February 2, 2018 Edition

Many Two-Year Bills Meet Their Fate in Legislature

This Wednesday marked the deadline for the Legislature to advance bills introduced in 2017 out of their house of origin to keep them in play. Early this week, the Senate and Assembly moved a number of of two-year measures to the next house while leaving many more behind, rendering them dead bills. The Legislature continues with bill introductions and increasing committee activity in what is already shaping up to be a busy spring ahead.

There are a handful of public health-related informational hearings that have been scheduled for the coming weeks. These hearings include:

  • Assembly Select Committee on Health Care Delivery Systems and Universal Coverage
    • Monday, February 5 – Implementation Challenges for Universal Coverage
    • Wednesday, February 7 – Options for Universal Coverage
  • Assembly Committee on Environmental Safety and Toxic Materials
    • Tuesday, February 13 – Childhood Lead Poisoning Prevention Program and the Status of Testing Low-Income Children for Lead Exposure

Below, we detail several bills of interest to CHEAC Members. Our weekly CHEAC Bill Chart is available here.

Environmental Health

AB 626 (E. Garcia) as amended 01/22/2018 – Oppose

Assembly Member Eduardo Garcia’s AB 626 was passed out of the Assembly and to the Senate this week. The measure would create a new type of food facility defined as “microenterprise home kitchens” in the California Retail Food Code. Individuals would be allowed to operate these new entities in private home kitchens and sell potentially-hazardous food products. Local health departments would be required to permit and inspect these entities.

CHEAC and our county partners, including HOAC, CSAC, UCC, and RCRC, maintain a joint opposition to the measure over concerns of increased risks of foodborne illness and increased regulatory and enforcement measures beyond the scope and ability of local health departments. AB 626 will be assigned to a Senate policy committee in the coming weeks.

AB 1964 (Maienschein) as introduced 01/30/2018 – Pending

For several years, there have been legislative efforts to define “day camps” in statute under existing law for organized camps. CHEAC has opposed such efforts as an expansive new mandate on local health departments to regulate a broad new type of camp at the local level.

Assembly Member Brian Maienschien (San Diego) introduced a new Day Camps bill this week.  It mirrors previous efforts; however, it does include new language defining two types of day camps (Tier 1 and Tier 2) with the difference being between those camps providing food services and those not.

CHEAC’s Legislative Committee will be reviewing the bill in depth during next week’s Committee meeting and will formulate CHEAC’s official position on AB 1964; however, we ask local health departments to review the new language and provide comments to CHEAC staff by COB on Wednesday, February 7 in order to help inform our Legislative Committee discussion.

Health Coverage/Health Reform

AB 11 (McCarty) as amended on 01/10/2018 – Support

Assembly Member Kevin McCarty’s AB 11 was passed from the Assembly to the Senate this week. The measure would require screening services under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program to include developmental screening services for individuals zero to 3 years of age.

Tobacco Control

AB 1097 (Levine) as revised on 01/18/2018 – Support

This week, AB 1097 by Assembly Member Marc Levine was advanced from the Assembly to the Senate. The measure would ban smoking on state beaches and parks and impose a $50 violation fine. Despite Governor Brown vetoing previous measures which proposed the same ban, the Assembly once again passed the measure for the third year in a row.

With Less than One Week Remaining, Government Funding Deal Yet to Be Struck

After a brief shutdown and short-term continuing resolution that was passed in mid-January, less than one week remains before federal government funding expires on Thursday, February 8. Negotiations between Congressional leaders and the White House have continued, though an agreement has yet to be struck. Congress will be forced once more to pass another short-term continuing resolution to extend current federal government funding levels—the fifth of its kind since September 30, 2017—or face another federal government shutdown.

Congressional Republicans are piecing together a six-week funding measure to keep the federal government open through Friday, March 23. The measure is likely to be taken up for consideration and a vote by Congress in the early part of next week. Republicans have indicated they may include a funding reauthorization for community health centers and expired Medicare provisions to attract support from Congressional Democrats, though details are unclear.

Absent from the short-term funding measure are significant issue items, including a bipartisan agreement to spending caps, reforms to the nation’s immigration system, or a solution to the Deferred Action for Childhood Arrivals (DACA) Program that expires next month. Reports suggest little appetite for another government shutdown among Congressional Republicans or Democrats, particularly after last month’s three-day shutdown yielded no material results over agreements on significant issues.

