April 29, 2022 Edition

Policy Committees Meet Fiscal Bill Deadline, Face Non-Fiscal Bill Deadline Next Week

Policy committees of the California State Senate and Assembly today met the deadline to hear and report to fiscal committees measures with a fiscal impact. Policy committees next week will face a similar deadline to hear and report to the floor bills without a fiscal impact.

Below, we highlight actions on several measures of interest to CHEAC Members.

Communicable Disease Control

AB 2516 (Aguiar-Curry) as amended April 18, 2022 – SUPPORT

Assembly Member Cecilia Aguiar-Curry’s AB 2516 would require health insurance and plan coverage for the Human Papillomavirus (HPV) vaccine for persons for whom the vaccine is FDA approved. The bill was heard in the Assembly Health Committee this week and advanced to the Assembly Appropriations Committee on a 12-1 vote with two members not voting.

SB 1479 (Pan) as amended April 4, 2022 – SUPPORT

SB 1479 by Senator Richard Pan would require CDPH to coordinate COVID-19 testing in local educational agencies, preschools, and childcare centers. The bill was heard in the Senate Education Committee on Wednesday and was advanced to the Senate Appropriations Committee on a 5-2 vote.

Environmental Health

AB 1737 (Holden) as amended April 20, 2022 – OPPOSE

Assembly Member Chris Holden’s AB 1737 would establish a statewide regulatory structure for children’s camps to be administered by local agencies. The measure was heard in the Assembly Public Safety Committee on Tuesday and was passed to the Assembly Appropriations Committee on a 5-0 vote with two members not voting.

Injury Prevention

AB 1929 (Gabriel) as amended March 15, 2022 – SUPPORT

AB 1929 by Assembly Member Jesse Gabriel would require DHCS to establish a community violence prevention and recovery program under which violence preventive services would be provided as a covered benefit in the Medi-Cal program. The measure was heard in the Assembly Health Committee on Monday and advanced to the Assembly Appropriations Committee on a 13-0 vote with two members not voting.

Health Coverage

AB 1995 (Arambula) as amended March 24, 2022 – SUPPORT

Assembly Member Joaquin Arambula’s AB 1995 would eliminate Medi-Cal premiums and subscriber contributions for children, pregnant or postpartum women, and individuals with disabilities. The measure was heard in the Assembly Appropriations Committee this week and was placed on the Suspense File for consideration at a later date.

Public Health Emergency Preparedness

AB 2546 (Nazarian) as amended April 28, 2022 – WATCH

Assembly Member Adrin Nazarian’s AB 2546 was heard in the Assembly Health Committee this week and passed to the Assembly Appropriations Committee on a 14-0 vote with one member not voting. Amendments taken by the author from the Assembly Health Committee addressed CHEAC’s opposition relative to the curtailment of public health authorities.

Senate Democrats Issue 2022 Budget Plan

This week, ahead of the Governor’s May Revise, the California State Senate Democrats issued their 2022-23 Budget Plan, “Putting California’s Wealth to Work for a More Equitable Economy.” The plan highlights priority investments for the state in consideration of the state’s rebounding economy. The overall goals of the Senate Democrats are to build an equitable economy using California’s wealth to support middle class and struggling families.

The Putting Wealth to Work plan includes the following priorities:

Public Health and Healthcare: The plan includes significant investments to expand access, increase affordability, and improve the quality of health care and health services statewide. Notably, the plan includes $750 million for to public health infrastructure; additional details on this amount were not provided. On the health care front, the plan calls for funding to make health care more affordable for middle income Californians, accelerate the expansion of full-scope Medi-Cal coverage for all regardless of immigration status, and provide continuous Medi-Cal coverage for all children ages 0-5.

$18 Billion for Combating Climate Change: The plan includes funding to combat various climate concerns including water resiliency and drought, wildfires, protecting communities and natural resources, offsetting impacts on disadvantaged communities due to climate change, clean energy projects, and utilizing nature to fight against climate change.

