BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Deborah V. Ortiz, Chair
BILL NO: AB 774
A
AUTHOR: Chan
B
AMENDED: June 22, 2005
HEARING DATE: June 28, 2006
7
FISCAL: Appropriations
7
4
CONSULTANT:
Hansel / ag
SUBJECT
Hospital charity care and discount payment policies
SUMMARY
This bill requires hospitals to develop policies regarding
discount payments and charity care for financially
qualified patients, as defined. Requires hospitals to
limit expected payment for services provided to patients
with family incomes below 350 percent of the federal
poverty level who are eligible for discount payments.
Requires hospitals to post notices of and to provide
patients with a written summary of their policies for
financially qualified patients at the time of discharge or
when the service is provided. Requires hospitals to notify
patients at the time of billing of their potential
eligibility for government programs and for the hospital's
charity care and discount payment programs. Prohibits
hospitals from reporting adverse information to a credit
agency or commence civil action against a patient for
nonpayment prior to 150 days after initial billing for
patients who are uninsured or underinsured. Prohibits
hospitals from using wage garnishments or liens on primary
residences as a means of collecting unpaid bills for
patients who are eligible for the hospital's charity care
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of discount payment policies. Authorizes the Director of
the Department of Health Services (DHS) to levy
administrative penalties for violations of the of the
bill's provisions. Provides that compliance with the
bill's provisions constitute a condition of hospital
licensure.
ABSTRACT
Existing law:
1.Establishes the Office of Statewide Health Planning and
Development (OSHPD), which is charged with enforcement of
various provisions of law relating to health facilities,
including hospitals.
2.Requires hospitals to report financial and utilization
data to OSHPD in accordance with procedures and forms
established by OSHPD.
3.Requires every private, non-profit hospital to submit
annually to OSHPD a community benefits plan that details
how the hospital identifies and addresses community needs
within the hospital's service area.
4.Provides that a community benefits plan may include:
a. a description of the health care services rendered
to uninsured, underinsured and individuals eligible
for public programs;
b. a description of other services rendered to the
community, such as health promotion, medical research
and medical education; and,
c. an accounting of the cost of providing these
services.
This bill:
1.Establishes requirements for general acute care,
psychiatric and special hospitals pertaining to the
development and implementation of charity care and
discount payment policies, as well as hospital billing
and collection practices for financially qualified
patients, as defined; requires general acute care
hospitals to comply with the requirements as a condition
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of licensure.
2.Requires general acute care, psychiatric and special
hospitals to maintain understandable, written policies
regarding charity care and discount payments for
financially qualified patients.
3.Defines "financially qualified patient" as a patient who
is a self-pay patient, as defined, or a patient with
inadequate insurance, as defined, and who has a family
income that does not exceed 350 percent of the federal
poverty level (FPL).
4.Defines a "patient with inadequate insurance" as a person
whose family income does not exceed 350 percent of the
federal poverty level and whose annual deductibles exceed
five percent of the patient's annual income or a lower
level, if applicable under the hospital's charity care
policy.
5.Provides that uninsured or patients with inadequate
insurance who are at or below 350 percent of the federal
poverty level, or a higher level at the discretion of the
hospital, shall be eligible to apply for a hospital's
charity care or discount payment policy
6.Allows hospitals, in determining eligibility for charity
care, to consider income and monetary assets of the
patient. Provides that monetary assets shall not include
retirement and deferred compensation plans, the first
$10,000 of monetary assets, and 50 percent of assets over
the first $10,000 from the consideration of eligibility.
7.Requires hospitals to limit expected payment for services
to patients at or below 350 percent of the federal
poverty level who are eligible for discount payments to
the greater of the amount of payment the hospital would
receive from Medicare, Medi-Cal, Healthy Families or any
other government-sponsored health program in which the
hospital participates.
8.Requires patients, or their legal representatives, who
request discount payments or charity care to provide the
hospital with documentation of income.
