BILL ANALYSIS
SENATE HEALTH AND HUMAN SERVICES
COMMITTEE ANALYSIS
Senator Deborah V. Ortiz, Chair
BILL NO: SB 921 S
AUTHOR: Kuehl B
AMENDED: April 21, 2003
HEARING DATE: May 7, 2003 9
FISCAL: Revenue and Taxation / Appropriations 2
1
CONSULTANT:
Hansel / ak
SUBJECT
Single payer health coverage
SUMMARY
The bill would establish the California Health Care System to
provide universal health care using a single payer system.
ABSTRACT
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
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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.
4.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. Establishes the California Health Care System (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. Provides that the HCA shall be comprised of a Health Policy
Board, the Office of Consumer Advocacy, and the Office of
Medical Practice Standards.
3. Declares 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
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health care planning.
4. Specifies the organization of the office of the
commissioner and requires 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 services provided under
this division.
d. Develop, implement, and review formulae for determining
budgets for health care services.
e. 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.
f. Implement, to the extent permitted by federal law,
standardized claims and reporting methods under this
division, including a system of centralized electronic
claims and payments.
g. 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.
h. 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.
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i. Negotiate for prescription drug and durable and
nondurable medical equipment to achieve the lowest possible
cost available under the CHCS formulary.
j. Negotiate for, or set, rates, fees and prices involving
any aspect of the CHCS, and establish procedures relating
thereto.
aa. Administer the revenues of the Health Care Fund.
bb.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, and 3) an Office of Medical
Practice Standards and a Medical Practice Standards
Advisory Board.
cc.Administer all aspects of the HCA that include the
following:
Establish standards and criteria for allocation of
operating funds and funds from the Health Care Fund.
Meet regularly with the chief medical officer and
the consumer advocate to review the impact of the HCA and
its policies on the regions.
Establish health system goals in measurable terms.
Establish statewide health care databases to support
health care planning.
Implement policies to assure culturally competent
and linguistically sensitive care and develop mechanisms
and incentives to achieve this purpose.
5. Specifies the membership and duties of the Health Policy
Board including to:
a. Establish policy on medical issues, 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
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health facilities for capital improvements shall be
evaluated.
1.Specifies 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.
c. Establishing a toll-free telephone number to receive
complaints regarding the HCA and its services.
d. Recommending improvements to the HCA, the commissioner,
the Health Policy Board, the Office of Medical Practice
Standards, and the Medical Standards Practice Board.
e. Examining the extent to which individual health
facilities and clinics meet the needs of the community in
which they are located.
f. Receiving, investigating, and responding to complaints
from any source about any aspect of the CHCS, referring the
results of investigations to the appropriate professional
provider or facility licensing boards or law enforcement
agencies.
g. Publishing an annual report to the public and the
Legislature containing a statewide evaluation of the HCA.
h. Holding public hearings, at least annually, throughout
the state concerning complaints and suggestions from the
public.
1. Specifies 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
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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.
1.Creates an Office of the Inspector General for the CHCS within
the Office of the Attorney General with powers and duties as
specified.
2.Requires that the CHCS be operational no later than January 1,
2006; requires the commissioner to appoint a transition
advisory group to assist with the transition to the CHCS with
membership and duties as specified.
3.Creates the Health Care Fund and obligations, as specified.
4.Requires 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.
g. A budget for prescription drugs.
1.Requires 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.
2.Allows providers and facilities licensed in California to
participate in the CHCS and allows them to choose whether they
will be recompensed as fee-for-services providers or as part
of a capitated provider network.
3.Requires the budget for fee-for-services providers to be
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divided among categories of licensed health care providers, in
order to establish a total annual budget for each category.
4.Requires commissioner to negotiate fee-for-service
reimbursement rates or salaries for health care providers. In
the event negotiations are not concluded in a timely manner,
the commissioner shall establish the reimbursement rates.
5.Allows facilities, group practices, and integrated health care
systems to choose to be reimbursed through a global facility
budget or on a capitated basis.
6.Requires 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.
7.Requires 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 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.
1.States 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:
On all cigarettes sold in this state, ___ on each
pack of cigarettes.
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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:
On all beer sold in this state, ___ on each 12-ounce
can and at a proportionate rate for any other quantity.
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.
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.
