BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 982|
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THIRD READING
Bill No: AB 982
Author: Firebaugh (D)
Amended: 8/22/02 in Senate
Vote: 21
SENATE BUSINESS & PROFESSIONS COMMITTEE : 5-1, 8/5/02
AYES: Figueroa, Johannessen, Machado, Murray, O'Connell
NOES: Morrow
SENATE APPROPRIATIONS COMMITTEE : 12-0, 8/15/02
AYES: Alpert, Battin, Bowen, Escutia, Johannessen,
Johnson, Karnette, McPherson, Murray, Perata, Poochigian,
Speier
ASSEMBLY FLOOR : 70-3, 6/6/01 - See last page for vote
SUBJECT : Health care
SOURCE : California Medical Association
California Primary Care Association
Latino Coalition for a Health California
DIGEST : This bill establishes the Dental Loan Repayment
Program of 2002 (administered by the Dental Board), the
Physician Loan Repayment Program of 2002 (administered by
the Medical Board) and the California Medical and Dental
Student Loan Repayment Program of 2002 (administered by the
Office of Statewide Health Planning and Development).
Senate Floor Amendments of 8/22/02 specifically provide
when money will be transferred and how much will be
transferred. The amendments also state that the California
CONTINUED
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Medical and Dental Student Loan Repayment Program shall not
become operative unless appropriate funding is made
available.
ANALYSIS : This bill (relative to the Dental Corps Loan
Repayment Program):
1. Establishes the Dental Corps Loan Repayment Program of
2002 (Dental Corps Program) to be administered by the
Dental Board.
2. States intent language for the Dental Board, in
developing and implementing the Dental Corp Program, to
consult with the OSHPD, the dental community, including
ethnic representatives, dental schools, health advocates
representing ethnic communities, primary care clinics,
public hospitals and health systems, statewide agencies
administering state and federally funded programs
targeting underserved communities, and members of the
public with health care issue-area expertise.
3. Requires Dental Corps Program participants to possess a
current valid license to practice dentistry in
California, to have full-time status and to commit to a
minimum of three years of service in a dentally
underserved area. Authorizes the Dental Board to define
full time status and establish exemptions on a
case-by-case basis.
4. Provides that the guidelines created by the Dental Board
shall provide priority consideration to applicants who
are best suited to meet the cultural and linguistic
needs and demands of dentally underserved populations
and that meet one or more of the following criteria: (a)
speak a Medi-Cal threshold language; (b) come from an
economically disadvantaged background; (c) have received
significant training in cultural and linguistically
appropriate service delivery; (d) have worked with
dentally underserved communities for at least three
years; or, (e) recently received a license to practice
dentistry.
5. Provides that the practice setting shall be located in a
dentally underserved area and that the Dental Corps
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Program participant serves a patient population that
consists of at least 50% dentally underserved
populations.
6. Creates the Community Healthcare Service Expansion Fund
and the Dentally Underserved Account within that Fund.
7. Transfers $3,000,000 from the State Dentistry Fund to
the Dentally Underserved Account. Provides that the
funds shall be placed in the account in order to repay
the loans per agreements made with dentists.
8. Provides that after a Dental Corps Program participant
has completed 1 year of service the Dental Board shall
provide up to $25,000 for loan repayment. Provides that
after a Dental Corps Program participant has completed 2
consecutive years of service the Dental Board shall
provide up to an additional $35,000 for loan repayment.
Provides that after a Dental Corps Program participant
has completed 3 consecutive years of service the Dental
Board shall provide up to an additional $45,000 for loan
repayment. Limits loan repayments to $105,000 per
individual.
9. Requires the Dental Board, no later than October 1,
2004, to report to the Legislature on various items,
including an evaluation of the effectiveness of the
Dental Corps Program and recommendations for maintaining
or expanding its operation.
This bill (relative to the Physician Corps Loan Repayment
Program):
1. Establishes the Physician Corps Loan Repayment Program
of 2002 (Physician Corps Program) to be administered by
the Division of Licensing of the Medical Board.
2. States intent language for the Division of Licensing, in
developing and implementing the Physician Corps Program,
to consult with the OSHPD, the medical community,
including ethnic representatives, medical schools,
health advocates representing ethnic communities,
primary care clinics, public hospitals and health
systems, statewide agencies administering state and
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federally funded programs targeting underserved
communities, and members of the public with health care
issue-area expertise.
3. Requires Physician Corps Program participants to possess
a current valid license to practice medicine in
California, to have full-time status and to commit to a
minimum of three years of service in a medically
underserved area. Authorizes the Division of Licensing
to define full time status and establish exemptions on a
case-by-case basis.
