BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1726
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|AUTHOR: |Bonta |
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|VERSION: |May 31, 2016 |
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|HEARING DATE: |June 29, 2016 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : Data collection
SUMMARY : Requires specified state agencies, when collecting demographic
data for their respective purposes, to collect and tabulate data
for additional major Asian and Native Hawaiian groups, and other
Pacific Islander groups, as specified.
Existing law:
1)Prohibits an application to any state department, board, or
commission from including any question relative to an
applicant's race, sex, marital status, or religion, except for
the collection of data on gender and marital status to be
obtained subsequent to employment for research and statistical
purposes.
2)Requires a state agency, board, or commission that directly or
by contract collects demographic data as to the ancestry or
ethnic origin of Californians to use separate collection
categories and tabulations for the following:
a) Each major Asian group, including but not
limited to, Chinese, Japanese, Filipino, Korean,
Vietnamese, Asian Indian, Laotian, and Cambodian; and,
b) Each major Pacific Islander group, including
but not limited to, Hawaiian, Guamanian, and Samoan.
1)Requires the Department of Industrial Relations and the
Department of Fair Employment and Housing, in the course of
AB 1726 (Bonta) Page 2 of ?
collecting demographic data directly or by contract as to the
ancestry or ethnic origin of California residents, to collect
and tabulate data for the following:
a) Additional major Asian groups, including but
not limited to, Bangladeshi,
Hmong, Indonesian, Malaysian, Pakistani, Sri Lankan,
Taiwanese, and Thai; and,
b) Additional major Native Hawaiian and other
Pacific Islander groups, including but not limited to,
Fijian and Tongan.
This bill:
1)Requires the Departments of Public Health (DPH) and Health
Care Services (DHCS), on or after July 1, 2017, in the course
of collecting demographic data directly or by contract as to
the ancestry or ethnic origin of California residents 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, to
collect and tabulate data for the groups mentioned in 3)
above.
2)Requires the Trustees of the California State University (CSU)
or the Regents of the University of California (UC), on or
after July 1, 2017, whenever the entity collects demographic
data as to the ancestry or ethnic origin of students for a
report that includes student admission, enrollment,
completion, or graduation rates, to collect and tabulate data
for the groups mentioned in 3) above. Requires the provisions
in this bill to apply to the UC only if the Regents, by
resolution, make it applicable.
3)Requires the Board of Governors of the California Community
Colleges (CCC), on or after July 1, 2020, whenever the entity
collects demographic data as to the ancestry or ethnic origin
of students for a report that includes student enrollment,
completion, or graduation rates, to collect and tabulate data
for the groups mentioned in 3) above.
4)Requires state agencies to make any data collected publicly
available by posting the data on their Internet Web sites, as
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specified. Requires CSU, UC, and CCC to comply, where
applicable, with the federal Family Educational Rights and
Privacy Act, and to observe federal criteria for ensuring
statistical significance of data collected and published.
5)Requires DPH, DHCS, CSU, and UC, within 18 months after a
decennial United States Census is released to the public, to
update their data collection to reflect the additional major
Asian, Native Hawaiian, and Pacific Islander groups as they
are reported by the United States Census Bureau. Requires this
requirement to apply to the CCC 18 months after the 2030
decennial census is released to the public.
6)Prohibits the provisions in this bill from applying to
demographic data of graduate or professional schools of the
UC.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)UC. The system already collects the additional data for
undergraduate students, as required in this bill.
2)CSU. Minor absorbable costs.
3)CCC. Minor absorbable costs.
4)DPH. Will be impacted in several areas, incurring total costs
of about $600,000 for two years and $80,000 every 10 years
following release of a new census.
a) The Center for Health Statistics and Informatics would
need two additional research positions to include vital
records data currently collected but not reported and to
ensure statistical reliability and privacy of individuals.
The workload includes the need for development of new
statistical coding of data to produce the strata specified
for the data files, and to ensure the integrity and quality
of the data produced. In addition, staff will need to
determine if the disaggregated data produced is
statistically reliable and ensure that re-identification of
individuals was not possible for confidential data. This
work applies to County Health Status Profiles, Death Data
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Trend Summaries, Birth Profiles and other statistical
tables derived from birth and death data prepared with
breakdowns by race/ethnicity. According to the Department,
the analysis to prevent re-identification of individuals is
rigorous and becomes complex and time-consuming at the
level of detail proposed by this bill.
b) The California Reportable Disease Information Exchange
(CalREDIE) system would require additional staff time to
modify the system and update paper forms to collect the
additional race/ethnicity data. The Division of
Communicable Disease Control (DCDC) would require one
position over two years to modify the CalREDIE system, work
with the CalREDIE vendor to populate the race sub-category
information, update and publish the Electronic Laboratory
Reporting (ELR) specification guide to reflect that the
race sub-category information is required/mandatory,
canvass ELR submitters to comply with the new standard, and
update approximately 60 paper forms in order to comply with
the bill's.
