Senate Health Committee

And you may begin when you are ready. Thank you, Madam Chair. Well, before I begin, I would like to thank you, Madam Chair, and your committee staff for their time, their engagement, and thoughtful feedback throughout this process. I particularly appreciate the Chair's commitment to ensuring that any policy we advance does not unintentionally further disadvantaged lower income and underserved communities. Thank you for that. While we may approach this issue from different perspectives, we share the same fundamental goal, protecting children, and ensuring that every young athlete has the best possible chance of surviving a sudden cardiac emergency. For that leadership and engagement, I sincerely thank you. AB 387 builds upon the foundation established by Nevaeh's Youth Sports Act and seeks to address implementation challenges that have become apparent as youth sports organizations prepare to comply with the existing AED requirements. Under current law, youth sports organizations are responsible for ensuring AED access during practices and games. However, many of these organizations, particularly those serving low-income and underserved communities, conduct their activities at public parks, recreation facilities, school athletic complexes, and other venues that may have already AEDs available on site. AB 387 recognizes that reality and creates a shared responsibility framework between youth sports organizations and the facilities where athletic activities occur. The bill requires collaboration between facilities and youth sports organizations to ensure AED access and encourages both parties to identify ways to share the cost associated with providing this life-saving equipment. Importantly, the bill does not eliminate the responsibility of the youth sports organizations to ensure AED access. If a facility does not have an AED available, the youth sports organization remains responsible for ensuring access to an operating device during the practice or during a game. I also want to acknowledge the Chair's concerns regarding affordability and the impact on disadvantaged communities. Those concerns are legitimate and deserve continued attention My office and I remain committed to exploring future funding opportunities partnerships and other avenues that can help expand AED availability while minimizing financial burdens on the communities that can least afford them Throughout this process, my team and I have met extensively with youth sports organizations, cities, counties, park districts, school interests, and risk management organizations. Those conversations have resulted in meaningful amendments to the bills, including clarifying responsibilities, strengthening collaboration requirements, and creating greater flexibility for facilities and youth sports organizations to work together towards compliance. In that same spirit of collaboration, I would like to thank this commitment to the committee today. Should AB 387 move forward, I will amend the bill in its next committee to remove the requirement that facility operators procure an AED and instead require that any AED already installed at a facility be made accessible to the youth sports organizations during official practices and matches, as well as clarifying and strengthening the collaboration requirements between youth sports organizations and facility operators to ensure clear communication and coordination regarding AED availability. Our work is not finished. There are still conversations to have and issues to resolve. And I remain fully committed to working with all interest parties to get this policy right. Our children deserve nothing less. Should this bill move out of committee today, I remain fully committed to continuing these conversations and working towards a solution that addresses the concerns raised while preserving the bill's core public safety purpose. At its core, AB 387 is about ensuring that when a child suffers sudden cardiac arrest, there is a realistic and practical pathway to lifesaving intervention. This bill seeks to improve access to ADs, strengthens preparedness, and encourages collaborations among organizations and facilities that serve California's young athletes every day. And for those reasons, when the time is right, I respectfully ask for an aye vote.

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

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

Madam Chair, members, Doug Houston representing the California Park and Recreation Society. For the committee's edification, we are opposed unless amended. We're going to be transitioning to support if amended. We want to reserve the right to continue work with the author and the legislature when the amendments are adopted.

Good afternoon Madam Chair and members of the committee Ethan Naegler here on behalf of the California Association of Recreation and Park Districts CARPD is a statewide association representing 70 recreation and park districts that collectively own operate and maintain more than 6 million acres of parks and open space in California I want to thank the author's office for working collaboratively with us over the past 12 months on this bill. I also want to thank the committee staff for their significant work on the bill throughout this time. We have been working closely with both the author's office and committee staff on amendments, and we look forward to seeing those amendments reflected in print. We remain opposed to the bill in print, but anticipate removing our opposition as soon as those amendments are officially adopted. We share the author's goal of improving safety and youth supports. Thank you, and I'm happy to answer any questions.

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

Hello, Caroline Grinder on behalf of the League of California Cities. CalCities hasn't opposed unless amended to the bill in print, but really appreciate the work of the authors, staff, and committee staff and the amendments. We look forward to reviewing those and hopefully removing our opposition in the next committee.

Good afternoon, Eric, on behalf of the California State Association of Counties. I very much appreciate the efforts by authors, sponsors, and committee staff to work with us on our concerns. I'm looking forward to continued conversations, but opposed today.

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

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

Well first of all I want to thank Assemblymember for your focus and your dedication to this issue It is extremely important You know sudden cardiac arrest is not something that we think of happening to our youth but it is And more and more we're hearing stories about kids collapsing on fields. And the only reason why they were saved was because you had an AED device around. And so it is extremely important that we have access to those, that our kids have access to those. At the same time, it is important that whatever we enact here at the state is not discriminatory, just in statute. and the fact that we would require this, which could bump up fees for our youth sports, would automatically make that some kids and families wouldn't be able to participate in it anymore. We're dealing in a situation where the issue of affordability is something that we talk about a lot and California is becoming less and less affordable for everyday Californians. Youth sports are so important I mean both of my boys have participated in youth sports It not only shows you how to work together as a team It gives you the ability to show your leadership skills And in this world where our kids are constantly sitting down on some device This is another avenue for physical activity As we're dealing with issues of childhood obesity and diabetes and hypertension and kids that we never thought they would have to deal with this stuff. But it also opens doors for many, many who may not have ever thought about being able to go to college or having a profession maybe as a sports announcer or an athlete. This is a way to open up doors. And so we have to make sure that we're looking out for their health in terms of their cardiac health, but also not closing the doors for some students, some youth, some families that would not be able to bear the burden of an extra $10, $15, $25. We also don't want to close certain facilities. I know my kids, they, you know, through our little league in my area, we practice at the school site. And I can easily see the schools saying, no, you can't have access to our facilities, especially on the weekends when no one is here. and therefore because of this you cannot you can no longer practice or play on some of these fields and so it's a balance I appreciate what you've done I recognize the fact that we still have another year to to get it right and I would like to work with you next year to figure out how we can get this right because it is that important but I do appreciate the amendments that you have taken today. It's an extremely important issue. And I think once we get it right, we can really use this as a model for the rest of the country. And with that, if you'd like to close.

Good afternoon, Chair and Senators. Yes. I'm pleased to present AB 1682, a bill that would increase accessibility to scalp cooling for cancer patients who undergo chemotherapy. The California Cancer Registry reports that nearly 200,000 Californians are diagnosed with cancer annually, with about 30,000 of those cases involving breast cancer. For many cancer patients, chemotherapy is vital as it targets rapidly dividing cancer cells. However, this affects healthy cells, such as hair follicles, which leads to significant hair loss. Hair loss is one of the most visible and emotionally distressing side effects of chemotherapy. It affects a patient's confidence, mental health, and autonomy about when and how to disclose their diagnosis. To help combat this, scalp cooling is an evidence-based treatment that is used for hair loss by cooling the scalp before, during, and after chemotherapy to limit the amount of medication that reaches hair follicles. Although scalp cooling has been successful in reducing chemotherapy-induced hair loss, access remains limited by its cost, especially as coverage is inconsistent across private insurance and Medi-Cal. Patients are often required to pay out-of-pocket, with costs ranging from $4,000 to $5,000 for a full course of treatment, making it inaccessible for many. EB-1682 would remediate this by requiring California health plans and insurers to cover FDA-cleared scalp cooling devices when prescribed by a provider This bill ensures that scalp cooling is recognized as part of the oncology support services and expands access to an evidence-based treatment that can reduce one of the most nuanced side effects of cancer care Speaking in support today are Alexa Meyer, a breast cancer survivor and founder of a survivor-led community and apparel brand and Lisa Robe, Clinical Account Manager at Paxman Scalp Cooling.

Good afternoon. My name is Alexa Meyer. I live in Concord, and I'm honored to be speaking to you today in support of AB 1682. A week before my daughter's first birthday, a clogged duct from breastfeeding led me to schedule an early mammogram. Although that finding was benign, the mammogram ultimately led to the discovery of breast cancer at just 33 years old. The day I heard the words, you have cancer, my world changed instantly. Of all the fears that came with my diagnosis, one of the things I worried about most was losing my hair during chemotherapy. To some people, hair may seem cosmetic, but for many cancer patients, losing your hair is the moment your diagnosis becomes real and visible to the world. It can affect your confidence, your identity, and your ability to show up as yourself in everyday life. Fortunately, my treatment center offered access to a Paxman scalp cooling system. Over 12 consecutive weeks of chemotherapy, I spent roughly 40 hours connected to the machine. It wasn't always comfortable, but that's a decision I would make again without hesitation. I saved nearly all of my hair throughout treatment, which I finished less than three months ago. While scalp cooling didn't change my diagnosis, it profoundly changed my treatment experience. As a young mother, it helped me maintain a sense of normalcy for my family. It allowed me to look in the mirror and still recognize myself. During treatment, I built a community for breast cancer patients and survivors. Through that work I connected with hundreds of women across the country at every stage of the breast cancer journey I witnessed the devastating impact that hair loss can have on mental health self and recovery The emotional effects of hair loss can persist long after chemotherapy ends, making it more difficult for patients to reintegrate into their lives with confidence. I paid about $1,500 out of pocket for my scalp cooling treatment, which was not covered by insurance. While I'm grateful I could do so, no one should have to choose between their financial well-being and access to supportive care that can meaningfully improve their quality of life. Cancer treatment is about more than just survival. It's also about preserving dignity and confidence while patients fight for their future. I can say with certainty that scalp cooling made one of the hardest seasons of my life more manageable. My experience should not be the exception. Thank you. Good afternoon, Chair and members of the committee. My name is Lisa Raub. I'm a breast cancer survivor, a mother, and a proud Californian. I'm here today because I had the great fortune of being able to preserve my hair with scalp cooling when I went through chemotherapy 12 years ago. When I heard the words, you have cancer, it wasn't the surgeries, the disfigurement, the pain, the nausea, or even facing my mortality that scared me. Sorry. It was the idea of losing my hair, not only for me. but because I knew that for my children, seeing me without hair would be terrifying and traumatic. And I'm not alone. Studies have shown that for 75% of cancer patients, hair loss is the most feared side effect of chemotherapy, and approximately 10% of patients may decline treatment due to their fear of hair loss. My experience led me to seek opportunities to help other patients facing the same diagnosis, and for the past nine years, I have worked with hundreds of patients and clinicians at cancer centers across California to make FDA-cleared mechanical scalp cooling available to them. I have seen the difference it can make for patients to be able to move through treatment with greater confidence and dignity. However, this option is out of reach for many, and far too many doctors tell me that cost is the barrier for their patients. The average patient out-of-pocket expense is $2,500, leaving it inaccessible for many Californians. In oncology, evidence-based treatments that manage other side effects of chemotherapy are routinely covered. Scalp cooling should be no different. Side effect management should never be determined by financial circumstances. In January of this year, the AMA recognized scalp cooling as a standard of care practice by issuing permanent Category 1 CPT codes for insurance coverage. AB 1682 aligns coverage with current clinical practice and helps ensure that access to this treatment is based on medical need rather than patient's ability to pay. Five other states have now enacted legislation requiring coverage for scalp cooling. Californians and all Californians deserve to have access to this standard of care as well. Thank you so much for your consideration and support of AB 1682. Thank you.

Christine Smith, Halifax, California, in support. Gilbert Lara here on behalf of BioCom, in support. Brock Campbell from Lighthouse Baptist Church in Santa Maria, in support. Emily Campbell with Lighthouse Baptist Church in Santa Maria in support. Kevin Guzman with the California Medical Association in support McKay Carney on behalf of Cottage Health in support

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

Thank you. Appreciate that. Seeing no further comments, really want to thank you so much, Assemblymember Hart, for bringing this bill forward and really thank your witnesses for coming and sharing your very personal stories with us. You know, scalp cooling has been shown. It's evidence-based to show that it really does help prevent hair loss at a time when it's so devastating for individuals and their families. I appreciate the fact that you've brought this forward. I understand what Senator Menjavar is saying. There's only so much that we should be adding on and the cost of premiums and things like that. But this is something that I think is definitely important. And as people live longer and as we learn more about different things, unfortunately more people will be touched by individuals in their families or in their close surroundings who have been diagnosed with things like breast cancer or have to undergo chemotherapy for other things as well. And so I do think that this is a very important addition that we offer for patients and their families at this time. So I will let you close, and at the appropriate time we'll take a motion on your bill. Thank you.

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

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

Not seeing anyone else who would like to register their support. If there's anyone that would like to speak as lead opposition, this is your time to come forward to the table. Not seeing any movement. If anyone would like to register their opposition, please come forward to the table. Not seeing anyone. We'll now bring it back to the committee. Vice Chair Valladares.

seeing no further comments want to thank the assembly member for your dedication on this this is definitely one of the ones that you have really honed in and you're working on you know every year to make sure that we get it right it is important that we do get it right this is a very important system that we are trying to develop here in California. And, you know, we are all very well aware of the challenges with in our behavioral health space. Things have just gotten even worse after COVID. And, you know, we're really trying to figure out how we can bring a system up to where it should have already been, you know, long, long, long time ago. With this particular their bill, kind of to the vice chair's point, this was a gut and amend, which always shortens the time frame. And so committee staff was not able to do as much with this bill as we would have liked to, to have said, yes, this is good from a health perspective to get it out. But recognizing that this is an important issue to get right, we're going to go ahead and let it out with as the assembly members say stated the commitment that our staff will continue to work with your staff and your sponsors as you move into the next committee so that whatever bill lands on the floor and then back on the assembly is one that is a little bit better hashed out than maybe what we have today but really want to appreciate your commitment to this issue and with that

Thank you. And at the appropriate time, we will take it. Thank you. Okay. I see file item number six, AB 1843, Assemblymember El Haware. And you may begin whenever you are ready.