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9.Requires hospitals to provide patients with a written
summary of the hospital's policy for financially
qualified and self-pay patients at the time of admission
or provision of service, as specified, and to post notice
of their policies in visible locations including, but not
limited to, the emergency department, billing office,
admissions office and other outpatient settings.
10. Requires hospitals to make reasonable efforts to
obtain from the patient, or their representative,
information about whether private or public health
insurance may fully or partially cover the charges for
care provided, as specified.
11. Requires a hospital that bills a patient who did not
provide proof of third party coverage at the time care
was provided or upon discharge, to provide the patient
with a clear and conspicuous notice that includes
specified information, including a statement that if the
consumer does not have health insurance coverage he or
she may be eligible for Medicare, Medi-Cal, the Healthy
Families program, the California Children's Services
program or charity care and how the patient can obtain
applications for these programs. Requires hospitals to
include similar information in bills that it sends to
patients.
12. Requires hospitals to provide the applications for
Medi-Cal and the Healthy Families program in the billing
for any patient who does not show proof of coverage by a
third party at the time care is provided.
13. Prohibits a hospital or any assignee of the hospital
from reporting adverse information to a credit agency or
commencing civil action against a patient for nonpayment
prior to 150 days after initial billing if the patient
lacks coverage or provides information that he or she may
be underinsured, as defined. Provides that the time
period shall be extended if the patient has a pending
appeal for coverage of services, as specified.
14. Prohibits hospitals from sending any unpaid bill to a
collection agency if doing so may negatively impact a
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patient's credit, if the patient qualifies for
eligibility under the hospital's charity care or discount
payment policy and is attempting in good faith to settle
an outstanding bill.
15. Prohibits hospitals or collection agencies operating
on their behalf from using wage garnishments or liens on
primary residences as a means of collecting unpaid
hospital bills for patients eligible under the hospital's
charity care or discounted payment policies.
16. Requires any extended payment plans offered by
hospitals to patients eligible under the hospital's
charity care or discount payment policy, or any other
policy for assisting low-income patients in settling past
due bills, to be interest free.
17. Provides that the provisions of the bill do not
diminish any protections consumers have under existing
federal or state debt collection or consumer protection
laws, as specified.
18. Requires hospitals and their assignees, prior to
commencing collection activities against patients, to
provide a clear and conspicuous written notice containing
information about the patient's rights pursuant to state
and federal debt collections statutes, as specified.
19. Requires hospitals to provide the OSHPD with a copy of
their charity care and discount payment policies,
including eligibility procedures, review process and the
applications.
20. Allows the Director of DHS (Director), after notice
and opportunity for hearing, to levy administrative
penalties against hospitals for violations of the bill's
provisions. Requires the Director, in determining the
amount of the penalty to consider the nature, scope and
gravity of the violation; the facility's history of
violations; the demonstrated willfulness of the
violation; and the behavior of the facility with respect
to violations, including whether the facility mitigated
any damage or injury resulting from the violation.
21. In lieu of an administrative penalty, provides that
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the Director may require the hospital to provide care at
no cost to financially qualified persons in an amount
comparable to three times the amount billed in excess of
the limits allowed by the bill for patients eligible for
charity care or discount payments.
22. Requires the Director to order the hospital to
reimburse patients who were overcharged, as specified;
provides that the hospital must use an equivalent amount
of funds to provide charity care to financially qualified
patients if the hospital is unable to locate any such
patients.
23. Allows a facility to appeal an administrative penalty,
as specified, including through adjudication of the
violation.
24. Provides that amounts paid for services by patients
who qualify for the hospital's policy do not constitute
the hospital's uniform, published, prevailing, or
customary charges or preclude recognition of the
hospital's established charge schedule for purposes of
payment limits under Medi-Cal, Medicare, worker's
compensation, or other public programs.
25. Contains a severability clause in the event that a
hospital's limits on expected payments established by the
bill result in a federal determination that the
hospital's established charge schedule does not reflect
the hospital's customary or prevailing charges.