c) The Office of AIDS (OA) would require on position to
lead the reprogramming of OA data systems and the
production of statistical reports with the required
categories (as allowed under HIV confidentiality laws) and
to provide consultation in the amendment of regulation.
d) The Response and Surveillance System for Childhood Lead
Exposures (RASSCLE) blood lead reporting system would
require one-half position ($80,000) initially), within 18
months of the 2020 census, and again within 18 months of
each succeeding census to update the data system.
e) The Maternal Child and Adolescent Health (MCAH) program
data collection system would need to be updated for the
racial/ethnic populations not currently in the system and
required in the bill, which would then be added to reports
from the Adolescent Family Life Program (AFLP) that include
the type and amount of health care coverage, pregnancy
rates, and housing numbers. One-time costs to update these
systems would range between $5,000 and $10,000.
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5)DHCS. Based on similar legislation last year, the Department
would incur one-time costs of at least $150,000 to make
computer system upgrades. Current computer systems used to
manage enrollment and benefits for the Medi-Cal program do not
allow for the collection of demographic information at the
level of detail required in the bill. The computer systems
that would require modification include three state operated
systems and three county-operated systems used to enroll
individuals in Medi-Cal
PRIOR
VOTES :
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|Assembly Floor: |54 - 22 |
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|Assembly Appropriations Committee: |14 - 6 |
|Assembly Health Committee: |13 - 3 |
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|Assembly Higher Education |10 - 2 |
|Committee: | |
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COMMENTS :
1)Author's statement. According to the author, relying on
aggregate data of the Asian Pacific Islander (API) community,
the state fails to recognize that different API ethnic
subpopulations have different social and economic conditions.
If the needs of each are not addressed 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 API
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 API groups
within the API population raise the average outcome of the
greater API population as a whole. For example, although data
related to the average API student demonstrates high academic
achievements, disaggregated data sheds light on the harsh
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reality that Southeast Asian subgroups suffer from much lower
achievement rates than other API groups. Similarly, data from
a 2013 report done 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)Existing data collection. Existing law requires a state
agency, board, or commission that directly or by contract
collects demographic data as to the ancestry or ethnic origin
of Californians to use separate collection categories and
tabulations for each major Asian group, as specified, and each
major Pacific Islander group, as specified. According to the
Senate Education Committee analysis on this bill, this
requirement appears to apply to the California State
University (CSU) and the California Community Colleges (CCC),
but not to the University of California (UC). However, all
three segments are currently collecting this information. The
CCC collects information on 11 different API communities on
its application CCC Apply. As of 2009, the CSU application was
modified to provide applicants with over 50 different API
categories from which to self-identify. Additionally, the
existing practices of the UC on data collection exceed what is
required in this measure. A 2013 report of API students at CSU
Fresno, "The Academic Challenges of Southeast Asians at Fresno
State," found significant educational disparities within the
API group and Southeast Asian community. A closer look at the
respective API ethnic groups showed that 97% of Hmong students
were first generation college students who came from larger
households, and 62% came from a low-income household.
3)Disparities in data collection. 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
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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 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.
4)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.
5)Double referral. This bill was heard in the Senate Education
Committee on June 22, 2016, and passed out with a vote of 7 to
2.
6)Related legislation. SCR 134 (Pan), would urge DPH to endorse
and support the "Screen at 23" campaign's efforts to increase
awareness of diabetes among Asian-American communities,
including the use of appropriate screening measures for
Asian-American patients and to eliminate disparities, and
would urge DPH to encourage all public and private health
providers and facilities to also participate in these efforts.
SCR 134 is pending on the Senate Floor.
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AB 2424 (Gomez), would, among other things, create the
Community-based Health Improvement and Innovation Fund in the
State Treasury from which moneys would be available, upon
appropriation by the Legislature, for certain purposes,
including, but not limited to, reducing health inequity and
disparities in the rates and outcomes of priority chronic
health conditions, including diabetes. AB 2424 is set to be
heard in the Senate Health Committee on June 29, 2016.
7)Prior legislation. AB 176 (Bonta of 2015), was very similar to
this bill. AB 176 was vetoed by Governor Brown, whose veto
message read, in part: "[?] I am wary of the ever growing
desire to stratify. Dividing people into ethnic or other
subcategories may yield more information, but not necessarily
greater wisdom about what actions should follow. To focus just
on ethnic identity may not be enough. CSU, community colleges,
and UC already provide many ways in which to self-identify,
including choosing among several ethnic identities. In the
case of CSU, there are 50 choices for API applicants alone.
AB 411 (Pan of 2013), would have required DHCS, upon available
funding, 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 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 was vetoed by Governor
Brown 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 procuring this additional data, he was confident
that they would procure it.
AB 1737 (Eng of 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 of 2007), would have required various state
entities to report collected demographic data according to
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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 of 2006), was substantially similar to AB 176
(Bonta), 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.