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

putting off getting treatment due to financial constraints, constant appointments to the next and next test, and who are overwhelmed by the system and the requirements they know they will inevitably face. I know how thankful they are for our help. Our residents want to be treated. As a caseworker, I can get them to their appointment and in the door to the doctor's office, and the physician I work with wants to and is ready to treat them immediately. However, it is the inevitable next pro-authorization step that gets in all of our way. In our work, we've seen that these insurance-imposed requirements can mandate dangerous and unnecessary procedures. These include liver biopsies, where 1 in 20 patients might be at risk for life-threatening bleeding, and costly genotype testing, which can run patients hundreds of dollars out of pocket, even though leading medications are pan-genotypic and can work regardless of the genotype. Beyond the patient burden already, pro-authorizations exhaust our medical teams. My colleagues spend up to 13 hours per case chasing faxes, labs, providers, and patients fighting for prior authorization approval. With your support and I vote on this important bill, we can align with evidence-based care, ensure health equity, and get our Californians secure. Thank you. Thank you. You may begin. Again, my name is Jonathan Froxwijk. I'm the Director of Health Equity. Justice Policy for San Francisco AIDS Foundation, which is a co-sponsor of this legislation. As providers of hepatitis C treatment, we at San Francisco AIDS Foundation see firsthand the transformative impact that accessing a hepatitis C cure can have on a person's life. Unfortunately, many insurance companies in California prevent people living with hepatitis C from getting cured by requiring prior authorization for these drugs. Requiring prior authorization for hep C treatment conflicts with the definitive medical guidelines on hepatitis C in the U.S., which recommend timely treatment for almost all people living with the disease. Many insurers also request information or procedures that are not recommended, but are costly and dangerous, like liver biopsies. These insurance company hoops often result in people living with hep C not getting cured. About two-thirds of people who have private insurance and are diagnosed with hep C don't start treatment within a year. PA is one reason why. AB 1843 addresses this issue by first prohibiting insurers from acquiring PA for most hep C treatment drugs, and second requiring that insurers' PA processes align with medical guidelines. Treating hepatitis C saves the healthcare system money. This is just common sense. The cost of a single 8 to 12 week course of medication is much lower than the cost of treating a lifetime of complications like cirrhosis and liver failure. The CHBRP analysis of AB1843 found that for every person cured of hep C, the healthcare system saves $7,650 every year. The analysis also found that the bill would have a negligible impact on health insurance premiums. Given this cost effectiveness, we strongly encourage you to advance AB1843. Thank you for your consideration, and I'm happy to answer any questions. Thank you. If there's anyone else in the audience that would like to register their support, please come to the microphone, state your name, your organization, and your position. Good afternoon, Angela Hill with the California Medical Association in support. Thank you. Good afternoon, Jessica Brand on behalf of the California Life Sciences in support. Thank you. Christine Smith, Health Access California in support. Thank you. Scott Zuko with Liver Coalition of San Diego and the Eliminate Hepatitis C of San Diego County in support. Thank you. Farrah McDade-Ting on behalf of the County Health Executives Association of California in support. Thank you. Isabella Uruguata with the Health Officers Association of California in support. Thank you. Ryan Suze on behalf of APLA Health in support. Thank you. Thank you. Sarah Weber with the Drug Policy Alliance in support. Thank you. Good afternoon. Laura O'Connor. As a Californian family member whose sister passed away from hep C, I'm in strong support of this bill. Her untimely death was due to delays in insurance and multiple different kinds of medications and hospitals, but it was very much part of this. So thank you very much, Assemblymember. Thank you. Madam Chair and members, Rand Martin on behalf of the AIDS Healthcare Foundation in strong support of this bill. Thank you. Thank you. Good afternoon. Trent Murphy with the California Association of Alcohol and Drug Program Executives in support. Thank you. Seeing no one else who would like to register their support, we'll now open it up to anyone that would like to speak as lead opposition to this bill. Please come to the table Thank you Thank you, Cassidy Heckman, on behalf of the California Association of Health Plans. While we appreciate the author's intent for AB 1843 today, we have significant policy concerns and must respectfully oppose it. AB 1843 prohibits plans from conducting prior authorization, or PA, on drugs used to treat hepatitis C. Just last year, the legislature passed SB 306, which established a comprehensive regulatory process that evaluates the use of prior authorization by health plans. This is a real-time regulation. Health plans will start submitting PA data to regulators next month. And as you know, regulators will review this data, then identify and publish a list of services that are approved more than 90% of the time. And on January 1, 2028, health plans will no longer require PA for those identified services. However, as a part of the SB306 process, it was determined and considered whether specialty drugs, particularly Tier 3 and Tier 4, should be exempt. Ultimately, it was determined these medications should remain subject to PA, a decision that reflected the significant costs associated with these drugs and an understanding of the role PA can play in ensuring enrollees receive appropriate treatment for an affordable price. Therefore, we are concerned that AB 1843 would deviate from the recent and deliberate policy decision to maintain UM safeguards for higher-cost specialty medications. I'd also be remiss if I didn't also note the prescription drug prices have increased by more than 70% since 2017. In the case of prescription drug mandates, CAP will continue to encourage thorough review of prescription drug costs, which remain a major driver of health care expenditures. And since health plans already cover drugs used to treat EPSI, we unfortunately oppose any mandate that prevents us from designing a formulary that preserves affordability and access for our enrollees. For these reasons, we respectfully oppose and want to thank the author and sponsors for their continued conversations. Sorry. Good afternoon, Chair and Members. Matt Akin with the Association of California Life and Health Insurance Companies, also respectfully in opposition to AB 1843. In the interest of time, I would just like to align my comments with my colleague at CAP and just very quickly reiterate that we are concerned that this bill would broadly eliminate PA for an entire class of drugs, removing an important tool used to ensure safe, evidence-based, and cost-effective care. We are also concerned that establishing drug-specific coverage mandates into statute limits plans' abilities to adapt to evolving clinical guidelines. I want to thank the authors and sponsors for their continued engagement on this bill, and we look forward to future conversations as the bill moves forward today. Thank you. Thank you. If there's anyone else that would like to register their opposition to the bill, this is your time to come forward to the microphone. state your name, your organization, and your position. Seeing no one, we'll bring it back to Senator Caballero. Thank you, Madam Chair. I appreciate you bringing this bill. Let me ask the opposition something, because I get processes, and I understand processes and I I'm a big believer that they're really critically important you set up a process you utilize it in it and it it achieves the goals for which the process was set up the challenges is that we're talking about a disease that if not treated can result in death as we hear we heard or a much more serious condition and I wonder if your cost benefit analysis or your cost analysis whether the increase in a medical care after the fact or if a denial is is achieved if that's part of the analysis analysis that's done because I you know I I'm a big believer in prevention and the more we can get to the root of what is causing our obesity high blood pressure hypertension and and and the diabetes, the diseases, frankly, the diseases of excess in our society, the more we're going to get a control over the very issue you're talking about, which are prescription drugs that are driving up the cost of health care. So I wonder if you could address that particular issue. Yeah, I would just say, you know, in the context of AB 1843, I don't think our plans have done an analysis or a cost-benefit analysis of, you know, further treatment being more cost-effective than the particular cost of the drug. I will say this is an issue that health plans face regularly, which is the cost of prescription drugs. So, you know, it's not specific to this bill or specific to this disease. It's just something that we have to consider when designing our formularies and having negotiations. I understand. Okay. Thank you very much. I appreciate that. Seeing no further comments, I want to thank you, Assemblymember, for bringing this bill forward. It's a tough issue because it's not like these medications aren't covered by insurance companies. companies. It's just where they're tiered, and so sometimes you do have prior authorization or you do have step therapy. And the other issue for me is the entire SB306 process, that that was something that we just passed. It was negotiated. These tier three and tier four drugs were not included in that, primarily around the issue of cost. I'm assuming I was not in the room, I was not the author, but understanding that getting the whole prior authorization bill through was something that was years in the making. And this does kind of seem to go around it or undo it a little bit. And so understand the opposition's concern about opening this would then allow for a wide variety of other kind of medications in these tiers to be able to kind of skirt the process that we all agreed to last year. But definitely appreciate you bringing this bill forward. And with that, we'll let you close. I really appreciate you bringing up the piece about SB306. And definitely for us, it's not about skirting around the process, just recognizing the negligible costs, recognizing that it won't impact the broader framework and knowing that this is just has such a high rate of curing a disease that is really like we know when someone has hepatitis C when they go to the doctor to have to go through another process of having to prove that they need these drugs we recognize just is really causing more harm so really appreciate your consideration and respectfully ask for your aye vote thank you and thank you to your witnesses once we get a quorum we will take it up thank you we will now move back to file item 2 AB 1629 Assembly member Haney and you may be chair and members I want to start by thanking you and your staff for their work on the bill and accept the committee amendments AB 1629 will help prevent patients from paying large upfront costs for out-of- network dental care by requiring insurers to pay dentists directly when a a patient chooses to assign their benefits. Every month, millions of Californians pay their monthly dental insurance bill but never get the care that they're entitled to. California has over 35,000 active dentists. The issue isn't a lack of dentists. It's that some insurance companies may narrowly exclude in-network services, pushing patients to seek out-of-network care. Despite patients already obtaining assignment of benefits, non-contracting providers may exclude from receiving direct payments with insurance companies. Twenty-eight states have implemented assignment of benefits legislation that requires insurers to reimburse dentists directly, and California is behind. These restrictions force patients to travel long distances for care or pay the full out-of-pocket costs due to inadequate provider networks and restrictive insurance policies. In most cases, patients would have to pay the costs up front and wait for prolonged periods to get reimbursed. Patients should not have to choose between paying large upfront costs or delaying dental care, care that can mean the difference between prevention and serious long-term health consequences. AB 1629 will end this limbo by requiring insurers to reimburse dentists with a written assignment of benefits, regardless of their contracting status, rather than require patients to pay high out-of-pocket costs up front and wait prolonged periods for reimbursement. It will also require insurance companies to report network adequacy data, which measures whether a health plan has enough in-network dentists in the right locations. We've had productive conversations with opposition and other stakeholders and have taken significant amendments along the way with this bill, including, I think, ones that we work very closely with you and your staff on, which we appreciate. and with me in support of the bill to testify is Eric Dowdy from the California Dental Association and Shelby Aravello, a patient advocate coordinator. Thank you. You have a combined total of five minutes. Thank you, Dr. Weber Pearson and members of the committee. Eric Dowdy with the California Dental Association and proud to be sponsoring AB 1629. Too many Californians are paying for dental coverage they can't actually use. AB 1629 makes practical targeted improvements to change that. First, it strengthens network adequacy oversight to ensure that dental plans have enough dentists and patients to find in-network dentists. And second, AB 1629 requires plans to honor a patient's assignment of benefits request. When a patient chooses an out-of-network dentist, the insurer would send payment directly to the dental office, not the patient. Without AOB, patients must pay the full cost of treatment out of pocket and then wait to be reimbursed. For working families, that financial barrier makes their coverage effectively worthless. Assignment of benefits is not a new concept. As the Assemblymember said, 28 other states already have this requirement in place and dental plans, including Delta Dental, already comply where it's required. Some locations comply voluntarily where it's not. Importantly, states with assignment of benefits laws have not experienced shrinking dental networks or rising premiums. In many cases, we've seen just the opposite. We appreciate the committee's work on the amendments to be adopted today, which improve cost transparency and establish exceptionally strong disclosure requirements to protect patients. And we appreciate the long conversations with committee staff on the bill and remain committed to pursuing additional transparency and plan accountability as a key part of dental insurance reform. For these reasons, we respectfully ask for your aye vote. Good afternoon, Chairperson and members of the committee. My name is Shelby Arevalo, and I'm the founder of the National Dental Advocacy Program, a California-founded nonprofit organization dedicated to helping patients navigate barriers to accessing dental care. Today, we serve patients across California and throughout the United States. I have spent more than 16 years in dentistry, beginning chairside as a dental assistant and advancing through management, billing, and coding. Today, I serve as a board-certified patient advocate, working directly with patients, families, and providers, navigating a healthcare system that is often confusing, overwhelming, and difficult to access. Through this work, I see firsthand the barriers patients face when simply trying to obtain necessary dental care. Many patients, particularly those in rural communities, those with disabilities, complex medical conditions, or severe dental anxiety struggle to find an in-network provider able to meet their needs. When they finally locate a qualified dentist who can provide treatment, they're often met with another barrier, the inability to assign their insurance benefits directly to that provider. I've worked with patients suffering from severe infections, patients requiring sedation, and patients who have spent months searching for care. In many cases, they call dozens of offices before finding a provider who can help them. Yet, even after finding treatment, some are required to pay the entire cost up front and wait for reimbursement because their dental plan refuses to honor their assignment of benefits request. For many families, that financial burden is simply impossible. Patients should not be penalized for seeking care from a provider who can meet their needs, especially when network limitations leave them with few practical options. Assignment of benefits is not about providers. It's about patient choice, access to care, and removing unnecessary financial barriers that delay treatment. AB 1629 also helps address concerns surrounding network adequacy by ensuring regulators have more complete picture of the provider network patients rely on. Access to care begins with accurate accountability. Every meaningful improvement in healthcare starts when patients have a seat at the table. AB 1629 represents an important step toward improving access, transparency, and fairness for the patients we serve. Thank you for your time and consideration. I respectfully ask for your vote in favor of AB 1629. If there's anyone else in the audience that would like to register their support for this bill, please come to the microphone, state your name, your organization, and your position. Good afternoon, Chair. Jasmine Asher, representing the California Association of Orthodontists. We are in support. Thank you. Thank you. Madam Chair and members, Janice O'Malley with AFSCME California in support. Thank you. Michelle Rivas on behalf of the California Association of Oral and Maxiofacial Surgeons in support. Thank you. Kevin Guzman of the California Medical Association in support. Thank you Good afternoon Chair and members Jennifer Tannehill with Erin Reed and Associates on behalf of the California Dental Hygienists Association also in support Thank you. Seeing no further individuals wishing to register their support, if there's anyone in the audience that would like to speak as lead opposition, please come to the table. you will have a combined total of five minutes. Chair Pearson, members of the committee, my name is Sierra Feldman on behalf of Delta Dental of California in respectful opposition to AB 1629. While we do appreciate and acknowledge the amendments that have been proposed, we remain significantly concerned about the impact this bill will have to patients. We want strong networks. We want as big of networks as possible. But when dental networks weaken, patients lose access in network care, resulting in higher out-of-pocket costs. Strong dental networks are essential to patient access and affordability, and plans want to partner with providers. But network participation is a two-way partnership. Dentists agree to negotiated fees and consumer protections in exchange for this direct payment and patient volume. And direct payment is a key driver of network participation. AB 1629 is mandating that we extend the benefit of direct payment to non-contracted dentists without them agreeing to consumer protections or negotiated fees. This undermines network participation, pushing patients out of network where care is more expensive and the protections are weaker. The risk to networks is not theoretical. In our assessment, states with similar policies have seen declines in network participation. In California, even a modest decline could translate into hundreds of million dollars of increased out-of-pocket costs to patients. And this is a cost borne by patients, not dental plans. In-network dentists cannot charge more than the negotiated fee, whereas out-of-network dentists can charge their full charges. AB 1629 would allow non-contract dentists to receive direct payment from a plan while still billing patients for the remaining balance. If assignment of benefits is expanded, it is critical that providers who receive direct payment from a plan accept that payment as payment in full aside from any cost sharing. Allowing providers to bill a patient after a plan's payment continues to shift the higher out-of-pocket cost to patients. Plans are committed to working with providers, but ultimately, as written, this bill still continues to weaken networks, limiting access to in-network care, stripping negotiated protections, and driving up out-of-network costs. For these reasons, we respectfully urge your no vote. Thank you. Good afternoon, Madam Chair and members. Christy Weiss on behalf of the California Association of Dental Plans. We are opposed to the bill in print. We received the amendments last night and are reviewing them. with our association members and are working through that process today as we speak. We want to acknowledge the hard work of the committee, and these amendments do go a long way towards removing the association's concerns, particularly the removal of the language requiring predetermination that was particularly problematic for our plan members. I think the most important thing for the association's members is to make sure that our plan members understand, you know, when they're going out of network, right what the implications of that are what the costs are what benefits they may not be receiving from their plan and just really to make sure that our plan members understand their benefits and are using them as much as possible So we still opposed at this time but really appreciate how far the bill has come Thank you. Thank you. If there's anyone else in the audience that would like to register their opposition, this is your time to come to the microphone, state your name, your organization, and your position. Alexis Rodriguez of the California Chamber of Commerce in opposition. Thank you. Thank you. Olga Shaila with the California Association of Health Plans, also in opposition. Thank you. Thank you. Matt Akin with the Association of California Life and Health Insurance Companies, also respectfully in opposition. Thank you. Seeing no further individuals that would like to register their opposition, we'll bring it back to committee members. Well, I would like to thank you, Assemblymember Haney, for bringing this bill forward, for allowing for us to engage in this conversation. it's not the easiest issue we've had some pretty tough negotiations but really appreciate your staff the sponsors, the health staff in being able to get us to the place that we are today and with that I would like for you to close thank you I appreciate it and thank you Madam Chair and to your staff as you said there was a lot of great work done on this bill under your direction and I really do appreciate everyone who's participated, including the opposition. We do have amendments that I think address some of the concerns and I know that the conversations will be ongoing hopefully as this bill moves forward and very much respectfully ask for your aye vote. Absolutely. At the appropriate time we will and just want to clarify that the amendments because again this was a tough negotiation but they will have to be adopted in business and professions and not in this committee because of timing absolutely all right thank you thank you we will now move to file item number number 5, AB 2540 by Assemblymember Stefani. And you may begin whenever you are ready. Thank you, Madam Chair and colleagues. Today I'm presenting AB 2540, which is the Community College Student Right to Access Act. And first, I want to start by thanking the committee staff for their hard work and partnership with my office, as well as the community colleges for their thoughtful engagement throughout this process. And I will be accepting the amendments we have agreed to, which will be taken in the next committee. So thank you so much for that. Four years ago today, the United States Supreme Court overturned Roe v. Wade. With one decision, the court stripped away a constitutional right that millions of Americans had relied on for nearly half a century. It was a devastating step backward for reproductive freedom. California responded by reaffirming our commitment to reproductive health care. California has long said that access to care should not depend on who you are, where you live, or how much money you have. But today, that is exactly what happens for many college students in our state. Imagine two students living in the same community One attends a UC or CSU The other attends a community college Both are working towards a degree Both may be balancing jobs family responsibilities and the pressures of school Both need access to reproductive health care But only the student at the UC or CSU is guaranteed access to medication abortion services through their campus health system. The other student at the community college may have to navigate transportation barriers, take time off for work, find a provider miles away, which we've heard stories of, or simply go without care altogether. And the reality is, the student facing those barriers is often the student who can least afford them. Community college students are among the most diverse students in California. They are more likely to be low-income, more likely to be first-generation college students, more likely to be working while attending school, and more likely to be balancing family and caregiving responsibilities. These students are doing everything we ask of them. They are pursuing an education, building a future, and strengthening our workforce. Yet when it comes to access to reproductive health care, we are not treating them the same as students attending four-year institutions. That disparity is what AB 2540 is solving for. This bill expands equitable access to medication abortion services for students attending community colleges by requiring colleges with existing student health centers to provide these services. And let me be clear, reproductive health care is essential health care. Access to that care should not depend on whether a student attends a UC, a CSU, or a community college. This bill allows services to be provided through existing campus health centers, through telehealth, through contracted providers, or community partnerships. It also improves transparency by requiring colleges to publish information about available services so students know where they can turn for care. I've said this before in every committee I've presented this bill in. Community college students are not second class. They deserve the same life-saving access to reproductive health care. And with me today in support is Alicia Nagpal, who is with the Student Senate for California Community Colleges, and Dr. Pana Lossi, a family medicine physician who has provided primary and abortion care for over 30 years. Thank you. You will have a combined total of five minutes. Good afternoon, Chair Weber Pearson and members of this committee. My name is Alicia Neckball and I sit here as the Vice President of Legislative Affairs for the Student Senate for the California Community Colleges, the official voice of 2.2 million students across California. I am also here not just as a student leader, but as someone personally impacted by reproductive health challenges. Our support for this bill is grounded in distribution of clear and comprehensive information for available reproductive and sexual health resources, which AB 2540 establishes. AB 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 Medicaid and apportioned services through SB 24 in 2019, community college students do not. They are more likely to be low-income, working, and place-bound. Students in remote areas, such as the far north, often don't have the same access to services that students in urban regions may have. Students who are struggling to make ends meet may not have reliable health care. With this discrepancy, students in the CCC system are disproportionately affected and cannot access timely reproductive health care. Instead, they may be forced to miss class, delay their education, or dropout entirely. Barriers should to care become barriers to college completion. This matters most for the students who are already navigating the greatest challenges. Foster youth, undocumented students, students of color, and first-generation students who have the least margin of disruption in their lives. Access to these resources expands on the equity work that should be strived for in healthcare and in higher education. This bill ensures that students are well informed about services and how to access them. The bill means timely, affordable care. It means privacy, dignity, and autonomy when students seek support. And it affirms the simple truth. Community college students deserve the same standard of care as any other student in California. AB 2540 affirms the simple truth. Us community college students deserve the same standard of care. We respectfully urge your aye vote. Thank you. Hello. Hello. Hi. Hello. Hi. My name is Dr. Pana Lassi, and I'm a family medicine physician who has provided primary care and abortion care for over 30 years. I'm also the very proud mother of a daughter who just finished a fabulous culinary program at our local community college. Many of my daughter's classmates and friends come from immigrant and low-income families and worked part-time or full-time while going to school. If we truly believe in reproductive freedom, justice, and equity in California, then we must pass this bill. I want to stress how safe early medication abortion is. A recent study in the journal Contraception shows that staying pregnant was 35 times deadlier than having an abortion. The major complication rate is less than half a percent, and the mortality rate is 0.6 per 100,000 procedures. For comparison, the mortality rate for a colonoscopy is approximately 3 per 100,000 procedures, five times higher. I understand that the idea of providing medication abortion might feel daunting to people who have not been active in reproductive health care recently. but it is very doable. My family practice clinic started offering medication abortions in 2003, 23 years ago, so I have first-hand experience. I also helped Sonoma State implement medication abortion services after SB24 and have consulted with many other clinics about adding abortion care to their practices. What has been universally true is that it feels scary before starting, But after implementation, providers reflect that it's really not medically or technically difficult at all. Routine ultrasounds and follow-ups are no longer required. And if providers have questions, they can call the California state-funded UCSF Reproductive Health Hotline for immediate free help. There are also free on-call services to help patients after hours. The benefit to students is enormous by not having to delay care and interrupt their studies because they can get what they need from trusted providers right on campus. I know that everyone working in the community college system is committed to providing the best education and health care to their students, and I strongly encourage a yes vote on AB2540. Thank you very much. Thank you. anyone else in the audience that would like to register their support please come forward state your name your organization and your position chair members Austin Webster with W Strategies on behalf of the Student Senate for California Community Colleges also here just to answer questions Thank you. Thank you, Chair and members. Angela Pontus on behalf of Planned Parenthood Affiliates of California, in support. Thank you. Good afternoon. Angela Hill with the California Medical Association, in support. Thank you. Lizzie Guansona here on behalf of Training and Early Abortion for Comprehensive Health Care or TEACH in support. Thank you. Good afternoon, Georgia Post-Ladies on behalf of Lieutenant Governor Eleni Kunalakis in support. Thank you. Thank you. Good afternoon, Adam Kegwin on behalf of California LULAC in support. Thank you. Christine Smith, Health Access California in support. Thank you. Martin Rudosevich on behalf of Reproductive Freedom for All California, co-sponsors. Thank you. Good afternoon. Isela Bravo on behalf of URGE and California