BILL ANALYSIS Ó AB 176 Page 1 Date of Hearing: April 21, 2015 ASSEMBLY COMMITTEE ON HEALTH Rob Bonta, Chair AB 176 (Bonta) - As Amended April 14, 2015 SUBJECT: Data collection. SUMMARY: Requires specified state agencies to report and publish data using collection and tabulation categories, for Native Hawaiian, Asian, and Pacific Islander groups (API), whenever they collect demographic data, as specified. Specifically, this bill: 1)Requires the Board of Governors (BOG) of the California Community Colleges (CCC), the Trustees of the California State University (CSU), and the Regents of the University of California (UC), whenever said entities collect demographic data as to the ancestry or ethnic origin of students for a report that includes student admission, enrollment, completion, or graduation rates, to use specified collection and tabulation categories for Native Hawaiian, and other API groups. 2)Requires the Department of Public Health (DPH), Department of Health Care Services (DHCS), and Department Managed Health Care (DMHC) to use additional collection and tabulation categories for Native Hawaiian (NH), Asian, and Pacific Islander (API) groups whenever said entities collect demographic data. AB 176 Page 2 3)Requires the BOG, CCC, CSU, and UC to collect and publish specified data, in compliance with the Family Educational Rights and Privacy Act, and requires these entities to observe criteria for ensuring statistical significance of data collected and published. 4)Requires DPH, DHCS, and DMHC whenever they collect patient demographic data on level of health care coverage, amount of health care coverage, rates for major diseases, leading causes of death per demographic, subcategories for leading causes of death in California overall, pregnancy rates, and housing numbers, each must use the following separate collection categories and tabulations, in addition to the categories required by existing law: a) Major Asian groups, including, but not limited to, Bangladeshi, Hmong, Indonesian, Malaysian, Pakistani, Sri Lankan, Taiwanese, and Thai; and, b) Major Native Hawaiian and other Pacific Islander groups, including, but not limited to, Fijian and Tongan. 5)Requires DPH, DHCS, and DMHC to make any data collected publicly available, except for personal identifying information by posting the data on the Internet Website of the agency on or before July 1, 2012, and annually thereafter. Requires DPH, DHCS, and DMHC to update their data collection to reflect the additional Asian groups and additional Native Hawaiian and API groups as they are reported by the U.S. Census Bureau within 18 months after a decennial U.S. Census AB 176 Page 3 is released to the public. EXISTING LAW: 1)Requires state agencies, boards, and commissions that directly or by contract collect demographic data as to the ancestry or ethnic origin of Californians to use separate collection categories and tabulations for each major API group, including, but not limited to, Chinese, Japanese, Filipino, Korean, Vietnamese, Asian Indian, Laotian, Cambodian, Hawaiian, Guamanian, and Samoan. 2)Requires the Department of Industrial Relations (DIR) and the Department of Fair Employment and Housing (DFEH) to collect and tabulate data for additional major Asian groups. FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee. COMMENTS: 1)PURPOSE OF THIS BILL. The author states many of the communities within the API population face similar challenges in California, such as language barriers and immigration; however, they differ on many issues. The author asserts this is most evident with respect to education and public health, where the outcomes of some of the largest NH and API groups within the aggregate population raise the average outcome of the greater NH and API population as a whole. The author points to data from a 2013 report done by the Asian American Center for Advancing Justice, which demonstrates that 14% of Asian Americans are uninsured; disaggregated data shows that AB 176 Page 4 Korean, Tongan, and Thai have uninsured rates higher than 22% whereas only 8% to 10% of Japanese and Asian Indian populations are uninsured. The author contends that the lack of disaggregated data for the NH and API community within the public health sector is limiting the state's ability to provide the best health care to this population. The author concludes that this bill will enable the state and public to identify trends that are typically unseen through aggregate data, and ensure that the state is adequately meeting the health needs of its residents. 2)BACKGROUND. a) Aggregate vs. disaggregated data. Data aggregation is any process in which information is gathered and expressed in a collective or summary form, for purposes such as statistical analysis. A common aggregation purpose is to get more information about particular groups based on specific variables such as age, profession, or income where the data are aggregated to preserve the confidentiality of individuals. Disaggregated data are data that have been extrapolated from aggregated data and divided and broken down into smaller information units. Disaggregating data is another critical step to gaining increased knowledge from collective or aggregated information. Fully disaggregating data helps to expose hidden trends, and can enable the identification of vulnerable populations. b) Need for disaggregated data. According to the 2010 U.S. Census, there are currently over 4.8 million Californians of Asian descent. NH and API subgroups represent over 50 ethnic backgrounds and speak over 100 different languages, thus language and cultural barriers pose health care problems