On all distilled spirits sold in this state, ____ on
each 1.75 liter bottle and at a proportionate rate for
any other quantity.
1.States 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 health care tax of __ percent
on their wage income.
21.States 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.
22.Exempts employers from the payroll tax requirements who have
established an employee benefit plan subject to federal law
which preempts the Act. Directs the commissioner to pursue
reasonable means to secure a repeal or waiver of any provision
of federal law that preempts the Act.
23.Provides for collection of health care costs from collateral
sources until such time as all other payers for health care
have been terminated.
24.Requires the commissioner to seek necessary waivers,
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exemptions, agreements, or legislation so that all federal,
state, and county payments for health care within the state
shall be paid directly to the CHCS. Provides that the
responsibility of the CHCS for providing care is secondary to
existing federal, state, or local governmental programs for
health care services to the extent that funding for these
programs is not transferred to the Fund.
25.Requires the commissioner, if allowed as specified, to pay
all premiums, deductible payments, and coinsurance for
qualified Medicare beneficiaries, as specified.
26.Requires the CHCS, if allowed as specified, to pay Medicare
Part B premiums for all individuals who are eligible for both
the CHCS and the Medicare program.
27.Provides that all California residents shall be eligible for
CHCS.
28.Allows any eligible individual to choose to receive services
under the CHCS from any willing participating professional
provider.
29.Specifies 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, inpatient and outpatient, diagnostic, durable
medical equipment, rehabilitative, health education, home
health, prescription drug, mental health, dental, vision, case
management, substance abuse, and skilled nursing services.
30.Excludes 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.
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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.
31.Prohibits 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,
subject to limits as specified.
32.Provides that the agency and the commissioner, as well as
actions to negotiate or set rates, fees, or prices, and the
promulgation of all regulations, shall be exempt from the
regulatory oversight and review of the Office of
Administrative Law, with exceptions.
FISCAL IMPACT
According to an analysis of a proposal similar to SB 921 by the
Lewin Group, expenditures in the first year of operation would
total about $135 billion. Expenditures for health care services
would total about $132. 3 billion and program administration
would account for about $2.4 billion. About $66 billion of this
would come from redirecting funding for current government
programs. The bill states the intent of the Legislature to
dedicate revenue from a new personal income surtax, cigarette
and tobacco surtax, and an alcohol surtax to fund the remaining
costs.
BACKGROUND AND DISCUSSION
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.
The author states there are no uniform regulations and statutes
governing the health care system leading to a highly fragmented
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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 Gross Domestic Product, 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). 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
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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.
According to the UCLA Center for Health Policy Research, an
estimated 6.3 million Californians lacked health insurance at
some time in 2001. According to UCLA, lack of health insurance
is heavily associated with income, type of employment, and
geographic region. According to an analysis by the Lewin group,
single payer proposals have the potential to cover virtually all
of the uninsured and extend benefits to the currently insured,
while reducing total health spending in the state, due to
administrative and other savings.
Arguments in 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 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.
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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 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.
Arguments in 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
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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.
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 diseases. CAHU believes the bill would
create problems for physicians with reduced income, and would
create increased administrative costs.
The California Chamber of Commerce states that the bill does
nothing to address the underlying costs impacting health care
premiums. The Chamber notes that a majority of voters in Oregon
rejected a similar proposal on the November 2002 ballot. The
Chamber also argues that SB 921 will disproportionately impact
small businesses which cannot afford health coverage.
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
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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.
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 (also in Senate
Health and Human Services).
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).
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POSITIONS
Organizations in Support
9 to 5, Bay Area Chapter, National Association of
Working Women
A Window Between Worlds
ACCESS
Activist Arts
ACT UP East Bay
Alameda County Advisory Commission on Aging
AFSCME Retirees, Chapter 36
Alameda County Advisory Commission on Aging
Alameda County Board of Supervisors
Almaden Hills United Methodist Church
Amalgamated Transit Union, Local 192
American Association of University Women
American Civil Liberties Union of Southern
California
American Civil Liberties Union, South Bay Chapter
American Medical Student Association
American Medical Women's Association, Inc.
