Assemblymember Blanca Pacheco, a Downey Democrat, says Assembly Bill 1821 is intended to protect local governments from frivolous or abusive records requests, including requests generated by artificial intelligence. But open-government advocates warn the measure would erode California’s Public Records Act and weaken the public’s ability to monitor city halls, school districts, county agencies and other public bodies across the state, including throughout Southern California and the Inland Empire.

The latest version of the bill would allow public agencies to delay certain requests, charge at least $88 per hour to search for and review records considered to be for “commercial use,” and take requesters to court if officials believe the request was made with “malicious intent.”

Pacheco first introduced a broader version of the proposal in March, when it drew criticism from transparency advocates and concern from some of her Assembly colleagues. She later narrowed the bill so it focused primarily on giving agencies more time to respond to records requests, a change that helped it pass the Assembly in May.

Now, many of the most controversial provisions have returned — and critics say the new language is even more restrictive than the original.

“Transparency is important to me,” Pacheco told CalMatters. “We just want it to run efficiently, and these are just minor amendments or minor tweaks to the Public Records Act.”

Local governments have long argued that large or repeated public records requests can overwhelm staff and drain time from other public services. Supporters of the bill, including the League of California Cities, say agencies need tools to deal with bad-faith requests and emerging uses of public records, including companies seeking large volumes of government emails or documents to build private products.

Donald Larkin, an attorney representing the League of California Cities, has pointed to a 2023 case in which someone sought Bay Area city officials’ emails to train an artificial intelligence service they intended to sell to local governments.

But First Amendment attorneys and open-government groups say California law already gives agencies the ability to push back against requests that are overly broad or unduly burdensome. They also argue that in practice, agencies sometimes delay or withhold records for months or years even under current law.

David Snyder, executive director of the First Amendment Coalition and a former journalist, said public access to government records is central to accountability.

“The only way that there’s any government accountability is that people know what the government is doing,” Snyder said. “This looks a lot like an effort to evade accountability.”

David Cuillier, a University of Florida journalism professor who serves on the federal Freedom of Information Act advisory committee, said the proposal would take California in the wrong direction.

The changes, he said, could “make California stand out as the most secretive state in the country.”

A key provision would allow agencies to sue people they believe are seeking records with “malicious intent.” If a court agreed, the requester could be required to pay $88 an hour to obtain the records.

Government agencies in other states have filed lawsuits against people they describe as vexatious requesters, though those cases have often been unsuccessful. Critics say California would be the first state to explicitly authorize agencies to sue over alleged malicious intent in public records requests.

Snyder said putting that authority into law would encourage agencies to fight requests rather than comply with them.

“It would be easily weaponized by agencies seeking to thwart transparency and accountability, as has already happened elsewhere in the country,” he said.

Shaila Nathu, a senior attorney with the ACLU of Northern California, said even the threat of litigation could discourage people from seeking public documents.

Pacheco said she does not expect cities to file lawsuits frequently, noting that agencies would have to go to court to recover a limited amount of fees. She described the provision as a safeguard for extreme cases.

“Hopefully this will curb the bad actors,” she said. “I don’t anticipate that this would slow down legitimate requests.”

The bill’s proposed fee structure has drawn some of the strongest objections. Under current law, public agencies generally may charge only the direct cost of copying records, often between 10 cents and 50 cents per page. The law also prohibits agencies from restricting access based on why someone wants the records.

AB 1821 would allow agencies to impose higher charges when they determine a request is meant to advance a “commercial, trade, or profit” interest. The bill would exempt certain requesters, including journalists, academics and government agencies.

For other members of the public, agencies could ask for information to determine the purpose of a request. Those who do not respond “promptly” could be treated as commercial requesters, though the bill does not define what qualifies as prompt.

Pacheco acknowledged that the determination could vary by situation.

“It’s so fact-specific that it’s kind of hard to say what’s reasonable, what’s prompt,” she said. “Most people will reply if a city asks, and then the city can then obtain the records for the individual.”

In an email to CalMatters, Pacheco spokesperson Alina Evans said the assemblymember does not want taxpayers to subsidize “the cost of building or improving a private company’s commercial product.” Evans also said Pacheco plans to amend the bill so it does not require every requester to explain the reason for seeking records.

Transparency advocates remain unconvinced. Snyder said the language would give agencies wide discretion to scrutinize requesters’ motives and potentially treat people differently depending on how officials view their purpose.

