But this track record of advancement doesn’t impress prominent California politicians. The 11 candidates to succeed Newsom in Tuesday’s primary are arguably as obscure as any collection of candidates for an open statewide office in the 21st century.

Three candidates have each won support of key elements in the Democratic coalition, and one Republican hopeful has also stood out. But since the state’s major independent pollsters have skipped the race, it’s difficult to know what to expect Tuesday. Based on money raised as of campaign spending reports published May 13, here’s a look at the major candidates in order of those who had the most resources.

Sacramento Democrat Eleni Kounalakis, 52, had raised $4.5 million, at least $2.5 million of it her own money; a Sunday Sacramento Bee story reported the updated sum is actually $4.2 million. She is a developer who served as U.S. ambassador to Hungary under the Obama administration, having been sworn in by Secretary of State Hillary Clinton in 2010. Kounalakis, pictured, who would be the first woman lieutenant governor, has emphasized her housing background as giving her insights into addressing California’s housing crisis, and also focuses on reducing income inequality.

Kounalakis is counting on Clinton’s 2016 network of fundraisers and supporters to help her make the final two in November. This network includes her father, wealthy Sacramento developer Angelo Tsakopoulos, a prolific Clinton fundraiser who has given nearly $5 million to a nominally independent expenditure committee formed by the California Medical Association that has touted her candidacy. U.S. Sen. Kamala Harris, D-San Francisco, another Clinton backer, is all aboard.

State Sen. Ed Hernandez, 60, an Azusa Democrat and optometrist backed by labor, has raised $2.8 million. One of the reasons the CMA supports Kounalakis is its distaste for Hernandez’s efforts to allow medical professionals, including optometrists, to offer care that can now only be provided by those with traditional medical degrees. But it is unclear how Hernandez would have more means to advance such legislation as a lieutenant governor than in the Legislature.

Hernandez says if elected, he would push a broader health agenda, emphasizing the need to give access to care to 3 million state residents who now are shut out. Of the private polling that had been done by mid-May, Hernandez reportedly had the lead going into the final weeks of the primary campaign.

Piedmont Democrat Jeff Bleich, 56, an attorney who served in the Obama White House as a special counsel; as U.S. ambassador to Australia; and as chair of the California State University Board of Trustees; had raised $2 million. Bleich has emphasized policy goals of reforming higher education and improving environmental protections.

Like his two Democratic rivals, Bleich has support from key party factions, including environmental groups such as the Sierra Club and various LGBT organizations. The former president of the California State Bar also has state trial lawyers in his corner, as well as Rep. Adam Schiff, the Burbank Democrat who has become a national figure because of his high-profile opposition to President Donald Trump.

The most viable Republican on the ballot, Pasadena international import-export businessman Cole Harris, had $1.9 million in campaign funds at last report, nearly all from his own checkbook. Harris has the state GOP’s endorsement and was the first lieutenant governor candidate to run TV ads in the important Los Angeles metro market. But he has done relatively little retail campaigning, and his bare-bones campaign website offers few policy specifics beyond support for the Trump administration and border security and opposition to socialized health care.

Harris’ endorsement from the state GOP might be enough to carry him to the November runoff. But it is unclear if he is ready to self-fund a statewide general election race, and most California Republican insiders expect GOP donors to care more about preserving seven endangered U.S. House seats in the Golden State than any other California campaigns.

A proposal to add new fees to water bills to help pay for improvements to water systems in rural areas with tainted supplies is back before the Legislature, and this time it has the support of the Brown administration.

Last year, activists sought to build support for the concept of a new levy on water after reports came out that at least 300 communities in California had water supplies that were at least as unsafe as those in Flint, Michigan – a city that has gotten national attention for years for its lead-tainted water. Most of the communities were in Central Valley farm areas.

State Sen. Bill Monning, D-Monterey, used the “gut-and-amend” approach to rework SB623 from a bill more generally about improving water quality into a measure that added a maximum 95-cent fee to the monthly bills of all but poor water customers, among other provisions. But the amended bill never advanced.

This year, a similar fee proposal was included in Brown’s 2018-19 budget bill. The fee could go higher than 95 cents per month for some residential users, depending on meter size. Businesses would also have to pay fees that could go as high as $10 a month for heavy industrial and commercial users. The task of collecting the fees would be assigned to the State Water Resources Control Board,

Under Brown’s budget, the state Department of Food and Agriculture would also collect fees from companies that produce and use fertilizer and from dairy operations. The Sacramento Bee reported last month the fees were justified by the Brown administration on the grounds that fertilizer and manure runoff were to blame for significant groundwater pollution.

