Assembly Health Committee

Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Good afternoon and welcome to the Assembly Health Committee's hearing on Tuesday, April 7th. Before we begin, I want to make sure everyone understands our committee procedures to ensure we maintain order and run a fair and efficient hearing with the goal of hearing as much from the public within the limits of our time. We seek to protect the rights of all who participate in the legislative process so that we can have effective deliberation on the critical issues facing California. Rules of conduct by members of the public include no engaging in conduct that disrupts, disturbs, or otherwise impedes the orderly conduct of this hearing, engaging in personal attacks of members of this committee, authors, staff, or 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 and support must be those accompanying the author or who otherwise have registered a support position with the committee, and the primary witness and opposition must have their opposition registered with the committee per the instructions on our website. All other support and opposition can be stated at the standing mic when called upon to simply state your name, affiliation, and position. All testimony comments are limited to the bill at hand. I would like to note the committee will be hearing two separate bills regarding AI and healthcare, AB 1979 by Bonta and AB 2575 by Ortega. We will hear these two bills back-to-back to accommodate a witness for their testimony and for a film crew to be able to set up with minimal distraction. As special orders of business, today's hearing will begin with a special order of business to allow members of the committee to consider and for members of the public to express their opinions about AB 2651. We realize that many people have traveled to Sacramento to voice their opinions and we want to hear from you, but unfortunately our time to hear this matter is not unlimited. We will dispense with the special order shortly after 2 o'clock as the committee has 21 other bills to hear on the regular agenda. For housekeeping, I would like to note that Speaker has appointed Assembly Member Rogers to be a substitute for Assembly Member Celeste Rodriguez for today's hearing. On consent, the following bills have been proposed for consent for today's hearing. Any member of the committee may remove a bill from the consent agenda. The consent items include item number three, AB 1773 by Rubio with a motion of due pass to appropriations. Item number four, AB 1956 by Valencia with a motion of due pass to appropriations. Item number six, AB 1985 by Berman with a motion of due pass as amended to higher education. Item number eight, AB 2093 Bauer-Cahan with a motion of due pass to communications and conveyance. Item number 10 AB 2160 by Celeste Rodriguez with a motion of due pass as amended to appropriations. And item number 14 AB 2391 by Ahrens with a motion of due pass as amended to higher education. With that we will start as a subcommittee until we have quorum. And we will now begin with our special order item AB 2651 by Bonta and our Majority Leader as CECILIA ARGHIER will convene Good afternoon everyone, glad to see everyone here. Our first bill will be AB 2651 Bonta informed parents healthy schools act if the witnesses for Miss Bonta

Welcome. Thank you. Good afternoon, chair and members. As noted, my name is Dr. Ian Kim. I'm a family physician. I care for children and families here in the Sacramento region. I'm I'm also an educator at the UC Davis School of Medicine, and I'm a parent here in Sacramento. On behalf of the California Academy of Family Physicians, we are a proud co-sponsor of AB 2651. We represent 11,000 family physicians, as well as residents and medical students across the state. As a family physician, I care for patients across their lifespan, from birth until patients take their last breath. and we receive specialized training in pediatrics in particular. We provide comprehensive pediatric services such as well-child visits and immunizations. I have conversations every day in clinic with parents about vaccinating their children. Vaccine effectiveness depends on maintaining high vaccination rates. When vaccine rates drop even a little, diseases can quickly spread, putting children and entire communities at risk. We are seeing the consequences now, as Assemblymember Bonta has noted. Just today, two new measles cases you may have heard have been announced in Sacramento County. AB 2651 is a simple, practical solution to ensure parents are notified when their child's school falls below critical herd immunity levels. Parents deserve to have clear, timely information to make informed decisions about their child's health and safety. There's a saying that you shouldn't have to touch fire to know that it's hot. And I think that there are very good reasons for people to have skepticism or confusion about the importance and the safety of vaccines. And I hope that this bill and I expect this bill will contribute to more safety for the community. As a family physician and a parent, I'm dedicated to preventing illness. I respectfully ask for your aye vote. Thank you.

Good afternoon. My name is Shereen Walter, past president and current health advocate from the California State PTA. And I'm here today on behalf of families and parents across California and also a proud co-sponsor of AB 2651. Parents want to keep their children safe at school, but they can only make informed decisions when they have accurate, timely information. Right now, families must search for school-level vaccination data in complex California Department of Public Health reports or learn about issues indirectly, like the local news revealing that a school is being audited for low vaccination rates. This bill offers a simple solution. It ensures that when vaccination rates at a school fall below the level needed to prevent the spread of diseases, parents are notified. That's it. It doesn't change existing vaccine requirements. It doesn't take away choice. It simply provides transparency and gives families the information they need. We know that schools are places where illness can spread quickly, and high vaccination rates are critical to protecting not just individual children, but entire communities. Maintaining herd immunity is especially important for medically vulnerable children and those who cannot be vaccinated. vaccines have saved millions of lives and remain one of the most effective tools we have to prevent serious disease and protect public health when vaccination rates drop the risk to our children increases Parents deserve to know when the risk changes in their child school This bill respects parents by keeping them informed and supports healthier, safer school communities. It's about transparency, safety, and informed decision-making. On behalf of California State PTA and the families we represent, I respectfully ask for your aye vote. Thank you very much.

Thank you very much. Vanessa Cahina on behalf of the California Academy of Family Physicians, proud co-sponsors here in support. Angela Hill with the California Medical Association in strong support. McLean Rosansky with the Alameda County Office of Education in support. Farrah McDae Ting on behalf of the County Health Executives Association of California in support. Hi, Kelly Macmillan on behalf of the American Academy of Pediatrics, California in support.

Pradid Sidhu with the CSA, California Society of Anesthesiologists. Thanks.

We were told we could have our technical witness sit with them for answers. We have the two witnesses on that are here right now. Thank you.

Good morning, Chair and members. My name is Karen Amagon. On behalf of Voice for Choice Advocacy, we are opposed to AB 2651 unless it is amended. We support transparency in protecting vulnerable populations. However, after conversations with the author's office and committee staff, we remain concerned that this bill will create unintended harm without delivering meaningful public health benefit. The CDPH school vaccine compliance data does not reflect what this bill suggests. It is a limited point-in-time snapshot based only on kindergarten and seventh grade collected at the beginning of the school year with no follow-up or updated data, yet it will be sent out to all parents as if it represents the entire school over time. A significant portion of students counted as not up to date are conditional entrants. These include students completing vaccine schedules, awaiting required intervals, as well as those facing barriers, such as homelessness, foster placement, military transitions, undocumented status, or limited access to timely care. These students are compliant with the law, yet are counted in a way that suggests risk. In many cases, a school may be flagged based on just a few students who are often identifiable due to medical conditions, disabilities, or life circumstances, increasing the likelihood of bullying and discrimination. Transparency requires context. Percentages alone are not enough. We respectfully ask that this bill be amended to exclude exempt and conditional students, use end-of-year data, clearly label grade-level data, and target notifications only to those requiring their next dose. Alternatively, consider an advisory approach directing parents to existing data with appropriate context or focus outreach on families who are truly behind. Without these 51 creates more harm than benefit. Thank you for your time and consideration.

Coleman, co-founder of V is for Vaccine, a public demonstration group focused on informed consent and medical choice. I'm here to address a serious concern with this bill, the requirement to notify parents when a school's vaccination rate falls below a state-defined threshold, signaling an increased risk of disease transmission. Now here's the concern. In California, there is no philosophical exemption from vaccines. There is no religious exemption. The only option left is a narrowly granted medical exemption, meaning the only kids that can be permanently in school without all mandated and required vaccines are kids who have an IEP and kids who have a medical exemption. When the group is this small, anonymity doesn't really exist. So when a school sends a notice home saying vaccination levels are below safe thresholds, because of existing California law, it becomes obvious who is being referenced. There now is a very real risk to those medically vulnerable children, the very children these laws are claiming to protect, to become the target of fear and anger or outright discrimination from other parents and even students. It doesn't take much for a child to be identified, singled out, or blamed. This is not a question of if it will happen, but how often and how severely. Publicly signaling that a school is unsafe because of its IEP and medically exempt students risks stigmatizing disabled children and turning them into scapegoats. Even without intent, this kind of public signaling can function like a modern-day scarlet letter, where a small group of children becomes implicitly marked as the source of risk. This is not a position any child should be put in. Transparency is important, but it must never come at the expense of protecting students from discrimination and harm. Please protect our disabled and vulnerable children and vote no on this bill. Thank you.

Brian Hooker, Children's Health Defense, Chief Scientific Officer. I stand in opposition. Thank you.

Tara Thornton, co-founder of Freedom Angels, also in strong opposition. Thank you. Denise Aguilar, co-founder of Freedom Angels, in opposition. Thank you. Sophia Carstens, Decentralized America, strong opposition. Thank you. Good afternoon, members. Kasia Williams, California parent, affiliated with a Voice for Choice advocacy, asking for your no vote. Thank you.

Good morning. April Robinson with a Voice for Choice advocacy and a mother of a special needs vaccine injured child in strong opposition unless amended. Thank you.

Good morning. I'm Michaela Sweeney. I am with Catalyst Legacy, and I'm the legislative analyst for CFRW, and I am in very strong opposition. Thank you. Julie Thread here from Butte County to advocate for the vaccine injured me being one of them seven grandmother of seven Florida doesn't do this we don't need this I strongly oppose thank you thank you good afternoon Ronald F. Owens Jr. retired state worker former information officers to California Department of Public Health strongly opposed thank you thank you sorry Kelly McMillan I in support I forgot a client Children Specialty Care Coalition in support Great thank you very much All right seeing no other opposition

Thank you, Madam Chair. I want to thank Chair Bonta for your leadership in authoring this really critical public health legislation. AB 2651 to protect our California kids. In San Jose, where I represent, there are nine elementary schools who have reported an MMR rate of less than 95% for their kindergarten students in the year 2025. That's a total of 460 students who attend these schools. These families and these kids and all of our kids in California students deserve to know if their kids might be at risk. The rate of community immunity against measles is 95%. In other words, if 95% of people who are vaccinated against measles, even if the occasional cases spring up, we won't have an outbreak and we're able to protect these kids. However, if we fall below 95%, we know that measles moves very quickly. For example, there is an ongoing outbreak in South Carolina right now where kindergarten MMR coverage is about 92 percent. Now, that seems like a high number, but it is below the threshold for community immunity. And as a result, there are 997 confirmed cases of measles in South Carolina. The point of this bill is not to shame anyone. It is to make sure that parents know what the risk level is. As mentioned, this data is already publicly available, but it is difficult to find. We owe it to parents and, more importantly, their children to make sure that they get the information that they need. So, again, I want to thank Chair Bonta for authoring this bill and to keep fighting to help California parents be informed. as a former homeless student, as a former foster youth student, as someone who grew up with an IEP. I personally want to thank the author for ensuring transparency in our public health decisions for our students. I'd love to be considered as a co-author. Thank you.

Thank you. I spent six hours yesterday in the budget sub hearing on health, where we are going to make some very critical decisions about the future of our health care and the ability to be able to control some public health issues that we know will happen when people don't have care. And one of those concerns is that we will no longer have the resources that we need to ensure, particularly for people who are indigent, that they have the ability to get primary care, preventative care, including vaccinations. We already have outbreaks here in the state of California, as Assemblymember Ahrens noted. It is of deep concern. This bill is very simple. It seeks to be able to provide transparency to parents so that they can make informed decisions. And it also, I just want to reiterate, does not provide any additional information that isn't already available. It uses what CDPH already has available to be able to provide the noticing that we are requiring of schools to be able to do And certainly doesn provide any de only provides de data no personal data or information about any individual child With that, it is an important time for us to be able to step up in California to be able to ensure we have the best public health that we can provide to our children in our schools. Our children come into our schools, they leave, they go home to their siblings who are newborns, they go home to their elders who are immunocompromised, they go home to their family and friends who may not have been able to be vaccinated. We want to make sure that our parents have that information so that they can make healthy decisions for their children. With that, I respectfully request your aye vote. Thank you very much.

I do.

Thank you, Madam Chair and members. I am the chair of the California Hospital Finance Facilities Authority. And a couple years ago, we issued 17 distressed hospital loans to some of the hospitals, community hospitals and rural hospitals who are either on the verge of bankruptcy or with just a couple of months of working capital left. And all of these hospitals are still facing financial strain. And so this bill would not only help hospitals recover some of the debt, but as the Assemblywoman said, it would also bring peace of mind, help people's credit rating, and also allow them to move on with their lives. Many other states have either done this or are in the process of doing it, including Rhode Island, Vermont, Connecticut, New Jersey, Illinois, and North Carolina. And we have a couple of excerpts. Tanya, a single mother of three young children in North Carolina, was able to have her medical debt erased after surviving cancer, allowing her to focus on raising her kids instead of overwhelming bills. And then Alvin, who survived Hurricane Katrina, carried medical debt for years tied to that hardship. Through a debt relief program, that burden was finally lifted, giving him long time, long overdue financial relief. Right now, currently in California, there are 1,450 licensed debt collectors who are currently out there collecting the debt on Californians. So this is not a new concept, but we are modeling this bill after a successful L.A. County pilot program that had two tranches of money that successfully relieved so many Californians' debt. So, you know, respectfully ask for your I vote to help our fellow Californians who are still struggling, especially in the highest burdens affecting medical debt are ages 50 to 64 years old. And that is similar here in California. Good afternoon, committee. My name is Patrick Henning. I'm the chief deputy treasurer for the state of California. I just wanted to highlight a couple of things. The National Library of Medicine did a study recently, and they found about 26% of households in the United States are experiencing medical debt. And that was just a couple years ago. Those numbers only get higher. And I would just like to say this. Medical debt is not something that accumulates by choice. Nobody chooses to get sick, but yet are straddled with these high and expensive medical bills. For those and all the reasons you heard today, we respectfully ask for your eye book. Thank you.

Thank you, Chair Bonta. I just wanted to commend our author, our majority leader for this bill, and our treasurer. I previously got sick when I was in college, and had it not been for the Affordable Care Act and having been covered under the ACA to stay on my insurance plan until after I graduated, I would be in hundreds of thousands of dollars of medical debt. And so it is completely an affordability issue for the millions of Californians right now who may be under crushing medical debt. So would love to be considered added as a co-author and happy to move the bill when appropriate. But thank you for bringing this forward.

Thank you, Madam Chair. Good afternoon, members. I am proud to present or introduce AB 1570, a Women's Caucus Priority Bill. This measure is aimed to eliminate out-of-pocket costs for medically necessary diagnostic and supplemental breast imaging, such as breast MRIs and ultrasounds, ensuring access to the full continuum of breast cancer screening and diagnosis without financial barriers. What we say regularly, we know to be true, is that early detection saves lives, but only if patients can afford the follow-up care that comes after an initial screening. In 2023, I was diagnosed with breast cancer. I found it through a regular mammogram screening And then I was called back and had to receive a physical examination as well as additional mammogram that looked at in a 3D way including an ultrasound and then a biopsy. Thankfully, through the coverage I had, I had no out-of-cops expenses, so I had no thought to wait until I got paid again, or was I going to choose between feeding my family or getting medical care. And many patients, like myself, a mammogram is only just the first step. Additional imaging is often medically necessary to officially confirm or rule out cancer. While screening mammograms are covered at no cost, follow-up diagnostic and supplemental imaging often come with significant out-of-pocket costs, rising up to the hundreds and thousands. I have a friend right now who has not did her secondary testing because the cost is $900 and she's waiting. And of course, her friends wouldn't allow that, so she won't have to wait longer. But healthcare access looks different for different communities, impacting communities of color and lower socioeconomic communities differently than their white and wealthier counterparts. Patients needing access to care may need to choose between paying rent for the month and taking care of groceries for the week, versus timely supplemental care, forcing patients to delay or forego critical life-saving care, which leads to a dangerous gap in the screening process. No patient should have to choose between financial stability and life-saving care. AB 1570 is a vital, cost-effective policy that improves outcomes and reduces long-term health care costs. With me today is Dr. Ann Darrow, Assistant Professor of Clinical Medicine, breast radiologist at UC Davis Department of Radiology, and Leslie Bradshaw, a volunteer advocate with Susan G. Komen. Welcome. Please start.

Thank you. Welcome.

Thank you very much for your testimony. Very meaningful. Are there others in support that would like to come to the microphone? And it's name, organization, and position only. These are support.

Seeing none, I will move to witnesses in opposition. Chair members, Olga Shiloh. Would you like to sit here? I'll just make brief comments here.

