April 16, 2021 Edition
This week, the California State Senate and Assembly continued with a series of policy committee hearings, amending measures and advancing bills through the legislative process. Recall, the Legislature has two weeks to hear and report any bills with fiscal implications in their houses of origin. Bills without any fiscal implications must be heard and reported in their houses of origin by May 7.
Notably this week, Governor Gavin Newsom signed into law a $536 million early action budget package to enable to state to take urgent action on projects supporting wildfire suppression, improving forest health, and building wildfire resilience in communities. The measure, SB 85, was signed into law alongside legislative leaders at a fuels management project in Butte County on Tuesday. Recall, the Governor and legislative leaders reached an agreement on the spending package late last week.
Below, we highlight several bills of interest to CHEAC Members, including CHEAC’s sponsored measure, AB 240. The latest edition of the CHEAC Weekly Bill Chart is available here.
Public Health Infrastructure
AB 240 (Rodriguez) as introduced January 13, 2021 – SPONSOR
CHEAC’s sponsored bill, AB 240 was heard in the Assembly Appropriations Committee this week. This measure would require the California Department of Public Health (CDPH) to contract with a qualified entity to evaluate the adequacy of the local health department infrastructure and make future staffing, workforce, and resource needs recommendations. AB 240 has been placed on the Assembly Appropriations Suspense File.
COVID-19
AB 54 (Kiley) as introduced amended April 5, 2021 – OPPOSE
AB 54, by Assembly Member Kevin Kiley, was heard in the Assembly Business and Professions Committee this week. The measure would prohibit the Department of Consumer Affairs and any licensing board within the Department, except those that are healing arts, as well as the Alcoholic Beverage Control Board, from revoking the license of any licensee for failure to comply with any COVID-19 emergency order without being able to prove non-compliance with emergency orders resulted in transmission of the virus. AB 54 failed to pass out of the Assembly Business and Professions Committee on a vote of 6-7 with six members not voting.
SB 397 (Jones) as amended March 15, 2021 – OPPOSE
SB 397, authored by Senator Brian Jones was heard this week in the Judiciary Committee. The measure which would establish under state of emergency or local emergency to deem religious services to be an essential and necessary service. The measure would also prohibit the state and local government to discriminate against any religious organizations and allow for any religious organization to continue to operate without having to enforce any health, safety, or occupancy requirement. SB 397 was heard in the Senate Judiciary Committee this week where it failed passage 2-7 with two members not voting.
Health Coverage/Health Care Reform
AB 4 (Arambula) as introduced December 7, 2020 – SUPPORT
This measure, authored by Assembly Member Joaquin Arambula, was heard in Assembly Health Committee this week. AB 4 would expand Medi-Cal to all undocumented adults with an income at or below 138% FPL. This measure passed out of committee on an 11-3 vote with one member not voting and now moves on to the Assembly Appropriations Committee.
Health Equity
SB 17 (Pan) as amended April 5, 2021 – SUPPORT
Senator Richard Pan’s SB 17 establishes a statewide Office of Racial Equity to be governed by a Racial Equity Advisory and Accountability Council to organize, manage, administer, and recommend strategies for advancing racial equities. Additionally, this measure requires the office to develop a Racial Equity Action Plan that would align to the Racial Equity Framework. SB 17 passed out of Senate Judiciary Committee with an 8-1 vote with two members not voting and moves on to Senate Appropriations Committee.
Maternal, Child, and Adolescent Health (MCAH) Services
AB 1046 (Rubio) as introduced February 18, 2021 – SUPPORT
Assembly Member Blanca Rubio’s AB 1046 was heard this week in the Assembly Health Committee. The measure would require the California Health and Human Services (CHHS) Agency to consult with stakeholders to improve state and counties’ ability to effectively draw down Medi-Cal funding for maternal-infant and early childhood home visiting programs. AB 1046 was advanced out of the committee on consent and now moves on to the Assembly Appropriations Committee.
This week, the California Senate Democrats released “Build Back Boldly: Senate Democrats Budget Priorities for 2021-22 and Beyond” detailing priority investments for the state as the economy recovers from the COVID-19 pandemic. The overall goals of the Senate Democrats include a more equitable economy that supports and improves pathways out of poverty, a stronger middle class that improves affordability of housing, health care, and education, and a better economy for all state residents.