$1.6 Billion to Assist Struggling Californians: The plan includes funding for the reduction or prevention of children living in deep poverty, improved foster care, senior, and disabled support, food assistance programs, changes to child support rules, and tax breaks.

$3 Billion to Combat Homelessness: The plan includes increased funding for Project Homekey and Homeless Housing, Assistance and Prevention (HHAP) Grant, and funding for the Encampment Resolution Program.

$955 Million to Improve Public Safety and the Judicial System: The plan includes funding to support victims of crimes, prevent homelessness and reduce crime and recidivism, and ensure equitable access to justice.

$10.6 Billion to Strengthen California’s Workforce: The plan includes funding for workforce development for students of color and low-income communities, behavioral health workers, childcare workers, nursing home workers, and the re-entry population. It also includes funding to support women/nonbinary individuals in the department of Industrial Relations.

Budget & Fiscal Review Subcommittee No. 3 also highlighted a priority to provide ongoing funding for the Health Equity and Racial Justice Fund.

For additional details, the full Senate Democrat Budget Plan is available here.

LAO Warns of Fiscal Challenges in Out-Years

This week, California Legislative Analyst Gabriel Petek issued a post warning of potential state budget problems in coming years despite California’s persistent strong state tax collections. The LAO recently conducted a fiscal analysis of 10,000 possible revenue scenarios, finding that in 95 percent of its simulations, the state encountered a budget problem at fiscal year 2025-26. Notably, the likelihood of a budget of a budget problem is unaffected by the future trajectory of state tax revenues.

The LAO notes that continued revenue growth could increase the state’s constitutional funding obligations enough to cause large recurring deficits. With the state reaching the state appropriations limit (SAL), each additional dollar of revenue must be allocated consistent with SAL requirements, generally making them unavailable to fund baseline expenditures.

Additionally, the state must also continue to spend required amounts on education and reserve and debt payments. Combined, the LAO estimates that for every dollar of tax revenue above the SAL, the state faces approximately $1.60 in constitutional funding obligations. Based on scenario analysis, if revenues exceeded median expected growth, SAL requirements could reach $20 billion to $45 billion by 2025-26. Therefore, each additional dollar of revenue above the limit worsens the state budget outlook.

In response to this outlook, the LAO recommends that the Legislature consider rejecting the bulk of the Governor’s $10 billion in non-SAL-excludable budget proposals. The LAO further notes that rejecting proposed spending alone, even in favor of SAL-excludable outlays, likely would be insufficient since constitutional obligations would accumulate faster than incoming revenue in future years. Therefore, the LAO suggests that the Legislature hold unspent funds in reserve to help pay for the state’s anticipated SAL-related obligations. Longer-term, lawmakers will likely need to weigh fundamental questions about the size of state government and whether to seek a voter-approved amendment to Proposition 4, which enacted the SAL.

The LAO offers commentary on economic conditions in California and the country, ultimately calling for budget resilience-enhancing actions in the immediate term. The LAO notes that the Governor’s budget plan is “not a fiscally sustainable starting point” considering Department of Finance (DOF) estimates indicating negative balances in state discretionary reserves from 2023-24 through 2025-26.

The full post from the LAO is available here.

California Issues Extreme Heat Action Plan

This week, Governor Gavin Newsom announced the state has released its Extreme Heat Action Plan, outlining a strategic and comprehensive set of state actions to adapt and strengthen resilience to extreme heat.

With the launch of the Extreme Heat Action Plan, the Newsom Administration is announcing an all-of-government approach to address extreme heat across four action areas:

  • Building Public Awareness and Notification
  • Strengthening Community Services and Response
  • Increasing Resilience of the Built Environment
  • Utilizing Nature-Based Solutions

The full Extreme Heat Action Plan is accessible here.

