As I researched information on the process of policy-making I was intrigued by the cute cartoons and graphical representations of how bills become law. It seemed that perhaps this was incongruent with what we see in public… it takes a long time to pass a law. I decided to follow the path of California Senate Bill 1004 (SB 1004). This bill provides palliative care benefits for California residents receiving Medicaid insurance services. California’s Medicaid program operates under the name Medical. With the expansion of the Medical program, after the passage of the Affordable Care Act, approximately 30% of Californians are expected to participate in this insurance coverage (Gorn, 2014). Thus, although SB 1004 was created to reach a certain group of individuals a large number of residents will be affected by this legislation.
John Kingdon (2011) writes that “the critical factor that explains the prominence of an item on the agenda is not its source, but instead the climate in government or the receptivity to ideas of a given type, regardless of the source” (p. 72). SB 1004 was introduced by Senator Ed Hernandez. Senator Hernandez is an optometrist and serves as the Chair for the Senate Committee on Health. While Senator Hernandez is certainly a well-respected and trusted authority in the political arena, palliative care legislation had moved to the forefront of the discussion because of its proven ability to provide quality, cost-effective healthcare interventions. This bill was initiated based on the success of its predecessor AB 1745, a pediatric palliative care waiver program.
SB 1004 was introduced by Senator Hernandez for the first time on February 13, 2014, it was signed into law by Governor Brown on September 25, 2014. Let me show you what happened in between:
|2/13/2014||Introduced. Read first time. To Com. on RLS. for assignment. To print.|
|2/14/2014||From printer. May be acted upon on or after March 16.|
|2/27/2014||Referred to Com. on HEALTH.|
|4/2/2014||Set for hearing April 30.|
|4/22/2014||Set, first hearing. Hearing canceled at the request of author.|
|4/23/2014||Set for hearing May 7.|
|5/5/2014||From committee with author’s amendments. Read second time and amended. Re-referred to Com. on HEALTH.|
|5/7/2014||From committee: Do pass and re-refer to Com. on APPR. (Ayes 9. Noes 0. Page 3402.) (May 7). Re-referred to Com. on APPR.|
|5/9/2014||Set for hearing May 19.|
|5/19/2014||Placed on APPR. suspense file.|
|5/20/2014||Set for hearing May 23.|
|5/23/2014||Read second time. Ordered to third reading.|
|5/23/2014||From committee: Do pass. (Ayes 7. Noes 0. Page 3707.) (May 23).|
|5/27/2014||Read third time. Passed. (Ayes 34. Noes 0. Page 3599.) Ordered to the Assembly.|
|5/28/2014||In Assembly. Read first time. Held at Desk.|
|6/2/2014||Referred to Com. on HEALTH.|
|6/18/2014||From committee: Do pass and re-refer to Com. on APPR. (Ayes 18. Noes 0.) (June 17). Re-referred to Com. on APPR.|
|7/2/2014||Set, first hearing. Referred to APPR. suspense file.|
|8/14/2014||From committee: Do pass as amended. (Ayes 12. Noes 0.) (August 14).|
|8/18/2014||Read second time and amended. Ordered to second reading.|
|8/19/2014||Read second time. Ordered to third reading.|
|8/22/2014||Ordered to third reading.|
|8/22/2014||Read third time and amended. (Page 6343.)|
|8/26/2014||In Senate. Concurrence in Assembly amendments pending.|
|8/26/2014||Read third time. Passed. (Ayes 77. Noes 0. Page 6496.) Ordered to the Senate.|
|8/27/2014||Assembly amendments concurred in. (Ayes 36. Noes 0. Page 4908.) Ordered to engrossing and enrolling.|
|9/4/2014||Enrolled and presented to the Governor at 11 a.m.|
|9/25/2014||Chaptered by Secretary of State. Chapter 574, Statutes of 2014.|
|9/25/2014||Approved by the Governor.|
(From SB-1004 Health care: Palliative Care, California Legislative Information)
**Note that each vote on this bill was unanimously in favor. There were no listed opponents to the bill. It would be interesting to follow the process on more highly contested legislation.
I learned several things while following the path of SB 1004:
-As Kingdon referenced, the timing must be right for a successful policy implementation.
Healthcare is looking for high value, low cost interventions.
-New policy does need trusted and committed supporters.
Senator Hernandez and palliative care advocates.
-A large majority of the work on policy takes place in committees.
Committee on Rules, Committee on Appropriations, Committee on Health
– Even without significant opposition, policy implementation is a lengthy process.
February 13- September 25 just in the senate and assembly.
Finally, successful policy development is not complete just by obtaining the right signatures. This is merely another step in the process. On February 23 the Department of Health Care Services will be holding a stakeholder meeting to discuss the implementation of SB 1004. The meeting is open to providers, health plans and community advocates, among others. I am looking forward to attending this meeting and sharing the discussion with you in the coming weeks.
California State Senator Dr. Ed Hernandez, O.D. (2015) Retrieved from http://sd22.senate.ca.gov/
Gorn, D. (2014) Medical enrollment jumps to 11.3 million. California healthline.Retrieved from http://www.californiahealthline.org/capitol-desk/2014/11/medical-jumps- to-11-3-million
Kingdon, J. (2010). Agendas, Alternatives, and Public Policies, Update Edition (2nd ed.). London: Longman Publishing Group.