Latinas for Reproductive Justice, proud co-sponsors and support. Thank you. Hello. Alana Ladisar on behalf of the American Nurses Association of California in support. Thank you. Hi. Kim Robinson with Black Women for Wellness. Action Project and also giving AME2 for Access Reproductive Health in support and also co-sponsors. Thank you. Seeing no one else that would like to register their support, if you would like to speak as lead opposition, this is your time to come to the table. Just two witnesses to speak as lead opposition. Thank you, and you both will have a combined total of five minutes. Good afternoon, Chair and members. My name is Michelle Barkley, representing Health Services Association California Community Colleges, HSA CCC. We have an opposed position on the bill at this time, but anticipate removing opposition based on amendments discussed this week. To be clear, HSA CCC strongly supports students' access to comprehensive reproductive health care, including abortion. We appreciate the author, committee sponsors, and the Chancellor's Office for the continued collaboration and thoughtful work on recent amendments on AB 2540. We especially value the added flexibility allowing colleges to partner with outside providers. This is an important step that recognizes campuses may support students through a mix of on-site services, telehealth, and community partnerships. We want to highlight a few practical considerations. Each model brings different operational needs. On-site care may require new clinical staffing and infrastructure. still relies on campus coordination and oversight. Community partnerships can be effective, but provider availability varies widely by the region. Community college health centers are already operating at or near capacity and are designed for short-term care, implementing multiple service pathways simultaneously, will take careful planning and support. Sustainable ongoing funding will be essential to ensure colleges can expand access while maintaining core services students depend on HSACCC is committed to continuing to work collaboratively with the authors and stakeholders to help ensure this bill is both student-centered and implementable. Thank you for your consideration. Thank you. Good afternoon, Chair and members. My name is Megan Pennell and I am a current community college student at Folsom Lake College. I'm here today in opposition of AB 2540, which promotes and expands access to abortion drugs on community college campuses. While I have never been pregnant, nor do I have any children of my own, I have worked in public education and watched friends juggle school and parenthood. The stress of going to school for a degree alone is a lot, and to be able to handle that while also being a parent is something I have always admired in others. It shows how strong people can be while also showing their children that nothing is impossible. Instead of promoting abortion and choosing to end a life out of convenience, we should be giving college students resources to help them. For example, providing them with options for adoption if they choose they aren't ready to be a parent, offering child care centers on campus so that they can attend class while their child is well cared for. My mother was sexually assaulted at a young age and got pregnant with me. Rather than telling someone, she chose to hide her pregnancy because she wanted to give me the ultimate gift of life. She knew there was a chance that someone would try to pressure her into abortion. She is my inspiration to fight for the millions of beautiful children who have no voice. Time or circumstance should not dictate the value of life. Did I deserve to die for the crimes of my father? California does not impose capital punishment. if we do not punish criminals with death, why should an innocent child receive a death sentence because of the circumstances of his or her conception? Why are we so quick to end the life out of convenience instead of offering resources for the mother and her child? Young women with unplanned pregnancies should be encouraged to have their children instead of making abortion an option women feel pressured into because that's the only option offered for an unplanned pregnancy. From someone who is happy to be alive, I respectfully urge a no vote on AB 2540. Thank you. If there's anyone else in the audience that would like to register their opposition, please come and state your name, your organization, and your position only. Good afternoon, David Bola. On behalf of the SFV Alliance, we are in opposition. Thank you. My name is Leandra Wells with the California Family Council. I completed my degree three weeks after my baby boy was born. We respectfully oppose this bill. Thank you. Thank you. James Delcourt, Living Well Medical Clinic, Grass Valley. Stand opposed. Thank you. Good afternoon. Justin Selmick on behalf of the California Community College Chancellor's Office. We don't have an official position, but we are supportive of the intent, and we are aligned with the concerns of the Health Services Association and the community college CEOs. But as our witness spoke, there have been amendments that are pending that will hopefully remove our concerns going forward. Thank you. Seeing no further individuals that would like to register their opposition support or tween position, we'll bring it back to the committee. I want to thank Assemblymember Stefani for bringing this bill forward. It is extremely important that we as a reproductive state a state that believes in allowing for people to have all options of what they want to do with their bodies that we do work on getting this right Also understanding though the challenges of our community colleges Community colleges are not UCs, they're not CSUs, they don't have the same resources, and not all community colleges are the same. Some are very large, and some are very, very small, and are very limited in terms of resources. And I think sometimes when people think, oh, well, you can do telehealth, and they've never actually done telehealth, they don't understand some of the intricacies and some of the modernization that you must have, the infrastructure that you must have in order to be able to do something like a telehealth. And so I really appreciate you agreeing to these amendments. I think that it does address a lot of the opposition's concerns, but at the same time, still allowing for disclosure on all campuses about what options are available, and also allowing for those community colleges that do have the ability to do this, to continue or to provide the service for their students. And with that, you may close. Thank you, Madam Chair. chair and yes I do want to thank the community colleges for working with us on this bill this is not to add any burdens to their already overstressed system we want to make sure that we are working with them and that's why we accepted the amendments and will continue to work and address those remaining concerns but you know this bill is about equity it's about dignity it's about making certain that we have reproductive health care access to all those students who need it and I thank you for your consideration I respectfully ask for an aye vote. Thank you and at the appropriate time whenever we establish quorum we will do that. Alright we will now move to file item 8, AB 1929 by Assemblymember Ortega. And you may begin when you are ready. Thank you, Madam Chair. I'm also chairing my own committee, so I'm actually going to make my comments very brief to allow my witnesses to make their comments. Thank you for allowing me to present AB 1929 today, which is a Latino Caucus Priority Bill. AB 1929 requires health plans to participate on the Covered California Healthcare Exchange to disclose all the investments they make with the subsidies and patient premiums they receive, including investments in for-profit prisons and immigration detention centers. AB 1929 is a sunshine law ensuring that the public knows which health plans are investing in the well-being of their communities and which are profiting from destroying them. Here to testify with me today is Joe Gizinski, Executive Director of UNAC, and Christopher Sanchez on behalf of Central American Resource Center of California. Thank you. You have a combined total of five minutes. Thank you and good afternoon, Chair Weber Pearson and members of the Health Committee. My name is Joe Gizinski. I'm the Executive Director of the United Nurses Association of California, Union of Healthcare Professionals, or UNAC-UHCP. We represent approximately 41,000 registered nurses and healthcare professionals across California. UNACUACP is a proud sponsor of AB1929 because it affirms a simple principle. Healthcare organizations, many operating as nonprofits, carry an obligation to the public they serve. That obligation is grounded in transparency. Transparency must be a fundamental condition doing business with the state of California. Nonprofit health plans benefit from a public trust reinforced by taxpayer support and the expectation that its resources provide meaningful community benefit. With that trust, health care organizations have an obligation to provide the public with a clear understanding of how they are putting those resources to use. This is not about restricting the rights of health care systems to decide how they invest. This is about the taxpayer's right to transparency. AB 1929 honors that right. It ensures that investment choices and the values behind those choices are accessible and visible. People deserve to know when a healthcare system's investments conflict with the values or well-being of the communities they serve, or when they conflict with the values that the organization claims to represent. Patients deserve this. Employees deserve this. The taxpayers of California deserve this. On behalf of the 41,000 healthcare professionals we represent, we respectfully ask for your aye vote. Good afternoon, Madam Chair and members. Christopher Sanchez with the Massa Verde Group here on behalf of the Central American Resource Center, Caresen, the largest Central American immigrant rights organization in the country, here today as a proud co-sponsor and strong support of AB 1929, a bill that would make appropriate disclosures so Californians can make educated decisions whether choosing a health care plan. Caresen stands firmly against anyone, any system, or any company benefiting and profiting from the detention of immigrants in private detention facilities who have a a long history of human rights violations. Our organization knows firsthand the inhumane conditions of these private detention centers because we represent individuals and their families who are in these centers and members of our legal service team have gone inside these detention centers to service the clients. They have witnessed signs of malnutrition, lack of proper hygiene, lack of medical care, and signs of physical abuse. Our clients have told us about significant overcrowding and there have been countless reports of deaths that are based on violence and lack of medical treatment in these facilities. These detention centers are solely designed for profit of immigrants and under the Trump administration these policies have been implemented to ensure that there is no due process of immigrant proceedings resulting in forever detention to maximize profits for these private detention companies. It is clear that there is a lack of accountability from the federal government to hold these private detention centers and their investors accountable. It's our job to do so and simply to have simple disclosures. To date, God has synergies your aye vote. Thank you. If there's anyone else in the audience that would like to register their support for this bill, please come forward, state your name, your organization, and your position only. Madam Chair, Janice O'Malley with AFSCME California. We are proud co-sponsors. Thank you. Thank you. Hello. My name is Elizabeth Dubbs. I'm a nurse midwife, and I'm a supporter of it. Thank you. I'm also a UNAC member. Thank you. Hello. Camille Stone, Certified Nurse Midwife. I am in support of this. Thank you. Seeing no further individuals that would like to speak in support. If there's anyone in the audience that would like to speak as lead opposition, this is your time to come forward to the table. And you will have a combined total of five minutes Good afternoon Chair members Olga Shiloh on behalf of the California Association of Health Plans in opposition to AB 1929 AB 1929 creates a fundamental mismatch by assigning responsibilities to Covered California that is not designed or equipped to carry out. It is not clear what gap this bill fills or why Covered California should be tasked with filling it. Furthermore, Covered California is not a health plan regulator. Neither does it have the expertise or the infrastructure to determine what qualifies as material investment holdings, evaluate Form 5500 filings, or adjudicate compliance. This bill would effectively require it to do all three. It also places the exchange in the position of posting and explaining complex non-healthcare financial disclosures to consumers. At a time when its core mission is enrollment and retention, Covered California has raised concerns that this could confuse or even discourage consumers from signing up for coverage. The exchange already operates in a challenging environment and has just 11 participating carriers today. We should focus on stabilizing and strengthening that market, not adding new requirements that could make participation less attractive. Finally, as the committee analysis notes, much of this information is already publicly available through existing reporting frameworks. For these reasons, we respectfully ask for a no vote. Thank you. Madam Chair and members, Stephanie Watkins on behalf of the Association of California Life and Health Insurance Company, I echo many of my colleagues' comments. We do represent the major health insurers that are regulated under CDI. I'd just like to note, and I think it's addressed in the analysis, that much of this information, I think that the author and sponsor we're initially seeking is provided through annual and quarterly disclosures that are required as a part of the National Insurance Commissioner's Model Law, that they are publicly available and provided to CDI. And just to give you some examples, these include real estate, mortgage loans, bonds and stocks, alternative investments that include disclosures for nontraditional assets such as private equity, hedge funds, joint ventures, and mineral rights, short-term investments, and cash and cash equivalents. So much of this information is already provided, and we're a little confused as to during this specific time when affordability is at the forefront of everyone's mind, if it's the best use of resources to add additional administrative burden and cost to the health care system, that doesn't necessarily fill a gap, but it feels very duplicative of what's already provided. So for those reasons, we are opposed to the bill, but if it does move forward, we look forward to having continued conversations. Thank you. Thank you. If there's anyone else in the audience that would like to register their opposition, this is your time to come forward. State your name, your organization, and your position only. Thank you. Alexis Rodriguez for the California Chamber of Commerce and Opposition. Thank you. Seeing no further individuals that would like to register their opposition, we'll bring it back to committee. Vice Chair Valladares. Thank you. Thank you, Madam Chair. I have major concerns with this bill. You know, health care is personal and families don't buy insurance because they care about what stocks or funds their insurer owns. They buy insurance because they want to know when their child gets sick. They want they want coverage when their spouse needs surgery or when a loved one is diagnosed with cancer, that the care is going to be there. And this bill moves us away from that mission from my perspective California already regulates insurers to ensure that they are financially sound and that they able to pay claims But this isn about protecting patients It's about publicly exposing and scrutinizing lawful investment decisions so that they can become targets in political debates. And for me, that's a dangerous precedent. Today, health insurers, tomorrow, banks, more nonprofits, you name it. But if there's fraud, let's investigate it. If there's mismanagement, let's stop it. But government should not be in the business of politicizing investment portfolios. And at a time when Californians are struggling with the cost of care, we should be focused on lowering premiums, increasing access, and improving patient outcomes, not creating new bureaucracy. So my question is, how does this bill improve access, and how does this bill make health care more affordable at a time when we're raising taxes to cover health care for Californians? How does this accomplish that? To the sponsors. What I would say, to answer your question, what this bill does as far as when we talk about access, it's access to information for the consumer. I'm talking about access to care, to medical care. How does it improve it? Well, for the consumer who's seeking to make judgments about the community in which they live, and health care is part of this, to provide insurance for their family. I've been on the exchange. I understand what it provides, and it does provide, you know, there's a lot of personal information that's given from the patient here. And what this bill does is it says that when it relates to investment, which has a huge impact on the community, investments in, you know, fossil fuels, investments in things that deal with mental health, predatory lending, investments that have everything to do with health care, as a consumer, I would like to know, and that's what this bill seeks to do, is in a transparent way of not having to go through a whole bunch of forms. I would have no idea where to get the information that was listed before. It's all over the place. So what the bill does is it's from a consumer point of view. It says let's make the revenue that I pay and the revenue that these insurance companies achieve, let's see where they're investing in that situation. So the answer is it doesn't improve it. I'm talking about the person that is trying to get a doctor's appointment. I'm talking about – so it does not improve access to care. I would concede that it's not – To the opposition, does anything in this bill improve access to care? Oh, sorry. I mean, from our perspective, no. I think it increases administrative costs, which therefore increase the general premiums that ratepayers pay and ultimately then makes health care less affordable. And I would say that while I appreciate the fact that not all consumers necessarily know that they can access CDI, to the degree this information is publicly available, those within the advocacy community do know and can make that publicly known to the people that they work with. I mean, at the end of the day, all of this is quarterly and annually reported to CDI. It's publicly available, and it's quite comprehensive to the degree that you want to do the investigation on who's investing and where. I think that's an important key element that our community can access and provide to those who are interested. But adding additional administrative costs at a time when enhanced subsidies are gone, people are really struggling, I don think it brings more to the consumer I think it just an additional administrative cost and a duplicative process I mean that from our perspective I'm just generally frustrated right now that we are trying so hard to find dollars to pay for care. And at a time when we are raising significant taxes for families this year to pay for access to care. And for access to care to undocumented immigrants, too. That's what we're doing this year. We're here addressing or presenting bills that I think make it even more political. And so I can't get to support on this because I have a fundamental opposition to what I think it's going to do. And my priority is making health care more accessible for every Californian and making it less expensive. Because people are struggling to pay for prescriptions, to pay for premiums, and then we're raising taxes. So I'll end with that. Thank you. I'm not seeing any other senator that would wish to speak. I want to thank you, Assemblymember, for bringing this bill forward. It is important to have information to know who's investing what and where. I do have some concerns, though, because that information, although maybe not in one consolidated place, is already available. and where we are right now we have to weigh the cost of consolidating all that information that's already out there against the cost that the patients will have with the increase in their premiums because of the increase in the administrative burden. I don't personally think that it is going to improve health outcomes. I don't personally think that it's going to improve access to health care. And, you know, there was technical assistance from Covered California, which on June 19th, which really states that this is far outside of their role as an Affordable Care Act marketplace. You know, they even say it's unclear what information consumers would obtain that's not currently available through public filings. The fact that they themselves don't have any experience with forms 5500 for any employee benefit plan. I'm just really concerned that we would be putting more cost on patients and not getting significant returns. understand the purpose of the bill understand the fact that people should know but I'm just wondering at this time is it worth us increasing their premiums and when you're looking at patients that are on Covered California I mean everybody's struggling right now but they're definitely struggling and we've seen some people have to drop their tears in order to keep their insurance at this time. So I'm just not sure if what we would get from consolidating all of this information is worth the cost to those families. And for some of them, they may end up having to remove off of insurance completely. But definitely understand and appreciate you bringing this forward. And with that, I know you have a committee, so you can close. Thank you. And I appreciate With the author's comments and the opposition, I definitely, you know, agreed to take a look at some of the comments they've made in terms of the regulatory authority and willing to take amendments as it relates to that because I do not want it to be a burden. It's about transparency and ensuring that we as premium payers, you know, you talked about increased premiums and access to health care. We should also have a right to know where our dollars are being invested. and if in fact they are being invested in detention centers that are hurting our communities and our babies and our mothers. And if we want to talk about health cuts and political, we should also acknowledge that a lot of the reasons that we're having to make these cuts is because the big, beautiful bill cut $799 million in health care access to give tax breaks for billionaires. So we should really look at both issues, not just one, if we're going to talk about health care access and why we're having to make these difficult decisions. With that, I respectfully ask for your aye vote. Thank you. And when we get a quorum, we will take that bill out. We are now going to go down to file item 23, AB 2651. I want to thank Assemblymember Herbedian for allowing Assemblymember. Okay, well we will hold off on that and go to file item 11, AB 2030 from Assemblymember Lowenthal. And you may begin when you're ready. Thank you, Madam Chair and members. For the opportunity to present AB 2030, this will prohibit the sale of over-the-counter diet pills and supplements marketed for weight loss or muscle building to individuals under age. 18, I want to begin by clearly outlining which products this bill does and does not cover. First, the bill only applies to dietary supplements that are marketed or represented for the purpose of achieving weight loss or muscle building. This bill does not prohibit the sale of any specific supplement, including creatine, provided it is accurately labeled for what it is. And second, the bill only applies to dietary supplements, not conventional food products that have an FDA-mandated nutrition facts label. Most protein drinks and many protein powders are sold as food and would not be covered by this bill. And third, nothing in this bill prohibits the sale of dietary supplements to an adult. This bill only applies to minors. Adolescents face unique risks when it comes to dietary supplements marketed for weight loss and muscle building, particularly because of how heavily these products are promoted to young people and the well-documented harms these products cause. Extensive research documents the dangers of these products. The American Academy of Pediatrics has strongly cautioned against teens using weight loss supplements. These products are not recommended by physicians but they are widely available in pharmacies, grocery stores, specialty chains, and on the internet. The use of these supplements for weight loss and muscle building is associated with mental health vulnerabilities such as eating disorders and dysmorphic body disorders Young people with a history of depression and body dissatisfaction are at an elevated risk of using this category of supplements beyond levels recommended by the manufacturer Additionally, according to the American Academy of Pediatrics' recent guidelines, they discouraged the use of sports supplements in athletes younger than 18 years old, emphasizing that a balanced diet is the way for young people to get all the necessary nutrition that they need. The health risks associated with these products are well-documented and particularly concerning for younger users. Weight loss and muscle-building supplements have been linked to serious adverse events, including cardiovascular complications, liver disease, hospitalization. Dietary supplements are not regulated like pharmaceutical drugs, Yet over the last decade, more than 750 supplement brands have been found to be tainted with pharmaceutical drugs. While the FDA identified these tainted supplements, less than half of these products were recalled. Unlike prescription medications, these products do not need to demonstrate safety or effectiveness before being sold, allowing potentially dangerous items to remain widely accessible. Experts and clinicians consistently caution against youth use precisely because of this lack of testing. Studies and clinical guidance emphasize that these products are not recommended for adolescents, as their effects on the developing bodies remain inadequately studied. Yet despite this, adolescents can easily purchase these products in stores or online without any age verification. This creates a situation in which minors have open access to substances that may pose serious health risks without adequate safeguards or accurate information. Given that these products have high rates of use among vulnerable youth, documents linked to harmful behaviors and medical events, and no way to test if these products are safe for children, restricting access to individuals under 18 is a reasonable and a necessary public health measure. AB 2030 would establish clear and forcible age restrictions on the sale of over-the-counter diet pills and dietary supplements marketed for weight loss or muscle building. The bill creates meaningful safeguards to prevent youth access by requiring age verification for in-store and online purchases. By limiting access to these products for minors, this legislation can help reduce the development of severity of eating disorders, of body dysmorphia, of related mental health challenges amongst youth. Just like existing age restrictions done for other harmful products, AB 2030 provides a practical and immediate step to better protect California's youth from dangerous and misleading weight loss and muscle-building supplements. Before I turn it over to my witnesses, I want to thank the stakeholders on both sides of this bill for their thoughtful engagement throughout the year. I appreciated the constructive feedback we received, and in the Assembly, I amended the bill to address most of the concerns raised by opposition. And in addition, I'm committed to taking an amendment at the next available opportunity that will reduce the civil penalty in the bill to $500 from $1,000. Here to testify in support of AB 2030 is Lizzie Guansona, Legislative Advocate for the Center for Science, the Public Interest, CSPI, and Izzy Mann, Striped California Youth Team Captain and student attending Occidental College. Thank you. You will have a combined total of five minutes. Good afternoon, Chair and Committee members. I'm Lizzie Guansona with Shaw Yoder and Treesh Melzer and Lang. I'm here today representing the Center for the Science and the Public Interest, a proud co of AB 2030 CSPI is a national nonprofit that has been at the forefront of food and supplement safety for 55 years CSPI does not take donations from government or industry As you just heard this bill would prohibit the sale of over diet pills and weight loss or muscle building dietary supplements to minors Despite the well-documented risks of these products, they can legally enter the market without FDA's pre-market safety review or approval. As a result, they are widely available and heavily marketed to youth, including on online platforms, often with false promises and deceptive claims of efficacy. FDA and other health experts warn against the use of these products, citing serious health risks, including liver damage, hospitalization, and even death. The American Academy of Pediatrics considers the use of diet pills a high-risk eating behavior among children and discourages their use. AAP also discourages teen use of performance-enhancing substances, which include muscle-building supplements, as they can do more harm than good. Between 2007 and 2016, the FDA identified 776 dietary supplements adulterated with active pharmaceutical ingredients, over half of which were marketed for weight loss or muscle-building. These adulterants included illegal stimulants, steroids, and prescription drugs that can pose serious health risks. This type of legislation has precedent, as it is modeled after a similar bill in New York that was enacted in 2024. Since the New York bill went into effect, major retailers like Amazon have gone even further and implemented stronger compliance protocols and third-party testing requirements for supplements. AB 2030 will not only protect children, but will also lead to major retailers being more responsible when selling dietary supplements. California should enact these strong evidence-based protections to keep kids safe. I respectfully ask for your aye vote. Good afternoon, Madam Chair and members of the committee. Thank you for the opportunity to speak with you today. My name is Izzy Mann, and I'm a college student from Pasadena, attending Occidental College and the California captain for the Strategic Training Initiative for the Prevention of Eating Disorders at the Harvard T.H. Chan School of Public Health. And I'm here in strong support of AB 2030. I'm here not only as an advocate, but as someone who has personally struggled with an eating disorder that landed me in the hospital. And I know firsthand how accessible and deceptive these products are, especially as a young person navigating body image pressures amplified by social media and diet culture. That experience is what drives my work and is what brings me here today. However, my story is not unique and the science confirms it. These products are not reviewed by the FDA before they reach store shelves, meaning minors can easily purchase supplements that may contain banned drugs, toxic chemicals, or heavy metals. These products send over 23,000 people to the emergency room every year, and youth who use them experience severe medical injuries at three times the rate of those taking ordinary vitamins. AB 2030 is a common-sense safeguard. It doesn't ban these products. It simply ensures they are not sold to minors. I wish this bill had existed when I was younger, which is why I urge this committee to vote aye on AB 2030 to give today's youth the protection I didn't have. Thank you. Thank you. If there's anyone else in the audience that would like to register their support, please come to the microphone. State your name, your organization, and your position only. Thank you. Good afternoon, Madam Chair and members. Christopher Sanchez here on