Senate Standing Committee on Health

Item number 12, AB 2319 Assembly Members Wilson and Weber California Dignity and Pregnancy and Childbirth act and item number 18, AB 3218 Assemblymember Wood Unflavored tobacco list so we have 17 bills today with 10 of them being on our proposed consent calendar.

For those taking note, the consent calendar consents consists of the item number one, AB 1841 Assemblymember Weber Student Safety item number six, AB 2161 Assemblymember Arambula the Early Psychosis Intervention plus program item number seven, AB 2237 Assembly Member Aguiar Curry Children and Youth item number nine, AB 2703 Assembly Member Aguiar Curry federally qualified health centers and Rural Health Clinics item number 11, AB 2271 Assemblymember Ortega

St. Rose Hospital with amendments item number 13 AB 2428 Assembly Member Calderon Medical item number 14, AB 2549 Assembly Member Gallagher Patient visitation with amendments item number 15 AB 2550 Assemblymember Gabriel Business Establishments Building Standards item number 16 AB 2599 Environmental, Safety and Toxic Materials Committee Water Public beaches and item number 19, AB 2859 Assemblymember Jim Patterson Emergency medical technicians peer support with amendments having done that, let's move forward with our first item.

And our first item is AB 1843 Assemblymember Rodriguez, emergency ambulance employee employees. Please proceed when ready.

Thank you Chair and Senators. Thank you for the opportunity to present AB 1843. First, I would thank you Mister Chair for your Committee staff, for your work and attention on this bill. Today, I will accept the Committee's amendments.

This bill will significantly improve and expand the mental health and emotional support options available for our EMS workers in the private sector ambulance companies. With over 35 years working in the EMS field, I know firsthand the difficulties of being a first responder and encountering traumatic incidents daily.

We are consistently exposed to death, severe injuries, and life threatening conditions, all while working long and irregular hours. This combination of factors creates stressful work and home environments. In 2018, the voters approved Proposition 11, which provided private emergency ambulance employees up to 10 employer-paid mental health sessions through an employer assistance program known as EAP.

However, these resources have been inadequate or difficult to access. For example, EMS workers cannot access providers who specialize in their first responder-related issues. As a result, these workers are often using their limited EAP sessions just to find an appropriate provider to serve their needs.

Additionally, the American Psychological Association found that 15 to 20 sessions are needed for our first responders to begin recovering from diagnosed PTSD incurred on the job. To resolve these issues, this bill would increase the number of EAP sessions and allow our EMS workers to be treated by providers familiar with their particular industry and its challenges.

Private ambulance employees face challenges in scheduling appointments with providers in a timely manner. This bill requires appointments to be scheduled within 48 hours upon request, ensuring private ambulance employees receive timely care. AB 1843 will also require peer-to-peer support services to be available for private ambulance employees.

Unfortunately, a 2016 survey by the National Association of EMTs found that only 28% of agencies nationwide adopted peer support programs. With AB 1843, our first responders will have the resources and support they need to address the mental health needs and recover so that way they can continue providing Californians with emergency care they need and deserve.

With me today to provide testimony is Amber Stoer from Sacramento representing United Steelworkers. Thank you.

Thank you. Please proceed when ready.

Chair Roth and Health Committee Members, my name is Amber Stoer and I am a 15 year EMT of Local 12911 and a staff rep with USW in Central Valley. I appreciate the opportunity to speak to you today on behalf of my local members and our siblings of USW Local 1853 in Southern California.

Every day our members leave for work not knowing what type of situation will be encountered that day. The one thing we do know is that the dedication and care we provide within multiple communities can mean the difference between life and death. As first responders, it is our privilege to serve our patients with the best possible care.

Unfortunately, the care that may be needed to us is not given the same consideration nor commitment. It is this reason I am here today to speak in support of AB 1843, to ensure that access and follow through to receive mental health care and effective EAP program administration responsibility is achieved.

AB 1843 provides a critical pathway to these much needed services. Currently, we have members who have, after months of follow up, unable to get an appointment or receive any EAP assistance. Repeatedly they have been told by facilitators there isn't anyone available to see them and to follow up monthly on their own, to no avail.

It defeats the purpose of an EAP if the mental health care needed isn't there for months on end or at all. While performing a job that daily places workers directly into volatile and dangerous situations. The PTSD effects and impacts are very real, as is the care needed.

That care should and must be provided by someone who has experience and training in trauma counseling. Responding to critical incidents is what we do each day, putting ourselves at risk without any thought other than saving lives.

Today we ask you to support AB 1843 to ensure our members can have access to what they need to potentially save their lives when experiencing their most difficult challenges. I respectfully ask for your aye vote on behalf of all first responders who need this for their mental health and well-being.

Thank you to Assemblymember Rodriguez for authoring this critical bill and I thank you Chair and Members for your time and consideration.

Thank you ma'am. Thanks for joining us. Any other witnesses in support of this measure?

Good afternoon Mister Chair. Janice O'Malley from AFSCME California, also on behalf of our United EMS Workers Local 4911, here in support. Thank you.

Thank you.

Thank you Mister Chair. Megan Subers on behalf of the California Professional Firefighters, in support.

Thank you. Good to see you. Any other witnesses in support? Okay, any witnesses in opposition to this measure? Please identify yourself for the record and you may proceed when ready.

Good afternoon. I'm Sean Henschel, here on behalf of American Medical Response, California's largest provider of emergency ambulance services. AMR is respectfully opposed to AB 1843 as is currently written. The problems of mental health and inherent stress associated with EMS are not in dispute today.

Regrettably, the EAP language proposed today does not solve the problem. This comes down to what is the purpose of the program. EAP is intended to serve immediate and short term issues and to triage referrals when appropriate to specialized long term care. California's own HR Benefits website states the same: short term and referral.

Our data around current utilization of EAP is below 3% and of that 3%, the employees that use EAP services, the average utilization is 4.5 visits. The low visit utilization demonstrate that the employees are being referred to long term treatment before maxing out on EAP sessions.

PTSD and other serious mental health issues do not simply go away after 20 visits. They can require years of long term mental health treatment, correctly pointed out by the author. This long term coverage is being provided under existing health insurance as is required under Proposition 11. Again, EAP is not intended to address long term mental health needs.

After 20 visits, the provider or patient relationship that's been established over a few weeks or months is severed abruptly and causing unfair harm to the patient. Proposition 11 was carefully written to require mental health coverage, education, and increased EAP access, which is better than the coverage required for public EMS employees.

The cost of increased EAP is not the concern, but spending more and getting nothing in return that addresses the issue is a problem. What we need is for health insurers to pay reasonable reimbursement rates to mental health professionals to ensure long term access. What we need is more mental health professionals that support specialize in EMS issues.

The provider shortage is very correctly noted in the policy comment within the Committee analysis. Thank you for that. In close, AMR's opposition is not about a cost issue, but simply that if an increased benefit is going to be funded by the employer, it should actually help to address the problem.

AMR respectfully requests a no vote at this time and welcomes any dialogue from the author or this Committee around addressing increasing access to providers. Thank you.

Thank you. Any other witnesses in opposition to this measure? Name, position and affiliation only, please.

Good afternoon. Jared Maas on behalf of the 911 Ambulance Alliance, in opposition.

Thank you. Any other opposition witnesses? Seeing none. Let's bring the matter back to the dais and my colleagues. Colleagues, any questions, comments or concerns? Senator Menjivar.

Assemblymember, do you have any response to the fact that only approximately 3% of employees are utilizing the already 10 afforded sessions?

Well, for one, it's a very small utilization of only 10 and it takes time to find that right provider, right. And sometimes you can't even find it in 10, you need more. So once again, it's just allowing 10 more--

Sorry, sorry. Sometimes you can't find it in 10 what?

In 10 visits to find the right person that can help you with your issues. So my whole point is just extend--

I would push back on that. I don't think it takes 10 visits to find if that therapist works for you. As a therapist myself or as someone who obtained therapy, you don't wait 10 sessions. In 10 sessions, that means it's going really well.

You sever the relationship if it's not going well after one or two sessions, three max. So if only 3% of employees are utilizing now, why do we need to increase it?

Well, once again, this is a very unique situation, right. And private sector EMS, as you know, you worked in that industry. It's very hard to find people that can relate to your type of job you do, right. It's very different than any other type of occupation, so to speak.

So once again, just to me, allowing 10 more extra sessions in case it's needed, right. Because sometimes not everybody's going to be-- Their problems going to resolve within 10 sessions. So why not just 10 more as they already talked about, it takes up to 20 sessions to relieve your issue.

I mean it's going to be on case by case basis, right? Data can see one thing, but that's not the whole picture because everybody's different, right.

If we look for therapists just dependent on if they had similar experiences then nobody would be able to find a therapist. We look for therapists who have background in CBT, cognitive behavioral therapy, who are trauma-informed, who know about, who can provide psycho education.

So I wouldn't say that we're looking for therapists specifically who have they themselves seen emergencies and so forth. And I'm not here to say this population does not need all the love and support that they need, because they do and they are a higher level of experiencing these kind of cases. But I'm a data-driven person.

If the data says that only 3% are utilizing it, I guess I'm not convinced that we need to increase it. And I'm not hearing anything from you Assemblymember as to why we need to increase it if it's not fully being utilized.

Well once again, I mean we can go back and forth all day and my thing is that's just that part of the data. But sometimes it's hard for some other folks that may need that more time, right.

Is there something in your bill that will help us capture more data?

Well this isn't really a data-driven bill, just more about allowing 10 extra sessions.

So how will we know this is successful if we allow 10 more?