The March 23 funding expiration date that is likely to be included in the short-term continuing resolution is raising alarm in Washington, however. The Congressional Budget Office (CBO) released a report this week indicating that if the nation’s debt ceiling is not increased by Congress, the U.S. Treasury will be unable to borrow additional funds and will run out of cash in the first part of March 2018. The U.S. Treasury separately urged Congress to increase the debt ceiling limit by the end of February. Without an increase of the ceiling, the U.S. would run the risk of defaulting on its loans.

Congressional leaders are reportedly viewing the debt ceiling increase with consternation and prefer to tie the ceiling increase to another must-pass measure such as a government funding measure. At this time it is unclear, however, if the ceiling increase will be addressed next week.

With few days remaining before another government shutdown, Congress will be hard-pressed to pass another short-term funding measure and, eventually, address persistent big ticket items including a longer-term government funding measure, the debt ceiling limit, and DACA.

CDC Director Fitzgerald Resigns over Financial Conflicts of Interest

This week, U.S. Centers for Disease Control and Prevention (CDC) Director Brenda Fitzgerald resigned over reports that she purchased tobacco company shares while serving as the nation’s top public health official. One day after purchasing stock in Japan Tobacco, Fitzgerald reportedly toured the CDC’s Tobacco Research Laboratory, which is tasked with studying the impacts of tobacco on human health.

Fitzgerald’s purchase of tobacco stock came amid ongoing concerns over her complex financial arrangements which forced her to recuse herself from a number of the agency’s key activities and duties. In several instances, Fitzgerald was unable to appear at Congressional hearings due to potential financial conflicts of interests related to the matters being discussed, including the flu epidemic and public health threats. As such, Fitzgerald faced increasing scrutiny from Congressional members about her progress in divesting financial stakes in multiple companies that presented potential conflicts, including pharmaceutical, healthcare, and food industry companies.

According to an official statement from the U.S. Department of Health and Human Services (HHS) regarding Fitzgerald’s stock holdings, Fitzgerald “could not divest from them in a definitive time period,” prompting her resignation. Prior to her six-month stint at CDC, Fitzgerald was previously the Commissioner of the Georgia Department of Public Health. CDC Principal Deputy Director Anne Schuchat has been named acting director.

Trump Administration Approves Indiana Medicaid Work Requirements

Today, the U.S. Department of Health and Human Services (HHS) Secretary Alex Azar granted approval to Indiana to incorporate state Medicaid modifications, including work requirements, lockout provisions, and premium increases. Indiana’s waiver now requires able-bodied individuals younger than 60 years of age to work at least 20 hours per week on average, be enrolled in school, or participate in the state’s job training program to remain eligible for coverage. The requirements do not apply to pregnant women, primary caregivers, medically frail individuals, and those receiving substance use disorder treatment.

Beneficiaries not meeting all requirements will be suspended from the program until they comply with the requirements for one full month. The approved plan builds upon lockout provisions which bar beneficiaries from coverage for six months for not meeting certain criteria such as failing to submit or update eligibility documents.

The approved Medicaid plan expands on provisions envisioned and developed by then-Governor Mike Pence and consultant Seema Verma, who is now the Centers for Medicare & Medicaid Services (CMS) Administrator.

Recall, the Trump Administration last month issued new guidelines encouraging states to implement work requirements for beneficiaries to remain eligible for health care coverage, an unprecedented step in the program’s 53-year history. Indiana is the second state to receive CMS approval for such requirements, with Kentucky being the first state. Several patient advocacy groups have filed federal lawsuits over the new guidelines, arguing that the requirements do not align with the purpose of Medicaid.

KFF Releases Report on Out-of-Pocket Medicare Spending, Finds Increasing Cost Burdens

The Kaiser Family Foundation (KFF) recently released a report analyzing Medicare beneficiaries’ out-of-pocket health care spending as a share of income, both currently and projections moving into the future. The report presents estimates for out-of-pocket spending burden for Medicare beneficiaries overall, as well as by demographic, socioeconomic, and health status measures. The report found:

  • In 2013, Medicare beneficiaries’ average out-of-pocket spending was 41 percent of average per capita Social Security income
  • By 2030, Medicare beneficiaries’ out-of-pocket spending is projected to rise to 50 percent of average per capita Social Security income
  • Spending burdens were found to be higher for women than men, increase for people ages 85 and over, and increase for those in poor health or with modest income

The full KFF report is available here.