Division of the Budget
Landon State Office Building Phone: (785) 296-2436
900 SW Jackson Street, Room 504 adam.c.proffitt@ks.gov
Topeka, KS 66612 Division of the Budget http://budget.kansas.gov
Adam C. Proffitt, Director Laura Kelly, Governor


February 13, 2024


The Honorable Beverly Gossage, Chairperson
Senate Committee on Public Health and Welfare
300 SW 10th Avenue, Room 142-S
Topeka, Kansas 66612
Dear Senator Gossage:
SUBJECT: Fiscal Note for SB 390 by Senate Committee on Public Health and Welfare
In accordance with KSA 75-3715a, the following fiscal note concerning SB 390 is
respectfully submitted to your committee.
SB 390 would enact the Conscientious Right to Refuse Act and would prohibit an
employer, healthcare entity, school, or person from discriminating and committing other specific
acts as defined in the bill based on an individual's refusal of any vaccination, biologic,
pharmaceutical, drug, gene editing technology, DNA-or RNA-based product if an individual’s
refusal is for reasons of conscience. The bill would allow for private cause of actions to be filed
within two years of any direct or indirect injury suffered as a result of a violation of the Act. The
bill would define “conscience” as theistic and non-theistic moral and ethical beliefs as to what is
right and wrong that are sincerely held with the strength of traditional religious views. The bill
would also include other definitions as used throughout the Act.
In addition, SB 390 would repeal KSA 65-126, 65-127, 65-129, and 65-129c, which all
relate to the isolation and quarantine powers of the Secretary of Health and Environment for
infectious or contagious diseases.
The Kansas Department of Environment (KDHE) states that enactment of SB 390 would
remove the authority of the Secretary of Health and Environment to control the spread of infectious
or contagious diseases by repealing KSA 65-126, 65-127, 65-129 and 65-129c. The bill would
disallow “treatment of an individual differently from any other individual who accepted the
medical intervention,” which the agency states would include vaccination and treatment. The
agency notes this would remove public health authority to order individuals who have been
exposed to a vaccine-preventable disease and are not immune to the disease because of past natural
disease or vaccination to quarantine. The bill would also remove the authority to order individuals
with active disease, such as active tuberculosis, who refuse treatment to isolate during their
infectious period.
The Honorable Beverly Gossage, Chairperson
Page 2—SB 390

SB 390 would also remove any school’s, healthcare entity’s, or employer’s right to refuse
service or entry to anyone who had refused a vaccination, biologic, pharmaceutical, drug, gene
editing technology, DNA- or RNA-based product for reasons of their own conscience. Currently
KSA 72-6262(b) allows for medical and religious exemptions of health tests or inoculations for
preschool, daycare, elementary, junior high, or high schools within the state. SB 390 would
remove the need for medical or religious exemptions based on individual conscientious which
could lead to less students being immunized and more children at risk of being exposed to diseases
like measles, mumps, polio, pertussis, hepatitis, and flu.
KDHE indicates that rules and regulations, including those specific to isolation and
quarantine, are tailored for individual diseases such as tuberculosis, Ebola, smallpox, and measles
which are based on the infectious agent, how the disease spreads, the disease's unique infectious
period, and its unique incubation period. In Ohio, 85 locally acquired measles cases were
confirmed between October 2022– February 2023, with 29 of those cases hospitalized. The
median total cost of a measles outbreak in the United States is approximately $152,308. The cost
of each measles case is estimated to be $32,805, with $223 estimated for each contact, and a daily
cost of the investigation estimated to be $4,000. The overall cost of an outbreak is estimated to be
$3.4 million ($47,479 per case or $814 per contact). Most of the costs, approximately $2.3 million,
are associated with public health response followed by productivity losses of about $1.0 million,
and direct medical costs of about $76,000. The agency notes that the incidence of outbreaks and
the costs associated would be expected to rise without quarantine and isolation authority.
In Kansas, an outbreak of multidrug-resistant tuberculosis (MDR TB) involving 13
individuals, aged six months to 58 years, in four households was identified in an urban Kansas
community during November 2021 through November 2022. An extensive contact investigation
involving hundreds of people who were household, school, and workplace contacts was conducted
by local, state, and federal public health professionals. The immediate public health response
focused on the identification, isolation, and treatment of persons with MDR TB. All household
contacts were evaluated for TB disease and latent TB infection with an interferon-gamma release
assay blood test or tuberculin skin test, chest imaging, and sputum testing. Many of the active TB
cases were hospitalized for months, including babies and children, who did not have insurance.
The state granted an additional $340,000 dollars of federal funding to the county to cover its
increased staffing needs during the outbreak response. The ability to enforce quarantine and
isolation was imperative to the success in containing this debilitating and deadly disease.
KDHE estimates new costs could be up to $20.0 million, including $10.0 million from the
State General Fund, in FY 2024 and $30.0 million, including $15.0 million from the State General
Fund, in FY 2025. Assumptions used for the estimate in the increased cost of public health
investigations resulting from increased cases and contacts of infectious diseases are based on
published literature and based on the analysis of the above mentioned Ohio 2022-2023 measles
outbreak and the Kansas MDR TB outbreak in 2021-2022.
KDHE states that the overall fiscal effect of the proposed legislation includes increased
cost of public health investigations, which would fall to local and state public health to cover, plus
the cost to insurance companies, including the state Medicaid program, to cover additional
healthcare costs. In the long-term, the agency states that the elimination of isolation, quarantine,
and other measures to control the spread of infectious and contagious diseases could lead to an
increase in case of disease, which would lead to more associated costs.
The Honorable Beverly Gossage, Chairperson
Page 3—SB 390

The Office of Judicial Administration states enactment of SB 390 could increase the
number of cases filed in district courts because it allows for civil suit to be filed. This could result
in more time spent by judicial and nonjudicial personnel processing, researching, and hearing these
cases. The Office estimates enactment of the bill could result in the collection of docket fees and
fines assessed in those cases filed under the bill’s provisions, which would be deposited to the
State General Fund. The bill would not affect other revenues to the Judicial Branch. However, a
fiscal effect cannot be estimated.
The Board of Regents indicates that passage of the bill would have an effect on the
operations of postsecondary educational institutions. However, no fiscal effect would be
anticipated. The Department of Education reports there would be no fiscal effect on the agency.
The Department for Aging and Disability Services states that the bill would not affect the agency
as it does not utilize any of the authorities that would be repealed, and the agency does not have
any authority over the hiring practices for individuals, providers, or facilities other than minimum
education and background check requirements. The Department of Labor indicates that enactment
of SB 390 could affect the agency if a violation of the Act were to occur; however, the agency
does not anticipate any fiscal effect. Any fiscal effect associated with SB 390 is not reflected in
The FY 2025 Governor’s Budget Report.
The Kansas Association of Counties and the League of Kansas Municipalities were unable
to estimate the fiscal effect on cities and counties. KDHE reports that counties would incur
increased costs for public health investigations and other multi-sectoral fiscal effects caused by the
strain put on businesses, health centers, and schools due to infectious disease.


Sincerely,

Adam C. Proffitt
Director of the Budget


cc: Amy Penrod, Department of Health & Environment
Leigh Keck, Department for Aging & Disability Services
Gabrielle Hull, Department of Education
Becky Pottebaum, Board of Regents
Dawn Palmberg, Department of Labor
Trisha Morrow, Judiciary
Wendi Stark, League of Kansas Municipalities
Jay Hall, Kansas Association of Counties


Statutes affected:
As introduced: 74-3201b, 65-126, 65-127, 65-129, 65-129c