December 22, 2017 Edition
CHEAC Staff wishes everyone a very happy holidays and happy new year! The CHEAC Office will be closed on Monday, December 25, Tuesday, December 26, and Monday, January 1. Staff availability will be limited next week. Our CHEAC Weekly Update will not be distributed next week and will resume the week of January 1, 2018.
This morning, President Donald Trump signed into law a sweeping $1.5 trillion tax reform measure. After entering into conference committee to finalize the measure last week, Congressional Republicans secured enough votes for the measure to gain passage in the House and Senate on Tuesday and Wednesday. On Wednesday afternoon, President Trump hosted Congressional Republicans at the White House for a celebration of the passage of the measure.
H.R. 1, the Tax Cuts and Jobs Act, significantly reduces tax rates and modifies credits and deductions for individuals and businesses. Notably, the corporate tax rate is permanently reduced from 35 percent to 21 percent; individual tax rates are reduced temporarily.
On Monday, the Joint Committee on Taxation (JCT) released its analysis which found that approximately 23 percent of tax cuts for individuals included in the bill would go to those in the middle class. Over the next decade, however, those same individuals would see their taxes rise.
Also according to the analysis, middle class taxpayers (about half of the people filing taxes in the U.S.) would receive about $61 billion in tax cuts in 2019. Taxpayers making $500,000 or more (one percent of people filing taxes in the U.S.) would also receive $61 billion in tax cuts in 2019.
H.R. 1 includes a repeal of the Affordable Care Act (ACA) individual insurance coverage mandate tax penalty beginning in 2019. The Congressional Budget Office (CBO) previously estimated that with the elimination of the individual mandate, the number of uninsured Americans will increase by 13 million over the next decade. Average health insurance premiums are also expected to increase by 10 percent with the elimination of the mandate penalty.
As we previously reported, H.R. 1 threatens existing vital programs, including Medicare and the Prevention and Public Health Fund (PPHF). If Congress does not enact offsetting budgetary savings, the Statutory Pay-As-You-Go Act of 2010 (SPAYGO) will be triggered, resulting in massive automatic program funding cuts over the next ten years.
With the passage of H.R. 1, Congressional Republicans delivered on a long-promised legislative commitment. Congress has now adjourned for the December holidays and will return in early January where it faces several high-profile legislative battles in 2018.
Late this week, Congress passed another short-term government funding measure, once again narrowly avoiding a government shutdown. Recall, Congress passed a two-week funding measure on December 7 that extended current federal government funding levels through today, December 22. Congressional Republicans were left scrambling to piece together a funding measure earlier this week after placing much of their focus on the tax reform measure that was passed on Wednesday.
The stopgap spending bill that was passed in the House and Senate on Thursday extends current federal funding through January 19, 2018. The measure provides temporary funding extensions for a handful of programs, including, most notably, the Children’s Health Insurance Program (CHIP) and community health centers.
CHIP will receive $2.85 billion and community health centers and related programs will receive $550 million. Funding for CHIP and community health centers previously expired on September 30, 2017, and will now expire on March 31, 2018.
The temporary funding authorizations for CHIP and community health centers will be offset by cutting $750 million from Prevention and Public Health Fund (PPHF) between FY 2019 and FY 2022. At this time it is unclear what impact the PPHF cuts will have on the U.S. Centers for Disease Control and Prevention (CDC). The PPHF provides approximately 12 percent of the CDC’s yearly budget.
Given the delay by Congress to reauthorize CHIP funding, states and families throughout the country have been increasingly worried about the fate of the program. Several states, including Colorado, Utah, Connecticut, Alabama, and Virginia, had previously sent out notifications to families indicating that their coverage may be terminated at the end of January without a Congressional reauthorization.
California previously indicated that its funding would have run out in early January or perhaps even sooner without federal reauthorization. No coverage-loss notifications were sent to enrollees, largely because nearly all California CHIP beneficiaries were rolled into Medi-Cal for administrative purposes as part of the Affordable Care Act (ACA) Medicaid Expansion in 2014. California agreed with the federal government to keep these children enrolled in Medi-Cal through September 2019. Though, there remain in upward of 32,000 California children not included in the Medi-Cal arrangement that could be impacted without a long-term Congressional reauthorization.
This week’s temporary CHIP funding authorization provides states reprieve for several months, but it is reported that that the funds will likely be depleted before the end of March. The Centers for Medicare and Medicaid Services (CMS) recently released guidance indicating states are spending CHIP funds faster than initially projected.
Since CHIP’s previous expiration at the end of September, states have relied on supplemental federal funds and other sparse reserves to maintain CHIP. Despite this week’s temporary funding, states are likely to still brace for CHIP shutdowns in the spring. States and families throughout the country continue to highlight the need for a long-term funding authorization by Congress.
The House and Senate have agreed, in principle, on a five year extension of the CHIP program. However, there appears to be no consensus on how to fund the program. Congressional Republicans have proposed funding CHIP by cutting and modifying other health-related programs, including Prevention and Public Health Fund (PPHF) and Medicare. Congressional Democrats are opposed to using funds from other health programs to fund CHIP.
On other health-related matters, it was previously expected that Senate Republicans would include provisions in this week’s continuing resolution to address Affordable Care Act (ACA) marketplace stability with a measure from Senators Lamar Alexander (R-Tennessee) and Patty Murray (D-Washington) to fund cost-sharing reduction (CSR) payments to health insurers. A separate measure from Senators Susan Collins (R-Maine) and Bill Nelson (D-Florida) to provide reinsurance funding to help health insurers cover high-risk enrollees has also been proposed.