Asian & Pacific Islander American Health Forum
Asthma Education and Resource Council
Berkeley Retired Teachers Association
Beth Shir Sholom
Breaking Barriers
Breast Cancer Action
Burma Forum Los Angeles
Butte County Health Care Coalition
California Advocates for Nursing Home Reform
California Association of Midwives
California Church Impact
California Commission on Aging
California Commission on the Status of Women
California Council of Community Mental Health
Agencies
California Democratic Council
California Democratic Party Disability Caucus
California Dental Hygienist's Association
California Disability Alliance
California Federation of Teachers
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California Foundation for Independent Living
Centers
California Independent Public Employees Legislative
Council
California Insurance Commissioner Garamendi
California National Organization of Women
California Nurses Association
California Optometric Association
California Part Time Faculty Association
California Physicians Alliance
California Public Health Association - North
California Retired Teachers Association, East Bay
California School Employees Association
California Senior Legislature
California Society for Clinical Social Work
California Teachers Association
California Women's Law Center
Carlton Designs
Center for Independence of the Disabled, Inc.
Center for Independent Living-Fresno
Central Coast Center for Independent Living
Child Care Law Center
Citizenship Project
City and County of San Francisco
Cities of Berkeley, Santa Cruz, Santa Monica
Claremont House Residents' Council
Coalition for a Living Wage
Coalition for Quality Health Care
Coast-to-Coast Community Campaigns
Community Action Board, Santa Cruz County, Inc.
Community Clinic Association of Los Angeles
County
Community Homeless Alliance Ministry
Community Leadership Development Council
Community Rehabilitation Services, Inc.
Congress of California Seniors
Congress of California Seniors, Region 3
Consumer Federation of California
Consumers Union
Contra Costa County Advisory Council on Aging
Contra Costa County Senior Nutrition Program
Advisory Council
Council on Wireless Technology Impacts
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Counseling and Consulting Association
County of Sacramento, Department of Health and
Human Services
Dayle McIntosh Center
Death Penalty Focus, Santa Cruz Chapter
Democratic Action Club of Chico
Democratic Party of the San Fernando Valley
Democratic Socialists of America, East Bay
Democratic Women of Santa Barbara County
Democrats for Change
Demos Democratic Club of Hayward
Disability Resource Agency for Independent Living
Drug Policy Alliance
Dunham & Associates
East Bakersfield Community Health Center
East Bay Peace Action
East Bay Women for Peace
El Cerrito Democratic Club
Elections Committee of the County of Orange
Evergreen Democratic Club of San Jose
Faculty Association of California Community
Colleges, Inc.
Family Counseling Center
Federation of Retired Union Members, Santa Clara
and San Benito County
Four Winds Inc.
Fresno County Democratic Central Committee
Friends Committee on Legislation of California
Funeral Consumers Alliance of Monterey Bay, Inc.
Gardena Valley Democratic Club
Garment Worker Center
Globallinx Network, Inc.
Gray Panthers California
Gray Panthers of Berkeley, Central Contra Costa
County, Long Beach, Marin, Sacramento, San
Francisco, South Bay, Southern Alameda County
Green Party, Counties of Alameda, San Mateo, Santa
Clara, Santa Cruz
Hadassah Southern California Nurses Council of San
Diego County
Health Access California
Health Care Council of Orange County
Health Care for All - California
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Health Care for All, Central California, Marin, Los
Angeles, Sacramento Valley, San Francisco, Santa
Barbara, Santa Cruz, South Bay/Long Beach,
Orange County, Tulare/Kings County
Hermanson's Employment Services
Homeless Health Care Los Angeles
Ideas in Motion
Independent Living Resource Center
Independent Living Resource Center San Francisco
Insure the Uninsured Project (ITUP)
Interfaith Council on Religions, Race, Economic and
Social Justice
International Friendship Society
Jennings/Des Anges
Jericho
Kayline
Kennedy Club of San Joaquin Valley
Lambda Letters Project
Latino Issues Forum
Law Offices of Stewart, Green and McGowan
League of Women Voters of Santa Barbara
Lise Matthews and Associates
Lifelong Medical Care
Long Beach Greens
Los Angeles Alliance for a New Economy
Los Angeles Breast Cancer Alliance
Los Angeles Coalition to End Hunger and
