BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 572
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|AUTHOR: |Beth Gaines |
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|VERSION: |July 2, 2015 |
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|HEARING DATE: |July 15, 2015 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : Diabetes prevention: treatment.
SUMMARY : Requires the Department of Public Health (DPH) to update the
California Wellness Plan 2014 to include specified items, and
requires DPH to report to the Legislature on or before January
1, 2018, and as specified, on the progress of the update.
Existing law:
1)Establishes DPH to protect and improve the health of
communities through education, promotion of healthy
lifestyles, and research for disease and injury prevention.
Establishes the California Diabetes Program (CDP) within DPH.
2)Provides DPH with the authority to perform activities that
protect, preserve, and advance public health, including
studies and dissemination of information.
This bill:
1)Requires DPH to update the California Wellness Plan 2014
(Plan) to include the following items:
a) Priorities and performance measures that are
based on evidence-based strategies to prevent or
control diabetes. Requires the Plan to identify
expected outcomes of the proposed priorities and
performance measures and establish benchmarks for
controlling and preventing relevant forms of diabetes.
b) An analysis of the financial impact of
diabetes on the state. Requires this assessment to
include the number of persons living with diabetes,
the number of family members affected by diabetes, the
financial impact diabetes and its complications have
on the state, and the financial impact of diabetes in
comparison to other chronic diseases and conditions.
AB 572 (Beth Gaines) Page 2 of ?
c) A summary of expenditures by DPH on programs
and activities aimed at preventing or controlling
diabetes.
d) A summary of the amount and source of any
funding directed to DPH for programs and activities
aimed at controlling or preventing diabetes.
e) A description of the existing level of
coordination between state departments and entities
regarding activities, programmatic activities, and the
provision of information to the public regarding
managing and preventing diabetes and its
complications.
f) A detailed budget blueprint identifying needs,
costs, and resources required to update the Plan.
Requires this blueprint to include a budget range for
each priority and performance measure identified.
g) Policy recommendations for the prevention and
management of diabetes.
2)Requires DPH to submit a report to the Legislature on or
before January 1, 2018, and biennially thereafter, that
includes the progress of the Plan updates. Requires the report
to also include recommendations for improving Plan items based
on activities and findings to date. Requires DPH to make this
report and any updates available on its Internet Web site.
3)Specifies that the requirement to submit a report to the
Legislature is inoperative on January 1, 2024.
4)Makes findings and declarations about the increased prevalence
of diabetes in the state and the total health care cost of
diabetes and related complications.
FISCAL
EFFECT : According to the Assembly Appropriations Committee:
1) Costs of $275,000 in the first year for staff and contract
costs for fiscal and economic analysis, and $125,000 (General
Fund) ongoing until the 2024 sunset for one full-time staff to
track progress and report biennially.
2) Potentially significant up-front cost pressure to fund action
steps to prevent and control diabetes, with potentially
significant long-term savings if such action is successful.
AB 572 (Beth Gaines) Page 3 of ?
PRIOR
VOTES :
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|Assembly Floor: |80 - 0 |
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|Assembly Appropriations Committee: |17 - 0 |
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|Assembly Health Committee: |17 - 0 |
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COMMENTS :
1)Author's statement. According to the author, diabetes has
reached epidemic levels in California. As of 2012, about one
in seven adult Californians has diabetes and as many as one in
three will be diagnosed in the near future. The total cost for
treatment of diabetes in California exceeds $24.5 billion.
This dollar amount includes hospitalization, outpatient
treatment, disability payments, loss of individual
productivity, and more. As the number of those affected
increases, so too will the cost. Many of the costs related to
diabetes go towards the treatment of preventable disease
related complications. These costly complications, such as
blindness and limb amputation, are avoidable if the patient is
properly educated on the management of the disease. When
people are made aware of the signs of the onset of diabetes,
they will be able to address the situation and seek medical
attention before the disease has progressed and the
irreversible damage to the body has been done.