FISCAL IMPACT
Unknown costs (special fund) for OSHPD and DHS related to
administrative and enforcement provisions of the bill.
Unknown costs to University of California hospitals and
state-funded health care programs related to the
restrictions on hospital billing and collections
established by the bill.
BACKGROUND AND DISCUSSION
According to the author, AB 774 creates consumer and
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financial protections so that uninsured and underinsured
families can get the hospital care they need without facing
financial ruin. The author points out that there is no
current law regarding the prices that uninsured and
underinsured consumers pay for health care or regarding
collection practices for health care debt. The author
points to a February 2005 study published in the journal
Health Affairs which surveyed 1,771 personal bankruptcy
filers and which found that about half cited medical causes
for their bankruptcy. The study found that among those
whose illnesses led to bankruptcy, out-of-pocket costs
averaged $11,854 since the start of illness, and that
medical debtors were 42 percent more likely than other
debtors to experience lapses in health insurance coverage.
The author asserts that requiring hospitals to develop and
disseminate policies on payment allowances and to provide
payment allowances are modest steps to protect low-income
uninsured and underinsured patients when they experience a
need for hospital services.
The author intends for the provisions of AB 774 to
supercede similar provisions contained in the pending
tobacco tax initiative (Tobacco Tax Act of 2006) related to
hospital charity care and billing practices, which are
summarized below.
Previous legislative efforts related to hospital billing
and collections practices
The issue of hospital's billing and collections practices
has received considerable attention since 2002, resulting
in numerous articles and several bills calling attention to
what were being perceived to be overly aggressive billing
and collections practices of hospitals vis-?-vis uninsured
and low-income patients.
The author introduced similar legislation in the 2003 - 04
session (AB 232), which died on the Senate floor. The same
session the Legislature passed SB 379 (Ortiz), which would
have required hospitals to develop, post and disseminate
charity care and reduced payment policies, and would have
limited allowable charges for patients with incomes below
400 percent of the federal poverty to the greater of
Medicare, Medicaid, or workers compensation payment
amounts. The bill was vetoed by the Governor
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In response to press attention and pending legislation, in
February 2004, several hospital organizations, including
the California Healthcare Association (CHA), issued
voluntary guidelines to protect consumers from hospital
overcharging. CHA's guidelines state that regulatory
reform is needed to enable hospitals to effectively respond
to the individual needs of low-income uninsured patients
and that CHA anticipates that the United States Department
of Health and Human Services (HHS) will provide guidance on
how hospitals can appropriately bill the uninsured. In the
meantime, CHA urged its member hospitals to adopt the
voluntary principles and guidelines to better meet the
needs of patients who cannot afford the health care
services they receive.
The guidelines encourage hospitals to do a number of things
with regards to low-income, uninsured patients, including:
1.Ensuring that financial assistance policies clearly state
the eligibility criteria (i.e., income, assets) and the
process used to determine whether a patient is eligible
for financial assistance.
2.Limiting expected payments from patients eligible for
financial assistance to amounts that do not exceed the
payment the hospital would receive from Medicare, other
government sponsored health programs, or as otherwise
deemed appropriate by the hospital.
3.Having written policies about when and under whose
authority patient debt is advanced for collection, and
using the hospital's best efforts to ensure that patient
accounts are processed fairly and consistently.
4.Posting notices regarding the availability of financial
assistance to low-income uninsured patients in visible
locations throughout the hospital, such as
admitting/registration, billing office, emergency
department, and other outpatient settings.
5.Sharing financial assistance policies with appropriate
community health and health services agencies and other
organizations that assist such patients.
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6.Attempting to communicate with patients in their primary
language when discussing the hospitals financial
assistance policies; and ensure that staff are
knowledgeable about the existence of the hospital's
financial assistance policies.
In vetoing SB 379, the Governor stated:
"Recently, the hospital community voluntarily adopted
guidelines to
assist low-income uninsured Californians who receive
services at a
hospital but cannot afford to pay the bill in full.
