BILL ANALYSIS                                                                                                                                                                                                    Ó



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          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,       |                    |








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          |                |     |Quirk, Santiago,      |                    |
          |                |     |Weber, Wood, Chau     |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
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          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);










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             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.









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          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.  










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          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  








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          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








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