BILL ANALYSIS
SENATE COMMITTEE ON INSURANCE
Senator Jackie Speier, Chair
SB 921 (Kuehl) Hearing Date: April 30, 2003
As Amended: April 21, 2003
Fiscal: Yes
Urgency: No
SUMMARY
The bill would establish the California Health Care System
(CHCS) to provide universal health care using a single
payer system.
DIGEST
Existing law
1. Establishes the Medi-Cal program, administered by the
Department of Health Services (DHS), which provides
comprehensive health benefits to low-income children
up to age 21, their parents or caretaker relatives,
pregnant women, elderly, blind or disabled persons,
nursing home residents and refugees who meet specified
eligibility criteria.
2. Establishes Medi-Cal eligibility criteria which vary
across program categories. Medi-Cal provides health
coverage to pregnant women and children up to the age
of one with family incomes up to 200% of the federal
poverty level (FPL), children ages 1 to 5 with family
incomes at or below 133% of FPL, children ages 6
through 19 and parents of children up to age 18 who
have family incomes up to 100% of FPL.
3. Establishes the Healthy Families program, administered
by the Managed Risk Medical Insurance Board, which
provides affordable health, vision and dental benefits
to uninsured legal immigrant and citizen children from
birth to age 19 who do not qualify for no
share-of-cost Medi-Cal and have family incomes at or
below 250% of FPL.
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4. Existing law provides for the regulation of health
care service plans by the Department of Managed Health
Care and health insurers by the Department of
Insurance.
This bill
1. Would establish the CHCS to be administered by the
newly created Health Care Agency (HCA) under the
control of an elected Health Care Commissioner
(commissioner) which shall be the single state agency
with full power to supervise every phase of the
administration of the CHCS.
2. Would provide that the HCA shall be comprised of a
Health Policy Board, the Office of Consumer Advocacy,
and the Office of Medical Practice Standards.
3. Would declare that the purpose of the CHCS shall be:
(a) To provide universal and affordable health care
coverage for all California residents.
(b) To provide California residents with an extensive
benefit package that includes prescription drugs.
(c) To control health care costs and the growth of
health care spending.
(d) To achieve measurable improvement in health care
outcomes.
(e) To increase provider, consumer, employee, and
employer satisfaction with the health care system.
(f) To implement policies that strengthen and improve
culturally and linguistically sensitive care.
(g) To develop an integrated health care database to
support health care planning.
4. Would specify the organization of the Office of the
commissioner and require the commissioner to do the
following:
(a) Implement statutory eligibility standards.
(b) Adopt annually a benefits package for consumers
which shall meet or exceed the minimums required by
law.
(c) Act directly or through one or more
contractors, as the single payer for all claims for
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services provided under this division.
(d) Develop and implement separate formulae for
determining budgets.
(e) Review the formulae for the budgets annually
for appropriateness and sufficiency of rates, fees,
and prices.
(f) Provide for timely payments to professional
providers and health facilities and clinics through
a structure that is efficient to administer and that
eliminates unnecessary administrative costs.
(g) Implement, to the extent permitted by federal
law, standardized claims and reporting methods under
this division.
(h) Develop a system of centralized electronic
claims and payments.
(i) Establish an enrollment system that will ensure
that all eligible California residents, including
those who travel frequently, those who cannot read,
and those who do not speak English, are aware of
their right to health care, and are formally
enrolled.
(j) Report annually to the Legislature and the
Governor on or before October 1 on the performance
of the CHCS, its fiscal condition and need for rate
adjustments, consumer copayments, or consumer
deductible payments, recommendations for statutory
changes, receipt of payments from the federal
government, whether current year goals and
priorities were met, future goals and priorities,
and major new technology or prescription drugs that
may affect the cost of health care.
(aa) Negotiate for prescription drug and durable and
nondurable medical equipment to achieve the lowest
possible cost available under the CHCS formulary.
(bb) Negotiate for, or set, rates, fees and prices
involving any aspect of the CHCS, and establish
procedures relating thereto.
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(cc) Administer the revenues of the Health Care
Fund.