behalf of the Consumer Federation of California in support. Thank you. Good afternoon. Kelly Macmillan on behalf of the American Academy of Pediatrics, California in support. Thank you. Seeing no one else that would like to register their support if there anyone in the audience that would like to register lead opposition this is your time to come forward to the table You have combined five minutes. Good afternoon, Madam Chair and members. Tatum Ackler with Samson Advisors here on behalf of the Council for Responsible Nutrition, which has taken an opposed and less amended position on AB 2030. And let me start by thanking the author for the productive conversations to date. CRN has a history of working constructively with authors seeking to address this issue in the past, including with Assemblymember Christina Garcia on AB 1341 in 2020, and subsequently with the chair through AB 82 just last year. Our engagement on those efforts was focused in great part on establishing a more balanced and targeted framework that does not bring unintended products within scope. Specifically, by tying scope solely to labeling and marketing claims, the main problem with AB 2030 is that it would bring products within scope that have no connection to the bill's purpose. Contrast that with AB 1341 by Assemblymember Garcia, which focused on products that may contribute to specified health conditions as determined by the Department of Public Health. In the end, while imperfect, we believe that AB 1341 struck the right approach and we appreciate the opportunity to raise our concerns here today. Thank you. Madam Chair and members, Don Gilbert on behalf of the Consumer Healthcare Products Association, otherwise known as CHIPA. CHIPA opposes the bill, but we do not oppose the goals of the bill. We respect the author's intent here. It's just an honest disagreement on a couple of provisions that we are concerned about. The first issue are provisions related to online transactions, online ordering of products where at the time that the product is ordered online there are mechanisms for disclosure of verifications of identification of who's buying to make sure they're over 18 and over and so on. The problem is the second part of that transaction is when the product legally is delivered to the presumably the resident in that case the bill requires a second verification of the same single transaction which requires either the actual purchaser should demonstrate who they are and show their ID to the delivery person or another adult do so that requires that someone be home which in this day and age is not necessarily the case the bill does not allow for sort of Amazon-style drop deliveries that we're familiar with and have become very regular in our lives. So our proposal or our opposition of that language is basically based on this problem where that provision eliminated from the bill, we would think that it would be a tighter bill in terms of verification. Quickly, the second issue, which Tatum touched on, goes to the scope of the bill. We also agree that the bill should apply, as the author indicated, to products that are marketed or labeled as weight loss or muscle-developing supplements, muscle-building supplements. However, the language in the bill lists five or six ingredients that are covered by the bill that make it an ingredients-based rule, and there are many, many many products that are going to be captured by this scope based on ingredients rather than how it's marketed that will make the bill very problematic and heart more difficult for legal sales of these products. So in short, we would love to remove our opposition if these two problems could be solved. If they remain in the bill, we respectfully request a no vote. Thank you. If there's anyone else that would like to register their opposition, please come to the microphone. State your name, your organization, and your position. Madam Chair and Senators, Anthony Molina on behalf of the Natural Products Association in opposition. Thank you. Michelle Rivas on behalf of the California Pharmacists Association we want to thank Mr. Lowenthal and staff and sponsors for addressing our concerns with that we will remove our position thank you thank you seeing no further individuals that would like to register their support opposition or tween position we'll bring it back to the committee Senator Grove I want to thank the author for bringing this bill forward. And I know your heart. Like, we've had several conversations regarding protecting children, your girls, my grandkids, and where we think the world is taking our young people these days. And so I do appreciate that. I do think the bill is very, very broad. And I do have a concern about the delivery factor as well that was brought up by the opposition. Green tea, extract, all these things that are in normal products that are on everyday shelves don't have a warning label. And this would require thousands of general health, wellness, energy, drinks, and products not marked currently to be labeled and intended for weight loss. Even though a green tree extract is just a, to me, it's a supplement in health care. I like green tea. I think it makes me stay awake longer without caffeine. And so I wouldn't want that to be treated differently. and I so I support the thought process and where you're going with it and I get your heart and I know where you're going with it but I can't support the bill today I'm not going to vote no because I think you're going to continue to work with the opposition and you're going to fix the concerns that not only they have but I have and I think my the vice chair has but I do appreciate your heart for making sure our youth are healthy so thank you. Thank you Vice Chair Valladares. Yeah if you could just weigh in a little bit on your willingness to work with the opposition on any amendments. I'm going to see this again in judiciary. I want to get to a point where, where I can support this. I have a nine year old daughter and I remember the days of, you know, teen magazine and what was it like heroin chic and trying to be skinny and shopping for over the counter weight loss drugs on with, you know, in, in the CVS aisle. And I don't want that for my daughter. And I think it's, It's only getting worse with AI and these unrealistic goals and looks and filters. And it's, you know, for the mom with a girl going into those tween years, it's scary. So I want to be able to get to support, but I would love some feedback on what you see. If I could continue, Madam Vice Chair, and algorithms, right, that are actually pushing young people to always be evaluating each other's bodies, focused on each other's bodies, whether they want to or not. That's what's driven actually to them on a regular basis. That is their reality. I always come from a position of safety first. That's where I like to start from and work backwards from there. Unfortunately, that hasn't happened in this. And I hear you loud and clear that there may be some unintended consequences and absolutely more than willing to work with the opposition and anybody, quite frankly, that can strengthen this legislation so that it can work for everybody. But I always start at a place of safety And in terms of the ingredients that is absolutely something that we should be looking at I less inclined to give up the notion of somebody being under 18 being able to accept this at the door. We do that with alcohol right now. We do that with other things right now. And I'm just concerned when you hear statistics about 23,000 young people being hospitalized every year from this where we cannot find a medical reason for young people to be taking these supplements. There is only an avenue for danger and even mental health issues. This should alarm all of us, and we should start from a place of safety. So I will absolutely work with anybody, Madam Vice Chair, and thank you for bringing that question forward. Thank you. Senator Caballero. I just wanted to thank you very much for focusing on this area. I know it means a lot to you, and I think the challenges of, you know, the Internet was going to bring us all of this free time and we were going to have this new world that was going to be really very cool. And there's some great things about it, no doubt about it. I can find anything out just by typing in what and where. but it has a tremendous impact on our kids and that impact is not always positive and mostly it's not positive and so we're going to have to come up with some methods to really protect them and I sat on a committee where we looked at these vape instruments that you would have no clue were vape instruments And so the more I learn about the challenges, yeah, the Sharpie, but also the USB that looks like it goes in a computer, but it's actually a vape instrument. So children take these to school, and you don't have any way to know that they've got vape products. There's ways to fool adults, I guess is what I'm saying. And so the more that we can be aware of it and try to plan for it, the better off we're going to be. So thank you very much. Thank you, Senator. Thank you. Well, I want to thank you, Assemblymember Lowenthal, for bringing this bill forward. I want to really thank the people who have come out and spoke, your witnesses, in support of this bill. This is not the first time that we've tried to get something like this passed in the legislature. And so it's always interesting when I hear people say, oh, it's too broad, when before we had something that was more narrow, more specific, and we still couldn't get it through. This is not an issue that I think we need to continue to kick the can down the road. We talked about, at that point, Assemblymember Garcia, who has been out of the legislature for a very long time trying to get a bill like this through. I had a bill that we tried to get through that dealt with this particular issue. And there's always someone to say, well, maybe, but, but not this, but not that, maybe too broad, not broad enough. We don't have time. While it's our children who are hurting as we keep going back and forth. I will be supporting this bill. I thank you for continuing and picking up the mantle and running with it. I would love to be a co-author on this bill. And I understand some of the concerns, because when you look at something like creatine or green you know tea extract like how bad could that be But we do know that things like green tea have been shown by studies to help with weight loss And even though we drink it as just a regular tea we also know that you can get it in capsule form And as you see in the analysis, there have been people who have used it and gotten liver injury from it. So this is not necessarily something that even though we as adults may consume, should necessarily be something that our children are consuming. and so I appreciate you looking into these things and would caution you about removing some of them as you continue to have your conversations. This is an important issue. I really hope that we're able to get this over the finish line this year because really, really, our children and their lives really depend upon this. And so with that, I would like for you to offer you to close. I thank you for those comments. they're meaningful and helpful. And I want to thank the witnesses, the opposition, all of the comments from the dais. As a matter of fact, everybody's coming from the same place here. And we all want our businesses to thrive while our kids are as healthy as they can be. And with that, I respectfully ask for your aye vote. Thank you. And once we get a quorum, we will take that motion up. You have another bill, file item 12, AB 2594. Thank you, Chair Weber-Pearson and members of the committee for the opportunity to present AB 2594. I want to start off by thanking the chair and staff of the committee for their thoughtful work on the amendments of this bill. I gladly accept the committee amendments. To start AB 2594 is a simple bill. It extends the sunset of the Voluntary Employees Beneficiary Association Direct Contract Piloting Program to 2030 and pulls back the pilot's interim report to January 1, 2029. But what is VEBA? VEBA is a tax-exempt joint labor management trust used to pay for qualified medical expenses. The California Schools Voluntary Employees Beneficiary Association is the administrator of the trust at the behest of the Department of Managed Health Care. Managing health expenses through a joint labor management trust empowers participating employers to collectivize, to establish self-funded programs, and negotiate with health insurers for better rates and benefits on behalf of their members. Beyond the aforementioned benefits inherent to the model, there are three compelling reasons for why this program should be extended. First, AB 2594 enables the pilot's interim reporting deadline to be contemplated within the extended pilot period. As the law currently stands, the interim report is set to be released after the end of the pilot, effectively ending the program before its assessment is done. Extending the pilot ensures that the legislature receives a data-driven assessment of the program before its end. Second, VEBA is an important test for whether alternative payment arrangements between a self-funded purchaser and providers can lead to savings and improved quality of care. Its extension would allow the legislature sufficient time and data to test whether similar models would be feasible or desirable. Third, preliminary data from the pilot has been promising Results collected by the pilot by Qmetrics and the Integrated Healthcare Association IHA show heartening improvements in health diagnostics high satisfaction ratings from its members 88 of its members reported that they were satisfied with Calviva. In conclusion, Calviva's pilot program is a very promising solution for healthcare affordability, given its ability to collectively negotiate on behalf of participating employers. It is worth extending so that we can evaluate its impact before we lose it. I'm proud to be joined by Betsy Radalow, representing CalVeba, and William Barcelona, representing the America's Physicians Group, testifying in support of AB2594. Thank you to the witnesses. You each have a total of five minutes. Thank you. Good afternoon, distinguished members of the committee. I'm Betsy Radalow, Area Vice President for VEBA Direct here on behalf of California Schools VEBA, a nonprofit joint labor management trust established in 1993 to take on rising health care costs for public employees. Today, CalvEBA serves more than 80 participating employers, including school districts and public agencies, and has over 160,000 members across the state. As fiduciaries to those members, CalVebo relentlessly pushes for better outcomes and affordability for our membership. We are honored to be running the pilot program authorized under AB 1124 and extended through AB 2063, which we call Vebo Direct. This represents California's first direct contracting pilot for a self-funded purchaser using novel payment structures, including capitation, allowing for the examination of these innovative payment methodologies against the currently available fee-for-service payment model. As a large purchaser, self-funding allows for increased transparency, complete access to our data, and the ability to design programs that meet the needs of our members, which include women's health, mental health, and high-touch advocacy. These novel payment models drive affordability and accessibility by aligning incentives between purchasers, providers, and patients. In our third year of the pilot, the preliminary data is yielding excellent results. More than 5,500 members across 23 participating employers have elected to enroll in this pilot. Our quality data shows a significant improvement relative to fee-for-service benchmarks. This translates to real savings, both in keeping teachers healthy and keeping them in the classroom, and treating conditions earlier when they are less costly. Assembly Bill 2594 extends the sunset date of the pilot to allow the DMHC to evaluate the pilot program effectiveness before the end of the pilot so the legislature can make informed policy decisions moving forward. In closing, I want to thank Assemblymember Lowenthal for advancing AB 2594 and for continuing California's leadership in value-based care. On behalf of our 160,000 members, I respectfully request your aye vote on AB 2594. Thank you. Thank you, Chair and members. Bill Barcelona with America's Physician Groups. We are the professional association that represents the three participating provider entities in this pilot, Rady Children's Hospital, Sharp Healthcare System, and UC San Diego. we are proud to work with VEBA directly on this innovative pilot and we are hoping for an for an i vote today and urge your support for this continued pilot thank you thank you if there's anyone else that would like to register their support for this pilot please come to the microphone state your name your organization and your position only thank Thank you. Good afternoon Chair and Members, Carlos Lopez with the California School Employees Association in support. Thank you. Good afternoon Chair and Members, Bryant Maramontes with the California Teachers Association in support. Thank you. Seeing no one else that would like to register their support, if there's anyone in the audience that would like to speak as a lead opposition witness, this is your time to come forward. Seeing no one come forward, if there's anyone that would like to register your opposition for this bill. This is your time to come forward. Seeing no one, we'll bring it back to Senators. Senator Grove. Thank you, Madam Chair, at the appropriate time, I'd like to move the bill. Thank you. Thank you. Seeing no further comments, would like to thank you for bringing this bill forward and also for working with our committee staff. One of my concerns is the fact that this has been a, which was, I think, initially supposed to be a three-year pilot, which is now much longer than that because of implementation delays and all of those things. But I want to make sure that once that report comes out, that we have the ability to continue or pull back if necessary. So thank you so very much for accepting those amendments and working with our staff. And with that, would you like to close? Respectfully ask for your aye vote. Thank you. Thank you very much. The perfect closure. Now, we will move to file item 23. AB 2651 by Assemblymember Bonta. Good afternoon, Chair and Committee members. I want to thank the Committee for working with my office, and I accept the Committee amendments. AB 2651 requires schools to notify parents when their child's school vaccination rates fall below the level required to achieve herd immunity as established by the California Department of Public Health. The herd immunity rate is the percentage of the population that must be immunized to prevent disease transmission and thus provide some protection even for those who lack immunity. To be clear, this bill will affect about 0.4% to 1.6% of schools. Of the 27,000 schools in California, this bill would currently apply to about 428 schools, 110 of which have been on CDPH's audit list for a consecutive three years. So this bill affects a very small number of schools, but it is a very critical bill because right now, for example, in LA Unified School District, this bill would only affect about 47 of its 1,200 schools. Most schools will never get this notification, and that's a good thing. This bill ensures that parents have the information they need to keep their children safe from preventable communicable diseases. A 2024 study published by The Lancet estimated that vaccines have saved 154 million lives globally since 1974, comparable to a rate of six lives every minute. Of those saved lives, 95% were children younger than five years old. Alarmingly, we are in a moment right now where outbreaks are increasing, and the data bears that very clearly. While measles was once eradicated in the United States, this year 10 counties in California alone have reported a total of 34 measles cases. For 24-25, 12 of the state's 58 counties, that's about 21%, reported that the percent of kindergartners with all required immunizations was below 90%. In addition to dire health outcomes preventing the spread of diseases is costly. LA County approximates that its first three measles cases of 2026 cost To ensure herd immunity in our schools is there parents need grade information on vaccination rates that readily available and actionable But right now, to find this data, parents would need to be aware of the concept of herd immunity, make the time to find the reports themselves, then have the knowledge to interpret those reports, And then parents would also need to do additional research across multiple sources to find recommended herd immunity thresholds. These burdens constrain parents' ability to make informed decisions about schools and child care settings. This is very hurtful for parents, particularly those with young children or medically vulnerable individuals in their lives and in their households who rely on high vaccination coverage to reduce exposure to risk. This is a simple notification bill that would allow parents to have accessible and actionable information. It's important to note that notification uses data that is already collected and already public, so the bill does not publish any new types of information. In addition, by calculating rates for grades, no individual student can be identified. CDPH also takes precautions for student de-identification in small schools. I want to note that on amendments that we have accepted, we've integrated feedback from the CDPH and opposition. We're also planning on amendments to clarify that CDPH will send the notification within a timely manner, as is their current practice. And we have amended the bill already to address the opposition's concerns by clarifying that non-classroom-based students and students with medical exemptions will not lower the school's vaccination rates, including the grade and time periods to which the data applies, and including additional context to proactively answer parents' questions. With me to testify today, I have Dr. Lisa Ward, the Regional Medical Director at Santa Rosa Partnership Health Plan of California, Denise Morgan, who is the California State PTA Board of Managers Education Commissioner and the Third District PTA President for the Greater Sacramento Area, And for technical questions, Natalie Pita, who is the legislative and policy advocate for the California Academy of Family Physicians. Thank you. You will have a combined total of five minutes. Can you hear me? Yes. Okay, thank you. Good afternoon, Chair and Senators. My name is Dr. Lisa Ward. I am a family physician, and I practice in a federally qualified health center in rural northern Sonoma County. I'm here on behalf of the California Academy of Family Physicians, a proud co-sponsor of AB2651. Family physicians care for patients across the lifespan, from infants to elders, and we receive special training and dedicated time in pediatrics. We provide comprehensive pediatric services, so well-child visits, sick visits, and lots and lots of immunizations. The relationships we form with our patients and their families allow us to have thoughtful conversations about vaccines and vaccine hesitancy. And since COVID, these conversations have become more frequent and less successful. At my clinic, we really wanted to understand what our patients thought was driving an uptick in vaccine hesitancy. So we did what we all should be doing, which is talking to our patients. And so we held focus groups and talked to patient advisory committees. And what they told us was pretty clear. They want clear easy information and they want it from trusted messengers in a timely way And so I feel like they telling us that providing families with trusted information is especially important because these vaccine decisions do not just affect our own children, an individual's child, but the health and the safety of our entire community. The vaccine effectiveness depends on maintaining high vaccine rates, and when these vaccine rates drop, diseases can spread quickly, especially in schools, putting children and our communities at risk of infection. And as you suggested, we're now seeing the consequences of infections like measles. In my time as a physician, I never thought I'd see a case of measles. And now I'm retraining to try to understand how to find it and see when it starts to break into my community. We've seen outbreaks across the country and here in California as well. And yet, when there is a disease outbreak, we see a surge in vaccine uptake in nearby communities because people, especially parents, understand the increased risk to their children and families. AB 2651 does not change any vaccine law. It's simply another tool we can use to provide critical information to our parents. It comes from a trusted source, our public health officials, it moves through schools, our trusted messengers, and it can be delivered in a timely way before an outbreak begins. And when parents have timely, accurate information, they can make informed decisions about their children's health and safety. Thank you all, and I respectfully ask for your aye vote. Good afternoon, Madam Chair and members. My name is Denise Morgan. I am an Education Commissioner for the California State PTA, representing over a half a million members here in strong support of AB 2651, the Informed Parents Healthy School Act, which we are proud co-sponsors of. We support the improvements proposed through recent amendments. Right now, vaccination rate information is only available to families who know where to look, how to interpret what they find, and can read English. In fact, 428 California schools are currently being audited for low vaccination rates, and most parents have no idea. AB 2651 fixes that. When a school's vaccination rate falls below the threshold needed to prevent disease spread, families receive notification from their school in the languages their communities actually speak. Schools have an established relationship with families built on trust. That existing relationship is precisely why they are the right messenger. CDPH handles the science and the explanation, writing the notification with resources and contact information. Schools simply deliver that information through the channels families already know and trust. It is not a burden. It is a public health tool schools are uniquely positioned to support. Families cannot protect their children or their communities from preventable disease without information. AB 2651 delivers that information in time, in their language, through the school they already trust. On behalf of California State PTA, I respectfully ask for your aye vote. Thank you. Thank you. If there's anyone else in the audience that would like to register their support for this bill, please come to the microphone, state your name, your organization, and your position only. Thank you. Angela Hill, California Medical Association, in support. Thank you. Carlos Lopez, California School Employees Association, in support. Thank you. Beth Monalski, the SCO California, in support. Thank you. Kelly Macmillan on behalf of the Children Specialty Care Coalition and the American Academy of Pediatrics in support Thank you Tim Madden representing the California Chapter of the American College of Emergency Physicians in support Thank you. Eric Dowdy with the California Dental Association also in support. Thank you. Farrah McDade Ting on behalf of the County Health Executives Association in support. Thank you. Seeing no one else that would like to register their support, if there's anyone that would like to speak as lead opposition, please come to the table. We will have two witnesses to speak in lead opposition. You will have a combined total of five minutes. Great. Good afternoon, Chair and members. My name is Joshua Coleman, co-founder of V is for Vaccine, a public demonstration group focused on informed consent and medical choice. My firstborn son, Otto, became paralyzed from the waist down after developing a known vaccine side effect called transverse myelitis following a 17-month round of vaccinations. That experience led me to spend years studying vaccine policy and advocating for informed consent. My organization, V is for Vaccine, peacefully demonstrates in public places across the country. We hold signs containing factual vaccine information that we believe people should know. Things like vaccine manufacturers are exempt from liability. Vaccines are not placebo safety tested. The reactions we have received simply for displaying those signs have included being spit on, having equipment damaged or destroyed, signs ripped away and destroyed, people physically assaulted, and even receiving threats of violence and murder. I can tell you from real-life experience that people get very triggered very easily over this topic, and that is why I'm concerned about this bill. If a letter is sent home telling parents that their child's school has fallen below a vaccination rate established to prevent the spread of vaccine-preventable diseases, it is reasonable to expect that some parents will be frightened, some angry, and some both, and many will want to do something about it. First, I want to thank the author for the recent amendments excluding medically exempt students from the immunization rate calculation. Those medically fragile children should not have to bear the burden of fear, frustration, or blame, and I appreciate that change. However, an unintended side effect of this amendment is that it narrows the focus onto the remaining vulnerable population still included in the calculation. students with disabilities receiving services through an IEP. These are disabled children with physical, developmental, or cognitive disabilities. I would hate to see disabled children become the students others don't want to sit next to, play with, or befriend because they have been perceived as a reason that a notification was sent home. I respectfully ask that students with IEPs be afforded the same protection that has already been extended to medically exempt students. If that amendment is adopted, V is for vaccine will withdraw its opposition to AB 2651. Thank you for your time and consideration. Good afternoon, Chair and members. My name is April Robinson with a voice for choice advocacy. We thank the author and the Senate Health Committee staff for their continued work on AB 2651. However, there still are some areas that need to be further amended so that daycare and preschool programs are not included, and so that students with IEPs, as Josh mentioned, are not counted in a way that misrepresents their legal status. First, daycare and preschool immunization numbers should not be treated the same as school checkpoint data. These numbers are highly variable because they depend on the age of each child and the timing of the required doses. A child may be considered missing a dose one month and fully up to date the next, simply because of age-based vaccine timing. By the time a notice is generated, mailed, and received by parents, the information may already be outdated or misleading. That does not create a meaningful transparency. It creates confusion and unnecessary fear for families like mine. Second, students with an IEP and individual education program must be handled differently. California law protects these students' right to attend school and receive the full program required by their IEP, even if they're not fully vaccinated. This has been repeatedly confirmed in the courts where schools have attempted to exclude these students from classrooms. CDPH already recognizes this reality by placing IEP students in the category as requirements met but missing doses. In other words, these students are legally allowed to be in school, but in the current bill language are still counted as missing doses. That creates a serious discrimination concern. IEP students are similarly situated to medically exempt students for purposes of classroom presence. They are legally attending school and not fully vaccinated. They should not be counted in a way that makes them appear noncompliant or that causes their school to be flagged because disabled students are exercising rights protected under state and federal law. We respectfully request amendments excluding daycare and preschool programs and excluding IEP students from any calculation that triggers parent notices. Thank you. If there's anyone else that would like to register their opposition to the bill, please come forward and state your name, your organization, and your position only.

