BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1795|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
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THIRD READING
Bill No: AB 1795
Author: Atkins (D), et al.
Amended: 8/15/16 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 6/15/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 5-0, 8/11/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NO VOTE RECORDED: Bates, Nielsen
ASSEMBLY FLOOR: 77-1, 6/2/16 - See last page for vote
SUBJECT: Health care programs: cancer
SOURCE: Susan G. Komen
DIGEST: This bill makes changes to the Breast and Cervical
Cancer Early Detection Program within the Department of Health
Care Services regarding eligibility for screenings, as
specified.
ANALYSIS:
Existing law:
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1)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services.
2)Establishes the Breast and Cervical Cancer Early Detection
Program, administered by DHCS through the Every Woman Counts
(EWC) program, to provide breast and cervical cancer screening
services under the Centers for Disease Control and Prevention
(CDC) grant at the level of funding budgeted from state and
other resources during the fiscal year in which the
Legislature has appropriated funds for this purpose.
3)Requires a provider or entity that participates in the federal
National Breast and Cervical Cancer Early Detection Program
(NBCCEDP) to provide screening services to an individual only
if the individual's family income has been determined not to
exceed 200% of the federal poverty level.
This bill:
1)Requires individuals to be eligible for breast cancer
screening and diagnostic services through the EWC program if
they meet eligibility requirements and a) are of any age and
"symptomatic," as defined, and b) are within the age range for
routine breast cancer screening, as recommended by the United
States Preventive Services Task Force, subject to any federal
action relating to breast cancer screening that overrides
those recommendations.
2)Defines "symptomatic" as an individual presenting with an
abnormality or change in the look or feel of the breast, as
specified.
Background
In 1990, the CDC created the NBCCEDP through Public Law 101-354.
This law authorized CDC to grant funds to states to screen a
reasonable number of low income, uninsured women for breast and
cervical cancers, provide referrals for follow-up and medical
treatment for women with abnormal test results, develop and
disseminate information for preventing breast and cervical
cancers, improve the training of health professionals in
preventing these cancers, and monitor the quality of screening
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procedures. The mission of the EWC program is to save lives by
preventing and reducing the devastating effects of cancer
through early detection and diagnostic services. EWC provides
free clinical breast exams, mammograms, pelvic exams, and Pap
tests to California's low income uninsured and underserved
women. These screening services facilitate early detection that
may prevent untimely cancer deaths. Each year, EWC provides care
for approximately 300,000 individuals. According to information
available on DHCS's Web site, EWC is funded, in part, by $.01 of
the $.02 tax on each pack of cigarettes sold in California that
is allocated to the Breast Cancer Fund (BCF).
The state's Breast and Cervical Cancer Treatment Program (BCCTP)
provides coverage for breast and cervical cancer treatment and
services related to cancer diagnosis. BCCTP provides treatment
coverage for approximately 9,000 individuals each year, through
both federal and state funding. Currently, the state-funded
BCCTP is not aligned with the federally funded BCCTP, causing
gaps in service and treatment for women diagnosed and treated
through the state-funded program. Under California's BCCTP,
treatment coverage is limited to 18 months for breast cancer and
24 months for cervical cancer. Federal funding provides coverage
for the duration of treatment. State funding also does not allow
coverage to a woman who is re-diagnosed with the same cancer at
the original cancer site while the federally funded program
does.
Comments
1)Author's statement. According to the author, this bill will
help ensure that women have timely access to life-saving
services to detect and treat cancer early. This bill affects
low-income women in California who are uninsured or
underinsured, and it allows them to complete necessary
treatment for breast and cervical cancer without an arbitrary
deadline to cut-off that critical treatment; it requires that
those in remission for breast and cervical cancer who are
later re-diagnosed with the same cancer not be turned away for
treatment; and it permits those individuals who are
symptomatic for breast cancer to receive necessary breast
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cancer screening services.
Related/Prior Legislation
AB 49 (Buchannan, Chapter 351, Statutes of 2014) established the
breast cancer awareness special interest license plate program
to generate funds to raise awareness of early breast cancer
screening. Requires the proceeds from the license plate sales to
be deposited in the Breast Cancer Control Account to fund EWC
programming.
SB 1348 (Cedillo of 2008) would have required DPH to provide
breast cancer screening services to women who are 38 years of
age and older and who meet other eligibility standards for
breast cancer screening services under existing state and
federal law. SB 1248 was held under submission in the Senate
Appropriations Committee.
AB 478 (Friedman, Chapter 660, Statutes of 1993) established a
$.02 tax on each pack of cigarettes sold, with the revenue
deposited in the BCF and the proceeds to be divided equally
between the Breast Cancer Research Account and the Breast Cancer
Control Account.
