BILL ANALYSIS Ó
SB 1139
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SENATE THIRD READING
SB
1139 (Lara)
As Amended August 15, 2016
Majority vote
SENATE VOTE: 28-11
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+-----------------------+---------------------|
|Health |13-4 |Wood, Bonilla, Burke, |Maienschein, |
| | |Campos, Chiu, Gomez, |Patterson, |
| | |Roger Hernández, |Steinorth, Waldron |
| | |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, Quirk, | |
| | |Santiago, Weber, Wood, | |
SB 1139
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| | |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 degree 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);
b) The Registered Nurse Education Fund;
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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 except for certain classes of students granted
status under specified federal immigration law, 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:
0004151
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