for many individuals within these subgroups. A 2010 study by the Asian and Pacific Islander American Health Forum demonstrated that different NH and API subgroups have varying health care problems. Data from the AB 176 Page 5 report revealed NH and Filipino adults have some of the highest rates of obesity and diabetes in the state, whereas Korean adults suffer from the highest rates of serious psychological stress in the state. The report also showed Tongans and Koreans have some of the highest uninsured rates in the state 3)SUPPORT. Supporters of this bill state the lack of disaggregated data collection by public health state agencies undermines efforts to increase awareness of public health intiatives and increase preventive care. Supporters contend this bill is necessary to ensure that limited public health resources are effectively utilized on the populations that need them most. Supporters conclude that disaggregated data will also be useful to organizations within the public which examine the optimal public health support services are necessary to best assist the community. 4)CONCERNS. DPH has expressed concern that the additional collection and tabulation categories may lead to a small enough sample size that information may be personally identifiable. DPH is seeking clarification that data reporting would be statewide rather than on a countywide basis. DPH also raises concerns about whether third party data - data used by DPH, but not collected by it - would be covered in the bill provisions. DMHC states they deal primarily with insurance and medical complaints, and infrequently collect demographic data. DMHC contends that any data gathered is on a scale small enough to be statistically insignificant and possibly personally identifiable. DMHC is concerned that the provisions of this bill would apply in the case that DMHC expands collection of AB 176 Page 6 demographic data. 5)POLICY CONSIDERATIONS. Some supporters of the bill have advocated for inclusion of the Iu Mien ethnic group as one of the additional major Asian groups specified for collection and tabulation by the departments. According to Lao Family Community Development, there are approximately 50 thousand Iu Mien in the entire U.S. This bill mandates that DPH, DHCS, and DMHC update their collection and tabulation categories with any new categories provided with the release of a decennial census. Iu Mien have yet to be included as a distinct category in the U.S. Census, but would be covered by the bill provisions in the case that the group is in the future. This bill currently requires the higher education authorities to collect data in a manner that complies with federal privacy law and is statistically significant. The current language does not contain such requirements for the public health authorities within this bill. The Committee may suggest to the author amendments later in the legislative process to safeguard the privacy of individuals and ensure statistical significance of the data collected. 6)PRIOR LEGISLATION: a) AB 1088 (Eng), Chapter 689, Statutes of 2011, requires DIR and DFEH to collect and tabulate data for additional major Asian groups. b) AB 1737 (Eng) of 2010, would have required certain state AB 176 Page 7 agencies to use additional separate collection categories and tabulations for major Native Hawaiian and API groups. AB 1737 was held on the suspense file of the Assembly Appropriations Committee. c) AB 295 (Lieu) of 2007 would have required various state entities to report collected demographic data according to each major API group and make that data available to the public to the extent that disclosure did not violate confidentiality. AB 295 was vetoed by the Governor. d) AB 2420 (Lieu) of 2006 would have expanded from 11 to 23 the ancestry or ethnic origin collection categories required to be collected by any state agency, board, commission, California Community Colleges, or the California State University. Also, would have required the above entities to collect, tabulate, report, and make available to the public any data collected on the groups. AB 2420 was held on the Senate Appropriations Committee Suspense File. 7)DOUBLE REFERRAL. This bill is double referred, it was heard in the Assembly Higher Education Committee on April 7, 2015 and passed out on a vote of 12-1. REGISTERED SUPPORT / OPPOSITION: Support Alliance for Boys and Men of Color Asian Pacific American Labor Alliance - Alameda Chapter Asian Pacific American Labor Alliance California Black Health Network California Commission on Asian and Pacific Islander American Affairs AB 176 Page 8 California Immigrant Policy Center California Pan-Ethnic Health Network California State University Cambodian Association of America Families in Good Health Fresno Interdenominational Refugee Ministries Healthy House Within a MATCH Coalition Hmong National Development, Inc. Iu Mien Community Services Khmer Girls in Action Khmer Parent Association Lao Family Community Empowerment, Inc. Los Angeles Community College District National Commission on AAPI Research in Education National Council of Asian Pacific Islanders OCA - Asian Pacific American Advocates OCA - Greater Los Angeles Pasadena Community College District Project Prevention Coalition Service Employees International Union California Southeast Asia Resource Action Center Stone Soup Fresno United Cambodian Community University of Southern California Student Coalition for Asian Pacific Empowerment West Coast Asian Pacific Islander Student Union Young Invincibles 54 Individuals Opposition None on file. AB 176 Page 9 Analysis Prepared by:Rylan Gervase / HEALTH / (916) 319-2097