At a minimum,
these guidelines allow patients who are at or below
300 percent of the
federal poverty level to apply to the hospital for
financial
assistance. Additionally, the guidelines limit the
costs of
procedures to reflect the prices paid by government
payers, require
hospitals to post their financial assistance policies
and their
eligibility criteria and encourage hospitals to help
eligible
patients apply for public health programs. By choice,
many hospital
systems have adopted guidelines that exceed the
aforementioned
minimum standards adopted by the hospital community,
further
protecting patients at risk of financial harm.
I recognize the proponents desire to assist self-pay
patients with
large hospital bills by requiring price discounts but
I also
recognize that the hospital community took a
significant step in
adopting these guidelines, especially those hospitals
that are
struggling financially themselves. Ultimately, I
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decided that the
voluntary guidelines must be given time to be
implemented and
reviewed."
In light of continued pressures from the Legislature and
consumer advocates, the pending tobacco tax initiative
contains provisions dealing with charity care and billing
and collections that would apply to hospitals that receive
allocations of tobacco tax revenues under the initiative.
Under the proposed initiative each hospital receiving an
allocation of funds would be required to:
Maintain an understandable, written charity care and
discount payment policy.
Provide that patients whose income is at or below 350
percent of the federal poverty level are eligible to
apply for hospital's charity care and discount payment
policy, except for rural hospitals, which may establish
lower levels of eligibility.
Limit expected payment for services to the greater of the
amount the hospital would receive from Medicare or any
other government-sponsored health program.
Post notices regarding availability of its charity care
and discount payment policy in visible locations
including, but not limited to, admissions, billing
office, emergency department, and other outpatient
settings. Notices must include instructions on how to
apply for the hospital's policy and contact number for
more information.
Establish a written policy defining standards and
practices for the collection of debt.
Include at the time of billing a statement that indicates
that if the patient meets certain low-income
requirements, they may be eligible for a
government-sponsored program or the hospital's policy and
contact information for additional information about the
hospital's policy.
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Not knowingly send that patient's bill to a collection
agency prior to 120 days from the time of initial
billing, and without first having made more than one
attempt to collect the bill, or while the completed
application is being processed by a government agency or
the hospital if the patient has completed an application
for government-sponsored coverage or under the hospital's
charity care or discount payment policy.
Not send the unpaid bill to any collection agency if the
hospital knows that doing so may negatively impact the
patient's credit, if a patient qualifies for the
hospital's policy and is attempting in good faith to
settle an outstanding bill.
Not use wage garnishments or liens on primary residences
as a means of collecting unpaid hospital bills from
patients who are eligible for the hospital's charity care
and discount payment policy.
The initiative provides that it does not limit the ability
of the Legislature to enact charity care or discount
payment policies applicable to all acute hospitals as a
condition of licensure and further allows the Legislature
to amend its provisions to further its purposes with a
statute passed by a 2/3 vote.
Arguments in support
Health Access, the sponsor of AB 774, and other consumer
groups state that hospitals can and do charge patients the
highest sticker price and some are successful in collecting
higher payments from the uninsured than from insured
patients. Health Access states that hospitals publicly
report spending about one percent of revenue on charity
care, but are not required to disclose the circumstances
under which a patient might qualify for such free care.
Proponents point out that hospitals can refer patients,
both insured and uninsured, to collections within weeks
after care is provided and that sending a patient to
collections within 30 to 60 days puts the credit rating of
even insured patients at risk if insurers fail to pay in
that narrow window, and provides little time for uninsured
patients to arrange their finances so that payment can be
made.
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Health Access and consumer groups note that while hospitals
have adopted voluntary guidelines with regard to their
billing and collections practices, "mystery shopping"
studies conducted by Health Access and the California
Health Care Foundation have shown that many self-pay
patients do not get basic information from hospitals about
their consumer rights and financial options, suggesting
that the voluntary guidelines are not being complied with.