4. Provides that the guidelines created by the Division of
Licensing shall provide priority consideration to
applicants who are best suited to meet the cultural and
linguistic needs and demands of patients from medically
underserved populations and that meet one or more of the
following criteria: (a) speak a Medi-Cal threshold
language; (b) come from an economically disadvantaged
background; (c) have received significant training in
cultural and linguistically appropriate service
delivery; (d) have 3 years experience working in
medically underserved areas or with medically
underserved populations; or, (e) recently received a
license to practice medicine.
5. Provides that the practice setting shall be located in a
medically underserved area and that the Medical Corps
Program participant serves a patient population that
consists of at least 50% medically underserved
populations.
6. Creates the Community Healthcare Service Expansion Fund
and the Medically Underserved Account within that Fund.
7. Transfers $3,450,000 from the Medical Board's Contingent
Fund to the Medically Underserved Account. Provides
that the funds shall be placed in the account in order
to repay the loans per agreements made with physicians.
8. Provides that after a Physician Corps Program
participant has completed 1 year of service the Division
of Licensing shall provide up to $25,000 for loan
repayment. Provides that after a Physician Corps
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Program participant has completed 2 consecutive years of
service the Division of Licensing shall provide up to an
additional $35,000 for loan repayment. Provides that
after a Physician Corps Program participant has
completed 3 consecutive years of service the Division of
Licensing shall provide up to an additional $45,000 for
loan repayment. Limits loan repayments to $105,000 per
individual.
9. Requires the Division of Licensing, no later than
October 1, 2004, to report to the Legislature on various
items, including an evaluation of the effectiveness of
the Physician Corps Program and recommendations for
maintaining or expanding its operation.
This bill (relative to the California Medical and Dental
Student Loan Repayment Program):
1. Establishes the California Medical and Dental Student
Loan Repayment Program of 2002 (Student Loan Repayment
Program) to be administered by the OSHPD.
2. States intent language for the OSHPD, in developing and
implementing the Student Loan Repayment Program, to
consult with the Dental Board, the Medical Board, the
medical and dental community, including ethnic
representatives, medical and dental schools, health
advocates representing ethnic communities, primary care
clinics, public hospitals and health systems, statewide
agencies administering state and federally funded
programs targeting underserved communities, and members
of the public with health care issue-area expertise.
3. Provides that any individual enrolled in an institution
of postsecondary education participating in the Student
Loan Repayment Program may be eligible to receive a
conditional warrant for loan repayment to be redeemed
upon becoming employed as a physician or dentist in a
medically or dentally underserved area.
4. Provides that in order to be eligible to receive a
conditional loan repayment warrant, an applicant must
have been judged by his or her postsecondary institution
to have outstanding ability on the basis of criteria
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that may include, but not be limited to, any of the
following: (a) grade point average; (b) test scores; (c)
faculty evaluations; (d) interviews; (e) or, other
recommendations.
5. Provides that to be eligible, the applicant has to have
received, or is approved to receive, a loan under
certain, specified loan programs.
6. Provides that to be eligible, the applicant has to agree
to provide services as a licensed physician for up to
three consecutive years, after obtaining a license from
the Medical Board in a medically underserved area, or
the applicant has agreed to provide services as a
licensed dentist for up to three consecutive years,
after obtaining a license from the Dental Board in a
dentally underserved area.
7. Provides that the OSHPD shall ensure that priority
consideration be given to applicants who are best suited
to meet the cultural and linguistic needs and demands of
patients from medically and dentally underserved
populations and that meet one or more of the following
criteria: (a) speak a Medi-Cal threshold language; (b)
come from an economically disadvantaged background; (c)
have received significant training in cultural and
linguistically appropriate service delivery; or, (d)
have done a medical rotation serving medically
underserved populations or provided dental services to
members of a dentally underserved population.
Comments :
According to information provided by the Author's office,
this measure is a collaborative effort involving such
organizations as the California Primary Care Association
(CPCA), the Latino Coalition for a Healthy California
(LCHC), the California Medical Association (CMA), the
California Dental Association (CDA) and the Medical Board.
The Author states that this measure addresses the lack of
culturally and linguistically competent physicians and
dentists to adequately care for California's diverse
medically/dentally underserved populations.
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The proponents point out that in order to become a
physician or dentist, most medical and dental students must
incur significant education-related debt. Because this
debt prevents many physicians and dentists from working in
shortage designation areas serving medically underserved
populations, this measure's loan repayment program is
critical for reducing greater numbers of doctors and
dentists to needy areas.
NOTE: See Senate Business and Professions Committee
analysis for further comments.
Related Measures Aimed at Addressing Underserved
Populations . AB 1045 (Firebaugh) would, among other
things, create the Licensed Physicians and Dentists from
Mexico Pilot Program, and would create a separate pilot
program aimed at placing international medical graduates in
underserved areas.
