HEARING OF THE SENATE COMMITTEE
ON HEALTH THEM A WELCOME
EVERYONE HERE -- WE HAVE TWENTY
SEVEN BILLS ON OUR AGENDA -- WE
ARE.
NOT HEARING ITEM NUMBER TWENTY
TWO A. B. TWELVE FORTY SIX BY
SUMMER Là MOUNTS SO THAT'S
BEING -- WE'RE NOT HEARING THAT
ITEM TODAY WE HAVE FOUR ITEMS
ARE CONSENT CALENDAR ITEM NUMBER
EIGHT AB SIX SEVENTY EIGHT BY
SUMMER FLORA WITH AMENDMENTS --
ITEM NUMBER ELEVEN EIGHTY SEVEN
FORTY SIX BY SOME MEMBER WOULD
ITEM NUMBER TWELVE EIGHTY SEVEN
SIXTY TWO BY SUMMER QUIRK AND
ITEM NUMBER SEVENTEEN A. B. --
TEN FOR BY SUMMER MCCARTY WITH
AMENDMENTS -- SO THOSE ARE THE
ITEMS THAT ARE CONSENT -- SO
WE'LL GO AHEAD AND BEGIN IS A IS
SIMPLY AS ASUS -- SUB COMMITTEE --
REMINDER.
THE RULES IS THAT WE OFFER SIX
MINUTES FOR EACH SIDE -- FOR
TESTIMONIES OF YOU HAVE MULTIPLE
WITNESSES YOU CAN FIGURE OUT THE
AT THE TIME BUT USUALLY GET SIX
MINUTES TOGETHER.
AND THEN WE TAKE ADDITIONAL --
TESTS AND BASICALLY PEOPLE CAN
NAMES STATE THEIR NAME
ORGANIZATION AND POSITION AT THE
MICROPHONE.
AND EXPRESS -- THEIR POSITION --
EITHER IN FAVOR AND OPPOSITION
OF THE BILL SO WITH THAT -- I
SEE IS A MEMBER -- WOULD WELCOME
AND DO YOU HAVE SEVERAL ITEMS
BEFORE US AND I UNDERSTAND THAT
YOU WISH TO BEGIN WITH -- ITEM
NUMBER FOURTEEN SB EIGHT TWENTY
FOUR SO WE'LL GO ON WE GO AHEAD
BEGIN WITH THAT ITEM.
ALL RIGHT.
THAT'S CORRECT RIGHT US SERVICE
ITEM.
DO YOU WHICH YOU YOU'RE OUT
TAKEN WHATEVER YOU WISH.
OKAY THAT THAT IS FINE OKAY SO --
I WILL START WITH ITEM NUMBER
ONE AB.
ONE SEVENTY FOUR PLEASE WELCOME
VERY MUCH.
THANK YOU VERY MUCH SENATORS --
IN THIS YEAR'S BUDGET -- SB
SEVENTY EIGHT WAS COULD WEEK WE
CREATED -- IN IN SIZE AND
POSSIBLE SIR SB SEVEN SEVENTY
EIGHT WE CREATED.
UNTIL -- JANUARY ONE TWENTY
TWENTY THREE THE INDIVIDUAL
MARKET ASSISTANCE -- TO PROVIDE
HEALTH COVERAGE OF FINANCIAL
ASSISTANCE TO CALIFORNIA
RESIDENTS WITH HOUSEHOLD INCOMES
AT OR BELOW 6100% OF THE FEDERAL
POVERTY LEVEL INCLUDING ADVANCE
PREMIUM ASSISTANCE SUBSIDIES AB
ONE SEVENTY FOUR WOULD ENSURE WE
VIEW THE ENROLLMENT FIGURES
COLLECTED BY COVER CALIFORNIA.
AS A RESULT OF THESE NEW
SUBSIDIES I REQUEST BUT
RESPECT THE ASPIRIN AYE VOTE AND
I HAVE A WITNESS HERE IN SUPPORT.
I THANK YOU IN THIS IS SUPPORT.
GOOD AFTERNOON MISTER CHAIR AND
MEMBERS AND JDS HERE ON BEHALF
OF HEALTH ACCESS CALIFORNIA --
AND WE ARE PLEASED TO SUPPORT
AND SPONSOR AB ONE SEVENTY FOUR
WHICH IS THE REPORTING BILL TO
TRACK AND MONITOR.
ENROLLMENT FOR THE NEW STATE
SUBSIDY PROGRAM THAT PROVIDES
AFFORDABILITY AFFORDABILITY HELP
IN THE INDIVIDUAL MARKET -- WE
ARE PLEASED TO HAVE HAD
BIPARTISAN SUPPORT IN THIS
COMMITTEE FOR THE CHAIRS BILL TO
CREATE AFFORDABILITY HEALTH FOR
CALIFORNIANS WITH INCOMES
BETWEEN. SEVENTY TWO THOUSAND
DOLLARS FOR AN INDIVIDUAL OR ONE
HUNDRED FIFTY THOUSAND DOLLARS
FOR A FAMILY OF FOUR AB ONE
SEVENTY FOUR WOULD ENSURE THE
LEGISLATURE AND ADMINISTRATION
HAVE INFORMATION RELATED.
TO APPLICANTS DEMOGRAPHICS
ELIGIBILITY DETERMINATIONS
GRIEVANCES APPROVALS TO NILES
AND ANY OTHER RELEVANT
INFORMATION THAT WOULD BE USEFUL
FOR THESE REASONS WE ASK FOR
YOUR AYE SUPPORT THANK YOU.
OKAY THANK YOU OTHER WITNESSES
REPORT BACK MY FRONT.
THEN FLOOR IN BEHALF OF WESTERN
CENTER ON LAW AND POVERTY WE
APOLOGIZE FOR NOT GETTING OUR
LETTER IN BUT WE SUPPORT
TRACKING THE NEW STATE SUBSIDIES.
THANK YOU.
CITY OF ONE AMERICAN ACADEMY OF
PEDIATRICS AND SUPPORT THANK YOU.
KELLY BRAXTON BEHALF OF THE
ASSOCIATION CALIFORNIA
HEALTHCARE DISTRICTS IN SUPPORT
THANK YOU.
TAKE A BREAK OUR NATIONAL
ASSOCIATIONS SO SHORT CALIFORNIA
CHAPTER IN SUPPORT THANK YOU.
MY CONSUMERS CALIFORNIA HEALTH
PLUS ADVOCATES IN SUPPORT THANK
YOU.
ALL RIGHT ARE THERE ANY
WITNESSES IN OPPOSITION.
CITY NINE QUESTIONS COMMITTEE
MEMBERS.
OKAY -- SEEING NO QUESTIONS FOR
COMMITTEE MEMBERS SAID.
THANK YOU SO MUCH FOR YOUR WORK
ON THE BILL I KNOW WE WERE IN
THE BUDGET ABLE TO PUT IN THE
SUBSIDIES SCIENCE IT THIS IS NOW.
THE BILL TO NOW TRACK THE
RESULTS OF THAT ACTION.
WOULD YOU LIKE TO CLOSE THIS
RESPECTFULLY ASK YOUR AYE VOTE
WHEN YOU HAVE A QUORUM OKAY SO
THAT'S WHAT YOU DO HAVE A QUORUM
YET SO WE'RE NOT ABLE TO MAKE A
MOTION TAKE A VOTE THAT AT THIS
POINT TIME BUT WE WILL GO AHEAD
AND WHEN THAT HAPPENS.
WE WILL DO SO OKAY AND NEXT YOU
WANT TO TAKE UP.
NOW YOU I TAKE OF EIGHTY OKAY.
ALL RIGHT SO WE'RE GONNA MOVE ON
TO ITEM NUMBER FOURTEEN AB.
EIGHT TWENTY FOUR THANK YOU
DOCTOR CHAIR AND SENATORS --
FIRST WANT TO THANK.
THANK YOU TO THE COMMITTEE --
AND STAFF FOR YOUR HARD WORK ON
THIS BILL.
THERE ARE AMENDMENTS WE AGREED
TO TAKE BUT DUE TO THE TIME
CONSTRAINTS WILL BE TAKING THEM
AND JUDICIARY A MOCK UP IS
AVAILABLE WILL BE GETTING THAT
MOCK UP OUT TO YOU -- AB EIGHT
TWENTY FOUR AIMS TO DETER WHAT
IS KNOWN AS PAY FOR DELAY --
THESE ARE AGREEMENTS OR
SETTLEMENTS BETWEEN GENERIC AND
BRAND BY BRAND MANUFACTURERS IN
ORDER TO DELAY MARKETING A
GENERIC VERSION OF A DRUG FOR
SOME VALUE.
AB EIGHT TWENTY FOUR DOES THIS
BY ESTABLISHING THE STANDARD OF
REVIEW FOR THE COURTS TO USE
WHEN REVIEWING PAY FOR DELAY
AGREEMENTS.
THE BILL ESTABLISHES A
PRESUMPTION THAT THESE
AGREEMENTS ARE ANTI COMPETITIVE
THE DRUG COMPANIES HAVE THAT
THEN HAVE THE BURDEN OF PROOF
APPROVING THE SETTLEMENT ARE PRO
CONSUMER.
THE EVER INCREASING COST OF
PRESCRIPTION DRUGS CONTINUES TO
IMPACT CALIFORNIA'S AND PAY FOR
DELAY SETTLEMENTS ARE
CONTRIBUTING TO THESE
UNCONTROLLABLE PRICES.
THE SETTLEMENTS INHIBIT
COMPETITION AND FORCE CONSUMERS
PAY MORE WHILE DRUG COMPANIES --
PROFITS INCREASE COST
CONTAINMENT IS A CRITICAL ISSUE
AND HEALTH CARE THAT NEEDS TO BE
ADDRESSED COSTS AFFECT WHAT
GOVERNMENT GOVERNMENT EMPLOYERS
AND MOST IMPORTANTLY WHAT PEOPLE
HAVE TO PAY FOR THEIR HEALTHCARE.
AB EIGHT TWENTY FOUR JUST JUST
THAT INSURES THAT CONSUMERS HAVE
ACCESS TO LOWER COST GENERIC
DRUGS AS SOON AS POSSIBLE AND
HELP SIGNIFICANTLY REDUCE THE
DRUG OF THE PRICE OF DRUGS FOR
ALL PAYERS.
I RESPECTFULLY ASK YOUR AYE VOTE
I HAVE WITNESSES HERE WITH ME
AND AND ALSO AT SOME TECHNICAL
SUPPORT AS WELL.
OKAY AND HOW ME WITNESSES ARE
THEY'RE HERE. TO DO I CAN
REMEMBER SIX MINUTES BETWEEN THE
TWO OF YOU THEN OKAY WELCOME.
GOOD AFTERNOON MISTER CHAIR AND
MEMBERS YES MAN PELLET HERE ON
BEHALF OF HEALTH ACCESS
CALIFORNIA THE STATE WIDE HEALTH
CARE CONSUMER ADVOCACY COALITION
IN STRONG SUPPORT OF AB.
EIGHT TWENTY FOUR AB EIGHT
TWENTY FOUR WOULD CRACK DOWN ON
COLUSA AGREEMENTS BETWEEN BRAND
NAME DRUG MANUFACTURERS AND
GENERIC COMPANIES IN WHICH THE
BRAND NAME COMPANY PAYS THE
GENERIC COMPANY TO DELAY THE
LOWER COST DRUGS FROM COMING TO
MARKET.
MEMBERS WHAT IS THE POINT IN
CREATING LIFE SAVING MEDICATIONS
IF PATIENTS CAN'T AFFORD THEM OR
GO BANKRUPT IN ORDER TO PAY FOR
THEIR MEDICATION.
WE ARE JUST TALKING ABOUT HIGH
WE SPECIALIZE DRUGS HERE WE'RE
TALKING ABOUT INSULIN AND
ANTIBIOTICS DRUGS THAT HAVE BEEN
AROUND FOR DECADES.
EVEN THOUGH CALIFORNIA CAPS
COPAYS AT TWO HUNDRED FIFTY
DOLLARS PER PRESCRIPTION TWO
HUNDRED FIFTY DOLLARS PER MONTH
CAN ADD UP PRETTY QUICKLY
ESPECIALLY IF YOU'RE TAKING
MULTIPLE MEDICATIONS.
THE PRACTICE OF PAY FOR DELAY IS
ALREADY ILLEGAL UNDER ANTI
COMPETITION LAW BUT UNDER
EXISTING LAW IT IS DIFFICULT TO
PROVE.
WHAT AB EIGHT TWENTY FOUR DOES
IS TO SHIFT THE BURDEN OF PROOF
AND LEVELS THE PLAYING?
PLAYING FIELD SO THAT DRUG
MANUFACTURERS NEED TO PROVE WHY
THESE TYPES OF AGREEMENTS ARE
NOT ANTI COMPETITIVE.
BOTH BRAND NAME AND GENERIC
COMPANIES HAVE BAKES THIS
PRACTICE INTO THEIR BUSINESS
MODEL.
A TWO THOUSAND AND TEN FEDERAL
TRADE COMMISSION REPORT FOUND
THAT PAY FOR DELAY AGREEMENTS
COST CONSUMERS THREE POINT FIVE
BILLION DOLLARS PER YEAR.
AND BETWEEN TWO THOUSAND AND TEN
AND TWO THOUSAND FIFTEEN THE FTC
LOOKED AT NINE HUNDRED PATENTS
SETTLEMENT AGREEMENTS AND FOUND
THAT A HUNDRED FIFTY OF THEM
WERE POTENTIALLY PAY FOR DELAY
AGREEMENTS.
ACCORDING TO THE NATIONAL HEALTH
EXPENDITURE DATA THREE HUNDRED
AND THIRTY THREE BILLION DOLLARS
PER YEAR WAS SPENT ON
PRESCRIPTION DRUGS IN.
TWO THOUSAND SEVENTEEN IT IS
CLEAR THE PAY FOR TôI
AGREEMENTS ARE ONE OF THE
DRIVERS OF INCREASING DRUG COSTS.
AND THIS PRACTICE IS NOT SOME
RELIC OF THE PAST PAY FOR DELAY
GRUMMAN'S ARE STILL HAPPENING
JUSTIN MAY A LAWSUIT WAS FILED
AGAINST GILLY AD FOR ENGAGING IN
THIS PRACTICE FOR HIV
MEDICATIONS.
WHEN PHARMACEUTICAL COMPANIES
CONSPIRED TO KEEP DRUGS OFF THE
MARKET TO INFLATE PRICES
CONSUMERS ARE FORCED TO PAY
EITHER OUT OF POCKET OR THROUGH
THEIR PREMIUMS? FOR THESE
REASONS WE ASK FOR YOUR AYE VOTE
AND I'M PLEASED TO INTRODUCE
KAREN MASTODONS TO SHARE HER
PERSONAL STORY OF HIGH CROSSED
PRESCRIPTION DRUGS.
CHAIRMAN PAN MEMBERS OF THE
COMMITTEE.
THANK YOU FOR HAVING ME HERE
TODAY.
MY NAME'S CAM MASSILLON.
I'M A LIFELONG CALIFORNIAN I'VE
LIVED IN SACRAMENTO SINCE.
NINETEEN EIGHTY CURRENTLY I WORK
AS A WAITRESS IN TOWN.
AND WHEN I'M NOT AT WORK I LOVE
SPENDING TIME WITH MY FAMILY
TRAVELING AND CROCHET.
I ALSO LIVE WITH ASTHMA AND
DIABETES.
NOT A DAY GOES BY WHEN I DON'T
THINK ABOUT THE IMPACT.
THESE CONDITIONS HAVE ON MY LIFE.
TO HELP MANAGEMENT DIABETES MY
DOCTOR PRESCRIBED A DRUG CALLED
BY DEAR AND BE SIZE.
LAST WEEK MY PHARMACIST HERE
SACRAMENTO TOLD ME.
ME MY ONE MONTH SUPPLY WOULD
COST EIGHT HUNDRED TWENTY SIX
DOLLARS AND NINETY NINE CENTS.
MY INSURANCE DOESN'T COVER IT.
THAT'S HIGHER THAN MY RENT.
I CAN'T AFFORD IT SO I'M FORCED
TO RELY ON SAMPLES FROM MY
DOCTOR.
I AM GRATEFUL FOR THE SAMPLES
BUT I KNOW I CAN NOT DEPEND ON
THEM FOR OVER.
AND I'M TERRIFIED FOR TH DAY
WHEN THEY'LL RUN OUT.
THERE'S NO GENERIC FOR BY DARIAN
AND THE DRUG MANUFACTURER
ASTRAZENECA HAS HELD MONOPOLY ON
THE DRUG SINCE.
TWO THOUSAND TWELVE I DON'T KNOW
IF ASTAZENECA IS BLOCKING THE
GENERIC VERSION OF THE DRUG I
NEED TO STAY HEALTHY BUT I DO
KNOW.
THAT IN TWO THOUSAND SIXTEEN
ASTRAZENECA ENTERED INTO A
PATENT SETTLEMENT WITH THE
GENERIC MANUFACTURE.
TIVO THE SETTLEMENT WAS OVER THE
SHORT ACTING VERSION OF MY DRUG
CALLED.
BY THE END OF THE TERMS OF THE
SETTLEMENT DICTATED THAT TIVO
COULD NOT MAKE THIS IT'S GENERIC
AVAILABLE FOR SIXTEEN MONTHS.
HAS ASTRID JANICA ZENICA DONE
THE SAME FOR MY DRUGS I DON'T
KNOW.
BUT WHAT I DO KNOW IS THAT DRUG
PRICES KEEP GOING UP.
AND PAY FOR DELAYED DEALS ARE
DRIVING UP COSTS BY HOLDING BACK
CHEN ERIC'S FROM THE MARKET.
THIS COMMITTEE CAN CHANGE THAT
ASSEMBLY BILL EIGHT TWENTY FOUR
WOULD AND PAY FOR DELAY AND HELP
TO MAKE DRUG PRICES LOWER. FOR
THE OTHER CALIFORNIANS.
WE ARE DESPERATE FOR RELIEF.
SO I URGE YOU TO VOTE YES FOR
THIS BILL BECAUSE IF THERE'S ONE
THING I KNOW TO BE TRUE.
IS THAT.
DRUGS DON'T WORK IF PEOPLE CAN'T
AFFORD THEM THANK YOU SO MUCH
FOR YOUR TIME.
GOOD AFTERNOON MISTER CHAIRMAN
MEMBERS OF THE COMMITTEE MY NAME
S RUNNING COULD GEORGE ON THE
LEGISLATIVE ADVOCATE WITH
ATTORNEY GENERAL MISTER AS
OFFICE.
ON BEHALF OF THE ATTORNEY
pASSEMBLY MEMBER WOULD FOR
OFFERING THIS IMPORTANT PIECE OF
LEGISLATION.
AND HIS LEADERSHIP ON PROTECTING
HARD WORKING CALIFORNIANS FROM
THE HIGH PRESCRIPTION DRUG COSTS.
ATTORNEY GENERAL BECAUSE THERE
IS PROUD TO SPONSOR AB EIGHT
TWENTY FOUR WHICH AIMS TO REDUCE
PRESCRIPTION DRUG COSTS BY
INCREASING ENFORCEMENT AGAINST
COLUSA PAY FOR DELAY AGREEMENT.
ALTHOUGH THESE AGREEMENTS
CURRENTLY CAN BE ANTI
COMPETITIVE UNDER CURRENT LAW
ENFORCEMENT EFFORTS TO GO AFTER
THE AGREEMENTS ARE COMPLEX AND
CURRENT LIES TILTED IN FAVOR OF
THE PHARMACEUTICAL INDUSTRY.
THE NAFTA MEANT OF AB EIGHT
TWENTY FOUR WILL CLEARLY AND
EXPRESSLY GIVE THE ATTORNEY
GENERAL ANOTHER TOOL TO DETER
THE PLOT PROLIFERATION OF THESE
TYPES OF AGREEMENTS.
AND SUPPORT WROTE MORE ROBUST
ENFORCEMENT CALIFORNIA IS
ALREADY A LEADER IN FERRETING
OUT THESE AGREEMENTS AND SHINING
A LIGHT ON THEM THROUGH DOJ'S
ANTITRUST.
SECTION NOW CALIFORNIA CAN BE A
LEADER IN STATE LEGISLATION
DETERRING THIS HARMFUL CONDUCT.
TODAY I AM JOINED BY MY
COLLEAGUE DEPUTY ATTORNEY
GENERAL CHERYL JOHNSON IN OUR
ANTI TRUST DIVISION IS JOHNSON
IS A LEADING PRACTITIONER IN
THIS FIELD HAVING LITIGATE IN
THE AREAS OF PATENT LAW.
AN ANTI TRUST LAW FOR ALMOST
FORTY FIVE YEARS AND HAS HANDLED
EVERY PAPER DELAY CASE THE
ATTORNEY GENERAL'S OFFICE HAS
ENGAGED IN.
INCLUDING ON THE CASE THAT
EVENTUALLY WENT TO THE US
SUPREME COURT FTC VERSUS
ACTIVISTS AND THE AGES LOW'S
INVOLVEMENT IN THE CALIFORNIA
SUPREME COURT CASE IN RECENT PRO.
MS JOHNSON WILL BE HERE TO
ANSWER ANY TECHNICAL QUESTIONS
YOU MAY HAVE TODAY -- SENATORS
THANK YOU FOR YOUR TIME AND YOUR
CONSIDERATION THE ATTORNEY
GENERAL'S OFFICE RESPECTFULLY
ASKS FOR YOUR AYE VOTE THANK YOU.
OKAY THANK YOU OTHER WITNESSES A
SUPPORT A NAME THE WORKSTATION
POSITION THANK YOU.
MISTER CHAIR MEMBER SERRA FLOCKS
CALIFORNIA LABOR FEDERATION IN
SUPPORT [inaudible]
THANK YOU.
VERY CLEAN IN S. WITH A OR P. IN
STRONG SUPPORT.
THANK YOU.
ENTER WEIGHT WITH THE CALIFORNIA
PUBLIC EMPLOYEES RETIREMENT
SYSTEM IN SUPPORT THANK YOU.
MAXINE AND TELL MY BEHALF THE
NATIONAL MULTIPLE SCLEROSIS
SOCIETY IN SUPPORT.
THANK YOU. THREE TO START PAYS A
PERMANENT A IN SUPPORT
[inaudible]
THANK YOU.
CARL SUPPORTER BLUESHIELD OF
CALIFORNIA IN SUPPORT.
THANK YOU NICK LOUISA'S
CALIFORNIA ASSOCIATION OF HEALTH
PLANS IN SUPPORT THANK YOU.
CHECK OF REAGAN NATIONAL
ASSOCIATION OF SOCIAL WORK
CALIFORNIA CHAPTER IN SUPPORT
THANK YOU.
KELLY BE MY BEHALF THE
CALIFORNIA MEDICAL ASSOCIATION
IN SUPPORT THANK YOU.
MEGAN SUPERS CALIFORNIA HEALTH
PLUS ADVOCATES IN SUPPORT.
THANK YOU FICTION PLOY WESTERN
CENTER ON LAW AND POVERTY IN
SUPPORT THANK YOU.
GOOD AFTERNOON BLANCA CASTRO ON
BEHALF OF THREE POINT THREE
MILLION A A RP MEMBERS AND
SUPPORT.
YOU -- CHILD DISABILITY RIGHTS
CALIFORNIANS SUPPORT YOU.
SECBRAMBLE HERE ON BEHALF OF
THE CALIFORNIA TEACHERS
ASSOCIATION AND SUPPORT THANK
YOU.
TIM VALDERRAMA WITH THE WHITE A
GROUP ON BEHALF OF NEXT GEN
CALIFORNIANS SUPPORT.
THANK YOU.
RIGHT I SEE THAT WE HAVE.
QUICKLY.
I WE ARE MERITS ON BEHALF OF A
LATINO COALITION FOR ALL THE
CALIFORNIA STRONG SUPPORT.
THANK YOU ALL RIGHT -- ACTUALLY
WE'RE GETTING A LITTLE PAUSE
HERE I SEE WE HAVE A QUORUM
SECTOR CAN YOU PLEASE CALL THE
ROLL TO SELL THE SCORM.
HAND HERE AND HERE STONE STONE
HEAR GONZALEZ AND SALAS HERE
GROW HER TADO LEYVA.
LEYVA HERE MITCHELL MITCHELL
HERE MINING RUBIO.
THAT WE HAVE A CAR NOW OKAY --
OPPOSITE THE TESTIMONY IN
OPPOSITION.
AND IF YOU CAN PLEASE MAKE ROOM
AT THE FRONT.
FOR THE OPPONENTS.
THE JUST THE ONE I THINK THERE'S
MORE PEOPLE COMING UP SO WE'LL
NEED.
TO MAKE MORE ROOM UP THERE YOU
CAN MOVE AROUND THE EDGES.
TO SO WE CAN LET YEAH.
OKAY AGAIN -- I THINK THERE'S
THREE OF YOU REMEMBER SIX
MINUTES AND NO TIME TO FORGET
THE LAST ONE THEN THAT'S AT A
TIME SO JUST KEEP IN MIND YOUR
FELLOW TESTAMENT THAT THE FIRES
OKAY.
WELCOME.
THANK YOU DOCTOR PANDA MEMBERS
MY NAME IS BRETT MICHELIN I'M
WITH THE ASSOCIATION FOR
ACCESSIBLE MEDICINES A AM
REPRESENTS THE GENERIC
BIOSIMILAR MANUFACTURERS IN
AMERICA.
WE ACTUALLY SUPPORT THE GOAL OF
DOCTOR WOULD AND THE THE
PROPONENTS OF THIS THE BEST WAY
TO REDUCE THE COST OF MEDICINES
IS THROUGH.
GENERIC DRUGS.
pWAYS TO GET -- TO DRUGS TO
MARKET QUICKER HE HAS PROVEN TO
BE THESE TYPES OF SUPPLEMENTS.
CALIFORNIA SAVED OVER TWENTY
FOUR BILLION DOLLARS ANNUALLY BY
THE USE OF GENERIC DRUGS.
AIMS CONCERN AT THE WAY THAT THE
BILL AS DRAFTED IS NOT ONLY
GOING TO PREVENT NEW GENERIC
DRUGS FROM COMING TO MARKET AND
SAVING PATIENTS MONEY.
BUT IT COULD ALSO TAKE SOME
GENERIC OFF THE MARKET IF THE
PROVISIONS OF THOSE PRIOR
SETTLEMENTS ARE NOW CALLED INTO
QUESTION AND UNDER LEGAL THREAT
IN CALIFORNIA.
A TYPICAL CASE IT'S THE BRAND
MANUFACTURER WHOSE FILING SUIT
AGAINST A GENERIC MANUFACTURER
WHO'S TRYING TO ATTACK THE
PATENT TICKET THAT HAS BEEN
TYPICALLY ESTABLISHED BY THE
BRAND COMPANIES IN ORDER TO
PROTECT THEIR MONOPOLIES.
SETTLEMENTS HAVE PROVEN TO SAVE
BILLIONS OF DOLLARS.
THE RECENT CASE OF EXAMPLE OF
THAT IS HIS HUMOR.
SO WITH THE WORLD'S BEST SELLING
DRUGS WHEN THE TOP GROSSING
DRUGS ON THE MARKET SINCE TWO
THOUSAND AND TWO IN TWENTY
SIXTEEN ALONE MEDICARE MEDICAID
PAID OVER THREE POINT THREE
BILLION DOLLARS FOR THE STRUCK.
PATENTS WOULD DELAY GENERIC
COMPETITION UNTIL.
TWENTY THIRTY FOUR DUE TO
SETTLEMENTS THIS DRUG IS NOW
GOING TO BE AVAILABLE IN ABOUT
SIMILAR FORM IN. TWENTY TWENTY
THREE EVEN THOUGH THIS IS ELEVEN
FULL YEARS BEFORE PATENT
EXPIRATION.
THIS DRUG NOW COULD NOT THE
POTENTIALLY COULD COULD HAVE A
DELAY IN COMING TO MARKET EVEN
THOUGH THE AGREEMENTS.
HAVE ESTABLISHED IT AT THAT
PERIOD.
BECAUSE AB EIGHT TWENTY FOUR
ASSUMES THAT EVERY SETTLEMENT IS.
ANTI COMPETITIVE IT'S A
PRESUMPTION THAT THE
MANUFACTURER MUST COME IN AND
DEFEAT IN ORDER.
TO HAVE WON THE SETTLEMENTS THAT
AGAIN THAT TYPICALLY.
THE MAIN PROVISION.
IS TO ALLOW GENERIC COME TO
MARKET BEFORE PATENT EXPIRATION.
THIS TYPE OF LEGAL JEOPARDY IT'S
GOING TO PUT.
GENERIC COMPANIES IN A POSITION
OF HAVING TO DECIDE.
WHETHER OR NOT THEY CAN
AGGRESSIVELY ATTACK.
THE BRAND'S PATTON THAT IS THAT
EXIST.
THE NUMBER OF PATENTS ON ON
DRUGS IT HAS GROWN EXPONENTIALLY
OVER THE OVER THE LAST SEVERAL
YEARS.
IT IS VERY DIFFICULT FOR A
EIGHTY DREADED GENERIC TO BE
ABLE TO DEFEAT EVERY SINGLE
PATENT IN ORDER TO COME TO
MARKET IN FACT IF YOU LOSE ONE
CLAIM OF ONE PARTICULAR PATENT.
THAT GENERIC IS PRECLUDED AND
TELL ALL OF THE PATENTS THAT IT
TRIED TO QUESTION HAVE EXPIRED
WE'VE SEEN THIS IN THE TAMOXIFEN
CASE.
PERFECT EXAMPLE ONE COMPANY
SETTLED IT WAS ALLOWED TO COME
TO MARKET FOR NINE YEARS BEFORE
PATENT EXPIRATION.
EVERY OTHER COMPANY ARGUE TO
FINALITY THEY ALL COST.
ONLY ONE GENERIC HAS BEEN PROVED
TO BE ABLE TO COME AT THAT TIME
ON TAMOXIFEN.
THERE IS A GREAT CONCERN OVER
THE WAY THAT THE BILL IS DRAFTED
AND SOME OF THE PROVISIONS I
THANK YOU I KNOW I NEED TO MOVE
ON AND WHILE SOME OF THE OTHERS
TO TESTIFY.
BUT IT JUST OF ONE FINAL POINT
THERE WAS A SEA CHANGE IN SOME
OF THE DATA THAT HAS BEEN CITED
BY THE PROPONENTS THAT OCCURRED
PRIOR HìNH TWENTY TEN STUDY AN
FTC STUDY.
THAT'S DATA THAT IS IS PRE
ACTIVISTS DECISIONS SINCE HE
ACTIVIST DECISION BY THE US
SUPREME COURT.
WE ARE DOWN.
TO FIVE CASES THAT ARE
SETTLEMENT SEVERAL QUESTION AND
AND BEEN IN TWENTY FIFTEEN THE
MOST RECENT THERE IS ONE
SETTLEMENT THAT HAS BEEN
QUESTIONED BY THE FTC. FOR THOSE
REASONS WERE ASKING FOR A VOTE
IN OPPOSITION TODAY PLEASE.
SEVERAL OVER TWO MINUTES BETWEEN
THE REST.
A SHORT LIST SICK ON BEHALF OF
FARM -- PHARMA HAS TAKEN AN
OPPOSE AND LESS AND ENDED
POSITION ON THE BILL INSTEAD OF
GOING OVER BACKGROUND I'M JUST
GONNA GO OVER OUR AMENDMENTS
QUICKLY SO WE HAVE TIMEFOR THIS.
OTHER WITNESS PHARMA HAS TO
AMENDMENTS THAT -- MAKE CHANGES
TO THE FRAMEWORK FOR EVALUATION
OF THE SETTLEMENTS THAT MAKE THE
FRAMEWORK MORE FAIR AND BALANCED
WITHOUT UNDERMINING THE INTENT
OF THE BILL.
THE FIRST IS TO REMOVE THE
EXPANDED PRIVATE RIGHT OF ACTION
THAT IS CREATED AS PART OF AB
EIGHT TWO FOUR AND THE SECOND IS
TO REMOVE SOMETHING CLLED THE
LESS RESTRICTIVE MEANS TEST.
WHAT THIS DOES IS -- FORCE THE
JUDGE WHEN THERE'D WEIGHING THE
BENEFITS AND THE CONS OF THIS
AGREEMENT. TO FIND THAT EVEN IF
AGREEMENT IS PRO COMPETITIVE IF
THEY BELIEVE IT COULD HAVE BEEN
MORE PRO COMPETITIVE THEY WOULD
HAVE TO CONCLUDE IT WAS ANTI
COMPETITIVE. FOR THAT REASON
WE'RE ASKING FOR THAT PARTICULAR
TEST TO BE STRUCK IN FROM THE
BILL ALSO IT IS MORE FAIR AND
BALANCED WE'VE -- ENJOYED
WORKING WITH THE AUTHOR ON THE
SPELLING LOOK FOR TO CONTINUE TO
WORK WITH THEIR OFFICE THANK YOU.
TURN MEMBERS MICHAEL LOAD AND BE
UP THE CIVIL JUSTICE ASSOCIATION
OF CALIFORNIA ARE WE HAVE AN
OPPOSE UNLESS AMENDED WE'VE
ASKED FOR TWO VERY SPECIFIC
AMENDMENTS. TO ALIGN THE BILL
MORE CLOSELY WITH THE
CONTROLLING SUPREME COURT CASE
ON THIS WHICH IS KNOWN AS CIPRO --
CONGRATULATIONS TO THE ANALYSIS
FOR MAKING SENSE OF THIS
INCREDIBLY COMPLICATED LEGAL
QUESTION BUT WE HAVE ASKED FOR
CLARIFICATION THAT THERE BE NO
PRIVATE RIGHT OF ACTION.
BEYOND THE PROVISIONS OF THE
CIPRO LINE OF CASES SECONDLY.
WE HAVE ASKED THAT THE STACKING
OF PENALTIES BE ADDRESSED WHEN
USE WHEN YOU STACK THE STATUTORY
PENALTIES ALONG WITH THE UNFAIR
COMPETITION LAW PENALTIES WE
BELIEVE THE PENALTIES ARE
EXCESSIVE.
WE UNDERSTAND THIS IS MIKE MAY
BE MORE JUDICIARY COMMITTEE.
LINE OF QUESTIONING BUT WE HAVE
ASKED FOR TWO AMENDMENTS AND
UNTIL THEN WERE OPPOSE THANK YOU.
THANK YOU OTHER WITNESSES IN
OPPOSITION.
THANK YOU MISTER CHAIRMAN AND
MEMBERS MORE TOP ON BEHALF OF
BIO COM WE TO HAVE AN OPPOSE
UNLESS AMENDED POSITION.
THANK YOU.
DROUGHT COOK FOR THE CALIFORNIA
MANUFACTURERS AND TECHNOLOGY
ASSOCIATION WE OPPOSE.
THANK YOU.
FACING THE OTHER WITNESSES JUST
BEFORE I TAKE QUESTIONS ONE
THING ICE BECAUSE THIS IS A
FAIRLY COMPLEX BILL I'D SWAT BE
SURE WE'RE ALL ON THE SAME PAGE
ON THIS.
FIRST OF ALL THIS IS ABOUT
ALLOWING GENERICS TO COME THE
MARKET BEFORE THE END OF THE
PATENT THIS IS NOT POST PASS
THIS IS BEFORE THE END OF THE
PATENT NOW.
I UNDERSTAND THE THERE'S A
FEDERAL LAW -- HATCH WAXMAN THAT
CREATES A MECHANISM AND ALSO
CREATE SOME INCENTIVES --
ESSENTIALLY A HUNDRED EIGHTY
DAYS COLUSA TO THE PARADE FOR
THE FIRST GENERIC.
WHO -- CHALLENGE -- BASICALLY
CHALLENGES SUCCESSFULLY
CHALLENGES THE PATENT AND THAT
THE PATENT IS FOUND NOT TO BE --
I GUESS -- SOUND THAT THAT --
THEY THEY WOULD HAVE THE
EXCLUSIVITY AND THAT.
POTENTIALLY THIS BILL IS WORKING
OR WITH THIS MECHANISM TO TRY --
TO TO AFFORD THE OPPORTUNITIES
FOR PEOPLE TO COME AND AND AND
CHALLENGE THE PAN AND THEN ALSO --
COME TO MARKET BEFORE THE END OF
A PATENT NOW THERE'S SOME
DISCUSSION ABOUT HOW THE PATENTS
ON THE NATURE OF THE PATENTS
THAT THE BRAND NAME BUT I JUST
WANT TO BE VERY CLEAR THIS IS
NOT ABOUT THOSE PAT AND WE SAY.
PAY FOR DELAY IS ACTUALLY NOT A
DELAY BEYOND THE END OF THE
PATENT IT'S ABOUT COME THANK YOU
MARK.
GEN X. COMING TO MARKET BEFORE
THE PATENT AND I UNDERSTAND THAT.
YOU KNOW THE CONTENTION IS IS
THAT -- GENERICS ARE BEING
DELAYED FROM COMING AS EARLY
BECAUSE OF BASICALLY SETTLEMENTS
THAT ARE MADE AND THAT -- THAT
WHEN THE ISSUES RELATED TO THE
SETTLEMENTS IS IS THAT.
A IF YOU'RE.
TENCHI PAYING ARE GIVING
SOMETHING OF VALUE AND WE MADE
SOME AND THAT IS TO GET THAT SO
BUT THE YEAH AND IF YOU
BASICALLY THAT YOU SHOULDN'T BE
GIVING SOMETHING TO YOUR
COMPETITOR.
THAT IS IN A CONDITION FOR THEM
STAY ON THE MARKET THAT'S THE
INHERENT ISSUE THAT ALSO COMES
UP.
SO WHAT HAPPENS IS SOMEONE SAYS
I'M GOING TO CHALLENGE THE THE
PATENT -- WE SAY WELL YOU KNOW
WHAT INSTEAD OF GOING ALL THE
THE COURT LET'S SETTLE -- AND
THE ISSUE NOW IS I'M GOING TO
GIVE YOU SOMETHING SO THAT YOU --
BASICALLY STALE THE MARKET IS
PART OF THE AGREEMENT AND THAT
AND TO STAND AS THE SORT OF THE
CORE ISSUE WE'RE DEALING WITH.
HERE WITH THIS BILL AND HOW THE
DIFFERENT INCENTIVES GO BACK AND
FORTH AND SO FORTH AND SO I JUST
WANT TO SAY THAT BECAUSE I THINK
THERE'S SOME AS I WAS TALKING TO
MEMBERS I THINK THERE'S SOME.
MISUNDERSTANDING ABOUT EXACTLY
WHAT THIS BILLS ABOUT THIS IS
NOT ABOUT THOSE PATENT PERIOD
THIS IS ABOUT PRE PAT AND PERIOD
AND THE STRENGTH OF PATENTS AND
THE CHALLENGE CHALLENGES THE
PATENT IN A STRUCTURE THAT'S
BEEN CREATED IN FEDERAL LAW. TO
ACTUALLY ENCOURAGE CHALLENGING
OF THOSE PATENTS AS A WAY -- TO
TO BRING GENERICS TO MARKET
BEFORE THE EXPIRATION THE
REGIONAL PATENTS AND AGAIN WHEN
CAN ARGUE ABOUT.
THEY ARE GRANTED BY THE PATENT
OFFICE SO THEY HAD TO GET
APPROVAL FROM THE PATENT OFFICE
BUT SOME PEOPLE WOULD ARGUE THAT.
SOME OF THESE PATENTS ARE.
YEAH PERHAPS NOT AS SOLID IS.
THEY MAY BE USED AS A WAY TO
DRIVE AWAY COMPETITION AS WELL
BUT THIS AGAIN THOSE ARE PASS
RECOGNIZED BY THE PATENT OFFICE.
SO -- SO IT WITH THAT.
QUESTIONS FROM COMMITTEE MEMBERS
ICE CENTER MITCHELL AND THEN
CENTER STONE OKAY SIR MITCHELL.
PARDON ME IF YOU ALREADY ROUTE
ADDRESS THIS -- MISTER CHAIR --
BUT ASSEMBLY MEMBER WOULD IT'S
MY UNDERSTANDING THAT -- THERE
IS AN INTEREST -- IN EXCLUDING
GLOBAL AGREEMENT FROM THE BILL.
AND COULD YOU JUST TELL ME YOUR
POSITION ON THAT -- I'M I'M NOT
THE TECHNICAL EXPERT ON HIS BUT
I DO HAVE SOMEONE WHO CAN HELP
ME WITH THE ANSWER ON THAT WOULD
BE HELPFUL TO ME.
TO SAID IF I MAY -- AT THE WITH
THE PEN LITIGATION THAT IS THE
SUBJECT OF THE SETTLEMENT
AGREEMENT IS -- CONCERNS US
PATENTS PATENTS ONLY HAVE AN
EFFECT INSIDE THE UNITED STATES
WHAT WE HAVE LEARNED THROUGH
LOOKING AT SEVERAL OF THESE
AGREEMENTS.
IS THE PHARMA COMPANIES ARE NOW
PAYING ONE ANOTHER BY CARVING UP
WORLD MARKETS AND LEADING.
ONE COMPANY TAKE THE US MARKET
AND LETTING THE OTHERS ENTER.
THE REST OF THE WORLD SO IT IS
BEOME A VEHICLE BY WHICH
CONSIDERATION IS TRANSFERRED TO
A GENERIC TO STAY OFF THE US
MARKET SO.
THAT'S WHY WE'RE VERY --
UNRECEPTIVE TO ANY EXEMPTION FOR
GLOBAL SETTLEMENTS.
AND THROUGH THE CHAIR IF -- THE
OPPONENTS CARE TO RESPOND.
NATURALISTIC ON BEHALF OF PHARMA --
I CAN'T SPEAK TO THAT SPECIFIC
AMENDMENT BECAUSE THAT'S NOT
SOMETHING THAT PHARMACY KING BUT
JUST -- TO SHARE THE FEDERAL
TRADE COMMISSION LOOKS AT EVERY
SINGLE ONE OF THESE AGREEMENTS
THAT -- IS REACHED BETWEEN --
BRAND MANUFACTURED IN A GENERIC
MANUFACTURE AND EVERY YEAR THEY
PUT OUT A REPORT THAT SAYS HOW
MANY OF THESE HAD REVERSE
PAYMENTS AND THEM.
AND THEY FOUND IN THEIR TWENTY
SIXTEEN REPORT WHICH IS THE MOST
RECENT ONE THAT ONLY ONE OF
THESE TWO HUNDRED AND SOME
AGREEMENTS ACTUALLY HAD A
PAYMENT IN THEM -- I'M.
EXCUSE ME BUT I WOULD LIKE TO
CORRECT THE RECORD I HAVE THE
FTC THAT'S FINE.
PLEASE SEE THE FTC'S TWENTY
SIXTY REPORT ACTUALLY REPORTED
THIRTY AGREEMENTS OF THE TWO
HUNDRED THIRTY TWO AGREEMENT
SAID RECEIVE WHICH IS A RECORD
NUMBER.
INVOLVED -- POSSIBLE PAY FOR
DELAY ANOTHER SEVENTEEN INCLUDED
POTENTIAL PAY FOR DELAY.
AND WHEN THEY USE THAT TERM THEY
SAID THEY CAN'T TELL FROM
LOOKING AT THE FACE OF THE
AGREEMENTS BECAUSE THEY ARE SO
OPAQUE.
WHETHER SOME OF THE PROVISIONS
ARE ACTUALLY OPERATING AS
DISGUISES FOR THE TRANSFER OF
PAYMENTS SO -- UNFORTUNATELY THE
SETTLEMENT AGREEMENTS ARE NOT A
RELIC OF THE PAST THEY ARE
CONTINUING TO PROLIFERATE.
IN FACT WE HAD A REORD NUMBER
OF SETTLEMENT AGREEMENTS
REPORTED TO THE FTC IN.
TWENTY SIXTEEN THANK YOU MISTER
CHAIR THANK YOU DOCTOR.
OKAY SIR STONE.
I'M SORRY IS MISTERCHAIR --
THAT WAS ONE OF THE STATS THAT
IT THE HEAD ALSO BROUGHT ON
TWENTY MITCHELL. ONE OF THE THE
UPON RESPOND TO THAT OR NOT SURE
I OPENED UP FOR OF THE STORY
[inaudible]
JUST.
MAKE SURE I'M CLEAR ON HOW I
REFER TO THAT. ONE SETTLEMENT --
NUMBER IN.
THE PROPONENTS ARE CORRECT THE
FTC DID FIND. THIRTY TWENTY NINE
OF THOSE THIRTY INCLUDED
SETTLEMENTS INCLUDING THE
LITIGATION EXPENSES.
THE FTC'S RULED AND EVEN THIS
BILL INCLUDES SOME ASPECTS OF
LITIGATION EXPENSES ONCE THOSE
ASPECTS ARE REMOVED THOSE
PROVISIONS ARE REMOVED FROM
TWENTY NINE OF THOSE THIRTY
CASES THAT LEAVES ONE CASE.
THAT'S WHERE.
I GOT IT THE REASON I BROUGHT UP
THAT NUMBER.
OKAY THURSTON THANK YOU I WAS
GOING TO A FOLLOW UP ON THAT AND
I APPRECIATE YOUR YOUR ANSWER SO.
YOU KNOW IT AS I LOOK BACK ON MY
CAREER AND I'VE SEEN.
IN. THIRTY SIX YEARS OF BEING A
PHARMACIST I'VE SEEN.
TREMENDOUS ADVANCES AND AND AND
MEDICAL CARE AND TREMENDOUS
ADVANCES AND AND THE DEVELOPMENT
OF LIFESAVING DRUGS.
AND SO WE WERE TAUGHT IN
PHARMACY SCHOOL THE DRUG COMPANY
GOES THROUGH ALL THIS RESEARCH
INVOLVING THE AT SEVENTEEN YEARS
OF PROTECTED STATUS WHERE YOU
CAN.
YOUR INVESTMENT IN.
AND HOPEFULLY LIKE MOST -- DRUG
COMPANIES TO REINVEST THAT MONEY
TO FIND.
ETHICAL F. AGO EFFICACY CURES
FOR DISEASES AS AN EXAMPLE ALL
USE OF DRUGS OF ALL THE AS AN
EXAMPLE WE HAVE A CURE. FOR
HEPATITIS C. -- NOT AN
INEXPENSIVE DRUG BUT WHEN YOU
LOOK AT THE ALTERNATIVE OF NOT
HAVING THE DRUG.
IT COSTS THE HEALTH SYSTEM IN
INSURANCE COMPANIES A HECK OF A
LOT MORE MONEY -- IN DOING LIVER
TRANSPLANTS IT'S CENTRO
[inaudible]
SO.
IT'S ALSO MY UNDERSTANDING
THROUGH YOUR TESTIMONY.
THAT AS OF TWO THOUSAND NINETEEN-STATISTICS SHOW THAT THESE.
ALLEGE DEALS ARE ARE NONEXISTENT
HOW YOU MADE IT VERY CLEAR TO
YOUR TESTIMONY AS WELL AND THAT --
THE TALKS ABOUT -- DEALS THAT
OCCUR OCCUR IN THE SHADOWS
[inaudible]
BUT ALL THESE.
DEALS HAVE TO BE BROUGHT FORWARD
TO THE FEDERAL TRADE COMMISSION
CORRECT.
THIS IS A TRANSPARENT PROCESS
NOT ONLY IS A TRANSPARENT.
BUT THEY HAVE TO COMMUNICATE
THAT TO THE COURTS.
SO EVEN GUESS HE FURTHER --
LEGAL REVIEW SO.
IS THERE AN INCENTIVE FOR A
BRAND NAME COMPANY THAT HAS.
SEVENTEEN YEARS OF PATENT TO
WORK OUT A DEAL. TO ALLOW A
GENERIC TO COME ON EARLIER PRIOR
TO THE PATENT WHEN THEY ACTUALLY
COULD TAKE A RIGHT TO THE END OF
THE SEVENTEEN YEARS I THINK
THAT'S THAT'S AN APPROPRIATE
BUSINESS THING -- FOR A COMPANY
TO DO.
AND SO -- MY CONCERN HELLO OVER
THE BILL IS THAT.
WHAT HAPPENS IF WE GO THROUGH
THIS PROCESS AND THE FTC FINDS
THAT?
THE PROCESS IS PRO COMPETITIVE
AND THE STATE OF CALIFORNIA
FINDS THAT.
ANTI COMPETITIVE [inaudible]
THEN.
WHAT WE DO IN A STATEMENT LIKE
THAT I DON'T KNOW IF THE AUTHOR
CAN ANSWER THE QUESTION OR?
ANY OF THE PANELISTS BUT I DON'T
BELIEVE AND AND AND I CAN ASK
HER -- ATTORNEYS HERE THAT I
DON'T BELIEVE THAT THE FTC.
DECIDES WHETHER SOMETHING IS PRO
COMPETITIVE OR NOT.
I'M A PART OF THE PROBLEM THAT
WE'RE TRYING TO ADDRESS HERE IS
THAT -- WE HAVE A DIFFICULT TIME
AS AS SPEAKING FOR THE LIKE THE
STATE OF CALIFORNIA FOR GETTING
INFORMATION -- AND SO WE ARE
CHANGING THE ASSUMPTION HERE
WERE SAYING THAT THESE
AGREEMENTS ARE ARE ARE ANTI
COMPETITIVE UNTIL YOU CAN PROVE
THAT THE ART ANTI COMPETITIVE --
WE AT THAT HAS BEEN A
FUNDAMENTAL CHALLENGE FOR THE
ATTORNEY GENERAL'S OFFICE IS TO
BE ABLE TO GET THE INFORMATION
TO REALLY TO REALLY VALUE THAT
BUT AS FAR AS I'M AWARE THE FTC
DOES NOT DETERMINE WHETHER
SOMETHING IS PRO COMPETITIVE --
ON THE BASIS THAT ONE ON THE WAY
THAT WE'RE LOOKING AT I THINK OF
THEIR DIFFERENT AND JEREMY HAVE
A FURTHER CLARIFICATION IN CASE
I DIDN'T SCREW IT UP TO BAT.
WELL I JUST WANNA ADAM AND MAKE
THE RECORD A LITTLE CLEARER NOT
ALL AGREEMENTS GET REPORTED TO
THE FTC FOR INSTANCE AGREEMENTS
INVOLVING BIOLOGICS.
HAVE NOT BEEN REQUIRED TO BE
REPORTED TO THE FTC AN FTCTHE
ONLY THING THAT THE FTC GETS IS
A WRITTEN AGREEMENT.
AND THE WRITTEN AGREEMENT MAY
SIMPLY SAY WE GOT NO
CONSIDERATION THEY DON'T GET ANY
OTHER EVIDENCE SO WHEN THEY DO
THEIR REPORT THAT THEY SENT TO
CONGRESS THEY ARE SIMPLY SAYING
WE LOOKED AT THE FACE OF THE
AGREEMENT [inaudible]
A IT.
EITHER PASS IT IT LOOKS
SUSPICIOUS AND THEY HAVE THIS
NEW BOOK CATEGORY.
THAT IS GROWING EVERY SINGLE
YEAR THAT IS 70% INCREASE IN THE
CATEGORY OF SUSPICIOUS
AGREEMENTS BETWEEN TWENTY
FIFTEEN AND TWENTY SIXTEEN AND
AND THEY DON'T MAKE ANY
DETERMINATION THEY HAVE
ABSOLUTELY NO EVIDENCE BEFORE
THEM OTHER THAN THE AGREEMENT
ITSELF SO THEY NEVER DETERMINE
WHETHER IT'S PRO COMPETITIVE.
AS A PRACTICAL MATTER WITH THE
STATE OFTEN WORKS WITH THE FTC
WE'RE ONLY GOING TO FOCUS ON
THOSE CASES THAT ARE THE MOST
EGREGIOUS AND WE TYPICALLY --
HAVE A HAVING NO DISAGREEMENTS
WHAT THE FTC I CAN'T IMAGINE
THAT SITUATION EVER OCCURRING
THESE CASES ARE SO HARD TO BRING.
I CAN IMAGINE THAT WE WILL BOTH
BE BRINGING THE SAME ACTION WITH
DIFFERENT RESULTS OKAY BUT THE
POINT IS TO FILL THEM TO MENTION
YOU MENTION REPORTING TO
CONGRESS WHICH OFF TO REPORT TO
THE COURTS.
AND TALK ABOUT SUSPICIOUS
AGREEMENTS JUST BECAUSE A
SUSPICIOUS DOESN'T MEAN THEY'RE
DOING SOMETHING UNETHICAL OR
ILLEGAL RIGHT SO I'D LIKE TO
HAVE FARM HAVE A CHANCE TO
RESPOND TO THAT.
TOO THANK YOU SENATOR -- SO IT
THE F. T. C. CAN TAKE ACTION IF
THEY BELIEVE THAT AN AGREEMENT
IS ANTI COMPETITIVE AND THEY
HAVE HISTORICALLY TAKEN ACTION
WHEN THEY BELIEVE CELL.
AND THE FRAMEWORK FOR WHICH THEY
CAN TAKE THAT ACTION WAS CREATED
UNDER FTC VERSES ACTIVIST IN.
TWENTY THIRTEEN IS AB EIGHT TO
FOUR IS PASSED IN CALIFORNIA IT
WILL HAVE A DIFFERENT FRAMEWORK
FOR REVIEWING THESE CASES THAN
THE F. T. C. WILL HAVE. TO
DETERMINE IF THERE IS ANTI
COMPETITIVENESS AND THIS IS WHY
PHARMA IS ASKING FOR AMENDMENTS
TO THE BILL TO MAKE IT THE
FRAMEWORK THAT CALIFORNIA WOULD
USE. TO BE MORE FAIR AND
BALANCED SO THAT WAY IF THEY
JUDGE BELIEVE SOMETHING IS --
NOT ANTI COMPETITIVE BUT BECAUSE
OF THIS LESS RESTRICTIVE MEANS
STATUS BELIEVE LIKE WELL THEY
COULD HAVE COME TO MARKET A DAY
EARLIER SO I HAVE TO CONCLUDE
ITS ANTI COMPETITIVE THIS WOULD
ALLOW THE JUDGE TO CONCLUDE
NATURALLY THAT IT WAS BROKEN.
OKAY JUST A COUPLE MORE
QUESTIONS AND DIRECTED TO ISSUE --
PHARMACY TO MIND.
ARE YOU FAMILIAR WITH THE IMS
INSTITUTE FOR HEALTHCARE
INFORMATICS -- STUDY THAT SHOWED
THAT.
GENERIC DRUGS BEING INTRODUCE --
WERE SAVING BASICALLY SIX POINT
SEVEN FIVE YEARS ON THE AVERAGE
PRIOR TO A PATENT EXPIRATION.
AND AS I ALSO HAVE EVIDENCE THAT
TEVA.
PHARMACEUTICALS.
ROGER -- COMPANY OUT OF ISRAEL
RIGHT IN TWO THOUSAND NINE THAT
SUPPLEMENTS REMOVED A HUNDRED
AND THIRTY EIGHT YEARS OF OF
MONOPOLY PROTECTION AND PROVIDED
A HUNDRED TWENTY BILLION.
IN SAVINGS TO CONSUMERS THROUGH
EARLY GENERIC ENTRY.
SO NO WONDER DO COULD DO YOU
AGREE WITH THOSE -- REPORTS AND
TWO IF THIS BILL WERE TO BECOME
LAW DO YOU SEE THAT THE STATE OF
CALIFORNIA AND CERTAINLY AS
CONSUMERS COULD.
BE PAYING MORE. FOR DRUGS AND
WHAT I THINK THE GOOD AUTHORS
TRYING TO CHEW THROUGH HIS BILL
YEAH THANK YOU FOR THAT QUESTION
SENATOR -- YES I AM FAMILIAR
WITH THE IMS REPORT AND THERE'S
ACTUALLY ANOTHER STUDY IN TWENTY
SIXTEEN OUT OF DUKE THAT LOOKED
THAT THESE CHALLENGES FROM
GENERIC MANUFACTURERS AND THEY
FOUND THAT.
THERE IS BEEN AN INCREASE IN
THESE CHALLENGES AND DURING THAT
SAME PERIOD THE AMOUNT OF TIME
THAT A BRAND IS ACTUALLY ON THE
MARKET HAS DECREASED EARLIER YOU
MENTIONED THAT BRAND.
MANUFACTURERS GET A PATENT FOR
TWENTY YEARS FROM THE TIME THAT
THEY PUT IN AN APPLICATION
THAT'S NOT BEFORE IT COMES TO
MARKET BUT TWENTY YEARS TOTAL
DURING RESEARCH AND DEVELOPMENT
TIME.
THEY FOUND THAT BECAUSE OF THESE
CHALLENGES THE AVERAGE TIME TO
THE BRAND ACTUALLY HAS ON THE
MARKET HAS DECREASED WHILE THERE
HAS BEEN AN INCREASE IN THESE
CHALLENGES.
AND SO CHANGING THE FRAMEWORK
THAT IS GOING TO OCCUR --
DISCOURAGE THE SETTLEMENTS IS
GOING TO LEAD TO LAST GENERICS
GETTING ON TO THE MARKET SOONER
OKAY AND THEN -- LASTLY -- IF
YOU COULD COMMENT ON THAT THE
PRIVATE RIGHT OF ACTION THAT
THAT THAT'S A CONCERN FOR FOR ME
AS WELL I HOPE THE AUTHOR IS
GOING TO WORK WITH YOU ON THAT --
IT SEEMS TO ME THAT -- THIS
WOULD ALLOW ANYONE RIGHT TO
BASICALLY FILE -- LITIGATION.
AND IF WE'RE TALKING ABOUT THE
LEASE IN GETTING GENERICS ON THE
MARKET I THINK -- THAT THIS
WOULD HAPPEN THE REVERSE EFFECT
OF THROUGH THE TREMENDOUS TOWARD --
INVESTMENT IN GOING THROUGH THE
COURTS WITH MULTIPLE.
PLAINTIFFS THAT WILL EVER SEE IT
TODAY OR GET ON THE MARKET.
VERY CONCERNED ABOUT THAT
CORRECT BECAUSE THIS BILL WE DO
BELIEVE THAT THERE IS AN
EXPANDED PRIVATE RIGHT OF ACTION
IN THIS BILL AND WE BELIEVE
BECAUSE THERE IS THE PRESUMPTION
THAT THESE -- AGREEMENTS ARE
ANTI COMPETITIVE BEFORE ANY
OTHER FACTS ARE PRESENTED THAT
WE COULD SEE AN INCREASE IN
LITIGATION AND IF YOU WOULDN'T
MIND I'D LOVE TO HAVE THE PERSON
FROM SEJAK EXPERTISE.
SO I'M AN EXPERT AT KNOWING WHAT
I'M NOT AN EXPERT AT AS I
UNDERSTAND THIS VERY COMPLICATED
BODY OF LAW AGAIN LAID OUT
NICELY IN THE ANALYSIS YOU OF
THIS.
CAUSE OF ACTION WITH THE BURDEN
SHIFTING TO THE DRUG
MANUFACTURER.
UNDER CIPRO THERE WERE FOUR
ISSUES THAT THE PLAINTIFF HAD TO
ESTABLISH WHICH HAS BEEN REDUCED.
TO TWO SO IT'S MAKING IT EASIER
FOR THE PERSON TO BRING THE
ACTION.
AND THEN THE BURDEN SHIFTS TO
THE DRUG MANUFACTURER TO SHOW
THAT IT'S NOT ANTI COMPETITIVE
AND MY UNDERSTANDING IS GOING
DOWN TO TWO IS WHY WE ASK FOR AN
AMENDMENT THAT TO THE EXTENT YOU
HAVE A PRIVATE.
THIRD PARTY PLAINTIFF THAT THAT
THE STANDARDS BE THE SAME AS
ARTICULATED IN THE SERB PRO
DECISION.
THANK YOU AND I GUESS SO LASTLY
FOR THE AUTHOR WAS AS AN
AMENDMENT THAT YOU'RE
CONSIDERING OR ARE NOT
CONSIDERED I'M NOT CONSIDERING
THAT I DON'T BELIEVE THAT THIS
CREATES A NEW PRIVATE RIGHT OF
ACTION -- UNDER THE MY MY
UNDERSTANDING IS -- THAT IT DOES
NOT AFFECT EXISTING PRIDE IRAQ
RIGHT THE PRIVATE RIGHT OF
ACTION UNDER THE CART RIGHT ACT.
I DON'T BELIEVE THAT I DON'T
BELIEVE THIS IS AN EXPANSION OF
THAT -- WE CAN AGREE TO DISAGREE
ON THAT BUT IT'S ALREADY THERE
IN THE CART RIGHT ACT.
AND I'D ALSO I ALSO THE
CONTENTION THAT ARE THE CONCERN
THAT THIS IS GOING TO LEAD TO A
PROLIFERATION OF OF OF LEGAL
ACTIONS I THINK IS I THINK IS IS
IS WRONG.
THESE ARE EXTREMELY EXPENSIVE
CASES TO BRING TO TRIAL IN MANY
CASES IT COULD BE FOUR TO FIVE
TO SIX MILLION DOLLARS FOR
WITNESSES.
LOAN THE EXPERT WITNESSES ALONE
TO PUT THESE TOGETHER SO THIS IS
NOT GOING TO LEAD TO A YOU KNOW
YOU'RE NOT GOING TO HAVE YOU
KNOW.
THE CORNER THE GUY ON THE CORNER
IS AN ATTORNEY BRINGING THESE
BRING THE SUITS OF THE THE
MAJORITY SINCE RUSSIA BEING
COULD BE BROUGHT.
THROUGH THROUGH THROUGH THE
STATE OR A AN EMPLOYEE OF A
LARGE EMPLOYER MAYBE A UNION
TRUST SOMEBODY WHO HAS A VESTED
INTEREST IN.
AND CAN ACTUALLY FRONT THE THE
HUGE COST IS GOING TO TAKE TO
LITIGATE A CASE LIKE THIS SO I
DON'T BELIEVE IT'S GOING TO LEAD
TO THAT KIND OF PROLIFERATION
YOU'RE CONCERNED ABOUT.
I APPRECIATE YOUR EXPLANATION
BUT I KNOW ONE THING.
I KNOW THE DRUG COMPANIES ARE
DEEP POCKETS AND I KNOW THERE'S
A LOT OF ATTORNEYS OUT THERE
THAT MIGHT BE WILLING TO MAKE AN
INVESTMENT TO TRY TO GO AFTER
THOSE DEEP POCKETS.
AND I'M CONCERNED WE MIGHT SEE
SOME FRIVOLOUS LAWSUITS SAID --
GET IN THE WAY OF AND I GUESS I
WOULD JUST SAY -- YOU KNOW.
STOP THE ACTIVITY AND THERE
WOULDN'T BE A NEED FOR THIS SO
THAT IS THE THAT IS A POINT.
THERE WAS A FEDERAL TRADE --
FEDERAL TRADE COMMISSION --
PRESENTATION TO CONGRESS ABOUT
TEN YEARS AGO THAT SAID.
THE PROCESS ISN'T WORKING VERY
WELL THEY ACTUALLY CALLED THE
CALLED OUT AND SAID WE NEED
LITIGATION TO HELP SOLVE THIS
ISSUE.
NOW CONGRESS HAS FAILED TO ACT.
THERE IS A BILL BEFORE CONGRESS
NOW -- BUT WE ALSO KNOW THAT
IT'S REALLY DIFFICULT FOR
ANYTHING TO HAPPEN IN CONGRESS
THESE DAYS.
SO.
THE FEDERAL TRADE COMMISSION
CALLED ON CONGRESS TO ACT.
WE ARE ACTING IN CALIFORNIA IN
YES WE ARE GOING TO CREATE A
DIFFERENT STANDARD A STRICTER
STANDARD WHICH WE ARE WE HAVE
THE RIGHT TO DO IN CALIFORNIA WE
HAVE THE RIGHT.
TO THINGS DIFFERENTLY -- THE
FLOW OF THE FEDERAL THE FEDERAL
LAW IS IS NOT THE CEILING HERE.
WE WE HAVE THE ABILITY TO DO
THAT IN THE BEST INTEREST OF THE
CITIZENS OF CALIFORNIA.
OKAY SO I ACTUALLY -- BEFORE
MILAN TAXI I DO WANT TO CLARIFY
AND IT -- THIS ISSUE SO I
CERTAINLY UNDERSTAND -- THAT
SEJAK THINK STIRS AND THE
EXPANSION OF THE PRIOR ACTION
BECAUSE IT'S EASIER TO BRING
SUIT.
I ADMIT ARE LEDGE COUNCIL
DISAGREES THEY DON'T THINK THAT
THERE IS A CERTAINLY I DON'T
THINK ANYONE SAID THERE'S A NEW
PIRATE ACTION TO QUESTIONS
WHETHER THERE'S AN EXPANDED
PRIVATE RIGHT OF ACTION.
YES THE BILL DOES MAKE IT EASIER
FOR PEOPLE TO BRING SUIT -- BUT
WE THAT THAT'S NOT VIEWED BY
PLEDGE COUNCIL AS AN EXPANSION
THE PRIVATE RIGHT OF ACTION I
WOULD ALSO MENTION THAT YOU'VE
ACCEPTED AMENDMENTS SO THERE'S A
SAID AMENDMENTS ONE AMENDMENTS.
WHO'S SO WE PUT A LITTLE
GUARDRAIL BASICALLY SAYS CLEAR
FIGHTING ANY PENALTIES AWARDED
UNDER THE BILL'S PROVISIONS CAN
ONLY BE RECOVERED BY THE
ATTORNEY GENERAL AND A CREW TO
THE STATE OF CALIFORNIA SO.