Thank you. Thank you. Are there any others in opposition? All right, seeing none, we'll move on to questions from the members. Any members have questions or comments? I see none. Would you like to close? Thank you. And I appreciate all those that came up and showed their support, as well as those that have testified who have real-life experience in their family and in their own help with this, and a doctor who basically saves lives through diagnosis, and even opposition. And I understand their concerns. And I think the analysis prepared by the Health Committee is very thorough in not addressing those, but in bringing those to light. And, of course, as a legislator, I'm always open to consideration any adjustments that need to be made to make this workable and get this across the finish line. As one of my witnesses noted, you know, it's personal. For me, having gone through this and recognizing the barriers that can be for so many women, I had a successful outcome. But there are people who were diagnosed at the same time as me who did not have as successful as an outcome. And that's very real. And that's what so many women and including men face, because this is not just a female disease. Any any being with breast, which is all human beings, are faced, could be faced with cancer. And like I said, I have someone real time who just finding out has waited nine months to get the secondary supplemental screening to determine whether they have what the issue they found in their first first test, whether that was real or not, whether it's cancer or not. And so nine months of agonizing waiting, nine months of being silent in shame because they couldn't afford the test. And that shouldn't happen in California and definitely not in this great country. And so with that, when it's the appropriate time, I respectfully ask for an I vote. Did you accept the amendments? I did. Absolutely. You know what? You're right. I thank the committee, but I forgot to thank the committee for the amendments. I just have a quick comment. I want to thank you for coming and bringing your daughter here today, the importance of education for our young ones, and that it takes bravery to have these kind of difficult conversations as families. I've been there, done that. And so thank you very much for coming. And I hope you got a picture when you're up at the microphone. But thank you very much for testifying today. And, Doctor, thank you as well. All right. We're going to move to item 12, and that is AB 2201, burner. Remember, whenever you're ready, you can begin. Good afternoon, members. AB2201 would keep Californians covered by restoring the prior flexibility of Medi-Cal eligibility determination and renewal processing in order to support county efficiency. As California faces the implementation of Medi-Cal changes on the horizon, county eligibility offices will be stretched thin by the sheer volume of incoming cases. This puts low-income Californians at risk of losing access to Medi-Cal due to additional and often unnecessary administrative red tape. We're already seeing these effects. The rate of successful automatic renewals has been cut in half since the flexibilities were turned off in June of last year. Now more than ever, it is important to protect the most vulnerable Californians from losing their health care coverage. AB 2201 will aid in that fight by reducing the burden on county workers and removing administrative barriers facing low-income Californians who bear the most immediate and devastating impacts imposed by H.R. 1. I respectfully ask for an aye vote at the appropriate time on this measure. And with me today to speak more on this bill is Whitney Francis with Western Center on Law and Poverty and Amanda Kirschner, CWDA's Director of Legislative Advocacy. Welcome. Good afternoon, Chair members. Whitney Francis with the Western Center on Law and Poverty, proud co-sponsors of AB2201, which would reinstate four proven eligibility and renewal strategies to streamline Medi renewal processing and minimize wrongful terminations for low Californians The combined impact of HR1 work requirements increased renewal frequency and sweeping changes to Medi and CalFresh threaten to overwhelm county eligibility offices with the sheer volume of cases. Low-income Californians are at risk of losing access to Medi-Cal due to these additional administrative barriers. However, these challenges are not new. California implemented federally approved renewal streamlining strategies beginning in December 2023 to reduce administrative burdens on individuals and counties during the Medi-Cal unwinding process. These strategies were successful in significantly improving the rates of automatic renewals and reducing the rate of people who lost coverage due to paperwork reasons. Despite the success of these strategies in reducing the administrative burden of Medi-Cal renewals, California turned them off in July 1st, 2025, and we have since seen a drastic drop in automatic renewal rates. This translates to hundreds of thousands of renewals that county workers must manually process each month. Renewals which could have been processed automatically had the strategies remained in place. It's imperative that California utilizes every tool at its disposal to reduce administrative burdens on county workers and eligibility barriers facing low-income Californians who bear the immediate impacts of HR1 imposed changes. This bill has no known opposition, and we urge your aye vote to protect Medi-Cal coverage for millions of Californians and to support the county workers who administer it. Thank you. Thank you. Welcome. Sorry about that. Good afternoon, Madam Chair and members. Amanda Kirchner on behalf of County Welfare Directors Association. We are here in support of AB 221. I want to thank the author for her work on this. I want to thank the staff for their analysis. Really appreciate that. Nearly 15 million people are on Medi-Cal in California, and our county human services eligibility workers help determine their eligibility for each and every one of those clients. And we take that very seriously. We know how important it is to have access to health care and that it affects more than just the health care. It affects all of our families and our children. Unfortunately, with the recent changes in H.R. 1, we are estimating that between 1.8 to possibly 3 million people could lose their coverage because of paperwork and other administrative barriers. H.R. 1's new work requirements for Medi-Cal eligibility, as well as the increased frequency of our redeterminations from once a year to every six months, creates difficulties for our clients who are otherwise eligible for Medi-Cal but may fall off because of paperwork and administrative burdens. We are deeply invested in ensuring that as many people as possible remain eligible and enrolled for Medi-Cal. AB 2.0.1 reinstates four proven Medi-Cal flexibilities. This includes auto-verification for zero income, for stable income, the auto-verification for income below 100% of the federal poverty level, and it helps us streamline our asset verification system and our workflows. Counties are going to do our best to prepare for H.R. 1, but the impacts will be significant. And we know that these strategies will help us reduce our workloads. We want to help folks maintain continuous coverage to also help avoid and mitigate continuing costs where folks who have dropped off delay coverage, which we just heard about in the last presentation, and then come back on. But now it's several months later, and what was something that was preventable becomes something much more urgent. So with that, we move forward with our proven strategies to streamline eligibility, and we urge your support. Thank you. Thank you. We're going to establish a quorum while we have everybody huddled here, so bear with us. Bonta Chen Addis Aguirre Aguirre here Aarons Aarons here Coloza Coloza here Carrillo Gonzales Gonzales here Johnson Johnson here Patel Patterson Rogers Rogers here Sanchez Chiavo Chiavo here Sharp Collins Sharp Collins here Stephanie Stephanie here We have a quorum. All right, let's move on. We will now have witnesses in support. Name, organization, and position, please. Kelly LaRue on behalf of the California Kidney Care Alliance in support. Angela Pontes on behalf of Planned Parenthood Affiliates of California in support. Hi, Juanita Martinez on behalf of Fresenius in support. Yasmin Pellet with Justice and Aging in support. Thank you. David Gonzalez on behalf of the California Bleeding Disorders Council in support. Kelly Brooks on behalf of the urban counties of California and the rural county representatives of California here in support. Nicole Wordleman on behalf of the Children's Partnership, proud co-sponsor in support. Christine Smith, Health Access California, also co-sponsor in support. Malik Bynum with the County Behavioral Health Directors Association in proud support. Thank you. Carly Stelzer with the California Behavioral Health Association in support. Evan Fern with Disability Rights California in support. Alia Griffin with the American Federation of State and Municipal Employees in support. Mara Velas with the Latino Coalition for a Healthy California Proud Co-sponsor and in support. Andrea Rivera with the California Association of Public Hospitals and Health Systems in support. Nora Angelis with Children Now in support. Brian Suza on behalf of the San Francisco AIDS Foundation in support. Kevin Guzman with the California Medical Association in support Nasset Short on behalf of Peach representing Community Safety Net Hospitals in support Farrah McNade Ting on behalf of the County Health Executives Association of California in support Natalie Pita on behalf of the California Academy of Family Physicians in support Ramon Costa Blanc, California Alliance for Retired Americans, in support. Darlene Dupree with the Association of Regional Center Agency, representing California Network of 21 Regional Centers, here in support. Omar Altamimi with the California Pan-Ethnic Health Network, here in support. Thank you. All right. Is there anyone else in support of the bill? Seeing that, is there any witnesses in opposition that would like to testify? Seeing none. Is there anyone here that would like to oppose the bill? All right, seeing none. Are there any questions, members, that you have from the Assembly member? I don't see any questions, so you're getting off scot-free, Ms. Berner. Would you like to close? Yes. On behalf of myself, my sponsors, and it seems like everybody and their mother, I respectfully ask for your aye vote. Do you have any amendments? Did you accept the amendments? That's you. Apparently, yes. I was going to help you with that All right I need a motion and a second We have one from Aarons Assemblymember Aarons and Assemblymember Scheidwo Okay, call the roll, please. The motion is due pass as amended to appropriations. Bonta, Chen, Addis, Aguirre-Curri. Aye. Aguirre-Curri, aye. Aarons? Aye. Aarons, aye. Coloza? Coloza, aye. Carrillo? Gonzalez? Aye. Gonzales, aye. Johnson. Johnson, aye. Patel. Patterson. Rogers. Aye. Rogers, aye. Sanchez. Chiavo. Chiavo, aye. Sharp Collins. Sharp Collins, aye. Stephanie. Bill's on call. Thank you very much for presenting. Thank you to your supporters here today. all right we're going to move on to item 16 AB 2448 assemblymember Berman please join us well this is a fishy one Good afternoon, Assemblymember and witnesses. Please proceed when you're ready. Thank you, Madam Majority Leader and colleagues. I hope this bill has as much support as the last one. In the years since Roe was overturned, attacks on reproductive and gender-affirming care have steadily intensified, threatening access to health care services for millions of Californians. As a result, it is critical that medical providers have access to technology to protect sensitive medical information so that patients who have received reproductive and gender-affirming care cannot be identified and targeted. AB 2448 would reinforce existing state law and require the implementation of this technology to protect the privacy and security of medical records. All Californians deserve access to critical health care services without fear. I respectfully ask for an aye vote, and I'm joined today by Angela Pontes with Planned Parenthood Affiliates of California and Tiffany Brokaw with the Attorney General's Office. Good afternoon. Thank you, Chair and members. Angela Pontes on behalf of Planned Parenthood Affiliates of California, representing the seven Planned Parenthood Affiliates across the state. We are a proud co-sponsor of this bill, and thank you to Assemblymember Berman and Bauer-Cahan for championing this policy. In 2023, following the Dobbs decision, California passed AB 352 to strengthen privacy protections for sensitive health information like abortion care by protecting sensitive medical records from being inappropriately shared outside of California without patient authorization. AB 2448 follows up on this law by clarifying that electronic health records vendors must not only develop the technology, but also enable the technical capabilities needed for providers to protect their patients' data. Planned Parenthood health centers strongly believe that patients deserve access to health care without fear of legal or criminal consequences from data sharing. And if an individual is uncertain about whether their medical information will be protected, they may hesitate to seek the care they need. AB2448 supports efforts currently underway by health technology companies and providers to better coordinate patient care and protect patient confidentiality at the same time. We ask for your aye vote. Thank you. Good afternoon. Good afternoon, Chair and members. Tiffany Brokaw here on behalf of Attorney General Rob Bonta, who is proud to co-sponsor this bill. We thank Assemblymember Berman and Assemblymember Bauer-Cahan for carrying it. AB 2448 would ensure that vendors of electronic health records are implementing operational safeguards to secure data so that healthcare providers have the technological capabilities to segregate and protect reproductive health care information. Across the country, increasing restrictions on reproductive health care have been accompanied by heightened concerns about the potential misuse of sensitive patient information. While existing law requires certain entities to maintain policies and procedures to protect medical information, the next step is to ensure that these entities are implementing these protections. AB 2448 effectuates that next step, and it builds on California's commitment to advance and protect reproductive health care for those who seek and administer it. And for these reasons, we respectfully ask for an aye vote. Thank you very much. We'll move on to other witnesses in support. Name, organization, position only. You can just come up to the microphone. Well, looks like there's one. That's right. Keshav Kumar with Lighthouse Public Affairs on behalf of Reproductive Freedom for All and our over 400,000 California members who could not be here in strong support and appreciation of the author. Thank you very much. All right, we'll move on to opposition. Is anyone in opposition? Seeing none. Is there anyone here that would like to, is there a tweener or anyone here? Seems like there's not. All right. Would you like to close, Mr. Oh, yeah. Is there any questions of the committee? This is a quiet crowd today. Yeah. I got a lot of bills I know. All right. Would you like to close, Assemblymember Berman? I appreciate the brevity of my colleagues on the committee and respectfully ask for I vote when the time comes. The time is now. Heck yeah. All right. You got a quorum faster than I did in BNP this morning. It's been moved. I don't know. Would I get a second? Okay. Okay. Would you please? Please call for roll, please. Item 16, AB2448, motion is due pass to privacy and consumer protection. Bonta, Chen, Addis, Aguiar-Curry. Aye. Aguiar-Curry, aye. Aarons. Aye. Aarons, aye. Coloza. Aye. Coloza, aye. Carrillo. Aye. Carrillo, aye. Gonzales. Gonzales, aye. Johnson. Johnson, no. Patel. Patterson. Rogers. Aye. Rogers, aye. Sanchez. Shiavo? Shiavo, aye. Sharp Collins? Sharp Collins, aye. Stephanie? Bill's on call. Thank you very much for the presentation. We are looking for authors, and for those of you that are sitting in your office, if you could please make your way down here, we'd really appreciate it. Thank you. Thank you Thank you. Thank you. Thank you It looks like I found somebody. This is file number 7, AB2034. Assemblymember Addis, do you have your witnesses here yet? Okay. Good afternoon. Good afternoon. Come join us at the table. the table alright assembly member you can begin when you feel comfortable thank you madam chair and members and staff who has been sharing a lot of information with us and our advocates today I'm here to present AB2034 the food additive safety and transparency act this bill will strengthen Thank California's ability to protect consumer health from harmful and dangerous food additives that make their way into our food supply. This bill complements existing law to ensure greater transparency in the food industry by helping to identify hidden and potentially harmful chemicals entering our food supply. Before we dig in, we have heard concerns regarding implementation and feasibility. And I am committed to working with CDPH, with committee staff, both this committee and we're working with committee staff. Should we get out of this committee? We're working with the ESTM committee staff as well and stakeholders to refine the bill while maintaining the transparency and the focus on public health. So the problem is that consumers are exposed to dozens of chemicals through the food that we eat every day. And at the federal level, the FDA is responsible for ensuring the safety of our food supply, including making sure that food additives, which are substances added to processed food that can be used to alter their sensory properties or increase their shelf life are safe to consume. But food manufacturers can completely go around the FDA pre-market review by self-certifying that their additives are generally recognized as safe or grass. And so there's a thousand grass substances that have entered the food supply, over a thousand, without FDA or public knowledge that are linked to really bad things like heart and brain defects, infant leukemia, suppression of estrogen and liver and kidney and intestinal toxicity. So AB2034 would address this basically by creating more transparency in labeling so that consumers understand what they're picking up off the shelf. and by allowing some flexibility in terms of small businesses, as well as businesses who use the voluntary process through the FDA to be able to certify their foods as being safe. Joining me to testify in support is Thomas Gilligan Principal Scientist with the Center for Science in the Public Interest and Nancy Buremeier the Director of Program and Policy for the Breast Cancer Prevention Partners. Great. Thank you very much. You can proceed, either one of you. Thank you. Good afternoon. I'm Thomas Gilligan, Principal Scientist at the Center for Science in the Public Interest, or CSPI. I have a PhD in biomedical sciences with a focus on toxicology. CSPI is a national nonprofit that has been at the forefront of food safety, nutrition, and health for 55 years. We accept no donations from government or industry. CSPI is proud to sponsor Assembly Bill 2034. As you just heard from Assemblymember Addis, this bill targets loopholes in federal laws that put Californians at risk from unsafe and poorly tested food chemicals. I'd like to address some of the arguments that have been raised by the opposition. Importantly, AB 2034 does not duplicate AB 1264, which was passed last year. AB 1264 focused on ultra-processed foods in schools. AB 1264 did not address the grass loophole or vague ingredient labeling. This bill, AB 2034, does both of those things and does so for the entire food market, not just school foods. So simply put, AB 1264 will protect schoolchildren from harmful processed foods. AB 2034 will protect all Californians from unsafe chemicals. Additionally, despite what the opposition has said, there should be little to no impact on food prices for Californians. And that's because under federal law, food manufacturers have an ongoing obligation to ensure that their products are safe. Even if companies choose to use grass ingredients without notifying the FDA, they are still required to prove those chemicals are safe using publicly available information. AB2034 will require companies who skip the voluntary FDA process to share that information with the state instead. The FDA process is entirely free. Chemicals that go through that voluntary process will be exempt from the state process. Finally, AB2034 exempts small businesses. I therefore ask for your aye vote respectfully. Thank you. Thank you very much. Next witness, please. Good afternoon, Chair and members. Thank you for the opportunity to testify, and thank you, Assemblymember Addis, for your leadership on AB2034 to make our food safer. I'm here on behalf of Breast Cancer Prevention Partners, a science-based organization working to prevent breast cancer by reducing exposure to harmful chemicals. Nothing is more visceral to the public than the safety of the food we eat, and especially what we feed our children. A February poll by the Pew Research Center found that nearly 80% of U.S. adults are concerned about harmful chemicals in food, and almost half are very concerned. Americans depend on the FDA to safeguard our food supply. Unfortunately, it is failing us. Under the grass loophole, companies can add chemicals to food and food packaging without meaningful independent review or even telling the FDA. Some examples include methyl and propyl parabens, both hormone disruptors and propyl paraben has been shown to accelerate the growth of breast cancer cells. Flavor chemicals linked to cancer deemed grass by industry groups. partially hydrogenated oils or trans fats and butylated hydroxy anisole or BHA a prop 65 listed carcinogen the FDA has removed the grass designation for some of these chemicals but only after years of advocacy and they should never have been allowed in the first place a B2034 also brings much knowledge transparency to chemicals hidden under terms like natural flavors and spices. In 2020, this legislature passed SB 312, requiring disclosure of chemicals in fragrance and flavors and personal care products. Today, Californians have more transparency about what's in their shampoo than what's in their food, even though many of the same chemicals are used in both. It's time to fix that inequity. In the face of federal inaction, California must once again lead to protect public health. I respectfully ask your aye vote. Thank you very much. Are there other support witnesses here? And if you'd like to stand and give us our name, organization, position only. Good afternoon. Lizzie Guansona here with the sponsor of the bill, CSPI, also asked to share support for a number of organizations, including Rising Communities, FPEIS Foundation, Strategic Training Initiative for Prevention of Eating Disorders, SF Bay Physicians for Social Responsibility, Clean Water Action, Bay Area Community Resources, CalPIRG, National Consumers League, and the United Parents and Students, as well as Dr. Gerard from University of Michigan. Thank you. Thank you. Good afternoon chair members Karen Amagon on behalf of voice for choice advocacy and we are in support of this bill. Thank you. Thank you. Okay, let's move on to opposition to anyone opposing the bill please come on up to the table if you'd like. And you get two minutes apiece. Welcome. Okay. Good afternoon, Chair Bonta and members of the committee. My name is Dr. James R. Coughlin. I'm a PhD trained at UC Davis toxicologist and an independent consultant with 47 years of experience in nutritional toxicology based in Orange County. I work with food producers and manufacturers throughout California, the U.S., and globally on issues of ingredient safety and regulatory compliance. I have concerns that AB2034 would duplicate rather than meaningfully strengthen California's already robust food safety framework, raising three key issues. First, while not perfect, the federal GRAS framework is currently under active review by the FDA. State action at this time risks creating duplication or potential conflict with forthcoming federal updates. Importantly, the scientific standard underlying GRAS established in the 1958 Food Additives Amendment is the same standard applied to direct food additives. Grass determinations rely on panels of highly qualified independent scientists who must reach consensus based on publicly available evidence and well-established scientific principles. This is a structured science-based process grounded in longstanding federal law. Second, AB2034, as currently drafted, would establish a new state-level review and disclosure system that substantially overlaps with existing authorities. California already maintains one of the most comprehensive food safety systems in the world including the Real Food Healthy Kids Act and more than four decades of Proposition 65 implementation Agencies such as OEHA routinely evaluate carcinogenicity and reproductive toxicity making additional layers potentially duplicative rather than additive and potentially confusing for consumers. Third and final, the bill's proposed ingredient assessment and licensure framework does not clearly provide a pathway for manufacturers to respond to or to supplement the record thank you very much thank you respectfully urge you no vote thank you madam chair and members of the committee I'm Erin Radin here on behalf of the Consumer Brands Association we represent the consumer packaged goods industry which in California supports over 300,000 direct jobs, powers the economy with 22 billion in wages and injects 48 billion into California's economy. From facts up front to digital disclosures like Smart Label, CPG companies lead the way in delivering consumers the information they need in the format they want. AB 2034 is being marketed as a consumer transparency bill but it is actually an ingredient review bill that simply layers on a second regulatory system adding cost and bureaucracy, not protection, And for those reasons, we must respectfully oppose. Last year, this body enacted AB 1264, the Real Food Healthy Kids Act, which established a comprehensive framework for evaluating and regulating food ingredients, including many of the same substances that AB 2034 targets. That program is just about to begin rulemaking and should be allowed to be implemented before another costly and conflicting review system is contemplated. In addition, Prop 65 already mandates rigorous review and public warnings for chemicals linked to cancer and reproductive harm. And CDPH already has the authority under existing law to regulate, restrict, and ban unsafe food additives. A new report by the Policy Navigation Group estimates implementation would cost California $34 million in its first three years, with $15 million in ongoing costs thereafter. Previous economic impact studies have noted that a patchwork of state legislation, like California's AB2034, will also lead to an increase of 12% in grocery costs. We welcome a dialogue with the author on consumer transparency and do not have any indication what the amendments will be, but we certainly do look forward to reviewing those and seeing if they impact any of these concerns. But right now, AB2034 does not increase consumer transparency. It is a grocery tax that establishes a duplicative California-only ingredient review program increasing costs for the state, businesses, and California families. Thank you very much. Are there others that oppose the bill that would like to speak? Name, organization, position only. Just come up to the microphone. Good morning, Madam Chair and members. Jason Bryant on behalf of the National Confectioners Association. We're opposed. Thank you. Thank you. Good afternoon. Leticia Garcia with the California Retailers Association, also opposed. Thank you. Nicole Quinonez on behalf of Cal Chamber and the Food Ingredient Safety Coalition in opposition. Thank you. Good morning. Anna Mobile with KSC on behalf of the California Grocers Association in opposition. Thank you. Marjorie L. Yous Sampson Advisors here on behalf of the California League of Food Producers as well as the Council for Responsible Nutrition in respectful opposition. Elizabeth Esquivel with the California Manufacturers and Technology Association also in opposition. Good afternoon Tricia Garinger with Agricultural Council of California respectfully opposed Good afternoon Katie Davey with the Dairy Institute of California in opposition Good afternoon, Sherry McHugh representing the American Beverage Association in opposition. Thank you. Dennis Albionne on behalf of the California Grain and Feed Association, California Seed Association, and California Warehouse Association. We look forward to working on these amendments with the author as well. Thank you. Randy Pauk on behalf of the American Chemistry Council in opposition. Thank you very much. Anyone else? Seeing none. Are there any questions from the members? We have a motion to move the bill and a second. Are there any questions to the bill? Yes. I just wanted to thank the author for you and I have worked together on a number of things, but I just want to thank you for the conversations we've had. Two cities in my area would be greatly affected by this, over 100 jobs, and I know that you've committed to working with myself and other folks to make sure that we keep those jobs, not just in my district, but throughout California. I just really want to thank the author for taking this issue on as well. Thank you. Anyone else? Seeing none. I want to thank you for bringing this bill forward, Assembly member. This bill raises an important conversation about the generally recognized as safe loophole. While there are conversations about closing the loophole at the federal level, our state legislature has a history of being ahead of the curve to ensure that ingredients in our food are safe. I am supportive of the overall goal of ensuring greater transparency regarding the ingredients in our food in order to allow consumers to make informed choices. This bill is going to Environmental Safety and Toxic Materials Committee, and I encourage the author to keep working on it, to work with the stakeholders as this bill moves forward to address the opposition's concerns and ensure effective implementation. One idea is to narrow the scope of this bill to a database modeled after the California Safe Cosmetics database, which would require companies to submit to DPH all of their products that contain GRAS and submit safety data to DPH. DPH could then create a database including this data. The author may wish to consider this approach in order to reduce costs and address implementation concerns. With that, would you like to close? Thank you so much, Madam Chair, and I want to thank the various members that have reached out with their questions and concerns, and I've had a lot of robust conversations over the course of that, and also, you know, working