December 20, 2019 Edition
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.
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:
Gubernatorial
Appointees
- 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
Legislative
Appointees
- 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)
Ex-Officio
Members
- 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.
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.
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.