptive, but not nearly as disruptive as when she got pregnant, I can promise you. I would love to be at it as a co-author. I think that when we talk about maternal health, it doesn't even just start with the pregnancy. The data is very clear that access to care prior to conception has huge outcomes for both the mother and the child, and that if we are serious about supporting families in this state, this is a very minor tweak that can be made to have a better outcome for folks. So with that, I'd be more than happy to support the bill, and I hope our colleague is watching from home. Assemblyman Patel. Thank you for bringing this bill forward, And I continue to be surprised that pregnancy is not already a life-changing qualifying event for health insurance. I think many families that knowingly are family planning already are on the insurance that covers and meets their needs because they want to be ready and prepared for when that happens. But for those who were not expecting pregnancy and all of a sudden find themselves pregnant, it is absolutely a qualifying event. And we know from history, from something as basic as addressing cleft lip and cleft palate with vitamin B in prenatals, we know that there are cost-saving measures that will come out of families, mothers, expecting mothers being able to access prenatal care at a quality and level which will help improve outcomes for children as they grow. So did the Chiburb analysis have anything, the previous year's one, did it have any extrapolation on possible cost savings for increasing the access to prenatal care? Thank you. Thank you. I think at this point we know the Traburpa analysis actually was referenced to a Wahab bill from the Senate last year that actually was quite a bit more extensive just on the opposition's point around the cost. And we assume that the actual cost, given the limitation to just looking at the eligibility for pregnancy, would be significantly lower. In response to your question specifically, Assemblymember, there is strong evidence that maternity services will improve outcomes for infants and mothers. And we know that there is significant preventative savings when mothers or those who might go from being uninsured to insured, which this legislation would allow to be able to happen. And also we know that there are significant cost savings when we have prenatal care, a part of what a mother is able to offer their fetus throughout the process. So we don't have in the TRIBURP analysis anything that speaks to that. But I think we know for sure that there are significant savings and better health outcomes for children when they able to receive prenatal care I certainly agree with that I mean I don have a fine point on those numbers but it not hard to imagine that there going to be significant cost savings long term With that, I would love to be added as a co-author. My team has sent Assemblymember Rodriguez an email, and we hope that this bill progresses. Thank you. Thank you. Salimra Addis. Thank you so much, and thank you, Madam Chair, for presenting this bill. And thank you, Assemblymember Rodriguez, for bringing two important bills forward today. I just think this is a wild conversation. I'm astounded we're having this conversation. And I did a little Google search. And actually, pregnancy used to be a preexisting condition where insurance companies could just deny you coverage up until the 2010s. We've made huge growth in the last 15 years. I'm astounded that we would be not just very easily making this easier for pregnant women, but one piece of data I wanted to bring up is that birth rates are declining across the U.S., and birth rates are declining in California in specific. And when we look at the population data, it's actually very precarious because our percentage of people 65 and above is increasing drastically. The percentage of working age people who about 20 to 64 is somewhat stagnant, somewhat the same. But the percentage of people zero to 18 is drastically declining. And the number one reason people say that they're not having children is cost. It's wholly to do with the economy and people want to be able to grow their families. It benefits our state and our nation to grow our families. So to have any kind of opposition on this bill, I'm just I'm really surprised. I find it totally wild actually sitting here listening to any kind of opposition on this. So obviously I support the bill. And thank you, Madam Chair, for presenting it on behalf of Assemblymember Rodriguez. Assemblymember Stephanie. Thank you. Yes, I perked up as well because I'm absolutely confounded by this discussion. I just don't understand how being pregnant can be compared to anything else or any other specific mental condition. It's the only one specific medical condition that can bring life into this world. So I am baffled by this conversation, and I just want to thank the author for bringing this forward, and I would love to be added as a co-author. Thank you. That's Eleanor Pacheco, then Leader Curry. Sorry, Chair. May I also ask to be added as a co-author? Thank you. Thank you. And Madam Chair, thank you for presenting this very important bill on behalf of Assemblymember Rodriguez. And Assemblymember Rodriguez, if you're watching, we miss you and just want to say hi. But I would love to be added as a co-author as well. So thank you very much. I'm baffled. More than happy. I'd like to be at as co-author, and I appreciate the author bringing it forward and you presenting it for her today. Thank you. Any other questions or comments from the committee? With that, Madam Chair, would you like to close? Thank you. I will start out by also noting that this is a priority of the California Legislative Women's Caucus, and rightly so. You know, there have been some instability moments in the markets recently. recently One is that we have a declining number of open labor and delivery units across the state of California which makes it more challenging for a person who is pregnant to actually identify a place where they might be able to safely give birth We also know that this legislation is partially in response to