Senate Democrats identify their approach to available American Rescue Plan funds to be received by California, which include limiting ongoing negative impacts of the COVID-19 pandemic, providing additional fiscal relief to small businesses and nonprofit organizations, filling gaps in other federal stimulus programs to assist local governments and other entities, and funding critical and eligible infrastructure projects.
The Build Back Boldly budget proposes eight significant investments, as well as key budget subcommittee packages. The eight transformative investments include:
- Debt Free College: This proposal includes three parts, focusing on improving and filling gaps in the current Cal Grant Program, expanding the Middle Class Scholarship to specified CSU and UC students, and assisting Californians with current student debt.
- Universal Access to Early Care and Education: Senate Democrats propose to make significant investments in childcare slots, a childcare worker training program, and childcare provider support.
- Homelessness, Housing Affordability, and Homeownership: The budget includes a multipart approach to housing and homelessness in California, including a $20 billion, five-year commitment to end the state’s homelessness crisis through the acquisition and rehabilitation of permanent housing options and funding local efforts to reduce homelessness. The plan additionally incorporates approaches to improve housing affordability and create a new first time homebuyer program.
- Wildfire Prevention and Resilience: Senate Democrats intend to build upon early budget action taken on wildfire investments to provide a sustainable, multiyear commitment to addressing wildfire risks in California.
- Drought Protection: The proposal outlines a major $2 billion commitment to address and mitigate the impacts of drought, including through safe drinking water improvements, water efficient landscapes, and other one-time and immediate investments in water quality and recycling to reduce drought impacts.
- Health Access and Affordability: Senate Democrats propose to reduce Covered California deductibles and copays, expand access to Medi-Cal to all income-eligible residents regardless of immigration status, reform asset tests for Medi-Cal eligibility, and commit to address health inequities.
- Small Business and Nonprofit Support: The budget proposal outlines fiscal support for California’s small businesses and nonprofit organizations, including through additional stimulus grants, tourism promotion, live event support, and an expansion of employee hiring and retention tax credits.
- State Systems Improvements: Senate Democrats propose to improve government services and customer access, including for the Employment Development Department, invest in broadband infrastructure, and upgrade aging IT/software systems among state agencies.
The Senate Democrats Build Back Boldly budget plan includes specific packages assembled by each of the Senate’s five budget subcommittees. Notably, for the Senate Budget & Fiscal Review Subcommittee No. 3 on Health and Human Services, the subcommittee identifies a series of investments in the public safety net and aging services.
Subcommittee No. 3 additionally details a public health package, which includes:
- Recommitting to investments in state and local public health infrastructure to achieve improved population health and maintain vigilance against future infectious disease outbreaks.
- Developing a coordinated strategy to reduce preventable diseases and transmission of infectious diseases.
- Developing an agile public health workforce that can cross-train in multiple public health priorities to address long-term and emergent needs.
- Maintaining diagnostic and epidemiological capacity built up during the pandemic and reorienting to other pressing public health needs when the emergency ends.
- Investing in public health strategies to address the vast health disparities exacerbated by the pandemic, based on enhanced data collection to identify inequities among subpopulations.
Recall, the Governor will release his May Revise budget in early May, at which point the Legislature is anticipated to shift its focus back to budget activities to reach the June 15 constitutional deadline to pass a budget for the upcoming fiscal year. The full Senate Democrats’ Build Back Boldly plan is available here.
On Thursday, California expanded its COVID-19 vaccine eligibility to all residents ages 16 and older. The eligibility expansion comes as nearly half of all residents ages 16 and older in the state have already received at least one dose of the COVID-19 vaccine, including nearly three-fourths of residents ages 65 and older.
Recall, the state expanded COVID-19 vaccine eligibility to residents ages 50 and older beginning April 1. Over 24 million COVID-19 vaccine doses have been administered in the state to date, with 4.9 million doses administered among residents in the lowest Healthy Places Index quartile. Residents are able to book a COVID-19 vaccine appointment by visiting MyTurn.ca.gov.
Additional information from the Governor’s Office is available here.