Health Access argues that by including provisions in the
pending tobacco tax initiative that are substantially
similar to AB 774, that would apply to hospitals that
receive allocations of funding under the initiative,
hospitals have acknowledged that voluntary guideline are
not sufficient to ensure that hospitals improve their
billing and collections practices.
Finally, Health Access points out that as amended AB 774
reflects several concessions and modifications, including a
reduction in the income level to qualify for charity care
and reduced payments from 400 percent of FPL to 350
percent, making underinsured patients (as opposed to
uninsured) eligible for discounted payments only, reducing
the waiting period before hospitals can commence hard
collections from 180 days to 150 days, eliminating civil
penalties for violations of the bill's provisions, and
allowing hospitals to use an asset test in determining
patients' eligibility for charity care.
Arguments in opposition
The California Hospital Association (CHA) states that AB
774 places the burden of a dysfunctional health care system
on hospitals. Hospitals must provide emergency care to
anyone who needs it but are finding it difficult to keep
their doors open because of the growing number of
uninsured, inadequate reimbursement from Medi-Cal and
Medicare, and a long list of unfunded mandates. CHA and
other hospitals argue that AB 774 imposes rigid and
punitive requirements on hospitals without recognizing any
of the underlying factors that are creating the growing
problem of the uninsured. They also argue that, unlike the
hospitals' voluntary guidelines, AB 774 does not allow
California's hospitals the flexibility to adapt their
policies to variations in the patient populations and
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resources that they face. In addition, opponents argue
that hospitals should not be required to provide charity
care to patients with insurance with high deductibles.
Health plans are increasingly marketing high deductible
products so that employers and enrollees can obtain premium
savings; the changes proposed by AB 774 would exacerbate
that trend and encourage underinsurance as an option for
many persons.
CHA and other hospitals point out that hospitals face
numerous unfunded mandates and that this bill will make it
increasingly difficult to provide care and operate
emergency rooms and trauma centers to serve those who need
help. Finally, opponents argue that the penalties in the
legislation will unnecessarily punish innocent mistakes,
invite litigation over technical discrepancies, and funnel
scarce resources away from providing care.
Writing in reference to the previous version of the bill,
the California Association of Collectors opposes provisions
of the bill that impose a blanket prohibition on the use of
wage garnishments or liens to obtain payment of hospital
bills irrespective of the debtor's ability to pay the debt,
and states that existing requirements governing the use of
wage garnishments and judgment liens provide substantial
consumer protections to debtors.
Previous legislation
SB 24 (Ortiz, 2005) - would have required hospitals to
develop, post and disseminate charity care and reduced
payment policies for hospitals, and limit allowable
charges for patients with incomes below 400 percent of
the federal poverty to the greater of Medicare, Medicaid,
or workers compensation payment amounts, and would have
required non-profit hospitals to provide a minimum
threshold of charity care. Died in the Senate
Appropriations Committee.
SB 379 (Ortiz, 2003) - would have required, effective
June 1, 2005, hospitals to develop, post and disseminate
charity care and reduced payment policies, which include
minimum eligibility requirements of 400 percent of the
federal poverty level, limitations on expected payments
from qualified patients, and limits on billing and
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collection activities. Vetoed by the Governor.
AB 232 (Chan, 2003) - would have required each hospital
to develop a self-pay policy specifying how the hospital
determines prices to be paid by self-pay patients, as
defined, and limits these prices for patients below
specified income levels. Would have established limits
on billing and collection activities of hospitals and
their agents. Died on the Senate floor.
SB 1394 (Ortiz, 2001) - would have required hospitals to
establish and publicize charity care policies and
established a reduced payment schedule for uninsured and
underinsured persons. Would have limited collections and
billing activities of hospitals for 120 days following
discharge. Died on the Senate floor.
COMMENTS AND QUESTIONS
1.Bill amended substantially since it was last heard.
Senate Health Committee heard this bill on June 22, 2005,
where it failed passage and was granted reconsideration.