(dd) Procure funds, including loans, lease or
purchase property, obtain appropriate liability and
other forms of insurance for the CHCS, its employees
and agents.
(ee) Establish, appoint, and fund as part of the
administration of the HCA, the following:
(1) A Health Policy Board.
(2) An Office of Consumer Advocacy with
offices convenient to all the residents of the
state.
(3) An Office of Medical Practice Standards
and a Medical Practice Standards Advisory
Board.
(a) Administer all aspects of the HCA that include
the following:
(1) Establish standards and criteria for
allocation of operating funds
and funds from the Health Care Fund.
(2) Meet regularly with the chief medical
officer and the consumer
advocate to review the impact of the HCA and
its policies on the
regions.
(3) Establish health system goals in
measurable terms.
(4) Establish statewide health care
databases to support health
care planning.
(5) Implement policies to assure
culturally competent and
linguistically sensitive care and develop
mechanisms and
incentives to achieve this purpose.
5. Would specify the membership and duties of the Health
Policy Board including to:
(a)Establish policy on medical issues,
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population-based public health issues, research
priorities, scope of services, expanding access to
care, and evaluation of the performance of the
system.
(b)Investigate proposals for innovative approaches to
health promotion, disease and injury prevention,
education, research, and health care delivery.
(c)Establish standards and criteria by which requests
by health facilities for capital improvements shall
be evaluated.
6. Would specify the organization and duties of the
Office of the Consumer Advocate including:
(a) Developing standards and procedures for
resolving consumer disputes with the HCA.
(b) Developing educational and informational guides
for consumers describing their rights and
responsibilities, and informing them on effective
ways to exercise their rights to secure health care
services. The guides shall be easy to read and
understand, available in English and other
languages, and shall be made available to the public
by the HCA, including access on the HCA's Internet
Web site and through public outreach and educational
programs.
(c) Establishing a toll-free telephone number to
receive complaints regarding the HCA and its
services. The hearing and speech impaired may use
the California Relay Service's toll-free telephone
numbers to contact the Office of Consumer Advocacy.
The HCA's Internet Web site shall have complaint
forms and instructions online.
(d) Examining complaints and suggestions from the
public.
(e) Recommending improvements to the HCA, the
commissioner, the Health Policy Board, the Office of
Medical Practice Standards, and the Medical
Standards Practice Board.
(f) Examining the extent to which individual health
facilities and clinics meet the needs of the
community in which they are located.
(g) Receiving, investigating, and responding to
complaints from any source about any aspect of the
CHCS, referring the results of investigations to the
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appropriate professional provider or facility
licensing boards or law enforcement agencies.
(h) Publishing an annual report to the public and
the Legislature containing a statewide evaluation of
the HCA.
(i) Holding public hearings, at least annually,
throughout the state concerning complaints and
suggestions from the public.
7. Would specify the organization of the Office of
Medical Practice standards which shall be headed by
the chief medical officer whose duties shall include:
(a) Study and report on the efficacy of health care
treatments and of drugs for particular conditions.
(b) Evaluate medical services to determine credible
evidence of significant benefit.
(c) Identify causes of medical errors and
procedures that would decrease those errors.
(d) Establish an evidence-based formulary.
(e) Identify treatments and medications that are
unsafe or have no proven value.
8. Would create an Office of the Inspector General for
the CHCS within the Office of the Attorney General
with powers and duties as specified.
9. Would create a transition advisory group to assist
with the transition to the CHCS with membership and
duties as specified.
10. Would create the Health Care Fund and obligations, as
specified.
11. Would require the commissioner to prepare an annual
budget to include:
(a) A CHCS budget that includes all expenditures.
(b) Facility and provider budgets for each of the
two principal mechanisms of professional provider
reimbursement (fee-for-service and integrated health
delivery system, and for individual health
facilities and their associated clinics).
(c) A capital investment budget.
(d) A purchasing budget.
(e) A research and innovation budget.
(f ) A workforce development budget.
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12. Would require the commissioner to limit growth of
health care costs in the CHCS budget by reference to
changes to state gross domestic product, population,
employment rates, and other demographic indicators.
