BILL ANALYSIS                                                                                                                                                                                                    






                        SENATE HEALTH AND HUMAN SERVICES
                               COMMITTEE ANALYSIS
                        Senator Deborah V. Ortiz, Chair


          BILL NO:       SB 108                                       
          S
          AUTHOR:        Romero                                       
          B
          AMENDED:       March 12, 2003
          HEARING DATE:  March 26, 2003                               
          1
          FISCAL:        Rules / Appropriations                       
          0
                                                                      
          8
          CONSULTANT:                                                
          Vazquez / ak
                                        

                                     SUBJECT
                                         
                   Emergency medical services:  alcohol: fee

                                     SUMMARY  

          This bill would enact the Alcohol-Related Emergency  
          Services Reimbursement Act of 2003, which would require the  
          Department of Alcoholic Beverage Control to collect a $0.05  
          per drink fee from specified wholesalers.  The bill  
          establishes the Alcohol-Related Emergency Services  
          Reimbursement Trust Fund, administered by the State  
          Department of Health Services, to allocate reimbursement to  
          specified local emergency medical services providers that  
          incur expenses in providing services for alcohol-related  
          emergencies.  

                                     ABSTRACT  

          Existing law: 
          1.Creates the Alcoholic Beverage Control Act, which imposes  
            various functions and duties on the Department of  
            Alcoholic Beverage Control (ABC) with respect to the sale  
            of alcoholic beverages and related licensing. 

          2.Creates the Alcoholic Beverage Tax Law, requiring the  
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            State Board of Equalization (BOE) to assess and collect  
            excise taxes imposed on beer, spirits, and wine. 

          3.Authorizes each county to establish a Maddy Fund upon  
            adoption of a resolution by the board of supervisors and  
            requires, after the costs of administration are deducted,  
            the Maddy Fund to reimburse physicians and hospitals for  
            patients who do not make payment for emergency medical  
            services and for other emergency medical services  
            purposes as determined by each county, as specified.  

          4.Creates the County Medical Services Program, administered  
            by the Department of Health Services (DHS), to assist in  
            the provision of emergency services.  


          5.Imposes an excise tax on alcoholic beverages as follows:
                 For all beer, four cents per gallon;
                 For all still wines containing not more than 14% of  
               absolute alcohol by volume, one cent per wine gallon;
                 For all still wines containing more than 14% of  
               absolute alcohol by volume, two cents per wine gallon;
                 For champagne, sparkling wine, excepting sparkling  
               hard cider, whether naturally or artificially  
               carbonated, thirty cents per wine gallon;
                 For sparkling hard cider, two cents per wine  
               gallon;
                 For all distilled spirits of proof strength or  
               less, two dollars per wine gallon; and
                 For all distilled spirits in excess of proof  
               strength, four dollars per wine gallon.

          1.Imposes an excise surtax (in addition to the excise tax)  
            on alcoholic beverages as follows:
                 For all beer, sixteen cents per gallon;
                 For all still wines containing not more than 14% of  
               absolute alcohol by volume, nineteen cents per wine  
               gallon; 
                 For all still wines containing more than 14% of  
               absolute alcohol by volume, eighteen cents per wine  
               gallon;
                 For sparkling hard cider, eighteen cents per wine  
               gallon;
                 For all distilled spirits of proof strength or  
               less, one dollar and thirty cents per wine gallon; and
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                 For all distilled spirits in excess of proof  
               strength, two dollars and sixty cents per wine gallon.

          This bill: 
          1.Makes various legislative findings, including: 
                 Emergency medical services are inadequate to  
               properly meet the needs of the residents of  
               California.  
                 Alcohol-related incidents on California roads cost  
               over $3 billion per year in monetary costs.
                 Alcohol is a factor in nearly one-third of all  
               vehicle crashes in the state, and emergency rooms and  
               trauma centers are the primary medical services  
               providers for those injured in these incidents.
                 From July 1, 2000, to June 30, 2001, inclusive, 60%  
               of all patients admitted to emergency rooms and trauma  
               centers in Los Angeles County tested positive for  
               alcohol.
                 Emergency rooms and trauma centers can no longer  
               afford to continue to pay for these services without  
               reimbursement.
                 The State of California is facing an unprecedented  
               budget shortfall that necessitates drastic cuts in  
               programs and services to the people of California.