SOMEONE WHO GOES AND PURSUE THIS
LAWSUITANY SORT OF PENALTY
ACTUALLY THEY CAN'T GET IT COMES
TO THE STATE SO THE COULD BE A
THIRD PARTY AND AGAIN THIS IS
GOING TO JUDICIARY TO DIG INTO
MORE OF THESE PARTICULAR ISSUES
BUT AT LEAST ONE WE SOUGHT OUT.
ADVICE FROM LEDGE COUNCIL AROUND
THE PRIMARY ACTIONS AN ISSUE
THAT I ACTUALLY YOU KNOW I HAVE
COME TO THE ALSO HAVE CONCERNS
ABOUT.
THE THAT WAS THE EXPLANATION
RECEIVE THE ELSE I THINK THERE
MAY BE SOME DIFFERENCE OF
OPINION IS IT AND I DO
ACKNOWLEDGE THAT SEJAK POSITION
ABOUT.
SAYING THAT WHILE IT IS EASIER I
MEAN THAT'S A SOMETIMES THAT'S
PURPOSE THE BILL TO MAKE HE'S
HERE -- BECAUSE NOTHING BECAUSE
THAT THE GOING TO PROPONENTS NOT
ENOUGH IS HAPPENING IS I THINK A
DAUGHTER JUST MENTIONED AS WELL
BUT THAT IN ITSELF.
THERE'S NOTHING AT ANY THAT IN
ITSELF IF YOU THINK IS AN
EXPANSION.
THAT THESE DIFFERENT THAN
ACTUALLY THERE'S NO OTHER
PROVISION A BILL THERE'S NO
PROVISION A BILL THAT ACTUALLY
IS EXPANDING THE PRIVATE RIGHT
OF ACTION AND AGAIN WE BANDED
AUTHORS IT DOES AGREE TO AN
AMENDMENT THAT SAYS.
THAT TO CLARIFY THAT THE ANY
PENALTIES ACCRUE BACK TO THE
STATE OF CALIFORNIA THE ATTORNEY
GENERAL SO I JUST WANT TO BE
CLEAR ABOUT LEASE WITH THE
THINGS THAT WE'VE DONE IN THIS
COMMITTEE ADDRESSING THAT ISSUE.
AND CERTAINLY PERHAPS YOU DO
SURE WHO'S MORE EXPERTISE MAY
GET INTO MORE OF THAT.
CENTER GROVE.
THANK YOU MISTER CHAIR AND I
APOLOGIZE FOR BEING LATE.
I DO HAVE A COUPLE QUESTIONS --
IT'S MY UNDERSTANDING LIKE IN
NET -- OTHER COUNTRIES TO AVOID
EXPENSE SALUTE EXPENSIVE AND
TIMELY SETTLEMENTS I GUESS YOU'D
SAY -- LITIGATION DELAYS SO THAT
WE CAN DELIVER THE PRODUCTS TO
MARKET.
A BRANDY GENERIC MANUFACTURERS
OFTEN ENTER INTO SETTLEMENT
AGREEMENTS INCLUDE GLOBAL
AGREEMENTS AND THERE'S AN
EXEMPTION YOU DON'T HAVE AN
EXEMPTION FOR WHAT WOULD BE
GLOBAL SETTLEMENTS.
NOT AGREEMENT SORRY SO IS A
REASON WHY YOU DIDN'T TAKE ON
THE GLOBAL SETTLEMENT ISSUE WE
ACTUALLY WE ANSWER THAT QUESTION
WERE HAPPY TO ANSWER IT AGAIN
FOR YOU SORRY I APOLOGIZE ALL
HAVE -- CHERYL TO SPEAK TO THAT.
SO THE REASON WE DON'T HAVE AN
EXEMPTION FOR GLOBAL SETTLEMENTS
IS BECAUSE THE LITIGATION THAT'S
BEEN SETTLED.
UNDER THE HATCH WAXMAN ACT OF
THE B. B. C. I. A. RELATES TO US
PATENTS.
AND US PATENTS ONLY GOVERN
COMPETITION IN IN THE US MARKET.
SO IF WE ALLOW.
THE PARTIES TO CARVE UP WORLD
MARKETS WHAT HAPPENS IS THE
BRAND.
CAN HEY THE GENERIC TO STAY OFF
THE US MARKET AND LET THEM
COMPETE IN THE REST OF THE WORLD
AND WE'VE ACTUALLY SEEN
INSTANCES OF THAT.
ON IN IN THE INSULIN DRUGS WHERE --
ONE INSULIN MANUFACTURER HAS
AGREED TO STAY OFF THE US MARKET
BUT IS COMPETING IN ALL THE
WORLD MARKET SO WE DON'T WANT IT
TO BE.
A VEHICLE FOR THE TRANSFER OF
CONSIDERATION -- PAYMENT
[inaudible]
IN RESPONSE [inaudible]
EITHER -- YES PEOPLE KEEP A
BRIEF BECAUSE WE ADDRESS THIS
ISSUE BEFORE.
IT DIES YEAH SURE -- THANK YOU.
ALL HAVE TO EXPLORE SO LITTLE
IGNORANCE ON THE INTERNATIONAL
MARKETS BUT I CAN SAY IS THAT
THESE DO NOT.
HAPPEN IN SECRET THE SUB TYPES
OF SUPPLEMENTS THAT THEY DON'T
OCCUR THAT WAY THEY ARE REPORTED
TO THE FTC THE FTC DOES REVIEW
THEM AND THE LATEST DATA.
SHOWS AND WE DO THIS DISCUSSES
EARLIER AGAIN -- TO WAS DOWN TO
ONE SETTLEMENT THAT THEY CALLED
INTO QUESTION.
IN SOME AS FAR AS GLOBAL AND AND
AND COMPANIES CUTTING UP THE THE
WORLD MARKET -- YOU KNOW AS I
CERTAINLY CAN'T SPEAK TO THAT
INSULIN WAS MENTIONED THERE ARE
NO GENERIC OR BIOSIMILAR
INSOLENCE IN THE UNITED STATES
YET.
WE'RE WORKING VERY VERY HARD.
TO BRING THOSE FORWARD -- BUT
IT'S IT'S A VERY DIFFICULT DRUG
AND IN FACT THE FDA'S CHANGE THE
PATHWAY TO BE ABLE TO DO THAT --
AND SO THAT'S WHAT REALLY THE
DELAY IN INSULIN PRICES HAVE
BEEN OR INSULIN -- GENERIC DRUGS
OR BY -- SELLERS COMING TO
MARKET.
pSOME SORT OF GLOBAL AGREEMENT.
THANK YOU.
AM I GUESS I HAVE A CONCERN THAT --
IF YOU'RE LEGISLATION IS WRONG I
MEAN IF IT'S WRONG AND IT
DOESN'T PROVIDE CONSUMERS WITH --
GENERIC DRUGS AVAILABLE ON THE
MARKET AM I THINK YOU NEED A
BACKUP PLAN BECAUSE YOU KNOW
LOOKING AT THE INFORMATION THAT
I HAVE IT IT'S GONNA ACTUALLY
ADVERSELY AFFECT BRINGING
PRODUCTS TO MARKET.
FROM A GENERIC STANDPOINT AND
SORRY I WISH THERE WERE SOME
TYPE OF BACKUP PLAN BUT I DO --
I DO AGREE WITH SENATOR STONE
AND I THINK THE CHAIR FOR
CLARIFYING THE AMENDMENTS ON THE
PRIVATE RIGHT OF ACTION BECAUSE
IT'S ABOUT THE SETTLEMENT IT'S
NOT ACTUALLY IT'S ABOUT THE THE
COST OF LITIGATION AND COMING TO
A SETTLEMENT AGREEMENT.
AND SO I AM GLAD THAT IT'S NOT
GOING TO A THIRD PARTY OR
SOMEONE WHO BRINGS THE THE
LAWSUIT BUT IT COMES BACK TO THE
STATES SO THERE'S NO.
YOU KNOW -- ACTION I GUESS THAT
THE ATTORNEYS WOULD HAVE.
TO YOU KNOW WHEN YOULOOK AT A
FIFTY MILLION DOLLAR SETTLEMENT
YET 33% PLUS THIRD PARTY
ADMINISTRATION FEES THAT ARE IN
YOUR OWN HOUSE PER SE.
THEN THAT'S A HUGE ISSUE BUT AT
IS THERE ANY CHANCE OF THAT CAN
GO TO FEDERAL COURT HAS WELL
WHICH ONCE AGAIN WE WE WOULD
LOVE TO HAVE THE FEDERAL
GOVERNMENT ENGAGE IN ACTUALLY
COME UP WITH THE LAW WE'VE BEEN
WAITING FOR THAT TO HAPPEN FOR
MANY YEARS AS I SAID.
EARLIER THE FTC IS CALLED UPON
CONGRESS TO TO CHANGE THE LAW
AND CONGRESS FAILED TO ACT
THAT'S WHY WERE ACTING HERE IN
CALIFORNIA.
THE REALITY IS IF SOMEHOW WE WE
WE WE OFTEN DO THINGS AND LET IT
THAT LEGISLATION THAT.
THAT REQUIRE US TO GO BACK AND
MAKE ADJUSTMENTS TO WE HAVE THE
ABILITY TO DO THAT -- AND I
WOULD I WOULD SAY THAT IN THIS
CASE IF WE FIND THAT THE THINGS
ARE WORKING EXACTLY THE WAY WITH
YOU WE WILL GO BACK AND DO THAT
AND I HAVE DONE THAT WITH OTHER
PIECES OF LEGISLATION SO.
I'M NOT GONNA SAY THAT
EVERYTHING IS PERFECT FROM
BEGINNING I WOULD IMAGINE
THERE'S PEOPLE ON THE DíAS WHO
HAVE BILLS I THOUGHT WERE
PERFECT WE FOUND OUT THAT
SOMETHING WASN'T QUITE RIGHT.
MAYBE NOT YOU CENTER.
BUT BUT BUT YOU KNOW THE THE
READOUT THE REALITY IS THAT THIS
IS -- THIS THIS IS AN ISSUE AND
AND WE ARE WE ARE TAKING.
AND I AND I WOULD SAY I WOULD
SAY JUST IN GENERAL WHAT IS WHAT
IS FASCINATING ABOUT THIS TO ME
IS THAT.
THE PREMISE ON WHICH ROBIN IS
REALLY VERY SIMPLE -- I THINK
THE OPPOSITION IS THAT A VERY
GOOD JOB OF TRYING TO MAKE IT
MAKE IT REALLY CONFUSING AND
THAT'S AND THAT'S DISAPPOINTING.
I DON'T I I I HAVE TO DISAGREE
ON GETS CONFUSING I JUST THINK
THAT YOU MAYBE HAVE ONE BAD
APPLE AND THEN YOU'RE TRYING TO
RAINY IN AN ENTIRE INDUSTRY.
THAT -- HAS BEEN COMPLIANT WITH
THE LAW AND NOT PAY THIS PAID A
DELAY OR WHATEVER YOU WANT TO
CALL IT I MEAN THE MAJORITY OF
THE CONTRACTS OF THE SETTLEMENTS
HAVE GONE FORTH AREN'T LIKE THAT
BASED ON THE EVIDENCE THAT WE'VE
SEEN -- THAT SO I'VE BEEN SHOWN
SO I THINK THIS ONE OR TWO BAD
APPLES THAT HAVE BEEN REFERENCED
HERE DOESN'T REQUIRE LEGISLATION
TO TO REGULATED ENTIRE INDUSTRY
THAT COULD DELAY CONSUMER
PRODUCTS FROM THE OR GET FROM
THE FROM THE GENERIC SIDE TO
COME TO THE MARKET.
AND WHEN I LOOK AT THE
MANUFACTURER WHETHER IT'S
GENERIC OR NOT GENERIC THE
INVESTOR TREMENDOUS AMOUNTOF
MONEY -- AND ALL THE FAILURE IN
WHAT THAT COST THEM TO DEVELOP A
DRUG THAT THAT HAS THE
OPPORTUNITY TO WORK AND SAVE
LIVES AND YOU KNOW THAT'S A
SIGNIFICANT INVESTMENT YOU HAVE
TO BILL TO MAKE YOUR MONEY BACK
SOMEHOW.
AND IF THAT MEANS YOU HAVE A
PATENT ON IT FOR TWENTY YEARS
AND YOU GET TO CREATE THAT
REVENUE JUST FOR YOURSELF.
THEN THAT'S A BUSINESS
OPPORTUNITY -- THAT CREATES --
BUT THE PAYS THE BACK FOR THE
INVESTMENT THEY MADE TO BE ABLE
TO SAVE PEOPLE'S LIVES -- AND TO
HAVE THE ATTORNEY GENERAL IN
THIS PIECE OF LEGISLATION STEP
IN AND STOP ALL OF THAT FROM A
BUSINESS STANDPOINT I THINK ITS
INTERFERENCE FROM GOVERNMENT
THAT SHOULDN'T BE.
ALLOWED I THINK WHAT DOES AGREE
TO DISAGREE I WOULD SAY THAT --
THAT IF WE WERE TALKING ABOUT
THE PRIMARY PATTON COMPOUND
PATTON -- YEAH MAYBE THAT MAYBE
SOME OF THE LINE IT WOULD WOULD
LET LINE OF THINKING MIGHT BE
MORE APPROPRIATE.
BUT THIS COULD GIVE AN EXAMPLE --
TRUE BOTTOM -- MADE BY KELLY AT
WAS ON THE MARKET IN -- NINETEEN
EIGHTY SEVEN I BELIEVE -- WE ARE
STILL -- BECAUSE OF TWEAKS AN
ADDITIONAL COMPOUNDS THAT HAVE
GONE ALONG THIRTY TWO YEARS
LATER THAT IS STILL UNDER PATENT
PROTECTION.
SO THERE IS A THERE IS THERE HAS
BEEN AN AGREEMENT REACHED TO
BRING A GENERIC TO MARKET A
COUPLE YEARS SOONER.
BUT WE'RE WELL BEYOND THE
SEVENTEEN YEARS OF PATENT
PROTECTION HERE.
AND SO I HAVE ASKED I HAVE ASKED
THE OPPOSITION IF YOU HAVE
SETTLEMENT AGREEMENTS THAT BRING
SOMETHING TO MARKET CLOSE --
SOONER.
IT WHICH WHICH IS.
WHICH IS PART OF THIS BILL.
THEN SHOW ME PLEASE SHOW ME THAT
IS PRO COMPETITIVE SHOW ME THAT
IT'S GOOD FOR THE CONSUMER AND
NOT NECESSARILY JUST GOOD.
FOR THE MANUFACTURERS.
AND SO FAR NO ONE HAS BEEN ABLE
TO PROVIDE THAT EVIDENCE TO ME
[inaudible]
YES MA'AM.
MATHIS AND I'M JUST JUST JUST
JUST BRINGING IT AT JUST
BRINGING IT. TWENTY THIRTY YEARS
LATER -- TO THE MARKET A COUPLE
YEARS SOONER.
IS NOT NECESSARILY PRO PRO
COMPETITIVE CONSUMERS.
YES MA'AM THANK YOU SENATOR AT
AT THE HEART OF THIS IS IF THAT
LITIGATION BETWEEN THE GENERIC
AND THE BRAND WENT ALL THE WAY
TO COURT.
WHAT WOULD THE COURT DECIDE WITH
THE COURT DECIDE THAT THE PATENT
WAS VALID IN THERE FOR THE
GENERIC HAD TO STAY OFF THE
MARKET OR NOT?
AND IN THE MAJORITY OF CASES
WHEN THESE GO ALL THE WAY TO
COURT BRAND MANUFACTURERS WHEN.
AND SO THE GENERIC IS NOT ABLE
TO COME TO MARKET INTEL THAT
PATENT EXPIRES THE SETTLEMENTS --
WHILE THE GENERIC TO COME TO
MARKET SOONER.
THAT'S MY UNDERSTANDING TOO
THANK YOU AND THE OTHER IN.
SORRY.
ANY OTHER QUESTIONS COMMITTEE A
CENTERS ON OF A RECALL OF SO I I
HEARD A A FACT THAT -- THE PAD
PROTECTION AND UP FOR A DRUG
IT'S MANUFACTURED IN THE UNITED
STATES IS COVERED BY PATENTS AND
JUST THE UNITED STATES.
AND THAT'S NOT MY UNDERSTANDING --
WHEN YOU HAVE -- A DRUG LIKE
SAVOLDI -- MADE IN THE UNITED
STATES WHAT IS COVERED IN A
PATENTED MEAN THAT -- FRANCE
COULD -- JUST COPY THE DRUG A
COLOR DIFFERENT NAME ANDAND I'M
MARKET AND MY AND MY CORRECT IN
THAT ASSUMPTION.
THANK YOU SENATOR FOR THE
QUESTION.
I BELIEVE THAT EACH COUNTRY HAS
THEIR OWN APPROVAL PROCESS FOR
THE DRUGS SO WHEN YOU DO GET
SOMETHING APPROVED IN THE UNITED
STATES IT'S JUST FOR THE US
MARKET PLACE AND THEN COMPANIES
WILL MAKE DECISIONS.
VOTER ON APPLICATION OF THE
COUNTRIES OF SERVICE CERTAINLY A
GLOBAL DRUG COMPANY THEY'RE
GOING TO PROTECT.
THEIR INTERESTS BY HAVING THIS
PATENT PROTECTION WHICH BRINGS
BACK AGAIN I KNOW IT'S NOTSHERMAN ABOUT THESE GLOBAL
SETTLEMENTS -- THESE DO AFFECT
GLOBAL COMPANIES THAT HAVE
GLOBAL PATENTS -- AND I DON'T
SEE THE EFFICACY -- OF OF
EXCLUDING THEM -- ALSO -- IT WAS
IT.
NEWS TO ME THAT -- WHEN YOU HAVE
A PRIVATE RIGHT OF ACTION THAT
THE BENEFICIARY THE AWARD COULD
BE SOMEONE OTHER THAN THE
PLAINTIFF?
SO MY QUESTION COMING FROM A
PHARMACIST AND NOT AN ATTORNEY
AND IS A PROBABLY MORE FOR YOU
DID YOU DID YOU DID YOU SHERRY
BUT WHAT IF YOU FILE THE CASE IN
FEDERAL COURT AS A PRIVATE RIGHT
OF ACTION.
DOES THE STATE LAW.
IF THIS COMES INTO LAW COME INTO
EFFECT WHERE THE STATE BECOMES A
BENEFICIARY OF ANY AWARD.
OR IF IT'S FILED IN A FEDERAL
COURT DOES THE PLAINTIFF IN THE
PLATE IS ATTORNEY AT A
PERCENTAGE OF COURSE OF THAT
AWARD.
THAT'S A GOOD QUESTION
UNFORTUNATELY I DON'T HAVE AN
ANSWER BUT I CAN LOOK INTO IT
FOR YOU AND GET BACK TO YOU.
DO YOU HAVE AN ANSWER FOR I'M
NOT SURE.
MISTER CHAIR THROUGH THE CHAIR
MICHAELA FOR SEE JACK BUDGET AND
NO THEY'RE TURNING GENERAL'S
OFFICE HAD AT THE FIRST ANSWER
TO THAT QUESTION.
RIGHT I UNDERSTAND THIS IS A
STATE LAW I DON'T KNOW OKAY TAKE
THIS A FEDERAL COURT I MEAN THE
TO TO ADDRESS US OURSELVES
QUESTION RIGHT YOU COULD BE IN
FEDERAL COURT IF YOU PLAYED BOTH
A FEDERAL ANTITRUST CASE.
AS WELL AS THE STATE AND I TRUST
CASE.
OF THIS LAW WOULD GOVERN THE
NINETY JUDICATA SAN.
OF THE STATE CASE AND FEDERAL
LAW WOULD GOVERN THE JUDICATA
AND AT THE FEDERAL CASE SO UNDER
THE FROM THE STATE -- LAW IT
THIS FOR WORK WERE TO BECOME LAW --
ANY PLAINTIFF TO GET RECEIVED AN
AWARD THE STATE WOULD BE THE
CUSTODIAN OF THAT AWARD CORRECT.
WELL UNDER THIS LAW THE PENALTY
ONLY A CRUISE TO THE ATTORNEY
GENERAL.
SO A PRIVATE PLAN F. COULD NOT
CLAIM ANY PENALTIES UNDER ABA
TWENTY WHY DO WE HAVE A PRIVATE
RIGHT OF ACTION IF IT'S ETERNAL
GENERAL IT'S BASICALLY THE
BENEFICIARY OF ANY AWARDS.
WHAT THE WE DO NOT CHANGE THE IT
WE DO NOT CREATE A NEW PRIVATE
CONSERVE ACTION?
ASSEMBLY SO YOUR YOUR YOUR
POSITION IS THERE IS NO PRIVATE
RIGHT OF ACTION IN THIS BILL.
NO THEY THERE IS THERE IS A
PRIVATE RIGHT OF ACTION BUT
THAT'S THE SAME AS THE EXISTING
LAW UNDER THE CART RIGHT AT OKAY
SO THEY CAN SEEK RELIEF AS SAME
AS THEY WOULD UNDER THE CART
RIGHTACT -- WHICH THEY'VE BEEN
ABLE TO DO IN OTHER ANTI TRUST
CASES AGAINST PHARMACEUTICAL
COMPANIES.
THE OTHER THING THAT WE'RE
TALKING ABOUT IS THERE'S A
PENALTY THAT ONLY THE ATTORNEY
GENERAL CAN GO AFTER AND SEEK SO
A PRIVATE PLAINTIFF CANNOT SEEK
AS A MEANS OF RELIEF THAT
PENALTY OKAY.
I KNOW DRUGS I DON'T KNOW.
EXCEPT THAT MISTER CHAIR.
AGAIN I THINK THIS NEEDS FURTHER --
IS GOING TO JIM MASTICATION --
WE MIGHT BE TALKING ABOUT
PENALTY VERSUS DAMAGES YOU CAN
ALSO GET A CLAIM UNDER THE
UNFAIR COMPETITION LAW.
AND I'M NOT SURE THAT THAT HAS
TO GO TO THE STATE SO WE MAY BE
TALKING ABOUT DIFFERENT TYPES OF
RELIEF.
CAN I JUST ADDRESS AT ONE POINT --
WE'VE EXPLICITLY SET IN THE BILL
THAT THE ATTORNEY GENERAL CAN
ONLY RECOVER PENALTIES ONCE SO --
WE WOULDN'T WE WOULDN'T WE COULD
EITHER GET THE PENALTIES AS THEY
ARE IN THE BILL OR UNDER YOU SEE
OUT BUT WE COULDN'T DO TWICE ME
SPECIFICALLY TO THAT.
RIGHT OKAY ALL RIGHT SO I'D THAT
AND THIS IS HEALTH COMMITTEE --
OTHER I REALIZE IT'S REALLY
IMPORTANT TO THIS BILL PERHAPS
WILL LEAVE THE LEGAL DISCUSSION
FOR JUDICIARY AMENDMENTS THAT WE
CLARIFY THAT YES UNDER THE CAR
RIGHT ACT.
THAT'S WE EAT OUT.
BUT COUNSEL STATED THERE'S NO --
EXPANSION OF THE PRIVATE RIGHT
OF ACTION WE HEAR WHAT SEE JACK
SAID THAT THEIR VIEWS THAT YOUR
VIEW -- TINK OF REPRESENT
CORRECTLY FROM YOUR TESTIMONY IS
THAT.
YOUR EXPENSES BECAUSE IT'S
EASIER TO CARRY THE SUIT BUT NOT
BECAUSE OF ANYTHING ELSE OKAY.
ANY OTHER QUESTIONS FROM
COMMITTEE MEMBERS.
OKAY THE BILL'S BEEN MOVED.
WAS THERE SOMETHING YOU WITH
WELL I AGAIN AT THAT'S TO KEEP A
REALLY BRIEF YEAH.
JUST ROLLED JERRY JUST VERY
BRIEFLY THEN.
I STARTED MY TESTIMONY WITH WE
AGREED WITH.
PURPOSES AND LIMITING PAY FOR
DELAYED THIRD LARGE AN
UNJUSTIFIED PAYMENTS THIS BILL'S
GOING WAY BEYOND THAT THESE ARE
CONTENTIOUS FIGHTS BETWEEN.
THE GENERIC MANUFACTURE AND THE
BRAND MANUFACTURER WE'RE
CHALLENGING THEM THEY'RE SUING
US IN COURT OUR GOAL FOR THOSE
WHO BELIEVE THAT SHOULD THAT
MANUFACTURES ARE HERE TO MAKE
MONEY GENERIC MANUFACTURERS MAKE
MONEY BY SELLING DRUGS.
GRANTED WE ONLY MAKE 20% OF THE
TOTAL DRUG REVENUE.
EVEN THOUGH WE'RE 90% OF THE
MARKET.
WE WANT TO SELL DRUGS WE ARE NOT
IN THIS JUST TO GET A SUPPLEMENT
TO GO HOME.
AND THAT'S WHY WE'RE CONCERNED
ABOUT THIS BILL.
THANK YOU SO -- SEEN NO OTHER
QUESTIONS FIRST OF ALL --
DECEMBER WOULD -- IS A FELLOW
HEALTH CREATURE ALWAYS
APPRECIATE YOUR OFFERS OF
IMPROVEMENTS TO MY BILLS THANK
YOU -- AND I HAVE YOUR DOCTOR
CAN THANK YOU.
ALL RIGHT THE MOVE THAT OFF THE
TABLE NOW.
HOWEVER I DO UNDERSTAND CENTER
MITCHELL'S BILLS ALWAYS PERFECT
ON THE SECTION SO I I I WAS THE
KNOWLEDGE THAT.
OKAY -- SO FIRST WHAT I WANT
THANK YOU FOR WORKING WITH MY
STAFF I AND MY THANK YOU FOR
AGREEING TO TAKE THE AMENDMENTS --
WE'VE OFFERED -- SAID THE VERY
MENTION THE ONE TO JUST CLARIFY
ON THE PENALTY IN THE PRAYER OF
ACTION WE ALSO.
RECOGNIZE THAT WE WANT TO TRY
SOME CLARITY.
ABOUT SOME PROVISIONS -- THAT --
BECAUSE THE ORIGINAL BILL THAT
SAY IF YOU OFFER ANYTHING OF
VALUE THAT THINGS THAT.
IN OUR MIND -- THAT -- I'M NOT
DOING A ROYAL WE I'M DIANE.
COLLECTED BY STAFF THAT -- SO WE
HAVE SOMETHING SO FOR EXAMPLE
ALLOWING A GENERIC TO COME THE
MARKET EARLIER IS OF SOMETHING
OF VALUE TO THE GENERIC BUT THAT
IS THE WHOLE PURPOSE OF WHAT
WE'RE TRYING TO ACHIEVE SO THAT
SHOULD NOT BE COUNTED AGAINST --
THE PHARMACEUTICAL COMPANY THAT
THEY OFFERED THAT IN A
SETTLEMENT RATE THAT'S ACTUALLY
WHAT WE WANT TO HAVE HAPPEN.
RIGHT -- BE ABLE TO PROVIDE SOME
LITIGATION -- RELEASED BECAUSE
OF THE EXPENSE THAT THE GENERIC
HAD TO PUT UP TO THE NATIONALLY
PURSUE SHOULD NOT BE CONSIDERED --
THE IDEA THAT IT'S A DEAD OR FOR
GIVING AND YET -- COSTS THAT
WERE SO SO WE PUT THOSE ARE THE
AMENDMENTS -- SO WE WANT TO
CREATE SOME CLARIFICATION AS TO
THINGS THAT COULD BE CONSIDERED
A VALUABLE BUT REALLY ARE IN
LINE WITH I THINK THE GOAL OF
THE POLICY WHICH IS TO TRY.
TO CREATE AN OPPORTUNITY FOR
JACK TO COME TO MARKET -- OF
EARLIER -- AS INCENTIVIZE BITE
THE FEDERAL HATCH WAXMAN ACT SO --
SO APPRECIATE YOU TAKING THE
AMENDMENTS -- AND WHY NO IT
DOESN'T SATISFY ALL OF THE
CONCERNS OF THE OPPOSITION I
LEAST I THINK THAT -- WE DO ALSO
WHILE WILL AND APPRECIATE THE
ATTORNEY GENERAL -- IS
INTERESTED AND AND ACTUALLY
STILL AND RECOGNIZE THE
CONSTRUCT IS YOU KNOW IT IS A
CHALLENGING I HAVE TO SAY YOU
KNOW -- TO BUT THAT THE
CONSTRUCT IS. TO ALLOW THE
ATTORNEY GENERAL TO BETTER BE
ABLE TO GET INFORMATION LOOK
INTO SETTLEMENTS THAT MAY BE --
THAT THAT WOULD BE ONES THAT
WOULD RAISE COSTS.
FOR FOR THE FOR THE PEOPLE OF
CALIFORNIA PLAN COMES
PHARMACEUTICAL COSTS THAT MAY.
NOT BE NECESSARY IN THE BEST
INTERESTS -- THAT WOULD BE I
GUESS THE BEST INTEREST OF THE
PUBLIC AS WELL -- THAT WOULD --
THAT WOULD THEN BE BORNE BY THE
PEOPLE THE STATE OF CALIFORNIA
SO -- WITH THAT I WANT TO THANK
YOU SO MUCH FOR WORKING WITH MY
STAFF ON THIS ISSUE I KNOW THIS
IS AND HOW THE TECHNICAL I KNOW
IT'S GOING TO JUDICIARY SO THERE
SO MAYBE SOME UP FEEL FOR OUT
PLEASE CLARIFY THIS -- BUT
CERTAINLY -- I WELL I THINK YOU
AND I'M CERTAINLY OF THE
SUPPORTING THE BILL -- THANKS TO
THE GOOD WORK THAT YOU'VE DONE
WHICH LIKE THE CLOTHES -- I
WOULD I WOULD RESPECTFULLY ASK
YOUR AYE VOTE JUST NOTE THAT
THIS IS THE THE PREMISE WHICH
WHICH OPERATING IS IS FAIRLY
SIMPLE -- THE EXECUTION IS A
LITTLE COMPLICATED ISSUE AS YOU
WELL KNOW -- I'M COMMITTED TO
CONTINUE WORKING ON THIS FOR THE
PROCESS WE HAVE TAKEN NUMEROUS
AMENDMENTS -- WE'VE MET WITH
LOTS OF COMPANIES -- AND TO AND
TAKEN INTO CONSIDERATION ANYBODY
WHO BRINGS US.
A SUGGESTION THAT ACTUALLY IS IS
IS GERMANE TO THE PURSUIT OF
WHAT WE'RE TRYING TO DO WE ARE
HAPPY TO DO IF WE ARE.
AND WE ARE POTENTIALLY CREATING
AN UNINTENDED CONSEQUENCE WERE
HAPPY TO ADDRESS THAT AND AND WE
WILL CONTINUE TO DO SO.
I RESPECTFULLY ASK.
OKAY THANK YOU THE BILL'S BEEN
MOVED BY SERRA LEYVA.
THE MOTION IS TO PASS REFERRED
TO THE COMMITTEE ON JUDICIARY --
SECRETARY PLEASE CALL THE ROLL.
HI AN ICE STONE STONE NO
GONZALEZ GONZALEZ I GROWTH.
GROWTH KNOW HER TADO.
HER TOTAL AYE LEYVA LEYVA AYE
MITCHELL.
MITCHELL AYE MONNING RUBIO AYE
RUBIO AYE [inaudible] SIX TWO
OKAY THE BILL AS SIX TWO AND SO
WHAT I THINK GIVEN THE VETS GET
UP THE WHOLE THE ROLE FOR OPEN --
FOR CAPS MEMBERS I SHOULD SAID
THIS EARLIER I'D DIE AND HER
STAGE TEST MAY YOU'RE TAKING
YOU'LL BE ACTUALLY TAKING UP
AMENDMENTS THEMSELVES AND
JUDICIARY COMMITTEE RIGHT.
THANK YOU VERY MUCH SIMILAR
WORDS ALL RIGHT.
THAT'S I KNOW I KNOW YES.
BELIEVE ME I KNOW [inaudible]
OKAY.
SO THE NEXT TO THE BILL -- IS
ITEM NUMBER BY SHE OF TWO MORE
HERE -- SO YOU DO DO I TAKE UP
ITEM NUMBER -- TWO IF I ORDER
NEXT YES OKAY SO LET'S MOVE TO
ITEM NUMBER.
TWO EIGHTY TO NINETY YES.
I AFTERNOON WITH AGAIN.
DOCTORS HEARING MEMBERS.
THE PROPOSAL BEFORE YOU IS NOT A
NEW.
ONE AB TWO NINETY IS VERY
SIMILAR TO SB ELEVEN FIFTY SIX
OF LAST YEAR -- CARRIED BY
MICHAEL WATER IN YOUR COLLEAGUE
SENATOR LEYVA.
SENATOR LEYVA IS MADE BILL MADE
IT TO THE GOVERNOR'S DESK -- BUT
WAS VETOED.
IN MY BILL I'VE INCLUDED
LANGUAGE TO ADDRESS THE VERY
CONCERNS EXPRESSED BY THEN
GOVERNOR BROWN [inaudible]
ADDITIONALLY.
MY BUT MY BY OFFICE THE SPONSORS
AND THE SENATE HEALTH COMMITTEE
STAFF HAVE BEEN WORKING
DILIGENTLY TO ADDRESS THE CHAIRS
CONCERNS AND THAT OF THE
CALIFORNIA MEDICAL ASSOCIATION
REGARDING RATE SETTING.
I WOULD LIKE TO THANK EVERYONE
FOR THEIR HARD WORK ADDRESSING
THIS ISSUE.
I'VE AGREED TO TAKE AMENDMENTS
THAT PROVIDE ARBITRATION AS AN
OPTION TO THE DEFAULT MEDICARE
RATES SO THERE IS AN OPPORTUNITY
FOR PROVIDERS TO MAKE A CASE.
FOR AN ALTERNATIVE HIGHER RATE.
I BELIEVE THIS PROCESS WITH RIDE
AN ALTERNATE TO MARKET
CONTROLLED BY A LIMITED NUMBER
OF COMPANIES THAT DISTORTS THE
REIMBURSEMENT CONTRACTING
PROCESS WHILE OFFERING PROVIDERS
AN OPPORTUNITY TO MAKE A CASE
FOR WHY THE RATES SHOULD BE
HIGHER.
I WILL ALSO BE TAKING AMENDMENTS
TO ADDRESS THE CONCERN ADDRESSED
BY THE OPPOSITION THAT ANY COST
SAVINGS OBTAIN IN THE BILL WILL
JUST ADD TO CAN INSURANCE
COMPANY PROFITS THEY WON'T AS AB
AFTER WE GET DONE I HOPE.
THE BILL THE FINES AND REAP AND
PLACES REQUIREMENTS ON
FINANCIALLY INTERESTED PROVIDERS
THAT DIRECTLY OR INDIRECTLY MAKE
PREMIUM PAYMENTS FOR CONSUMERS --
INSURANCE WITH THE OBJECTIVE AND
OF ENHANCING PROFITS.
HEALTHCARE PREMIUMS ARE READY
TOO EXPENSIVE FOR MANY PEOPLE
AND GIMMICKS BY PROVIDERS ARE
USED TO ENSURE THAT
REIMBURSEMENT RATES ARE HIGHER
THAN THEY SHOULD BE.
I BELIEVE IT'S TIME FOR THE
LEGISLATURE TO INTERVENE.
THE BILL WILL PREVENT PROVIDERS
FROM GAMING THE SYSTEM AS A
MECHANISM TO ARTIFICIALLY
GENERATE THREE TO FOUR TIMES THE
MEDICARE RATE PROVIDING THE SAME
EXACT CARE THEY PROVIDE TO
EVERYONE ELSE.
WHY YOU HAVE ALREADY PROBABLY
ALREADY HEARD ARGUMENTS AND EVEN
ADD TO SCARE PATIENTS ABOUT THE
SYSTEM?
THAT HOW THE SYSTEM OF CARE WILL
COLLAPSE IF THIS BILL PASSES OR
HOW TERRIBLE FOUNDATIONS NEED TO
SEE SUCH -- PROVIDING ASSISTANCE
IN CALIFORNIA I REMAIN
UNCONVINCED THAT THESE THE
LIMITED NUMBER OF PATIENTS
RECEIVING ASSISTANCE UNDER THIS
PROGRAM WILL FUNDAMENTALLY
DISRUPT THE CARE THEY RECEIVE.
AS FOR TERRIBLE SYSTEMS
WITHDRAWING FROM THE CALIFORNIA
MARKET THERE'S CERTAINLY A
DIFFERENCE OF OF OF OF OPINION
IN THE LEGAL COMMUNITY ON THAT
FACT.
MY HOPE THAT THE AMERICAN KIDNEY
FOUNDATION A REVISIT SIR LEGAL
OPINION IN LIGHT OF TO LEGAL
OPINIONS I EVER RECEIVED ONE
FROM OUR LEGISLATIVE COUNSEL.
AND THE OTHER FROM OUTSIDE
CORPORATE COUNSEL THE DO NOT
BELIEVE THAT AB TWO NINETY WILL
IMPACT THEIR ABILITY TO CONTINUE
PROVIDING ASSISTANCE.
THE GAMINGOF THE SYSTEM IS
HARMFUL IN SEVERAL WAYS BUT A
PRIMARY CONCERN IS HOW IT DRIVES
UP THE COST FOR EVERYONE -- BY
SHIFTING RISK TO A FRAGILE AND
COSTLY INDIVIDUAL MARKET.
AB TWO NINETY PREVENT PROTECTS
LEGITIMATE THIRD PARTY PAYMENT
MECHANISMS REMOVES THE
INCENTIVES PROMOTE FOR PROVIDERS
TO GAME THE SYSTEM.
AND ESTABLISHES SAFEGUARDS A
WHOLE PATIENTS WHO MAY HAVE
INADVERTENTLY BEEN CAUGHT UP IN
ONE OF THESE PAYMENT SCHEMES
HARMLESS.
THE BILL DOES NOT PRECLUDE ANY
ENTITY FROM CONTRIBUTING TO A
TERRIBLE ORGANIZATION FOR THE
PURPOSE OF HELPING A PATIENT. TO
PAY FOR THEIR CARE COVERAGE IT
ONLY PREVENTS THAT ENTITY FROM
INCREASING THEIR PROFITS BY
MAKING THESE CONTRIBUTIONS
THROUGH MAKING THESE.
WITH THESE ET WITH THESE
ENTITIES CONTINUE TO MAKE THESE
CONTRIBUTIONS MAY BE THE REAL
INDICATION ABOUT WHETHER THEY'RE
MORE CONCERNED ABOUT PATIENTS OR
PROFITS.
HERE SUPPORT TODAY LARA FEE A
OWES -- FORMER DIVVIED EMPLOYEE.
SERRA FLOCKS OF CALIFORNIA LABOR
FED AND IF THE IF TIME ALLOWS
STEPHANIE WALKEN'S DISSOCIATION
OF CALIFORNIA LIFE AND HEALTH
INSURANCE COMPANIES. SIX MINUTES
WE UNDERSTAND.
EXACTLY SO YOU GUYS FIGURED OUT
ON SIX MINUTES UP IT'S UP.
THANK YOU.
GOOD AFTERNOON CHAIR AND MEMBERS
MY NAME IS LAURA FEE IDEALS.
I WORK FOR DE VITA FOR ALMOST
TWELVE YEARS AS BOTH AS AN
ADMINISTRATIVE ASSISTANT AND AS
AN INSURANCE SPECIALIST.
OVER THE PAST YEARS I WATCHED A
VIDA INCREASINGLY PUSH TO HAVE
MORE COMMERCIALLY INSURED
PATIENTS AND THEIR CLINICS. FOR
EXAMPLE BEFORE THE OPEN
ENROLLMENT PERIOD A FEW YEARS
AGO.
I WAS ASSIGNED TO A NEW TEAM
THAT WAS INSTRUCTED TO PERSUADE.
DIALYSIS PATIENTS TO APPLY FOR
INDIVIDUAL MARKET HEALTH PLANS
FOR WHICH THE AMERICAN KIDNEY
FUND WOULD PAY THE PREMIUMS.
I WAS GIVEN A LIST OF PATIENTS
AND TOLD TO APPROACH THEM.
AT THE CLINIC.
AND PERSUADE THEM.
IF THE VETO WAS TRULY ACTING IN
THESE PATIENTS BEST INTEREST I
WOULD HAVE BEEN TOLD TO SHARE
BOTH THE POTENTIAL BENEFITS AND
DOWNSIDES OF SIGNING UP. FOR
COMMERCIAL INSURANCE HOWEVER I
WAS ONLY TRAINED TO SHARE.
POTENTIAL BENEFITS.
I WAS NOT TOLD TO WARN PATIENTS
THAT THEY MIGHT HAVE HIGHER CO
PAYS OR DEDUCTIBLES I WAS NOT
TOLD TO WARN PATIENTS AT THE
MAIN NET MAY HAVE TO CHANGE
DOCTORS.
I WAS NOT EVEN TOLD TO WARN
PATIENTS BUT THEY NEEDED TO
CHECK WITH THEIR TRANSPLANT
FACILITIES TO MAKE SURE THEIR
NEW COMMERCIAL INSURANCE
WOULDN'T IMPACT THEIR SPOT ON
THE TRANSPLANT LIST.
ONCE I CONVINCED THE PATIENT TO
SIGN UP FOR THE COMMERCIAL PLANS
I GAVE THEIR NAME TO AN
INSURANCE COUNSELOR WHO HELP THE
PATIENT CHOOSE.
THEIR INSURANCE PLAN AND
APPLYING TO HAVE THE A. K. F.
COVER THE PREMIUMS.
THEN IN TWO THOUSAND FIFTEEN I
STARTED AT THE VITA PASADENA
FOOTHILLS.
I WAS TOLD THAT NEW PATIENTS WHO
STILL HAD COMMERCIAL INSURANCE.
HAD TO MEET WITH THE INSURANCE
COUNSELOR INSTEAD OF ME HELPING
TO EDUCATE THEM ABOUT THE OPTION
OF MEDICARE.
THE INSURANCE COUNSELORS FOCUS
WAS GETTING THESE PATIENTS ON
COBRA.
WITH THE A. K. A. PAYING THE
PREMIUMS.
INSTEAD OF EDUCATING PATIENTS
ABOUT ALL THERE ARE OPTIONS.
IT WAS CLEAR.
THAT THE POINT WAS DEFEATED
WOULD GET HIGHER REIMBURSEMENT
RATES FROM COMMERCIALLY INSURED
PATIENTS GOING ON TO COBRA.
I SUPPORT AB TWO NINETY BECAUSE
IT WILL ENSURE THAT THE VITA
DOESN'T HAVE AN INCENTIVE TO DO
WHAT THEY HAD ME DO.
AND THAT WAS PRESSURE PATIENTS
TO SIGN UP FOR COMMERCIAL HEALTH
INSURANCE THAT MAY END UP
COSTING THEM MORE.
AND JEOPARDIZING THEIR
CONTINUITY OF CARE.
I THANK YOU AND I URGE YOU TO
SUPPORT AB.
TWO NINETY MISTER CHAIR MEMBERS
SIR FLOCKS FROM THE CALIFORNIA
LABOR FEDERATION AND WE ARE AND
HERE IN SUPPORT OF AB.
TWO NINETY THE REASON WE SUPPORT
IS BECAUSE THERE ARE CERTAIN
DIALYSIS CLINICS IN CALIFORNIA
THAT ARE EXPLOITING CONSUMER
PROTECTIONS IN THE AFFORDABLE
CARE ACT SO THEY CAN KEEP
PATIENTS ON COMMERCIAL COVERAGE
AND CHARGE INFLATED PRICES.
AND WHAT'S THE IMPACT OF THAT
WHY DO WE SUPPORT THIS BILL.
THE IMPACT IS THAT IT IS DRIVING
UP PREMIUMS IN AN ALREADY
EXPENSIVE MARKET THE ANALYSIS
NOTES THAT THE AMERICAN KIDNEY
FOUNDATION OFFERS PREMIUM
SUPPORT TO ALMOST.
FIFTEEN HUNDRED PEOPLE THAT HAVE
EMPLOYER OR COBRA COVERAGE IN
THE STATE OF CALIFORNIA.
THAT MEANS THAT IT IS EMPLOYERS
IT IS WORKERS IT IS PEOPLE IN
THE STATE OF CALIFORNIA THAT ARE
PAYING THESE HIGHER PREMIUMS
BECAUSE DIALYSIS IS SO EXPENSIVE.
AND THESE CLINICS ESPECIALLY
WANT THE ONES WITH DOMINANT
MARKET POWER ARE ABLE TO CHARGE
THREE TO FOUR TIMES EVEN UP TO
TEN TIMES AS NOTED IN THE
ANALYSIS WHAT THE MEDICARE RATE.
WOULD BE FOR PATIENTS THAT ARE
ELIGIBLE FOR MEDICARE SOME WHO
MIGHT BE ELIGIBLE FOR MEDICARE
AL AS WELL.
SO WE ARE PAYING THOSE HIGHER
PRICES FOR THOSE INFLATED RATES
IN EVERY DISTRICT IN CALIFORNIA.
AND THERE'S AN IMPACT ON THE
PATIENTS IT'S PEOPLE THING -- A
COMMERCIAL COVERAGE IT MUST BE
BETTER IT'S GREAT YOU WANT
COMMERCIAL COVERAGE.
WITH COMMERCIAL COVERAGE THERE
COULD BE A SIX THOUSAND DOLLAR
DEDUCTIBLE THERE'S COPAYS
THERE'S COINSURANCE FOR THE
OTHER ISSUES YOU MAY HAVE WHEN
YOU'RE ON DIALYSIS.
AND DOES PATIENTS ARE ON THE
HOOK FOR THAT WE HAVE AN
AFFORDABILITY CRISIS WE HAVE
TERMS LIKE FINANCIAL TOXICITY.
IN THE THE MEDICAL SPEAR AND
PEOPLE ARE STRUGGLING IN STILL
GOING INTO MEDICAL DEBT ON
COMMERCIAL COVERAGE.
SO WE THINK AB TWO NINETY IS A
SENSIBLE BALANCE BETWEEN
PROTECTING PATIENTS AND ENDING.
BASICALLY A SCAM THAT IS
EXPLOITING THE AFFORDABLE CARE
ACT AND IS REALLY ONLY BEEN HERE
GOING ON FOR FIVE YEARS SO WE
URGE YOUR SUPPORT OF AB.
TWO NINETY JUST REALLY QUICKLY
SEVENTY WATKINS WITH THE
ASSOCIATION OF CALIFORNIA LIFE
AND HEALTH INSURANCE COMPANIES --
WERE HAPPY TO BE HERE IN SUPPORT
TODAY WE SPENT A LOT OF TIME
WITH MANY OF YOU TALKING ABOUT
DALLAS THIS CLINICS BUT WITH
EVERY GOOD BUSINESS MODEL THAT
MAKES A LOT OF MONEY FOR SOMEONE.
WE'VE ALSO SEEN THIS IN THE
SUBSTANCE ABUSE SPACE -- THERE'S
BEEN OTHER BILLS IN THAT SPACE
THAT HAVE COME BEFORE YOU THAT
TALK ABOUT BRINGING PEOPLE IN
FROM OUT OF STATE FINING THEM
NOT FOR COMMERCIAL COVERAGE.
KEEPING THEM ADDICTED IN THE
SYSTEM AND THEN AFTER THE NINETY
DAY TREATMENT PLAN WHAT THEY DO
IS THEY CUT THEM OFF OF
ASSISTANCE THEY END UP HOMELESS
IN CALIFORNIA.
I MEAN I THINK THAT THERE IS
THERE IS A CONCERN TO THE DEGREE
THAT -- THIS BUSINESS MODEL WILL
CONTINUE FORWARD AND OTHERS WILL
PARTICIPATE IN IT TO THE COST OF
EVERYONE THANK YOU THANK YOU.
THANK YOU OTHER WITNESSES IN
SUPPORT NAME ORGANIZATION AND
POSITION.
AFTERNOON TEN VALDERRAMA ON
BEHALF OF AS HE ARE YOU STATE
COUNCIL WE JUST WANT TO THANK
THE CHAIR AND STAFF FOR SOME
REALLY THOUGHTFUL AMENDMENTS AND
MORE IN STRONG SUPPORT.
THANK YOU.
AM J. D. AS ON BEHALF OF HEALTH
ACCESS CALIFORNIA IN SUPPORT
THANK YOU.
CARLOS APART OUR BEHALF OF BLUE
SHIELD OF CALIFORNIA AND SUPPORT
THANK YOU.
JOHN WINGER ON BEHALF AMERICA'S
HEALTH INSURANCE PLANS AND
SUPPORT THANK YOU.
ALL THE MINIMUM THE GOVERNMENT
OR SOMETHING WITH RENTAL AND
YEAH A BILL INTO.
CRISIS THANK YOU.
BETTER TO MEET IS.
THEY LIVE WITHIN.
IN WITH THE FIT IN WITH THE
STATE OF A MELISSA.
THE MELISSA WITH THAT'LL.
YEP FOR YOUR AVE THANK THE THANK
CRISIS THANK YOU.
EMERSON BUT DO A DALLAS IS
PATIENT CARE TECHNICIAN TWENTY
THREE YEARS FROM RIVERSIDE
CALIFORNIA IN SUPPORT OF AB.
TWO NINETY THANK YOU.
BERNARD SO DIRE.
OF THE HOUSES THE COMMISSION FOR
TEN YEARS STRONG SUPPORT AB TWO
NINETY THANK YOU.
MICHAEL BONNER S. C. R. U. U. H.
W. SACRAMENTO OFF STRONGLY
SUPPORT AB TWO NINETY THANK YOU.
ROOM WOMEN IN SACRAMENTO AND I
SUPPORT [inaudible]
THANK YOU.
CARLOS THE TENURE HEALTHCARE
JUSTICE CALIFORNIA DISTRICTS
HE'S I SUPPORT THIS BILL THANK
YOU.
HELLO SO YELLIN MCCURRY YOU'LL
BINGO THEY PUT IN THE CALIFORNIA --
WILL RULE IS TO IS WHAT MANY
SOLD FEDERAL [inaudible]
THE YOUR POOR YOUR OF OF IT IN
THE LITTLE IN THE HE YOU'LL
COULD YOU THE OWNER BUT IT'S
ANOTHER CALL NEARLY SIS ETERNAL
SOMEBODY KNOCK ON THE OTHER
SYSTEM [inaudible]
CRISIS.
SEE WHEN I STARTED ME NUMBER IS
SETTLED BACK IN BATTLE SO EVEN
GONE BATTLE THEY FRESNO BINGO UP
AGAIN BY MILLIE'S OLD BATTLE.
HE IS STILL YEAH BUT YOU'RE NOT
THE MAN I PROPOSES YOU'RE NOT
BAY THEY'LL KNOW INTO ME ESPOSO
FOR YEARS YOU KNOW THEY THE
ALLEY SYSTEM BEING GRASS YES.
THIS.
THIS IS LIKE A THREE YEAR FOR
YELLOW PROPUESTAS.
THE YES.
CLASSES.
LISTING ACOSTA ROMEO MUST BUS
INTO THE ALLEY C. SO THAT THE
CITY DOES SAY SOMETHING ABOUT
THE SACRAMENTO YEP WE GOT UP
WITHOUT A THOSE MOMENT THAT
ACCESS.
CRISIS.
TOM READ FREE WITH THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION IN SUPPORT.
THANK YOU.
NICK LOUISE'S ON BEHALF OF THE
CALIFORNIA ASSOCIATION HEALTH
PLANS IN SUPPORT THANK YOU.
YOUR INBOX BOYD HEALTHCARE
JUSTICE AND A GOOD DIALYSIS
GUARDIAN IN FULL SUPPORT OF THIS
BILL.
THANK YOU.
WELL MY NAME IS JOHN FROM
MADONNA FROM CITY SANTA MARIA --
CURRENTLY RESIDE IN DAVIS GRAD
STUDENTS AND COMMUNITY REGIONAL
DEVELOPMENT I AM IN SUPPORT OF
THIS THE ASSEMBLY BILL.
TO NINETY THANK YOU.
THERESA START KAISER PERMANENTE
A IN SUPPORT THANK YOU.
SENATOR WORD SENATOR PAN.
JEFF TURNED A KIA ADVOCATING FOR
KERA IN PLEASE CHECK IN YOUR
NOTICES TO SEE BECAUSE SOME OF
THEM HAVE BEEN MISPLACED ABOUT
SUPPORTING AN OPPOSITION FOR
KERA.
SO WE PLEASE CHECK IN THERE
WHAT'S GOING ON ELECTRONICALLY.
THAT'S WEBSITE BUT SUPPORTING
THANK YOU.
OKAY -- WITNESSES IN OPPOSITION.
MAKE ROOM AT THE TABLE FOR THEM
AND JUST CLARIFY HOW ME
WITNESSES ARE TESTIFYING HERE.
FOR OKAY SO YOU GOT SIX MINUTES
TO THREE OKAY YOU GOT SIX
MINUTES WILL GIVE YOU A FEW OF
US STATE RAN OVER A FEW EXTRA
SECONDS WE GIVE YOU THAT TIME AS
WELL SO THERE'S EQUAL TIME -- SO
WELCOME [inaudible]
THANK YOU.
MR ERM MEMBERS JERRY HEX
REPRESENTING TODAY THE
CALIFORNIA MEDICAL ASSOCIATION.
IN OPPOSITION AND WE HAVE OPPOSE
THIS BILL BASED ON THE RATE
SETTING COMPONENT THAT HAS BEEN --
IN THIS BILL THROUGHOUT THE
PROCESS AND WE APPRECIATE THAT
THERE WAS AN ATTEMPT MADE TO
ADDRESS THAT PORTION OF THE BILL --
WE DO REMAIN IN OPPOSITION AND
UNFORTUNATELY ACTUALLY BELIEVE
THESE AMENDMENTS MAKE THE BILL
WORSE.
SO IT SEEMS THAT THEY AMENDMENTS
WERE MODELED AFTER AB.
SEVENTY TWO WHICH WAS A BILL
THAT WAS NEGOTIATED WITH CMA IN
AN ATTEMPT -- TO FIX A SITUATION
IN WHICH THERE WAS NO AGREEMENT
ON RATES.
FOR PATIENTS THAT WE'RE OUT OF
NETWORK SO YOU HAVE A PATIENT
THAT BECAUSE THE DOCTOR OUT OF
NETWORK.
THE SENATE BILL FOR A SERVICE AT
A RATE THAT THE HEALTH PLAN DID
NOT AGREE TO THE HEALTH PLAN
PAYS THE PAYMENTS AT A RATE THAT
THE PROVIDER DIDN'T AGREE TO AND
THE PATIENT IS STUCK IN THE
MIDDLE -- THE SOLUTION FOR THAT
PROCESS WAS TO HAVE AN INTERIM
PAYMENT OF A 125% OF MEDICARE.
THAT WAS NEGOTIATED ON IN
AGREEMENT WITH ALL PARTIES
BECAUSE THERE WAS NO AGREEMENT
TO THAT RATE.
WHAT IS THAT PROCESS IS BEING
PLACE TO SB TWENTY FOUR FOUR
SITUATION THAT WE THINK IS
ACTUALLY THE OPPOSITE OF THAT?
IN THIS SITUATION THEIR PATIENTS
TRYING TO CONTINUE THEIR
COMMERCIAL COVERAGE THEY HAVE
BEEN PAYING THEIR PREMIUM AT A
RATE.
THERE IS AN AGREEMENT ALREADY ON
THAT PROVIDER RATE BETWEEN THE
HEALTH PLAN BETWEEN THE PATIENT
THERE'S A CONTRACT IN PLACE AND
WHAT THAT RATE IS.
BECAUSE THE PATIENT CAN NO
LONGER PAY THEIR PREMIUM AND A
THIRD PARTY IS PAYING IT.
THIS BILL WOULD ALLOW THE HEALTH
PLAN TO THEN GET OUT OF THAT
CONTRACT.
HEY RAY AT A MEDICARE RATE WHICH
IS WHAT WE'VE HEARD IS NEGATIVE
1% OF THE ACTUAL COST.
AND THERE'S NOTHING TO MY
KNOWLEDGE IN THE IN THE
AMENDMENTS THAT REQUIRE
REIMBURSEMENTS -- OF PREMIUMS
FOR THAT NEGOTIATED RISK THAT
WAS AND PUT IN PLACE FOR ALL OF
THE PREMIUMS THERE'S NOTHING AND
AMENDMENTS THAT REQUIRE THE
PREMIUMS TO GO DOWN IF THERE IS
A COST SAVINGS.
WHAT WE'RE AWARE OF IS IT DOES
REQUIRE THE THE PROVIDER TO TAKE
THIS INTO RIGHT AT MEDICARE AND
THEN INDIVIDUALLY THEY WOULD
HAVE TO GO TO AN ARBITRATION
PROCESS? TO TRYING TO GET THAT
RATE UP FOR SOMETHING THAT HAS
ALREADY BEEN NEGOTIATED AN ARTY
AGREED ON SO WE BELIEVE -- THE
SET TO A TERRIBLE PRECEDENT WE
ALSO BELIEVE IT HARMS PATIENTS
THAT CAN'T CAN NO LONGER FORM OF
FOR THE PREMIUMS AND RELY ON
THESE CHARITY -- PROGRAMS AND
FOR THOSE REASONS WERE IN
OPPOSITION TODAY THANK YOU.
MISTER CHAIRMAN AND MEMBERS OF
THE COMMITTEE MY NAME IS LEVINE
BURDEN I'M PRESIDENT CEO OF THE
AMERICAN KIDNEY FUND -- A. K. F.
AS A SERVE AN ORGANIZATION THAT
FOR ALMOST FIFTY YEARS HAVE BEEN
HAS BEEN HELPING PATIENTS FIGHT
KIDNEY DISEASE PREVENTION
THROUGH DIALYSIS AND
TRANSPLANTATION.
IN THE STATE OF CALIFORNIA LAST
YEAR WE PROVIDED ASSISTANCE TO
ALMOST FOUR THOUSAND PEOPLE WHO
DEPEND UPON ARC GRANTS TO HELP
PAY THEIR HEALTH INSURANCE
PREMIUMS. FOR THESE PEOPLE ABOUT
HALF FOR HELP WITH MEDICARE AND
MEDIGAP POLICIES.
WE'VE ALWAYS OPERATED THE
AMERICAN KIDNEY FROM WITH THE
HIGHEST STANDARDS ETHICAL
STANDARDS AND EFFICIENCY FOR
THIS WE'VE BEEN REWARDED THE
WITH THE HIGHEST RATINGS FROM
ORGANIZATIONS THAT REVIEW
CHARITY NAVIGATOR.
WE'RE SEVENTEEN YEAR RUNNING
RECIPIENT A FOUR STAR CHARITY
PLACE ENOUGH AMONG THE TOP TEN
CHARITIES IN THE COUNTRY WE DO
ALL OF THIS WITH THE STAFF OF
EIGHTY PEOPLE.
DESPITE OUR GREAT WORKING
COMMITMENT TO PATIENTS AYE
LAWYERS HAVE DETERMINED THAT WE
WILL BE FORCED TO SHUT DOWN IN
CALIFORNIA IF AB TWO NINETY IS
AN ACTIVE.
MY GENERAL COUNSEL IS HERE TODAY.
FIRST I KNOW THAT THERE ARE
DIFFERENT LEGAL OPINIONS ABOUT
WHETHER WE CAN SAFELY CONTINUE
OPERATIONS UNDER AB.
TWO NINE BUT THE ADVISORY
OPINION FOR OUR PREMIUM
ASSISTANCE PROGRAM IS FROM THE
INSPECTOR GENERAL AT THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES AND IS LEGALLY BINDING.
AND REQUIRES THAT WE ACT IN GOOD
FAITH TO COMPLY WITH ITS
ARRANGEMENTS.
SHOULD WE NOT DO SO WE A. K.
YEAH ARE LIABLE TO THE I. G. FOR
SANCTIONS.
YOUR OWN GENERAL COUNSEL ON PAGE
SIX OF ITS LETTER TO CHAIRMAN
WOULD CONFIRMS A CALF CONCLUSION
BUT AB TWO NINETY WOULD TAKE US
OUTSIDE THE PROTECTION OF OUR
ADVISORY OPINION.
WHY WOULD WE SEE AN ORGANIZATION
THAT HAS ALWAYS PLAYED BY THE
RULES STEP OUT ON A LIMB WHEN
OUR BEST JUDGMENT AND THAT OF
YOUR OWN LEGAL COUNSEL SAYS THAT
AB TWO NINETY TAKES US OUTSIDE?
THE PROTECTIONS OF THE I. G..
WHEN THE COUPLE LAW?
BUT AN ABLE THE IG OPINION WAS
WRITTEN I WAS A PRESIDENTIAL
APPOINTEE IN THE CLINTON
ADMINISTRATION AND I CO LEAD AN
EFFORT IN THE DEPARTMENT.
TO DEVELOP THIS LEGISLATION I
CAN TELL YOU THAT OUR CHIEF
CONCERN WAS PROTECTING AGAINST
DISCLOSURE SO THAT PATIENTS
COULD MAKE.
UNFETTERED CHOICES OF THEIR OWN
AS TO THEIR HEALTHCARE PROVIDERS.
NOW A CAMPUS A CAMPUS FORCED TO
SHUT DOWN IN CALIFORNIA.
HERE'S WHAT HAPPENS THE
THOUSANDS OF PATIENTS IF THEY
COULD NOT FIND ANOTHER WAY TO
PAY THEIR PREMIUMS.
MANY WILL LOSE MEDICARE ALL
TOGETHER OR FACE UNLIMITED OUT
OF POCKET EXPENSES IF THEY CAN'T
PAY THEIR MEDIGAP POLICIES.
THOSE WHO DEPEND UPON COBRA MAY
LOSE COVERAGE FOR THEIR ENTIRE
FAMILY.
AND THOSE WHO TURN TO MEDI CAL
MAY BE FACED WITH AFFORDABLE
SPEND DOWN REQUIREMENTS.
MANY WILL LOSE INSURANCE
ALTOGETHER AND HAVE TO SEEK
EMERGENCY DIALYSIS OF HOSPITALS.
FINALLY THERE'S SOMETHING VERY
DISTURBING TO ME.
ABOUT THE FACT THAT FOLKS IN
KIDNEY FAILURE ARE
OVERWHELMINGLY BLACK AND BROWN.
THIS IS NOT TRUE AT THE
BEGINNING STAGES OF THE DISEASE
WHEN IT AFFECTS ALL GROUPS
PROPORTIONATELY.
WHY IS THIS THE CASE?
IT IS BECAUSE WE HAVE A BROKEN
DOWN HEALTHCARE SYSTEM THAT DOES
NOT GIVE PEOPLE THE CARE WHEN
THEY NEED.
I URGE THE COMMITTEE NOT TO
APPROVE. TWO NINETY BECAUSE IT
WOULD FURTHER BREAK THE SYSTEM
AND NOW I WANT TO TURN TO MISTER
RUSSELL HAS UNFORTUNATELY TIME
IS UP IF YOU USED UP ALL YOUR
TIME SO I'VE ONLY TAKE NAME DOES
ORGANIZATION POSITION FROM THE
REMAINING WITNESSES.
MARSHALL STRESSING VICE
PRESIDENT GENERAL COUNSEL FOR
THE AMERICAN CAN BE FOUND.
OKAY AS IN OPPOSITION.
OKAY [inaudible]
THANKS SIR.
SACRAMENTO I'M SORRY OKAY SO
AGAIN NAME.
ORGANIZATION YEAH ONE AND
POSITIONED AND AND WE'RE MOVING
ON RUSSELL DESMOND DIAL SAYS
PATIENT DISTRICTS.
SIX OKAY THANK YOU I ASSUME IN
OPPOSITION YOU'RE HERE TONIGHT
THANK YOU OKAY.
OTHER WITNESSES IN OPPOSITION
PLEASE BACK FROM AGAIN NAME IF
YOU HAVE AN ORGANIZATION
ORGANIZATION AND THEN POSITION.
HI FELICIA GOT ALL I AM FROM
SACRAMENTO AND I'VE BEEN A
PATIENT CARE TECHNICIAN FOR TEN
YEARS AND I AM IN OPPOSITION OF
AB TWO NINETY UPON. FOR MY
PATIENTS THANK YOU.
IS AN DOLAN FROM GRASS VALLEY
CALIFORNIA AND I'M A REGISTERED
NURSE IN CALIFORNIA FOR FORTY
YEARS TEN YEARS OF IT IN
DIALYSIS I OPPOSE THIS OP THIS.
THE PHONE BILL.
THANK YOU.
A GOLD BUCKLE ID NORTH HIGHLANDS
CALIFORNIA AND I OPPOSE AB.
TWO NINETY THANK YOU.
NATALIE SOUTH DATA A MARINO
SOCIAL WORKER AND ON BEHALF OF
MY PATIENTS AYE OPPOSED AB.
TWO NINETY THANK YOU.
TANYA SPURGEON I AM A SOCIAL
WORKER.
AND FROM ELK GROVE I AM OPPOSED
STRONGLY TO AB TWO NINETY M.
BEHALF OF MY PATIENTS.
THANK YOU.
JENNIFER ROBBINS I'M A LICENSED
CLINICAL SOCIAL WORKER IN THE
DIALYSIS FIELD AND I AM STRONGLY
OPPOSED AB TWO NINETY OKAY THANK
YOU.
DONNA THE SO THE I'M A
REGISTERED DIETITIAN IN
pSACRAMENTO AND I ALSO OPPOSE AB.
TWO NINETY THANK YOU.
