CHEAC Staff wishes all a very happy holidays and joyous new year! The CHEAC Office will be closed December 25 and January 1, and staff availability will be limited over the next two weeks. The CHEAC Weekly Update will take a brief hiatus during this time and will resume publication during the week of January 6, 2020.
December 20, 2019 Edition
Governor Gavin Newsom on Wednesday announced the launch of the Healthy California for All Commission and appointed his commissioners to the group, consisting of health experts in business, philanthropy, academia, and labor. Recall, the Healthy California for All Commission was created as part of the 2019-20 Budget Act and is tasked with developing a plan for advancing progress toward achieving a health care delivery system for California that provides coverage and access through a unified financing system, including, but not limited to a single payer financing system. The Commission must prepare an initial report to the Governor and Legislature by July 2020 with a final report due in February 2021. The first Commission meeting will take place on January 27 in Sacramento.
The Commission consists of 13 voting members – eight appointed by the Governor and four appointed by the Legislature – and includes California Health and Human Services Secretary Dr. Mark Ghaly who will serve as the chair of the Commission. The Commission also has five ex-officio, non-voting members.
Members of the Healthy California for All Commission are:
- Carmen Comsti, Regulatory Policy Specialist at the California Nurses Association and National Nurses United
- Jennie Hansen, Independent Consultant at Hirsch and Associates, LLC
- Sandra Hernandez, President and Chief Executive Officer of the California Health Care Foundation (CHCF)
- William Hsiao, Research Professor of Economics at Harvard University
- Rupa Marya, Associate Professor of Medicine at the University of California, San Francisco (UCSF)
- Robert Ross, President and Chief Executive Officer of The California Endowment
- Richard Scheffler, Professor of Health Economics and Public Policy at University of California, Berkeley
- Andy Schneider, Research Professor of Practice at the Georgetown University Center for Children and Families
- Sara Flocks, Policy Coordinator at the California Labor Federation (Senate)
- Janice Rocco, Deputy Commissioner of Health Policy and Reform at the California Department of Insurance (Senate)
- Antonia Hernandez, Chief Executive Officer of the California Community Foundation (Assembly)
- Anthony Wright, Executive Director of Health Access (Assembly)
- Richard Figueroa, Acting Director of the Department of Health Care Services (DHCS)
- Peter Lee, Executive Director of Covered California
- Don Moulds, Chief Health Director of CalPERS
- Senator Richard Pan, Chair of the Senate Health Committee
- Assembly Member Jim Wood, Chair of the Assembly Health Committee
In announcing the launch of the Commission, the Office of Governor Newsom touted the Governor and Legislature’s actions to move California closer to universal health coverage by expanding coverage, increasing Covered California subsidies, and taking on rising prescription drug prices. Additional information from the Governor’s Office is available here.
This week, the Department of Health Care Services (DHCS) announced its selection of 30 individuals for the Medi-Cal Rx Advisory Workgroup. Recall, Governor Gavin Newsom earlier this year issued an executive order directing various state agencies to achieve cost-savings for drug purchases made by the State of California. Under the order, DHCS is tasked with transitioning all Medi-Cal pharmacy services from managed care to fee-for-service by January 1, 2021.
The DHCS Medi-Cal Rx Advisory Workgroup will meet in-person seven times between January 2020 and April 2021 to help facilitate and further inform DHCS’ ongoing Medi-Cal Rx implementation efforts. Workgroup members represent various organizations and entities, including hospitals, clinics, health plans, counties, pharmacies, tribal health programs, consumer advocates, and others. The full workgroup membership list is available here. The workgroup will primarily focus and provide input on:
- Roles and responsibilities of DHCS, the Medi-Cal Rx Contractor, and Medi-Cal Managed Care Plans
- DHCS’ implementation strategies, tools, and timelines, including but not limited to, provider education and outreach and beneficiary notifications
- Medi-Cal pharmacy policy development, which will include the scope of the carve-out, prior authorization, and utilization management protocols
- Changes to existing Medi-Cal pharmacy committees
DHCS will also conduct three larger Medi-Cal Rx Public Forums in-person and via webinar, which will be one hour and length and provide status updates to help ensure that the broader stakeholder community is kept up to date about the Medi-Cal Rx implementation activities and timelines. DHCS will only take questions and comments from those participants attending in-person. All interested organizations and entities are invited to participate. The public forums will be held on February 18, 2020, June 17, 2020, and December 9, 2020. Additional information and reminder notices will be provided as each date nears, and a final agenda will be provided at least 10 days in advance of each meeting.
Additional information on the DHCS Medi-Cal Rx initiative is available here.
