BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 775
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|AUTHOR: |Chiu and Burke |
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|VERSION: |May 4, 2015 |
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|HEARING DATE: |June 24, 2015 | | |
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|CONSULTANT: |Melanie Moreno |
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SUBJECT : Reproductive FACT Act.
SUMMARY :1. Enacts the Reproductive Freedom, Accountability, Comprehensive
Care, and Transparency Act and requires clinics and other
facilities that provide family planning or pregnancy-related
services to provide specified notices to clients.
Existing law:
1)Requires the Department of Public Health (DPH) to inspect and
license health facilities, including but not limited to
clinics.
2)Provides for exemptions from licensing requirements for
certain types of clinics, including federally operated
clinics, local government primary care clinics, clinics
affiliated with an institution of higher learning, clinics
conducted as outpatient departments of hospitals, and
community or free clinics. Provides for exemptions for
community or free clinics that are operated on separate
premises from the licensed clinic and are only open for
limited services of no more than 20 hours per week (also known
as intermittent clinics).
3)Authorizes DPH to take various types of enforcement actions
against a primary care clinic that has violated state law or
regulation, including imposing fines, sanctions, civil or
criminal penalties, and suspension or revocation of the
clinic's license.
4)Grants a specific right of privacy under the California
Constitution and provides that the right to have an abortion
may not be infringed upon without a compelling state interest.
AB 775 (Chiu and Burke) Page 2 of ?
This bill:
1)Enacts the Reproductive Freedom, Accountability, Comprehensive
Care, and Transparency Act (Reproductive FACT Act).
2)Defines a "licensed covered facility," for the purposes of the
Reproductive FACT Act, as a licensed clinic or an intermittent
clinic operating under a primary care clinic whose primary
purpose is providing family planning or pregnancy-related
services, and that satisfies two or more of the following:
a) The facility offers obstetric ultrasounds,
obstetric sonograms, or prenatal care to pregnant
women;
b) The facility provides, or offers counseling
about, contraception or contraceptive methods;
c) The facility offers pregnancy testing or
pregnancy diagnosis;
d) The facility advertises or solicits patrons
with offers to provide prenatal sonography, pregnancy
tests, or pregnancy options counseling.
e) The facility offers abortion services; or,
f) The facility has staff or volunteers who
collect health information from clients.
3)Defines an "unlicensed covered facility," for the purposes of
the Reproductive FACT Act, as a facility that is not licensed
and does not have a licensed medical provider on staff or
under contract who provides or directly supervises the
provision of all of the services, whose primary purpose is
providing pregnancy-related services, and that satisfies two
or more of the following:
a) The facility offers obstetric ultrasounds,
obstetric sonograms, or prenatal care to pregnant
women;
b) The facility offers pregnancy testing or
pregnancy diagnosis;
c) The facility advertises or solicits patrons
with offers to provide prenatal sonography, pregnancy
tests, or pregnancy options counseling; or,
d) The facility has staff or volunteers who
collect health information from clients.
4)Specifies this bill does not apply to a clinic directly
conducted, maintained, or operated by the United States or any
AB 775 (Chiu and Burke) Page 3 of ?
of its departments, officers, or agencies; or, a licensed
primary care clinic that is enrolled as a Medi-Cal provider
and a provider in the Family Planning, Access, Care, and
Treatment Program (FamilyPACT).
5)Requires a licensed covered facility to disseminate to clients
on site the following notice in English and in the primary
threshold languages for Medi-Cal beneficiaries as determined
by DHCS for the county in which the facility is located:
"California has public programs that provide immediate free or
low-cost access to comprehensive family planning services
(including all FDA-approved methods of contraception),
prenatal care, and abortion for eligible women. To determine
whether you qualify, contact the county social services office
at [insert the telephone number]."