Homelessness
Los Angeles County HIV Drug and Alcohol Task
Force
Los Angeles County Board of Supervisors
Los Angeles Gay and Lesbian Center
Marin County Pharmaceutical Association
Marin Democratic Club
Marin Family Action
Marin Interfaith Council
Marin Interfaith Youth Outreach
Marin United Taxpayers Association
Matthews De Turck Architecture
Mental Health Association in California
Mental Health Association in Los Angeles County
Metropolitan Community Church, Los Angeles
Mexican American Legal Defense and Educational
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Fund (MALDEF)
Middle East Children's Alliance
Minerva Consulting
Monterey Peninsula Monthly Meeting of Friends
NAMI Yuba-Sutter
National Association for the Advancement of
Colored People (NAACP), Pasadena Branch
National Association of Social Workers - California
National Association of Social Workers, Santa
Barbara County Unit
National Council of Jewish Women, Los Angeles
National Council of Jewish Women, Sacramento
National Organization of Women (NOW),
Oakland/East Bay, San Jose/South Bay
National Women's Political Caucus, Alameda North,
San Fernando Valley
Neighbor to Neighbor, San Francisco
Old Lesbians Organizing for Change
Older Women's League of California
Older Women's League - Inland Empire, Sacramento,
San Francisco, Ohlone/East Bay
Operation Access
p-conn-tie Hot Ties
Pacific Unitarian Church
Palo Alto Friends Meeting
Palos Verdes Peninsula Democratic Club
Peace Action of San Mateo
Peninsula Democratic Coalition
Peninsula Peace and Justice Center
People for a National Health Program
Peoples Democratic Club
Performing & Media Arts
Pharmacists Planning Service, Inc.
PICO California Project
Planning for Elders in the Central City
Planned Parenthood Affiliates of California
Pride At Work
Professional Pharmaceutical Advocates
Progressive Jewish Alliance
Quincy Foundation for Medical Research Charitable
Trust
Rainbow Coalition
Resources for Independent Living
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Richmond Greens
Ritter House
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Rolling Start, Inc.
San Benito County Health and Human Services
Agency
San Francisco AIDS Foundation
San Francisco Bay Area Physicians for Social
Responsibility
San Francisco Department and Commission on the
Status of Women
San Gabriel Valley Pharmacists Association
San Mateo Community College Federation of
Teachers
Santa Barbara Monthy Meeting of the Society of
Friends
Santa Clara County Health Care Committee
Santa Cruz County Coalition for a Living Wage
Screen Actors Guild
Seal Press
Senior Advocacy Council, Pasadena
Service Employees International Union (SEIU)
SEIU, Locals 415, 535, 616, 949
Southern California Americans for Democratic
Action
Sherman Oaks Democratic Club
South Hayward Parish
- Good Shepherd Lutheran Church
- Mt. Eden Presbyterian Church
- St. Clement Catholic Church
- Starr King Unitarian Universalist Church
- United Church of Hayward
- Wesley United Methodist Church
- Westminster Hills Presbyterian Church
St. Anthony Foundation
St. John the Baptist Episcopal Church
St John's Health Center
St. Mary's Center
The Shefa Fund
Through the Looking Glass
Trinity United Methodist Church of Berkeley
Unitarian Universalist Church of Ventura
United Electrical, Radio and Machine Workers of
America, UE District 10
United Nurses Association of California/Union of
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Health Care Professionals
United Union of Roofers, Waterproofers and Allied
Trades, Local No. 81
U.S.A/Cuba InfoMed
Valley Democrats United
Valley Financial
Van Dyke and Associates
Venice Family Clinic
Vote Health
Warehouse Union Local 6, ILWU
West Contra Costa Healthcare District
West County Toxics Coalition
Westside Family Health Center
Women Democrats of Placer County
Women's Cancer Resource Center
Women's Foundation
Women's International League for Peace and
Freedom, Berkeley/East Bay Monterey, Penninsula
Branch Santa Cruz
Worksafe! Volunteers
Numerous individuals
Organizations in Opposition
Blue Cross of California
California Association of Health Plans
California Association of Health Underwriters
California Association of Physician Groups
California Health Care Association
California Manufacturers & Technology Association
California Beer and Beverage Distributors
Chamber of Commerce, California
Chamber of Commerce of Cerritos, Chico, Encinitas, Irvine, Santa
Fe Springs
Coalition of California Insurance Professionals
Coors Brewing Company
Health Net, Inc.
Logret Import and Export Company
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