BILL ANALYSIS �
SB 416
Page 1
Date of Hearing: July 5, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 416 (Kehoe) - As Amended: June 30, 2011
SENATE VOTE : 25-14
SUBJECT : Health: survey.
SUMMARY : Requires, not later than January 1, 2013 voluntary
questions related to sexual orientation, gender identity, gender
expression, to domestic partnership and gender of one's spouse
to be included in the California Health Interview Survey (CHIS)
and the Behavioral Risk Factor Surveillance System (BRFSS).
Specifically, this bill :
1)Requires, no later than January 1, 2013, to the extent
permitted by federal law, the Department of Public Health
(DPH) and the Department of Health Care Services (DHCS), to
collaborate with the Regents of the University of California
(UC) to include appropriate voluntary, demographic,
self-identification information pertaining to sexual
orientation, gender identity, and gender expression into the
questions asked by CHIS.
2)Requires, if CHIS includes any question about marital status,
that questions about registered domestic partnership status
and about the gender of the spouse or partner also be
included.
3)Requires, no later than January 1, 2013, to the extent
permitted by federal law, DPH and DHCS to collaborate with the
state coordinator for the BRFSS to include appropriate
voluntary, demographic, self-identification questions
pertaining to sexual orientation, gender identity, and gender
expression into the questions asked by BRFSS.
4)Requires, if BRFSS includes any question about marital status,
that questions about registered domestic partnership status
and about the gender of the spouse or partner also be
included.
EXISTING LAW :
SB 416
Page 2
1)Establishes DPH to protect and promote the health status of
Californians through population-based public health programs
and services. Establishes the Cancer Surveillance and
Research Branch within DPH to collect statewide data about
cancer and cancer risk factors, conduct surveillance and
research into the causes, cures, and controls of cancer, and
communicate the results to the public including directing,
managing, and monitoring the Survey Research Group (SRG).
2)Requires demographic data to be collected for health and human
services programs.
3)Requires that in the usual course of reviewing and revising
all public-use forms that refer to or use the terms spouse,
husband, wife, father, mother, marriage, or marital status,
that appropriate references to state-registered domestic
partner, parent, or state-registered domestic partnership be
included.
4)Requires that domestic partners, former domestic partners, and
surviving domestic partners have the same rights, protections,
and benefits, and shall be subject to the same
responsibilities, obligations, and duties under law as are
granted to and imposed upon spouses, former spouses, and
widows or widowers in a civil marriage.
FISCAL EFFECT : According to the Senate Appropriations
Committee:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
Health care survey data collection:
- CHIS Up to $50 Up to $100 Up to
$100 General
- BRFSS Up to $14 Up to $21 Up to $21
General/
Federal
Increased service delivery Unknown, major cost pressure
General/
Federal
COMMENTS :
1)PURPOSE OF THIS BILL . According to the sponsors, Equality
California (EQCA), data relating to California's Lesbian, Gay,
SB 416
Page 3
Bisexual, and Transgender (LGBT) population is not being
currently collected in a consistent manner by the state or
federal government. EQCA contends that a growing body of
research has documented that LGBT people differ from the
general population in terms of income, poverty rates, public
benefit program participation, mental health, physical health,
victimization, and employment discrimination. EQCA points out
that the state currently administers a number of statewide
surveys that collect important information about Californians.
Specifically, according to EQCA, CHIS, the nation's largest
state health survey gives a detailed picture of the health and
healthcare needs of California's large and diverse population,
and the BRFSS, a federal survey administered by the state, has
tracked health conditions and risk behaviors in the United
States since 1984. The sponsors point out that although these
and other studies collect demographic information such as
race/ethnic identity, age, family size, health and safety
information, and other data, they do not include questions
about LGBT people in a manner that allows for uniform
compilation and reporting.
According to the author, in the absence of data, policy
makers, businesses, and the public risk making decisions based
on myths and stereotypes about LGBT people. The author states
that the data made available by this bill would provide much
needed information to businesses, social service agencies,
community organizations, researchers, the public, and others.
The author contends that the goal of the bill is accomplished
by directing the inclusion of uniform voluntary
self-identification questions regarding sexual orientation,
gender identity and gender expression, domestic partnership
status, and the gender of a spouse.