6)Permits the notice to be combined with other mandated
disclosures, but requires it be disclosed through one of the
following methods:
a) A public notice posted in a conspicuous place
where individuals wait that may be easily read by
those seeking services from the facility. Requires the
notice to be at least 8.5 inches by 11 inches and
written in no less than 22-point type;
b) A printed notice distributed to all clients in
no less than 14-point type; or,
c) A digital notice distributed to all clients
that can be read at the time of check-in or arrival,
in the same point type as other digital disclosures.
Requires a printed notice be available for all clients
who cannot or do not wish to receive the information
in a digital format.
7)Requires an unlicensed covered facility to disseminate to
clients on site and in any print and digital advertising
materials including Internet Web sites, the following notice
in English and in the primary threshold languages for Medi-Cal
beneficiaries as determined DHCS for the county in which the
facility is located:
"This facility is not licensed as a medical facility by the
State of California and has no licensed medical provider who
provides or directly supervises the provision of services."
AB 775 (Chiu and Burke) Page 4 of ?
8)Requires the onsite notice for unlicensed covered facilities
to be a sign at least 8.5 inches by 11 inches and written in
no less than 48-point type, and to be posted conspicuously in
the entrance of the facility and at least one additional area
where clients wait to receive services.
9)Requires the notice in the advertising material for unlicensed
covered facilities to be clear and conspicuous. Defines "clear
and conspicuous" to mean in larger point type than the
surrounding text, or in contrasting type, font, or color to
the surrounding text of the same size, or set off from the
surrounding text of the same size by symbols or other marks
that call attention to the language.
10)Makes covered facilities that fail to comply with the
Reproductive FACT Act liable for a civil penalty of $500 for a
first offense and $1,000 for each subsequent offense. Permits
the Attorney General (AG), city attorney, or county counsel to
bring an action to impose a civil penalty after:
a) Providing the covered facility with reasonable
notice of noncompliance, which informs the facility
that it is subject to a civil penalty if it does not
correct the violation within 30 days from the date the
notice is sent to the facility; and,
b) Verifying that the violation was not corrected
within the 30-day period.
11)Requires any penalty resulting from an action brought by the
AG to be deposited into the General Fund. Requires the
penalty, if the action is brought by a city attorney, to be
paid to the treasurer of the city in which the judgment is
entered. Requires the penalty, if the action is brought by a
county counsel, to be paid to the treasurer of the county in
which the judgment is entered.
12)Makes the provisions of the Reproductive FACT Act severable,
and prohibits, if any provision of the Act or its application
is held invalid, that invalidity from affecting other
provisions or applications that can be given effect without
the invalid provision or application.
FISCAL
EFFECT : This bill is keyed non-fiscal
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PRIOR
VOTES :
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|Assembly Floor: |49 - 26 |
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|Assembly Judiciary Committee: | 7 - 3 |
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|Assembly Health Committee: |12 - 5 |
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COMMENTS :
1)Author's statement. According to the author, California has a
proud legacy of respecting reproductive freedom and funding
forward-thinking programs to provide reproductive health
assistance to low income women. The power of the law is only
fully realized when California's women are fully informed of
the rights and services available to them. Because family
planning and pregnancy decisions are time sensitive,
California women should receive information that helps them
make decisions and access financial support at the sites where
they seek care. It is in the best interest of the state,
patients and providers that women are aware of available
assistance for preventing, continuing or terminating a
pregnancy. According to the Department of Health Care
Services, the Affordable Care Act expansion has made millions
of Californians, 53 percent of them women, newly eligible for
Medi-Cal. It is also critical that women know whether they are
receiving care from licensed medical professionals when they
are making important reproductive health decisions. AB 775
ensures that women in California are fully informed of their
options and are able to make their own healthcare and
pregnancy-related decisions.