A 2016 study from the UC Davis Agriculture Sustainability Institute found that nitrogen pollution from synthetic fertilizers had already contaminated state aquifers to such an extent that a clean-up effort would take decades – even if use of the fertilizers was immediately banned.

Water agencies say existing revenue sources should be used

The Association of California Water Agencies, which has more than 400 member agencies that deliver about 90 percent of the state’s water, opposes the Brown administration’s proposal, which it calls a “water tax.” Its website argues that the 300 communities with dangerous water supplies can have their infrastructure repaired using existing funding sources.

There is no widely agreed-on estimate of how much money such repairs would cost. A private consulting firm estimated the annual tab would be about $140 million, the Legislative Analyst’s Office reported last month. But the LAO questioned whether the numbers could be trusted. If the estimate is right, that means the repairs would cost a little more than one-tenth of 1 percent of the state’s current $125 billion general fund budget.

Talking points used by Association of California Water Agency members cite this statistic. They also emphasize that new billing mandates would be severe headaches for smaller water districts with tiny staffs.

But the Brown budget proposal has also quickly rounded up supporters who declare that it is unconscionable that the 300 communities – which have an estimated 1 million residents – have to deal with “Third World conditions.”

That was how state Sen. Ed Hernandez, D-Azusa, characterized the matter in an interview last month with the Sacramento Bee. Hernandez visited some of affected communities last year and found that it was common for residents to spend as much as 10 percent of their earnings on buying clean water.

Upsetting years of tradition and new trends alike, Gov. Jerry Brown signed into law sweeping new measures that put consumers and producers of nicotine-based products on the defensive.

One bill will “raise the legal age to buy products from 18 to 21,” while another “dramatically tightens restrictions on e-cigarettes,” NPR reported. “Anyone who gives tobacco or tobacco paraphernalia to someone under 21 could be found guilty of a misdemeanor crime,” the Associated Press cautioned. “Under the new law, 18 to 20-year-olds will no longer be allowed to buy tobacco in California starting on June 9.”

So-called vapes have been incorporated into a crackdown critics said would make it harder for traditional smokers to find less harmful alternatives to tobacco. Applicable legislation now “defines e-cigarettes as tobacco products, barring their use in workplaces, schools, hospitals and on public transit,” according to the Los Angeles Times. “The bill also requires vaping devices and liquids to be sold in child-resistant packaging. They also cannot be marketed to minors.”

Nevertheless, Gov. Brown did exercise some restraint around the issue of taxing smoking. He “vetoed a bill that would have permitted cities and counties to establish their own tobacco taxes,” NPR added, based on his discomfort level with the number of other tax hikes voters might usher in. “Although California has one of the lowest cigarette taxes in the nation, I am reluctant to approve this measure in view of all the taxes being proposed for the 2016 ballot,” said Brown in his veto message. 

Just the beginning

The new laws, Sacramento watchers noted, are themselves only the tip of the iceberg for public health-focused legislators. California State University and even community college students could soon be barred from smoking or vaping on campus. The legislation that would bar them, Assembly Bill 1594, “squeaked out of the 80-member Assembly on a 41-23 vote,” the Sacramento Bee reported, “with all but two of the votes against coming from Republicans and several Democrats not casting votes.”

Nationally, meanwhile, U.S. policymakers were poised to follow California’s lead, although the Golden State has become just the second state across the country, after Hawaii, to hike the smoking age to 21. (As the Associated Press noted, “more than 100 local jurisdictions around the country have made the change, including New York, Chicago and San Francisco.”) A new federal rule promulgated through the Food and Drug Administration will subject tobacco and classified-as-tobacco products to extraordinary new scrutiny. Going forward, “every e-cigarette on the market — and every different flavor and nicotine level — would require a separate application for federal approval,” according to USA Today. “Each application could cost $1 million or more, says Jeff Stier, an e-cigarette advocate with the National Center for Public Policy Research and industry officials.”

Conflicting conclusions

Scientific research on the relative benefits of vaping have been mixed. But new studies conducted in the United Kingdom have led researchers there to reach a conclusion completely at odds with the emerging expert consensus in the U.S. In a new report, the Royal College of Physicians has endorsed vaping “as part of a ‘harm reduction’ strategy that encourages smokers to move to less dangerous forms of taking nicotine, the addictive substance in tobacco,” U-T San Diego recently reported. “The advice contradicts conclusions from some researchers and American government agencies. These focus on getting smokers to quit entirely, or at least to use federally approved means of nicotine replacement therapy with the goal of totally quitting nicotine use. And results in other countries may not apply in the United States, they say.”

