BILL ANALYSIS Ó
AB 2775
Page 1
Date of Hearing: April 19, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 2775
(Gallagher) - As Amended March 17, 2016
SUBJECT: Abortion services facilities: pregnancy center
notice.
SUMMARY: Requires facilities that offer abortion services to
disseminate a notice to clients providing a telephone number for
a specific organization, and stating that non-profit pregnancy
centers can provide a variety of specified services.
Specifically, this bill:
1)Requires a facility that offers abortion services to
disseminate to clients onsite the following notice:
"If you are considering continuing your pregnancy, nonprofit
pregnancy centers can provide services at no cost to you, that
may include consultation, pregnancy testing, ultrasound
services, support groups, parenting programs, material
assistance, and sexually transmitted disease or sexually
transmitted infection (STD/STI) testing. To find a center
near you, call 1-800-712-HELP."
2)Requires the facility to disseminate the notice in the primary
threshold languages for Medi-Cal beneficiaries as determined
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by the Department of Health Care Services (DHCS) in which the
facility is located.
3)Requires the onsite notice to be a sign at least 8.5 inches by
11 inches, written in no less than 36-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.
EXISTING LAW:
1)Licenses and regulates clinics, including primary care clinics
and specialty clinics such as surgical clinics, by the
Department of Public Health (DPH).
2)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.
3)Establishes the California Reproductive Privacy Act, which
provides that the state shall not deny or interfere with a
women's right to choose or obtain an abortion prior to
viability of the fetus, or when the abortion is necessary to
protect the life or health of the woman, and makes legislative
findings and declarations that every individual possesses a
fundamental right of privacy with respect to personal
reproductive decisions, and that every woman has the
fundamental right to choose to bear a child or to choose and
to obtain an abortion, as specified.
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4)Enacts the Reproductive Freedom, Accountability, Comprehensive
Care, and Transparency Act (Reproductive FACT Act).
5)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.
6)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:
7)"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]."
8)Permits the notice to be combined with other mandated
disclosures, but requires it be disclosed through one of the
following methods:
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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.
9)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.
10)Requires an unlicensed covered facility to disseminate to
clients on site and in any print and digital advertising
materials including Internet Websites, 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:
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"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."
11)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.
12)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.
13)Specifies this bill does not apply to a clinic directly
conducted, maintained, or operated by the United States or any
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).
14)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.
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15)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.
FISCAL EFFECT: This bill has not been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, pregnancy
resource centers are a tremendous resource to pregnant women
who need help and support. The author states that women who
are deciding to keep their child deserve the opportunity to
know about this resource, and this bill does not change how
the current law is structured, but simply offers information
on resources available in the community if a woman chooses to
keep her baby. The author concludes, providing women with
information about all their options and resources should be at
the forefront of the California Health and Safety Code, and
this bill seeks to make this a reality.
2)BACKGROUND.
a) 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
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affected by unintended pregnancy and its consequences. In
2008, the unintended pregnancy rate among women with
incomes lower than the federal poverty level (FPL), at 137
per 1,000, was more than five times as high as the rate
among women with incomes greater than 200% FPL (26 per
1,000).
b) Abortion data. According to a 2014 Guttmacher Institute
document titled "State Facts About Unintended Pregnancy:
California," contraceptive use is a key predictor of
women's recourse to abortion. The very small group of
American women who are at risk of experiencing an
unintended pregnancy but are not using contraceptives
account for more than half of all abortions. Many of these
women did not think they would get pregnant or had concerns
about contraceptive methods. The remainder of abortions
occur among the much larger group of women who were using
contraceptives in the month they became pregnant. Many of
these women report difficulty using contraceptives
consistently. According to the Guttmacher Institute, at
current rates, about three in 10 American women will have
had an abortion by the time she reaches age 45.
Approximately, 58% of women having abortions are in their
20s; 61% have one or more children; 85% are unmarried; 69%
are economically disadvantaged; and 73% report a religious
affiliation. No racial or ethnic group makes up a
majority: 36% of women obtaining abortions are white
non-Hispanic; 30% are black non-Hispanic; 25% are Hispanic;
and, 9% are of other racial backgrounds.
According to the Centers for Disease Control and Prevention
(CDC), in 2012, 699,202 legal induced abortions were reported to
CDC from 49 reporting areas. The abortion rate for 2012 was
13.2 abortions per 1,000 women aged 15 to 44 years, and the
abortion ratio was 210 abortions per 1,000 live births.
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Compared with 2011, the total number and ratio of reported
abortions for 2012 decreased 4%, and the abortion rate decreased
5%. Additionally, from 2003 to 2012, the number, rate, and ratio
of reported abortions decreased 17%, 18%, and 14%, respectively.