13. Would allow providers and facilities to choose whether
they will be recompensed as fee-for-services providers
or as part of a capitated provider network.
14. Would require the budget for fee-for-services
providers to be divided among categories of licensed
health care providers, in order to establish a total
annual budget for each category. Each of these
category budgets shall be sufficient to cover all
included services anticipated to be required by
eligible individuals choosing fee-for-service at the
rates negotiated or set by the commissioner. In the
event negotiations are not concluded in a timely
manner, the commissioner shall establish the
reimbursement rates.
15. Would require the budget for capitated providers to be
sufficient to cover all eligible individuals choosing
an integrated health care delivery system at the rates
negotiated or set by the commissioner. All
facilities, group practices, and integrated health
care systems may choose to be reimbursed through a
global facility budget or on a capitated basis. The
commissioner shall adjust budgets on the basis of the
health risk of enrollees, the scope of services
provided, proposed innovative programs that improve
quality, workplace safety, consumer, provider and
employee satisfaction, costs of providing care for
non-members, and an appropriate operating margin.
16. Would require the commissioner to implement cost
controls to include:
(a) Postponement of introduction of new benefits or
benefit improvements.
(b) Postponement of new capital investment.
(c) Adjustment of provider budgets to correct for
inappropriate provider utilization.
(d) Limitations on provider reimbursement above a
specified amount of aggregate billing.
(e) Deferred funding of the Reserve Account.
(f) Establishment of a limit on aggregate
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reimbursements to pharmaceutical manufacturers.
(g) Imposition of co-payments or deductible
payments.
(h) Imposition of an eligibility waiting period in
event of substantial influx of individuals into the
state for purpose of obtaining health care through
the CHCS.
17. Would require the commissioner, if allowed as
specified, to pay all premiums, deductible payments,
and coinsurance for qualified Medicare beneficiaries,
as specified.
18. Would state the intent of the Legislature to dedicate
revenue from the following sources for deposit in the
Health Care Fund:
(a) A personal income tax surtax for health care on
unearned income at the rate of __ percent.
(b) A cigarette and tobacco products surtax for
health care as follows:
(1) On all cigarettes sold in this state, ___ on each
pack of cigarettes.
(2) On tobacco products other than cigarettes sold in
this state, a tax rate determined by the State Board
of Equalization that is equivalent to the tax imposed
on cigarettes.
(c) An alcohol surtax for health care as follows:
(1) On all beer sold in this state, ___ on each
12-ounce can and at a proportionate rate for any other
quantity.
(2) On all still wines containing not more than 14
percent of absolute alcohol by volume that are sold in
this state, ___ on each 750 milliliter bottle and at
a proportionate rate for any other quantity.
(3) On champagne, sparkling wine, and sparkling hard
cider whether naturally or artificially carbonated,
sold in this state, ___ on each 750-milliliter bottle
and at a proportionate rate for any other quantity.
(4) On all distilled spirits sold in this state, ____
on each 1.75 liter bottle and at a proportionate rate
for any other quantity.
19. Would state that it is the intent of the Legislature,
commencing on January 1 of the second year following
passage of this division and quarterly thereafter, to
require all persons employed in this state to pay a
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health care tax of __ percent on their wage income.
20. Would state that it is the intent of the Legislature,
commencing on January 1 of the second year following
passage of this division and quarterly thereafter, to
require all employers of resident employees to pay a
health care tax of __ percent of total payroll.
21. Would provide that all California residents shall be
eligible for CHCS.
22. Would allow any eligible individual to choose to
receive services under the CHCS from any willing
participating professional provider.
23. Would specify that covered benefits shall include all
medical care determined to be medically appropriate by
the consumer's health care provider. These benefits
include, but are not limited to, all of the following:
(a) Inpatient and outpatient health facility or
clinic services.
(b) Inpatient and outpatient professional provider
services by licensed health care professionals.
(c) Diagnostic imaging, laboratory services, and
other diagnostic and evaluative services.
(d) Durable medical equipment, appliances, and
assistive technology including prosthetics,
eyeglasses, and hearing aids and their repair.
(e) Rehabilitative care.
(f) Emergency transportation and necessary
transportation for health care services for disabled
persons.