any medical invention bill. That's what we need. I oppose this bill.

Seeing no further individuals that would like to speak in opposition, we'll bring the bill back to committee. Senator Menjivar.

Senator Grove.

Could one of you come back to the microphone, please? Thank you. Thank you Madam Chair.

for bringing this bill forward. It is a bill about transparency to allow for parents and families to know what's happening at their school. You know, it's interesting. I went on CDPH's website to look for this information and found it extremely challenging to find it. With health staff, they were like, well, maybe it's over here and maybe it's over here and maybe it's there and we finally found it and interestingly enough not only was it hard to find it was completely out of date the last reported information I think was 2022 so for a family that wants to know or for a family that needs to know this information it is critical that they have it and so I thank you for bringing this bill forward I'm sure that your work continue to work with CDPH to ensure that what's being reported is the things that they're already asking for. And I would love to be a co-author on this bill. And I think that there are also some areas that we need to improve with informing parents that we're not doing at this point. And so this is one piece. Looking into it, I've found another piece that we need to work on with future legislation. But really thank you for bringing this bill forward, putting students first, putting families first, putting their communities first. And with that, we'd welcome you to close.

Thank you, and once we get a quorum, we will make a motion. All right, now we are going to move back to file item number 9, AB 1970, and thank Assemblymember Herbedian for letting Assemblymember Bonta go, who had been waiting since the beginning of this hearing. And you may begin when you are ready.

at the appropriate time. Thank you. Thank you. You will have a combined total of five minutes.

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

Thank you. Seeing no further individuals that would like to register their support, if there's anyone that would like to speak and lead opposition to this bill, this is your time to come forward.

We will have a combined total of five minutes.

If there's anyone else that would like to register their opposition to this bill, this is your time to come forward to the microphone. Seeing no one, we'll bring it back to committee. No comments? Well, Assemblymember, I would like to thank you so much for working with us on this very important bill. And with that, we'll let you close.

Once we get a quorum, we will do that. Okay, alright, we are going to move down in the file to file 17, AB 2135 by Assemblymember Calra.

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

If there's anyone that would like to register their support for the bill, please come forward, state your name, your organization, and your position only.

If there's anyone in the audience that would like to speak and lead opposition, this is your time to come forward. Seeing no one, if there's anyone that would like to register your opposition, this is your time to come forward to the microphone. State your name, your organization, and your position.

Seeing no further members of the audience who would like to register their support, opposition, or in between, bring it back to the committee. Seeing no comments. Assemblymember Calra, thank you so much for your work on this very important topic and for working with this committee. And with that, would you like to close?

And we will do that at the appropriate time once we get a quorum. We will now move to file item number 13, Assemblymember Rodriguez, AB 2066. and thank you so much for letting Assemblymember Calra go before you You may begin whenever you ready Thank you

You will have five minutes for your presentation.

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

Kelly Brooks on behalf of the Santa Clara County Board of Supervisors here in support.

Ethan Nagler on behalf of the City of Glendale in support.

If there's anyone who would like to speak and lead opposition to this bill, now is your time to come forward to the table. And you will have a combined total of five minutes.

If there's anyone else that would like to register their opposition, this is your time to come forward. State your name, your organization, and your position. Seeing none, we'll bring it back to committee. Vice Chair Ryan Ayers.

Senator Groh.

You know, it's interesting the things that we have to, you know, have legislation for in this state, you know, things that we would think would be common sense. because you know that you're pregnant, we know that you need to see providers, and in this country you need to have insurance, because most of us cannot pay out of pocket for it. And I also want to remind people about, yes, this may impact health plans, but think about the cost to health plans and the entire health care system when you have people who are pregnant who do not have prenatal care. And high-risk pregnancies are extremely dangerous, not only to the mother and the patient and the baby that they're carrying, but also extremely expensive to the health care system, which we all ultimately end up paying. And so as we're talking about these numbers, think about what happens when someone is not able to get early genetic screening. that we know happens generally within the first trimester. Or if they show up at 32 weeks and have missed, you know, the screening for gestational diabetes and now you've got multiple issues with that mother and that child. Or they show up having, you know, a placental abruption because they have undiagnosed hypertension, which then led to preeclampsia. So these things are extremely important to be able to evaluate very, very early on. And I know to the concern about someone choosing a more generous plan, well, we know, especially in this day with affordability and the cost of health care, you may choose a less expensive plan because you believe that you're young, you're healthy, you don't need a bunch of other stuff. But once you become pregnant, you will need more. And you may not have thought that when you were choosing a plan, but now you're in this situation. And so to have that ability to get a plan that will actually meet your needs at that time is extremely important. I would recommend to the author to go back and, in your conversations and your discussions, talk about the potential for, I won't say a timeline restriction, like after they find out they're pregnant, but something around that, because what we really want is for people to enroll as soon as they find out that they're pregnant and not to wait for four, five, six months later because then all of these things that we're talking about can become a reality. And so, you know, I know we had talked about it, weren't able to really figure that out, but I would really strongly recommend that you continue in those conversations. So I do acknowledge that concern on the part of opposition. And with that, thank you so much for bringing this very, very important bill forward. Would also love to be a co-author and you may close.

Thank you, and when we get a quorum, we will move on that bill. Thank you so much. We will now move to file item 14, AB 2160, by Assemblymember Rodriguez. And you may begin when you are ready.

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

All right, seeing no one else that would like to register their support, if there's anyone that would like to speak as lead opposition, this is your time to come forward to the table. Seeing no movement, if anyone would like to register their opposition, this is your time to come to the microphone. Seeing no one, we'll bring it back to the committee. Seeing no comments, Senator Grove will move the bill at the appropriate time. Assemblymember Rodriguez, thank you so much for bringing this important bill to us, and would you like to close?

an aye vote to support nursing mothers and children. Thank you. Thank you so much. And at the appropriate time, we will take Senator Groves' motion. Up for a vote, we will now move to file item 15, AB 2302, also by Assemblymember Rodriguez.

You will have a combined total of five minutes.

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

Kelly Brooks on behalf of the Santa Clara County Board of Supervisors in support

If there's anyone that would like to speak and lead opposition to this bill, this is your time to come forward to the table You will have a combined total of five minutes