Covered California Details New Enrollment Data, Reports on Five Years of Improving Affordability and Access
On Wednesday, Covered California released new data detailing open enrollment figures for the 2020 coverage year, revealing that 230,000 Californians have selected a plan as of December 16. This figure represents an increase of approximately 16 percent compared to last year’s open enrollment period at this point in time. More than 1.15 million existing consumers have renewed their plans for the upcoming year, giving Covered California approximately 1.38 million plan selections for 2020. Notably, Covered California is only halfway through its open enrollment period and continues processing renewals; a full accounting and comparison of data will be available after open enrollment closes on January 31, 2020.
For the 2020 coverage year, California will be providing additional financial assistance to eligible consumers, becoming the first state to offer subsidies to many middle-income consumers who have previously not qualified for such assistance. More than 540,000 individuals have been determined eligible for the new state subsidy, including approximately 28,000 in the middle-income range of 400 to 600 percent of the federal poverty level (FPL).
As part of its preliminary data release, Covered California also released two new reports detailing how California has leveraged all available aspects of the Affordable Care Act (ACA) to benefit millions of California residents. The first report, “Covered California’s First Five Years: Improving Access, Affordability, and Accountability,” highlights key strategies by Covered California and the State of California to hold health insurance companies accountable, lower costs, and further build on the ACA. The second report, “Covered California Holding Health Plans Accountable for Quality and Delivery System Reform,” summarizes how the 11 health insurance companies with which Covered California contracts met contractual requirements imposed on them to foster better quality, healthier populations, and lower costs, with particular attention to health equity and their efforts to promote changes in how health care is delivered. A supplemental chart pack further details key actions and impacts of Covered California’s work.
According to Covered California, the reports show how California has implemented the ACA – by expanding Medicaid and establishing a state-based marketplace – and has gone beyond the law by providing state-funded subsidies and restoring the individual mandate. Additional information is available here.
This week, Congress approved final federal appropriations packages for Fiscal Year 2020, which officially began on October 1, 2019. Totaling $1.4 trillion, all of the various appropriations bills were bundled into two separate “minibus” packages – one is for most domestic programs and priorities (plus international assistance) and the other is for national security and commerce and treasury programs and priorities.
Both Congressional Republicans and Democrats made several significant concessions in reaching a final agreement, notably with Republicans securing more funding for national security-related issues and Democrats securing increased funding for domestic programs. Under the new spending plan, federal spending increased by $50 billion in new investments compared to FY 2019. President Donald Trump indicated he will sign the measures by the end of the day today, preventing a federal government shutdown when current funding expires at midnight tonight.
High-level health related issues that were addressed in the agreement include increasing the smoking age to 21 nationwide, the repeal of three Affordable Care Act (ACA) related tax provisions (medical device, Cadillac health plan, and fees on health insurers), and funding for gun-related violence research.
Of particular note to local health departments, the spending package includes:
- $50 million to support modernizing public health data surveillance and analytics at the U.S. Centers for Disease Control and Prevention (CDC), as well as state and local health departments. Funding is to be used to update antiquated data reporting to a common data platform that will enable the nation’s public health workforce to use real-time data to predict and prevent public health threats in the future.
- $140 million to the CDC for Ending the HIV Epidemic activities.
- $70 million to bolster the Ryan White HIV/AIDS program with funds distributed to high-need jurisdictions. The overall Ryan White program will be funded at $2.4 billion, representing an increase of $70 million from FY 2019. An additional $50 million will be directed to health centers in high-need jurisdictions to increase the use of PrEP among high-risk groups.
- $476 million in continued funding for opioid abuse and overdose prevention with the CDC directed to continue funding to states for their prevention and surveillance activities.
- $616 million for the 317 Immunization Grants Program, an increase of $5 million from FY 2019, to help assist efforts in combating increased infections of vaccine-preventable diseases such as measles.
- $230 million to address tobacco and electronic cigarettes, an increase of $20 million from FY 2019. Funding is to be targeted to state and local health departments so they will be able to direct adequate resources to stem the tide of youth use of electronic cigarettes.
- $675 million for the Public Health Emergency Preparedness program (same as FY 2019).
- $276 million for the Hospital Preparedness program, an increase of $11 million from FY 2019.
- $12.5 million directed to the National Institutes of Health to conduct research on firearm injury and mortality prevention.
A statement regarding the appropriations measures from the National Association of County and City Health Officials (NACCHO) is available here.