          2.Enacts the Alcohol-Related Emergency Services  
            Reimbursement Act of 2003. 

          3.Requires the ABC to collect a five-cent ($0.05) per drink  
            fee from wholesalers located in California who distribute  
            alcoholic beverages to retailers for consumption 

          in the state.  The fee is based on 1.50 ounces of distilled  
            spirits, 12 ounces of beer, and 5 ounces of table wine. 

          4.Requires that all funds collected as a result of the  
            above-described fee be deposited in the Alcohol-Related  
            Emergency Services Reimbursement Trust Fund, newly  
            created in the State Treasury.  

          5.Requires that ABC be reimbursed for the costs of  
            implementation of the Act. 

          6.Requires that fees collected pursuant to the Act be used  
            solely to implement the Act, and that the ABC shall not  
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            collect fees in excess of the amount needed to fully  
            implement the Act. 

          7.Requires that the Trust Fund be administered by DHS and  
            that it shall consist of fees collected by ABC as  
            outlined above.  

          8.Requires that all moneys in the fund be continuously  
            appropriated to DHS, without regard to fiscal years, for  
            purposes of implementation of the Act. 

          9.Makes the following persons and entities eligible for  
            receipt of the funds: local emergency medical services  
            providers, including emergency departments, trauma  
            centers, emergency and oncall physicians, entities that  
            provide initial prehospital emergency medical  
            stabilization services, emergency ambulance  
            transportation, and other emergency medical professionals  
            and entities that meet the qualifications established by  
            the department for reimbursement of expenses incurred in  
            providing services for alcohol-related emergencies. 

          10.Defines alcohol-related emergency as an incident that  
            results in the provision of medical services, including  
            transportation, to a victim who is injured as a result of  
            the ingestion of alcohol.  

          11.Requires that DHS adopt regulations that establish  
            criteria to identify incidents and emergencies that  
            qualify as alcohol-related emergencies. 

          12.Requires that qualifying entities shall submit forms to  
            DHS for purposes of obtaining reimbursement. 

          13.Requires DHS to adopt regulations necessary to implement  
            this chapter. 

                                  FISCAL IMPACT  

          The author estimates that the collection of $0.05 per  
          serving of the alcoholic beverages identified in the bill  
          from wholesalers is likely to generate approximately $700  
          million per year in revenue. 


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                            BACKGROUND AND DISCUSSION  

          This bill creates the Alcohol-Related Emergency Services  
          Reimbursement Act of 2003, which imposes a $0.05 per drink  
          fee on any wholesaler located within the state who  
          distributes alcoholic beverages to retailers for  
          consumption by consumers.  The fee is based on 1.50 ounces  
          of distilled spirits, 12 ounces of beer, and 5 ounces of  
          table wine.  These fees will be collected by the Department  
          of Alcoholic Beverage Control (ABC), and deposited in the  
          Alcohol-Related Emergency Services Reimbursement Trust  
          Fund, established in the State Treasury.  The Department of  
          Health Services (DHS) will administer the Fund, allocating  
          reimbursement to local emergency medical services providers  
          that meet qualifications established by DHS for  
          alcohol-related emergencies.  

          Current Regulation and Taxes on Alcohol  
          The alcoholic beverage tax is a per-gallon excise tax  
          collected on the sale, distribution, or importation of  
          alcoholic beverages in California.  Revenues from the tax  
          are deposited into the Alcoholic Beverage Control Fund and  
          are withdrawn for use by the state's General Fund or used  
          to pay refunds in the program.  According to the State  
          Board of Equalization (BOE), in 2000-01, there were 2,739  
          registered taxpayers for purposes of the Alcoholic Beverage  
          Tax.