CDC Issues Health Alert on COVID-19 Therapeutics Availability

The Centers for Disease Control and Prevention (CDC) this week issued a nationwide health alert to update health care providers, public health departments, and the public about the availability and use of recommended therapies for COVID-19 and to advise against using unproven treatments that have known or potential harms for outpatients with mild to moderate COVID-19.

The CDC notes that for patients with mild to moderate COVID-19 who are not hospitalized and who are at an increased risk for severe COVID-19 outcomes, several treatment options, including antiviral medications and monoclonal antibodies, are now widely available and accessible. According to the CDC, systemic corticosteroids are not recommended to treat patients with mild to moderate COVID-19 who do not require supplemental oxygen. Antibacterial therapy is also not recommended for COVID-19 in the absence of another indication.

Notably, the CDC urges that staying up to date with COVID-19 vaccination is still the best way to prevent serious outcomes of COVID-19, including severe disease, hospitalization, and death.

The full CDC Health Alert is available here.

Moderna Seeks EUA for COVID-19 Vaccine for Children Under Six Years Old

On Thursday, Moderna announced it is requesting a formal emergency use authorization (EUA) from the U.S. Food and Drug Administration (FDA) for its mRNA COVID-19 vaccine for use in children ages six months to under six years. Moderna seeks an EUA for a low-dose version of its vaccine based on a study of approximately 6,700 children finding that two doses of the vaccine administered 28 days apart to children under six years old triggered levels of antibodies equivalent to those seen in older children and adults.

The vaccine appears to be approximately 51 percent effective for children ages six months to less than two years, and 37 percent effective for those ages two to less than six years. Company officials indicate that while the level of effectiveness is lower than anticipated, it is not surprising given the study was conducted when Omicron became the dominant variant.

Recall, earlier this year, Pfizer-BioNTech sought an EUA from the FDA for its COVID-19 vaccine for young children under five years old. However, after new data emerged indicating two doses of vaccine were ineffective, the FDA Vaccines and Related Biological Products Advisory Committee (VRBPAC) postponed its consideration of the request.

The FDA is anticipated to consider Moderna’s request over the coming weeks. Additional information is available here.

FDA Proposes Rules Prohibiting Menthol Cigarettes and Flavored Cigars

This week, the U.S. Food and Drug Administration (FDA) unveiled two proposed product standards to prohibit menthol as a characterizing flavor in cigarettes and to prohibit all characterizing flavors (other than tobacco) in cigars. According to the FDA, these actions have the potential to significantly reduce disease and death from combusted tobacco product use, the leading cause of preventable death in the U.S., by reducing youth experimentation and addiction, and increasing the number of smokers that quit.

The FDA’s proposed regulations will only address manufacturers, distributors, wholesalers, importers, and retailers who manufacture, distribute, or sell such products. The proposed regulations do not include a prohibition on individual consumer possession or use.

Beginning May 4, 2022, the public can provide comments on the proposed rules. The FDA will also convene public listening sessions on June 13 and June 15 to expand direct engagement with the public, including affected communities.

Additional information is available here.

2022 County Health Rankings Released

County Health Rankings & Roadmaps (CHR&R), supported by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, this week released its 2022 County Health Rankings, providing a county-by-county examination of health statuses and conditions.

As the country recovers from the COVID-19 pandemic and crises of racism and economic exclusion, CHR&R underscores the importance of advancing a just recovery, working together for fair and living wages, and creating community conditions for families to thrive. CHR&R indicates the COVID-19 pandemic highlighted the interdependence of public health, community and economic development, and education sectors and calls for action to strengthen relationships across sectors to advance economic security and health for all.

The full 2022 County Health Rankings National Findings report is available here. County-by-county health rankings are available here.

2020 Forces of Change Report Issued by NACCHO

This week, the National Association of County and City Health Officials (NACCHO) released a report on its 2020 Forces of Change survey, which focused on effects to local health department infrastructure caused by the COVID-19 pandemic. More than half of local health departments reported their leaders and staff were targets of harassment in response to COVID-19 protection measures during the first year of the pandemic. The survey also found strained financial and staffing capacities hindered a robust response to COVID-19, forcing health departments to suspend public health services and exacerbating existing health inequities.