I'M CIVIL SIMON I'M A SOCIAL
WORKER FOR DIALYSIS MISSION --
STRONGLY OPPOSE A. B. TWO NINETY
THANK YOU.
LOL AS PATIENT ADVOCATE --
SEGMENT OF CALIFORNIAN I OPPOSE
AB TUNING THANK YOU.
HI JAMIE HAIL SACRAMENTO I'VE
BEEN IN DIALYSIS FOR TEN YEARS
AND I STRONGLY OPPOSE AB TWO
NINETY THANK YOU.
I HER JEEP MARTINEZ I'M FROM
STOCKTON CALIFORNIA I'VE BEEN IN
DIALYSIS FOR TWENTY THREE YEARS
AND I STRONGLY OPPOSE AB TWO
NINETY FROM MY PATIENTS THANK
YOU.
HI MY NAME IS LAURA GONZALEZ
FROM STOCKTON CALIFORNIA BEEN A
TECHNICIAN FOR TWENTY THREE
YEARS I OPPOSE.
THANK YOU.
CHAIR MEMBERS ALEX AUTHOR THE
CALIFORNIA HOSPITAL ASSOCIATION
IN OPPOSITION THANK YOU.
ANDRE EVER PADAS FROM SACRAMENTO
AREA I'VE BEEN A DIALYSIS
TECHNICIAN FOR EIGHTEEN YEARS
AND I STRONGLY OPPOSED MY
PATIENCE THANK YOU.
GOOD AFTERNOON MISTER CHAIR JUST
DEPENDS ON BEHALF OF DEFEATED IN
OPPOSITION.
THANK YOU.
HELLO I'M CURTIS ROBINSON HAVE
BEEN IN SACRAMENTO AND I'VE BEEN
A DIALYSIS NURSE FOR ABOUT
THIRTEEN YEARS AND I OPPOSE
EIGHTY TO NINETY THANK YOU.
KERRY GREEN FROM SACRAMENTO
CALIFORNIA AND I OPPOSE AB TWO
NINETY THANK YOU.
GOOD AFTERNOON MY NAME IS DANA
SIERRA MICHELLE AND I AM A
REGISTERED NURSE AND I OPPOSE
EIGHTY TO NINETY THANK YOU.
GOOD AFTERNOON MY NAME IS KELLY
AWESOME WITH DIALYSIS PATIENTS
CITIZENS A NATIONAL NONPROFIT
PATIENT ADVOCACY ORGANIZATION
AND WE OPPOSE AB.
TWO NINETY THANK YOU.
TIM TO THE FROM AUBURN
CALIFORNIA AND I OPPOSE AB TWO
NINETY THANK YOU.
SHOWING ALL HER DOUBTS
TECHNICIAN TWENTY HERE'S MY
OPPOSE AB.
TWO NINETY THANK YOU.
AB LOS STYLES THE SOCIAL WORKER
AND BY ON BEHALF OF MY PATIENTS
AYE OPPOSED EIGHTY TO NINETY
THANK YOU. FOR NINE CAN MALIK
CAM PER CALIFORNIA.
UGH CARE PROVIDER FOR FORTY
YEARS AND I OPPOSE THIS HARMFUL
ASSEMBLY BILL [inaudible]
THANK YOU.
MICHAEL LONG P. R. PCT FOR
FIFTEEN YEARS AND AYE OPPOSED
[inaudible]
THANK YOU.
NOW PHOTO DIALYSIS DIETITIAN AND
I OPPOSE THANK YOU.
STEPHANIE HI MADE OUT OF WOOD IN
CALIFORNIA A SOCIAL WORKER I
STRONGLY URGE YOU TO VOTE NO FOR
MY PATIENTS THANK YOU.
TRICIA PETERSON CARE GIVER IN
ELK GROVE CALIFORNIA -- STRONGLY
IN OPPOSITION OF THIS BILL THANK
YOU.
JOSEPH CITY FROM SACRAMENTO
CALIFORNIA I AM A CARE GIVER IN
DIALYSIS AND I STRONGLY OPPOSE
THIS BILL.
THANK YOU.
AT THE CHAU MUHAMMAD ARMORS
WILLIAM THE CITY I'VE BEEN IN
DIALYSIS FOR FIFTEEN YEARS
TAKING CARE FOR PATIENTS AND I
STRONGLY OPPOSE THIS.
THANK YOU THANK YOU.
SELENA PRIOR CALIFORNIA SEVEN
DOUBLE ACP OPPOSED.
THANK YOU.
WHEN DOES YOUR BEHALF OF PERCENT
AS MEDICAL CARE IN OPPOSITION?
THANK YOU.
MICHAEL ARNOLD ON BEHALF OF THE
CALIFORNIA DIALYSIS COUNCIL IN
STRONG OPPOSITION OKAY THANK YOU
[inaudible]
OKAY -- FOR WE TAKE QUESTIONS I
DO THINK BECAUSE THERE'S SOME
STATEMENTS MADE ABOUT OUR LEDGE
COUNCIL I THINK IT'S IMPORTANT
THAT I ACTUALLY READ WHAT THE
CONCLUSION THE LEDGE COUNTS
REPORT IS JUST SO THAT WE DON'T
HAVE ANY DISAGREEMENTS ABOUT
WELL LET'S COUNT SAID.
SO YOU CAN HAVE DIFFERENT
OPINIONS ABOUT THAT BELIES
PEOPLE DIFFERENT LEGAL OPINIONS
THAT'S FINE I ALSO WANT TO BE
SURE WE HAVE AN ACCURATE READING
OF WHAT THE LEDGE COUNCIL
ACTUALLY SAID.
WHICH WE SOUGHT OUT AND SO THIS
IS THE CONCLUSION OF THE ACTUAL
LETTER DOES OF ROAD FORWARD
READING I'M NOT SO THIS NINE
EDITORIAL COMMENT ANYWAY.
CONCLUSION AND THIS IS A LETTER
THAT WAS ACTUALLY DRESSED TO US
A MEMBER WOODS FROM LEDGE
COUNCIL IN THE STATE'S INCLUSION
IT IS QUOTE IT IS OUR OPINION
BASED ON THE FACTS AVAILABLE TO
US.
THE AMERICAN KIDNEY FUND WOULD
REMAIN IN COMPLIANCE WITH THE
ARRANGEMENT APPROVED BY ADVISORY
OPINION NINETY SEVEN POINT.
ONE ISSUED BY THE OFFICE OF THE
INSPECTOR GENERAL OF THE FEDERAL
DEPARTMENT OF HEALTH AND HUMAN
SERVICES IF ASSEMBLY BILL NUMBER.
290-201-92020 REGULAR SESSION IS
ENACTED AND THE AMERICAN CAN YOU
FUND COMPLIES WITH THE CHANGES
ENACTED BY THE BILL.
HOWEVER THIS WOULD BE A FACTUAL
DETERMINATION MADE BY THE OFFICE
OF THE INSPECTOR GENERAL IT
COULD INVOLVE THE CONSIDERATION
OF FACTS NOT AVAILABLE TO US
UNQUOTE I JUST WANT TO BE SURE
THAT. FOR OUR DISCUSSION THAT
THAT'S THE FACTUAL STATEMENT
FROM THE THAT'S A STATEMENT FROM
THE LEDGE COUNCIL SO WITH THAT
YOUR QUESTIONS FROM COMMITTEE
MEMBERS.
A CENTER STONE.
THANK YOU MISTER CHAIR AND THIS
IS NOT UNCOMMON -- IN SENATE
HEARINGS THAT WE HAVE -- DOOLING
ATTORNEY OPINIONS.
AND WE AS THE ELECTED OFFICIALS
NEED TO COME TO THE CONCLUSION
SO WE FEEL ARE IN THE BEST
INTERESTS OF OUR CONSTITUENTS
BUT WE DIDN'T REALLY GIVE A
LEGAL COUNSEL FOR THE AMERICAN
ASSOCIATION -- TO OPINE ON ON
THAT RULING MIGHT MY CONCERN IS
THAT WE HAVE OF COURSE LET'S
COUNCIL SAYS ONE THING AND I
THINK.
I'M GONNA PREDICT THAT YOU'RE
GONNA SAY SOMETHING PROBABLY TO
THE OPPOSITE -- BUT THE BOTTOM
LINE OF THIS IS THAT -- YOU KNOW.
MS BURTON YOU YOU RUN A FOUR
STAR CHARITY.
THAT -- CATERS TO THE NEEDS OF
FOUR THOUSAND PEOPLE THAT ARE
NOT TRIPOLI -- HILL THESE ARE
PEOPLE THAT HAVE SIGNIFICANT
MORE ABILITY.
AND DISEASE STATES [inaudible]
THAT.
WE NEED THE CONVENIENCE AND
NECESSITY. THREE TO FOUR DAYS A
WEEK.
A GETTING DIALYSIS TREATMENTS
WHICH WE KNOW OR NOT SHE WE KNOW
THAT THERE IS A COUPLE OF
PROVIDERS OUT THERE THAT ARE.
LARGE -- THANK HEAVENS THAT
THEIR LARGER THERE OUT THERE
BECAUSE I REPRESENT A LOT OF
RURAL AREAS.
AND IT MAY NOT BE PROFITABLE.
WAS SOME OF THE POPULATION
CENTERS THAT I HAVE IN MY
DISTRICT THAT OUR ROLE.
THAT CAN REALLY.
ALLOW YOUR CENTER.
MORE COMPETITORS SENATOR TO TO
BE PROFITABLE BASED ON THE
VOLUME OF PATIENTS THAT ARE
THERE SO -- JUST LOOKING OVER.
THE DISTRIBUTION OF YOUR
PATIENTS THAT TO CONTRIBUTE.
VAST SUMS OF MONEY TO AN CENTER
PANS DISTRICT SEVENTY FIVE
PEOPLE AND SENATOR TADO IS
NINETY EIGHT PEOPLE SENATOR
GROVE IS EIGHTY FOUR PEOPLE.
SENATOR LEYVA YOU WIN THE PRIZE
A HUNDRED FIFTEEN CENTER RUBIO
SIXTY SIX SENATOR MITCHELL
EIGHTY TWO SENATOR.
GONZALEZ NINETY SEVEN AND I
MISSED MYSELF HERE MISTER STONE
NINETY NINE SO THAT'S A TOTAL OF
ALMOST.
SIX HUNDRED FIFTY PEOPLE.
NOW -- IF I HEARD YOU YOU PEOPLE
SAY THAT -- WE WOULD BE 1100%
PROTECTED BY A INCREASING THIS
BILL -- I MAY LOOK AT IT THROUGH
A DIFFERENT LIFE BUT I AM NOT
SURE AND I WANT TO TAKE UP A
RISK.
A FOUR THOUSAND PEOPLE THEY'RE
GOING TO BE SCRAMBLING.
AND HAVING TO GO THROUGH BECAUSE
I LEGAL JUDICIAL.
MECHANISMS TO TO GET THEIR
TREATMENT SO -- IF YOU COULD
PLEASE JUST BRIEFLY IN NOT
GETTING INTO A HORRIFIC DETAILS
TAMI.
RIGHT TO THE POINT WHY YOU FEEL
THE INSPECTOR GENERAL.
OPINION -- IS IN CONFLICT WITH
HIS BILL AND WHAT IS THE
POSITION OF A K. F. WILL YOU
STAY OR DO WE BE FORCED TO GO.
THANK YOU SENATOR FOR THE
QUESTION AT THE THE ANSWER
QUICKLY AS WE WILL GO -- IT'S
NOT A MATTER OF IF IT'S THAT WE
WILL.
AND THE REASON THAT THE AMERICAN
CAN BE FUN WILL GO IF THIS LAW
IS PASSED IS BECAUSE THERE IS
DIRECT CONFLICT BETWEEN THE TEXT
OF AB.
TWO NINETY AND THE DISCLOSURE
REQUIREMENTS CONTAINED THEREIN.
AND THE PROVISIONS OF NINETY
SEVEN DASH ONE NINETY SEVEN DASH
ONE IS THE OFFICE OF THE
INSPECTOR GENERAL ADVISORY
OPINION.
UNDER WHICH WE OPERATE.
AND MEMBERS I URGE YOU TO PLEASE
LISTEN TO THE PIECE OF THE MEMO
TO MISTER WOOD.
THE DOCTOR PAN WITH ALL DUE
RESPECT TO NOT READ TO YOU.
BECAUSE WE SUBMIT THAT THE
CONTROLLING LEGAL QUESTION HERE
TODAY.
IS IN FACT THE QUESTION THAT
MISTER WOULD ASK OF LEDGE
COUNCIL.
IN IT JUNE TWENTY EIGHT LETTER
TO MISTER WOULD LEAD COUNSEL
SAID.
DEAR MISTER WOULD YOU HAVE ASKED
WHETHER A K. F. WOULD REMAIN IN
COMPLIANCE.
WITH THAT APPROVED ARRANGEMENT
IF ASSEMBLY BILL.
TO NINETY IS ENACTED AND THE A.
K. F. COMPLIES WITH THE
REQUIREMENTS OF THAT BILL.
THE ANSWER TO THAT QUESTION TO
MISTER WOOD IS FOUND PAGE SIX OF
THE MEMO.
OR LEDGE COUNCIL SAYS AND I
QUOTE DIRECTLY FROMLEDGE
COUNCIL'S MEMO TO MISTER WOULD.
BECAUSE THE DISK BECAUSE OF
THESE DISCLOSURE REQUIREMENTS
WERE NOT PART OF THE ARRANGEMENT.
CONSIDERED BY THE OFFICE OF THE
INSPECTOR GENERAL WHEN IT ISSUED
OPINION NINETY SEVEN DASH.
ONE THAT OPINION WOULD NOT
INSURE.
THAT THE VERSION OF THE PATIENT
ASSISTANCE PROGRAM OPERATED BY
THE AMERICAN KIDNEY FUND IS IN
COMPLIANCE WITH AB TWO NINETY
WOULD BE IMMUNE FROM -- IG
SANCTIONS.
PLEASE MAKE NO MISTAKE ABOUT
WHAT LEDGE COUNCIL IS TELLING
THE MEMBERS BUT THEY TOLD MISTER
WOULD.
THERE IS DIRECT CONFLICT BETWEEN
AB TWO NINETY AND THE FEDERAL
VISOR OPINION UNDER WHICH WE
OPERATE. TO RECEIVE A FAVORABLE
ADVISORY OPINION FROM THE OFFICE
OF THE INSPECTOR GENERAL.
MEANS THAT THEY BLESSING
ARRANGEMENT EXACTLY AS IT IS
REQUESTED FROM.
A GROUP LIKE THE AMERICAN KIDNEY
FUND.
AB TWO NINETY REQUIRE SOMETHING
THAT IS NOT IN NINETY SEVEN DASH.
ONE IT REQUIRES US TO PUT THE
NAMES OF PATIENTS ON A LIST.
ALL OF THE FOUR THOUSAND
PATIENTS A CALIFORNIA RECEIVING
ASSISTANCE.
BY THE WAY WE DON'T HAVE
PERMISSION FROM THE PATIENTS TO
DO THIS PUT THEIR NAMES ON THE
LIST AND PROVIDE A LIST OF THE
INSURANCE COMPANIES.
SO IT CAN TRIGGER THE RATE
SETTING PROVISION OF THIS BILL.
THAT IS NOT WITHIN THE BOUNDS OF
WHAT NINETY SEVEN DASH ONE SAYS.
TO DO SO WOULD PUT US IN GRAVE
DANGER OF LOSING OUR ADVISORY
OPINION NOT ONLY FOR CALIFORNIA
BUT NATIONWIDE.
IT IS UNEQUIVOCALLY A WE WILL
LEAVE IF THIS BILL IS PASSED WE
DO NOT TAKE ADVICE FROM OUR
OPPONENTS LEGAL COUNSEL -- AND
WEEP AND WE BELIEVE THAT THE THE
LEDGE COUNCIL HAS IN FACT.
CORRECTLY POINTED OUT THE ISSUE
HERE AND CONCLUDED THE SAME
THING THAT A THAT THE AMERICAN
CAN YOU FIND CONCLUDED.
SINCE THE BEGINNING AND AS A
FOLLOW UP SO WHAT WOULD WHAT
WOULD HAPPEN IF YOU PULL OUT OF
CALIFORNIA WILL WIN.
WHAT WITH THE DISPOSITION BE AT
LEAST FOUR THOUSAND PEOPLE HOW
QUICKLY?
WHEN THEY BE ABLE TO FIND
INSURANCE AND?
GET THE SET UP AND WHAT IS THE
PROCESS IN TRUTH WE DO NOT KNOW
THEY WOULD HAVE TO PAY THEIR OWN
PREMIUMS WE PAY.
OFF FOR FOR PEOPLE WERE SYSTEM
IN CALIFORNIA HALF OF THEM ARE
HAVING THEIR MEDICARE AND
MEDIGAP PREMIUMS PAID.
IF THEY CAN'T PAY THOSE THEY
LOSE ACCESS TO MEDICARE IF THEY
LOSE ACCESS TO MEDIGAP THEY FACE
UNLIMITED OUT OF POCKET
EXPENDITURES.
IF WE'RE HELPING THEM WITH THEIR
WITH WITH THEIR COBRA AND THEY
CANNOT CONTINUE TO TO DO THAT
THEY'RE FULL FAMILIES MIGHT LOSE
COVERAGE MANY PEOPLE WILL NOT BE
ABLE TO FIND ANY COVERAGE AT ALL.
AND WILL END UP IN HOSPITAL
EMERGENCY ROOMS SOME WILL GO TO
MEDI CAL BUT THEY HAVE A SPEND
DOWN REQUIREMENT AND MANY MANY
OF THESE PEOPLE ARE UNEMPLOYED
AND CANNOT PAY THEY'LL SPEND
DOWN.
WHAT IS THE AVERAGE -- GRANTED
THE TO U. CONTRIBUTOR FOUR
THOUSAND PEOPLE YOU HAVE AN
AVERAGE NUMBER THAT -- THERE THE
BENEFICIARY OF THIS A THOUSAND
DOLLARS A MONTH IS A TWO
THOUSAND DOLLARS A MONTH IT
VARIES QUITE A BIT BECAUSE OF
MEDICAID MEDICARE ON THE ONE
SIDE WOULD BE ON THE LOW SIDE
AND SOME OF THE OTHER INSURANCE
WOULD BE ON THE HIGHER SIDE I
DON'T HAVE.
A BUT WE CAN PROVIDE THAT TO YOU
AND THEN IT WAS A MENTION THAT --
THAT THIS -- POTENTIAL BILL AND
THE REDISTRIBUTION OF THESE FOUR
THOUSAND PEOPLE WOULD BE THIS
DISPARAGINGLY -- LEE AGAINST UP
PEOPLE OF COLOR CAN YOU
ELABORATE ON THAT THE TRUTH WITH
US TO THAT STATEMENT OR IS A
FALSE.
YEAH THAT IS AN ABSOLUTELY TRUE
STATEMENT AND AS I MENTIONED
WHILE AT THE BEGINNING OF KIDNEY
DISEASE THE THE DISEASE'S
DISPROPORTIONATELY SPREAD AMONG
ALL RACES IN GROUPS.
OF PEOPLE THE THE NUMBER WHO
ACTUALLY GO INTO KIDNEY FAILURE --
IS DISPROPORTIONATE AMONG
AFRICAN AMERICANS AND AMONG
LATINOS AND THAT IS BECAUSE
PEOPLE DO NOT GET ACCESS TO CARE
WHEN THEY NEED IT BY THE TIME
THEY GET THEIR THEIR IN KIDNEY
FAILURE.
THAT'S WHY PEOPLE QUESTION IF I
MIGHT I WANT TO CALL ON MISTER
DESMOND JUST REALLY BRIEFLY TO
TELL YOU THE PATIENT WE'RE
TALKING ABOUT HIM.
MR DOES MEN OF SORRY TO GET
CHANCE TO MEET YOU BEFORE.
WHERE THEY HAVE?
THE CHANCE MY NAME IS RUSSELL
DOES WHEN.
AND I AM A DIAL IT.
TRY TO KEEP HER BRIEFLY
SEPARATELY SO -- MY SITUATION IS
SIMILAR TO WHAT.
WAS JUST DESCRIBED -- I DON'T
HAVE THE MONEY TO PAY FOR MY
HEALTH CARE.
OKAY AMERICAN KIDNEY FUND PAYS
FOR MY I HAVE A MEDIGAP --
SUPPLEMENTAL MEDICAL INSURANCE
THEY PAY THE PREMIUM THAT ON
THAT.
OKAY I DON'T HAVE THE MONEY TO
PAY IT OTHERWISE -- WHAT HAPPENS
WITH ME IS THAT?
MY SOCIAL SECURITY DISABILITY IS
MY ONLY INCOME.
WHEN YOU CONSIDER THE FACT THAT
I HAVE TO PAY MY LIFE?
YOU KNOW NECESSARY THINGS FROM
LIFE -- GREAT.
FOOD MEDICATION MEDICAL
APPOINTMENTS AND EVERYTHING.
THERE IS NOTHING LEFT.
YOU KNOW WITHOUT A KEY OF
SUPPORT.
THERE IS NO REASON FOR ME TO
EVEN TRY TO CONTINUE TO LIVE.
BECAUSE I CANNOT MAKE MY MY
FINANCIALS -- I HAVE RIGHT NOW
SO MUCH GOING ON WITH ME IN
TERMS OF MY MEDICAL [inaudible]
CONDITION.
MY FINANCIAL CONDITION ON TOP OF
THAT.
IN THIS IS OVERWHELMING.
OKAY.
WOULD YOU SEE IS THAT ANYBODY IN
A PATIENT WHO WAS ON DIALYSIS
WILL LIKE IN MOTION.
A TURBULENT OCEAN [inaudible]
ON IN A CABLES PROVIDING ME A
LIFE RAFT [inaudible]
OKAY.
IF IF YOU ALLOW A CARE. TO BE
PUSHED ASIDE YOU TAKE WIN MY
LIFE.
FOR AND THERE'S NO POINT WHERE
DO YOU LIVE SIR I LIVE IN
SACRAMENTO SACRAMENTO SO YES I
HAVE YOU CLOSE -- TO A DIALYSIS
CENTER THIS CALM I ATTEND -- THE
DIALYSIS MANZANITA CLINIC IN
CARMICHAEL AND YOU GO THREE FOUR
TIMES A WEEK AGO THREE TIMES A
WEEK FOR FOUR HOURS A TREATMENT.
AT THE THE AMERICAN CAN BE FUN
WERE TO GO AWAY HOW WOULD YOU.
PAY FOR YOUR SUPPLEMENTAL
INSURANCE WHY WOULD NOT BE ABLE
TO YOU WOULD QUALIFY FOR MEDI
CAL OR ANY OTHER ASSISTANCE I I
HAVE MEDI CAL BUT THE PROBLEM
WITH MEDI CAL IS I HAVE A SURE
COST.
BUT SURE OF COURSE IS FIFTEEN
HUNDRED DOLLARS BEFORE THEY WILL
START TO PAY AN EXTRA TWO
HUNDRED DOLLARS A MONTH.
I DON'T HAVE FIFTEEN HUNDRED
DOLLARS.
THERE'D BE NO WAY THAT I COULD
MAKE THAT UP SO MY CHOICE TO BE
FOOD.
LIVE IN A CARDBOARD BOX BECAUSE
IT CAN PAY MY RENT.
AND THEN NOT PAY FOR MY
MEDICATIONS OR SEE MY DOCTOR.
THERE WILL BE NOTHING.
WE APPRECIATE YOU BEING HERE
TODAY AND SHARING YOUR STORY
THANK YOU.
BUT I COULD I TRANSCEND.
THEY DRESS THAT CAN ACTUALLY
THAT THE CENTER STONE -- BUT I'M
SURE SOME OKAY YES.
EN ROUTE I ONE THING MISTER
DESTINED FOR BEING HERE AS WELL --
I APPRECIATE YOUR STORY AND I
APPRECIATE YOUR CONCERN.
THERE IS NOTHING IN THIS BILL.
THAT WOULD PREVENT A K. F. FROM
GIVING YOU YOUR MEDIGAP
INSURANCE.
WHAT THIS BILL IS FOCUSED ON IS
THE PRIVATE INSURANCE PORTION OF
THIS?
A CAP DOES NOT HAVE TO LEAVE
CALIFORNIA.
IN THE END NOT SUPPLY THAT
INDEED THAT PART OF IT FOR YOU
WE'RE TALKING ABOUT THE FIFTEEN
HUNDRED PATIENTS THAT ARE HERE.
THAT IS PART OF WHAT I'VE BEEN
SEEN OVER AND OVER AND OVER
AGAIN IS MISINFORMATION.
THIS IS NOT GEARED AT PEOPLE WHO
ARE ON MEDICARE CURRENTLY WE'RE
A K. F. IS PAYING THE
SUPPLEMENTAL THAT DOESN'T AFFECT
THEM AT ALL.
NOT AT ALL SO IT'S A MISS IT IS
MISINFORMATION AND I'M AND I'M
DISAPPOINTED BY THAT QUITE
FRANKLY IF I MAJOR QUE NO
[inaudible]
CENTER LEYVA.
THANK YOU MISTER CHAIR.
SORRY LET ME GET CLOSE TO THE
MICROPHONE.
DOCTOR WOULD ASSEMBLY MEMBER I
JUST WANT TO THANK YOU FOR
PICKING UP THE MANTLE -- WHERE I
LEFT OFF AND I'M HAPPY TO BE A
CO AUTHOR ON THIS BILL
[inaudible]
IN.
I JUST I'M GLAD YOU STATED WHAT
YOU STATED ABOUT -- A. K. OF
BEING ABLE TO PICK UP THAT --
BENEFIT BECAUSE I KNOW ALSO THAT
THE THIS BILL DOES NOT PROHIBIT
THAT FROM HAPPENING.
AT THE END OF THE DAY THIS COMES
DOWN TO PROFITS -- I NOTICED A
VIDA IS NOT AT THE TABLE -- TO
TO DEFEND THEMSELVES WHEN I
CARRIED THIS BILL LAST YEAR I
MET WITH I DON'T KNOW IF IT WAS
OUR C. E. O. OR ONE OF THEIR
EXECUTIVES.
WHO WAS BRAGGING ABOUT OPENING
FIFTY MORE DEFEATED CLINICS IN
THE SOUTHERN CALIFORNIA NOT
CALIFORNIA BUT IN SOUTHERN
CALIFORNIA?
YOU DO NOT OPEN.
CLINICS YOU DO NOT OPEN ANY
BUSINESS IF YOU DON'T THINK
YOU'RE GOING TO MAKE MONEY AND
FIFTY IS NOT AN INSIGNIFICANT
AMOUNT.
SO THIS IS ABOUT.
KICKBACKS THIS IS ABOUT A SCHEME
THIS IS ABOUT CORPORATIONS
CORPORATE HIGH HOUSING.
PEOPLE'S HEALTH CARE SCARING THE
CRAP OUT OF PEOPLE AND MAKING
THEM THINK THAT THEY WON'T GET
COVERAGE.
MISTER DESMOND I HAVE FOUGHT MY
ENTIRE ADULT LIFE TO MAKE SURE
PEOPLE HAVE ACCESS TO AFFORDABLE
HEALTH CARE.
I WOULD NEVER CARRY A BILL I
WOULD NEVER VOTE FOR SOMETHING
THEY WOULD HARM YOU OR ANY OTHER
PATIENT YOU DON'T KNOW ME SO YOU
DON'T KNOW IF THAT'S TRUE OR NOT.
BUT IT IS TRUE.
I IF MANY OF YOU MAY OR MAY NOT
REMEMBER THERE WAS A PROPOSITION
ON THE BALLOT IN NOVEMBER.
AND ALL THIS PROPOSITION WOULD
HAVE DONE WAS A THE PROFITS OF
DE VITA AND FOR SENIORS. 215%.
THEY SPENT A HUNDRED AND TWENTY
MILLION DOLLARS SCARING THE CRAP
OUT OF PEOPLE AND MAKING SURE
THAT THAT PROPOSITION DIDN'T
PASS.
THIS IS ABOUT PROFITS IT IS NOT
ABOUT PEOPLE IT IS NOT ABOUT
PATIENT CARE.
DOCTOR WOULD I APPLAUD YOU FOR
CONTINUING TO WORK ON THIS -- I
LOOK FORWARD TO SUPPORTING THE
BILL AND I HOPE THAT THE
MISINFORMATION THAT CONTINUES TO
BE PUT OUT THERE IS STOPPED
BECAUSE IT'S REALLY UNFAIR TO
THE PATIENTS.
THANK YOU AND ALL MOVE THE BILL
WHEN APPROPRIATE.
QUESTION CENTER MITCHELL.
THANK YOU -- THANK YOU --
ASSEMBLY MEMBER.
I'M CURIOUS -- AND TRYING TO
FIGURE OUT WHAT ROLE THIS
ORGANIZATION PLAY SO -- YOU KNOW
AT AND WHO THEY ARE GOVERNED ARE
CONTROLLED BY YOU KNOW HEALTH
PLANS ARE GOVERNED BY KNOCKS
KEEN.
AND SO AS A NONPROFIT ENTITY --
MISTER WOOD OR THE CHAIR YOU
KNOW WHO PROVIDES OVERSIGHT.
OVER THIS ENTITY.
AUTHOR ANSWER THAT EXCEL -- ALAS
MAYBE JOAN CAN HELP I DON'T SEE
DON'T KNOW.
IF THERE IS ANY [inaudible]
SO -- AS WITH ANY NONPROFIT THE
OVERSIGHT WOULD BE THE
ORGANIZATION'S BOARD.
WHICH I UNDERSTAND IS LARGELY
INDEPENDENT OF DIALYSIS
PROVIDERS -- AND HAS.
FAIRLY GOOD CONFLICT OF INTEREST
PROVISIONS.
HOWEVER.
WHAT REALLY IS THE CASE IS THAT
82% OF THE AMERICAN KIDNEY FUNDS
REVENUE COMES INTO CONTRIBUTIONS?
FROM THE VITA AND FRESENIUS
THESE CONTRIBUTION THE IDENTITY
OF THESE CONTRIBUTORS IS MASKED
IN PUBLIC DISCLOSURES HOWEVER
IT'S BEEN DISCLOSED IN THE NEW
YORK TIMES AND DISCLOSED
REPEATEDLY.
IN SEC FILINGS AND OTHER PUBLIC.
FILINGS TO REGULATORS -- ALSO
DEFEATED FRESENIUS ARE THE ONLY
TWO COMPANIES LARGE ENOUGH TO BE
THOSE CONTRIBUTORS.
IT WOULD BE A WILDLY
DISPROPORTIONATE SHARE OF ANY
OTHER DIALYSIS COMPANIES REVENUE
BUT IN THE AMERICAN KIDNEY
FUND'S ANNUAL FINANCIAL
STATEMENTS BASED STATE.
THAT TWO HUNDRED AND FIFTY WITH
LIVES TURNED FORTY SEVEN MILLION
DOLLARS.
OF THE REVENUE CAME FROM JUST TO
CORPORATE CONTRIBUTORS.
CURIOUS TO ME IN TERMS OF IF
THEY'RE NONPROFIT AND AND AND
HOW THOSE TWO CORPORATIONS COULD
EVEN.
YOU KNOW CHARACTERIZES DONATIONS
IS TAX DEDUCTIBLE BECAUSE
THERE'S ALWAYS THE ISSUE HAVING
COME FROM NONPROFIT EXECUTIVE
MANAGEMENT AT A TIPPING ISSUE.
YES TWO LARGE OF YOUR BUDGET
COMES FROM ONE SOURCE -- THAT
WAS ALWAYS AN ISSUE WITH
FOUNDATIONS THAT YOU KNOW I
FOUNDATION COULDN'T BE INVOLVED
INTO BEING IF THE LITTLE LION
SHARE OF YOUR ORGANIZATION
BUDGET COMES FROM ONE
ORGANIZATION WITHIN THE IRS GETS.
CURIOUS TO SAY THE LEAST ABOUT
YOUR DAUGHTER AND THE NONPROFIT
BUT SEPARATE FROM THEIR
NONPROFIT STATUS GIVEN THE FACT
THAT THEY ARE ENGAGING IN --
HELP NOT HEALTH CARE DELIVERY
BUT IN IN AND FUND DEAN HEALTH
CARE SERVICES LIKE AN INSURANCE
COMPANY WOULD THERE IS NO OTHER.
INSURANCE REGULATOR THAT'S
INVOLVED WITH THIS NONPROFIT
ORGANIZATION THE ACTUAL
MECHANISM IS NOT THAT THE
AMERICAN KIDNEY FUND PAYS.
FOR A PAYS.
CLAIMS THEY PAY FOR HEALTH
INSURANCE PRODUCTS.
SO THEY WILL PAY THAT'S THAT'S
WHY WE SEE THE HEALTH INSURANCE
PLANS HERE IN SUPPORT OF THE
BILL.
BECAUSE IT IS THAT THE PRIVATE
HEALTH INSURANCE PLANS WHO WHO'S
RISK POOLS.
ARE BEING BURDENED BY PATIENTS
pPUBLIC ASSISTANCE PROGRAMS.
SO PATIENTS WHO OTHERWISE WOULD
BE ON MEDICARE.
ARE BEING TOLD.
STAY ON COBRA BEING WILL PAY
YOUR PREMIUM.
AND THAT RAISES A PRIVATE HEALTH
INSURANCE RATES FOR ALL
CALIFORNIANS AND FINAL QUESTION
IF I MAY MISTER CHAIR.
THE QUESTION -- THE GENTLEMAN
WHO WAS THANK YOU VERY MUCH FOR
SHARING WITH US YOUR PERSONAL
EXPERIENCE -- A SHERIFF COST IN
MEDI CAL TO THE TO THE FIFTEEN
HUNDRED DOLLARS IF SOMEONE COULD.
PROVIDE ME WITH SOME INFORMATION
ABOUT THAT IF YOU ARE AN MEDI
MEDI RECIPIENTS -- A FIFTEEN
HUNDRED DOLLAR.
THERE IS A SPEND DOWN WE HAVE
FOR MEDI CAL WILL KICK IN.
ACTUALLY -- ACTUALLY LOOKING AT
SCOTT VAN YOUR RIGHT NO.
HE USED TO WORK FOR THE SENATE
[inaudible]
IF SOMEONE.
PLANE THAT TO ME I WOULD REALLY
CHEN YEAH I SEE A WHOLE BUNCH OF
PEOPLE IN THE FRONT ROW WHO KNOW
LITTLE ABOUT MEDICARE MEDICARE.
MISTER CHAIR HOLD ON THE SO IS --
BUT NO ACTUALLY WE SHOULD
PERHAPS AS WE HAVE CONSENT WELL.
YEAH OKAY.
THANK YOU TERRY FROM WESTERN
CENTER ALL RIGHT.
I THINK WE WILL RECOGNIZE YOU AS
SOMEONE WHO IS KNOWLEDGEABLE IN
THIS AREA I HAVE SOMETHING THAT
WE CAN GIVE OUR COMMITTEE
STAFFERS TO DO THAT BUT I DON'T
SEE CAN REALLY OR SO YES
[inaudible]
PROGRAM.
MANY MEDI CAL PART PROGRAMS ARE
PEOPLE WHO ARE AGED AND DISABLED
THEY'RE ON A MEDICALLY NEEDY
PROGRAM AND SO IF YOUR INCOME IS
OVER A CERTAIN AMOUNT SIX
HUNDRED DOLLARS.
YOU PAY THE REMAINDER OF YOUR
INCOME AS A SHARE OF COST.
PRIOR TO YOUR MEDI CAL ACTUALLY
STARTING TO PAY FOR YOUR
COVERAGE AND THAT BECOMES YOU
KNOW THE AMOUNT THAT WAS
MENTIONED YOU KNOW.
OFTEN WELL OVER HALF OF
SOMEBODY'S INCOME.
SO IT'S NOT LIKE REAL INSURANCE
IN THAT CASE RIGHT HEY THE SPEND
DOWN RIGHT THANK YOU OKAY AND
THAT I SEE -- HEALTH COMMITTEE
SINCE ON MEDI CAL THE UNITED.
THE ENERGY HERE DISCUSSION.
SO I I'M FINE OKAY COULD YOU GOT
THE ANSWER YOU WANT OKAY AND I
THINK I THINK THAT'S A RELIABLE
SOURCE OF INFORMATION OKAY.
ANY FURTHER QUESTIONS OKAY US
ALL RIGHT LOCAL CENTER GROVE AND
INSTEAD RUBIO.
THANK YOU MISTER CHAIR I'D LIKE
TO AND DRINK SOME OF MY
QUESTIONS TO MS BURTON YOU'RE
THE CEO OF AMERICAN KIDNEY
FOUNDATION YES THE AMERICAN CAN
BE FUN AMERICAN TO DEFEND THAT
YES I APOLOGIZE AND AND I WAS
READING YOUR BIO.
HI CREDENTIALS APPOINTED BY.
PRESIDENT CLINTON.
THE ORGANIZATION THE RENDON
SEEMS VERY -- CREDIBLE
[inaudible]
OF ALL THE AWARDS THAT SHE
RECEIVED AND I'D LIKE TO DIRECT
MY QUESTIONS TO MR DOES MEN.
AND BASED ON THE OPINION WHETHER
WE AGREE OR DISAGREE WITH WHAT
LEAD COUNSEL HAS PROVIDED HERE
ARE YOU DO YOU TEND -- TO
RECOMMEND TO YOUR BOARD. TO STAY
IN CALIFORNIA AND OPERATE AND
PAID THESE -- THESE -- PREMIUMS
THAT HELP PEOPLE ACQUIRE THIS
TREATMENT.
OR ARE YOU LEANING TOWARDS THE
SEEM TO YOUR OWN LEGAL COUNSEL.
AND YOUR OPINION OF WHAT LET'S
COUNCILS LETTER IS WHAT WE HAVE
ALREADY DISCUSSED THIS MATTER
WITH OUR BOARD.
BECAUSE WE WANT PATIENTS TO HAVE
AS MUCH NOTICE AS POSSIBLE THIS
IS NOT AN EASY DECISION FOR US.
BECAUSE OF THE I. G. OPINION
APPROVES A SPECIFIC ARRANGEMENT
WE DON'T HAVE A CHOICE WE DO NOT
WANT TO ABANDON PATIENTS IN
CALIFORNIA BUT WE DO NOT HAVE A
CHOICE.
AND FOR THIS ADVISORY OPINION WE
CANNOT BE CONSISTENT WITH THAT
AND COMPLY WITH.
TO NINETY AND OUR BOARD AGREES
WITH THAT.
SO AND IF YOU.
LEAVE CALIFORNIA IS THERE A WAY
FOR THESE PATIENTS TO BE BEATEN
ARE AWARDED GRANTS LIVING IN
CALIFORNIA BUT I DON'T I CAN'T
SEE GETTING TREATMENT ELSEWHERE
BECAUSE YOU GET THREE TIMES A
WEEK RIGHT NOW IT'S JUST NOT
VIABLE -- SO I GUESS I ANSWERED
MY OWN QUESTION THE OTHER THING
IS TAT YOU WERE TRYING TO
COMMENT ON THE SPEND DOWN FOR
THE MEDICARE ARE MEDICARE YOU'RE
TRYING TO COME IN ON THE SPEND
DOWN.
AND I GUESS I'M TRYING TO FIND
OUT FROM EITHER YOU OR MISTER
DESMOND LET'S JUST SAY FOR
ARGUMENT'S SAKE.
MR DOES MAN BRINGS AND SIXTEEN
HUNDRED DOLLARS A MONTH JUST FOR
EASY MATH.
AND ANYTHING OVER SIX HUNDRED
DOLLARS A MONTH HAS TO BE SPENT
DOWN TO PAY INTO MEDICARE OR
THIS FOR HIM TO GET THE
TREATMENT THAT YOU PROVIDE FOR
OR THAT YOU PAY FOR TAP PROVIDE
SEEM.
AND IS IT FAIR TO SAY THAT IF HE
DOES BRING IN SIX HUNDRED
SIXTEEN HUNDRED DOLLARS A MONTH
ANYTHING OVER SIX HUNDRED
DOLLARS A MONTH HAS TO GO TO PAY.
FOR THE TREATMENT IS THAT A FAIR
STATEMENT I THINK THAT THE
EXPLANATION THAT WAS PROVIDED IS
A GOOD ONE THAT THERE IS I CAN'T
TELL YOU IN CALIFORNIA.
EXACTLY WHAT THOSE BREAK POINTS
ARE BUT HE KNOWS THEM VERY WELL
AND THAT THAT IS -- WHAT WOULD
HAPPEN IS THAT ANYTHING OVER THE
SIX HUNDRED HE WOULD HAVE TO PAY
IN TERMS OF THE IN TERMS OF THE
SPEND DOWN?
MR DES MEN CAN YOU LIVE WHERE
YOU LIVE NOW AND WHAT YOU LIVE
ON IN THE FOOD YOU EAT IN THE
RENT YOU PAY ON SIX HUNDRED
DOLLARS A MONTH.
ABSOLUTELY NOT.
IS THIS -- TREATMENT THAT YOU
GET THEM AND WHERE THE PREMIUMS
ARE PAID FOR BY THE AMERICAN
KIDNEY FRIEND -- IN A LIFE AND
DEATH SITUATION FOR YOU YES YES.
AS IT IS EVEN WITH THE HELP THAT
I RECEIVED FROM AMERICA KIDNEY
FUND.
I AM I AM I AM ROBBING PETER TO
PAY PAUL [inaudible]
YOU KNOW -- YOU HAVE TO
UNDERSTAND THAT IN ADDITION TO
MY HEALTHCARE ISSUES -- I HAVE
THE REGULAR COST OF LIVING.
YOU KNOW WITH THE RENTS
SKYROCKETING TRANSPORTATION
COSTS FOOD COSTS MEDICATION
COSTS GOING UP CONSTANTLY --
INSURANCES.
THERE THERE REALLY IS NO LIFE
RAFT FOR ME I'M I'M I'M TRADING
WATER THANK YOU SIR.
M. MISS BURTON -- IT'S BEEN.
WIDELY SAID SEVERAL TIMES THAT
TWO PARTICULAR ORGANIZATIONS
CONTRIBUTE TO THE AMERICAN
KIDNEY FAN.
DOES ANYONE FROM FOR SENDING US
OR TO BE TO SIT ON YOUR BOARD.
NO ONE FROM THE VETO OR FOR
CYNTHIA SITS ON OUR BOARD WE
HAVE VERY STRICT ALL CONFLICT OF
INTEREST REQUIREMENTS FOR OUR
BOARD.
IS A BOARD OF BOB MAXIMUM TWENTY
SIX PEOPLE AND NO ONE ON THE
BOARD OR ON OUR STAFF CAN HAVE
ANY FINANCIAL INTEREST TO A
RELATIONSHIP WITH THE DIALYSIS
PROVIDER.
AND IF IF IF I MIGHT ADD TO THAT.
I FEEL THAT I MUST DEFEND THE
REPUTATION OF THE AMERICAN
KIDNEY FUN I AGREE FULLY WE'VE
GOT TO GET THE FACTS ON THE
TABLE.
OF THE THE THE UNIQUENESS OF THE
I. G. OPINION AND THE
ARRANGEMENT THAT IT DESCRIBES
MAKE SURE THAT WE TREAT ALL
PROVIDERS THE SAME.
OF THE PROVIDERS WHO ACTUALLY
REFER PATIENTS TO THE AMERICAN
KIDNEY FUN 40% OF THEM DO NOT
CONTRIBUTE AT ALL.
WE MUST PROVIDE GRANTS IN THE
ORDER THAT WE RECEIVE THE GRANT
APPLICATIONS AND WE MUST NOT
DISCRIMINATE AGAINST ANY.
OUR PATIENTS WHO SEES A PROVIDER
ALL WHO DOES NOT CONTRIBUTE AND
WE HAVE NEVER DISCONTINUED.
ALL THE IT IS ALSO IMPORTANT.
TO UNDERSTAND THAT IF WE PULL
OUT OF CALIFORNIA YES WE ARE
PULLING OUT OF ALL PROGRAMS
BECAUSE AGAIN THAT IS THE WAY
THE OPINION IS WRITTEN THAT WE
DEAL WITH ALL INSURANCE.
AND ALL HEALTH COVERAGE ON AN
EQUAL BASIS SO WE CAN'T JUST
DEAL WITH ASSISTING PEOPLE FOR
MEDICARE BUT IGNORING OTHER
COVERAGE THAT'S AVAILABLE.
THESE ARE NOT CHOICES THAT WE
HAVE THEY ARE REQUIREMENTS.
SO AND I GUESS MY NEXT QUESTION
IS IS ANYBODY FROM FEES FOR CDS
OR PERSON IS OR DE VITA TELL YOU
WHO TO GIVE.
OF ASSISTANCE TO BETTER THAN
ANOTHER PROVISION OF THE I. G.
OPINION THAT WE CAREFULLY UP
CAREFULLY EMPLOYMENT AND THAT IS
THAT OUR DECISIONS ARE TOTALLY
INDEPENDENT.
OF ANY INFLUENCE FROM ANY OF
CONTRIBUTOR TO THE FUN INDEED A
CONTRIBUTED TO THE FUN IN THE
OPINION SAYS THIS.
CAN THE SHOULD NOT HAVE ANY
EXPECTATION OF ANY RETURN FOR
WHAT THEY CONTRIBUTE TO THE FUN
THE MONEY GOES INTO A SINGLE
POOL.
PEOPLE APPLY FOR ASSISTANCE AND
IS PROVIDED FOR THOSE WHO
QUALIFY ON A FIRST COME FIRST
SERVE BASIS.
AT A DEPTH ROUGHLY AT IS IT
THREE THOUSAND OR HOW MANY
PEOPLE. FOR ALMOST FOUR THIRTY
SEVEN HUNDRED THIRTY SEVEN
HUNDRED PEOPLE THAT THAT ARE OF
THE BENEFICIARIES OF THE
AMERICAN KIDNEY FAN.
A YOU SAID 40% OF THOSE
BENEFICIARIES -- THAT GET
TREATMENT GET TREATMENT
ELSEWHERE OTHER THAN THESE TWO
PROVIDERS IS THAT WHAT I
UNDERSTOOD ALL NO I SAID WHAT I
SAID WAS THAT A BILL APPROVED
PROP PROVIDERS WHO REFERRED
PEOPLE TO THE PROGRAM. 40% DON'T
CONTRIBUTE THEY DON'T CONTRIBUTE
TO THE PROGRAM RIGHT OKAY.
AND BY JASON LOOK AT MY NOTES
HERE.
THERE WAS A STATEMENT MADE BY MY
COLLEAGUE ABOUT TO MEETING WITH
THE PRESIDENT OR THE SOME
EXECUTIVE AT ONE OF THE
FACILITIES THAT THE TWO ENTITIES
THAT WE'RE TALKING ABOUT ARE
DISCUSSING TODAY.
AND THEY OPEN FIFTY NEW CLINICS --
WE'RE GOING WE'RE GOING TO OPEN
FIFTY NEW CLINICS WILL THERE ARE
FIFTY EIGHT COUNTIES IN THE
STATE OF CALIFORNIA THAT WOULD
BE MAYBE.
ONE PER COUNTY.
M..
PARDON ME.
SO.
THAT THE ONE PER COUNTY I GUESS
AND WE'RE ALL ABOUT AFFORDABLE
ACCESS TO HEALTH CARE SO I WOULD
APPLAUD THEM IF THEY OPENED.
HUNDRED SO WE HAVE TO ANNE'S
COUNTY WOULD BE BENEFICIAL IN
BETTER SERVICE -- I THANK YOU
FOR YOUR TESTIMONY MISTER DOES
MAN -- I AT MISS MISSED BURTON
AND I MISTER DOES WHEN I THINK
YOU FOR YOUR TESTIMONY AND I
THINK YOU -- FOR EXPLAIN THAT I
ALSO THINK THAT -- DID VISUAL
THAT CAME UP AND GIVE US THAT
COMMENT ON THE MEDICARE ISSUE DO
YOU KNOW THE SPEND DOWN OF SIX
HUNDRED DOLLARS I DON'T THINK
THERE'S VERY MANY PEOPLE IN THE
STATE OF CALIFORNIA WERE 53%.
OF THE PEOPLE SAY THEY CAN'T
AFFORD TO LIVE HERE CAN LIVE ON
SIX HUNDRED BUCKS A MONTH EVEN
IN MY AREA WHICH WAS DEEMED THE
MOST AFFORDABLE -- I'VE I'VE
BEEN GIVEN A LIST HERE.
AS A HUNDRED FIFTEEN NAMES OF
PEOPLE JUST LIKE MR DOES IN MY
DISTRICT.
THANK YOU AND I'M.
I'M REALLY CONCERNED ABOUT THAT
COVERAGE GOING AWAY OR SPENDING
DOWN. TO SIX HUNDRED DOLLARS IN
ORDER TO SURVIVE.
AND SO THANK YOU THANK YOU FOR
ANSWERING MY QUESTIONS OKAY SIR
RUBIO.
THANK YOU.
I HAVE A COUPLE OF QUESTIONS --
AND OTHERS BEEN A LOT THAT'S
BEEN SET AYE I WANT TO ASK THE
FOUNDATION.
CAN YOU SHARE WITH ME IF YOU
GUYS ARE PROVIDE SERVICE TO
UNDOCUMENTED INDIVIDUALS.
YES WE DO.
DO YOU HAVE AN IDEA OF OW MANY
OF THOSE YOU SERVICE.
I DO NOT BECAUSE WE DO NOT WE DO
NOT -- REQUEST THAT INFORMATION
SO I DO NOT KNOW THE NUMBER --
THE THE THE STATUS IS NOT A
FACTOR THE FACTOR -- IS THE
INCOME AND WHETHER OR NOT THE
PERSON MEETS THE EYE INCOME
CRITERIA.
THANK YOU -- I HAVE ANOTHER
QUESTION AND I GUESS AT THIS IS
FOR THE THE CHAIR.
WERE THERE ANY CONVERSATIONS I'M
SORRY BECAUSE I KNOW THIS IS
SOMETHING THAT -- THE TURN I
SPENT A LOT OF TIME OVER AN HOUR.
BUT SPEAKING ABOUT IN CHINA GO
OVER SOME OF THE CONCERNS AND I
DON'T REMEMBER THE CONVERSATION
BUT DID WAS THERE ANY
CONVERSATIONS ABOUT MECHANISM
AND MECHANISMS IN PLACE. TO
PREVENT DOT EDU -- I THINK WE
HEARD A TESTIMONY OR YOU'RE
ABOUT -- TRYING TO CONVINCE
PATIENTS TED TO GO ON CORPORATE
IS WAS THERE ANY CONVERSATIONS
ABOUT THEM.
SERVICES CERTAINLY -- AND THE
THE AT THE ALTAR AREA SO IT WILL
CERTAINLY I THINK WE WENT TO THE
BIG ISSUES THAT WERE TRIED
DRESSED IN THIS.
BILL WELL DOCTOR CAN SPEAK --
TWO THOUSAND BUT LET ME JUST SAY
THAT.
BY THE ISSUES THAT THE AUTHORS
STRAYED DRESSED IN THE BILL
WHICH WE WORKED WITH THE AUTHORS
OFFICE AROUND IS.
MICHAEL SELF DEALING.
AND SO FUNDAMENTALLY.
THAT IS THE ISSUE OF V. -- OF
BASICALLY A PROVIDER AND BY THE
WAY I'M A PROVIDER SO I HAVE A
PROVIDER AL THAT -- IF PROVIDER
SAYING THAT WELL YOU KNOW WHAT
WHAT HAPPENS IS THAT.
IF I CAN PAY THE IN I HAVE A
PARTICULARLY GOOD DEAL WITH A
PARTICULAR INSURANCE COMPANY OR
SEVEN TURNS COMPANIES.
AND I CAN FIND A WAY TO HAVE
SOMEONE YOU KNOW THAT THAT I CAN
PAY FOR THE FOR YOU KNOW CHANNEL
MONEY NOT NECESSARY FOR THAT
PARTICULAR PATIENT EVEN
STATISTICALLY SEND MONEY TO A
FOUNDATION THAT WILL THEN PAY
THAT PREMIUM BECAUSE THE
PREMIUMS ONLY A SMALL PORTION OF
THE ACTUAL.
REIMBURSEMENT RIGHT SO NOW
STATES 20% RIGHT SO WHAT HAPPENS
AT THE FIVE FOLD RETURN.
SO I CAN GET SOME MONEY AND
WHETHER AT AND SO FORTH AND THEN
I CAN PUT MONEY INTO THAT.
AND THEN I GET PAID FIVE TIMES
ISN'T THAT STRONG DOWN THE RISK
FULL FOR THE INSURANCE COMPANY
THAT'S NOT SOMETHING WE IN
POLICY WOULD WANT TO ENCOURAGE
ALL RIGHT SO THAT'S SO THAT'S
THE OVERALL IT SO THAT'S WHEN IT.
THE OVERALL ISSUES NOW -- I WANT
TO ALSO ACKNOWLEDGE THAT.
A CHAOS AND IT DOES HAVE -- YOU
KNOW THEY DO NOT ENGAGE IN
STEERAGE -- WHICH I KNOW THE
OTHER FIRST OF ALL -- YOU AND
ALLOW IT BUT ALSO WE DON'T YOU
KNOW.
ETCETERA IT IS MORE BILL IT IS --
THEY HAVE PLAYED THINGS IN PLACE
YOU HEARD ABOUT SOME OF THEM
THAT PROTECTED BUT THERE'S ALSO
THE CHALLENGE OF IS THAT WHEN
80% OF YOUR MONEY COMES FROM THE
SENSUALLY.
THE TO THE LARGEST PROVIDERS --
THEY'RE NOT AMY A PARTICULAR
PATIENT RIGHT THAT'S ALL BLINDED
AND SO FORTH BUT THE PROBLEM
DOES RAISE SOME QUESTIONS OF
WELL STATISTICALLY OF IGAVE
SOME MONEY I KNOW I'M GOING TO
GET LIKE A TWO THREE FOLDER FOR
FOLDER RETURNED FROM DOING THIS
FROM BUT MONEY PUT IN AND I'M.
40% OF MARKET LET'S SAY.
GOOD CHANCE THAT I'M GOING TO DO
BETTER THAN THE AMOUNT OF MONEY
TO PUT AN END SO THAT WAS AN
ISSUE THAT WE WANT TO TRY.
TO FIGURE OUT IS AS WELL NOT TO
HAVE SO IT'S GOOD THAT'S MORE OF
A STATISTICAL THING BECAUSE THEY
DO NOT GET GAUGE ON THE VERY
CLEAR A K. F. DOES NOT ENGAGE WE
DO NOT SEE ANY EVIDENCE OF AND
THEY DO NOT.
ENGAGE IN LIKE -- WELL GUESS
WHAT YOU KNOW SOMEBODY GIVES THE
MONEY AND THEN THAT PARTICULAR
PATIENT GOES TO THAT THE
PROVIDER THEY ARE BLIND TO THAT
THAT'S A MONDAY NIGHT STAY OUR
BLINDS YOU KNOW THEY GET THE
MONEY THEY GIVE IT TO SOMEONE
THEY THAT PERSON GOES.
A PROVIDER THEY ARE NOT DIRECTED
TO WHICH PROVIDER TO GOING TO
THEY'RE NOT DIRECTING.
EXACTLY -- WHICH INSURANCE
COMPANY THAT SPECIFICALLY IT'S
THE PATIENTS I SO THERE ARE
THOSE PROTECTIONS IN PLACE BUT
THAT BUT THAT DOES AND I THINK
WHAT YOU HEAR IS IS THAT.
THE PROBLEM IS WHAT THE WHEN THE
IS THAT.
AN ARRANGEMENT DIG THIS THE THE
CHALLENGE TO OUR HEALTHCARE
SYSTEM AND WE TALK ABOUT RAISING
OVERALL PREMIUMS IS IS ABOUT.
IS IS THAT YOU REALLY LEVERAGING
THE RISK POOL WHICH IS BASICALLY
ALL OF US WHO PRIDE FIVE
INSURANCE WELL PAYING IN AND AND
SO WHEN WE GET SICK WE IT
COVERED RIGHT.
SO THE CHALLENGES THAT WHAT
HAPPENS IS WHEN YOU HAVE A PLACE
YOU KNOW WHO'S ALREADY EXPENSIVE
FIGURING YOU HAS NEEDS I SHOULD
SAY.
GRADY HAS NEEDS AND THEN SOMEONE
SAYS WELL YOU KNOW WHAT WE'RE A
PRETTY GOOD POWER TO NEGOTIATE
WITH THE HEALTH INSURANCE
COMPANY BECAUSE IT'S ONLY.
WERE VERY BIG PLAYER AND WE MAY
BE THE ONLY DIALYSIS OR WHATEVER
PROVIDER AT THAT PARTICULAR
SERVICE IN THE AREA.%
IT'S REALLY HARD FOR THE INSURER
TO NEGOTIATE WITH NOW WE GOT A
GOOD RATE AND THEN WHAT HAPPENS
IS THAT WELL THE PROBLEM IS A
PATIENT CAN'T.
YOU KNOW THE CAN OF THE DAY
BASICALLY YOU COULD EITHER DO
PUBLIC INSURANCE MEDICARE OR
PRIVATE INSURANCE AND PRIVATE
INSURANCE PAYS A LOT MORE AND SO
I CAN PAY A LITTLE BIT AND I GET
A LOT MORE.
THAT'S THAT'S ON THE BACKS OF
ACTUALLY.
ALL THE OTHER PEOPLE PAYING INTO
THE INSURANCE AND I THINK THAT'S
THE ISSUE WERE TRYING TO ADDRESS --
BUT I WILL PERHAPS I SHOULD TURN
IT TO THE AUTHOR TO SEE YOU TO
IN TERMS OF THAT HE'S TRYING TO
ADDRESS THIS AND WE WILL TRY TO
WORK OUT AMENDMENTS TO TRY TO TO
TO DEAL WITH.
SO -- AND WE DO HAVE A MAN IS A
SPECIFICALLY SAY KNOWS DURING
WHICH AGAIN I KNOW A TF DOES NOT
DO THAT KNOWS DURING BY THE AT
AND BUT NO STRING BY THE
FACILITY ITSELF REQUIRES
FACILITIES TO POST INFORMATION
WHERE CONSUMERS CAN GO TO GET
OBJECTIVE INFORMATION ABOUT
MEDICARE SO.
THEY ACTUALLY HAVE.
ACTORS INFORMATION.
SO AND I PERHAPS YOU DO AND IF
YOU WANNA BUT THE AUTHOR ALSO
TRY TO ANSWER THE QUESTIONS ALL
THAT BECAUSE THANK YOU MY
QUESTION -- WELL SO RIGHT NOW I
HAVE A COUPLE OF CONCERNS ONLY
BECAUSE WHEN I I HEARD TO SAY
RIGHT NOW ABOUT.
THAT ARE THE FOUNDATION DOESN'T
DIRECTLY.
GET INVOLVED IN AND I DON'T
DISAGREE WITH MY COLLEAGUES
ABOUT TALKING ABOUT THE PROFIT
AND AND THE OTHER TWO ARE
TARGETS THAT BEEN MENTIONED HERE
WHICH IS I BELIEVE DE VITA AND
PRESSING AS BUT I ALMOST FEEL
LIKE THEY WERE PENALIZING THE
FOUNDATION.
AND THE ATTEMPT OF OF OF GOING
AFTER THESE OTHER YOU KNOW.
RECEIVED ABOUT PLAYERS AND WHEN
I HEARD THE NUMBER RIGHT NOW
THAT 40% OF OTHER PROVIDERS ALSO
SEND PATIENTS TO YOU.
AND THESE OTHER 40% PROVIDERS
DON'T CONTRIBUTE TO THE
FOUNDATION.
AND SO I SEE THAT THAT'S ALSO
REALLY HIGH NEED NOT JUST WITH
THESE TWO THAT.
THAT CONTRIBUTE BUT THESE OTHER
PROVIDERS THAT ALSO SEE THE NEED --
AND SO THAT'S KIND OF WHERE I'M
STRUGGLING BECAUSE I KNOW THAT
THE KIDDING FOUNDATION IS TRYING
TO DO GOOD WORK AND BECAUSE OF
THESE OTHER PEOPLE THAT WERE
TRYING TO TARGET I FEEL LIKE
THEY'RE TAKING THE HEAD.
I WANT TO TALK A LITTLE BIT
ABOUT -- I HEARD THE GENTLEMAN
I'M SORRY I DON'T KNOW YOUR NAME
YOU TALKED ABOUT THE AG.
AND YOU LITERALLY READ THE THE
CONVERSATION BETWEEN BOTH OF YOU.
AND I KEEP HEARING -- TO YOU
WILL LEAVE CALIFORNIA IF THAT'S
THE CASE AND I KNOW THAT THERE
IS DISAGREEMENT.
BUT I'M ALSO A LITTLE BUT YOU
KNOW I WAS READING -- RIGHT NOW
IS GOING OVER -- WHAT THE CHAIR
READ WHICH WAS THE CONCLUSION TO
OUR?
COUNCIL AND EVEN THOUGH THEY SAY
THEY DON'T BELIEVE THEY WILL
LEAVE THEY CONCLUDED BY SAYING
HOWEVER IT'S THIS WOULD BE A
FACTUAL DETERMINATION MADE BY
THE OFFICE OF THE INSPECTOR
GENERAL.
AND COULD INVOLVE CONSIDERATION
OF FACTS THAT ARE NOT AVAILABLE
TO US RIGHT NOW SO THERE IS AN
UNKNOWN THEY HAVE NOT
DEFINITIVELY SAD.
THAT.
THEY WON'T LEAVE OR OR WILL
LEAVE THIS IS NOT A CERTAINTY
FOR ME.
AND THE REASON I SAY THAT
BECAUSE I SPEND THE LAST TWO
MONTHS MEETING WITH SOME OF THE
PATIENTS IN MY DISTRICT WHICH IS.
THERE'S QUITE A BIT.
AND I WANTED TO PUT A FACE TO TO
THE DISCUSSION BECAUSE I KNOW
SOMETIMES WE GET INTO THE POLICY
AREA BUT WE FORGET THAT THERE'S
PEOPLE BEHIND THIS.
I KNOW IT'S THIRTY THIRTY SEVEN
HUNDRED FROM WHAT I HEARD RIGHT
NOW BUT I DO HAVE AROUND SIXTY
SIX AND I WAS ABLE TO MEET WITH
A GROUP OF PEOPLE TRYING TO
UNDERSTAND.
WHAT THEIR CIRCUMSTANCE WELL AS?
AND AND THEY DON'T NECESSARILY
FIT THE PROFILE THAT WE'RE
TALKING ABOUT YOU KNOW THESE ARE
NOT PEOPLE THEY WERE.
AND ONE CIRCUMSTANCE AND SOMEONE
TRY TO DRAG HIM INTO ANOTHER AYE
THESE ARE PEOPLE THAT WERE
BENEFITING -- FROM THIS -- EXTRA
HELP ONE OF THEM SAID THAT EVERY.
SHE'S BEEN ON DIALYSIS FOR EIGHT
YEARS AND EVERY I THINK THREE
MONTHS IT'S LIKE ANOTHER SEVEN
HUNDRED OR SO OUT OF POCKET THAT
SHE CAN'T AFFORD -- SHE IS -- A
SPECIALIST WITH THE LAPD IN
DOWNTOWN LA AND SHE HAS A GOOD
JOB A GOOD SITUATION BUT WHEN%
SHE NEEDED TO HAVE DIALYSIS SHE
STARTED FALLING ON HARD TIMES
AND THIS WAS.
WHAT SAVED -- AND SO I RIGHT NOW
I'M CONCERNED THAT THERE IS NOT
A PLAN . FOR THE THIRTY SEVEN
HUNDRED PATIENTS SO THAT'S WHERE
MY FOCUS IS.
WHAT I DO WITH THOSE THREE SEVEN
WELL I'M NOT NECESSARY TALK
ABOUT THEIR SEVEN THIRTY SEVEN
IT'S THE GROUP OF PEOPLE THAT I
MET IN MY DISTRICT -- THAT
REALLY TRULY DEPEND ON THE
SERVICE LIKE I'M CONCERNED ABOUT
THEIR LAPSED AND AND COVERAGE IN
SERVICE AND TRYING TO FIGURE
THIS OUT I'M.
NOT A PATIENT BUT I CAN ONLY
IMAGINE IT'S REALLY TAX SCENE
AND MENTALLY EXHAUSTING A
PERHAPS VERY EMOTIONAL SO I
CANNOT IMAGINE WHAT THAT
TRANSITION PERIOD.
LOOKS LIKE BUT I I WILL ALSO
WRAP UP WITH THE FACT THAT YOU
KNOW I ALSO AS YOU SURE YOU DO.
COVER UNDOCUMENTED INDIVIDUALS
AND AND I'M NOT SURE YOU CAN
TELL ME HOW MANY OR WHAT THE
AGES ARE BUT YOU KNOW IF THEY'RE
GOING TO BE SOME PEOPLE IN
BETWEEN THEIR THAT MAY NOT BE
ABLE TO GET.
HELP ELSEWHERE AND SO I WAS
STRUGGLING WITH THE UNCERTAINTY
WITH THE CONCLUSION OF OUR LEGAL
COUNSEL THAT SAYS THAT.
THEY COULDN'T DEFINITIVELY SAY
YES OR NO THAT THEY DON'T HAVE
THEIR FAX AT THEIR DISPOSAL SO I
WOULD LIKE TO KNOW THAT THERE'S
A PLAN BEFORE THE THIRTY SEVEN
HUNDRED PATIENTS.
AND ASSURANCE THAT.