          The excise tax on beer and wine is generally paid by  
          manufacturers, wine growers, and importers.  Sellers of  
          beer and wine must pay the excise tax if the tax was not  
          paid.  For distilled spirits, in general, the excise tax is  
          paid by wholesalers based on sales to in-state retailers.   
          Sellers of distilled spirits must pay if the excise tax was  
          not paid by the wholesaler.  

          Current Tax Rates
          

           ----------------------------------------------------------- 
          |Beverage Type |Current Tax   |Current       |Current Rate  |
          |              |              |Surtax        |Per Gallon    |
          |--------------+--------------+--------------+--------------|
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          |Beer          |$0.04         |$0.16         |$0.20         |
          |--------------+--------------+--------------+--------------|
          |Wine          |$0.01         |$0.19         |$0.20         |
          |--------------+--------------+--------------+--------------|
          |Wine >14%     |$0.02         |$0.18         |$0.20         |
          |Alcohol       |              |              |              |
          |--------------+--------------+--------------+--------------|
          |Champagne and |$0.30         |$0.00         |$0.30         |
          |Sparkling     |              |              |              |
          |Wine          |              |              |              |
          |--------------+--------------+--------------+--------------|
          |Hard Cider    |$0.02         |$0.18         |$0.20         |
          |--------------+--------------+--------------+--------------|
          |Distilled     |$2.00         |$1.30         |$3.30         |
          |Spirits       |              |              |              |
          |--------------+--------------+--------------+--------------|
          |Spirits 100+  |$4.00         |$2.60         |$6.60         |
          |Proof         |              |              |              |
           ----------------------------------------------------------- 

          Federal excise taxes were increased in the Revenue  
          Reconciliation Act of 1990, which was the first increase  
          since 1951.  The current federal alcohol excise taxes are  
          as follows: 
               Beer:          $18.00 per 31-gallon barrel
               Wine:                         $1.07 per gallon 

               Spirits:            $13.50 per gallon

               Calculated per "drink" as defined in this bill:
               Beer:          Approximately $0.05 
               Wine:          Approximately $0.04
               Spirits        :Approximately $0.16 

          In order to bridge the gap between revenues and expenses in  
          the 1991-92 state budget, a surtax was added to the  
          existing excise tax on alcoholic beverages, effective July  
          15, 1991.  Assembly Bill 30 (Chapter 86, 1991) added the  
          alcoholic beverage surtax under current Section 32220,  
          effective July 15, 1991.  According to the Board of  
          Equalization, before this 1991 tax increase, excise taxes  
          on most alcoholic beverages had remained the same since the  
          1950s, with the exception of an increase in the excise tax  
          on distilled spirits in 1967.  

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          Emergency and Trauma Care 
          The author states that this measure intends to reimburse  
          emergency room and trauma centers for alcohol-related  
          emergency services.  According to a report recently  
          released by the California Medical Association, one of the  
          bill's sponsors, hospital emergency losses during fiscal  
          year 2000-01 reached $390 million, an increase from $325  
          million in 1999-00, and $317 million in 1998-99.  In  
          2000-01, emergency room and physicians losses totaled $541  
          million, a 24% increase from the year before.  

          A recent report titled "Stretched Thin: Growing Gaps in  
          California's Emergency Room Backup System" completed by the  
          Senate Office of Research outlined that in California,  
          hospital emergency room visits increased 12% between 1990  
          and 1999, from 8.4 million to 9.4 million visits.  Critical  
          care visits increased by 43% and urgent visits by 20%.  The  
          total number of visits per emergency department increased  
          by 27% during that time, but critical visits jumped by 59%  
          and urgent visits by 36%.  

          The report identified reasons for the sharp upturn in  
          emergency room utilization, including fewer constraints on  
          access to emergency room services by health maintenance  
          organizations; Medi-Cal patients' higher ER utilization  
          because they are do not receive the preventive care they  
          require for chronic and treatable diseases; the overall  
          rising number of uninsured, now estimated at 6.3 million,  
          physician shortages and lack of specialists in many areas  
          of the state; reductions in medical training slots; other  
          shifts affecting the availability of on-call specialists;  
          and health plan requirements for accessibility of  
          physicians, among others.  

