BILL ANALYSIS Ó
-----------------------------------------------------------------
|SENATE RULES COMMITTEE | SB 1139|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
-----------------------------------------------------------------
UNFINISHED BUSINESS
Bill No: SB 1139
Author: Lara (D), et al.
Amended: 8/15/16
Vote: 21
SENATE HEALTH COMMITTEE: 7-2, 4/13/16
AYES: Hernandez, Hall, Mitchell, Monning, Pan, Roth, Wolk
NOES: Nguyen, Nielsen
SENATE APPROPRIATIONS COMMITTEE: 5-2, 5/27/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NOES: Bates, Nielsen
SENATE FLOOR: 28-11, 5/31/16
AYES: Allen, Beall, Block, Cannella, De León, Galgiani,
Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill, Hueso,
Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell,
Monning, Pan, Pavley, Roth, Vidak, Wieckowski, Wolk
NOES: Anderson, Bates, Berryhill, Fuller, Gaines, Huff,
Moorlach, Morrell, Nguyen, Nielsen, Stone
NO VOTE RECORDED: Runner
ASSEMBLY FLOOR: 56-20, 8/18/16 - See last page for vote
SUBJECT: Health professionals: medical degree programs:
healing arts residency training programs:
undocumented immigrants: nonimmigrant aliens:
scholarships, loans, and loan repayment
SOURCE: California Pan-Ethnic Health Network
Pre-Health Dreamers
DIGEST: This bill prohibits a student, including a person
SB 1139
Page 2
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 repayment and forgiveness programs from denying an
application based on an applicant's citizenship or immigration
status.
Assembly Amendments (1) delete a provision that encouraged the
University of California to develop a process for awarding
student financial aid; (2) specify that except for certain
classes of students granted status under specified federal
immigration law, this bill does not apply to nonimmigrant
aliens, as specified; and (3) make other technical, conforming
changes.
ANALYSIS:
Existing law:
1)Establishes the California Healthcare Workforce Policy
Commission (Commission) and requires the Commission to, among
other things, identify specific areas of the state where unmet
priority needs for primary care family physicians and
registered nurses exist; establish standards for family
practice training programs, family practice residency
programs, primary care physician assistants programs, and
programs that train primary care nurse practitioners; and
review and make recommendations to Office of Statewide
Planning and Development (OSHPD) concerning the funding of
those programs.
2)Establishes the Health Professions Education Foundation (HPEF)
within OSHPD. Requires HPEF to solicit and receive funds from
foundations and other private and public sources and to
provide financial assistance in the form of scholarships or
SB 1139
Page 3
loans to students in the health professions who are from
underrepresented groups.
3)Establishes, under the HPEF, scholarship, loan, and loan
repayment programs for registered nurses, vocational nurses,
geriatric nurse practitioners, clinical nurse specialists, and
mental health professionals who agree to practice for
specified periods of time in underserved areas and in
designated practice settings, as specified.
This bill:
1)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.
2)Prohibits programs within the HPEF from denying an application
based on the citizenship status or immigration status of the
applicant.
3)Requires an applicant, 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.
4)Applies 2) and 3) to the following programs:
a) Programs supported through HPEF;
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 ,
SB 1139
Page 4
h) The programs administered pursuant to the Health
Professions Career Opportunity Program, commonly known as
the Mini Grants Program, and California's Student/Resident
Experiences and Rotations in Community Health, commonly
known as the Cal-SEARCH program.
5)Specifies that except for certain classes of students granted
status under specified federal immigration law, this bill does
not apply to nonimmigrant aliens, as specified.
Comments
1)Author's statement. 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. The limited resources and lack of specialty
services in these communities leads to longer waiting times
and longer journeys to appointments. SB 1139 would 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 HPEF, which targets health
professionals who are able to provide culturally and
linguistically appropriate care within medically underserved
areas. Currently the HPEF only allows for the submission of
SSN, which bars undocumented individuals seeking medical
professions from applying. This bill would reduce barriers to
undocumented individuals by enabling an applicant to provide
an ITIN in lieu of a SSN, and prohibit the HPEF from barring
an applicant based on his or her immigration status, while
also addressing service gaps that are desperately needed in
those communities.