Those classified as commercial requesters could be charged $22 an hour in administrative fees and $66 an hour in professional fees for searching, reviewing and redacting records. Critics note that the California Supreme Court ruled in 2020 that similar charges can threaten the public’s right of access.

Cuillier called the proposed hourly rate “outrageous” and said it could place public records out of reach for many low-income Californians.

The bill also would change response deadlines depending on how a request is filed. Current law requires agencies to respond within 10 calendar days and allows an extension of up to 14 additional calendar days in certain circumstances. The law does not require requests to be submitted in a specific format, though many agencies use online portals.

Pacheco’s bill would change those deadlines to 10 and 14 business days, but only for requests submitted in person or by email during normal business hours. Requests submitted by fax, mail or through an online portal would not receive the same guaranteed timeline, according to critics.

The timing of the latest amendments has also angered open-government groups. Tracy Rosenberg, advocacy director for Oakland Privacy, said significant changes made after Assembly approval can lead to poorly vetted legislation. She described AB 1821 as “a virtual horror show of governmental non-transparency.”

Evans told CalMatters in March that the idea for the bill came from one of Pacheco’s trips sponsored by special interest groups. Pacheco reported receiving more than $45,000 in sponsored travel last year, the most of any California lawmaker, including a study tour in Spain, a golf tournament in Pebble Beach and a conference in Maui.

Asked recently which trip inspired the proposal, Pacheco said she did not remember and said the bill grew out of multiple conversations with local governments.

Evans said the latest amendments reflect discussions with the League of California Cities, the California State Association of Counties, the city of Downey, municipal clerks and several lawmakers on the Assembly Judiciary Committee. That committee previously approved a narrower version of the proposal.

For residents across California, the debate could affect one of the main tools used to scrutinize government spending, police practices, development decisions, school district operations and communications by elected officials. Open-records advocates say any new costs or legal risks could discourage ordinary residents from asking questions of their local agencies.

Pacheco and supporters argue the bill is meant to protect public resources from abuse. Opponents say it would give those same agencies too much power to decide who gets records, how quickly they get them and at what price.

Original source: CalMatters

The post Lawmaker’s Bill Raises Fears California Could Become Nation’s ‘Most Secretive’ State appeared first on The Hemet & San Jacinto Chronicle.

How much do you pay for gas? How much is your electric bill? What about cable?

Those numbers popped into your head right away, right?

Now, about your last hospital bill? How much did you pay for the Band-Aid they used after they drew your blood? Did you know how much your last breast biopsy or hip replacement was going to cost you out-of-pocket before your procedure? Chances are you didn’t.

If you go to a hospital for a procedure, your out-of-pocket costs are rarely discussed. And therein lies the problem. Most patients don’t know how much they must pay for the procedure until they get their bill in the mail months later. 

Why?

Well, in my case, that’s the $8,523 question. (More to come on this a bit later in our story.)

For years, patient advocates and health policy experts have called for transparency in hospital prices to make it easier for patients to compare prices, save money, and avoid financial debt. The goal should be to allow patients to make the best health and financial decisions. Still, most prices are not openly disclosed, and the government doesn’t seem ready to punish the non-compliant.

By Jan. 1, 2021, U.S. hospitals had to make a public list of the standard charges for most items and services. However, according to a January 2023 article in the Journal of General Internal Medicine, most hospitals are not compliant. 

While this lack of transparency hurts all patients, another report says Blacks and low-income patients in rural areas are hurt the most by murky hospital prices.

Rappers unite to push for hospital pricing transparency 

Medical debt incurred from health care costs is an increasing problem for older Americans, especially African Americans and Latinos. African Americans had 2.6 times higher odds of having medical debt than whites, according to this 2016 study. More than half of Black Americans and 50% of Latinos have medical debt, compared to 37% of whites, according to a 2022 Kaiser Family Foundation report. 

Blacks are also more likely to be contacted by a collection agency and to borrow money because of medical debt. In contrast, the study said whites are more likely to use their savings.

Worrying about how you are going to pay for a medical bill is stressful, and it should be the last thing a person in recovery is thinking about as they try to heal.

This kind of stress could be significantly reduced if patients had access to actual prices in health care, according to some of the most iconic men in the hip-hop industry.

Last year, hip-hop heavy hitters Chuck D, Fat Joe, Rick Ross, French Montana, Method Man, and Busta Rhymes joined forces with the nonprofit Power to the Patients to roll out a series of PSAs pushing for affordable and equitable health care.

In one of the 30-second ads, the rappers jointly say, “Today, all across the country, hospitals and insurers hide their prices, and it’s creating fear, debt, and devastation all over this country.”

