April 6, 2018 Edition

California Legislature Returns for a Busy April Season

The California Legislature returned to Sacramento after a week-long Spring Recess for what is already shaping out to be a busy April season as Legislators work to meet the April 27 deadline for fiscal bills to be passed by the policy committee of their house of origin. Key activities and bills of interest are provided below. For detailed information, please refer to this week’s version of the CHEAC Weekly Bill Chart.

Assembly Committee Changes. Assembly Speaker Anthony Rendon announced a series of committee changes to take effect immediately. For the Assembly Health Committee, Assembly Member Chad Mayes will replace Assembly Member Brian Maienschein as Vice Chair and Assembly Member Frank Bigelow will replace Assembly Member Marc Steinorth on the committee.

Latino Caucus Bill Package. The California Latino Caucus announced their priority legislation for 2018, which focuses on protecting the rights and improving the lives of all Californians and California communities. Their 20-bill legislative package includes the following bills:

  • SB 946 (Lara) Safe Sidewalk Vending Act
  • SB 974 (Lara) Health4All Adults
  • SB 1108 (Hernandez) Protecting Access to Medi-Cal Coverage
  • SB 1155 (Hueso) Language Accessibility in Courts
  • AB 1037 (Limón) CA Dreamer Service Incentive Grant Program
  • AB 1786 (Cervantes) Articulation Agreements for California Veterans
  • AB 1862 (Santiago & Carrillo) Funding for TPS Immigration Services
  • AB 1877 (Limón) Emergency Communication Translation
  • AB 1885 (E. Garcia) CA Resident Worker Program & Economic Stabilization Act
  • AB 1942 (Santiago) Earned Income Tax Credit
  • AB 2015 (Reyes) Assisting Students with FAFSA and Dream Act Applications
  • AB 2079 (Gonzalez Fletcher) Sexual Harassment Prevention for Janitorial Workers
  • AB 2372 (Gloria) CA’s Sustainable and Affordable (CASA) Housing Act
  • AB 2477 (Rubio & Low) Dream Resource Liaisons
  • AB 2514 (Thurmond) Grant Program for Dual Language Instruction
  • AB 2597 (Arambula) Programs in Medical Education (PRIME)
  • AB 2772 (Medina) Ethnic Studies
  • AB 2885 (Rodriguez) Zero Emission Vehicles Rebates in Disadvantaged Communities
  • AB 2887 (Aguiar-Curry) Farmworker Housing Centers
  • AB 3022 (Gonzalez Fletcher) Retroactive High School Diplomas for Deported Pupils

CHEAC Bills of Interest. Below, we highlight activity from this week related to several bills of interest to CHEAC Members:

Environmental Health

AB 626 (E. Garcia) as amended on April 2, 2018 – Oppose

Assembly Member Eduardo Garcia’s AB 626 was significantly amended in the Senate this week. The amends were largely related to enforcement, health, and sanitation provisions. Recall, the measure would create a new type of food facility define as “microenterprise home kitchens” in the California Retail Food Code. Individuals would be allowed to operate these entities in private home kitchens and sell potentially-hazardous foods. Local health and environmental health departments would be required to permit and inspect these entities.

Some of the most notable recent amends would allow on-site consumption of foods and exempt microenterprise home kitchens from a variety of health and sanitation requirements. Local enforcement agencies would not be allowed to impose food safety requirements different from or in addition to those included in the bill, would be required to provide reasonable advance notice for inspection visits, and would not be allowed to conduct more than one inspection per year (unless consumer complaints occur). The amends also specify that a microenterprise home kitchen permit issued by a county shall be valid in any city within the county regardless of whether the city has authorized such kitchens.

The CHEAC Legislative Committee and Executive Committee continue to analyze these most recent amends and their potential impact. CHEAC and our county partners, including HOAC, CSAC, UCC, and RCRC, continue to oppose the measure over increased risks of foodborne illness and increased regulatory and enforcement requirements beyond the scope and ability of local health and environmental health departments.

The measure has been referred to the Senate Health and Senate Judiciary Committees and is expected to be heard in June.

Health Coverage/Health Care Reform

AB 2430 (Arambula) as revised on April 4, 2018 – Support

AB 2430 by Assembly Member Joaquin Arambula was heard in Assembly Health Committee this week. The measure seeks to expand Medi-Cal eligibility for seniors or disabled individuals by changing the income eligibility from 100% FPL to 138% FPL. CHEAC supports the measure alongside a lengthy list of supporters. The measure was unanimously passed by the Assembly Health Committee and will be heard next in the Assembly Appropriations Committee.