THE KIDNEY FOUNDATION WILL LEAVE
AND I'M NOT SURE I'M HEARING
THAT ONE OR THE OTHER.
I WILL CONTINUE TO LISTEN TO THE
DISCUSSION BUT RIGHT NOW I'M
CONFLICTED BECAUSE I KNOW THAT I
WANT PATIENTS TO GET CARE AND
THAT'S MY STRUGGLE.
SENATOR ME OUT MATCH COM AND AND
AND MY COUNSEL MAY ALSO WANT TO
ADD.
THE THE THE THE POINT THAT YOU
MAKE THAT THE PEOPLE THAT YOU
MET WITH MAY NOT LOOK LIKE SOME
OF THE FOLKS THAT WERE IMAGINE I
MINE.
IS A VERY IMPORTANT POINT IN
THIS POPULATION WE HAVE PEOPLE
WHO HAVE WORKED YOU KNOW ALL OF
THEIR LIVES.
LIKE MISTER DESMOND.
M. THEY SUDDENLY KIDNEY DISEASE
DEVELOP SOMETIMES OVER DECADES.
BUT YOU DO NOT HAVE SYMPTOMS
VERY OFTEN UNTIL YOU'RE IN FULL
BLOWN KIDNEY FAILURE AND SO
WHATEVER YOU HAVE SPENT WHATEVER
YOU HAVE BEEN ABLE TO AMASS OVER
YOUR LIFE CAN BE GONE.
IN THE BLINK OF AN EYE.
THE TO TAKE THE ISSUE THAT WAS
BROUGHT ABOUT COBRA.
COBRA IS NOT SOMETHING THAT YOU
CAN PUT A PERSON ON A PERSON IS
WORKING AND EARNS COAL BUT TO
CONTINUE BUT THEY HAVE TO PAY
THE FULL PREMIUM.
WE HELP THOSE PEOPLE.
THERE IS THOSE ARE PEOPLE WHO
HAVE BEEN PAYING PAYING THEIR
TAXES PAYING THEIR HEALTH
INSURANCE AND ALL OF THE OTHER
ON THE SOUTH SEAS OF LIFE ON AN
ONGOING BASIS.
THEY'RE NOT TRYING TO CHANGE
THEIR INSURANCE THEY'RE TRYING
TO HOLD ON TO WHAT THEY HAVE.
SO THAT THEY CAN KEEP THEMSELVES
TO KEEP THEMSELVES WELL AND IT'S
VERY IMPORTANT TO UNDERSTAND
THAT THAT DISTINCTION AND WE WE
ARE HAPPY TO WORK CONTINUE TO
WORK WITH.
MISTER WOOD AND ERIC A SOME
WOMEN WOULD AND AND SENATE
OPINION TO TRY TO GET.
TO RESOLVE SOME OF THESE ISSUES
OF THAT THEY HAVE BROUGHT UP WE
WE'VE WE'VE OFFERED CERTAIN
AMENDMENTS TO DEAL WITH THE FACT.
THAT HOW DO WE PROTECT THOSE
PEOPLE WHO ARE CONTINUING THE
COVERAGE THAT THEY'VE HAD ALL
ALONG THOSE ARE REALLY VERY
IMPORTANT DISTINCTIONS.
WELL AND AND I SAY THAT BECAUSE
IT LIKE I SAID I DON'T HAVE THIS
DISCUSSION UP HERE NOT.
KNOW WHO I WAS TALKING ABOUT SO
WHEN I MET WITH THESE
INDIVIDUALS.
I MEAN WELL EDUCATED AS YOU
STATED THEY WORKED ALL THEIR
LIVES IN THE YOU KNOW HOW
PROFESSIONS THAT ARE YOU KNOW
QUITE -- IMPRESSIVE AND YET YOU
KNOW WHEN THEY STARTED YOU KNOW
EIGHT YEARS -- SHE SAID SHE WENT
TO HER SAVINGS AND THEN -- SHE
WAS STRUGGLING JUST TO EVEN PAY
FOR HER AND SHE TOOK OUT LOANS
AND THEN IT BECAME A CYCLE MY
POINT IS THAT.
IT YOU KNOW SHE JUST NEEDED HELP
AND AS SHE WAS ABLE TO GO TO
THAT IS THE FOUNDATION AN AND SO
AGAIN YOU'RE YOU'RE RIGHT SHE
DID EVERYTHING.
CORRECTLY AND THEN SHE WASN'T
ANTICIPATING THIS ILLNESS -- BUT
AGAIN I REALLY JUST WANTED TO
MAKE SURE THAT I KNEW WHAT I WAS
TALKING ABOUT AND THESE ARE
PEOPLE MY DISTRICT BY MATT ONE
ON ONE WHO SHARE THEIR STORIES
AND AND SO AGAIN I STRUGGLING
WITH THE FACT THAT I LIKE I SAID
I YOU KNOW.
I DON'T WANT TO GET INFORMATION
TO LEASE BUT YET I FEEL LIKE
THERE'S AN UNCERTAINTY ABOUT
WHETHER IT WILL LEAVE OR NOT AND
AND SO THAT'S DIFFICULT FOR ME
WHEN I DON'T HAVE LIKE A CERTAIN
ANSWER.
THAT'S WHY I WAS ASKING IF THERE
WAS SOME KIND OF PROTECTIONS
THAT WE CAN.
PUT IN PLACE SO THERE IS NO
STEERING AS THEY CALLED IT AND
BUT I DID HEAR DOCTOR POUND SAY
THAT YOU DON'T.
PARTICIPATE IN THAT THAT THERE'S
SAFEGUARDS AGAINST THAT AND
CONFLICTS OF INTEREST SO.
SO I AGAIN I'M I'M STILL A
LITTLE CONFLICTED SO AGAIN --
CONTINUE TO LISTEN TO THE
CONVERSATION IF I MIGHT CALL ON
OUR GENERAL COUNSEL TO TALK A
LITTLE BIT ABOUT THAT LAST
STATEMENT AND THE LEDGE COUNCIL
YES.
THANK YOU FOR THE QUESTION
CENTER -- CENTER MITCHELL LAST
QUESTION EARLIER WHAT WHAT IS
THE GOVERNING BODY OF AND I
THINK WHAT SHE MEANT WAS OF THE
HEALTH INSURANCE PREMIUM PROGRAM
BECAUSE OF COURSE THE AMERICAN
KIDNEY FUND.
IS GOVERNED BY A BOARD OF
TRUSTEES OF THE NATIONAL BOARD
OF TRUSTEES OR TWENTY FIVE THE
HEALTH INSURANCE PREMIUM PROGRAM
HIT THAT WERE HERE TALKING ABOUT
TODAY.
IS GOVERNED BY NONE OTHER THAN
THE OFFICE OF THE INSPECTOR
GENERAL AND SPECIFICALLY.
OFFICE OF THE INSPECTOR GENERAL
ADVISORY OPINION NINETY SEVEN
DASH.
ONE LEGISLATIVE COUNSEL HAS
CONCLUDED.
THAT ASSEMBLYMAN WOODS BILL TO
NINETY CONFLICTS WITH ALONE ON
ON ON AND THAT'S NOT TRUE LET'S
LET'S LET'S OKAY YOU PULL THAT
ONE SENTENCE.
RIGHT I READ THE CONCLUSION NOW
I COULD READ THE WHOLE MEMO BUT
I THINK PEOPLE HAVE THAT AND
ANALYSIS AND I'M CERTAINLY HAPPY
TO SHARE WITH THEM.
BUT I READ THE SUMMARY.
I MEAN IN THAT SO YOU TOLD ONE
LINE OUT AND THERE'S A SUMMARY
SO I APPRECIATE YOUR THOUGHTS
COUNSEL FOR THE AMERICAN CAN YOU
FOUNDATION.
YOU HAVE YOUR OWN OPINION I
RESPECT THAT YOU KNOW YOU HAVE
YOUR OWN LEGAL OPINION THIS IS
THE LEAD COUNSEL FOR THE
LEGISLATURE YOU CAN CERTAINLY
DISAGREE.
RIGHT THE HEALTH LAWYERS CAN
DISAGREE THAT'S FINE BUT I THINK
IT'S AN APPROPRIATE FOR YOU TO
MISS CHARACTERIZE.
WHAT ARE LEDGE COUNCIL HAS TOLD
US OKAY TO SPEAK FOR THE
AMERICAN GINNY FOUNDATION SPEAK
FOR YOUNG LEGAL OPINION BUT
DON'T CLAIM THE LEDGE COUNCIL?
OF THE CALIFORNIA LEGISLATURE
SAID SOMETHING THEY DID NOT SAY
ALL RIGHT SO I JUST WANT I WARN
YOU.
PLEASE DO NOT DO THAT YOU KNOW
IF I MADE THAT THAT KINDA
SATISFIES LIKE AS I WAS JUST
SHARING SOME OF MY CONCERNS.
AND ONE OF THE THINGS THAT I
WANTED TO THE FIGHT.
MAY I KNOW THERE'S A LOT OF
SPANISH SPEAKING.
OF PEOPLE HERE WHO CAME WHO
EXPRESS THEIR CONCERNS AND I
ALSO LIKE TO SAY TO THEM IN
SPANISH IF.
YOU ALLOW ME.
GETTY OTHER SEATTLE OFFICE ON
NORTH CAROLINA'S MANUAL GIVING
AND ON UP IN THE U. K. UP
WILLIAM ASSIST OPERABLE HE'S FOR
PROPUESTAS LA YES.
GET ALREADY DIALECTICAL BUT
SIMPLY LOOK AT THIS ME SAID THE
SCANDAL BASED ON OFFICE AND I
YOU THEM THOUGH.
GET THAT I GOT AND I YOU KNOW
THAT THEY LEFT FROM THE CEILING.
YOUR ETERNAL TENEMOS BLIND BUT I
THAT I LIKE HAND PICKED LIST AS
ME SAID THAT SINCE I'VE HAD THIS
GAME.
NO ONE UP IN A PLAN BUT I BUT I
YOU THAT ONCE -- MEDICAMENTO E.
OKAY THE OTHER CBO NOMINADA THEY
CAME OUT THEY WOULD OUT AND GETS
US.
DOES HE WANT TO MEET PERSONA. TO
BE UNLIKELY THAT CAN ASSIST SEAT
THEM BY MERELY IMPORTANT BEEN
ONLY HAD I NOT BEEN SEEN THANK
CUIDADO.
I MEAN BUT I DON'T DAY SEE.
DONNA YOU THAT.
ALL I CAN THINK IN THE COMMENTS
ABOUT SHARE MY CONCERNS WITH YOU
GUYS.
ALL RIGHT SIR LEYVA.
THANK YOU MISTER CHAIR SO WE'VE
HEARD A LOT OF DISCUSSION ABOUT
THE OFFICE OF THE INSPECTOR
GENERAL AND THIS OPINION THAT A
K. F. IS USING.
AM I CORRECT IN THAT THAT
OPINION WAS RENDERED IN.
NINETEEN NINETY SEVEN SO IT'S
TWENTY TWO YEARS OLD YES YOU ARE
CORRECT BUT IT HAS BEEN REVIEWED
OVER THE OVER THE COURSE OF OF
TIME SINCE THEN SO WHEN WAS THE
LAST TIME YOU ASKED HIM FOR
OPINION ON THIS.
YOU DO NOT GO BACK AND ASK FOR A
SUBSEQUENT OPINION BUT THE ID
CONTINUES TO ISSUE OPINIONS IN
THE SAME AREA -- AND A FEW YEARS
AGO THEY DID A REVIEW ACROSS THE
BOARD -- OF OPINIONS IN GENERAL.
IS THERE ARE SOME MIGHT WANT TO
COMMENT I I DON'T KNOW IF THAT'S
TRUE NUYS AT TRUE WE CAN'T ELSE
OFFICE OF THE INSPECTOR GENERAL
FOR AN OPINION ON THE KNOB I'M
SORRY I'M I'M.
MAY HAVE MISS -- MAY NOT OF
ANSWER THAT QUITE AS I INTENDED
I'M NOT SAYING THAT WE CANNOT
ASK THEM YOU ASKED ME WHEN WAS
IT RE REVIEWED.
I WAS SIMPLY SAYING THAT THE
PROCESS IS NOT FOR AN
ORGANIZATION TO HAVE AN OPINION
TO GO BACK EVERY SO MANY YEARS
AND SAY WOULD YOU TAKE A LOOK AT
MY OPINION AGAIN BUT THE ID DOES
SUBSEQUENTLY ISSUE ADDITIONAL
OPINIONS.
THAT YOU FOLLOW IN YOUR REVIEW
NOW I DON'T HEAR FROM YOU SO MY
QUESTION IS IF YOU'RE SO
CONCERNED ABOUT THE OFFICE OF
THE INSPECTOR GENERAL AND THEIR
OPINION WHY WOULD YOU NOT GO TO
THEM.
YESTERDAY WHEN THE BILL WAS
INTRODUCED AND ASK THEM FOR AN
OPINION IF THINGS HAVE CHANGED
IN THE LAST TWENTY TWO YEARS.
THE THE WAY THE PROCESS WORKS IS
THAT NUMBER -- ONE THE WE WOULD
NOT RECEIVE QUITE FRANKLY A
TIMELY RESPONSE ON THAT KIND OF
OF OF OF QUESTION WE CAN READ
OUR OPINION AS WE HAVE DONE.
BUT THE CRITICAL THING HERE AND
I WITH ALL DUE RESPECT MISTER
CHAIRMAN I'M NOT SAYING THAT THE
LEDGE COUNCIL SAID SOMETHING
THAT THEY DIDN'T SAY.
THAT IS NOT WHAT WE'RE IMPLYING --
BE AND AND I GREW TO THAT
CONCLUSION IS WHAT THEY SAID.
WHAT WE ARE AT YOUR OWN OPINION
THAT'S FINE BUT DON'T MISS
REPRESENTS A RITE WHAT WHAT I'M
SAYING SIR IS THAT?
WHAT IS REALLY CRITICAL IS WHAT
SPECIFIC ARRANGEMENT WAS
APPROVED YOU CAN ALL PINE ON?
WHAT ELSE MIGHT HAPPEN?
WHAT WE'RE REFERRING TO IN THE
LEDGE COUNCIL LETTER IS THAT
THEY SAID THIS ARRANGEMENT GOALS
BEYOND INTO NANI GOALS BEYOND
WHAT YOU ARE APPROVED?
IT GOES BEYOND THAT AND THEN
THEY OPINED ON HOW OLD THE I. G.
MIGHT RE INTERPRET WERE THEY TO
REVIEW THE WHOLE THING ALL
TOGETHER AGAIN AND SAID THAT
THEY BELIEVE THAT THE IG WITH
THAT APPROVE THAT.
AND WHAT WE'RE SAYING IS THAT AS
A CHARITABLE ORGANIZATION.
WE CANNOT STEP OUT ON A LIMB AND
SAY WELL WE'RE GOING TO LEAVE
THE SAFETY OF KNOWING WHAT WE'RE
DOING IS FOLLOWING THE RULES AND
INSTEAD WE'RE GOING TO GO OUT ON
WHAT THEY MIGHT APPROVED GOING
FORWARD.
SO BACK TO ME THANK YOU
APPRECIATE YOUR DRESSING THE
CHAIR BUT BACK TO MY QUESTION
WHY WOULD YOU NOT HOUSE THEM FOR
AN UPDATED OPINION WE'VE HAD SO
MUCH DISCUSSION ABOUT THAT TODAY.
AND TO ME IT JUST SEEMS LOGICAL
IF YOU'RE ACTUALLY SAYING THAT
YOU WOULD LEAVE CALIFORNIA BASED
ON THIS TWENTY TWO YEAR OLD
DECISION I WOULD GO TO THEM AND
SAY IT'S TWO THOUSAND NINETEEN
CAN WE GET.
AN UPDATED OPINION OR DOES YOUR
OPINION WE HAVE SEVENTY FIVE
THOUSAND PEOPLE IN TIS COUNTRY
NATIONWIDE WHO ARE DEPENDENT
UPON THIS PROGRAM WE'RE GOING TO
TAKE THE ACTION THAT WE THINK
IT'S IN THE BEST INTEREST OF ALL
OF THOSE PEOPLE.
AND IT IS TRUE THAT WE WE WILL
CONTINUE TO CONFER WITH THE ID
BUT WE'RE GOING TO TAKE THE STEP
AND WHETHER OR NOT WE ASK FOR AN
ADDITIONAL OPINION OR ASK FOR RE
REVIEW.
IT'S GOING TO DEPEND UPON WHAT
WE THINK IT'S IN THE BEST
INTEREST OF THE SEVENTY FIVE
THOUSAND PATIENTS THAT WE ASSIST
NATIONWIDE OKAY SO THIS IS A
CALIFORNIA DECISIONS IS A
CALIFORNIA BILL.
SO JUST IT IT IT'S FINE I OUSTED
YOU DON'T HAVE AN NSWER --
JONES DO YOU HAVE ANYTHING TO
ADD TO THAT.
I'D LIKE TO TAKE A STEP BACK
JUST A MOMENT AND I I APPRECIATE
THIS DISCUSSION BECAUSE THE A
CALF DID.
IN NINETEEN NINETY SIX NINETEEN
NINETY SEVEN ALONG WITH.
SEVEN AS SEVEN DIALYSIS
COMPANIES.
ARMORS SIX BILLION ABOUT AN ITEM
THAT BUT A UNNAMED DIALYSIS
COMPANIES SEEK AN OPINION FROM
THE IG.
SO IT WAS NOT THE O. I. G..
MOVING FORWARD WITH THIS OPINION
IN THE ABSENCE OF A REQUEST IT
WAS THE A CALF AND DIALYSIS
PROVIDERS.
pIG APPROVED WAS AN ARRANGEMENT
THAT HAD SUBSTANTIAL GUARD RAILS
SOME OF THOSE GUARD RAILS WERE
THAT THE COMPANIES WOULD NOT.
ADVERTISE PUBLICLY.
THE HIT PROGRAM THE A CAPS
PREMIUM ASSISTANCE PROGRAM.
THAT THEY WOULD NOT DISCLOSE
DIRECTLY OR INDIRECTLY TO
PATIENTS THAT THE THAT THE
PROVIDER CONTRIBUTED -- THOSE
REALLY ARE SOME OF THE THE
ABSOLUTELY CRITICAL THEIR OTHER.
GUARD RAILS IN PLACE BUT THOSE
ARE ARE PRETTY CRAPPY ONES
[inaudible]
AND THOSE THE SITUATIONS HAVE
CHANGED OVER THE YEARS -- BUT
THAT'S REALLY A LOT OF WHERE THE
A CALF IS HINGING THEIR CONCERN
AND CLAIMING THAT THEY WOULD
NEED TO LEAVE CALIFORNIA -- WITH
REGARD TO THE DISCLOSURE TO
PATIENTS.
WE TOOK VERY SERIOUSLY THE A
CAPS CONCERNED THAT THE BILL
COULD THROUGH AS THE LEGISLATURE
CALLED IN IT AT THE LEDGE
COUNCIL CALLD AN ATTENUATED
PROCESS.
THAT A PATIENT COULD BECOME
AWARE THAT THEIR CLINIC.
WE TOOK THAT VERY SERIOUSLY AND
SO.
WE AMEND WE AMENDED THE BILL.
WE TOOK AMENDMENTS -- DOCTOR
WHAT AMENDED THE BILL TO PREVENT
IN ANY WAY THE DISCLOSURE OF A
CLINICS PROVIDER STATUS.
AND WHAT THAT LOOKS LIKE IS THAT
FOR EVERY OTHER TYPE OF PROVIDER
IN THE STATE.
THEY WOULD BE DEEMED FINANCIALLY
INTERESTED.
IF THEY ARE EITHER PAYING A
PATIENTS PREMIUMS.
OR IF THEY ARE ARE CONTRIBUTING
TO AN ORGANIZATION THAT IS
CONSIDERED FINANCIALLY
INTERESTED.
WE CREATED A NEW ENTIRELY NEW
CATEGORY.
OF FINANCIALLY INTERESTED ENTITY
THAT THE THAT ENCOMPASSES
DIALYSIS CLINICS.
AND THE LEGISLATION IS CURRENTLY
AT SECTION -- F. TO SEE WITH THE
AMENDMENTS TO THE MOVE TO G. TO
SEE IF YOU WANT TO READ IT --
SAYS THAT FOR A DIALYSIS CLINIC
TO BE CONSIDERED FINANCIALLY
INTERESTED.
THEY EITHER HAVE AT LEAST A 10%
MARKET SHARE IN CALIFORNIA OR
CONSIDERED A LARGE DIALYSIS
ORGANIZATION BY THE FEDERAL
GOVERNMENT WHICH MEANS THEY HAVE
MORE THAN TWO HUNDRED CLINICS
NATIONALLY.
THAT MEANS THE PROVIDER STATUS
THE PROVIDER -- CONTRIBUTE
CONTRIBUTE CONTRIBUTOR STATUS
THE A CALF NOW HAS NOTHING TO DO.
WITH WHETHER A CLINIC IS
CONSIDERED FINANCIALLY
INTERESTED UNDER THE BILL.
AND THAT IS VERY CLEAR -- WHAT
THAT MEANS IS THAT THERE IS NOW
ZERO CHANCE BUT THE A CALF WOULD
BE DISCLOSING DIRECTLY OR
INDIRECTLY TO A PATIENT?
THAT THE CLINIC IS A CONTRIBUTOR
THE A CALF WOULD BE REQUIRED TO
FOLLOW THE DISCLOSURE
REQUIREMENTS TO THE HEALTH
INSURANCE PLANS FOR ALL PATIENTS
FOR WHOM.
IT RIGHTS GRANTS THAT WOULD MEAN
CONTRIBUTOR CLINICS AND NON
CONTRIBUTOR CLINICS ALIKE --
WE'VE MADE THIS UNIFORM EVEN
THOUGH THE BILL NO LONGER WOULD
APPLY TO SOME CLINICS WHO ARE
CONTRIBUTORS.
BECAUSE THOSE CLINICS BELONG TO
SMALLER SYSTEMS ARE INDEPENDENT
CYST OR INDEPENDENT CLINICS.
AND DO NOT HAVE THE MARKET SHARE
TO BE DEMANDING THE INCREDIBLY
EXORBITANT COMMERCIAL RATES --
SO WE HAVE WE TOOK THE A CHAOS
CONCERN.
BROKE THAT LINKAGE WHICH MEANS
THAT WE NOW FEEL THAT IT IS
DISINGENUOUS BE CLAIMING THAT.
THAT PART OF THE O. I. G. MEMO
IS.
EVEN AT RISK OF BEING VIOLATED
BEFORE THEY GO BACK TO A NEW A
NEW -- IG OPINION HOWEVER.
THE DIALYSIS COMPANIES DO
ROUTINELY VIOLATE THE O. I. G.'S.
FOR EXAMPLE CURRENTLY AS OF AN
HOUR IN TWO HOURS AGO NOW ON TO
THE THIS WEBSITE IS AN
ADVERTISEMENT TO THE PUBLIC
REGARDING THE AMERICAN THE
AMERICAN KIDNEY FUND.
AND HEALTH INSURANCE PREMIUM
PROGRAM.
IS UNDER AN FAQ REGARD -- FOR
PATIENTS SEEKING TO A PAYMENT
FOR THEIR COBRA COVERAGE.
THAT IS A PLANE LETTER VIOLATION.
OF THE IG OPINION.
ALSO INTEL IF YOU YEARS AGO BOTH
THE VITA AND FRESENIUS ROUTINELY
IN THEIR SEC FILINGS STATED.
BUT THERE IS.
PREMIUM ASSISTANCE AVAILABLE
FROM THE A CALF AND THE COMPANY
AS WITH MOST OF OUR COMPETITORS
CONTRIBUTES TO THE A. K. YEAH.
SO IF THOSE TYPES OF PLAIN
LANGUAGE IN PRINT VIOLATIONS ARE
NOT CAUSING THE A. K. F..
HARPER.
WE HAVE GONE THROUGH GREAT
LENGTHS IN THIS BILL TO MAKE
SURE THAT THERE IS NOT AN A
VIOLATION OF THE O. I. G.
OPINION BECAUSE WE DO WANT THE A
CALF TO CONTINUE.
WE DO FEEL THAT THE A CALF
PROVIDES A VALUABLE SERVICE IT
WOULD HAVE BEEN MUCH EASIER TO
WRITE A BILL.
THAT WOULD HAVE.
DISALLOWED THIRD PARTY PREMIUM
PAYMENT THE BILL EXPLICITLY
STATES THE HEALTH INSURANCE
PLANS HAVE TO ACCEPT THESE
PAYMENTS.
AND IT'S IN THE A CALF WILL BE
ABLE TO CONTINUE TO OPERATE WE
VALUE THE A. K. F. AND THEIR
PARTICIPATION IN THE CAL IN
CALIFORNIA AS AN OPTION FOR
PATIENTS.
AND FEEL THAT WE HAVE SATISFIED
THOSE CONCERNS.
THANK YOU JOHN THANK YOU MISTER
CHAIR OKAY CENTER TADO.
QUESTION [inaudible]
YEAH.
THANK YOU DOCTOR WOULD FOR
BRINGING THIS BILL AND OTHERS
FORWARD ON I WANT TO START
EXPRESS SEED -- YOU KNOW HOW
MUCH I ADMIRE YOUR LEADERSHIP
AND AND WORK ON IMPROVING -- GET
ACCESS TO HEALTH CARE IN THE
STATE IN MAKING IT MORE
AFFORDABLE [inaudible]
AND YOU KNOW I DON'T DISAGREE
WITH THE ISSUES THAT THE YOU
HAVE RAISED HERE TODAY AND THAT
YOU'RE TRYING TO ADDRESS THROUGH
THIS BILL.
I AM NOT A A FAN OF BIG PROFITS
AND OBVIOUSLY I NOT A FAN OF
INCREASED HEALTH CARE COST FOR
THE CONSUMERS -- AND I'M NOT
GOING TO SIT HERE AND AND
PRETEND THAT I HAVE A SOLUTION
OR THAT.
MY POSITION IS THAT.
THE CORRECT POSITION OR THAT
YOUR POSITION IS IS THE WRONG
POSITION NOT OR THAT I KNOW IT
ALL RIGHT I THINK THAT.
THERE'S A LOT OF DEBATE GOING
BACK AND FORTH.
AND WE WON'T KNOW.
WHO IS RIGHT AND WHO IS WRONG
UNTIL AFTER THE FACT AND SO --
BUT I WANTED TO SHARE WITH YOU
MY OPPOSITION TO TO TO THE BILL
TODAY AND BECAUSE IT'S A DEEPLY
PERSONAL ONE TO ME -- YOU KNOW
ABOUT THREE YEARS AGO MY
GRANDMOTHER.
PASSED AWAY SHE HAD BEEN ON
DIALYSIS FOR ABOUT TEN YEARS.
AND WHEN WE FIRST WE KNEW THAT
SHE HAD CHALLENGES WITH DIABETES
AND AND WHATNOT -- BUT WHEN WE
LEARNED THAT SHE HAD.
TO YOU KNOW TAKE A DO DIALYSIS
TREATMENT -- WE DIDN'T ASK.
YOU KNOW HOW BIG ARE YOUR
PROFITS.
WE WERE WORRIED AND CONCERNED
ABOUT WHETHER OR NOT SHE WAS
GOING TO BE ABLE TO GET THE
TREATMENT THAT SHE NEEDED TO
SURVIVE.
BECAUSE DIALYSIS TREATMENT AS A
MATTER OF LIFE OR DEATH.
IT IS NOT A JOKE IT IS NOT
SOMETHING THAT SHOULD BE PLAYED
WITH IT IS SOMETHING THAT IS
VERY SERIOUS -- EVEN MORE SO TO
ME BECAUSE I HAVE THREE COUSINS
ON DIALYSIS RIGHT NOW
[inaudible] THREE ALMOST EVERY
RELATIVE ON MY FATHER'S SIDE HAS
PASSED AWAY BECAUSE OF KIDNEY
FAILURE.
ALL HAVE HAD TO YOU KNOW GO
THROUGH DIALYSIS TREATMENT.
SO WE CAN SIT HERE AND DEBATE
ALL DAY WHO IS RIGHT WHO IS
WRONG WHO IS LINE WAS NOT LINE.
I DON'T KNOW I DON'T HAVE THE
ANSWER OF WHOSE LINE WHO'S NOT
WHO'S RIGHT WHO'S WRONG I DON'T
HAVE THAT ANSWER ALL I KNOW IS
THAT.
MY NUMBER ONE PRIORITY IS THAT.
THE PEOPLE OF MY DISTRICT AND
PEOPLE ACROSS THE STATE OF
CALIFORNIA.
THAT MY RELATIVES MY LOVED ONES
AT THE POTENTIALLY ME EVEN IN
THE NEAR FUTURE BECAUSE KIDNEY
DISEASE KIDNEY FAILURE RUNS IN
MY FAMILY.
THAT WE HAVE ACCESS TO THE
TREATMENT THAT WE NEED BECAUSE
THIS IS A TREATMENT THAT.
IF YOU DON'T HAVE.
IT'S FATAL YOU'D DIE.
AND I THINK ANYONE IN THIS ROOM
WOULD PAY WHATEVER IT WOULD.
YOU KNOW OF TAKES TO MAKE SURE
THAT THEIR LOVED.
STATE ALIVE AND FOR ME THAT'S
THE REASON WHY I'M VOTING NO
TODAY.
VERY SIMPLE IT'S IT'S I I WANT
TO YOU KNOW WISH YOU SUCCESS I I
HOPE IT THIS ALL WORKS OUT
BECAUSE I THINK THAT THE ISSUE
THAT YOU'RE TRYING TO ADDRESS
OUR LEGITIMATE.
ISSUES -- BUT FOR ME IT'S I
DON'T WANT TO PUT THAT RISK.
IT IN IT YOU KNOW ON THE TABLE
FOR THE PEOPLE THAT I CAN YOU
KNOW CARE ABOUT AND THE PEOPLE
OF MY DISTRICT AND BEYOND. THREE
I WILL RESPECTFULLY -- OPPOSE
THIS BILL TODAY.
CENTER AND SALAS.
YES THANK YOU AND THANK YOU --
EVERYBODY WHO SPOKE AND ALREADY
I KNOW THERE'S A LOT OF EMOTIONS
AND DISCUSSION ABOUT THIS I
APPRECIATE THAT AND THANK YOU TO
DOCTOR PAN.
FOR WORKING VERY HARD AS WELL AS
ASSEMBLY MEMBER WOULD THANK YOU
VERY MUCH FOR FOR THIS I
APPRECIATE YOUR YOU BRINGING
THIS FORWARD AND I WILL BE
SUPPORTING THIS TODAY -- A
COUPLE QUESTIONS I JUST WANT TO
CLARIFY AND THE NEW PER PERSON
ON THAT THE SENATE'S ASIDE.
AND I JUST WANT TO MAKE SURE
THAT WE'RE CLEAR HERE SO WHAT IS
THE PER MEDICARE DIALYSIS
TREATMENT VERSES THE
REIMBURSEMENT RATE -- DO WE HAVE
THOSE THOSE TWO NUMBERS.
THEM MEDICARE IF SOMEONE WERE TO
GO THROUGH MEDICARE OUT WHAT'S
THAT REIMBURSEMENT MEANT RATE
VERSES THE AMERICAN CAN YEAH
THAT IS NOT INFORMATION THAT I
WOULD WOULD HAVE ONE OF OUR FIRE
WALLS IS THAT WE DO NOT GET
INVOLVED IN THE BUSINESS
OPERATIONS.
OF DIALYSIS CENTERS OKAY.
WELL I THINK IT'S FROM.
FROM WHAT IT LOOKS LIKE IT LOOKS
LIKE IT'S ABOUT THREE HUNDRED
DOLLARS VERSUS FOUR THOUSAND
DOLLARS SO MAYBE YOU DON'T HAVE
THAT INFORMATION BUT I'VE BEEN
LOOKING YOU KNOW EVERYWHERE SO
IT LOOKS LIKE I DO HAVE ONE BIT
OF INFORMATION THAT MIGHT BE
HELPFUL.
I THINK THAT FIGURE THAT FOUR
THOUSAND DOLLAR FIGURE WAS
WIDELY INCLUDED IN NEW YORK
TIMES ARTICLES -- I DON'T I
CAN'T TELL YOU THE NUMBERS BUT
THERE IS THERE IS WIDE VARIATION
ALL AMONG THEM AND THOSE ARE
NEGOTIATED RATES BUT I CAN'T
SPEAK -- TO AYE AYE I CAN ONLY
SAY THAT THAT IS THAT IS OUTSIDE
THE NORM BUT I CANNOT SPEAK TO
SPECIFIC RATES BECAUSE I JUST
DON'T HAVE THAT INFORMATION.
OKAY THANK YOU -- I GUESS
ANOTHER QUESTION I HAVE IS.
IS THE AMERICAN KIDNEY FUND I'M
JUST WONDERING -- YOU DO SOME
SUCH GREAT WORK AS EVERYBODY
SAID FOR FIVE STAR -- AND HOW
YOU'RE WORKING WITH PATIENTS ON
THE FRONT END VERSUS THE BACKEND --
ARE YOU INFORMING THEM OUR
MESSAGING TO THEM THAT THEY YOU
KNOW WHAT THEIR OPTIONS ARE
BEFORE.
THEY HAVE TO GO THROUGH THIS
OTHER ROUTE THROUGH COMMERCIAL
OUR WORK IS NOT JUST WITH PEOPLE
WHO ARE ALREADY IN KIDNEY
FAILURE.
IT'S TRYING TO HELP PEOPLE
UNDERSTAND ESPECIALLY PEOPLE WHO
ARE AT HIGH RISK UNDERSTAND THAT
EVEN THOUGH THEY MAY NOT HAVE
SYMPTOMS THAT IF THEY'VE GOT
CERTAIN CHARACTERISTICS THAT
THEY'VE GOT A FAMILY HISTORY.
IF THEY'VE GOT HIGH BLOOD
PRESSURE OR THEY GOT DIABETES
THOSE KINDS OF THINGS THAN THEY
NEED TO GET TESTED WE GO IN
COMMUNITIES AROUND THE COUNTRY --
WE USE OUR WEBSITE IS A VERY
EFFICIENT WAY OF GETTING ON
INFORMATION AND AND RECENTLY WE
HAVE STARTED SOME EFFORTS TO NOT
ONLY GET OUT AND SCREEN AND TALK
AND PROVIDE EDUCATION -- BUT TO
MEASURE THE IMPACT OF WHAT WE'RE
DOING AND THEN IF A PERSON IS
KßT IN KIDNEY FAILURE WE NOT
ONLY PROVIDE THE FINANCIAL
ASSISTANCE AGAIN WE'RE TRYING TO
HELP THEM HAVE THE BEST OUTCOMES.
SO WE ARE AGAIN PROVIDING
EDUCATION AND SUPPORT -- AND
OPPORTUNITIES FOR PATIENTS TO BE
MUTUALLY SUPPORTIVE OF EACH
OTHER SO THAT THEY GET THE BEST
OUTCOMES POSSIBLE SO WE'RE
HELPING PEOPLE WITH A WIDE RANGE
OF THINGS WITH REGARD TO HEALTH
INSURANCE WE DO NOT ADVISE
PEOPLE ON HEALTH INSURANCE.
PEOPLE MAKE THOSE DECISIONS ON
HEALTH INSURANCE AND ON DIE
DIALYSIS PROVIDERS AND THEIR
OTHER HEALTHCARE PROVIDERS
BEFORE THEY COME TO US AND IF
THEY QUALIFY FINANCIALLY FOR
ASSISTANCE THEN WE WILL PROVIDE.
OKAY -- WELL THAT IS WHERE I-FEEL REALLY UNSETTLED IS THAT
YOU KNOW I I DON'T KNOW WHY
THESE PATIENTS ARE IT SEEMS TO
ME THAT THERE'S A LOT OF AND
MISINFORMATION AS IT YEAH.
AS MISTER DESMOND SAID HERE.
YOU KNOW HE WASN'T REALLY SURE
IT SEEMS LIKE OF THE OPTIONS --
AND I KNOW A LOT OF THE PATIENTS
THAT ARE IN MY DISTRICT -- ALSO
DON'T KNOW THEIR OPTIONS AS WELL
SOME AND I'M AND SETTLED WITH
THEM NOT KNOWING WHETHER THEY
CAN GO THROUGH MEDI CAL MEDICARE.
A PRIVATE OPTION.
AND JUST THE SAME MESSAGING --
IS THAT THEY'RE NOT ABLE TO GET
TRANSPLANTS AND YOU KNOW THERE'S
JUST A LOT OF MISINFORMATION OUT
THERE SO FOR THAT REASON.
AND I RESPECT CERTAINLY WHAT YOU
DO AND I THINK -- YOU FOR THE
INFORMATION AS WELL YOU KNOW I
WILL BE SUPPORTING THIS BILL AND
I DO THINK -- WE ABSOLUTELY HAVE
TO PUT OUR PATIENTS FIRST AND I
HOPE THAT THAT.
WILL GO BEYOND ANYTHING ELSE --
HERE THANK YOU.
OKAY SIR GROVE [inaudible]
YES YES.
ADD ONE COMMENT OR QUESTION.
THAT I WANTED TO ASK -- THERE IS
A COMMENTS MADE EARLIER ABOUT
WHY DON'T YOU GO BACK TEAMS THAT
ARE THE OFFICES BUDGET WHAT YOU
GO BACK AND GET A REVIEW.
IS DOES THAT REVIEW COME WITHOUT
RISK.
IT DOES NOT.
SO YOU WOULD BE JEOPARDIZING IF
IT WAS ADVERSELY AFFECTED
SEVENTY FIVE THOUSAND PATIENTS
ACROSS THE NATION.
OKAY AND THEN THE OTHER THING IS
THAT IT'S MY UNDERSTANDING BE
SOMETHING ELSE IS THAT WE HAVE
THAT THERE IS A TWO THOUSAND
FOURTEEN OPINION -- WHICH IS
JUST FIVE YEARS OLD THAT
ADDRESSES A NINETY SEVEN POINT --
ONE IN AFFIRMS THAT DECISION SO
JUST FOR FY IN YOUR COUNSEL MAY
KNOW THAT -- A THAT'SIT THAT'S
IT I GUESS THAT AND IF I MIGHT
ADD I THINK THOSE OF BY
APPRECIATE THOSE VERY IMPORTANT
POINTS.
THAT JUST A FEW MONTHS AGO -- AN
ORGANIZATION CALLED HEARING
VOICES HAD THEIR ADVISORY
OPINION ALL WITHDRAWN BECAUSE
THEY SHARE PATIENT INFORMATION
ON WHO THEY WERE ASSISTING.
SO IF I MEAN I'M A SENIOR
SHARING PATIENT INFORMATION BUT
IF YOU'RE ADVISORY OPINIONS WITH
DRAWN.
WHAT HAPPENS THE AMERICAN KIDNEY
FAN AND THEN THERE FOR THE
THIRTY SEVEN HUNDRED PEOPLE LIKE
MR DESMOND OR SOLD FIVE THOUSAND
SEVENTY FIVE TO SEVENTY FIVE
THOUSAND PEOPLE WOULD BE WITHOUT
OUR ASSISTANCE AT THE OPINION
WERE WITHDRAWN?
AND I GUESS AGAIN MIGHT MIGHT
HUGE CONCERN I HAVE IS.
IF IT IS WITH IF IF FOR WHATEVER
REASON YOU CEASE TO EXIST WHAT
WHAT HAPPENS LIKE.
LIKE I KNOW I THE OTHER BILL
BEFORE ASKED IF I THOUGHT YOU
HAD A BACKUP PLAN BUT IF IF
AMERICAN CAN DEFEND LEAVES
CALIFORNIA.
IS THERE A BACK UP PLAN THAT WE
IMMEDIATELY RESPOND. TO TO HELP
PEOPLE OR DO THEY HAVE TO JUST
SPIN DOWN THEIR ENTIRE LIFE
SAVINGS ARE LIFE EVERYTHING TO
SIX ON OUR BACKS.
SO I GUESS MY I HAVE IT THAT'S
MY HUGE THAT'S MY THING SO ALL
THE STUFF ON THE OUTSIDE BUT WHO
CONTRIBUTE TO DOESN'T COMPUTERS
TO THE PLANS PAY.
I MY CONCERN IS THESE.
THESE PEOPLE THIRTY SEVEN
HUNDRED PEOPLE IN IN
CALIFORNIA'S SEVEN FIVE THOUSAND
OBVIOUSLY CROSS THE NATION BUT
YOU KNOW OF A HUNDRED OF THEM IN
MY DISTRICT THAT ARE JUST LIKE
THAT TO WOMEN SITTING.
RIGHT HERE IN FRONT OF US SO
THANK YOU.
OKAY A CENTER MITCHELL.
THE QUESTION POLLS ABOUT -- OF
YOUR THIRTY SEVEN YOU YOU STATED
THAT YOU DO PROVIDE SERVICES TO
UNDOCUMENTED CALIFORNIA
RESIDENTS WE DON'T KNOW THE
EXACT NUMBER COULD YOU GIVE ME
GENERAL PERCENTAGE BECAUSE WE'VE
EXPRESSED SUCH CONCERN ABOUT THE
THIRTY SEVEN HUNDRED I I'M JUST
CURIOUS IF YOU HAVE A GENERAL
IDEA.
OF THE PERCENTAGE.
I DO NOT HAVE I DO NOT HAVE SUCH
A NUMBER.
AND NO ONE CAN GET THAT FOR US
WHILE WE'RE HERE.
WE AS I MENTIONED WE DON'T ASK
YOU DON'T ASK THE QUESTION OKAY --
JUST WANTED BECAUSE AS WE'VE
TALKED ABOUT BEING CONCERNED
ABOUT ON ACCESS TO CARE AND THE
THIRTY SEVEN HUNDRED RECOGNIZING --
THAT -- MANY UNDOCUMENTED FOLKS --
AND BECAUSE OF LACK OF ACTION BY
THIS LEGISLATURE CONTINUE TO NOT
HAVE ACCESS MAGICALLY LOW INCOME
BECAUSE WE'VE NOT EXPANDED
MEDICAID OUT TO ALL THE THAT'S
ONE SIGNIFICANT WAY IN WHICH WE
COULD MAKE SURE THE PEOPLE HAVE
ACCESS TO HEALTH COVERAGE.
SO IF I WERE TO GET A SENSE OF
THE PERCENTAGE THAT THAT -- BY
LACK OF ACTION BY THIS
LEGISLATURE COULD INDEED BE
COVERED AND HAVE THE FULL
COMPREHENSIVE -- PACKAGE OF
SERVICES SO THANK YOU MAY I CAN.
SHOWED A LITTLE BIT OF LIGHT ON
THAT.
PLEASE.
OF IN OCTOBER TWENTY SIXTEEN TO
VETO -- ISSUED A PRESS RELEASE
STATING THAT IT WOULD NO LONGER
ASSIST PATIENTS.
WHO WERE IN EMERGENCY ONLY
MEDICAID IN SEEKING GRANTS FROM
THE A CALF -- IN TWENTY SIXTEEN
DEFEATED ISSUED A PRESS RELEASE
SAID THEY WOULD NO LONGER ALLOW.
INDIVIDUALS WHO HAD EMERGENCY
MEDICARE AL.
WHICH AS I UNDERSTAND THAT TO
MEAN UNDOCUMENTED CALIFORNIA
RESIDENTS FROM BEING ABLE TO
PURSUE I SEE YOU'VE TURNED YOUR
LIGHT ON WOULD YOU LIKE TO
RESPOND YES BECAUSE I I CANNOT
SPEAK TO THAT I DON'T KNOW
ANYTHING ABOUT THAT PRESS
RELEASE BUT I CAN TELL YOU.
THAT AN INDIVIDUAL CAN COME
DIRECTLY TO THE AMERICAN KIDNEY
FUN AND APPLY FOR ASSISTANCE.
BUT WE STILL DON'T KNOW THE
NUMBER RIGHT BUT THEY DO NOT
HAVE TO GO THROUGH A DIALYSIS
PROVIDER TO APPLY FOR SITE YOU
STILL DON'T KNOW THE NUMBER THAT
YOU'RE PROVIDING.
OKAY THANK YOU FOR THE
CLARIFICATION I APPRECIATE THAT
INFORMATION.
OKAY.
SEE NO THE QUESTIONS I A TO SAID
A FEW QUESTIONS OF MY OWN I WISH
TO POSE SO -- I'M GLAD YOU'RE
HERE WITH JUDGE GENERAL COUNSEL
AND A SO.
YOU HAVE STATED HERE IN THIS
HEARING ON PUBLIC RECORD THAT
YOU WILL LEAVE CALIFORNIA --
MISTER DESMOND I THANK YOU SO
MUCH FOR BEING HERE I BELIEVE
YOU MAY BE MORE LIKE
CONSTITUENTS SO THANK YOU -- SO
ACTUALLY THE BILL DOES NOT
AFFECT MR DOES MEN DIRECTLY
BECAUSE HE DOES NOT FALL IN THE
CATEGORY IS NOT HAVE COMMERCIAL
INSURANCE.
ARE YOU SAYING THE A TF WILL
PULL OUT OF EVERY PATIENT IN
CALIFORNIA INCLUDING ONES WHO
WOULD NOT BE AFFECTED SO DURING
YOUR COUNSEL'S HERE IS TO USE IT
SO THIS WOULD NOT.
SO THE I DID DID YOU SO MISTER
DESMOND WOULD NOT BE AFFECTED
DOWN YOUR CONTRIBUTION TO HIM
WITHOUT THE AFFECTED BY THIS
BILL THIS IS THE WOULD NOT FALL
UNDER THE IG SO YOUR YOUR YOUR
OWN OPINION RIGHT BECAUSE YOU'RE
A COUNCIL SAYS.
WELL THIS WILL MAKE YOU DO SOME
SO YOU'RE NOT HAVE TO REPORT ANY
INSURANCE COMPANY MISTER DESMOND
BECAUSE HE'S NOT SO BECAUSE THAT
FALLS OUTSIDE OF THIS BILL SO
ARE YOU SO I JUST WANNA BE VERY
CLEAR ABOUT WHAT YOU ARE SAYING
WITH YOUR COUNSEL NEXT TO YOU
WHAT.
DID VICE YOU YOU SAY THAT YOU
WILL BE DOING FOR THE RECORD ON
THE PUBLIC RECORD YOU ARE SAYING
AMERICANS ANY FUNCTION OF
COMPOUND ATION WELL THEY
ABANDONED MISTER DOES MEN AND
PEOPLE LIKE HIM WHO ARE NOT
AFFECTED BY THE BILL.
WE HAVE TO TREAT ALL.
NO I JUST YES OR NO THE ANSWER
IS WE WILL PULL OUT FOR ALL
PLANS INCLUDING INCLUDING OKAY
SO BASICALLY YOU'RE PUTTING A
GUN TO OUR HEAD OKAY THANK YOU --
I APPRECIATE THAT.
OKAY -- YOU KNOW I A I A BECAUSE
THERE ARE PATIENTS WHO ARE NOT
AFFECTED BY THIS BILL AND
CERTAINLY AGAIN YOUR I
APPRECIATE THAT YOU HAVE.
YOUR OPINION -- FROM YOUR
COUNSEL AND CERTAINLY I
UNDERSTAND THAT YOU HAVE TO
LISTEN TO YOUR COUNSEL GETTING
YOU CERTAIN OPINION AS WELL --
NO I IT'S THAT SAID WE WE HAVE A
DIFFERENT LEGAL OPINION BUT
AGAIN YOUR COUNSEL IS YOUR
COUNCIL SO YOU DO NEED TO LISTEN
TO THEM.
ICE AND UNDER CERTAINLY
UNDERSTAND THAT POSITION -- I I
DO THINK THAT THIS IS PERHAPS
MORE OF A CHOICE.
THAT YOU'RE MAKING MORE THAN
ANYTHING ELSE.
BUT YEAH I YEAH SO I'VE BEEN
I'VE BEEN MOVE -- I AM A BIT
FRUSTRATED YOU KNOW BECAUSE WHEN
I FIRST CAME INTO HERE AND YOU
CAME TO MY OFFICE AND MANY
OTHERS AS WELL -- YOU KNOW I
HAVE I HAVE TREMENDOUS YOU KNOW
I TREMENDOUS SYMPATHY.
INITIALLY FOR WHAT YOU ARE
EXPRESSING.
BUT I HAVE TO SAY.
AND ACTUALLY I'M SORRY SIR HER
TAUGHT IT WAS NEARLY OF THAT A
FAMILY MEMBER WHO NEED DIALYSIS
AS WELL.
OKAY SO I KNOW HOW IMPORTANT IT
IS IT IS LIFE.
BUT IT'S LIFESAVING IT'S THAT IF
YOU DON'T HAVE IT YOU'LL DIE.
RIGHT I MEAN IT IS THAT CRITICAL
AND THAT THAT'S WHAT THEY'RE
TAUGHT US SAYS I CERTAINLY
UNDERSTAND THAT MYSELF.
RIGHT AND THAT'S WHAT I THINK WE
NEED TO BE EXTRA CAREFUL ABOUT
THIS RIGHT NOW I UNDERSTAND --
CERTAINLY HEAR WHAT CENTER GROVE
IS SAYING AS WELL.
ALL RIGHT AND I KNOW THAT YOU
KNOW HIS EVEN BETTER NINETY
BECAUSE THAT'S WHAT THE PURPOSE
YOUR FOUNDATION IS [inaudible]
RIGHT.
THAT IS EXACTLY AND SO --
BECAUSE IT'S SO CRITICAL.
WE ALSO HAVE TO BE CAREFUL.
THAT IN.
OUR DESIRE NOT JUST DESIRE NEED
NECESSITY OF BEING SURE THAT
THESE PATIENTS GET THE CARE THEY
NEED.
AND THAT'S WHY SHE WHY BY THE
WAY CONGRESS DECIDE INCLUDE AS
PART OF THE MEDICARE PROGRAM IN
THE SEVENTIES I MEAN IT'S KIND
OF A UNIQUE.
PIECE STATE ENTERED AT OKAY --
WE ALSO HAVE TO BE SURE THAT THE
WAY WE STRUCTURE THIS.
ISN'T IN A WAY THAT IS -- THAT
THERE'S EITHER REALITY MOST
IMPORTANTLY BY EVEN THE
PERCEPTION.
THAT.
THESE PATIENTS ARE NOW AN
OPPORTUNITY. TO THEN MAKE --
YEAH TREMENDOUS FINANCIAL GAIN
BECAUSE REALLY WE ARE WE ARE WE
NEED TO STEP UP TO FIGURE THAT
OUT RIGHT SO YOU KNOW WE THINK
ABOUT LIKE I'M TAL OF FOR YARDS
RIGHT HOSPITAL'S BASICALLY HAVE
TO SWALLOW THE CLASS.
AND SOMETIMES YOU DO HEAR PEOPLE
SAY WELL YOU KNOW WHAT.
WHY SHOULD I PAY FOR IT I'VE
HEARD THAT STATEMENT MADE BEFORE
BECAUSE AFTER ALL YOU HAVE TO
TAKE CARE OF THEM?
THE HOSPITAL THEY SHOULD TO
SWALLOW THE COST THE EARTH
ETCETERA BECAUSE YOU KNOW WHAT
YOU GONNA DO A YOUNG ABANDONED
THEM AND LIKE NO WE DON'T WANT
ABANDONED BUT IT TAKES MONEY TO
RUN.
THE E. ARE RIGHT AND SO I
UNDERSTAND IT TAKES MONEY TO RUN
THE DIALYSIS CENTERS BUT THE
SAME TIME.
WHAT I'M CONCERNED ABOUT A
MENTION BEFORE AND I DISCUSSIONS
IS THAT -- WE DON'T WANT TO HAVE
ALSO A SITUATION WE'RE
RECREATING -- THAT -- THAT
BASICALLY SAYS -- WHERE
ESSENTIALLY WHAT HAPPENS IS
BECAUSE THEY'RE SO GOOD SO SUCH
A NECESSITY TAKE CARE OF THEM?
THESE PATIENTS THAT SOMEONE SAYS
WELL THAT'S GREAT AND SO WHAT
HAPPENS IS THAT I CAN -- HAVE A
CREW DEL WE NEED TO TAKE CARE OF
THEM THEY'RE PEOPLE WHO CAN'T
AFFORD.
TO WE HAVE A FOUNDATION WE'RE
GONNA CHANNEL SOME MONEY THERE
AND THAT THEN WILL HAVE ALLOW US
TO MAKE.
YOU KNOW FRANKLY MORE MONEY OFF
OF THAT THAT WE WANT TO BE SURE
THE COSTS ARE COVERED THAT'S BY
THE WAY WHY I INSISTED AND AND
I'M APPRECIATE TO SUMMER WOULD
ADDING TO HIS BILL -- A
MECHANISM TO SAY YOU KNOW WHAT
IF THE MEDICARE RATES WHICH BY
THE WAY IS ESTABLISHED BASED ON
COST REPORTS AND SO FORTH -- YOU
KNOW I I HAVE SOME SKEPTICISM
ABOUT MEDICARE AND THAT'S WHY I
WANTED TO HAVE THIS AMENDMENT.
I HAD YOU KNOW SOME SKETCHES
ABOUT USING THAT AS A BENCHMARK --
SO FORTH I'M NOT SURE IT'S A
GOOD ONE BUT YOU KNOW WHAT WE
HAD SOME DISCUSSIONS WE TRY TO
WORK SOMETHING ELSE OUT.
WE LAND WE STILL ENDED UP
PLANNING THERE BUT TO HAVE THIS
ARBITRATION MECHANISM BECAUSE
WHAT I SAID IS THAT THAT THAT
THAT THE CERTAINLY THE DIALYSIS
COMPANIES.
WHO ARE RIGHT THE DIALYSIS
CENTERS DESERVE TO GET PAID?
BE IT AMOUNT TO TAKE CARE OF
THOSE PATIENTS BECAUSE THEY NEED
THAT CARE WE CAN'T HAVE THEM
CLOSING UP GOING BANKRUPT NOT
ABLE TO RUN -- BECAUSE IF THEY
GO AWAY.
BILL WE HAVE A BIG PROBLEM RIGHT
THEY WE NEED THEY NEED TO HAVE
ACCESS CARE.
THAT'S REALLY REALLY IMPORTANT
THAT'S WHY SAID NOW WE HAVE TO
PUT A MECHANISM THAT THEY CAN
MAKE THEIR CASE AND AND DO THAT.
AND WHILE SOME PEOPLE MAY
DISAGREE ABOUT THE DETAILS OF
WHAT WE WORKED OUT.
I THINK AT LEAST WE TRIED TO
TREAT THAT MECHANISM RIGHT WE
ALSO TRIED TO PUT SOME MORE HELP
AT SOME THAT AMENDMENTS TO TRY
ADDRESS SELF DEALING I KNOW THAT
SOMETHING YOU'RE A COALITION
SUPPORTED A K. ATHENS -- CAME
INTO MY OFFICE SAID YES WE WANT
TO BE SURE WE TRY TO DEAL THE
SELF DEALING PART.
SO TRYING TO STRIKE THIS BALANCE
IN BEING SURE THAT PEOPLE LIKE
MR DOES MEAN HERE.
IS ARE ARE GOING TO GET.
THE CARE SHE NEEDS.
AT THAT ALRIGHT AT DOWN TO THAT
WHAT WE'RE DOING IS IS THAT WE
BUT WE'RE IN A WAY THAT ALSO.
DOESN'T CREE INOPPORTUNE FOR
SOMEONE SAID YOU KNOW WHAT
BECAUSE WE KNOW WE HAVE TO TAKE
CARE OF THESE PEOPLE THIS AN SS
CITY TO DO THIS.
THAT WE'RE NOW GOING TO CREATE A
MECHANISM FOR WE CAN DRAW DOWN
ON THE SINCE THE THE RISK FULL
AND DIVERSE COOL SOUNDS LOW
ADMINISTRATIVE ITSELF ABOUT IT
REALLY MEANS DRISKELL MEANS.
EVERYONE OF US WHO PAYS AND VICE
THAT PRIVATE INSURANCE.
OKAY THE OVERALL THE PEOPLE WHO
ARE WORKING HARD IN THEIR JOBS
WHO ARE ACTUALLY GOING ON STRIKE
BECAUSE THEY HAVE TO NEGOTIATE
BECAUSE THEY'RE TRYING TO KEEP
THEIR HEALTHCARE.
ALL RIGHT AND THEIR SWALLOWING
UP ALL THEIR WAGES ALL THE
INCREASE BECAUSE THE COMPANIES
ARE TRYING TO MAKE MONEY YOU
KNOW TRYING TO BALANCE TO LABOR
COSTS ARE SAYING.
OUR HEALTHCARE COSTS GOING UP
ETCETERA RIGHT AND SO THAT'S
CERTAINLY BEEN ISSUE WE'VE BEEN
DEALING MORE BROADLY BUT WHAT WE
CAN DO IS HAVE A SITUATION WHICH
AND IT'S NOT JUST ABOUT THE
ALICE IS I HAVE TO LOOK AT THE
BIGGER PICTURE WE DON'T.
WANT TO CREATE OPPORTUNITIES FOR
PROVIDERS AND I'M A PROVIDER --
THAT WHERE BASICALLY PEOPLE CAN
LEVERAGE THE RISK FOR BECAUSE
THEN WE'RE GOING.
TO BASICALLY DESTROYED INSURANCE
MARKET IN THE END I MEAN IT'S
IT'S GONNA BE MET ON WORKABLE
RIGHT SO WE CAN'T HAVE PEOPLE
CHERRY PICKING AND SO FORTH AND
DRY AND AND DRIVING COSTS THAT
WAY.
ALRIGHT BUT WE NEED TO BE SURE
THE INSURANCE IS THERE WHEN I
NEED THEM AND I THINK THIS IS
ONE OF THE CHALLENGES OF BEEN
STRUGGLING WITH RIGHT BECAUSE
WHAT ELSE WE PUT PROTECTIONS IN
THE ACA WE SAID.
YOU CANNOT DISCRIMINATE AGAINST
PEOPLE FOR PRE EXISTING
CONDITION THAT'S REALLY REALLY
IMPORTANT.
RIGHT WE FOUGHT WE FOUGHT FUND
THOUGHT BE SURE WE GOT THAT.
RIGHT BUT THAT MEANS THAT
INSURERS CAN'T SIT BACK AND GO
YOU KNOW WHAT.
SOMEONE'S HEAD NEEDS ALICE'S
RIGHT HAND.
TURNS OUT YOU KNOW WE HAVE WE
CAN'T NEGOTIATE BECAUSE THERE'S
ONLY A COUPLE BIG PLAYERS AND
AND SO WHAT HAPPENS IS THAT WE
ARE REQUIRED BY LAW TO HAVE AN
ADEQUATE NETWORK WE CAN'T
NEGOTIATE ADEQUATELY SO NOW WE
HAVE THAT WE NOW WE HAVE.
YOU KNOW THEIR SMALL NUMBER WE
HAVE T CONTRACTED RATE
MISSILES IS OH WOW LOOK THAT'S A
GREAT RATE.
AND NOW WHAT HAPPENS IS BUT THE
PEOPLE WHO CAN'T AFFORD TO STAY
ON THIS PRIVATE INSURANCE AND
THEN THEY GO BE BUMPED OFF THE
MEDICARE SO NOW WHATEVER THEIR
CHANNEL THINGS AROUND.
OKAY SO I REALIZE YOU'RE TO NOW
IT'S INTERESTING YOU'RE THE ONE
WHO'S SITTING HERE WE HAVE BUT I
MEAN THAT THAT'S THE BALLOTS
WERE TRYING TO STRIKE HERE AND I
KNOW THAT'S WHAT THE SENATE
WOODS WE HAVE.
YOU KNOW I APPRECIATE TAKE SOME
AMENDMENTS BECAUSE I THINK WE A
SLIGHTLY DIFFERENT PINIONS ABOUT
MOVIE SO WE WANT TO CREATE THE
OPPORTUNITY SURE THE DIALYSIS
COMPANIES WILL.
GET A RUBIO REASONABLE
REIMBURSEMENT PAYMENT -- ON
AGAIN THIS IS AN ILL SMALL GROUP
OF PATIENTS WHERE REALLY THE
SITUATION IS IS THAT.
THEY YOU KNOW.
WHERE THERE'S THE SICKLY THERE
ARE CERTAIN THAT MEAN THERE A
WITH -- AT THE 280% YOUR DONORS
YOU SHOULD KNOW YOUR TOES ARE
ANYWAY -- AND THEN THERE 80% THE
MARKET MARKET SHARE AND SO AND
THEN THERE'S SENSUALLY.
LEVERAGING THE POTENTIALLY
LETTERING THE THE RISK FULL AND
I THINK THAT'S THAT'S NOT A
SITUATION THAT IS GOOD FOR OUR
CURRENT HEALTHCARE SYSTEM.
AND SO THAT'S THAT'S THE
CHALLENGE -- I MIGHT THINK
SIMILAR WOULD FOR TRYING TO
ADDRESS THAT AND I REALLY
APPRECIATE ALL THE WORK WE'VE
BEEN ABLE TO DO TOGETHER -- AND
TRYING TO CREATE SOME MECHANISMS
TO PUT SOME GUARDRAILS AROUND
THAT -- SO THAT -- WE STRIKE
THAT BALANCE MAYBE IT'S NOT THE
PERFECT BALANCE BUT I THINK THAT
THAT'S WHAT WE'RE TRYING TO DO
AND I CERTAINLY HOPE.
AND AGAIN YOU KNOW -- I WOULD
URGE THE AND IT'S AND MUCH OF
HIS YOU'RE SORT OF LIKE IN THE
MIDDLE OF THIS -- BUT I WOULD
CERTAINLY URGE -- YOU KNOW
YOU'RE AN ADVOCATE FOR PEOPLE
WITH KIDNEY DISEASE AND END
STAGE RENAL DISEASE AND SO I
HOPE IN YOUR ADVOCACY -- YOU'LL
RETHINK THIS DECISION ARE THIS
IDEA OUT THIS ANNOUNCEMENT THE
YOU'VE MADE HERE TO SAY I'M JUST
GONNA PULL OUT OF CALIFORNIA
OKAY THERE ARE PATIENTS LIKE
MISTERDESMOND WHO ACTUALLY
DON'T AFFECTED BY THE BILL --
THERE ARE OTHER THINGS YOU CAN
ASK IN L. A. G. L. IT'S ARE A WE
HAVE I THINK THAT THE I THINK
YOU YOU HEARD OR SOMEBODY.
TOURNEY'S THAT MAYBE JUST THAT'S
THE FIGURE OUT WHAT WE CAN DO
AROUND THAT -- BUT YEAH BUT I
THINK WE HAVE TO DRESS THIS
OTHER PROBLEM AS WELL AND SO --
SO WITH THAT -- I'M CERTAINLY
GONNA BE SUPPORTING THE BILL
TODAY -- SOME MEMBER WAS WOULD
YOU LIKE TO CLOSE.
THANK YOU THANK YOU VERY MUCH --
DOCTOR PAN.
WE'VE HEARD A LOT TODAY HERE --
BUT I WANT TO BRING IT BACK TO
THE THE ISSUE THAT THAT THAT
BROUGHT ME TO HEAR -- YOU HAVE
COMPANIES.
THAT MAKE CONTRIBUTIONS TO
CHARITABLE FOUNDATION.
THAT WHEN I MAKE A CONTRIBUTION
TO A CHARITABLE FOUNDATION I DO
THAT.
I'LL TRADE STICKLEY I DON'T
EXPECT ANYTHING IN RETURN FROM
THAT FOUNDATION.
BUT WHAT HAPPENS HERE.
IS IT THIS FOUNDATION.
THROUGH THE GOOD WORK THIS IS
NOT DISPARAGING THE FOUNDATION
AT ALL AND I WANT TO COME BACK
TO THAT IN A MINUTE.
BY THE PLAN.
THAT ALLOWS THE DIALYSIS COMPANY
TO CHARGE. THREE TO UP TO TEN
TIMES POTENTIALLY IN OTHER AREAS.
THE MEDICARE RATE.
THERE FIVE THERE BY READING A
HUGE WINDFALL [inaudible]
NOW. TO THE IT THERE ARE
GUARDRAILS A CAMP IS NOT KNOW
WHO THE WHO WHO THE RECIPIENTS
ARE -- OR WHERE THE FUNDING IS
COMING FROM BUT YOU ARE
ABSOLUTELY RIGHT EARLIER THIS IS
A NUMBERS GAME.
IT'S A PRETTY DARN GOOD CHANCE
THAT FOR THIS CONTRIBUTION
YOU'RE GOING TO REAP A PRETTY
SIGNIFICANT WINDFALL ON THE
OTHER END.
IT'S A PRETTY GOOD CHANCE OF
THAT.
WHEN YOU CONTROL 82% OF THE
MARKET?
AND 92% OF THE REVENUE.
THROUGHOUT THE UNITED STATES.
BY TWO COMPANIES.
THE REASON WE HAVE THE SITUATION
WE HAVE IS BECAUSE OF THE
CONSOLIDATION OF THE MARKET.
THERE USED TO BE A WHOLE LOT OF
OTHER PROVIDERS BUT THE TWO
PROVIDERS THAT WE'RE TALKING
ABOUT.
HAVE COME IN AND GOBBLED UP IN
IN SOME CASES ACTUALLY SET UP
SHOP NEXT DOOR TO A SMALLER. ONE
FOR THE PURPOSE OF CONSOLIDATION
OF THE MARKET.
NOW WE TALK ABOUT THE I. G.
OPINION AND I WANT TO SAY.
I HAVE NO ISSUE WITH THE A. K.
F..