Well let's put it into practice. Let's pass the legislation and see if it works. Right now there's nothing we can do because we don't have the extra 20, extra 10.

I'd like another question for-- Question for the opposition. If this is maybe explained from my personal knowledge, if we increase it to 10 more and it's 20 and it's a low utilization, what then is the problem if the employees won't even use the rest?

Thank you for the question. Through the chair. It's our understanding that there are not providers of EAP that are willing to offer that many sessions.

What would end up being is the employer would end up being the insurer, which there's been significant pushback from employees that they would not want their employer to be the insurer simply because 20 is not offered. The slippery slope argument of going from 20 to 30 to 50 of just in case there's somebody that might need it.

Your point is very well taken as far as data. The legislation is not there. There's only four and a half visits per session per year per issue. It continues to reset. So our confusion is really not whether or not treatment should be had, it's where it should be had. And our argument would be under existing long term healthcare.

And thank you, maybe for either the Assemblymember or you, can you help me walk through the process of the referrals? So they're afforded 10 through the--I'm butchering the acronym--EAP? They have the ability to be transferred, referred elsewhere for longer term, and they, through that provider, can always request more and more sessions through their provider.

Is the root of the problem here that our personnel or first responders are not getting access to mental health?

Well, I think for one group, if you want to bring it to that level, I don't think a part-time employees offer these benefits and they should as well. So if you want to look about not everybody. So that is a group of employees in the private sector, EMS, that are not covered by EAP.

But with this bill, we want to try to cover that as well. But since, once again, going back to the 10 visits, since it's a very small amount to some employees, so I figured I'm only going to get 10 visits and it may not, I'm going to need more. So I think with some folks, it's why even bother with it.

That's why you see the low data of the 3%, right. If we have allowed a little bit more time, I think you will see more folks accessing it, but because we're not there yet. So how can you really get that, capture other data like you're referring to?

But they can always, always they can be referred. They can be referred even if I say, hey, I only get 10 sessions, but in those 10 sessions, they can refer me elsewhere for long term.

I don't know if somebody can-- I can't tell you for sure. I don't want to tell you false information.

I agree with you Assemblymember, part time members should get, and I don't think I would have any of these questions if the bill in front of me said, hey, we want to offer part-time employees the same benefits that full-time employees have in relation to mental health.

But I'm trying to figure out where you got this number, 20 seems to be arbitrary. Maybe I missed it in your opening. I did miss it in your opening.

Well, if we talk about 50% of patients begin recovery from PTSD with some patients requiring more than 20 sessions to achieve that, there's some information regarding that the 10 is not enough. So it's coming back from other data that we found out that 10 may not be enough for some folks.

And as far as you know, I mean, if we look about it, we're talking about private sector EMS workers, right, that deal with so many tragedies day in and day out. So why not just offer them a little bit more benefits when it comes to mental health as we know, it's really big now more than ever.

So I'm just looking at, let's just give them more time if needed. And so that way they don't say, well, I'm going to have 10 anyway, but if we can extend it to 20, maybe I have a better chance of getting my issue taken care of, right.

And the fact that once again, part-time employees aren't allowed some of these benefits. So let's look at the bigger picture, too, right?

I get the part-time. I guess I'm still just, you know, and it may be odd coming from a social worker, right?

I'm always-- I'm all for mental health, but I also want to make sure, like, it's data-driven and it sounds like they can always be referred and they can get endless amount of therapy sessions through their direct provider. I don't see the gap. I only see the gap for part time.

So my point as well is if the opposition has issues with the 10, why not just give them 10 more? What's so big with allowing 10 more visits? Maybe not everybody's going to use it, right. But there may be some that are, because everybody's different, right? Everybody responds to therapy and treatment differently than one another.

You just can't say that, well, on average-- but there's other folks that may not capture, we're not capturing that. They need that extra 10.

So do you have a response? And this will be my last question. I asked that question to the opposition because I didn't understand either. If not everyone's using it, why can't we just offer more then?

And he shared that there are EAPs that since they don't offer 20, they can't find providers who do this, that then they themselves will become the insurer. Do you think that's the case?

Well, everybody's going to have their difference of opinion, right. I'm just trying to allow that extra flexibility. As far as that, I think that's something--

Is that your opinion, that EAPs will not provide 20 and so--

I would hope not. I wish they would. I hope they would.

In your process through this legislation, have you had conversations that there are EAP providers that are going to offer 20 sessions?

I believe so, but I can't tell you for sure.

Thank you, Senator Menjivar. Let me-- Listen, I'm going to support the measure. The bill has more in it than just this 20,10 business. But I'm fascinated by the question, and I'm not sure we got the answer. If there's a low utilization rate at the employer-- Well, let me go back to the basics.

An employer assistance program is a program set up by the employer to provide assistance to employees. So the employer, then, I assume, contracts with providers to provide the assistance to employees, right?

That's exactly correct, sir.

Okay, so if you have a low utilization rate on a program that currently provides 10, we can have a conversation about why increase it from 10 to 20. But why is there a problem if we increase it from 10 to 20 if there's a low utilization rate at 10?

That was the question, I think, that my colleague asked, and I didn't understand the answer. So I'm going to ask you to sort of reframe it so the simpleton that I am can figure this out.

I'm happy to provide some clarity. Again, as the proponent of Prop 11 from 2018, I can speak to a little bit of historical background on this. We actually researched when we were crafting the Proposition on the idea of even doing 40, and we found that there wasn't a provider to be able to offer that.

Excuse me. There wasn't a what?

There was not a provider offering a program covering 40 sessions for EAP.

Well, that's a different issue. You might have to get two providers for four, right. No, I understand. You may have to contract with two companies.

That's not my understanding. I would defer to an expert in the mental health field on how many different providers you need to get multiple things, but my understanding was that Proposition 11--

Sorry. Even if you do two providers, that's two different therapists. So you would have to cut therapy right in the middle of sessions and then go to another provider. That further harms the client point.

Very well taken. Yep.

Listen, you can-- I don't understand if the company-- If you get one company that provides a certain benefit, but your obligation to your employees is for double that benefit, and they can only give you two. What prevents the company from contracting with two providers to provide the full scope of benefits that you want to provide?

I was not the one that was doing the business of, you know, trying to find this program. My understanding that I was told was that it was not available offer. So the utilization was low because there was not a great enough need and people being properly referred to long term care.

Yes, it is. The market for more than 10, and in this case, up to 20, we could not find. It was not available. It might be available in the marketplace elsewhere, but the understanding that I was given from the client was that it was not an available program.

Well, so the remedy, did anybody suggest an amendment to this bill to include the phrase, to the extent that EAP programs are available to provide the service?

I would be more than happy to take that amendment suggestion back to my client.

You'll have to discuss it with the author. And then the other issue is you use the term self-insurer. How does the employer self insure for EAP benefits under the circumstances that we've been talking about?

I do not want to speak out of turn on that point. My understanding--

It's all self insured because the employer is paying for it, right?

It is referred out as far as paying for it at a base level, but who the insurer is gets to be a complicated issue, is what I was told on whether or not a secondary provider would be able to cover 20 units or 20 visits at that point.

Would AMR or any employer that was subject to this law have to pay out of pocket themselves for the full coverage of 20, whether or not it gets used?

So are you saying then if you, once you hit the 10, if your obligation is 20, and the EAP provider that you've contracted with will only agree to provide 10 sessions for the contract price that the employer would then need to pay out of the employer's general fund for the additional 10 sessions, separate and apart from the EAP contract?

I believe that is what the case would be.

With the therapist that's providing the service?

Yes.

Because obviously, as the brains of the operation pointed out, we do talk about continuity of care. So the same therapist would be providing the service?

I can't speak to that. I'm not in that space.

Conversation with the author when we get finished here. Thank you. Senator Menjivar, did that help address your question? Okay, any other questions, comments, colleagues? I guess Assmeblymember you may close.

Once again, just respectfully asked for high vote. Thank you very much. Appreciate it.

When we get a quorum.

Begin a quorum. Thank you both for being here. Sorry to grill you, sir.

Of course. Anytime, sir. Thank you.

When we get a quorum, we'll take a motion and we will take a vote. Thank you very much, both of you. Who's? Item Number Four: AB 2075. Do we have Assembly Member Alvarez here? Yes, sir. Resident Access Protection Act. Please proceed when ready.

Thank you, Mr. Chair and Committee Members. I'm here to present Assembly Bill 2075, the Resident Access Protection Act. I want to start by thanking the Chair and the staff of the committee for working with us on this bill, and I want to let you know we will be accepting the committee's amendments.

Assembly Bill 2075 is a bipartisan bill that would provide residents of long-term care facilities with the right to in-person, on-site access to visitors during public health emergencies as long as they follow the same safety protocols as the staff at the facilities. I want to emphasize the last point.

Visitation is only allowed if the visitor follows the same safety protocols as the staff at the facility. Assembly Bill 2075 is a result of of a working group established during the pandemic who was tasked with develop recommendations regarding best visitation practices and policies for long-term care facilities during public health emergencies.

The working group met five times over the course of six months and included participants from advocacy groups, state agencies, facilities, public health officials, and medical groups. The report with its findings were published in October of last year, and the workgroup was clear in its takeaway.

It is--a quote from the report--'it is essential for family and friends to have access to residents, including during a state of emergency.' At its core, AB 2075 recognizes the consequential role that loved ones play in ensuring that residents receive the attention, the love, and the care that they need, which augments the role of facility staff.

We remain committed to working with opposition to find more middle ground to ensure that we balance public health and safety with visitation rights. To that end, we have unilaterally added compromise provisions that seek to meet them in the middle.