On Tuesday, the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) recommended a temporary pause in the administration of the Johnson & Johnson COVID-19 vaccine out of an abundance of caution following the emergence of six reported cases of a rare and severe type of blood clot. The U.S. has administered just shy of seven million Johnson & Johnson vaccines, and the six blood clotting cases have occurred among women ages 18 to 48 with symptoms occurring six to 13 days after vaccination.
The CDC’s Advisory Committee on Immunization Practices (ACIP) convened an emergency meeting to review the Johnson & Johnson vaccine on Wednesday amid the reported cases of blood clotting, but ultimately opted to extend the temporary pause on the vaccine while additional data is collected on potential cases and risk factors. The ACIP is set to again meet next week to review additional data and determine whether to modify its vaccine recommendations against COVID-19.
Following the federal government’s recommendation, the California Department of Public Health (CDPH) recommended all California COVID-19 vaccine providers to temporarily halt the administration of the Johnson & Johnson vaccine. The Western States Scientific Safety Review Workgroup convened this week to review the safety and efficacy of the Johnson & Johnson vaccine but decided to align itself with the CDC Advisory Committee on Immunization Practices (ACIP) decision to gather additional data.
During remarks provided during press conferences this week, Governor Gavin Newsom indicated the Johnson & Johnson vaccine comprises only four percent of the total COVID-19 vaccines received by the state and expressed confidence in the state’s ability to vaccinate residents using Pfizer and Moderna vaccines to allow the state to retire the Blueprint for a Safer Economy on June 15, as previously announced.
A joint statement from the CDC and FDA is available here. A statement from CDPH on the temporary pause of the vaccine is available here.
This week, the Biden-Harris Administration White House announced a number of significant investments in the federal government’s continued response to the COVID-19 pandemic. Below, we highlight these actions:
- Fighting COVID-19 Virus Variants: Pointing to the rapid rise of COVID-19 virus variants nationwide, the Biden-Harris Administration announced significant investments to improve the nation’s capacity to detect, monitor, and mitigate virus mutations made possible through the American Rescue Plan. In carrying out this work, the Administration announced:
- $1 Billion to Expand Genomic Sequencing: This funding is anticipated to assist the U.S. Centers for Disease Control and Prevention (CDC), states, and other jurisdictions improve their capacity to identify COVID-19 mutations and monitor the transmission of variants. The majority of this work is anticipated to be carried out by the CDC through partnerships with state laboratories and laboratory partners. An initial $240 million is being made available nationwide; California is slated to receive just over $17 million and Los Angeles County will receive a direct allocation of $6.4 million. Remaining funding is anticipated to be dispersed over the coming years.
- $400 Million to Support Innovation Initiatives: This funding will establish six Centers of Excellence in Genomic Epidemiology, which will operate as partnerships between state health departments and academic institutions. Ares of focus for these centers will likely include bioinformatic workflows and the critical integration of genomic and epidemiologic data.
- $300 Million to Build and Support a National Bioinformatics Infrastructure: This investment will support bioinformatics throughout the U.S. public health system, creating a unified system for sharing and analyzing sequence data in a way that protects privacy and improves informed decision making. This funding will additionally support training to increase sequencing in clinical settings and expand the CDC’s Bioinformatics Fellowship program.
Additional information on the Biden-Harris Administration’s investments in fighting COVID-19 virus variants is available here.
- Support for Indian Country: The Biden-Harris Administration additionally announced its investment of more than $4 billion to combat COVID-19 in Indian Country. Funding from the American Rescue Plan is anticipated to expand COVID-19 testing and treatment, increase health services to those at higher risk of COVID-19, and expand the abilities of health facilities to serve Native American populations. Specifically, this includes:
- $600 Million to Increase COVID-19 Vaccines: The Indian Health Service (IHS) will invest $600 million to support COVID-19 vaccination efforts in Indian Country, including through mobile vaccination efforts, large scale vaccination events, and other activities to help connect American Indians and Alaska Natives to vaccines. Funding will also be available to support for trusted local voices and medical professionals to conduct community outreach.
- $1 Billion to Detect, Diagnose, Trace, Monitor, and Mitigate COVID-19 Infections: The IHS will invest $1 billion to increase contact tracing, drive-through testing sites, pop-up testing sites, and other public health efforts to combat the continued spread of COVID-19.