          Consumption and Calculation of Revenues
          Based on numbers provided by the Board of Equalization,  
          which are from 2001, the estimates for revenue under this  
          proposal are as follows:


           ----------------------------------------------------------- 
          |   Drink   |  Gallons  | "Drinks"  |  Fee Per  |  Revenue  |
          |           | Consumed  |Per Gallon |  Gallon   | Produced  |
          |           | in CA Per |           | (Based on |           |
          |           |   Year    |           | $0.05 Per |           |
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          |           |           |           | "Drink")  |           |
          |-----------+-----------+-----------+-----------+-----------|
          |Beer       |643,000,000|10.67      |$0.5335    |$343.0     |
          |           |           |           |           |million    |
          |-----------+-----------+-----------+-----------+-----------|
          |Wine       |87,000,000 |25.6       |$1.28      |$111.4     |
          |           |           |           |           |million    |
          |-----------+-----------+-----------+-----------+-----------|
          |Spirits    |41,000,000 |85.3       |$4.26      |$174.9     |
          |           |           |           |           |million    |
           ----------------------------------------------------------- 
           ------------------------------------------------------------ 
          |Total Projected Revenue Under Proposal:         |$629.3     |
          |                                                |million    |
          |                                                |           |
           ------------------------------------------------------------ 

          The author indicates that alcohol consumption is not  
          expected to change, particularly if the new fee is  
          nominally or not passed along to the consumer.  Per capita  
          alcohol consumption has remained static for the past 30  
          years.  If alcohol companies do pass on the fee, a study  
          shows that there is very little correlation between  
          increased prices and decreased consumption.  
          Alcohol Assessment in Other States 
          According to the author, California ranks approximately  
          just above the national median (20th) in its excise tax on  
          beer.  Californians consume approximately 10% of all  
          alcohol in the United States.  As indicated in the previous  
          table, California assesses $0.20 of taxes per gallon of  
          wine ($0.005 per drink), $3.30 of taxes per gallon of  
          distilled spirits ($0.013 per drink), and $6.60 of taxes  
          per gallon of 100 proof distilled spirits, using federal  
          definitions of "drinks."  
          
          According to the Center for Science in the Public Interest,  
          Alcohol Project, Washington D.C., seventeen other states  
          are currently considering increasing their alcohol excise  
          taxes.  These include Arkansas, Maryland, Nevada,  
          Pennsylvania, Connecticut, Missouri, New Mexico, South  
          Carolina, Georgia, Montana, Ohio, South Dakota, Nebraska,  
          Oregon, Utah, Washington, and Wyoming.  

          Nexus Between Alcohol and Emergency Injuries 
          The author states that alcohol is a factor in nearly  
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          one-third of all motor vehicle accidents in the state, and  
          emergency rooms and trauma centers are the primary medical  
          service providers for those injured in these incidents.   
          From July 1, 2000 to June 30, 2001, 60% of all patients  
          admitted to emergency rooms and trauma centers in Los  
          Angeles County tested positive for alcohol.  In 2000, over  
          1,400 persons were killed in alcohol-related crashes in  
          California and the National Highway Traffic Safety  
          Administration reports that alcohol is a factor in 32% of  
          California crashes.  Alcohol-related incidents on  
          California roads cost over $3 billion per year.  

          According to National Clearinghouse for Alcohol and Drug  
          Information, alcohol is a factor in 68% of manslaughters,  
          62% of assaults, 54% of murders and attempted murders, 48%  
          of robberies, and 44% of burglaries.  A report to Congress  
          by the U.S. Department of Health and Human Services  
          reported in 2002 that alcohol was involved in 37% of rapes.  
           The National Transportation Institute determined that for  
          every alcohol beverage sold in California, $0.90 is spent  
          on health care and related costs caused by alcohol-related  
          injuries.  

