BILL ANALYSIS
SB 921
Page 1
Date of Hearing: June 22, 2004
ASSEMBLY COMMITTEE ON HEALTH
Rebecca Cohn, Chair
SB 921 (Kuehl) - As Amended: June 16, 2004
SENATE VOTE : 23-14
SUBJECT : Single payer health care coverage.
SUMMARY : Establishes the California Health Care System (CHCS)
administered by an elected commissioner who heads the California
Health Care Agency (CHSA). Provides health insurance to all
California residents through a consolidated claims, financing,
and administrative system. Replaces all private health insurance
policies and eliminates all health insurance premiums paid by
residents and their employers, except for services not provided
by CHCS. Requires that the commissioner seek waivers from the
federal government to merge all federal health care funds and
any required state matching funds into the system. Grants the
commissioner full power to supervise, plan and coordinate the
delivery and financing of health care in California. Provides a
comprehensive, uniform benefit package to all residents.
Specifically, this bill :
1)Establishes CHCS, administered by the CHCA, an independent
agency under the control of the elected Health Care
Commissioner (Commissioner). Provides for the election of the
Commissioner for four-year terms. Requires the first
Commissioner to be appointed by the Governor and confirmed by
the Senate. Requires that CHCS be operational no later than
January 1, 2006.
GOVERNANCE
2)Establishes the following entities within CHCA: The Health
Policy Board; The Office of Consumer Advocacy; The Office of
Health Care Planning; The Office of Health Care Quality; and
The Health Care Fund.
3)Requires the Commissioner to appoint the deputy health
commissioner, the director of the Health Care Fund, the
consumer advocate, the chief medical officer, and the director
of Health Care Planning.
4)Requires the Commissioner to administer all aspects of CHCA
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and to do all of the following:
a) Implement eligibility standards;
b) Establish an enrollment system;
c) Establish a comprehensive budget that ensures adequate
funding to meet the health care needs of the population;
d) Establish standards and criteria for allocation of
funds;
e) Negotiate for or set rates, fees and prices involving
any aspect of the health care system;
f) Utilize the purchasing power of the state to negotiate
price discounts for prescription drugs and durable and
nondurable medical equipment and ensure that price
discounts achieved for the system formularies are available
to all California residents, health care providers,
wholesalers and retailers;
g) Establish annual statewide health care goals for capital
expenditures established;
h) Ensure the establishment of an electronic claims and
payments system; and,
i) Report annually to the Legislature and the Governor.
5)Establishes the 28-member Health Policy Board, with membership
that includes representatives of doctors, nurses, hospitals,
clinics and other providers as well as consumers, business and
labor who are appointed by the Governor and the Legislature.
Board membership also includes officers of CHCA and the
Secretary of the Health and Welfare Agency. Requires the
Health Policy Board to establish medical and public health
policy and standards and evaluate proposals, as specified.
6)Creates the Office of Consumer Advocacy headed by the consumer
advocate to represent the interests of health care consumers.
Specifies the duties of the consumer advocate, including
establishing offices and toll-free numbers, developing dispute
resolution procedures and consumer guides, evaluating how
health facilities meet community needs, responding to
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complaints, and holding statewide public hearings.
7)Creates within the Office of the Attorney General (AG) an
Office of Inspector General (IG) for CHCS. Requires the
Governor to appoint the IG subject to Senate confirmation.
Grants the IG, under the direction of the AG, powers to
investigate, audit and review the financial and business
records of anyone that provides services or products to CHCS.
FUNDING
8)Establishes the Health Care Fund in the State Treasury.
Requires the Director of the Health Care Fund, during the
first five years of the operation of CHCS, to maintain a
reserve account that equals at least 5% of the system's
budget. Permits the director, after five years, to reduce the
minimum reserve requirement to 3% of the system's budget.
9)Requires the Director of the Health Care Fund to immediately
notify the Commissioner when annual costs appear to exceed
annual revenues. Requires the Commissioner to determine the
cause of excessive costs and implement cost control measures
as specified.
10)Requires the Commissioner, in the event cost control measures
are not sufficient to assure adequate funding, to recommend
additional measures to the Legislature to assure sufficient
funding. Establishes a process of temporary funding if the
State Budget is not enacted by June 30 and if the Commissioner
determines that funds in the reserve account are inadequate to
cover costs until the budget is enacted.
11)Establishes factors for Commissioner to consider in
establishing and adjusting budgets.
12)Permits health care providers to choose how they wish to be
compensated.
13)Requires the Commissioner to do all of the following:
a) Negotiate fee-for-service reimbursement rates,
capitation rates, and operating budgets;
b) Determine annually a capital investment threshold level
below which approval for a capital investment is not
required;
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c) Establish a budget to support research and innovation;
d) Establish a budget to support the development and
training of a health system workforce that is sufficient to
meet the health care needs of the population; and,
e) Give special consideration for training to workers who
have been displaced from employment due to the inception of
the system.
14)Prohibits health care providers from charging or receiving
payments for covered services except those provided by CHCS.