2)BACKGROUND . A study conducted by the Institute of Medicine at
the request of the National Institutes of Health (NIH) on the
state of the science regarding the health of LGBT people was
released in March 2011. According to Secretary Sibelius, of
the United States Department of Health and Human Services
(HHS), the report provides the scientific community with the
first comprehensive overview of health-related research in
this important area. She states that it concludes by
recommending that NIH develop and implement a comprehensive
research agenda to advance our knowledge and understanding of
LGBT health, including demographic studies and inequities in
health care, and the social contexts in which LGBT people
SB 416
Page 4
live. According to Secretary Sibelius, the report also calls
for federally funded surveys and electronic health records to
collect data on sexual orientation and gender identity while
protecting patient confidentiality. In addition, the report
recommends enhanced training to strengthen LGBT health
research at NIH, and asks NIH to encourage grant applicants to
address explicitly the inclusion or exclusion of sexual and
gender minorities in their clinical studies. She concluded by
stating that the report was an important step in identifying
research gaps and opportunities, as part of an overall effort
to understand and address the health needs of lesbian, gay,
bisexual, and transgender people and that HHS looked forward
to continuing their work to address these needs and reduce
LGBT health disparities.
With regard to California, some of the limited data that is
available shows:
a) That 13.4% of lesbian/bisexual women and 7.2% of
gay/bisexual men live in poverty (CHIS, 2007);
b) Children in gay and lesbian couple households have
poverty rates twice those of children in heterosexual
married couple households (UC Los Angeles (UCLA) study from
the Williams Institute); and,
c) In 2008, hate crimes based on sexual orientation and
gender identity were the third most common type of hate
crime, comprising 20.3% of hate crimes (California
Department of Justice).
3)CHIS . CHIS is conducted by UCLA, Center for Health Policy
Research in collaboration with DPH and DHCS every two years.
CHIS conducts random-dial telephone interviews with up to
50,000 or more California households in 44 geographic areas in
California and claims to be the nation's largest state health
survey. It is funded by a variety of public agencies and
private organizations such as DPH, DHCS, California Children
and Families Commission, the California HealthCare Foundation,
and the California Endowment. The persons included in CHIS
are a statistically representative sample of the entire
state's diverse population. According to CHIS, the survey
covers dozens of essential health topics, from asthma,
diabetes, and obesity to immigrant health and the number of
Californians with health insurance. Many core questions are
repeated in each survey in order to measure significant shifts
over time. New questions are also added each survey year to
address emerging concerns that are important for planning and
SB 416
Page 5
policy development.
In 2009, CHIS included questions in the category of
"Respondent Characteristics" that asked about sexual
orientation, registered domestic partner, and the gender of
the spouse. However, the author's goal is to ensure that the
questions are phrased in a manner that is most likely to
elicit useful and uniform data with regard to the LGBT
population such as also including questions relating to gender
identity and gender expression.
4)BRFSS . The BRFSS is a state-based system of health surveys
that generate information about health risk behaviors,
clinical preventive practices, and health care access and use
primarily related to chronic diseases and injury. Conducted
by the 50 state health departments as well as those in the
District of Columbia, Puerto Rico, Guam, and the U.S. Virgin
Islands with support from the Centers for Disease Control and
Prevention (CDC), BRFSS provides state-specific information
about issues such as asthma, diabetes, health care access,
alcohol use, hypertension, obesity, cancer screening,
nutrition and physical activity, tobacco use, and more.
According to the CDC, it is the world's largest, on-going
telephone health survey system, tracking health conditions and
risk behaviors in the United States yearly since 1984.