          Rationale for Alcohol "Fee" 
          In June 1978, California voters added article XVIII A,  
          commonly known as the Jarvis-Gann Property Initiative or  
          Proposition 13, to the state Constitution.  The  
          initiative's purpose was to assure effective real property  
          tax relief by means of an interlocking package consisting  
          of a real property tax rate limitation, a real property  
          assessment limitation, a restriction on state taxes, and a  
          restriction on local taxes.  Proposition 13 added to the  
          state Constitution the requirement that any changes in  
          State taxes enacted for the purpose of increasing revenues  
          collected, must be passed by not less than two-thirds of  
          all members of the Legislature.  Therefore, any legislation  
          proposing to increase taxes must be passed by a two-thirds  
          majority of the Legislature.

          In Sinclair Paint Co. v. the State Board of Equalization  ,  
          the Supreme Court considered the issue of whether the Child  
          Lead Poisoning Prevention Act of 1991 (Act), which assessed  
          fees on manufacturers or other persons contributing to  
          environmental lead contamination, constituted in effect a  
          tax increase thus requiring a two-thirds vote majority  
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          under Proposition 13.  The Supreme Court concluded that the  
          Act imposed a bona fide regulatory fee, not taxes, and  
          therefore did not fall under Proposition 13.  Therefore,  
          legislation imposing regulatory fees may be passed by a  
          majority vote of the Legislature, while legislation  
          increasing taxes, requires a two-thirds majority vote of  
          the Legislature.

          The Supreme Court has defined regulatory fees as those  
          charged in connection with regulatory activities, which  
          fees do not exceed the reasonable cost of providing  
          services necessary to the activity for which the fee is  
          charged and which are not levied for unrelated revenue  
          purposes.

          Roles of Department of Alcoholic Beverage Control and Board  
          of Equalization 
          ABC was created in 1955 by a Constitutional Amendment  
          (Article XX, Section 22) and is vested with exclusive power  
          to license and regulate persons and businesses engaged in  
          the manufacture, importation, distribution and sale of  
          alcoholic beverages in California.  The ABC administers and  
          enforces the provisions of the Alcoholic Beverage Control  
          Act.  Approximately 50% of the Department's resources are  
          devoted to its licensing mandate.  Investigators and  
          Licensing Representatives in the field process applications  
          for alcoholic beverage licenses and complete investigations  
          on the moral character and source of funds of the applicant  
          and suitability of the proposed premises.  The remaining  
          50% of the Department's resources are devoted to its  
          enforcement mandate.  Investigators investigate and make  
          arrests for violations of the Alcoholic Beverage Control  
          Act and Penal Code that occur on or about licensed  
          businesses.  

          The following entities must register with the State Board  
          of Equalization if they obtain a license by the ABC:  
          manufacturer, winegrower, wine blender, distilled spirits  
          manufacturer's agent, rectifier, wholesaler, importer,  
          customs broker, and on-sale general brew pub.  Given its  
          current role in the collection of taxes from the  
          above-stated entities, the Board of Equalization might be  
          better choice as the collector of the fees assessed by SB  
          108.  BOE completed an analysis on AB 2744 in 2002, which  
          proposed a surtax increase.  In the analysis, the BOE  
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          provided the following cost estimate and explanation for  
          administration expenses associated with implementation of a  
          change in this area, which offers an indication of the  
          resources that may be necessary to implement SB 108: 
                                
            Enactment would have an impact on the BOE's  
            administrative costs incurred for programming,  
            modification of returns to reflect the new tax rates,  
            notification of all affected taxpayers registered with  
            the BOE prior to the rate change, increased workload in  
            the return processing area due to errors on returns, and  
            increased workload for the audit and compliance staff  
            administering the tax program.  