Thank you. Before you begin, we can finally establish quorum. Assistant, please call the roll. Weber Pearson. Here. Valladere. Valladere here. Caballero. Durazo. Here. Durazo here. Gonzalez. Here. Gonzalez here. Grove. Here. Grove here. Menjivar. Here. Menjivar here. Padilla. Perez, Rubio, Smallwood Quevas. We have a quorum. Quorum is established. You may continue. Great, thanks. My name is Craig Fellner. I'm the Director of Government Affairs for the Infant Nutrition Council of America. Infant formula is the most highly regulated food in the U.S. food supply. Infit Formula is produced under rigorously controlled conditions supported by robust validated food safety management systems Infit Formula manufacturers identify potential risks for heavy metals and monitor heavy metal levels across raw materials and final product Heavy metals in trace amounts have always been a part of the human diet. They exist in the environment and may be absorbed or ingested by plants and animals from which food ingredients, including infant formula, are sourced. Heavy metals are found in fruits, vegetables, meat, and seafood, even when organically grown or raised, and in human breast milk. Our members have protocols in place to reduce the presence of these substances and ingredients to ensure that any trace levels and finished infant formula remain safe for consumption and meet international standards. We are asking that we not be simply added to the existing testing and reporting program that is currently law for baby food. The difference in formula and baby food are stark. Rightfully so, infant formula is regulated like a medicine, whereas baby food is regulated like all other foods in a grocery store. And most importantly, infant formula is the sole source of nutrition for a baby other than breast milk, whereas there are many, many choices to feed your older baby in a grocery store. So as Missy explained, instead of just looping us into a baby food program where we are proposing language mandating all manufacturers or brand owners who seek to sell infant formula products in the state of California must annually attest to CDPH through written documentation that their infant formula products are in compliance with the European Union and standards set soon by FDA. In the current global landscape, the EU sets the most stringent and extensive regulatory limits for heavy metal contaminants in the world. It's also important to understand that these standards are not static, but rather are continually updated to reflect our current understanding of the impact of these heavy metals on infants. Our members are committed to providing safe, high-quality infant formula products. Our proposal transforms the current bill into an easy-to-understand, helpful safety bill that provides useful, science-based, reassuring information that infant formula, one of the most important products that parents and caregivers purchase, is safe to consume because it meets rigorous, science-based standards. Thank you so much. Look forward to answering any questions. Thank you. At this point, if anyone else would like to register their opposition, please come to the microphone, state your name, your organization, and your position. Marisol Ibarra-Buslama with Consumer Brands Association and Respectful Opposition, Opposed Unless Amended. Looking forward to working with the author. Thank you. Seeing no one else who would like to speak in opposition support or tweener, we'll bring it back to committee. Senator Menjavar. It's awkward. She's my assembly member, but I have a question. I did. I shared that. She cheated and sent me a photo of her baby with a onesie that I sent her. Doing this for the babies. Yeah. I just had a couple of questions. We've been going back and forth on this. You know, this committee two years ago had a similar bill. we were able to exempt Baby Formula because there was concern about the fear. And two questions I have. Your sponsors utilized WIC as an example to help better protect, but WIC, if I'm not mistaken, has selected options. options and they only have one option to choose from. So if we're putting out the one option they get to choose for infant formula now has all this stuff on the label, that could potentially block them out of buying that one product they're allowed to buy because they're worried now that it has all these numbers, it has this on there, even though it doesn't show if it's unsafe or safe. If you could address that first. Yeah, and I'd like to give an opportunity to Sarah and Carly who represent WIC as well to provide comments first. I can just say, while I don't want to speak for our friends at CDPH WIC, I will say that WIC is not a stranger to providing parent education. It's a pretty core tenant of the WIC program, and that includes teaching parents how to read nutrition labels. And so this would actually be a unique opportunity to help parents with questions that they already come to WIC with. Okay, so even though they'll have just one option to choose from, given that you're saying the WIC program already is a holistic program because it provides education, and they'll simply further educate them. In the event that there was an issue where the formula was not safe to be sold because of the presence of heavy metals, I think that the state already has a precedent of responding during the 2022 recall because of the cyanobacter contamination. They were able to temporarily allow flexibility for many different brands of formula to be sold in that instance to WIC participants. Right, sure. Go ahead. Can I respond briefly, ma'am? I'll get to you. Okay. I have questions for you. Thanks so much. Sorry. Can you expand, or either of you, what the label will say? Is the label just going to say that it has, I mean, there's so many lists of things that you could test for. Lead is pretty simple, and I agree there's no safe level of lead for our children. But all the other things, is it just going to list the amount of each heavy metal on the label? So the label will have a QR code that says for more information on heavy metals. So it's not going to list it. It will not list anything. And we have not prescribed exactly how they have to present that, and we welcome further discussion. Okay. To the, Missy, opposition, you shared amendments. I'd like to hear from you how you believe that these are stronger, this is a stronger language for consumer protection. Thank you, Senator, for the question. And quite frankly, we're proposing a ban, which basically says that any infant formula sold in the state of California has to test lower than the EU standards that currently exist, which are the strictest in the world. The FDA doesn't currently have a standard, but we also have language in what we've offered the author in that if the FDA does develop a standard and it happens to be stricter than the EU standard, we will follow whichever is stricter. The bill as it currently is is a disclosure bill. We fail to understand how or why a disclosure bill is more strict or more strenuous than a ban, which is what we're proposing. And this information is already available on the FDA website. I printed it off the website today. And it's easily, you know, you can look at it and see the different formulas broken down by manufacturers. So there is a way for individuals who want this information to access it. We just don't think this is something that the average parent, especially if cost is a consideration, because let's be clear, baby formula is not inexpensive. For them to try out various different brands based upon 0.00 whatever differences, parts per billion on any of these things is not necessarily in their best interest or the best interest of their child. So we're offering a solution that basically says if it's on a California shelf, this is safe for your child to consume Does CDPH have the capacity to review if it meets the EU standard or not That what you proposing right for the CDPH to review it We're not proposing that CDPH review it. We're basically saying if we are putting our names on the line and we would be providing them with an attestation that they can review at any time. And by the way, under the existing Sherman Act, they can have access to this information already. That is current law. So if at any time CDPH wants to go through and access our information on these testing levels, they can do it now. And the attestation provides them with another avenue, another venue for them to come after us and to take enforcement action. That's why we include it. And quite frankly, when we presented this option or these amendments to the author's office, we gave them many different options for enforcement in hopes of having a dialogue to figure out what the best method would be. That, unfortunately, hasn't happened. We would like very much for that to happen. So we're not tied to the attestation, but we just thought it would be a way for them to have another avenue to come after us if, for whatever reason, we don't meet any of these standards. Assemblymember, I know you wanted to. Yes, I just wanted to share that the amendments that have been provided to this bill were not provided in good faith. The opposition provided a complete gut and amend to this bill. It relies on self-attestation from the same industry that has been sued by our own attorney general for lack of transparency. It asks that Californians simply trust manufacturers without providing any way of verifying whether it meets safety standards. And parents shouldn't have to rely on a manufacturer's word that a product is safe. That's not consumer protection. Public discourse creates accountability, builds trust, and allows families to make informed decisions. If companies are already testing their products and meeting safety standards, which is the claim, sharing those results we don't believe should be controversial. In addition, the proposal builds off of an existing proven framework that CDPH already has developed for baby food and prenatal vitamins, which was referred to before. this gut and amend proposal would cost taxpayers millions of dollars in a time that we simply cannot do that and should not be put on taxpayers instead of industry. Thank you for that, Senator. And you mentioned the manufacturers that were sued and the sponsors you talked about because of the lawsuit, they now have to test. Is that frequency the same frequency that this bill is asking to test on a monthly basis? So my understanding of that settlement is that it's time limited to five years, so it's not indefinite. And the levels that, I'd actually like to take this opportunity to clarify, the levels set in that attorney general settlement are actually lower for lead than the EU standards. The EU standards are 20 parts per billion for powdered and 10 parts per billion for liquid, whereas the attorney general settlement levels are five parts or seven parts per billion, depending on the composition. So it's worth noting that the California standards are actually more protective than the EU levels for lead specifically. and my understanding is that it's an annual disclosure. It's not lot-specific testing, which is what this bill is asking for. So the lawsuit just included annual reporting but no testing. The bill is asking for it. Sorry, no testing and reporting of results. So the testing was required. On an annual basis, but the bill is asking for a monthly test. The bill is asking for testing of lot-specific, so I'm actually not sure of the cadence for producing lots of formula, But it is a lot specific, which I believe the results that the FDA just released in their recent really massive testing was sort of a market basket testing. So it not a lot specific either It was really comprehensive But my understanding was it not a lot specific I believe It a lot specific Thank you I just want to address a couple things The reason why we up here talking to y'all today is because baby food and infant formula are different. And when a mom is standing in a store, she has a hundred choices to feed her 18-month-old or 14-month-old baby. Or a dad. They shop too. Yeah, yeah, yeah. And so my point is, we're the sole source to nutrition other than breast milk. And so we're willing to attest to a standard because what we don't and what we fear is moms and dads will get anxious and will get scared by these numbers. And we know from some pediatricians that they'll go and they'll Google homemade formulas or they'll go buy almond milk, which we know doesn't have the 30 mandated ingredients that we have to put in. FDA tells us what's supposed to be in our formula to closely mimic the results of breast milk. And so we want to provide a comfortable situation. We know moms and dads, when they're in a store buying infant formula, most of the time they're there through some trials and tribulations. and they're going through a tough time. And we always say as manufacturers of Inferforma, you should breastfeed your babies. That's what God provided for nutrients. But we know millions of moms and dads can't do that. They do it for as long as they can. They may supplement half and half when they go back to work. So we want to make that situation the best situation it could be in a grocery store. And so we know our formula is safe. We just got a clean bill of health from FDA about a month ago. And so we're providing the answers to the test, essentially. The underlying bill provides a whole bunch of very small, minute numbers on a website. We're willing to attest to testing under the EU limit as the prerequisite of putting it on a shelf. So we're giving the moms and dads the answers to the questions. My last question is, if the bill is not prescriptive in how the labeling or what the label is going to look like, I mean, I don't scan anything on my food. There's a QR code. It is prescriptive. It says you must put on the label for more information about toxic was taken out of heavy metals. Click here on this QR code. So it's prescriptive of what it says. But it won't be on the actual product. It's if you want to scan a QR code if the consumer goes the next step to actually scan the QR code. So what I just mentioned is actually on the product. It would be on the label itself with a QR code. The measurements will not be. The measurements won't. Numbers won't be on it. No, no, no, because we probably can't fit it on there. I mean, FDA is in charge of our label. Every change that we make, how minute it is, we have to get it approved by FDA. So they're kind of in charge of our label. We couldn't fit it on there. There's already a bunch of mandates of what we have to put on there with respect to our nutrients. Okay. Thank you. Senator Groh. Thank you. I'd like to follow up just with a few questions. And the reason why is because the first QR code, the bill that was done, I did it with a student who was worried about digits on the back of a card and a QR code to be able to access mental health services for students on the back of an ID card. And the governor actually signed the bill with a QR code, the first time it's ever been done. That QR code has to be linked to someplace. Where is your QR code linked to? To their website. Whose website? The manufacturer's. The manufacturer's website. so if there a QR code that referenced to thank you for that if there a QR code that references stuff to link to your website are you saying that your website this bill is saying that you going to have to ask 0 or you know parts per billion or whatever that you'll have to create a page for that? Yes. Essentially, you just have to be informative to the test results on the website. So you have to inform the test results, which you already have from the FDA, correct? We've given the FDA over the last – the study they just released was all of our data from 2023 to 2025. That's what they scrubbed. And so we give that data to the FDA. Okay. I'm just trying to get to the point. I want to try to understand what I'm asking you, so I'm going to ask you in a different way. If I scan a QR code because I go to the grocery store and I'm looking to buy baby formulae, and it takes me to your website. It takes me right to the page where you have the FDA results that says you're safe and you're monitored by the FDA and you meet all the requirements. Well, the requirements of the bill are that we put the raw data, testing data on there. So mom or dad would have to look and decipher between .0025, whatever, parts per billion versus some really small, minute number that's going to be similar. Thank you. I got it. If it's a trust issue with the manufacturer, why not just allow them to have the FDA information in there instead of the 20-page document of what's actually in the formula? And I realize it's transparency, but so two things. If they're required to change their manufacturing stuff under the EU standard, does that make you create two things? One, let me start here first. So two things. If you guys do a EU standard, is there any other state in the nation that does a EU standard? or are you going to separate yourselves out from California for a California manufacturer and will you only produce a California manufactured baby formula that complies with a EU standard that isn't sold anywhere else? I'm just curious. Well, all of our formulas currently test under the EU standard now, so we wouldn't have to do anything different, which I think is probably what is upsetting to the sponsors. But we assert that the fact of the matter is that our products are safe. But that would be the first in the nation attestation program. Okay. The ban is what would be the first in the nation in that if at any point because – An enforceable ban, yeah. If at any point any of the batches that are tested, because there is routine testing that happens, that if any of those batches test higher than the EU levels, they would not be allowed for sale in California. So – and I know it was a proposed gut and amend, and I'm not trying to – you're the author of the bill. I'm not trying to tell you to change your bill. I'm just saying that I have the same fear. If you can achieve what you want to achieve to make sure you have safe baby formula on the shelf, they're willing to ban anything that comes across that doesn't meet a certain standard that's stricter than the FDA federal standard that regulates baby formula now. And your intent is to make sure that we have good product baby formula out. Because I do sit on budget sub three with my colleague, and we do have, I mean, I don't want to say the population, but the population that we deal with in budget sub three. I mean, is it in English and Spanish? Is it in different languages? We have a lot of different languages. So is it required to be in different languages? Is it just in English? I'm just asking. Under the bill, I think it doesn't really reference language. Okay. I'd like to ask Ms. Clements to respond. Thank you. Sure, go ahead. Just to clarify, the bill is actually not prescriptive, that the website contains raw data. so we've seen with baby food that they've gotten pretty creative because there's nothing that prohibits manufacturers from making the information accessible. So for baby food, they have used the EU levels in the absence of FDA levels while those are being set. And it's a pretty user-friendly presentation. And it's not actually as simple always as 0.02, 0.025. Like Consumer Reports did testing last year that found that some of the baby formula options had levels of arsenic that were just under the EU level or almost twice the level for drinking water. So it's not so much the minutiae of decimals, and of course these are very small amounts, but let's say I'm a mother or a father who's concerned about arsenic in my child's formula. Or a grandmother. Or a caregiver of any kind. Or a godmother. And I want to make sure, because it matters to me and I'm worried about it, that my child consumes the lowest level of arsenic possible. If I can scan two QR codes and see, oh, that one has 19.5 and the EU level's 20, that's a little close for comfort for me, and this one has 1.4, I will, even if I am not a scientific person, and I will understand that 1.4 is much closer to zero and much farther away from 20 than 19 is. Even if you're Hmong or Hispanic and you don't speak English? It's English and Spanish. Oh, it is English and Spanish? Why ask that? They didn't know. Okay. Okay. Yes, sir. So I would just say, you know, that's the point that was asked earlier about, you know, all these numbers are going to be similar. They might be slightly above or slightly below. You take a family that needs to purchase a more economical formula, Maybe it's a brand from Target, Walmart, Walgreens. What does that mom or dad think? If they look at it and they're able to decipher it, let's say they are, and it's slightly above some other more expensive premium brand, what kind of anxiety are they going to have? And so that's sort of the genesis, and that's why we feel like it's fair to let moms or dads know, is it safe or is it not safe? And you can make a decision for your infant formula based on could be price, could be whether little Johnny tolerates it or not, and it also could be a decision between you and your pediatrician. Okay, so now you've sparked that grandmother in me. Are you saying that your cheaper formula is higher contaminated than your most – you said higher-priced formula may be less? There are obviously different price points for formula. That's all I'm saying. Not necessarily, Senator. Not necessarily or no? No. The point is the differences between all of these different brands are so small. And for a parent who does not have the necessary scientific training and or background, they could look at that and think that maybe it is inferior or worse than a different product at a different price point. And for someone who is income constrained, they might then lose more trust in that product, even though that loss of trust is not warranted. That is our concern because they're all so close to each other. It just creates and stokes an unnecessary concern or fear. A lot of times the heavy metals level. Thank you. I was going to say. That's okay. Okay. Thank you. So I do have a question on the AG. You said there was a lawsuit with the Attorney General that says that it has to exceed the EU formula, which is, I don't know, 0.20 parts per billion or whatever you said, right? 20? Sorry, go ahead. The Attorney General settlement was specific to lead, and it established a new, more protective standard than what is used by the EU. So, okay, so the EU standard. So on our baby formula in California because of the lawsuit, is California baby formula manufactured at a different way so it meets the to levels according to the Attorney General lawsuit separate from any other state Do you already do that I don't believe there. None of my members manufacture infant formula in California, but it's made in other states and shipped to California. I really can't speak to exactly the batches and the SKUs and where they go. So we can't regulate that. I don't know. We can only regulate what's sold here. Right. Because they don't manufacture it here. Right. Okay. All right. Thank you. Thank you, Madam Chair. Okay. Seeing Senator DeRazzo. I just want to thank the author. The issues that are being brought up are the same values and protections that I was shooting for in my menstrual products bill, SB 754. And that's because we want to know what's in the products that we're putting in our bodies. We want to know what's safe for us and for our children. But in talking to several people, it's women, how are we mindful of how sensitive this issue is for new parents? The author is a new parent, so she's most mindful, I think, of anyone here. But I just want to make sure that we're not giving our babies formula where the message is that's a harmful option or somehow it's going to hurt our babies. Because that would really be – I know that's not what you're – obviously that's not what you're looking for in any way, shape, or form. But it just happens and we've got to be mindful of it. Thank you. Thank you. I want to thank the author for bringing this forward. I want to thank those who have spoken in support and against. We definitely want to make sure that what we are taking in, what our babies are taking in from conception on is as healthy and free as possible of these very toxic metals. but I want to go back because I don't know of an industry that has come up with a request for a ban so that is very intriguing to me I want to ask the author again what is your concern with the ban? Through your bill and through Senator Marsucci's bill on baby food there is an existing structure through the department to implement this bill. The cost associated with the proposal would not allow it, I think, to make it past our fiscal committees in our current fiscal situation. And I am open to further discussions, but I think what this does is provide transparency. I thought there was a very interesting question by Senator Grove regarding, are there more heavy metals in lower cost infant formula options? This bill will provide the transparency to answer that question, and we can then elevate that conversation if the industry is exceeding these levels and providing a danger to our children, which I recognize as well. we don't want to set any alarm bells for any parents but when you read about lawsuits and recalls that alarms parents transparency should not be a threat we should drive companies to do better and drive them to go towards zero because we know that a lot of these elements are not safe even in any amount like lead And so if you would like more I would ask my witness to provide I would agree that health and transparency is extremely important. I do also get concerned about the ability to truly interpret certain data. And, you know, even myself with an MD, some of this is not my area. And so if I'm looking at it, it may be difficult for me to interpret, and I have a graduate degree, and so I get concerned about just a QR code and a link to a source that has this data information, and how am I, especially as a brand-new parent, I'm juggling all of these other things, supposed to be able to interpret this information. So the data that you just showed us, where is that data? The data is accessible on the FDA website. They released it about a month ago. April 26th. Well, there you go. The data is there because of what? Because we mandate it? Because the federal government mandates it? It's an FDA program called Closer to Zero, which somebody mentioned earlier. It's the activity of setting limits and trying to drive children's and baby food and then ultimately infant formula closest to zero as we can get. And so it's part of that effort. Okay. And so how often do you have to upload that data? Well, it's just available. It's available. It was a – I'm not sure how long it took them to do the study, but the study was conducted using two years' worth of data. So I think one of the concerns is, all right, so we have this data point today, right? What about in a year? How are we going to get that data? It's not clear to us the intervals in which they're going to test, although the FDA did say in a press release that they were going to continue to test infant formula going forward. But I just, I'm sorry, I can't tell you exactly the intervals for that. And it has to be said that the FDA often conducts unannounced inspections of our facilities, and they do the testing there. So that may be why we don't yet know what the intervals are, because they just may show up and do it at that particular point. So then let me ask you, this QR code, Assemblymember Rodriguez, this QR code that's going to link to the testing, where is that testing information coming from? So that testing would be lot specific, and I actually misspoke earlier. The data is lot specific, but the testing information that the QR code takes you to would be specific to the lot of infant formula you are holding in your hand, and that would come from the new testing requirements for manufacturers. From this bill? Yes, and I actually know a lot of it about the FDA data that was just released. That was a massive undertaking in response to multiple issues, but there was the Consumer Reports study that I mentioned, and the day after that was released, the FDA announced Operation Stork Speed to look into heavy metals. And like we said, it's multiple years of data. I don't believe that there's a cadence to recreate that level of effort. I believe this was an undertaking to demonstrate and answer the question that it is safe. But the difference between that data and the data this bill would require would be that it is specific to what you are buying today and not data from 2023. So I have a question to opposition. I completely agree with your premise that getting this information via a QR code is very confusing and have no clue what it means You know if you off versus another one is that good bad and different But also understand that as of right now, we do not have a law or a path to test these products on any kind of regular basis. So it's great that we have this one report that came out, but we don't know when the next one will come, and we're talking about, you know, things current. Has there been any thought, because I know you had talked about your concern about trust with self-attestation, keeping the requirements for testing and for those that test above the threshold be banned for selling in California. Do you want us to just comment generally on that? I mean, has that been a part of the conversation because it gives you the testing so there's not necessarily self-attestation, but at the same time it removes the need for a parent to decipher a bunch of very complicated information. So you're saying they would disclose the testing to our California State Department? They could disclose it to our State Department but whoever is above that threshold would not be able to be sold here on the shelves in here in California. So that's essentially what our crux of our proposal kind of is in the direction it's going. We would absolutely be willing to talk with the with the author about that and and it's a negotiation and a discussion that we love to have absolutely so this is what I'm going to say to Assemblymember Rodriguez you have a great bill it is important for us to sell and provide things that are safe here in California I am very concerned about just this mass information that people will not be able to understand. And at the end of the day, it may not lead to what we're trying to get to, which is for people to use safe products. Removing those products is really the best way to go about it. But I do understand your concern about if someone's just attesting, yes, this is safe, this is safe. You have a method in your bill that would require lot testing. I strongly suggest that you all have conversations about keeping that part and adding the ban so that we're selling and providing the safest things possible without the burdensome of a QR code and some information that families and parents may not be able to digest. I'm going to have the health committee staff continue to work with your staff to see how we can get this moving. And with that, would you like to close? I want to thank you all for the robust conversation and questions. We will take your feedback. We will continue to work on this bill. Thank you for understanding the intent. You just heard a bill about lactation support. not all mothers have the ability or choose to nurse their children and them having safe products for what their children rely on for the first weeks and months of their life is so critical. And so thank you for hearing the bill today. And I respectfully request your aye vote. Thank you. We actually have a quorum. So I will take a motion, moved by Senator Gonzalez. I thought I heard you. Okay. The motion is do pass and re-referred. No, I'm sorry. This one is do pass and re-referred to the Committee on Environmental Quality. Secretary, please call the roll. Weber Pearson. Aye. Weber Pearson, aye. Varaderas? Not voting. Varaderas, not voting. Caballero? Aye. Caballero, aye. Durazo? Aye. Durazo, aye. Gonzales? Aye. Gonzales, aye. Grove? Not voting. Grove, not voting. Menjivar? Aye. Menjivar, aye. Padilla? Perez? Rubio? Smalled, Cuevas? 5 to 0, we'll place that on call. Thank you. We will now move to file item 18, AB 2194, by Assemblymember Valencia. How are you? How are you? Oh, this is an easy one. This is an easy one. Should be an easy one. Okay. Words matter. Words matter. You're telling me. You should be here to begin with. Assemblymember, you may begin when you are ready. Thank you, Madam Chair. Muy buenas tardes, members. I want to start off by thanking the Chair for her engagement on this bill and also her committee for the work that they have done thus far to get us to this point. I want to also state that I'll be accepting the committee's proposed amendments. Due to timing, they will be taken in the next committee as well. AB 2194 aims to strengthen the governance of CalOptima Health, my district's county-organized health care system that serves nearly one in three residents within Orange County. The amendments I introduced on June 15 were focused on depoliticizing the CalOptima board and making sure the board is governed first and foremost for its members. That goal had real support. Local stakeholders reached out to back it and wanted to ensure that the depoliticizing of the board would take place. However, after receiving further outreach, including outreach by our boards of supervisors, I made the decision to not move forward with those amendments as drafted. I want to be thoughtful in how I approach policy and all feedback matters to me. However, stepping back from those amendments does not mean the problem in my county has gone away or that I'm taking my eye off the ball. Recent actions by the CalOptima board and board members departures from that board only further prompt the need for impartiality CalOptima is unique because their governance structure has been codified into state statute the only public health care system in the state to have done that This gives us, the legislature, the authority and responsibility on this particular issue. After working with the committee, we have new language that takes a more measured step in what I hope to accomplish an audit to ensure governance systems are performing at the highest level. This audit will review the board's policies and collective actions and deliver recommendations to ensure services are maximized for families, seniors, and children. I will not stop fighting for the most vulnerable residents in my district. I proudly represent half of the – excuse me. I proudly – in my district, there are half of the members who are constituents and depend on Medi-Cal, and I will continue to be proudly representing them in these efforts. These amendments are a step in the right direction, and as legislators, we all well know, We took some very difficult budget votes in order to fill the gap because of the H.R. 1 cuts, and this issue matters more than ever, hence why I would like to move forward with this proposal. Thank you. You will have five minutes for your presentation. Thank you, Madam Chair. I'm Janet Nguyen, Orange County Supervisor and currently a board member as well to CalOptima. I want to start out by thanking Madam Chair, your committee staff, and the Assemblymen for taking our concerns seriously and for understanding how important Board of Supervisors oversight is to CalOptima. I also want to say thank you to some of the committee members who I've reached out to as well, and thank you for your time to meeting with us and or our staff. My understanding is that the latest amendment would remove the two most concerning parts of the prior amended language, the supervisors, oversight, and the appointment authority. Our county appreciates this. CalOptima manages more than $4 billion in public health care dollars. At one point, the grand jury found that having only one county supervisor in the CalOptima board was not enough. That is why the structure was changed to include two county supervisors. We can all agree that accountability is important. After the former supervisor, Andrew Doe, scandal, we have focused on cleaning up the system, closing gaps, and protecting public funds. At the state level, I co-authored legislation to strengthen CalWATIMO's safeguards. At the Board of Supervisors, I've called for independent audits into all contracts, decisions, and public funds connected to the former supervisor. So, yes, we supported independent audit. There is just small language in there that might undercut this purpose. Specifically, we are concerned with the language that focuses on preserving executive staff's independent contracting authority within the auditing section. We had four safety net hospitals removed from the Medi-Cal network through an executive decision without a board's vote. That affected tens of thousands of members' access to care, especially in my district. This is exactly the kind of authority we should not simply preserve without board's oversight. Staff's independence cannot mean executive staff can make all contract decisions without meaningful CalOptimum board's review and or approval. In conclusion, we respectfully request an aye vote and look forward to working with the author on these minor refinements. Thank you. Good afternoon, Madam Chair and members of the committee. My name is Vicente Sarmiento, Orange County Supervisor for the 2nd District and also Chair of the CalOptima Board of Directors. First let me begin by just thanking you and your staff consultant for the work on the revisions that were accepted by the Assemblymember I I also want to thank the assembly member for his work and for his time We met earlier today and it appears that 99 of what we were seeking is in here So we are very, very grateful on behalf of all the members that we co-represent. I am just as concerned about their care as you are. For many of our members that are losing their coverage, we know that we've lost about and We're projecting about 175,000 members to be dropped from CalOptima and Medi-Cal coverage as a result of barriers. So we are working towards the same goal. We believe that the revisions that were reconciled with this committee and the member's office and the county and the CalOptima team look to be ones that we can support. We took an opposed position earlier, but that was withdrawn based upon the recommended language. And that's where we are. We certainly look forward to working through any minor refinements. I don't see anything that is going to create another barrier to this. I think we're very, very close. We certainly support the Assembly members' motion to support the revised language and look forward to working with your team. But we just thank you because we know it happened all very quickly, and many people worked on this quite a bit. So we thank you on behalf of all our residents in the county. Thank you. If there's anyone else in the audience that would like to register their support for this bill, please come to the microphone. State your name, your organization, and your position only. Michael Sean Wright, Director of Field Medicine for Wound Walk, the nation's largest street medicine team, with the revised language we strongly support. Thank you. Good afternoon, Madam Chair. members Megan Loper on behalf of the California Hospital Association and the Hospital Association of Southern California with the amendments today and we're pleased to move from opposed and to neutral so thank you so much for the work at the committee thank you Kelly Brooks on behalf of the urban counties of California and the rural county representatives of California with the amendments discussed at the hearing today we will be removing opposition thank you Kathy Mossberg with With the local health plans, same for us. With the amendments that we really appreciate, all your time and effort on this, we remove our opposition. Thank you. Brendan McCarthy with the California State Association of Counties. Similarly, we'll be removing our opposition, and we thank the author and the committee for their work on this. Thank you. Seeing no further individuals that would like to speak in support or tweener, is there anyone that would like to speak and lead opposition to this bill? Seeing no one, if anyone would like to register their opposition to this bill, please come to the microphone, state your name, your organization, and your position. Seeing none, we'll bring it back to the committee. I'll move the bill. The bill has been moved by Senator Grove. Assembly Member Valencia, we really want to thank you so much for working with this committee, understanding that you recognized a problem that needed to be fixed in your area. You've kind of gone a long way with this bill, but really appreciate you working with staff, Really appreciate staff and also supervisors as well for reaching out and having conversations about what it is that is needed in your area. And hopefully with the amendments, we're able to come to a place where, you know, people feel much more comfortable. A lot of the opposition has been removed but still gets at the issue that you were trying to fix in the first place And so with that would you like to close Thank you Madam Chair I agree with you 100 percent And also want to just express my gratitude to the supervisors once again for their openness to collaborate on this issue We had a very productive conversation that ended, as Supervisor Sarmiento mentioned, at the same place, the depoliticizing and ensuring that we're moving resources in the best way possible in Orange County. I do want to note the example that Supervisor Nguyen raised regarding a health care provider in the county. Cal Optima was very public about the moving away from that health care provider in Orange County due to the fact that only 1.5% of Cal Optima's members were receiving services from this particular contract in a whole year. So there was a very policy-driven decision as to why that decision was made. Fast forward to where we're at today. The county is in a hole when it comes to Medi-Cal resources due to HR1 to the tune to about $325 million. Unfortunately, a very recent action within the last month reinstated that very same contract and paid back about $30 million due to lost contract revenue because of the stoppage of their usage. So again, in an effort to ensure that efficiency is at the forefront of the decisions being made, I think this is a good first step, and I think the conversation should continue. So with that, respectfully, I'll pray as well. Thank you. The motion has been made by Senator Grove. The motion is due pass and re-referred to the Committee on Local Government. Assistant, please call the roll. Weber Pearson. Aye. Weber Pearson. Aye. Balladeros. Aye. Balladeros. Aye. Gaviero. Aye. Gaviero. Aye. Durazo. Aye. Durazo. Aye. Gonzales. Aye. Gonzales. Aye. Grove. Aye. Grove. Aye. Mandelvar. Padilla. Aye. Padilla. Aye. Pérez. Rubio. Smaller Cuevas. Aye. Smaller Cuevas. Aye. 8-0, we'll place that on call. Thank you. We will now move to file item 20, AB 2244, by Assemblymember Gabriel. assembly member you may begin when you are ready thank you very much madam chair and colleagues and I want to thank you in the committee for your thoughtful work on this bill I will be accepting the committee amendment. I am pleased today to present AB 2244 legislation designed to empower Californians to make better informed and healthier choices by increasing transparency around ultra processed foods. In recent years, doctors and scientists have increasingly warned us about the negative health consequences of ultra processed foods, which have been linked to serious health harms, including cancer, cardiovascular disease, diabetes, metabolic disorders, reproductive harm, and neurobehavior issues in children. These products are often filled with harmful additives and specifically engineered to interfere with our brain signals in ways that contribute to food addiction. In recent years, California has emerged as a national leader in addressing the growing health risks associated with UPFs. We began three years ago by banning the most dangerous additives, selecting chemicals where the industry couldn't credibly push back. We then moved to limit additives in our school foods and then to restrict Ulta processed foods in our schools. Last year Governor Newsom signed into law the Real Food Healthy Kids Act, legislation that established a framework to phase out dangerous ultra-processed foods from California schools. It was a historic win for our kids and for public health, and it passed with overwhelming bipartisan support. I'm proud of California's leadership over the past three years. But despite this progress, more work is needed to protect our kids and to improve public health. And so now it's time to address ultra-processed foods in our grocery stores. In particular, consumers continue to face real challenges in identifying healthier products, Ingredient lists are often long, technical, and incomplete, leaving families without clear, accessible tools to distinguish between minimally processed and highly processed foods. Our view is that parents shouldn't need a Ph.D. in chemistry to understand what they're feeding their kids. And that's why we have introduced AB 2244. This bill would establish a non-ultra-process certified seal that manufacturers could place on products that meet clear, science-based standards for not being ultra-processed. process. Modeled after the successful and widely recognized USDA organic label, the seal would provide consumers with a simple, trustworthy way to identify healthier options with a quick glance. The bill would also require large grocery stores in California to display these healthier products in a prominent, high-traffic area of the store so that busy shoppers can find healthier options quickly and conveniently. This bill is a common-sense approach that will enable consumers to quickly compare products and empower them to make better informed choices. It will also allow manufacturers to highlight healthier products and rewards companies that are doing the right thing. And so doing this bill will address the dangers of ultra-processed foods, but in a way that strengthens consumer choice, drives innovation, and promotes healthier options across the food supply without banning any products. I want to highlight that we have had productive conversations with opposition and are proud to have moved the California Grocers Association from opposition to support. We are happy to accept amendments today and are committed to working collaboratively with all other parties to produce the strongest possible bill. Finally, I want to thank the many medical researchers and public health advocates who have worked in close partnership with us on this bill. I'm proud that it's supported by a coalition that includes the California Medical Association, the American Academy of Pediatrics, the American Diabetes Association, the American Heart Association, the Crohn's and Colitis Foundation, United Nurses Association of California, the California Grocers Association, and many more. I'm pleased to have with me today to testify in support of this bill, Scott Faber from the Environmental Working Group. Thank you and respectfully request your aye vote. Thank you. You'll have a total of five minutes for your presentation. Thank you, Madam Chair and members of the committee. Thank you, Assemblymember Gabriel, for your leadership. My name is Scott Faber, and I'm testifying today on behalf of the Environmental Working Group, a sponsor of AB 2244. I'm also an adjunct professor of law at Georgetown Law School, where I teach food and farm law. And prior to joining EWG, I was the Vice President for Federal Affairs for the Consumer Brands Association. As Assemblymember Gabriel just told you, the overwhelming scientific evidence shows that ultra-processed foods have been linked to serious health harms, ranging from diabetes to an increased risk of dementia. Processed foods are part of a healthy diet, but ultra-processed foods, or UPS, are different from processed foods because they have been engineered in ways that make our food not just delicious but literally irresistible. Consumers are increasingly trying to avoid UPFs, and there are many processed foods in the grocery store that are not ultra-processed and are lower in saturated fats, sodium, and added sugars. However consumers are struggling to distinguish between UPFs and these healthier processed foods the voluntary non seal authorized by AB 2244 will help consumers by applying the definition you created in AB 1264 to the marketplace and by asking grocers to make these non-UPF options easier to find. Minimally processed foods like olive oil, nuts, and pasteurized milk are all non-UPF options eligible for the non-UPF seal. California's definition of UPFs closely mirrors the consensus definition published by UPF experts just a month ago, which recommends that UPFs be defined as foods containing a cosmetic additive such as artificial flavors, synthetic colors, stabilizers, thickeners, and emulsifying agents, very similar to the definition that you crafted last year in AB 1264. Let me reiterate, the non-UPF seal authorized by AB 2244 is completely voluntary. By contrast, many other countries, including Mexico and Canada, have required mandatory warnings on the front of unhealthy processed foods. So let's help consumers build healthy diets. I urge you to support AB 2244 to help consumers find better options for their families. Thank you. Thank you. If there's anyone else in the audience that would like to register their support for this bill, please come to the microphone, state your name, your position, and your organization only. Thank you. Lizzie Guansona here on behalf of the California Medical Association, American Heart Association, and the Office of Kat Taylor all in support. Thank you. Thank you. Nora Angelis with Children Now in support. Thank you. Kai Clausen on behalf of Breast Cancer Prevention Partners in support. Thank you. Thank you. Good afternoon, Kelly Macmillan on behalf of the American Academy of Pediatrics, California. Thank you. Good evening, Taylor Turfo on behalf of the California Groceries Association. We appreciate working with the author and happy to support. Thank you. Seeing no further individuals wishing to register their support, if you would like to speak as lead opposition, please come to the table at this point. You will have five minutes for your presentation. Hello, Chair and members. My name is Katie Little. I'm with the California League of Food Producers in opposition to AB 2244. I'd like to thank the committee and staff for their work on this bill. You may have seen CLFP's concerns outlined in the analysis. And although some past amendments have relieved some of our concerns, we remain opposed at this time since DPH has not yet started the process of defining what a school safe food is, as depicted by AB 1264 last year as part of the several definitions that are going to move through the Department of Public Health and what is going to be defined as a UPF in those different definitions. I would just like to say that we have concerns because those definitions can encompass foods that are normally thought as healthy, as kind of discussed before with my colleague here. We are concerned because olive oil and cheeses, other dairy products, could get wrapped into that definition of ultra-processed foods. So, again, until we know what those definitions are and when they're set by DPH, this program would kind of line right up with the labeling of those certain foods. And so we just have concerns with those kind of parallel processes going on at the same time. Thank you. Thank you. If anyone else would like to register opposition, this is your time to come to the microphone, state your name your organization and your position Good evening Katie Davey with Dairy Institute in opposition for the reasons stated by Katie Little Thank you. Marisol Ibarra-Buslama with Consumer Brands Association and the California Manufacturers Technology Association, also in opposition of the bill. Thank you. Seeing no further individuals that would like to speak and support opposition or in between, we'll bring it back to the committee. Senator Grove? Thank you, Madam Chair. It's interesting. We just had a bill that we all thought we needed a Ph.D. to read the product that's in it for baby formula. And then you're saying we should need a Ph.D., but I think people are going to need a Ph.D. for that last bill. I know Senator Nilo and I will. Maybe the chair won't, but Senator Nilo and I will. I just want to make sure because I can't find a clear definition. It says in the bill on page 4, line number 25, that the old processed food is defined in Section 10.4661. Is that the same definition that you used in 1264 last year? Yes, Senator. I just want to make sure it's the same definition, and you know why I'm asking, right? Because I think California-grown produce and farmers and pistachio farmers and individuals that provide healthy snacks to kids should still be able to provide those. And the way the bill was written previously, your previous bill, you worked very well with me to make sure that we could still have those healthy snacks produced by our own growers and farmers here in California in our schools. And I just want to make sure that definition hasn't changed. That's exactly right. And I would just thank you for your really helpful engagement on that. And as you know, we took more than 50 amendments in crafting that definition. We worked really, really hard with stakeholders and scientists and experts. And so we feel like we have a great definition. And so that's the definition that we're using in this bill. That's what I want to clarify, because I looked on YAS Chat GPT and they couldn't confirm that, which kind of bothered me a little bit, too. But anyways, thank you. I applaud you for going after this. I know that I think you were Maha before Maha even was a thing. And I really do. I think you've been working on this for such a long time that that's a true statement. And as long as that definition is the same definition in 1064, I'd be glad to support the bill. Thank you, Senator. Or 1264. Thank you. Vice Chair Valladares. Thank you, and thank you for asking that question, Senator Grove, for my clarification as well. And I just want to say that, you know, it has been amazing to watch you dig into this issue and to really look at this with the lens of creating competition as opposed to mandates, which is why I'm super excited about this bill and to be able to support it. And we've had conversations in the past about this being a bipartisan issue and being a parent, and I just really appreciate your work on this. Happy to move the bill when it's appropriate. Thank you very much. Senator Perez. I just want to thank you again for all of your efforts, particularly in this space. You know, last year you had your first bill on ultra-processed food, which was really a big deal.