Tellingly, California’s anti-smoking legislators preserved one big carve-out for a certain class of smokers — military personnel age 18-20. “[B]efore you scream that you can fight for your country but you can’t light up,” the LA Weekly reported, as state Sen. Ed Hernandez, D-West Covina, admitted, “you can light up if you’re fighting for your country.”

“Under a law expected to go into effect by April, women in California will be able to stop by their neighborhood pharmacy and buy birth control pills without a prescription,” the Los Angeles Times reported. “Proponents argue that easing women’s access to birth control will reduce unintended pregnancies, which make up as many as half of all pregnancies nationwide.”

Not everyone cheered the result. “Critics have argued that not requiring a doctors visit to get birth control could reduce the number of women who get tested for STDs and breast cancer,” CBS San Francisco noted. Pro-life advocates have also been uneasy, concerned that allies of abortion providers would use readier birth control access to strengthen their legal and political position.

California’s proximity to Latin American areas affected by the Zika virus, however, spurred Pope Francis to put pro-lifers a bit more at ease. In recent remarks, he “suggested women threatened with the Zika virus could use artificial contraception, saying ‘avoiding pregnancy is not an absolute evil’ in light of the global epidemic,” the Associated Press reported. “The pope unequivocally rejected abortion as a response to the crisis in remarks Wednesday as he flew home after a five-day trip to Mexico.”

An accelerating trend

With the regulatory changes, the Golden State has positioned itself close to the forefront of a relatively new approach to clearing the use of birth control. “California will become the third state to permit pharmacist-issued birth control once the law, passed in 2013, gains regulatory approval,” the Times observed. “Similar legislation in Oregon was approved last year and enacted in January. Hawaii lawmakers introduced a similar measure last month, and advocates in New Mexico and Alaska say they want to follow suit.” Washington has permitted pharmacist-dispensed birth control for several decades.

The bill behind the law, SB493, was introduced last year by state Sen. Ed Hernandez, D-West Covina. The state pharmacy board had anticipated the law working its way through the Sacramento bureaucracy in time to take effect “as early as Oct. 1,” the Orange County Register reported last June. “The board recently finalized the protocols but they still have to be reviewed by multiple state agencies for legal and budgetary approval.”

Clearing SB493 was not as simple as waving along birth control. The law “also allows pharmacists to prescribe prescription-strength inhalers, gums and lozenges for nicotine addiction, as well as medication for travel abroad, including vaccinations and antibiotics. Along with hormonal contraceptives, these three categories of drugs are considered preventive services for major public health issues,” the Register noted.

Red tape and startups

But a technicality specific to pharmacists’ requirements took an additional toll on getting birth control onto shelves. The approval process “ground to a halt when several doctors and the American Congress of Obstetricians and Gynecologists questioned whether pharmacists should have to check a woman’s blood pressure, saying the test would be an unnecessary barrier for women,” the Register reported separately last month. “The Obstetricians and Gynecologists group argued that blood pressure can be adequately obtained through self-reporting and that self-reporting would increase access to contraception.”

Meanwhile, Silicon Valley has moved on birth control at a characteristically speedy pace. “At a time when users can summon a meal, a massage or marijuana through a smartphone app, Nurx and fellow San Francisco startup Lemonaid Health, as well as a few other companies, are working to make getting hormonal birth control as easy as requesting an Uber ride,” the San Francisco Chronicle noted. “It’s an evolution of telemedicine to simplify access to some standard prescription drugs, a system designed to appeal to younger people already accustomed to on-demand gratification.”

“AB339 is designed to ensure consumer access to vital medications,” said the bill’s author, Assemblyman Rich Gordon, D-Menlo Park, on the Assembly floor June 3. “Californians with cancer, HIV/AIDS, hepatitis, multiple sclerosis, epilepsy, lupus and other serious and chronic conditions, need high-cost, specialty drugs. Today, consumers with these serious health conditions can be asked to pay as much as $6,600 for a month’s prescription for a single drug. AB339 limits what a consumer pays to $275 per 30-day prescription.”

The updated version of the bill reduces that to a $250 copay limit for a 30-day supply, with the exception of those with bronze insurance plans who would be liable to pay up to $500 for a 30-day drug supply.

“The California Health Benefits Review Program, which analyzed AB339, found that there’s a preponderance of evidence from studies that persons who face higher cost sharing for prescription drugs are less likely to maintain meaningful levels of adherence than persons who face lower cost sharing,” said Gordon. “And poor adherence to prescription drug therapy for chronic conditions is associated with higher rates of hospitalization and emergency department visits.”