2)Unintended pregnancies. Almost half of all pregnancies in
California are unintended. According to a 2014 Guttmacher
Institute document titled "State Facts About Unintended
Pregnancy: California," an extensive body of research links
births resulting from unintended or closely spaced pregnancies
to adverse maternal and child health outcomes and myriad
social and economic challenges. Economically disadvantaged
women are disproportionately affected by unintended pregnancy
and its consequences. In 2008, the unintended pregnancy rate
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among women with incomes lower than the federal poverty level,
at 137 per 1,000, was more than five times as high as the rate
among women with incomes greater than 200 percent of poverty
(26 per 1,000).
3)Crisis pregnancy centers. According to a 2011 report by the
Public Law Research Institute of UC Hastings College of the
Law, CPCs are pro-life (largely Christian belief-based)
organizations that offer a limited range of free pregnancy
options, counseling, and other services to individuals that
visit a center. CPCs are local non-profit organizations,
generally receiving substantial funding and resources from at
least one large pro-life umbrella organizations such as: Care
Net, International Heart Beat, and the National Institute of
Family and Life Advocates. CPCs typically do not offer
services that conflict with pro-life pregnancy options, like
abortion referrals or procedures. In contrast, full-service
organizations that provide pregnancy-related services offer a
wider variety of services including administering medical
tests, performing medical procedures (including abortions),
and providing counseling in pregnancy options. At least 228
CPCs exist in California and approximately 2,500 exist
nationwide. CPC networks claim that centers collectively
extended pregnancy services to approximately 1.8 million women
between 2008 and 2013.
4)University of California, Hastings College of Law research
report. In the fall of 2009 the Assembly Business,
Professions and Consumer Protection Committee, concerned that
CPCs throughout California were disseminating medically
inaccurate information about pregnancy options available in
the state, requested a report by the University of California,
Hastings College of Law regarding CPCs' practices and
potential legislative options for regulating them. Issued in
April 2011 and updated in June 2015, "Pregnancy Resource
Centers: Ensuring Access and Accuracy of Information,"
discusses several options for regulation of CPCs, ranging from
creating new regulations, leveraging existing regulations
aimed specifically at medical services, as well as creating a
new statute. Because approaches that have treated CPCs and
full-service pregnancy centers differently have been
challenged as violating the First Amendment, the report
concludes that the best approach to a statutory change would
regulate all pregnancy centers, not just CPCs, in a uniform
manner.
AB 775 (Chiu and Burke) Page 7 of ?
5)Policies in other locales. The City of New York enacted
regulations in 2011 and Montgomery County, Maryland adopted a
resolution in 2010 requiring CPCs without medical staff to
post signage indicating that they do not have a licensed
medical professional on staff and that pregnant women are
encouraged to consult with a licensed health care provider.
The City of New York's regulations also required CPCs to
disclose whether or not it provides referrals for abortions,
emergency contraception, and prenatal care. In 2014, an
appeals court overturned those provisions and the requirement
that CPCs tell clients that New York City health officials
recommend that pregnant women consult a licensed healthcare
provider, but upheld the medical staff notification piece. The
City and County of San Francisco passed a false advertising
ordinance aimed at CPCs, called the Pregnancy Information and
Protection Ordinance, which was challenged by CPC owner in
court as a violation of free speech. The ordinance was upheld
by a federal court earlier this year.
6)Support. Black Women for Wellness and NARAL Pro-Choice,
California co-sponsors of this bill, and numerous other
organizations, including, California Council of Churches
IMPACT, California Latinas for Reproductive Justice, Maternal
and Child Health Access, and Planned Parenthood, California,
state that this bill will enable women to seek the care they
wish to obtain and providing context for counseling given at
unlicensed facilities. They also state that distributing a
notice of reproductive health services would ensure that women
in any reproductive health or pregnancy counseling facility
know that California respects their rights and provides
assistance. The California Primary Care Association (CPCA)
states this bill will protect patients by allowing them to
fully understand their rights when it comes to their
reproductive freedom and to not be deceived by organizations
whose sole purpose is to provide them with a biased view that
does not allow them to make their own informed choice. CPCA
notes that many of their community clinics and health centers
grew out of the women's movement and their members believe a
women's right to choose is a fundamental health right that
must be protected. The American Nurses Association, California
(ANA\C) writes that all California residents should have
access to reproductive health services, and more than 700,000
California women become pregnant every year, approximately
half of them unintentionally. ANA\C states thousands of women
AB 775 (Chiu and Burke) Page 8 of ?