The provisions include flexibility for state and local authorities when handling public health emergencies by authorizing them to define how visitors can demonstrate proficiency in following safety protocols, capping the amount of visitors who can visit simultaneously, and even the ability to institute a seven-day lockout period with the opportunity to extend it seven more days if they feel is necessary.

I've also clarified that staff will be prioritized as it relates to PPE use and loved ones can only visit if they follow the same safety protocols as staff, which includes the donning of PPE. Through committee amendments and previous committees and this one, I have clarified that the Governor can supersede this act through his emergency powers and that public health order that requires an evacuation notice would not be subject to this bill.

This is one of the bills in this session that I have really attempted to go above and beyond to find that middle ground, and I will continue to do that as I do with all my legislation to try to offer solutions. We can get into the details of what we've done to date to amend the bill to bring it to what it is today, but at the end of the day, this is a bill that recognizes that during unfortunate circumstances like pandemics, it is still important and necessary for us to have access to our loved ones who are in facilities where they are being cared for.

And you will hear some testimony from individuals who have had experience in this, and so I'll ask Tony Chicotel first from the California Nursing Home Reform to be our first witness.

Please proceed when ready. Thank you for joining us.

Thank you for the opportunity to talk about this very important bill. Thank you to the committee staff for its great analysis. One of the enduring horrors of the Covid Pandemic was the immense suffering in nursing homes. There was so much death and despondency. Many deaths were due to Covid, and many deaths were due to the neglect fueled by understaffing and the terrible mistake of locking out family and friends who provided life-sustaining care. We cut off many residents' lifelines unrelentingly month after month.

We had reports of residents with cognitive impairment who didn't understand, couldn't understand why their families weren't showing up anymore. We had LGBTQ residents who talked about being re-traumatized, who had survived the 1980s AIDS epidemic, feeling re-traumatized once again with all of the isolation imposed on them.

Last year, at the behest of the Legislature, 35 organizations and groups participated in this statewide workgroup to recommend best practices for how to deal with access during public health emergencies. We wanted to make sure that we balance access to the people who love these residents the most and ensure that the access did not unduly endanger them.

The workgroup's recommendations are the roadmap for AB 2075. Residents are guaranteed access to the people who care for them best, while giving state and local public health officials the ability to impose any safety measures they feel are necessary to ensure resident safety, so long as they are no more stringent than those that are imposed on the staff.

You're going to hear from the bill opponents that AB 2075 restricts their ability to respond to emergencies, that the bill limits their options. AB 2075 is not about restrictions on tools or tactics. Public health officers retain their ability to set safety protocols or to even isolate long-term care residents.

What AB 2075 does is codify a foundational principle that family support is every bit as important as staff support for the health and well-being of long-term care residents. The bill ensures that nobody can tell a family support person that they are less essential to the welfare of a resident than a staff person. Please vote yes on this very important bill.

Thank you, sir. Next, please. Ma'am, please identify yourself for the record.

Good afternoon. My name is Maitely Weissman. I'm a family caregiver and co-founder of the Essential Caregivers Coalition. I've provided care for my mom, Celia, for as long as I can remember. Since she was young, she's navigated a traumatic brain injury, incomplete quadriplegia, and a communication disorder. My caregiving continued when she moved into a memory care home in our CFE.

I augment staff care daily. I bring a straw or spoon to her lips. Otherwise, she cannot eat or drink. I also help her to bathe, dress, toilet, transfer, move about, and communicate. I know her nonverbal cues, and I help others learn them. Pandemic visitor restrictions abruptly stopped all of that support.

They failed to recognize family caregiving as urgent and essential work. My mom rapidly lost weight and became agitated, withdrawn, depressed, and sometimes unresponsive. Her already limited communication skills dwindled further. With high staff turnover, no one noted these changes, nor the bruises, rashes, bad hygiene, lethargy, dehydration, and delirium.

Increased ER visits revealed unusual blood pressure, dangerous levels of dehydration, contusions, a broken clavicle, aspiration pneumonia, and recurrent C. diff, all in the first several months of lockdowns that were supposed to protect her. In a vulnerable person, unchecked dehydration can be deadly in a matter of days.

Now we know that in a public health emergency, staff dwindles and turns over constantly. Plus, emergency waivers permit new hires to have no training, no experience, and no background checks. Without consistency in caregiving, my mom wasn't getting help to drink and eat.

New hires and agency staff didn't stay long enough to learn to bring the straw to her lips or to recognize her thirst cues. I watched my mom struggle to survive because family caregivers were locked out, miscategorized, and underutilized. But then something went right, for us anyway.

First, it's important to note that hospitals always let me in to stay by her side 24/7 in proper PE-PPE from the very beginning. That's thanks to the ADA. We don't have that in long-term care, though. But against all the rules in that pre-vaccine time, her facilities management chose to let me inside too, at first on a limited basis and then 24/7 when they saw how much I freed up staff to focus on other residents and reduce their PPE burn because they didn't have to come into her room so often, which means donning and doffing each time.

During their biggest Covid outbreak, my mom was still recovering from C. diff and staffing was thinner than ever, so I moved in. To follow all precautions for both Covid and C. diff, I slept in an N95 mask, eye protection, a gown, gloves, and booties, and thankfully, we both remained Covid-negative. Because the facility took a rare leap of faith and granted me early access, I was able to get her almost all the way back to her baseline health, and she is thriving today.

Our story is a model for what could be if family caregivers are recognized as essential resources in public health emergencies. We don't know what the next infectious disease will bring, but logically, if anytime a staff caregiver is allowed to enter with precautions, so can a resident's designated support person. It's all hands on deck during these times.

I also urge against arbitrary waiting periods when it makes sense to tie family caregiver access to staff caregiver access and protocols. In some cases, like severe hydration, for example, for someone like my mom, a mere few days could be too long to wait. Please support AB 2075. Help us become collaborators in good public health outcomes. Make family caregivers resident-designated support persons, another tool in the public health arsenal. Thank you.

Thank you. And thank you for coming to speak to us today. Are there any other witnesses in support of this measure? Name, position--affiliation, rather--and position on the measure only, if I could ask.

Danita Stromgren, volunteer with AARP California, representing our 3.2 million members, in support of the bill. Thank you.

Thank you, ma'am. Next, please.

Abby Alvarez with LeadingAge California, in support.

Thank you. Yes, ma'am.

Good afternoon, Chairman. Blanca Castro, State Long-Term Care Ombudsman, co-sponsor, and in strong support.

Thank you.

Hello. Jason Sullivan-Halpern with the California Long-Term Care Ombudsman Association, in strong support.

Thank you, sir. Now let's turn to opposition, if any. Opposition witnesses? First we'll take the lead opposition witness. You're welcome to join us at the--or witnesses--you're welcome to join us at the table here, and we'll get to the rest in a moment. Please identify yourselves for the record and proceed when ready.

Good afternoon, Chair and members of the Committee. I'm Dr. Ken Cutler with the Health Officers Association of California. We appreciate the intent of AB 2075 to support residents in long term care facilities and hope visitation is never curtailed again.

But we respectfully oppose AB 2075 because it places significant limitations on emergency response that could hinder future efforts to protect health and safety. When considering this Bill, I ask that you consider not what Covid landscape looks like now when we have significant population immunity, plenty of vaccine and improved medical treatment.

But remember what it looked like in early 2020. We had a novel virus we didn't fully understand, no vaccine available and hardly any testing capacity.

Where I worked, we had six counties using one public health lab that could run 20 to 40 tests a day, compared to more than 300,000 tests a day in California by the end of that year. We also had inadequate supplies of personal protective equipment. Healthcare workers and facility staff put their lives at risk coming to work.

And please don't forget that 40% of all COVID deaths in California in those early months happened in long term care facility residents and staff, and future scenarios could be worse when faced with challenging and complex emergencies, health officers balanced the measures used with the magnitude and nature of the threat.

The COVID pandemic was unprecedented and outbreaks themselves in long term care facilities had devastating consequences. So any action to limit visitation were never taken lightly, never intended to be punitive. They were issued out of care and concern and often put the health official at personal and professional risk. There are guardrails.

Health officer orders need to be reasonable, narrowly tailored to the objective, and can be challenged. And orders evolved as knowledge increased, vaccines and immunity emerged and the virus changed. We absolutely recognize that social connections are vital and strongly support visitation until it endangers health and safety. And that should happen only rarely.

Prior to the pandemic, public health officers had not imposed long term restrictions on visitation, and again, we hope never to do so again. But unfortunately, we know communicable diseases can and do evolve quickly and spread rapidly.

And none of us knows how severe the next one will be, who will be most vulnerable and what specific protective measures will be needed. AB 2075 dictates that even in a declared emergency, local orders cannot suspend, supersede or modify the measure except in narrow ways and without regard to the nature or type of emergency.

We therefore respectfully ask that you oppose AB 2075. Thank you.

Thank you, next please,

Mister Chair and members, Betsy Armstrong with the County Health Executives Association and regretfully also in an opposed position. The Covid-19 pandemic was unprecedented, and unprecedented actions were taken with the health and safety of Californians front of mind. Public health officials work tirelessly to understand the virus and protect communities under constantly changing conditions.

Public health officials have been scrutinized, harassed, and even threatened for implementing public health measures that we know saved lives. We absolutely acknowledge the value and importance of family and visitors to residents in these facilities. Since the start of the pandemic, local health departments have gained pragmatic and actionable experience and have already begun implementing lessons learned.

Health departments have since improved lines of communication and have hired infection preventionists to work with these facilities to keep residents healthy and minimize the spread of disease. However, we must be mindful of potential public health threats that could endanger residents, facility staff, and our communities.

