April 26, 2019 Edition

Legislature Returns from Spring Recess, Meets Fiscal Bill Deadline

On Monday, the California Legislature returned from its Spring Recess to a busy week of committee hearings and bill negotiations. Today is the deadline for policy committees to hear and report all bills with a fiscal impact introduced in their house of origin. Next Friday is the deadline for policy committees to hear and report all remaining bills without a fiscal impact introduced in their house of origin.

There were a number of high-profile bill hearings this week spanning a wide array of issues, including vaccination exemptions, housing developments, charter schools, and law enforcement use-of-force. Committee hearings lasted multiple hours, often stretching well into the evening, as legislators worked to advance bills ahead of today’s fiscal bill deadline.

Notably this week, two additional measures attempting to limit sugar-sweetened beverage (SSB) consumption in California succumbed to increased scrutiny and skepticism by legislators and industry stakeholders. AB 138 by Assembly Member Richard Bloom was pulled from the agenda in the Assembly Revenue and Taxation Committee just prior to its scheduled hearing on Monday afternoon. AB 138 would impose a $0.02 fee per fluid ounce on SSBs and allocate revenues to a number of state agencies and departments for the purposes of promoting health equity, reducing health disparities, improving oral health, and preventing chronic disease conditions.

Reports indicated Assembly Member Autumn Burke, Chair of the Assembly Revenue and Taxation Committee, will remain opposed to AB 138 – or any future similar proposal – if the measure does not steer SSB fee revenues toward lowering the cost of bottled water in low-income and disadvantaged areas of the state. Burke voted in favor of AB 138 earlier this month in the Assembly Health Committee; however, the measure lost her support after reported amendments were not finalized prior to its hearing in the Assembly Revenue and Taxation Committee. While Bloom shelved the proposal for this year, he indicated his continued commitment to fighting “against well-funded and powerful special interests that profit at the expense of the public’s health and welfare.”

AB 765 by Assembly Member Buffy Wicks also experienced a similar fate on Tuesday just prior to its scheduled hearing in the Assembly Health Committee. The measure would require that only specified healthy beverages be made available in checkout aisles of retail stores. Wicks earlier this month rescheduled the measure’s hearing, attempting to work through enforcement provisions and other logistical considerations of the measure. Wicks, vowing to pursue the measure again next year, indicated in a statement, “The link between sugary drinks and obesity, diabetes, and heart disease is undeniable … I am committed to finding practical solutions, like increasing the healthy checkout options at checkout aisles, to promote the best interests of California’s health.”

The shelving of both AB 138 and AB 765 mark the second and third defeat of legislative efforts targeting SSB consumption in California. Recall, AB 766 (Chiu), which sought to prohibit large SSB fountain drinks, was withdrawn earlier this month. Two of the five measures proposed as part of the SSB package remain in play, however. AB 764 (Bonta), prohibiting SSB financial incentives, and SB 347 (Monning), requiring SSB warning labels, continue to make their way through the legislative process.

Below, we highlight several other items of interest to CHEAC Members. Our CHEAC Weekly Bill Chart is available here.

Communicable Disease Control

SB 276 (Pan) as amended April 9, 2019 – SUPPORT

SB 276 by Senator Richard Pan was heard in the Senate Health Committee on Wednesday, featuring hundreds of individuals in support and opposition and lasting over five hours. SB 276 would require physicians to submit a statewide standardized immunization medical exemption request form and require the state public health officer or designee to approve or deny the request upon determining sufficient medical evidence that the immunization is contraindicated utilizing guidance from the U.S. Centers for Disease Control and Prevention (CDC). The California Department of Public Health (CDPH) would be required to create and maintain a database of approved medical exemption requests and make available the database to local health officers. The state public health officer and local public health officers would also be authorized to revoke a medical exemption if it is determined that the exemption is fraudulent or inconsistent with applicable CDC guidelines.