(g) Language interpretation for health care
services, including sign language for those unable
to speak, or hear, or who are language impaired, and
Braille translation or other services for those with
no or low vision.
(h) Child and adult immunizations and preventive
care.
(i) Health education.
(j) Hospice care.
(aa) Home health care.
(bb) Prescription drugs that are listed on the
system formulary. Nonformulary prescription drugs
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may be included where special standards and criteria
are met.
(cc) Mental health care.
(dd) Dental care.
(ee) Podiatric care.
(ff) Chiropractic care.
(gg) Acupuncture.
(hh) Blood and blood products.
(ii) Emergency care services.
(jj) Vision care.
(aaa) Adult day care.
(bbb) Case management and coordination to ensure
services necessary to enable a person to remain
safely in the least restrictive setting.
(ccc) Substance abuse treatment.
(ddd) Care of up to 100 days in a skilled nursing
facility following hospitalization.
(eee) Dialysis.
24. Would exclude coverage of:
(a) Health care services determined to have no
medical indication by the chief medical officer and
the Medical Practice Standards Advisory Board.
(b) Surgery, dermatology, orthodontia, prescription
drugs, and other procedures primarily for cosmetic
purposes, unless required to correct a congenital
defect, restore or correct a part of the body that
has been altered as a result of injury, disease, or
surgery, or determined to be medically necessary by
a qualified, licensed health care provider in the
system.
(c) Private rooms in inpatient facilities, unless
determined to be medically necessary by a qualified,
licensed provider in the system.
(d) Services of a professional health care provider
or facility that is not licensed or accredited by
the state.
25. Would prohibit the commissioner from allowing
deductible payments or copayments during the initial
two years of the systems operation, but then shall
determine whether deductible payments or copayments
should be established, as specified.
COMMENTS
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1. Purpose of the bill . The author states the bill would
establish the CHCS which would be administered by an
elected commissioner who heads the HCA, and that the
CHCS would provide health insurance to all California
residents through a consolidated claims, financing and
administrative system, and replace all private health
insurance policies and eliminate all health insurance
premiums paid by residents and their employers.
The author states there are no uniform regulations and
statutes governing the health care system leading to a
highly fragmented health insurance and delivery system
that is administratively complex and annually diverts
billions of dollars in health care spending from
direct health care services to administrative costs.
The author adds that it provides care based on income
and insurance status rather than medical need, with
intricate interactions with public and private health
insurance programs, providers, and regulatory agencies
that are confusing and time-consuming for consumers
and providers alike.
The author believes existing law provides no mechanism
for stabilizing the growth in health care spending
that is quickly outpacing growth in GDP, and that
absent budgeting capabilities, growth in health care
spending is rapidly surpassing the ability to afford
current levels of benefits or to add new benefits
related to technological improvements. International
comparisons demonstrate the ability of single payer
health care systems stabilize the growth in health
care spending.
The author points out that health care providers spend
increasing amounts of time navigating the porous
network of public and private health insurance
programs. For example, UCSF Children's Hospital works
with nearly 80 different health insurance policies and
public programs each with its own benefits package,
formulary schedule, and rate of co-payments and
deductibles. One peninsula group practice serving
70,000 patients works with 6,000 different health
insurance plans.
The author states between 20-30% of the health care
dollar is spent on administration (excluding profit).
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A quantitative analysis performed by the Lewin Group
that a single payer system, California could reduce
administrative costs to 1.8% of health care spending,
allowing the system to divert $14 billion dollars
annually to direct health care services. The author
notes the bill aims for 5% administrative costs, with
the higher rate being assumed as a cost of making the
transition.
The author believes the bill would: create cost
control authority; create the means for equitable
distribution of resources and incentives to practice
in under-served areas; create risk-adjusted
reimbursement; return medical decision-making to
medical providers and dramatically decrease
administrative complexity; and implement bulk
purchasing of pharmaceuticals and medical equipment.