Those threats could be known, like ebola or another unknown novel virus that public health will have to learn and respond to. Outbreaks start locally, diseases know no boundaries, and people travel across county lines every day, whether for work, recreation, or to visit loved ones.

The faster we stop the spread of a disease locally, the better protected all Californians will be. And while we cannot predict when there may be another time, hopefully never where stopping the spread means pausing visitation in these facilities because the public health threat is so significant.

Since the time this Bill was introduced, California's local health departments have responded to various measles cases, a tb outbreak, shigella outbreaks, HEP-A, and legionnaires disease, among others, but without any changes to visitation, demonstrating that it's never our first response to to infectious disease. We appreciate the engagement with the authors office and the proponents of this Bill.

However, we've been unable to reach a balance between aligning visitation in a public health emergency with public health guidance and measures.

And while the author's proposed amendment, as noted in the analysis, would allow public health orders to suspend visitation for a maximum of 14 days, 14 days may not be enough time to ensure the appropriate measures are in place to protect residents, workers, and our communities. Public health guidance is tailored to the threat.

It considers who is the most vulnerable, the personal protective equipment, hospital beds, resource availability, including whether there's a vaccine to prevent the spread or medication to minimize the effects of the disease.

And it evolves as the science evolves, AB 2075 would leave public health with less tools to protect long term care facilities and our communities at large when the next public health threat comes. And it's not a matter of if, it's a matter of when, it's for those reasons, we must oppose AB 2075. Thank you.

Okay, thank you. Any other opposition witnesses. Name, affiliation and position on the measure only, please.

Mister Chair and Members. Victoria Rodriguez with Nielsen Merksamer on behalf of Contra Costa County and respectful opposition.

Thank you. Next, please.

Good afternoon. Jared Moss on behalf of the City of Long Beach in respectful opposition.

Thank you.

Good afternoon. Dylan Elliott on behalf of Napa County in opposition, as well as on behalf of the city and County of San Francisco, currently in an opposed unless amended position as outlined in their letter to the Committee and author. Thank you.

Thank you. Any other opposition witnesses? Seeing none. I'm going to bring it back to the dais, but before I turn it over to my colleagues, let me just ask a couple of questions of those opposed.

You know, given the fact that the Bill permits a local government order to supersede the provisions of the Bill during a declared State of emergency, to limit visitation, at least in terms of simultaneous visitation, or to require visitors to follow certain safety protocols that were also required of faculty and staff, and the requirement that visitors don appropriate PPE and go through training, and then also, of course, the amendment that reserves to the Governor the power to declare a State of Emergency under the Emergency Services act, which my understanding is does not contain any sort of day or month limitation.

Don't you believe that that's enough to provide locals with sufficient authority and protection under this Bill?

If it's that serious an event, even if it's in one county, do you not think that the Governor is going to exercise their authority to declare a State of Emergency, whether it's in that county or a region or the entire State of California?

I would hope in the. I would hope in the right circumstance that the right Governor would do the right thing for the county. We have had a long standing principle of local public health authorities. They know their communities best. They know their facilities best when in terms of the local seven days,

with seven days extension, again, we don't know what the specific next threat will look like. There are many infectious diseases with very long incubation periods that could take longer than seven days. And also the Bill was expanded. So it's not just designated support persons who know the residents well. It's all visitors who can come in.

And in terms of the cap on simultaneous, that's a capacity of a simultaneous visit per resident. There are facilities with over 100 residents. That is a lot of visitors. And every time.

But the Bill, just, not to interrupt you, but the Bill permits a state or local government order to state the terms by which visitors or healthcare and social service providers, so visitors and providers can demonstrate their proficiency to follow the same safety protocols of staff.

And I thought there was another provision here that permits state or local government order to supersede the provisions of this Bill during a State of emergency, to limit the number of visitors or healthcare providers who may simultaneously visit a resident. So there is some authority, notwithstanding the amendment, to allow locals to control that.

Again, I would say that's in a very narrow way, not limiting. There's no full cap on limitation. It's limiting the number of simultaneous visits for a resident.

But wouldn't you, for example, if the Bill, if we had an Ebola situation or something even worse? By the way, I went to Emory University. Ebola was down at Emory. I watched the whole operation down there at work or not.

If we had a situation like that in one of our 58 counties, or maybe two, would not the local health officials, if they felt this Bill interfered with their authority to properly manage the situation, reach out to the state health officer and the Governor and request a declaration of emergency?

They would.

Don't you think that the Governor would respond in that situation if, in fact, you had compelling reasons to do more than this Bill allows you to do?

Having the Governor have the ability to supersede is an improvement in the Bill. We think that the locals should also have the authority, knowing their jurisdiction best and in principle, with the traditions of public health that have stood California in good stead.

And in terms of Ebola, in terms of the putting, donning and doffing of personal protective equipment, we can say the conditions in which people could demonstrate their use of it. It takes a team to do that. And just demonstrating the ability doesn't mean that you can maintain it through a long visitation.

We don't know who's going to be monitoring that situation, who's going to be reporting breaks in protective equipment, that type of thing. And also, if you think about all of the efforts to do that, that will be taking staff time away to train, doing that while people need care in these situations.

Well, I don't necessarily, don't recall, but I'm not sure that the Bill requires that you take staff away to do the training. Training needs to be provided by someone.

That's correct.

You know, the other thing is we have 58 counties and we have 50 local health officers, and I am fairly certain, like any other occupation in life, there are differing levels of ability and differing levels of experience.

So I'm not sure that it's inappropriate to rely on the Governor and the health operation up here in Sacramento in the most serious and critical of cases, to call the shot as opposed to letting the shot be called 58 different ways in 58 different counties. But I guess that's just me.

Let me turn it over to my colleagues in case anyone has any questions, comments or concerns. Senator Gonzalez?

Yes, thank you, Mister chair. And thank you for the first question, because I did obviously have that same question in terms of the retention of local authority come from Long beach. I've got my own health Department. Like I often mention to folks, it's not just Los Angeles County, it's the City of Long Beach's Health Department.

And I know you've received the opposition letter, Assemblymember, you may have, but relative to that letter, it does. You know, I understand what you're doing here, and I completely feel as though folks do need that extra care and that extra visitor. I absolutely believe that.

I've had friends who've had family members that have passed during COVID with no one there. And that's very heartbreaking. Absolutely. But I also know that in Long Beach specifically, we did a pretty darn good job.

I will say. Our Doctor, Anissa Davis, who I hope you would connect with after this moves on, if it should move on, one of the best, I would say health directors in all of the State of California, and she is still very strongly opposed to this.

So it will be hard for me to support this Bill today, too. But as been mentioned, the retention of local authority, setting a precedent, the resource limitations, as mentioned, you know, the PPE which you said you would address. So I'll ask you about that, I think first, and then I'll go on to others.

Yeah, I don't have the City of Long Beach letter in front of me, so I can't reference it. Unfortunately, what I would say is, and you heard it in the exchange between the Chair and the testimony of the witnesses. We have tried to get to a point, again with this Bill.

As I said in my opening statement, more than any Bill this session, of trying to figure out a way to achieve the goal that you just mentioned, the goal of ensuring that individuals have access to their loved ones during these types of crises.

I also didn't, I didn't mention this in my opening, but I think it's important to mention this, is that this, this Bill isn't just an idea that just came out of nowhere. It was a few years ago that a colleague in the Assembly introduced and was attempting to introduce this Bill, actually.

And as a result of the process, the Bill became a study or a working group, and it required that people meet and come up with some recommendations. So this Bill is actually based on recommendations of months of work, of input from the stakeholders, all that you see at the table.

And in fact, the Bill, some might argue, is more limiting than the recommendations that came out of, out of that report.

And so we have attempted, and the latest version, which is my suggestion it was not from opposition, is let's give at least a seven day break period so that people can kind of find their feet during a time of this type of public health emergency. You just don't know what's happening. So I heard that argument.

I said, okay, well, let's give them some time. Let's give them seven days and give them an additional seven days so that they can again find their feet.

And hopefully by then they can establish all of the provisions that they require for individuals to come in and visit, including whatever protective equipment needs to be worn or any other guidance that needs to be followed. And so we've attempted to get to a place where this might not be resolved.

The opposition may just feel, and the public health official and Long Beach may just feel, that they should always just make the decision of when to allow visitors. And if that's the position, which quite honestly, I think that's really the position of public health officials, I don't know that there's going to be a common ground.

I come from the position of respecting public health, and we have to do that. And I think there's measures within the Bill to do that. But also I want to make sure that people have access to visitation.

And so again, this might just be one of those where there is no way to really come to an agreement with individuals who might just disagree with allowing folks to visit their loved ones during these public health emergencies.

Yeah. And I would, you know, certainly understand that you have taken amendments to make this a little bit more feasible for implementation. I totally thank you for that. But I don't think that health officers, or certainly my specific health officer in Long Beach, does not want to allow visitors.

I think that has been mentioned by one of the opposition witnesses is that that would be the last resort. Right. We try to do everything we can to allow the visitors allow more flexibility, accessibility first, before enacting a lot of these regulations, which quite honestly, we don't want to have to do.

But we've seen it really, really bad. I mean, Long Beach, I think, had one of the best outcomes because we were so proactive and yes, we had to make some really tough decisions, but I trusted that our Health Director made those decisions, weighing all of this, every certain factor.

But I think it does set a precedent, which I'm a little worried about. The vulnerability of other long term facility care residents also is something to consider.

I know you are considering that, but I just think if it's not just that one person that wants a visitor, what about the rest of the facility residents that may be getting something from that other visitor? And in Long Beach, we're 500,000 residents, 32 facilities. It's a lot to manage.

