Scope of Practice Bill Comes to California

Published on
June 12, 2013

The Affordable Care Act (ACA) will help millions of Americans access health insurance, yet the doctors to treat these millions in California are in short supply. According to an editorial in the Press-Telegram, 42 of California’s 58 counties fail to meet the federal government’s basic standards for the number of primary care physicians, even before the implementation of the ACA.

In an effort to address this need, the editorial explains that state Senator Ed Hernandez, who chairs the Senate Health Committee, introduced a package of bills (SB 491, SB 492, and SB 493) that would expand the ability of nurse practitioners, pharmacists, and optometrists to treat patients with primary care. Nurse practitioners hold either a master’s or doctorate degree in medical education. On May 28, the Senate passed SB 491 and 492 on the following day.

As the editorial notes, the California Medical Association (CMA) opposes the bills. The California Pharmacists Association (CPhA) supports the proposed legislation, along with other members of Californians for Accessible Health Care, which includes the California Society of Health-System Pharmacists (CSHSP), California Association for Nurse Practitioners (CANP), and the California Optometric Association (COA).

Below is a breakdown of political campaign contributions these organizations have made since 2003.

Contributions to California Candidates and Campaigns from Supporters and Opponents of SB 491, SB 492, and SB 493


2012 Election Cycle

2004–2012 Total

California Pharmacists Association



California Society of Health-System Pharmacists



California Association for Nurse Practitioners



California Optometric Association


$1.3 million

Supporters’ Total


$1.8 million


California Medical Association

$1.2 million

$6 million**

*All given to bill sponsor Sen. Hernandez, who was not up for election.

**Total reflects contributions from 2003–2012 cycles.

After the Senate passed two of the three bills, the next stop is the state’s Assembly, according to the AP/Sacramento Bee. Along the bills’ path, the Institute’s Legislative Committee Analysis Tool (L-CAT), can help track the relevant political donations. For instance, to determine what committee members received money from what organizations, select “California” and “Senate” from the dropdown menus, then “Business, Professions, and Economic Development.” Select “Health” from the Sector menu to see all contributions to committee members from donors who work in or represent the health industry, such as the CMA.

The above L-CAT search shows that contributors from the health industry have contributed $731,690 to members of this committee. Scroll down the page to Table 3 to see this committee’s Top 20 contributors from the health industry. The CMA was the second-highest contributor, with $33,550 given to five of the ten committee members, including: Bill Emmerson, Curren Price Jr., Jerry Hill, and the bills’ sponsor Ed Hernandez. The COA came in sixth on the list of top health industry contributors, with $20,600 given to the same four committee members. The CPhA also made the top 20 list, contributing $11,900 to the four committee members mentioned above.

Overall, the California Dental Association was the committee’s top contributor from the health sector, giving $49,300 to five members: Hernandez, Price, Hill, Emmerson and Marty Block.

California is not the only state considering whether or not to tackle the doctor shortage problem by broadening the scope of what services other providers can offer. Nurse practitioners are lobbying lawmakers in as many as 34 states to change current regulations, and since 2011, state legislators have introduced 1,795 scope-of-practice-related bills. By investigating the major players surrounding “scope of practice” bills in their own states and researching their contributions to state level candidates and committees on reporters can further their readers’ understanding of the debate.

Image by Andy G via Flickr