with committees and working on how we might continue to improve the bill, as many bills through the legislature are improved through the committee process. So we're committed to doing that and just want to thank everyone for the robust dialogue and respectfully ask for your aye vote. Thank you very much. Secretary, please call the roll. The motion is due pass to Environmental Safety and Toxic Materials Committee. Bonta, Chen, Addis. Aye. Addis, aye. Aguiar-Curry. Aye. Aguiar-Curry, aye. Ahrens. Aye. Ahrens, aye. Coloza. Coloza, aye. Carrillo. Aye. Gonzalez. Gonzales I Johnson Patel Patterson Rogers Rogers I Sanchez Chiavo Chiavo I sharp Collins Stephanie that feels on call thank you very much we're gonna move to item number 22 AB 2598 assemblymember Krell Thank you Good afternoon Assemblymember Crowell you can start when you're comfortable about doing that. Thanks so much good afternoon everyone thanks for having me here to talk about Assembly Bill 2598 today. First off I want to accept the amendments and thank the committee staff for all of their hard work on this bill. I also want to thank the surviving, I want to thank the family members of loved ones who they lost. That's the impetus for this bill. Jessie Peterson is one of those people who died whose family members were looking for her and whose remains were in a storage facility with us here today. It's her mom, Ms. Kongi, who will be talking about the bill, along with Anthony Chicotel, senior staff attorney with the California Advocates for Nursing Home Reform. But really, this bill and this issue wouldn't have come to light if it hadn't been for family members who were searching for their loved ones. So I want to back up and give you some background on this bill and explain why this is necessary to fill a gap that we currently have in our law, something that was really shocking for me to learn about on KCRA News. and that's that family members were dying in hospitals here in Sacramento. Their loved ones were not notified. Meanwhile, their loved ones were out looking for them, some of them even filing missing persons reports, going to sheriff's offices, going to county offices, trying to figure out, even going to homeless encampments, trying to figure out where the person had gone. And really, they had died in a hospital setting and the hospital was not fulfilling its responsibility to notify next of kin. So what this bill does is it closes that gap, Not only does it require the hospital to notify the next of kin, which is already law, but it creates an enforcement mechanism. If the next of kin cannot be located, it requires them to inform the public guardian's office. But right now there's a gap because when that's happened, when there hasn't been notifications, the Department of Public Health hasn't really had enforcement power. They haven't really had teeth to do anything to fix the problem. If you're wondering how bad of a problem this really is, KCRA's investigation revealed 180 cases where a loved one had died and the next of kin hadn't been notified and a death certificate hadn't been issued. And the time range for this is all of these cases, the 180 cases I'm talking about, are over six months. One of them was over three years. So that's the gap that we're trying to close with this bill. Assembly Bill 2598 will give DPH clear authority, will require notification of next of kin, and will have real consequences, financial consequences, if the next of kin is not notified within that timeframe. So here with me today is Ginger Conjie, family member of a patient whose death notification was significantly delayed, as well as Anthony Chick Hotel, senior staff attorney at the California Advocates for Nursing Home Reform. Thank you. Sure, yeah. Go ahead, please start. Good afternoon, Chair and members. My name is Ginger Congee. I'm the mother of Jessie Marie Peterson. Jessie Marie died on April 8, 2023. While in the care of Mercy San Juan Medical Center, she was 31 years old. Our family was not informed of her death at the time, despite the hospital having my contact information as her next of kin and them contacting me on multiple occasions prior to that. Mercy San Juan also did not report her death to the coroner and did not complete her death certificate for nearly a year. She was alone, stored in an off-site facility, decomposing to the point she could no longer be identified by fingerprints or her tattoos. Only a name bracelet they placed when she was admitted. We searched for Jessie through that year, filing a missing person report, posting her information on the DOJ website, visited places she frequented and showed her picture to house locations in hopes of finding where she was last seen. No family should ever have to endure this. We couldn't have a proper burial for her or send her off with our well wishes. We couldn't have an open casket. No family should ever have to endure this. We're not the only family that this happened to. My heart goes out to the families of Michael Gray, Tanya Walker, Charles Harvey, and more than 100 other families who are impacted by the same lack of accountability. This is not an isolated incident at Mercy San Juan. It's a systemic failure. AB 2598 is about making sure this never happens again. It's about accountability, timely notification, and basic human dignity for patients and their families. I'm asking you on behalf of Jessie Marie, her sisters, and every family affected, please pass this bill. Thank you. Thank you very much. Good afternoon. I'm Tony Ciccatello. I work for California Advocates for Nursing Home Reform. We provide free guidance and advocacy services for consumers of long-term care in California. Unfortunately we don't get many calls about notification, delayed notification of death, but we do occasionally from nursing homes. We had one last year where a family was a friend of a deceased nursing home resident called us and told us that the family hadn't been informed for over four months. After the resident's death, the family had no idea that this had happened. And the funeral home was asking for $7,000 before they would release the body. That's illegal, but that's the kind of thing that we get when we don't have a clear statutory requirement for notification of death. I was really surprised after the KCRA stories came out that we don't have a clear requirement. We have a requirement to notify the public administrator when there's no next of kin that are known, but there's no specific law that says you must notify next of kin. So this bill gets to that, which is really important. We also have a lack of enforcement mechanisms here. In the Mercy San Juan case, the Department of Public Health issued federal deficiencies for governing body and quality assessment. They didn't really have a good hook for failure to notify next of kin of death at the state level. So this bill, 2598, fills these holes, these pretty significant holes that we have in the statutes right now. So definitely encourage your yes vote, please. Thank you very much. Are there others that would like to be a witness in support? Good afternoon, Madam Chair and members. Trent Smith on behalf of the California State Association of Public Administrators, Public Conservators, and Public Guardians. We haven't yet adopted a formal support position, but we're well on our way to supporting the bill. We had some very good conversations with the author office and then we have a couple more conversations later this week We still looking for one more addition to the bill to require hospitals and health institutes to pass on whatever personal information they may have of the decedent so that the public administrator can carry on with trying to find the next of kin. So thank you. We urge your support. Thank you very much. Are there any others that are here to support? Seeing none. Any witnesses in opposition? Seeing none. Is there a tweener here? Welcome. Good afternoon. Vanessa Gonzalez with the California Hospital Association. And CHA does not have a position on the bill. However, we'd like to thank the author and committee staff for your willingness to address some technical and clarifying items. A couple more issues to work through, however confident we'll get to a good place as the bill moves forward. Thank you. Thank you very much. Members, do you have any questions, comments? We have Assemblymember Aarons. Okay. Assemblymember Johnson. Thank you. I want to thank the author for bringing forward this bill and also your testimony. Thank you for being willing to share. I just have a clarifying question. Can you give me some clarity on the definition of next of kin? yes it would be the family member who's listed with the hospital okay i know that there i know you're working through some conversation i think there's some clarity there and i've had some folks reach out um and i am definitely i'm in support i want to continue the conversation just need some clarifying language in there for how what is considered next of kin um in situations that are maybe not common but you have my support. Thank you very much. Absolutely. Thanks so much. And I'm committed to continuing to work with the stakeholders. Are there any other comments or questions? I want to thank you for bringing this bill forward. You know, until sometimes it just kind of hits you in the face, you don't realize what has happened to our loved ones. And so I want to thank you for your testimony. I can't imagine how painful that has been for all of your family and yourself. So I would like to be a co-author on the bill, and I thank you for bringing it forward. And with that, would you like to close? Yes, thanks so much. Happy to have you as a co-author on the bill, Ms. Majority Leader. I have deep appreciation for all the family members that came to my office, that came to KCRA, that are here today in support of this bill. Without their brave testimony and being willing to share painful aspects of their lives, we wouldn't be able to stop this harm from occurring in the future. So with deep gratitude to them, I respectfully ask for your aye vote. Thank you. Secretary, please call the roll. The motion is due pass as amended to the Judiciary Committee. Bonta. Chen. Aye. Chen, aye. Addis. Addis, aye. Aguirre-Curie. Aye. Aguirre-Curie, aye. Aarons. Aye. Aarons, aye. Coloza. Coloza, aye. Carrillo. Aye. Carrillo, aye. Gonzales. Johnson. Johnson, Aye. Patel. Patterson. Rogers. Aye. Rogers. Aye. Sanchez. Shiavo. Aye. Shiavo. Aye. Sharp Collins. Stephanie. That bill's out. Thank you very much. I looking for authors Thank you everyone for having patience It a lot of committee hearings today I think we'll go ahead and take up consent. I have a motion. So moved by Shai. Second by Addis. Secretary, please call the roll. On consent, Bonta. Chen. Aye. Chen, aye. Addis. Addis, aye. Aguirre-Curray. Aye. Aguirre-Curray, aye. Ahrens. Aye. Ahrens, aye. Coloza. Coloza, aye. Carrillo. Aye. Carrillo, aye. Gonzales. Johnson. Johnson, aye. Patel. Patterson. Rogers. Aye. Rogers, aye. Sanchez. Chiavo. Chiavo, aye. Sharp-Collins. Stephanie. Consent calendars out Members if you're available please come down we'd like to have you present your bills We're going to go ahead and do some add-ons since we have some time here. Secretary? Item 1, AB2651. I need a motion. Motion by Addis. I need a second. Second by Rogers. Secretary? Item 1, AB 2651, Bonta. Motion is due. Passed as amended to education. Bonta, Chen, Addis? Aye. Addis, aye. Aguiar-Curri? Aye. Aguiar-Curri, aye. Aarons? Aye. Aarons, aye. Coloza? Carrillo? Aye. Carrillo, aye. Gonzales? Johnson? Johnson, no. Patel? Rogers Rogers aye Sanchez Chiavo Chiavo aye Sharp Collins Stephanie bills on call item 2 AB 1 5 7 0 Wilson I need it Second. Secretary, please call the roll. Motion is due pass as amended to Appropriations Committee. Bonta, Chen. Aye. Chen, aye. Addis. Aye. Addis, aye. Aguiar-Kurri. Aye. Aguiar-Kurri, aye. Ahrens. Aye. Ahrens, aye. Colosa. Carrillo. Aye. Carrillo, aye. Gonzalez. Johnson. Johnson, aye. Patel. Patterson. Rogers. Aye. Rogers I Sanchez Chiavo Chiavo I Sharp Collins Stephanie that bill on call we move over to item add-ons for item 7 a b 2034 addis bonta chen chen no patel patterson sanchez That bill is still on call. Item 9, AB2123 by Aguirre-Curry. We did get a motion. We need a second. Second by Addis. Secretary, please call the roll. Item 9, AB2123, motion is due pass as amended to Banking and Finance Committee. Bonta Chen Chen I Addis Addis I Aguirre curry Aguirre curry I Aaron's Aaron's I Colosa Carrillo Carrillo I Gonzalez Gonzalez I Johnson Johnson no Patel Patterson Rogers Rogers I Sanchez Sanchez now Shiavo Shiavo I sharp Collins Stephanie. Item 9 is on call. We have add-ons for item 12, AB 2201. Berner. Bonta. Chen. Chen, aye. Addis. Addis, aye. Carrillo. Carrillo, aye. Patel. Patterson. Sanchez Stephanie That bill is out We missed you Adding on to item 12 AB 2201 Sanchez Sanchez aye And it's still out item 16 for add-ons a B two four four eight Bonta Chen status at a sigh Patel Patterson Sanchez Sanchez no Stephanie that bills out item 22 AB 2598 Krell Bonta Gonzalez Gonzalez I Patel Patterson Sanchez Sanchez I sharp Collins Stephanie That bill is out. Yeah. We're going to go back to consent, Bill. On consent, Bonta. Gonzalez. Gonzalez, aye. Patel. Patterson. Sanchez. Sanchez, aye. Sharp-Collins. Stephanie? Consent calendar is out. Right. We're going to do item number 20, AB 2551, Assemblymember El-Hawari. Welcome, Assemblymember. As soon as you get comfortable, go ahead and start. Thank you so much, Madam Chair. Good afternoon, Madam Chair and members. I'm proud to present AB 2551, a bill that will increase transparency regarding how many people must go out of network to access behavioral health care. Many Californians struggle to access behavioral health services. Communities of color report some of the lowest rates of mental health service use. Californians who speak a language other than English, LGBTQI plus individuals, and Black, Indigenous, and people of color communities face additional barriers to equitable care. Part of the reason for this is that many consumers must go out of network to find providers who meet their cultural or linguistic needs. In doing so, they are forced to pay high out-of-pocket costs. Nationally, consumers spend about $15 billion out-of-pocket each year for mental health treatment. Admittedly, as someone who prioritizes going to therapy every week with an LCSW who I can identify with, who I've built a rapport with after six years, and have also week after week paid out-of-pocket, I recognize that while I love her and she's amazing, I have to transition because of how much it costs and because we recognize that also at this point I have to find someone in network in order to be able to continue to afford it. And so I'm in that transition period. And so, AB 2551 requires health plans and insurers to collect and publicly share data on how many people must go outside their network to get behavioral health care and the total expenditures these individuals pay out of pocket to receive such care. It also requires health plans and insurers to document why individuals went out of network in the first place. For example, whether people are going out of network because they can't find care that is easy to navigate or that meets their cultural or language needs. For these reasons, AB 2551 would increase transparency regarding behavioral health care access and hold health plans accountable for providing culturally competent care. This is about ensuring our constituents can access the behavioral health care they need without going out of network and paying thousands out of pocket. It's also about making sure that insurance actually works for the people it's meant to serve. Joining me today is Omar Altamimi Senior Legislative Advocate with the California Pan Health Network and Kimberly Robinson a Community Liaison with Black Women for Wellness Welcome Good afternoon chair and members My name is Omar Altamimi I am the senior legislative advocate for CPEN, the California Pan-Ethnic Health Network, a multicultural health policy organization dedicated to improving the health of communities of color in California. CPEN is a proud sponsor of AB 2551, the Behavioral Health Affordability Act. The bill lays critical groundwork for improvement of behavioral health coverage and network adequacy for Californians covered by health insurance, particularly communities of color and those with limited English proficiency. Despite strong federal and state mental health parity laws, access to behavioral health care is at a crisis point in California, with consumers increasingly forced to go out of network to access behavioral health care. This crisis is compounded for communities of color, including limited English proficiency in LGBTQIA plus communities, who reported some of the lowest rates of utilization of mental health services and face additional barriers to equitable care, as you'll hear from today's witness, Kim Robinson. When consumers are unable to access in-network care, they must wait for care, go without it, or go out of network and pay out of pocket. That means paying twice, since this care should already be covered by their health plan and is already paid for with their premiums. This is unacceptable and only further exacerbates the unaffordability crisis and places undue hardship on families. Among commercially insured people with moderately severe or severe depression symptoms. Nearly one in three said they went without care because of cost. Nationally, consumers pay $15 billion in out-of-pocket expenses for treatment for mental health disorders. Individuals seeking mental health care are six times more likely to have to go out of network for care compared to other services. CPEN has heard numerous stories of individuals with health insurance not able to access care in a timely manner and having to pay for it themselves. When health plan provider networks are not sufficient to meet patient needs, people suffer. It's simply not acceptable for health plans to keep kicking the can down the road. Understanding how often, why, and how much is paid by health plan enrollees when they are forced to go out of network for their care should be a priority for all health plans as a critical way to understand the existing gaps in care. This is exactly what AB 2551 will do. The bill turns invisible barriers into measurable data by requiring health plans, which already must conduct data collection and survey activities of all their enrollees each year, to add questions related to the out-of-network use of behavioral health care. AB 2551 will also give insurance regulators. Thank you. Finish your last sentence. Yeah, for these reasons, I respectfully request an aye vote on this bill and pass it to our colleague, Kim Robinson. Thank you. Thank you. Good afternoon, Chair Bonta and members. My name is Kim Robinson, and I'm here today in support of AB 2551, the Behavioral Health Affordability Act. During the COVID-19 pandemic, we were told that telehealth would make assessing behavioral health care easier. In theory, care was supposed to be more accessible than ever. But for many of us, especially Black women and people with marginalized communities, that simply wasn't the reality. I had health insurance. I paid my monthly premiums like I was supposed to. But when I tried to find a behavioral health provider who was culturally competent, someone who understood my lived experiences, I quickly realized that having insurance didn't actually guarantee access to the care that I needed. While searching specifically for an African-American woman who provided mental health care, I found that even though telehealth services were widely available, there was only one provider in my insurance network who fit that description, and she had an extensive waiting list. After nearly two months of searching, the only option provided to me by my insurance carrier was to attend group counseling. That wasn't something that I was interested in engaging in And so I was forced to use a provider who not only didn look like me but also wasn equipped to properly address my mental health needs After spending 30 minutes pouring out my heart and soul instead of offering tools and guidance to help me cope with what I was dealing with, she offered me some literature to read, and then the conversation shifted to her talking about her cat. In that moment, I realized this was not someone who was going to be able to properly care for me. And honestly, the realization made me feel even more discouraged and depressed. To make matters worse, my insurance only allowed a limited number of visits. I didn't want to waste those visits on someone who wasn't in tune with what I was experiencing. So I was forced to stop and start the entire process over again while still paying my insurance premiums the whole time. That meant I was essentially paying twice, once for my insurance and then again with my time, energy and sometimes out of pocket. One provider charged $150 an hour. Trying to find care that actually worked for me was a job in and of itself. Thank you so much. Can you final comment? Yes. So for people like me and so many others across California navigating the same barriers, I respectfully ask for an aye vote on AB 2551. Thank you. Thank you so much. Are there any other witnesses in support to testify with your name, organization, and position only. Good afternoon. Evan Fern with Disability Rights California in support. Peter Hansel here on behalf of the AARP California. AARP is in support. Good afternoon, Madam Chair. Malik Bynum with the County Behavioral Health Directors Association in support. Nicole Wordleman on behalf of the Children's Partnership in support. Nora Angelis with Children Now in support. Katie Gandines with Health Access California in support. Thank you. Good afternoon, Chair members. J.P. Hanna on behalf of the California Nurses Association in support. Thank you. Are there any primary witnesses in opposition? Thank you. Thank you. You'll each have two minutes. Madam Chair and members, Olga Shiloh on behalf of the California Association of Health Plans. CAP appreciates the author's focus on improving access to behavioral health care, and we share the goal of making it easier for people to get timely, affordable care, especially when they are in crisis. However, at this time, we must respectfully oppose AB 2551. We recently had an opportunity to have a good conversation with the sponsors about their goal with this bill, and we welcome that opportunity to continue meeting with the author and the stakeholders. While well-intentioned, our primary concern is that the bill adds a new annual survey and reporting mandate on top of extensive behavioral health oversight that already exists, including parity requirements, network adequacy standards, timely access rules, and reporting to DMHC and CDI. Implementing an annual survey program at scale would be expensive and operationally complex. We are not convinced it would meaningfully improve access. We also recognize that California faces a well-documented shortage of behavioral health providers, particularly those willing to contract with plans and insurers. More broadly, the challenge we're trying to solve, thin networks and high auto-network charges, are driven by the provider shortage and by market dynamics where some providers can remain out of network set their own rates and bill full charges Regrettably this weakens incentives to participate in networks and ultimately drives higher health care costs CAP welcomes solutions that preserve timely access to care, protect consumers from excessive charges, and encourage providers to participate in networks. We appreciate the conversation and remain committed to working with the author, committee, and stakeholders on a constructive path forward. Thank you. Good afternoon, Chair and members. Matt Akin on behalf of the Association of California Life and Health Insurance Companies, also respectfully opposed to AB 2551. I would like to align my comments with my colleague at CAP and reiterate that while we agree that California faces a shortage of behavioral health providers, we are concerned that this bill oversimplifies why patients seek out-of-network behavioral health care. In many cases, especially in PPO products, out-of-network use reflects planned design rather than a lack of access. and closed network products out-of-network care is only approved when specific criteria are met. And when it is, member cost-sharing is already capped at in-network levels under SB 855 and its implementing regulations. Outside of these circumstances, plans and insurers often have no visibility into out-of-network services or costs unless a claim is submitted, making it unclear how the bill's survey and reporting requirements could be done accurately. Finally, we believe it is important to point out that out-of-network providers can set and collect full bill charges without the constraints of negotiated rates. Regrettably, this only further weakens incentives for providers to participate in plan, ensure networks, and ultimately drives higher costs for consumers and employers. For these reasons, we respectfully remain opposed to AB 2551, but we do look forward to future conversations with the author and sponsors if the bill does move forward today. Thank you very much. Thank you. Any additional witnesses in opposition who would like to offer me to? Seeing none, I will bring it back to the committee for any questions or comments. Assemblymember Addis. I'm happy to move the bill if it hasn't been moved. And I just wanted to thank the author and your witnesses for coming and certainly respect the position of the opposition. But I would say in my county and across the Central Coast, we're experiencing exactly this, which is that people have insurance, but they can't find providers who will take that insurance, largely because the rates are too low for them to be able to take that insurance. and I hear experience after experience where people had a mental health professional or a therapist as it were as you've as you've all kind of just described they had somebody they were seeing that person they had a relationship with that person and then all of a sudden that person isn't able to take the insurance anymore and describes it as the insurance is no longer providing the rate that it once provided and so the therapist can no longer and these folks have to go to a lot of schooling. Many of them have student loans from going to their schooling. They have to be able to get paid enough to be able to pay those loans back and make a living wage in a place like California that's very expensive. And I would add that in a place like the Central Coast that's very expensive. And so I hear from constituents time and time and time again what a huge problem it is that they are paying twice. As your witness has mentioned, they're paying for insurance and then they can't find a provider who can afford to take the insurance so then they're paying the provider and then they have a reduction in services because they can't afford to pay for the frequency of services that they once had when they had insurance so for us on the central coast this has become acute i hear from it more than most other issues that i hear for and so just want to thank the author for bringing this forward love if you're taking co-authors to be added as a co-author. Absolutely. Thank you. Assemblymember Schiavo. Thank you so much for bringing this forward, and I want to echo the comments by Assemblymember Addis. I think when you're talking, I agree with the opposition that providers are not willing to take insurance. We find this a lot. But that seems like a systemic problem within the insurance system. And and the problem is that in addition to, you know, the things that Assemblymember Addis was talking about, the low pay being a part of it. I have also heard about the incredible amount of paperwork, about a number of issues when it comes to verifying your information, having to verify your information with insurance companies on a regular basis, and then being told you haven't verified it when you have, and it's a part-time job just to make sure you stay on the insurance list. if you are actually taking insurance, which I know is becoming less and less common. And in the middle of a mental health crisis, for people not to be able to get therapy through the insurance that they're paying for is a disservice, to say the least. So I hope – we shouldn't have to do these bills is partly what I'm trying to say. You could just fix it and, you know, and and do a better job of making sure that people are getting what they deserve to be paid, making sure that it's an easier system for the providers, because it's a little bit cart and horse, I think, situation when you're talking about this issue. And I'd love if we didn't have to do any of these bills and it was just available for folks when they need it. So hopefully there is reflection on how it can be a more streamlined process and supportive process for providers to be able to come into the insurance system as well. Assemblymember Patterson? Great, thank you. I'm going to support this bill today largely because I agree with my colleagues that there are limited numbers of providers that will accept the insurance or that actually just provide this service at all. And if we're going to get people off the street and things like that, we actually need to increase. But I do want to say, however, it's not just private insurance that underpays providers. Medi-Cal has for generations has grossly underpaid providers, and it's hard to find providers to do anything, particularly help those with disabilities, including mental health issues. So, um, so I don't just blame, you know, the private insurance. Uh, I think we have a systemic issue, um, you know, that we have to, we have to figure out, but, uh, I look forward to supporting the bill today. Thank you. Seeing no other comments or questions from the committee uh assembly member you can close I respectfully ask for your eye vote Thank you Thank you so much We have a motion by Addis Is there a second By Colosa. With that, Secretary, please call the roll. The motion is do pass to appropriations. Bonta. Aye. Bonta, aye. Chen. Chen, aye. Addis. Aye. Addis, aye. Aguiar Kuri. Aguiar Kuri, aye. Aarons. Coloza Coloza aye Carrillo Carrillo aye Gonzales Gonzales aye Johnson Johnson aye Patel Patel aye Patterson Patterson aye Rogers Rogers aye Sanchez Sanchez aye Chiavo Chiavo aye Sharp Collins Sharp Collins aye Stephanie Stephanie aye That bill is out. Thank you Assemblymember. We are going to move on now to item number 21, AB 2575 by Ortega. Thank you, Assemblymember, whenever you are ready. Please press the button for the mic. Okay, thank you. Thank you, Madam Chair and members for the opportunity to present AB 2575 today. First, I'd like to thank the committee staff for their work, and I accept the proposed amendments listed in the analysis. AB 2575 is built around a simple principle. In healthcare, artificial intelligence should only support clinical judgment, not replace it. AI may offer promise but in real-world settings these tools can still get it wrong. AI that can generate false alarms or miss serious conditions. For example, a nurse was forced to take a blood sample