BILL ANALYSIS Ó SB 1139 Page 1 SENATE THIRD READING SB 1139 (Lara) As Amended August 1, 2016 Majority vote SENATE VOTE: 28-11 ------------------------------------------------------------------ |Committee |Votes|Ayes |Noes | | | | | | | | | | | | | | | | |----------------+-----+----------------------+--------------------| |Health |13-4 |Wood, Bonilla, Burke, |Maienschein, | | | |Campos, Chiu, Gomez, |Patterson, | | | | |Steinorth, Waldron | | | | | | | | |Roger Hernández, | | | | |Lackey, Nazarian, | | | | |Ridley-Thomas, | | | | |Rodriguez, Santiago, | | | | |McCarty | | | | | | | | | | | | |----------------+-----+----------------------+--------------------| |Appropriations |14-5 |Gonzalez, Bloom, |Bigelow, Gallagher, | | | |Bonilla, Bonta, |Jones, Obernolte, | | | |Calderon, Daly, |Wagner | | | |Eggman, Eduardo | | | | |Garcia, Holden, | | SB 1139 Page 2 | | |Quirk, Santiago, | | | | |Weber, Wood, Chau | | | | | | | | | | | | ------------------------------------------------------------------ SUMMARY: Prohibits a student, including a person without lawful immigration status, and/or a person who is exempt from nonresident tuition, who meets the requirements for admission to a medical school program at any public or private postsecondary educational institution that offers such a program, or who meets the requirements for admission to a healing arts residency training program whose participants are not paid, from being denied admission based on his or her citizenship or immigration status. Prohibits specified grant and loan forgiveness programs from denying an application based on an applicants' citizenship or immigration status. Specifically, this bill: 1)Prohibits grant and loan forgiveness programs from denying an application based on the citizenship status or immigration status of an applicant. 2)Requires an applicant, for grant and loan forgiveness programs, when mandatory disclosure of a social security number (SSN) is required, to provide his or her SSN, if one has been issued, or an individual taxpayer identification number (ITIN) that has been or will be submitted. 3)Applies 1) and 2) above to the following programs: a) Programs supported through Health Professions Education Foundation (HPEF); SB 1139 Page 3 b) The Registered Nurse Education Fund; c) The Mental Health Practitioner Education Fund; d) The Vocational Nurse Education Fund; e) The Medically Underserved Account for Physicians; f) Loan forgiveness and scholarship programs created through the Mental Health Services Act; g) The Song-Brown Health Care Workforce Training Act, and, h) To the extent permitted under federal law, the California State Loan Repayment Program; and, the Mini Grants Program and the California's Student/Resident Experiences and Rotations in Community Health, or CalSEARCH Program. 4)Clarifies that this bill does not apply to nonimmigrant aliens, as specified. FISCAL EFFECT: According to the Assembly Appropriations Committee, administrative costs to the Office of Statewide Health Planning and Development (OSHPD) to modify regulations for health care workforce grant, loan forgiveness, and scholarship programs in the range of $60,000 (Health Professions Education Fund, funded by various fees, grants, and private donations), as well as potential minor costs to review additional applications. SB 1139 Page 4 COMMENTS: According to the author, there are currently 168 designated medically underserved areas in California across all 58 counties. Patients in medically underserved areas face significant challenges to access health care services and the limited resources and lack of specialty services in these communities leads to longer waiting times and longer journeys to appointments. The author states this bill would help to increase the number of physicians and health care workers in medically underserved areas by ensuring that all individuals who wish to pursue a medical profession may compete for scholarships and loan repayments available under the HPEF, which targets health professionals who are able to provide culturally and linguistically appropriate care within medically underserved areas. Physician supply in California. A 2014 California HealthCare Foundation (CHCF) report, "California Physicians: Surplus or Scarcity?" found that the number of physicians in California increased 39% from 1993 to 2011, and has outpaced the state's 20% growth rate in the general population. However, demand for physician services is expected to increase with the aging of the state's population and the implementation of the Patient Protection and Affordable Care Act. The report also notes Latinos were underrepresented among physicians. While 38% of the state's population was Latino, only 4% of physicians were Latinos. Access to healthcare. California is home to the largest number of primary care physicians and nurse practitioners in the country. However, the state ranks 23rd in the number of primary care physicians per resident. The CHCF report states that California has only 35 to 49 primary care physicians per 100,000 Medi-Cal enrollees. Federal guidelines call for the state to have 60 to 80 doctors per 100,000 patients. SB 1139 Page 5 Supreme Court's Decision on Immigration. On June 23, 2016, the Supreme Court announced that it had deadlocked on the case United States v. Texas, No. 15-674 which effectively blocked President Obama's immigration plan. The Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA), and Deferred Action for Childhood Arrivals (DACA) would have shielded from deportation and/or made eligible for work permits three categories of unauthorized immigrants: 1)DAPA (parents). Unauthorized parents of children who are United States citizens or legal permanent residents born on or before November 20, 2014 would be shielded from deportation. To qualify parents must have been in the United States (U.S.) since January 1, 2010; 2)DACA (children). Unauthorized immigrants born after June 15, 1981 who were brought to the U.S. before their 16th birthday and have been in the country since June 15, 2007; and, 3)Expanded DACA. Unauthorized immigrants brought to the U.S. as children before January 2010. The status of young people who had qualified for the initial DACA program, which was created in 2012, was not at issue in the Supreme Court case. According to a February 2016 Migration Policy Institute report, "Deferred Action for Unauthorized Immigrant Parents: Analysis of DAPA's Potential effects on Families and Children," more than 10 million people live in households with at least one potentially DAPA-eligible adult, and the majority of those eligible for all of the president's initiatives live in California, Texas, and New York. Impact of DACA on medical schools. According to a perspective published in the journal Academic Medicine in December 2014, it SB 1139 Page 6 is difficult to estimate the full impact of DACA on the medical school applicant pool as DACA may also increase undergraduate completion among this group. One estimate in California indicated that only about 10% to 20% of undocumented students who graduated from high school enrolled in college. This is in contrast to the general population in which the percentage of high school graduates who subsequently enrolled in college was 68.2% in 2011. Moreover, the national graduation rate for bachelor's degrees (completion in six years or less) is about 59%. A low estimate of potential, undocumented students in medical school can be estimated by applying current rates of enrollment of undergraduate education among undocumented students (10%) and subsequent entry into the field of medicine (about 2%-3%) to estimates of total DACA potentials in the United States (1.8 million). This results in an estimated 5,400 new largely underrepresented minority physicians in the coming decades. Financial aid for DACA students. According to the Academic Medicine article, the price tag of a medical education is extremely high. Financing a medical education is a challenge for all medical students, but it is particularly difficult for DACA students because they are legally excluded from receiving federal financial aid. DACA students may be eligible, however, to apply for private need- and merit-based scholarships, private loans, school loans, and institutional aid. Some states expect DACA students to pay more expensive international student fees for their education, 12 states have passed laws allowing DACA students to qualify for in-state tuition at public universities, including California and Texas, the two states with the largest populations of DACA students. Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0003765 SB 1139 Page 7