Federal Appeals Court Finds ACA Individual Mandate Unconstitutional, Sends Case Back to Lower Court for Further Study
The U.S. Court of Appeals for the Fifth Circuit in New Orleans on Wednesday struck down the Affordable Care Act’s individual mandate, ruling on a 2-1 vote that the coverage requirement was unconstitutional after Congress in 2017 eliminated the tax penalty that was intended to enforce it. Despite ruling against a core component of the ACA, the Appellate Court panel did not invalidate the rest of the law, allowing it to stand while U.S. District Court Judge Reed O’Connor of Texas was ordered to “employ a finer-toothed comb” and conduct “a more searching inquiry” into which of the law’s components could survive without the individual mandate.
Recall, District Judge O’Connor in December 2018 struck down the entire ACA on the grounds that the individual health insurance mandate could not be severed from the rest of the law because it was “the keystone” to the broader act. Judge O’Connor shortly afterward issued a stay on his ruling while the ruling was challenged by a 21 state coalition led by California Attorney General Xavier Becerra. Wednesday’s ruling by the Fifth Circuit Court of Appeals further places the ACA in limbo as the severability assignment given to the lower court in Texas is expected to take an extended amount of time and likely stretch beyond the 2020 election.
Citing concerns with leaving millions of Americans in limbo regarding their health care, Attorney General Becerra on Wednesday suggested California may be poised to immediately appeal Wednesday’s decision to the U.S. Supreme Court. “It’s time to get rid of the uncertainty,” Becerra remarked following the ruling. “Americans don’t need to be jerked around when it comes to their health care.” During a call with the public on Thursday, Becerra further discussed the possibility of filing with the Supreme Court to have the matter heard this coming spring for a summer ruling.
If the Supreme Court – which has twice upheld the ACA since its enactment in 2010, albeit under a different judicial makeup – were to agree with the Fifth Circuit Court of Appeals on the matter, the decision could have massive and far-reaching implications for the country’s health care delivery system, industry, and economy. Becerra noted in an announcement these potential impacts, including the nearly $1.3 trillion in federal funding (including Medicaid expansion and public health funds), how the ACA has assisted more than 12 million Americans receive coverage through Medicaid expansion, 9 million Americans receive tax credits to afford insurance through individual marketplaces, and millions of working families who rely on high-quality employer-sponsored insurance plans.
For now, the case heads back to the district court that already attempted to overturn the law in its entirety, and uncertainty on the matter is expected to persist for the foreseeable future. While California and the broader coalition of states attempting to preserve the ACA have yet to formally file a motion on Wednesday’s ruling, the matter is all but certain to be a significant topic of interest in the new year.
The U.S. Senate recently confirmed Stephen Hahn, M.D. as the 24th Commissioner of the U.S. Food and Drug Administration (FDA). Hahn was confirmed by the Senate on a 72-18 vote. Hahn was previously a professor of radiation oncology and the chief medical officer of the University of Texas MD Anderson Cancer Center and had not previously served in any official government capacity.
During his confirmation hearing, Hahn faced a series of questioning from Senators on whether he intended to finalize the FDA’s proposed ban on the sale of flavored electronic cigarette products. Hahn ultimately did not commit to finalizing the ban, but indicated the urgency and importance of the issue, remarking, “I very much agree and support that aggressive action needs to be taken to protect our children.”
As FDA Commissioner, Hahn is expected to face a number of pressing public health- and health-related issues, including on topics such as opioids, prescription drug pricing, regulation of food and dietary supplements containing CBD, and food safety standards, among others. Additional information on Hahn is available here.
The Center at the Sierra Health Foundation recently announced a request for applications (RFA) for $20 million in funding and technical assistance for organizations that are developing or increasing community substance use disorder (SUD) prevention, outreach, and education focused on youth. The Center was awarded the California Department of Health Care Services (DHCS) Proposition 64 Youth Substance Use Disorder Prevention Program contract and seeks to prioritize youth education, prevention, and early intervention efforts to connect youth and their families to programs that include wraparound care in communities disproportionately harmed by past and current drug policies and criminalized for SUD.
Grants of up to $1 million per project will fund organizations working with youth ages 12 to 26 years old in urban and rural areas of the state, particularly communities of color disproportionately impacted by the war drugs. Funding will support projects through November 2022. Eligible organizations applying for funding must take the following approaches: 1) Invest in youth leadership and development; 2) Provide services and support through the cultural lens of the impacted community; and 3) Promote population-level impacts through policy, systems, and environmental change (PSE).
A webinar for prospective applicants to review the RFA will be held on Friday, January 10 from 10:00 am to 11:30 am. Applications are due by Thursday, February 6 at 1:00 pm. The full RFA is available here. Additional information on the funding opportunity, including webinar registration, is available here.
The San Francisco Department of Public Health (SFDPH) recently produced a video providing a brief overview of the role and work of their department’s environmental health inspectors. The video covers the wide array of aspects and settings of the job, as well as the skills and education needed to become an inspector. Check out the video available here.