BILL ANALYSIS Ó
AB 1592
Page 1
ASSEMBLY THIRD READING
AB 1592 (Beth Gaines)
As Amended May 28, 2014
Majority vote
HEALTH 19-0 APPROPRIATIONS 17-0
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|Ayes:|Pan, Maienschein, |Ayes:|Gatto, Bigelow, |
| |Ammiano, Chau, Bonilla, | |Bocanegra, Bradford, Ian |
| |Bonta, Chávez, Chesbro, | |Calderon, Campos, |
| |Gomez, Gonzalez, Roger | |Donnelly, Eggman, Gomez, |
| |Hernández, Lowenthal, | |Holden, Jones, Linder, |
| |Waldron, Nazarian, | |Pan, Quirk, |
| |Nestande, Patterson, | |Ridley-Thomas, Wagner, |
| |Ridley-Thomas, Wagner, | |Weber |
| |Wieckowski | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Requires the Department of Public Health (DPH), as
part of the California Diabetes Program (CDP), to submit a
report to the Legislature by December 31, 2015 which includes
information on the fiscal impact of diabetes to the Medi-Cal
program, among other things, as well as provide proposals to
reduce the impact of diabetes and its complications.
Specifically, this bill :
1)Requires DPH, as part of CDP to submit a report to the
Legislature by December 31, 2015 which includes the following:
a) An assessment of the benefits of implemented programs
and activities aimed at preventing and controlling diabetes
which documents the amount and source of funding directed
to DPH and the Department of Health Care Services (DHCS) by
the Legislature for programs and activities aimed at
reaching those with diabetes;
b) The amount and source for any funding directed to DPH
and DHCS that may be used for the purposes of the action
plans required pursuant to this bill;
c) A description of the level of coordination existing
between DPH and DHCS in preventing, treating, managing, and
increasing awareness of all forms of diabetes and its
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complications;
d) Detailed action plans for combating diabetes with a
range of actionable items for consideration by the
Legislature which will aid in attaining goals set by the
DPH California Wellness Plan and Diabetes Burden Report;
and,
e) A detailed budget blueprint identifying needs, costs,
and resources required to implement the plans developed by
DPH which includes a cost-benefit analysis to assist in
prioritizing plans by level of efficiency.
2)Allows DPH to update the report as necessary in future years
and requires DPH to make the report and any updates available
on its Internet Web site.
3)Requires DHCS to provide DPH with any relevant data for the
report and requires all data transferred to DPH from DHCS to
conform to federal Health Insurance Portability and
Accountability Act requirements.
4)Makes various findings and declarations, including that DPH
will have completed a Diabetes Burden Report by December 31,
2014.
EXISTING LAW : Establishes DPH to protect and improve the health
of communities through education, promotion of healthy
lifestyles, and research for disease and injury prevention.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)One-time costs of about $300,000 General Fund (GF) to DPH for
staff to produce the report.
2)Minor and absorbable costs to DHCS to provide relevant data.
3)To the extent the report makes detailed recommendations to
spend state funds on programs to combat diabetes, this bill
could result in cost pressure to the GF.
COMMENTS : According to the author, the State of California has
no plan in place to mitigate the escalating fiscal impact of
diabetes, and while there has been extensive legislation enacted
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to promote awareness and cost saving measures for conditions
such as cardiovascular disease and tobacco addiction, current
law is woefully inadequate in regard to diabetes. The author
states that diabetes has reached epidemic levels in California,
and as of 2012, about one in seven adult Californians have
diabetes and many more will be diagnosed in the near future.
Finally, the author states that this bill would require the CDP
to create and submit to the state a diabetes action plan, which
will provide policy guidance addressing the escalating fiscal
impact of diabetes treatment and care.
Diabetes is a chronic medical condition marked by high levels of
blood glucose (a form of sugar) resulting from defects in
insulin production, insulin action, or both. Type 1 diabetes,
previously known as juvenile diabetes, is an autoimmune disease
in which the body does not produce the hormone insulin. There
is no known way to prevent type 1 diabetes. Type 2 diabetes
(previously called non-insulin-dependent diabetes or adult-onset
diabetes) in adults, accounts for about 90% to 95% of all
diagnosed cases of diabetes. It usually begins as insulin
resistance, a disorder in which the cells do not use insulin
properly. As the need for insulin rises, the pancreas gradually
loses its ability to produce it. Gestational diabetes occurs in
pregnant women who have never had diabetes before but have
higher than normal blood glucose levels during pregnancy.
Immediately after pregnancy, 5% to 10% of women with gestational
diabetes are found to have diabetes, usually type 2. Women who
have had gestational diabetes have a 35% to 60% chance of
developing diabetes in the next 10-20 years. Prediabetes is a
condition in which individuals have blood glucose levels higher
than normal but not high enough to be classified as diabetes.
People with prediabetes have an increased risk of developing
type 2 diabetes, heart disease, and stroke. Without
intervention, about one out of four people with prediabetes will
develop diabetes within three to five years. Ethnic minorities
and those who are poor or disadvantaged have especially high
rates of diabetes.
According to the CDP, diabetes costs in California exceed $24
billion each year. Total health care and related costs for the
treatment of diabetes in California are about $24.5 billion.
Direct medical costs (e.g., hospitalizations, medical care,
treatment, supplies) account for about $18.7 billion, the other
$5.8 billion include indirect costs such as disability payments,
time lost from work, and premature death. The average annual
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treatment cost per case for diagnosed diabetes in the United
States (U.S.) was nearly $10,000 in 2007.
There is no known cure for diabetes. Increased risk of heart
disease, stroke, and kidney damage (and the need for dialysis as
a result) are the most deadly effects. Uncontrolled high blood
sugars may also affect the eyes and cause blindness. Diabetes
frequently affects circulation, and a simple cut on the foot can
lead to an amputation due to infection. Diabetics tend to
experience longer hospitalizations and mortality rates.
California has an estimated 3.9 million adults with diabetes
(2010), and the numbers are rising rapidly.
This year DPH published the California Wellness Plan (Plan), the
result of a statewide process led by DPH to develop a roadmap
with partners and create communities in which people can be
healthy through improving the quality of clinical and community
care, increasing access to usable health information, assuring
continued public health capacity to achieve health equity, and
empowering communities to create healthier environments. The
Plan contains short, intermediate, and long-term objectives with
measurable effects on a variety of chronic diseases, including
diabetes. DPH's chronic disease programs plan to collaborate
with local and state partners, including the Office of Health
Equity, engaged in diabetes prevention to implement the
objectives. DPH intends to monitor the progress of the Plan
objectives and publish regular reports on outcomes.
DPH is currently working on a Diabetes Burden Report with an
anticipated completion of December 31, 2014. The report will
include information on the prevalence of diabetes in California
compared to the rest of the U.S., risk factors for developing
diabetes and diabetes complications, as well as the prevalence
of obesity, inactivity, and cardiovascular disease risk factors
(smoking, hypertension, hypercholesterolemia) among diabetics as
compared to non-diabetics in California. The report will
address the prevalence of pre-diabetes, complications of
diabetes, and diabetes mortality in California compared to the
rest of the nation. The report will also outline DPH programs
and activities that address the burden of diabetes in
California.
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097
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