2)Diabetes in California. DPH issued a study, The Burden of
Chronic Disease and Injury, in 2013 that highlights some of
the leading causes of death, such as heart disease, cancer,
stroke, and respiratory disease, all of which have a strong
connection to obesity. Diabetes is another serious chronic
disease stemming from obesity that adversely affects quality
of life and results in serious medical costs. The last decade
has witnessed a 32% rise in diabetes prevalence, affecting
some 3.9 million people and costing upwards of $24 billion per
year. According to the Center for Disease Control and
Prevention (CDC), more than one-third of U.S. adults are
obese, and approximately 12.5 million children and adolescents
AB 572 (Beth Gaines) Page 4 of ?
ages 2 to 19 years are obese. Research indicates a tripling in
the youth obesity rate over the past three decades. While this
increase has stabilized between the years 2005 and 2010, in
2010, 38%of public school children were overweight and obese.
Overweight youth face increased risks for many serious
detrimental health conditions that do not commonly occur
during childhood, including high cholesterol and type-2
diabetes. Additionally, more than 80% of obese adolescents
remain obese as adults.
3)CDP. The CDP was established in 1981 and represents a
partnership between DPH and the University of California, San
Francisco. It primarily receives its funding from the CDC. A
few key objectives that the CDP focuses on include:
a) Monitoring statewide diabetes health status and risk
factors;
b) Engaging in outreach to increase awareness about the
disease;
c) Guiding public policy to support at-risk and
vulnerable populations;
d) Offering leadership, guidance, and resources to
community health interventions;
e) Seeking to improve the health care delivery system;
and,
f) Reducing diabetes-related health disparities.
The CDP achieves these through partnering with different
individual, community, health care, policy, and environmental
entities.
4)The California Wellness Plan. In February 2014, DPH's Chronic
Disease Prevention Branch published the Plan, the result of a
statewide process led by DPH to develop a roadmap for DPH and
partners to promote health and eliminate preventable chronic
disease in California. The Plan aligns with the Let's Get
Healthy California Taskforce priorities and includes 26
priorities and performance measures developed in 2012 that are
based upon evidence-based strategies to prevent chronic
disease and promote equity. The Plan contains short,
intermediate, and long-term objectives with measurable effects
on a variety of chronic diseases, of which diabetes is a major
focus. The Plan also contains 15 objectives specific to
diabetes, including objectives to increase utilization of
diabetes prevention and self-management programs, as well as
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broad objectives to reduce the prevalence of obesity and
diabetes among children and adults. DPH's chronic disease
programs plan to collaborate with local and state partners,
including the Office of Health Equity, that are engaged in
diabetes prevention to implement the objectives. DPH intends
to monitor the progress of Plan objectives and publish regular
reports on outcomes.
According to DPH, the Chronic Disease Control Branch Chief
ensures that, at a minimum, the Plan is reviewed in
conjunction with partners every five years to assess the need
for a new version. As funding permits and partners agree, a
process to create a new version of the Plan will be developed
and implemented, overseen by the Director of Coordination. The
process will capture observations and recommendations based on
lessons learned from Plan implementation efforts and from
which updated priorities and evidence-based strategies can be
determined. The process will identify specific revisions,
assign them to responsible parties, and establish target dates
for completion. This review process will be consistent with
the CDC and Evaluation Program guidelines. Triggers for
reviewing the Plan sooner than the five year cycle include,
but are not limited to: a) major changes to DPH authority; or
b) major changes in federal and/or state funding, guidance, or
requirements. Any future versions of the Plan developed in
conjunction with partners will also be available to the public
on DPH's Web site. DPH further states that a one-day statewide
conference is planned for 2017 for partners and programs to
report on progress or short term outcomes of goals of the
Plan. A summary of conference reports will be posted online
after the conference.