- $2 Billion for Tribal Health Systems: The IHS will also provide $2 billion to replace lost revenues attributable to the COVID-19 pandemic, which reduced reimbursement from Medicare, Medicaid, VA, and private insurance. These funds will help make up for the financial losses experienced across the Indian health system, as well as strengthen long-term health care in Indian Country.
Additional information on the Biden-Harris Administration’s investments in Indian Country is available here.
During Black Maternal Health Week, the Biden-Harris Administration announced a series of actions to address the maternal health crisis in the U.S. Notably, the Biden-Harris Administration highlighted the disproportionate rates of maternal morbidity and mortality experienced in the U.S. compared to other countries, as well as the fact that black women are roughly two to three times more likely to die from pregnancy complications than non-Hispanic white women.
President Joseph R. Biden, Jr. signed a first-ever proclamation marking Black Maternal Health Week. Additionally, to strengthen health equity and address racial disparities in maternal health, the Biden-Harris Administration identified the following actions:
- Increased Investments in Reducing Maternal Morbidity and Mortality: The President’s recent discretionary funding request includes a series of investments to reduce maternal morbidity and mortality, improve health equity, and end race-based disparities throughout the country by:
- Investing $200 million to implement implicit bias training for health providers, create state pregnancy medical home programs, bolster maternal mortality review committees, expand rural maternal health programs, and assist local governments in placing early childhood development experts in pediatrician offices.
- Increasing funding for the U.S. Department of Health and Human Services Office for Civil Rights by 24 percent to ensure protections of civil rights in health care.
- Providing $340 million to the Title X Family Planning Program to improve access to vital reproductive and preventive health services and advance gender and health equity.
- Prioritizing investments in programs that protect rural health care access and expand the pipeline of rural health care providers.
- Supporting women and children by providing $6 billion for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to help vulnerable families put healthy foods on the table and address racial disparities in maternal and child health outcomes.
- Approval of the First Medicaid Section 1115 Waiver to Extend Postpartum Coverage: The HHS Centers for Medicare and Medicaid Services (CMS) recently approved a Medicaid Section 1115 Waiver in Illinois that allows the state to extend postpartum coverage to Medicaid-eligible women beyond 60 days and up to 12 months. This approval will help ensure access to vital health services, promote better health outcomes, and reduce the rate of maternal morbidity and mortality. Illinois is the first state to extend postpartum coverage to all pregnant persons under Medicaid, and the Biden-Harris Administration invites all states to provide full Medicaid benefits during pregnancy and the extended postpartum period.
- $12 Million for Maternal Obstetrics Care in Rural Communities: The Health Resources and Services Administration (HRSA), at the direction of the Biden-Harris Administration, released a notice of funding opportunity to make available $12 million in new awards for the Federal Office of Rural Health Policy’s Rural Maternity and Obstetrics Management Strategies (RMOMS) program. RMOMS is designed to develop models and implement strategies that improve access to and continuity of maternal obstetrics care in rural communities. For the first time, RMOMS applicants will be required to focus on populations that have historically suffered from poorer health outcomes, health disparities, and other inequities.
Additional information on the Biden-Harris Administration’s maternal health actions is available here.
This week, the U.S. Department of Health and Human Services (HHS) released proposed new regulations governing the Title X Family Planning Program. Title X, enacted as part of the 1970 Public Health Service Act, provides individuals with comprehensive family planning and related preventive health services including breast and cervical cancer screening and STI/HIV testing.
The new regulations proposed by the Biden-Harris Administration would undo the rules issued in March 2019 by the Trump Administration. Recall, the rules finalized under the Trump Administration prohibit Title X providers from referring patients to certain reproductive health services and limit sites that are eligible to receive Title X funds. The finalized rule additionally specifies that clinics that refer patients to other facilities for abortion services would no longer qualify for Title X funds to provide low-income women with comprehensive family planning and reproductive health services. Several lawsuits were filed against the Trump Administration following the finalization of the Title X rule in 2019, though nationwide injunctions were invalidated, allowing the Trump Administration to enforce its new Title X rules. Following the judicial actions, many reproductive health services providers, including Planned Parenthood, exited the Title X program.
In California, eight local health departments have served as Title X subgrantees, delivering reproductive health services to residents at 46 sites in those jurisdictions. LHDs that are not direct subgrantees work closely with community-based Title X providers to ensure access to essential health services.