The author states the United States leads the world in
health care spending at about $5,000 per person per
year on average - more than twice the average in other
industrialized countries, and that despite our high
level of spending, the U.S. ranks 37th in
population-based health outcome measurements according
to the World Health Organization, well below the
rankings of all other industrialized nations. This is
true because a large portion of the $5,000 is not
going to health services and because nearly 20% of the
population has no health insurance. The author
believes the bill will correct both of these problems.
The author states the bill has as its purpose,
establishing universal health insurance for all
California residents, stabilizing growth in health
care spending, including costs to employers, and
improving health outcomes and consumer and provider
satisfaction.
2. Support . The American Civil Liberties Union believes
that access to health care should be considered as
more a right than a privilege. The Congress of
California Seniors believes the California health care
crisis cannot be solved through a years-long series of
incremental legislation. Consumers Union notes that
the recent state Health Care Options Project found the
single payer proposal to be the most cost-effective
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means of reaching universal coverage, and the bill
would make more funding available for health care that
our current wasteful and duplicative multi-insurer
system.
Health Access states the bill would guarantee health
coverage to every Californian, regardless of income or
employment, by shifting current private and public
financing to a single system of public financing
similar to Medicare. Health Access notes that
millions of adults, most of them working people,
remain uninsured or are vulnerable to periods
uninsurance during job changes and other life
transitions, and that most of these adults either
cannot afford or cannot obtain health coverage.
Health Care for All California believes the bill would
build a healthcare system that is scientifically,
economically and ethically sound. The League of Women
Voters of California and others believe that a basic
level of quality health care and affordable cost
should be available to all, and that the bill would
provide equitable distribution of services, efficient
and economical delivery of care, advancement of
medical research and technology, and a reasonable
total expenditure level for health care.
The Older Women's League and others state the high
cost of health care and prescription drugs has been
extremely difficult for so many women and that the
situation is not improving with HMOs dropping their
coverage and increasing their premiums, and that the
current health-care system is woefully lacking with
too much of the money going to administrative costs.
PICO and others note that there have been many reforms
have worked to expand health coverage for many
Californians, but a high percentage of our state's
population remain uninsured, and they believe it is
important to begin identifying long-range options to
address the structural problems of our state's
health-care system.
The Service Employees International Union and others
state that lack of insurance coverage, either
permanently or intermittently, prevents people from
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getting care that they can afford when they need it,
and that the uninsured and get half as much care, they
pay more for it, and their health and their finances
suffer as a result, and believe the bill will correct
this.
3. Opposition . The Association of California Life and
Health Insurance Companies (ACLHIC) disagrees with the
two major premises of the bill: that government
systems are more efficient than private business, and
that a single payer system would cost less than the
current private system. ACLHIC points out that
patients in Canada or England face lengthy waiting
times for services and their medical outcomes are very
poor compared to the United States, and California
particular. ACLHIC states that not only are survival
rates from cancer and other life-threatening diseases
abysmal in comparison, but the services Californians
take for granted are so rationed that what should be
routine treatment becomes life-threatening.
The California Association of Health Plans (CAHP)
states proponents of single payer reforms believe that
wiping out competing health plans will generate
enormous savings from lowered administrative costs and
the elimination of profit, and that the savings will
be so substantial than 7 million uninsured
Californians can be immediately afforded health-care
coverage with not a penny of additional financing.
CAHP states that the bulk of the administrative costs
will not eliminated under a single-payer system.
Claims payment, utilization review, disease and care
management programs, the development of drug
formularies, and customer service functions make up a
lion's share of what is commonly called
"administration," and that none of these functions are
wasteful or inefficient and none can be ignored under
a single-payer system. Instead the bill establishes
an impressive array of new agencies, commissions,
advisory bodies, and elected officeholders to carry
out precisely these tasks.
The California Association of Health Underwriters
opposes the bill because it would create problems for
patients with medical rationing, reduced access to
medical technology and higher mortality for treatable
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diseases. CAHU believes the bill would create
problems for physicians with reduced income, and would
create increased administrative costs.
The California Beer and Beverage Distributors and
others believe it is unfair and unjust to fund
California's health care crisis on the backs of
employers with a tax increase on alcoholic beverage
products and through higher employee payroll taxes at
a time California businesses are already burdened with
the dramatic increases in workers' compensation,
unemployment insurance, and fuel and utility costs.