Given the large decreases in the total number, rate, and ratio
of reported abortions from 2011 to 2012, in combination with
decreases that occurred during 2008 to 2011, all three measures
reached historic lows.
c) Crisis Pregnancy Centers (CPCs). CPCs are facilities,
both licensed and unlicensed, which present themselves as
comprehensive reproductive health centers, but are commonly
affiliated with, or run by organizations whose stated goal
is to prevent women from accessing abortions. A 2015 NARAL
Pro-Choice America report on CPCs notes that the National
Institute of Family and Life Advocates (an organization
with over 1,300 CPC affiliates) states on its website that
it is on the front line of the cultural battle over
abortion, and its vision is to provide [CPCs] with legal
resources and counsel, with the aim of developing a network
of life-affirming ministries in every community across the
nation in order to achieve an abortion-free America. The
NARAL report also sent several researchers into CPCs to
receive the counseling offered, and they widely reported
that they were provided with inaccurate information,
including only being given information regarding the risks
of abortion, being told that many women commit suicide
after having an abortion, and that abortions can cause
breast cancer.
3)SUPPORT. Concerned Women for America (CWA) supports this bill
and states that it attempts to balance the outrageous attack
on pregnancy resource centers that occurred with the passage
of AB 775 (Chiu and Burke), Chapter 700, Statutes of 2015.
CWA also states that the people who work in pregnancy resource
centers have a deep love and genuine concern for women and
their babies, and the joy and hope that women experience
through the care they receive at these centers make a
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challenging season of life so much more bearable and even a
blessing. The California Right to Life Committee, Inc.
supports this effort to provide pregnant girls and women with
alternate resources when they are at abortion facilities,
stating that this is a minimal measure to bring some equality
to the recognition that women have choices when they are
pregnant.
4)OPPOSITION. The American Academy of Pediatrics, California
(AAP-CA) opposes this bill and states every year, nearly 42
million women around the world choose abortions, and nearly
half of these procedures are unsafe. AAP-CA notes that women
choose unsafe abortions for a number of reasons, including
economic burdens and familial and societal pressures, and
pregnant teens are even more vulnerable to these pressures.
AAP-CA concludes that by requiring abortion clinics to post a
notification encouraging women who want to continue their
pregnancies to visit a CPC, this bill would represent an
additional barrier to access to safe and legal abortions, and
increase the risk that pregnant teens will resort to unsafe
and illegal abortions.
The California Family Health Council (CFHC), also in opposition,
states because decisions around family planning and pregnancy
are time sensitive, and care early in pregnancy is important,
women need to receive accurate information about affordable
health care options at the sites where they obtain care. CFHC
contends that CPCs use misleading advertising to target women
who may be pregnant to give them medically inaccurate
information about abortion and contraception, and delay them
from receiving the real medical care they need from health
care professionals.
Numerous other organization oppose this bill, including the
American Congress of Obstetricians and Gynecologists, District
IX, California, ACT for Women and Girls, California Women's
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Law Center, NARAL Pro-Choice California, and the National
Council of Jewish Women, noting that the phone number abortion
clinics would be required to post is Option Line, run by an
umbrella organization for CPCs, the sole purpose of which is
to prevent women from accessing abortions.
5)RELATED LEGISLATION.
a) AB 2134 (Waldron) requires licensed clinics that perform
abortions to post a notice advising clients that it may be
possible to reverse the effects of the abortion pill. AB
2134 is currently pending in the Assembly Health Committee.
b) AB 2081 (Grove) provides that a health care service
plan is not required to include abortion as a covered
benefit, and would prohibit the Director of the Department
of Managed Health Care from denying, suspending, or
revoking a plan's license, or otherwise sanction or
discriminate against a health plan, if the health plan
excludes coverage for abortions. AB 2081 failed passage in
the Assembly Health Committee.
6)PREVIOUS LEGISLATION.
a) AB 775 enacts the Reproductive FACT Act and requires
clinics and other facilities that provide family planning
or pregnancy-related services to provide specified notices
to clients.
b) AB 1254 (Grove) of 2015 was substantially similar to AB
2081. AB 1254 failed passage in the Assembly Health
Committee.
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c) AB 2336 (Grove) of 2014 would have prohibited a person
from performing, or attempting to perform an abortion if
they know the pregnant woman is seeking the abortion on
account of the gender of the unborn child. AB 2336 failed
passage in the Assembly Health Committee.
d) ACA 5 (Grove) of 2014 would have prohibited, except in
the case of an emergency, a physician from performing an
abortion on an unemancipated minor unless the physician has
notified one of her parents, or a judge has granted the
unemancipated minor a waiver of the notification
requirement. ACA 5 failed passage in the Assembly Health
Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
California Catholic Conference, Inc.
Californians for Life
California Right to Life Committee, Inc.
Concerned Women for America
Six individuals
Opposition
ACT for Women and Girls
American Academy of Pediatrics
American Civil Liberties Union
American Congress of Obstetricians and Gynecologists, District
IX, California
California Family Health Council
California Women's Law Center
Community Action Fund of Planned Parenthood of Orange and San
Bernardino Counties
Law Students for Reproductive Justice
NARAL Pro-Choice California
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National Council of Jewish Women
Physicians for Reproductive Health
Planned Parenthood Advocates Pasadena and San Gabriel Valley
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Affiliates of California
Planned Parenthood Mar Monte
Unite for Reproductive & Gender Equity
Analysis Prepared by:Lara Flynn / HEALTH / (916) 319-2097