Policy At A Glance: January 2019 INSTITUTE FOR HEALTH POLICY AND LEADERSHIP

AB 186 Controlled Substances: Overdose Prevention Program

Vetoed 2018 Health-related Bills

2018 Vetoed Health Legislation in California

AB 186. Controlled Substances: Overdose Prevention Program According to the Centers for Disease Control and Prevention (CDC), over 60 percent of all drug overdose deaths in 2014 involved an opioid.1 In California alone, there were 21,787,042 opioid prescriptions, 4,281 opioid overdose emergency room visits, and 2,196 opioid overdose deaths in 2017.2 Nationally, 72,306 Americans died from drug overdoses in 2017, up from 63,632 deaths in 2016.3 To mitigate the continuing rise in drug-related overdose deaths, efforts are underway in some parts of the country to install “safe injection sites.”

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In October, Governor Brown signed 1,016 out of 1,217 bills passed by California’s legislature during its regular session. In this issue of ‘Policy At A Glance,’ we will provide a roundup of five health

bills that garnered attention but were ultimately vetoed by the Governor in 2018.

Governor Jerry Brown signed over a thousand bills in his final year in office, ranging from cyber bullying to price gouging on rental homes after natural disasters to including women in corporate boards.

He also vetoed a number of bills related to health. Below is a summary of five high-profile measures that were vetoed, listed in numerical order by Assembly Bill (AB) or Senate Bill (SB).

Medi-Cal: Managed Care Plans: Informational Materials

AB 2299

SB 320

SB 1125

SB 1127 Pupil Health: Administration of Medicinal Cannabis: Schoolsites

Federally Qualified Health Center and Rural Health Clinic Services

College Student Health Center Sexual and Reproductive Health Preparation Fund

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Safe injection sites (also called drug consumption facilities or medically supervised injection centers) is a “hygienic space supervised by health care professionals where people who use drugs can consume pre-obtained drugs, sterile consumption supplies, and access to referrals to substance use disorder treatment.”4 These medically supervised facilities do not discourage the use of opioids but reduce their harm by promoting safer opioid consumption. While most injection sites are currently located in Europe, Canada, and Australia, Seattle, Philadelphia, Denver, and Vermont are considering opening theml.5 AB 186 would have created pilot injection sites in California, specifically, in the city and county of San Francisco, to allow opioid users to take drugs under the supervision of medical professionals until January 1, 2022.

AB 186 was originally introduced in 2017 to include eight California counties but the 2018 version was narrowed to San Francisco. Supporters believe that safe injection sites can refer individuals to detoxification and housing services, reduce overdose, improve access to treatment, and increase safe use behaviors while saving lives.6 Opponents of AB 186, including the California State Sheriff’s Association and the California District Attorney’s Association, believe that the bill sends the wrong message, helping “addicts find safe, public places to use” drugs rather than helping users “fight dangerous drug use.”7 In his veto message, Governor Brown sided with the opponents, stating that allowing drug use in government-sponsored

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injection sites will not reduce drug addiction and concluding that the disadvantages of the bill outweigh the benefits.6

AB 2299. Medi-Cal: Managed Care Plans: Informational Materials

According to the most recent report from the United States Census Bureau, 44 percent of Californians speak a language other than English at home.8 Language barriers and the resulting miscommunication can prevent individuals from accessing healthcare or obtaining health information. Therefore, providing health-related information in English as well as other languages is important to improving the health outcomes of the population.