Health Net opposes the bill because it requires the
provision of all medical care, giving unfettered
discretion to providers in deciding what services to
provide, and while perhaps appealing, this is a recipe
for cost overruns. Health Net states that no other
single payer system gives providers such power,
because to do so would bankrupt the system, and
therefore the bill provides a false promise.
4. Related legislation .
SB 2123 (Lee & Watson), introduced in 1998, would have
established a short, modified framework for a
California single payer system, but the bill failed in
the Health and Human Services Committee.
SB 480 (Solis-Chapter, Statutes of 1999) required the
secretary of the California Health and Human Services
Agency to report to the Legislature concerning options
for achieving universal health care coverage and to
establish a process to develop those options.
SB 1414 (Speier), introduced in 2002, would have
created Healthy California to provide universal
coverage by expanding and consolidating public health
programs and requiring employers to provide health
insurance using a "pay or play" approach, but failed
in Senate Appropriations.
SB 2 (Burton & Speier) would create an approach to
universal health coverage by mandating all employers
provide health insurance using a "pay or play"
approach (in Senate Insurance).
AB 30 (Richman) would expand Healthy Families to
include working adults without children (in Assembly
Health).
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AB 923 (Wesson) would enact legislation that makes
provision for rural health care for farmworkers
(Assembly Rules).
AB 1527 (Frommer) would mandate employers with more
than 50 employees to provide health insurance using a
"pay or play" approach (Assembly Health).
AB 1528 (Cohn) would mandate all employers to provide
health insurance using a "pay or play" approach,
require individuals without employer provided health
insurance to obtain health insurance, and would create
the California Essential Health Benefits Program
(Assembly Health).
POSITIONS
Support
A Window Between Worlds
Access
AIDS Coalition to Unleash Power
Alameda County Advisory Commission on Aging
Alameda County Board of Supervisors
Amalgamated Transit Union Local 192
American Civil Liberties Union, South Bay Chapter
American Civil Liberties Union, Southern California
American Federation of State, County, and Municipal
Employees
American Federation of State, County, and Municipal
Employees Retirees #36
American Medical Student Association
American Medical Women's Association
Asthma Education and Resource Council
Berkeley Retired Teachers' Association
Beth Shir Shalom
Breaking Barriers Community Services Center
Breast Cancer Action
Breast Cancer Alliance, Los Angeles
Burma Forum
Butte County Health Care Coalition
California Advocates for Nursing Home Reform
California Association of Midwives
California Church
California Commission on the Status of Women
California Democratic Council
California Democratic Party Disability Caucus
California Dental Hygienists' Association
California Disability Alliance
California Federation of Teachers
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California Independent Public Employees Legislative Counsel
California Nurses Association
California Optometric Association
California Part-Time Faculty Organization
California Physicians Alliance
California Public Health Association-North
California Retired Teachers Association, East Bay Division
California School Employees Association
California Senior Legislature
California Society for Clinical Social Work
California Teachers Association
California Women's Law Center
Center for Independence of the Disabled
Center for Independent Living, Fresno
Central Coast Center for Independent Living
Child Care Law Center
Citizenship Project
City of Berkeley
City of Santa Monica
Claremont House Residents' Council
Coalition for Quality Health Care
Coalition for a Living Wage, Santa Barbara
Coast-to-Coast Community Campaigns
Community Action Board of Santa Cruz County
Community Homeless Alliance Ministry
Community Leadership Development Council
Community Rehabilitation Services
Congress of California Seniors
Consumers Union
Contra Costa County Advisory Council on Aging
Contra Costa County Senior Nutrition Program Advisory
Council
Council on Wireless Technology Impacts
County of Sacramento Department of Health and Human
Services
Dayle McIntosh Center
Death Penalty Focus