do not know the legal options they have, or the funding
resources available to them, and this bill will help ensure
that pregnant women receive the information they need to make
an informed decision. Forward Together states that women in
California face a threat from manipulative crisis pregnancy
centers which pose as comprehensive reproductive health
centers, but are, in fact, anti-choice organizations that
target women with the goal of blocking them from considering
abortion as an option and using proven contraceptive methods.
Forward Together contends that CPCs use false and misleading
advertising to appeal to women, who think they may be pregnant
and are looking for comprehensive reproductive health care,
and then manipulate and shame these women by peddling
medically inaccurate information about abortion and
contraception.
7)Opposition. The California Catholic Conference (CCC) states
that on its surface, the bill proposes to regulate the state's
pregnancy centers, but in actuality is aimed at discriminating
against those pregnancy centers that hold a pro-life
viewpoint. CCC contends that such unfair legislation may
discourage women from getting the assistance that they need
and deserve as well as expose many of these pregnancy centers
to needless criminal or civil sanctions for failure to comply.
CCC concludes that because they believe all life is sacred,
they support programs which offer medical, economic and
emotional support for pregnant women and children, so that
they can make life-affirming choices. The California Right to
Life Committee, Inc. (CRLC) states that, if enacted, it could
set a precedent for many other businesses that are not like or
appreciated by one group in society which could bring a law
suit against another business, company, or agency. CRLC asks
us to consider car dealerships: what if they were to be seen
as anti-environmental with misleading advertising, selling too
many cars, and making citizens not anxious to take high speed
rail? CRLC asks: would it not be possible that the California
High Speed Rail Authority require that car dealerships
advertise High Speed Rail locations, schedules, and fees?
CRLC argues the provisions of this bill would not be best
practice for the car industry any more that it would be for
pro-life pregnancy centers to have to promote services which
they consider morally reprehensible.
SUPPORT AND OPPOSITION :
Support:
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Attorney General Kamala Harris (co-sponsor)
Black Women for Wellness (co-sponsor)
NARAL Pro-Choice California (co-sponsor)
ACT for Women and Girls
Alameda County Board of Supervisors
Alameda County Public Health Department
American Congress of Obstetricians and Gynecologists District IX
American Nurses Association\California
Anti-Defamation League
California Association for Nurse Practitioners
California Church IMPACT
California Family Health Council
California Latinas for Reproductive Justice
California Nurses Association
California Pan-Ethnic Health Network
California Primary Care Association
California Religious Coalition for Reproductive Choice
California Women Lawyers
California Women's Law Center
Center on Reproductive Rights and Justice, University of
California, Berkeley School of Law
Citizens for Choice
City and County of San Francisco
City and County of San Francisco Department of Public Health
City of Berkeley
City of Los Angeles Mayor Eric Garcetti
City of West Hollywood
Feminist Majority
Forward Together
Fresno Barrios Unidos
League of Women Voters of California
Maternal and Child Health Access
National Center for Youth Law
National Council of Jewish Women California
National Health Law Program
Planned Parenthood Affiliates of California
San Francisco Women's Political Committee
Unite for Reproductive and Gender Equity
Western Methodist Justice Movement
Women's Community Clinic
Oppose:
Alternatives Pregnancy Center
California Catholic Conference
California Right to Life Committee
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California, Concerned Women for America
Capitol Resource Institute
Marin Pregnancy Clinic
National Institute of Family and Life Advocates
Open Arms Pregnancy Center
Numerous individuals
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