after receiving an erroneous alert for sepsis, adding to the patient's bill. In another instance, a nurse followed protocol suggested by the algorithm and diagnosed a patient with something benign. That patient died with severe respiratory and renal failure. AI can also reflect the same biases that already exist in the data they were trained on. One algorithm assigned black patients a lower likelihood of adverse health outcomes than white patients who were at the same risk because the tool used healthcare cost as a proxy for health needs. Because the system historically spent less money on treating black patients, the AI model codified and recreated this discrimination. Knowing these faults, our frontline healthcare workers find themselves in an impossible double bind. Their employers are using these tools and making workers follow their output, But if the AI is wrong and the patient is harmed it is the workers and not the AI who face liability Follow the machine get blamed Override the machine risk retaliation When an AI tool goes awry because of a developer's or an employer's failure to develop safeguard, someone can try to hold them liable. But developers and employers can use a legal loophole called superseding cause by pointing the finger at healthcare workers for failing to catch the AI's mistake. When they win using this loophole, they face zero liability, even if their negligence caused harm. To address this, AB 2575 has three key provisions. First, the bill prohibits employers from retaliating against a healthcare worker for using their professional judgment to either override or follow an AI recommendation. Second, this bill requires AI tools to carry a nutrition fact label that lets healthcare workers know the risk and intended uses of the tools they use. Third, it prevents a developer or employer from using this superseding cause loophole to shift blame to a healthcare worker to avoid liability for their mistakes made in patient care. The purpose of AB 2575 is not to stifle innovation. We're using it. We use it in everyday items that we hold, our phones. I know when I've gone to the doctor, I've been asked if my notes, if AI can transcribe my notes. So it's there. It's happening. The concern is that it's moving really fast. It's so fast that we are trying to play catch-up when it comes to accountability, when it comes to transparency, and when it comes to patient safety. I, for one, do not want an AI tool to determine whether I need some kind of medication or some kind of treatment. I want that ultimate decision to be made by my health care providers. And if my health care provider decides that that AI that they're being asked to use is making the wrong call, then I don't want my health care provider to be retaliated against. That is the purpose of AB 2575. And I'm not alone in this. A poll from last year showed that while many Americans are turning to AI for answers on some medical questions, I'm sure many of us have used some of those sites ourselves, the vast majority, 79%, don't think that it can be trusted. Not yet. So AB 2575 helps empower healthcare workers to speak up and advocate for their patients. Justifying in support today is board president of the California Nurses Association, Kathy Kennedy. Also with me today is Sarah Phlox from the California Labor Federation. And I also have Deborah Reggie, an AI researcher at UC Berkeley, and Carmen Comste from the California Nurses Association in the back for technical witness to help answer any questions. Thank you. Your primary witnesses will have two minutes each. Please go ahead. Good afternoon, Madam Chair and members. My name is Catherine Kennedy, President of the California Nurses Association and co-sponsor of AB 2575. AB 2575 addresses the reality many nurses and other healthcare workers are confronting today Our employers are telling us that we must use artificial intelligence AI systems without basic information about these tools such as clear protections to object or override them without fear of retaliation. As nurses, we are asking multiple questions, such as what is the tool doing? What is its intended use? What data is it using? What are its risks and limitations? How well does it work or not? And we are not getting any answers. So when employers expect nurses to rely on this technology that we cannot meaningfully evaluate, object to, or override, then it puts our patient's safety at risk. In response, AB 2575 would put three common sense guardrails in its place when AI systems are used in patient care. Transparency, override protection of health care workers, and accountability for the developers. and health facilities that deploy these systems. After 46 years as a bedside RN, I know safe patient care is never just about what's on the screen or on the chart. It is about the uniqueness of the person, and as an RN, I am constantly assessing, listening, observing, and evaluating. So patient care is more than just executing the prediction that technology generates. For example, in the emergency department, ED, an AI triage tool estimates a patient's severity of illness and assign the patient a low priority score based on the information entered in the system when asked specific questions about their condition or their symptoms. Now, if you have an actual triage nurse, that person would immediately observe, touch, or even notice an odor of the patient's condition, or they may be pale, their skin is cool. All of those things make a difference. Thank you. Last comment. So my last comment is this. AI tools that our employers are asking us to use in patient care is something that we just – we need to be able to override it, and I respectfully ask your AI vote. Thank you. Madam Chair, members, Sarah Phlox from the California Federation of Labor Unions. And we are a proud co-sponsor of this bill. It is part of a large package of bills we have to establish worker technology rights as the new labor standards for the 21st century. And the goal of all of those bills is to ensure that human workers and human expertise is in control of AI tools and not being replaced by them. And the opposition coalition to this bill wrote in one of their letters that, quote, So we have a shared obligation and commitment to ensure that these AI tools are developed and deployed responsibly, equitably and transparently. Well, that is great because what AB 2575 does is codify the conditions and guardrails that are necessary to make sure we meet those AI goals goals and to ensure that any benefits of this technology, since these are much touted benefits that we are going to get, that those accrue to workers, to patients, and to the public, and not just to the tech developers or the employers who are using those tools. We need actual laws and not just commitments to make sure that that happens. So this bill puts in place three key parameters, conditions necessary for that, that we have across our bills. The first is advanced notification. workers need to know what tools are being used and the information that is going into them and coming out of them. The committee did an excellent, excellent analysis. And starting on page eight, there are a number of examples. The author gave one of them of where the information of the algorithms that were used, the inputs, the potential risk. Like a healthcare professional needs that information to use their professional judgment. That is one. Two is the freedom to be free from retaliation. And the second is ensuring fair accountability. That is what is needed to codify to make sure humans are in command. We urge your aye vote. Thank you. Are there any others in support who would like to offer a Me Too, your name, affiliation, and position on the bill. Good afternoon, Madam Chair and members. Roxanne Gould representing the American Nurses Association of California in strong support. Thank you. Good afternoon, Chair and members. Omar Altamimi with the California Pan-Ethnic Health Network in support. Good afternoon, Chair and members. Connor Gussman on behalf of Teamsters California and the engineers and scientists of California in proud support. Thank you. Good afternoon. Good afternoon, Aaliyah Griffin with the American Federation of State County Municipal Employees in support. Good afternoon, Madam Chair, members of the committee. Navneep Puryear on behalf of the California School Employees Association in support. Thank you, Mitch Steiger with CFT, a union of educators and classified professionals, also in support. Jennifer Robles with Health Access California in support. Eric Paredes with the California Faculty Association in support. J.P. Hanna with the California Nurses Association, proud to sponsor this measure. Whitney Francis with the Western Center on Law and Poverty in support. Ramon Costa Blanc, California Alliance of Retired Americans in support. Shirley Toy, member of California Nurses Association, strong support. HEMELA RAUS, REGISTERED NURSE AND MEMBER OF CALIFORNIA NURSES ASSOCIATION IN SUPPORT. CATHY DENIS, ACTIVE BEDSIDE REGISTERED NURSE DIRECTOR ON THE CALIFORNIA BOARD OF NURSES. PLEASE VOTE YES ON THIS FOR ME AND MY MEMBERS. THANK YOU. THANK YOU. WE WILL NOW MOVE TO ANY PRIMARY WITNESSES IN OPPOSITION. PLEASE COME FORWARD. You'll each have two minutes. Thank you. Thank you, Chair and members. Alexis Rodriguez with the California Chamber of Commerce here in opposition to AB 2575. AB 2575 seeks to impose numerous notification and disclosure requirements on healthcare facilities using AI tools and systems. This bill will negatively impact those tools that are already safely and effectively used in healthcare every day. AI tools and systems have the ability to improve the early detection of life-threatening conditions. AI is already helping clinicians detect sepsis sooner improve the accuracy of cancer screenings assist with screening patients medication orders and more To be clear CalChamber believes that AI in healthcare should not replace providers It's there to support them and the practice of medicine. Medical professionals can and should use their professional judgment when using these tools. With that said, AB 2575 would impose liability on healthcare entities and AI developers whenever there is harm resulting from a professional using these tools. If a patient is harmed, there should be a thorough investigation on who or which tool is truly at fault. Strict liability on the healthcare facility and developer will only discourage the use of AI in the clinical setting and dissuade innovation and creativity of future tools. We share the goal of responsible AI use in healthcare, but unfortunately, AB 2575 only moves us in the wrong direction. For these reasons, we respectfully urge a no vote. Thank you. Good afternoon, Chair and members. George Sorries with the California Medical Association here representing over 50,000 physicians and medical students in California. We're here in opposition to AB 2575 by Assemblymember Ortega. This bill would put numerous new reporting, documentation, and notification requirements on physician practices that are using artificial intelligence tools to help deliver safe and effective patient care. This bill is overly broad and risk-creating unintended consequences that could ultimately harm the very patients it seeks to protect. Physicians across California are already facing an unsustainable level of administrative workload. Studies consistently show that doctors spend nearly as much time on documentation and compliance as they do on patient care, which routinely leads to professional burnout. The bill's language restricting the use of technologies that may replace or limit professional judgment is vague and open to wide interpretation. In current medical practice, physicians routinely rely on clinical decision support tools, many of which incorporate AI to assist, not replace, physician decision making. These tools help identify early warning signs of serious conditions, reduce medication errors, improve diagnostic accuracy, and assist in clinical note taking. Under this bill, physician practices will be hesitant to use these tools out of concern they could be seen as limiting physician judgment, even when they are clearly beneficial. This bill risks discouraging innovation in patient care. California has long been a leader in both health care and technological advancements. This measure would have detrimental impact on the responsible development and implementation of new tools that improve efficiency and patient outcomes. Additionally, this bill introduces legal and operational uncertainty for physicians. The concept of professional judgment is already well established through medical standards of care and overseen by state licensing boards. This ambiguity may lead to increased administrative burden and defensive practices that detract from patient care. At a time when California is grappling with physician shortages, burnouts, federal funding cuts to health care, and access to care challenges, we should be reducing unnecessary administrative burdens, not expanding them. This bill would only add to those issues. Every additional minute spent on administrative tasks is a minute taken away from direct patient care. We fully support and always have supported appropriate oversight. Thank you. For these reasons, we respectfully ask for a no vote. Thank you. Thank you. Others in opposition, please come to the mic to offer your name, affiliation, and position on the bill. Madam Chair, members, John Wenger on behalf of Advanced Medical Technology Association, Avamed, in opposition. Madam Chair, Mark Farouk on behalf of the California Hospital Association, in opposition. Madam Chair and members, MJDS on behalf of Kaiser Permanente in opposition. Desette Short on behalf of Adventist Health in opposition. Olga Shiloh on behalf of the California Association of Health Plans also in opposition Jennifer Snyder on behalf of the California Life Sciences in opposition Jason Schmelzer on behalf of TechNet in respectful opposition Matt Akin on behalf of the Association of California Life and Health Insurance Companies, in opposition. Thank you, Chair and members. Ryan Perini on behalf of ATA Action, the advocacy arm of the American Telemedicine Association, in respectful opposition. Thank you. Ryan Spencer with the California Radiological Society, the California Society of Pathologists, and Ochen in opposition. Thank you. Gilbert Laurie here on behalf of Biocom in opposition. Thanks. Madam Chair and members, Dennis Cuevas Romero on behalf of the California Primary Care Association advocates in respect for opposition. Thank you. With that, we'll bring it back to the committee for any questions or comments. some majority leader. Thank you very much, and I'm sorry that we didn't get to touch base today, Ms. Ortega. I appreciate the work on this bill so far. I appreciate the intent to ensure AI is used safely in health care and to protect patients as well as providers. AI is already improving care, reducing provider burnout, allowing more time with patients, And I see that with some of my doctor friends right now. This has alleviated some of the workload for them. I appreciate the committee amendments to limit notifications that could lead to burnout. But as drafted, I'm concerned that the bill may be too broad and could limit proven tools that support patient care. I also have concerns with the employer retaliation liability provisions that need more clarity to avoid unintended consequences. I'm supporting the bill today and I encourage the author to keep working with stakeholders to address these concerns and strike the right balance. Thank you very much and I'll support it for today. Assemblymember Rogers. Thank you so much, Chair. I want to thank the author as well for bringing this forward. I think you know I'm the husband of a nurse and I can appreciate that you're bringing a bill that is really focused on protecting workers as we enter into this new environment. I also want to bring it back to sort of the 50,000-foot view, which is this is very downstream from a bigger issue that the legislature needs to grapple with, which is broadly around liability related to AI and who is liable when AI goes wrong or when it's used as a tool and nothing happens. We have seen small issues, whether it be from autonomous vehicles and liability related to that, to enormous issues like Grok deciding that it was going to put out illegal and inappropriate underage pictures. And we have not yet come to a clear decision on how to assess liability when the tool itself is the problem and the outcome. We don't want to stifle the innovation. I'm sure we'll be able to move forward in that space. But I do appreciate this bill looks at what has consistently happened up to this point, which is shifting the blame away from the tool and onto the practitioner. And I'll be supporting your bill today. I just wanted to see if Ms. Raji had a comment about the liability issue broadly raised by Assemblymember Rogers. Good afternoon, everyone. I think what Assemblymember Rogers brought up was really important The bill makes sure that any worker in the loop who is being a human reviewer of AI does not unintentionally or for whatever reason become a scapegoat for the problems that happen with AI Unlike what opposition said, this is not about strict liability. This is about preventing an affirmative defense from being used to put workers in front of liability on AI harm to patients. It's simply saying that we want to make sure that there can be accountability and that workers are not being the ones blamed. Yeah, just to add a bit to that, I think there's current ambiguity under the current system in which, you know, the law is built around human decision makers and what it means for human decision makers to make the wrong call. And so when you introduce an AI system that might have some degree of autonomy in decision making, it becomes ambiguous. And so part of the function of this bill and related bills is to clarify that ambiguity, to make it clear sort of who is ultimately in charge, which is the human decision maker, who should be in charge, which is the human decision maker. I also wanted to briefly comment on an earlier point around the feasibility of this bill in terms of impractical and technical terms. A lot of the technical infrastructure required for these bills, AI inventories, notification, the integration of features into electronic health record systems, are requirements that are also being discussed at the level of the FDA and ONC and other regulators at the federal level. And so a lot of AI vendors, for example, will have to think about integrating some of these transparency features moving forward. And a lot of health systems will have to think about integrating this type of AI transparency infrastructure. And so this is not far from existing requirements or requirements that these stakeholders will have to consider anyways. Assembly Member Schiavo. Thank you so much for this bill. Thanks for being here today. I know the opposition mentioned that they agreed that AI should not replace workers, healthcare workers, and that it should support them, and then went on to say that there should be, if something negative happens to a patient, that there should be a full investigation. You know, my concern after working for 13 years with nurses and hearing lots of stories is that sometimes that's too late. You can't just investigate. And so I'd be curious to hear what Ms. Kennedy thinks about just waiting to investigate later if there's a problem that comes up. Well, there always is a problem. And so, you know, it really, we should be able to override if we see something, because I mentioned the uniqueness of each individual person. So when you have an algorithm that may set in stone exactly what we're supposed to do for this particular patient, it doesn't allow for that individuality, that uniqueness that sometimes, not sometimes, a lot of the times a nurse may pick up that the algorithm itself doesn't pick up. So when you override it, when you say, no, I don't think so, not for this particular person. So for example, if the algorithm states that the patient really needs fluids, IV fluids, but yet you have somebody sitting in front of you that may be a dialysis patient and you have to limit the amount of fluids, but yet their blood pressure is going down, you're I'm going to put two liters of fluid in this patient. I'm going to talk to the physician, override it, and not go any further. So that's what I'm talking about is the opportunity to look at something, look at the patient. This doesn't meet. I mean, in my mind, I would have stopped. But sometimes you're not allowed to because you have the employer or your manager saying, just do it. That's what I'm talking about. Right. And it would be too late. Too late. Exactly. Exactly. And, you know, what some of the things that I've heard from working with nurses for so long, including you, is that there was some discussion around this, even around telehealth and some of the challenges around telehealth, that how important it is as a nurse to be able to see a patient directly, to see the color of their skin, to see if they're clammy, to be able to touch and feel the skin. And that those are things that are really important indicators. And obviously, computers also can't necessarily do those things, at least not at this point. And so, you know, having, I can't imagine anyone feels comfortable with AI making decisions without some kind of human override. Like this just seems incredibly common sense to me. And so, you know, can you talk a little bit about some of those things that are so important for nurses to be able to see, smell, feel, touch that would be important indicators that may be different than an AI algorithm is giving you? You know, like I said, I think that we're not anti-technology at all because, as the Assemblywoman stated, is that we see this in our everyday life. However, I think what's important is that we're the last person before. You know, we are the ones that are in front of the patient day in and day out. And if we see that the algorithm is stating for us to do something where we clinically have seen in experience, I've worked as a registered nurse for 46 years. There are many times when a doctor has asked me to do something, and because I've seen something in the past that was a bad outcome, I would stop and we would have a discussion to talk about that and say, no, not in this case. And a lot of times when you have like newer nurses that are maybe less experienced and are very, you know, they are they see the algorithms and, you know, they they feel that they need to do what the algorithm states as opposed to stopping and pausing for a minute. I think that it can have some significant and severe consequences. The concern also is that sometimes you're pressured. You know, it's it's it's almost like people look at us like we just do tasks. Nursing is an art and a science. It's more than just task. It's about looking at who's in front of you. You have the algorithm that states that you need to do certain things. But yet as a nurse, you're looking at that individual to say no. And so at that point, we should be able to override it, have a talk with a physician to say, come to the bedside, look at what I'm seeing. And that I'm concerned about, having been at the bedside for such a long time. and with the introduction of AI into healthcare at a very, very fast pace, I'm extremely concerned because it's almost become second nature. I mean we begin to look at it and maybe even believe it And so you really and it been untested And I fear that you know we using our patients as guinea pigs instead of really looking at what it is that we really bringing into health care without it being untested and unregulated And so I'm extremely concerned about that. I hope that answers the question. Thank you. And just if you could clarify from CMA some of the concerns. I mean, one of the things that I've noticed just as a patient myself is that there's certainly a number of benefits to AI, right? Even though it's a little creepy, AI taking the notes when you go to the doctor's office now, I feel like the doctor is able to look me in the eye more and focus on the patient care piece. and not have to be in front of the screen and taking notes constantly to chart things, which I appreciate. I am hoping that those notes are reviewed by the physician before they go into my chart for accuracy and making sure that they are. But I mean, so that seems like an important human interaction, right? And override, essentially, right? you can approve or not or correct charts. But what are some examples of this kind of overwhelming paperwork that you're talking about? Yeah, so I appreciate the question. On the note take, absolutely, physicians are always trained and taught to review it before the final submission to it. It's extremely important. And I know the profession takes it very serious, as well as other folks, part of the care team. As far as the other kind of burdens and notifications related to the bill is that it's left really ambiguous and there is is a anytime that these tools are used I know there's some amendments that we're still going through right and you know those are kind of highlighted or summarized in the analysis but you know anytime that a tool would be used it would then be on either the physician the or the health facility or the clinic to then notify the the employer or the employee I'm sorry that this tool is being used and we feel that that is overly broad and is too much information that will just detract away from patient care now that's not to say that we don't value folks being properly trained and the tools being properly trained, but, you know, we think that it will bog down an already cluttered system. I mean, I, if I am a healthcare worker, I think I would want to know if AI is being used in the course of care with a patient and how, you know, I mean, I think, I don't know. I have to disagree on that. I think that's important for anyone in the, you know, in the line of care to be able to know and understand. But I guess for the author, are there any responses to some of these concerns coming up from CMA? Yeah, we've heard some other concerns. And, you know, as some member Agia Curry mentioned, she had some concerns as well. So we're looking into this. We're continuing to kind of move forward through the process and make changes as we hear some of these issues so we're definitely open to it you know again we don't want to overload the system with reporting or to the point where it's you know it doesn't become effective anymore we want it to be effective so we're definitely hearing what you guys are saying and looking into possibly amending it some more thank you well yeah thank you so much I want to move the bill if it hasn't been moved already and moved by Shiavo seconded by Rogers assemblymember Patel and then assembly member Patterson Thank You assembly Assemblymember for bringing this bill forward in a very complex landscape It very important that we have these robust conversations and really make a push as the state of California for protecting patients and access to care. With that, I do have a couple of technical questions that I would like to explore with you. One of them is around the definition of cover tool and the technology used in the cover tool. And if you could please describe to me a little more specifically what kind of tools you were talking about. We know that AI can be used very effectively in diagnostics, for example, in radiological screenings. it can detect cancer much more quickly than even a very expertly trained radiologist or radiology technician. We also know that AI can be used in other lab tools. So what I would like to know is what is the general definition of cover tool? And does it include things, for example, software that might be used in calculations or scoring systems or other general algorithms that are used in the background for, for example, in diagnostics? So I think in this particular bill, the definition of AI was seen through the lens of autonomy. So there's sort of two views on this. One is sort of any system in which the decision is not necessarily defined by a series of explicitly defined steps, but it's determined through data. So a data-defined decision or a data-defined system, that's sort of what we would consider an AI tool. but also any tool in which there's sort of a range of instances in which the user might lose decision-making power or autonomy. That's sort of the other dimension through which the definition of AI is explored here. And so there's a bunch of different applications and healthcare applications that you named in which, you know, you could have a tool branded as AI. I think in this particular bill, you know, there's a CDSS tool. So these are clinical decision support systems. So these are tools that are leveraged by different health workers as part of their clinical or operational context. That's one in which there is sort of this active role of decision making. And then the other set of tools are a range of tools in which data defines the decision that comes out of that system. And often there's a temptation to remove the human from that process. You know, there was mention in the bill of, you know, the possibility of like healthcare AI agents in which, you know, you might automate the outcome of some of these decisions in a way that could yield adverse outcomes. You know, someone mentioned AI scribes in which the current ecosystem of AI scribe products are ones in which, you know, you just transcribe the interaction with the patient and then it yields information that the doctor can then interact with and assess. But there is a temptation and there is sort of an aspiration of some folks in that industry to perhaps feed that scribe outcome into something like billing processes or prescription processes or discharge note processes. And so the temptation to automate is really what this bill is addressing across a range of different AI products. And so that temptation shows up for a range of products. And really what this bill is trying to address is that when that temptation occurs, we should keep that human in the loop. And that humans should have the opportunity to be able to maintain their authority to override the system when it tries to make a decision independent of typical human oversight. So I think that that really what this bill is addressing across a range of different AI products But it like you kind of mentioned it more of a marketing term across a range of different data defined technologies Well, I really appreciate you clarifying around that, because that certainly seems to help me align better my thoughts and my concerns as well. And follow up question to that, then, is in the current clinical setting, do we see situations where AI is the decision maker? Is that happening already? Are there protocols in our hospitals or with our current decision makers where there is a requirement to follow the AI protocol? So I'm happy to speak to it, but I also know that you probably have examples. Similar to, you know, so the example that I was trying to give in the ER where it assigns an assessment score of a patient. And so depending on how the person answers the question, they may have a lower score, meaning that