Permits providers to charge for services not covered by CHCS.
15)Requires the commissioner to establish a system of provider
reimbursement that ensures timely payments for all covered
health care services and actuarially sound reimbursement
rates.
16)Requires that reimbursement rates for providers employed in
integrated health care systems be determined by negotiations
between providers and their employers.
17)Requires that reimbursement rates for health care providers
choosing fee-for-service reimbursements be negotiated on a
class basis with the Commissioner by representatives of health
care providers who are democratically selected by the
represented providers or provider networks. States
Legislative intent that negotiations provided for be conducted
in a manner that is consistent with the state action immunity
doctrine, which establishes immunity from federal and state
antitrust laws for conduct taken or supervised by a state.
18)Requires that the AG independently review contracts and
confirm, modify, or vacate each contract.
REVENUES
19)States legislative intent for CHCS revenues to derive from:
a) A personal income tax for health care on earned and
unearned income;
b) An employer payroll tax; and,
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c) A self-employed business tax.
GOVERNMENT PAYMENTS
20)Requires the Commissioner to seek necessary waivers or
legislation, so that all current federal payments to the state
for health care are paid directly to CHCS, which will then
assume responsibility for all benefits and services previously
paid for by the federal government with those funds.
21)Requires the Commissioner to establish formulas for equitable
contributions to CHCS from counties and other local government
agencies.
FEDERAL PREEMPTION
22)Requires the Commissioner to pursue all reasonable means to
secure a repeal or a waiver of any provision of federal law
that preempts any provision related to CHCS. Requires the
Commissioner, in the event a repeal or a waiver cannot be
secured, to exercise his or her powers to promulgate rules and
regulations, or seek conforming state legislation, consistent
with federal law, in an effort to best fulfill the purposes of
CHCS.
ELIGIBILITY
23)Specifies that all California residents are eligible for CHCS
and that residency be based upon physical presence in the
state with the intent to reside. Requires that visitors to
California be billed for all services received under CHCS.
24)Requires an individual to be presumed eligible if he or she
arrives at a health facility and is unconscious, comatose, or
otherwise unable to document eligibility, or if the individual
is a minor.
BENEFITS
25)Permits any eligible individual to choose to receive services
under CHCS from any willing provider participating in the
system.
26)Requires coverage of all medical care determined to be
medically appropriate by the consumer's health care provider
to be covered except as specified. Specifically, includes the
following benefits:
a) Inpatient and outpatient health facility services;
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b) Inpatient and outpatient professional health care
provider services by licensed health care professionals;
c) Diagnostic imaging, laboratory services, and other
diagnostic and evaluative services;
d) Durable medical equipment, appliances, and assistive
technology, including prosthetics, eyeglasses, and hearing
aids and their repair;
e) Rehabilitative care;
f) Emergency transportation and necessary transportation
for health care services for disabled and indigent persons;
g) Language interpretation and translation for health care
services, including sign language for those unable to
speak, or hear, or who are language impaired, and Braille
translation or other services for those with no or low
vision;
h) Child and adult immunizations and preventive care;
i) Health education;
j) Hospice care;
aa) Home health care;
bb) Prescription drugs that are listed on the system
formulary. Permits nonformulary prescription drugs to be
included where standards and criteria established by the
commissioner are met;
cc) Mental and behavioral health care;
dd) Dental care;
ee) Podiatric care;
ff) Chiropractic care;
gg) Acupuncture;
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hh) Blood and blood products;
ii) Emergency care services;
jj) Vision care;
aaa) Adult day care;
bbb) Case management and coordination to ensure services
necessary to enable a person to remain safely in the least
restrictive setting;
ccc) Substance abuse treatment;
ddd) Care of up to 100 days in a skilled nursing facility
following hospitalization;
eee) Dialysis; and,
fff) Benefits offered by a bona fide church, sect,
denomination, or organization whose principles include
healing entirely by prayer or spiritual means provided by a
duly authorized and accredited practitioner or nurse of
that bona fide church, sect, denomination, or organization.
27)Permits the Commissioner to expand benefits beyond the
minimum benefits when there are sufficient funds to cover the
expansion.
28)Excludes from coverage by CHCS the following:
a) Health care services determined to have no medical
indication;
b) Primarily cosmetic procedures, unless required to
correct a congenital defect or one caused by injury or
disease, or determined to be medically necessary by a
qualified provider;
c) Private rooms in inpatient health facilities, unless
determined to be medically necessary; and,
d) Services of a provider or facility that is not licensed
or accredited by the state.
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COPAYMENTS AND DEDUCTIBLES
29)Prohibits the Commissioner from instituting any deductibles
or copayments, except for self-referred specialist visits
during the initial two years of CHCS' operation. Requires the
Commissioner and the Health Policy Board to review this policy
annually, beginning in the third year of operation, and
determine whether deductibles or copayments should be
established.
30)Limits the total annual copayments, if established, to $250
per person and $500 per family. Limits annual deductibles, if
established, to $250 per person and $500 per family.
Prohibits copayments or deductibles from being established for
preventive care.