AB 2872 (Thomson) requires the Medical Board to convene a
working group to study methods to reactivate the Fifth
Pathway Program in California medical schools, and to
submit a report to the Legislature including options for
the Legislature to consider in order to facilitate the
establishment of one or more Fifth Pathway Programs.
Current and Prior Loan Repayment Measures . AB 2935
(Strom-Martin) establishes the California Pharmacist
Scholarship and Loan Repayment Program, funded by a
voluntary $25 contribution by pharmacists, to pay for the
educational expense and repay qualifying educational loans
of pharmacists who agree to practice in medically
underserved areas.
AB 668 (Chan, Chapter 249, Statutes of 2001) requires the
OSHPD to report to the Legislature on the feasibility of
establishing a California Dental Loan Forgiveness Program.
It should be noted that the OSHPD has not yet completed
this report.
SB 760 (Murray, 2001) would have appropriated $1 million to
the OSHPD to create a new program patterned on the National
Health Service Corps Loan Repayment Program, but with
exceptions that were similar to those in this bill. The
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governor vetoed that bill stating that he believed local
practice sites should contribute some matching funds to
"make an investment in the health professionals they
attract with the assistance of a government loan program."
However, it should be noted that SB 760 was to be funded
from the state's General Fund, while this bill will
completely fund the scholarship and loan program from
licensee fees (loan repayment) or if funds become available
in the future (scholarship).
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
Fiscal Impact (in thousands)
Major Provisions 2002-03 2003-04 2004-05
Fund
Loan programs 3,000 Special*
Loan programs 3,450 Special**
* State Dentistry Fund
** Contingent Fund of the Medical Board of California
According to Senate Appropriations Committee (8/5/02
amended version), the total cost of this measure is $6
million and this amount would be entirely offset by license
fees paid by dentists and physicians. Both funds have
adequate reserves to cover the costs of these loan
repayment programs.
SUPPORT : (Verified 8/22/02)
California Medical Association (CMA) (co-source)
California Primary Care Association (CPCA) (co-source)
Latino Coalition for a Healthy California (LCHC)
(co-source)
California Medical Association - Medical Student Section
Alliance Medical Center
Alliance for Rural Community Health
Arroyo Vista Family Health Center
Asian & Pacific Islander American Health Forum
Asian Health Services
Association of Asian Pacific Community Health Organizations
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Borrego Community Health Foundation
California Dental Association
California Pan-Ethnic Health Network
California Psychiatric Association
California Rural Indian Health Board, Inc.
Central Valley Health Network
CommuniCare Health Centers
Community Health Partnership
Consumers Union
Council of Community Clinics
Lieutenant Governor Cruz Bustamante
LifeLong Medical Care
Long Valley Health Center
Medical Board of California
Mexican American Legal Defense and Educational Fund
National Council of La Raza
National Latina Health Orgainizations
North Coast Clinics Network
North County Health Services
Northeast Valley Health Corporation
Open Door Community Health Centers
Planned Parenthood Affiliates of California
Queens Care Family Clinics
San Ysidro Health Center
Six Rivers Planned Parenthood
Southern Trinity Health Services
Supervisor Blanca Alvarado, County of Santa Clara, Second
District
Supervisor Juan Arambula, County of Fresno, District 3
Tarzana Treatment Centers
Tiburcio Vasquez Health Center, Inc.
Support if Amended :
California Association of Public Hospitals and Health
Systems
ARGUMENTS IN SUPPORT : The CMA (co-source) believes
that this bill will focus on developing methods,
strategies and financial incentives to increase
physician supply in California and to strengthen
existing programs aimed at medical students, residents
and physicians that could eliminate the
mal-distribution and ease the current access to care
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crisis in California.
ASSEMBLY FLOOR :
AYES: Aanestad, Alquist, Aroner, Ashburn, Bates, Bogh,
Briggs, Calderon, Bill Campbell, John Campbell,
Canciamilla, Cardenas, Cardoza, Cedillo, Chan, Chavez,
Chu, Cogdill, Cohn, Correa, Cox, Diaz, Dickerson, Dutra,
Firebaugh, Florez, Frommer, Goldberg, Havice,
Hollingsworth, Horton, Jackson, Keeley, Kehoe, Kelley,
Koretz, La Suer, Leach, Leonard, Longville, Lowenthal,
Maddox, Maldonado, Matthews, Migden, Mountjoy, Nakano,
Negrete McLeod, Oropeza, Robert Pacheco, Rod Pacheco,
Papan, Pavley, Pescetti, Richman, Runner, Salinas,
Shelley, Steinberg, Strickland, Strom-Martin, Thomson,
Vargas, Wayne, Wesson, Wiggins, Wright, Wyland, Wyman,
Hertzberg
NOES: Daucher, Harman, Leslie
CP:jk 8/23/02 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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