the decision of CMS to further truncate the enrollment period that has historically run from November 1 to January 31 to now only be from November 1st to December 31st. So a month matters in the life cycle of prenatal care. And I want to note that in that time, one might have been able to, through the open enrollment process, go and seek the ability to get on an insurance plan. I want to note that I often laud that California is always ahead of the curve in this regard in many policy areas. On this particular area. However, California will be joining 12 other states, Colorado, Connecticut, District of Columbia, Illinois, Maine, Maryland, New Jersey, New York, Rhode Island, Vermont, Virginia, and not the state, but Washington, D.C., with likely Massachusetts and Iowa also considering joining in that. A qualifying life event is certainly something that is transformative. I can't imagine anything more transformative than pregnancy to be able to be considered a triggering event. I would also, Assemblymember Rodriguez, like to be added as a co-author to this, and I will list here. I want to thank Assemblymember Rodriguez for bringing forward this very important legislation and for being inspired by your current birth to be able to allow us to be able to not only welcome Valentina, but also recognize that we have a lot of growth to be able to do here in the state of California. With that, I respectfully ask of the committee for an aye vote. Thank you, Madam Chair. The bill has been moved by Leader Curry and seconded by Sonia Patel. Secretary, please call the roll. The motion is due passed to Appropriations Committee. Bonta? Aye. Bonta, aye. Chen? Chen, aye. Addis? Aye. Addis, aye. Aguirre-Curray? Aye. Aguirre-Curray, aye. Pacheco? Aye. Pacheco, aye. Coloza? Coloza, aye. Carrillo? Gonzalez? Gonzalez, I. Johnson. Johnson, I. Patel. Patel, I. Patterson. Patterson, I. Rogers. Rogers, I. Sanchez. Sanchez, I. Chiavo. Sharp, Collins. Stephanie. Stephanie, I. That bill is out. Thank you very much. Thank you. I will note that that received unanimous and bipartisan support. With that, we have heard all of the bills on the agenda for today's hearing, so we will move to making sure that we are voting on everything now. We will start with the consent calendar. Secretary, please call the roll. We need a motion by Aguirre Curry, seconded by Pacheco. Thank you On consent Bonta Aye Bonta aye Chen Aye Chen aye Addis Aye Addis, aye. Aguirre-Curri. Aye. Aguirre-Curri, aye. Pacheco. Aye. Pacheco, aye. Coloza. Coloza, aye. Carrillo. Gonzalez. Aye. Gonzalez, aye. Johnson. Johnson, aye. Patel. Patel, aye. Patterson. Patterson, aye. Rogers. Aye. Rogers, aye. Sanchez. Aye. Sanchez I Shiavo sharp Collins Stephanie Stephanie I the consent calendar is out we will now move up to the starting and file item number item number one AB 1591 it has been motion and seconded and we are lifting the call motion is do pass to higher education Bonta I Bonta I Chen Chen I Addis Aye. Addis, Aye. Aguirre-Curri. Aye. Aguirre-Curri, Aye. Pacheco. Aye. Pacheco, Aye. Coloza. Coloza, Aye. Carrillo. Gonzalez. Gonzalez, Aye. Johnson. Aye. Johnson, Aye. Patel. Aye. Patel, Aye. Patterson. Aye. Patterson, Aye. Rogers. Aye. Rogers, Aye. Sanchez. Aye. Sanchez, Aye. Chiavo. Sharp, Collins. Stephanie. Aye. Stephanie, Aye. That measures out. Item number two, AB-1607 by Mark Gonzalez. We'll continue to be on call. We will move to item number six, AB-1864 by Berman. Lifting the call. Oh, adding on. Aguiar Curry. Aguirre Curry, aye. Pacheco? Aye. Pacheco, aye. Coloza? Coloza, aye. Gonzalez? Gonzalez, aye. Patterson? Patterson, aye. Chiavo? Sharp-Collins? That bill is still out. We'll move to item number 7, AB 2011 by Hart. Lifting the call. Aguiar Curry Aguiar Curry, aye, Coloza Coloza, aye, Gonzalez Gonzalez, aye, Patterson Sanchez Sanchez, aye, Sharp-Collins That bill is out Moving on to item number 8 AB 2030 by Lowenthal Lifting the call Coloza Coloza I Gonzalez Gonzalez I Patterson Sanchez Sanchez no Chiavo Sharp Collins item eight Sharp Collins I That measures out. Moving on to AB 2066, file item 9, Celeste Rodriguez for add-ons. Carrillo, Chiavo, Sharp Collins, Sharp Collins, I. Moving to item number 13, AB 2302 by Celeste Rodriguez. Coloza Coloza I Carrillo That bill is still out Item number 14 AB 2311 AB 2311 for add-ons Bonta I Bonta I Gonzalez Gonzalez I Patterson Sanchez Sanchez I Sharp Collins Sharp Collins I item number 16 AB 24 57 by Connelly for add-ons Aguiar curry Aguiar curry I Pacheco Pacheco aye Coloza Coloza aye Gonzales Gonzales aye Patterson Patterson aye Chiavo Sharp Collins aye that bill is still out and we will we will do a consent for Sharp Collins who's present Sharp Collins aye thank you Thank you, committee members. I know that you are wrapping up your participation on several committees. So, okay. All right. We're going to go through again. Okay. Just one more time. Consent. on consent Carrillo Carrillo I Chiavo item number one AB 1591 Carrillo Carrillo I Chiavo Sharp Collins Sharp Collins I Okay. All right. Item number two, AB 1607. Carrillo. Carrillo, aye. Schiavo. Sharp Collins. Sharp Collins, aye. Moving on to item six, AB 1864. Schiavo. Sharp Collins. Sharp Collins, aye. Item number seven, AB 2011. Sharp Collins. Sharp Collins, aye. Item number eight, AB 2030. Chiavo. Item number nine, AB 2066. Carrillo. Carrillo, aye. Chiavo. These are all for add-ons still. Item number 13, AB2302. Carrillo. Carrillo, aye. Item number 14, AB2311. Coloza. Coloza, aye. Item number 16, AB2457. All right. Thank you, committee members. We are waiting on one more committee member. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. We're going to move now for add-ons, and we will begin with consent calendar. Chiavo Chiavo I Item number 1 AB 1591 Chiavo Chiavo I Item number 2 AB 1607 by Gonzalez Chiavo Chiavo I Item number 8 AB 2030 by Lowenthal Chiavo Chiavo I Item number 9 AB 2066 by Celeste Rodriguez is. Shiavo. Shiavo, aye. Item number 16, AB 2457 by Connelly. Shiavo. Shiavo, aye. Thank you very much, Assemblymember, for the back and forth. Thank you, Chair. With that, we are adjourned. Thank you. Thank you.