DELIVERY OF CARE
31)Permits all licensed or accredited California health care
providers to participate in CHCS.
32)Requires patient care to be coordinated by a primary health
care provider. Requires, in general, patients to have a
referral from their primary care provider to see a specialist
without paying a copayment. Exempts from the copayment
requirement referrals by emergency health care providers.
Requires no referral to see a dentist or to see a specialist
with whom the patient had an established relationship before
the implementation of this bill.
33)Requires the chief medical officer, as director of the Office
of Health Care Quality, to do all of the following:
a) Support the delivery of high quality care, as specified,
and promote health care provider and patient satisfaction;
b) Recommend and update regularly evidence-based standards
of care, an evidence-based pharmaceutical formulary, and
priorities for needed benefit improvements;
c) Develop, in collaboration with the consumer advocate and
the planning director, a statewide "Partnerships For
Health" program to educate the public, health care
providers, and the health care workforce about personal
health maintenance, prevention of disease, improving
communication between patients and providers, and improving
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quality of care; and,
d) Recommend, in collaboration with the planning director,
an appropriate ratio of primary care medical practitioners
to specialty medical practitioners, and incentives and
other methods to achieve the recommended ratios.
34)Requires the Commissioner to ensure the development of a
system of electronic medical records.
35)States that nothing in this bill is intended to repeal any
legislation or regulation governing the professional conduct
of any person licensed by the State of California or any
legislation governing the licensure of any facility licensed
by the State of California.
OTHER PROVISIONS
36)Exempts CHCA and the Commissioner from the regulatory
oversight and review procedures of the Office of
Administrative Law (OAL).
37)Requires the Commissioner to appoint a transition advisory
group to assist with the transition to CHCS. Requires the
transition advisory group to make recommendations to the
commissioner, the Governor, and the Legislature on how to
integrate health care delivery services and responsibilities
of the current departments and agencies responsible for health
programs into CHCS. Requires the transition advisory group to
investigate the feasibility and costs of including the
delivery of health care aspects of workers' compensation,
state disability insurance and long-term care into CHCS.
38)Requires that the transition to CHCS not adversely affect
current publicly funded health care programs.
39)Requires the transition to CHCS to be funded from a loan from
the General Fund and from private sources identified by the
commissioner.
EXISTING LAW does not provide a system of universal health care
coverage for California residents. Existing law provides for the
creation of various programs to provide health care services to
persons who have limited incomes and meet various eligibility
requirements. These programs include the Healthy Families
Program administered by the Managed Risk Medical Insurance
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Board, and the Medi-Cal program administered by the Department
of Health Services. Existing law provides for the regulation of
health care service plans by the Department of Managed Health
Care and health insurers by the Department of Insurance.
FISCAL EFFECT : Unknown
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
needed because existing law has led to a highly fragmented
health insurance and delivery system that is administratively
complex and that annually diverts billions of dollars in
health care spending from direct health care services to
administrative costs and that provides care based on income
and insurance status rather than medical need. According to
the author, intricate and complicated interactions with public
and private health insurance programs, providers, and
regulatory agencies are confusing and time-consuming for
consumers and providers alike.
The author believes that existing law provides no mechanism for
stabilizing the growth in health care spending that is quickly
outpacing growth in gross domestic product (GDP). Absent
budgeting capabilities, growth in health care spending is
rapidly surpassing our ability to afford current levels of
benefits or to add new benefits related to technological
improvements. The author notes that health care providers
spend increasing amounts of time navigating the porous network
of public and private health insurance programs. For example,
UCSF Children's Hospital works with nearly 80 different health
insurance policies and public programs each with its own
benefits package, formulary schedule, and rate of co-payments
and deductibles. One medical group practice serving 70,000
patients works with 6,000 different health insurance plans.
The author states that 20 to 30% of the health care dollar is
spent on administration (excluding profit). A quantitative
analysis performed by the Lewin Group, Inc. found that, under
a single payer system, such as this bill, California could
reduce administrative costs to 1.8% of health care spending,
allowing the system to divert $14 billion dollars of
administrative costs annually to direct health care services.
Businesses, unions, and other institutions that provide health
insurance are particularly harmed under the fragmented system.
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While health insurance premiums are rising unpredictably,
often by as much as 20% in one year, employers, large and
small, unions, and even powerful purchasers such as CalPERS,
are no longer able to stabilize health care costs or benefits
through negotiations.
According to the author, our current system fragments and
dilutes the purchasing power of Californians with regard to
pharmaceuticals and medical equipment. We are paying about
50% more than Europeans, Australians, Japanese, and Canadians
for the same drugs produced by the same companies. This could
be changed if California implemented bulk purchasing of
pharmaceuticals and medical equipment under this bill. The
author reports that the United States leads the world in
health care spending at about $5,000 per person per year on
average, more than twice the average in other industrialized
countries. Despite our high level of spending, the U.S. ranks
37th in population-based health outcome measurements according
to the World Health Organization, well below the rankings of
all other industrialized nations. This is true because a large
portion of the $5,000 is not going to health services and
because nearly 20% of the population has no health insurance.