Actual Effect of Cost Sharing

The actual effect of cost sharing may be more nuanced, according to the legislative analysis prepared for the Senate Health Committee’s July 15 hearing: “[T]here is some evidence that the effect of cost sharing may differ depending on the specific disease and specific specialty drug. There is a preponderance of evidence that cost sharing has stronger effects on use of health care services by low-income persons compared to high-income persons. However, this was not observed in a recent well-done observational study from Massachusetts.”

Gordon responded to the concern that his bill would increase insurance premiums by pointing out that CHBRP “found that premium increases are estimated to be only 0.3 percent for enrollees with group insurance and 0.7 percent for enrollees with individual market policies. As demonstrated by this data, the benefits of this bill increasing medication adherence far outweigh any negatives. Join me in supporting these important consumer protections, which ensure that Californians are better able to afford their prescription drugs and that drug benefit designs are not discriminatory.”

He was in fact joined by most of the Democrats in the Assembly where the bill passed, 48-30, with no other discussion. It also passed along party lines in the Senate Health Committee, 7-2, after witnesses testified to its pros and cons.

Advocacy Organizations Tout Effectiveness of Medicinal Improvements

“This is a bill about basic consumer protections,” said Sawait Seyoum, representing the advocacy organization Health Access California. “A recent study found that the average consumer has about $2,300 in liquid assets in their checking or savings account. Today we expect the average constituent to pay over half of what they have in their account for a single prescription in the first month.

Touting the effectiveness of medicinal improvements was Anne Donnelly, representing Project Inform, which advocates for those with HIV and hepatitis C.

“Over the years since we started working on HIV, people with HIV have started moving from a life expectancy of about 43 days to a normal life span, and we have ended the transmission of HIV from HIV-infected moms to their babies,” she said. “And that’s in large part due to the effectiveness of HIV drugs. Now we have an HIV drug that when used appropriately can stop new infections.

“So the hope of ending this epidemic really depends in large part on these drugs being accessible and affordable to Californians living with and at risk for HIV. We need AB339 to ensure that everybody with a serious health condition or at risk for one, not just people living with HIV but including people living with HIV, have access to the drugs they need at a price they can afford.”

Opposition to Bill Focused on Increased Premiums

But the bill might actually have the opposite effect, according to Nick Louizos, representing the California Association of Health Plans.

“Our opposition to this bill is fairly simple,” he said. “Legislatively designing health benefits increases premiums. We can legislatively create the best benefit packages in the world, but if no one can afford them, that’s pretty useless from our perspective. This has been demonstrated time and time again. The independent analysis of the introduced version of this bill does show premium increases of close to $400 million on individuals and employers.”

That analysis, which was done before the bill’s scope was reduced to include only prescription drugs providing essential health benefits, estimated it would result in a $162 million increase in employer-funded premiums in the private insurance market and a $216 million premium increase by individual purchasers.

But there may be big costs associated with the current version of the bill. The analysis states that it may include “unknown, potentially significant fiscal impact on the private health insurance market. By requiring coverage of single-tablet regimens and extended release prescription drugs, carriers lose negotiating power, leading to unknown higher drug costs.”

Louizos said that the state health benefit exchange, Covered California, has estimated “that over a three-year period, prices could increase by 3 percent. And that’s a pretty significant percentage from our perspective, considering all the cost drivers in the health care system.”

John Caldwell, representing Pharmaceutical Care Management Association, is also opposed:

“[It} appears to require the brand pharmaceuticals that have been on the market the longest, and thus most often prescribed, would get favored status,” he said. “In some cases this would be the most expensive, in some cases it may not be. So we don’t see the reasoning behind that. We think it’s just going to require redoing the [cost] tiers on an annual basis based on what is the most popular drug.

 

“Another issue: AB339 essentially forces coverage of more expensive brand HIV pharmaceuticals that are in single-tablet form when less expensive brands or generics in multi-tablet form are available. As the Assembly Appropriations Committee analysis noted, the burden of proof to refuse coverage of these drugs, according to the bill’s provisions, appears very high, essentially meaning they would have to be covered. This provision would completely eliminate any incentive for the manufacturers to negotiate on plan formularies.”

Further Discussion Encouraged

The only committee comment came from the chairman, Sen. Ed Hernandez, D-West Covina:

“I agree that there are conditions that need to be dealt with, especially very expensive ones. I believe that we need to make sure that the consumer doesn’t have to go bankrupt.

 

“But there’s something that I think we really need to really have a discussion. There’s an underlying problem, and it still deals with overall controlling costs to the health care system – and that’s the increasing cost of prescription medications. At the end of the day what’s going to happen is that you’re going to have lower payments to the consumer, but yet if you have escalating drug costs, guess what, all of those costs are going to be passed onto the consumer in the form of premium increases throughout the entire system.”

