BILL ANALYSIS AB 3128 Date of Hearing: May 4, 1994 ASSEMBLY COMMITTEE ON JUDICIARY Phillip Isenberg, Chair AB 3128 (Speier) - As Introduced: February 23, 1994 SUBJECT: This bill eliminates the requirement to obtain a premarital šblood test prior to receipt of a marriage license. BACKGROUND History. In California, couples may obtain either a "confidential" or ša "public" marriage license. A public marriage license requires applicants što obtain a "marriage health certificate" (MHC). The MHC requires (a) both šapplicants to have a physical examination (not more than 30 days old) and a šblood test for syphilis, and to be provided with optional HIV testing and šinformation; and (b) the female is additionally required to be tested for šrubella. The requirement to obtain a premarital blood test prior to šobtaining a marriage license was enacted as part of the Family Law Act, šcreated by SB 252 (Grunsky) in 1969. In the early 1900s there was a significant increase in syphilis in the U.S. šthat created a public health hazard. As a result of this, states began šenacting premarital testing requirements. (The first such law was passed šby Connecticut in 1935.) By the mid-1940s, 43 of the 48 states had a šrequirement for premarital syphilis testing. In 1943, with the discovery that penicillin was an effective treatment for šsyphilis, the syphilis infection rate declined significantly. However, šabout the same time, it was discovered that infection of a pregnant woman šwith rubella was a cause of congenital malformation. In the 1970's, the šrubella vaccine was made widely available. Thereafter, 14 states added a šrequirement for premarital rubella testing. One intent of the rubella štesting was to identify women who had not been immunized, with the hope šthat providing them additional information about the potential health šhazards would encourage them to get the needed immunization. Facts. In 1978, a study in New York City was made of the efficacy of špremarital blood tests. The study demonstrated that of the 116,000 špremarital tests performed at an overall cost of $2.3 million to marriage šlicense applicants, only 39 cases of syphilis were detected. This resulted šin a cost-per-confirmed case of almost $60,000. The California Department of Health Service (DHS) conducted a statewide šsurvey in 1992 and found that of the 614 laboratories that completed the šsurveys (97% of the laboratories statewide performing testing) laboratory štesting revealed: - continued - AB 3128 Page 1 AB 3128 1) There were only 37 new cases of syphilis (0.78% of the premarital population), and 95% of the premarital population had been immunized against rubella (90% of the general population). 2) The cost for the premarital screening program in 1992 was in excess of $20 million, while the direct benefit was only $.6 million. (The direct benefit was defined as the savings in medical costs derived from prevented cases.) 3) The cost of finding one case of syphilis was $413,122. As the result of a Grand Jury investigation of the efficacy of premarital screening, San Diego County found that the cost in 1992-93 for discovering the two cases detected was $245,889. San Diego also found that a large percentage of people were applying for "confidential" marriage licenses in order to avoid the blood test requirement. In 1992-93, 61% of the 23,132 marriages in San Diego County were confidential marriages. DIGEST Existing law requires applicants for a public marriage license to present ša Marital Health Certificate (MHC), signed by a physician, stating that: 1) The male has had a physical examination within the past 30 days, as well as a blood test for syphilis. 2) The female has had a physical examination within the past 30 days, as well as a blood test for syphilis and rubella. 3) Both applicants have been provided the option of HIV testing and information regarding this disease. This bill repeals the Family Code sections regarding premarital šexaminations, thus eliminating the requirement for an MHC and any špremarital blood testing. FISCAL EFFECT This bill will not be referred to the Assembly Committee on Ways and Means. COMMENTS 1) Sponsor's Statement. The sponsors of this bill, the Health Officer's Association of California and the California Association of County Clerks, state that the evidence is clear that the premarital blood test provisions are no longer medically justified, or cost effective. Vaccines have all but wiped out congenital rubella and treatment with penicillin has removed the health threat of syphilis. As of 1993, California is one of only 17 states that still have premarital testing requirements. - continued - AB 3128 Page 2 AB 3128 2) Opposition. The Committee On Moral Concerns (CMC) opposes this bill because it believes that sexually transmitted diseases are at an all time high, and, in fact, we should be testing for more diseases, not less. CMC argues that couples who have cohabited and shared intimate relations do not need blood tests and can obtain a confidential marriage license to avoid such. SUPPORT OPPOSITION California Conference of Local Health Committee On Moral Concerns Officers The American College of Obstetricians and Gynecologists The San Diego Grand Jury The Lutheran Church of the Master Planned Parenthood Affiliates of California - continued - AB 3128 Page 3