The author believes this bill corrects both of these problems.
2)BACKGROUND . According to the UCLA Center for Health Policy
Research, over six million children and nonelderly adults in
California were uninsured for all or part of the year in 2001.
Although 79% of Californians were insured all year, one in
five (21%) lacked coverage for some or all of the year. Of
the 6.3 million Californians who lacked insurance, over 1.3
million were children. Over half the uninsured, 52.6%, or 3.3
million people were uninsured for more than a year. There are
substantial disparities in coverage stability across ethnic
and racial groups. About 86% of whites and African Americans
were insured all year in 2001 compared with lower proportions
for Asian Americans and for American Indians and Alaska
Natives. Latinos are the least likely to be insured all year
(64.1%) and the most likely to be uninsured all year (22.8%).
Coverage stability varies even more by family income. Among
nonelderly persons with family incomes of at least 300% FPL,
89.9% were insured all year compared with just 61.3% of those
below poverty. Just 3.7% of those with incomes of 300% FPL or
more were uninsured all year, less than one-sixth the
proportion (24.8%) of those below poverty.
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3)SUPPORT . Supporters argue that despite incremental reforms
enacted over the last decade, it has become clear that our
heath care system cannot be fixed using partial measures that
do not address its structural problems. Supporters believe
this bill corrects the underlying problems of inefficiency,
waste and partial coverage that continue to undermine
California's health care system. According to supporters, all
Californians lose when emergency rooms are overcrowded with
uninsured patients, when billions of dollars are wasted on
administrative costs, and when insurance premiums become
unaffordable and benefits are reduced. Supporters argue that
we need a health care system that works for everyone, that
treats everyone equally, and that provides the security of
knowing that no Californian will ever lose their access to
health care because they have lost their job, have a
pre-existing condition or simply cannot afford it.
4)OPPOSITION . Opponents argue that this bill will result in a
multi-billion-dollar-tax increase on Californians due to the
costs of transitioning to a new system and the ongoing costs,
which opponents do not believe will be less than our current
system. Opponents believe the bulk of the administrative
costs, which proponents of the bill hope to save, will not be
eliminated under a single-payer system. These include the
costs of claims payment, utilization review, disease and care
management programs, the development of drug formularies, and
customer service functions, which make up the majority of what
is commonly called "administration." Opponents state that none
of these functions are wasteful or inefficient and none can be
ignored under a single-payer system.
Opponents argue that one needs only to look at Canada's public
health care system to see the negative effects of a
government-created and controlled health care system.
Opponents state that Canada spends more on health care than
any other universal access industrialized nation, yet ranks
only slightly higher than Hungary, Poland, and Turkey in the
quality of service its citizens receive. Major problems
include access to doctors and very limited access to high tech
equipment such as MRI and CAT scan machinery, for which the
average wait is two months. According to opponents, in a
recent Canadian Medical Association survey, 49% of the
respondents said they would welcome an approach that would mix
private health care into their public health care system.
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5)PREVIOUS LEGISLATION . SB 2 (Burton), Chapter 673, Statutes of
2003, enacted the Health Insurance Act of 2003, a "pay or
play" approach, to provide health coverage to employees (and
in some cases their dependents) who do not receive job-based
coverage and who work for large and medium employers. A
referendum on SB 2 is on the November 2004 ballot. AB 1528
(Cohn), Chapter 672, Statutes of 2003, requires the Governor
to convene the California Health Care Quality Improvement and
Cost Containment Commission and requires the commission to
issue a report to the Legislature and the Governor making
recommendations for health care cost containment. AB 1527 of
2003 (Frommer) would have expanded health care coverage by
building upon the existing employment-based health insurance
system using a "pay or play" approach to require employers
with more than 50 employees to provide coverage to their
employees. AB 1527 was referred to the conference committee
that also considered SB2 and AB 1528 and was later withdrawn.
6)QUESTIONS AND COMMENTS .
a) This bill states Legislative intent to fund CHCS by a
personal income tax, an employer payroll tax, and a
self-employed business tax. Has the author considered a
payroll tax that would apply to both employers and
employees as is the case with Social Security and Medicare?
b) This bill exempts CHCA and the Commissioner from the
regulatory oversight and review procedures of OAL. What is
the justification for this? Would it be better to grant
emergency regulatory authority to the Commissioner for a
fixed number of years (probably two or three) to expedite
the process of establishing the CHCS without a blanket
exemption from regulatory oversight?
c) This bill should explicitly state how CHCA will provide
coverage to California residents when they are temporarily
out-of-state.
d) This bill requires that all coverage for state residents
for covered benefits must be through CHCA, effectively
eliminating private insurance except to cover benefits
excluded by CHCS. Currently, many California residents are
covered under preferred provider organization plans, which
allow "self-referral" to specialists. Would this bill
allow private insurance to cover the cost of copayments for
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"self-referral"? Would it allow private insurance to cover
the cost of a private hospital room?
