BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 176
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|AUTHOR: |Bonta |
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|VERSION: |June 30, 2015 |
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|HEARING DATE: |July 8, 2015 | | |
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|CONSULTANT: |Shannon Muir |
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SUBJECT : Data collection
SUMMARY : Requires the California Community Colleges, California State
University, University of California, Department of Health Care
Services, and Department of Managed Health Care to disaggregate
collection and tabulation categories for Native Hawaiian, and
Asian and Pacific Islander groups.
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 Asian and Pacific
Islander 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 those groups listed above, as well as
additional major Asian groups including, but not limited to,
Bangladeshi, Hmong, Indonesian, Malaysian, Pakistani, Sri
Lankan, Taiwanese, and Thai, and additional major Native
Hawaiian groups and other Pacific Islander groups including,
but not limited to Fijian and Tongan.
This bill:
1)Requires the Board of Governors of the California Community
Colleges (CCC) and the Trustees of the California State
University (CSU), and requests the Regents of the University
of California (UC), when collecting demographic data on
AB 176 (Bonta) Page 2 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
Asian and Pacific Islander groups as follows:
a) Until the release of the next decennial
census, use the categories that were used as of
January 1, 2015;
b) Within 18 months after release of the
decennial census, use Native Hawaiian and Asian and
Pacific Islander categories as reported by the United
States Census Bureau;
c) Report on additional major Asian groups,
including, but not limited to Bangladeshi, Cambodian,
Hmong, Indonesian, Laotian, Malaysian, Pakistani, Sri
Lankan, Taiwanese, and Thai, and additional major
Native Hawaiian and other Pacific Islander groups
including, but not limited to, Fijian and Tongan; and,
d) Observe current standards regarding compliance
with the Family Educational Rights Privacy Act and
observe criteria for ensuring statistical significance
of data collected and published.
2)Requires CCC, CSU and UC, by July 1, 2016, to collect and
publish specified demographic data on their respective
websites and update the data annually.
3)Specifies that the provisions in this bill regarding
categorization requirements do not apply to graduate or
professional schools at UC. Requires this bill to only apply
to UC only if the UC Regents make it applicable by resolution.
4)Requires on or after July 1, 2016, the Department of Health
Care Services (DHCS) and the Department of Managed Health Care
(DMHC), when collecting patient demographic data for reports
on the type and amount of health care coverage, rates for
major diseases, leading causes of death, as specified,
pregnancy rates, and housing numbers, to use the following
separate collecting categories and tabulations, in addition to
the existing categories required by current law:
a) Major Asian groups, including, but not limited
to, Bangladeshi, Hmong, Indonesian, Malaysian,
Pakistani, Sri Lankan, Taiwanese, and Thai; and,
AB 176 (Bonta) Page 3 of ?
b) Major Native Hawaiian and other Pacific
Islander groups, including, but not limited to, Fijian
and Tongan.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, based on the May 28, 2015 version of this bill:
1)UC and CSU: Minor and absorbable costs.
2)CCC: Districts currently report on about one-third of the
Census subgroups. Given that this measure would not require
reporting for all subgroups until around 2023, districts
should be able to encompass this change within the course of
updating their current practices, costs should not be
significant.
3)DHCS: Non-responsive.
4)DMHC: No additional costs, as recently enacted legislation
already will require the department to meet the requirements
of this measure.
PRIOR
VOTES :
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|Assembly Floor: |77 - 1 |
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|Assembly Appropriations Committee: |17 - 0 |
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|Assembly Higher Education |12 - 1 |
|Committee: | |
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COMMENTS :
1)Author's statement. According to the author, when relying on
aggregate data of the Asian and Pacific Islander community, the
state of California fails to recognize that different Asian and
Pacific Islander ethnic subpopulations have different social and
economic conditions. If the needs of each are not addressed
AB 176 (Bonta) Page 4 of ?
properly, California runs the risk of greater health care costs
and lower educational outcomes for our future generations. Data
disaggregation is imperative for uncovering social, economic, and
educational disparities within the greater Asian population.