SB 974 (Lara) as introduced on February 1, 2018 – Support

SB 974, by Senator Ricardo Lara and a priority bill for the California Latino Caucus, would expand full-scope Medi-Cal eligibility to undocumented adults with income at or below 138% FPL. The measure, sponsored by Health Access California and the California Immigrant Policy Center, is supported by a wealth of organizations representing labor, immigrant rights, clinics, and physicians among others. CHEAC has taken a support position on SB 974, which was passed by the Senate Health Committee on a partisan vote, with Republicans voting no. The measure now moves to the Senate Appropriations Committee.

Maternal, Child, and Adolescent Health Services

AB 2785 (Rubio) as amended on April 5, 2018 – Support

AB 2785 by Assembly Member Blanca Rubio would require all California Community Colleges and the California State University to provide reasonable accommodations on all campuses for a lactating student to express breastmilk, breastfeed an infant, or address other breastfeeding needs. The bill would also ensure that a student does not incur an academic penalty as a result of using these accommodations and that a student be provided an opportunity to make up missed work.

CHEAC supports AB 2785, which was passed by the Assembly Higher Education and now moves on to the Assembly Appropriations Committee.

Assembly Explores Adverse Childhood Experiences in Joint Informational Hearing

On Tuesday, the Assembly Budget Subcommittee No. 1 on Health and Human Services and the Assembly Budget Subcommittee No. 2 on Education Finance convened a joint hearing exploring Adverse Childhood Experiences (ACEs). The hearing, co-chaired by Assembly Members Arambula and McCarty, began with a panel of experts illustrating the impact of adverse childhood experiences and chronic stress on health, emotional well-being and development and sharing various approaches to addressing those impacts.

Dr. Nadine Burke Harris, a San Francisco pediatrician, founder and CEO of the Center for Youth Wellness and author of ‘The Deepest Well’, shared her personal experiences as a provider and how she personally explored the ties amongst health conditions her patients were experiencing and the environment in which they were living. She noted that 17 percent of Californians were living with four or more ACEs, which places those individuals at a higher risk for heard disease and is associated with seven of the ten leading causes of death.

Some of the interventions discussed included updating Medi-Cal health forms to screen for violence, food insecurity, housing instability and violence, in addition to building protective factors, bringing mental health services into schools, improving data collection, expanding ACEs, training educators, revisiting the cycle of violence and providing opportunities for interventions, and greater utilization of the EPSDT benefit.

CHEAC provided remarks during public comment to noting our desire to be engaged in future discussion around ACEs and the need to apply a prevention lens to the issue as well. CHEAC highlighted interventions already employed by local health departments, such as home visiting programs and domestic violence initiatives, which help prevent new ACEs in a child’s life.

Before concluding, Assembly Member Arambula again referenced Oprah’s 60 Minutes Interview and noted that addressing ACEs seems to address population health. ACEs are likely to be a growing topic of interest amongst the Legislature. The joint committee hearing agenda can be viewed here.

Healthy People 2020 Webinar Scheduled for Next Week, LA County Department of Public Health to Present

Healthy People 2020 will be holding a webinar on Tuesday, April 10 from 9:30 am to 11:00 am to review progress made in two Healthy People 2020 topic areas of public health infrastructure and preparedness. The webinar will cover strong organizations and resilient communities and will specifically feature the work of Los Angeles County Department of Public Health in collaborating with community partners to build public health infrastructure and preparedness capacity.

Additional information and webinar registration are available here.

U.S. Surgeon General Issues National Advisory on Naloxone Use and Availability

On Thursday, U.S. Surgeon General Jerome Adams issued a national public health advisory urging more Americans to keep on hand and learn how to use effectively the opioid antidote naloxone. While many first responders carry naloxone, the advisory suggests family, friends, and those who are personally at risk of an opioid overdose to ensure the antidote drug is readily available.

Since 2010, U.S. opioid overdose deaths have doubled from more than 21,000 to more than 42,000 in 2016, and the most significant increase has occurred among deaths related to illicit fentanyl and other synthetic opioids. Surgeon General Adams noted that an average of 115 Americans die per day due to opioid overdose, and the widespread availability and effective use of naloxone in overdose instances can save lives.

This is the first U.S. Surgeon General public health advisory issued since 2005, and the advisory comes as part of the Trump Administration’s broader ongoing effort to address the nationwide opioid epidemic. The Trump Administration has indicated naloxone availability and use is a key part of its response, along with prevention, treatment, recovery, and law enforcement strategies.