AB 2299 would have requested Medi-Cal managed care plans to develop and translate all written health education and informational materials into threshold languages at or below the sixth grade reading level by January 1, 2020. Threshold languages are languages spoken at a high proportional rate within a region. California has thirteen languages categorized as threshold languages - Spanish, Vietnamese, Cantonese, Armenian, Russian, Mandarin, Tagalog, Korean, Arabic, Hmong, Farsi, Cambodian, and other Chinese.9

Governor Brown vetoed AB 2299 because “current laws and contractual practice are sufficient to compel plans to make these important health care documents understandable for Medi-Cal beneficiaries.”10

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SB 320. Public University Student Health Centers: Medication Abortion Readiness: Abortion by Medication Techniques: College Student Health Center Sexual and Reproductive Health Preparation Fund

SB 320 would have required public universities (University of California, California State University, and California Community Colleges) to offer abortion pills at on-campus health centers beginning January 1, 2022. Currently, California’s public university student health centers do not provide abortion pills (mifepristone and misoprostol) to students.11 When SB 320 was being debated, several concerns were raised, including:

§ How to provide follow-up care and care for emergencies

§ Security issues from providing abortions on campus

§ Maintaining the health center staff’s skills to use an ultrasound machine to determine whether the medication can be administered safely

Supporters argued that the bill would help students avoid the burden of seeking these services off campus. Opponents argued that easily accessible abortion pills will reduce the effort and thought involved in the decision process prior to an abortion. Governor Brown vetoed SB 320 believing that the bill was not

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necessary, as the services required by SB 320 are widely available off campus.11

SB 1125. Federally Qualified Health Center and Rural Health Clinic Services

In California, if a patient receives treatment through Medi-Cal (the State’s Medicaid program) at a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) from both a medical provider and a mental health provider on the same day, the state will only reimburse the health center for one visit. This is because in California, encounters with more than one health professional or multiple encounters with the same health professional taking place on the same day at a single FQHC or RHC location is regarded as a single visit. Therefore, patients needing both medical and mental health or dental services must come back on another day to seek those treatments for that treatment to be reimbursed as a second visit.

SB 1125 would have allowed the FQHC or RHC to bill for a maximum of two visits taking place on the same day at a single location if the patient 1) suffers illness or injury requiring additional diagnosis or treatment or 2) has a medical visit and a mental health visit or a dental visit. California Children’s Hospital Association, CalOptima and others supported SB 1125 while the California Department of Finance opposed. Governor Brown vetoed the bill, stating that SB 1125 should be considered as part of the budget process due to its costs and ongoing fund commitment.12

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SB 1127. Pupil Health: Administration of Medicinal Cannabis: Schoolsites

In California, it is illegal for students to take their medically-prescribed marijuana in public schools or for school staff to administer medical marijuana to students.13 Students, especially those who suffer from severe seizures such as Lennox-Gestaut Syndrome, have to be taken away from school property to receive their daily dose of medical marijuana. SB 1127, known as Jojo’s Act, would have allowed a parent or a guardian of a student to possess and administer non-smokeable and non-vapeable medical marijuana to authorized students on campus. Governor Brown vetoed SB 1127 for being “overly broad as it applies to all students instead of limited cases” and going “too far to allow use of medical marijuana for youth.”14 Senator Jerry Hill, who introduced SB 1127, has indicated that he will reintroduce this bill in a future legislative session.13 References

1. https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm?s_cid=mm655051e1_w

2. https://discovery.cdph.ca.gov/CDIC/ODdash/ 3. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-

death-rates 4. https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=2017201

80AB186 5. https://www.npr.org/sections/health-shots/2018/09/07/645609248/whats-

the-evidence-that-supervised-drug-injection-sites-save-lives 6. https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201

720180AB186 7. https://cssrc.us/issue/oppose-ab186 8. https://www.sacbee.com/news/politics-government/capitol-

alert/article42713214.html 9. https://www.dhcs.ca.gov/dataandstats/statistics/documents/rasb_issue_bri

ef_annual_threshold_language_report.pdf 10. https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=20172

0180AB2299 11. https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201

720180SB320 12. https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201

720180SB1125 13. https://csba.org/-

/media/CSBA/Files/GovernanceResources/GovernanceBriefs/201811MarijuanaImpact-MarijUseInSchools.ashx?la=en&rev=7d86219f4f7c43269c79cf44dc782684

14. https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180SB1127

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Questions? Please contact Helen Jung, DrPH, MPH. Senior Health Policy Analyst at the Institute for Health Policy & Leadership (helenjung@llu.edu)