2)Statewide shortages of health care providers. Statewide
shortages of health care providers currently exist in several
major health professions. Recent health care workforce
research indicates that health professional shortage,
distribution, and diversity issues impact access to primary,
SB 1139
Page 5
allied, mental, and dental health care in California today.
The demand for these health care professions is also
forecasted to grow faster than professions in other
industries. Additionally, health care workforce needs are
projected to increase dramatically due to population aging,
growth, and diversity. This existing shortage is expected
intensify as about 4.7 million more Californians have gained
access to health insurance as a result of the implementation
of the Affordable Care Act. Inability to meet health care
workforce needs will have serious adverse consequences on
health access, quality, and cost.
3)Presidential action on immigration. In November 2014,
President Obama announced that the federal Department of
Homeland Security (DHS) would not deport certain undocumented
parents of U.S. citizens and parents of lawful permanent
residents. President Obama also announced an expansion of the
Deferred Action for Childhood Arrivals (DACA) program for
youth who came to the United States as children. Under a
directive from the secretary of DHS, these parents and youth
may be granted a type of temporary permission to stay in the
U.S. called "deferred action." Deferred action is a form of
administrative relief from deportation whereby DHS authorizes
a noncitizen to remain in the U.S. temporarily. These
individuals may also apply for an employment authorization
document (a work permit) during the deferred action period. A
grant of deferred action is temporary and does not grant
citizenship or permanent lawful status. However, a person
granted deferred action is considered by the federal
government to be lawfully present for as long as the grant of
deferred action status. These actions are expected to affect
up to 4.4 million people, according to DHS.
The United States Citizenship and Immigration Services
announced that, due to a federal court order, it would not
begin accepting requests for the expansion of DACA on February
18, 2015 as originally planned and has suspended
implementation of Deferred Action for Parents of Americans and
Lawful Permanent Residents (DAPA). The court's temporary
injunction, issued February 16, 2015, does not affect the
existing DACA and individuals can continue to request an
initial grant of DACA or renewal of DACA under the original
SB 1139
Page 6
guidelines. Separately, the Texas federal court preliminarily
blocked, on procedural grounds, the President's DAPA and
expanded DACA initiatives (but not original DACA) on February
16, 2015. The Department of Justice appealed this order, and
arguments were heard on July 10, 2015. On November 9, 2015, a
divided panel of the Fifth Circuit Court of Appeals upheld the
lower court's ruling in a 2-1 decision. The following day, the
Department of Justice announced its intention to seek Supreme
Court review of the Fifth Circuit's decision. On January 19,
2016, the Supreme Court agreed to take the case and heard oral
arguments on April 18th, with a decision being announced in
late June 2016.
4)Impact of DACA on medical schools. According to a perspective
published in the journal Academic Medicine in December 2014,
it 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. A low estimate,
using the same method but imputing the current, general
graduation rate (59%) to DACA students, puts the number at
about 3,000 potential future physicians.
5)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,
SB 1139
Page 7
to apply for private need- and merit-based scholarships,
private loans, school loans, and institutional aid. Also, some
state laws allow undocumented students to apply for publicly
funded grants. Medical schools can assist DACA students by
offering financial planning advice early on, in order to
prevent financial status from being a prohibitive barrier to
their matriculation in the face of limited options for
financial assistance. Medical schools can further encourage
students to join their programs by creating flexible and
generous scholarship packages and providing paid
opportunities, such as research positions, within their
programs. Whereas 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to Assembly Appropriations Committee:
Administrative costs to 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.