they may be seen, they may be considered less of a priority, less acute. And so they may be sitting in the emergency area a lot longer than they should have been. Whereas if you were to have a triage nurse that's actually watching that patient come through the doors, you immediately know that this person needs to be seen. And sometimes if we go to this type of product, you could miss something right away. Yeah, I appreciate that. I think I have a couple other examples. That's helpful. So yeah, I think triaging in a lot of operational contexts is one in which there's like a high risk of automation. So this is sort of allocating beds. And a lot of those tools are actually built on insurance data. So they're making these decisions based off of historical decisions made around bed allocation. And so you can imagine how that could potentially make worse existing inequalities in terms of resource allocation within a hospital setting. But that's one scenario, triaging and sort of hospital operations is one in which there's a high risk of automation. There's also a lot of risk of automation in sort of this AI scribing and billing pipeline. So a lot of, you know, as folks rightfully mentioned, there's a lot of administrative burden associated with doctor's notes and discharge notes and all of these things. But it's also correlated with, you know, doctors really having to make very important choices as to instructions for patients leaving the hospital or even inpatient care and definitely around billing. And so to automate any aspect of that pipeline is incredibly tempting to just sort of, you know, look at a doctor's note or a transcription of an interaction and parse out, you know, the appropriate billing outcome from that interaction. But, of course, there are risks associated with that as well. And then I'll say the last one, which is a lot of imaging tools that feed into diagnostic processes. Right now, there's also a strong temptation from folks that are looking to automate aspects of that process, though, you know, clearly the pushback from different health workers around the safety of that. Yeah, we certainly don't want to support any cognitive offloading that our practitioners would want to have to ensure the highest quality of care for our patients. We want our physicians and our care providers, our nurses, to be making those decisions. It's very important that we stick to that. I think when we look at AI and algorithms, hospitals have established protocols. They are very rudimentary algorithms, right? The triage protocols have been there for a long time. And I think the dream or sort of the aspiration is to have AI supporting existing protocols and processes that are in place. And the concerns that you raise are also very important. We don't want them being the decision maker because they're just not there yet. They are hallucinations, sure, in our large language models. We've seen that, as Assemblymember Rogers spoke to a little bit earlier. I would like to hear thoughts from the opposition. I I'm hearing your concerns about it being broad and possibly burdensome, but wanted to hear your thoughts on some of the questions that I put forward. Yeah, so I can certainly say that we are always advocating in the past and previous legislation and will do moving forward to always ensure that a human physician is the final decision maker on any sort of clinical decision. And we certainly wouldn't be here in this position if that was not the case of what we believed is happening and what we've heard from our members is happening out in the clinical setting and all of our different various facilities. So – and then as it relates to the radiological question as well, I think that we will be looking at future legislation to – California state law looks – it does already protect against a radiologist being replaced by some sort of algorithm or an AI bot, so to speak. And we will do everything we can to tighten that moving forward. So we have not seen that, but, you know, the concerns are well taken on that. And as it relates to any other sort of, you know, clinical decision, we always want to ensure that the physician or a human health care provider is the final decision maker. Yes, thank you for the question, and I'm happy to take that question back to our membership and get more info for you. Thank you. And I'll just close, if I can, with I really appreciate you, Assemblymember Ortega, for trying to address the concerns of the opposition. I think it's important when we take these big steps to protect patient care that we're making sure we don't have blind spots and that we build policies that can be enduring and work as we shift towards the future. Thank you. I will be supporting your bill today. Assemblymember Patterson. Great. Thank you. So I didn't take a single meeting on this bill. Not that my staff didn't have a lot of meetings and we didn't talk about it and research and things like that. But so I'm just listening to the testimony and reading the bill and doing my research and things like that. And I question for CMA in terms of opposition. It sounds to me the opposition is twofold for you. One liability. and the second one being the disclosures in terms of how heavy that is. Am I missing anything else? I would say there's a lot to this bill. We have a slew of concerns with it, but I'd say those are two of the big buckets that generally summarize it. Happy to kind of clarify any of those specific issue areas that you highlighted, the two, But that does pretty much summarize it, and always happy to discuss further outside of here. Okay. Great. Well, I know my colleagues would agree with me on this, that I in no way speak for any other Republican in this building. But my guess is I think we're open to these discussions. I think we open to ensuring that clinical decisions are not made by AI I think we are open I think about being in the ER and having a cardiac issue and being hooked up to a machine and it beeping and watching my heart and then it gets low and it shocks me automatically or something. I want a nurse to push that button. And then there's this company in Utah that is prescribing psychiatric drugs only initially with a doctor's review, but eventually it'll be via chatbot. And we ain't going to be doing that in California. But also, I'll tell you my concerns on this is, and I think it's similar to everybody else's, is I do think we don't want to be in a point, and maybe we have some fair disagreements on this, but this is not this bill. I don't want to stop automation necessarily in the hospitals. I want to allow AI into our medical field. I want to use it. I want to, as it gets better, I want to know what's going on and how that can help actually provide patient care and help the providers and help the nurses provide patient care. I have concerns on this bill with the disclosures that are required. and much, you know, was mentioned by the opposition. But, you know, I've talked with practitioners, you know, in the evening or the end of the month, and they're worried about closing their, you know, closing the files and all that, you know, so they get through all the billings and things like that. So, I mean, it's like the amount of paperwork on our providers is insane. I think it's fair to say if there's some kind of disclosure, so you guys can, you know, the nurses can hash it out on the local level, right? of whether that tool is okay or not. But the level of disclosures that are being mandated in the bill, I think are too much. It's too heavy. I think it's gonna really bog down a lot of stuff that's going on, so I would make it more minimal. I mean, I wouldn't make it as simple as like a Prop 65 warning, which absolutely everybody in the world ignores, but some kind of disclosure I think is fair. But I want to make sure – you mentioned also the triaging, right, going into the ER. I do – I have concerns about that. I really do. But also I'm not really open – but the thing is this bill doesn't necessarily stop that from happening. I think you can have that battle at the local level or in another bill some other day. You know, this bill requires disclosure of that occurring. Right. It doesn't correct me if I'm wrong. This doesn't actually prevent that from happening right now. Correct. I think it allows allows for disclosure, but also override as well. So, yes, yeah, I am in 100 percent of support of that, you know, so. So I think we can get to a place. I think, you know, I can't support it today, but I think, you know, keep working on it. Come, you know, maybe just this is Assemblymember Joe Patterson here, but I'm willing to have these discussions. I think it's a really, really important issue, and I don't want to prevent AI from being in the medical field. And sometimes it might mean that, you know, maybe there's automation here and not a person, and that might be okay in some areas. But, again, your bill isn't necessarily preventing that. It's requiring the disclosure of it so people can make the determination on their own. And I think that is okay. But it very okay Yo go You can interrupt me Yeah I just I don think I going to change your mind but just to share a different perspective No one has ever changed my mind Yeah, Assemblymember Patel sort of shared the fact that a lot of these technologies are really automating their understanding of existing protocol. And I think the ethos behind the technology is that, oh, well, if most of the nurses are just following protocol, then we should be able to replace that human with an algorithm or a system that can just automatically do that. The reality is that, like you mentioned, nurses make very nuanced judgments every day beyond protocol. And so there's always this role that they have to play in terms of accurately identifying exceptions. And those are exceptions that could be the difference between life and death here. And so I think the opportunity to notify the nurses of exactly how a decision is being made in a triage situation, let's say assigning a patient a bed, and then giving them the opportunity to identify those exceptions based off of additional information they can see, smell, touch, et cetera, and then override a decision that they see as inappropriate can be incredibly important. I think that that's an important component of the bill, and I think also the liability protections are important too. I don't necessarily want liability put on the hospitals, by the way. I mean we got to sort of figure that out, so I think that's another thing. But I think the – but the disclosure you're saying is fine, but that's not – the disclosure in the bill is actually quite lengthy. I hear you. So I'm just saying – Like a multilayered situation. I'm just saying maybe more than just Joe Patterson someday can get around this. If we kind of keep working on it is all I'm saying. And I know the author will. I'm just saying, you know, let's try to keep working on it so we can get, you know, 80 votes when it gets to the floor. And we're not impeding AI from actually helping patients. But the most important people in that, bar none, are the nurses. And by the way, people can sit here and say, like, oh, well, the intention, well, where are the nurses going to go with this next? Like, they're going to try to, you know, get rid of all AI. Look, I don't know. I don't care. I'm reading what the bill says. All right? So we can get – I think we can get there. So I'm just saying let's keep working on it, all right? Thank you. Thank you. Any other comments or questions from the committee? Seeing none, Assemblymember, you may close. Thank you, Madam Chair and members, for the robust conversation. I think we are all learning a lot about AI in the healthcare field through the variety of different bills that are being introduced this year. And I do appreciate all the questions that have come up today. You know, we are not trying to stop automation. At least I'm not. Not in this bill. It's there. It's being used. AI is in health care. What we're trying to do is, you know, what the public wants us to do, which is have transparency, some guidelines, and some accountability. That is what my bill is attempting to do. When it comes to the disclosure, I hear you. We are going to continue to work on that piece, and I'm open to those conversations. The liability concerns as well, this is our first committee, open to continuing the dialogue. And Assemblymember Patterson, I will be coming to your office. I will be following you around this legislation, and I will make sure that you are my 80th vote. And with that I would respectfully ask for an aye vote Thank you We have a motion and a second Please call the roll The motion is due pass to the Labor and Employment Committee Bonta Aye Bonta aye Chen. Addis. Aguiar-Curry. Ahrens. Caloza. Carrillo. Not voting. Gonzalez. Johnson. Johnson, no. Patel. Patel, aye. Patterson. Rogers. Rogers, I Sanchez. Shiavo. Shiavo, I Sharp Collins. Stephanie. Stephanie, I. That bill's on call. Thank you. We are going to now, for the sake of a joint witness, move on to item number 11, AB 2161 by Bonta. Oh, excuse me. Sorry. item number 5, AB 1979 by Bonta. Madam Chair, when you're ready. Thank you. This is not deja vu. Good afternoon, Chair and members. I want to start by accepting the committee amendments to AB 1979. This bill addresses the proliferation of AI into health care in two important ways. It prohibits the use of AI-enabled tools and devices in healthcare settings to replace the professional judgment of licensed healthcare professionals or to enable an unlicensed individual to do work that would require a license. And it clarifies provisions of the confidentiality of Medical Information Act to ensure that direct-to-consumer health AI products that seek to access individuals' medical records protect those records as otherwise required law. We've all been seeing the AI rapid deployment into many aspects of our daily lives. It's in our phones, our emails, everything we search on Google, the advertisements we see, and so much more. But it's also being deployed in our healthcare, as we've just talked about. Reuters reported earlier this year, at least 1,357 medical devices using AI are now authorized by the FDA. double the number it has allowed to do so in 2022. Researchers from John Hopkins, Georgetown, and Yale Universities recently found that 60 FDA-authorized medical devices using AI were linked to 182 product recalls, according to a research letter published by the JAMA Health Forum in August. Last year, I co-chaired with this committee and the Privacy and Consumer Protection Committee and an informational hearing on the use of AI in healthcare. We explored there what the challenges and opportunities are and the ways that AI is already being used to assist in testing, diagnosis, and administration. Some of the key takeaways from that hearing were that there is an opportunity for AI to enhance and improve healthcare, but only if it is done carefully and accounts for not just the potential for bias in developing the systems, but the complex nature of human technology interaction when a provider is using the AI. In their work on mitigating bias in AI, the Berkeley Haas Center for Equity, Gender, and Leadership tracks publicly available instances of bias in AI systems using machine learning. In their analysis of around 133 biased systems across industries from 1988 to the present day, the center found that 44%, that's 59 systems, demonstrated gender bias, with 26%, 34 systems exhibiting both gender and racial bias. When automated decisions are deployed in healthcare, biased historical data can lead to patients becoming recommended substandard care on the basis of their race or ethnicity. A 2017 study found that a biased system led doctors to promote or perform more C-sections on Black and Latino people than on white people. Discrepancies like this can perpetuate historical biases and lead to worse healthcare outcomes. These are just some of the examples of the challenges in deploying these types of tools, because even when a human may be in the loop, reviewing an AI system's output for errors is substantively different cognitive task than generating a clinical note or medical advice. Certainly a through line of many of the opposition letters to this bill was agreement that AI should not replace professional judgment. But now with the proposed amendments, we're hearing that AI simply does not replace professional judgment. It's increasingly clear that the use of AI is evolving faster than our laws. and regulations can keep up. Hippocratic AI has marketed AI health agents as replacements for nurses. A study by University of California, San Francisco last year experimented with using chat GPT to triage patients in the emergency department instead of RNs. Protecting patient safety, keeping our professional workforce engaged in their work and ensuring the integrity of healthcare will rely on us not deferring clinical decisions to AI, not while we are still working to understand and the potential risks along with the benefits. Here to testify are Kathy Kennedy, who is a registered nurse and president of the California Nurses Association, the sponsor of the bill, and Deb Raji, who is a researcher focusing on AI accountability. As a reminder, you should get two minutes, please. Again, good afternoon, chair and members, Katherine Kennedy, RN, president of California Nurses Association and sponsor of AB 1979. As nurses, our profession is both an art and a science. We care for people at some of the most vulnerable moments of their lives, and it's during those moments that patients, people, do not need or want a machine imitating, and often done poorly, the practice of nursing or medicine. What people want is a licensed clinician who uses their professional judgment, clinical skills, and lived experiences and human compassion to provide that safe, effective care. And for the nurses at the bedside, we don't just execute tasks. We are constantly assessing and utilizing the scientific method through the nursing process to provide the individualized and holistic care for each of our patients that they deserve. This is why AB 1979 matters. Professional health care judgment cannot be automated by an algorithm. The bill is based on a simple principle. If the California law says that a licensed health professional must perform a health care activity, AI should not be allowed to do that care in our place. It preserves the human-in-command standard where the nurse, doctor, or other licensed clinician remains the actual decision-maker and not the AI tool. Today these tools are being used in areas of patient care that require clinical judgment including assessment diagnosis clinical decision patient education and handoff However these are all core functions of licensed clinical practice AB 1979 would ensure that AI cannot be used in patient care to replace the professional judgment of nurses or other licensed healthcare professionals. Importantly, this bill also makes clear that patient data remains protected by existing health privacy law when AI is used. To be clear, this bill does not ban supportive technology as nurses use technology every day. It simply reaffirms patient privacy laws and preserves a clear boundary around the care that California law preserves reserves to licensed human health care professionals. For that reason, I respectfully ask for your aye vote. Thank you. Please proceed. Good afternoon, Chair members. Hi, I'm Deb Raji. I'm a computer science researcher at UC Berkeley that works on AI accountability, especially in public interest deployment settings. I work very closely with various civil society groups as well as AI practitioner networks, including those in the healthcare space, notably the Health AI Partnership, which is a practitioner network of about 50 different health systems across the U.S. Under the Hippocratic Oath, physicians and other health workers are charged with a very heavy mandate. First, do no harm. However, so far, the evidence has already declared that many AI systems can fail, sometimes catastrophically but often perniciously, in unexpected ways that risk causing real and lasting harm, especially to marginalized populations if deployed prematurely and inappropriately in high-stakes applications such as healthcare. Research has already revealed that much of the benchmark performance being reported by corporate vendors of AI health technology is inadequately tested. The contrived scenarios and medical exam-style tests the vendors report do not capture actual performance outcomes within a complex deployment setting. In addition to this, the tendency towards regulatory arbitrage, internal tool development, and a still immature emergent regulatory ecosystem means that currently deployed tools do not always go through a rigorous approval process. As a result, the health systems deploying this technology tend to overestimate what the technology is capable of, especially in the absence of human oversight. As outlined in AB 1979, health systems deploying AI technology need to take seriously their responsibility to adopt, integrate, and monitor these AI systems that they introduce within clinical settings. Through participation from AI users and the impacted population in the healthcare setting, we can protect the most vulnerable patients from continuing to experience harm through inappropriate AI deployment. Thank you. Anybody in the room that wants to add on in support, this is the time to do so. Nobody in the room in support. Please state your name, affiliation, and position on the bill. Mr. Chair, member Sarah Flox, the California Federation of Labor Unions in support. Thank you. Thank you, Chair and members. J.P. Hanna on behalf of the California Nurses Association, sponsor of this measure. Thank you. Shirley Toy, registered nurse and member of California Nurses Association, in support. Pamela Rouse, registered nurse and member of California Nurses Association, in support. Kathy Dennis, practicing bedside registered nurse, director on the California Nurses Association, in support. Thank you. Primary witnesses in opposition, please step forward. And again, as a reminder, you should get two minutes. Good afternoon Chair and members George Sorris with the California Medical Association We here in respectful opposition to AB 1979 by Assemblymember Bonta I want to highlight our appreciation for the conversations we had with the author and her staff over the past few weeks and look forward to continuing that work on this bill. We shared the author's commitment to protecting patient safety and preserving the integrity of clinical decision-making. We do not have concerns with a section of the bill requiring entities to adhere to strict confidentiality standards regarding the use of medical information. However, we believe a blanket ban on the ability of clinicians to utilize AI and their clinical decision-making process will not result in the best outcomes for patients. While we appreciate the proposed amendments in the bill analysis, we believe this bill would still effectively prohibit AI-assisted technologies and core clinical activities, such as patient assessment, care coordination, patient education, and clinical documentation, even when these tools are used under the direct supervision of a physician and do not replace physician judgment. In current practice, many AI-enabled tools are embedded in electronic health records and clinical workflows to improve accuracy, reduce administrative burden, and enhance patient outcomes. These include clinical decision support systems, predictive analytics for early detection of deterioration, and tools that assist in summarizing complex medical information. Prohibiting their use in any context involving professional judgment would effectively eliminate their utility in clinical settings. important. AI and healthcare today functions as a tool, not as a substitute for physician expertise. Physicians remain responsible for interpreting AI-generated recommendations, validating their accuracies, and making final clinical decisions. We support and have sponsored legislation that puts appropriate safeguards in place without overburdening physicians, but we do not support restricting the safe use of AI in healthcare. We appreciate your consideration of our concerns and I'm happy to answer questions at the appropriate time. Thank you, chair and members of the committee. and members of the committee, Mark Farouk on behalf of the California Hospital Association, representing nearly 400 hospitals and health systems, respectfully opposed unless amended to AB 1979. We too want to acknowledge the conversations with the author and staff on the bill. We also appreciate the attempt to address our opposition in the proposed amendments, but unfortunately, we believe that even with those changes, the bill would still ban the use of AI in health care. The use of AI by California hospitals and health systems assist licensed professionals, it does not replace them. AI-powered tools are already saving lives, alerting care teams to early signs of sepsis, improving the detection and prevention of cancer, flagging dangerous drug interactions, just to name a few. These are patient-centered tools delivering real improvements in patient outcomes. AI also makes it easier for healthcare professionals to do their jobs. It reduces administrative burden, streamlines clinical documentation, and helps providers spend less time on paperwork and more time with patients. These aren't futuristic concepts. They are embedded in the electronic health record platforms that providers not only use every day, but are required to use as part of the state's data exchange framework. AB 1979 will disrupt the functionality of these EHR systems by capturing a variety of embedded technologies. They're simply evolutions of tools and evaluations used in health care for decades. Due to its broad definitions, the bill introduces sweeping restrictions that cast doubt on technologies already in use and sends a message to patients that AI-assisted care is inherently suspect, even when a licensed professional is guiding every step in making the final decision. If patients lose trust in AI-assisted care delivered under professional oversight, they will turn to unregulated consumer AI models with no clinical validation and no accountability. This is a far more dangerous outcome than anything this bill is trying to prevent And for those reasons we remain opposed unless amended Thank you Thank you Those that are here to submit to an opposition please state your name affiliation, and position on the bill. Thank you, Mr. Chair and members. MJDS, on behalf of Kaiser Permanente, in respectful opposition. Mr. Chairman, Chris McKaylee, on behalf of the Civil Justice Association of California, in respectful opposition. Thank you. Thank you, Mr. Chair. David Gonzalez on behalf of America's Physician Groups, opposed, but we'll look at the amendments and I appreciate them. Thank you. Thank you, Mr. Chair and members. Jason Schmelzer on behalf of TechNet, in respectful opposition. Thank you, Chair and members. Ryan Perini on behalf of ATA Action, in respectful opposition. Thank you. Ms. Short on behalf of Adventist Health, in opposition. Mr. Chair and members, Olga Shiloh on behalf of the California Association of Health Plans in respectful opposition. Alexis Rodriguez with the California Chamber of Commerce in opposition. Thank you. Ryan Spencer with the California Radiological Society in respectful opposition. Gilbert Lahr with Biocom with an opposed unless amended position. Thank you. Without a ticket to the committee members, questions, comments? Yes, madam. Okay. I want to thank the chair for your work on this bill so far. Sorry. I appreciate the intent of this bill to preserve physician judgment and protect patients. I agree we need guardrails to protect patients, but I'm also concerned that the bill, as written, could limit helpful and safe uses of AI. AI has a lot of promise in our healthcare industry, as we know, it can help doctors spend less time on paperwork and more time with patients. I appreciate the committee amendments changing any activity to replacing professional judgment. This is a step in the right direction with these amendments, and I'll also be supporting the bill today. Moving forward, I would like to encourage the author to keep working with stakeholders to clearly define what replacing professional judgment means and that that clarity will help us make sure we don't restrict tools that support but do not replace doctors. Thank you. Anybody else? Dr. Patel first. Thank you. Yeah, thank you for bringing this bill forward, echoing some concerns and interest as with the previous author and the previous bill. I want to piggyback off a little bit of what Assemblymember Aguirre-Kurri was talking about. Can you explain a little bit better what professional judgment means and how the guardrails you want to create around AI replacing professional judgment? Because in my understanding, with how AI tools are used right now in the clinical setting, it's used more as a tool as advancements such as microscopes were used to help identify disorders within blood or tissue samples. Thank you for that question. I will say that there are basically two different kinds of use cases that we are trying to get at. And this will be, unfortunately, a long way around to your response. response. So in mid-January, well, I should say in November and December, we were sitting here talking about kind of devastating cuts to access to healthcare for basic individuals because of HR1. The reality of people not being able to actually have access to a doctor or a healthcare practitioner is, something that we know is going to be a sad reality and exacerbated by HR1 in the near future. Mid-January, Chad GPT Health and Claude for Healthcare released with very, very grandiose ideas the fact that they were releasing a platform that was direct to consumer, essentially. They quoted that 230 queries a week were made around health care concerns or issues. So at the same time that we're reducing the ability for somebody to see an actual health care practitioner, a human health care practitioner, we're flooding the market, so to speak, with platforms, AI agents and platforms that basically created an opportunity for people to have all the kinds of questions that they asked or needed help with. through these platforms. Now, that starts to roam into this area of clinical practice, right? They call it supplemental care or assistance. But in reality, if you are asking a series of questions, queries about a particular illness concern that you have and you are getting and you are allowed to have your medical data integrated into that, your x-rays, your prior doctor's visits, we are going pretty close into the use case of what clinical practice could look like. So the long answer is that that's the kind of substitution of professional judgment that starts to come out of these platforms when we don't have any guardrails around that. So that's kind of one use case in the application of needing to limit the replacement of professional judgment. And then the second use is related to the concerns raised by CMA and CHA around a healthcare practitioner needing to be able to use the tools that they have available to them, the AI tools that