While saying no further comments, really want to thank you, Assemblymember. As was stated, you really have been a champion in this area and really appreciate it because, unfortunately, we have moved into a space where what we are consuming is really very unhealthy and is actually contributing to all of the chronic conditions and shortening of lifespan And unfortunately when you talk about a lot of these ultra foods you'll find them disproportionately available in certain communities and in certain areas where you have more fresh foods and fresh fruits than those that don't have a lot of these things in other communities. And so as we try to close that health gap, the life expectancy gap, when we talk about social determinants of health or social drivers of health, having access or at least the knowledge of what is healthy and what is not as healthy is extremely important. We're not removing it, but we're giving people the information. And so I want to thank you for this bill, very proud co-author of this bill, and with that to see you close. Thank you.

Thank you for that. I believe the motion has been made by Senator Grove. The motion is due pass and re-refer to the Committee on Judiciary. Assistant, please call the roll. Weber Pearson.

Weber Pearson, aye. Banderas.

Caballero. Durazo.

Durazo, aye. Gonzalez?

Gonzalez, aye. Grove?

Grove, aye. Menjivar? Padilla?

Padilla, aye. Perez?

Perez, aye. Rubio? Smallwood Covas?

Smallwood Covas, aye. 8-0, we'll place that on call. Thank you. We will now move to file item. I see he's on the edge of his seat. 24 AB 2405 by Assemblymember Gibson. You may begin when you are ready.

Glad to. Good evening, Madam Chair and members. Christy Weiss with Capital Advocacy. It's all good. On behalf of the Martin Luther King Jr. Community Hospital, Dr. Nacosti is going to provide the bulk of our testimony. But I just wanted to really thank the committee for all of the work that the staff did helping us kind of work through some of the issues in the bill. And so I just want to acknowledge that and take it away. Thank you, Assemblymember. Thank you, Senators. My name is Dr. Nakasi, and I'm the Vice President of Community and Government Affairs of Martin Luther King Hospital in South Los Angeles. I'm here in support of the bill. Our emergency department is facing overcrowding crisis that endangers patient safety and medical care. We have 29 beds, but routinely see 350 patients a day, making us one of the busiest emergency departments in the United States of America. Top 20. Even our chapel and gift shop today are used for patient care. One unfair reason why are drop-offs by patients by law enforcement agencies far away from our community. Timely access to appropriate care is a matter of statewide concern. EMS is required to transport patients to the nearest appropriate receiving facility, yet law enforcement do not have uniform standards. This inconsistency in transport practices results in unsafe delays, unfair distribution of patients across healthcare facilities, and overcrowding of safety net hospitals. We see this firsthand. In a four-month period, we had 400 law enforcement drop-offs. On April 4th at 1228 a.m., a patient on a 5150 hold was dropped off from San Gabriel near Pasadena. The distance from San Gabriel to MLK Community Hospital is 22 miles. This drop-off would have had to bypass more than 13 facilities. Huntington Hospital, San Gabriel Valley Hospital, Garfield Medical Center, Monterey Park Hospital, Adventist Healthwide Memorial Hospital, and eight others. For someone in a behavioral health crisis, that delay can be dangerous. Minutes matter. This also creates unfairness. A small number of facilities end up carrying a disproportionate load, straining our hospitals and worsening overcrowding. AB 2405 fixes this by creating a simple, common sense, and uniform standard. If law enforcement transports someone on a 5150 hold, go to the nearest facility. I respectfully ask for your aye vote. Thank you.

Thank you Madam Chair and Senators Corey Salzillo on behalf of the California State Sheriff Association in opposition to AB 2405 Appreciate the committee's work, the author's work, the sponsor's work on the amendments. I would say overall they make some good changes, they make some bad changes. One thing I would note is the previous version, finally the version that's in print, which will no longer be the case, but finally included an allowance for exigent circumstances. So when there was some reason that a peace officer wouldn't take a 5150 to the nearest facility, that there was sort of an allowance for that. Now, I will say that it wasn't a very good exigent circumstances because it was limited to mass casualty events and a few other narrow examples, but at least it recognized the problem with putting these rigid requirements in statutes. And now with the amended version, that language is gone. The bill also imposes an unfunded mandate that law enforcement agencies report quarterly on several categories of data relative to ED transport. The bottom line is this sort of law enforcement practice should not be subjected to specific statutory regulation. There are many factors that might go into a decision as to where a person should be transported and local protocol should be determinative. We don't have statutory transport standards for 5150 patients because it's not our primary function. We're not routinely transporting people to emergency departments. Certainly, it's rare in acute medical circumstances, but also in 5150 cases. And when peace officers and deputy sheriffs do make those transports, it takes time. And they end up having to stay with the person who they are caring for and who they are taking to this placement. So, again, acknowledge the work that's been done. But still, the bottom line is this puts rigid standards into statute that we disagree with. So we'd ask for your no vote. Thank you. Evening, Chair and members, Jonathan Feldman with the California Police Chiefs Association. Echo the comments from my colleague. I'll just say that law enforcement is not medical transport. They're not meant to be medical transport. They do in exigent circumstances on 5150 cases. But they don't have, like our fire and our EMS, a list of available facilities, which facilities might be on diversion, where the hospitals are, where they should take them, additional alternatives to hospitals to drop them off at. Why someone's going from Pasadena into MLK Hospital, I don't know. But I'm sure that there's a reason that they drove 22 miles. I would also like to better understand the scope of the data that you keep bringing up because I haven't had a chance to verify any of that with the L.A. County chiefs. I still feel like this is a local issue that needs to be addressed at a local level. There are statewide counties, regions that are not having this problem that we're going to subject all of our law enforcement in rural areas. I know there's been mention of the Bay Area cities having similar problems. I haven't heard any of that from our local law enforcement agencies or chiefs down there. And at the end of the day, you know, an officer is going to sit there with a patient having to map quest which hospital is closest to them by either geographic or time. They're going to waste time doing that. They're not going to have the systems, again, that our fire and EMS are going to have that are going to tell them where to go. And if they get it wrong, they're going to be exposed to some type of civil litigation or liability. I know the penalties were stripped from the bill, but that doesn't mean that an agency can violate state law and not face some type of consequences. Again, I think there's other ways to get at this. I think there a local problem that does need to be addressed but I don think it through this bill or through statutory reforms And for that reason we are opposed Thank you If there anyone else who would like to register their opposition this is your time to come forward Please state your name your organization and your position Madam Chair, members, Julian DeVores on behalf of the League of California Cities. We currently have an opposed position. We really appreciate the committee staff, the author, and the sponsors listening to our concerns about the previous version, which was in the Emergency Medical Services Act, which we just couldn't find a way to make that work. So we appreciate moving it out of that code section. But we still do have concerns with some of the mandates that are remaining in the bill for law enforcement. Hope to continue to work on those issues as the bill moves forward, but really appreciate the amendments. Thank you.

Good evening, Madam Chair and Senators. Doug Subbers on behalf of the California Professional Firefighters. We are opposed to the bill in print, but do appreciate the work of the committee and the author and the sponsors and look forward to reviewing the amendments with our leadership. Thank you.

Thank you very much, Madam Chair. I appreciate your staff's work on this. I appreciate the testimony and obviously appreciate the author. I just want a clarification on the impetus for the bill operationally, statistically. I heard some of that testimony referenced in support of the bill, And I'm a dinosaur by today's standards because it was decades ago when I did this work before college or law school, so it's been a long time. But even then, for officers in the field when dealing with an individual that's going to go under 5150 for a 72-hour evaluation or beyond, it's not at all unusual to have a need for that individual to be evaluated at a medical facility in ed or otherwise not at all unusual but the typical protocol there was to have ems respond on site do an evaluation assessment and per their protocols handle the transport for officers to be transporting folks to to eds in my experience and i may i may be missing something or it may have changed that was extreme extremely extremely extremely rare i mean it just did not happen as the chief's testimony pointed out there was a variety of reasons why from you know patient outcome standpoint protocol standpoint you know liability stamp i mean all kinds of issues infrastructure cost time and the whole nine yards so it's extremely extremely rare so i want to make sure i better and i'm inclined to work with the author to help him move his bill and you know keep if you're trying to get at something that maybe you as the author assembly member have experienced some unusual set of circumstances with respect to the particular facility at martin luther king I am very, however, familiar with some of the social justice, equitable sort of issues that have been in play when there are sometimes too much movement of persons in a certain condition or a certain need to facilities that are in communities that are poor and underserved. and you have an over concentration of that. I'd be very interested in just understanding like what the data is behind that because I will concede I've seen that. That's been a problem for decades. But here this just what's been described is kind of in my experience was exceedingly rare. So can you enlighten me about a little more clarity about what we're trying to get at? Do we have some numbers? Do we have some data? Do we know why officers are transporting people? to emergency departments directly and why EMS is not doing that? Is it more expeditious? Is you don't want to wait around for EMS to respond because they're overwhelmed? Is it like, what's going on, I guess, is my technical question, if you'll indulge me, Assemblymember.

Doctor, you want to take that because you have the data? Yeah, I'm happy to. So we've heard from the Palm Springs area, the San Diego area, the Sacramento area, and Los Angeles area of this practice of bypassing the closest facility from multiple regions. One of the big reasons we have the data reporting provisions is to better understand the full scope, scale, and extent of this and the rationale why. And so that's a really important part of the bill is it explains when you bypass the nearest facility, what is the reason? Because that is very critical for us to understand, which isn't being collected at present day. So we are hearing this on the field from multiple jurisdictions and communities, but that is a big reason why we have the data reporting to better understand the full extent of this. The other second part of the question is because of SB 43's expansion of grave disability, the first expansion in 50 years of state law, this will only get more challenging because now there is involvement with that expansion of putting individuals under 5150 holds and bringing them to these facilities. So we also want to get ahead of what is already a crisis from getting worse. I understand that testimony, Doctor, and I appreciate it. And I may have missed it, so I apologize to the chair and the committee if I just missed something that's obvious. But the language that I see, even in the amended mock-up for the proposed amends, deal with peace officer transport. When you have somebody who meets the threshold for assessment, peace officers are the ones that are causing transport or lawfully detaining this person for evaluation. is it to the psych facility at the hospital? Is that co-located in the ED? Does LA have a different system for the physical facility wherein those evaluations are conducted? Is it always in an ED? Sometimes it's a general hospital that has the LPS designation to have these 5150 patients, but sometimes it's a standalone psychiatric facility that's a 5150. Okay. I think I follow you better now. Thank you for the clarification.

Vice-Chair Valladares.

Yes.

If I might clarify, I think the circumstance you're speaking to, Senator, is the bill in print. The amendments that the committee has recommended and that the author is accepting is significantly narrowing the scope of the bill to just 5150 patients. Okay.

Yeah, if I may respond. We've been tracking the data. It's okay. Okay. Yeah, it's okay.

Thank you, Madam Chair. I appreciate the author's passion for his community and trying to solve this problem that we don't have data. We have the data the doctor has collected in different things. I just did some quick research on the language in the bill, or the amendments, actually, that changed it, and it does only address 5150 holds, and I didn't get a whole list. You talked very quickly about every hospital that was passed in that 22-mile. There were seven hospitals, and you rattled them off. But Martin Luther King Hospital is clearly a place where they can take 5150s and treat them, and you have an in-house or somehow close in the same facility or campus, a psychiatric hold where you can hold a 5150 for up to I believe 72 hours But the Pasadena Hospital it not that possible It called the Huntington Hospital They do not have that same caseability So could it be that law enforcement is transferring that person that's a 5150 hold to Martin Luther King Hospital, bypassing those other hospitals, because Martin Luther King has a designated site-deccurate facility attached to them where they can evaluate them in the yard, stabilize them, and then move them to the next-door building? Is that part of the issue? Could I clarify? It's a great question. There are 52 designated facilities in LA County. 52. Designated facilities. For 5150 holds. Correct. So the distance, 22 miles, we could get the list, but there's probably 6 to 12 facilities bypassed of the 5150 facilities. But when you say facilities, are you talking about hospitals? I mean, like if, again, and again, and I'm law enforcement is way smarter than I am. But if I've got my grandkid in the backseat and I need to find someplace to go again, not a 5150, I'm going to take her to an ER room. I'm not going to look for an urgent care that I don't know exactly who the doctors are or where they're at. I'm going to go to the hospital that I know. So I think it's more reputation of your hospital being exemplary in treatment for people, and you have this facility right there available to make sure that the people get a continuity of care. And I think I would commend law enforcement for doing that because based on what I've looked at just to comparison to the two hospitals that you mentioned, the Martin Luther King Jr. Hospital and the Huntington Hospital, you are by far the most excellent comprehensive care for 5150 holds than that other hospital. So I guess to get them the best care, I mean, are we looking for the best care or are we looking for the quickest care? I'm looking for the best care. So that's my question. You have a you're an you're an extraordinarily proficient hospital. You provide this specific service with doctors on site on a continuous basis where another hospital might only have a wall time doctor. You know, I don't know, somebody that had to be called in from another facility or whatever. but law enforcement knows if they take them to that facility, your facility, they have, at least it looks like, if it was me and I was law enforcement, based on what I just looked at at those two hospitals that you mentioned, I would immediately go to you because you're the expert in the field in that area. And somebody else may not get the most proper treatment. So I commend law enforcement for doing that. But is there a dispute there?

I think you're the best. Sorry.

No, no. They're looking for the best facility.

But I guess I go back to the same statement that I just made. Based on – and I don't remember all the hospitals that you mentioned – you are by far the best at 5150 holds. Whether you're the best at, I don't know, cardiovascular – I didn't look at that. But I don't know. You know what I mean? but you are by far an incredibly high-performing hospital. And I guess I think that law enforcement being able to, oh, yeah, Martin Luther King, they take care of this stuff and take them there. I think that it's not – I don't think it's malicious. I think it's regarding continuity and quality of care.

I appreciate you recognized our tremendous quality. I actually very much appreciate that because the hospital has starred very well four to five stars on the federal government rankings. So one, thank you for. Yeah, thank you for appreciating that. At the same time, I will say there are multiple other five star and four star hospitals, including amongst those 52 facilities that are designated for these patients. And so we by far are not the only one. And I will say it's not a decision of us versus another hospital one mile away. This is a flagrant bypassing of a half dozen to dozen high-quality LPS facilities. So I could understand a local decision. Like I said, sir, I didn't memorize every hospital you rattled off. I just – the Pasadena Hospital, which is a Huntington hospital, and I just did the comparison of those two. So it wasn't a true comparison. I'm just saying based on the information that I just looked at, you were by far the most qualified hospital. So anyways, it is only 5150 holds, and I think those are probably some of the most difficult people to deal with when you're picking them up. And maybe the stress on the 5150 hold is even heightened because an officer is involved in that hold. They're in the back of a police car. Think about that.