6)DRAFTING ERRORS . On page 7, line 32, after the word "at"
insert "least"; on page 8, line 3, after the word "means"
insert "a"; on page 30, line 1, it appears the following
should be deleted: "or the commissioner."
REGISTERED SUPPORT / OPPOSITION :
Support
California Insurance Commissioner, John Garamendi
A Window Between Worlds
AARP
ACCESS, Empowering People with Disabilities
ACT UP East Bay
AFL-CIO, South Bay Labor Council
AFSCME Retirees, Chapter 36
AFSCME, AFL-CIO
Alameda County Advisory Commission on Aging
Alameda County Health Care Services Agency
All American Home Center
Alliance for Democracy of Sonoma County
Alliance for Democracy, Mendocino Coast Chapter
Alliance for Democracy, San Fernando Valley Chapter
Almaden Hills United Methodist Church
Amalgamated Transit Union, Local 192
American Association of University Women, California
American Association of University Women, Santa Barbara Branch
American Association of University Women, Santa Monica Bay Area
Branch
American Civil Liberties Union, South Bay Chapter
American Civil Liberties Union, Southern California
American Federation of Television and Radio Artists
American Medical Student Association
American Medical Women's Association, Inc.
American Nurses Association of California
Americans for Democratic Action
Americans for Democratic Action, Southern California
Area Agency on Aging, Area 1
Asian and Pacific Islander American Health Forum
Asian Pacific American Legal Center of Southern California
Asian Pacific Women's Center
Association of Community Organizations for Reform Now
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Association of Pleasanton Teachers
Asthma Education and Resource Council
Being Alive Los Angeles, Inc.
Berkeley City Council
Berkeley Retired Teachers Association
Beth Shir Sholom
Black American Political Action Committee of Contra Costa County
Breaking Barriers
Breast Cancer Action
Burma Forum, Los Angeles
Butte County Health Care Coalition
Calegislation
California Advocates for Nursing Home Reform
California Alliance for Retired Americans
California Association of Alcoholism and Drug Abuse Counselors
California Association of Midwives
California Association of Nurse Practitioners
California Association of Public Hospitals and Health Systems
California Church Impact
California Clean Money Campaign
California Coalition for Youth
California Commission on Aging
California Commission on the Status of Women
California Council of Community Mental Health Agencies
California Democratic Council
California Democratic Party Disability Caucus
California Democratic Party, Los Angeles County
California Democratic Party, Senior Caucus
California Democratic Party, Women's Caucus
California Dental Hygienist's Association
California Disability Alliance
California Family Health Council
California Federation of Teachers
California Foundation for Independent Living Centers
California Immigrant Welfare Collaborative
California Independent Public Employees Legislative Council
California Nurses Association
California Optometric Association
California Part Time Faculty Association
California Physical Therapy Association
California Physicians Alliance
California Public Health Association - North
California Public Interest Research Group
California Retired Teachers Association, East Bay Division
California School Employees Association
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California Senior Coalition
California Senior Legislature
California Society for Clinical Social Work
California State Pipe Trades Council
California Teachers Association
California Women Lawyers
California Women's Law Center
Californians for Disability Rights, Inc.
California-Pacific Annual Conference of the United Methodist
Church
Capitola City Council
Carlton Designs
Castro Valley Democratic Club
CBC Professional Pharmacy, Inc.
Center for Independence of the Disabled, Inc
Center for Independent Living, Fresno
Central American Resource Center
Central Coast Alliance United for a Sustainable Economy
Central Coast Center for Independent Living
Central Labor Council of Alameda County, AFL-CIO
Child Care Health Linkage
Child Care Law Center
Citizen Project
City and County of San Francisco
City of El Cerrito-Committee on Aging
City of Gardena-Senior Citizen Commission
City of Pinole
City of Santa Monica
Clergy and Laity United for Economic Justice
Coalition for a Living Wage
Coalition for Community Health
Coalition for Humane Immigrant Rights of Los Angeles
Coalition for Quality Health Care
Coalition of Contingent Academic Labor - California
Coalition of Mental Health Professionals, Inc.
Coast-to-Coast Community Campaigns
Committee for Social Justice
Community Action Board, Santa Cruz County, Inc.
Community Clinic Association of Los Angeles County
Community Homeless Alliance Ministry
Community Leadership Development Council
Community Rehabilitation Services, Inc.