they have available to them, in a way that doesn't cause them to not have to be involved at all as healthcare practitioners in the final judgment of or decisions related to the practice of healthcare, much like what we just talked about in the prior legislation. So I think this bill is aiming and intending to get at both use cases. We recognize that there are opportunities to more clearly define and be more specific in those use cases. And I'm certainly going to be working with the opposition to make sure that we are striking a good balance around what that professional judgment is so that we can move forward. And I'll note that this bill is going to another committee where we will have the opportunity to do that. And the last bill is going to two other committees. So we are on the start of a long journey. So with follow up to that, because this is very interesting to me in general, does your bill then further regulate direct to consumer options as well? And then how does that deal with the interstate commerce clause? How will this regulate over internet providers? In the same way that we regulate internet providers across multiple, whenever we have it, and I don't think that it impacts the interstate commerce clause in any additional way than when we try to regulate Google or Facebook or Meta in digital worlds That first And I do think that there are applications to this legislation that impact those platforms They are primarily around ensuring that our privacy, our data privacy and patient data is protected because both of those platforms essentially said we are not subject to HIPAA because we are supplements and we are not practicing or acting in a clinical practice. And this clarifies that the CMIA has a purview over those platforms. Thank you. Thank you for bringing a thoughtful bill forward and appreciate you continuing to work with opposition to try to bridge any divide that there continues to be. Thank you. Assemblymember Rogers. Thanks so much, Chair. and just wondering how you were working to straddle that kind of opposition. Yeah, I will say that I am the biggest fan of my medical gadgets. I walk around with my Oura ring. I love the fact that you can have a CRM that generates data to be able to understand what your continuous glucose monitor, so you see GM, might be. And I think that those are really important aspects and devices of technology that should be integrated into our healthcare practice. We also know that given the rising cost of healthcare, being able to engage in automation and the use of those innovations and technologies is going to be one of the ways that we support not having skyrocketing healthcare costs over time. So I'm going to continue to thread the needle very carefully to be able to integrate the new research that we have emerging and make sure that we are also preserving our opportunity to provide quality health care as well as supporting the innovation that is rightfully so based here in California to be able to support that. It's a big task. This is a new space. There's a lot that we can do. And one of the things that I think we definitely need to be mindful of is not our witness, Raji, Ms. Raji spoke to it, kind of allowing for there to be a regulatory arbitrage so that we can kind of have people kind of skirt through the naming of things or the definition of things in a way that keeps us from being able to actually provide the necessary guardrails. And as you can tell, it's a very delicate needle that we are trying to thread. Yeah, no, absolutely. And I want to appreciate how difficult that is. I've been thinking about it just through the lens of some of my own family members. We have quite a few type 1 diabetics in my family. And obviously, their automated insulin pumps are game changers for them, especially my brother who was diagnosed when he was in his, I think, two or three. And just seeing the technology that has emerged that is automated that allows him to do things differently than he could have done while also not removing the discretion of working with his qualified health professional on what that plan can look like I think is a really important aspect to this conversation Thank you Assemblymember Any other committee member with comments or questions Seeing none Madam Chair would you like to close? I respectfully request your aye vote, and thank you for allowing us the opportunity to advance quality health care while also innovating in the state of California. I believe we need a motion and a second. We have a first and a second. Please call the roll. The motion is due pass as amended to Privacy and Consumer Protection Committee. Sanchez, no. Chiavo? Sharp, Collins? Stephanie? Gonzalez? Aye. Gonzalez, aye. That measure is on call. Thank you, Madam Chair. Thank you. Thank you for your patience. We are going to move to item number six, AB 1985 by Irwin. No. Oh. We, no. Item number 18, AB 2531 by Irwin. No. Please press the button. Good afternoon, Madam Chair and members. I am pleased to present AB 2531 today. In December of last year, the Trump administration finalized a rule to prohibit the Veterans Health Administration, known as the VA, from providing abortion care. The potential effects of this decision are profound. Veterans in California who have worn the uniform and put their lives on the line are now being denied basic reproductive health care from the VA because of the Trump administration's discriminatory policies toward women. Throughout my tenure in the legislature, I have always maintained a steadfast commitment to our veterans. Whether it's through my time as chair of the military and veterans affairs committees or through legislation I ran to place Proposition 1 on the 2024 ballot, It has always been a priority of mine to ensure that we take care of the people that have served our country. And taking care of our veterans is exactly what this bill does. AB 2531 puts our veterans first to where the federal government has failed them. It narrowly expands access to our existing uncompensated care grant program, so it will include veterans whose federal health care coverage does not include abortion services. This will ensure that our veterans who cannot receive abortion care or counseling through the VA health system are not left behind. The bill also requires that the California Department of Veteran Affairs include a link to abortion in their existing list of resources for veterans to ensure that our veterans know that they have access to critical, their critical health care coverage. With me to testify in support of this bill today is Angela Pontes on behalf of the bill's sponsor, Planned Parenthood Affiliates of California. Thank you, Chair and members. Angela Pontes on behalf of Planned Parenthood Affiliates of California, representing the Planned Parenthood affiliates across the state. We are a proud sponsor of this bill and we thank the author for addressing this issue. As stated, AB 2531 responds to recent federal action that severely restricted access to abortion care through the VA system. Under this new policy, the VA can only provide abortion in life-threatening circumstances, which we know is an intentionally ambiguous threshold that has dangerous and cruel consequences. Despite Despite California's constitutional protections for reproductive freedom, our state's veterans and VA providers cannot obtain or provide abortion care. To address this inequity, AB 2531 would narrowly expand eligibility in the uncompensated care grant program to include veterans. Without this bill, veterans may only access care by paying out of pocket at a non-VA provider. Planned Parenthood health centers are proud to be amongst the state's uncompensated care providers that offer abortion and contraception, we ask for your aye vote. Thank you. Are there others in the room who would like to offer a Me Too in support? Please come forward, state your name, affiliation, and position on the bill. Good afternoon, Madam Chair, Roxanne Gould with the American Association California Nurses Association in support of the bill. Good afternoon, Chair and members. Symphony Barbie on behalf of the ACLU California Act in support. Charles Wright on behalf of the California Association of Veterans Service Agencies in support. Craig Pulsar on behalf of Equality California in support. Good afternoon chair members. Keshav Kumar with Lighthouse Public Affairs on behalf of Reproductive Freedom for All and our over 400,000 California members in strong support. Good afternoon, Chair and members. Jessica Moran with Capital Advocacy on behalf of the California Hospital Association in support. Kevin Musman with the California Medical Association in support. Second. Moved by Patel, seconded by Rogers. Sorry, seconded by Majority Leader Aguirre-Curry. Are there any primary witnesses in opposition? Please go ahead, you'll have two minutes. Thank you. Chair and members, my name is Leander Wells with the California Family Council. I'm here today to oppose AB 2531, which uses taxpayer dollars to promote abortion to military women. This bill fails to provide the true support our military women deserve. I recently heard the story of Bethany Sorrows, a veteran who shared her horrifying abortion experience. She explained that there is an assumption that women in the military will choose abortion if they want to continue serving, rather than be seen as using pregnancy to avoid deployment. As she put it, quote, a good soldier will have an abortion, continue the mission, and choose duty over motherhood." AB 2531 reinforces that same message that in order to serve your country, you must end your child's life. This assumption undermines women's capacity, dismisses their unique ability to bring life into the world, and overlooks the support system that enables them to succeed in both roles, such as adoption, pregnancy centers, safe surrender locations, and other material assistance. Solely promoting abortion on government websites without equally presenting alternatives is a breach of public trust and fails to provide balanced information. I believe when women are equipped with resources, they are empowered to choose life. Additionally, abortion is associated with a higher risk of mental health issues. According to a study by Priscilla K. Coleman, with a PhD, women are 34% more likely to develop anxiety disorders, 37% more likely to experience depression, 110% more likely to engage in alcohol misuse, and 115% more likely to exhibit suicidal behaviors. We must ask ourselves, is this truly what we want our veterans to endure? The U.S. Department of Veterans Affairs reports that veterans already experience higher rates of PTSD, depression, and suicide risk than the general population. Is the military prepared to take responsibility for both the moral implications and the psychological effects on the women who serve our country? For these reasons, we respectfully urge a Novo on AB 2531. Thank you. Thank you. Are there any others in opposition? Please come forward with your name, affiliation, and position on the bill. David Bullock, SFV Alliance, in opposition. Greg Burt, vice president of the California Family Council, in opposition. Thank you. Thank you. Seeing no other opposition, I will bring it back to the committee for any comments or questions. Assemblymember Patel. Thank you, Assemblymember Irwin, for bringing this bill forward and protecting our constituents in ways that they didn't realize they may have needed protection. Can you clarify a comment from the opposition? Are we talking about veterans or active duty individuals? The bill as drafted applies to veterans. Thank you. Assembly member Stephanie. Thank you, Chair. And I want to thank Assemblymember Irwin for bringing this bill forward. As a daughter of a Vietnam vet, I am very in tune with how much we don't do for our veterans, and I think this is extremely important. Also, I just want to address the opposition. I think the assumptions being made about our female veterans are quite frankly offensive, as if they can't make informed decisions for themselves. And if you're taking co-authors, I would like to be one. majority leader i'd like to just be a co-author thank you with that i don't see any other committee uh comments uh thank you assembly member erwin for bringing this forward i think at this time right now uh when we have so many of our military engaged in battle to protect and serve this country. I'm very thankful that you've brought this forward and always mindful of your commitment and passion to protect our veterans and those in service. Thank you. Would you like to close? Disrespectfully ask for your aye vote. Thank you. We have a motion in a second. Please call the roll. The motion is due pass to the Military and Veterans Affairs Committee Bonta Aye Vonta aye Chen Addis Aguirre Aye Aguirre aye Aarons Coloza. Coloza, aye. Carrillo. Aye. Carrillo, aye. Gonzalez. Aye. Gonzalez, aye. Johnson. Johnson, no. Patel. Patel, aye. Patterson. Rogers. Aye. Rogers, aye. Sanchez. Sanchez, no. Chiavo. Sharp-Collins. Stephanie? Stephanie, aye. That bill's on call. Thank you, Assemblymember. We will move now to item number 17, AB 2489 by Lowenthal. Call. You. Speaker Lewenthal, at your pleasure, sir. Mr. Chair, thank you so much. If you see me walking around the room fidgety, it's not because I'm nervous. It's because I'm having incredible sciatic pain right now. If the health committee could get me a new sciatic nerve, I would be grateful. Mr. Chair and members, I would like to start today by accepting the committee amendments, and I also want to thank the committee staff for their work on this very important bill. AB 2489, this is the California Veterans Right to Try Act. It authorizes California's research advisory panel to apply directly to the FDA for a multi-site clinical trial of psilocybin, ibogaine, and other psychedelic compounds specifically designed for veterans. And I'm just so proud today to be joined by my colleague, Mr. Gonzalez, who has shared with me, and I think he will share with the committee, the challenges that veterans have with PTSD, the personal challenges, the group challenges, and the lack of optionality to confront those challenges. Unlike most clinical trials, this one will enroll veterans with overlapping conditions, PTSD, depression, traumatic brain injuries, and substance use disorders, the very same veterans who are routinely screened out. California is home to more than 1.5 million veterans, the largest veteran population in the country, and we are failing them. Since 2001, over 125,000 veterans have died by suicide in America. We lose between 17 and 44 veterans to suicide every single day. In California, veterans die by suicide at more than double the rate of other Californians. 29% of veterans of the global war on terrorism are living with PTSD. Existing medicine has struggled to treat veterans with traumatic brain injuries, treatment-resistant depression, and substance use disorders. And worse yet, the veterans who need help the most are the ones who are most likely to be turned away from clinical trials. FDA guidelines discourage enrolling subjects with comorbidities that describes virtually every veteran with serious mental health needs And so veterans are getting on planes They traveling to clinics in Mexico and Jamaica and Europe to access treatments that should be available here in California. And that is unacceptable. Veterans are falling through three gaps, access to treatment, no inclusion in research, and no data to drive FDA approval. And this bill aims to close all three. First and most importantly, this bill will save lives. It will give our research authority panel the legal authority to pursue a formal, medically supervised trial, putting California at the forefront of veteran mental health research. Additionally, it will generate the safety and efficacy data the FDA needs to move toward approval. Lastly, it will bring veterans home. They will no longer need to leave this country to access a treatment that might save their life. It will position California as a national model for bold, compassionate action. And if this research leads to positive outcomes, these therapies may become available through the VA and mainstream medical systems across the country, benefiting every veteran in every state. Our veterans served us without hesitation, and this bill aims to serve them with the same commitment. Here to testify in support of AB 2489 are Dr. Mitchell, the chair of the research advisory panel of California, and Nathan Fletcher, a Marine combat veteran. Joining them to address any technical questions is Kershid Koja, Veterans Exploring Treatment Solutions. Prior to that, I want to give my colleague, joint author, Assemblymember Gonzalez, the ability to address the committee. Thank you, Madam Chair. Thank you, too. my co-author, our co-authorship and your leadership is specifically in this and I lay there for about 45 minutes on the ground see I'm a happy-go-lucky guy like you guys know I try to keep things positive and the darkness of the room Mind you, it wasn't dark But the darkness of the room Overtook everything 24 months before that Seems like the world was crashing all around It seemed like every Friday another Marine Died by suicide And they were in my circle It almost felt like 9-11 every single day. I thought I was going to be number 11. I really believed I was number 11. And I sat there as a man of faith, with that dental floss of faith clinging on for help. And I honestly didn't know how to get it. I just, even though I had coached them, I was immersed in the darkness. The demons were all around. The demons that we talk about that follow us back home. So I sit here as assemblyman. I sit here as vice chair of military and veterans affairs committee. I sit here as a Marine Chief Warrant Officer and Combat Veteran But I sit here as a man who thought I was broken from the horrible things that you're never supposed to see. I thought I was number 11. So I'm thankful for the author and for everyone here. we don't need another service member to take their life by suicide. It's one of the most horrible things you can ever experience because the ripple effects still plague me to this day. So we have the ability today to save a life and to save many lives if we join together because standard medicine isn't working. We need to think outside the box to make sure that we are saving the men and women who have put their life on the line. So with that, as a combat veteran, as your colleague, and as a friend, not only am I asking you, I'm begging you. Join us in helping to save some lives by looking at this and making sure that we can make a difference. You can make that difference today. Thank you. Thank you. You'll have two minutes for the witnesses. Good afternoon, Madam Chair and Assembly members. My name is Jennifer Mitchell. I'm a professor at UCSF in the Departments of Neurology and Psychiatry. I'm the Associate Chief of Staff for Research at the San Francisco VA. and I am the chair of the Research Advisory Panel for the State of California, but I am here as a private citizen to express my support for AB 2489, the Veterans Right to Try Act. This bill is in keeping with recent bills passed in Texas, Washington, Utah, and Connecticut, and with a similar bill currently under consideration in Georgia that would allow veteran access to psychedelic medicines for a variety of different mental health conditions. Currently, several dozen psychedelic clinical trials are being conducted in this country, and there is evidence demonstrating their efficacy for a number of different mental health indications, yet we don't have a mechanism by which these can be made available to our veterans who are among the most vulnerable and difficult to treat of clinical populations. I believe that the FDA will continue to provide investigational new drug, IND, approval for state-sanctioned programs, and that a California state program would enable us to identify, study, and develop a safe and effective system for psychedelic access for our veterans. The research advisory panel currently evaluates research using Schedule I and Schedule II controlled substances, and already reviews a myriad of IND packets each year that are focused on studying psychedelic medicines. So assisting with the generation submission and oversight of an IND for the state of California seems like an appropriate task for the panel to assist with. This bill should not necessitate new state funding. There are currently a number of statewide funding initiatives, such as the one recently released from the State Commission for Behavioral Health, that are tasked with driving transformational change across the state's mental health system. And I've already heard from groups who are interested in applying for state or federal funding for research in response to the potential passing of this bill. Thank you very much for the opportunity to address the Assembly Health Committee today. Thank you. Thank you, Dr. Mitchell. Thank you, Madam Chair. It's nice to see you and be in your committee today. And a special thank you to Assemblymembers Lowenthal and Gonzalez for carrying this cause. I was a human intelligence, counterintelligence specialist in the United States Marine Corps. I fought and saw combat in the Sunni Triangle region of Iraq and the Horn of Africa, in Yemen, and a variety of other places you wouldn't normally go. A number of my friends died at war. And, you know, they didn't die for politics or geography. They died for each other. And as a nation, we honor that sacrifice. But that is not the story of my generation of veterans. The story is this. Since the attacks of September 11th, more than four times the number of Iraq and Afghanistan veterans have killed themselves than those who died in combat. More than four times. War didn't kill most of us. Coming home did. And nothing that we've done in the last two decades has made a dent. Nothing has moved the needle. Nothing has changed the trajectory. When I called the VA for help, I was told it was a 14-month wait for a therapist for PTSD. A 14-month wait for a combat veteran decorated for valor under enemy fire. But they had a psychiatrist that could talk to me tomorrow. And that gave me great hope. And that team's call with the psychiatrist lasted for all of 14 minutes if you round up. And they overnighted me seven different prescription pills to take every single day. That doesn't heal. It hides. Fortunately, a friend pointed me to Veterans Exploring Treatment Solutions who sent me to a licensed clinic in Mexico for a medically supervised Ibogaine treatment. And it changed everything. The horrific and torturous nightmares that have plagued me every single night for 15 years, they ended. the anxiety lifted, the depression broke. I could feel love and joy. I could not see everything as a threat. I went from not drinking but kind of being an asshole about it to not even thinking about it. Since my treatment, I have not taken a single prescription pill for anything. It was life-changing. But in order to get that treatment, those who are willing to die for this country have to leave this country because more than five decades ago, a political decision outlawed treatment that they knew then were the most effective forms of treatment for addiction and for trauma. And we're not here asking for legalization. We're not asking for recreational use. We're not asking for decriminalization. We're asking you to consider opening the door just a little bit for combat veterans to have clinical treatment under medical supervision, if it's what they choose and they want to do. Because when I think about this issue, I think about one of my closest friends, Giorgio. We call him Gio, a Marine Corps Special Operations veteran, and he saw how this treatment had helped me and it helped others. And he got on the wait list. But it's a long wait. And he didn't make it. And July 18th, the strongest man I've ever met in my life killed himself. He survived Iraq, he survived Afghanistan, and he couldn't survive here. The burden of peace is not supposed to be greater than the burden of war And so we asking you have peer reviewed studies that show this is the most effective form of treatment for PTSD You have thousands of veterans who are saying it works. And we're asking you, please just open the door in a medical setting in a controlled environment to allow veterans who choose this to be able to access it here. In closing, I'll say please stop leaving veterans to feel that the only source of hope is found down the wrong end of a gun barrel. Thank you. Thank you very much, and it's very nice to see you, Assemblymember Fletcher. If there are others who want to offer support, please come forward. Moved by Roger, seconded by Aguirre-Curry. Are there any members of the public who would like to be primary witnesses in opposition? Madam Chair, with your indulgence, if I could stay up here. Dylan Elliott, on behalf of the California State Association of Psychiatrists, want to begin by saying apologize to the committee and author staff for our late transmittal of our letter of opposition. Just want to share at the outset, we wholeheartedly support the underlying effort of the author and the sponsors of this proposal. Did have some concerns with the administrative proposal laid out. I believe that the committee amendments do significantly and meaningfully address a lot of the concerns that we had raised. Look forward to formally reviewing our position at the next available opportunity and just want to say we appreciate the committee, the author, and the author staff. Thank you very much. Thank you. Any others who would offer a Me Too in opposition? Seeing none, I will bring it back to the committee for any comments or questions. Assemblymember Patterson. Great. Thank you. And thanks for obviously, you know, both of you, my current colleague and also former legislator for sharing your personal stories and appreciate the witnesses. You know, this is like, you know, the eighth time is my fourth year in the legislature and like the eighth time I've seen a bill kind of like on this subject, you know, and in 2023, actually, a Republican had a similar bill, similar member Waldron. and I think I was the only no vote on that bill. And my concerns at that time were, I mean, honestly, and it's kind of interesting, I don't really care what people kind of do on their own time as long as it's not harming somebody else. But we have seen and we continue to see issues with recreational use of marijuana. I don't care what anybody says. And like we actually ignore studies that show that especially the potency today can have some negative consequences. Now, that doesn't wipe out the benefits that people may get from it one way or another. Um, you know, and since this time, since 2023, um, you know, I've, uh, spent a lot of time focusing on treatments that interestingly enough are banned in the United States and not anywhere else on all sorts of, all sorts of interesting things. And you can say like, oh, I can go to this country and get this treatment. And, you know, just today I had a bill pass out a committee to take testosterone off the list of California's controlled substances when the federal government does. How many instances of abuse and death do you have from people of testosterone? But it continues to be a scheduled drug in the United States. Human growth hormone is banned basically only in the United States because and this is the honest truth then Joe Biden led the charge because of baseball because people are concerned about home runs being hit in baseball And instead we have men withering away in the United States because they can get hormone replacement therapy because of the laws in this country only It makes no sense. And so I've spent time looking at our controlled substances list and valid treatments that we have no access to in this country. And this is another one of those, I believe. I do have some concerns about just, I mean, regular, basically abuse from it. I mean, I think we know that that happens now to some extent. Um, you know, but what we're talking about with this bill is first of all, very, very narrow, uh, super narrow, one might argue too narrow. Um, but it's, I think a step in the direction where I've done enough research to know that there are enough benefits out there for people that have experiences like you've mentioned and people often describe it as, uh, like they can't even describe it, you know? And it sounds honestly crazy, like a crazy experience, but everybody is like, this changed my life. But you can't even consider it in the United States. It's crazy. And instead, a lot of people, especially without means, are going to other countries where they see a person who's been like somebody somewhere, blessed them to do this procedure where we really should be having qualified professionals. do these things, right? And that's not to dismiss cultural experience or anything like that. I'm just saying the medical experience component. So anyways, long story to say, I've come around to this idea. I think this bill is very limited in its application. I think it's worth exploring for the betterment of, I mean, really where the United States should go on this. And also, it kind of requires the federal government to be involved in this also. Just like my testosterone own bill requires the federal government to act first, actually. So I think this is a very well-measured bill, and I look forward to supporting it today. And actually, I'd like to be at it as a co-author. Thank you. Any other comments or questions from the committee? I want to thank the co-authors, the joint authors, for bringing forward this bill, and I especially want to appreciate Mr. Fletcher for your persistence in fighting for your fellow brothers and sisters and for honoring GEO. I've had an opportunity to talk to you for a couple of years about this bill. And I'm thankful that with the committee amendments, we've been able to strike, I think, a very nice balance that will allow for us to be able to take the first step, hopefully not of too many, but the first step in the right direction for the state of California that will allow us to be able to recognize that the FDA is still not taking the action that it needs to, but also know that we are going to be able to provide some support. and to those servicemen who have fought so valiantly for our country. With that, authors, would you like to close? I just want to say with gratitude to our veterans and respectfully ask for your aye vote Thank you We have a first motion and a second Please call the roll. The motion is due pass as amended to appropriations. Bonta? Aye. Bonta, aye. Chen? Aye. Chen, aye. Addis? Aguirre-Curri? Aye. Aguirre-Curri, aye. Ahrens? Ahrens, aye. Coloza? Coloza, aye. Carrillo? Aye. Carrillo, aye. I, Gonzales. Gonzales, I, Johnson. Johnson, I, Patel. Patel, I, Patterson. Patterson, I, Rogers. Rogers, I, Sanchez. Sanchez, I, Chiavo. Sharp, Collins. Stephanie. Stephanie, I. That measures out. Thank you very much. We are going to now move to item number 15, AB 2431 by Patel. Thank you, Assemblymember, whenever you're ready. Thank you, Madam Chair and colleagues. Thank you for the opportunity to present AB 2431. I want to start by saying that I accept all of the committee's amendments and want to thank the committee chair