The video continues: “We need actual prices in health care. Not averages, not estimates. We need real prices … We demand prices and transparency in health care.”

It’s call for elected officials, health care executives, and insurance companies to begin informing patients how much they will have to pay out of pocket.

The push for transparency from some of the most respected rappers is a big deal because the hip-hop community can galvanize young people from different races, classes, and communities together to fight for a cause.

America got a sense of how powerful those young voices can be after the nation watched in disbelief as a video showed a white police officer kneeling on the neck of George Floyd for nine minutes in Minneapolis on May 25, 2020, killing the handcuffed black man. Before he died, Floyd could be heard telling police that he can’t breathe at least 16 times. “Please, the knee in my neck. I can’t breathe.”

After Floyd’s death, young protesters marched in 140 cities across the U.S. to demand changes in law enforcement and an end to racism.

Buildings were set ablaze, a police station was burned down, some police offices were defunded, and some demands were met.

Imagine if the hip-hop community could get even a sliver of that same enthusiasm and demand for justice on hospital pricing transparency.

Technically, all hospitals are supposed to comply with the 2021 federal law. Still, they have no incentive to move beyond a snail’s pace because, since some political officials have already said they should be given time to become compliant. 

A set of regulations issued by the U.S. Departments of Treasury, Labor, and Health and Human Services rolled out in three phases.

• Phase one: Health plans were supposed to publicly post readable files for in-network and out-of-network rates by Jan. 1, 2022.
• Phase two: Health plans were supposed to provide an internet service tool with information on costs for 500 specified items and services by Jan. 1, 2023. 
• Phase three: Expand phase two to all items and services by Jan. 1, 2024.

Most hospitals are not yet fully compliant.

Our hospital billed us for $8,500 over what they told us

The problem with hospital pricing transparency is compounded by the fact that in 2022, 42% of American adults without health insurance skipped medical treatment because they couldn’t afford it, compared with 26% of Americans with health insurance.

African Americans and Hispanics are more likely not to have insurance. Those who are at a higher risk for heart disease, kidney failure, prostate cancer, and asthma? African Americans and Hispanics.

Although my wife and child are on my company’s insurance plan, higher health care and “hidden costs” have made my family hesitant to go to the doctor.

My wife Damia made local news when she posted on Facebook how we received a bill from the hospital for more than $8,500 over the estimated cost of her surgery.

Before Damia had surgery for a parathyroidectomy in August 2020, she asked met with the hospital’s financial counselor  And was told  our out-of-pocket expense would be $1,101.99. 

However, we got our bill for $9,624.99 — that’s $8,523 over what we were told it would cost.

When my wife called the hospital to get to the bottom of the huge discrepancy, we were told Damia was billed for a doctor who was in the room and just watched her surgeon perform the surgery. The doctor then billed the insurance company, and it was rejected because the doctor was out-of-network. Insurance kicked it back to us, resulting in an outrageous bill.

This immediately made me think of “The Junior Mint” Seinfeld episode, where Jerry and Kramer joined medical students in a hospital operating theater to watch one of Elaine’s ex-boyfriends get a splenectomy. Kramer moves for a better view and even issues a “Psst!” at the surgeon because he could not see.

My wife couldn’t give consent to the arrangement in the room because she was under anesthesia, and the assistant who “watched” the surgery was not even in our network.

When local news picked up on the story, they interviewed my wife. They called the Medical College of Wisconsin asking about the case, and the hospital quickly said they cleared it up. The embarrassment caused the hospital to pay the observing surgeon’s cost and the entire bill.

“Even if you are awake and you say, Who is this other person, they say, Well, this person will be assisting me. Do you know to ask at that moment, ‘Hey, before you cut me open, is this person covered under my insurance?’” Damia told the Milwaukee station WTMJ-TV.

“How are we as patients supposed to be able to advocate for ourselves if there’s information we don’t know?” she asked.

Imagine if the hospital would have pulled this stunt on someone who didn’t know the power of the pen. This unexpected bill would have crippled most in my hometown of Milwaukee. For a city that has one of the poorest African American populations in the country, this bill could have been catastrophic.

The bottom line is that there is no reason not to have hospital pricing transparency. And those prices need to be established upfront — the price for a procedure shouldn’t change depending on who pops into the surgery room while a patient is under the knife.

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The post The Health Divide: The lack of transparency on hospital prices disproportionally affects Black patients appeared first on The Hemet & San Jacinto Chronicle.