Democratic Action Club of Chico
Democratic Central Committee, Fresno County
Democratic Socialists of America, East Bay
Democratic Women of Santa Barbara County
Demos Democratic Club of Hayward
Disability Resource Agency for Independent Living
Drug Policy Alliance
East Bakersfield Community Health Center
East Bay Peace Action
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Elections Committee of the County of Orange
Evergreen Democratic Club
Faculty Association of California Community Colleges
Federation of Teachers, San Mateo Community College
Federation of Retired Union Members of Santa Clara County
Four Winds West
Friends Committee on Legislation of California
Funeral Consumers Alliance of Monterey Bay
Garment Worker Center
Globallinx Network
Gray Panthers California
Green Party of Alameda County
Green Party of San Mateo County
Green Party of Santa Clara County
Hadassah Southern California Nurses Council of San Diego
County
Health Access California
Health Care Council of Orange County
Health Care for All, Central California Chapter
Health Care for All-California
Homeless Health Care Los Angeles
Independent Living Resource Center
JERICHO
Kennedy Club of the San Joaquin Valley
League of Women Voters of California
League of Women Voters of the Bay Area
Lambda Letters Project
Latino Issues Forum
LifeLong Medical Care
Los Angeles Alliance for a New Economy
Los Angeles Coalition to End Hunger and Homelessness
Los Angeles County HIV Drug and Alcohol Task Force
Los Angeles Gay and Lesbian Center
Long Beach Greens
Marin Family Action
Marin Interfaith Council
Marin Interfaith Youth Outreach
Metropolitan Community Church Los Angeles
Mexican American Legal Defense and Educational Fund
Middle East Children's Alliance
NAMI Yuba-Sutter
Nation Group
National Association for the Advancement of Colored People,
Pasadena
National Association of Social Workers
National Council of Jewish Women, Los Angeles
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National Council of Jewish Women, Sacramento
National Organization for Women
National Women's Political Caucus, Alameda North
Neighbor to Neighbor, San Francisco
Old Lesbians Organizing for Change, San Francisco
Older Women's League of California
Operation Access
Pacific Unitarian Church, Rancho Palos Verdes
Palo Alto Friends Meeting
Palos Verdes Peninsula Democratic Club
Peace Action of San Mateo
Peninsula Peace and Justice Center
People for a National Health Program
Peoples Democratic Club
Pharmacists Planning Service Inc.
PICO California Project
Professional Pharmaceutical Advocates
Progressive Jewish Alliance
Rainbow Coalition, West Contra Costa
Residents' Council of Claremont House
Resources for Independent Living
Richmond Greens
Ritter House
Rolling Start
San Benito County Health and Human Services Agency
San Francisco AIDS Foundation
San Francisco Department and Commission on the Status of
Women
San Gabriel Valley Pharmacists Association
Santa Barbara Friends Meeting
Santa Clara County Health Care Committee
Santa Cruz County Coalition for a Living Wage
Screen Actors Guild
Senior Advocacy Council of Pasadena
Service Employees International Union
Shefa Fund
Sherman Oaks Democratic Club
South Hayward Parish
Southern California Americans for Democratic Action
St. Anthony's Foundation
St. Mary's Center, Oakland
Through the Looking Glass
Trinity United Methodist Church
Unitarian Universalist Church of Ventura
United Electrical, Radio and Machine Workers of America, UE
District 10
SB 921, Page
20
United Nurses Associations of California/Union of Health
Care Professionals
United Union of Roofers, Waterproofers, And Allied Workers,
Local 81
USA/Cuba InfoMed
Valley Democrats United
Vote Health
Warehouse Union Local 6
West Contra Costa Healthcare District
West County Toxics Coalition
Women Democrats of Placer County
Women's Cancer Resource Center
Women's Foundation
Women's International League for Peace and Freedom
WORKSAFE
Numerous individuals
Oppose
Association of California Life and Health Insurance
Companies
Blue Cross of California
California Association of Health Plans
California Association of Health Underwriters
California Beer and Beverage Distributors
Chamber of Commerce, Cerritos
Chamber of Commerce, Chico
Chamber of Commerce, Encinitas
Chamber of Commerce, Irvine
Chamber of Commerce, Sante Fe Springs
Coors Brewing Company
Health Net
Logret Import and Export Company
Orange County Business Council
Wine Institute
Consultant: Michael Ashcraft, MD 916-445-0825