AB 2055 (Freidman, Chapter 661, Statutes of 1993) established
the Breast Cancer Control Account for purposes of breast cancer
research, detection services, and education. Modified the
allocation of tobacco tax funds so that 50% of the funds are
devoted to research and 50% for early detection services for
uninsured and underinsured women.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
1)Likely one-time administrative costs of $150,000 to $300,000
to update regulations and make necessary changes to billing
systems (General Fund). DHCS will likely need to make changes
to existing program regulations and systems for processing
claims (for example, no longer denying claims due to the
length of treatment time).
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2)Ongoing costs of about $200,000 per year from providing
eligibility for the Breast and Cervical Treatment Program for
reoccurring cases of cancer (General Fund). In recent years,
about 20 women per year were denied coverage because the
cancer was a reoccurrence of a previously treated cancer.
3)Potential increased costs, up to $2 million per year, to
increase eligibility for cancer screening services in the EWC
program to symptomatic women under 40 years of age
(Proposition 99 funds, federal funds, General Fund). Current
law does not limit participation in the EWC program based on
age. It is not clear whether symptomatic women who are under
40 years of age are currently being denied services. To the
extent that they are, and this bill eliminates that
limitation, there would be costs to the state. Based on the
reported incidence of cancer in women under 40 years of age,
staff estimates those potential additional costs being up to
$2 million per year. The EWC program is currently funded with
Proposition 99 Tobacco Tax funds and federal funds. To the
extent that there are additional costs and those funds are not
sufficient to pay for increased costs, there would be pressure
to appropriate General Fund for this purpose. (Because the EWC
program is not an entitlement, the state would not be
obligated to appropriate additional funding.)
SUPPORT: (Verified 8/12/16)
Susan G. Komen (source)
American Cancer Society Cancer Action Network
American Congress of Obstetricians and Gynecologists, District
IX (California)
American Federation of State, County and Municipal Employees
Association of California Healthcare Districts
Barbells for Boobs
Black Women for Wellness
Brown Temple Christian Methodist Episcopal Church
California Academy of PAs
California Association for Nurse Practitioners
CaliforniaHealth+ Advocates
California Health Collaborative
California Life Sciences Association
California National Organization for Women
California Nurses Association
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California Radiological Society
California Society of Plastic Surgeons
Cambodian Family Community Center
Cancer Support Community Benjamin Center
Cancer Support Community San Francisco Bay Area
Carrie's TOUCH
Central City Community Health Center
County Health Executives Association of California
Doctors for America
Health Access
Health Center Partners of Southern California
Hope Wellness Center
Johnson Chapel African Methodist Episcopal Church
Junior Leagues of California
MANA de San Diego
North Orange County Regional Health Foundation
Orange County Women's Health Project
Planned Parenthood Affiliates of California
Planned Parenthood Orange and San Bernardino Counties
Sacramento Community Cancer Coalition
Samoan National Nurses Association
Serve the People Community Health Center
Shanti
St. Mary Medical Center Foundation
Numerous Individuals
OPPOSITION: (Verified8/12/16)
California Department of Finance
ARGUMENTS IN SUPPORT: Supporters of this bill, largely
health providers, advocates, and numerous individuals, argue
that the state-funded BCCT program is not aligned with the
federally funded program, causing gaps in service and treatment
for women diagnosed and treated through the EWC program.
Supporters also argue that while the Affordable Care Act (ACA)
has expanded coverage and reduced California's rate of
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uninsured, up to 3.4 million Californians remain uninsured, and
limited benefit packages, such at the EWC and BCCT programs,
continue to be an important resource for that population.
Supporters state that this bill will help ensure that women have
timely access to receive the necessary services to detect and
treatment their cancers early.
ARGUMENTS IN OPPOSITION: The California Department of Finance
(DOF) argues that this bill creates an ongoing General Fund
cost, and the size of the population that will benefit from this
expansion is indeterminate. DOF states that with the
implementation of the ACA and the optional expansion of
Medi-Cal, individuals have greater access to preventive cancer
screenings and treatment.
ASSEMBLY FLOOR: 77-1, 6/2/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos,
Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh,
Dahle, Daly, Dodd, Eggman, Frazier, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Roger Hernández, Holden, Irwin,
Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Quirk,
Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark
Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams,
Wood, Rendon
NOES: Harper
NO VOTE RECORDED: Bigelow, Beth Gaines
Prepared by:Reyes Diaz / HEALTH / (916) 651-4111
8/15/16 19:47:24
**** END ****
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