AB339 will next be considered by the Senate Appropriations Committee.

TBEC Review / flickr

A surprise switch to a bill that would tightly regulate vaping has caused its sponsor to repudiate the legislation.

State Sen. Mark Leno, D-San Francisco, had advanced SB140 confidently, riding a wave of anti-smoking activism that sought to treat vapes, or e-cigs, the same way as traditional tobacco cigarettes in the eyes of the law. But Leno had to renounce his own bill after it transformed in committee. As the Los Angeles Times reported, the Assembly Governmental Organization Committee ensured its language “no longer treated the vapor devices as tobacco products that would face the same restrictions.”

“The proposal would have banned electronic cigarettes in workplaces, restaurants and other public places where smoking is prohibited. It would also have allowed sting operations against businesses that sell the vaping devices to minors. Leno said removing the designation of e-cigarettes as tobacco products allows manufacturers of vaping devices to continue marketing their products to minors.”

Tempers flare

It was a shocking defeat for anti-smoking advocates, who had not anticipated that the vape industry would be able to secure the amended language it sought. “No committee member moved to take up the modified bill, which was then held in the committee,” the Associated Press reported.

Leno’s public remarks reflected his frustration. “We all walk away. It is no longer our bill,” AP quoted him as saying.

“Leno angrily told the committee that he and the bill’s co-sponsors, which include the American Cancer Society, American Lung Association and American Heart Association, would not take part in advancing the diluted bill.”

“I no longer believe in it. I disassociate myself from it. It’s a very dangerous bill now,” said Leno, according to Business Insider. According to Leno, because nicotine comes from tobacco, and e-cigs utilize a liquid that contains nicotine, they ought to be classified as tobacco products. “It’s no small difference of opinion whether these are tobacco products or not,” he argued, according to the Sacramento Bee, “because if they’re not tobacco products, Big Tobacco can continue to market their ‘non-tobacco product’ to our children.” Although nicotine is traditionally taken from the tobacco plant, it is also naturally found in trace amounts within the tomato, potato and eggplant.

Cascade effect

The about-face on SB140 appeared to augur a broader defeat for the anti-smoking lobby, which had helped build momentum for another sweeping and high-profile piece of legislation. SB151, introduced by state Sen. Ed Hernandez, D-Azusa, was also pulled by its own sponsor.

That bill, which would raise the statewide legal age for purchasing tobacco products to 21, was shelved by Hernandez before a planned hearing, as the Bee reported. “Big Tobacco is following their usual playbook and trying to kill this bill quietly in a committee,” he said, according to the Bee, “though his office said he planned to continue pursuing the measure.”

Federal hurdles

Although the tobacco industry has favored federal over state-by-state rules on the availability of their products, the vape industry has had bigger concerns than the state of play in Sacramento. As the Wall Street Journal reported, the federal Food and Drug Administration has been expected this summer “to complete rules that would require federal approval for nearly all flavored liquid nicotine juices and e-cig devices sold in vape shops,” imposing potentially prohibitive costs on nervous businesses.

“The approval process could cost anywhere from $2 million to $10 million to collect data and put forward an application for each item, according to the regulatory consulting company SciLucent LLC.”

That alone could put a substantial dent in the Golden State’s smaller vape companies — with the much larger tobacco companies moving in instead. Rodney Jerabek, CEO of the California-based liquid nicotine business Five Pawns, told the Journal the expenses were daunting. “This could mean the end for a lot of small companies,” he said.

By the numbers

According to the bill’s supporters, the ban would be instrumental in dramatically reducing not only teen smoking but smoking in general. “Sen. Ed Hernandez, D-West Covina, said he introduced the bill, SB151, out of concern that an estimated 90 percent of tobacco users start before age 21,” the Los Angeles Times reported.

That statistic emerged from a recent Institute of Medicine study making the rounds in policy circles. Researchers suggested that “teen smoking could be curbed by 12 percent if the age limit was raised to 21,” as LAist noted, “making it harder for minors to find somebody to buy cigarettes for them.” In real numbers, the study concluded, the age-21 limit would ensure “more than 200,000 fewer premature deaths nationally for those born between 2000 and 2019.”

Although critics have pointed out that people older than 18 are adults eligible to be drafted and bound to signed contracts, the Times observed, momentum has gathered to raise the legal smoking age for reasons unrelated to consistency in the treatment of individual rights and responsibilities.

Tobacco-related illness has long represented a significant chunk of aggregate health care costs. For policymakers, that problem grows more serious the more those costs are shifted onto government and taxpayers. “Tobacco-related disease killed 34,000 Californians in 2009 and cost the state $18.1 billion in medical expenses, according to studies by UC San Francisco,” according to the Times.