5)State Auditor report. In January 2015, the State Auditor
published report 2014-113, titled "Even with a Recent Increase
in Federal Funding, Its Efforts to Prevent Diabetes Are
Focused on a Limited Number of Counties." The report
highlighted the fact that DPH manages federal grants that fund
its diabetes prevention efforts. California does not provide
any state funding for diabetes prevention. DPH spending on
diabetes prevention has declined over time due to reductions
in its federal funding. In fiscal year 2013-14, federal
funding for diabetes prevention decreased from more than $1
million in previous fiscal years to $817,000. DPH's maternal
diabetes program also experienced significant reductions in
federal funding over the last three fiscal years, declining
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from $1.2 million in fiscal year 2010-11 to $71,000 in fiscal
year 2013-14. In fiscal year 2012-13-the most recent year for
which nationwide data is available-California had the lowest
per capita funding for diabetes prevention in the nation. The
report also found that DPH spent its limited federal funds in
an appropriate manner and complied with applicable grant
requirements. For the 40 expenditures reviewed from fiscal
years 2009-10 through 2013-14, DPH expenditures were in
accordance with federal requirements, and the amounts spent
were found reasonable. Additionally, despite a concern that
was raised about the relationship between DPH diabetes and
tobacco control programs, the report found DPH has not spent
its limited diabetes funds on tobacco cessation activities.
The Auditor recommended that the state consider providing state
funding to support efforts to address diabetes, that DPH
should develop a process for identifying and applying for
federal funding opportunities, including routinely and
proactively searching for grants, and DPH should ensure that
staff responsible for diabetes prevention continues to develop
appropriate knowledge and skills.
6)Related legislation. SB 203 (Monning), would have required a
safety warning to be affixed to sugar sweetened beverages that
states "STATE OF CALIFORIA SAFETY WARNING: Drinking beverages
with added sugar(s) contributes to obesity, diabetes, and
tooth decay". SB 203 failed in the Senate Health Committee.
AB 270 (Nazarian), would require DPH to apply to the State
Department of Motor Vehicles to sponsor a diabetes awareness,
education, and research specialized license plate program.
Establishes the Diabetes Awareness Fund and specifies that
revenues from the fund will be used by DPH to fund programs
related to diabetes awareness and prevention. AB 270 is
pending in the Senate Appropriations Committee.
7)Prior legislation. SB 1316 (Cannella, 2014), would have
required the Department of Health Care Services, DPH, and the
Board of Administration of the Public Employees' Retirement
System to submit a report to the Legislature regarding their
respective diabetes-related programs. SB 1316 was never
referred out of Senate Rules Committee.
AB 1592 (Beth Gaines, 2014), would have required DPH to
complete and submit to the Legislature a Diabetes Burden
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Report by December 31, 2015, including, among other things,
actionable items for consideration by the Legislature that
would aid in attaining the goals set forth by DPH in the
California Wellness Plan for 2014. Would have required DPH to
include in the report guidelines that would reduce the fiscal
burden of diabetes to the state. AB 1592 was vetoed by the
Governor, stating that DPH had already submitted its Diabetes
Burden Report to the CDC, as required, and is unable to
withdraw the report to include additional information
prescribed by the bill.
8)Support. Supporters of this bill argue that diabetes is the
seventh-leading cause of death in the U.S. and is a leading
cause of adult blindness, kidney failure, and non-traumatic
amputation of the lower limbs. Supporters also point out that
one out of every seven adults (nearly three million) in the
state is diagnosed with diabetes, adding to health care costs
and related costs totaling nearly $37.1 billion, which could
be preventable with treatment and prevention programs.
Supporters further argue that diabetes disproportionately
affects underserved populations, including Black, Hispanic,
and Asian and Pacific Islander communities.
SUPPORT AND OPPOSITION :
Support: American Diabetes Association
American Federation of State, County and Municipal
Employees
Asian American, Native Hawaiian, and Pacific Islander
Diabetes Coalition
Association of California Healthcare Districts
Bayer Corporation
Biocom
Boehringer-Ingelheim Pharmaceutical Company
California Academy of Family Physicians
California Black Health Network
California Chronic Care Coalition
Congress of California Seniors
National Council of Asian Pacific Islander Physicians
Oppose: None received.
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