In presenting his measure, Senator Pan raised significant concerns over some physicians issuing immunization exemptions under the guise of medical necessity. He claimed a small number of “unscrupulous” physicians are advertising and selling “fake medical exemptions,” thereby threatening the public’s health and safety. Senator Pan referenced the ongoing measles outbreaks both in California and throughout the country and urged the need to take proactive steps in shoring up vaccination rates in the state.

Alameda County Interim Health Officer Dr. Erica Pan testified in support of the measure on behalf of the Health Officers Association of California (HOAC), providing critical expertise on the public health considerations of immunization exemptions, community immunity, and the threat of communicable disease outbreaks among unvaccinated individuals and communities. Those in support of the measure largely consisted of public health and healthcare professionals and organizations.

Several medical professionals testified in opposition to the measure, citing concerns over the erosion of the doctor-patient relationship. Those in opposition to SB 276 largely consisted of individuals and parents concerned about the safety of vaccines and those who see the measure as an infringement upon their rights.

Robust debate amongst committee members and witnesses followed the lengthy public comment period and featured discussions on community immunity, vaccine contraindications, and implementation considerations of the measure. SB 276 was advanced out of the Senate Health Committee to the Senate Appropriations Committee on a party-line vote of 7-2.

Relatedly, HOAC this week released a report on community immunity by legislative district. Using publicly available data, HOAC found that there are 835 schools in California who have a kindergarten MMR immunization rate of less than 95 percent, with nearly 398,000 children attending these schools. This report is available here.

Environmental Health

AB 377 (E. Garcia) as revised April 24, 2019 – SUPPORT

AB 377 by Assembly Member Eduardo Garcia was heard in the Assembly Appropriations Committee on Wednesday. Recall, AB 377 is the clean-up measure to AB 626 (Chapter 470, Statutes of 2018) which established microenterprise home kitchen operations. The measure provides clarifying and technical amendments around jurisdictional opt-in procedures, local permitting and inspection activities, and exempted food safety and sanitation provisions. CHEAC remains concerned with the potential for increased risk to the public’s health and safety through the operation of microenterprise home kitchen operations; however, CHEAC supports AB 377 as the measure provides greater clarity of critical provisions enacted through AB 626. AB 377 was unanimously advanced from the Assembly Appropriations Committee to the Assembly Floor.

Health Coverage/Health Care Reform

SB 29 (Durazo) as amended March 11, 2019 – SUPPORT

SB 29 by Senator Maria Elena Durazo was scheduled in the Senate Appropriations Committee on Monday. The measure would expand full-scope Medi-Cal to all undocumented adults in California with incomes at or below 138 percent federal poverty level (FPL). Senator Durazo waived presentation and the measure was placed on the Senate Appropriations Suspense File.  

SB 175 (Pan) as amended on April 3, 2019 – SUPPORT

SB 175 by Senator Richard Pan was heard in the Senate Governance and Finance Committee on Wednesday. The measure would institute a state-level individual health insurance coverage mandate in California. SB 175 would also require Covered California to conduct specified outreach and enrollment efforts among Californians who do not maintain minimal health coverage. The measure was advanced to the Senate Appropriations Committee on a 4-2 vote with one member not voting.

Jail and Community Corrections Services

SB 433 (Monning) as amended on April 11, 2019 – SUPPORT IN CONCEPT

Senator Bill Monning’s SB 433 was heard in the Senate Human Services Committee on Monday. SB 433 would require the California Department of Social Services (CDSS), in collaboration with CDPH, to establish and oversee the Office of Youth Development and Diversion (OYDD) Grant Program, consisting of up to five three-year pilot programs to be administered by county health departments. Under the grant program, counties would be required to conduct a series of activities in partnership with community-based organizations and local governmental entities related to youth development and diversion programming and services. SB 433 was unanimously advanced from the Senate Human Services Committee to the Senate Appropriations Committee on a 6-0 vote.