So it's hard to tell a health officer that, you know, you've got maybe seven days to think about it. I think it's a little arbitrary. So I'd like to continue working with you on this. I won't support the Bill today. I would ask that you do speak to R.

And I would love to convene a meeting with our Health Director so you can get a bit of an understanding of what the City's Health Department, how they function, and, you know, how well it ran despite all of this. So with that.

Sure. Just in response, if I may, I would just say that we do think that if this reaches a level, and you heard some of the exchange with the chair of where it's an emergency, that we have responsible individuals in the state and the public health officials would have time, whether it's the first seven day period or the additional seven day period, to request that the state declare an emergency to prevent this from happening.

I think. And you said it's arbitrary. Yes, it is arbitrary, because there has been no suggestion or offer on how to do that better. I'm trying to find a way to do this better, and this is something that we thought was a reasonable way to approach this.

But I'm happy to continue to talk as long as there's individuals who are willing to get to the end point of allowing visitation, which is what is stated as a desire, and we're saying the same thing. Tell us what other requirements you need to allow visitation. We're not hearing that. We're hearing we don't want to be allowed.

We don't want to be told that visitation should be allowed. We want to make that decision on our own whenever we think it's appropriate.

And I think that's where the fundamental disagreement is and where perhaps we might not be able to find common ground with public health officials potentially, but willing to continue to talk as we have been.

Thank you, Senator. Thank you, Assemblymember, for continuing to talk. Colleagues, any other questions, comments or concerns? I hear. I see. Senator Grove. Senator Grove.

Thank you, Mister chair. My apologies, Assemblymember and Chair, I was chairing rules, presenting, balancing health. So I apologize that I was late. I appreciate the conversation that we had about this Bill. I think all of us had similar stories to share during COVID a few years ago.

I think you have approached this in a very thoughtful manner, giving our public safety people, or, excuse me, our public health people, individuals or directors to be able to address concerns that they have and also if the Bill is passed, that they have the opportunity to remedy something, if something desperately needs to be taken care of.

But I listened to some of the objections or read some of the objections, and, you know, and I listened to my esteemed colleague next to me, and I think that you've approached this in a very thoughtful way. I understand it's a tough issue to come together on, but it's a very thoughtful way.

I think there's always a way where there's a, you know, where there's a will, there's a way. If there's a concern, which there very well could be about other residents, you could have an isolated room with a separate entrance. Most people have those in those facilities.

We had somebody meet in a stairwell one time during COVID just to, you know, provide that person comfort that was isolated. So I think there's, where there's a will, there's a way. And I think that the way you approach this Bill was very well balanced.

And so thank you for the conversation and answering all my questions that I had on the phone call the other day. Appreciate it, and I look forward to supporting your Bill today.

Thank you.

Thank you, Senator Grove, any other questions, comments or concerns? I don't see any. It's a very difficult issue. I appreciate the fact that you took the time to come and present your views. Very, very informative. So thank you, Senate Member, would you like to close?

Thank you again, appreciate the conversation. I think we're trying to accomplish a goal. It's not always easy. We've attempted again over months now to try to find a way to achieve public health safety.

Not a public health expert, I acknowledge that we do rely on that input, but really it would be helpful going forward is to try and get to the, try to get to yes. I always try to get to yes on my colleagues and their bills and when there's questions.

And I kind of need this to move along, to be able to hopefully message that we need to figure out a way to reach that common ground to ensure that this happens. At the end of the day, we learned a lot of lessons from COVID I do think we should remember that era, but we should also not continue.

We should learn from it. And I think that's what the intent of this conversation was through the working group that was formed. They learned from the, those mistakes and they learn from what worked well. And the legislation before you is reflective of that. And for that reason, I ask for your aye vote when appropriate.

Thank you. Assemblymember, I just want to say that you've taken a very professional approach to the way that you have managed this bill. I've appreciated that. You've obviously heard some concerns from some of my colleagues and some of those who have presented today.

I ask you to should the bill move forward, I ask that you continue to engage in conversations not only with my colleagues, but with those on, on both sides of the issue to see where we go. We don't have a quorum.

As soon as we do get a quorum, we'll take a motion and we'll take a vote on the bill. And again, thank you. Thank you all for presenting. Let's move to item number eight, Assemblymember Aguiar-Curry, Medical telehealth. Please proceed when ready.

Thank you for joining us.

Great. Thank you. Good afternoon, Senators. When I authored AB 32 in 2022, my clear intent was to increase patient choice and access to care via all forms of telehealth services for people, regardless of the type of health insurance.

Currently, people with private insurance benefit from insurance policies that cover all telehealth services equally, including mobile apps through asynchronous messaging. These apps are important because working families can access medical care on their own schedule without having to take time away from work or their families.

However, current Medi-Cal policies restrict asynchronous health telehealth options for their beneficiaries to only certain circumstances, which creates barriers to equitable care. This particularly impacts the ability for Medi-Cal beneficiaries to access sensitive services like reproductive and mental health care, that can be appropriately provided using asynchronous modalities, like apps.

AB 2339 would expand access to sensitive healthcare services that can be provided using asynchronous modalities for Medi-Cal beneficiaries. Allowing Medi-Cal beneficiaries to access this form of care will provide equal access to asynchronous telehealth services and give Medi-Cal beneficiaries the same convenient care as their peers with private insurance.

With me today to speak in support of the Bill is Mai Fleming, MD, FAAFP Assistant Clinical Professor at the Department of Family and Community Medicine at UCSF, and Molly Robson, Vice President of Governmental Affairs for Planned Parenthood Affiliates of California.

Welcome to you both. Thanks for joining us. Please proceed. Please identify yourselves for the record first, though. You might want to pull that a little closer. The last speaker decided to move it to the middle.

Hello. Good afternoon, Chair Roth and Health Committee Members. My name is Doctor Mai Fleming. I am a Family Medicine Physician with UCSF who provides medication abortion via telehealth with Hey Jane. I'm here today in strong support of this Bill.

So here in California, a state that is proud to be a reproductive freedom state, about a third of our counties still do not have a single abortion provider, leaving thousands of people without a local option when in need of abortion care.

This gap is currently being met by telemedicine providers like me who have been able to reach patients in every single one of those counties, including all of the most rural counties in California. This means that those patients have been able to access critical reproductive healthcare without needing to travel hours or hundreds of miles away to the nearest clinic.

For some, particularly young people, people experiencing reproductive coercion, people who cannot take time away from their jobs or to find childcare, finding the time, space, safety and privacy, even for a synchronous telemedicine visit, let alone for an in person visit, can be an impossible task, especially for a sensitive service like abortion care.

In asynchronous care, we ask all the same questions, order all the same medically indicated testing, and provide the same high standard of care with a robust multidisciplinary team of physicians, advanced practice Clinicians, nurses, just the same as we would with either in person care or synchronous telemedicine care.

And for some people, the only viable option for folks, without needing to interrupt their busy daily lives, is getting care via asynchronous care.

Asynchronous telemedicine, abortion care specifically, has been vigorously studied and has been found to be just as safe and effective and acceptable as in person care, including one study that was published by the American Journal of Public Health just this year showing that patients actually felt more cared for with asynchronous care than synchronous care within this care.

And my patients nearly universally expressed gratitude for having this care modality available, detailing how convenient it was, how they didn't know if, how, or even whether they would be able to access this abortion care without this option available.

Where I practice care, we actually offer the option of doing synchronous care or asynchronous care, and less than 1% of our patients actually even choose synchronous care. 99% prefer asynchronous care.

But this convenient, safe, and for some necessary option is not available to those who may have the highest need, because as it stands, Medi-Cal prohibits me from using asynchronous care to establish a patient-provider relationship with my patients.

Nearly one third of the patients accessing our services report an income of less than $20,000 a year, below the income limit to qualify for Medi-Cal.

So that means that thousands of the lowest income patients are being barred by California from being able to use their insurance to receive care from me in the modality that they need, or else forcing them to surmount additional barriers to attend a sensitive, synchronous telemedicine or an in-person visit.

Additionally, my patients who access asynchronous care are often able to receive the care that they need within days of finding out that they are pregnant, a timeframe that is unheard of in in-person care, or even synchronous telemedicine care, and a timeframe that everybody, regardless of their insurance, should be able to access.

AB 2339 would enable patients covered by Medi-Cal, those who already face some of the highest barriers to care, to access this timely, asynchronous telemedicine care and eliminate the barriers that I've personally seen with synchronous and in-person care.

Everybody deserves to act as care in the way that best suits their individual needs and circumstances, and that includes people who are publicly insured.

The State of California and all of you, as a representative of the people who live here, need to stand true to its promise as a reproductive freedom state and not be what stands in the way of people accessing equitable reproductive healthcare by voting yes on this Bill. Thank you.

Thank you, Doctor. Thanks for joining us. Yes, ma'am.

Hi, good afternoon. Chair Roth and Members. Molly Robson with Planned Parenthood Affiliates of California, representing seven affiliates that provide comprehensive sexual and reproductive health care, gender affirming care, and behavioral health services throughout the state.

When Covid began four years ago, Planned Parenthood quickly moved to implement secure telehealth appointments for sensitive services like birth control, STI treatment, pregnancy counseling, PrEP and PEP, and gender affirming care. Today, telehealth continues to be a popular choice for Planned Parenthood patients, even when in-person appointments are available.

Our patients continue to have the choice to access crucial services via telehealth without having to worry about the additional time and resources necessary to make an in-person appointment. More than 1 million Medi-Cal patients are seen by Planned Parenthood providers each year, comprising 80% of all Planned Parenthood patients in California.