ABSOLUTELY NOT THIS IS NOT ABOUT
THE A. K. F. THIS IS ABOUT A
BEHAVIOR.
THAT THE COMPANIES ARE USING TO
REAP PROFITS.
I RESPECT THE A CARE I'M HAPPY
WITH WHAT THEY DO.
I AM HORRIBLY DISAPPOINTED THAT
TODAY WE'RE HEARING THAT THEY
WILL PULL OUT OF THE ENTIRE
MARKET OF CALIFORNIA.
EVEN THOUGH.
MISTER DESMOND WOULD NOT BE
AFFECTED AT ALL BY THIS BILL.
WE'RE ALSO HEARING THAT THEY'RE
NOT REALLY WILLING TO SEND SOUND
LIKE THEY WANT TO GO AND ASK FOR
AND I G. OPINION.
YOU WANT TO FIGHT FOR YOUR
PATIENCE YOU WANT TO FIGHT TO
HELP.
KEEP PEACE PAY PAY PATIENTS ON
THESE PROGRAMS YOU WANT TO PACK
UP YOUR TENT AND GO GO AWAY FROM
CALIFORNIA.
I FIND THAT VERY VERY DISTURBING
[inaudible]
A DISTURBING.
WE HAVE SIXTY EIGHT THOUSAND
PATIENTS IN CALIFORNIA ON
DIALYSIS WE'RE TALKING ABOUT
FIFTEEN HUNDRED HERE.
NOT A HUGE NUMBER OF PEOPLE.
AND A K. F. AS WILLING TO JUST
PACK IT UP AND LEAVE CALIFORNIA
WITHOUT A FIGHT.
THAT'S REALLY REALLY
DISAPPOINTING.
REALLY DISAPPOINTING.
THIS IS ABOUT COST CONTAINMENT.
IF WE CAN ADDRESS.
WHAT I CONSIDER TO BE A SCHEME?
THAT IS DRIVING UP THE COST OF
HEALTH CARE.
THAT IS SO EGREGIOUS.
WE CANNOT CONTINUE TO KID
OURSELVES WE'RE EVER GOING TO
GET TO A POINT WE CAN COVER
EVERYBODY IN CALIFORNIA THAT WE
CAN EVER CONTAIN HEALTH CARE
COSTS.
LET'S QUIT KIDDING OURSELVES
FOLKS IT WE CAN'T SUPPORT
SOMETHING THE COP THAT CAN SCAN
CONTAINS COSTS.
BETTER SO EGREGIOUS.
WHY WE EVEN BOTHERING TO TELL
PEOPLE WE'RE GONNA TRY TO DO
THIS FOR GET COVERAGE FOR
EVERYONE CALIFORNIANS WILL NEVER
GET THERE?
WE'RE NEVER GOING TO GET THERE.
I'M DISAPPOINTED THAT.
LAST YEAR THERE WAS NO THERE WAS
NO OPINION THERE WAS NO LEGAL
OPINION THERE WAS NOTHING WHEN
CENTER LEYVA HAD HER BILL.
THERE WAS NO OPINION THERE.
I HEAR TODAY THAT THE O. I. G.'S
ACTUALLY SITS ON THEIR BOARD.
IS THAT WHAT I HEARD WHAT I HEAR
WHATEVER I HEARD SOME THERE WAS
SOME RELATIONSHIP.
THAT OR SOME SOME COPY GOOD
COMMUNICATION BETWEEN -- IGN AND
AND THAT'S THIS MY STATEMENT
THANK YOU.
I JUST DISAPPOINTED THAT -- THIS
TWENTY TWO YEAR OLD OPINION IS
SOMEHOW TREATED LIKE THE
CONSTITUTION OF THE BILL OF
RIGHTS THAT IS SOME HOW
COMPLETELY INVIOLABLE.
DO YOU THINK THE O. I. G.
ENVISIONED THIS IS THE WAY THIS
WILL PLAY OUT.
THAT THE COMPANIES WOULD TAKE
ADVANTAGE OF THIS FOR THEIR OWN
BENEFIT.
DO YOU THINK THE I. T. REALLY
PLANNED THAT THOUGHT ABOUT THAT.
DO YOU THINK THAT IF WE ASK FOR
AN OPINION THEY MIGHT SAY THE
WAY IT'S HAPPENING NOW IS BAD.
DO YOU THINK THEY MIGHT THAT
MIGHT HAPPEN.
IS THAT WHY YOU'RE AFRAID TO ASK
FOR THAT OPINION.
THE DONORS 82% YOUR DONATE DE
DENOMINATIONS COME FROM TWO
SOURCES.
IS HE IS HE A K. F. FREIGHT.
THAT IF THEY DON'T PULL OUT OF
CALIFORNIA THAT THE TWO BIG
DONORS MIGHT NOT CONTRIBUTE TO
THEM IS THAT POSSIBILITY.
I DON'T KNOW.
MY POINT IS IS THAT I'VE I'VE
OTHERS AND I AND I WILL I WILL
CLOSE HERE BUT WE WE WERE SAID
WE HAVE A LEGAL OPINION SAYS YOU
CAN'T DO THIS.
SO WE GOT TO LEGAL OPINIONS.
ARE LET'S COUNSEL AND OUTSIDE
CORPORATE OPINION THAT SAID.
THAT WOULD THEY COULD OPERATE.
NOW TO THE CORPORATE THE
CORPORATE ATTORNEY OR THE OR THE
COOL COUNSEL FOR A K. F..
CHOSE TO CHERRY PICK A LINE.
OUT OF THE BODY.
OF THE OF THAT IGNORING THE
CONCLUSION.
HOW MANY OF YOU ON THE DíAS OF
EVER BEEN INTERVIEWED?
AND HAD SOMEBODY PICK ONE
STATEMENT YOU MADE A MISS
CHARACTERIZE WHAT YOU WERE
TRYING TO REPRESENT.
THAT EVER HAPPENED ANYBODY ON
THE DíAS.
HAPPEN TO ME.
A LOT.
SADLY.
BUT THAT'S THE WORLD WE LIVE IN.
SO I ASK YOU I AM THE I HAVEN'T.
I HAVE A PROVIDER FOR CRYING OUT
LOUD I'M THE LAST PERSON WHO IN
THE WORLD WHO WANTS TO TAKE CARE
WAY FOR PEOPLE.
I WANNA GET CARE TO MORE PEOPLE.
WE CANNOT DO IT.
IF WE ALLOW.
ALL SET SCHEMES LIKE THIS TO
CONTINUE.
WE'RE WE'RE VIOLATING OUR
PROMISE TO CALIFORNIANS THAT
THERE ARE COURTS SOME OF US A
PLEDGE TO GET COVERS EVERYONE IN
CALIFORNIA.
WE CAN'T LET THINGS LIKE THIS
CONTINUE.
I HOPE A CAREFREE CONSIDERS.
DOESN'T ABANDON ACTUALLY GOES UP
TO FIGHT FOR THEIR PATIENTS.
HOPE THEY DO THAT.
I DIDN'T HEAR THAT TODAY JUST
ALL I HEARD WAS ONE OF BACK
APART TEN GO HOME.
THAT'S REALLY DISAPPOINTING --
SPECIALLY WHEN.
MR DEVIN WOULDN'T BE AFFECTED BY
THIS BILL AT ALL THERE WAS NO
JUSTIFICATION BY ANYBODY AS TO
WHY THEY WOULD HAVE TO LEAVE
MISTER DESMOND OUT OF THIS.
THE NOW WOULD STILL INSTEAD I DO
THEY SAID THEY JUST PULLED UP
EVERYBODY.
I'M VERY DISAPPOINTED.
SO AS YOU VOTE TODAY I THINK
ABOUT THIS THING ABOUT THE BIG
PICTURE WHAT WE'RE TRYING TO DO
HERE IN CALIFORNIA.
TRYING TO CONTAIN THE CASA
HEALTH CARE I WHICH IS ALREADY
GOING TO DOUBLE THE RATE OF
INFLATION CALIFORNIA.
HOW DO WE EVER GET THINGS UNDER
CONTROL HAD WE EVER DO THAT WE
CANNOT?
DO SOMETHING SO EGREGIOUS.
THAT ALLOWS FOR HUGE PROFITS.
FOR A CHARITABLE DONATION.
BUT THAT I RESPECTFULLY ASK YOUR
RIVAL.
THANK YOU MISTER DESMOND -- THE
PROCESS BY WHICH WE GO THAT YOU
KNOW WE HAVE QUESTIONS AND
PEOPLE DIRECT QUESTIONS AND THEN
WE HAVE THE CONCLUSION FROM THE
AUTHOR SO HE DOES GET THE LAST
WORD.
AND SO I APOLOGIZE BUT WOULD WE
ARE GOING TO NEED TO MOVE TO A
VOTE NOW BUT I THINK THE
QUESTION THOSE IN -- ACTUALLY
UNFORTUNATELY IN THAT THAT TIME
FOR THAT HAS PASSED SO THAT
SORRY THANK YOU.
OKAY SO IT'S BEEN MOVED THE
CENTER LATE.
SENT BY MOVE I CENTER LEYVA THE
MOTIONS TO PASS AS AMENDED --
AND REFERRED TO THE COMMITTEE ON
APPROPRIATIONS.
SECRETARY PLEASE CALL THE ROLL
AN I AN AYE STONE.
STONE NO GONZALEZ GONZALEZ I
GROWTH.
GROVE KNOW HER TADO.
ATTARDO NO LEYVA.
I MITCHELL.
MITCHELL AYE MONNING MONNING AYE
RUBIO [inaudible] FIVE THREE
THAT THOSE OUT [inaudible]
FIVE THREE THANK YOU.
YOU HAVE ANOTHER BILL.
ITEM NUMBER SHORT TWENTY AB.
ELEVEN SEVENTY FIVE THANK YOU
MISTER CHAIR AND MEMBERS -- AB.
ELEVEN RIGHT TO HAVE A FAMILY
RIGHT.
A US OVER THE WHOLE OF ELEVEN
SEVENTY FIVE WOULD MAKE SEVERAL
CHANGES TO IMPROVE HOW THE MEDI
CAL MENTAL HEALTH SYSTEM
FUNCTIONS.
BY INCREASING THE AMOUNT OF DATA
AVAILABLE CODIFYING KIA
CONTINUITY OF CARE REQUIREMENTS
FOR PEOPLE WHOSE CONDITION
CHANGES.
AND REQUIRING THE EXCHANGE OF
INFORMATION ABOUT PEOPLE BEING
TREATED BY SEPARATE PLANTS -- I
HAVE A COUPLE WITNESSES I
PROMISE I'LL BE BRIEF I
RESPECTFULLY ASK YOUR AYE ABOUT.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY PROUD TO CO
SPONSOR THIS IMPORTANT MEASURE
THAT WOULD -- IMPROVE I HAVE
SERVICES FOR MEDI CAL
BENEFICIARIES ACCESSING MENTAL
HEALTH SERVICES PEOPLE WITH
SEVERE MENTAL ILLNESS.
ARE FOUND TO DIE AT
SIGNIFICANTLY OF YOUNGER DUE TO
THEIR PHYSICAL HEALTH CONDITION
AND THIS BILL WOULD IMPROVE CARE
COORDINATION AS WELL AS
INTEGRATION OF MENTAL HEALTH
SERVICES.
YOUR SUPPORT FOR THIS BILL THAT
PASSED OUT OF THE ASSEMBLY WITH
BIPARTISAN SUPPORT IN OPPOSITION
THANK YOU.
THIS WITNESS THANK YOU A MISS
SHARE SENATORS MARKUPS ON THE
CALIFORNIA PENTATONIC HEALTH
NETWORK -- AS MY COLLEAGUE
MENTIONED -- ON AVERAGE PEOPLE
WITH SERIOUS MENTAL ILLNESS DIE
FIFTEEN TO THIRTY YEARS
PREMATURELY LARGELY DUE TO
PREVENTABLE -- AND MORE
TREATABLE.
PHYSICAL HEALTH CONDITIONS SUCH
AS DIABETES AND HEART DISEASE
THIS BILL WOULD PROVIDE DATA ON
THIS ISSUE ALLOWING US TO TAKE
STEPS FURTHER IN THE FUTURE TO
CLOSE THE STAGGERING DISPARITY
IN FOR THAT WE REQUEST ARRIVAL.
THANK YOU ALL RIGHT OTHER
WITNESSES IN SUPPORT.
A GOOD AFTERNOON JENNIFER ALLEY
WITH CALIFORNIA ASSOCIATION
HEALTH PLANS WE ACTUALLY HAVE A
SUPPORT OF AMENDED POSITION ON
THIS BILL WE'VE HAD VERY
MEANINGFUL CONVERSATIONS.
WITH THE AUTHOR STAFF OTHER
STAKEHOLDERS AND THE SPONSORS
AND WE LOOK FORWARD TO
CONTINUING THAT PROCESS WERE
LIKE THIS CLOSE OKAY THANK YOU
VERY VERY GOOD OKAY THANK YOU.
GOOD AFTERNOON ADRIN CHILDREN
WITH THE STEINBERG INSTITUTE IN
SUPPORT THANK YOU -- CHILD
DISABILITY RIGHTS CALIFORNIANS
SUPPORT IF YOU. TWENTY DEAL
GOING ON BEHALF OF THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION WE HAVE A LETTER OF
CONCERN WE ARE.
THANKFUL FOR THE DISCUSSIONS AND
WE LOOK FORWARD TO CONTINUING
THIS.
THANK YOU ALL RIGHT WITNESSES IN
OPPOSITION.
A SINGLE WITNESS OPPOSITION
QUESTIONS FROM COMMITTEE MEMBERS
SIR MOTION THERE'S A MOTION BY
CENTER LEYVA.
WHICH IS LIKE THE CLOSELY AFTER
I GO OKAY THANK YOU.
AND CERTAINLY IN SUPPORTERS BILL
AND THANK YOU FOR BRINGING THIS
FORWARD THE MOTION IS TO PASS
REFERRED TO THE COMMITTEE ON
RULES.
MASSACRE PLEASE CALL THE ROLL.
HI AND I STONE.
STONE AYE GONZALEZ GONZALEZ I
GROW.
HER TONTO.
TONTO AYE LEYVA AYE LEYVA AYE
MITCHELL.
MITCHELL AYE MONNING MONNING AYE
RUBIO.
RUBIO I DONNA OKAY THE BILLS --
LEVEL AT THAT YEP EIGHT VOTES
THAT WILL HOLD THE ROLE OPEN FOR
THE MISSING MEMBER.
OKAY NOW OFFICIATE AT OKAY --
GOOD.
SO -- BEFORE MOVE ON TO THE NEXT
ITEM AND LET'S SEE -- SOME
MEMBER CHIU RIGHT UP THE
HEADLIGHTS DO WANT AN OUNCE THAT --
WE ARE ALSO HOLDING OVER TO
ADDITIONAL BILLS ITEM -- BOTH BY
SUMMER BONTA ITEM NUMBER FIVE
EIGHTY FOUR ONE FOUR AND ITEM
NUMBER TWENTY SEVEN A. B.
FIFTEEN FIFTY SO LET'S MOVE ON
TO ITEM NUMBER THREE A. B..
THIRTY THIRD THREE EIGHTEEN
WELCOME [inaudible]
A GOOD.
EVEN IN CHAIR AND SENATORS -- NO
I'M HERE TO PRESENT -- TO IT.
A. B..
THREE EIGHTEEN THIS BILL WOULD
REQUIRE NATIVE SPEAKERS TO BE
INVOLVED IN THE FIELD TESTING OF
MEDI CAL BENEFICIARIES MATERIALS.
BY THE DEPARTMENT OF HEALTH CARE
SERVICES AND SPECIFY INFORMATION
MATERIALS SUCH AS THE NEW
MEMBERS PACKAGE AND PLAIN.
PLAN TERMINATION NOTICE BY
MANAGED CARE PLANS.
IT WILL ALSO ESTABLISH A
READABILITY WORKSHOP WORKGROUP
AND DESIGNATE A READABILITY
AXFORD TO REVIEW.
AND REVISE AT LEAST TEN KEY MEDI
CAL DOCUMENTS. FIVE OF THE OF TO
START COMMITTEE ARE EX FITS THE
DISEASE SPECIFIED IN THE BILL.
AND SOME GUIDANCE ARE PROVIDED
IN ORDER TO ENSURE THAT THE MOST
IMPORTANT DOCUMENTS ARE INCLUDED --
I HAVE HERE TODAY WAS ME TO
TOUCH WITH TESTIFIED IN SUPPORT
IS JANE.
FLORA FLORI WAS TO WESTERN
CONTENT -- ON LAW AND PROPERTIES.
BEARING MARCUS BECAUSE FREE
COUNTRY HOME.
SO WITH THE CALIFORNIA PLAN OUT
SICK HEALTH NETWORK.
BULLS ARE CO SPONSOR OF THE BILL.
OKAY I WITNESSES SUPPORT THANK
YOU THANK YOU MISTER CHAIR
SENATORS MARKETS GOT THROWN THE
CALIFORNIA SENATE THE HEALTH
NETWORK -- RECENTLY SOME OF OUR
PARTNERS UNDERTOOK A PROJECT --
IN WHICH THEY HAD NATIVE
SPEAKERS FROM THEIR COMMUNITIES --
REVIEW CERTAIN TRANSLATE
MATERIALS INCLUDING THE DRUG
MEDI CAL MENTAL HANDBOOKS IN
VARIOUS NOTICES.
ON SOME OF THE FEEDBACK WE
RECEIVE FROM FROM OUR PARTNERS --
DETAILED WHY A MORE THOROUGH
READABILITY PROCESS IS NEEDED --
FOR EXAMPLE PARTNERS THAT
REVIEWED MATERIALS TRANSLATE
INTO CAMBODIAN STATED THAT THEY
FOUND BOOKLETS HARD TO READ AND
UNDERSTAND.
THEY ENDED UP -- GOING THROUGH
THEM LINE BY LINE TO REACH
TRANSLATE THEM INTO SIMPLIFIED
LANGUAGE ESTATE IT ENDED UP
BECOMING JUST A TRANSLATION
PROJECT AS OPPOSED TO A REVIEW
BECAUSE THE TRANSLATED MATERIAL
DIDN'T MAKE SENSE OF THE
COMMUNITY -- THIS BILL SEEKS TO
SOLVE THE ISSUE OF DOCKING
READABILITY THROUGH A MORE
DETAILED PROCESS THAN WHAT'S
ALREADY IN PRACTICE BY REQUIRING
FIELD TESTING OF DOCUMENTS.
THAT MANY UNDERSERVED
POPULATIONS RELY ON TO INFORM
THEM OF THE SERVICES THAT ARE
AVAILABLE TO THEM MEDI CAL
PROGRAM FOR THESE REASONS WE ARE
PROUD TO CO SPONSOR AB THREE
EIGHTEEN THINK THE AUTHOR FOR
HIS LEADERSHIP ON THIS ISSUE AND
RESPECTFULLY REQUEST RIVAL.
GOOD AFTERNOON GENTLER ON BEHALF
OF WESTERN CENTER ON LAW AND
POVERTY -- AND WITH REGARDS THE
FIELD TESTING THAT THIS BILL
REQUIRES I JUST LIKE TO CLARIFY
THAT FIELD TESTING ISN'T YOU
KNOW SENDING THE MATERIALS OUT
TO THE COMMUNITY AND IN THIS
CASE LET IT LIKE THEY HAD TO DO
IS.
REVISE AND REDO EVERYTHING BUT
REALLY JUST REPORTING BACK IF
THEY UNDERSTAND IT TOO MANY
TIMES PEOPLE DON'T UNDERSTAND
ACRONYMS HAD BEEN TRANSLATED
THINGS ARE TOO FORMAL -- OR
SOMETIMES THE TRANSLATIONS JUST
LITERAL -- AND THEN IN ADDITION
THE OTHER PART OF THIS BILL WE
ALSO GOT A LOT OF FEEDBACK FROM
THE COMMUNITY THAT PART OF THE
PROBLEM WITH THE TRANSLATION IS
THE ORIGINAL ENGLISH DOCUMENT IS
INCOMPREHENSIBLE.
I'VE SEEN MEDI CAL DOCUMENTS
AIMED AT BENEFICIARIES THE I
MYSELF STRUGGLE TO UNDERSTAND SO
THAT'S WHY WE DO HAVE THIS
READABILITY WORKGROUP WHERE WE'D
BE REVIEWING THE TEN MOST
IMPORTANT DOCUMENTS.
SENDING HIM TO AN OUTSIDE SOURCE
AND ACTUALLY GETTING SOME
EXPERTISE ON HOW TO MAKE MEDI
CAL INFORMATION MORE
UNDERSTANDABLE.
THANK YOU.
THE BILL RATE THAT OTHER
WITNESSES A SUPPORT.
DEATH CAM RANH ON HEALTH ACCESS
CALIFORNIA AND SUPPORT.
YOU -- CHILD DISABILITY RIGHTS
CALIFORNIANS SUPPORT.
OKAY WITNESSES IN OPPOSITION.
I'VE PLEASE MAKE ROOM FOR THEM
AT THE TABLE PLEASE.
THE MIND HER ON BEHALF THE
CALIFORNIA DENTAL ASSOCIATION
AND SUPPORT OKAY THANK YOU ALL
RIGHT ANY OTHER WITNESSES
SUPPORT EVERY GOVERNMENT IS ON
BEHALF OF A LATINO COALITION FOR
HEALTHY CALIFORNIA STRONG
SUPPORT.
THANK YOU ALL RIGHT ANY OTHER
WITNESSES SUPPORT SEEN NINE
WITNESSES OPPOSITION.
TERM MEMBERS KATHY MUST FOR THE
LOCAL HEALTH PLANS OF CALIFORNIA
THE SIXTEEN LOCAL MEDI CAL --
FEE FROM SORRY MEDI CAL MANAGED
CARE PLANS IN YOUR COMMUNITIES
WE UNFORTUNATELY ARE IN THE
POSITION OF OF OPPOSING THIS
BILL AT THIS POINT WE DO WANT TO
THANK THE AUTHOR.
AND THE STAFF AND SPONSORS FOR
THEIR WORK ON THIS WE HAVE
TALKED A LOT AND WE TOTALLY
UNDERSTAND THAT A LOT OF THIS IS.
A MEDICAL INFORMATION THAT NEEDS
TO BE IN HERE DUE TO OUR SORT OF
THE CONTENT BEING REQUIRED BY DH
CS THAT WE CAN'T CHANGE LOCALLY
IS CAN IT CAN AND IS CONFUSING.
WE DON'T HAVE ANY PROBLEM WITH
THE STAKEHOLDER GROUP WE THINK
THAT THAT'S A REALLY GOOD IDEA
AND WE SUPPORT THAT OUR CONCERNS
LIE AROUND THE FIELD TESTING WE
DO FEEL TESTING NOW WE THINK THE
DEFINITION IS BROADER IN THE
BILL.
AND WE DO HAVE CONCERNS ABOUT
GOING THROUGH A LOT OF WORK AND
NOT GETTING MUCH BACK WE WE DO
WANT TO CONTINUE TO WORK WITH
THE AUTHOR AND THE SPONSORS ON
THIS.
AND HOPE TO GET SOMEWHERE ON
THIS SO THANK YOU -- GOOD
AFTERNOON JENNIFER ALI WITH
CALIFORNIA ASSOCIATION HEALTH
PLANS -- WE ALSO APPRECIATE THAT
THE WORK OF THE AUTHOR AND
SPONSORS -- WITH US ON THIS BILL
IT HAS IMPROVED SINCE IT WAS
INTRODUCED -- BUT WE DO REMAIN --
YOU KNOW HAVING SOME SERIOUS
CONCERNS WITH THE BILL -- WE'VE
PROVIDED AMENDMENTS TO THE
SPONSORS UNFORTUNATELY NOT ALL
OF OUR AMENDMENTS WERE ADOPTED
BY THEM ON THE KEY ISSUE THAT
WE'VE JUST KIND OF AGREED --
GOTTEN STUCK ON IS THE USE OF
THE NADER NATIVE SPEAKERS PART
OF THE FIELD TESTING.
I'M AS MISS MOSSBERG STATE WE
CURRENTLY DO DO FEEL TESTING BUT
WE HAVE SOME REAL CONCERNS WITH
THE USE OF A NATIVE SPEAKER --
WE HAVE CONCERNS THAT WE MAY NOT
KNOW HOW THAT PERSON IS ACTUALLY
QUALIFIED TO REVIEW WRITTEN
MATERIALS AND MAKE THE BEST
JUDGMENT ON THE QUALITY OF THE
TRANSLATED MATERIALS BECAUSE
WHEN WE USE PROFESSIONAL
TRANSLATORS WE KNOW -- THEIR
CERTIFICATION THEIR EDUCATION
THEIR THEIR READING LEVELS AND
SO THAT REMAINS THE BASIS FOR
OPPOSITION THANK YOU.
THE OTHER WITNESSES OPPOSITION.
OKAY SEEN A QUESTION FOR
COMMITTEE MEMBERS.
TING UNDISTURBED MOTION ON THE
BILL THAT'S RIGHT CENTER.
MAKE A COMMENT.
THANK YOU I SHOULD SAY WHY I
THINK THIS IS JUST -- BASED ON
MY PERSONAL EXPERIENCE I YOU
KNOW I WAS A TEACHER FOR
SEVENTEEN YEARS AT A SCHOOL AND
WE HAVE PROFESSIONAL TRANSLATORS
AND THAT THE AND I ENDED UP JUST
TAKING OVER AND BE THE
TRANSLATOR BECAUSE FRIENDS HAD
NO IDEA WHAT THE PAPERS WERE
SAYING THERE IS COMPLETELY A
DIFFERENT.
WAY OUR PROFESSIONAL SPEAK AS
OPPOSED HER ACTUAL FAMILIES AND
SO THERE'S ALWAYS A DISCONNECTED
EVEN THAT WASN'T A PROFESSIONAL
TRANSLATOR I BECAME THE OFFICIAL
TRANSIT JUST HIT -- MAKE SURE
THAT IT WAS UNDERSTANDABLE. TO
TWO OR THE REGION SO SO THAT'S
WHY I THINK I IT'S IMPORTANT SO
WITH THE BATTERY THANK YOU AND
SEVEN DEVICE AND RUBIO I'D SO I
SEE -- REVIEW I AM SUPPORTING
THE BILL TODAY HOPE YOU CONTINUE
TO WORK WITH THE OPPOSITION BUT
I WOULD SAY IS THAT.
I THINK TO TRULY MEET THE INTENT
OF THE BILL ANDERSON AND THE
ISSUE AROUND SAYING WELL WHAT
DOES A NATIVE SPEAKER MAIN BUT
IT REALLY HAS TO BE SOMEONE.
WHO UNDERSTANDS WHAT ESSENTIALLY
WHAT HOW THE LANGUAGE IS SEEN IN
THE COMMUNITY RIGHT OTHERWISE WE
WE ACTUALLY SAW A PROBLEM --
THIS YEAR -- AND THIS INVOLVED
ASIAN LANGUAGE HEBREW WENT
ACTUALLY DURING THE MEASLES
OUTBREAK IN NEW YORK THEY PUT
OUT THESE IN HEBREW AND SOMEONE
DIDN'T REALLY READ AT THE OF
WELL AS FROM THE COMMUNITY
STANDPOINT IT DIDN'T SAY WHAT
THEY WANTED TO SAY AND THAT'S A
PROBLEM RATE.
I KNOW THAT CERTAINLY --
ACTUALLY CERTAIN DEGREE MAYBE WE
SHOULD ALSO DO THIS THE ENGLISH
BECAUSE OFTENTIMES WE HAVE
THINGS IN LANGUAGE DOWN AND THAT
ARE IN ENGLISH THAT DON'T MAKE
SENSE TO MOST LAY PEOPLE AS WELL --
BUT CERTAINLY -- I THINK WHEN IT
COMES TO TRANSLATIONS -- NO BAD
TRANSLATIONS MEAN LEAD TO
MISINFORMATION AND SO I THINK
IT'S REALLY IMPORTANT THAT --
THAT -- WE TRADED I I'D WANTED
CHIEF WHAT THE SIMILAR CHIU
STRAIN TO ACHIEVE SO I RECOGNIZE
AND SO WHAT YOU TO WORK ON THAT.
BUT IT REALLY DOES MEAN SOMEBODY
BEYOND JUST HAVING A PERSONAL
CERTIFICATION SOMEONE WHO TRULY
UNDERSTANDS HOW THE LANGUAGE IS
RED AND PRETTY BECAUSE IT'S
REALLY NOT.
TRANSLATION I SHE'S ALWAYS SAY
WE HAVE INTERPRETERS WHO WORK
WITH ME BECAUSE THEY HAVE TO
KNOW THE CONTEXT IN WHICH WERE
SO A LITTLE TRANSLATION MAY NOT
CONVEY.
THE SAME THING THAT THE THING
THAT YOU THINK IT DOES AND SO
WITH THAT -- WOULD YOU LIKE TO
CLOSE.
THANK YOU VERY MUCH OF THE
SENATOR OF PAN AND SENATOR RUBIO
IDEA OF A AND YOU KNOW AS TO A
RECENT IMMIGRANT MYSELF AND
ENGLISH IS MY SECOND LANGUAGE
I'M STILL ENGLISH LEARNER.
I APPRECIATE YOUR COMMENT AND I
RESPECTFULLY ASK FOR YOUR AYE
VOTE HEY THANK YOU ALL RIGHT SO
THE BILL'S BEEN MOVED EMISSIONS
TO PASS REFERRED TO THE
COMMITTEE ON APPROPRIATIONS
SECTOR PLEASE CALL THE ROLL AND
HI AND I STONE.
STONE NO GONZALEZ GONZALEZ I
GROWTH [inaudible]
HER TITLE.
LEYVA.
LEYVA AYE MITCHELL.
MITCHELL AYE MONNING MORNING I
RUBIO.
RUBIO AYE [inaudible] SIX SIX TO
ONE OKAY SO THE BILL'S CURRENTLY --
SIX TO ONE AND WILL HOLD THE
ROLE OPEN FOR ABSENT.
MEMBERS THANK YOU ACCUSING.
GOOD NIGHT OKAY -- THIS SUMMER
CHAO [inaudible]
ALL RIGHT.
WELCOME THANK YOU VERY MUCH.
MISTER CHAIRMAN AND SENATORS --
AB THREE EIGHTY FOUR WOULD BRING
HEALTH INFORMATION COLLECTED BY
FDA APPROVED APPS THAT ARE USED
AT THE DISCRETION OF A PHYSICIAN
TO BE UNDER THE FDA HAS RECENTLY
A STREAMLINED PROCESS BY WHICH
DIGITAL HEALTH PRODUCTS OR
APPROVED.
GIVING HEALTH CARE PROVIDERS NEW
WAYS TO GET THE USEFUL AND
ACCURATE INFORMATION ABOUT THEIR
PATIENTS. FOR EXAMPLE THE FDA
HAS APPROVED THE DIGITAL AND
MOBILE CONNECTED INHALER THAT
CAN DETECT WHEN THE DEVICE IS
USED MEASURE THE STRENGTH OF THE
USERS IN HELL ATION.
AND TRANSMIT THIS INFORMATION TO
THE OTHER USES DOCTOR ALSO A
SEVERAL FORMS OF DIGITAL BILLS
ARE BEING YOU CAN USE.
THESE KILLS COMBINED INJECTABLE
MICROCHIP SENSORS WITH
PHARMACEUTICALS AND COMMUNICATE
WITH THE PATCH TO COLLECT
INFORMATION AND SINCE IT.
A TUNE UP A SIMILAR TO A FITBIT
NOW THIS PRODUCT CAN RECORD WHEN
WHERE AND IN WHAT QUANTITIES
ADDRESS IS -- CONSUMED.
AND THE PHYSICAL STATE OF THE
PERSON -- THAT TAKES A DRAG SUCH
AS TEMPERATURE OF PHYSICAL
ACTIVITY AND OUR HEART RATE
EXCEPT OUR POP HOWEVER IN ORDER
FOR THIS KIND OF DATA TO BE
CONSIDER MEDICAL INFORMATION ALL
IT NORMALLY NEEDS TO BE
GENERATED BY A HEALTH CARE
PROVIDER.
INFORMATION GENERATED --
COLLECTED BY ADDITIONAL HEALTH
APPLICATION MEANING AT THE
PATIENT LEVEL AND ALSO OUTSIDE
OF THE MEDICAL FACILITY A WOULD
NOT NECESSARILY BE CAPTURED
UNDER THE EXISTING DEFINITION OF
MEDICAL INFORMATION.
SB THREE EIGHTY FOUR WILL BRING
THESE TECHNOLOGIES AND ITS
MISSION DATE THAT THAT THEY
COLLECT UNDER CMI A PROVIDING BY
PROVIDING THAT ANY BUSINESSES
THAT -- THAT OFFERS SUCH
APPLICATION OR DEVICE TO A
CONSUMER SHALL BE A PROVIDER OF
HEALTH CARE.
THIS WILL ENSURE THAT SENSITIVE
HOW HEALTH DATA IS TREATED WITH
THE SAME ALL CARE AS STATED THAT
IS GENERATED IN A TRADITIONAL ON
MEDICAL SETTING.
AND PROHIBITS THAT INFORMATION
FROM BEING SURE WITHOUT THE
PATIENT'S WRITTEN CONSENT
WITHOUT A RESPECTFULLY ASK FOR A
VOTE.
THANK THANK YOU -- WITNESSES A
SUPPORT -- SEEING NONE WITNESSES
OPPOSITION [inaudible]
WELCOME.
DOCTOR PAN A CHAIRMAN MEMBERS
THANK YOU ALL OF A ROCK OR A
CALIFORNIA LIFE SCIENCES
ASSOCIATION -- NOT STRICTLY IN
OPPOSITION TO THE BILL WE WERE
LAST YEAR THIS IS BEEN KIND OF A
TWO YEAR PROCESS -- WE'RE STILL
REVIEWING THE AMENDMENTS WERE
PROPOSED LAST WEEK.
WANT TO RECOGNIZE THE AUTHOR I
IN PARTICULAR HIS COMMITTEE
STAFF -- IN IN PRIVACY COMMITTEE
WE'VE COME A VERY VERY LONG WAY
FROM WHERE WE WERE A YEAR AGO
EARLIER THIS YEAR -- SO WANT TO
COMMEND HIM AND HIS STAFF FOR
THOSE EFFORTS -- WE BELIEVE THAT
THESE MEDICAL DEVICES THAT DO
PROVIDE -- DATA ABOUT PATIENT --
INFORMATION IF YOU'RE TO
MEDICATION AMONGST OTHER THINGS
SHOULD BE PART OF YOUR PERSONAL
HEALTH RECORD WHICH THIS BILL
SEEKS TO DO AGAIN THE AMENDMENTS
LAST WEEK I THINK GET US TO A
pTIME -- TO FORMALLY CHANGE OUR
POSITION ON THE BILL BUT WANNA
YOU THINK YOU CAN ASSEMBLYMEMBER
TELL THANK YOU.
THE CHAIRMAN MEMBERS.
FEELING GROUPS OF THE VANCE
MEDICAL TECHNOLOGY ASSOCIATION.
REMAINING OPPOSED AT THIS TIME --
BASED ON THE SORT OF THE
PRESIDENT OF THE STATE BASED
APPROACH IN LIGHT OF THE TO
FEDERAL PROCEEDINGS IS A
REGULATORY PROCEEDING AND HAS
BEEN RECENTLY INTRODUCED.
A LANGUAGE IN CONGRESS -- BUT WE
REALLY APPRECIATE ALL THE TIME
AND EFFORT OF THE MEMBER AND AND
A FAT OF STAFF.
AND THAT'S THAT WERE OPPOSED TO
THIS TIME BUT RESPECTFULLY THANK
YOU THANK YOU.
QUESTIONS ARE COMMITTEE MEMBERS.
RIGHT YES SAYS IS GONNA SAY NO
CLEARLY OTHER RUBIO THE FACT
THAT THERE YOU DON'T WORKING IT
OUT AND YOU'LL HAVE TIME TO TALK
GET OVER MAKE SURE YOU COME.
TO ME I WAS GONNA MOVE THE BILL
AS WELL BUT THE OKAY TO WORK AND
ACTUALLY I JUST WANNA BE SURE
ANY OTHER WITNESSES OPPOSITION.
OKAY THIS ONE BE SURE ALL RIGHT.
OKAY WITH THAT -- THE BILL'S
BEEN MOVED OVER TO LIKE THE
CLOTHES ALL I ASK HER I WILL
THANK YOU VERY MUCH OKAY THANK
YOU VERY MUCH THE MOTIONS TO
PASS REFERRED TO THE COMMITTEE
ON JUDICIARY -- SECRETARY PLEASE
CALL THE ROLL AND I AND I STONE.
STONE NOW GONZALEZ GONZALEZ
SIGNED GROVE [inaudible]
HER TADO.
LEYVA LEYVA AYE MITCHELL
[inaudible]
MONNING [inaudible]
RUBIO [inaudible]
RUBIO I TWO ONE ONE CURRENTLY --
FIGHTS FIVE ONE WILL THE ROLL
OPEN.
pHOLD THE ROLE OPEN -- FOR ABSENT
MEMBERS TAKE CENTER TICKETS FOR
MUCH OKAY ALL RIGHT -- I DON'T
SEE SOME REMEMBERED GARCIA'S SO
I THINK IT'S SIMPLY KALRA IS
HERE -- AT THAT NOW I THOUGHT HE
WAS HERE MOMENT HE JUST LEFT
WITH.
OKAY WELL I SEE A SEMINARY QUE.
AT THE WELL IT IS A FILE ORDER
SO I THINK IT'S ACCURATE CURRY'S
NEXT SORRY I KNOW YOU'RE HERE.
OKAY SO THAT'S ITEM NUMBER
[inaudible]
TEN EIGHTY SEVEN FORTY FOUR THE
ACCOUNT [inaudible]
WELCOME.
THE GIRLS ROOM.
THANK YOU MISTER CHAIR MEMBERS.
I'LL START BY CLARIFYING THAT
I'M PROPOSING AMENDMENTS AS
OUTLINED IN THE ANALYSIS TO
CLARIFY THE INTENT OF THE BILL.
AND ADDRESS MANY OF THE CONCERNS
OF THE OPPOSITION.
AB SEVEN FOUR FOUR STRING THINGS
NONDISCRIMINATION STATUTES IN
EXISTING TELEHEALTH LAW TO
ENSURE THAT A HEALTH CARE
PROVIDER IS REIMBURSED FOR
SERVICES DELIVERED TO AN
ENROLLEE. TO TELEHEALTH WHEN
THOSE SAME SERVICES ARE COVERED
IN PERSON.
ALL CALIFORNIANS SHOULD HAVE
ACCESS TO HEALTH CARE REAL
REGARDLESS OF THEIR LOCATION AND
PROVIDER SHOULD BE INCENTIVIZE
TO EXPAND THE REACH.
THIS BILL DOES NOT EXPAND ANY
SERVICES THAT ARE COVERED IT
ONLY ADDRESSES THE MODALITY USED
TO PROVIDE THOSE COVERED
SERVICES.
WHETHER PROVIDERS SEES A PATIENT
PERSON OR THROUGH A VIDEO
CONFERENCE THEY SHOULD BE PAID
FOR THAT WORK THIS WILL ENSURE
THERE'S ACCESS IN THE MARKET.
AB SEVEN FOUR FOUR WILL
PARTICULARLY HELP CALIFORNIANS
AND RURAL COMMUNITIES MEDICALLY
UNDERSERVED AREAS AND THOSE HAVE
BEEN DISPLACED BY NATURAL
DISASTERS HAVE ACCESS TO
ESSENTIAL HEALTH CARE.
I WANT TO BE CLEAR HOWEVER THAT
THIS IS NOT A RURAL ISSUE WE
HAVE POCKETS IN ALL OF OUR
DISTRICTS WHERE ACCESS IS
LIMITED AND WE SHOULD BE DOING
WHAT WE CAN TO THE LEVERAGE
INNOVATION IN HEALTH CARE. TO
SERVE THESE POPULATIONS.
I'M GOING TO PASS IT OFF TO MY
SUPPORTERS NO GOOD SPEAK TO THE
CURRENT SITUATION WITH TELE
HEALTH AND THE IMPORTANCE OF
THIS BILL.
I THANK YOU WITNESSES SUPPORT.
THANK YOU MISTER CHAIR AND
MEMBERS OF THE COMMITTEE AMY
DRIVER NOT THE CALIFORNIA
MEDICAL ASSOCIATION SPONSORS OF
THE BELL -- EIGHTY SEVEN FORTY
FOUR IS A CRITICAL STEP TOWARD
IMPROVING ACCESS TO QUALITY
HEALTHCARE ACROSS CALIFORNIA BY
ENSURING THAT HEALTHCARE
PROVIDERS ARE OUT OF COOLEY.
REIMBURSED FOR TELEHEALTH
SERVICES ESSENTIALLY IT DESPITE
EXISTING ON TRYING TO ENSURE THE
HEALTH PLANS CAN'T TREAT
SERVICES DIFFERENTLY JUST
BECAUSE ARE PROVIDED THROUGH
TELEHEALTH -- THE PLANS ARE
STILL ABLE TO DO SO FOR INSTANCE
BY CONTRACTING WITH THIRD PARTY
CORPORATIONS AS THEIR SOLE
TELEHEALTH PROVIDER OR LIVING
COVERAGE FOR CERTAIN TELEHEALTH-MODALITIES THAT INHIBITS
CONTINUITY OF CARE FRAGMENTS THE
SYSTEM AND COST PATIENTS MORE.
WHILE DISREGARDING THE FACT THAT
TELEHEALTH IS AN EFFECTIVE TOOL
THAT CAN INCREASE ACCESS TO MANY
DIFFERENT TYPES OF CARE.
AND SERVICES THAT ARE EXACTLY
THE SAME AS THOSE PROVIDED IN AN
OFFICE OFTEN SELLING OF FACILITY
HERE AND WITH EVEN MORE COSTLY
EQUIPMENT.
AND UNFORTUNATELY THESE LIMITED
IN VARYING INSURANCE COVERAGE
RULES ON TELEHEALTH REDUCE
UTILIZATION AND INVESTMENT IN
ITS USE WHICH THIS BILL SEEKS TO
ADDRESS BY ENSURING TAUGHT TRUE
TEL HELP PARITY. FOR ALL
CALIFORNIANS RESPECTFULLY ASK
YOUR ABOUT.
MEKONG IS A THE DIRECTOR OF THE
CENTER FOR CONNECTED HEALTH
POLICY WHICH THE FEDERALLY
DESIGNATED NATIONAL TELL HEALTH
POLICY RESEARCH CENTER.
I'M NOT HERE IN THERE EITHER IN
SUPPORT OR AGAINST THE BILL I'M
HERE IN THE TECHNICAL CAPACITY
TO PROVIDE YOU WITH ANY.
ANSWERS TO POLICY QUESTIONS THAT
YOU MAY HAVE ASKED YOU SEE H. P.
IS THE NATIONAL TELEPATHS
RESOURCE CENTER WE DO EXAMINE
ALL THE TELL HEALTH LAWS
POLICIES A MEDICAID.
POLICIES FOR ALL FIFTY STATES
AND DISTRICT OF COLUMBIA.
WE WERE ALSO THE ORGANIZATION
THAT CREATED THE MODEL LANGUAGE
FOR THE CURRENT TELEHEALTH WALL
IN PLACE IN CALIFORNIA AND I CAN
TELL YOU IN OUR OBSERVATION
STUNNING THE LAWS IN OTHER
STATES.
CALIFORNIA HAS SLIPPED A LITTLE
BIT BEHIND IN THE
PROGRESSIVENESS OF THE LOSS
RELATED TO TELL HOW POLICY
REIMBURSEMENT.
OF RIGHT NOW WITH THE BILL WITH
AB SEVEN FOUR FOUR IT WILL PUT
CALIFORNIA FURTHER AHEAD AND
MORE IN KEEPING A PIECE WITH THE
COUNTRY THERE ARE A COUPLE OF
INTERESTING ITEMS WITH IN THE
BILL THAT MAKE IT A LITTLE BIT
MORE PROGRESSIVE.
SUCH AS ENSURING THAT -- NOT
ONLY OUR THIRD PARTY VENDORS
ABLE TO PROVIDE SERVICES THROUGH
THE HEALTH PLANS BUT ALSO IN
NETWORK PROVIDERS AS WELL.
SO IF THERE ARE ANY QUESTIONS
THAT THE COMMITTEE MEMBERS HAVE
REGARDING NATIONAL PULSE YOUR
STATE POLICY I'M HAPPY TO ANSWER
THOSE.
THANK YOU OTHER WITNESSES IN
SUPPORT.
KELLY BROOKS ON BEHALF OF THE
ASSOCIATION OF CALIFORNIA HEALTH
CARE DISTRICTS HERE IN SUPPORT.
ALEX SOUTHERN OF THE CALIFORNIA
HOSPITAL ASSOCIATION SUPPORT
THANK YOU.
MISTER CHAIR MEMBERS A RICK
ROLLINS REPRESENTED THE AUTISM
BUSINESS ASSOCIATION WE HAVE A
POSITION OF SUPPORT IF AMENDED --
WE ARE SEEKING AN AMENDMENT TO
ENSURE THAT FOLKS -- WITH AUTISM
IN CALIFORNIA HAVE.
HAVE ACCESS THROUGH BEHAVIOR
BEHAVIORAL THERAPY TO TELL
HEALTH SERVICES THANK YOU.
THANK YOU.
MAXINE ANTON BEHALF THE NATIONAL
MULTIPLE SCLEROSIS SOCIETY IN
SUPPORT.
THANK YOU.
THANK YOU MISTER CHAIRMAN
CONSUMERS ON BEHALF OF
CALIFORNIA HEALTH PLUS ADVOCATES
IN SUPPORT THANK YOU.
MY RIBS IN PLANNED PARENTHOOD
AFFILIATES OF CALIFORNIANS
SUPPORT YOU.
KATIE LADEN ON BEHALF OF THE
CHILDREN SPECIALTY CARE
COALITION AND SUPPORT YOU.
SO MY AND HER ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF
MARRIAGE AND FAMILY THERAPIST IN
SUPPORT THANK YOU.
CAP OR THEM ON BEHALF OF SILICON
VALLEY LEADERSHIP GROUP IN
SUPPORT THANK YOU.
RIGHT SPENT ON BEHALF OF THE
CALIFORNIA ACADEMY OF FAMILY
PHYSICIANS AND CHIN IN SUPPORT
THANK YOU.
MANY WE ON BEHALF OF SUTTER
HEALTH IN SUPPORT THANK YOU.
JONATHAN CLAY ABOUT THE SCRIPTS
HEALTH IN SUPPORT THANK YOU.
HEY WITNESSES OPPOSITION MAKE
ROOM FOR THEM IN THE FRONT
PLEASE. SEVENTY WHY CAN SOME WE
HAVE A THE ASSOCIATION OF
CALIFORNIA LIFE AND HEALTH
INSURANCE COMPANIES FIRST OF ALL
WE WOULD LIKE TO THANK THE
AUTHOR IN THE SPONSORED
COMMITTEE.
WE'VE HAD SOME REALLY PRODUCTIVE
CONVERSATIONS ABOUT THE RUBRIC
AROUND THE BILL I THINK WE DO
HAVE SOME CONCERNS MOVING
FORWARD WITH RESPECT.
TO THE PERIGEE ISSUE AND WANT TO
CONTINUE THIS CONVERSATION THAT
THE BILL MOVES FORWARD TODAY I
THINK WE ARE CONCERNED THAT TO
THE DEGREE WE'VE BEEN ABLE TO
NEGOTIATE DIFFERENT RATES FOR
TELEHEALTH IN OUR CONTRACTS THIS.
PRESUMABLY WOULD -- SUPPLANT
THOSE AND POTENTIALLY INCREASE
THE COST FOR CONSUMERS SO AS I
STATED BEFORE ITHINK WE REALLY
LOOK FORWARD TO CONTINUE TO HAVE
POSITIVE CONVERSATIONS THE BILL
WAS FOR TODAY AND WOULD LIKE --
TO KEEP THOSE ISSUES -- BAN --
SO FOR THOSE REASONS THAT WE
REMAIN OPPOSED TODAY THANK YOU.
MISS SHARE MEMBERS JOHN LINGER
ON BEHALF OF AMERICA'S HEALTH
INSURANCE PLANS ALSO
RESPECTFULLY HERE IN OPPOSITION.
WOULD ALSO LIKE TO THANK THE
AUTHOR AND STAFF AND SPONSORS
FOR THE CONVERSATIONS WE'VE HAD
VERY.
PRODUCTIVE CONVERSATIONS AND
LOOK FORWARD TO CONTINUING THOSE --
A HIT FROM A NATIONAL LEVEL IT'S
BEEN COMMITTED TO EXPANDING
ACCESS TO TELL HEALTH SERVICES
AND THERE'S BEEN.
A LOT OF ACTIVITY WITH CMS ON
THE NATIONAL LEVEL AS WELL -- I
THINK WE SHARE THE SAME CONCERNS
AS ACT CLICK AS FAR AS OUR
ABILITY -- TO NEGOTIATING
CONTRACTS AND SHIFT NEAR OF WE
HAVE SOME PROVIDERS THAT ARE
WILLING TO TAKE A LARGER INFLUX
OF PATIENTS AT A SLIGHTLY LOWER
RATE WE WANT THAT ABILITY TO TO
DO THOSE CON.
THOSE CONTRACTS COMPETITIVELY --
AND SO I THINK.
WE'RE HERE CONTINUING OPPOSITION
BUT HOPEFUL THAT WE CAN CONTINUE
HAVE THOSE CONVERSATIONS AND AND
SEPARATE THOSE NEXT.
THANK YOU OTHER WITNESSES IN
OPPOSITION.
JENNIFER ALLEY WITH CALIFORNIA
ASSOCIATION HEALTH PLANS THANK
YOU THANK YOU.
ELLERY NEAR FOR THE CALIFORNIA
CHAMBER OF COMMERCE WHICH THANK
THE AUTHOR STAFFING COMMITTEE
FOR WORKING SO HARD ON THIS BUT
WE'RE STILL OPPOSED AT THIS TIME.
THANK YOU.
ALL RIGHT A QUESTIONS COMMITTEE
MEMBERS US ARE STONE.
THANK YOU -- IT'S MY
UNDERSTANDING THAT -- CHILDREN
MAY NOT BE COVERED TO ACCESS FOR
BEHAVIORAL THERAPY -- WITH YOUR
BILL I'M NOT SURE IF YOU'RE
AMENDMENTS -- ADDRESS THAT -- MY
I'M CONCERNED ABOUT -- CHILDREN
WITH AUTISM -- BEING A
GRANDFATHER OF AUTISTIC CHILD
SOMETIMES -- IT'S VERY DIFFICULT
TO TRANSPORT THEM AND GETTING
THEM SERVICES CAN BE A
CHALLENGING ESPECIALLY IN SOME
RURAL AREAS SO I WAS WONDERING
IF YOU'RE CONSIDERING AN
AMENDMENT DELAY WILL SAY THAT --
REGARDING THE AUTISM PROVIDERS
AND I REALLY APPRECIATE THEY'VE
GOT COMING UP TODAY -- WE DO
WE'RE VERY CONCERNED ABOUT THE
ACCESS TO CARE I AM COMMITTED TO
CONTINUE TO WORK WITH THEM --
BECAUSE IT'S REALLY IMPORTANT
THAT YOU TRY TO HIT EVERY. ONE
POSSIBLE AND THEY HAVE BEEN OPEN
AND THEY HAVE A CONTACTED OUR
OFFICE SO WE WILL WORK WITH THEM --
WE'VE ANTICIPATE REVISED
GUIDANCE FROM DH CS UNTIL HELP
THIS MONTH SO WE'LL SEE WHAT WE
CAN WORK WITH THEM BUT I I
PROMISE YOU THAT I WILL CONTINUE
TO WORK WITH AND FUTURE WORD I
REALLY APPRECIATE THE JARGON AND
ADDRESS.
OKAY ANY OTHER QUESTIONS
REMEMBERS MOTION.
IT'S BEEN MOVED BY CENTER
GONZALEZ -- SO THE SUMMER
AGUIAR-CURRY OF ITS APPRECIATE
YOU BRING THIS BILL FORD.
A A CERTAINLY HEAR FROM THE
OPPOSITION ABOUT NEGOTIATED
RATES I THINK IF YOU'RE
PROVIDING THE EXACT SAME SERVICE.
I THINK WITH.
BAG TO ARGUE WHY IS IT THAT YOU
WOULD PAY A DIFFERENT RATE OR IS
IT COULD BE HIGHER LESS OR SO
FORTH.
ONE IT WOULD MAKE NOTE Y. SE THE
SAME EXACT SAME SERVICE I
UNDERSTAND THAT'S WEIRD AND
APPRECIATE YOU TAKING THE
AMENDMENTS -- MILLIE FOR EXAMPLE --
IN M. CODES WELL IF YOU HAVE THE
A VITAL SIGNS THEN PROBABLY THE
PERSON'S NOT FRONT OF YOU YOU'RE
NOT TO BE ABLE TO DO THAT OVER
SO.
BUT IT IS EXACTLY THE EXACT SAME
SERVICE YOU'RE GETTING PROVIDING
THE THE I DOING THIS THE EXAM
YOU'RE MEETING ALL THE CRITERIA.
IT DOES TO ME BAG BIT QUESTION
THAT WHY YOU WOULD PAY
DIFFERENTLY -- IT'S ALMOST LIKE
WELL IF YOU'RE SO ANYWAY HI SO I
APPRECIATE YOU KNOW IT'S GONNA
KEEP WORKING ON IT.
I I THINK THAT A LOT OF THINGS
THERE MAY BE SOME DIFFERENCES
PRIDE BECAUSE YOU KNOW OVER
WIRES TO ADDRESS IT WOULD BE
DIFFERENT SO I WOULD SAY LIKE
FOR EXAMPLE.
YOU PRIVATE YOU'RE NOT GONNA BE
CODING IN EM ON LEVEL THREE FOR
H. PHONE CONSULTAR K. BECAUSE
YOU JUST CAN'T DO ALL THE THINGS
OVER A TELEPHONE CALL I MEAN
JUST WOULD NOT.
EVER MATCH THAT AS A SOMEONE
WHO'S ACTUALLY YELL TAKES PHONE
CALLS AS A PEDIATRICIAN AND AND
SEES PATIENTS IN CLINIC AND SO
FORTH SO I SO I THINK SOME OF
THE ANXIETY ABOUT WHAT THIS WILL
DO.
A YEAH WELL I SHOULD SAY IN THIS
PLACE -- BUT I THINK PERHAPS ON
WHAT WE REALLY DID SAY IS THAT
IF IT'S THE EXACT SAME SERVICE
THEN YOU SHOULD GET THE PAY THAT
DELEGATE THE RATE AND WE SHOULD
BE NEGOTIATING THAT WAY AND THAT
IN FACT.
WOULD LIKE CHURCH TELEHEALTH
THAT THEY'RE ACTUALLY PROVIDING
THE EXACT SAME SERVICE WE DON'T
DISCRIMINATE AGAINST TELEHEALTH.
SO -- THAT AND AND THAT WAY SO.
THE US SO ANYWAY I APPRECIATE
CONTINUE WORKING TOGETHER I I
WOULD ALSO NOTE THAT THERE ARE
LOTS OF NATURAL CONSTRAINTS ON
THIS BILL ALREADY JUST BECAUSE
OF ITS IT IS THE EXACT SAME
SERVICE THERE'S A LOT OF THINGS
WE CAN'T DO OVER TELEHEALTH THAT
WERE.
REALLY DOES BUNDLED IN TOGETHER
WHICH WOULD MEAN THAT YOU WOULD
ACTUALLY NEGOTIATED RATE NOT FOR
THE ENTIRE SERVICE BUT FOR A
SUBSET AND THAT'S A WHOLE
DIFFERENT AGO SHE ASIAN.
SO I JUST WANNA MAKE THAT POINT --
AND APPRECIATE THE WORK ON THIS
BILL AND SO IT'S AS WHICH LIKE
THE CLOTHES I'M SURE I'D LIKE TO
JUST THINK WE'RE I WILL CONTINUE
TO WORK WITH THE STATE BECAUSE
PEOPLE OF THAT HAVE CONCERNS --
I DON'T BELIEVE THIS THE RATE
SETTING BILL I MUST ADMIT.
MY MINISTER THEY WERE TO JUST TO
CLARIFY THE HEALTH PLANS
PROVIDERS SHOULD WORK TOGETHER
AND HELP NEGOTIATE IF THEY NEED
TO DO SO SO THANK YOU VERY MUCH
AND I RESPECTFULLY ASK FOR YOUR
IPHONE.
THANK YOU AGAIN THANK YOU FOR
TAKING THE AMENDMENTS IT'S BEEN
MOVED TO MOTIONS TO PASS AS
AMENDED REFERRED TO THE
COMMITTEE APPROPRIATIONS SECTOR
PLEASE CALL THE ROLL.
AN ART AND EYEING STONE.
STONE AYE AYE GONZALEZ GONZALEZ
I'D GROW -- TADO LEYVA LEYVA AYE
MITCHELL [inaudible]
MONNING RUBIO.
OKAY THE BILL HAS FOUR VOTES
THAT WILL HOLD THE ROLE OPEN FOR
ABSENT MEMBERS THANK YOU VERY
MUCH ALRIGHT I SEE SOME MERIT
KALRA HERE I BELIEVE YOU.
KNOW PUTS -- GARCIA YOU'RE HERE
ALL RIGHT SORRY THERE YOU ARE
YOU ARE NEXT UP IN THE FOLLOW
ORDER.
AND I UNDERSTAND YOU ARE BOTH
PRESENTING YOUR OWN BILL ITEM
NUMBER SEVEN AS WELL AS FOR
ASSEMBLY MEMBER SALAS WHO'S
NUMBER SIX WHICH ONE DID YOU
WANNA TAKE A FIRST TAKE MY FIRST
OKAY SO WE'RE MOVING ON TO ITEM
NUMBER SEVEN EIGHTY SIX FIFTY
SIX WELCOME.
THANK YOU THE SB SIX FIFTY SIX
CREATES THE OPPOSITE HELP THE IN
SAFETY COMMUNITIES IN DEPARTMENT
OF PUBLIC HEALTH TO DEVELOP.
IMPLEMENT AND MONETARY
CALIFORNIA VISION AND A PLAN FOR
VIOLENCE PREVENTION SAFETY IN
DEALING WITH GOALS ALIGNS WITH
FUNDING TO DRY POPULATION LEVEL
RESULTS FOR DECREASING EXPOSURE
TO VIOLENCE AMONG CALIFORNIA'S.
MOST VULNERABLE PEOPLE AND
PLACES WANT TO THANK YOUR STAFF
FOR THE REPORT AND SOME OF THE
SUGGESTIONS RESPECTFULLY ASK FOR
YOUR AYE VOTE.
YOU HAVE TO WITNESSES THAT WILL
BE BRIEF SALEM VIA WITH ME PINE
JEFFREY VEIN ALSO.
LATINO COALITION FOR HEALTHY
CALIFORNIA OKAY THANK YOU
WITNESSES SUPPORT A GOOD
AFTERNOON WHEN I STARTED THIS MY
NAME IS THE ISRAEL BE ON WITH ME
BY MORE OF AN INDIVIDUAL
LEADERSHIP FOR PUBLIC
ADVANCEMENT ALSO REPRESENT THE
CALIFORNIA LINE FOR YOU THANK
COMMUNITY JUSTICE.
I GREW UP IN THE SALINAS
CALIFORNIA OFTEN.
ALL WE HAD WAS A SUPPORT WE
PROVIDED EACH OTHER THE
COMMUNITY CONDITIONS POVERTY
VIOLENCE AND THE DESPAIR THAT
GOES ALONG WITH THAT WAS
OVERWHELMING FOR ME AS A CHILD.
AT AN EARLY AGE I SUCCUMB TO THE
PRESSURES OF VIOLENCE AS A
RESULT I WAS INCARCERATED ON AN
OFFER EIGHTEEN OF MY FORTY ONE
YEARS.
THERE WAS ALWAYS A WELL RESOURCE
AND ACROSS AND COORDINATED
APPROACH TO MY PUNISHMENT AND
INCARCERATION BUT NEVER FOR
HEALING AND PREVENTION.
IMAGINE IF DECK DECADES AGO
CALIFORNIA HAD INVESTED IN A
COORDINATED APPROACH THAT
FOCUSED ON PREVENTING VIOLENCE
HEALING UNDERLYING TRAUMA AND
SUPPORT OF INTERVENTIONS FOR
PEOPLE CAUSING HARM.
THAT WAS NOT THE DECISION
CALIFORNIA MADE BACK THEN BUT IT
IS DECISION WE CAN MAKE TODAY.
TO MY PERSONAL EXPERIENCE A
MULTI GENERATIONAL VIOLENCE AND
TRAUMA I LEARNED THAT THE CYCLES
OF VIOLENCE CAN BE EFFECTIVELY
ADDRESS TO COMMUNITY BASED
PREVENTIONS.
AT ME BUT WE WORK WITH YOUTH AND
ADULTS WHO HAVE BEEN VICTIMS OF
VIOLENCE EXPOSED TO VIOLENCE AND
SOME WITH COST HARM.
AND WE USE CULTURAL CULTURALLY
ROOTED PRACTICES TO FOSTER
HEALING AND INVEST IN THEIR
LEADERSHIP AND STRENGTH.
THIS APPROACH IS WORKING IN
SALINAS IT'S ALSO WORKING IN
RICHMOND WERE HOMICIDES DOWN BY
50% BECAUSE A COMMUNITY BASED
VIOLENCE PREVENTION PROGRAMS.
IT'S WORK IN ALL THE PLACES
WHERE PEOPLE WHO HAVE BEEN
DIRECTLY IMPACTED BY VIOLENCE
HAVE STEPPED UP TO BUILD SAFER
NEIGHBORHOODS.
WE KNOW HOW TO BUILD REAL SAFETY
WE'RE DOING IT EVERY DAY BUT
THESE EFFORTS ARE NOT CORRELATED
ACROSS THE STATE AND THEY'RE NOT
PROPERLY FUNDED.
WITHOUT A STATEWIDE PLAN IN A
HOME FOR VIOLENCE PREVENTION
HEALING OUR EFFORTS ARE LIMITED
AND ISOLATED.
AND WE'RE NOT ABLE TO BILL
TOGETHER AND COORDINATE FOR FOR
FOR EVEN GREATER IMPACT.
CALIFORNIA NEEDS AN OFFICE ABOUT
THE STATE COMMUNITIES BY HAVING
A DEDICATED OFFICE WE CAN BRING
TOGETHER PEOPLE PRACTICES AND
RESOURCES UNDER ONE ROOF AND
FIND GREAT THE STATEWIDE PLAN.
AMBITION THAT WILL ALLOW HEALTH
AND SAFETY TO FLOURISH.
ALL IN WITH THE CALL FROM OUR
NEW SURGEON GENERAL THE
ATTRITION DR NINETEEN BURKE
HARRIS WHO STATES UNLESS YOU FIX
THE TRAUMA THE WHOLE IN THE SOUL
WHERE THE WOUND STARTED YOU'RE
WORKING.
AT THE WRONG THING.
MY REQUEST HERE TODAY THAT YOU
LISTEN WITH YOUR HEART AND
CONSIDER THOSE COMMUNITIES MOST
VULNERABLE TO VIOLENCE I HUMBLY
AND RESPECTFULLY ASK FOR YOUR
AYE VOTE THANK YOU FOR YOUR TIME
AND CONSIDERATION.
THANK YOU MISTER CHAIR AND
MEMBERS OF THE COMMITTEE MY NAME
IS DOCTOR JEFF PAYNE ALSO I'M
THE EXECUTIVE DIRECTOR FOR THE
THAT THE COALITION FOR ALL THE
CALIFORNIA.
WHERE THE STATE'S OLDEST HELP
POLICY ORGANIZATION ADVANCING
HEALTH EQUITY -- FOR THE STATE'S
LATINO COMMUNITY AS A PO ALL
PROFESSIONAL WHO HAS WORKED AT
THE INTERSECTION OF CRIMINAL
JUSTICE AND PUBLIC HEALTH.
I KNOW FIRST HAND HOW CRITICAL
ADDRESSING THE ISSUES OF
VIOLENCE AND TRAUMA ARE FOR
COMMUNITIES THIS INCLUDES
WORKING ON THE IMPLEMENTATION OF
OUR STATE'S PUBLIC SAFETY
REALIGNMENT.
INITIATIVE AT THE COUNTY SAN THE
WHOLE TEAM SERVICES AGENCY.
THE CDC HAS PROPOSED A SOCIO
ECOLOGICAL FRAMEWORK THAT
EXHIBITS OF VIOLENCE OPERATES IN
OUR SOCIETY AND MULTIPLE LEVELS
INCLUDING AT THE INDIVIDUAL
INTERPERSONAL COMMUNITY AND
SYSTEMS LEVELS.
THE RECOMMENDATIONS ARE TO STOP
VIOLENCE BEFORE BEGINS AND
INTERVENE AT ALL LEVELS.
AB SIX FIVE SIX ADDRESSES THE
NEED FOR COORDINATED STATEWIDE
APPROACHED AND CYCLES OF
VIOLENCE BY CREATING OFFICE OF
HEALTH IN SAFE COMMUNITIES.
IN CALIFORNIA LATINOS REPRESENT
40% OVERSEAS TO NEARLY THIRTY
NINE MILLION RESIDENTS I'M AND
YOUTH IT'S A GREATER SHARE
REPRESENTING OVER 50%.