Tobacco Control

AB 1718 (Levine) as introduced on February 22, 2019 – SUPPORT

AB 1718 by Assembly Member Marc Levine would prohibit the smoking and disposal of cigar or cigarette waste at all state coastal beaches or in state parks. The measure was scheduled for hearing in the Assembly Appropriations Committee on Wednesday; Assembly Member Levine waived presentation and the measure was placed on the Assembly Appropriations Suspense File.

SB 38 (Hill) as introduced on December 3, 2018 – SUPPORT

SB 38 by Senator Jerry Hill would prohibit tobacco retailers from selling any flavored tobacco products and sets forth enforcement and penalty provisions to be carried out by CDPH. The measure was scheduled for hearing in the Senate Appropriations Committee on Monday; Senator Hill waived presentation and the measure was placed on the Senate Appropriations Suspense File.

Senate Subcommittee No. 3 Convenes Another Marathon Hearing, CHEAC/HOAC Budget Request Presented

On Thursday, the Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services convened a day-long hearing on budget items falling under the purview of the Department of Health Care Services (DHCS) and the California Department of Public Health (CDPH). Senator Richard Pan chaired the meeting coming off the heels of chairing an eventful and lengthy Senate Health Committee hearing that went very late into Wednesday night. Several issues of interest to CHEAC were heard, including a our joint CHEAC/HOAC budget request for $50 million ongoing General Fund for local health department communicable disease infrastructure. Highlights are provided below:

CHEAC/HOAC Budget Request. Dr. Rob Oldham from Placer County presented the joint budget request, highlighting the challenges local health departments face in both preventing and controlling communicable diseases. Senator Pan raised questions regarding how funds would be distributed and offered his thoughts around exploring a mutual aid grant structure. CHEAC expressed a willingness to engage in further discussions.

The LAO provided brief remarks, noting that it is generally difficult to determine the appropriate level of funding for public health. The LAO further noted that current state and local public health funding is very categorical and not flexible, making it particularly challenging for public health to address localized needs; the LAO recommended that Senators keep these constraints in mind as they consider various proposals related to disease-specific funding streams.

Whole Person Care. DHCS briefly presented the Governor’s proposed one-time investment of $100 million General Fund for WPC Pilot counties to support housing and housing supportive services for individuals with mental illness experiencing homelessness or at risk of homelessness. DHCS noted the proposed allocation of the funding, which was released earlier this week. While CHEAC is still reviewing the proposed allocation of funding, CHEAC supports the Governor’s proposed investment into WPC.

Developmental and Trauma Screening. DHCS presented the Governor’s proposal to provide $60 million ($30m in Proposition 56 and $30m federal funds) for developmental screenings for children at nine months, 18 months, and 30 months of age, and as medically necessary and to provide $45 million ($22.5m Proposition 56 and $22.5m federal funds) to support trauma screenings for children and adults. CHEAC supports both Administration proposals.

STDs. Dr. Gil Chavez from CDPH presented the Administration’s request for $2 million ongoing funding to be provided to local health departments to prevent STDs. CDPH highlighted how funding provided to the local health jurisdictions in FY 2018-19 has been utilized. Senator Pan, recognizing $2 million is not nearly enough to address the high rates of STDs California is currently experiencing, asked the Department of Finance to examine the investment needed to bend the curve. The LAO offered to work with DOF to analyze the investment needed.  CHEAC supports this budget proposal.

End the Epidemics. Representatives of the End the Epidemics Coalition presented their budget requests for $20 million for HIV prevention services, $20 million for Hepatitis C micro elimination projects, $20 million for STD prevention, testing and treatment services, and $2 million to create an End the Epidemics Task Force to develop a statewide strategy to address HIV, Hepatitis C and STDS. Senator Pan acknowledged the challenges around STDs and expressed interest in a master strategy.

All items were held open. Meeting materials can be accessed here. A recording of the hearing can be found here.