In serving a patient population that is disproportionately low-income and historically underserved, Planned Parenthood strongly believes that telehealth, including asynchronous telehealth, is critical to address the health inequities and improve access to healthcare services for this population.

This Bill will ensure Medi-Cal patients have equitable access to healthcare through the same options afforded to commercially-insured patients, establish consistency in state law with existing protections for synchronous telehealth, and preserve a patient's right to choose a new provider for sensitive services via asynchronous telehealth platforms. I respectfully urge your aye vote on this Bill today. Thank you.

Thank you. Thanks for joining us. Any other witnesses in support? Name, affiliation and position only on the measure, please. Yes sir.

Thank you, Mister Chair and Members. David Gonzalez, on behalf of America's Physician Groups in support. Thank you.

Thank you. Next please.

Vanessa Cajina, on behalf of the California Academy of Family Physicians here in support.

Martin Radosevich, on behalf of Reproductive Freedom for All California in support.

Sarah Bridge, on behalf of Hims and Hers in support.

Libby Sanchez, on behalf of AltaMed in support.

Craig Pulsipher, on behalf of Equality California in support.

Abby Alvarez with LeadingAge California in support.

Thank you. Any other witnesses in support? Now let's turn to witnesses in opposition. Any lead witnesses first? Any others? Any other witnesses in opposition? Seeing none. Let's bring the matter back to the dais. Colleagues, any questions, comments or concerns? I see none. Assemblymember, it's your lucky day, you close.

I don't know if it's a lucky day. I'd like to have this done. You know, Senators, let me just be clear. This Bill does not change and certainly does not weaken the right for in-person care healthcare for Medi-Cal beneficiaries. It's just requiring, existing law requires any technology used for asynchronous telehealth to be secure and confidential, and that is always with a licensed health provider. Many modern health systems already have secure mobile applications for patient communication and electronic data transmission.

This Bill simply confirms the coverage of app-based telehealth services for Californians on Medi-Cal with those that have private insurance. Now, essentially what you're voting on today is whether or not Medi-Cal beneficiaries can have the same access to sensitive services that you all have with your private health insurance provider today.

Further, this Bill aligns with California's emphasis on patient choice in telehealth and further statewide efforts to expand access to reproductive and mental health care. I respectfully ask for your aye vote.

Thank you, ma'am. Thank you for joining us. As soon as we establish a quorum, we'll take a motion and we will take a vote.

We appreciate it. Thank you very much.

Next, Assemblymember Low has decided to allow Doctor Wood to proceed. Next, so we're going to take item number 17. Assembly Bill 2749 California Health Benefit Exchange Financial Assistance next. Doctor Wood, please proceed when ready.

First of all, I thank Assemblymember Low again, much appreciated and thank you Mr. Chair and Members. So I'd like to start by thanking you and Mr. Chair and Committee staff for your work on this bill. In recent years, California has made enormous strides towards both universal health coverage and labor relations.

In 2022, I authored AB 2530 which required Covered California to administer a program for workers who lose health insurance coverage due to a labor dispute. Under this program, those consumers would receive the same premium and cost sharing assistance as a consumer whose household income is at 138.1% of the federal poverty level.

During the first year of AB 2530's implementation, it was discovered that further clarification is needed in the language. Labor disputes, particularly in large industries, can be complex and affect surrounding employers and workers. This proposal clarifies eligibility for the program to reach the intended target of workers and employers who are directly involved in the strike.

It also provides additional clarifications and changes to the law that will better enable Covered California to implement the program and ensure benefits of this important program are administered effectively to workers who need them. Here to testify and support is Beth Cappell, representing a coalition of labor organizations, including Teamsters and Unite Here.

And here to answer any technical questions is Kelly Green, Director of Communications and External Affairs for Covered California.

Welcome to you both. Please proceed morning or afternoon.

Good afternoon, Chair. Beth Capell on behalf of Teamsters and Unite Here, and as a courtesy, the UFCW and SEIU as well with many other supporters. We're here in support. We're also here to report that the earlier legislation. We have happy things to report. It was implemented quickly and effectively by Covered California.

It went into effect on July 1 of last year, and in August there was a strike of a Teamster unit down the Central Valley where they lost health benefits and Covered California scrambled immediately and got them the coverage they were obligated to provide under the law.

In working through last year, both the entertainment industry strike that affected so many, and also the potential of a Teamsters UPS strike that would have affected more than 40,000 California families, we found that the law needed additional clarification, and the bill you have before you represents the decisions we made along with Covered California over the course of the year in attempting to implement the law.

I would also remind those of you who are on the Budget Committee that there is a pending budget request to assure that if we are in a situation similar to a Teamster UPS strike with tens of thousands of affected Californians, that there will be sufficient resources to meet the needs of all those Californians.

And with that, thank you. And we're pleased to be here in support.

Thank you for your presentation. Any other witnesses in support?

Thank you, Mr. Chair and Members. Megan Subers, on behalf of the Writers Guild of America West in support.

Thank you. Next, please.

Yvonne Fernandez, California Labor Federation in support.

Thank you. Next, please. Yes, ma'am.

Janice O'Malley with AFSCME California in support.

Thank you. Any of the witnesses in support? Witnesses in opposition to this measure? First, any lead witnesses? Any other witnesses in opposition? Seeing none. Let's bring the matter back to the dais. Colleagues, any questions, comments or concerns? Seeing none. Doctor Wood, you may close.

Just respectively request an aye vote when you get a quorum, and I feel your pain on that.

As soon as we get a quorum, we'll take a motion and we will do just that, sir. Thank you for your presentation.

Thank you, Members.

Assemblymember Low, item number five. AB 2132 Healthcare Services. Good to see you back, sir. Nice tie.

Please proceed when ready.

Thank you very much Mister Chair and colleagues. Happy pride. Good to see each and every one of you. And thank you very much for allowing me to present Assembly Bill 2132 which of course helps to ensure that we're tackling the unfortunate rise of tuberculosis in the State of California by requesting that physicians then help to address this issue.

By requesting that of offering TB screening tests, which of course will help to ensure that we're tackling this issue of rising cases in the State of California. I have additional witnesses to testify in support and I respectfully ask for aye vote.

Thank you, sir. Please proceed when ready. Please identify yourselves for the record though.

Honorable Members of the Senate Health Committee. My name is Priyanka Manghani and I am a public health professional and epidemiologist, having worked on TB and HIV control across India, Africa, and on USAID and CDC funded projects.

I'm also a tuberculosis survivor and I wish to leverage my personal journey and expertise to pioneer innovative solutions aiming to eradicate infectious diseases and transform lives. If we were to exclude COVID-19 data, TB is the deadliest infectious disease worldwide and kills every someone every 20 seconds.

Californians are disproportionately impacted by tuberculosis with an estimated 2 million Californians infected with TB. Of these 2 million Californians, only 23% are aware of their infection and only 13% have been treated. We have doubled the rate as compared to the national average seen in the United States. TB is underdiagnosed.

Latent tuberculosis infection can harbor itself in the patient's body for decades, such as 20 to 30 years without symptoms, and many people thus will not know that they have an infection until it is too late. Furthermore, people with latent TB infection do not have symptoms and they cannot spread TB bacteria to others.

However, the latent TB bacteria can become active in the body and multiply and in that case, the person will go from having a latent TB infection to being sick with active tuberculosis disease, which is a probability seen in 10 to 15% of the cases.

And for this purpose, it's crucial that people with latent TB infection should be treated so as to prevent them from developing an active TB disease. As a TB survivor, I cannot stress enough the importance of testing and timely treatment.

I was diagnosed with active TB and initially had no symptoms besides weight loss, which further developed into chest pain. This led to a complicated diagnosis since I had no productive cough to even do a sputum test.

I was finally diagnosed on the basis of a CT scan, which showed active TB infection, post which I completed my entire treatment and was declared TB-free after nine months of daily adherence to my medications. Adherence to TB medications is highly crucial, as poor adherence can promote the emergence of multidrug-resistant TB.

It can also promote prolonged infectiousness and poor treatment outcomes, as well as death, which has been seen in various TB endemic zones where I have worked in. TB kills more than 200 Californians each year. The percentage of people with TB who have been dying has been increasing.

In the year 2021217 people with TB died, that is 12% of the TB cases. Of these 61 people, that is, 28% died even before receiving treatment for TB. We've also seen that the vast majority of TB cases, which is 85%, have been attributable to progression of a latent TB infection to active TB.

In 2023, there were eight new TB outbreaks and 13 outbreaks are currently ongoing in 14 jurisdictions, each involving at least four persons.

Recently, we saw that the City of Long Beach in California in May 2024 declared a public health emergency due to an outbreak of tuberculosis, which had 14 active TB cases, nine hospitalization, as well as one death, and there were 170 people exposed.

These spikes can be attributed to the bacteria lying dormant for years before becoming deadly, which means that we had 20 to 30 years where we could have easily helped these patients get rid of their TB infections. The medical and societal cause of tuberculosis reached $265 million for California in the year 2023.

There's also a high burden of TB in patients with diabetes, end-stage renal disease, HIV infection, as well as hepatitis C. With people living with HIV are 16 times more likely to fall ill with TB as compared to those without HIV infection. And TB is known to be the leading cause of death in people infected with HIV.

Additionally, populations like Asian American Pacific Islanders, Latino, Black, as well as homeless populations are at a higher risk for tuberculosis for latent tuberculosis infection. We can't afford to make this mistake anymore. This is an issue of health equity.

AB 2132 would give these 1.5 million Californians a chance to become aware of their infections and make informed decisions about their health. Thank you for your time.

Thank you very much. That was almost five minutes, so that was fine. We need the presentation. Sir, I'd ask you to move it along. Thank you. Sure. Yours is equally valuable. So.

