BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 2696| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- CONSENT Bill No: AB 2696 Author: Beth Gaines (R) Amended: 4/18/16 in Assembly Vote: 21 SENATE HEALTH COMMITTEE: 9-0, 6/15/16 AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen, Pan, Roth, Wolk SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8 ASSEMBLY FLOOR: 80-0, 6/1/16 - See last page for vote SUBJECT: Diabetes prevention and management SOURCE: Author DIGEST: This bill requires the Department of Public Health (DPH) to submit a report to the Legislature, as specified with certain criteria, regarding the prevention and management of diabetes and its complications. This bill requires DPH to post annually specified information on its Internet Web site. ANALYSIS: 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. AB 2696 Page 2 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 submit a report to the Legislature, on or before January 1, 2019, that includes a summary and compilation of recommendations on diabetes prevention and management, if any, from the University of California (UC), the Centers for Disease Control and Prevention (CDC), the California Wellness Plan (Plan), statewide diabetes stakeholder groups, and other entities identified by DPH as having relevant findings and recommendations. 2)Requires the DPH report to include any recommendations on evidence-based strategies to prevent or manage diabetes, an analysis on the financial impact diabetes and its complications have on the state, policy recommendations for the prevention and management of diabetes, and the existing level of coordination between state departments in providing information to the public regarding managing and preventing diabetes and its complications. 3)Requires DPH, commencing July 1, 2017, to post information annually on its Internet Web site that includes a summary of the amount and source of funding directed to DPH and the expenditures on programs and activities aimed at preventing and managing diabetes. 4)Makes DPH's reporting requirement in 1) above inoperative on January 1, 2024. Makes findings and declarations about the effect of diabetes and its complications on the state's health care system, as well as the disproportionate effect on the underserved and on ethnic minorities. AB 2696 Page 3 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 dollars. 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 CDC, more than one-third of U.S. adults are obese, and approximately 12.5 million children and adolescents ages two 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 AB 2696 Page 4 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 UC 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)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 broad objectives to reduce the prevalence of obesity and AB 2696 Page 5 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 AB 2696 Page 6 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 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. Prior Legislation AB 572 (Beth Gaines, 2015) would have required DPH to update the California Wellness Plan 2014 to include specified items, including priorities and performance measures that are based upon evidence-based strategies to prevent and control diabetes, and to submit a report to the Legislature by January 1, 2018, to include the progress of those specified plan items. AB 572 was held under submission in the Senate Appropriations Committee. AB 270 (Nazarian, 2015) would have required DPH to apply to the State Department of Motor Vehicles to sponsor a diabetes AB 2696 Page 7 awareness, education, and research specialized license plate program. The bill would have established the Diabetes Awareness Fund, with revenues to be used by DPH to fund programs related to diabetes awareness and prevention. AB 270 was held under submission in the Senate Appropriations Committee. 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 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. The bill 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. FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: No SUPPORT: (Verified6/28/16) American Federation of State, County, and Municipal Employees, AFL-CIO Association of California Healthcare Districts California Center for Public Health Advocacy United Auburn Indian Community AB 2696 Page 8 OPPOSITION: (Verified6/28/16) None received ARGUMENTS IN SUPPORT: The California Center for Public Health Advocacy (CCPHA) argues that the state has no plan in place to mitigate the escalating fiscal impact of diabetes. While there has been extensive legislation enacted to promote awareness and cost saving measures for conditions, such as cardiovascular disease and tobacco addiction, current law is woefully inadequate in regards to diabetes. Diabetes prevention spending in California is lower than any other state, at just $.03 per person each year. CCPHA states that if legislative action is not taken, California can expect a worsening diabetes crisis that will overwhelm health care providers, dramatically increase health care costs, and leave millions of Californians suffering needlessly. ASSEMBLY FLOOR: 80-0, 6/1/16 AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, 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 Prepared by: Reyes Diaz / HEALTH / (916) 651-4111 6/29/16 15:50:52 **** END **** AB 2696 Page 9