The bill has been amended substantially since then and
the bill before the committee now reflects the efforts of
the author and sponsor to reach a compromise with the
California Hospital Association and other hospital groups
that would supercede the provisions of the pending
tobacco tax initiative dealing with this issue. Among
the changes from the version previously heard by the
committee, the bill reduces the income threshold for
patients to qualify for charity care or reduced payments
from 400 percent of the FPL to 350 percent of FPL, makes
underinsured patients (as opposed to uninsured) eligible
only for discount payments, allows hospitals to take into
account both income and assets of patients in determining
eligibility for charity care, reduces the time hospitals
must wait before engaging in "hard" collections on unpaid
bills from 180 to 150 days, and reduces the enforcement
provisions to eliminate civil penalties for violations.
Another significant change is that the bill in its
current form would make compliance with the bill's
provisions a condition of licensure for general acute
care hospitals.
2.Similarity to other bills heard by Health Committee. AB
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774 is similar to SB 24 (Ortiz) which was heard by the
Committee on March 30, 2005, and to SB 379 (Ortiz) and AB
232 (Chan), heard by the committee in the 2003-04
session. SB 379 would have required hospitals to develop
and post charity care and reduced payment policies and
placed limits on allowable charges and collection
practices for persons eligible to receive charity care or
payment allowances, similar to this bill; however, the
bill was vetoed by the Governor. SB 24 (Ortiz), as it
was heard by the committee, contained additional
provisions requiring nonprofit hospitals, as a condition
of maintaining their tax exempt status, to demonstrate
compliance with the provisions of the bill dealing with
development and posting of charity care and reduced
payment policies and limits on charges and collection
practices for persons eligible to receive charity care or
payment allowances. The bill also established a minimum
threshold for charity care expenditures for nonprofit
hospitals. The bill died in the Senate Appropriations
Committee.
3.Interaction of bill with proposed tobacco tax initiative.
The proposed Tobacco Tax Act of 2006 provides that its
charity care and discount payment provisions do not limit
the ability of the Legislature to enact charity care or
discount payment policies applicable to all acute care
hospitals as a condition of licensure. By providing that
it's provisions apply to acute care hospitals as a
condition of licensure, the author intends for the
provisions in AB 774 to supercede those in the proposed
initiative, with respect to acute care hospitals. AB 774
also applies to acute psychiatric and special hospitals,
which in some cases, may receive allocations under the
proposed initiative should it be enacted; for those which
do receive allocations, the provisions in the proposed
initiative would presumably take precedence.
4.Suggested technical amendments:
a. On page 3, lines 15 - 21, amend Section 127400 (c)
as follows:
(c) "Financially qualified patient" means a
patient who is both of the following:
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(1) A patient who is a self-pay patient,
as defined in subdivision (f) or an underinsured
patient a patient with inadequate insurance, as
defined in subdivision (g).
(2) A patient who has a family income that
does not exceed 400 350 percent of the federal
poverty level.
b. On page 6, line 31, delete "and self-pay" as
redundant language.
c. On page 6, line 33, replace "written estimate" with
"summary".
d. Make consistent the information that hospitals must
provide patients as part of billing for services in
Section 127420 (b) (page 8, lines 4 - 33) and Section
127425(c) and (d) (page 10, lines 10 - 26).
e. On page 10, line 11, replace "Section 124710" with
"Section 127410."
f. On page 10, line 28, replace "underinsured" with "a
patient with inadequate insurance."