             ------------------------------------------------------- 
            |               |1st Year |2nd Year |3rd Year |4th Year |
            |---------------+---------+---------+---------+---------|
            |Personal       | $865,800| $836,800| $320,600| $271,100|
            |Services       |         |         |         |         |
            |               |         |         |         |         |
            |---------------+---------+---------+---------+---------|
            |Operating      | $408,300| $127,800| $127,800|  $95,700|
            |Expense and    |         |         |         |         |
            |Equipment      |         |         |         |         |
            |---------------+---------+---------+---------+---------|
            |Total          |$1,274,10| $964,600| $448,400|$366,800 |
            |               |        0|         |         |         |
             ------------------------------------------------------- 




          Arguments in Support 
          The California Academy of Family Physicians states that the  
          ER care their members provide is often uncompensated or  
          undercompensated, which requires hospitals to "cost-shift"  
          the cost of the services onto insured patients through  
          higher hospital rates charged to health plans and insurers.  
           This "cost-shifting" results in lower capitation rates for  
          primary care physicians, and further stresses a system in  
          which too much primary care is now provided too expensively  
          in emergency rooms. 

          The Emergency Medical Services Administrators' Association  
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          of California write that they are acutely aware of the  
          fragile condition of California's emergency medical care  
          system.  Hospital emergency departments are overcrowded,  
          ambulances are frequently diverted from one hospital to  
          another, physician specialists are becoming unwilling to be  
          on-call for emergency cases, some hospitals are closing  
          their emergency departments, and trauma centers are also  
          threatening closure.  The California Catholic Conference  
          asserts that in this time of severe budget crisis, the  
          state has to come up with additional sources of revenue to  
          sustain critical services.  We can ill afford to close  
          trauma centers and emergency rooms.

          Supporters site a poll released by the field institute of  
          the California Health Care Foundation, which reveals that  
          78% of Californians support a $0.05 per serving increase in  
          state alcohol fees to avoid cutbacks in emergency medical  
          services and support health care.  The California Society  
          of Anesthesiologists, Inc. argue in support of the measure,  
          "Tobacco products are now taxed in recognition of the  
          health care costs they cause.  It is time to move in the  
          same direction with regard to alcohol."  Supporters also  
          argue that alcohol prices have not kept pace with  
          inflation.  In the past 50 years in the U.S., the average  
          prices for beer and wine have fallen by more than 25%  
          relative to the Consumer Price Index, according to a 2002  
          study. 

          Arguments in Opposition 
          Opponents to the measure argue that California's six  
          million uninsured are the primary reason for the financial  
          crisis of the state's emergency medical care system.  The  
          diminishing state trauma funding has also resulted in a  
          severely overburdened system.  Over the last fifteen years,  
          due in part to responsible behavior on the part of  
          California's alcohol beverage consumers, fewer drivers end  
          up in the ER and trauma care centers.  Alcohol-involved  
          traffic injuries are down over 50% since 1990 and  
          California's rate of drunk driving deaths has dropped 70%  
          since 1982.  

          Opponents, including California Beer and Beverage  
          Distributors, Family Winemakers of California, and  
          California Independent Grocers and Convenience Stores, also  
          state that the alcohol fee-financed program will very  
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          likely prove to be administratively unmanageable and could  
          take years of litigation to resolve.  Every patient would  
          have to be given a blood alcohol test, which is not  
          routinely done now.  This procedure will add additional  
          costs to the system.  Since alcohol is found in products  
          other than just alcohol beverages, questions will arise as  
          to the true source of any alcohol found in a patient's  
          system.  Opponents also state that emergency medical  
          services should be funded with a tax base paid for by  
          everyone.  Everyone needs to have access to these critical  
          services, 


          so it stands to reason that they should be broadly  
          supported by all taxpayers.  Opponents additionally cite  
          recent increases in workers' compensation costs, utility  
          costs, fuel costs, unemployment benefits, and health care  
          premium costs.  

          One organization writes with concern that the  
          qualifications established for reimbursement of expenses  
          incurred in the provision of services for alcohol-related  
          emergencies will be onerous and nearly impossible to  
          administer.  Reimbursement should go to ambulance-receiving  
          centers based upon volume of unfunded patients as opposed  
          to only patients under the influence of alcohol.  Unfunded  
          patients are identified through the quantifiable billing  
          and collection process, unlike the determination of  
          specific patients who are victims of alcohol-related  
          emergencies.  Not every patient is subject to alcohol  
          testing and often the physicians and nurses cannot  
          immediately confirm the source of the accident or injury -  
          this is left to police, sheriffs, and investigators.  