It is, but I will be on the brevity side. Thank you.

Thank you.

Honorable Members of the Senate Health Committee, my name is Michael Carson. I am the retired Orange County Tuberculosis Program Manager, and I am past President and current member of the California TB Controllers Association and a current member of the California Tuberculosis Elimination Advisory Committee.

In 2016, during my tenure as California TB Controllers Association President, we worked with the California Department of Public Health to issue a scientifically based provider piloted tool and user's guide for TB risk assessment and guidance for latent TB infection, or LTBI, testing.

In September of 2016, the United States Preventive Services Task Force issued recommendations for LTBI testing in primary care facilities. In 2017, Orange County conducted a study published in 2022 that found interventions, including adoption of a standardized TB risk assessment provider training, and use of a care coordinator, can help increase LTBI screening, testing, and treatment in community clinics.

Before this bill was even conceived, CDPH conducted a modeling study published in 2020 that simulated the exact provisions of this bill.

The study found that hypothetical testing and treatment with 100% adherence to either the USPSTF or CDPH tool testing recommendations would result in a 40% decline in active TB cases and a 45% decline in LTB prevalence within the first 10 years of implementation.

Even testing 25% of eligible patients during primary care encounters would result in a 30% decline in cases from baseline levels based on current scientific evidence, the California Adult TB Risk Assessment and Users Guide were updated in 2024.

This risk assessment and the Guide for Medical Providers to Prevent TB in four steps, plus other provider resources and tools are currently available on the CDPH tbfreecalifornia.org website.

AB 2132 will not only empower providers and patients to bring TB to the forefront of health, but also allow community-based organizations doing TB outreach to conduct much more robust work in their communities. Thank you for your time.

Thank you for your presentation. Any other witnesses in support? Name, affiliation, and position on the measure only, please.

Thank you. Dylan Elliott on behalf of the City and County of San Francisco in support.

Thank you. Next please.

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

Thank you. Yes ma'am.

Kat DeBurg, Health Officers Association of California in support.

Thank you. Yes sir.

Geoffrey Neil, representing the County of Contra Costa, also in support.

Thank you for joining us. Any other witnesses in support? Any other witnesses? Any witnesses in opposition? Let's start with lead witnesses in opposition? Feel free to take the table if you'd like.

Mister Chair. I'll be 20 seconds. So, give you some time back. Marvin Pineda on behalf of the California Primary Care Association, we want to thank the author and the sponsors for the progress they made on the bill. We continue to oppose unless amend due to the mandate.

We look forward to continuing to work with the sponsors and the author to remove our opposition. Thank you.

Thank you. Any other opposition witnesses? Seeing none. Let's bring the matter back to the dais. Questions? Senator Gonzalez.

Just want to say thank you for bringing this forward. You mentioned Long Beach and unfortunately having an outbreak. This is absolutely much needed. So, I don't think we have a quorum, but at the time we do. I'll be happy to motion. Thank you.

Assembly Member thank you very much. Please remind me, Senator, thanks for your comments. Any other comments? Questions? Concerns? Seeing none. Assembly Member Low, you may close.

Thank you very much, Mister Chair. And I just want to highlight a recent LA Times article in March 25th highlighting that the headline of this article is tuberculosis cases rising in California and state officials are sounding the alarm. This of course is important and imperative that we help address this issue.

I also want to acknowledge to thank the Committee for their work and accepting committee amendments as well. And I respectfully ask for your aye vote.

You read my mind. Thank you, sir. As soon as we get a quorum, we will take a motion and we will do just that. Thank you two for joining us.

Thank you very much.

Okay, Assembly Member Zbur, Assembly Bill 2258, healthcare coverage cost sharing. Please proceed when ready. Thank you for joining us.

Mr. Chair and Members. First, I want to begin by thanking the Committee for all their hard work and I accept the Committee's proposed Amendments. I'm proud to present AB 2258 which is sponsored by Insurance Commissioner Ricardo Lata, Equality California, APLA Health, the Los Angeles LGBT Center, and the San Francisco AIDS Foundation.

A study found that a $10 cost for HIV prevention medication doubled prescription abandonment rates, increasing the potential for HIV infections in these patients. Barriers to preventive care force people to choose between preventing expensive and devastating health problems before they occur, and putting food on the table.

While we do have protections for preventive care in California, some of them are based on federal protections, and there's concern that recent court cases may put federal preventive service requirements on which our state relies into peril.

That is why AB 2258 is so important, as it will codify in California law existing federal guidance requiring health plans and health insurers to cover services that are integral to the delivery of recommended preventive services without out of pocket costs, including reversible contraceptives, PREP and HIV and other STI screenings.

In essence, this bill is about ensuring that low income people have access to the same comprehensive and affordable preventive health care as everyone else. With me today are Craig Pulsipher, representing Equality California, and Kate Fisher from the California Department of Insurance, sponsors of the bill to provide additional information and assist with questions.

Thank you, sir. Please proceed when ready. Of course identify yourselves for the record.

Good afternoon, Chair and Members. Craig Pulsipher on behalf of Equality California, co-sponsor of AB 2258. Over the last several years, Equality California and the other co-sponsors of this bill have advanced and supported numerous efforts to ensure that LGBTQ and all Californians have access to comprehensive and affordable preventive healthcare.

These services include critical health interventions such as screenings for lung and colorectal cancer, statins to prevent cardiovascular disease, and PREP for HIV prevention.

Because of both state and federal guidance under the Affordable Care Act, health plans are required to cover not only the preventive services themselves, but also all of the services that are integral to providing the recommended preventive benefit without any patient cost sharing.

In the case of PREP, for example, this includes regular doctor visits, HIV and STI screening, and other labs that are an integral part of ongoing PREP care.

In large part because of the Affordable Care Act, PREP is now available at no cost to the vast majority of Californians who need it, and this remains a critical part of our ongoing efforts to end the HIV epidemic in California. Unfortunately, the progress we've made to expand access to PREP and other preventive services is currently under threat.

Just last year, a federal judge in Texas struck down key provisions of the ACA requiring health plans to cover preventive services at no cost. And while the case is currently on appeal, we must act now to strengthen existing law and protect access to these preventive services, regardless of what happens in the courts.

Importantly, AB 2258 will not impose any new requirements on health plans. It will simply codify existing state and federal guidance to ensure that our laws are as strong as possible in the face of ongoing attacks on the Affordable Care Act. Appreciate the sound membership in this space and respectfully urge your aye vote.

Thank you. Next, please.

Hi, Katie Fisher. I'm an attorney in the health equity and access office at the Department of Insurance. I'm here today on behalf of Insurance Commissioner Ricardo Lara.

We're proud co-sponsors of the bill and I don't think I could say anything better than what has already been said, so I can answer any questions, but we respectfully request your aye vote.

Thank you. Thank you for your brevity and thank you for being here, both of you. Witnesses in support, please identify yourselves. State your affiliation position on the measure only, please. Thank you, ma'am.

Becca Cramer, mater on behalf of ACLU California Action in support.

Thank you. Next please.

Thank you. Vanessa Kahina, on behalf of the California Academy of Family Physician here in support.

Thanks for joining us. Yes, ma'am.

Jennifer Robles with Health Access California in support.

Libby Sanchez, on behalf of AltaMed in support.

Thank you.

Meagan Subers, on behalf of the Los Angeles LGBT Center and CPCA Advocates in support.

Sandra Poole, on behalf of Western Center on Law and Poverty in support.

Thanks. Yes, sir.

Matt La Jay with SAIU California in support.

Thank you.

Abby Alvarez, on behalf of the San Francisco AIDS Foundation and Apple Health in support.

Thank you. Any other witnesses in support? Witnesses in opposition? Any witnesses in opposition? Lead opposition witness free to join us at the table or Mic's okay.

Hi. Mr. Chair Member. Steffanie Watkins on behalf of the Association of California Life and Health Insurance. First we'd like to thank the work the Committee's done and the author and sponsors. We did have a concern not on the underlying proponents of the bill, but specifically to enforcement language that was added.

We did get more clarity from the Department, so I really appreciate that and also the work that the Committee did on the language.

We'll be taking that back to our members, but I think our general discussion item would be to look towards the Department if there is additional enforcement authority that's necessary, just in general in the insurance code. We'd like to have that as a broader conversation with the Department and potentially a standalone bill to be discussed in future reference. Thank you.

Thank you. Thank you for working with the author and other individuals. Okay. Seeing no any other witnesses in opposition? Seeing none. Let me bring the matter back to the dias. Colleagues, any comments, questions or concerns? Seeing none. Assemblymember, you may call close.

Thank you so much. I want to thank your staff again, and I respectfully ask for an aye vote at the appropriate time.

As soon as we find the other Committee Members and establish a quorum, we will take a motion and we will do exactly that. Nice presentation. Thank you very much.

The Senate Committee on Health will be in recess for five minutes. Quorum first. Please call the roll.

[Roll Call].

We have a quorum. We also have an author, Senator Smallwood-Cuevas, presenting on behalf of Assembly Member Jones-Sawyer Item Number Three: Assembly Bill 2064: Community Violence Interdiction Grant Program. Please proceed when ready.

Thank you so much, Mr. Chair and Colleagues. I'm here to present, on behalf of Assemblyman Reggie Jones-Sawyer, AB 2064, which will establish the Community Violence Interdiction Grant Program. This bill is among the 14 priority bills identified by the California Legislative Black Caucus as part of the Reparations Bill Package.

This bill would be administered by the California Health and Human Services Agency and would require funding for community-driven solutions to decrease violence in our schools and neighborhoods as opposed to the continuation of incarceration. The funds would be secured through an appropriation of the savings from any future prison closure within the state.