as well as committee staff for working with me and my office on this bill. AB 2431 establishes key safeguards to protect providers and facilities from having payments reduced without documented review of clinical information supporting that billed service. The amendments from the committee allow this to be done through an algorithm but still require that the clinical information is taken into account. When When a physician treats a patient, they assign an evaluation and management, an EM code, that reflects either the complexity of the medical decision-making involved or the total time spent with the patient. That code is submitted to the health plan, which pays the physician according to their contracted rate for that code. Downcoding occurs when a plan unilaterally reduces the submitted EM code and the payment that goes along with it, below what the physician submitted. California health plans are increasingly using software algorithms to downcode thousands of claims at once, with no physician review, no examination of the medical record, and no notice to the treating physician until the deficient payment arrives. These algorithms target providers whose EM codes are consistently above average, treating statistical deviation as presumptive evidence of fraud. This logic is deeply flawed. Physicians who treat chronic and complex patients will, by definition, submit higher EM codes more often. Penalizing that pattern without analyzing any relevant clinical information means penalizing the doctors who take on the hardest cases. Smaller practices actually bear the greatest harm. Unlike large health care systems, small practices lack the administrative capacity to challenge denials or absorb unexpected payment shortfalls, and they have little leverage to negotiate with the plans directly. The result is financial instability for the practices that communities, particularly underserved ones, depend on most. AB 2431 closes this clear gap. If a plan is to reduce payment, the clinical information must be reviewed either by a qualified physician or following these amendments, an algorithm that takes into account all relevant information. This bill takes further steps to ensure physicians are notified when a provider is using a downcoding algorithm and establishes a right to appeal any downcoding decision. With me today, I have Dr. Gill and Shereen Gadusi as my witnesses in support of this bill. Thank you. Good afternoon, Madam Chair and honorable members of the Assembly Health Committee. I'd like to thank Assembly Member Dr. Patel for authoring the bill, and I'd like to thank Chair Bonta and Rihanna King for working tirelessly on this bill. I'm here to represent the California Medical Association. I'm a physician at UC Davis Medical Center. As physicians, we work to summarize information to provide a record of medical care given and our notes are then used to guide billing. Insurance companies demand that claims are submitted with a summary of billing codes in lieu of actually reviewing the chart. I'm shocked to learn that health insurance companies can choose to down code where they can decide to alter submitted claim for reimbursement to a different code for which payment is reduced. Currently, health insurers can unilaterally and arbitrarily alter claims, thereby unfairly reducing appropriate payment, sometimes in an automated fashion. Downcoding is done without requests for review of actual medical records. Insurance force physicians to appeal, thereby increasing administrative burden, delaying time of payment, and unnecessarily diverting time which could be used for patient care. This particularly impacts primary care physicians, and California is already dealing with shortages. These predatory practices threaten the viability of physician practices. AB 2431 ensures that physicians are paid for the level of care they actually provide. When insurance penalize physicians for delivering complex care, doctors are incentivized to limit their participation in certain insurance networks and patient sufferer. With implementation of these types of systems, insurances are effectively rewriting medical coding rules, with fewer physicians participating in certain insurance networks, longer wait times, and reduced access results. These impacts can ultimately worsen access to timely care, disrupt continuity care, and compromise long-term health. In closing, I encourage your support of AB 2431, which is about fairness and will require health plans to perform a documented review of clinical records before downcoding. Thank you. Thank you so much. You'll have two minutes. Good afternoon. Shereen Gadusi with the California Medical Association. I'm here for technical questions. Thank you. Any in the hearing room that would like to offer support? Thank you Dylan Elliott on behalf of the California State Association of Psychiatrists in support Tim Madden representing the California Chapter of the American College of Emergency Physicians the California Chapter of the American College of Cardiology, the California Rheumatology Alliance, and the California Society of Plastic Surgeons in support. Vanessa Kahina on behalf of the California Academy of Family Physicians here in support. Good early evening, Chair and members. Carmen Nicole Cox of the Cox Firm for Law and Policy on behalf of California Children's Hospital Association in support. Thank you. Good evening. Kelly McMillan on behalf of the California Society of Dermatologists, the American Academy of Pediatricians California, and the Children's Specialty Care Coalition in support. Jessica Rand with CalPo Advocacy on behalf of the Physician Association of California and the California Hospital Association in support. Thank you. Sarah Nacito on behalf of the California Chronic Care Coalition here in support. Ryan Spencer on behalf of the American College of OBGYNs, District 9, the California Society of Pathologists, the California Radiological Society, the California Pudiac Medical Association, and there's one more. Sorry, I was trying to do it off memory, damn it. Darn it. Oh, California Orthopedic Association, thank you. Angela Pontes on behalf of Planned Parenthood affiliates of California and support. Thank you so much. Thank you, Brian, for that moment. Are there any in opposition who want to serve as primary witnesses? Please come forward. Madam Chair and members, Olga Shiloh on behalf of the California Association of Helplands. CAP has an opposed position on AB 2431 as it is currently in print, as the bill would significantly restrict Helplands ability to conduct routine claims coding validation and would create substantial operational cost and compliance challenges without improving patient care. Plans from using many of the same tools that providers themselves rely on risks driving up health care costs and ultimately Increasing premiums for consumers that said we sincerely appreciate the committee's proposed amendments and are reviewing them closely We believe they present an important step in Addressing our primary concerns by recognizing the need for more balanced and data driven approach We are also continuing to evaluate the author's amendments and look forward to looking to working collaboratively with the committee author and the stakeholders as the bill moves forward. Thank you. Good evening, Chair members. Matt Akin with the Association of California Life and Health Insurance Companies. I'm also in opposition to the bill in print and would just like to align my comments with my colleague at CAP. We are still reviewing the amendments, but we are very pleased that it does address some of our primary concerns. We also appreciate that the amendments include data collection requirements on upcoding, which is a significant concern as illustrated in the analysis with respect to health care affordability. Thank you. Thank you. Are there any others in opposition who would like to register me to? Seeing none, I will bring it back to the committee for any comments or questions. Assemblymember Aguirre-Curry. Can you add me as a co-author, please? Seeing no other comments or questions, Assemblymember, would you like to close? Yes Respectfully ask for your aye vote Thank you We need a motion and a second by Aguirre seconded by Sharp Collins Secretary please call the roll The motion is due pass as amended to the Privacy and Consumer Protection Committee. Bonta? Aye. Bonta, aye. Chen? Aye. Chen, aye. Addis? Aguirre-Curray? Aguirre-Curray, aye. Ahrens? Ahrens, aye. Coloza? Coloza, aye. Carrillo? Aye. Carrillo, aye. Gonzales. Gonzales, aye. Johnson. Johnson, aye. Patel. Patel, aye. Patterson. Patterson, aye. Rogers. Sanchez. Sanchez, aye. Chiavo. Sharp-Collins. Sharp-Collins, aye. Stephanie. Stephanie, aye. That bill is out. Thank you so much. We are going to move on now to Assemblymember Stephanie's items, starting with item number 13, AB 2208. Moved by Sharp Collins, seconded by Ahrens. Thank You Madam Chair and colleagues. Today I'm presenting AB 2208, a bill designed to protect Californians against the harmful provisions of H.R. 1. As the big ugly bill threatens the Medi-Cal status of up to 2 million Californians, it is now more important than ever for the state to step up and ensure Californians have access to quality, affordable health care. As part of our state's response to these federal cuts, I am proud to author legislation that helps to ensure that no Californian is ever confronted with the impossible choice of foregoing life-saving care or paying unaffordable out-of-pocket costs. AB-2008 protects Californians against these harmful federal cuts through a three-part approach. First, this bill reduces the cost-sharing requirements for low-income Medi-Cal patients affected by H.R. 1 to just a penny. No patient should ever be afraid to access care because of high medical costs. This provision makes sure that Medi-Cal patients can continue to access affordable health care when they need it. Second, this bill also protects three-month retroactive reimbursement for new Medi-Cal patients. Retroactive coverage protects individuals who do not know they're eligible for Medi-Cal or are not able to apply until after an emergency happens. Under current H.R. 1 mandates, about 86,000 people per year would receive one month of retroactive coverage instead of three months. This extended coverage will prevent gaps in care for patients and further protect them from medical debt. Finally, AB 2008 mandates improvements to California's public benefit systems to ensure Californians can easily access critical information about their health benefits online. Over the last 10 years California was able to reduce the rate of its uninsured population by a third but H 1 could threaten to unravel decades of progress in a matter of one to two years The federal government has turned its back on Californians but now is the time to stand up and say enough is enough and I know many of you are doing that through various bills, and I thank you for that. This legislation reflects my commitment to maintaining access to coverage and care by mitigating HR1's devastating impact on our most vulnerable committees. With me today are Christine Smith from Health Access and Liza Thrantranen from Legal Services of Northern California. Good afternoon, Madam Chair and committee members. I'm Christine Smith with Health Access California, and we're proud to support this bill. California's Medi-Cal program currently provides coverage to nearly 15 million Californians, including children, older adults, people with disabilities, and working families. In 2014, California expanded Medi-Cal to include adults ages 19 to 64 without dependent children with incomes below 138% of the federal poverty level. Now under H.R. 1 passed by Congress last July, this expansion population is at risk of losing access to health care. The cuts included in H.R. 1 threatened to unravel years of progress on health care coverage and affordability in a matter of months. H.R. 1 imposes mandatory cost sharing for ACA expansion adults with incomes above 100% of the federal poverty line. This could result in Medi-Cal enrollees having to pay cost-sharing and going into debt to access health care if this is not addressed, with some likely to forego care altogether because of potential high costs. However, this bill would require the co-pays to be one cent to be made for non-emergency services received in an emergency department or emergency room when the services do not result in treatment of an emergency medical condition or inpatient admission. Medi-Cal enrollees will also be subject to HR1's limited retroactive coverage provisions, which reduces retroactive coverage from three months to one month for the expansion population, and two months for other Medi-Cal enrollees. Currently, retroactive coverage protects people who do not know they're eligible for Medi-Cal or are hospitalized after sudden medical crises and cannot immediately submit an application. This bill will also ensure that Medi-Cal enrollees are informed about their eligibility through mobile reporting and get information through text messages. This is critical to ensure ongoing access to health care. We respectfully ask for your aye vote. Good evening, Madam Chair and members. Liza Thanchanon with Legal Services of Northern California. We're a legal aid organization providing free direct legal services to health consumers in 31 counties. One of the most common issues low-income consumers contact us about is medical debt. And for many low-income individuals, even a single unexpected medical bill can set them down a cycle of instability. One of the most important protections against this kind of financial hardship is retroactive Medi-Cal coverage. While retroactive Medi-Cal is often associated with people who are completely uninsured at the time of a medical emergency, it's also an important safeguard to protect people who unknowingly experience a gap in their health insurance, as well as people who are underinsured and face unaffordable out-of-pocket costs despite having insurance. In many cases, these consumers may not realize they're eligible for or even need Medi-Cal until well after a medical emergency, making retro coverage vital to relieving financial strain and preventing medical debt from spiraling into long-term financial instability. In one recent case we had, we helped a 48-year-old man who had a medical emergency in October 2025. At the time, he had employer-sponsored insurance, which covered a portion of his emergency room visit, but due to the high cost sharing in his plan, he still had a big bill left over $1,000. Shortly after his ER visit, his work hours were reduced, and with his lower income, he couldn't afford the hospital bill. He contacted us, extremely anxious about the bill getting sent to collections. He told us he was already struggling to keep up with rent and basic expenses, and the hospital bill made him fear that he would fall even further behind. Luckily, he was eligible for Medi-Cal on the date of service and was able to get retroactive coverage for the bill, eliminating a major financial burden during an already difficult time. In another recent case we had, we helped a 38-year-old man who had been enrolled in a covered California plan with advanced premium tax credits. Early in the year, his work hours were reduced, which caused him to lose the tax credits and eventually his health insurance. However, he had not received any notices about it and was not aware of the change and only discovered that he had lost coverage when he had a medical emergency this past December and received a $7,000 bill. The unexpected bill caused him significant stress and confusion as he believed he still had insurance at the time of the visit. Fortunately, he was eligible for retroactive Medi-Cal coverage. These examples underscore the importance of retroactive Medi-Cal as a vital protection against medical debt. Such debt can create serious financial strain and threaten a person's ability to meet basic needs. Retroactive coverage is especially critical during periods of instability, including income loss, coverage gaps, and transitions, between insurance programs, but these billing and coverage issues often do not surface until several weeks after an emergency room visit. Thank you. Thank you. Are there others in the room in support of this measure? Please come forward with your name, affiliation, and position on the bill. Juanita Martinez on behalf of Fresenius Medical Care in support. Thank you. Evan Fern with Disability Rights California in support. Angela's with Children Now in support. Linda Way with Western Center on Law and Poverty, Proud Co-Sancer in support. Carly Stelzer with the California Behavioral Health Association in support. Nancy Netherland with Family Voices of California in support. Kelly LaRue for the California Kidney Care Alliance in support. Shel Johnston National Multiple Sclerosis Society in support. Chair and members, Austin Webster with W Strategies on behalf of UNITOS US in support. Yasmeen Pellet with Justice and Aging, co-sponsor and in proud support. Thank you. Vanessa Kahina on behalf of the California Academy of Family Physicians here in support. Omar Altamimi here with California Pan-Ethnic Health Network in support. Kevin Guzman with the California Medical Association in support. Ryan Sousa on behalf of the San Francisco AIDS Foundation in support. Char Velasco with CCHI California Coverage and Health Initiatives in support. David Gonzalez on behalf of the Bleeding Disorders Council of California in support. Mara Vélez with the Latino Coalition for Healthy California in support. Thank you. Are there any primary witnesses in opposition? Or any Me Too's in opposition? Seeing none, I will bring it back to committee for any comments or questions. Majority Leader wants to be added as a co I would appreciate that opportunity as well Thank you. Oh, I am already on, apparently. But this bill, Assemblymember Stephanie, is one of several that we are moving forward to be able to essentially mount an attack on the bill. The big bad bill that has. Stands to devastate so many Californians, I want to thank you for bringing it forward. I think it holds a lot of promise, and I'm hoping that this will be one of the bills that is able to hit the governor's desk and get signed with that. Would you like to close? Thank you, Madam Chair. I'm very grateful for your leadership in all of this as well. And thank you to the majority floor leader for asking to be a co-author, of course. And thank you to my witnesses. And thank God for legal aid, really. I respectfully ask for an aye vote. Thank you. There's a motion and a second. Please call the roll. The motion is due pass to appropriations. Bonta? Aye. Bonta, aye. Chen? Addis? Aguirre-Curie? Aye. Aguirre-Curie, aye. Aarons? Aye. Aarons, aye. Coloza. Coloza, I. Carrillo. Carrillo, I. Gonzales. Gonzales, I. Johnson. Johnson, no. Patel. Patel, I. Patterson. Patterson, no. Rogers. Sanchez. Sanchez, no. Chiavo. Sharp Collins. Sharp Collins, I. Stephanie. Stephanie, I. That bill is out. Thank you. We'll move on now to Assemblymember Stephanie's second bill, item number 19, AB 2540. Home stretch, members. Home stretch. Thank you, Madam Chair and colleagues. Today I'm presenting AB 2540, the Community College Student Right to Access Act. I want to start by thanking the Chair and the committee staff and stakeholders for their feedback and collaboration. AB 2540 will expand equitable access to medication abortion services for students attending community colleges across California. California has long made access to reproductive health care a core value, and this bill will move us closer to that goal by requiring community colleges that have existing student health centers to provide these services. While similar services already exist at the University of California and the California State University campuses, community college students currently face significant gaps in access to reproductive health care. And let me be clear, reproductive health care is essential health care, and access to this care should never be dependent on the type of college a student attends. It's past time for us to do right by all California students, no matter where they decide to attend. With the Community College Student Right to Access Act, we are closing a critical gap by ensuring that community college students, one of the most diverse and economically vulnerable populations in our state have the same access to care as their peers at four institutions This legislation would allow services to be provided specifically on college campuses that have existing health centers via telehealth or through contracted providers It also improves transparency by requiring colleges to publish information about available services. I want to recognize the work of former Senator Connie Leyva, who championed Senate Bill 24, which ensured that UC and CSU campuses provide medication abortion services. It's because of her leadership and the strength of our advocates that we now have the momentum to expand access beyond just four-year institutions. With me testifying today is Alicia Nagpal, a vice president of legislative affairs at the Student Senate for California Community Colleges, and Marge Plum, a nonprofit consultant supporting implementation of medication abortion services. Good afternoon Chair Bonta and members of this committee. My name is Alicia Nagball and I sit here as the Vice President of Legislative Affairs for the Student Senate for the CCC's, the official voice of 2.2 million students across California. I'm not here just as a student leader, but as someone personally impacted by reproductive health challenges. Access to equitable health care also includes access to reproductive health care. It is necessary and for many it is life-saving. Students in remote areas such as the far north often do not have the same services as students in urban regions may have. Students who are struggling to meet ends meet may not have reliable health care, and that's what this bill resolves. AB 2540 is an effort to provide equity when it comes to reproductive health care to some of our most vulnerable populations. While students at the UC and CSU campuses already have access to medicated abortion through SB 24, community college students who are more likely to be low-income, working, and place-bound often do not. With this discrepancy, students cannot access timely reproductive health care, and instead they are forced to miss class, delay their education, or perhaps even drop out entirely. Barriers to care become barriers to education. This bill would allow students to receive medicated abortion through their community college health center, making sure that even our most vulnerable students have access to what could be life-saving treatment. These are students who are a foster youth, immigrants, students of color, etc. Giving populations who are already disadvantaged the resources this provides expands on the equity work that should be strived in both healthcare and higher education. It means access to timely affordable care without having to travel hours, miss work, or navigate complicated healthcare systems. It means privacy, dignity, and autonomy. It means that a student's zip code or institution does not and should not determine whether or not they can access basic healthcare. This bill also ensures thoughtful implementation, leveraging funding, supporting campuses, and requiring accountability through reporting. AB 2540 affirms a simple truth. Community college students deserve the same standard of care as any other student in the state of California. We respectfully urge your aye vote. Thank you. Good evening, Chair and members. My name is Marge Plum, and I'm here in strong support of AB 2540. I previously directed the Solis Policy Institute at the Women's Foundation of California, where I worked with UC and CSU students and reproductive justice leaders to develop SB24. I've since continued tracking and supporting its implementation on behalf of the funders collaborative. While the implementation of SB24 is uneven in some places, UC and CSU campuses remain committed to providing this care. The campuses combined provided over 1 medication abortions a year for the past two years This is below the minimum estimate of need but California public universities are leaders throughout the nation and I believe they are well to address the remaining challenges. San Francisco State University shows what's possible. Their Student Health Services presents medication abortion on their website and in literature as part of comprehensive routine care, integrated, confidential, and stigma-free. In 2025, they provided over 100 medication abortions the highest in the CSU system and is well on its way to meeting expected need. Students are accessing care on campus from providers they trust without unnecessary delays. This model works and should be expanded. At California community colleges, the need is significant, estimated at approximately 1,000 medication abortions each month throughout the system. Providing this care is simpler than ever. Medication abortion is safe, highly effective, and can be provided via telehealth without physical exam, ultrasound, or specialized equipment. Some community colleges are establishing billing through California's family planning program called Family Pact and can easily add coverage through the state's presumptive eligibility for pregnant women program, making medication abortion free for all students who qualify. I respectfully urge your aye vote. Thank you. Are there others in support who would like to offer a Me Too? Please come forward with your name, affiliation, and position on the bill. Good evening, Madam Chair and members. Roxanne Gould representing the American Nurses Association of California in support. Chair and members, Austin Webster with W Strategies on behalf of the California Nurse Midwives Association in support. Deborah Bautiza Zavala in support on behalf of the California Latinas for reproductive justice and also in support by URGE, Unite for Reproductive and Gender Equity. Chair and members, Kathy Mossberg on behalf of Essential Access Health in support. Jennifer Robles with Health Access California in support. Kimberly Robinson with Black Women for Wellness Action Project in strong support, also a co-sponsor. Jason Henderson on behalf of the Faculty Association for California Community Colleges in strong support. Thank you. Good evening, Chair and members. Kashif Kumar with Lighthouse Public Affairs on behalf of Reproductive Freedom for All and our over 400,000 members in the state of California in strong support. And as a co-sponsor. Ryan Spencer on behalf of the American College of OBGYNs, J-9 in support. Nailed it. Kevin Guzman with the California Medical Association in support. Thank you. Are there any primary witnesses in opposition who have registered opposition? Good afternoon, Madam Chair and members. My name is Erin Azevedo. I am a student at UC Davis and I am opposed to AB 2540. I was handing out pregnancy resource brochures on campus this fall and a woman came up to me and whispered, I am so glad you're here. I didn't know that this was here when I was younger. Then gathering herself said, and I really wish I did. She then shared her story as a sexual assault survivor and how she felt abortion was the only option available. I'm here to say on behalf of her, that this bill is not what the community needs, and it is an unnecessary expenditure of state funds. For my peers, there is no lack of access or awareness to abortion. It is available on campus, at clinics, via telehealth, and even by mail. Access to abortion is not a concern in the state of California. What should take priority is more affordable family housing, child care without year-long wait lists, and referrals to medical care and support. I recently wrote a final paper on the resources available to pregnant and parenting students at UC Davis, and notably my professor, who was a parent during her own PhD program, was unaware of the many rights and supports available to her at the time. If even our faculty does not see that support, then it is clear that there are more pressing gaps in reproductive health care than access to abortion. One in four women in California receive inadequate prenatal care. At least 56 maternity wards have closed since 2012, half in just the past three years. Doctors are handling hundreds of births per year. The average OBGYN age is 51, with the most retiring by 59. Some rural counties have no OBGYNs at all. Maternal mortality has doubled with the highest rates among Black and Native mothers. All this decline in care has happened while abortion has expanded. When we reduce the students' needs down to abortion access at the expense of every other kind of care, it is exploitive and reproductive coercion. It is unfair and out of touch with what students actually need to thrive. For these reasons, I respectfully ask for a no vote on AB 2540. Thank you. Chair and members, my name is Leandra Wells with the California Family Council. I'm here today in opposition to AB 2540, which promotes and expands access to abortion drugs on community college campuses. I know what it feels like to face a pregnancy you were not prepared for. At 21, I was newly married in my last year of college and planning to intern in Washington, D.C. Then I discovered I was pregnant. I felt fear, uncertainty, and that my life as I knew was over. Yet with the support of my family, friends, and a local pregnancy center who gave me free care, I was able to finish my degree, embrace motherhood, and look, I have a good career. Many women who become pregnant in college feel overwhelmed just as I once did. What they truly need to support, not a one-size-fits-all solution like abortion, presented as a quick fix with lasting consequences. Abortion drugs are not safe. Research from the Charlotte Loeser Institute highlights patterns of emergency room visits and underreported complications. Likewise, the Ethics and Public Policy Center has called for stronger safeguards and better data transparency on the abortion pill. College campuses are not hospitals and many students' health centers are not equipped to handle serious complications such as hemorrhage or infections. Expanding and promoting these services without immediate access to emergency care puts students at risk. Students deserve real support, real choices. Resources like pregnancy centers, adoption services, and safe surrender sites should be accessible and widely known so women are empowered to choose life. I completed my degree just three weeks after my son was born. Solely promoting abortion tells women they cannot succeed if they become mothers. But we all know women are capable of far more than that. For these reasons, we respectfully urge a no vote on AB 2540. Thank you. Thank you. Are there others in the room who would like to offer an opposition Me Too name affiliation? Good evening Andrew Martinez with the Community College League of California The chief executive officers of California community colleges have shared a letter of concerns That reflected in the analysis And also I speaking on behalf of the Health Service Association of California Community Colleges as well which has also submitted a letter of opposition unless amended. And