Eyes Now Turn to Newsom After a First Year of Legislative Session Concludes

The 2019 California legislative session is on the books, with lawmakers concluding their business and adjourning at around 3:00 a.m. on Saturday, September 14.

Before gaveling down for the year, legislators sent several notable bills to the Governor. Among those was a bill to codify the Dynamex Decision, a statewide cap on rent increases, a delay on school start times, an environmental "Trump insurance" bill, and a cap on high-interest loans. Bills that didn't pass legislative muster included a proposal to expand Medi-Cal to undocumented seniors, bills to reduce single-use packaging, and a wildfire bond proposal. All told, lawmakers sent 1,337 bills to Governor Newsom this year. Over 800 of those measures were passed in the final month of session. 

Assembly Bill 1514 – CANP’s sponsored bill to add NPs as certified providers to the California Phones Program – passed out of the Legislature on August 30 and was signed by the Governor on September 12. Bills like AB 1514 are important steps as CANP works toward full practice authority for NPs. Because AB 1514 was declared an urgency statute (requiring two-thirds approval), its provisions take effect immediately.

Assembly Bill 890 – the bill by Assembly Member Jim Wood (D-Santa Rosa) that would have allowed nurse practitioners to practice independently – was made a two-year bill in the spring by the chair of the Assembly Appropriations Committee. This means that AB 890 did not move this year, but will be eligible to advance again in January.

Health care coverage and access to care are always focal points in California. Notwithstanding the bills that are specific to NPs, the bulk of the big ticket items this year were passed with the State Budget in June. On the Governor’s first day in office, he issued executive orders calling for an expansion of Medi-Cal coverage to young undocumented adults and expanded eligibility for health insurance subsidies for the middle class. Both of those proposals were included in the budget. Newsom also called for the creation of a single purchasing authority to negotiate prescription drug costs, which is currently in the preliminary implementation phase.

Outside the budget, legislators passed multiple bills in the health care space in the final weeks of session, including:

• bills that will make it more difficult for doctors to provide medical exemptions to students for immunizations
• a proposal to limit dialysis clinics’ profits
• legislation to require continued education courses for certain health care providers to include implicit bias training
• a proposal to extend the tax on managed care plans until 2023
• legislation requiring public universities to offer medication abortions (“abortion pills”) to students
• a measure aimed at reducing prescription drug prices by prohibiting brand name and generic drug manufacturers from entering into “pay-for-delay” agreements
• legislation allowing pharmacists to furnish HIV pre- and post-exposure medications to patients

Some health care bills didn’t make it out of the Legislature, including a resurrection of a previously-failed attempt to extend Medi-Cal coverage to undocumented adults over the age of 65, and scope of practice legislation. Many of these bills will be revisited in 2020.

Independent Contractor Classification

The California Supreme Court's 2018 Dynamex Decision was the biggest, most high-profile battle between business and labor this year in the Legislature. Dynamex created a new, tougher standard for independent contractor classification via the ABC Test, replacing the old Borello Test.

This year, Assembly Bill 5 was introduced by Assembly member Lorena Gonzalez (D-San Diego), a former labor attorney and progressive Democrat, to codify Dynamex, effective January 1, 2020. Sponsored by the California Labor Federation, AB 5 will result in approximately 2 million independent contractors in California being classified as employees.

The main target of the bill’s proponents is the gig economy, but countless other industries, including health care providers, will be impacted. Some obtained carve-outs in AB 5 (including insurance brokers, doctors, investment advisors, and "professional service” providers), but many others did not, including nurse practitioners.

CANP, along with a broader coalition of impacted health care organizations, worked diligently to try to secure an exemption to AB 5 for NPs. The California Hospital Association, the nurse anesthetists, physical therapists, optometrists, and others were all part of that coalition, advocating for an exemption for health professionals. CANP also advocated to remove the business-to-business provisions, which are extremely difficult to satisfy in health care settings, e.g. hospital contracting with providers.

AB 5 passed out of the Legislature on September 11 and the Governor is expected to sign it. The fight isn't over, however, and negotiations on additional amendments from industries seeking carve outs from Dynamex will continue next year.

All Eyes on Gavin

Legislators have vacated the Capitol to give Gavin Newsom room to spread out and deliberate over the nearly 800 bills on his desk. This is Newsom’s first year as Governor, so his bill signing and veto “style" remains to be seen. Although he was not shy about his policy objectives this year, he was not overly involved in the legislative process until the end of session. We know where he stands on some of the big issues like Dynamex and rent control, and he is expected to give more bills from his fellow progressives in the Legislature his stamp of approval than Jerry Brown did. Nonetheless, Newsom may throw a curveball or two at lawmakers in the coming weeks leading up to the Governor’s October 13 deadline for signing or vetoing bills passed this year.

Legislators will return to the Capitol for the second year of the 2019-20 session on January 6.