The 2020 Forces of Change report provides one of the only mid-pandemic examinations of circumstances surrounding the local public health response to COVID-19. The full report is available here. An infographic of the report’s findings is available here.

NACCHO Awards $2.3 Million in Infectious Disease Prevention Funding

The National Association of County and City Health Officials (NACCHO), with support from the Centers for Disease Control and Prevention (CDC) Division of Healthcare Quality and Promotion, has awarded a total of more than $2 million to 24 local health departments nationwide through the Building Local Operational Capacity for COVID-19, Healthcare Associated Infections, and Antimicrobial Resistance (BLOC COVID-19 +) Project.

Included in the awardees are the Alameda County Health Care Services Agency, Fresno County Public Health Department, and the San Diego County Health and Human Services Agency – Public Health Services.

Additional information is available here.

NACCHO Older Adult Falls Prevention Project Seeks LHDs

The National Association of County and City Health Officials (NACCHO), with support from the Centers for Disease Control and Prevention (CDC), continues its work on “Developing the Capacity to Support Older Adult Fall Prevention” project, which is designed to assist local health departments identify older adults at high risk for falls, increase awareness about fall risk and prevention among older adults, and partner with community and clinical resources to support fall prevention efforts.

NACCHO is seeking local health departments to participate in a “pilot process” to inform the creation of a guide intended to help local health departments plan and implement older adult clinical fall prevention programs. Potential participants should be interested in building a new clinical fall prevention program or expanding current programs to include screening, assessments, and interventions with clinical partners.

For additional information and to express interest in participating, local health departments should contact the NACCHO Injury and Violence Prevention Team at IVP@NACCHO.org by May 6. NACCHO will select up to five local health departments to participate.

UCLA CHPR Explores Future of Health and Wellness in California

The University of California, Los Angeles (UCLA) Center for Health Policy Research (CHPR) recently issued a research report examining the state of modern health and health care in California, the historical policy decisions and societal shifts that created the current situation, and trends influencing change in the existing health care environment. The CHPR report examines seven topic areas, including: 1) health systems and public programs; 2) insurance coverage and markets; 3) environmental influences; 4) chronic conditions and mental health; 5) child and adolescent health; 6) aging residents; and 7) racial justice and immigrant populations.

The UCLA research team assessed actions by California to ensure that all people have reasonably equal access to covered services and to ensure population health equity into the future. Researchers studied potential future scenarios and how each may be impacted by the resilience of the population, technological advancements, civic response to proposed and real changes, sustainability of changes in the long-term, and considerations of equity.

Researchers found that two factors that affect future health is whether state leaders will define “health” in broad or narrow terms and whether health care delivery systems are interoperable. Depending on those definitions and which systems will operate well together, California has four possible health system scenarios in the future:

  • Scenario 1: Patchwork of well-being – More than just clinical care limited to an individual, this localized health system recognizes factors that lead to health disparities and supports connections between housing, education, employment, and health at the community level.
  • Scenario 2: Uniform health and wellness – In this system, health and wellness include an understanding of the social determinants of health and are scaled for the whole state population. Health is highly integrated with social needs such as housing or education, and there is little regional variation in health and social services systems.
  • Scenario 3: Sickness systems – Health care focuses on clinical care for sick individuals and emphasizes individual responsibility for health. There is little integration of specialty or primary care, limited focus on prevention, and no larger interest in community health.
  • Scenario 4: Effective sickness system – Health care focuses on individualized care. A one-stop shop for all health care needs, this approach emphasizes clinical care solutions and individual responsibility to improve health outcomes rather than addressing community-level health disparities and inequities.

The research was conducted as part of the California 100 Initiative which seeks to move California toward an aspirational vision by changing policies, practices, attitudes, and mindsets to inspire a more vibrant future.

Additional information is available here.