Under the new rules by the Biden-Harris Administration, HHS proposes to readopt Title X regulations established in 2000 with additional modifications to strengthen the program and ensure access to equitable, affordable, client-centered, quality family planning services for all clients, especially those that are low-income. The proposed regulations will be open for public comment for 30 days until May 17, 2021.
Additional information from HHS is available here. The proposed regulations are available here.
New data published by the U.S. Centers for Disease Control and Prevention (CDC) this week found that reported annual cases of sexually transmitted diseases (STDs) in the U.S. continued to climb in 2019, reaching an all-time high for the sixth consecutive year. The newly released 2019 STD Surveillance Report found:
- 2.5 million reported cases of chlamydia, gonorrhea, and syphilis, the three most commonly reported STDs in 2019.
- A nearly 30 percent increase in reportable STDs between 2015 and 2019.
- The sharpest increase was in cases of congenital syphilis, which nearly quadrupled between 2015 and 2019.
According to the CDC, STDs can result in serious health consequences. If left untreated, some individuals can increase the risk of HIV infection, experience chronic pelvic pain, pelvic inflammatory disease, infertility, severe pregnancy and newborn complications, and infant death. Notably, the STD epidemic continued to impact racial and ethnic minority groups, gay and bisexual men, and youth the most significantly. These impacts include:
- For Racial and Ethnic Minority Groups:
- STD rates among African American or Black people were 5-8 times that of non-Hispanic white people.
- STD rates among American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander people were 3-5 times than that of non-Hispanic white people.
- STD rates among Hispanic or Latino people were 1-2 times that of non-Hispanic white people.
- Gay and Bisexual Men:
- Make up nearly half of all 2019 primary and secondary syphilis cases.
- Gonorrhea rates were 42 times that of heterosexual men in some areas.
- Young People Ages 15-24:
- Make up 61 percent of chlamydia cases.
- Make up 42 percent of gonorrhea cases.
The CDC outlines needs and opportunities available for state and local jurisdictions in controlling STDs, including through STD express clinics, partnerships with pharmacies and rural health clinics, and telehealth services.
Additional information on the latest CDC STD report is available here.
This week, the U.S. Centers for Disease Control and Prevention (CDC) released a report finding that four in 10 transgender women surveyed in seven major U.S. cities have HIV. The report also revealed that nearly two-thirds of African American/Black transgender women and more than one-third of Hispanic/Latina transgender women surveyed have HIV. The CDC report is one of the most comprehensive surveys of transgender women in the U.S. to date, incorporating findings from interviews with over 1,600 transgender women living in Los Angeles and San Francisco, among other U.S. cities.
According to the CDC, the findings demonstrate a pressing need for scaled-up HIV prevention and care strategies for transgender women. Stark racial and ethnic differences in HIV rates among survey respondents were identified, and nearly two-thirds of the women surveyed lived at or below the poverty level with 42 percent experiencing homelessness in the past 12 months. The study found also that only 32 percent of participants without HIV reported using pre-exposure prophylaxis (PrEP), which may be due to medical mistrust due to experiences of transphobia, lack of trans-inclusive marketing, and concerns about drug interactions between hormones and PrEP.
The CDC report outlines a series of other health conditions and risk factors among transgender women. A news release on the study is available here. The full CDC report is available here.
The California ACEs Aware initiative, a partnership between the Office of the California Surgeon General and the California Department of Health Care Services (DHCS), announced a webinar to be held on Wednesday, April 28 from 12:00 pm to 1:00 pm. The webinar is entitled, “Racism and Discrimination as Risk Factors for Toxic Stress,” and will explore research demonstrating how racism and other forms of discrimination can serve as risk factors to active a toxic stress response and lead to health conditions that have been empirically associated with exposure to adverse childhood experiences (ACEs).
The webinar will feature opening remarks by California Surgeon General Dr. Nadine Burke Harris and will review some of the main social and environmental factors that lead to heath disparities, discuss the role of racism and discrimination as risk factors for ACEs, and make the case to clinicians and clinical teams that implementing trauma-informed care principles and ACEs screening can help promote health equity.
Additional information, including webinar registration, is available here.