Health care reform efforts soldier on in California
Even in a year consumed by sickness, California legislators are considering significant — sometimes controversial — health policy measures.
California lawmakers are barreling toward an end-of-month deadline to pass or kill bills amid the biggest public health crisis the state has faced in a century.
Yet even in a year consumed by sickness, they’re considering significant — sometimes controversial — health policy measures that aren’t directly related to COVID-19.
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Much of this legislation predates the pandemic, having lacked the support to win approval in previous years. Now, the bills are making significant progress because they underwent rigorous vetting in the past. That puts them steps ahead in a year with little time for deliberation or debate.
They include bills to ban the sale of flavored tobacco products, such as menthol cigarettes and vaping liquids; allow California to develop its own brand of generic drugs; enhance the state attorney general’s power to reject hospital mergers; and allow nurse practitioners to practice independently.
“Some of these bills, which have pretty far-reaching effects, may just sweep through because [lawmakers are] trying to get out of here by the end of August,” said Garry South, a Democratic political strategist.
The California legislature has had a bizarre year. Lawmakers left town abruptly in March to comply with lockdown orders and then again in July when some Assembly members tested positive for COVID-19, cutting the legislative session short.
The reduced time means most policy committees scheduled fewer hearings in the last weeks of the session to debate bills. Because of COVID-19 restrictions, most witnesses are giving testimony over the phone and in video conferences, lawmakers are unable to have informal meetings in the hallways, and advocates have less opportunity to lobby officials.
Lawmakers face an Aug. 31 deadline to send bills to Gov. Gavin Newsom, who has until the end of September to sign or veto them.
Given the shortened time frame for voting and deliberation, legislative leaders repeatedly asked committee chairs and members of their houses to reduce their legislative load, focusing on the most pressing challenges, like COVID-19 and wildfires. Despite those directives, most officials acknowledge a need to address more than those issues this year.
“We have the capacity to do many different things, and there are many things we must tend to in this state,” Newsom said at a press conference in late July. “I look forward to signing many bills that the legislature sends down.”
Passage is not guaranteed in the last three chaotic weeks of the legislative session, but the following major health care bills have made it through one house of the legislature and are working their way through committees in the second chamber.
- SB-977 would give the attorney general new authority to regulate and potentially deny mergers between large for-profit hospitals, private equity firms and physicians’ groups. Attorney General Xavier Becerra has been working on this legislation for years in the face of strong opposition from hospitals.
- SB-793 is an enormously controversial bill that would go beyond the recent federal ban on flavors in vape cartridges, which excludes menthol and tobacco flavors. This measure would ban the sale of most flavored tobacco products statewide, including menthol cigarettes, an idea that has died and been resurrected in many forms in both the Senate and Assembly.
- AB-890 represents another long-standing Capitol feud, with the powerful doctor lobby opposing. The measure would allow nurse practitioners — nurses with advanced degrees and training — to practice medicine in some cases without oversight from a physician.
- SB-852 would establish a state office that would contract with drug manufacturers to produce or distribute low-cost generic drugs in California. Newsom floated the idea in January.
It’s not an accident that such weighty bills are the ones left standing after legislators were asked to slash their portfolio of bills this year, said Sen. Richard Pan (D-Sacramento), who chairs the Senate Health Committee.
When Pan culled the bills his committee would consider, he eliminated measures with unresolved questions, he said, because administration officials dealing with the pandemic were less available to testify as witnesses and lawmakers were unable to work closely with one another in the Capitol.
“Is this something that needs to be done this year/?” Pan said he asked himself.
That means many of the bills moving through his committee and other policy committees are largely the ones that have been scrutinized in previous years, Pan said.
“We spent a lot of time working through those issues and trying to get those all resolved for the committee,” Pan added.
But South warned that even legislation that has been heard in the past deserves the full debate and deliberation that would take place in a typical year.
“I don’t think the process is set up this year to be passing major legislation that affects major sections of society without adequate input from stakeholders and the general public,” he said.
Some lawmakers are keeping other measures alive by using the pandemic to sharpen pitches for their pre-COVID bills, with the refrain “Now more than ever.” Sure, the bill was important when it was introduced in February, they argue, but “now more than ever” it really has to pass.
“You’ve got legislators not used to having so many of their bills threatened,” said Rob Stutzman, a Republican political consultant. “It’s not surprising they’d be trying to adapt their proposals to the narrowed purview of this session, which is obviously COVID-related.”
Sen. Jerry Hill (D-San Mateo), author of the tobacco flavor bill, is employing this tactic.
“I know we’ve all had to reassess our priorities,” Hill said at an Assembly committee hearing. “Yet emerging evidence about smoking and COVID-19 suggests smoking can put people at greater risk.”
Another example of the “Now more than ever” trend is SB-855, a “mental health parity” bill that would strengthen requirements for private health insurance to cover medically necessary treatment for mental illnesses.
“Even before COVID, mental health and addiction were major crises in this country,” but the pandemic is making the crises worse, the bill’s author, Sen. Scott Wiener (D-San Francisco), said at a press conference last week. “People who were stable with their mental health are now losing stability.”
That’s not to say using COVID-19 as justification to pass a bill is just a gimmick; some problems really have gotten worse since the start of the pandemic, said Larry Levitt, executive vice president of health policy at KFF. (KHN, which produces California Healthline, is an editorially independent program of the Kaiser Family Foundation.)
“Mental health is a perfect example of the pandemic exacerbating problems that were already there,” he said.
Wiener’s measure has survived the Senate and several committees, but other lawmakers haven’t seen the same success.
Assembly member Adrin Nazarian (D-Van Nuys) lobbied hard for AB-2203, which would have capped out-of-pocket payments for insulin. Nazarian pointed to a study from the Centers for Disease Control and Prevention that showed 40% of people who died of COVID-19 had diabetes.
His bill sailed through the Assembly but wasn’t given a hearing in the Senate. He said he followed directions from leadership to reduce the number of bills he was carrying, paring them down from about 25 to fewer than 10.
“Without a pandemic, this was a straightforward bill that would protect consumers and curb health care costs,” Nazarian said. “I’m extremely upset and frustrated about this.”
KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
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