Special Report

John S. Lam, MD, MBA, FACS
Summary 2026 Legislative Activity
There are several policy issues and areas of legislation that impact healthcare and the practice of urology on a state level.

California Medical Association (CMA) Legislative Advocacy Day Summary – April 8, 2026

 

As government and the insurance industry continue to expand their influence over health care, physicians’ clinical autonomy is increasingly at risk. For urologists, this means growing pressure on your ability to make independent, patient-centered decisions based on your training and expertise.

Now more than ever, active engagement in advocacy is essential to ensure that medical decision-making remains in the hands of physicians—not insurers or regulators. Fortunately, you are not alone in this effort. Effective legislative advocacy relies on a coordinated strategy that includes direct lobbying, grassroots physician engagement, and political action through the California Urological Association and efforts through Legislative Advocacy Day.

The California Medical Association (CMA) hosted its 52nd Annual Legislative Advocacy Day on April 8, 2026 at the Sheraton Grand Sacramento Hotel. Several hundred physician and medical student leaders from all specialties and modes of practice met with legislators on priority health care issues that are important to all Californians. This event kicks off the night before with CMA’s California Medical Association Political Action Committee (CALPAC) Legislative Advocacy Reception. CALPAC is operated by physicians, for physicians, CALPAC supports state and federal candidates who align with CMA’s vision for protecting the integrity of medical practice and ensuring that physicians retain a leading voice in shaping the future of health care.

Several bills under consideration in California address emerging threats to patient safety, physician practice stability, and public trust in medicine. These proposals are directly relevant to urologists as both clinicians and small business operators. Below is a concise summary of four key bills that we discussed with lawmakers and CMA’s positions.

 

  1. E-Bike Safety – AB 2346 (Wilson)

CMA Position: SUPPORT (Sponsor)

 

Why it matters to urologists:

Trauma cases—particularly among pediatric and adolescent patients—are rising sharply due to high-speed e-bike injuries. While urologists may not be primary trauma providers, these incidents contribute to overall system strain and can involve genitourinary injuries in severe cases.

 

Key Provisions of Bill:

  • Establishes speed limits for minors (15 mph; 10 mph on sidewalks)
  • Requires safety features (speedometers, integrated lights)
  • Mandates clear labeling and disclosures at point of sale
  • Prohibits unlawful modification to increase speed
  • Allows local control over path-based speed limits

 

Bottom line:

A preventive, evidence-based approach to reduce serious injuries and protect pediatric populations.

 

  1. Automatic Downcoding – AB 2431 (Patel)

CMA Position: SUPPORT

 

Why it matters to urologists:

This bill directly impacts reimbursement, administrative burden, and practice sustainability—core concerns for urology practices managing complex and procedural care.

 

Key Issues:

  • Insurers are increasingly automatically downcoding claims without reviewing clinical records, which is a tactic health insurance companies use to alter a submitted claim to a lower cost service code, reimbursing physicians for a lower level of care than what was actually provided
  • Results in underpayment for complex care and costly appeals processes

 

Key Provisions of Bill:

  • Prohibits downcoding without documented clinical review
  • Requires transparency and explanation for any changes
  • Establishes efficient appeals processes, including batch appeals
  • Introduces enforcement mechanisms (fines, reprocessing)
  • Protects against targeting physicians treating complex patients

 

Bottom line:

Protects fair reimbursement and reduces administrative burden, helping sustain urology practices and preserve patient access.

 

  1. AI Deepfake Doctors – SB 1146 (Gonzalez)

CMA Position: SUPPORT (Sponsor)

 

Why it matters to urologists:

Urologists, like all physicians, are vulnerable to having their identity and credibility misused in fraudulent health advertising—particularly for supplements or men’s health products.

 

Key Issues:

  • AI-generated deepfakes are being used to impersonate physicians
  • These scams promote unproven or unsafe treatments, often targeting vulnerable patients

 

Key Provisions of Bill:

  • Requires clear disclosure when AI is used to simulate a provider’s likeness or voice in ads
  • Enables enforcement by the Attorney General
  • Focuses specifically on health-related advertising transparency

 

Bottom line:

Protects physician identity, preserves patient trust, and combats health misinformation.

 

  1. Naturopath Scope Expansion – SB 1333 (Jones)

CMA Position: OPPOSE

 

Why it matters to urologists:

This bill raises patient safety concerns around prescribing controlled substances and performing procedures without physician-level training—areas highly relevant to urologic care (e.g., minor procedures).

 

Key Concerns:

  • Naturopathic doctors would be allowed to:
    • Prescribe Schedule II–V controlled substances
    • Perform procedures (biopsies, abscess drainage, foreign body removal)
  • NDs do not complete medical residencies or equivalent clinical training

 

Risks:

  • Potential for medication errors, misuse, or addiction issues
  • Increased procedure-related complications
  • Fragmentation of care and patient safety concerns

 

Bottom line:

Expands high-risk clinical responsibilities without commensurate training, posing risks to patient safety.

 

Key Takeaways for Urologists

AB 2346: Prevents avoidable trauma injuries affecting healthcare system capacity

AB 2431: Protects your reimbursement and reduces administrative burden

SB 1146: Safeguards your professional identity and patient trust

SB 1333: Raises significant patient safety concerns due to scope expansion

 

On a federal level, CMA is asking bipartisan legislation introduced in Congress would that would exempt physicians and other health care professionals from a $100,000 filing fee on new H-1Bs visa petitions. The H-1Bs for Physicians and the Healthcare Workforce Act (HR 7961) aims to reduce a major cost barrier for hospitals and medical practices seeking to recruit international clinicians.