April Revenues Looking Up, Potentially Alleviating Concerns Over Shortfall

The Legislative Analyst’s Office (LAO) provides monthly updates on their tracking of the state tax collections and released their April update on personal income tax (PIT) collections earlier this week. April is an important month for PIT collections since it is the month that individuals are required to file final tax payments for the prior year. In January, PIT collections were coming in short of the Administration’s projections by roughly $2.7 billion. However, the shortfall was assumed to be the result of recent federal tax laws and as such April PIT collections were anticipated to be higher than projected. Currently, total PIT collections are about $2.5 billion ahead of projections for the month.

Corporation tax collections are also running ahead of projections by about $3.3 billion.

Federal Judge Issues Nationwide Preliminary Injunction Against Trump Administration Title X Rule

Late yesterday, a U.S. District Judge in the Eastern District of Washington State issued a nationwide preliminary injunction against the Trump Administration’s overhaul of the Title X family planning program, temporarily blocking the new rule that was set to take effect next Friday. Recall, the Trump Administration issued a final rule in March which would prohibit Title X providers from referring patients to certain reproductive health services and limit sites that are eligible to receive Title X funds. The rule further specified 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 preventive services.

U.S. District Judge Stanley Bastian, in issuing the injunction, indicated, “There is no public interest in perpetuating unlawful agency action.” The preliminary injunction goes into place while several other lawsuits against the Trump Administration’s final rule move forward, including one in California. A federal judge in Oregon also indicated earlier this week that he plans to issue an injunction on a similar but separate suit brought by 20 states and the District of Columbia. While U.S. District Judge Michael McShane of Oregon has yet to reveal the scope of his injunction ruling, he described the Trump Administration’s rule as a “ham-fisted approach to public health policy.”

Representatives from the U.S. Department of Health and Human Services (DHHS) had not yet responded to the issuance of the injunction out of the state of Washington. Given the other multiple pending legal actions against the Trump Administration’s Title X rule, additional developments on the matter are expected over the coming weeks.

TFAH Issues Report on Chronically Underfunded Public Health Infrastructure

This week, the Trust for America’s Health (TFAH) issued a report examining federal, state, and local public health funding trends, potential risks, and recommended investments and policy actions to prioritize prevention and effectively address ongoing and emerging threats. The report details significant nationwide public health challenges, including obesity, tobacco use, infectious diseases and foodborne illnesses, substance use disorders, suicide, and climate-related natural disasters. To adequately prepare for and address these challenges, TFAH indicates the need for a strong, well-resourced public health system focused on prevention, preparedness, wellness, and community recovery.

However, chronic underfunding and investments into the public health infrastructure remain a consistent and significant obstacle. In 2017, public health represented just 2.5 percent — $274 per person – of all health spending in the country. TFAH identifies evidence-based public health interventions, such as childhood vaccinations, school-based violence prevention programs, and indoor smoking bans, as effective strategies to improving health outcomes, preventing illness and death, and saving money over the long-term.

The TFAH report goes on to examine federal public health spending, finding that the budget for the U.S. Centers for Disease Control and Prevention (CDC) has not kept pace with the nation’s growing public health needs and emerging threats, particularly as it relates to substance misuse and weather-related emergencies. The CDC’s FY 2019 budget reflected a $143 million (two percent) increase over FY 2018 – after accounting for inflation, this increase for FY 2019 is essentially flat compared to the previous year. Looking further back, TFAH finds the CDC’s budget fell by 10 percent over the past decade (FY 2010-19) after accounting for inflation. California ranks 43rd in total CDC state funding per capita.

Critical CDC initiatives are examined by the report, finding that funding and support provided by the federal government over a broad range of topics – including community prevention, public health emergency preparedness and response, chronic disease prevention, substance misuse, and suicide prevention – are severely inadequately resourced and unable to provide sufficient support to states.