8)Support. Supporters argue that this bill would illuminate
economic, health, and educational disparities within Asian
American and Pacific Islander communities by requiring
collection of disaggregated demographic data by the specified
state agencies. Supporters state that this bill would increase
public access and awareness of this data by requiring the
agencies to annually publish demographic data on their Web
sites, as specified. Supporters state that data has the power
to reveal or to conceal the tremendous diversity within our
communities, and that API data in general often overshadows
unique challenges faced by Southeast Asian American and
Pacific Islander students and refugee communities, including
high rates of poverty, limited English proficiency, and
cultural barriers that have resulted in low educational
outcomes and impaired access to health care. Supporters argue
that without the collection and reporting of state data on
smaller API groups, their potentially greater needs are likely
to be overlooked and underestimated.
9)Opposition. Opponents state that this bill is a backward step
in equality in California, and they are troubled by the hidden
agenda. Opponents argue that stratified data collected by
government agencies and state universities may easily be
manipulated to advance race-based public policies that are
unlawful under the state's Constitution, and have a potential
to create social danger and racial tension. Opponents further
state that they are disturbed by the divisive and unfair
nature of this bill, as there is no mention of subgroups
within Hispanics, Whites, or African Americans, despite the
fact that these ethnic groups are equally diverse as Asian
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Americans, if not more.
SUPPORT AND OPPOSITION :
Support: Asian & Pacific Islander American Health Forum
(APIAHF) (Co-Sponsor)
California Pan-Ethnic Health Network (CPEHN)
(Co-Sponsor)
Empowering Pacific Islander Communities (EPIC)
(Co-Sponsor)
Southeast Asia Resource Action Center (SEARAC)
(Co-Sponsor)
Abriendo Puertas, Opening Doors
Alliance for Boys and Men of Color
American Cancer Society Cancer Action Network
American Civil Liberties Union of California
Asian Americans Advancing Justice-California
Asian American Cancer Support Network
Asian American Drug Abuse Program, Inc.
Asian Americans for Community Involvement
Asian Health Services
Asian Law Alliance
Asian Pacific American Labor Alliance- Alameda
Asian Pacific American Labor Alliance- Los Angeles
Asian Pacific American Labor Alliance- Sacramento
Asian Pacific Islander Obesity Prevention Alliance
Asian Pacific Partners for Empowerment, Advocacy and
Leadership
Asian Pacific Policy & Planning Council (A3PCON)
AYPAL
Banteay Srei
BPSOS
Brightline Defense Project
California Asian Pacific Chamber of Commerce
California Asian Pacific Islander Budget Partnership
California Immigrant Policy Center
California State Student Association
California State Treasurer John Chiang
California State University/Office of the Chancellor
California Teachers Association
California Young Democrats Asian Pacific Islander
Caucus
Canal Alliance
Chinatown Public Health Center
Chinese for Affirmative Action
Community Health Partnership
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East Bay Asian Youth Center (EBAYC)
Families in Good Health
Fathers & Families of San Joaquin
Fresno Interdenominational Refugee Ministries (FIRM)
Global Refugee Awareness Healing Center
Graduate Academic Achievement and Advocacy Program
Having Our Say Coalition
Health Access California
Healthy House Within a MATCH Coalition
Hmong Innovating Politics
Hmong National Development
Inland Empire - Immigrant Youth Coalition
Iu-Mien Community Services
Khmer Girls in Action
Khmer Parent Association
Korean Churches for Community Development
Korean Resource Center
Leadership Education for Asian Pacifics, Inc.
March of Dimes in California
Mental Health America in California
Mexican American Legal Defense and Educational Fund
Multicultural Council of America
National Asian Pacific American Women's Forum (NAPAWF)
National Asian Pacific American Women's Forum- Bay
Area Chapter
National Asian Pacific American Women's Forum- Los
Angeles
National Association of Social Workers - California
Chapter
National Council of Asian Pacific Americans
National Pacific Islander Education Network
Native Hawaiian and Pacific Islander Alliance
NICOS Chinese Health Coalition
OCA- Asian Pacific Advocates
OCA- East Bay
OCA- Greater Los Angeles
OCA- San Francisco Bay
Pacific Islander Health Partnership
PALS for Health
PolicyLink
Refugee & Immigration Ministries- Christian Church
(Disciples of Christ) in the US and Canada
Santa Clara County Board of Supervisors
SEIU California
Services, Immigrant Rights, and Education Network
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(SIREN)
Southeast Asian Assistance Center
Stone Soup Fresno
The Cambodian Family Community Center
The Campaign for College Opportunity
The Greenlining Institute
The San Francisco Foundation
TOFA Inc.
Union of North American Vietnamese Student
Associations
United Cambodian Community
University of California/Office of the President
Urban Strategies Council
Vietnamese Youth Development Center
Western Center on Law & Poverty
Youth ALIVE!
Oppose: Dublin Chinese Association
Foster City Chinese American Association
No Tower In Schools
San Diego Asian Americans For Equality
San Ramon Chinese Association
Silicon Valley Chinese Association
Small Hand Big Hand
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