The full U.S. Surgeon General advisory is available here.

National Safety Council Releases White Paper on U.S. Opioid Epidemic

The U.S. National Safety Council this week released a report on the nationwide opioid epidemic titled, “Prescription Nation 2018.” The report highlights the rapidly rising opioid overdose epidemic, economic impacts of the overdoses, and recommended actions to address the crisis and save lives. State-by-state progress in responding to the epidemic and strengthening laws and regulations is also included in the report.

The report discusses major dimensions of the opioid crisis and identifies six state-based actions to adequately respond to the epidemic. These actions are:

  • Mandating prescriber education
  • Implementing opioid prescribing guidelines
  • Integrating prescription drug monitoring programs into clinical settings
  • Improving data collection and sharing
  • Treating opioid overdose
  • Increasing availability of opioid use disorder treatment

Additional information and the full NSC report are available here.

CDC Vital Signs Highlights Antibiotic Resistance

This month’s edition of the U.S. Centers for Disease Control and Prevention (CDC) Vital Signs report explores antibiotic resistance (AR) and public health strategies to address the ongoing threat of dangerous bacteria. Nationwide tests in 2017 identified 221 instances of unusual resistance genes in “nightmare bacteria” that render such infections virtually untreatable.

The CDC has taken a more aggressive approach to antibiotic resistance over the last year by establishing a nationwide network of laboratories and laboratory capacity to more quickly identify and respond to these types of bacteria. Working closely with state and local health departments, the CDC is now able to mobilize a rapid response to control and prevent the spread of dangerous bacteria, particularly in health care facilities. In fact, the CDC estimates that this aggressive approach could prevent 1,600 dangerous bacteria infections in one state over three years.

The Vital Signs report highlights the important work of state and local health departments in leading the CDC Containment Strategy and urges health care providers and facilities to act swiftly in collaboration with public health officials at the first sign of unusual antibiotic resistance.

The full CDC Vital Signs report is available here.

CalHPS Reentry Health Policy Project Releases Report, Recommendations, and Policy Briefs

California Health Policy Strategies (CalHPS) recently released a report and other materials on the health and behavioral health needs of prison and jail inmates returning from custody to their communities. With support from the California Health Care Foundation (CHCF) and L.A. Care, CalHPS has been engaged in research and recommendation development to improve the effectiveness of health and behavioral health programs serving prison and jail inmates, particularly formerly incarcerated individuals who are medically fragile and those living with serious mental illness (SMI).

The report finds that a growing portion of the criminal justice population experiences physical and mental health problems, including higher risk of death, aging-related issues, and serious mental health conditions. The report outlines a series of recommendations and next steps to ensuring those exiting the criminal justice system are able to reintegrate into their community, access necessary health and social services, and find housing.

The full CalHPS report is available here and an overview of key findings is available here. CalHPS has also developed a series of policy briefs and recommendations available here.

TFAH Publishes Report on Creating an Age-Friendly Public Health System

With support from The John A. Hartford Foundation, the Trust for America’s Health (TFAH) released a report titled, “Creating an Age-Friendly Public Health System: Challenges, Opportunities, and Next Steps.”

The report examines the role of public health in contributing to an age-friendly society and improving the health and well-being of older Americans. A public health framework to guide activities, interventions, and strategies is included in the report. The framework is centered on five key potential roles for public health:

  • Connecting and convening multiple sectors and professions that provide supports, services, and infrastructure to promote healthy aging
  • Coordinating existing supports and services to avoid duplication of efforts, identify gaps, and increase access to services and supports
  • Collecting data to assess community health status (including inequities) and aging population needs to inform the development of interventions
  • Conducting, communicating, and disseminating research findings and best practices to support healthy aging
  • Complementing and supplementing existing supports and services, particularly in terms of integrating clinical and population health approaches

The report points to the rapidly changing U.S. demographics in which individuals are living longer, but with complex chronic disease and other health-related needs, and the unique role and services public health offers to address such challenges. The full TFAH report is available here.

NASEM Publishes Workshop Proceedings on Tax Policy to Advance Population Health

This week, the National Academies on Science, Engineering, and Medicine (NASEM) released proceedings that chronicle the national workshop Exploring Tax Policy to Advance Population Health, Health Equity, and Economic Prosperity that was held in December 2017 in Oakland. The proceeding summarizes presentations and discussions during the one-day workshop related to the use of taxation and tax policy as a means to influence population health. The workshop covered a range of potential financing sources for various population health activities from obesity and diabetes prevention to universal pre-kindergarten.

The workshop proceedings document and materials are available here.