CMA Capitol Insight is a biweekly column by veteran journalist Greg Lucas, reporting on the inner workings of the state Legislature.

It’s a Wrap

The 2013 legislative session is over, and the all-too-brief off-season begins. Like most legislative sessions, the final weeks were frenetic and had their share of last-minute deals and newly minted bills that had never been publicly aired. Usually, during two-year legislative sessions, the most controversial measures win approval in odd-numbered years. This is mainly because elections are held in even-numbered years. A minimum wage bill, stalled for the better part of nine months, was revved up and quickly passed just before the September 12 adjournment (more below.) So was a measure allowing undocumented immigrants to obtain a driver’s license. The chief difference between citizens’ licenses and the new licenses is that the letters “DP” (for “Driving Privilege”) instead of “DL” (for “Driver’s License”) will appear on the front. The back of the card will also include a sentence saying, “This card is not acceptable for official federal purposes.” Gov. Brown has said he will sign both measures. So far, nearly 600 other bills – legislative clerks are still processing the session’s output – have also landed on the Democratic governor’s desk. He has until mid-October to act on them. Overall, though, the atmosphere was fairly mellow by end-of-session standards. Partly that’s because one-third of the Legislature’s members are new. Because of the once-a-decade drawing of district lines and a change in California’s term limits law, they’re guaranteed at least a 10-year stay in office, if they want one. Unlike previously elected Assembly members with a maximum of six years in the lower house, these new members can take a “long-term” view. Rather than rushing to pass legislation, as their short-timer colleagues are wont, the newbies have been taking a wait-and-see approach. Like on questions regarding scope of practice. For those who believe that every day the Legislature does nothing is a terrific day for California, this is good news.

Speaking of Scope of Practice…

In the face of strong efforts to expand in potentially reckless ways the services to patients that pharmacists, optometrists and nurse practitioners can provide, doctors succeeded in shaping a more responsible package of legislation. The bills relating to what nurse practitioners and optometrists can and cannot do based on their training remain in Assembly committees. The California Medical Association (CMA) removed opposition to a bill relating to pharmacists, which will likely be signed by Gov. Brown, after it was changed to require additional training for pharmacists before they can initiate and administer vaccines and provide contraceptives. Says the CMA succinctly: “Allowing practitioners to perform procedures they simply aren’t trained to do can only lead to unpredictable outcomes, higher costs and greater fragmentation of care.”

The Morbidly Obese Female…

…Has yet to warble on how best to provide sufficient access to care without sacrificing quality. With or without the Affordable Care Act, a greater and greater percentage of health care delivery is managing chronic conditions like asthma or diabetes. Discussions on how to structure a system to do that will continue next year in the Legislature. Nurse practitioners, physician assistants and doctors banded together to support a measure, SB 494, taking a step in that direction. The bill allows the maximum patient-to-physician ratio to increase based on the number of physician assistants in a practice. A coalition including most of the same groups backed another bill, SB 352, expanding the ability of nurse practitioners, certified nurse-midwives and physician assistants to supervise medical assistants when doctors aren’t on the premises. Right now, such supervision in a doctor’s absence can only occur in community and free clinics. The bill, already signed by the governor, expands that to all outpatient settings. CMA says this in its support letter: “As California struggles with health care provider shortages and challenges to ensuring adequate health network capacity throughout the state, the efficient use of existing health manpower resources, including MAs, will become even more critical.”

But Wait, There’s More

Signed into law last week is a CMA-sponsored bill requiring the state Medical Board to give priority review to applications of doctors who want to work in a medically underserved part of the state or work with a medically underserved population. The federal Health Resources and Services Administration defines “underserved” places or populations as those with “too few primary care providers, high infant mortality, high poverty and/or high elderly population.” The bill, AB 1288, is the latest in CMA’s efforts to bring more balance to the state’s distribution of doctors. CMA also created the Steven M. Thompson Loan Repayment Program in 2002 to help bring more doctors to rural parts of the state or work with underserved Californians by helping erase some of their medical school debt.

Raising Wages

The boost in the minimum wage – the state’s first since 2008 – will have the broadest effect of any measure OK’d this year. California’s $8-an-hour minimum will climb to $9 on July 1, 2014, and $10 in January 2016. The 25 percent increase won’t give California the highest minimum rate in the country, though. Washington has a $9.19 hourly minimum, followed by Oregon at $8.95. Both are automatically increased annually to keep pace with inflation. Among the estimated 2.4 million Californians who earn a minimum wage, the change has a very direct impact – more take-home pay. In-home care workers represent a growing chunk of those 2.4 million Californians. Predictably, the state Chamber of Commerce opposed the boost, branding it a “job killer.” California’s 87,000 restaurants, which typically have narrow profit margins, say they feel the pinch of a minimum wage increase most acutely because of the large number of hourly workers in the industry. On the other hand, a higher hourly wage means more discretionary income, which could lead to more evenings out on the town.

Unscenic Highway

Also already signed into law is a measure removing a 37-mile stretch of Inland Empire freeway from the state’s network of “scenic” highways. It’s the first time since the California Scenic Highway program was created in 1963 that a section of roadway has surrendered the right to sport one of the iconic Golden Poppy signs. The request came from Riverside County, which wants to erect an electronic billboard near Cabazon on Interstate 10 east of Redlands, where the Morongo Band of Mission Indians operate a 148,000-square-foot casino, 310-room hotel, spa and outlet mall. While the section of roadway affected by the new law has been eligible for scenic highway status for decades, Riverside has never sought official designation. Given the development in the area over the past half-century, the area abutting the eight-or-more lane freeway wouldn’t have made the cut anyway. A 2011 review by Caltrans found too much “visual intrusion.” Chief among the intrusion is the brightly lit 2,700-slot Morongo casino, its expansive parking lot and 27-story hotel – the tallest structure in the Inland Empire. Caltrans also cited railroad tracks and an active gravel pit as further “visual intrusion.” Riverside says the electronic billboard will make money and allow the elimination of several traditional billboards along the freeway. Interestingly, it’s the rules contained in the county’s general plan regarding development along scenic highways that prevents it from erecting the new billboard, not the state scenic highways program itself. The county decided it was easier to use state money and time to simply eliminate scenic highway status than modify its own general plan. A lesson in that somewhere.

The Punch Line Is Ruined

Blame Monterey Mushrooms and the U.S. Department of Agriculture (USDA). Monterey Mushrooms learns that mushrooms grown in the wild are brimming with vitamin D. Good marketing opportunity for the largest producer of mushrooms on the planet. Less people are getting their recommended daily D dosage, which can lead to a variety of unwelcome conditions including rickets. What better message for Monterey Mushrooms: Stay healthy; eat chanterelles. The problem is commercial mushrooms are grown indoors, which deprives them of sunlight and vitamin D. This method of mushroom growing is the genesis for the famous rejoinder: “How are they treating you?” the straight person asks. “Like a mushroom,” the comedian replies. “I’m kept in the dark and fed nothing but horse manure.” Not anymore – or at least not all the time, according to a Sept. 10 report in the San Francisco Chronicle. With financial support from Monterey Mushrooms, USDA researchers discovered that if mushrooms are zapped with 30 seconds of ultraviolet light within a few hours of harvesting, a serving will then meet the USDA’s daily requirement for vitamin D. So blame Monterey Mushrooms because “I’m kept in the dark and fed nothing but horse manure before I’m briefly blinded” doesn’t have anywhere near the same ba-da-bing, ba-da-boom.