Although many of the communities within the Asian and Pacific
Islander population face similar challenges in California, such as
language barriers and immigration, they differ on many issues.
This is most evident with respect to education and public health,
where the outcomes of some of the largest Asian and Pacific
Islander groups within the Asian and Pacific Islander population
raise the average outcome of the greater Asian and Pacific
Islander population as a whole. For example, although data related
to the average Asian and Pacific Islander student demonstrates
high academic achievements, disaggregated data sheds light on the
harsh reality that Southeast Asian subgroups suffer from much
lower achievement rates than other Asian and Pacific Islander
groups. Similarly, data from a 2013 report by the Asian American
Center for Advancing Justice demonstrates that 14% of Asian
Americans are uninsured; disaggregated data demonstrates that
Korean, Tongan, and Thai have uninsured rates higher than 22%,
whereas only 8-10% of Japanese and Indian populations are
uninsured.
2)Background. According to an Asian and Pacific Islander
American Health Forum Report in 2010, in California,
aggregated Asian American and Native Hawaiian and Pacific
Islander data fail to capture the diversity and differences
across subgroups. For example, in the 1980s and 1990s,
aggregated Asian American and Native Hawaiian and Pacific
Islander data showed that the group had the lowest incidence
of breast cancer across races and ethnicities, and the belief
at the time was that "Asian women don't get breast cancer".
However, subsequent studies showed that Native Hawaiian women
had a very high incidence of breast cancer, second only to
white women, whereas Korean women had a very low incidence.
The high risk for Native Hawaiians was hidden by the
aggregation of data. Asian subpopulations also have varying
socioeconomic statuses, which are a large predictor of health
access. The 2010 U.S. Census data show Hmong Americans have a
poverty rate at 27.4%, compared to 9.3% of the aggregated
Asian community, and show low educational attainment levels
for Southeast Asians with14.8% of Hmong, 16% of Cambodian and
13.2% of Laotian Americans with a Bachelor's degree or higher
compared to 48.9% of Asians as a whole. The report stated that
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support for new primary data collection and longitudinal
studies are needed to fully capture the diverse social and
health assets and needs faced by all the Asian American and
Native Hawaiian and Pacific Islander communities.
3)Joint Informational Hearing. On March 11, 2015, the California
Senate and Assembly Committees on Health held a joint
information hearing to examine health disparities in
California. Testimony provided by the Southeast Asia Resource
Action Center illustrated how the lack of disaggregated data
masks disparities within the Asian and Pacific Islander
community. For example, 24% of Hmong and Cambodian Americans
have diabetes, but there are no data regarding the number of
Hmong and Cambodian Americans that are served by California's
Heart Disease and Prevention Unit. Among recommendations was
disaggregating data for DHCS. The Committees also heard that
the federal Office of Minority Health has issued guidelines
for the collection of more granular and disaggregated
categories for race and ethnicity, and accordingly, California
should take administrative steps to standardize demographic
data categories for race and ethnicity in order to reduce
health disparities. Further, these actions should be jointly
implemented by DHCS and DMHC.
4)Double referral. This bill was heard in the Senate Education
Committee on June 24, 2015, and passed by a 9-0 vote.
5)Prior legislation. AB 411 (Pan, 2013) would have required
DHCS, when entering into a new contract with an External
Quality Review Organization (EQRO) for the purpose of
performing work associated with Medi-Cal managed care
programs, to include in the terms of the new contract a
requirement that, upon approval of the contract, the EQRO
stratify all patient-specific Healthcare Effectiveness Data
and Information Set measures, or their External Accountability
Set performance measure equivalent, by certain
characteristics, including geographic area and primary
language. AB 411 would have required DHCS to publicly report
this analysis on its Internet Web site. AB 411 would have
provided that its provisions only be implemented to the extent
that funding is available. AB 411 was vetoed by the Governor
who stated that nothing in current law prevents DHCS from
requiring EQROs to provide more detailed data by geography,
race, ethnicity, or other demographic attribute. He concluded
that if DHCS saw a need or benefit that justifies the costs of
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procuring this additional data, he was confident that they
would procure it.