that also is reflected in the analysis as well. We want to thank the author and the sponsor for meeting with us to share with our concerns about implementation. Thank you, sir. Molly Sheehan with the California Catholic Conference in opposition. Thank you. David Bolag, the SFV Alliance in opposition. Greg Burt, vice president of the California Family Council in opposition. Thanks. Thank you. Seeing no other opposition, I will bring it back to the committee for any comments or questions. Assemblymember Aguirre-Curry and then Assemblymember Ahrens. Petition of a co-author by the majority leader, Assemblymember Ahrens. Thank you, Madam Chair. I want to thank the member from San Francisco for bringing up this really important piece of legislation and really highlighting the critical gap in health care coverage, that just because you're a community college student doesn't mean that you shouldn't have access to the same type of coverage as if you were a UC or CSU student. And to sort of dispel the inaccurate statements that were mentioned previously by the opposition, how critical, safe access to health care and abortion care is absolutely essential. And in other areas of the country where that's under attack, we've seen that there is no stopping abortion. you're stopping unsafe abortions and you're causing more havoc and you're causing dangerous procedures to happen, the likes of which we've seen many decades ago. And so we shouldn't be moving back. We should be moving forward in the state of California, offering health care to everyone. And that is exactly what this is. And it's not limiting or discouraging services provided to community college students. Before being elected, I was the president of a board of trustees for my community college in my community. When I was a student, we didn't have a food pantry. We have food pantries widely available now. We didn't have health care services. We have huge strides, and we need to go further. We didn't have bus and transportation passes. Many of our community colleges have them now. So you're pushing the envelope. You're saying that there are still gaps in coverage that we need. I want to thank the author for your bravery on making sure that accurate narratives are being presented when we're talking about health care coverage in the state of California. Be honored to be added as co-author. Assemblymember Patterson. Great, thank you, Madam Chair. Well, it might come as no surprise I have a different opinion than my colleague, Mr. Aarons, but, you know, I always think it's very interesting. I mean, I just perused a bunch of University of California Health Center websites and all this great information, you know, that's provided on contraceptives, HIV prevention, pregnancy testing, and then also medication abortion services, and all these other things. And then it's like referral for prenatal care. Am I like the only person in this room that thinks it crazy that the University of California and other institutions and what we do in this building is focus on people who want to have an abortion What about people who want to keep their babies? Like, I think we actually agree that there are a lot of expecting mothers who want and need help, and we should be helping them. And I think the UCs, honestly, it's shameful. All these health centers that exist that don't help these moms, these women that get pregnant on campus, and they have nowhere to go. And we will happily provide you with medication abortion, but, hey, we will provide you with a referral to some clinician if you're lucky enough to have insurance to get it covered. I can't believe it. But that said, I have a question on the actual bill. Like I'm – I honestly want to know what this bill – problem, this bill is solving because right now you can call Planned Parenthood and get medication abortion sent directly to your doorstep. So like what gap is this? Why can't the community colleges or UCs or anybody else just give the phone number for Planned Parenthood? Well, I've learned to pause when agitated, so I will let my witness answer that question. Medication abortion can be handled through telemedicine. What we know about college students is that it's a new experience for them, being away from home, being on campus. And for them to be able to go to a student health center on campus that they've walked by will help them be able to navigate their questions, including do they want to keep the pregnancy? Do they not want to keep the pregnancy? That's part of what happens in the UCs and CSUs now. There's pregnancy consultation with the students. for that student health center to then be able to call if they don't have the medication on site, to be able to call another provider with the student is going to help that student tremendously. During the four years that I worked on SB24, I have to – the parts that live with me are the student stories and how the idea of trying to figure out where to go, how to get there, whether to take time off class, whether, you know, are they going to have to pay for it? They don't, you know, because that's not readily available, is just really impossible for them. I mean, I had students in tears telling their stories to the team and to myself. and how I had a student who was a volunteer at Planned Parenthood. And she went, she's at one of the UCs. She went to the Student Health Center. They gave her a mimeograph page of abortion providers. One was a crisis pregnancy center. Another one wasn't doing abortions anymore. She was a volunteer at Planned Parenthood, and Planned Parenthood wasn't on the list. And so she thought because the Student Health Center gave her the list that she couldn't go to them. The student health centers have to be able to meet the student help them access the care provide the care themselves in order to let our students be able to stay in class to stay learning to stay growing Well, you know, I appreciate your answer. I mean, it, you know, nothing stops the health centers from providing information or requiring them to do so to provide the information to providers that have that provide a referral just like they do for maternity services. But, like, I'm just going to keep beating the drum. Look, I don't judge any woman who finds themselves in crisis in the decisions that they make. and I want to help every single woman that has an unplanned pregnancy. I think we have a major, major, major gap in this state for individuals that choose to keep their baby and find themselves in a situation where they don't know where to get help. I don't know if anybody even disagrees with me on that. But, like, we need to do more, and I want to help them too. So thank you for answering the question. Assemblymember Rogers. Thank you so much, Chair. Probably not too surprisingly, I disagree with my colleague as well. And to answer his question about why are Democrats introducing so many bills that are on access to abortion, the answer is because you don't see Democrats introducing legislation to remove the ability for women to have children. But you do see Republicans introducing legislation to take away the ability for women to have abortions. That's why we focus on it. Assemblymember Schiavo. I would just add on that point that what has continuously confounded me on this political division around abortion is that on the other side of the aisle, people will fight and fight and fight against abortion. a fight. I think you're making very good points about supporting families, supporting parents, moms who want to have kids. I think you're making excellent points about that. But yet at the same time, Republicans are cutting health care for families. Republicans are cutting CalFresh and food subsidies for families and kids. Republicans are cutting the whole safety net that needs to be there to support kids and families. And so it just blows my mind that Republicans are so adamant that you need to have kids when the number one reason for abortion is because you can't afford to have that kid. And if we supported families more, if we had a stronger safety net, if we made it so that you could go to school and have a kid, which is what my stepdaughter did, but it's hard. It is hard. And it is something that I wish we could come together on because I agree that We need to support moms. We need to have more of a safety net. But that is not our reality. And especially right now, as we are having hearings in our budget health subcommittee until 9 o'clock at night, talking about the disastrous cuts to health care that are happening right now, which is another reason why this bill is so important, because there are fewer places to go. You cannot just go to Planned Parenthood because they are closing clinics. They have been cut from the federal government budget on purpose, and you can't just go to Planned Parenthood anymore. So there should not be a difference for students, working class students, students who work, who are lower income typically in community colleges, should have the same access to medical abortion and health care that you have at a CSU or a UC. And that is simply what this bill does. It creates equity for students in our state at any of our public colleges and universities. And that's why I signed on as a co-author. Assembly member Gonzalez. Respectfully, first I want to thank the author for bringing this up. I don't think any man should be telling a woman how to handle their reproductive freedom, and considering that they'll never have to carry the weight of making that decision. So I want to be very clear about that, and also confirm that Planned Parenthood does not just participate in abortions. They participate in testing, in general health screenings, breast cancer screenings, cancer screenings, exams. They provide general health to most people. So I want to be very clear that when we talk about Planned Parenthood, it's not just about abortion. It's general health care. Thank you. Assemblymember Coloza. Thank you, Chair Bonta. I feel like we're completing one thought here from the dais to support our colleague for bringing forward this important bill. Just to add on to what my colleagues already mentioned, it was through the leadership of the Speaker, the pro tem, the governor, Assembly Democrats, that put forth the emergency funding to put forth $90 million because Planned Parenthood sites were closing because they were targeted in H.R. 1. And it's because of Assembly Democrats that we are protecting this access to reproductive health care. And I just want to remind everyone here that when we were having those hearings that Chair Bonta led on HR1 and the cuts and what they would do, I don't remember a single Republican colleague being here on the dice to listen to the testimony of what those cuts would do. And so respectfully disagree with everything that my colleague said. And I hope that next time you guys show up to the budget hearing, happily move the bill when appropriate. Moved by Caloza. Seconded by Sharp Collins. Assemblymember, thank you for bringing forward this bill. I wanted to just clarify a couple of points made by the opposition and from the dais here. First, this proposal, should it become a bill, will actually be funded through independent sources, not through state funding. I think that's important to clarify because we have fully expended all of our resources already to be able to ensure that we are providing reproductive care for many individuals and abortion care So we're thankful to be able to have that private resource in this moment or in time. Also just wanted to share and note that the analysis talks pretty significantly about the additional resources that are available in our community colleges and our CSUs and our UCs that are around behavioral health, counseling, the other aspects of consideration that people will need to think through as they are making decisions about their reproductive care and their decisions around and family planning. So I think that's also an important piece just to be able to note. I also wanted to clarify that we also have the opportunity to make sure that we are supporting legislation like this because we have a body, a legislative body, a majority that is willing to make sure that we are providing care for everybody. And I really appreciate that this is something that you are being very thoughtful about to make sure is available to every individual. I'll tell three quick stories. Sorry. First quick story. My mother went to community college in New York City, and because she wanted to be a student but couldn't afford child care, I was handed from student friend to student friend every single day in order to be able to make sure that she could pursue her college degree. And I think that Assemblymember Shalvo's point about us not being willing to fully fund and support families in their care of their children is one of the foundational concerns that we need to address here in California. Second story is I, as a student undergraduate, made a very important decision, transformative decision, very hard decision to have an abortion while I was in college. And I received, had the privilege of receiving care in my healthcare center on our student campus. in the state of California, in order to be able to participate in a UC or a CSU, you actually have to have insurance. So these are people who are already provided with insurance and we'll hope our finger cross our fingers and hope that that actually stays true. And my final story is that when I was in law school, I also had the ability to have a full prenatal care provided and was able to give birth to a beautiful baby girl six weeks before I graduated from law school through the auspices of the healthcare system that was afforded to me in my university system. So I want to thank you, Assemblymember, for bringing forward an opportunity for us to be able to provide equity for every individual in the state of California through all of our college systems. This is a very necessary bill, and I want to thank you for your leadership. And now that you've perhaps had a moment to take a beat, I would ask that you close. Thank you, Madam Chair, and thank you for sharing your lived experience with this and the fact that you had choices to make in those different times in your lives and you made a choice that worked for you And that what I all about That what all the colleagues that have spoken out in support of this are about is the choice to do whatever you need to do in that situation whether it have the baby whether it use medication abortion whatever it is it about the choice And I was joking when I said pausing when agitated because nothing is going to stop me from doing everything I can to make certain that reproductive health care is available to every woman and every person that needs it, no matter where they attend their university, CSU, community college. It should be available to everyone. And I'd wish maybe the assembly member had been at my press conference yesterday where he could have heard from the women and their lived experiences and what they've been through on their college campuses and how Planned Parenthood was too far away, two hours away, with a heavy student load, working two to three jobs, trying to make ends meet. student health care, reproductive health care needs to be made available conveniently not just to UC students, not just to CSU students but to our community college students as well. They are not second class and I will not stand for it. So I respectfully ask for your aye vote. We will clock that Assemblymember Stephanie. We have a motion and a second. please call the roll the motion is do pass to higher education committee Bonta I Bonta I Chen Addis Aguirre Curry Aguirre Curry I Aaron's Aaron's I Colosa Colosa I Carrillo Carrillo I Gonzalez Gonzalez I Johnson Johnson no Patel Patel I Patterson Patterson no Rogers Rogers I Sanchez Sanchez no. Chiavo. Chiavo aye. Sharp Collins. Sharp Collins aye. Stephanie. Stephanie aye. That bill is out. Thank you very much, Assemblymember. We're going to move on to our last item of the hearing, which is item number 11, AB 2161. I will be turning over the gavel to Assemblymember Colosa. Thank you. Okay, please begin when you're ready, Chair Bonta. Thank you, Chair and members. I'm proud to present AB 2161, a bill to ensure California does not go beyond federal law to impose harmful and ineffective work requirements on Medi-Cal recipients. As you know, H.R. 1 proposes new work requirements tied to health coverage. But let's be clear. Work requirements are not about work. They are about paperwork. They are about throwing up hurdles that result in people losing coverage even when they are working eligible or trying to comply We have seen this before in other states People lose health care not because they don qualify but because of paperwork reporting requirements and system failures AB 2161 ensures California does not amplify these harmful policies. Specifically, the bill would prevent the extension of federal work requirements to state-funded Medi-Cal populations where the state has discretion. It would reject unnecessary and duplicative bureaucratic processes that force families to prove what the state already knows through existing data systems, and it would promote the use of existing data and administrative tools to maintain coverage and reduce churn, which is inexpensive and bad for people. California should not go beyond federal requirements to impose additional barriers to care. These are individuals who are already working, seeking stability, and contributing to our communities, forcing them through unnecessary administrative hurdles undermines both public health and economic stability. Additionally, this bill contains additional protections for Medi-Cal members to make sure they can get and keep coverage. It contains an explicit requirement to measure compliance using specified data sources, requirements for notices and due process, making sure people are informed of their rights to appeal a decision to terminate their coverage, and a contingency provision requiring DHCS implement the new eligibility rules only to the extent the federal law implementing these eligibility rules is in place. Should that change at the federal level, this bill will allow the state to lift these burdensome requirements. AB 2161 is one of the several bills we are considering today on implementation of H.R.1. And the approach they all take is to comply with the law while preserving coverage for Californians to the maximum extent possible. Here to testify is Linda Way with the Western Center on Law and Poverty, a co-sponsor of this bill and the others that we've heard today, and Michelle Johnston with the National Multiple Sclerosis Society. Thank you so much, Chair. Witnesses, we allow two witnesses at two minutes each. You may begin when you're ready. Good evening. Linda Way with Western Center on Law and Poverty, proud co-sponsor of AB 2161, which fights back against cruel federal cuts that will result in over 2 million Californians losing Medi-Cal through the imposition of administrative red tape in the form of work reporting requirements and more frequent renewals. The Congressional Budget Office finds that work requirements not only fails to meaningfully increase employment rates or average earnings, but also delays access to care and decreases program participation by creating an additional administrative barrier. In fact, Arkansas and Georgia's experience with Medicaid work requirements led to a decrease in those with health coverage and no significant change in employment outcomes. Work requirements is unnecessary as most Medi-Cal members who can work are already working. Data shows that 63% of non-disabled, non-elderly adults enrolled in Medi-Cal are already working full-time or part-time. 14% are not working due to being a caretaker for a family member, and 8% are students. AB 2161 limits the administration's endorsement of HR1's work requirements through imposition of state-funded Medi-Cal members who are more likely to have legal and logistical issues proving work reporting compliance, even if they are working. The bill fights back by using data the state already has, cutting the red tape, and keeping families covered. Medi-Cal coverage not only decreases mortality and improves health outcomes, but is also linked to reductions in poverty rates, food insecurity, and evictions. Therefore I urge your aye vote to protect Medi-Cal coverage. Thank you. Good evening, Madam Chair and members of the committee. My name is Michelle Johnston. I'm Director of Advocacy and Policy for the National Multiple Sclerosis Society, and I also live with MS. Thank you for giving me the opportunity to speak in support of AB 2161. Sclerosis is an unpredictable disease of the central nervous system. It's typically diagnosed between the ages of 20 and 50. Symptoms vary from person to person and may include disabling fatigue, mobility challenges, cognitive changes, and vision issues. Nearly one quarter of the 68,000 Californians living with MS are covered by Medi-Cal, not including those who receive Medi-Cal home and community-based services. Work requirements are a barrier to access for people living with MS and other chronic illnesses. Many people with MS who may not meet the definition of disabled have symptoms that make it difficult for them to work full-time or even part-time, both in the short and long-term. About 80% of people living with MS live with fatigue, and over half of people with MS experience some form of cognitive symptoms. These common MS symptoms make it significantly more likely that eligible individuals will lose their Medi-Cal access as they struggle to navigate complex administrative procedures to prove that they're either working or qualify for an exemption. Individuals on Medi-Cal have spoken to me about the stress and anxiety of trying to manage the paperwork while living with a disease that makes organization a challenge. Coverage can lead to delays or gaps in necessary tests or treatments, which in the case of MS may result in serious, long-term, and irreversible consequences or disease progression. MS profoundly impacts not only those diagnosed with the disease, but also our care partners, some of whom are also enrolled in Medi-Cal. They frequently have to take time off work to care for their loved ones, which results in employment disruptions that may threaten their own Medi-Cal coverage. We appreciate the strategies in AB 2161 to minimize the administrative burdens, apply work requirements in the least harmful way, and give people multiple options for submitting their data. We urge your support for this important legislation. Thank you. Thank you. Now, any additional witnesses in support? If you can please approach the mic. Please give your name, organization, and position only. Christy Foy on behalf of the California Kidney Care Alliance and Fresenius Medical Care in strong support. Thank you. Good afternoon. Matt Velez with the Latino Coalition for Healthy California in strong support. Good evening. Austin Webster with W Strategies on behalf of UnidosUS in strong support. Good evening. Nancy Netherland with Little Lobbyist of California in strong support. Janice Canalen with Family Voices of California in strong support. Good evening, Danielle Bautista with United Wizard California in strong support. Nora Angelus with Children Now in support. Good evening, Vilma Bocanegra with Hijas del Campo in full support and also in partnership with the Health for All Coalition to name organizations who are not here today. Healthy Contra Costa California Rural Legal Assistance Foundation and as well as Comunidad Aliviadas Tomando Acci who are also in huge support of this bill Thank you Nicole Wordleman on behalf of the Children Partnership in support Natalie Pita on behalf of the California Academy of Family Physicians in strong support. Carly Stelzer with the California Behavioral Health Association in support. Omar Altamimi here on behalf of several organizations, the California Pan-Ethnic Health Network, Friends Committee on Legislation of California, East Bay Community Law Center, California Community Foundation, Southeast Asia Resource Action Center, and Young Invincibles, all in support. Christine Smith with Health Access California, a proud co-sponsor of the bill, and then also reading out other organizations, Multifaith Action Coalition, Vision y Compromiso, Trula, Building Health Communities Kern, and Lideras Campesinas, all in support. Thank you. Evan Fern with Disability Rights California in support. Ryan Sousa on behalf of the San Francisco AIDS Foundation in support. Ana Alvarez on behalf of Centro Voynacional para el Desarrollo Indígena Oaxaqueña, the National Council of Jewish Women California, and Organizing Rooted in Abolition, Liberation, and Empowerment in support. Good afternoon. Jennifer Robles on behalf of a few organizations. Alliance San Diego, AAPIs for Civic Empowerment, Greenfield Walking Group, all in support. Thank you. Nasset Short representing Peach, who represents the Community Safety Net Hospitals, in support. Yasmeen Pellet with Justice and Aging, proud co-sponsor and in support. Thank you. Jarlene Dupree with Association of Regional Center Agency representing California Network of 21 Regional Centers in support. Angela Pontes on behalf of Planned Parenthood Affiliates of California in support. Kevin Guzman with the California Medical Association in support. Eric Paredes with California Faculty Association in support. David Gonzalez on behalf of the American Diabetes Association in support. Ryan Spencer on behalf of the American College of OBGYNs, District 9 in support. Thank you. Now we will go to the opposition. Are there any witnesses in opposition that would like to come? Okay, seeing no witnesses in opposition. Now we will turn to members and my colleagues. Are there any questions from members of the committee? Not seeing any questions from the committee, we have Assemblymember Arons moving the bill, Assemblymember Sharp Collins is second. Now turn it over to the author to close. Thank you. It is incredibly important that California act right now. We know these work requirements will lead to people being systematically and systemically kicked off of Medi-Cal. we have estimates of 2.8 million people Medi-Cal members whose compliance with work or community engagement requirements will need to be verified DHCS estimates that 233 Medi members will lose coverage by June 2027 1 million by January 2028 and 1 million by June 2028 because of the imposition of work requirements It is within our power in the state of California for our state-only plan to ensure that we don't take the bait. It is absolutely critical that we ensure that people stay on Medi-Cal so that we don't have people without the ability to take care of their families, take care of themselves, and to be able to contribute to our communities. With that, I respectfully request your aye vote. Thank you, Chair Bonta, and thank you for your leadership on this issue and for working to streamline some of the requirements on H.R. 1 and the populations at risk and our Medi-Cal population. I would love to be added as a co-author, if you'll have me. And with that, I will turn it over to Secretary to please call the roll. The motion is due pass to appropriations. Bonta? Aye. Bonta, aye. Chen? Addis? Aguirre-Curri? Aye. Aguirre-Curri, aye. Ahrens? Aye. Ahrens, aye. Coloza? Aye. Coloza, aye. Carrillo? Aye. Carrillo, aye. Gonzales? Aye. Gonzales, aye. Johnson? Johnson, no. Patel? Patel, aye. Patterson? Rogers? Aye. Rogers, aye. Sanchez? Aye. Sanchez, no. Schiavo? Schiavo, aye. Sharp-Collins? Sharp-Collins, aye. Stephanie? Stephanie, aye. Addis? Addis, aye. That bill is out. Thank you, Madam Chair. And I turn the gavel back to you. We have now heard all of the bills in this hearing. All members of committee come back to committee. All those vote who desire to vote. All those vote who desire to vote. We will begin with our consent calendar for add-ons. on consent Bonta I Bonta I Patel Patel I Patterson Patterson I sharp Collins sharp Collins I Stephanie Stephanie I that is still out we're gonna lift the call on item one AB 2651 Bonta Bonta I Bonta I Colosa Colosa I Gonzales Gonzales I Patel Patel I Patterson Patterson no Sanchez Sanchez no Sharp Collins Sharp Collins I Stephanie Stephanie I That bill is out. Item number two, AB 1570. We are lifting the call for Wilson. Bonta. Aye. Bonta, aye. Coloza. Coloza, aye. Gonzalez. Gonzalez, aye. Patel. Patel, aye. Patterson. Patterson aye Sanchez Sanchez aye Sharp Sharp aye Stephanie Stephanie aye that bill is out item 3 is on consent Item number 5 AB 1979 by Bonta Lifting the call Addis Addis aye Ahrens aye Ahrens aye Shiavo Shiavo aye Sharp Collins aye Sharp Collins aye Stephanie Stephanie aye That bill's out. Item number six is on consent. Item number seven, AB 2034 by Addis, lifting the call. Bonta. Aye. Bonta, aye. Patel. Patel, aye. Patterson. Patterson, no. Sanchez. Sanchez, no. Stephanie. Stephanie, aye. That bill is out. Item number eight is on consent. Item number nine, AB 2123 by Aguirre Curry. Lifting the call. Bonta. Aye. Bonta, aye. Coloza. Coloza, aye. Patel. Patel, aye. Patterson. Item nine, AB 2123. Aye. Sharp Collins. Sharp Collins, aye. Stephanie. Stephanie, aye. That bill's out. Item number 10 is on consent. Item number 11, AB 2161 by Bonta for add-ons. Oh, we have everyone on that one. Item number 12, AB 2201 by Berner for add-ons. Bonta. Aye. Bonta, aye. Patel? Patel, aye. Patterson? Patterson, aye. Stephanie? Stephanie, aye. That is still out. Item number 13, AB 2208. Stephanie for add-ons. Addis? Addis, aye. Rogers? Aye. Rogers, aye. Chiavo? Chiavo, aye. That bill is still out. Item number 14 is on consent. Item 15, AB 2431 by Patel for add-ons. Addis. Addis, aye. Rogers. Aye. Rogers, aye. Shiavo. Shiavo, aye. That bill is still out. Item number 16, AB 2448 by Berman for add-ons. Bonta Aye Bonta Aye Patel Patel Aye Patterson Patterson No Stephanie Stephanie Aye That bill is still out Item number 17 AB 2489 by Lowenthal for add-ons Addis Addis Aye Shiavo Shiavo Aye Sharp Collins Sharp Collins Aye That bill is still out AB 18, sorry, item number 18, AB 2531 by Irwin for lifting the call. Addis. Addis, aye. Aarons. Aye. Aarons, aye. Patterson. Patterson, no. Schiavo. Schiavo, aye. Sharp Collins. Sharp Collins, aye. That bill is out. Item number 19, AB 2540 by Stephanie for Addams. Thank you. Addis, aye. That bill is still out. Item number 20, AB 2551 by El Hawari for Addons. Ahrens. Ahrens, aye. That bill is still out. Item number 21, AB 2575 by Ortega, lifting the call. Addis. Addis, aye. Aguirre-Curri. Aguirre-Curri, aye. Aarons. Aarons, aye. Coloza. Carrillo. Gonzalez. Gonzalez, aye. Sharp Collins. Aye. Sharp Collins, aye. That bill is still out. Item, that bill is out. Item number 22, AB 2598 by Krell for add-ons. Bonta. Aye. Bonta, aye. Patel. Patel, aye. Patterson. Patterson, aye. Sharp-Collins. Sharp-Collins, aye. Stephanie. Stephanie, aye. That bill is still out. With that, we will conclude our hearing. Oh, hold on. Assemblymember Colosa, if you want to vote on item number 21, please come back to the hearing room. We will wait for some minutes. Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Colosa. Colosa, aye. With that, we will adjourn the Assembly Health Committee hearing on April 7th. Thank you.