By allocating resources to these preventative initiatives, we reduce incarceration even further and focus on finding solutions to crime beyond the incarceration of our most vulnerable and underserved populations. AB 2064 allows for true rehabilitation through putting an emphasis on the community and the victims impacted, gives them voice, and reduces monetary expenditures accrued on imprisonment which has not been shown to reduce recidivism. I want to thank you, Chair and Members, for your attention. I respectfully ask for your aye vote.

Thank you. Any witnesses in support of this measure?

Dylan Elliott, on behalf of the California Academy of Child and Adolescent Psychiatry, in support. Thank you.

Thank you.

Kelly Brooks, on behalf of the Los Angeles County Board of Supervisors, here in support.

Thank you.

Sandra Poole, on behalf of Western Center on Law and Poverty, in support.

Thank you very much. Any other witnesses in support? Seeing none, witnesses in opposition? Seeing none. Bring it back to the dais. Colleagues, any questions, comments, or concerns? If not, seeing none, Senator, you may close.

Well, I thank you for your time and respectfully ask for your aye vote.

It's been moved by Senator Menjivar. Please call the roll.

[Roll Call].

Current vote is six to one. We'll hold that matter open for absent Members. Thank you. Let's now just point out to those who weren't here. Two bills were pulled from today's agenda. Item number 12, AB 20319 Assembly Members Wilson and Weber.

And item number 18, AB 3218 Assemblymember Wood we have 10 bills on our proposed consent calendar. Item number one, AB 1841 Assemblymember Weber student safety. Item number six, AB 2161 Assembly Member Arambula the Early Psychosis Intervention plus program. Item number seven, AB 2237 Assembly Member Aguiar Curry children and youth.

Item number nine, AB 2703 Assemblymember Aguiar Curry federally qualified health centers and rural health clinics. Item number 11, AB 2271 Assembly Member Ortega St. Rose Hospital. Item number 13, AB 2428 Assemblymember Calderon Medi Cal. Item number 14, Assembly Bill 2549 Assembly Member Gallagher patient visitation with amendments.

Item number 15, AB 2550 Assembly Member Gabriel business establishments. Item number 16, AB 2599 Environmental Safety and Toxic Materials Committee. Water and item number 19, AB 2859 Assembly Member Jim Patterson. Emergency medical technicians. Peer support with amendments. Is there a motion? Moved by Senator Nguyen. Please call the roll. The motion, by the way, is to the consent calendar.

[Roll Call]

Vote is 8-0. We'll hold the roll open for absent Members. Item number two, AB 1843, Assemblymember Rodriguez, emergency ambulance employees. The motion is do pass as amended, and we refer to the Committee on Judiciary. Is there a motion? Moved by Senator Glazer. Please call the roll.

[Roll Call]

Vote is 8-0. We'll hold the row open for absent Members. Item number four, AB 2075. Assemblymember Alvarez, resident Access Protection act. The motion I'll solicit is do pass as amended, and we refer to the Committee on Human Services. Is there a motion? Oh, Hurtado. Senator Hurtado made the motion. Please call the roll.

[Roll Call]

Seven to one. We're missing people still, right? Yeah. Rope is solid, Bill. Current vote is seven to one. We'll hold the row open for absent Members. Next item is item number five. AB 2132 Assemblymember Low health care services motion do pass as amended. rerefer to the Committee on Judiciary. Is there a motion?

Gonzalez had said earlier she wanted to.

Well, she's got to be here, though.

She's not here.

Senator Nguyen moves it. Let's call the roll.

[Roll Call]

I vote is 9-0. We'll hold the row open for APPCN Members. Next item. Item number eight. AB 2339 Assemblymember Agar Curry, medical telehealth. The motion will be do pass it and we refer to the Committee on Appropriations. Is there a motion? Senator Rubio makes the motion. Please call the roll.

[Roll Call]

Vote count is eight to zero. We'll hold the row open for absolute numbers. Next item. Item number 10. AB 2258, Assembly Members of health care coverage, cost sharing. The motion, if made, is do pass as amended, and we refer to the Committee on Appropriations. Is there a motion? By Senator Hurtado. Please call the roll.

[Roll Call]

Count is 90. Will hold the row open for Epson Members. Next item is item number 17. AB 2749 Assemblymember Wood, California Health Benefit Exchange. The motion, if made, do pass and re refer to the Committee on Appropriations. Is there a motion by Senator Glazer? Please call the roll.

[Roll Call]

Count is 90. We'll hold the row open for absent Members, and that count concludes the list we can get. Which ones do we have to call? Let's open the roll. We're going to start first on the consent calendar. For those of you who weren't here. The consent calendar. You know what it is. The motion was made by Senator Nguyen. The vote count on the consent calendar is eight to zero. Please the chair voting aye.Please open the roll,

[Roll Call]

Current vote is 10-0. We'll hold the row open for absent Members. Next item. Item number two. AB 1843. Assemblymember Rodriguez, emergency ambulance employees. The motion was do pass as amended and refer to the Committee on Judiciary. Current vote count is eight to zero. Chair voting aye. Please open the roll.

[Roll Call]

Current vote 10-0 will hold the row open for absent Members. Next item. Item number three. AB 2064. Assembly Member Joan Sawyer, Community Violence Interdiction grant program. Motion is do pass and refer to the Committee on Public Safety. Current vote 6-1. Chair voting aye. Please open the roll.

[Roll Call]

Current vote count nine to one. We'll hold the row open for absent Members. Next item. Item number four. AB 2075. Assemblymember Alvarez, resident Access Protection act. Motion to do pass, as amended, and we refer to the Committee on Human Services. Current vote seven to one share voting aye. Please open the roll.

[Roll Call]

Current vote 7-1 will hold the roll open for absent Members. Next item. Item number five is AB 2132. Assemblymember Low health care services. Motion do pass, as amended, and re refer to the Committee on Judiciary. Current vote 9-0 chair voting aye. Please open the roll.

[Roll Call]

Grove current vote 10-0 we'll hold the row open for absent Members. Next item. Item number eight. AB 2339. Assembly Member Aguiar Curry, medical telehealth. Moved by Senator Rubio. Motion do pass and re refer the Committee on Appropriations. Current vote 8-0. Chair voting aye. Please open the roll.

[Roll Call]

Current vote 9-0 hold the roll open for absent Members. Next item. Item number 10. AB 2258. Assembly Members of healthcare coverage cost sharing. Moved by Senator Hurtado. Motion do pass, as amended, and re refer to the Committee on Appropriations. Current vote 9-0 chair voting aye. Please open the roll. [Roll Call]

Current vote 9- 0 we'll hold the row open for absent Members. Next item. Item number 17. AB 2749 assemblymember Wood, California Health Benefit Exchange motion do pass and read. Refer to the Committee on appropriation moved by Senator Glazer. Current vote 90. Please open the roll. [Roll Call] Current vote 90. We'll hold the roll for absent Members. And that is it. On this go round,

That's okay. Let's open the roll. We're going to start with the consent calendar. Do I need. Senator, do I need to read off the bills for you for the consent calendar?

No, thank you, sir.

Okay. The consent calendar moved by Senator Nguyen. The motion do pass. Re refer the Committee on appropriations with the recommendation to send to the consent calendar. Current vote is 10-0. Care voting aye. Please open the roll.

[Roll Call]

Vote is 11-0. The consent calendar is out. Next item. Item number two. AB 1843. Assemblymember Rodriguez, emergency ambulance employees. The motion was do pass as amended. Re refer to the Committee on a Judiciary made by Senator Glazer. Current vote, 10-0. Chair voting aye. Please open a roll.

[Roll Call]

Grove aye. Vote -. That Bill is out. Next item. Item number three. AB 2064 by Assembly Member Joan Sawyer. Community Violence Interdiction grant program. Senator, men made the motion. Senator men. Senator Menjivar made the motion. Do pass. Re refer to the Committee on Public Safety. Current vote, nine to one share voting aye. Please open the roll.

[Roll Call]

Count is nine to two. That Bill is out. Next item. Item number four. AB 2075. Assemblymember Alvarez, resident Access Protection act. Motion by Senator Tahoe. Do pass, as amended, and re refer the Committee on Human Services. Current vote, seven to one. Chair voting aye. Please open the roll.

[Roll Call]

Current vote, count eight to one. That Bill is out. Item number five. AB 2132. Assemblymember Lowe, healthcare services. Motion by Senator Nguyen. Do pass, as amended, and re refer to Committee on Judiciary. Current vote, 10-0. Chair voting aye. Please open the roll.

[Roll Call]

Count 11-0, that matter is out. Next item. Item number eight. AB 2339. Assemblymember Aguiar Curry, Medi Cal Telehealth. Motion by Senator Rubio. Do pass and refer to the Committee on Appropriations. Current vote is nine to zero. Please open the roll. Chair voting aye.

[Roll Call]

Current vote, count 9-0, that matter is out. Next item. Item number 10. AB 2258 by Assembly Members of health care coverage cost sharing. The motion by Senator Hurtado. Do pass, as amended. And we refer the Committee on Appropriations. Current vote. Count 9-0. Chair voting aye. Please open the roll. [Roll Call] Current vote, 9-0.

That matter is out. Next item is item number 17, AB 2749 by Assemblymember Wood. California Health Benefit Exchange motion by Senator Glazer. Do pass and re refer to the Committee on Appropriations. Vote count is 9-0. Chair voting aye. Please open the roll. Senator Nguyen Grove vote count is 9-0. That matter is out. And that concludes the agenda for the Health Committee for today. We are adjourned.