AB 1737 (Eng, 2010), would have required certain state
agencies to use additional separate collection categories and
tabulations for major Asian and Pacific Islander groups. AB
1737 was held on suspense in the Assembly Appropriations
Committee.
AB 295 (Lieu, 2007), would have required various state
entities to report collected demographic data according to
each major Asian and Pacific Islander group and make the data
available to the public to the extent that disclosure did not
violate confidentiality. AB 295 was vetoed by Governor
Schwarzenegger who stated that this bill was unnecessary and
imposed additional costs on state agencies at a time the state
cannot afford them, and that existing law gives state agencies
the flexibility to expand upon current demographic categories
if necessary.
AB 2420 (Lieu, 2006), was substantially similar to this bill,
and would have expanded from 11 to 23 the ancestry or ethnic
origin collection categories required to be collected by any
state agency, board, commission, CCC, or CSU. AB 2420 was held
on suspense in the Senate Appropriations Committee.
1)Support. Several academic organizations are in support of the
bill. The UC Office of the President writes that this bill is
consistent with their goal and efforts to enroll a student
body that reflects California's diversity. The Executive
Committee of the UC Asian American and Pacific Islander Policy
Multicampus Research Unit states that without disaggregated
data problems in public health and education cannot be
addressed, leading to continuing disparities and higher costs
in services that may have been prevented with earlier
intervention. The Pasadena Area Community College District
states that greater data disaggregation is imperative for
uncovering social, economic, and educational disparities
within the greater Asian and Pacific Islander population.
Supporters also highlight the public health aspects of this
bill. The March of Dimes states that there is considerable
variation in rates of premature birth and infant mortality
across races and ethnicities and that this bill will increase
the availability of data on these disparities and benefits the
development of policies and programs to reduce these
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disparities. Hmong National Development, Inc. and Project
Prevention both state that current aggregation of Asian and
Pacific Islander data hinders public health research efforts.
2)Technical Amendments.
a) On page 3, lines 32 and 33, delete "observe
current standards regarding compliance" and replace
with "comply"
b) On page 4: delete lines 16-28, on line 35,
insert::
(3) On or after July 1, 2016, the Department of Health
Care Services or the Department of Managed
Health Care, whenever collecting demographic data as
to the ancestry or ethnic origin of persons for a
report that includes the type and 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, or housing
numbers.
SUPPORT AND OPPOSITION :
Support: Asian Americans for Community Involvement
AYPAL
California Asian Pacific Islander Budget Partnership
California Black Health Network
California Commission on Asian and Pacific Islander
American Affairs
California Faculty Association
California Immigrant Policy Center
California Pan-Ethnic Health Network
California State Council of the Service Employees
International Union
California State University
California Young Democrats Asian Pacific Islander
Caucus
Chinese for Affirmative Action (CAA)
Families in Good Health
Fresno Center for New Americans
Fresno Interdenominational Refugee Ministries
Healthy House Within a MATCH Coalition
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Hmong Movement Organizing for the Next Generation
Hmong National Development, Inc.
Hmong Student Association at California State
University, Fresno
Iu Mien Community Services
Khmer Girls in Action
Los Angeles Community College District
March of Dimes California Chapter
National Asian Pacific American Women's Forum
National Asian Pacific American Women's Forum Los
Angeles
National Asian Pacific American Women's Forum Orange
Coutny
National Asian Pacific American Women's Forum San
Diego
National Asian Pacific American Women's Forum San
Francisco Bay Area
OCA - Greater Los Angeles
Pasadena Community College District
Project Prevention Coaltion
San Jose Evergreen Valley Community College District
Southeast Asia Resource Action Center
Stone Soup Fresno
The Campaign for College Opportunity
United Cambodian Community
University of California
Young Invincibles
Numerous individuals
Oppose: None received.
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