Concerned Citizens of Leisure World, Laguna Woods
Congress of California Seniors
Congress of California Seniors, Region 3
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Congress of California Seniors, Region IV-A
Consumer Federation of California
Consumers Union
Contra Costa County Advisory Council on Aging
Contra Costa County Senior Nutrition Program Advisory Council
Council on Alcoholism and Drug Abuse
Council on Wireless Technology Impacts
County of Alameda, Board of Supervisors
County of Los Angeles, Board of Supervisors
County of Marin, Board of Supervisors
County of Sacramento, Department of Health and Human Services
County of Ventura, Board of Supervisors
Dayle McIntosh Center
Death Penalty Focus, Santa Cruz Chapter
Democratic Action Club of Chico
Democratic Party of the San Fernando Valley
Democratic Socialists of America, East Bay
Democratic Women of Kern County
Democratic Women of Santa Barbara County
Democrats for Change
Demos Democratic Club of Hayward
Disability Resource Agency for Independent Living
Dominican Sisters of San Rafael, Congregation of the Most Holy
Name
Drug Policy Alliance
Dunham & Associates
East Bakersfield Community Health Center
East Bay Peace Action
East Bay Women for Peace
El Cerrito Democratic Club
Elections Committee of the County of Orange
English Learning Advisory Committee
Episcopal Church of Saint John-the-Baptist
Equality California
Evergreen Democratic Club of San Jose
Faculty Association of California Community Colleges, Inc
Family Counseling Center
Family Medicine Center
Family Practice of Glendale
Federation of Retired Union Members, Santa Clara and San Benito
County
First Affirmative Financial Network
Four Winds Inc.
Fresno Center for Nonviolence
Fresno County Democratic Central Committee
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Fresno Stonewall Democrats
Friends Committee on Legislation of California
Funeral Consumers Alliance of Monterey Bay, Inc.
Gardena Valley Democratic Club
Garment Worker Center
Glendale Gardens
Glendale Greens
Globallinx Network, Inc.
Good Shepherd Lutheran Church
Gray Panthers, Berkeley
Gray Panthers, California
Gray Panthers, Central Contra Costa County
Gray Panthers, Long Beach
Gray Panthers, Marin
Gray Panthers, Sacramento
Gray Panthers, San Francisco
Gray Panthers, Santa Barbara
Gray Panthers, South Bay
Gray Panthers, Southern Alameda County
Greater Santa Cruz Federation of Teachers, CFT
Green Party of Alameda County
Green Party of Butte County
Green Party of California
Green Party of Marin County
Green Party of Mendocino County
Green Party of San Mateo County
Green Party of Santa Barbara County
Green Party of Santa Clara County
Green Party of Santa Cruz County
Green Party of Ventura County
Greenlining Institute
Hadassah Southern California Nurses Council, San Diego County
Hadassah, Central Pacific Coast Region
Happy Life Clinic
Harbor Free Clinic
Health Access California
Health Care Council of Orange County
Health Care for All - California
Health Care for All - California, Central California
Health Care for All - California, Los Angeles
Health Care for All - California, Marin
Health Care for All - California, Orange County
Health Care for All - California, Sacramento Valley
Health Care for All - California, San Francisco
Health Care for All - California, San Francisco Mid Peninsula
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Health Care for All - California, Santa Barbara
Health Care for All - California, Santa Clara County
Health Care for All - California, Santa Cruz
Health Care for All - California, Sonoma County
Health Care for All - California, South Bay/Long Beach
Health Care for All - California, Tulare/Kings County
Hermanson's Employment Services
Holguin & Garfield
Homeboy Industries
Homeless Health Care, Los Angeles
Hubert H. Humphrey Democratic Club
Human Care Alliance
Humanist Society of Santa Barbara
Independent Living Resource Center, San Francisco
Independent Living Services of Northern California
Integrated Medical Group of Rowland Heights, Inc.
Interfaith Council on Religions, Race, Economic and Social
Justice
International Friendship Society
Jennings/Des Anges
Jericho
Jewish Civic Action Network
Judge Joseph G. Kennedy Democratic Club, San Francisco
Just Health Care Committee of the Merced Labor Party
Justice Office Dominican Sisters of Mission San Jose, CA
Kayline
Kennedy Club of San Joaquin Valley
Korean Immigrant Workers Advocates of Southern California
Korean Resource Center
Lambda Letters Project
Latino Coalition for a Healthy California
Latino Issues Forum
League of Women Voters, California
League of Women Voters, Claremont Area
League of Women Voters, Fresno
League of Women Voters, Long Beach Area
League of Women Voters, Los Angeles
League of Women Voters, Pasadena Area
League of Women Voters, Santa Barbara
League of Women Voters, Santa Cruz County
League of Women Voters, West Contra Costa County
League of Women Voters, Whittier
Lifelong Medical Care
Lise Matthews and Associates
Live Oak Unitarian Universalist Congregation of Goleta, Social
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Concerns Committee
Local Health Care Coalition, Fresno County
Long Beach Democratic Club
Long Beach Greens
Los Angeles Alliance for a New Economy
Los Angeles Breast Cancer Alliance
Los Angeles Coalition to End Hunger and Homelessness
Los Angeles College Faculty Guild, Local 1521
Los Angeles County Democratic Party