Federal, state, and local health officials and researchers use
this information to track health risks, identify emerging
problems, prevent disease, and improve treatment.
a) California . The BRFSS in California is conducted by
SRG, a section within the Chronic Disease Surveillance and
Research Branch of DPH. It is supported in part by funds
from the CDC, the U.S. Public Health Service, and in part
by funds from the programs which add questions to the
survey. Data is collected monthly from a random sample of
California adults living in households with telephones. In
California, the annual sample size for this survey is
approximately 5,000 interviews. It has been used to:
i) Monitor the impact of tobacco control
legislation based on Proposition 99;
ii) Assess the quality of life of adult Californians
with arthritis in order to focus the California
Arthritis Partnership Program resources appropriately;
iii) Assess the prevalence of diagnosed osteoporosis
SB 416
Page 6
in California in order to target the California
Osteoporosis Prevention and Education Program resources
most effectively;
iv) Evaluate gun ownership and storage practices in
California;
v) Estimate potential lead exposure among adults
and households with children in California;
vi) Estimate adult and child asthma prevalence in
California to help study differences in asthma rates by
various demographics; and,
vii) Evaluate the health care status and the health
of uninsured California residents.
viii) Assess alcohol consumption and dependence.
ix) Assess the use of cancer screening tests.
x) Identify Californians who are at risk for being
overweight. Estimate sun avoidance and protection
practices among California's adults and children.
xi) Assess the knowledge of certain sexually
transmitted diseases (STDs) in order to target the
efforts of STD awareness programs.
xii) Monitor progress toward Healthy People 2010
goals for flu and pneumococcal immunization in
California's seniors and high-risk individuals.
b) Questionnaire design . The BRFSS questionnaire is
developed each year by CDC in collaboration with
participating state agencies. According to SRG, wherever
possible, questions have been selected from previously
conducted national surveys for comparability. The
questionnaire has three components. The first component
consists of a core set of questions that are administered
by all states participating in the BRFSS collection effort.
Many of the core questions have remained fixed from year
to year, although revisions are made to the core annually.
Changes are implemented at the beginning of each
interviewing year. Revisions to the core over the years
have included modifications in question wording, inclusion
of new questions or exclusion of previously asked
questions, changes in skip patterns, and changes in the
order in which questions were asked. Some changes have
been relatively minor, such as changes in the wording of
introductory statements. From 1992-99 CDC implemented a
"rotating core" strategy, allowing some core questions to
appear on the questionnaire in alternate years only. The
second component of the questionnaire consists of a series
SB 416
Page 7
of topical modules developed by the CDC. States have the
option of adding as many modules as they wish to the core
questionnaire each year. California has used several of
the CDC modules, although the same modules have not been
used consistently across all years of the survey. The
final component of the questionnaire consists of questions
designed and administered by individual states to address
issues of local concern. These have been revised annually
in California to address the needs of as many programs as
possible. BRFSS includes a California specific question to
determine whether California will yield results consistent
with other research that has shown sexual minority
community members have important health risk factors, such
as smoking. As with CHIS, the author's intent is to ensure
that questions include gender identity and gender
expression in a manner that is most likely to elicit
uniform, useful, and accurate information. In addition,
the BRFSS question on marital status does not ask the
gender of the spouse or partner and will therefore not
provide data that can be compared using this distinction.
5)SUPPORT . The Transgender Law Center (TLC), in support of this
bill, states that unfortunately, data relating to California's
transgender population is not being collected in a consistent
manner by the state or federal government. According to TLC,
the scant data we have comes from local surveys that, while
providing helpful information place us at a significant
competitive disadvantage when state and federal funding is
sought to reduce health, employment, housing and other
disparities that significantly affect the lives of all
transgender Californians. The supporters argue that while
they know and experience the challenges every day, they cannot
adequately demonstrate the health disparities until the data
becomes available.
6)PREVIOUS LEGISLATION . AB 1878 (Lieu) of 2010 would have
required the Department of General Services to revise all
public forms that collect demographic data to include
information related to sexual orientation, domestic
partnership status, and gender identity. AB 1878 was held
under submission and died in the Assembly Appropriations
Committee.
REGISTERED SUPPORT / OPPOSITION :
SB 416
Page 8
Support
Equality California (sponsor)
American Civil Liberties Union
BIENESTAR Human Services, Inc.
California Communities United Institute
California National Organization for Women
California Pan-Ethnic Health Network
City of Los Angeles
Gay-Straight Alliance Network
Mental Health America of Northern California
Openhouse
Planned Parenthood Affiliates of California
The Trevor Project
Transgender Law Center
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097