          Suggested Amendments 
          The California Association of Public Hospitals and Health  
          Systems suggests that the following language be added to  
          the bill, "The department shall adopt regulations for  
          distribution of funds that give weighted priority to  
          reimbursement for services to uninsured patients."  CAPH  
          states that due to the growing number of uninsured, rising  
          costs of providing medical care, and declining revenues to  
          safety net hospitals related to cuts at the federal, state,  
          and local levels, public hospitals and health systems face  
          severe budget shortfalls that threaten their ability to  
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          continue to provide care to their communities, including  
          emergency and trauma services.  The California Emergency  
          Nurses Association additionally urges the author to  
          consider language that allocates funds to  
          ambulance-receiving centers based on the volume of patients  
          receiving uncompensated care as opposed to only patients  
          under the influence of alcohol.  

          Related Legislation 
          AB 216 (Chan), currently being considered by the Assembly  
          Health Committee, imposes a fee of $.10 per "drink" of beer  
          and liquor.  The allocations from the fee revenue are  
          divided as follows: 8/9 to emergency rooms and 1/9 to  
          community-based organizations that provide alcohol abuse  
          treatment and prevention services for minors.  Wine is not  
          included in the measure, and the author states that this is  
          due to the fact that wine is not marketed to minors.  

          SB 248 and SB 928 (Romero), forwarded in the 2001-02  
          legislative session was substantially the same measure as  
          SB 108 and SB 5X.  It required the ABC to collect a  
          five-cent per drink fee from wholesalers in the state to  
          meet the needs of local emergency medical providers giving  
          services in alcohol-related emergencies.  SB 248 failed  
          passage in the Assembly Health Committee.  AB 2744 (Thomson  
          and Chan) in the 2001-02 session likewise failed passage in  
          Assembly Health Committee.  It sought to increase the  
          excise surtax on alcoholic beverages and stated legislative  
          intent that revenues generated by that bill will provide  
          moneys that would not otherwise be available for  
          expenditures from the General Fund for the purpose of  
          funding health care programs in California.
          AB 1298 (Wesson), Chapter 488, Statutes of 2001, increased  
          the annual licensing fees by specified amounts through 2004  
          and annually permitted the ABC to adjust the fees charged,  
          beginning in the 2005 calendar year, by an amount not to  
          exceed an inflation factor based on the Consumer Price  
          Index for the west region.  
          Identical Measure in the Extraordinary Session 
          SB 5X is identical to this measure, thus the analyses for  
          the two measures are the same.  

          Pending Amendments
          The author and Committee staff are currently drafting  
          amendments to present in Committee that address the  
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          following questions: 

          1.Would the collection function be better situated with the  
            Board of Equalization and not the ABC?  

          2.Is there language that can be inserted into the bill to  
            guide how reimbursement will occur?  Are there ways that  
            we can outline the criteria by which the DHS would  
            determine that an accident was alcohol-related?  How will  
            local emergency medical providers work with local law  
            enforcement in this area?  

          3.Should hospitals and local emergency medical providers  
            who treat more of the uninsured be prioritized for  
            reimbursement under this law?  Is there a methodology or  
            criteria for reimbursement that can be applied to ensure  
            that ERs in areas of the highest need are reimbursed  
            first?  

          4.Are there ways to standardize how hospitals collect  
            information on alcohol-related emergencies?  Can this  
            prevent reimbursements from being collected  
            disproportionately from hospitals that are  
            better-equipped to test for alcohol and make these  
            determinations? 

          5.The author has agreed to delete the word "table" from  
            page 3, line 11, allowing for the fee to apply to all  
            wine.  
