Los Angeles County HIV Drug and Alcohol Task Force
Los Angeles County Superior Court Legal Professional Unit
Los Angeles Free Clinic
Los Angeles Gay and Lesbian Center
Los Angeles Greens Party
Los Angeles Metropolitan Alliance and AGENDA
Low Income Self Help Center - San Jose
Management and Organization Development Excellence
Marin County Pharmaceutical Association
Marin Democratic Club
Marin Family Action
Marin Interfaith Council
Marin Interfaith Youth Outreach
Marin United Taxpayers Association
Marin Women's Commission
Matthews De Turck, Architecture
Mendocino County Democratic Central Committee
Mental Health Association, California
Mental Health Association, Los Angeles County
Metropolitan Community Church, Los Angeles
Mexican American Legal Defense and Educational Fund
Middle East Children's Alliance
Minerva Consulting
Monterey Bay Central Labor Council, AFL-CIO
Mt. Eden Presbyterian Church
Musicians Union, Local 6
Napa-Sonoma Friends Meeting
Nation Group
National Alliance for the Mentally Ill, California
National Alliance for the Mentally Ill, San Gabriel Valley
National Alliance for the Mentally Ill, Tulare County
National Alliance for the Mentally Ill, Yuba-Sutter
National Association for the Advancement of Colored People
(NAACP), Pasadena Branch
National Association of Broadcasters Employees and Technicians
National Association of Social Workers, California
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National Association of Social Workers, Santa Barbara County
Unit
National Center for Lesbian Rights
National Council of Jewish Women, California
National Council of Jewish Women, Los Angeles
National Council of Jewish Women, Sacramento
National Organization for Women, California
National Organization for Women, Oakland/East Bay
National Organization for Women, Sacramento
National Organization for Women, San Jose/South Bay
National Organization for Women, Santa Cruz County
National Organization for Women, San Diego County Chapter
National Women's Political Caucus, Alameda North
National Women's Political Caucus, Mendocino
National Women's Political Caucus, San Fernando Valley
National Women's Political Caucus, South Bay
Neighbor to Neighbor, San Francisco
New Frontier Entertainment
New Revelation Missionary Baptist Church, Inc.
Old Lesbians Organizing for Change
Older Women's League, California
Older Women's League, Inland Empire
Older Women's League, Ohlone/East Bay Chapter
Older Women's League, Sacramento Capitol Chapter
Older Women's League, San Francisco
Older Women's League, Santa Clara County
Operation Access
Orange County Friends Meeting
Orange Grove Monthly Meeting of the Religious Society of Friends
Pacific Clinics
Pacific Palisades Democratic Club
Pacific Pride Foundation
Pacific Unitarian Church
Pain Care Acupuncture Clinic
Painters and Tapers Local 913
Palo Alto Friends Meeting - Peace and Social Action Committee
Palos Verdes Peninsula Democratic Club
p-conn-tie Hot Ties
Peace Action of San Mateo
Peace and Freedom Party, California
Peace and Human Rights Coalition of the Inland Counties
Peninsula Democratic Coalition
Peninsula Peace and Justice Center
People for a National Health Program
People United for Economic Justice Building Leadership through
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Organizing
Peoples Democratic Club
Performing and Media Arts
Pharmacists Planning Service, Inc.
Physicians for Social Responsibility, San Francisco Bay Area
PICO California Project
Planned Parenthood Affiliates of California
Planning for Elders in the Central City
Pride At Work
Professional Pharmaceutical Advocates
Progressive Christians Uniting
Progressive Jewish Alliance
Quincy Foundation for Medical Research Charitable Trust
Rainbow Coalition
Real Estate Dynamics, Inc.
Residents' Council of Claremont House
Resources for Independent Living
Richmond Commission on Aging
Richmond Greens
Richmond Progressive Alliance
Richmond Vision 2000
Ritter House
Riverside County Acupuncture & Herb Clinic
Rolling Start, Independent Living Center
Saint John's Health Center
Salinas Action League
San Benito County Health and Human Services Agency
San Fernando Valley Interfaith Council
San Francisco AIDS Foundation
San Francisco Commission on the Status of Women
San Francisco Department on the Status of Women
San Gabriel Valley Democratic Women's Club
San Gabriel Valley Pharmacists Association
San Jose Peace Center
San Luis Obispo Green Party
San Mateo Community College Federation of Teachers
San Ramon Valley Education Association
Santa Barbara County Action Network
Santa Barbara County Democratic Central Committee
Santa Barbara Jewish Secular Society
Santa Barbara Monthly Meeting of Friends, Society of Friends
Santa Barbara Women's Political Committee
Santa Clara County Health Care Committee
Santa Cruz Action Network
Santa Cruz City Council
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Santa Cruz County Board of Supervisors
Santa Cruz County Coalition for a Living Wage
Santa Rosa Democratic Club
Save San Jose Medical Center Coalition
Screen Actors Guild
Seal Press
SEIU, California State Council
SEIU, Local 415
SEIU, Local 535
SEIU, Local 616
SEIU, Local 660
SEIU, Local 949
Senior Access Adult Day Health and Alzheimer's Care
Senior Advocacy Council, Pasadena
Senior Citizens Advisory Council, Orange County
Seniors Council of Santa Cruz and San Benito Counties
Seniors Medi-Benefits
Services, Immigrant Rights and Education Network