JUST AMONG ONE FORM OF VIOLENCE
GUN VIOLENCE LET LIVE NEXT YOUTH
ARE DISPROPORTIONATELY IMPACTED
ACCORDING TO A STUDY FROM THE
VIOLENCE POLICY CENTER BETWEEN
NINETEEN EIGHTY NINE AND TWENTY
SIXTEEN SEVENTEEN THOUSAND
IDEALS WERE KILLED BY GUN
VIOLENCE IN OUR STATE.
AN ALARMING 45% IS DEBTS WERE
USE TEN TO TWENTY FOUR YEARS OLD.
A RATE FOUR TIMES LARGER
COMPARED TO WHITE YOU INDIRECT
EFFECTS OF VIOLENCE MAY INCLUDE
TRAUMA IMPERIAL OUTCOMES IN
CLEAN PTSD STRESS ANXIETY AND
DEPRESSION.
PRACTICES THAT ARE COMMON FORM
CULTURALLY APPROPRIATE COMMUNITY
CENTERED AND UTILIZE A SOCIAL
DETERMINANTS OF HEALTH FRAMEWORK
THAT A KNOWLEDGES GENERATIONAL
TRAUMA LEGACIES OF SEX THE
SEXISM RACISM.
AND COLONIALISM ARE EFFECTIVE
STRATEGIES TO REDUCE AND AND
VIOLENCE AND PROMOTE PEACE
HEALING IN SAFETY FOR THESE
REASONS ELSIE SHE'S PROUD TO CO
SPONSOR.
EIGHTY SIX FIVE SIX THANK YOU.
ALL RIGHT OTHER WITNESSES IN
SUPPORT.
I KNOW THE WITNESSES SUPPORT ALL
RIGHT OUTSIDE WITNESSES AN
OPPOSITE OKAY PLEASE COME UP TO
THE MICROPHONE THERE THE ANGEL
MAC PUBLIC HEALTH ADVOCATES A
PROBLEM CO SPONSOR IN IN GREAT
SUPPORT.
THANK YOU.
CAITLYN DEAN THE ALLIANCE FOR
BOYS AND MEN OF COLOR AND POLICY
LINK PROUD CO SPONSORS IN
SUPPORT.
THANK YOU.
MY NAME IS CARLOS ONE BILLION
VIA WITH ME BUT IN STRONG
SUPPORT THANK YOU.
LINDA TENER WHAT'S WITH THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK IN THE HAVING OUR SAY
COALITION IN SUPPORT THANK YOU.
JIM WHEN BURKE ON BEHALF OF THE
FRIENDS COMMITTEE ON LEGISLATION
CALIFORNIA IN SUPPORT.
THANK YOU ALL RIGHT OTHER
WITNESSES IN OPPOSITION.
SAY NINE QUESTIONS OF COMMITTEE
MEMBERS -- YES CENTER LEYVA.
I HAVE NO QUESTION I JUST WANT
TO THANK YOU FOR BRINGING THE
BILL FOR THE IT'S A FANTASTIC
BILL AND WE JUST HAVE TO KEEP
WORKING IN THIS AREA.
HAPPY TO SUPPORT IT AND HAPPY TO
MOVE IT WHEN THE TIME IS
APPROPRIATE.
THANK YOU US CENTER MONEY.
THANK YOU MISTER CHAIR I ALSO
WANT TO THINK.
THE AUTHOR FOR BRINGING FORWARD.
THE WITNESS FROM YOU SALINAS.
IT SEEMS LIKE A NO BRAINER BUT
WE TALK ABOUT PREVENTION.
PROBLEM AND HEALTH CARE THE
PROFIT IS IN TREATING ILLNESS
AND DISEASE.
IF YOU TAKE THAT.
PARALLEL TO THE CRIMINAL JUSTICE
SYSTEM.
WE TREAT.
CRIMINALS AFTER THE FACT.
THIS BILL STARS TO INVEST IN
PREVENTION SO THANK YOU FOR
BEING HERE.
AGAIN THANKS TO THE AUTHOR GLAD
TO SUPPORT IT TODAY THANKS.
SENATE MITCHELL YOU.
UP.
OKAY SORRY ALL RIGHT.
IS IS THERE A MOTION.
ALL RIGHTS IN MOVE I SAID
ORIGINAL ALL RIGHT -- AND AGAIN
I WAS THANK YOU.
THERE WERE GARCIA FOR BRING THIS
BILL FORD CERTAINLY IN SUPPORT
WHICH LIKE CLOTHES JUST WANTED
TO ACKNOWLEDGE THE POWERFUL
TESTIMONY THE YOU JUST HEARD
FROM OUR TWO WITNESSES ABOUT
THIS IMPORTANT ISSUE.
RESPECTFULLY ASK FOR YOU I WILL
OKAY THANKS VERY MUCH IT'S BEEN
MOVED TO MOTIONS DO PASS
REFERRED TO THE COMMITTEE O
PUBLIC SAFETY SECTOR PLEASE CALL
THE ROLL.
HI I STONE.
STONE NO GONZALEZ GONZALEZ I
GROW HER TANU LEYVA LEYVA AYE
MITCHELL.
MITCHELL MONNING MONNING AYE
RUBIO.
OKAY THE BILL CURRENTLY IS FIVE
ONE THE OF THE BILL VOTES TO GET
OUT FOR HOLD THE ROLE FOR OPEN
FOR ABSENT MEMBERS THANK YOU.
ALL RIGHT.
THANK YOU ALL RIGHT AND THEN YOU
GO PRESENTS ITEM NUMBER SIX
EIGHTY FOUR EIGHTY FOR SOMEONE
RIVER SALAS I WOULD MAKE MENTION
THAT THIS BILLS HAS SUPPORT ON
BOTH SIDES SO WE KEEP THINGS
BRIEF -- THAT BE GREAT I
RESPECTFULLY ASK FOR YOUR RIVAL.
OKAY ALL RIGHT.
THERE YOU GO ALL RIGHT WITNESSES
IN SUPPORT.
THE INDICATION IS YOU HAVE
THERE'S A LOT OF PEOPLE EAGR TO
VOTE FOR THIS BILL SO -- WITH
THAT SO.
YOUR PRESENTATION THAT I THINK
YOU'RE TALKING TO PEOPLE WHO
WANT HEALTH [inaudible]
WELCOME.
GOOD AFTERNOON I'M GONNA SHARE
THE FINDINGS FROM OUR STUDY ON
THE MENTAL HEALTH SERVICE ACT IN
OLDER ADULTS SPONSORED BY THE
OVERSIGHT AND ACCOUNTABILITY
COMMISSION.
THIS IS THE FIRST STUDY THAT
ASSESSED HOW WELL MENTAL HEALTH
SERVICES SPONSORED BY THE MHSAA
OR SERVING OLDER ADULTS.
WHICH ARE DEFINED AS PEOPLE
SIXTY AND OVER WITH SERIOUS
MENTAL ILLNESS.
WE FOUND SIGNIFICANT UNMET NEEDS
AND GEOGRAPHIC DISPARITIES
ACROSS THE STATE.
FEW PROGRAMS ARE OUT REACH
EFFORTS WERE TAILORED TO THE
COMPLEX CARE NEEDS OF OLDER
ADULTS.
OUTCOMES MEASUREMENT AND DATA
WERE QUITE LIMITED AND WE
IDENTIFIED ISOLATED PROGRAMS
OPERATING AN INDIVIDUAL COUNTIES.
WE ALSO NOTED THAT THERE IS A
LACK OF LEADERSHIP AT THE STATE
FOR OLDER ADULT MENTAL HEALTH.
SO BASED ON THESE FINDINGS WE
MADE SEVERAL RECOMMENDATIONS
INCLUDING TO ESTABLISH A FULL
TIME ADMINISTRATIVE LEADERSHIP
POSITION AT THE STATE LEVEL THAT
WOULD BE DEDICATED TO ADULT.
OLDER ADULT MENTAL HEALTH
SERVICES.
WITH THE PROPER AUTHORITY THIS
LEADERSHIP POSITION COULD
CONTRIBUTE TO AN OVERSEE THE
IMPLEMENTATION OF STATE POLICIES
TO IMPROVE SERVICES.
PROVIDE NEEDED OVERSIGHT
ESTABLISH STANDARDIZED DATA
REPORTING.
GUIDE COUNTY EFFORTS TO ENHANCE
OLDER ADULT OUTREACH AND
DOCUMENTATION OF UNMET NEED.
PROMOTE STANDARDIZED GERIATRIC
TRAINING AN INCREASE SERVICE --
INTEGRATION EFFORTS.
WE RECOGNIZE THAT GOVERNOR
NEWSOME RECENTLY ISSUED THE
EXECUTIVE ORDER FOR MASTER PLAN
ON AGING AND WE APPLAUD THIS
EFFORT.
HOWEVER THE NEED FOR THIS
POSITION AS A MEDIA AND CRITICAL
AND SHOULD NOT BE TABLE DURING
THAT PLANNING PROCESS.
OUR FINDINGS WERE SUPPORTED AND
FURTHER QUANTIFIED BY THE TWENTY
SEVENTEEN DATA BOOK IN REPORT
RECENTLY ISSUED BY THE
CALIFORNIA BEHAVIORAL HEALTH
PLANNING COUNCIL.
IN CLOSING I LEAVE YOU WITH A
FEW IMPORTANT NUMBERS.
USING A CONSERVATIVE ESTIMATE OF
ABOUT 10% OF PREVALENCE RATE FOR
MENTAL AND BEHAVIORAL HEALTH
DISORDERS WE HAVE ABOUT SEVEN
HUNDRED THOUSAND OLDER
CALIFORNIANS WITH THESE NEEDS.
YET.
TWENTY SIX THOUSAND OLDER ADULTS
RECEIVED BEHAVIORAL AND MENTAL
HEALTH SERVICES IN THE LAST
FISCAL YEAR THIS REPRESENTED 4%.
OF THE TOTAL NUMBER OF PEOPLE
SERVED AND ABOUT 4%.
OF OLDER CALIFORNIANS IN NEED OF
THESE SERVICES.
OLDER ADULTS ARE 16% OF THE
ADULT MEDICAL POPULATION AND YET
LESS THAN 2% RECEIVED EVEN.
ONE SPECIALTY MENTAL HEALTH
SERVICE DURING THE FISCAL YEAR.
SIXTEEN SEVENTEEN AND FINALLY IN
A FORTY FIVE COUNTY STUDY DATA
SHOWED THAT ONLY ONE POINT 5%.
OF OLDER ADULTS RECEIVED ANY
PREVENTION AND EARLY
INTERVENTION SERVICES SPONSORED
BY THE MHSAA.
SO AS YOU CAN SEE THE SITUATION
IS DIRE AND REQUIRES IMMEDIATE
ATTENTION AND RIGHT NOW NO ONE
HAS RESPONSIBILITY TO MAKE THE
SYSTEM.
MORE RESPONSIVE TO THE NEEDS OF
OLDER CALIFORNIANS THANK YOU.
THANK YOU AGAIN I WOULD MENTION
THAT WE HAVE A LOT OF SUPPORT
FOR YOU WOULD LIKE TO GET TO A
VOTE AS SOON AS POSSIBLE SECOND
DAY OR SOME OTHER ISSUES I DO
WANT TO HEAR YOUR TESTIMONY BUT
IF YOU KEEP A BRIEF THAT BE
APPRECIATED.
SEE WHAT I CAN THANK YOU SENATOR
PENN IN MEMBERS CAROL SO FROM
THE CALIFORNIA COMMISSION ON
AGING.
IN STRONG SUPPORT OF AB FOR
EIGHTY WE BELIEVE THAT
ESTABLISHING AN OFFICE DEDICATED
TO OLDER ADULT MENTAL HEALTH
WILL DO ADDRESS A CLEAR NEED FOR
THE SYSTEM TO PROVIDE
APPROPRIATE HAD HEALTH CARE FOR
THIS POPULATION.
I'M YOU'VE ALL HEARD THAT
CALIFORNIA'S OLDER ADULT
POPULATION IS GROWING AT AN
UNPRECEDENTED RATE WHAT YOU MAY
NOT HAVE HEARD IS THAT OVER 20%
OF OUR OLDER ADULTS LIVE AT OR
NEAR POVERTY.
OVER 40% HAVE INSUFFICIENT
INCOMES TO MEET THEIR MONTHLY
EXPENSES -- LIVING LONGER MEANS
THAT THEY LIVE LONGER WITH
CHRONIC CONDITIONS OFTEN ENDING
IN DISABILITY AND ISOLATION.
THESE FACTORS ALONE ARE CAUSE
FOR ANXIETY AND DISTRESS AT ANY
AGE.
ADD TO THIS THE REALITY THAT
OLDER ADULTS WITH THE ONLY AGE
GROUP THAT IS CERTAIN TO FACE
ONE OR MORE OF THE FOLLOWING.
LOSS OF CAREER FAILING HEALTH
THE DEATH OF FRIENDS AND FAMILY
OR LOVED ONES ECONOMIC AND
SECURITY VULNERABILITY TO
EXPLOITATION.
THESE FACTORS PLACE THEM AT
SIGNIFICANT RISK FOR DEPRESSION
ANXIETY PSYCHOLOGICAL TRAUMA AND
SUICIDE.
IN FACT RESEARCH SHOWS THAT
BETWEEN 7290% OF ADULTS OVER.
SIXTY FIVE HAVE BEEN EXPOSED TO
AT LEAST ONE POTENTIALLY
TRAUMATIC EVENT DURING THEIR
LIFE.
COUNTED AMONG THIS GROUP ARE
HOLOCAUST SURVIVORS KOREAN WAR
VIETNAM WAR IRAQI WAR VICTIMS --
VETERANS OF SURVIVORS OF JIM
CROW DISCRIMINATION ELDER JEEP
OF THE ELDERLY REFUGEES AND AN
INCREASING NUMBER OF ELDER ABUSE
SURVIVORS.
LGBT CUES ADULTS ALSO SERVED AS
A PROMOTION IT LEVELS OF
DISCRIMINATION VICTIMISATION.
FILED FOLLOWING A LIFETIME OF
BEING OSTRACIZED BY FAMILY AND
COMMUNITY.
CALIFORNIA'S MENTAL HEALTH
MASTER PLAN OUTLINES AN OLDER
ADULT SYSTEM OF CARE.
BUT THAT SYSTEM EXISTS ONLY ON
PAPER.
CURRENT LAW THAT ADDRESSES ADULT
AN OLDER ADULT PROGRAMS TOGETHER
THIS APPROACH FAILS TO RECOGNIZE
THE CLEAR DIFFERENCES THAT EXIST
BETWEEN THE TWO AGE GROUPS.
AB FORTY BRINGS A DIRECT FOCUS
ON THE GERIATRIC AND
SOCIOLOGICAL ISSUES REQUIRED TO
UNDERSTAND OLDER ADULT MENTAL
HEALTH NEEDS.
ESTABLISHMENT ESTABLISHING THIS
NEW POSITION IN THE DEPARTMENT
OF HEALTH CARE SERVICES CREATES
THE OVERSIGHT AND GUIDANCE
NECESSARY. TO DEVELOP IT -- AND
EFFECTIVE OLDER ADULTS SYSTEM OF
CARE WE ASK FOR YOUR IPHONE.
OTHER WITNESSES IN SUPPORT.
GOOD AFTERNOON ADRIN SULTAN WITH
THE STEINBERG INSTITUTE IN
STRONG SUPPORT THANK YOU.
CHAIR MEMBERS GOT THE MOST FOR
THE CALIFORNIA ASSOCIATION OF
AREA AGENCIES AND SUPPORT THANK
YOU.
ALEX SOUTHERN CALIFORNIA
HOSPITAL ASSOCIATION IN SUPPORT.
THANK YOU ALL RIGHT SEEN OTHER
WITNESS WITH THIS IS IN
OPPOSITION.
A SINGLE WITNESS OPPOSITION
QUESTIONS ARE COMMITTEE MEMBERS
THEIR MOTION MILK OKAY TO MOTION
BY CENTER.
MINING.
SEVERAL GARCIA ALSO MEMBER SALAS
EXTENDED AND THAT'S EXACTLY WHAT
I'VE DONE RESPECTFULLY ASK DR
ALL OKAY THANK YOU I WILL.
I THINK ASSEMBLY EVER SALAS
SHOULD BE VERY GRATEFUL THAT YOU
SAID STAND IN FOR HIM THANK YOU.
ALL RIGHT SO THEM IT'S BEEN
SECONDED THE MOTION TO PASS
REFERRED TO THE COMMITTEE
APPROPRIATIONS SECTOR PLEASE
CALL THE ROLL AND I AND I STONE.
STONE I AM GONZALEZ GONZALEZ I
GROWTH HER TADO LABOR LEYVA AYE
MITCHELL.
MITCHELL AYE MONNING.
MONNING AYE RUBIO.
AT THE HEAD SIX VOTES AT SIX
ZERO RIGHT NOW WILL HOLD THE
BILL OPEN FOR ABSENT MEMBERS ALL
RIGHT CENTER KALRA.
WELCOME.
WE HAVE ITEM NUMBER NINE AB
[inaudible]
SEVEN THIRTY ONE THE CORD.
I NEED TO BRING THAT AND WITH
THAT.
RIGHT.
THANK YOU THANK YOU MISTER SURE
MEMBERS OF ONE OF THE START UP
IS NOW WILL BE ACCEPTING A
AMENDMENTS IS OUTLINED THE MOCK
UP TO ADDRESS.
POLICY COMMON STATED IN THE
ANALYSIS -- SENATE BILL SEVEN
THIRTY ONE EXPANDS THE RATE
REVIEW PROCESS TO THE LARGE
GROUP MARKET AND ENHANCES THE
PROCESS TO PROVIDE CONSUMERS AND
REGULATORS A CLEAR PICTURE OF
HEALTH CARE COSTS.
TRANSPARENCY IS CRITICALLY
IMPORTANT CONTAINING COSTS AND
AB SEVEN THIRTY ONE HAS BROAD
SUPPORT CONSUMER GROUPS LABOR
AND EMPLOYERS WHO STAND TO
BENEFIT.
FROM PAYING LOWER COSTS FOR
THEIR HEALTHCARE.
IN CALIFORNIA PREMIUMS FOR
EMPLOYER HEALTH INSURANCE PLANS
A RISEN TWO HUNDRED AND 49%
SINCE TWO THOUSAND TO MORE THAN
SIX TIMES.
THE INCREASE IN THE STATE'S
OVERALL INFLATION THE
SKYROCKETING COST OF HEALTHCARE
IS CONTRIBUTING TO WASTE OUR
NATION.
AND FUELING INCOME INEQUALITY IN
THE STATE BECAUSE WHAT WE PUT
INTO OUR HEALTHCARE SYSTEM
ULTIMATELY COMPLETE COMPETES
WITH WAGE INCREASES AND
HOUSEHOLD BUDGETS.
WE ADDRESS WORKLOAD CONCERNS BY
REQUIRING TEAMMATES SEE AS CITY
I THE ONLY RATE REVIEW THE
METHODOLOGY USED FOR LARGE
GROUPS EXPERIENCE RATED PLANS TO
DETERMINE IF.
THE BASE RATE ON THE METHODOLOGY
USE ARE UNREASONABLE OR
UNJUSTIFIED.
ADDITIONALLY PURCHASERS A LARGE
GROUP EXPERIENCE RATED PLANS
WITHOUT THE ABILITY TO REQUEST
FOR FULL RATE REVIEW SHOULD THE
RATE INCREASE MEET SPECIFIED
CRITERIA.
CALIFORNIA HAS HAD A ROBUST RATE
REVIEW FOR THE INDIVIDUAL AND
SMALL GROUP MARKETS FOR HEALTH
INSURANCE.
SINCE.
TWO THOUSAND ELEVEN AND IT SAVED
INDIVIDUALS AND SMALL BUSINESSES
TWO HUNDRED AND TWENTY SIX
MILLION DOLLARS ALREADY SINCE
THE LAW WAS ENACTED.
IMPROVING AND BUILDING UPON RATE
REVIEW WILL ALLOW GREATER
TRANSPARENCY AND SCRUTINY ON
WHAT IS DRIVING RISING PREMIUMS
OF A GOES INTO REYES.
BECAUSE MILLIONS OF CALIFORNIANS
GAIN ACCESS TO HEALTH CARE TO
THE LARGE GROUP MARKET THE
POTENTIAL IMPACT THIS BILL HAS
TO COMBAT RIGHT TO COMBAT RISING
COST OF HEALTHCARE SYSTEM.
AND PROVIDE RELIEF TO CONSUMERS
NEGATES THOSE COSTS BY HEALTH
PLANS THAT WOULD BE REQUIRED TO
FILE THE NECESSARY INFORMATION.
TO A COMPLY.
AND GOOD TO MAKE IT CLEAR
THERE'S NOTHING IN AB SEVEN
THIRTY ONE THAT PREVENTS A LARGE
EMPLOYER FROM NEGOTIATING WITH
THE HEALTH PLAN TO TAILOR
BENEFITS THE NEEDS OF THAT
EMPLOYER.
AND THEIR EMPLOYEES AB SEVEN
THIRTY ONE SIMPLY REQUIRES STATE
REGULATORS TO MAKE SURE THAT
HEALTH PLANS ARE USING
METHODOLOGY AND ASSUMPTIONS THAT
ARE REASONABLE AND JUSTIFIED.
SMALL BUSINESS OWNERS IN
CALIFORNIA SAVE ALMOST HALF A
BILLION DOLLARS BECAUSE A RATE
REVIEW WHY SHOULDN'T EMPLOYERS
WITH TWO HUNDRED OR TWO THOUSAND
PLAYERS GET THE SAME SERVICE
FROM THEIR STATE.
THE COST OF RATE REVIEW AND
INDEED ALL THE LICENSING COSTS
ASSOCIATED WITH HEALTH PLANS ARE
TINY THE ENTIRE BUDGET FOR THE
DEPARTMENT OF MANAGED HEALTHCARE.
AMOUNTS TO LESS THAN POINT 005%
OF PREMIUMS. EIGHTY SEVEN
MILLION DOLLARS IS THE D. M. A.
H. C. BUDGET OUT OF A HUNDRED
EIGHTY FOUR BILLION IN PREMIUMS
READ REVIEWS ONLY A FRACTION OF
THAT.
EIGHTY SEVEN MILLION DOLLAR
BUDGET TO THE NEW COST RATE
REVIEW UNDER EIGHTY SEVEN THIRTY
ONE IS TINY AND REALLY IS THE
RATE PAYERS IT IS THE PLEASE THE
LARGE EMPLOYERS.
THAT STAND TO REALLY SAY
BILLIONS OVER THE YEARS AHEAD IF
WE DO HAVE A ROBUST RATE REVIEW
PROCESS -- BUT WITH ME TO
TESTIMONY AS BETH CAPELL
REPRESENTING HEALTH ACCESS UNITE
HEARING TEAMSTERS ANSWER FOX IN
THE CALIFORNIA LABOR FEDERATION
START FAST RELIABLE.
OKAY WITNESSES IN SUPPORT HOW
MANY PEOPLE TESTIFYING YOU KNOW
YOU GET SIX MINUTES SORRY YEAH --
GOOD AFTERNOON MR TURN MEMBERS
YES MENTALITY ON BEHALF OF
HEALTH ACCESS CALIFORNIA THE
STATE WIDE HEALTH CARE CONSUMER
ADVOCACY COALITION AND CO
SPONSOR OF EIGHTY SEVEN THIRTY
ONE ONE OF THE REASONS THE
AFFORDABLE CARE ACT HAS BEEN
SUCH A SUCCESS IN CALIFORNIA IS
THAT TIME AND TIME AGAIN WE HAVE.
ASKED OURSELVES HOW CAN WE
IMPROVE ON THE ACA AND DO EVEN
MORE TO MAKE HEALTHCARE MORE OF
WHAT AFFORDABLE AND AVAILABLE
HERE IN CALIFORNIA.
IN TWO THOUSAND TEN CALIFORNIA
WENT BEYOND THE REQUIREMENTS OF
THE ACA AND REQUIRED RATE REVIEW
FOR EVERY PRODUCT IN THE
INDIVIDUAL AND SMALL EMPLOYER
MARKET.
RATE REVIEW IS WORKING AND
CALIFORNIA AS YOU'VE ALREADY
HEARD FROM MISTER KALRA SINCE WE
STARTED REVIEWING RATES FOR
HEALTH INSURANCE PREMIUMS SMALL
BUSINESSES AND CONSUMERS HAVE
pDOLLARS.
HOWEVER THERE ARE TEN MILLION
PEOPLE IN THE LARGE EMPLOYER
MARKET WHO DO NOT HAVE THE SAME
LEVEL OF PROTECTION WHEN IT
COMES TO RATE REVIEW.
HEALTH INSURANCE HEALTH CARE
PREMIUMS IN THE LARGE GROUP
MARKET HAVE BEEN RISING STEADILY
WITH NO REVIEW FOR REGULATORS TO
ENSURE THAT INCREASES ARE
REASONABLE AND JUSTIFIED.
AS ASSEMBLYMEMBER KALRA SAID
EIGHTY SEVEN THIRTY ONE WAS
AMENDED TO ADDRESS WORKLOAD
CONCERNS FOR BOTH THE DEPARTMENT
OF MANAGED HEALTH CARE AND THE
DEPARTMENT OF INSURANCE.
ABOUT THE COST OF RATE REVIEW AS
MR CALLER SAID.
IN TWENTY SEVENTEEN INSURERS
BROUGHT IN A HUNDRED AND EIGHTY
FOUR BILLION DOLLARS IN PREMIUMS
FOR COMMERCIAL COVERAGE IN
CALIFORNIA THE BUDGET FOR D. MHC
IS EIGHTY SEVEN MILLION DOLLARS.
AND RATE REVIEW IS ONLY A
FRACTION OF THAT BUDGET.
AND THE ADDITIONAL RATE REVIEW
THAT WE WOULD ADD ON TOP WOULD
BE A MODEST ADDITION TO THAT.
AB SEVEN THIRTY ONE BUILT ON
PROVEN SUCCESS AND COULD
POTENTIALLY SAVE LARGE
BUSINESSES AND CONSUMERS
HUNDREDS OF MILLIONS OF DOLLARS
BY APPLYING RATE REVIEW TO THE
LARGE GROUP MARKET FOR THESE
REASONS WE RESPECTFULLY REQUEST
YOUR AYE VOTE.
GOOD AFTERNOON MISTER CHAIRMAN
MEMBERS MARIO YOU DID HEAR FROM
UNITED HERE REPRESENTING TENS OF
THOUSANDS OF A HOTEL ROOM
CLEANERS.
CASINO BARTENDERS AND CAFETERIA
COOKS WHO ALONG WITH THEIR
FAMILIES IN CALIFORNIA.
HEALTH CARE THROUGH COLLECTIVE
BARGAINING AGREEMENTS -- WORKERS
AND UNITE HERE ARE FIGHTING TO
GET IN THE MIDDLE CLASS.
AND ALONG WITH HEALTH ACCESS THE
CALIFORNIA LABOR FEDERATION
TEAMSTERS AND AS HE ARE YOU
CALIFORNIA.
HEALTH CARE.
IS A BARRIER THAT'S WHY WE'RE CO
SPONSORING THIS BILL IT'S A
LABOR MANAGEMENT BILL THAT THE
GROCERS INTO TROUBLE BECAUSE
SENIORS SUPPORT AS WELL.
LAST FALL EIGHT THOUSAND MERRY
OUT WORKERS WENT ON STRIKE.
BECAUSE ONE JOB SHOULD BE ENOUGH
TO LIVE WITH DIGNITY WHEN YOU
WORK FOR THE WEALTHIEST HOTEL
COMPANY IN THE WORLD.
IN SAN FRANCISCO WORKERS WERE ON
THE PICKET LINE FOR SIXTY ONE
DAYS.
HEALTH CARE WAS A DECISIVE
REASON IN THE LENGTH OF THAT
STRIKE.
AIRLINE CATERING WORKERS IN
TWENTY EIGHT CITIES INCLUDING
LOS ANGELES SAN DIEGO AND SAN
FRANCISCO HAVE JUST VOTED TO
STRIKE IF RELEASED BY THE
GOVERNMENT.
THE COST OF HEALTHCARE IS A KEY
REASON WHY THOUSANDS OF UNITE
HERE MEMBERS JUST VOTED YES HERE
IN SACRAMENTO THE CASINO WAS
PAYING NORTH OF TEN DOLLARS AN
HOUR FOR HEALTH CARE ELSEWHERE
HOTELS PAY MORE THAN.
THIRTEEN EACH YEAR INSURERS
TELLER EMPLOYERS.
WE MUST PAY MORE TO KEEP THE
SAME BENEFITS THAT OUR PLAYERS
TURN AROUND AND SAY THAT DESPITE
INCREASING COSTS AND FOOD
TRANSPORTATION HOUSING NOT TO
MENTION RECORD PROFITS IN THE
HOSPITALITY INDUSTRY.
THEY'RE JUST AS A MONEY FOR
RAISES OF COURSE HOSPITALITY
WORKERS AREN'T ALONE IN THIS AS
MISS BELL IS SAID TEN MILLION
CALIFORNIANS GET HEALTHCARE IN
THE LARGE GROUP MARKET.
CALIFORNIA IS LUCKY TO HAVE SOME
INSIGHT INTO THAT MARKET THANKS
TO SENATOR LENO'S SB FIVE FORTY
SIX FROMTWENTY FIFTEEN THE PAST
THREE YEARS UNITE HERE SCRIPT
HAS SCRUTINIZED THE DATA
PROVIDED UNDER THAT LAW.
AND WE'VE SEEN THE SAME TRENDS.
PREMIUMS KEEP GOING UP FASTER
THAN INFLATION AND ITS PRICE
INCREASES NOT UTILIZATION
DRIVING THOSE COST INCREASES THE
OPPOSITION.
SAYS HEALTH INSURERS ALREADY
REPORT KOBE IS INFORMATION
REGARDING THEIR RATES THAT AB
SEVEN THIRTY ONE WOULD
CONTRIBUTE ADDITIONAL BURDENS WE
SUBMIT THAT THE REAL REASON
BEHIND THEIR OPPOSITION IS A
DESIRE TO AVOID.
ANY KIND OF OVERSIGHT OF THEIR
PRICING POWER WHICH CONTRARY TO
THEIR CLAIM THAT RATE REVIEW --
IN THE SMALL AN INDIVIDUAL GROUP
MARKETS HAS NOT BEEN USED TO
LOWER HEALTHCARE COSTS HAS
ALREADY SAVED US HALF A BILLION
DOLLARS IN THE STATE.
THE OPPOSITION TO SEARCH AB
SEVEN THIRTY ONE IS AN
UNNECESSARY INTERVENTION IN
NEGOTIATIONS BETWEEN AND I QUOTE
SOPHISTICATED MARKET ACTORS WE
AGREE.
THAT UNION TRUST FUNDS ARE FUNDS
ARE AMONG THE MOST SOPHISTICATED
PURCHASERS.
BUT THAT MISSES THE FUNDAMENTAL
POINT ASK YOURSELF IF YOU'RE
BUYING HEALTHCARE FOR TWO
HUNDRED OR EVEN TWO THOUSAND
EMPLOYEES.
HOW MUCH BARGAINING POWER DO YOU
HAVE COMPARED WITH AN INSURER
WITH EIGHT MILLION COVERED LIVES?
HIGHER DRIVE VOTE THANK YOU.
HERE MARIN ABOUT THE CALIFORNIA
GROUP ASSOCIATION -- HAPPY -- TO
SUPPORT THIS MEASURE ALONG WITH
OUR FRIENDS IN LABOR -- THE
GROCER GROCERS ARE ARE ONE OF
THE OF THE CROSS INDUSTRY IS ONE
OF THE INDUSTRIES THAT HAS A
STRONG RELATIONSHIP WITH LABOR --
AT THIS AT ISSUE ACTUALLY THE
ISSUE OF HEALTHCARE IN THE
INCREASING COSTS IS IS ONE OF
THE REASONS WHY.
YOU KNOW LABOR NEGOTIATIONS AS
YOU ALL KNOW THAT THEIR THIRD ON
THE PRECIPICE OF A STRIKE IN
SOUTHERN CALIFORNIA ONE OF THE
REASONS BEHIND THAT IS
INCREASING EL COSTS IN AS WAS
REFERRED TO EARLIER.
I MEAN THERE'S INCREASING COSTS --
WE NEED MORE MONEY ON THE TABLE
TO BE ABLE TO WORK WITH OUR
EMPLOYEES AND AND TO COME
TOGETHER AS EMPLOYERS TO SAVE
MONEY BECAUSE IN AN ENTRY LIKE
OURS WITH LOW MARGINS.
YOU KNOW WE NEED TO BE ABLE TO
TO PAY OUR WORKERS WHAT THERE
WERE TO PROVIDE THE BENEFITS
THAT THEY WANT THAT WE WANT TO
PROVIDE THEM.
AND THIS IS PUTS NO LIMIT ON
INCREASES ALL IT ASKS FOR IS
TRANSPARENCY -- IF AS PEOPLE
ASSERT THAT INCREASES IN COSTS
ARE TRULY NOT GOING UP -- THEN
YOU SHOULD HAVE NO PROBLEM WITH
WITH THE TRANSPARENCY BECAUSE
THEN YOU CAN SAY WELL OKAY THAT
STATE SAID.
YOUR RATES ARE COOL IF THEY'RE
NOT COOL THEY'RE NOT COOL BUT
THE END OF THE DAY -- WE JUST
WANT TO MAKE SURE THE
TRANSPARENCY IS THERE A TWO
ALLOWS TO SAVE MONEY TO LIVE
PROVIDES THE CARE THEY HEALTH
CARE THAT ARE EMPLOYERS
EMPLOYEES -- NEED AND THAT WE
WOULD LIKE TO PROVIDE THEM SO
RESPECT ANSWER ABOUT.
CAN'T WE ARE OUT OF TIME SO YOU
CAN INTRODUCE YOURSELF IN
POSITION AND YOUR VISIT. FOR
HEALTH ACCESS TEAMSTERS IN NIGER
TO ANSWER QUESTIONS.
THANK YOU OTHER WITNESSES IN
SUPPORT.
MARKETS GOT THROWN ON BEHALF
REDUCTION CALIFORNIANS SUPPORT
HE LINDA TENER WHAT'S ON BEHALF
OF THE CALIFORNIA PAN I THINK
HEALTH NETWORK ALSO IN SUPPORT
THANK YOU.
MATT BROUGHT FOR THE TEAMSTERS
UNITE HERE MACHINISTS UTILITY
WORKERS -- IN SUPPORT THANK YOU
THANK YOU.
STUDY THEY AT THE RALLY SERVER.
OF FOR A AYE UNITE HERE.
YOU THAT YOUR LOCAL FORTY NINE
IN SUPPORT.
THANK YOU.
OTHER HANDLE RAYBURN WITH UNITE
HERE IN SUPPORT THANK YOU.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY IN SUPPORT THANK
YOU.
HELLO TRITON ON BEHALF INACTION
CALIFORNIANS SUPPORT THANK YOU.
SIR FLOCKS CALIFORNIA LABOR
FEDERATION SPONSOR AND SUPPORT
THANK YOU.
MEGAN SUPERS CALIFORNIA
PROFESSIONAL FIREFIGHTERS AND
SUPPORT HE REBEKAH GONZALEZ
NATIONAL ASSOCIATION OF SOCIAL
WORKERS CALIFORNIA CHAPTER IN
SUPPORT YOU.
JIM I'M BURKE ON BEHALF OF THE
FRIENDS COMMITTEE ON LEGISLATION
THE CALIFORNIA IN SUPPORT.
THANK YOU.
RIGHT WITNESSES IN OPPOSITION
AND PLEASE MAKE ROOM FOR THEM AT
THE TABLE [inaudible]
HI WELCOME.
ARE WE DONE WITH SUPPORT.
WE ARE -- LIKE THE DUDE ADD
SPORT.
YES I'M HERE IN SUPPORT ON
PLEASE SEND ALL WITH THE
INTERNATIONAL LONGSHORE AND
WAREHOUSE UNION.
IN THE INLAND BOATMEN JUNIOR OF
THE PACIFIC IN STRONG SUPPORT
THANK YOU ALL RIGHT ANY OTHER
WITNESSES SUPPORT.
RIGHT OPPOSITION THANK YOU
WELCOME THANK YOU MISTER CHAIR
AND MEMBERS NICK LOUISE -- SOME
BEHALF THE CALIFORNIA
ASSOCIATION OF HEALTH PLANS IN
OPPOSITION TO ASSEMBLY BILL.
SEVEN THIRTY ONE OFFERS I'D LIKE
TO SAY WHAT WE HAVEN'T SEEN ANY
AMENDMENTS SO WE CAN'T COMMENT
ON THOSE.
AND YOU KNOW THE HOWEVER BY THE
DESCRIPTION OF THOSE AMENDMENTS --
DAYS SEEM JUST CLARIFYING IN
NATURE DON'T CHANGE THE
UNDERLYING POLICY AND THEREFORE
DON'T CHANGE OUR POSITION ON THE
BILL SO.
THANK YOU -- THE FIRST LIKE TO
START OFF SAYING THAT OBVIOUSLY
YOU KNOW WERE IMPORTANT YOUR
HEALTH CARE WE MADE STRIDES
THROUGH THE BUDGET PROCESS IN
INCREASING ACCESS TO HEALTH
COVERAGE TO MORE MORE
CALIFORNIANS.
WE'RE HAPPY TO SUPPORT THOSE
PROPOSALS.
WE KNOW THAT -- THERE NEEDS TO
BE A DIALOGUE AROUND
AFFORDABILITY IN COST
CONTAINMENT SUPPLEMENTS.
THOSE COVERAGE INCREASES AND
WE'RE HAPPY TO BE A PART OF
THOSE CONVERSATIONS IN FACTWE
SUPPORTED BILLS TODAY THEY GO
DIRECTLY UP THE D. UNDERLYING
COST OF HEALTH CARE -- IN SO
WHERE DO YOU CAN YOU CONDITION
OF COURSES APPEARS IN HEALTH
CARE SYSTEM TO IT TO BE A PART
OF THOSE DISCUSSIONS.
HOWEVER WE BELIEVE THAT THIS
BILL GOES IN THE EXACT OPPOSITE
DIRECTION -- ONE OF MY MAIN
POINTS HERE IS THAT THIS IS NOT
A SIMPLE TRANSPARENCY BILL.
THIS BILL IS A DIRECT REGULATORY
INTERVENTION ON HEALTH PLAN
RATES BETTER AGREED TO BETWEEN
TWO PARTIES THE HEALTH PLANS IN
THE LARGE EMPLOYERS.
WE BELIEVE IT'S AN APPROPRIATE
FOR THE STATE TO STEP IN BETWEEN
THIS PROCESS.
AND TO CHARACTERIZE THESE
AGREEMENTS BY -- POTENTIALLY
STAMPING THEM IS UNREASONABLE.
THIS BILL IN OUR VIEW SUGGESTED
SUBJECTS A SIGNIFICANT NUMBER OF
LARGE EMPLOYER PRODUCTS TO
REGULATORY REVIEW PROCESS THAT
WILL BE EXPENSIVE TO ADMINISTER
FOR BOTH THE STATE AND THE
HEALTH PLANS.
THERE ARE LITERALLY THOUSANDS OF
EMPLOYER PRODUCTS IN THE STATE
OF CALIFORNIA.
THE TEAM MADE SEE IN CD I
REPORTED THIS YEAR THAN IN
TWENTY EIGHTEEN THERE ARE
APPROXIMATELY SEVENTEEN THOUSAND
RENEWING LARGER PRODUCTS IN THE
MARKET.
THE BUREAUCRATIC UNDERTAKING
REQUIRED BY THIS BILL WILL
INCREASE HEALTHCARE COSTS.
OPERATING COSTS FOR THE DO YOU
NEED SEE WHICH IS ENTIRELY
FUNDED BY THE HEALTH PLANS -- IN
CD I WOULD RISE DUE TO IT ADDED
TO MINISTRY REQUIREMENTS TO GROW
THESE AGENCIES AND OF COURSE
HEALTH PLANS WOULD HAVE TO TAKE
ON NEW ADMINISTRATIVE COSTS TO
COMPLY WITH THE V. I. REGULATORY
PROCESS.
SO WITH A DOUBLE WHAMMY ON OUR
ADMIN LOAD -- ADDING ADDITIONAL
BUREAUCRATIC RECORD BUREAUCRACY
AND HEALTH CARE WILL NOT LOWER
COSTS FOR YOUR CONSTITUENTS
INSTEAD THESE COST INCREASES
WILL BE PASSED ON IT ALSO
CONSUMES MORE OF THE PREMIUM
DOLLAR LESS GOES ON TO DIRECT
CARE MORE GOES TO ADMINISTRATION.
FURTHERMORE -- AB. SEVENTY
THIRTY A. B. C.'S ME -- SEVEN
THIRTY ONE IS REDUNDANT OF OTHER
POLICIES -- ERR OR NEXUS OF
THOSE LARGE GROUP RATE
INFORMATION ISCURRENTLY PUBLIC
IN TRANSPARENT -- CALIFORNIA'S
HEALTH PLANS ARE ALREADY SUBJECT
TO A NUMBER OF DATA AND
REPORTING LAWS IN OTHER
TRANSPARENCY EFFORTS INCLUDING
SUBMISSION OF AGGREGATED LARGE
GROUP RATES. TO STATE REGULATORS.
SO YES WE HAVE TRANSPARENCY
ALREADY ON LARGE GROUP RATES.
THIS RESULTS IN PUBLIC REPORTS
BY TWO AGENCIES AND PUBLIC
MEETINGS ARE HELD BY TWO
DIFFERENT AGENCIES OR
DEPARTMENTS AS WELL ON AN ANNUAL
BASIS.
SO WHAT IS THIS TRANSPARENCY
SHOWN -- LARGER PREMIUM
INCREASES ACCORDING TO THE LAST
REPORT ARE LOWER THAN IN OTHER
MARKETS OF THE HEALTH INSURANCE --
UNIVERSE -- ALSO LARGE TO
PREMIUMS ARE TRAINING AT A LOWER
RATE THAN MEDICAL TRAINED IN
PHARMACY TREND -- IN THAT'S
ACCORDING TO THE TWENTY EIGHTEEN
REPORTS.
IN THE VAST MAJORITY OF
EMPLOYEES ARE IN GOLDEN PLAN IN
THE CLEVELAND BENEFIT PLANS A
COMPARABLE RATES ON TO THE
INDIVIDUAL MARKET SO THEY'RE
GETTING A GOOD VALUE ON IN IN IN
THAT MARKET.
CAP IS SUPPORTED SOME OF THESE
TRANSPARENCY EFFORTS ARE
REFERRING TO WHEN THEY BENEFIT
CONSUMERS IN THE MARKET HOWEVER
WE HAVE TO STRIKE A REGIONAL
BALANCE AND WE DON'T BELIEVE OF
THIS BILL DOES THAT.
WERE ALSO INVOLVED IN THE HEALTH
PAYMENTS DATA REVIEW COMMITTEE
THAT WAS ESTABLISHED ASKYOU
YEAR.
OTHERWISE KNOWN AS THE ALL PAYER
CLAIMS DATABASE -- AND SO THE
PURPOSE OF THIS COMMITTEES TO
ESTABLISH TIME YOU KNOW --
SYSTEM WIDE TRANSPARENCY ON IN
THE EFFORT TO LOWER COSTS IN AND
YOU KNOW WE'RE HOPEFUL WE CAN
COME TO SOME SORT OF STOP
POSITIVE STRUCTURE AROUND THAT --
SO ON TOP OF EVERYTHING THAT'S
BEEN CURRENTLY DONE WE DON'T
BELIEVE IS A COMPELLING REASON
NOW IT'S YOU REQUIRE LARGE GROUP
RATES TO BE SUBJECT TO REVIEW.
FOR REQUIRE OUR PLAS TO TO
SUBMIT A VOLUMINOUS AMOUNTS OF
NEW INFORMATION.
THERE FOR WE ASK YOU TO VOTE NO
ON EIGHTY SEVEN THIRTY ONE THANK
YOU. SEVEN WALK INS ON BEHALF OF
THE ASSOCIATION OF CALIFORNIA
LIFE AND HEALTH INSURANCE
COMPANIES WE TO HEAR ARE OPPOSED
TO THIS MEASURE.
UNFORTUNATELY WE DO SEE THIS IT
IS EXPANSION THE REGULATORY
AUTHORITY I'M INTERESTED JUSTICE
NOT UNDERSCORE WHAT MY COLLEAGUE
MENTIONED BUT WHEN THE OVER MUCH
ABOUT MY ADMINISTRATION PUT
TOGETHER RATE REVIEW THEY
SPECIFICALLY DID LOOK AT THE
SMALL AN INDIVIDUAL GROUP
MARKETS.
POTENTIALLY THOSE ARE PRICE
TAKERS THERE'S NO NEGOTIATION
THERE THIS ARE OFF THE SHELF
PRODUCTS AND AS THEY LOOKED AT
LARGE GROUP THEY ACTUALLY
UNDERSCORED.
THE FACT THAT THESE ARE
SOPHISTICATED ENTITIES.
IT'S AN INCREDIBLY COMPETITIVE
MARKET PLACE THAT OUR MEMBERS
STRIVE TO PROVIDE AS MUCH
INFORMATION AND DISCLOSE AS MUCH
INFORMATION AS POSSIBLE TO LET
THEM KNOW WHAT GOES INTO THE
RATE DEVELOPMENT AND WHAT THEIR
PREMIUM VALUE GETS THEM.
SO WHEN WE DID ADOPT IN
CALIFORNIA LAW THE ORIGINAL RATE
REVIEW A DID HAVE A TRIGGER
MECHANISM THAT IF THE FEDERAL
GOVERNMENT DID CHOOSE AT SOME
POINT TO ADD LARGE GROUP.
THAT IT WOULD AUTOMATICALLY
TRIGGER ON IN CALIFORNIA SO
THAT'S ONE OF THE CONCERNS IS
THAT THROUGH THAT PROCESS AT NO
TIME TO THE FEDERAL GOVERNMENT
AND UNDER THE OBAMA
ADMINISTRATION CHOOSE INCLUDE
LARGE GROUP WE THINK THAT'S
BECAUSE THEY DID ACKNOWLEDGE THE
SOPHISTICATION OF THOSE ENTITIES.
AND THE ABILITY FOR THEM TO
NEGOTIATE THE BEST RATES AND
BENEFITS STRUCTURES FOR THEIR
MEBER COMPANIES SO WE ARE
CONCERNED CERTAINLY WITH
ADDITIONAL ADMINISTRATIVE COSTS
IN BURDEN TO THE DEPARTMENTS WE
HAVE CONCERNS ABOUT THE
DEPARTMENT'S ABILITY TO MOVE
THROUGH THE LARGE VOLUME OF RATE.
AND FILINGS AND FOR THOSE
REASONS WE CONTINUE TO BE
OPPOSED TO THE BILL THANK YOU.
THE OTHER WITNESSES IN
OPPOSITION.
JOHN WINGER IBF AMERICA'S HEALTH
INSURANCE PLANS APOLOGIZE FOR
NOT DINNER LETTER AND ON TIME
BUT WE ARE MAIN POST.
THANK YOU.
VALERIE NERVE FOR THE CALIFORNIA
CHAMBER OF COMMERCE WE REMAIN
OPPOSED.
THANK YOU.
I SEE ANOTHER WITNESS OPPOSITION
QUESTION FOR COMMITTEE MEMBERS.
NOW IS OUR MOTION.
OKAY A JUDGE OF QUESTION TWO
OKAY CENTER LEYVA A QUICK
COMMENT -- SINCE TO THIS --
GROCERS THAT TALKED ABOUT THE
200-032-0004 STRIKE I REMEMBER
THAT WHILE I WAS THERE ALL
HUNDRED AND FORTY ONE DAYS I
DON'T REMEMBER IF.
HE WAS THERE OR NOT -- BUT I
WOULD ALSO JUST SAY THAT I
APPRECIATE THE COMMENT ABOUT
MAKING SURE THEY HAVE ENOUGH TO
PAY WAGES BECAUSE I GOOD WAY
JUST BECAUSE I KNOW THAT YOU
HAVE SCABIES IN NEGOTIATIONS
RIGHT NOW WAGES ARE STICKING
POINT.
SO -- GOOD TO HEAR THAT YOU'RE
WORKING ON THE WAGES AND I'M
HAPPY TO SUPPORT THIS BILL TODAY.
I THANK YOU.
ALL RIGHT IT'S BEEN NOT TO MOVE
VICE ARE LEAVE -- I FIRST OF ALL --
SO RICARDO AND THANK YOU FOR
WORKING WITH THEIR COMMITTEE IN
TAKING THE AMENDMENTS -- I
UNDERSTAND THE OPPOSITION IS
PRETTY MUCH OPPOSED TO THE
THRUST OF THE BILL ITSELF SO I'M
NOT SURE ANY AMENDMENTS WOULD
CHANGE YOUR MIND ON THAT WE DID
TRY AND APPRECIATE YOU WORKED
WITH US TO TRY TO LEAST.
DECREASE SOME OF THE REPORTING
BURDEN I CERTAINLY RECOGNIZE AND
THE CONCERN OF THE OPPOSITION
ABOUT THE VOLUME AND AMOUNT OF
MINISTRY OF WORKING COSTS THAT
MIGHT OCCUR TO THE PLAN AS WELL
AS THE STATE SO I APPRECIATED
THAT SAID THAT'S A CONCERN BUT I
DO THINK THAT THE THRUST.
OF THE BILL ITSELF IS ACTUALLY --
AND AND HAVING THIS RATE
REVIEWED THERE IS VALUE TO THAT
AND AND SO -- SO THEY'LL BE
SUPPORTING THE BILL TODAY --
WHICH LIKE CLOSE.
THANK YOU MISTER CHAIRMAN AND
AND YOU'RE ABSOLUTELY RIGHT THAT
THERE IS VALUE.
IT'S RARE THAT WE ARE ALREADY
HAVE A PROVEN MODEL THAT WORKS
THAT WE CAN EXPAND THE TARDY
SAVE.
BILLION GREAT REVIEWS BEEN A
FRACTION OF THE EIGHTY SEVEN
MILLION DOLLAR BUDGET THE
DEPARTMENT OF MANAGED HEALTHCARE
I THINK THE HALF BILLION DOLLARS
SAVED CONSUMERS AND SMALL
BUSINESSES.
AS WELL WORTH THAT INVESTMENT
AND NOW WE HAVE THE OPPORTUNITY
TO EXPAND IT I UNDERSTAND SOME
OF THE OF OPPOSITION BECAUSE
THAT HAPPILY DOLLARS CAME FROM
SOMEWHERE AND IT CAME.
FROM RATES ARE UNREASONABLY HIGH
AND SO -- IT BROUGH GONNA TRY TO
GET MORE MONEY INTO THE POCKETS
OF LARGE EMPLOYERS BUSINESSES
AND CONSUMERS WITHOUT RESPECT
GAS WHEN I VOTE.
THANK YOU SO THE IT'S BEEN MOVED
THE MOTION IS TO PASS AS AMENDED
AND REFERRED TO THE COMMITTEE
APPROPRIATIONS SECTOR PLEASE
CALL THE ROLL.
AM I AND II STONE STONE NO
GONZALEZ GONZALEZ I GROVE HER
TADO LEYVA THEY'VE AYE MITCHELL.
MITCHELL AYE MONNING MONNING AYE
RUBIO.
OKAY THE VOTES FORTY FIVE ONE
WILL KEEP THE ROLE OPEN FOR
ABSENT MEMBERS THE OF THE FITS
GET IT OUT THANK YOU.
ALL RIGHT I SEE F. SEVEN PENSION
NORRIS'S HERE THINK YOU'RE NEXT.
LIKE THE FLIP OVER.
ALL RIGHT I THINK THE DITCH.
SHE RACES AND HERE RIGHT OKAY.
RIGHT YEAH OKAY SO SO THEIR
PENSION ARE SAID LEAVE YOUR UP
NEXT -- WELCOME TO AND IF YOU
HAVE A UNDERSTAND THE THREE
BILLS BEFORE US SO -- TO JUST DO
THEM FILE ORDER NUMBER THEN OR
DID YOU THAT'S A GREAT AND THEN
I'M ALSO GOING 25% AS A THREE
SEMINARS OUR OUR CON SO OKAY.
YEAH SORRY SO LET'S START WITH
ITEM NUMBER.
FIFTEEN EIGHTY NINE ONE NINE
THREE CHAIRED MEMBERS BEFORE I
BEGIN MY PRESENTATION I WOULD
LIKE TO ACCEPT THE AMENDMENTS
OUTLINED IN THE COMMITTEE
ANALYSIS.
THANK YOU TO THE CHAIR AND FIVE
THE STAFF OF FOR YOUR ASSISTANCE
ON NOT ON MOVING THIS BILL
FORWARD.
THE PURPOSE AT EIGHTY NINE
NINETEEN IS TO ESTABLISH
ADDITIONAL TO TOOLS AND
ENFORCEMENT. TO PREVENT BODY
BURKE GREEN SCHEMES THAT PREY ON
VULNERABLE PATIENTS SEEKING
LEGITIMATE SUBSTANCE ABUSE
TREATMENT.
THE SCOPE AND SCALE OF
CALIFORNIA'S OF AMERICA'S
APPEARED CRISIS REALLY IS
STAGGERING IN CALIFORNIA IN
TWENTY SEVENTEEN MORE THAN TWO
THOUSAND PEOPLE DIED FROM.
AIDS.
AND ACCORDING TO THE CDC HUNDRED
THIRTY PEOPLE DIE IN THE UNITED
STATES TERM OPIOIDS EVERY SINGLE
DAY.
THIS NOW MAKES OPIOID OVERDOSE
AT TOP FIVE CAUSE OF DEATH.
IT'S HEARTBREAKING AND AT EVERY
STEP WE HAVE UNSCRUPULOUS ACTORS
WHO ARE PROFITEERING FROM THIS
CRISIS.
PHARMACEUTICAL COMPANIES WHO
HAVE ENGAGED IN DECEPTIVE
MARKETING PRACTICES DOCTORS HAVE
KNOWINGLY OVER PRESCRIBED THESE
DRUGS AND UNSCRUPULOUS
REHABILITATION CENTER OPERATORS
TO EXPLOIT PATIENTS FOR PROFIT.
WELL THERE ARE GOOD ACTORS
OPERATING IN THIS SPACE AND
DOING GOOD WORK.
THERE ARE FAR TOO MANY HORROR
STORIES PATIENT IS RECRUITED
FROM OUT OF STATE BY A BODY
BROKER.
OUT OF NETWORK INSURANCE
POLICIESARE PURCHASED AND RUN
OUT THOUSANDS OF DOLLARS AFTER
THIRTY SIXTY NINETY DAYS WHEN
INSURANCE RUNS OUT THE PATIENT
IS CARBS EXACERBATING
CALIFORNIA'S HOMELESSNESS CRISIS.
SOMETIMES PATIENTS ARE EVEN
ENCOURAGED TO RELAPSE IN ORDER
FOR THE CYCLE TO BEGIN AGAIN A
CYCLE THAT FAR TOO OFTEN ENDS IN
THE PATIENT'S DEATH.
THIS BILL AB NINE NINETEEN
BUILDS OFF AT THE STATE AND
FEDERAL REGULATORY FRAMEWORK
ESTABLISHED BY SB TWELVE TWENTY
EIGHT LAST YEAR AND THE
ELIMINATING KICKBACKS.
IN RECOVERY ACTIVE TWENTY
EIGHTEEN TO PROVIDE MORE
RESOURCE AND ADDITIONAL TOOLS
FOR ENFORCEMENT IN ORDER TO
INSURE PROPER IMPLEMENTATION AT
THE RECENT FEDERAL AND STATE
LAWS AIMED AT ENDING THE
HORRIFIC AND PACKS AS
SPECIFICALLY AB NINE NINETEEN
WILL REQUIRE THE DEPARTMENT OF
HEALTH CARE SERVICES. TO
ESTABLISH ENFORCEMENT PROGRAM TO
STOP THE BODY BURKE CREEN
SCHEMES.
ADDITIONALLY THE SPELL LIMITS
HOW FACILITIES THAT OFFER
HOUSING AND TRANSPORTATION AS
INDUCEMENTS TO TREATMENT.
ARE ABLE TO TO DO SO.
THANK YOU AND ACTUALLY THEIR
SUPPORT ON BOTH SIDES SO --
STUDENTS -- SO GRAVITY WOULD BE
APPRECIATED EVEN HER EMOTION NOW
ALREADY SO.
REVENUE CREATED THANK YOU IT IS
IMPORTANT FOR THESE PROJECTS.
WATER A CHAIR MEMBERS MY NAME'S
EVAN MARNIE I'VE BEEN IN LONG
TERM RECOVERY NOW FOR OVER
FOURTEEN YEARS AND WORKING IN
THE PROFESSION OF ADDICTION%
TREATMENT. FOR ALMOST ELEVEN
YEARS NOW I'M CURRENTLY THE
OWNER EXECUTIVE DIRECTOR OF AN
OUTPATIENT PROGRAM BURBANK
CALIFORNIA.
I PERSONALLY TAKING CALLS FROM
PEOPLE THAT WERE TIRED OF LIVING
WITHIN THIS CYCLE OF
EXPLOITATION AND ABUSE -- ONE
INDIVIDUAL THAT COMES TO MIND
WAS WOULD HAVE BEEN SOBER FOR
FIVE MONTHS AND HAD A JOB AND
WAS TOLD THAT HE NEEDED TO
CONTINUE TO GO TO INTENSIVE
OUTPATIENT TREATMENT IN ORDER TO
KEEP HIS HOUSING.
HE DIDN'T QUALIFY FOR INTENSIVE
OUTPATIENT TREATMENT ANYMORE HE
DID MEET MEDICAL CRITERIA -- AND
SO.
THERE'S OTHER THERE'S OTHER
EXAMPLES THAT I CAN SPEAK OF
I'VE ALSO TAKING CALLS FROM
ATTENDING -- FROM PEOPLE THAT
WERE GOING TO THEIR TREATMENT
CENTERS AND GETTING TREATMENT
FOR THEIR LIFE THREATENING
DISEASE OF AT OF ADDICTION BUT
BECAUSE OF THEIR INSURANCE WOULD
NOT PERMIT THEM TO REMAIN IN
TREATMENT WERE TURNED OUT INTO
THE STREETS.
INCREASING -- INCREASING ARE
HOMELESS POPULATION AS WE NOTING
CALIFORNIA -- THESE PEOPLE ARE
BEING GIVEN FREE HOUSING IN
COORDINATION WITH THEM BEING AN
INTENSIVE OUTPATIENT PROGRAMS
AND MANY OF THEM WILL BE TOLD
ENCOURAGING EVEN GIVEN THE MEANS
TO RELAX IN ORDER TO CONTINUE IN
THEIRTREATMENT ONCE INSURANCE
STOPS AUTHORIZING.
ALLOWING THEM TO REMAIN IN
RECOVERY RESIDENCES OR SOBER
LIVING HOMES SOME MAKE IT BACK
AND OTHERS DON'T.
THESE HOMES ARE WRITTEN WITH
PEOPLE WHO ARE STILL USING AND
ALLOWED TO USE.
IT FOR SOMEONE SEEKING RECOVERY
IT PAINTS A REALLY DIM PICTURE
NOT ONLY OF RECOVERY BUT THE
TREATMENT COMMUNITY.
THIS OVER ARCHING KERR IS CREE
LOT OF DISTRUST OF A PROFESSION
PEOPLE WHO WERE AT THE MOST
HORRIBLE STAGE.
REACHED OUT AND WE'RE TOLD WILL
FLY YOU OUT AND EVERYTHING WILL
BE TAKEN CARE OF ONCE AGAIN END
UP HOMELESS STILL USING THEIR
DREADED CHOICE AND EVEN DYING
MANY OF THESE PEOPLE CHOOSE
CALIFORNIA BECAUSE WE ARE FOR
THINKERS WE ARE INNOVATIVE IN
OUR TREATMENT PRO CHOICE.
AND WHY NOT. EIGHTY NINE
NINETEEN WILL END THESE
PRACTICES WHILE PROTECTING
LEGITIMATE TREATMENT PROVIDERS
WHO WISH TO HELP PEOPLE FIND
HOUSING OR GAIN ACCESS TO
TREATMENT IN FAIR AND
TRANSPARENT WAYS THAT DO NOT
REPLACE CLINICAL JUDGMENT WITH
PROFIT MOTIVE.
I THINK ASSEMBLY WOMAN
PETRIE-NORRIS FOR HER
WILLINGNESS AND TO ADDRESS THIS
FORMER PATIENT BROKERING IN ASK
FOR YOUR AYE VOTE.
THANK YOU NEXT WITNESS AGAIN
BREVITY'S REALLY APPRECIATED A
DAY THAT'S CALIFORNIA CONSORTIUM
ADDICTION PROGRAMS AND
PROFESSIONALS WITH THE SPONSORS
OF TWELVE TWENTY EIGHT
INDUCEMENTS AREN'T COVERED BY
THAT UNFORTUNATELY THE
DEPARTMENT -- READ IT AS ONLY A
REFERRALS FROM THIRD PARTY SO
THIS WILL TAKE CARE OF THIS THIS
APP PART BROKEN OUR DRIVER.
THANK YOU OTHER WITNESSES A
SUPPORT [inaudible]
I CRUNCH.
ON BEHALF OF THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION AND THE CALIFORNIA
SOCIETY OF ADDICTION MEDICINE
PLEASED TO BE IN SUPPORT.
KELLY BE MY BEHALF OF THE
CALIFORNIA MEDICAL ASSOCIATION
INSUPPORT THANK YOU.
THURSDAY WAS ASSOCIATION OF
CALIFORNIA CITIES ORANGE COUNTY
WE APOLOGIZE FOR NOT GETTING OUR
SUPPORT LETTER RAM BUT THIS IS A
CRITICAL ISSUE ORANGE COUNTY
WITH THINK THE AUTHOR
[inaudible]
THANK YOU.
NICOLE ORNAMENT ON BEHALF OF THE
ORANGE COUNTY BOARD OF
SUPERVISORS AND SUPPORT.
THANK YOU ALL RIGHT AND IT AND
SEEN OTHER WITNESSES IN SUPPORT
WITNESSES OPPOSITION SCENE @IN
SOUTH POSITION IT'S BEEN THAT'S
BEEN MOVED ACTION BY CENTER
STONE NOTE OF QUESTIONS --
THANKS SO MUCH RAIN THIS BILL
FOR DEBT WHICH LIKE THE CLOTHES.
THANK YOU FIVE WITHOUT A
RESPECTFULLY ASK YOUR I'VE OKAY
TO BUILD A NEW BY CENTER STONE
THE MOTIONS TO PASS AS AMENDED
REFERRED TO THE COMMITTEE
APPROPRIATIONS SECRETARY PLEASE
CALL THE ROLL.
HI CAN I STONE.
STONE AYE AYE GONZALEZ GONZALEZ
I GROW FURTADO LEYVA
[inaudible]
MITCHELL.
MITCHELL AYE MONNING MONNING AYE
RUBIO.
OKAY THAT BILL IS CURRENTLY FIVE
ZERO FIVE IT'S IT'S ENOUGH TO
GET OUT TO HOLD THE ROLE OF
CONTRAPTION MEMBERS OKAY NEXT
ITEM IS ITEM NUMBER SIXTEEN
EIGHTY NINE TWENTY I UNDERSTAND
THIS IS ALSO SUPPORT SUPPORT
[inaudible]
CHECK.
SUIT YES THIS IS ALSO IN THE
ARENA OF SUBSTANCE ABUSE
TREATMENT AT AN EIGHTY NINE
TWENTY WHICH IS KNOWN AS CHAIR
IT'S LIFE.
WILL IMPROVE AN UPDATE
CALIFORNIA'S FRAMEWORK FOR
SUBSTANCE ABUSE TREATMENT.
HI THIS IS A CRITICAL FIRST STEP
TO ENABLE LAWMAKERS TO DEVELOP
SOUND POLICY IN THIS AREA HI I'M
WITH THAT I'M REALLY PLEASED TO
INTRODUCE A SUPPORTER HERE TO
TESTIFY.
WHEN THE MCINTYRE THE FOUNDER OF
CHARTS Là?
OKAY THANK YOU WELCOME. THREE
RUNNING BACK AND FIRE.
IN TWO THOUSAND AND FOUR I GOT
THAT CALL THAT NO PARENT WANTS
TO GET.
MY SON JURíDICAMENTE TO SOBER
LIVING HOME IRONICALLY CALLED
THE SAFE HOUSE.
I WANTED TO GET IN BED AND STAY
THERE BUT INSTEAD I DECIDED TO
BECOME BETTER AND NOT DETER.
NOW I DEDICATE THE REST OF MY
LIFE TO SAVING OTHERS BY FOUND
INSURANCE LAW.
MY STORY IS NOT UNIQUE I STAND
HERE TODAY FOR THE HUNDREDS OF
VICTIMS OF LOST THEIR LIVES AT
ROGUE GREE HAPPENS.
I INVESTIGATE THESE DEATHS THE
DAILY ON I'M HORRIFIED AND WHAT
I'VE DISCOVERED.
IN TWO THOUSAND AND FOURTEEN I
GOT A CALL ABOUT ANOTHER YOUNG
BOY DONOVAN DOYLE LIKE MY SON
SHARE AND HE DIED IN A ROW REHAB.
THEN IT WAS TERRY.
ROBERT CHAD ERIC JAMES AND
MATTHEW.
WHO ALL DIED AT THE SAME
FACILITY?