However, with limited time remaining before a government shutdown and disinterest among other Congressional Republicans, neither the CSR measure nor the reinsurance funding measure was offered as part of this week’s continuing resolution. Senators Collins and Alexander indicated they would take up their respective legislation upon their return after the holidays.
Congress notably declined to address a host of other pressing issues in the continuing resolution before recessing late Thursday. Upon their return in January, Congress will need to nearly immediately begin work on a full-year funding measure that will likely include provisions for fixes to the Affordable Care Act (ACA), a long-term CHIP reauthorization, immigration, national security, and defense spending, among other items.
Late Thursday, The U.S. House of Representatives passed an $81 billion disaster relief package to provide aid to communities impacted by hurricanes Florida, Puerto Rico, Texas, and the U.S. Virgin Islands, as well as wildfires in Northern and Southern California.
The House measure was met with resistance in the Senate Thursday evening, where Senate Republican leaders determined it would not be possible to gain a consensus to pass the measure before adjourning for the holidays. Senate Democrats also expressed concerns with the measure, largely citing inadequacies in assistance for Puerto Rico’s Medicaid program and provisions around potential tax increases in affected areas.
The House nearly doubled the amount of disaster relief funds in their bill compared to the White House’s request from last month. The House measure is now expected to sit for several weeks until Congress returns after the holidays.
Given a surge in consumer interest, Covered California extended the enrollment deadline through today, December 22, for health coverage that will begin on January 1, 2018. Over the last two weeks, Covered California has experienced a significant increase in new consumers signing up for coverage. Overall open enrollment figures compared to last year are also significantly higher.
Further, a recent analysis conducted by Covered California determined that net monthly premiums for enrollees who receive financial assistance are on average 10 percent lower than what new and renewing consumers paid last year.
While the deadline for coverage that will begin on January 1 is today, Californians will have until January 31, 2018, to enroll in coverage. For individuals that enroll after today, health insurance coverage will not start until February 1, 2018, at the earliest.
More information on Covered California’s extended deadlines and recent analyses is available here.
Nationally, nearly nine million people have signed up for health insurance coverage through December 15 through the HealthInsurance.gov marketplaces that operate in 39 states. Despite an open enrollment period that was reduced by half, as well as significant federal budget cuts to outreach and enrollment activities, this year’s enrollment numbers nearly match last year’s numbers, surpassing expectations.
More than 2.5 million Americans have enrolled in coverage in state-operated insurance marketplaces through December 15, many of which continue to allow individuals to sign up for coverage over the next several weeks.
The California Health and Human Services Agency is seeking feedback from stakeholders on the statewide Let’s Get Healthy initiative. In 2012, the Let’s Get Healthy Task Force adopted 10 year goals to improve the health and wellbeing of California. Six goal areas were developed and key indicators were identified to measure progress in these areas.
Since then, the California Health and Human Services Agency has been working with partners to advance the mission of Let’s Get Healthy, empower communities to innovate around population health challenges, and share best practices throughout the state.
Given that the Let’s Get Healthy initiative is approaching its five year milestone, the State is embarking on a “refresh” process to identify targeted areas of opportunity to optimize the initiative and ensure efforts are most effectively focused on improving health outcomes and reducing health disparities for all Californians.
You are invited to provide your early feedback through the Agency’s stakeholder input survey. The survey is open through January 12, 2018, and CHEAC Members are encouraged to share their feedback on the initiative’s progress.
The California Department of Public Health (CDPH) Prescription Drug Overdose Prevention Initiative is partnering with the Harm Reduction Coalition to hold a free, two-part webinar series about naloxone. Registration is requested by January 5, and information on the webinars is below:
Part I: Overdose Education and Naloxone Distribution
Tuesday, January 9, 10:00 am – 11:30 am
Part II: Implementing Naloxone Distribution Systems
Wednesday, January 10, 1:30 pm – 3:00 pm
The Trust for America’s Health released this week Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism. The report determined that the country does not invest sufficiently to maintain strong, basic core capabilities for public health security readiness, and, instead, is in a continuous state of inefficiently reacting with federal emergency supplemental funding packages following each disaster.
The report provides state-by-state scores of key indicators of public health preparedness, on which California scores a six out of 10. The report also details key recommendations, such as supporting sufficient emergency preparedness funding and a complementary public health emergency fund, supporting global health security, and strengthening health system preparedness.
More information is available here. The full report may be viewed here.
The National Academies of Science, Engineering, and Medicine (NASEM) recently released the report Strategies to Limit Sugar-Sweetened Beverage Consumption in Young Children. The report summarizes the presentations and discussions of a workshop convened earlier this year by NASEM’s Food and Nutrition Board. The report may be accessed here.
The American Public Health Association, in conjunction with Transportation for America, recently produced a guidebook on Partnering with Metropolitan Planning Organizations to Advance Health Communities. The guide is intended for public health practitioners as a primer for working across various sectors to create and foster environments that support physical activity and advance health equity. Included in the guide are strategies for working with local planning agencies and the transportation sector. The guide is available here.
The two organizations also produced a guide on Building Healthy and Prosperous Communities: How Metro Areas are Implementing More and Better Bicycling and Walking Projects. The guide details ways in which local governments are strategizing, developing, and implementing new ways to improve bicycling and walking in their jurisdictions. The guide is available here.