SUPPORT: (Verified 8/17/16)
California Pan-Ethnic Health Network (co-source)
Pre-Health Dreamers (co-source)
American Academy of Pediatrics
American Civil Liberties Union of California
Asian Law Alliance
California Immigrant Policy Center
California Mental Health Connection
California Primary Care Association
California State Council of the Service Employees International
SB 1139
Page 8
Union
Community Health Partnership
Courage Campaign
Department of Medicine at the University of California, Irvine
Doctors for America
Educators for Fair Consideration
The Greenling Institute
Having Our Say Coalition
Health Access California
Inland Empire Immigrant Youth Coalition
Latino Medical Student Association
National Association of Social Workers
National Immigration Law Center
Services, Immigrant Right, and Education Network
Stanford University's Latino Medical Student Association
Western Center on Law & Poverty
Six Individual Letters
OPPOSITION: (Verified 8/18/16)
Californians for Population Stabilization
ARGUMENTS IN SUPPORT: The Pre-Health Dreamers state that in
California alone, there are 285 undocumented students in the PHD
network and among them 169 are interested in medicine, 16 in
dentistry, 26 in nursing, six in pharmacy, and many others
interested in allied health professions. PHD states that they
believe that their members can contribute significantly to the
quality of care in California because many are often bilingual
and bi-cultural, and are deeply motivated to give back to their
communities, which are often underserved. The California
Pan-Ethnic Health Network states that undocumented individuals
can serve as key practitioners to address chronic shortages of
medical professionals and they deserve to compete in state
programs that help defray the cost of their training, especially
when their licensing fees support these very programs. Numerous
supporters write that most undocumented students, including
those in the medical field, face major challenges financing
their education because they struggle to access loans, and do
not qualify for federal loan forgiveness programs. The Asian Law
SB 1139
Page 9
Alliance writes that this bill will ensure that all individuals
who wish to pursue a medical profession may compete for
scholarships and loan repayments available under HPEF. The
National Immigration Law Center writes that this bill promotes
public health by increasing the pool of qualified health
professionals who will provide culturally and linguistically
competent medical services in underserved areas. The American
Academy of Pediatrics, California states that while this bill
underwrites a motion that is the ethically right thing to do in
support of our medial trainees, it will also further our goals
of building a larger, stronger healthcare workforce. The Western
Center on Law and Poverty states that this bill will ensure that
all people, regardless of their immigration status, have access
to the state's scholarship and loan forgiveness programs for
health professionals. Educators for Fair Consideration states
that most undocumented students, including those in the medical
field, face major challenges financing their education because
they struggle to access loans, and do not qualify for federal
loan forgiveness programs. SEIU California writes that they are
committed to working toward comprehensive immigration reform at
the federal level to remove barriers to education for
immigrants, however, until those changes can happen at the
federal level, they support improvement of state law to ensure
that no one is discriminated against based solely on their
immigration status. The California Primary Care Association
writes that clinics cannot provide timely, quality, culturally
competent care if they do not have the health care workforce
needed to provide that care and that this bill w California
Pan-Ethnic Health Network il provide for health professional
students who plan to practice in the underserved communities of
California.
ARGUMENTS IN OPPOSITION:Californians for Population
Stabilization writes that there is a limited amount of money
available for scholarship and loan forgiveness programs, and
giving those funds to illegal immigrants simply reduces the pool
available to legal students. CAPS further asserts that the
State of California has done an abysmal job of maintaining
infrastructure, protecting open spaces, and providing quality
public education, and much of its failure is due to the flood of
illegal immigration that has overwhelmed the state.
SB 1139
Page 10
ASSEMBLY FLOOR: 56-20, 8/18/16
AYES: Alejo, Arambula, Atkins, Baker, Bloom, Bonilla, Bonta,
Brown, Burke, Calderon, Campos, Chang, Chau, Chiu, Chu,
Cooley, Cooper, Dababneh, Daly, Dodd, Eggman, Frazier,
Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez,
Gonzalez, Gordon, Gray, Hadley, Holden, Irwin, Jones-Sawyer,
Lackey, Levine, Linder, Lopez, Low, McCarty, Medina, Mullin,
Nazarian, O'Donnell, Quirk, Ridley-Thomas, Rodriguez, Salas,
Santiago, Mark Stone, Thurmond, Ting, Weber, Williams, Wood,
Rendon
NOES: Travis Allen, Bigelow, Brough, Dahle, Beth Gaines,
Gallagher, Grove, Harper, Jones, Kim, Maienschein, Mathis,
Mayes, Melendez, Obernolte, Patterson, Steinorth, Wagner,
Waldron, Wilk
NO VOTE RECORDED: Achadjian, Chávez, Roger Hernández, Olsen
Prepared by:Melanie Moreno / HEALTH / (916) 651-4111
8/29/16 10:34:41
**** END ****