JOEY COREY CAITLYN BRANDON AND
DOZENS MORE WHO HAVE DIED IN
ORANGE COUNTY.
A WEEK DOESN'T GO BY THAT I
DON'T GET A PHONE CALL FROM
HEART BROKEN MOM OR DAD.
I CANNOT KEEP COMING TO THE
STATE WITH THIS LIST OF DEAD
BOYS. TWO HUNDRED PEOPLE DIED
YESTERDAY OF OVERDOSES AND TWO
HUNDRED WILL DIE TODAY.
I AM HERE TODAY TO GIVE A VOICE
TO VICTIMS SURVIVORS AND
FIGHTERS.
AS WE CHALLENGE THIS BILLION
DOLLAR INDUSTRY THAT PLACES
PROFIT OVER PEOPLE SAFETY.
THE STIGMA OF ADDICTION AND THE
FEAR OF BEING JUDGED WILL OFTEN
HAVE FAMILIES WAIT UNTIL THE
LAST MINUTE TO REACH OUT FOR
HELP.
THEY OFTEN FEEL TERRIFIED ALONE
AND DESPERATE TO FIND HELP FOR
THEIR LOVED.
ONE SOME PROVIDERS WILL
STRATEGICALLY PREY UPON THIS
FEAR TO GET A YOUNG PERSON INTO
THEIR SO CALLED TREATMENT
PROGRAM. FOR MANY FAMILIES THIS
PREDATORY BEHAVIOR WILL APPEAR
AS A GIFT A KIND AND
COMPASSIONATE STRANGER WHO CAN
ANSWER THEIR PRAYERS INTO THEIR
CHILD IS RETURNED HOME IN A BODY
BAG.
THE MENTAL HEALTH PARITY ACT.
AND THE AFFORDABLE CARE ACT
SIGNIFICANTLY INCREASED ACCESS
TO MENTALHEALTH SERVICES OVER
THE LAST DECADE.
EXPANDING COVERAGE TO MORE THAN
SIXTY TWO MILLION AMERICANS.
WHO HAD LITTLE TO NO BENEFITS
BEFORE?
HOWEVER THIS RISE IN ACCESS TO
REHABILITATION CARE THROUGH THE
ACA AND MH PA.
COMBINED WITH THE HEIGHTENING.
OPIOID AND SUBSTANCE ABUSE
CRISIS AND INFUSION OF PRIVATE
EQUITY DOLLARS INTO THE
REHABILITATION INDUSTRY HAS
CREATED AN ENVIRONMENT RIGHT FOR
PROFITEERING AND FRAUD IN MENTAL
HEALTH AND SUBSTANCE ABUSE
TREATMENT.
JERRY IT'S LAWS ABOUT GETTING.
IS ABOUT BEING ABLE TO GET SOBER
IN A HEALTHY AND SAFE WAY.
THERE MUST BE FAIL SAFES IN
PLACE.
I'M HERE TODAY AS JURORS MOM AND
THERE ARE HUNDREDS OF OTHER
ACTIVISTS MOTHERS AND FATHERS
SEEKING CHANGE.
ALTHOUGH CHANGE WON'T HELP BRING
ANY OF OUR CHILDREN BACK IT WILL
CREATE A LEGACY FOR FUTURE
MEMBERS OF OUR COMMUNITIES TO
RECEIVE SAY FOR TREATMENT.
CALIFORNIA IS THE LARGEST
ECONOMY IN THE IN THE NATION AND
WE MUST DO BETTER FOR PATIENTS.
THANKS SO MUCH FOR SHARING THIS
AND I'M SORRY.
SUN.
OTHER WITNESSES AND SUPPORT A
GOOD AFTERNOON MR TURN MEMBERS
CONNIE DOGGETT ON BEHALF OF THE
COUNTY BEHAVIORAL HEALTHDIRECTORS ASSOCIATION WANT TO
THANK THE AUTHOR FOR THE RECENT
AMENDMENTS AND AND SUPPORT ALSO
FOR THE COUNTY THE CALIFORNIA
SOCIETY OF ADDICTION MEDICINE.
THANK YOU THANK YOU.
MIXING MENTALITY HALF THE
CALIFORNIA ASSOCIATION OF
ALCOHOL AND DRUG PROGRAM
EXECUTIVE SINCE PARK THANK YOU.
SHERRI DAILY WITH THE CALIFORNIA
CONSORTIUM OF ADDICTION PROGRAMS
AND PROFESSIONALS IN SUPPORT.
THANK YOU RIGHT SEEN OTHER
WITNESSES SUPPORT ANY UP WITH
HIS OPPOSITION BILLS BEEN MOVED
BY CENTER STONE SEARCHED ON THE
JOB I JUST WANTED -- TO THINK
THE WITNESS AND I'M SORRY FOR
YOUR LOSS.
BUT I APPRECIATE THE TRIGGER
DEDICATING YOUR LIFE.
TO TRYING TO STOP THIS --
SENSELESS LOSS OF LIFE AND AND I
THINK IT'S APPROPRIATE TO
COLLEGE HERE IT'S LIVE PRE SHEET
THAT -- ASSEMBLY MEMBER PATRIOT
NORRIS'S BRINGING IT FORWARD.
AND I COULD TELL YOU THAT --
MANY MY COLLEAGUES ARE GOING TO
CONTINUE TO TRY AND IN THE
PUBLIC SAFETY ARENA TO
STRENGTHEN THE LAW SO WE CAN
HOLD THOSE ACCOUNTABLE FOR
CUDDLING SOMEBODY'S VERY
DANGEROUS DRUGS LIKE FENTANYL --
ON INNOCENT PEOPLE THAT USE IT
AND ULTIMATELY PASS AWAY FROM IT
AND EUROPE CITY RIGHT ANOTHER
TWO HUNDRED ARE GOING TO GO
TODAY AND WE NEED.
TO PUT THE BRAKES ON IT SOME HOW
ABOUT YOU BEING HERE IS VERY
IMPORTANT AND MY CONDOLENCES TO
YOU.
THANK YOU CENTER MONEY.
THANK YOU MISTER CHAIR I ALSO
WANT TO THANK THE AUTHOR FOR
BRINGING THIS FORWARD IN.
THANK YOU CHAIR IT'S MOM FOR
YEAR.
PROCESSING YOUR LOSS BY HELPING
OTHERS IN HELPING US TO
HOPEFULLY.
THANK YOU SO MUCH FOR BEING HERE.
THANK YOU AND AGAIN OUR THANK
YOU -- SUMMER PACINO'S RAINS FOR
NINETY ONE THANK YOU SO MUCH FOR
SHARING YOUR STORY ABOUT YOUR
SON JARED AND I'M SO SORRY ABOUT
WHAT HAPPENED TO HIM BUT THIS IS
THIS.
READY TURN THIS HOPEFULLY WE CAN
TRY TO ADDRESS THAT FOR ANYONE
IN THE FUTURE.
SO WITH THAT I WOULD LIKE TO
CLOSE.
THANK YOU FOR THOSE COMMENTS AND
DAD RESPECTFULLY ASK FOR AFFECT.
THANK YOU OKAY SO THE MOTIONS TO
PASS REFERRED TO THE COMMITTEE
APPROPRIATIONS SECTOR PLEASE
CALL THE ROLL AND I AND I STONE
STONE AYE GONZALEZ.
GONZALEZ SIDE GROW FURTADO'S
LEYVA MITCHELL.
MITCHELL AYE MONNING MONNING AYE
RUBIO.
HEY FOR EARLY AS FIVE IT'S FIVE
ZERO HOLD OF A BILL OPENED FOR
HOLDER OFTEN FOR HER AS A NUMBER
SEVEN THAT'S ENOUGH IT'S GET IT
OUT OKAY.
SO YOUR NEXT BILL ALSO HAS
SUPPORT ON BOTH SIDES -- GREAT
SO -- THAT'S A. B. THAT'S ITEM
NUMBER NINETEEN A. B..
ELEVEN TWENTY EIGHT EVERYONE
LOVES YOUR BILLS.
I'M HERE TODAY I HAD TO ASK FOR
YOUR SUPPORT FOR A BI ELEVEN
TWENTY EIGHT THE GOAL OF THIS
SPELL IS TO EXPAND ACCESS TO
PACE THE PROGRAM FOR ALL
INCLUSIVE CARE.
FOR THE ELDERLY I HAD PAYS IS A
WELL RESPECTED AND EFFICIENT
PROGRAM THAT AIMS TO KEEP
SENIORS IN THEIR HOMES AND
COMMUNITIES.
NOT IN IN INSTITUTIONS BUT THERE
IS A CRITICAL SHORTAGE OF PACE
FACILITIES ACROSS THE STATE OF
CALIFORNIA.
NUMBER OF THINGS ARE TRYING TO
DO TO ADDRESS THAT THEY'VE
FIXING THE SPELLS IS PRIMARILY
ADMINISTRATIVE ESSENTIAL ARE
GOING TO CONSOLIDATE THE LICENSE
STRUCTURE FUNCTIONS.
WITH IN THE DEPARTMENT OF HEALTH
CARE SERVICES IN ORDER TO
EXPEDITE AND STREAMLINE
APPROVALS AND EXPAND CAPACITY
FOR THESE IMPORTANT SERVICES.
ARE HAPPY TO INTRODUCE OUR
WITNESSES HERE TOO I TO TESTIFY
IN SUPPORT AND JUST THE CLIP FOR
YOUR ACCEPTING AMENDMENTS AND
YES WE ARE ACCEPTING MOMENTS AND
THANK YOU FOR YOUR WORK ON THIS
BILL AS WELL.
THANK YOU AND AGAIN I'D MENTION
THAT THEIR SUPPORT ON BOTH SIDES
OF BREVITY IS REALLY APPRECIATE
IT.
WELCOME THANK YOU MISTER
CHAIRMAN -- PETER HANSEL CEO CAL
PACE WERE THE STATE ASSOCIATION
OF THE PACE PROGRAMS.
PACE AS HAS BEEN DESCRIBED AS A
VITAL LINK FOR FOR ALL SENIORS
IN THE COMMUNITY WERE VERY VERY.
PROUD TO BE SUPPORTING THE
PROGRAM -- IN -- SERVING ABOUT
EIGHTY FIVE HUNDRED FOR ALL
SENIOR STATEWIDE AND CERTAINLY
WANT TO THANK THE SOME A MEMBER
FOR BRINGING THIS BILL FORWARD --
IT'S A BEAUTIFUL PROGRAM BUT
IT'S A VERY LONG COMPLEX PROCESS
TO GET A PIECE PROGRAM APPROVED --
IT CAN TAKE UPWARDS OF TWO YEARS
OR MORE AND IVOLVES GETTING
APPROVAL AT THE STATE LEVEL AND
THE FEDERAL LEVEL.
YOUR ANALYSIS DOES A VERY GOOD
JOB OF DESCRIBING THIS
BIFURCATION IT'S CUMBERSOME IT'S
TIME CONSUMING AND THE REVIEW --
IS VERY TO POCKET OF BETWEEN THE
LICENSING REVIEW FUNCTIONS THAT
THE APARTMENT PUBLIC HEALTH CARE
IS OUT AND THE PROGRAM APPROVAL --
FUNCTIONS A DEPARTMENT HEALTH
CARE SERVICES THIS BASICALLY
STREAMLINES A PART OF THE
PROCESS BY CONSOLIDATING THE
RESPONSIBILITIES ASSEMBLYMEMBER
ASSEMBLY MEMBER SAID -- IT'S
REALLY A WIN WIN IT ALLOW
PROGRAMS TO START UP IN A MORE
TIMELY WAY IT'LL BRING PEACE
ACCESS TO PAYS.
IN COMMUNITIES THAT NEEDED BY
LIAM TIME AWAY AND I THINK I'LL
JUST STOP THERE AND ANSWER
QUESTIONS ON THE BILL.
THANK YOU -- CHAIRMAN DOCTOR PAN
THANK YOU SENATORS.
I'M LYNN FROM OR I AM PRESIDENT
OF HEALTH CARE INITIATIVES AT
TURNER IMPACT CAPITAL WE BUILD
THE FACILITIES THAT THE PACE
PROGRAMS OPERATE IN.
THE GENESIS OF THIS BILL STARTED
LAST FALL IN AND DISCUSSIONS I
HAD WITH ASSEMBLY MEMBER
PETRIE-NORRIS AND HER STAFF
[inaudible]
AND AS PETER JUST BROUGHT OUT.
WE HAVE.
LESS THAN 10% OF ELIGIBLE
SENIORS THAT ARE AT THAT HAVE
ACCESS NOW TO PACE FACILITIES IN
CALIFORNIA.
THIS BILL WILL GO A LONG WAY TO
STREAMLINING THE PROCESS MAKING
IT POSSIBLE FOR THEM TO GET
ACCESS TO IN TERRIFIC PROGRAM --
I SPEAK IN SUPPORT OF THE BILL.
THANK YOU OTHER WITNESSES IN
SUPPORT RIGHT THANK YOU MISTER
CHAIRMAN TOM SHE HERE ON BEHALF
OF INNOVATIVE INTEGRATIVE HEALTH
FRESNO PACE.
IN SUPPORT OF THIS MEASURE
APPRECIATE THE WORK OF THE
AUTHOR THANK YOU THANK YOU.
KELLY BUCKS HERE ON BEHALF OF
THE CENTERS FOR OLDER
INDEPENDENCE A PIECE -- PROGRAM
OPERATING IN ALAMEDA AND CONTRA
COSTA COUNTIES.
THANK YOU -- CHILD DISABILITY
RIGHTS CALIFORNIANS SUPPORT
THANK YOU.
OFFERED A MEDINA HERE ON BEHALF
OF ALL TO MAKE HEALTH SERVICES
AND SUPPORT.
THANK YOU ALL RIGHT -- SEEN
OTHER WITNESS OPPOSITION SUPPORT
ANY WITNESSES IN OPPOSITION.
SAY NONE THE MODE THE BILL'S
BEEN MOVED BY CENTER STONE ANY
QUESTIONS FOR COMMITTEE MEMBERS.
THE NONE.
WONDERFUL WILL THANK YOU SO MUCH
FOR MY STAFF ON THE AMENDMENTS --
THE THE MOTION IS TO PASS AS
AMENDED AND REFERRED TO THE
COMMITTEE APPROPRIATIONS SECTOR
PLEASE CALL THE ROLL.
HI AND I STONE STONE AYE
GONZALEZ GONZALEZ I GROW HER
TANTO LEYVA.
MITCHELL.
MITCHELL AYE MONNING MONNING AYE
RUBIO.
OKAY THE CURRENT LOTUS FIVE ZERO
OF THE VOTES TO GET OUT HOLD THE
ROLE OPEN FOR ABSENT MEMBERS AND
FINALLY YOU'RE PRESENTING ITEM
NUMBER TWENTY THREE AB.
THIRTEEN OH NINE BY SOME OF OUR
CON I THINK THIS ONE MIGHT
ACTUALLY HAVE SOME MORE
DISCUSSION.
READY HE LEFT YOU WITH THAT.
ONE THANK YOU MISTER CHAIR.
AT FIRST AS THE ASSEMBLYMEMBER
WOULD LIKE TO ACCEPT THE
COMMITTEE AMENDMENTS AND EXTENDS
FOR HER THANKS TO COMMITTEE
STAFF FOR THEIR WORK ON THE
SPELL.
AB THIRTEEN OH NINE WOULD CHANGE
THE OPEN ENROLLMENT DEADLINE
FROM JANUARY FIFTEENTH TO
JANUARY THIRTY FIRST. FOR
INDIVIDUALS TO PURCHASE
INDIVIDUAL COVERAGE IN OUR
STATE'S EXCHANGE COVERED
CALIFORNIA.
AND IN THE INDIVIDUAL MARKET
ALLOWING MORE CALIFORNIANS
ACCESS TO AFFORDABLE HEALTHCARE.
AB THIRTEEN OH NINE HELPS IN THE
CONTINUED SUCCESS OF OUR STATE
IMPLEMENTATION OF THE AFFORDABLE
CARE ACT.
AND BENEFITS THE NEARLY TWO
POINT FIVE MILLION CONSUMERS
THAT PURCHASED THEIR COVERAGE
AND COVER CALIFORNIA AND FORMER
STATES INDIVIDUAL INSURANCE
MARKET.
AS THE NEW YEAR BEGAN IN TWENTY
NINETEEN CALIFORNIANS ONLY HAD
TWO WEEKS TO SIGN UP FOR
COVERAGE IN JANUARY.
DUE TO THIS AND OTHER FEDERAL
ROLL BACKS THE ACA COVER
CALIFORNIA SOUGHT DROP THE 24%
IN NEW ENROLLMENT.
PROVIDING CONSUMERS ENOUGH TIME
TO EDUCATE THEMSELVES ABOUT
DIFFERENT COVERAGE OPTIONS IS
THE SENSIBLE THING TO DO
ESPECIALLY DURING A HECTIC
STRESSFUL AND OFTENTIMES COSTLY
HOLIDAY SEASON.
THE AMENDMENTS THAT WE ARE
TAKING TODAY WILL MITIGATE LAPSE
OF COVERAGE BY CREATING THE
MECHANISM NECESSARY TO ENSURE
THAT THE PLANTS GET ELEVEN
MONTHS WORTH OF PAYMENTS.
AND THE CONSUMERS GET ELEVEN
MONTHS WORTH OF COVERAGE.
I HAVE TWO WITNESSES TO SPEAK
HERE IN SUPPORT OF THE BELL.
AND JTS FROM HEALTHAXIS
CALIFORNIA AND LYNETTE. TEN A
RELIC FROM THE CALIFORNIA PAN
ETHNIC HEALTH NETWORK.
THANK YOU WELCOME THESE BEGIN.
MR CHAN MEMBERS AND JDS HERE ON
BEHALF OF HEALTH ACCESS
CALIFORNIA PROUD TO BE CO
SPONSOR OR SPONSORING AB.
THIRTEEN OH NINE THE LEGISLATURE
AND THE GOVERNOR JUST REQUIRED
CALIFORNIANS TO PURCHASE HEALTH
INSURANCE BY REINSTATING THE
MANDATE.
AB THIRTEEN OH NINE IS DESIGNED
TO MAKE IT EASIER FOR PEOPLE TO
DO JUST THAT -- BY GIVING THEM A
LITTLE BIT MORE TIME AFTER THE
HOLIDAYS TO BUY HEALTH INSURANCE
EVERY YEAR COVER CALIFORNIA
COMPETES WITH HOLIDAY MARKETING.
MARKETING ADDITIONALLY A DURING
EVEN NUMBERED OF YEARS COVERED
CALIFORNIA DELAYS MARKETING AND
ADVERTISING UNTIL AFTER THE
NOVEMBER ELECTIONS.
YOU TOO HIGH ADVERTISING COSTS
AND TO AVOID COMPETING WITH
ELECTION CAMPAIGN ADS THIS
EFFECTIVELY SHORTENS THE OPEN
ENROLLMENT PERIOD BY TWO TO
THREE WEEKS.
THERE IS ALSO YOU EVIDENCE THAT
SHOW PEOPLE WHO SIGN UP DURING
THE LAST TWO WEEKS OF JANUARY
TEND TO BE HEALTHIER THAN THOSE
WHO SIGN UP EARLIER.
IN CONTRAST PEOPLE WHO NOTING
NEED CARE BECAUSE THEY HAVE
ONGOING HEALTH CONDITIONS ARE
THE FIRST TO REVIEW AND SIGN UP
FOR COVERAGE.
YOU WILL HEAR FROM THE
OPPOSITION THAT THERE WILL BE A
GAP IN COVERAGE FOR THOSE WHO
SIGN UP IN THE LAST TWO WEEKS OF
JANUARY.
WE HAVE OFFERED NUMBER OF
OPTIONS TO HELP ADDRESS THIS
ISSUE AND DRAFTED AMENDMENTS GET
SOME NONE OF THEM SEEM TO WORK
OPERATIONALLY FOR THE PLANS.
UNLIKE OTHER KINDS OF INSURANCE
SUCH AS AUTO HOMEOWNERS FLOOD
AND OTHERS HEALTH PLANS AND
HEALTH INSURANCE CANNOT TAKE A
PREMIUM PAYMENT AND MAKE
COVERAGE EFFECTIVE IMMEDIATELY
WE CANNOT EXPLAIN THIS.
HEALTH PLANS ARE ALSO NOT SET UP
TO ACCEPT PAYMENT FOR PART OF
THE MONTH SO IF YOU SIGN UP ON
JANUARY.
THIRTY ONE AND THEY GET A CHECK
FOR THE PREMIUM ON FEBRUARY TWO
YOU MIGHT HAVE TO WAIT FOR
COVERAGE UNTIL MARCH ONE WE CAN
EXPLAIN THIS ALSO.
IF THE HEALTH PLANS ARE UNABLE
TO ENROLL PEOPLE IN COVERAGE
PROPERLY OR FOR PART OF A MONTH
IT IS THE HEALTH PLANS CREATING
THAT GAP IN COVERAGE NOT THE
CONSUMER WHO SIGNED UP FOR
COVERAGE.
AND PAID THEIR PREMIUMS AND ONE
STAR COVERAGE TO START
IMMEDIATELY.
WE SHARE A COMMON GOAL OF PEOPLE
GETTING HEALTH INSURANCE AND
CALIFORNIA NOW REQUIRES IS AB
THIRTEEN OH NINE MAKES IT EASIER
FOR THESE REASONS WE
RESPECTFULLY ASK FOR YOUR AYE
VOTE THANK YOU.
A LINDA TENER WHAT'S ON BEHALF
OF THECALIFORNIA PAN ETHNIC
HEALTH NETWORK WE'RE IN SUPPORT
OF AB THIRTEEN OH NINE AS THIS
BILL TAKES A STEP TOWARD
REDUCING BARRIERS TO ACCESS.
IN FACT RECENT COVER CALIFORNIA
DATA HAS SHOWN A DECREASE IN
ENROLLMENT AMONG SPANISH
SPEAKING AND KERKORIAN SPEAKING
CONSUMERS.
THIS BILL RECOGNIZES THE NEEDS
OF COMMUNITY MEMBERS ESPECIALLY
THOSE WITH LIMITED ENGLISH
PROFICIENCY WHO MAY NEED
ADDITIONAL TIME TO LEARN ABOUT
THEIR COVERAGE OPTIONS AND
ENROLL.
THIS IS ESPECIALLY IMPORTANT IN
THE MIDST.
OF A BUSY.
AND OFTEN BUSY TIME OF YEAR WE
SEE THIS AS AN ISSUE OF EQUITY
AND FOR THOSE REASONS WE ASK FOR
YOUR SUPPORT ON AB.
THIRTEEN OH NINE THANK YOU OTHER
WITNESSES IN SUPPORT
[inaudible]
BACK MICROPHONE.
RENTS SPENCER BEHALF THE
CALIFORNIA ACADEMY OF FAMILY
PHYSICIANS IN SUPPORT THANK YOU.
LYDIA BORN AMERICAN ACADEMY OF
PEDIATRICS AND SUPPORT THANK YOU.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY IN SUPPORT THANK
YOU.
BRANDON MARCH WITH THE
CALIFORNIA MEDICAL ASSOCIATION
IN SUPPORT THANK YOU.
RIGHT.
WHAT IS OPPOSITION?
PLEASE MAKE SOME ROOM
[inaudible]
FOR WELCOME.
I THINK YOU -- BOBBY BRIEF
MISTER CHURNING LOUISE'S ON
BEHALF OF THE CALIFORNIA
ASSOCIATION OF HEALTH PLANS
WHICH SEVEN OPPOSE UNLESS
AMENDED POSITION ON THE BILL WE
HAVE HAD SEVERAL DISCUSSIONS
WE'VE BEEN TRYING TO FIGURE THIS
OUT.
WE'LL TAKE A LOOK AT THE
AMENDMENTS THAT WERE -- HANDED
OUT TODAY I WANT TO CLARIFY IN
OUR OUR MAIN ISSUE IS THAT WE
WANT IN ROLE -- COVERAGE TO BE
EFFECTIVE IN THE INDIVIDUAL
MARKET FOR FOR ENROLLEES AS
EARLY IN THE YEAR AS POSSIBLE --
WHEN WE DO THIS IT MEANS MORE
MONTHS OF COVERAGE MORE MONTHS
OF PREMIUM COLLECTION THAT'S
BETTER FOR THE INDIVIDUAL AND
ROLY AND IT'S OUR IT'S BETTER
FOR THE OVERALL MARKET IN THERE
FOR ALL ENROLLEES?
SO WE'RE TRYING TO GET TO A
PLACE WHERE WE CAN EFFECTUATE
COVERAGE ON FEBRUARY FIRST
INSTEAD OF MARCH FIRST.
AND SO YOU THERE ARE TECHNICAL
ISSUES ASSOCIATED WITH THAT IT'S
NOT REALLY AFFECT YOU IN THE
COVERAGE -- THERE'S MORE THAN
THAT THERE'S GIVEN THE PERSON'S
ID CARD OUT THERE'S MAKING SURE
THAT THE ENROLLEES ARE IN THE
PROVIDER OR NETWORK PROVIDER
SYSTEMS AND IDENTIFIED AS A
HEALTH PLAN ENROLLEE.
ID CENTER SO THERE'S SO A YOU
KNOW IT'S A LITTLE MORE
COMPLICATED THAT THAT THAT THAT
THAT THAT'S OUR THING THAT WE WE
WE WANT COVERAGE TO START AS
EARLY IN THE YEAR AS POSSIBLE WE
THINK IT'S BETTER FOR PEOPLE IN
THERE FOR THE MARKET AND SO.
WILL CONTINUE TO WORK AT IT AND
WE'LL TAKE A LOOK AT THESE IN
THE MEANTIME THANK YOU.
THANK YOU OTHER WITNESSES
OPPOSITION TO NON QUESTIONS FROM
COMMITTEE MEMBERS -- MOTION OF
THE OCEAN FROM CENTER MINING --
SO.
AGAIN THANK YOU FOR PRESENTING --
FOR FOR SOME A MEMBER OF OUR CON
I YOU KNOW I THINK THAT --
APPRECIATE THAT THE HEALTH PLANS
WE GOT TO SEE WHAT WE CAN TRY TO
DO -- RECOGNIZING THAT FORTUNE
WE ALSO ARE OFFERING UP AGAINST
HUMAN BEHAVIOR WHICH IS WAITING
TILL THE LAST MINUTE ACTUALLY IF
YOU'RE RELATIVELY HEALTHY -- SO
I APPRECIATE THAT THE AUTHORS
AND CONTINUE WORKING AND
SPONSORS ON THIS -- SO WITHOUT
WHICH LIKE CLOSE.
IN LATE THE AUTHORED SHARES THE
SAME GOALS I AM INSURING THAT
CONSUMERS HAVE ENOUGH TIME TO
SIGN FOR COVERAGE.
AND MINIMIZING COVERAGE GAPS
YEAH I THINK THAT THE GOAL OF
EVERYBODY IN THIS ROOM IS TO
COVERS MANY CALIFORNIANS AS
POSSIBLE AND THAT CERTAINLY THE
AUTHOR'S INTENT.
HI THIS BILL HAS RECEIVED
BIPARTISAN SUPPORT IN THE
ASSEMBLY AND DEATH.
ON BEHALF OF ASSEMBLY MEMBER OF
OUR QUE HAN RESPECTFULLY ASK FOR
PRIVATE.
OF LET'S KEEP THE CONVERSATION
GOING SO THE MOTION IS TO PASS
AS AMENDED TO REFER TO COMMITTEE
ON APPROPRIATIONS SECTOR PLEASE
CALL THE ROLL.
HI AND I STONE.
GONZALEZ GONZALEZ SIDE GROW
FURTADO LEYVA.
THEY'VE AYE MITCHELL MITCHELL
AYE MONNING MONNING AYE RUBIO.
THE BILL HAS CERTAINLY FIVE ZERO
SEVEN EFFORTS TO GET IT OUT TO
HOLD THE ROLE OPEN FOR ABSENT
MEMBERS.
THANK YOU.
RIGHT I THINK THE NEXT UP IS
SUMMER QUIRK.
HERE OKAY I THINK YOU ARE NEXT
UP WITH.
ITEM NUMBER TWENTY ONE AB.
ELEVEN SEVENTY EIGHT I'LL BE
BRIEF.
OKAY ALL RIGHT.
THANK YOU CHAIRMAN SENATORS --
AB ELEVEN SEVENTY EIGHT REQUIRES
PROPRIA PRO.
BIOTIC MANUFACTURERS TO LABEL
THEIR PRODUCTS WITH THE GENUS
SPECIES AND STRAIN.
OF MICRO ORGANISMS IN DIETARY
SUPPLEMENTS.
THE BILL IS SUPPORTED BY THE
CALIFORNIA MEDICAL ASSOCIATION
AND THE INDUSTRY GROUP.
THE INTERNATIONAL FOOD ADDITIVES
COUNSEL IN THIS NO OPPOSITION --
WITH ME TODAY IS ERIC LEVY A PHD
STUDENT STUDYING INFECTIOUS
DISEASES AT UC BERKELEY AND ZACH
ABBOTT PHD SCIENTIST IN THE C.
E. O. OF C. BIOTICS.
A WELCOME -- SHE DIED NO YOU FOR
WAY TO LONG TIME FISHY TO KEEP
IT BRIEF THANK YOU.
HELLO CHAIR AND MEMBERS OF THE
SENATE HEALTH COMMITTEE -- I'M
HERE TODAY BECAUSE I WON A
COMPETITION HOSTED BY THE UC
CENTER OF SACRAMENTO WHICH ASKED
TO GRADUATE STUDENTS TO DRAW ON
OUR UNIQUE EXPERTISE TO PROPOSE
NEW POLICY IDEAS -- CURRENT
PROBIOTICS LABELS INCLUDE
BACTRIS SPECIES BUT SCIENTISTS
PREFER TO USE AN ADDITIONAL
LEVEL OF SPECIFICITY WHICH IS
CALLED THE STRAIN.
YOU CAN THINK OF BACTERIAL
STRAINS LIKE BREEDS OF DOGS ALL
DOGS ARE THE SAME SPECIES BUT IF
YOU IMAGINE A DOCKS AND AS A
POLICE CANINE.
YOU CAN UNDERSTAND THE
IMPORTANCE OF SPECIFICITY PASSED
A SPECIES LEVEL.
SIMILARLY A BACTRIS SPEED STRAIN
IMPACTS ITS FUNCTION BUT STRAINS
ARE NOT REQUIRED TO BE LISTED ON
MANUFACTURE LABELS UNDER CURRENT
FEDERAL LAW.
MORE DETAILED STRAIN LEVEL
LABELING AS A RESULT OF AB
ELEVEN SEVENTY EIGHT WILL ENSURE
THAT THIS CRUCIAL INFORMATION IS
READILY AVAILABLE TO ALL.
THANK YOU.
I THINK FOR ME SPEAK TODAY AND I
KEEP MY COMMENTS BRIEF BUT
AVAILABLE FOR QUESTIONS.
MY NAME IS ZACH ABIT -- A PEACHY
MICROBIOLOGIST AND THE CEO OF
THE PROBIOTICS COMPANY.
I SUPPORT MANDATORY MANDATORY
PROBIOTIC STRAIN LABELING FOR
TWO MAIN REASONS FIRST PROBIOTIC
BUSINESSES SUCH AS MINE ARE
PREDICATED ON THE SCIENTIFIC
FACT.
THAT BACTERIAL STRAINS HAVE
DIFFERENT PROPERTIES WE GO
THROUGH YEARS OF AFTER IN RIGOR
TO ISOLATE DEVELOP AND CHARACTER
AYE STRAINS AND THEN FILE
PATENTS TO PROTECT THE STRAINS
FOR THE PURPOSE OF EXCLUSIVE USE.
WITHOUT MANDATORY STRAIN
LABELING THIS EFFORT IS UNDER
CUT MEASLES.
SECOND WITHOUT REQUIREMENT FOR
MANUFACTURER TO LABEL THEIR
STRAINS THERE IS AN THERE IS
THEREFORE NO REQUIREMENT TO EVEN
KNOW WHAT TRAINS THEY'RE PUTTING
INTO THEIR PRODUCTS.
THIS IS OBVIOUSLY NOT IN THE
BEST INTEREST OF THE PUBLIC OR
THE INDUSTRY THANKS.
THANK YOU ANY OTHER WITNESSES IN
SUPPORT.
BRENT IN MARCH WITH THE
CALIFORNIA MEDICAL ASSOCIATION
AND SUPPORT.
A THANK YOU ALL RIGHT HELLO
WITNESSES IN OPPOSITION.
SEEING NONE QUESTIONS COMMITTEE%
MEMBERS IT'S BEEN MOVED BY
CENTER MINING.
IT'S Y. SE SO I WOULD LOVE TO
SPEND MORE TIME DIGGING OUT ON
THIS THING.
BUT THANK YOU SO MUCH FOR
READING THIS BILL FORD
APPRECIATE CONGRATULATIONS ON
GETTING THE AWARD -- AND THAT
THANK YOU SO MUCH FOR BRINGING
THIS BILL FORWARD.
ALL RIGHT I WOULD LIKE TO CLOSE.
I WANT TO THANK -- ERIC FOR
COMING UP WITH THIS IDEA AND
ZHAO THEN GAVE -- FOR MY SCIENCE
FELLOW WHO DID HER PHD WORK ON
THE CUT MY MICROBIOME. FOR
STAFFING THIS BILL THANK YOU
VERY MUCH I ASK FOR YOUR AYE
VOTE.
THANK YOU AS A PHYSICIAN I
REALLY WANT TO ASK MORE
QUESTIONS NOW.
OKAY SO THE VET BUT BY MY
COMMITTEE MEMBERS ARE TELLING
THEY ARE SORRY.
HELD OFF HOLD OFF OKAY.
THE MOTION IS DO PASS AND
REFERRED TO THE COMMITTEE ON
APPROPRIATIONS I'VE HEARD BY
COMMITTEE MEMBERS.
SECOND PLEASE CALL THE ROLL CAN
HI.
STONE GONZALEZ IT IS ALSO A GROW
HER TADO.
LEYVA LEYVA AYE MITCHELL.
MITCHELL AYE MONNING.
MONNING AYE RUBIO.
THE BILL HAS FURNACE FIVE VOTES --
THAT'S ENOUGH TO GET OUT WILL
THE ROLE OPEN FOR ABSENT MEMBERS
AND THANK YOU SO MUCH THANK YOU
SENATORS FOR BEING HERE SO LATE
AND THANK YOU -- MY WITNESSES
FOR ALSO STAIN HERSELF LATE.
I THANK WELL THE JOURNAL CLUB
TOGETHER LATER OKAY -- I SEE
SOME A RADIUS I AND NUMBER
THIRTEEN EIGHTY SEVEN SEVENTY
FOUR WELCOME.
THANK YOU MISTER CHAIR MEMBERS.
I'D LIKE TO BEGIN BY THANKING
THE CHAIR AND COMMITTEE STAFF
FOR WORKING WITH MY OFFICE ON
THIS BILL.
I ACCEPT THE COMMITTEE
AMENDMENTS BEING SHARED WITH YOU
WHICH REMOVE THE COLLECTION OF
INFORMATION REGARDING SPECIFIC
FACILITIES.
AND IN ADDITION A DELETE THE
SUNSET FROM THE BILL.
MOVING FORWARD I WILL BE
CONTINUING TO WORK WITH THE
OFFICE OF STATEWIDE HEALTH
PLANNING AND DEVELOPMENT IN
REFINING DEFINITIONS WITHIN THE
BILL.
AB SEVEN SEVEN FOUR REPRESENTS
AN IMPORTANT FIRST STEP IN
ASSESSING OUR CAPACITY TO
PROVIDE MENTAL HEALTH SERVICES
STATEWIDE.
THIS BILL REQUIRES ARE SPREAD.
TO TRACK A BY TIME THE WAITING
PERIODS FOR PATIENTS AND
EMERGENCY DEPARTMENTS.
THE STATE A SPECIFIC PURPOSE IS
TO GAIN FURTHER INFORMATION
REGARDING HOW LONG PATIENTS ARE
WAITING FOR DISCHARGE OR
TRANSFER ESPECIALLY IN CASES
WHERE THERE IS NEED OF
PSYCHIATRIC CARE.
WHEN INDIVIDUALS ARE IN NEED OF
MENTAL HEALTH SERVICES THEY
OFTEN SEEK CARE AT THE NEAREST
EMERGENCY DEPARTMENT?
IN MANY CASES ONCE YOU VALUE
WAITED.
A PATIENT MUST BE TRANSFERRED TO
A SEPARATE DEPARTMENT TO BETTER
ADDRESS THEIR NEEDS.
ALTHOUGH IT IS ACKNOWLEDGED THAT
EXTENDED PERIODS OF WAIT TIME
FOR INDIVIDUALS IN NEED THE
SERVICES IS A PROBLEM.
THERE'S BEEN MORE TALK THAN
ACTION.
AB SEVEN SEVEN FOUR REPLACES
RHETORIC WITH DATA ALLOWING US
TO BETTER EVALUATE HOSPITAL
EMERGENCY DEPARTMENT TRANSFERS
AND DISCHARGES IN WAITING
PERIODS.
ESPECIALLY THOSE REQUIRING AND
REQUESTING PSYCHIATRIC.
CARE HERE TO TESTIFY ON BEHALF
OF THIS BILL IS TO MADDEN
REPRESENTING THE CALIFORNIA
CHAPTER OF THE AMERICAN COLLEGE
OF EMERGENCY PHYSICIANS.
BUT BROWN MEMBERS TO MAN RIVERS
IN THE CALIFORNIA CHAPTER THE
MAN CALLED EMERGENCY PHYSICIANS
IN WERE THE SPONSOR OF THIS BILL
FOR SURE LIKE THE THINK THE
STAFF AND CHAIR FOR THEIR TIME
AND DISCUSSIONS ON THE BILL.
WE'RE VERY EXCITED ABOUT THE
IDEA OF FINALLY PUTTING SOME
DATA TO THE PROBLEM THAT WE SEE
IN THE MERGED APARTMENT EVERY
DAY.
WHICH IS OUR CHALLENGE WAS
GETTING OURS ARE MENTAL HEALTH
PATIENTS TO THE CARE THAT THEY
REALLY NEED OUR JOB IS TO
STABILIZE THE PATIENT.
AND THEN ASSESS THEM IF THEY DO
HAVE AN UNDERLYING MENTAL HEALTH
CONDITION NEEDS ORE CARE WE
NEED TO TRANSFER THEM.
ME TO ANOTHER FACILITY
ANECDOTALLY WE TALK ABOUT
STORIES OF A SIXTEEN YEAR OLD
GIRL UC DAVIS TO STAY IN THE
MERCY DEPARTMENT FOR THIRTY DAYS
WAITING TO BE TRANSFERRED TO THE
FACILITY.
I'LL BE NICE TO UNDERSTAND IT
THIS IS AN ANOMALY AT THIS IS A
ONE TIME SITUATION OR FOR SEEING
SOME TYPE OF A TREND IN THIS
AREA THIS DATA WILL HELP US
BETTER UNDERSTAND THAT -- FOR
THOSE REASONS WE RESPECTFULLY
ASK FOR IPHONE.
OKAY THANK YOU OTHER WITNESSES
SUPPORT.
MISTER CHAIR AND MEMBERS BRANDON
MARCH WITH THE CALIFORNIA
MEDICAL ASSOCIATION WITH SUPPORT
BILL AND THANK THE AUTHOR FOR
WORKING ON THIS.
THANK YOU.
RIGHT -- WITNESSES OPPOSITION.
IT'S COME UP TO THE TABLE.
CHAIR MEMBERS ALEX HAWTHORN THE
CALIFORNIA HOSPITAL ASSOCIATION.
WE CURRENTLY HAVE AN OPPOSE
POSITION.
ON THIS BILL I WANT TO SAY THAT
WE AGREE WITH EVERYTHING THAT'S
BEEN SAID WHEN WE SURVEYED OUR
HOSPITALS LAST YEAR THEY
IDENTIFIED.
EMERGENCY ROOM OVERCROWDING FROM
MAJOR HEALTH ISSUES IS THEIR
NUMBER ONE ISSUE.
SO WE KNOW THIS IS A PROBLEM
MORE COMMITTED TO ADDRESSING IT.
THE CONCERN WE HAVE WITH THIS
BILL IS WHEN WE LOOK AT IT WE
HAVE TO DO A COST BENEFIT
ANALYSIS.
WE ARE BEING ASKED TO EXPAND A
SIGNIFICANT AMOUNT OF MONEY TO
COMPLY WITH THE REPORTING
REQUIREMENTS WE DO A LOT OF
REPORTING ALREADY -- WE DON'T
ALWAYS SUPPOSING REPORTING BUT
IF WE'RE GOING TO BE EXPENDING
PROBABLY MILLIONS OF DOLLARS TO
DO IT WE WOULD LIKE TO KNOW
CLEARLY WHAT THE RETURN S GOING
TO BE AND AGAIN WE'RE NOT SAYING
THAT IS BAD WHERE DATA DRIVEN
ORGANIZATION.
BUT BECAUSE WE KNOW THERE'S A
PROBLEM WE WOULD RATHER EXPEND
OUR RESOURCES SOLVING THE
PROBLEM -- IN THAT MANNER SO IT
THIS TIME WE HAVE AN OPPOSE
POSITION APPRECIATE THE BUILDING
NARROWED HOPEFULLY WE CAN
CONTINUE WORKING ON IT --
ESPECIALLY WITH THE REGULATOR
WHO KNOWS HOW THESE ISSUES WORK
VERY WELL.
MR CHAIRMAN MEMBERS THEO PALES
REPRESENTED AT HEALTH FACILITIES --
WE TOO ARE VERY CONCERNED ABOUT
THE PROBLEM WE'VE ACTUALLY PUT
ARM A POCKETBOOK WARM MOUTH IS
WE OWN A PSYCHIATRIC HOSPITAL IN
NORTHERN CALIFORNIA.
WE'VE WORKED WITH THIS
SPONSORING YOUR COMMITTEE ON A
BILL THAT WAS HERE I BELIEVE IT
WAS LAST WEEK MAYBE WAS TWO
WEEKS AGO TO MAKE SURE THESE
PEOPLE GET TO THE RIGHT PLACE AT
THE RIGHT TIME.
AND GET TAKEN CARE OF QUICKLY AS
POSSIBLE MAKE SURE ALL
FACILITIES IN THE COUNTY ARE
PARTICIPATING IN THAT IN DENVER
AT THAT IT.
ENDEAVOR YOU KNOW.
UP IMAGES ROOMS VERY MUCH OUR
FUNCTION OF SOCIETY AND RIGHT
NOW IT'S NOT PRETTY RIGHT WE IT
IS AMAZING THAT THESE PEOPLE
WORKING ARMORED ASSUMES EVEN GET
THROUGH THE DAY -- WE COLLECT A
TON OF DATA AMONG DOING OTHER
THINGS.
THE DIFFICULTY WITH THIS
PARTICULAR DATA SAID IS THAT
THERE'S A TIME STAMP ELEMENT TO
IT THERE IS NOT JUST ANOTHER
FIELD THAT WE CAN PUT IN OUR
EXISTING SOFTWARE.
SO WE HAVE TO REINVENT THE WHEEL
FOR THIS A LITTLE AMOUNT OF DATA
GOING BACK TO THE PREVIOUS
WITNESSES COST BENEFIT.
COST BENEFIT ANALYSIS.
WE ALL THE MANDATES THAT WE
PASSED LAST YEAR WE PASSED A
HOMELESS DISCHARGE BILL OR
HOSPITALS ARE STRUGGLING TO MAKE
SURE WE HAVE ENOUGH JACKETS FOOD.
TAXI CAB RIDES AND SHELTERS FOR
PEOPLE FOR GOD. FOR HOMELESS
PEOPLE DISCHARGED TO GET INTO WE
ARE OVER TAXED YOU'RE ASKING US
TO MAKE A BIG INVESTMENT FOR A
LITTLE BIT OF DATA WE JUST DON'T
THINK THE THRESHOLD HERE WE
THINK THRESHOLD YEARS TOO LOW.
IF YOU'RE GONNA REQUIRE SUSPEND
THIS KIND OF MONEY IT SHOULD BE
FOR REAL DATA WE BELIEVE THERE
ARE OTHER WAYS TO COLLECT THIS
INFORMATION.
AND THIS IS JUST TOO EXPENSIVE.
RIGHT AT THE OTHER WITNESSES
OPPOSITION.
ALL RIGHT.
QUESTIONS FOR ME MEMBERS IS OUR
MOTION THERE'S A MOTION BY
CENTER LEYVA -- I TO SAY FIRST
OF ALL I THANK YOU -- SOME REYES
FOR WORKING WITH OUR OFFICE WE
DID WORK TO SLIM IT DOWN I
CERTAINLY -- WE HEARD -- FROM
THE HOSPITALS.
I I DO THINK I REALIZE WITH
DIFFERENCE OF OPINION THAT -- WE
DID FEEL THAT THE TIME ISSUED
THE TIME ACTUALLY -- WAS VERY
VERY VERY IMPORTANT AND VALUABLE
DATA AND TRY TO UNDERSTAND
WHAT'S GOING ON THE REGISTER
WHAT THE BARRIERS ARE GOING ON
SO WE SLIM DOWN A LOT OF DATA
ELEMENTS OF THE SPONSORS
ORIGINALLY WANTED BECAUSE THAT
WILL WHAT ARE YOU TRYING TO GET
AT WAS A GOING TO DO.
AND THEY FINALLY AGREED SAID NO
AND WE DIDN'T WHAT WE'VE BEEN
WORKING WITH US BUT AS WELL THE
REGULATORS WELL SO.
SHE YOU WILLIAMS CONCEDED WORK
TOGETHER I THINK THAT THIS
PARTICULAR ELEMENT THAT WE HAVE
IN THE BILL I REALIZE NOW THERE
MAY BE SOME CHALLENGES DOING IT
WE'VE BEEN CONVERSATIONS LAST
BUT BUT CERTAINLY.
WANT TO THANK THE AUTHOR AND
SUPPORT THE AUTHORS EFFORT TO
SAY IF THAT'S TRUE -- FIGURE OUT
THOSE DATA ON THIS WE REALLY
NEED TO GET SO -- WITH THAT --
WHICH LIKE CLOSE.
I THINK THAT IF WE RECOGNIZE
THAT THERE IS A PROBLEM I THINK
WE NEED TO RECOGNIZE JUST HOW
SERIOUS THE PROBLEM IS AND
UNLESS WE KNOW WHEN THE PERSON
COMES INTO THE EMERGENCY ROOM.
THE TIME THEY COME IN AND THE
TIME THEY ARE DISCHARGED.
IT'S ALREADY RHETORICAL WE WE
DON'T REALLY KNOW HOW LONG
THEY'RE WAITING IN THE WAITING
ROOM.
AND THAT'S AN ISSUE THAT NEEDS
TO BE RESOLVED.
ALONG WITH THE ISSUE REGARDING
OUR MENTAL HEALTH PATIENTS AND
HOW QUICKLY THEY CAN BE
TRANSFERRED.
WITHOUT I RESPECTFULLY ASK FOR
YOUR IPHONE HEY THE BILL'S BEEN
MOVED TO MOTIONS TO PASS AS
AMENDED -- SECURITIES CALL THE
ROLL.
HAND BY AN ICE STONE GONZALEZ
GONZALEZ I'D GROW FURTADO LEYVA
LIVE AYE MITCHELL.
MITCHELL AYE MONNING MONNING AYE
RUBIO.
THE BILL HAS FIVE VOTES WILL
HOLD THE ROLE OF THE DRAFT
MEMBERS THANK YOU THANK THE
RIVER BERMAN I THINK YOU ARE
NEXT ON TRACY OF THERE'S NO.
ALL RIGHT SO THAT'S ITEM NUMBER
TWENTY FOUR A. B. [inaudible]
THIRTEEN TWENTY TWO WELCOME.
YEAH AND OUR GRAYSON WAS HERE HE
WAS HERE FOR A LONG TIME ANYWAY.
THANK YOU MISTER CHAIRMAN
SANDERS FIRST I WANT TO THANK
THE CHAIR AND IS COMMITTEE FOR
THEIR WORK ON THIS BILL AND FOR
THE CHURCH PREVIOUS COMMENTS
WHEN THE BILL IS HEARD AND
SENATE EDUCATION COMMITTEE.
I WILL BE ACCEPTING THE
COMMITTEES SUGGESTED AMENDMENTS
DESCRIBED IN THE ANALYSIS OF
FORTY CONTINUING CONVERSATIONS
WITH YOUR COMMITTEE AS WE
DISCUSS THE BILL WITH THE
DEPARTMENT OF HEALTH CARE
SERVICES AND THE GOVERNOR'S
OFFICE.
SCHOOL BASED HEALTH SERVICES
PLAYED A KEY ROLE IN ENSURING
THAT CALIFORNIA STUDENTS ARE
HEALTHY AND READY TO LEARN.
IN CALIFORNIA THERE'S NO
INSTITUTIONALIZED PARTNERSHIP
BETWEEN THE DEPARTMENT OF HEALTH
CARE SERVICES WHICH OVERSEES
MEDI CAL AND THE CALIFORNIA
DEPARTMENT OF EDUCATION TO
COORDINATE VARIOUS HEALTH
PROGRAMS AND SERVICES DELIVERED
THROUGH SCHOOLS. TO ADDRESS THIS
A. B. THIRTEEN TWENTY TO
ESTABLISH AN OFFICE OF SCHOOL
BASED HEALTH PROGRAMS WITHIN THE
CALIFORNIA DEPARTMENT OF
EDUCATION.
WITH THE UPCOMING EXPANSION OF
ELIGIBILITY TO RECEIVE FEDERAL
FUNDS FOR SCHOOL BASED HEALTH
SERVICES.
THERE IS AN OPPORTUNITY FOR AN
OFFICE OF SCHOOL BASED HEALTH
PROGRAMS THE PLAY A VITAL ROLE
IN ASSISTING SCHOOLS THAT WISH
TO PARTICIPATE IN THESE PROGRAMS.
TO DRAW DOWN FEDERAL FUNDS
ENSURING THAT CALIFORNIA
STUDENTS MAY CONTINUE RECEIVING
HEALTH AND MENTAL HEALTH
SERVICES AT SCHOOL SITES.
I RESPECTFULLY ASK FOR AYE VOTE
ON A. B. THIRTEEN TWENTY TWO AND
WITH ME TODAY ARE TRACY MENDEZ
EXECUTIVE DIRECTOR OF CALIFORNIA
SCHOOL BASED HEALTH ALLIANCE.
AND TWENTY TRICK GUERO CAP FROM
THE CALIFORNIA TEACHERS
ASSOCIATION.
GOOD EVENING.
I'M RECOGNIZING WHERE ONE OF THE
ONLY THINGS HOLDING YOU BACK
FROM YOUR JULY FOURTH HOLIDAY
WILL RAMATICALLY SHORTEN OUR
REMARKS AND TRACY MENDEZ.
EXECUTIVE DIRECTOR OF THE
CALIFORNIA SCHOOL BASEDHEALTH
ALLIANCE A SENATOR BERMAN -- AS
ASSEMBLY MMBER BERMAN SORRY
SUGGESTED A CALIFORNIA SCHOOLS
HAVE BECOME AN INCREASINGLY
IMPORTANT PLACE WHERE
CALIFORNIA'S YOUNG PEOPLE
RECEIVE THE PRIMARY CARE DENTAL
VISION AND ESPECIALLY MENTAL
HEALTH SERVICES THEY NEED.
EVEN IN AND EVEN AN ENVIRONMENT
OF INCREASED AND INSURANCE
COVERAGE.
BUT IT'S HARD IN A NOTE WE KNOW
THIS FIRST HAND IT'S VERY HARD
FOR SCHOOLS AND SCHOOL DISTRICTS
AND HEALTH CARE PROVIDERS TO
NAVIGATE THE COMPLEX TERRAIN.
OF THIS MULTI DISCIPLINARY CROSS
SECTORAL COLLABORATION AND TO
WORK -- THEY STRUGGLE TO WORK
WITH THE STATE'S MEDICAID SCHOOL
MEDICAID PROGRAMS.
AND WE KNOW THAT MANY STATES TO
RESOLVE THESE ISSUES BY CREATING
OFFICES OF SCHOOL HEALTH SIMILAR
TO THE ONE THAT -- A. B.
THIRTEEN TWENTY TWO IS PROPOSING
WE BELIEVE THIS WILL HELP.
FURTHER ENRICH OUR PROGRAMS ARE
SCHOOL HEALTH PROGRAMS AND AND
SERVE OUR YOUTH WELL SO WE
ENCOURAGE YOUR AYE VOTE THANK
YOU VERY MUCH.
THANK YOU TONY TRIGGER ON THE
HAVE THE CALIFORNIA TEACHERS
ASSOCIATION BOTH OF THESE GROUPS
TODAY ARE CO SPONSORS OF THE
BILL.
A STUDENT WHO DOES NOT FEEL WELL
CANNOT LEARN AND A LACK OF
AVAILABLE CARE IS AN EQUITY
ISSUE AND VERY MUCH CONTRIBUTES
TO IT AND KEEP ME GAPS.
WE NEED TO INCREASE THE NUMBER
OF SCHOOLS PARTICIPATING AND
MAINTAIN THEIR PARTICIPATION WE
MUST ENSURE A HIGH LEVEL OF
COMPLIANCE IN ACCORDANCE WITH
THE PROGRAM'S REQUIREMENTS.
CALIFORNIA SCHOOLS MUST AVOID
PAY BACKS A PROP NINETY EIGHT
FUNDING DO PROGRAM
IRREGULARITIES.
INCREASING SCHOOL DISTRICT
PARTICIPATION IS A WAY TO
INCREASE THE NUMBERS OF
CREDENTIALED SCHOOL NURSES.
COUNSELLORS PSYCHOLOGISTS AND
SOCIAL WORKERS THAT INDIVIDUAL
SCHOOL SITES IT'S AN OPPORTUNITY
TO INCREASE THEIR RANKS WE ASK
FOR AN AYE VOTE.
THANK YOU OTHER WITNESSES IN
SUPPORT.
VIDEO PORN REPRESENTING
CALIFORNIA SCHOOL NURSES WERE
PROUD CO SPONSORS I AM ALSO --
GIVING A A SUPPORT FOR
CALIFORNIA SCHOOL BOARDS
ASSOCIATION THEY ARE UNABLE TO
BE HERE THIS EVENING.
THANK YOU THANK YOU I WILL THANK
YOU.
HELLO THOUSAND TEACHERS FOR
HEALTHY KIDS CO SPONSORS STRONG
SUPPORT THANK YOU.
SELECT US HERE WE HAVE A
CALIFORNIA ACADEMY OF CHILD AND
ADOLESCENT PSYCHIATRY IN SUPPORT
THANK YOU.
REBEKAH GONZALEZ NATIONAL
ASSOCIATION OF SOCIAL WORKERS
CALIFORNIA CHAPTER IN SUPPORT
YOU.
CONNIE DELGADO OF THE HAVE THE-COUNTY BEHAVIORAL HEALTH
DIRECTORS ASSOCIATION WE HAVE A
SUPPORT COMMAND WE WANT TO SEE --
COORDINATION WITH THE LOCAL
PAPER HEALTH AGENCIES UP WE'RE
GOING TO CONTINUE THE
DISCUSSIONS WITH THE AUTHOR
THANK YOU OKAY THANK YOU.
RIGHT ARE THERE ANY WITH THIS IS
IN OPPOSITION.
SAY NONE QUESTIONS COMMITTEE
MEMBERS COMMENTS.
OKAY IT'S BEEN MOVED BY CENTER
MITCHELL -- THE SERVER BERMAN I
THINK IT THANK YOU SO MUCH FOR
WORKING OUR OFFICE I UNDERSTAND --
SOME ANXIETY ON THE PART OF THE
AUTHORS ABOUT THAT BUT I THINK
IT'S REALLY IMPORTANT BRING DCS
TO THE TABLE.
AND I AM DETERMINED TO SEE THAT
THAT HAPPENS BECAUSE WITHOUT
THEM AT THE TABLE THIS OFFICE IS
NOT GOING TO BE AS EFFECTIVE AS
I THINK WE ALL HOPE AND DESIRED
SO -- WITH THAT -- SO -- I WAS
GONNA ASK THIS BECAUSE IT'S
COMING TO MY COMMITTEE NOW I'M
GOING TO ASK I'D LOVE TO BE CO
AUTHOR OF THAT BE GREAT THANK
AREA.
ALL RIGHT BECAUSE I MAKE THIS
HAPPEN CELL AND HOPEFULLY IT'S A
SINGLE DTS AS WELL SO ALL RIGHT.
SO WITH THAT -- WHICH LIKE
CLOTHES I RESPECTFULLY ASK DR --
THANK YOU FOR FOR YOU AND YOUR
COMMITTEE STAFF WORKING WITH US
ON THIS AND BRIDGES YOU COMING
ON AS A CO AUTHOR.
ALL RIGHT SO THE MOTIONS TO PASS
AN AMENDED REFERRED TO THE
COMMITTEE ON APPROPRIATIONS
ACCURATE PLEASE CALL THE ROLL.
AN HI AND I STONE GONZALEZ
GONZALEZ I GROW HER TADO LEYVA.
LEYVA AYE MITCHELL.
MITCHELL AYE MONNING MONNING AYE
RUBIO.
CURRENTLY HAS FIVE VOTES IT'S
ENOUGH TO GET IT OUT TO HOLD THE
ROLE OF AN FOR ABSENT MEMBERS
THANK YOU.
ALL RIGHT I SEE THIS IN THE
RETAIN WELCOME.
AGAIN NEXT SO -- THAT'S ITEM
NUMBER TWENTY FIVE A. B.
[inaudible]
THIRTEEN SIXTY WELCOME.
THANK YOU -- FIRST IMAGES THANK
YOU AND YOUR COMMITTEE STAFF FOR
THEIR WORK ON THE BILL WE ARE
HAPPY -- TO TAKE THE AMENDMENTS
TO CLARIFY THAT FOOD SAFETY
REQUIREMENTS OF THE SOUL EXPENSE
OF THE FOOD DELIVERY COMPANY.
AGAIN THE BILL ESTABLISHES BASIC
HEALTH AND SAFETY STANDARDS FOR
GROCERY DELIVERY THROUGH ONLINE
PLATFORMS. FOR THESE ONLINE
DELIVERY OUT COMPANIES THE BILL
REQUIRES THE DELIVERY PERSON OF
FOOD AND SAFETY TRAINING FOR
FOOD TO SPOIL EASILY LIKE MEAT
AND DAIRY.
DELIVER ME COLD MUST MEET AND
VEHICLE SAFETY STANDARDS AND
HAVE LIABILITY INSURANCE.
COMPOSED LIKE TO RESPONSIBLE IS
ON THE GROCERY STORES AND THE
ONLINE PLATFORM FOR FOOD
DELIVERY IN PERMITS THE
CALIFORNIA.
DEPARTMENT OF PUBLIC HEALTH TO
ENFORCE THE BILL IN ADOPTING
ELATION.
WITH THAT WE HAVE TO BRIEF
WITNESSES OKAY AND JUST TO TO BE
CLEAR THE THANK YOU SO MUCH FOR
TAKING THE MEN IT'S
UNDERSTANDABLE ACTUALLY TAKEN UP
PRIOR TO A JUDICIARY COMMITTEE
GOT THANK YOU YEAH THIS WEEK.
THANK YOU WITNESSES ABOARD.
THANK YOU MISTER CHAIRMAN
MEMBERS OF THE COMMITTEE I ALSO
WANT TO ECHO.
OF SEVEN MEMBER TAKES COMMENTS
TAKING YOU AND YOUR STAFF FOR
YOUR EFFORTS.
OF A BIRD A TRICKLE ME UP THE
UNITED FOOD AND COMMERCIAL
WORKERS SPONSORS OF THE BILL --
AS FOLKS MAY KNOW.
CURRENTLY THE THE DELIVERY
PLATFORMS THE COMPANIES TO THE
DELIVERIES FOR GROCERY STORES
ARE COMPLETELY UNREGULATED.
THERE ARE NO REGULATIONS RUN --
STANDARDS RUN A LAWSUIT COVER
THEM IT'S A NEW INDUSTRY
RECOGNIZE THAT.
HOWEVER -- IT IS IMPORTANT.
FOR THE PUBLIC TO KNOW THAT THE
FOOD THEY'RE GETTING IS NOT
CONTAMINATED SETTLE TRIED ANYWAY
THE BILL DOES THAT.
I KNOW THAT THE OPPOSITION IS
GOING TO COME FORWARD AND AND
TRY TO MAKE SOME COMPARISONS AND
LET ME JUST -- START BY SAYING.
THIS DOESN'T APPLY TO GROCERY
STORES BECAUSE GROCERY STORES
ALREADY HAVE -- THIRTY HAVE THE
CALIFORNIA RETAIL FOOD COURT
WHICH IS OVER A HUNDRED PAGES
AND HAS SEVERAL PROVISIONS
INCLUDING -- PRODUCES FOR
PROTECTION COME CONTAMINATION A
TIME TEMPERATURE RELATIONSHIPS
UP FOOD STORAGE.
THERE'S COVERAGE ALREADY IN THE
STORES AND ALL OF THE DRIVERS TO
DELIVER ON THE HELP THE STORES
THAT ARE EMPLOYEES OF STORES ARE
ALSO COVERED.
IN THE REQUIRED TO HAVE
REFRIGERATOR TRUCKS.
THAT.
LANGUAGE WAS PART OF THE
REASONABLE WE REMOVED IT.
BECAUSE OF THE IN RESPONSE TO
THE OPPOSITION AND NOW THE BILL
BASICALLY THE STANDARD FOR THE
CARS AND LICENSING MEMBERS WILL
BE WHAT IS ALREADY IN PLACE FOR
UBER LEFT.
IN TERMS OF INSPECTIONS AND
LICENSING SO WE PICKED UP THE
BILL MAKES SENSE OF STREAMLINED
AND A FOOD RUNNER CARD IS NO
LONGER REQUIRED.
BUT IT DOES MEET THE
REQUIREMENTS OF THIS BILL.
RESPECTFULLY ASK FOR LEVEL.
MISTER CHAIR JUST ONE FOR THE
LOCAL ENVIRONMENTAL HEALTH
CHARACTERS WE REGULATE THE
RETAIL FOOD FACILITIES AND WE
APPRECIATE AMENDMENTS TAKEN.
BECAUSE THAT'S MOVE THE BILL
FROM THE LOCAL RETAIL FOOD
INSPECTORS TO THE STATE WE
CANNOT REGULATE ONE OF THESE
MOVING.
PLATFORMS WE ALSO JUST WANTED TO
STATE THAT UNTIL THERE IS AN
ALTERNATIVE -- TRAINING
OPERATION -- CERTIFICATION WE
THINK THAT THE FOOD HANDLER
TRAINING IS IS GOOD ENOUGH FOR
RIGHT NOW SO I THINK THAT'S
USEFUL IT IT COVERS -- A CROSS
CONTAMINATION PREVENTION AND AND
OTHER IMPORTANT FOOD SAFETY
THING SOBRE AS AN AYE VOTE.
THANK YOU OTHER WITNESSES IN
SUPPORT THIRTY BOILS IN BEHALF
OF AMERICAN STATURE GROWERS AB
CALIFORNIA FRESH PRODUCE AS
ASIAN WESTERN ACTORS ARE
ASSOCIATION WHICH I THINK THE
SOME WOMEN HIS STAFF AND THE
COMMITTEE STAFF FOR WORKING WITH
US AND WE ARE NO LONGER POST
ABOUT.
THANK YOU THANK YOU.
MISTER CHAIR MEMBER SERRA FLOCKS
CALIFORNIA LABOR FEDERATION IN
SUPPORT HEY THANK YOU.
RIGHT.
SEEN OTHER WITNESSES IN SUPPORT.
BUT THIS IS IN OPPOSITION.
PLEASE.
MAKE ROOM FOR THE OPPONENTS AT
THE FRONT HERE IN HIS RIVER AT
THE SIDE [inaudible]
WELCOME.
MR TURN MEMBERS CORPS IN JENSEN
ALTEC MATT HERE TODAY I'M IN
OPPOSITION AB -- THIRTEEN SIXTY
WE APPRECIATE THE EFFORTS OF
THIS COMMITTEE -- AND THE
CONVERSATIONS WE'VE HAD WITH YOU
ALL -- AND YOUR STAFF ON ON THIS
BILL I'M WE DO WERE REMAIN IN
STRONG OPPOSITION -- WE ARE MORE
THAN HAPPY TO SIT DOWN AND TALK
ABOUT -- APPROPRIATE -- TRAINING
AND FOR THE FOOD DELIVERY CON IN
THE FOOD THIRD PARTY FOOD
DELIVERY CONTEXT -- THOSE
CONVERSATIONS HAVE NOT BEEN HAD
WE'RE HAPPY TO HAVE THOSE
CONVERSATIONS BUT WE CONTINUE TO
FEEL THAT -- REQUIRING US TO
ABIDE BY CURRENT STATUTES THAT
ARE MADE FOR THE COMMERCIAL FOOD
DELIVERY IS NOT APPROPRIATE FOR
THIS -- THIRD PARTY FOOD
DELIVERY -- MODELS -- SO THE
BILL SPECIFICALLY.
REQUIRES US TO AT THE SOLE
EXPENSE OF THE THIRD PARTY FOOD
DELIVERY PROP FORMS TO PROVIDE
TRAINING TO DRIVERS AS OUTLINED
UNDER CURRENT LAW WHICH WE AGAIN
DO NOT BELIEVE IS APPROPRIATE
FOR THESE BUSINESS MODELS THAT
ALSO REQUIRES.
