April 26, 2019 Edition
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.
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.
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.
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.
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.
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.
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.
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.
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.