Shefa Fund
Sherman Oaks Democratic Club
Smithyman Construction Co., San Leandro CA
Sober Living Network
Social Action Committee of the Unitarian Universalist Church of
Ventura
Social Justice Committee of the First Unitarian Church
Social Workers for Social and Economic Justice
Society for Humanistic Judaism, LA Chapter
South Hayward Parish
Southern California Library for Social Studies and Research
Southern California Public Health Association
St. Clement Catholic Church
St. John the Baptist Catholic Church, El Cerrito - Social
Concern Board
St. John the Baptist Episcopal Church
St. John's Presbyterian Church
St. John's Senior Center
St. Joseph Church, Hawthorne CA
Starr King Unitarian Universalist Church
Statewide California Coalition for Battered Women
Stinson Beach Medical Center
Stockton Metro Ministry
Strawberry Creek Monthly Meeting of the Religious Society of
Friends
Sunrise Acupuncture Medical Center
Sutter County Democratic Women's Club
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Through the Looking Glass, National Resource Center for Patients
with Disabilities
Town and Country Democratic Club
Trinity United Methodist Church of Berkeley
U.S.A/Cuba InfoMed
UA Local Union 393
Union for Reform Judaism
Unitarian Society of Santa Barbara, Social Justice Committee
Unitarian Universalist Church of Ventura
Unitarian Universalist Fellowship of San Luis Obispo County
Unitarian Universalist Fellowship of Santa Cruz County
Unitarian Universalist Society of Hayward
United Democrats of Vallejo/Benicia/American Canyon
United Electrical, Radio and Machine Workers of America, UE
District 10
United Farm Workers of America, AFL-CIO
United Methodist Church, California-Pacific Annual Conference
United Methodist Women, Centennial Unit, Sacramento, CA
United Nations Association, Santa Cruz Chapter
United Nurses Association of California/Union of Health Care
Professionals
United Steelworkers of America
United Teachers of Los Angeles, UTLA
United Union of Roofers, Waterproofers and Allied Trades, Local
No. 81
University of California, Los Angeles
University of California, San Francisco
Valley Democrats United
Valley Financial
Van Dyke and Associates, Land Use Planning
Venice Family Clinic
Vote Health
Warehouse Union Local 6, ILWU
Wesley United Methodist Church
West Contra Costa Healthcare District
West County Toxics Coalition
West Hollywood City Council
West Hollywood Democratic Club
Western Law Center for Disability Rights
Westminster Hills Presbyterian Church
Westside Family Health Center
Westside Greens
Women Creating Peace Collective
Women Democrats of Placer County
Women For: California
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Women For: Orange County
Women Helping all People
Women in Black, Riverside
Women's American ORT
Women's Cancer Resource Center
Women's Coalition South Bay, Redondo Beach
Women's Crisis Support
Women's Foundation
Women's International League for Peace and Freedom,
Berkeley/East Bay
Women's International League for Peace and Freedom, Monterey
County
Women's International League for Peace and Freedom, Pajaro
Valley Branch
Women's International League for Peace and Freedom, Peninsula
Branch
Women's International League for Peace and Freedom, San Jose
Women's International League for Peace and Freedom, Santa
Barbara
Women's International League for Peace and Freedom, Santa Cruz
Women's International League for Peace and Freedom, Watsonville
Work and Family Coalition of Alameda County
Workman's Circle/Arbeter Ring, Southern California District
Worksafe!
Z's Holistic Health Care Center
33rd Assembly District Democratic Committee
9 to 5, Bay Area Chapter, National Association of Working Women
2,209 Individuals
Opposition
Ad Industries, Inc.
AeA
Aetna, Inc.
America Health Insurance Plans
American Specialty Health Plans
Association of California Life and Health Insurance Companies
Blue Cross of California
Blue Shield of California
California Association of Health Plans
California Association of Health Underwriters
California Association of Physician Groups
California Bankers Association
California Beer and Beverage Distributors
California Building Industry Association
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California Business Properties Association
California Chamber of Commerce
California Healthcare Association
California Manufacturers and Technology Association
California Manufacturers Association
California Restaurant Association
California Retailers Association
California Right to Life Committee, Inc.
Chamber of Commerce, Apple Valley
Chamber of Commerce, Carlsbad
Chamber of Commerce, Cerritos
Chamber of Commerce, Chico
Chamber of Commerce, Encinitas
Chamber of Commerce, Greater Bakersfield
Chamber of Commerce, Irvine
Chamber of Commerce, Pico Rivera
Chamber of Commerce, Santa Fe Springs
Coalition of California Insurance Professionals
Coors Brewing Company
Family Wine Makers of California
Federation of Retired Union Members
Health Net, Inc.
Howard Jarvis Taxpayers Association
Impact International
Inland Empire Economic Partnership
Logret Import and Export Company
Mueller Homes
National Association of Insurance and Financial Advisors of
California
National Federation of Independent Business
Perry Color Card
Sanford-Lussier, Inc.
Sloat Higgins Jensen and Associates
Western Illuminated Plastics, Inc.
One Individual
Analysis Prepared by : John Gilman / HEALTH / (916) 319-2097