A developing trend

Some evidence of the policy’s likely impact has accumulated in states where the smoking age was previously hiked. “Although most states set the minimum age at 18, Alabama, Alaska, New Jersey and Utah set it at 19, and some localities have set it at 21,” according to The Washington Post. “Higher age limits seem to correspond with lower smoke rates in these states; Utah and New Jersey also have among the lowest smoking rates in the country, No. 1 and No. 5, per Gallup, while Alaska has the most improved, and Alabama is somewhat of an outlier in the South, as it’s not among the states with the highest smoking rates, like its neighbors Mississippi and Louisiana.”

California could be the first state to deny tobacco to under-21s. But other western states could swiftly follow suit. According to KPPC, “Legislatures in Oregon and Washington are considering similar bills and lawmakers in Hawaii have passed a bill and sent it to the governor.” Among the localities setting the legal age at 21, Hawaii County has been joined by New York City.

Next, vaping

Traditional tobacco products were not the only ones on the state Senate’s chopping block. SB140, introduced by state Sen. Mark Leno, D-San Francisco, also passed handily, on a 24-12 vote.

As the San Francisco Chronicle reported, that bill “would include e-cigarettes in the definition of tobacco products in order to prohibit the devices from being used at workplaces, schools and public places, just as tobacco products are under the state’s Smoke Free Act. SB140 would also make it a misdemeanor to provide e-cigarettes to minors.”

The tandem advance of the state Senate’s anti-smoking and anti-vaping bills raised the prospect that the two approaches would converge in the near future, raising the vaping age to 21. “California bans the sale of e-cigarettes to anyone under 18,” the Chronicle observed, “but Leno said young teens still have access to them and they are becoming increasingly popular among middle and high school students.” If Hernandez’s bill were to pass before Leno’s, vaping would automatically be restricted in the same manner as traditional cigarette smoking.

State Senator Ed Hernandez, D-West Covina, has reintroduced legislation that would allow nurse practitioners to treat patients and obtain diagnostic tests without the sign-off from a physician. He serves as chair of the Senate Health Committee.

“This is not a new fight here in California, but with 2.5 million previously uninsured Californians receiving health coverage under the Affordable Care Act, we need to pass this law to ensure that more trained health care professionals are available,” said Hernandez, according to the Sacramento Business Journal.

He added, “It is well documented that California is facing a shortage of primary care physicians and giving trained nurse practitioners full practice authority would go a long way to help remedy this situation.”

2013: Revival of SB493

Last legislative session, Hernandez authored Senate Bill 493, which passed the Senate on a 22-12 vote. Among the expanded responsibilities included in that earlier bill were “ordering durable medical equipment, prescribing drugs, establishing diagnoses, referring patients, performing procedures that are consistent with their training, and delegating tasks to medical assistants, among others.”

The 2013 measure eventually stalled in the State Assembly, due in large part to the concerns from the California Medical Association. The CMA, which represents 40,000 members of the state’s medical community, argued Hernandez’s proposal would compromise patient safety.

“Nurse practitioners are an important part of the health care team and, when practicing under physician supervision, can significantly increase access to quality medical care in a community,” the CMA wrote in opposition to SB493, according to a legislative analysis. “Allowing nurse practitioner practice without standardized protocols and physician supervision reduces patient safety and quality of care.”

Hernandez has yet to offer specific language for this session’s bill, Senate Bill 323. In order to meet the February 27 bill introduction deadline, he introduced placeholder language, also known as a “spot” bill.

Health care system stressed by Affordable Care Act

Fewer than 5 percent of the state’s 408,413 nurses have the advanced training and years of experience to be designated a nurse practitioner. As of Sept. 2013, 18,541 active nurse practitioners were registered and licensed by the Board of Registered Nursing.

Hernandez contends these nurse practitioners can help address the increased demands on the country’s health care system, which is under stress from the wave of new patients that signed up for insurance rather than pay a fine under the Affordable Care Act, also called Obamacare. In 2014, 6.7 million people obtained private health insurance, according to the Associated Press, “flooding a primary care system that is struggling to keep up with demand.”

Here in California, an estimated 1.2 million people have enrolled in new private health plans since the launch of the ACA, according to the San Jose Mercury News. That doesn’t include another 2.7 million new enrollees in Medi-Cal, the state’s taxpayer-funded health program. More than 12 million people, roughly a third of the state’s population, are enrolled in Medi-Cal.

