BILL ANALYSIS Ó AB 2109 Page 1 ASSEMBLY THIRD READING AB 2109 (Pan) As Amended April 23, 2012 Majority vote HEALTH 13-5 APPROPRIATIONS 12-5 ----------------------------------------------------------------- |Ayes:|Monning, Ammiano, Atkins, |Ayes:|Fuentes, Blumenfield, | | |Bonilla, Eng, Gordon, | |Bradford, Charles | | |Hayashi, | |Calderon, Campos, Davis, | | |Roger Hernández, Bonnie | |Gatto, Hall, Hill, Lara, | | |Lowenthal, Mitchell, Pan, | |Mitchell, Solorio | | |V. Manuel Pérez, Williams | | | | | | | | |-----+--------------------------+-----+--------------------------| |Nays:|Logue, Mansoor, Nestande, |Nays:|Harkey, Donnelly, | | |Silva, Smyth | |Nielsen, Norby, Wagner | | | | | | ----------------------------------------------------------------- SUMMARY : Makes changes to existing requirements which allow school-aged children, as specified, to be exempt from immunization requirements as long as a parent or a guardian files a letter or affidavit to the governing authority indicating that immunization is contrary to the parent or guardian's beliefs. Specifically, this bill : 1) Requires, on and after July 1, 2012, a separate form prescribed by the California Department of Public Health (DPH), to accompany the letter or affidavit to exempt a child, as specified, from required immunization requirements because immunization is contrary to the child's parent's or guardian's beliefs. 2) Requires the form in 1) above to include both of the following: a) A written statement signed by a health care practitioner that indicates that the health care practitioner provided the parent or guardian of the person, or the person if an emancipated minor, who is subject to the immunization requirements, with information regarding the benefits and risks of the immunization and the health risks of the communicable diseases, as specified, to the person and to AB 2109 Page 2 the community; and, b) A written statement signed by the parent or guardian of the person, or the person if an emancipated minor, who is subject to the immunization requirements that indicates the information specified in 2) a) above was received. 3) Requires the written statements signed by the health care practitioner and the parent or guardian, as specified in 2) a) and b) above to be signed not more than six months from the date when the person subject to the immunization requirements is first admitted to the school. States that if the person was admitted to the school prior to entering the seventh grade and is about to enter the seventh grade, then an additional letter or affidavit shall be filed with the written statement signed by the parent or health care practitioner not more than six months from the first day of school. 4) Authorizes a copy of the signed written statement to be accepted in lieu of the original form. Requires a signed letter from the health care practitioner that references the person's name to be accepted in lieu of a statement on the original form. 5) Defines a health care practitioner for purposes of this bill as any of the following: a) A physician and surgeon licensed by the Medical Board of California; b) A nurse practitioner who is authorized to furnish drugs, as authorized by law; c) A physician assistant who is authorized to administer or provide medication, as authorized by law; d) An osteopathic physician, as specified; or, e) A naturopathic doctor who is authorized to furnish or order drugs under a physician and surgeon's supervision, as specified. FISCAL EFFECT : According to the Assembly Appropriations AB 2109 Page 3 Committee: 1)Based on DPH experience with another recent change to immunization requirements, one-time costs for notification including printing, mailing, and development of informational materials in the range of $80,000 federal funds. Issuing regulations and developing the form would result in one-time staff time costs of $50,000, distributed among a number of existing federally funded staff. 2)Minor, absorbable one-time costs to Department of Social Services (DSS) Child Care Licensing Division staff and K-12 school administrative staff for training on the new requirement. 3)Potential increase of $20,000 General Fund under Proposition 98 funds annually in state-reimbursable mandate costs to K-12 school administrative staff to ensure compliance with the new form. DSS costs related to ongoing enforcement are expected be minor and absorbable. 4)Any impact on Medi-Cal or Healthy Families Program from a small number of increased office visits, to the extent any program enrollees seek exemptions and require additional office visits to do so, is likely to be negligible. COMMENTS : According to the author, "California is one of only 20 states that allows for a personal beliefs, or philosophical exemption to school or childcare immunization requirements. Under existing law, to exempt the child from the immunization requirements, a parent or guardian must only provide a signed written statement or sign their name to a two-sentence standard exemption statement on the back of the School Immunization Record. While parents do have a choice to exempt their children, they are not required to document their concerns about vaccines or affirm that they have reviewed fact-based, accurate information regarding the risks and benefits of vaccines and the risks of vaccine-preventable diseases. The continued increase in personal belief exemptions and resultant decreases in community immunization rates in California will result in outbreaks of diseases such as measles, mumps, and pertussis. Exposure to these preventable diseases not only places the individual child at risk, but the entire community, including infants too young to be fully immunized and individuals with AB 2109 Page 4 compromised immune systems, who are vulnerable to complications of vaccine-preventable diseases, including death. This measure would rectify this problem by creating a process where parents would be able make an informed decision for their children." School-aged children are required to obtain immunizations for certain types of diseases to be admitted in school. There are exceptions to this requirement. First, if the physical or medical condition of a child would make immunization unsafe, as long as a statement by a licensed physician to this effect is submitted to the governing authority. Second, if a letter or affidavit is filed with the governing authority indicating that the immunization is contrary to the beliefs of a parent or guardian; this exemption is generally referred to as the personal belief exemption or philosophic exemption. According to the Centers for Disease Control and Prevention, aside from the philosophic exemption, some states allow for religious exemptions on the grounds that the religious beliefs of some people are in opposition to vaccination. Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916) 319-2097 FN: 0003463