Week 5- The Process of Health Care Policy Making

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:

Date Action
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.


7 thoughts on “Week 5- The Process of Health Care Policy Making

  1. elscott says:

    I am so glad that you posted a timeline of the process that the bill went through! Just as you mentioned, this wasn’t even a bill that had opposition and it took seven months before it received the governor’s approval! In following this idea, I too looked up a bill but one at the federal level. HR1339 deals with palliative care and was introduced into Congress March 21, 1013 as the Palliative Care and Hospice Education and Training Act (Congress.gov, 2014). This bill did not gain as much ground as the California one that you followed, which I feel is typical of bills introduced at the federal level! After it’s introduction it was referred the same day to the House Committee on Energy and Commerce and was referred again the following day to the Subcommittee on Health. Although the bill itself contained such a great push for funding and education in regards to palliative care, unfortunately these referrals were as far as this particular bill reached.

    The progressive movement after a bill is introduced is a trying and tedious one! Do you think that persons who are against improvements in palliative are mostly uneducated on the topic or do you feel that it is a matter of funding or neither?


    Congress.gov. (2014). H.R.1339 – Palliative Care and Hospice Education and Training Act. Retrieved from https://www.congress.gov/bill/113th-congress/house-bill/1339/


  2. dignitydiscussion says:


    You were not kidding about how lengthy the policymaking process it; and that was for a bill with NO opposition. Can you imagine with a topic like physician-assisted suicide? I was curious after reading your post and in the state of Oregon, the Death with Dignity law was actually passed in 1994, but did not take effect until 1997; and even then the federal government attempted to overturn the judgement in the Supreme Court (e.g., Gonzales vs. Oregon) (Death with Dignity, 2015). One of the take home points I got from my interview with Sam Arora, a past Maryland State Representative, was “good” bills usually don’t pass the first time around (in his experience). That is not to say the SB 1004 is not a “good” bill. Thank you very much for the timeline. The visual assists with understanding just how long the change process can be!

    Death with Dignity Center (2015). About us. Retrieved from http://www.deathwithdignity.org/aboutus


  3. clarinet20 says:

    I liked how you incorporated the SB 1004 into your discussion of how a bill becomes a law. You brought up an excellent point that this issue was brought to their attention because it can provide better care at lower cost. According to Longest (2010), typically the matters that are considered urgent or important advance to legislation. You showed a perfect example of this!
    Although this bill was signed into policy, that is only the beginning. That is excellent that you are going to attend the meeting. I hope you’ll share what you learned. Isn’t it amazing how much time and how many meetings are necessary for this process? I find it completely fascinating.


  4. aalaniz1 says:

    Thank you for a very informative and great example of policymaking in progress. It can certainly be a very lengthy process. Longest (2010), discusses the process of legislation development with introductions of legislative proposals then referrals to appropriate committees and subcommittees, house and senate floor activity, conference committee, etc. Its a wonder some controversial laws make it through.

    Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.


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