Millions of new patients, without a corresponding increase in medical care providers, have led to longer wait times and people complaining of difficulty finding doctors accepting new patients — a problem that, Hernandez says, can be addressed through expanded scope-of-practice.

“If we truly want to increase access to quality care, especially in areas of our state where the provider shortage is at its worst, then we must allow trained medical professionals like Nurse Practitioners the ability to practice to the full extent of their training,” Hernandez said in a statement last year. “It’s unacceptable to mandate people purchase health coverage without taking steps to ensure those same people are able to use their coverage to see a qualified health care provider.”

A 2014 report by the Bay Area Council Economic Institute argued that expanding the scope-of-practice for nurse practitioners is “one of the most effective steps that states can take to increase the supply of primary care providers while maintaining high quality and driving down costs.”

In its placeholder language, SB323 promises it “will assist in addressing the primary care provider shortage by removing delays in the provision of care that are created when dated regulations require a physician’s signature or protocol before a patient can initiate treatment or obtain diagnostic tests that are ordered by a nurse practitioner.”

Shorter wait times with lower professional standards

It’s not yet clear how many nurse practitioners would be covered by Hernandez’s proposal. In 2013, Hernandez began with a requirement that nurse practitioners receive 6,240 hours under the supervision of a physician. The bill was later amended to reduce the time by a third to just 4,160 hours.

That change reflects the trade-off for proponents of scope-of-practice expansion: in order to add a meaningful number of new health care providers, the change requires a reduction in professional standards. Two-thirds of the state’s nurse practitioners already “have furnishing numbers … which allows them to order or furnish drugs and devices to patients using approved standardized procedures,” according to the legislative analysis for Hernandez’s 2013 bill. In other words, the majority of nurse practitioners already have one of the expanded powers sought with the proposal.

As CalWatchdog.com has reported, Hernandez unsuccessfully introduced a trio of scope-of-practice bills during the 2013-14 legislative session. The most controversial of the three measures, Senate Bill 492, would have expanded the scope-of-practice for optometrists.

Hernandez and his wife, Diane, operate an optometry practice in La Puente. As of June 2013, Hernandez had accepted more than $140,000 in campaign contributions from optometrists.

Each session brings a biennial reshuffling of committee assignments. But some lawmakers aren’t waiting to get acquainted with their new perches.

New committee chairs have already introduced legislative proposals to increase privacy rights, change the way transportation projects are funded and dramatically alter the state’s tax structure.

Gatto tapped for new privacy committee

In December, Assembly Speaker Toni Atkins, D-San Diego, announced the 2015-16 committee assignments and, in the process, rolled out a new committee, the Assembly Committee on Privacy and Consumer Protection. To lead the new committee, Atkins tapped former Appropriations Committee Chairman Mike Gatto, D-Los Angeles.

“I created the committee because California consumers need a strong driving force to help ensure our privacy remains a right and not a luxury,” the speaker said at a January press conference.

The committee is expected to be one of the most closely watched of the legislative session. Steven Greenhut, the U-T San Diego’s California columnist, described it as “one of the most significant committees in the Assembly given myriad and growing threats to our privacy and civil liberties.”

Gatto has already seized on his new role by introducing legislation to enhance privacy protections for blood donors. Assembly Bill 170 would strengthen notification requirements and allow patients to destroy blood samples. Gatto says many parents aren’t aware that screening samples from newborns are often stored by large biobanks, which allow outside researchers to conduct tests on those donated samples.

“Whenever data is stored, data can fall into the wrong hands,” explained Gatto, a Loyola Law School graduate. “Parents should have the right to protect their children and people should have the right to control how their personal medical records are used once they reach adulthood.”

Hernandez’s monopoly on health legislation

State senators benefit from longer terms, generally have more legislative experience and retain top staff members. Consequently, they have found it easier to advance their new committees.

Senate President Pro Tem Kevin de Leon, D-Los Angeles, announced committee chairmanships in December. By the time the full roster of committee members was released on Jan. 7, state Sen. Ed Hernandez, the new chair of the Senate Health Committee, had four health-related bills in print.

To date, the West Covina Democrat has introduced a total of eight bills, all related to public health issues. The most high-profile, Senate Bill 151, would raise the smoking age in California from 18 to 21 years old.

“Tobacco companies know that people are more likely to become addicted to smoking if they start at a young age,” said Hernandez, who also works as an optometrist. “We can no longer afford to sit on the sidelines while big tobacco markets to our kids and gets another generation of young people hooked on a product that will ultimately kill them. That is why I believe we need legislation like SB151.”