So I'm a little, one of my questions is, has this conversation happened before today or over the last couple of days? In other words, this is a very dramatic example that you all are bringing forward about hundreds of people being bypassed. I just, is that happening without conversation about why and how to fix it? Or is this the first time taking it up? Because it's happening. Right under our noses. Are you talking about the... The problem described about the drop-offs. No. I mean, I guess I'm just like, there's so many factors here. I'm not sure. There's so many issues, so many factors. It's hard to zero in and say, here's the solution for this. I find it hard to understand a solution to this. because on the one hand it seems so obvious that how can this be happening but on the other hand if it is happening then how come it wasn't talked about and tried to solve in a different way than a state law where it might not fit right maybe i'm wrong i'm missing something but right if i may just add some context to this the county board of supervisors took a resolution and address this. So the supervisor, Holly Mitchell, recognized this and brought this before the Board of Supervisors a few years ago. And it was passed. And I think the doctor can talk about that resolution. And they recognize that this has been an ongoing situation. And so it was that prompted this. And for me to hear and see the overwhelming amount of patients at Martin Luther King Hospital, and this is just one of the factors that contributes to not only the distressed Martin Luther King Hospital being deemed a distressed hospital, but also me trying to make sure that this hospital's doors remain open to making sure that it provides the kind of care and get the kinds of recognition. is received that is providing the kind of care that it needs for the entire region and recognizing that this adds to the overwhelming of services there at the hospital and trying to do something about it. That's what gave rise to Assembly Bill 2405 and that's why we're here. And to the opposition, we've continued to work with the opposition and I believe this indicative of those who have testified, whether it's firefighters and the leagues of cities, that we continue to work with opposition to try to get them to a neutral position, and we'll continue to do so. But I would like the good doctor to talk about what happened with the L.A. Board of Supervisors and that resolution. Did you want him to answer that? Okay. Thank you.

If there anything you want to say Yes From my conversations with the police chiefs in LA County they were unaware of this issue at least at this level Not even aware of the resolution So passing a resolution without having conversations directly with the police chiefs down there on how to fix this and why they passing them up

Sorry, through the – may I just very briefly, Madam Chair, thank you.

Senator Perez just left. And then Senator Smallwood. Oh, there's someone. Well, no, she just left, so Senator Smallwood. Okay.

Thank you. Senator Caballero.

I appreciate the dialogue.

Well, I want to thank you, Assemblymember Gibson, for bringing this very important bill forward, allowing for us to engage in this conversation. I want to thank those who came out to speak in support and in opposition. I apologize that you had to miss your flight. It's okay. Question for you, doctor. When someone comes to your hospital and is placed on a 51, you know, 50, they come to the emergency room first, right?

And then you do have a psychiatric unit at your facility. It's complicated.

Okay, so your hospital doesn't actually even have the full facility to take care of these patients, to admit them.

So let me ask you this. So you have patients that come to you on 5150 to your emergency room. You deem that they need to be admitted.

What do you do while you're waiting for that bed? Where does that patient go?

So they're staying in your emergency room.

Taking up beds that could be used by others who are coming for emergent situations.

An appendectomy, ectopic pregnancy, or whatever, right?

So they are having to wait longer time in hallways, streets. And Senator Grove just came back in, and I know we had this conversation before, but I want you to clarify the fact, once again, that MLK Hospital does not have a psychiatric inpatient unit.

We have an LPS designated urgent care, psychiatric urgent care run by the county on campus.

Yet we get these patients. So it again illustrates this challenge.

It's on black concrete outside our hospital waiting for placement to psych facilities.

they are taking up beds and spaces in the emergency room that could be used by others who are coming in for emergent reasons. And, you know, understanding that, I think you had mentioned this, said there have been laws that we have been passing recently that deal with who can take patients that are people who are 5150, and there is a chance that the numbers may grow from what you currently have based on some of the things that we've done here in Sacramento.

Yes. Okay. And so when you have certain hospitals or emergency rooms that are overburdened, then It prevents them from being able to take care of other patients. It's also a strain financially, and you mentioned the fact that MLK is a financially distressed hospital, and you guys are amazing at what you do, and if we want you to continue to take care of everybody in L.A. County, then we should fund it to the point where you are able to take care of L.A. County, but we haven't done that yet, which is why you are distressed and always coming to us asking for money. I think I look at this from a very different lens because, as Senator Smallwood Cuevas was talking about patient dumping, and it's not technically that term anymore because of Amtala, but, you know, understanding that certain patients are taken to certain facilities in certain communities is not new. It's not just L.A. As you mentioned, San Diego and some other places, San Francisco has complained. I trained at county facilities. I trained at Cook County Hospital, and I would look up and say, how the heck did this patient get here from way over there? I then worked in the busiest hospital, Parkland Hospital, faculty at UT Southwestern, but another county facility in Dallas, and I'd look, how did you get here? So, I applaud you, Assemblymember Gibson, for tackling this issue. It's not an easy issue to tackle, but I think we also have to recognize that some of the things that we've done in the behavioral health space are making it more challenging. We're putting more on our police officers and also subsequently on our local hospitals. And so, if someone needs care, they need to be taken to the nearest facility. and not taken across town to a hospital who has some resources, not all, and even if they did have all, there's still only a certain capacity that any particular hospital can hold. So I want to thank you so much for bringing this bill forward. Thank you so much for engaging in this very long but very important discussion. Thank you so much for coming, and you may close.

Thank you, Senator Durazo. And before you close, I also just want to highlight that the data portion in this bill I think is extremely important. I mean, people have been asking what are the numbers and why. So thank you so much for that and for taking the amendments, and you may close.

Thank you. Assemblymember Gibson will entertain a motion at this point. Moved by Senator Gonzalez. The motion is due pass and re-refer to the Committee on Public Safety. Assistant, please call the roll. Weber Pearson. Aye. Weber Pearson, aye. Barrideras. Caballero. Aye. Caballero, aye. Durazo. Aye. The Rosa I Gonzalez Gonzalez I growth menjivar Menjivar I Padilla Padilla I Perez Perez I Rubio Smaller covers small covers I Eight to zero we'll hold that vote open We will now move to file item 26, AB 2538 by Assemblymember Macedo. And thank you so much. I know you've been here for hours. I'm so sorry. Just a little bit. I missed my own event. It's fine. You can begin whenever you're ready.

Good evening, Madam Chair and Senators.

Thank you. You will have a combined total of five minutes for your presentation, and thank you for staying so long.

Good afternoon, Chair and Senators. I am Diana Peterson, RN, Director of Operations.

Thank you so much for your testimony. I did let you go over about two minutes because I know that you guys have been here like all day. If there is anyone else in the audience who would like to register their support for this bill, this is your time to come to the microphone. Not seeing any movement. If there's anyone that would like to register or speak in opposition to this bill, please come forward. Not seeing anyone moving. We'll bring it back to committee. Senator Menjivar.

Thank you, Senator. Thank you, Singh. No further. Senator Grove.

From Vaisalia.

Four, four and a half hours.

Well, we came up last night.

I took good care of them, Senator.

no further comments from any senators, I want to thank you so much, Assemblymember, for bringing this very important bill forward, for waiting all of this time. So I will let you close.

witnesses. Committee doesn't usually run this long. If you have to come back, don't worry on another bill. It shouldn't be this long. Okay at this time I will entertain a motion moved by Vice Chair Valladares. The motion is do pass as amended and re-refer to the committee on appropriations. Assistant please call the all. 11 to 0. That bill is out.

Thank you. Okay, we are now moving to our last bill of today. Once we hear this bill, we will go back and vote from the top on all of our bills one time. Thank you. We are now on file item 29 AB 2613 By Assemblymember Sharp Collins You may begin

Girl I got you

Yeah I'm ready You may begin

I can also make this short. Good evening, Madam Chair and committee members. My name is Christine Smith with Health Access California, and we are proud to support AB 2613. When contracts break down between health systems and insurance companies, patients are left in the middle. While existing law requires health plans to cover the completion of services by a terminated provider, It is only if requested by the enrollee and if the provider and plan agree on terms and reimbursement. As such, this continued care is often challenging to access. Patients may be unaware of changes until they are denied care or faced with unexpected costs. This bill will require plans to use timely, accessible communication methods, including opt-in digital communication, to make sure people are getting messages they choose to receive. I will admit that as a busy working mom of a toddler, it's hard to track everything I need to track, even as a professional health advocate When a message is electronic I much more likely to see it and be able to respond For low patients who may move often people with mobility issues or others with limited access to mail for differing reasons, even just normal life activities, this bill will improve their access to crucial updates from the plans and improve their access to essential care. We respectfully ask for your aye vote. Thank you. If there's anyone else in the audience that would

Thank you, everyone. I'll make this very quick. Cassidy Heckman, on behalf of the California Association of Health Plans, very appreciative of the committee's amendments. However, we're still opposed unless amended for two reasons. The first is block transfer notifications are highly regulated, and we have concerns with the requirement that it's both an electronic and a mail notification for efficiency and effectiveness. We recommend that it's an either-or. And additionally, health plans must submit their block transfer filings to the DMHC at least 75 business days before potential contract termination, and after the filing is submitted, they must notify their enrollees 60 days prior to that termination. Due to the way the bill is currently drafted, we recommend this section of the bill is cleaned up and clarified in order to ensure continued access to care during this process. I want to thank the author for conversations and the committee for the amendments, and we look forward to continuing those discussions.

Thank you. If there's anyone else in the audience that would like to register opposition, this is your time to come forward. Not seeing anyone, we'll bring it back. Senator Grove.

Not seeing any further comments Assemblymember Sharp Collins. Thank you so very much for bringing this very important bill forward and working with our staff on amendments. I will be accepting the committee amendments. Thank you. And would you like to close?

been made by Senator Grove. Motion is due pass as amended and re-refer to the committee on appropriations. Secretary, please call the roll. Weber Pearson. Aye. Weber Pearson, aye. Varaderas. Varaderas, aye. Caballero. Caballero, aye. Durazo. Durazo, aye. Gonzales. Gonzales, aye. Grove. Grove, aye. Menjivar. Menjivar, aye. Padilla. Padilla, aye. Perez. Perez, aye. It's okay. Rubio. Rubio. Rubio, aye. Smald Covas. Smotkovs, aye. 11-0. 11-0, that bill is out. Assemblymember, thank you so much for your patience and waiting. Okay, committee, we are going to go back to the top. We're going to go back to the top. We're going to go through this one time. Starting with our consent calendar. consent calendar files items 4 7 10 19 22 25 27 and 28 a b 16 96 1868 uh 2009 23 52 23 48 24 86 25 62 and 25 98 do i have a motion on the consent calendar moved by vice chair via daris assistant please call the roll weber pearson hi weber pearson i very daris Aye. Paredes, Aye. Gaviero, Aye. Gaviero, Aye. Dorazo, Aye. Dorazo, Aye. Gonzales, Aye. Gonzales, Aye. Grove, Aye. Grove, Aye. Menjivar, Aye. Menjivar, Aye. Padilla, Aye. Padilla, Aye. Perez, Aye. Perez, Aye. Rubio, Aye. Rubio, Aye. Small Cabas, Aye. Suamicovas, Aye. 11-0. 11-0. Consent calendar is adopted. We will go to file item number 1, AB 387. May I have a motion, please? Moved by Vice Chair Valladares. Motion is due pass and re-refer to the Committee on Education. Assistant, please call the roll. Weber Pearson. Aye. Weber Pearson. Aye. Valladares. Aye. Valladares. Aye. Caballero. Aye. Caballero. Aye. Durazo. Aye. Durazo. Aye. Gonzalez. Aye. Gonzalez. Aye. Grove. Aye. Grove. Aye. Menjivar. Aye. Menjivar. Aye. Padilla. Aye. Padilla. Aye. Perez. Aye. Perez. Aye. Rubio. Aye. Rubio. Aye. Smallcavas. Aye. Smolkovas, aye. 11-0. That bill is out. We'll move to file item number 2, AB 1629. Can I get a motion? Move bill. Move by Senator Rubio. Motion is due pass and re-refer to the Committee on Business, Professions, and Economic Development. Assistant, please call the roll. Weber Pearson. Aye. Weber Pearson, aye. Valladares. No. Valladares, no. Caballero. Aye. Caballero, aye. Durazo. Aye. Durazo, aye. Gonzalez. Aye. Gonzales, aye. Grove? Grove, no. Menjivar? Aye. Menjivar, aye. Padilla? Aye. Padilla, aye. Perez? Aye. Perez, aye. Rubio? Aye. Rubio, aye. Smarkovas? Aye. Smarkovas, aye. 9-2. That bill is out. We'll now move to file item 3, AB 1682 by Assemblymember Hart. Can I get a motion? Moved by Vice Chair Valladares. motion is due pass and re-refer to the committee on appropriations assistant please call the roll weber pearson i weber pearson i very dareis my dares i caballero caballero i durazzo durazzo i gonzalez gonzalez i grove grove i menjivar menjivar i padilla padilla i perez I. Perez, I. Rubio? I. Rubio, I. Smolkovas? I. Smolkovas, I. 11-0. That bill is out. We'll move to file Item Number 5, AB 2540 by Assemblymember Stefani. Can I get a motion? Moved by Senator Perez. Motion is due passed and re-referred to the Committee on Education. Assistant, please call the roll. Weber Pearson? I. Weber Pearson I Carri de res Caballero I draw Rosso to Rosso I Gonzalez Gonzalez I Grove menjivar menjivar I Padilla Padilla I Perez Perez I Rubio Rubio I small coves small coves I Grove, no. Nine to one. Nine to one, that bill is out. We will now move to file item six, AB 1843. Can I get a motion? Move by Senator Smallwood Cuevas. Motion is due pass and re-refer to the Committee on Appropriations. Assistant, please call the roll. Weber Pearson? Aye. Weber Pearson, aye. Valladeras? No. Caballero? Aye. Caballero, aye. Durazo? Aye. Durazo, aye. Gonzales? Aye. Gonzales, aye. Grove? No. Grove, no. Mandjavar? Padilla? Aye. Padilla, aye. Perez? Aye. Perez, aye. Rubio? Aye. Rubio, aye. Small Covas? Smokovas, aye. 8 to 1. That bill is out. We'll now move to file item 8, AB 1929. Can I get a motion? Move by Senator Gonzalez. Motion is due passed and re-refer to the Committee on Judiciary. Assistant, please call the roll. Weber Pearson? Not voting. Videras? No. Varadarys no. Gaviero? Aye. Gaviero aye. Durazo? Aye. Durazo aye. Gonzales? Aye. Gonzales aye. Grove? No. Grove no. Menjivar? Padilla? Aye. Padilla aye. Perez? Aye. Perez aye. Rubio? Smaller covers? Smaller covers, aye. 6 to 2, that bill is out. We'll move to file item 11, AB 2030. Can I get a motion? I'm sorry. I'm sorry. Yep. I'm sorry. We're going back to 9. AB, file item 9, AB 1970 by Assemblymember Harabedian. Can I get a motion? Moved by Senator Padilla. Motion is do pass as amended and re-refer to the committee on appropriations. Assistant, please call the roll. Weber Pearson? Aye. Weber Pearson, aye. Varadaris? Aye, buddy. Caballero? Aye. Caballero, aye. Durazo? Aye. Durazo, aye. Gonzales? Aye. Gonzales, aye. Grove? Not voting. Menjivar? Aye. Menjivar, aye. Padilla? Aye. Padilla, aye. Perez? Aye. Perez, aye. Rubio? Aye. Rubio, aye. Smarkovas? Aye. Smarkovas, aye. 9 to 0. 9 to 0, that bill is out. We'll go to file item 12, AB 2594. Sorry no now we at 11 Sorry AB 2030 Can I get a motion Moved by Senator Caballero Motion is due passed and we refer to the Committee on Judiciary Assistant, please call the roll. Weber Pearson? Aye. Weber Pearson, aye. Valladeras? Is this file item 11? 11. Okay, not voting. Caballero? Aye. Caballero, aye. Durazo? Aye. Tarazzo, aye. Gonzalez? Aye. Gonzalez, aye. Grove? Menjivar? Aye. Menjivar, aye. Padilla? Aye. Padilla, aye. Perez? Ten or eleven. Eleven. Eleven? Oh, aye. Perez, aye. Rubio? Aye. Rubio, aye. Smarkovas? Aye. Smarkovas, aye. Nine to zero. That bill is out. We'll move to file item 12, AB 2594. Can I get a motion? Moved by Vice Chair Valladares. Assistant, please call the roll. Weber Pearson. Aye. Weber Pearson, aye. Valladares. Aye. Valladares, aye. Caballero. Aye. Caballero, aye. Durazo. Aye. Durazo, aye. Gonzalez. Aye. Gonzalez, aye. Grove. Aye. Grove, aye. Menjivar. Aye. Menjivar, aye. Padilla. Aye. Padilla, aye. Perez, aye. Rubio, aye. Rubio, aye. Small Covas, aye. 11-0. 11-0. That bill is out. We're now at file item 13, AB 2066. Can I get a motion? Move bill. Move by Senator Caballero. Motion is due pass and re-refer to the Committee on Appropriations. Assistant, please call the roll. Weber Pearson, aye. Weber Pearson, aye. Varaderos, aye. Varaderos, aye. Cavillero. Aye. Cavillero. Aye. Terrazo. Aye. Terrazo. Aye. Gonzales. Aye. Gonzales. Aye. Grove. Aye. Grove. Aye. Menjafar. Aye. Padilla. Aye. Padilla. Aye. Perez. Aye. Perez. Aye. Rubio. Aye. Rubio. Aye. Smolkovas. Okay. 11-0. That bill is out. We will move to file item 14, AB 21. Can I get a motion? Move the bill. Move by Senator Caballero. Motion is due, passed, and we refer to the Committee on Appropriations. Assistant, please call the roll. Weber Pearson. Aye. Weber Pearson, aye. Valladeras. Aye. Valladeras, aye. Caballero. Aye. Caballero, aye. Durazo. Aye. Durazo, aye. Gonzales. Aye. Gonzales, aye. Grove. Aye. Aye. Padilla, aye. Perez? Aye. Perez, aye. Rubio? Aye. Rubio, aye. Smarcovas? Aye. Smarcovas, aye. 11-0. 11-0. That bill is out. We'll now move to file item 15, AB 2302. Can I get a motion? Lift the call. Oh, lift the call. Yes. Okay, we'll lift the call on that bill. Please call the absent members. Please. Bye, Daris. Grove Padilla Padilla aye Perez Perez aye Rubio Rubio aye Smarnkovas Smarnkovas aye 9-0 That bill is out We are now at file item 16 AB 2093 Assemblymember Barcahan Can I get a motion Moved by Vice Chair Valladares Motion is due pass and re-refer to the Committee on Emergency Management. Assistant, please call the roll. Weber Pearson. Aye. Weber Pearson, aye. Valladares. Aye. Valladares, aye. Caballero. Aye. Caballero, aye. Turazo. Aye. Turazo, aye. Gonzalez. Aye. Gonzalez, aye. Grove. Aye. Grove, aye. Menjivar. Menjivar, aye. Padilla. Padilla, aye. Perez. Perez, aye. Rubio. Rubio, aye. Smolkovas. Smolkovas, aye. 11-0. 11-0. That bill is out. We'll now move to file. Can I move items 18, 19, 21, and 22? 20 and 22. 20 and 22. Can we do that? Can we do that? We are now at file item 17, AB 2135. Can I get a motion? Moved by Senator Caballero. Motion is due, passed, as amended, and re-refer to the Committee on Judiciary. Assistant, please call the roll. Weber Pearson? Aye. Weber Pearson, aye. Valladerez? Caballero? Aye. Caballero, aye. Durazo Durazo aye Gonzalez Gonzalez aye Grove Menjivar Menjivar aye Padilla Padilla aye Perez Perez aye Rubio Rubio aye Smarkovas Smarkovas aye 9-0 10-0 That bill is out We will now move to file item 18 AB 2194 Lift the call. Call the absent members. Menjivar? Menjivar, aye. Perez? Aye. Perez, aye. Rubio? Aye. Rubio, aye. 11-0. 11-0. That bill is out. We'll now move to file item 20, AB 2244. Please lift the call. Call the absent members. Gaviero? Menjivar? Menjivar aye. Rubio? Aye. Rubio aye. Ten. Ten to zero. That bill is out. We are now at file item 23, AB 2651. Can I get a motion? Moved by Senator Padilla. Motion is due, pass and re-refer to the Committee on Education. Assistant, please call the roll. Weber Pearson. Aye. Weber Pearson. Aye. Valladares. No. Valladares. No. Caballero. Aye. Caballero. Aye. Durazo. Aye. Durazo. Aye. Gonzalez Gonzalez I grove grove no manjivar manjivar I padilla padilla I Perez Perez I Rubio Rubio I small covers small covers I 9 to 2 that bill is out We're now at file item 24, AB 2405. Please call the absent members. Bayadaris, Grove, Rubio. Aye. Aye. 9-0. Gibson. Gibson. 24-7. 9-0, that bill is out. Thank you. Thank you. The Senate Committee on Health is now adjourned. Good job, man.