                                                         Continued---




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                                    POSITIONS 

             Please note that this is a combined list of positions  
                                  received on 
                  SB 108 and SB 5X, which are identical bills
          
                             Organizations in Support
                                        

          California College of Emergency Physicians
             (co-sponsor)
          California Medical Association (co-sponsor)
          California State Firefighters' Association, 
             Inc. (co-sponsor)  
          Ability First
          Administrators' Association of California AltaMed Health  
          Services Corporation
          American Association of Retired Persons
          American College of Obstetricians and  
             Gynecologists
          American Federation of State, County and 
             Municipal Employees, AFL-CIO
          Asian Pacific Policy & Planning Council
          Association for Los Angeles Deputy 
             Sheriffs, Inc. 
          Association of Trauma Program Managers 
             of Los Angeles County
          Barrio Planners Inc. 
          Bassett Unified School District 
          California Academy of Family Physicians
          California Ambulance Association
          California Association of Physician Groups California  
          Association of Public Hospitals
             and Health System
          California Catholic Conference 
          California Council on Alcohol Problems
          California Emergency Nurses Association 
          California Healthcare Association
          California Nurses Association 
          California Psychiatric Association
                                                         Continued---




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          California Police Chiefs' Association
          California Rural Indian Health Board, 
             Inc.
          California Society of Anesthesiologists, Inc. 
          California State Firefighters' Association, 
             Inc.
          CHARO Community Development Corp.
          City of El Monte
          City of Huntington Park 
          City of La Puente
          Congress of California Seniors 
          Drug Policy Alliance Network
          East Los Angeles Community Youth Center
          El Monte City Council 
          Emergency Medical Services 
             Administrators' Association of California
          Emergency Nurses Association 
          Glenn County
          Gray Panthers
          Hacienda La Puente Unified School District
          Hotel Employees and Restaurant Employees 
             International Union 
          Imperial County Medical Society 
          International Brotherhood of Electrical 
             Workers Local Union 11
          International Institute of Los Angeles Laborers'  
          International Union of North 
             America, Local 300, AFL-CIO
          Los Angeles County Board of Supervisors
          Maravilla Community Advisory Committee
          Motion Picture Studio Grips, Local 80
          Napa County Medical Society 
          Painters & Allied Trades District Council 36
          Plaza Community Center 
          Riverside Sheriffs Association 
          Service Employees International Union, 
             Local 1877
          Service Employees International Union, 
             Local 434B
          Service Employees International Union, 
             Local 99
          Sierra Sacramento Valley Medical Society 
          Solano County Medical Society 
          Sonoma County Medical Association 
          TELACU
                                                         Continued---




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          Tri-City Mental Health Center
          Seven individuals
           










































                                                         Continued---















                           Organizations in Opposition
           

          7 - Eleven
          Agricultural Council of California
          Anheuser-Busch Companies, Inc.
          Bay Area Beverage Company 
          Beauchamp Distributing Company Budweiser High Sierra  
          Distributing
          California Alliance for Consumer Protection California  
          Association of Winegrape 
             Growers 
          California Beer & Beverage Distributors
          California Beverage Merchants
          California Grocers Association
          California Hotel and Lodging Association
          California Independent Grocers & 
             Convenience Stores
          California Manufacturers and Technology 
             Association 
          California Restaurant Association
          California Retailers Association 
          California Small Brewers Association
          California Teamsters Public Affairs Council 
          Central Coast Distributing 
          Coors Brewing Company
          Couch Distributing Company, Inc.
          Diageo
          Distilled Spirits Council of the United States
          Family Winemakers of California
          Gate City Beverage 
          Golden Gate Restaurant Association
          Grocery Manufacturers of America
          Howard Jarvis Taxpayers Association 
          House of Daniels, Inc.
          Korean American Grocers Association of 
             California 
          L & M Distributors 
          Miller Brewing Company
          Mission Beverage Co.
                                                         Continued---



          STAFF ANALYSIS OF SENATE BILL 108 (Romero)            Page  
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          Napa Valley Vintner's Association
          Nor-Cal Beverage Co., Inc.
          Otra Beer
          Recovery California Coalition
          Southern Wine & Spirits of America, Inc.
          Southern Wine and Spirits of America
          Stash Distributing, Inc.
          The Wine Institute 
          Tri-Eagle Beverage
          V. Santoni & Company
          Wine & Spirits Wholesalers of California, 
             Inc.
          Young's Market Company
          Four Individuals


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