Beall tackles transportation projects, greenhouse gas reduction

In his 2015 Inaugural Address, Gov. Jerry Brown called for the state to reduce petroleum use in cars and trucks by 50 percent. If he’s to achieve that goal, he’ll need the help of state Sen. Jim Beall, D-San Jose, the new chair of the Senate Transportation Committee.

“It’s an honor to be assigned to oversee the Senate Transportation and Housing Committee,” Beall said in December when committee assignments were announced. “California faces many challenges in improving highway maintenance and removing litter and graffiti from our roads. Equally important is linking mass transit with affordable housing to reduce urban sprawl, traffic congestion and greenhouse gas emissions.”

Beall’s first bill of the new term, Senate Bill 9, would make changes to how large mass transit projects in the Transit and Intercity Rail Capital Program are funded. Under existing law, 10 percent of the annual proceeds of the Greenhouse Gas Reduction Fund goes towards capital and operating expenditures for intercity, commuter and urban rail services. Beall says he intends the bill to secure “funding certainty for projects, such as the BART extension to San Jose.”

The San Jose lawmaker has also introduced a spot bill that would affect the administration of the Department of Transportation. Spot bills act as a placeholder for language to be added at a later date.

Hertzberg focuses on tax reform

State Sen. Bob Herzberg, D-Van Nuys, is expected to turn his chairmanship of the Committee on Governance and Finance into a substantive conversation about tax reform. He proposed a $10 billion sales tax on services that would include everything from accounting to yoga classes.

“I am honored Senate Pro Tem Kevin de León appointed me to chair the Committee on Governance and Finance during this crucial time in our state’s financial history,” Hertzberg said. “California has many challenges, not the least of which is how government is financed and operates. I look forward to working with the Pro Tem and Gov. Brown to find ways to improve financing for higher education and K-12 education and to help local government with the goal of ensuring upward mobility for all Californians.”

The former Speaker of the Assembly says his Senate Bill 8, which among other things would impose a new sales tax on services, would level out “the state’s boom-and-bust tax structure.”

Surveys and anecdotal evidence show that Asian-Americans are generally more entrepreneurial and more suspicious of government, which should incline them to the GOP. But it hasn’t worked out that way.

Now, however, we’re seeing just the sort of fracture we would expect if Asian-Americans acted in the traditional, what’s-in-it-for-me? way of interest groups. They’ve figured out that affirmative action in college admissions punishes Asians in the name of atoning for the history of white racism. Check out the lead paragraph of this Pasadena Star-News story — the Vietnamese-American reporter isn’t buying the “racial justice” sales pitch at all:

“SAN GABRIEL — Asians in the San Gabriel Valley and beyond joined forces Friday to rally against a proposed Senate constitutional amendment that they said would punish their children for working hard to achieve the American Dream.

“Olivia Liao, president of the Joint Chinese University Alumni Association, said Senate Constitutional Amendment No. 5 is racist because it allows public education institutions to give preferential treatment on the basis of race, sex, color, ethnicity or national origin.

“'(Legislators) feel like the Chinese-American community isn’t paying attention to politics,’ Liao said. ‘We are concerned citizens. We need to stand up when things are not right; we need to be heard. We shouldn’t have any (exceptions) related to race. After all, America is a free country.’

 “State Sen. Ed Hernandez, D-West Covina, is sponsoring SCA 5, an amendment that would repeal portions of Proposition 209, which prohibited discrimination against people based on their unchangeable identities. If passed, the amendment would allow public education institutions to give preferential treatment on the basis of race, sex, color, ethnicity or national origin.”

Affirmative action = racial preferences

Wow. That’s as free of lefty spin as any news account I have ever seen of how California’s college admissions practices worked before Prop 209’s passage in 1996.

To paraphrase and condense what I wrote back in 2012, what the media almost never point out is that the UC admissions status quo before 1996 indisputably punished a minority. This is from the March 31, 1996, N.Y. Times story about UC’s adoption of a plan that even before Prop. 209 was passed would have phased out the use of race as a factor in deciding college admissions by spring 1998:

“An internal [UC} report in May 1995, based on a computer simulation, predicted that such a change would result in a 15 to 25 percent overall rise of Asian-Americans at the University of California, and as much as 25 to 35 percent increase at Berkeley and U.C.L.A., where 75 percent of students would be admitted on merit. The number of whites would remain about the same, but Hispanic students would dip 5 to 15 percent and African-Americans would drop somewhere between 40 and 50 percent.”

So without affirmative action, white student numbers would have been unchanged, but Asian-American student enrollment would have exploded. For some reason, in 1996, this didn’t resonate with California’s Asian population. Now it seems to be.

Good. As John Roberts said, “The way to stop discrimination on the basis of race is to stop discriminating on the basis of race.”