BILL ANALYSIS �
SB 416
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Date of Hearing: August 17, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
SB 416 (Kehoe) - As Amended: June 30, 2011
Policy Committee: Health Vote:13-4
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires, not later than January 1, 2013, data on
sexual orientation, gender expression and identity, and domestic
partnership status to be collected in two statewide health
surveys, as specified. 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 California Health Interview Survey (CHIS).
2)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 Behavioral Risk Factor Surveillance
System (BRFSS) to include appropriate voluntary, demographic,
self-identification questions pertaining to sexual
orientation, gender identity, and gender expression into the
questions asked by BRFSS.
3)Requires, for CHIS and BRFSS, the inclusion of questions about
registered domestic partnership status and about the gender of
the spouse, if the surveys include any question about marital
status.
FISCAL EFFECT
1)One time GF costs to DPH and DHCS, conservatively in the range
of $100,000 (50% GF/50%federal), to develop a pilot telephone
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questions on gender identity and expression for inclusion in
CHIS and BRFSS surveys. State funding for CHIS is currently
provided by DPH through the General Fund and by DHCS through
federal matching funds.
2)Annual GF costs in the range of $7,000 to $20,000 to include
addittional questions on the BRFSS.
3)Unknown annual ongoing costs, at least $50,000, and
potentially exceeding $180,000 per two-year cycle (50%
GF/50%federal), to include additional survey questions on
CHIS.
4)Actual costs will depend on the number of people receiving the
questions, amount of time it takes to ask and answer the
questions, and whether some of the questions would be included
regardless of this bill. The first two factors relate to a
lack of a well-validated and generally accepted set of
telephone survey questions. Some of the questions, such as a
question on sexual orientation, would likely be included in
both surveys even in the absence of this bill; the inclusion
of other questions, even those that were included in 2009
surveys, is less certain.
Additionally, as explained below, gender identity and
expression are complex constructs and may take additional time
to clarify, if people are unfamiliar with what is being asked,
which could further increase costs beyond the estimates
presented here.
COMMENTS
1)Rationale . Available data indicate that lesbian, gay,
bisexual and transgender (LGBT) people face health
disparities. The author states that in spite of this, data on
sexual orientation, gender identity, and gender expression is
not systematically collected by state or federal surveys, and
the availability of such data can inform businesses, social
service agencies, community organizations, researchers, and
the public. This bill seeks to take a step forward in
systematizing the collection of this data by requiring certain
questions to be asked on two statewide health surveys, as
explained below.
2)Statewide Health Surveys .
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a) California Health Interview Survey (CHIS) . CHIS, a
telephone survey of over 50,000 Californians, is the
nation's largest health survey. CHIS is conducted every
two years by the UCLA Center for Health Policy Research, in
collaboration with DPH and DHCS. The last survey was
conducted in 2009. CHIS is funded by a network of public
agencies and private organizations, and covers dozens of
health topics. The 2009 survey included questions on
gender, sexual orientation, the gender of sexual partners,
and domestic partner status, but did not include specific
questions about gender identity or expression. CHIS
generally asks questions that have already been validated
and used in other large surveys instead of developing
questions in-house. This strategy helps facilitate
comparability with previously collected data, and helps
avoid significant costs and workload related to question
development, validation, and pilot testing.
b) Behavioral Risk Factor Surveillance System (BRFSS) . The
Behavioral Risk Factor Surveillance System (BRFSS) is a
national, state-based system of telephone health surveys
that collects information on health risk behaviors,
preventive health practices, and health care access. In
California, the survey is conducted by the Survey Research
Group of the DPH's Chronic Disease Surveillance and
Research Branch. The 2009 survey included questions on
gender, sexual orientation and marital status, but did not
include specific questions about gender identity or
expression nor domestic partner status.
1)Background . There is consensus among health researchers that
data collection on LGBT health issues needs improvement. This
year, an Institute of Medicine (IOM) committee that was
convened to assess the state of science on the health status
of LGBT populations recommended that more surveys collect data
about the demographics of these populations. Specifically,
they recommended data on sexual orientation and gender
identity be included in federally funded surveys.
The IOM committee also indicated that there is no generally
accepted and well-validated set of questions related to sexual
orientation and gender identity that can cover a variety of
situations. They conclude there is significant work to be done
to develop and validate measures that would make it easier for
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researchers to collect data on sexual orientation and gender
identity. As such, they called on the National Institutes of
Health to support the development and standardization of such
measures.
2)Definitions . This bill requires data collection on sexual
orientation, gender identity and gender expression. Data on
sexual orientation is commonly collected through surveys by
asking if an individual identifies as straight/heterosexual,
bisexual, or homosexual, and both CHIS and BRFSS already
collect sexual orientation data. Although sexual orientation
is a relatively common construct, CHIS indicates that they
have ceased asking individuals over 70 years of age questions
about sexual orientation due to concern that these questions
were not understood and answered accurately.
Gender identity and gender expression are more complex
constructs. Section 422.56 of the Penal Code defines the term
"gender" as sex, including a person's gender identity and
gender related appearance and behavior whether or not
stereotypically associated with the person's assigned sex at
birth. Gender identity is defined as one's basic sense of
being a man, woman, or other gender (such as transgender).
Gender expression is the set of characteristics in appearance,
personality, and behavior culturally defined as masculine or
feminine. Because constructs around gender identity and
expression are complex and multi-dimensional, it is unclear
precisely how many and what types of questions would need to
be added to the two surveys in order to meet the requirements
of this bill. In addition, these types of questions may
require more clarification and explanation than, for example,
a question related to the presence of absence of a health
condition or behavior.
3)Related Legislation . SB 747 (Kehoe) requires a number of
different state licensed and certified health professionals to
take at least one continuing education (CE) course on the
provision of adequate care to lesbian, gay, bisexual, and
transgender (LGBT) individuals. SB 747 is pending on the
suspense file of this committee.
4)Prior Legislation . AB 1878 (Lieu) in 2010 required the
Department of General Services (DGS) to revise all public
forms that collect demographic data to include information
related to sexual orientation, domestic partnership status,
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and gender identity. AB 1878 was held on the Suspense File of
this committee.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081