TFAH examines state public health funding and indicates that the ability of state health departments to fulfill critical and fundamental public health roles is heavily affected by federal funding. State public health funding was found to hold stable or increase in 33 states from FY 2017 to 2018; California’s state public health funding increased slightly by 2.8 percent during this period. Local public health funding is also examined by the report, finding a considerable number of local health departments throughout the U.S. experienced funding decreases over the past several fiscal years.

Citing the $4.5 billion gap between current funding and what is needed to build a strong nationwide public health infrastructure, TFAH details a series of policy actions and investments to achieve optimal health for all people in all communities. Recommendations include:

  • Substantially increase funding for the CDC, particularly in areas of community prevention, public health emergency preparedness and response, surveillance and data, healthy aging, and social determinants of health
  • Increase state and local investments in public health, prioritizing social determinants
  • Work across sectors to improve effectiveness and efficiency of public health investments

Given ongoing and emerging threats to the public’s health and safety, TFAH urges adequate investments into federal, state, and local public health systems and infrastructure. The full report, “Impact of Chronic Underfunding of America’s Public Health System: Trends, Risk, and Recommendations, 2019,” is available here.

Local Jurisdictions File Suit Over Cannabis Delivery Regulations

Earlier this month, 24 cities, and the County of Santa Cruz, filed suit in Fresno County Superior Court against the California Bureau of Cannabis Control (BCC) in response to the BCC’s adoption of regulations that allow for state-licensed cannabis firms to deliver their products to any physical address in California, including in cities and counties that have opted to not allow commercial cannabis activity within their jurisdictions. The lawsuit asks the court to rule on the state regulations because they are “inconsistent with the statutory authority of local jurisdictions to regulate or prohibit the delivery of commercial marijuana to a physical address within their boundaries.” To date, 161 of California’s 482 cities, have allowed commercial cannabis activity along with 24 of California’s 58 counties.

Also of note, Assembly Member Ken Cooley introduced AB 1530 to allow local jurisdictions to ban or restrict the delivery of cannabis within their jurisdictions; however, the bill failed passage in the Assembly Business and Professions Committee earlier this month on a split vote with a third of the committee members voting in favor of the measure, a third voting against the measure, and a third not recording a vote. The bill is likely dead for the year.

Community Reinvestment Grant Solicitation and Application Released

Earlier this week, the Governor’s Office of Business and Economic Development (GO-Biz) released the application for the first round of the California Community Reinvestment Grants (CalCRG). Recall, these funds from Proposition 64 (Adult Use of Marijuana Act) are directed to local health departments and community-based organizations to provide grants to support activities such as job placement, system navigation services, and linkages to medical care, for communities disproportionately affected by past federal and state drug policies. A total of $9.6 million is available for FY 2018-19, and awardees will have two years (August 2019-July 2021) to expend funds. Applications are due to GO-Biz on Thursday, May 16, and more information on the grant solicitation can be found here.

CHCF Features Work of WPC Pilots Through Papers, Video

The California Health Care Foundation (CHCF) recently released several resources related to California’s Whole Person Care (WPC) Pilots and their intensive work to coordinate physical health, behavioral health, and social services for Medi-Cal enrollees with the most complex health conditions. The WPC Pilots are part of Medi-Cal’s 1115 Waiver and seek to deliver comprehensive services and supports to individuals who are homeless, frequently visit emergency departments, or were recently released from jail or prison. 25 pilots are currently operating in the state with an enrollment of over 108,000 people as of December 2018.

CHCF recently published two papers related to the pilots’ progress to date:

Additionally, Marin County produced a short video on its WPC Pilot, providing a sense of services delivered, local impacts, and entities involved. The video is available here.

CSAC Solicits 2019 Challenge Awards Nominations for County Best Practices

The California State Association of Counties (CSAC) recently issued its solicitation for the 2019 Challenge Awards Competition which seeks to recognize the unique and creative spirit of California county governments as they find innovative, effective, and cost-saving ways to deliver programs and services to their residents. Awards are broken down by various issue areas, including health and human services, and jurisdiction population sizes. Entries are due by Friday, June 21. Additional information is available here.