AS THE PROPONENTS SAID A
NINETEEN POINT VEHICLE
INSPECTION EVERY TWO YEARS --
THIS MAY BE APPROPRIATE IN THE
TNC CONTACTS WHEN THEY ARE
TRANSPORTING PASSENGERS BOARD
TALK ABOUT FOOD DELIVERY
TRANSPORTATION HERE THIS IS TODD
OR TALKING ABOUT FOOD DELIVERY
FROM GROCERY STORES WHICH IS
MUCH DIFFERENT BUSINESS MODEL
THAN THE TRANSPORTATION NETWORK
COMPANY BUSINESS MODEL.
THE BILL ALSO GIVES THE
DEPARTMENT OF PUBLIC HEALTH THE
ABILITY TO ASSESS A CIVIL
PENALTY OF UP TO TWENTY FIVE
THOUSAND DOLLARS PER VIOLATION
AND DOES NOT REQUIRE GUIDANCE TO
BE GIVEN TO THESE COMPANIES ON
HOW TO COMPLY WITH THE NEW
PROVISIONS OF THE LAW DOES NOT
REQUIRE.
I HAD REGULATIONS IS A DOT DOES
NOT REQUIRE BEST PRACTICES OR
ANY OTHER GUIDANCE THAT SAYS A
MAY PROVIDE DOES NOT SAY SHALL.
FINALLY AND QUICKLY UNDERSTAND
IT'S LATE THE FDA FOOD SAFETY
MODERNIZATION ACT RULE -- ON
SANITARY TRANSPORTATION FOR
HUMAN AND ANIMAL FOOD WAS MADE
FINAL ON SEPTEMBER TWENTY
NINETEEN ADVANCE THE FDA'S
EFFORTS TO PROTECT FOODS BY
KEEPING THEM SAFE FROM
CONTAMINATION DURING
TRANSPORTATION.
FTA ACTUALLY PUBLISHED THREE
WAIVERS TO THIS ROLE ONE OF
WHICH WAS FOR DELIVERY OF THE
FOOD DIRECTLY TO THE CONSUMER BY
THE AUTHORIZED ESTABLISHMENT OR
FOR A THIRD PARTY DELIVERY
SERVICE.
AND THE FTA FOUNDER THIS WAIVER
THROUGH THEIR PUBLIC PROCESS OF
COMMENTS AND THAT THE WAIVER
WOULD NOT RESULT IN THE
TRANSPORTATION OF FOOD UNDER
CONDITIONS THAT WOULD BE UNSAFE
FOR HUMAN HEALTH OR CONTRARY TO
THE PUBLIC INTEREST.
THESE WAIVERS BECAME EFFECTIVE
IN APRIL TWENTY SEVENTEEN I'M SO
WE CONTINUE TO URGE THAT
CALIFORNIA IN THIS COMMITTEE TO
LOOK AT THE PROCESS BY THE FDA
IN WHICH THEY FOUND THESE THIRTY
THIRD PARTY GROCERY DELIVERY
MODELS DO NOT RESULT IN THE
TRANSPORTATION OF FOOD THAT
WOULD BE UNSAFE FOR HUMAN.
HEALTH OR CONTRARY TO THE PUBLIC
INTEREST AGAIN WE APPRECIATE THE
EFFORTS OF THIS COMMITTEE BUT
CONTINUE TO OPPOSE THE BILL.
HIGHER MARIN ABOUT THE
CALIFORNIA ASSOCIATION ALSO --
IN OPPOSITION FIRST WELL THANK
YOU TO THE CHAIR AND AND HIS
STAFF -- FOR HELPING THE THIS%
BILL ALONG.
JUST PUT THIS INTO CONTEXT AS
SOME OF YOU -- IN THIS COMMITTEE
MAY FOR A MAY RECALL A ASSEMBLY
BILL FOURTEEN SIXTY ONE BY AS A
MEMBER TONY THURMOND A COUPLE
YEARS AGO -- THAT BILLS ACTUALLY
COSPONSORED BY THE GROSS AND
YOU'VE CW -- IT SOUGHT TO
REQUIRE BLUE APRON EMPLOYEES TO
GET FOOD HANDLER CARDS.
AT THE TIME WHEN THE FIRST
AMENDMENT SAID THAT WE DID
WORKING IN COLLABORATION WITH --
THIS THE UFCW AND IS A MEMBER
THURMAN WAS TO TAKE OUT DRIVERS
FROM THAT BILL -- THE
UNDERSTANDING WAS THAT IT SHOULD
ONLY BE THE FOOD HAVE A
REQUIREMENT OF TRANSIENT ONLY BE
FOR PEOPLE WHO ARE ACTUALLY
HANDLING THE FOOD NOT TO THOSE
WHO ARE DELIVERY BECAUSE AGAIN
BACK THEN THE LOGIC WAS WILL
THERE LITERALLY TAKING THE FOOD
THERE.
NOT UNLIKE A RESTAURANT DELIVERY
DRIVER WHO BY THE WAY IS NOT
INCLUDED IN THIS BILL -- AS
ASSEMBLY ASSEMBLY JUDICIARY
COMMITTEE POINT OUT THIS
SOMEWHAT OF AN INCONSISTENCY
WHICH I WOULD ALSO POINT OUT AS
WELL.
KNOWING THAT A COUPLE YEARS AGO --
THE SPONSORS AND AND US
UNFORTUNATELY THE POSING NOW BUT
WE WORK TOGETHER TO TO TRY TO
CREATE A SOME SORT OF STRUCTURE.
CARS ARE TAKING OUT WE ARE TWO
YEARS LATER DRIVERS ARE BACK IN --
THAT BEING SAID I UNDERSTAND
DOCTOR PAN WE ARE MEANS WITH YOU
THAT THAT YOU SEEK SOME SORT OF
OF OF MAC OR SOME SORT OF
FRAMEWORK. FOR FOR THESESORTS
OF OF DELIVERY DRIVERS.
WHO I THINK -- AS COURT
INDICATED WE'RE OPEN TO THAT AND
AND WE CERTAINLY WOULD LIKE TO
HAVE THAT DISCUSSION -- AND WE
WOULD LIKE THE OPPORTUNITY TO
REALLY HAVE A WAY TO TO
STRUCTURE SOMETHING THAT.
KEEPS IN MIND THE FEDERAL --
WHAT'S GONE ON THE FEDERAL LEVEL
BUT ALSO TO KEEP IN MIND THE-UNIQUE SORT OF A BUSINESS MODEL
THAT THESE FOLKS HAVE A REMEMBER
YOU KNOW THESE -- INSERT CARD
TYPE BUSINESSES BRING THE
GROCERY STORE TO PEOPLE'S HOMES
WE HAVE SENIORS WHO CAN'T GET TO
THE STORE IN A BILL DRIVE PEOPLE
ON A TRANSPORTATION.
A LOT OF THESE IN SICKERT --
COMPANY TYPE COMPANIES ACTUALLY
HELP THE GROCERY INDUSTRY BY
TAKING THE GROSS STARTED THEM --
EFFORTS TO HAMPER THAT ACTUALLY
I MEAN IT COULD HAVE LONG TERM
HARM ON ON OUR INDUSTRY BECAUSE
WE WANT PEOPLE TO SHOP.
AT GROCERY STORES AND WE WANT
PEOPLE TO STILL COMPLETE THESE
TRANSACTIONS EVEN IF THEY START
ONLINE THROUGH MISTER CLARK THEY
WILL STILL BE DONE AT GROCERY
STORE A LOT AND UNION SHOPS WE
DON'T WANT.
THESE TRANSACTIONS GOING TO
OTHER FOLKS -- WHO MAY NOT BE
ABLE TO BENEFIT OUR EMPLOYEES
ARE COMPANIES -- SO WHAT WE'RE
ASKING IS YEAH WE'VE BEEN A WEEK
WE AGREE TO CERTAIN POINT THAT
THERE SHOULD BE SOME SORT OF
MECHANISM AROUND THIS WE JUST
ASKING FOR TIME TO WORK ON THAT
AND AND I THINK THAT.
YOU KNOW IF WE HAVE TIME TO SIT
DOWN WITH THE AUTHOR.
WITH THE SPONSORS WITH THAT THE
ESCROW FOLKS DR PAN YOUR STAFF
WE'D LOVE TO HAVE THAT'S BECAUSE
WE TOLD YOU WE'VE COMMITTED TO
THAT -- AND I THINK IF WE HOLD
THE BILL NOW POSSIBLY AGAIN I'D
LEAVE IT UP TO THE CHAIR AND THE
COMMITTEE TO TALK ABOUT THIS BUT
WE COME BACK IN IN JANUARY.
BILLS NOT DEAD WE CAN WORK ON IT
I MEAN YOU HAVE OUR COMMITMENT
THAT WE'RE GOING TO DO THAT --
AND I THINK THAT'S THAT'S WE ARE
I MEAN WE WE WOULD LIKE TO SHARE
THE CHAIRS -- TO WISH TO GET
SOMEWHERE HERE THERE IS SOME
SORT OF STRUCTURE ON THIS BUT WE
BELIEVE THAT THAT -- YOU KNOW
THROWING -- FOR SUGGEST AN IMAGE
IN A WEEK FOR SOMETHING THAT
THAT ARGUABLY SHOULD TAKE A
LITTLE BIT LONGER WE'RE JUST
ASKING FOR TIME TO TO REALLY SIT
DOWN AND AND WORK ON POLICY --
WHICH IS WHAT THE MORAL HERE TO
DO SO THANK YOU FOR THAT THANK
YOU THANK YOU SO VERY MUCH ALL
RIGHT OTHER WITNESSES IN
OPPOSITION.
BEEN HAVING WITH THE CALIFORNIA
CHAMBER OF COMMERCE IN
OPPOSITION THANK YOU.
DO YOU FEEL ON BEHALF OF DOOR
DASH IN OPPOSITION THANK YOU.
ON BEHALF OF CALIFORNIA
RETAILERS ASSOCIATION -- OUR
POSITION GIVEN THE MOST RECENT
AMENDMENTS AS WERE CONCERNED
ABOUT THE JOINT LIABILITY FOR
RETAILERS HAVING TO BE INVOLVED
IN WAYS JUSTICE BETWEEN -- THE
DELIVERY NETWORK FOLKS AND THEIR
EMPLOYEES OF THE DRIVERS SO --
THAT'S WHERE OPPOSED THANK YOU.
THANK YOU THANK YOU ALL RIGHT --
QUESTIONS FROM COMMITTEE MEMBERS
OKAY YES CENTER LEYVA.
THANK YOU MISTER CHAIR I THINK
THIS IS AN INCREDIBLY
COMMONSENSE BILL -- WHEN I
STARTED AT ALPHA BETA IN
NINETEEN EIGHTY FIVE AS A SENIOR
IN HIGH SCHOOL A VERY LONG TIME
AGO?
I WOULD HAVE NEVER IMAGINED THAT
GROCERIES WOULD BE DELIVERED TO
SOMEONE'S HOUSE.
AND I THINK IT'S INCUMBENT UPON
US TO CHANGE WITH THE TIMES AND
I ABSOLUTELY AGREE WITH THE
OPPOSITION WHEN THEY SAY WELL WE
BRING IN THE GROCERY STORE. TO
SENIORS ALL THE MORE REASON TO
MAKE SURE THAT FOLKS THAT ARE
DRIVING THAT FOOD KNOW THAT YOU
DON'T WANT THAT RAW CHICKEN
SITTING IN THE CAR FOR TOO LONG
OR IT MIGHT SPOIL.
IT'S THINGS THAT PEOPLE DON'T
KNOW OR YOU KNOW MAYBE IT'S A
SANDWICH SHE BROUGHT FROM THE
SERVICE DELI IN IT HAS MAY OWE
ON IT AND YOU WOULDN'T WANT THAT
TO BE.
IN THE CAR TOO LONG THE
INSPECTION OF THE CAR ARE YOU
WOULD BE SURPRISED AT HOW MANY
YOUNG PEOPLE BECAUSE THEY DON'T
HAVE GOOD PAYING JOBS.
DON'T HAVE REAL RELIABLE
TRANSPORTATION AND UNFORTUNATELY
THESE INSTANT CARTON OTHER JOBS
DON'T PAY A HIGH WAGE SO WE DO
WANT TO MAKE SURE THEY HAVE A
CAR IS NOT GOING TO BREAK DOWN.
GETS FIXED ON THE ROAD AND THEN
THE THE FOODS BEEN SITTING THERE
FOR AN HOUR OR MORE GETS TO
PEOPLE AND IT SPOILED.
I JUST THINK THIS IS A VERY
COMMON SENSE APPROACH TO WITH
THE CHANGING DYNAMIC THAT WE NOW
LIVE IN SO THANK YOU FOR
BRINGING THE BILL FORWARD AND
I'M HAPPY TO SUPPORT IT AND MOVE
IT WHEN APPROPRIATE.
THANK YOU CENTER OKAY NO OTHER
RIGHT -- SO I ALSO IS ONLY
RETAIN THANK YOU SO MUCH AND
SPONSORS FOR WORKING WITH WITH
OUR OFFICE AND AND AND YOU KNOW
WE REALLY DID HAVE A LOT OF BACK
AND FORTH AT WOULD POINT OUT I
MEAN I APPRECIATE THAT THE
OPPONENTS SAID NO BRING THE
GROCERY STORE TO PEOPLE'S.
HOME AND GUESS WHAT WE HAVE A
LOT OF REGULATIONS ON GROCERY
STORES.
RIGHT BECAUSE PEOPLE HAVE AN
EXPECTATION TO GO TO GROCERY
STORES FOOD WILL BE SAFE IT'S AT
RIGHT NOW THE GROCERY STORES
COMING TO THE HOME.
NOW THIS LINK HERE AND IN FACT I
YOU KNOW RECOGNIZE WE HAD THE
DISCUSSIONS HE SAID WELL OKAY.
THE GROCERY STORES HAVE.
BUT THE REGULATIONS AND SO THEY
WERE THE ONES DIRECTLY
RESPONSIBLE FOR THE DELIVERY HAS
AND THOSE REGULATIONS THAT APPLY
TO THEM AND SO THEY AND WHEN THE
GROCERY STORE COMES OF THE HOME.
THEY'RE REGULATED THE PROBLEM IS
NOW YOU HAVE ANOTHER ENTITY.
THAT THE GROSS FROM A CONTRACT
WITH.
BUT HIS RESPONSE OVER THE SEA
LEVEL WHAT RULES THEY HAVE TO
FOLLOW AND YOU KNOW WE WORKEDAND I APPRECIATE YOUR WORKING
WITH US IN THE SPONSORS.
WE START THE FOOD HAMMER CARTY
SAID WELL THAT'S NOT A PRO DOES
MORE DESIGNED FOR PEOPLE BUT WE
RECOGNIZE I THINK IS MENTION
BEFORE.
YOU HAVE FOOD THAT YOU HAVE
PERISHABLES -- YOU HAVE MEET YOU
HAVE MILK YOU HAVE OTHER TYPES
OF PERISHABLE FOODS AND SO IT'S
THAT.
AS A ONE X. SHOWS UP AT THE HOME
IT NEEDS TO BE OF THAT QUALITY
AND SO WE NEED TO BE SURE PEOPLE
HAVE THAT EDUCATION SOBELL ONE
FACT WE'VE PRETTY OPEN AND WE
SAID THEY JUST NEED TO KNOW
ABOUT THESE THINGS I THINK
THERE'S WORDS.
THIS IS BASIC FOOD SAFETY --
THIS IS WHAT THIS IS ABOUT AND
WE TALK ABOUT RESTAURANTS YOU
KNOW WHAT RESTAURANTS IS A
DIFFERENT SITUATION THEY'RE
PREPARED ENTER OUT WE CAN TALK
OF INFLAMMATORY SAGE ABOUT
RESTAURANTS LET'S HAVE A
CONVERSATION A RESTAURANT
DELIVERY.
BUT I THINK FLIPS THIS IS BILLS
ABOUT GROCERIES YOU KNOW WE ALL
WANT TO BE SURE THAT WHEN THAT
FOOD SHOWS UP THE DELIVERY
PERSON SHOWS UP AT THE HOUSE
BRING THE GROCERY STORE TO THE
SENIOR TO THE BIRDS IS DISABLED.
AND THAT IS OF THE QUALITY THAT
THEY SHOULD REASONABLY EXPECT
AND THE SAFETY OF OUR POST MOST
POORLY THE SAFETY SO I
APPRECIATE YOU WORKING WITH US --
ASSURE YOU CONTINUE TO WORK OF
THE OPPOSITION BUT I I THINK
THAT.
THIS BILL SHOULD CONTINUE TO
MOVE FORWARD AND AND SO I ASK
YOU.
TO CLOSE THANK YOU SENATOR VERY
JUST VERY VERY BRIEFLY ON THE
BILL'S BEEN IN PRINT SINCE
FEBRUARY WE'VE HAD.
THE OPPORTUNITY TO MEET WITH THE
OPPOSITION IN FACT JUST I THINK
THE WEEK BEFORE LAST WE MET WITH
ONE OF THE MOST PROMINENT.
COMPANIES THEY DIDN'T REALLY
OFFER ANY TRAINEE AMENDMENTS ANY
PARTICULAR MYTH ABOUT THE
VEHICLE WE WOULD'VE BEEN VERY
OPEN TO THATWE DIDN'T RECEIVE
ANYTHING.
AGAIN THIS IS NO WHERE AS YOU
HAD MENTIONED A MISTER CHAIR
THESE ARE NOWHERE NEAR THE
AMENDMENTS.
THAT WERE DATA GROCERY STORE
HOUSE TO GO UNDER THESE ARE VERY
FEW REGULATIONS RELATIVE TO
WHATEVER GROCERY STORE.
IN THIS COMMENTS AND USE IT AS
MY CLOTHES AND JUST -- DRIVER ON
THE THIRTEEN SIXTY A SAID THE
BILLS AND MOVE THE MOTION IS TO
PASS REFER TO THE COMEDIAN
GOVERNMENTAL ORGANIZATION SIZE
OFTHE COMMITTEE GO TO A SECTOR
PLEASE CALL THE ROLL.
HAN HI I AND STONE GONZALEZ
GONZALEZ I'D GROVE HER TADO.
LEYVA LEYVA AYE MITCHELL
MITCHELL AYE MONNING MONNING AYE
RUBIO RUBIO HI.
OKAY SO THE BILL HAS SIX VOTES
JUST FOR CLARITY THE FISH ELITE
IS REFER TO GEO BUT WITH THE
MINUTES HE TOOK ILL.
GET REDIRECTED THAT'S RULES JOB
NOT OURS BUT I DO CASE PEOPLE
WONDERING WHEN -- SHOT NEXT.
THANK YOU.
ALL RIGHT SO WE'LL KEEP THE ROLE
OPEN FOR ABSENT MEMBERS AND THEN
WE HAVE A SOBRE GIPSON AND I
UNDERSTAND YOU BOTH THE
PRESENTING YOUR OWN BILL AND
YOU'RE ALSO PRESENTING FOR
SUMMARY GRAYSON.
WHO I KNOW HAD BEEN WAITING HERE
FOR VERY LONG TIME AND -- SO I
WHICH BILL DID YOU WANNA TAKE A
FIRST LET ME IF I COULD TAKE UP --
ASSEMBLY MEMBER GRAYSON'S BILL
FIRST OKAY SO THAT'S ITEM NUMBER
EIGHTEEN A. B. ELEVEN SIXTEEN I
THANK YOU.
THANK YOU MISTER CHAIR AND
MEMBERS -- BY PLEASE PRESENT ON
BEHALF OF ASSEMBLY MEMBER
GRAYSON ASSEMBLY BILL ELEVEN
SIXTEEN WHICH WILL ESTABLISH A
PILOT PROGRAM THAT ALLOWS FOR
CONFIDENTIAL COMMUNICATION
BETWEEN TRAINING.
PEER SUPPORT TEAM MEMBERS AND
THEIR FELLOW EMERGENCY SERVICE
PERSONNEL PROVIDING PEER SUPPORT
TRAINING TO EMERGENCY SERVICE
PERSONNEL MANY OF WHOM ARE
ALREADY PROVIDING --
INFORMATIONAL SOCIAL -- SUPPORT --
WILL INCREASE THEIR
EFFECTIVENESS AND ENHANCE THEIR
ABILITY TO IDENTIFY POTENTIAL
HIGH RISK SITUATIONS BEFORE
CRISIS OF VENT OCCUR -- HERE
WITH ME TO PROVIDE SUPPORTING
TESTIMONY FOR ASSEMBLY BILL
ELEVEN SIXTEEN IS A
REPRESENTATIVE FROM THE
CALIFORNIA -- PROFESSIONAL
FIREFIGHTERS WHO WAS SELF
INTRODUCE.
THANK YOU MISTER CHAIRMAN
MEMBERS OF THE COMMITTEE
CHRISTIE BELL MY HERE ON BEHALF
OF THE CALIFORNIA PROFESSIONAL
FIREFIGHTERS.
THE INTEREST OF TIME I WOULD SAY
THESE PROGRAMS CAN LITERALLY
SAVE MY MEMBERS LIVES SO WE URGE
YOUR SUPPORT TODAY.
AND HOW THEY GOT GONZALEZ WITH
KAISER PERMANENTE IN STRONG
SUPPORT OUR CLINICIANS HAVE SEEN
THE IMPACTS OF THE RECENT
WILDFIRES.
IN THEIR CLINICS AND WE'RE HAPPY
TO BE IN SUPPORT OF THE BILL
TODAY THANK YOU THANK YOU.
I OTHER WITNESSES SUPPORT.
THANK YOU MY NAME IS AFFECT
WORKERS FOR THE CALIFORNIA STATE
FIREFIGHTERS ASSOCIATION VERY
STRONG SUPPORT THANK YOU.
I SEE NO OTHER WAY TO SUPPORT OR
DO ANY WITNESSES OPPOSITION.
PLEASE COME UP [inaudible]
MAKE.
SOME MINOR WITH THE CALIFORNIA
ASSOCIATION OF AMERICA FROM
THERAPISTS WE DON'T HAVE AN
OFFICIAL POST POSITION WE DO
HAVE SOME CONCERNS THAT WE'RE
WORKING WITH THE AUTHORS OFFICE
TO ADDRESS.
DISCONNECT KNOWLEDGE THE AUTHOR
AND HIS STAFF FOR THEIR
WILLINGNESS TO WORK WITH US AND
LISTEN TO THANK YOU SO MUCH.
ALL RIGHT ARE THERE ANY OTHER
WITNESSES AND OPPOSITION OR
TRAINERS OKAY SEEN NINE
QUESTIONS COMMITTEE MEMBERS OKAY
AS A MOTION BY SIR LEYVA.
AND AGAINST THAT THANK YOU AS
ERIKA THE SELLER GIPSON FOR
COMING TO PRESENT -- I'VE FOUGHT
MY APOLOGIZE I KNOW THAT WE DO
GO FILE ORDER I KNOW SOME
INTEGRATION WAS HERE FOR A VERY
LONG TIME WAITING IN.
THE SOBRE PREACHER YOU SETTING
UP AND AND AND PRESENT FOR HIM.
AND CERTAINLY SUPPORT A BILL
WHICH LIKE THE CLOTHES
RESPECTFULLY ASK WHEN I VOTE
OKAY THANK YOU SO THE MOTION IS
TO PASS REFERRED TO THE
COMMITTEE ON JUDICIARY SECTOR
PLEASE CALL THE ROLL.
AND I AND I STONE GONZALEZ
GONZALEZ I'D GROWN FURTADO LEYVA
LEYVA AYE MITCHELL.
MITCHELL AYE MONNING.
THANK YOU RUBIO.
RUBIO I OKAY THE BILL CURLY AS
FIVE VOTE SO KEEP THE ROLE OPEN
FOR ABSENT MEMBERS.
AND VERY MUCH FINALLY OF ITEM
NUMBER TWENTY SIX A. B.
[inaudible]
FIFTEEN FORTY FOUR WE WILL.
PLEASE BEGIN THANK YOU VERY MUCH --
MISTER CHAIRMAN AND MEMBERS I
LIKE TO START OFF BY A NOTING
THAT I WILL BE ACCEPTING THAT
MA'AM IT'S BASED ON THE
RECOMMENDATION.
OF THE COMMITTEE AND WILL BE
TAKING THESE OF THOSE AMENDMENTS
AND THE SENATE.
JUDICIARY -- THESE AMENDMENTS
REMOVE THE POLLS THIS CHARGE
PROGRAMS AND PROVIDE -- ON AN
ADDITIONAL THREE YEAR TO
CONTINUE THIS PROGRAM UNDER THE
EXISTING PILOT -- TO STUDY AND
FURTHER REVIEW THE OUTCOME IN
ADDITION THE AMENDMENTS WILL --
WILL CLARIFY THAT NOTHING IN
THIS BILL ALTERS -- ANY EXISTING
AUTHORITY FOR PARAMEDICS TO
TREAT OR SUPPORT HOSPICE
PATIENTS AND ENSURE THAT THE
MEDICAL RECORDS -- FOLLOW THE
PATIENTS BEING TRANSPORTED FROM
THE ALTERNATIVE DESTINATION
FACILITIES.
I WOULD LIKE TO THANK THE CHAIR
AND THE COMMITTEE STAFF WORKING
DILIGENTLY -- WITH US IN ORDER
TO STRENGTHEN HIS BILL THAT YOU
HAVE BEFORE YOU ASSEMBLY BILL
FOURTEEN US USE ME.
FIFTEEN FORTY FOUR IS A
CONTINUATION OF MY PREVIOUS
EFFORTS TO ENSURE OUR COMMUNITY
PARA MEDICINES -- IT ALTERNATIVE
DESTINATION PILOT PROGRAMS ARE
ABLE TO BE IMPLEMENTED STATEWIDE
MEMBERS WE HAVE A HEALTHCARE
CRISIS IN CALIFORNIA.
THIS CRISIS IS EVIDENT WHEN
PEOPLE CALL 911- AND
FIREFIGHTERS AND PARAMEDICS
RESPOND TO MENTAL HEALTH.
AND SUBSTANCE ABUSE EMERGENCIES
ONLY TO HAVE TO SIT IN THE
PATIENTS TO IT OVERCROWDING E.
R. WHERE THEY DON'T RECEIVE THE
PROPER CARE AT THE PROPER TIME.
A MEETING NINE ONE ONE USERS
AREN'T ABLE TO RECEIVE TIMELY
CARE BECAUSE OUR PARAMEDICS ARE
ABLE TO TRANSPORT PATIENTS TO
ALTERNATIVE DESTINATIONS SUCH AS
MENTAL HEALTH OR SOBERING
CENTERS.
COMMUNITY PER MEDICINES ALLOW --
OPS A SPECIALIZED TRAIN
SPECIALIZED TRAINED PARAMEDICS
TO PERFORM OUTSIDE OF THE CHURCH
THEIR TRADITIONAL ROLES TO
ENHANCE ACCESS TO CARE AB
FIFTEEN FORTY FOUR GUILDS LOCAL
AGENCIES THE AUTHORITY TO
DEVELOP THESE PROGRAMS AND
REQUIRE.
THAT THE STATE AUTHORITY TO
DEVELOP A MINIMUM A MINIMUM A
MINIMUM MEDICAL STANDARDS.
IT'S A THOUGHTFUL BALANCED
APPROACH TO GIVE THE LOCAL
AGENCIES THE FLEXIBILITY NOT ONE
UNDERSCORE FLEXIBILITY WHEN
INSURING OF A HIGH STANDARD OF
CARE IS MET IN EVERY PROGRAM
THIS BILL IS RIGHT. FOR OUR MOST
VULNERABLE PATIENTS WHO NEEDS
TIMELY ACCESS TO CARE BY THE
HANDS OF OUR TRUSTED.
MEDICS ARE TRUSTED PARAMEDICS
AND ARC TRUSTED HEALTH CARE
PROFESSIONALS HERE WITH ME TO
PROVIDE SUPPORTING ESTIMONY IS
CAPTAIN APRIL -- SLOW -- WHO'S A
REPLICA -- REPRESENTS THE SAN
FRANCISCO FIRE DEPARTMENT AND
TIM BATON WITH THE CALIFORNIA
EMERGENCY POSITIONS WHO WILL
SPEAK IN SUPPORT OF ASSEMBLY
BILL FIFTEEN FORTY FOUR RIGHT%
THANK YOU WELCOME HER SIX MINUTE
ROLE IF YOU WANNA BE SURE THAT
DEPRECIATED.
GOOD EVENING I'M COMFORTABLE SO
SERVICES COULD FIRE DEPARTMENT
I'VE BEEN A PARAMEDIC FOR
NINETEEN YEARS THE LAST THREE
AND A HALF I'VE BEEN A COMMUNITY
PARAMEDIC SERVING SOME OF THE
MOST.
CHALLENGING BOND WILL PATIENTS
IN THE CITY.
OUR PROGRAM EMS SIX OPERATES TO
PILOT PROGRAMS ONE IS ALTERNATE
DESTINATION SUFFERING CENTER
WHERE INDIVIDUALS WITH NO
MEDICAL COMPLAINTS CAN SAFELY
SOBRE FROM ALCOHOL AND BE
OBSERVED BY IN OUR AND THESE
pBY PARAMEDICS IF THEY MEET THE
CRITERIA THEIR OFFER TRANSPORT
TO THE SUFFERING CENTER.
IT IS VOLUNTARY AND NO ONE IS
EVER DENY CARE DIVERTING THESE
PATIENTS FROM ET TO AN
APPROPRIATE COMMUNITY RESOURCE
ALLOWS PUBLIC SAFETY RESOURCES
TO RETURN SERVICE MORE QUICKLY.
NEVER ITS PATIENTS WITH NO KEEP
MEDICAL NEED FROM THE ET THIS
GROUP OFTEN OVERLAPS WITH OUR
SECOND PILOT WHICH IS FREQUENT
USES A BE A MESS WE OFFER CASE
MANAGEMENT SERVICES WRAPAROUND
CARE TO THOSE WHO CALL.
THEM ONE FOUR TIMES IN A MONTH
OR TWO TIMES IN TWENTY FOUR
HOURS LAST MONTH IN THE CITY OF
SAN FRANCISCO SIX HUNDRED AND
THREE INDIVIDUALS MET THAT
CRITERIA.
THE COLLECTIVELY GENERATED ONE
THOUSAND AND TWENTY THREE CALLS
FOR SERVICE MANY FOR LOW
HUMIDITY COMPLAINTS UNMET SOCIAL
NEEDS AND SUBSTANCE USE
DISORDERS.
OUR TEAM OF THREE CAPTAINS OUR
PARTNERS FROM THE HOMELESS
AVERAGE TEAM THE CONTACT FOR THE
TOP TWENTY OF THOSE COLORS
REDUCING THEIR VOLUME. FOR THE
PREVIOUS MONTH BY 41% BUT
DIRECTING THEM TO SOBERING
SHELTER MEDICAL OR SOCIAL DETOX
TREATMENT ESSENTIAL TO HELP IN
PSYCHIATRY TEAMS.
WE SEE THESE INDIVIDUALS NEARLY
EVERY DAY ENOUGH FOR THEM
SUPPORT AND SERVICES WE ARE
INITIAL POINT OF CONTACT FOR AN
INDIVIDUAL TOO DISORGANIZED TO
PARTICIPATE IN THE TRADITIONAL
MODEL OF HEALTH CARE.
AND WE LIKE THEM TO SERVICES
WITHIN THE COMMUNITY SUCH AS
PRIMARY CARE MENTAL HEALTH
TREATMENT PROGRAMS THAT HOUSING
IN TURN THIS REDUCES THE EMS
USAGE AND THE ASSOCIATED STRAIN
ON PUBLIC SAFETY RESOURCES IN ET.
COMMITTEE PURPOSES BEEN SO
SUCCESSFUL APPROVING UP TO SPEED
WITH THEIR PILOT WITHIN THE CITY
ITSELF THIS CALL THE WHOLE
PERSON CARE.
THE PROGRAM GOALS ALIGNED
PERFECTLY WITH COMMUNITY PURPOSE
AND THAT IT PRIORITIZE IS
IMPROVED COORDINATION OF HEALTH
BEHAVIOR HEALTH AND SOCIAL
SERVICES THE PATIENT CENTERED
APPROACH WE MEET WEEKLY
PHYSICIANS.
NURSES AND SOCIAL WORKERS TO
IDENTIFY THE HIGH USES A BMS AN
APPROPRIATE RESOURCES FOR THEM.
THE GOALS REDUCE EIGHTY SIX BY
5% ANNUALLY THE PRELIMINARY DATA
SO FAR IS ENCOURAGING.
HEALTHCARE INNOVATIONS LIKE
WHOLE PERSON KAREN COMMUNITY
PURPOSE AND REPRESENTS
SUCCESSFUL PILOT PROGRAMS IN
CALIFORNIA SHOULD FIND WAYS TO
AUTHORIZED EXPAND THEIR USE.
THAT IS WHY I AM HERE TODAY TO
ASK YOU TO SUPPORT AB FIFTEEN
FORTY FOUR TWO SO WE CAN
CONTINUE TO PROVIDE THIS
CRITICAL COMMUNITY PARAMEDIC
SERVICES.
COMMITTEE PIRMASENS APPEALED THE
COMPETENCY ESTABLISH HEALTHCARE
SYSTEM AND ALLOWS US TO EXTEND
ITS REACH THOSE WHO NEED IT MOST
[inaudible]
THANK YOU.
MR CHAIRMAN MEMBERS A COMMITTEE
CHRISTIE BELL ON BEHALF OF THE
CALIFORNIA PROFESSIONAL
FIREFIGHTERS PLEASED TO BE CO
SPONSOR THIS MEASURE I JUST WANT
TO TAKE A MINUTE TO THANK THE
COMMITTEE.
STAFF AND CHAIRMAN FOR WORKING
WITH US ON THIS BILL OR YOUR
SUPPORT.
MEMBERS TO MAD RIVERS IN THE
CALIFORNIA CHAPTER THE MAN CALLS
MERGE THESE POSITIONS -- WORK
BEEN VERY ENCOURAGED WITH THE
RESULTS THE CAPTAIN'S LOAN JUST
TALKED ABOUT THE PROGRAMS ARE
GETTING TO PEOPLE WHO MAY NOT
NEED COMING IN THE MERCED
DEPARTMENT AND THEY'RE GETTING
INTO THE CARE THEY TRULY NEED TO
KEEP HIM OUT OF THE EMERGENCY
DEPARTMENT. TO THE EXTENT THAT
WE'VE COME ON AS A CO SPONSOR TO
THIS BILL IT'S A LONG WAYS FROM
THE POINT WHERE WE ACTUALLY
OPPOSED TO THE PILOT PROGRAMS
WHEN THEIR FIRST STARTED.
BUT BASED ON WHAT WE'RE SEEING
WE THINK THIS IS A NICE MODEL
THAT COULD BE ROLLED OUT TO THE
STATE.
AND SEE SOME EFFECTIVE RESULTS
FOR THOSE REASONS WE
RESPECTFULLY ASK FOR AYE VOTE
OKAY.
THANK YOU OTHER WITNESSES IN
SUPPORT. NINE BACK BACK FROM
OKAY I THINK THIS.
ONE EFFORT WORRY FOR THE
CALIFORNIA STATE FIREFIGHTERS
ASSOCIATION STRONG SUPPORT THANK
YOU.
MISTER CHAIR AND MEMBERS BRANDON
MARCH WITH THE CALIFORNIA
MEDICAL ASSOCIATION WE WANT TO
THANK THE AUTHOR AND THE
SPONSORS AND COMMITTEE FOR
WORKING WITH US WE DID HAVE SOME
CONCERNS BUT LOOK FORWARD TO
REVIEWING THE AMENDMENTS ONCE WE
SEE THEM.
OKAY THANK YOU.
PROSECUTORS HERE ON BEHALF OF
CITY OF SANTA MONICA IN SUPPORT
THANK YOU.
RIGHT SEEN OTHER WITNESSES
SUPPORT WITNESSES IN OPPOSITION
PLEASE MAKE ROOM FOR THEM AT THE
TIME [inaudible]
OKAY.
IT DOESN'T GO AWAY [inaudible]
OKAY.
MR CHAIRMAN MEMBERS STEPHANIE
ROBERSON ON BEHALF OF THE
CALIFORNIA NURSES ASSOCIATION --
RESPECTFUL OPPOSITION TO THIS
BILL -- WE OPPOSE THIS BILL AND
SIMILAR BILLS THAT WERE VETOED --
JUST ACTUALLY LAST YEAR A PLAIN
AND SIMPLE MEMBERS WE
RESPECTFULLY DISAGREE WITH THE
POLICY APPROACH AS AN ANSWER TO
THE ISSUE OF OVERCROWDING IN OUR
E. OURS AND SHOULD NOT BE A
DETRIMENT. TO PATIENT SAFETY WE
SIMPLY FLAT OUT DISAGREE WITH
THE RESEARCHER REPORTS.
THAT HAVE CAME OUT OF THAT PAIN
A MUCH DIFFERENT PICTURE THAN
WHAT WE ANALYZED.
AS AN ORGANIZATION THAT I
SCRUTINIZE THESE PILOTS IN EACH
REPORT SINCE ITS INCEPTION.
OF THESE PILOTS ALMOST SIX YEARS
AGO THE REPORTS ARE NOTHING MORE
THAN A SMOKING MERE SCREEN THAT
PURPORTS ALLEGED SAVINGS AND
TREMENDOUS PATIENT SATISFACTION.
IN FACT THESE PILOTS AND IN SOME
CASES I HAVE HAD LOW
PARTICIPATION IN IN THE
BEGINNING MANY OF THESE PILOTS
THAT YOU HAVE BEEN HEARING ABOUT --
WE'RE NEEDING HEALTHY PATIENTS
HEALTHY WHITE ENGLISH SPEAKING
MALES NOT AT ALL REFLECTIVE OF
CALIFORNIA.
SEVERAL PILOT SIMPLY SHUT DOWN
BECAUSE MS COULDN'T MEET THEIR
PRIMARY CONTRACTED JOB WHICH IS
RESPONDING TO FIRES AND OTHER
EMERGENCIES.
IN THE STATE OF NEW MEXICO THEY
SIMPLY PULLED OUT ALL TOGETHER
CITING.
BECAUSE IT DIDN'T SAVE MONEY OR
IMPROVE CARE WE'VE ALSO WORK
WITH THE CITY OF LONG BEACH WAS
RECENTLY PUSHED BACK ON THIS
PROPOSAL AS WELL.
NOT TO MENTION LOOKING AT THE
DATA IT HAS BEEN HARD FOR US TO
TRULY ANALYZE THE RAW DATA FROM
THE RESEARCH REPORTS THAT WE
BASS WERE FOR THE LAST SIX YEARS.
BECAUSE IT HAS NOT BEEN TURNED
OVER TO US SO IT IS IMPERATIVE
AS A PUBLIC POLICY BODY FOR US
TO HAVE A CONVERSATION OF THIS
MAGNITUDE OUT HOW TRULY SHIFT.
YOU KNOW HEALTH CARE -- IN TO
PUT IT IN TRYING IN STATUTE WE
NEED TO HAVE ALL THE FACTS AND
WE SIMPLY DO NOT HAVE THAT.
I'M PATIENT SAFETY THERE'VE BEEN
OVER THIRTEEN RESEARCH STUDIES
THAT FOUND SIGNIFICANT RATES UP
UNDER TRIAGE BY EMS PERSONNEL.
THESE RATES ARE AS HIGH AS 32%
ON TRANSPORTS TO ALTERNATE
DESTINATIONS I THINK YOU HAVE
SOME PAPERWORK IN FRONT OF HIM.
I JUST WANT TO YOU KNOW CAUTION
EVERYBODY BEFORE YOU YOU KNOW
MOVE ON THIS BILL THAT PATIENTS
WHO CALL 911- ARE MORE LIKELY TO
BE CRITICAL CRITICALLY ILL AND
ECONOMICALLY DISADVANTAGED.
AT THE END OF IT ALL WE DO NOT
SUPPORT THE USE OF PARAMEDICS
AND FIRE TO BE USED OUT OF THE
PRE HOSPITAL CONTEXT.
AT REYES MOMENTS AGO THE REPORT
THAT WAS WRITTEN IN RECENT YEARS
BY.
TWO PHYSICIANS OPPOSE ALTERNATE
DESTINATION AND THEIR BOTTOM
LINE WAS AND I QUOTE THE
LITERATURE DOES NOT SUPPORT
PARAMEDIC GUIDED DIVERSION OF
AMBULANCE PATIENTS AWAY FROM THE
E. D.. TO ALTERNATE DESTINATIONS
IN TERMS OF ONE COST SAVINGS AND
TWO OUTCOMES THIS IS OBVIOUSLY
COMPLETELY ILLUSTRATIVE OF THE
POST DISTRACT PILOTS HAVE BEEN
REMOVED I WANNA.
OBVIOUSLY THINK THE CHAIR FOR
YOU KNOW HIS WORK ON THAT AND
THE STAFF.
SO YOU KNOW IN THE END THERE --
INTERIM THINGS THAT WE CAN DO --
THE ER DOCS AGAIN I I ALWAYS
MENTION THIS THEY JUST GOT A
TWENTY MILLION DOLLAR BUDGET
ITEM TO GET DRUG AND ALCOHOL
COUNSELOR IN THE ET THIS IS WHAT
WE'RE TALKING ABOUT WE'RE
TALKING ABOUT.
FINDING RESOURCES AND MEETING
THE PATIENTS WHERE THEY ARE.
YOU KNOW UP AND DOWN THE STATE
THE OUR HOSPITALS ARE DOING
BRACKET MEDICAL EVALUATIONS
CUTTING DOWN THE TIME IN THE ER
FROM FORTY SIX HOURS TO WANTED.
TO SET THE END OF THE DAY YOU
KNOW WE NEED TO HELP HOSPITALS
BECOME A PARTNER BEAT OUT THE
SEAT AT THE TABLE.
AND THE ANSWERS AGAIN DO NOT
NEED TO BE ON THE BACKS OF OUR
PAY PATIENTS SO WITH THAT I
RESPECTFULLY URGE YOU KNOW ABOUT
THANK YOU VERY MUCH.
UNDER SENATOR OF BONTA MEMBERS
OF THE THE COMMITTEE MY NAME IS
BRIAN ANDERSON AND I'M THE ABOUT
THE MINISTRY FOR NAPA COUNTY AND
THE PRESIDENT OF THE EMERGENCY
MEDICAL SERVICES ASSOCIATION OF
CALIFORNIA.
AND ZACH HAS TAKEN OPPOSE A MUST
AMENDED POSITION ON AB FIFTEEN
FORTY FOUR AND TO BE BRIEF ALL
FOCUS ON TWO KEY AREAS OF
CONCERN.
FIRST AB FIFTEEN FORTY FOUR DOES
NOT RECOGNIZE A LOCAL EMS
AGENCIES EXISTING AUTHORITY TO
TRANSPORT PATIENTS TO TREATMENT
FACILITIES OTHER THAN EMERGENCY
DEPARTMENTS.
THE EXISTING X. FORTY IS FURTHER
CLARIFIED AND DRAFT REGULATIONS
ISSUED BY THE STATE EMS
AUTHORITY EARLIER THIS YEAR.
SECONDLY AB FIFTEEN FORTY FOUR
GIVES PUBLIC AGENCIES THE FIRST
RIGHT OF REFUSAL AND THE NAPA
EMS SYSTEM THIS COULD PROHIBIT
US FROM USING OUR SINGLE COUNTY
WIDE PROVIDER THUS ELIMINATING
THE EFFICIENCY THAT THE
LEGISLATION SEEKS.
FURTHER THIS PREFERENCE TO A
PUBLIC AGENCY IS GIVEN
REGARDLESS OF WHETHER THEY
PROVIDE BASIC LIFE SUPPORT OR
ADVANCED LIFE SUPPORT SERVICES.
AND DOES NOT CONTEMPLATE WHETHER
THE AGENCY EVEN HAS AMBULANCE
TRANSPORT CAPABILITIES.
OVER APPRECIATE ON ONE OF THE
KNOWLEDGE THE AMENDMENTS MADE TO
HOSPICE -- THAT -- ALLOW THE THE
CURRENT SYSTEM THAT ALLOWS
PARAMEDICS TO TAKE CARE OF THOSE
PATIENTS -- TO PROCEED -- AS IT
AS IT CURRENTLY DOES.
WE THANK YOU FOR YOUR TIME AND
HAVE TO ANSWER ANY QUESTIONS MY
NAME IS SON CAROL SNYDER ON THE
CURRENT EMS COMMISSIONER
REPRESENTING THE EMERGENCY
NURSES ASSOCIATION.
CALIFORNIA IN A HAS SUPPORTED
THE CONCEPTS OF ALTERNATE
DESTINATIONS AND COMMUNITY PARA
MEDICINES.
PROJECTS THEIR PROJECTS FROM THE
BEGINNING WHEN OTHER
ORGANIZATIONS LIKE CAL IS THAT
DID NOT SUPPORT THEM WE'D LIKE
TO CONTINUE THE COLLABORATION.
BETWEEN EMERGENCY DEPARTMENTS
AND PRE HOSPITAL CARE AS WELL AS
A COLLABORATION BETWEEN VARIOUS
EMERGENCY CARE PROVIDERS.
HOWEVER THIS BILL WOULD
EFFECTIVELY UNDERMINE THESE
EFFORTS BY CHANGING THE
COMPOSITION OF THE EMS
COMMISSION AND REMOVING OUR SEAT
FROM THE TABLE.
WE NEED TO CONTINUE TO OFFER
GUIDANCE AND EXPERTISE ON A
VARIETY OF EMERGENCY CARE ISSUES
WHETHER IT INVOLVES STROKES AND
SEMI REGULATIONS OR HOW TO
DETERMINE OPTIMAL DESTINATIONS
FOR TREATING VICTIMS.
THE KELLY IN A IS BEEN WORKING
TO AMEND AB FIFTEEN FORTY FOUR
TO REMOVE THE PROVISIONS THAT
WOULD ELIMINATE OUR ROLE.
IN THE M. S. COMMISSION HOWEVER
SINCE THE VISION IS NOT BEEN
REMOVED WE OPPOSE THIS
LEGISLATION.
THE CURRENT VERSION OF AB
FIFTEEN FORTY FOUR COMPLETELY
ELIMINATES THE CAL IN A SEAT ON
THE M. S. COMMISSION THE
POSITION THAT WE'VE HELD SINCE
THE NINETEEN EIGHTIES.
THAT'S A PREMIER MERCY NURSING
ORGANIZATION THE STATE OF
CALIFORNIA AND THROUGHOUT THE
WORLD IT IS DIFFICULT FOR ME TO
UNDERSTAND WHY YOU WOULD REMOVE
OUR VOICE FROM THE COMMISSION.
HE AND I HAD BY IS THE
COMMISSION ON EVIDENCE EVIDENCE
BASED PRACTICE FOR PRE HOSPITAL
EMERGENCY DEPARTMENT PATIENT
CARE.
REGARDLESS OF WHO ELSE IS ON THE
COMMISSION THEY'LL BE NO PERSON
WITH GREATER EXPERTISE REGARDING
EMERGENCY NURSING CARE THEN THE
IAN A MEMBERS AS A TO RUN IT BY
THE GOVERNOR -- WE'RE
PROFESSIONAL ORGANIZATION WHO
WORKS TO EDUCATE AND ADVOCATE
FOR SAFE PRACTICE AND SAFE CARE.
IAN IS AN INTERNATIONAL
PROFESSIONAL ORGANIZATION WITH
OVER FORTY FOUR THOUSAND MEMBERS.
OUR VOICES BEEN IMPORTANT TO
THIS COMMISSION FOR THIRTY YEARS
AND WE WOULD LIKE TO CONTINUE TO
KEEP OUR SEAT.
THANK YOU FOR HAVING THE
OPPORTUNITY TO TEST THANK YOU
THE OTHER WHEN THIS IS A FORTUNE
WERE OUT OF TIME -- SO JUST
NAME ORGANIZATION AND THAT
SENIOR POSITIONS OPPOSE CENTER
UP HERE HER NAME IS DEEPER ON
THE STATE DIRECTOR OF THE
CALIFORNIA COALITION CHILDREN'S
SAFETY AND HEALTH BUT ALSO
UNDERNEATH THAT IS THAT
ADVOCATES FOR HEALTH ECONOMICS
AND DEVELOPMENT.
AND WE'RE OPPOSE THIS BILL WERE
SUPPORTIVE OF THE COMMUNITY PER
MEDICINE BUT THIS BILL THE WAY
IT'S STRUCTURED CHANGING MEDIUM
ABOUT THE COVERAGES ATARI TITLE
ENDS UP SO JUST DO YOU POST OKAY
THANK YOU.
A BRIGHT NEBRASKA MATH OF THE
CALIFORNIA ASSOCIATION HEALTH
SERVICES AT HOME IN OPPOSITION
THANK YOU.
THANK YOU OTHER WITNESSES IN
OPPOSITION -- FIRM A DAY TEN ON
BEHALF OF THE CALIFORNIA STATE
ASSOCIATION OF COUNTIES OPPOSE
UNLESS AMENDED WANT TO THANK THE
SPONSORS AN AUTHOR FOR WORKING
WITH US BUT WE STILL DO HAVE
CONCERTS.
THANK YOU.
KAREN MEMBERS LAURIE JOHNS ON
BEHALF OF THE CALIFORNIA
PARAMEDIC FOUNDATION IN
OPPOSITION THANK YOU.
MICHELLE GIVENS OF THE COUNTY
HEALTH EXECUTIVES ASSOCIATION
ALSO AT THE OPPOSE LAST MINUTE
POSITION FOR THE SAME REASONS
ADD THAT MY COLLEAGUE FROM C.
SUCCEED OKAY THANK YOU.
I AND ZERO KONICA MY EMS MEDICAL
DIRECTOR I'M NOT SPEAKING ON
BEHALF OF THE EMERGENCY MEDICAL
DIRECTORS ASSOCIATION OF
CALIFORNIA AND WE OPPOSE UNLESS
AMENDED THANK YOU.
THANK YOU.
KELLY BROOKS ON BEHALF OF THE
URBAN COUNTIES OF CALIFORNIA AND
THE ROLE COUNTY REPRESENTATIVES
OF CALIFORNIA ALSO WITHIN OPPOSE
UNLESS AMENDED POSITION.
THANK YOU.
MISTER CHAIRMAN MEMBERS PAUL
YOUR ON BEHALF OF THE SAN
JOAQUIN COUNTY PURSUE RISES ALSO
OPPOSE UNLESS AMENDED.
OKAY THANK YOU ALL RIGHT.
US SEE NO OTHER WITNESS
OPPOSITION -- COMMITTEE ANY
COMMENTS QUESTIONS COMMITTEE
MEMBERS -- YES -- CENTRAL
GONZALEZ.
CAN YOU JUST RESPOND TO THE LACK
OF REPRESENTATION ON THE
COMMITTEE -- AND WHY THEY DO NOT
HAVE A SEAT ON THE COMMITTEE
ANYMORE WELL THEY WERE WELL THEY
HAVE A SEAT RIGHT NOW -- SENATOR
AND WHAT'S BEEN SET UP IS THAT
MEMBERS OF THE STATE FEDERATION
OF LABOR A WE HAVE NURSES THERE
WHO ALSO CONTINUE TO OPERATE
PROVIDE -- KNOWLEDGE -- IN THIS
PARTICULAR AREA.
WITH ALL DUE RESPECT SENATOR THE
EMERGENCY NURSING ASSOCIATION
OUR EXPERTS ADAM RESIDENCY
NURSING.
THE CALIFORNIA FEDERATION OF
LABOR DOES NOT GUARANTEE GETTING
EMERGENCY NURSE WITH A NOTE LET
ALONE AND THE AND A MEMBER.
IT'S VERY IMPORTANT THAT THE
CALIFORNIA IT'S TO PROFESSIONAL
ORGANIZATIONS THAT ARE BEING
REMOVED FROM THE COMMISSION.
IF THIS BILL PASSES.
BUT I WAS SIMPLY SAY THAT
THERE'S NO THERE'S PROFESSIONAL
NURSES AT THE STATE FEDERATION
OF LABOR WHO IS PART OF A LABOR
ORGANIZATION -- THAT IS
PROVIDING THAT KIND OF EXPERTISE
THAT KIND OF KNOWLEDGE -- THAT
GIVES TO INCREASE TO THE BOARD
ALL RIGHT THIS.
THROUGH THE CHAIR SO -- OKAY TO
FOR THE QUESTIONING SIEU VERY
WELCOME.
THANK YOU.
ANY OTHER QUESTIONS FOR
COMMITTEE MEMBERS.
IN AND OUT SO FOR THAT I JUST
WANNA SAY EFFORTS BY WHAT THANK
YOU A SIMILAR GIPSON -- FOR
WORKING WITH -- MY OFFICE -- AND
ALSO TO THE SPONSORS AS WELL --
YOU KNOW I'D END UP APPRECIATE I
MEAN WE HEARD A LOT OF SUPPORT
FOR COMMUNITY PARAMEDICS AND I
THINK YOU KNOW SOME OF THE
BOUNDARIES -- WE APPRECIATE YOU
WORKED WITH US ON THE ROUTE --
YEAH WE DO IT'S IT'S NOT A TOTAL
SOLUTION I ACTUALLY GREE WHAT
THOSE SAID BY THE NURSES LIKE
THIS IS THIS IS THIS IS.
THIS IS ONE IMPORTANT I THINK MY
MIND STEP AND WE'VE HEARD FROM
MANY PEOPLE EVEN OPPOSITION TO
SAID THE COMMITTEE PARA MEDICINE
PART WERE WE ACTUALLY WANT TO
SUPPORT.
I THINK THERE'S SOME ISSUES
AROUND GOVERNMENTS AND SO FORTH
THAT DOES COME UP -- BUT AND OF
THE AD BUT I THINK THAT YOU KNOW
WE NEED TO MOVE FORWARD ON THAT --
TRIAGE PART I HAD SOME CONCERNS
ABOUT THE POSSIBLE FATHER
PRECIADO -- THE AND YOU IN THE
SPONSORS OF WORKING WITH ME ON
THE AMENDMENTS WILL SEE WHAT THE
PILOTS SHOW -- WE'VE HAD SOME
MIXED -- RESULTS FROM THAT AND
SO I THINK FOR THE DEED SO --
YEAH I DO HAVE SOME CONCERNS AND
I SO WE'LL SEE HOW LOW THE
EXISTING POLICY BILLING BUT WITH
THAT -- WOULD YOU LIKE TO CLOSE
AND PERHAPS ALSO ADDRESS SOME OF
THE OTHER ISSUES THAT WERE
RAISED BY THE POP OPPOSITION.
SURE I'M SURE -- LET ME SIMPLY
SAY THAT.
I HAVE SINCE THE VERY BEGINNING
WHEN WORK WITH OPPOSITION WILL
CONTINUE TO DO SO AND CERTAINLY
CONTINUE TO WORK WITH YOUR WITH
YOUR OFFICE.
OF THIS BILL WHEREAS THIS BILL
MOVE FORWARD IN MOVES WERE TAKEN
MEMBERS WITH PASSED OUT THE
MEMBERS OF THE COMMITTEE -- WE
WILL CONTINUE TO WORK WITH --
THOSE WHO HAVE EXPRESSED
OPPOSITION CONCERNS AND EVEN
THOSE WHO -- MARGINALLY --
CONCERN BUT STILL SUPPORT THE
CONCEPT WE ARE WILLING TO WORK
WITH EACH AND EVERYONE OF THEM --
IN ORDER TO STRENGTHEN HIS BILL
THIS BILL ALSO WAS MOVING ON TO
JUDICIARY COMMITTEE -- THAT'S
WILL BE TAKEN THESE AMENDMENTS --
AND WE HAVE TIME TO WORK AND
MAKE IT BETTER SO I RESPECTFULLY
ASK WITH AN AYE VOTE.
ALL RIGHT THANK YOU SO VERY MUCH
AND AGAIN DIET THAT THANKS SO
MUCH FOR ALL YOUR WORKERS SO THE
IS THERE BEEN A SECOND.
MOTION YES OKAY BEEN MOVED BY
SIR LEYVA SO THE MOTIONS TO PASS
REFERRED TO THE COMMITTEE ON
JUDICIARY.
THANK YOU US A GROUP PLEASE CALL
THE ROLL AND I AYE STONE
[inaudible]
GONZALEZ.
GROWTH HER TADO.
HER TOTAL AYE LEYVA LEAVE AYE
MITCHELL.
MITCHELL AYE MONNING.
MONNING AYE RUBIO.
RUBIO AYE [inaudible] SIX OKAY.
OKAY SO -- THE BILL IS -- SIX
ZERO IT OUT.
THANK YOU VERY MUCH THANK YOU
FOR PRESENTATION ALL RIGHT.
IF YOU ARE A LOT SAYS HER MOTION
ON THE CONSENT CALENDAR OKAY
EXCELLENT SO WE HAVE -- FOR AYE
IS ON THE CONSENT CALENDAR YOU
SHOULD HAVE THAT BEFORE JEWS Và
NEWS [inaudible]
SEC.
OUR FIRST SECRETARY PLEASE CALL
THE ROLL THE CONSENT CALENDAR.
PAN HI CAN I STONE GONZALEZ FIVE
DOLLARS I'D GROW FURTADO.
PATADA AYE LEYVA LEAVE AYE
MITCHELL.
MITCHELL AYE MONNING MORNING I
RUBIO.
RUBIO AYE.
OKAY THE CONSENT KILLERS OUT
SEVEN ZERO OKAY SO WE'RE GONNA
START AT THE TOP OF THE FILE
ORDER AND ROLL DOWN.
OKAY SO.
OKAY SO STARTING WITH ITEM
NUMBER ONE EIGHTY ONE SEVENTY
FOUR BY SOME MEMBER WOULD -- TO
DELICIOUS THE PAST FOR A
COMMITTEE APPROPRIATIONS
SECRETARY PLEASE CALL THE
ELECTION WE NEED A MOTION THIS
IS HER FATHER SUBCOMMITTEE OKAY
IT'S BEEN MOVED BY CENTER LEYVA.
ALL RIGHT SO THE MOTIONS TO PASS
REFERRED TO THE COMMITTEE ON
APPROPRIATIONS US SECRETARY
PLEASE CALL THE ROLL PAN HI AND
I STONE GONZALEZ.
GONZALEZ I GROW FURTADO HER
TITLE AYE LEYVA.
AYE MITCHELL MITCHELL AYE
MONNING MONNING I RUBIO.
THIS ITEM NUMBER ONE EIGHTY ONE
SEVENTY FOR HEALTH COVERAGE
FINANCIAL SYSTEMS REPORTING.
RUBIO AYE.
SINCE SOME.
BILLS OUT SEVEN ZERO NEXT ITEM
IS ITEM NUMBER TWO EIGHTY TO
NINETY BY SOME MEMBER WOULD
SECRETARY PLEASE CALL THE ROLL
OF ABSENT MEMBERS [inaudible]
RUBIO.
OKAY.
SO THAT BILL WAS OUT.
FIVE THREE OKAY NEXT ITEM IS
ITEM NUMBER THREE AB THREE
EIGHTEEN BY SOME MEMBER -- TO
SECTOR PLEASE CALL THE ROLL OF
ABSENT MEMBERS GROW FURTADO HER
TITLE I LEYVA.
I HAD TO I APOLOGIZE OKAY. SEVEN
THOSE OUT SEVEN ONE NEXT ITEMS
ITEM NUMBER FOUR EIGHTY THREE
EIGHTY FOUR BY SOME NUMBER CHAO
CIRCULAR PLEASE CALL THE ROLL
THAT SOME MEMBERS ROW HER TADO.
RETARDED I MITCHELL.
MITCHELL AYE MONNING MONEY I
THAT BILLS OUT -- SEVEN ONE ITEM
NUMBER FIVE IS BEING HELD THE
NEXT COMMITTEE ITEM NUMBER SIX
EIGHTY FOUR EIGHTY BY A SIMILAR
SALAS SECTOR PLEASE CALL THE
ROLL THAT'S MEMBERS.
GROVE HER TADO HER TOTAL I RUBIO.
I THAT BILLS OUT EIGHT ZERO NEXT
TIME AS I'M NUMBER SEVEN EIGHTY
SIX FIFTY SIX BY SOME MEMBER
EDUARDO GARCIA SIXTY PLEASE CALL
THE ROLL ABSENT MEMBERS ROW HER
TADO.
HER TITLE I RUBIO RUBIO AYE. ONE
THAT BILLS OUT -- SEVEN ONE NEXT
TIMES I AND NUMBER NINE EIGHTY
SEVEN THIRTY ONE BY SOME EVER
KALRA SIX WITH THESE CALL THE
ROLL OF ABSENT MEMBERS GROWTH
HER TADO.
RICARDO I RUBIO RUBIO I THAT
BILLS OUT SEVEN ONE NEXT ITEMS I
AND NUMBER TEN EIGHTY SEVEN
FORTY FOUR BY SOME MEMBERS
AGUIAR-CURRY SIX FIFTIES CALL
THE ROLL ABSENT MEMBERS GROW
FURTADO.
HER TOTAL AYE MITCHELL MITCHELL
AYE MONNING MONNING AYE RUBIO.
RUBIO.
FIVE YEAH EIGHT AT THAT BILLS
OUT.
EIGHT ZERO THE NEXT ITEM IS ITEM
NUMBER THIRTEEN BY -- AB SEVEN
SEVENTY FOUR BY SOME MEMBER
RADIUS OF SIXTY PLEASE CALL THE
ROLL THAT SOME MEMBERS STONE
GROVE HER TADO.
HER TITLE I RUBIO [inaudible]
I THAT THOSE OUT SEVEN ZERO NEXT
ITEM IS ITEM NUMBER FOURTEEN
EIGHTY EIGHT TWENTY FOUR BY SOME
LUMBER WOODS.
SECRETARIES CALL THE ROLL ABSENT
MEMBERS RUNNING.
MONNING I THAT BILLS OUT SEVEN
TWO NEXT ITEMS I AM A FIFTEEN
EIGHTY NINE NINETEEN AS A MEMBER
PATRICK NORRIS.
A SECTOR PLEASE CALL THE ROLL
THAT'S MEMBERS GROW.
HER TADO HER TOTAL AYE LEYVA
LEYVA I RUBIO.
RUBIO AYE.
THAT BILLS OUT EIGHT ZERO NEXT
ITEMS I AM NUMBER SIXTEEN A. B.
NINE TWENTY BY SUMMER PETRIE NOR
SIX IT TAKES ALL THE ROLE THAT
SOME MEMBERS THROW.
HER TADO TITLE AYE LEYVA LEYVA
AYE RUBIO RUBIO I THAT BILLS OUT
EIGHT ZERO NEXT ITEM IS ITEM
NUMBER EIGHTEEN EIGHTY ELEVEN
SIXTEEN BY SUMMER GRAYSON.
SEPARATE THESE CALL THE ROLL
THAT SOME MEMBERS STONE GROWTH
HER TADO HER TITLE II MORNING.
MORNING I THAT BILLS OUT SEVEN
ZERO SIX ITEMS I'M NUMBER
NINETEEN EIGHTY ELEVEN TWENTY
EIGHT BY SUMMER PETRIE NOR
SECTOR PLEASE CALL THE ROLL
ABSENT MEMBERS ROVE HER TATO.
MASATO I LEYVA LEYVA AYE RUBIO.
RUBIO HI.
THAT BILLS OUT EIGHT ZERO NEXT
ITEMS I AM NUMBER TWENTY AB
ELEVEN SEVENTY FIVE BY SOME
REMEMBER WOULD SEXUAL PLEASE
CALL THE ROLL OF ABSENT MEMBERS.
GROVE.
OKAY THAT BILLS OUT EIGHT ZERO
NEXT ITEM IS ITEM NUMBER TWENTY
ONE A. B. ELEVEN SEVENTY EIGHT
BY SOME MEMBER QUIRK SECRETARIES
CALL THE ROLL ABSENT MEMBERS.
STONE GROVE HER TADO HER TITLE I
RUBIO.
RUBIO I THAT BILLS OUT.
SEVEN ZERO I NUMBER TWENTY TWO
WAS WITHHELD ITEM NUMBER TWENTY
THREE A. B. THIRTEEN OH NINE BY
SUMMER BAUER CONTACTED PLEASE
CALL THE ROLL OF ABSENT MEMBERS
STONE GROVE HER TONTO.
TONTO AYE RUBIO.
I THAT BILLS OUT -- SEVEN ZERO
NEXT ITEM IS ITEM NUMBER TWENTY
FOUR ASSEMBLY BILL THIRTEEN
TWENTY TWO BY SUMMER BERMAN
SOCRATES CALL THE ROLL ABSENT
MEMBERS OWN GROVE HER TATO FOR
TITLE I RUBIO.
RUBIO HI THAT BILLS OUT -- SEVEN
ZERO NEXT TIMES I'M NUMBER
TWENTY FIVE BY SOME ROUTINE AB.
THIRTEEN SIXTY SIX THREE PLEASE
CALL THE ROLL ABSENT MEMBERS
STONE GROVE HER TADO FOR TITLE
II.
THAT BILLS OUT.
SEVEN ZERO THE AND I THINK WE'LL
FINISH UP.
YEAH OKAY SO THAT THAT AND THEN
EIGHT NINE NUMBER TWENTY SEVENS
ALSO BEING HELD TO THE NEXT THE
THAT CONCLUDES THE AGENDA OF THE
SENATE COMMITTEE ON HEALTH AND
WISH EVERYONE A HAPPY JULY
FOURTH.
WITH THAT WE ARE ADJOURNED THANK
YOU