PRIOR ACTIONS
Senate Health Committee: 5 - 4 Failed Passage,
Reconsideration Granted
Assembly Floor: 43 - 34 Pass
Assembly Appropriations: 13 - 5 Do Pass
Assembly Health: 10 - 4 Do Pass
POSITIONS
Support
(to the current version of the bill)
Health Access California (sponsor)
AARP California
Applied Research Center
California ACORN
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California Commission on the Status of Women
California Federation of Teachers
California Labor Federation
California Public Interest Research Group
Community Health Councils
Congress of California Seniors
Consumer's Union
Gray Panthers California
JustHealth
Latino Coalition for a Healthy California
Western Centers on Law & Poverty
Support
(to the prior version of the bill)
American Federation of State, County, and Municipal
Employees
Asian and Pacific Islander American Health Forum
California Alliance for Retired Americans
California Church Impact
California Council of Churches
California Immigrant Welfare Collaborative
California National Organization for Women
Coalition for Community Health
Coalition for Humane Immigrant Rights of Los Angeles
East Bay Alliance for a Sustainable Economy
Greenlining Institute
Health Care for All - California
Insure the Uninsured Project
JERICHO
Lawyers' Committee for Civil Rights
Local Health Plans of California
Multicultural Area Health Education Center
Screen Actors Guild
Santa Cruz Chapter of Healthcare for All
United Nurses Association of California/Union of Health
Care Professionals
Valley Seniors
Opposition
(to the current version of the bill)
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Continued---
Adventist Healthcare Coalition
Alliance of Catholic Health Care
Anaheim Memorial Medical Center
Barlow Respiratory Hospital
California Hospital Association
Cedars-Sinai Health Systems
Centinela Freeman HealthSystem
Children's Hospital Los Angeles
Eden Medical Center
El Camino Hospital
El Centro Regional Medical Center
Fairchild Medical Center
Fallbrook Hospital
Feather River Hospital
Glendale Adventist Medical Center
Glenn Medical Center
Henry Mayo Newhall Memorial Hospital
Hospital Corporation of America
John F. Kennedy Memorial Hospital
John Muir Health
Kaweah Delta Health Care District
Lodi Memorial Hospital
Loma Linda University Medical Center
Long Beach Memorial Medical Center
Los Robles Hospital & Medical Center
Mammoth Hospital
Marshall Medical Center
Mayers Memorial Hospital District
Mercy Medical Center Redding
Miller Children's Hospital
Mission Community Hospital
Oroville Hospital
Pacific Hospital of Long Beach
Patient's Hospital of Redding
Plumas District Hospital
Presbyterian Intercommunity Hospital
Queen of the Valley Hospital
Redbud Community Hospital
Regional Medical Center of San Jose
Riverside Community Hospital
Saddleback Memorial Medical Center
San Antonio Community Hospital
San Joaquin Community Hospital
San Ramon Regional Medical Center
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Seneca Healthcare District
Sharp HealthCare
Sierra View District Hospital
Sonora Regional Medical Center
St. Elizabeth Community Hospital
St. Helena Hospital
St. Joseph Hospital Redwood Memorial Hospital
Stanford Hospital & Clinics
Surprise Valley Health Care District
Sutter Auburn Faith Hospital
Ukiah Valley Medical Center
Valley Health System
Watsonville Community Hospital
Western Medical Center Anaheim
West Hills Hospital
White Memorial Medical Center
Opposition
(to the prior version of the bill)
Biggs-Gridley Memorial Hospital
California Association of Collectors
Californians for Patient Care
Catholic Healthcare West
Citrus Valley Health Partners
Community Hospital of San Buenaventura
Community Hospital of the Monterey Peninsula
Continental Rehabilitation Hospital of San Diego
Cottage Health System
Fountain Valley Regional Hospital and Medical Center
Frank R. Howard Memorial Hospital
Kindred Hospital Westminster
Memorial Hospital of Gardena
Mission Hospital Regional Medical Center
Pacific Alliance Medical Center
Paradise Valley Hospital
Providence Holy Cross Medical Center
Providence Saint Joseph Medical Center
Ridgecrest Regional Hospital
Salinas Valley Memorial Healthcare System
Saint Louise Regional Hospital
STAFF ANALYSIS OF ASSEMBLY BILL 774 (Chan) Page
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San Bernardino Mountains Community Hospital
Scripps Health
South Coast Medical Center
Southern Humboldt Community Healthcare District
St. Jude Medical Center
University of California
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