February 9, 2018 Edition

After Overnight Shutdown, Trump Signs into Law Government Funding Deal

The federal government entered a partial shutdown overnight when funding briefly lapsed while Congress ironed out details for a short-term funding measure and a framework for a two-year budget deal. The shutdown was largely the result of Senator Rand Paul (R-Kentucky) who refused to allow a vote on the measure while he spoke out against revenue hikes and subsequent increases to the federal deficit that would occur under the proposed budget deal constructed by Senate leaders.

Ultimately, Senator Paul’s pleas to amend the measure were not considered, and the Senate passed the funding measure on a 71-28 vote after 1:00 am. The measure went to the House where it was similarly delayed by Minority Leader Nancy Pelosi over objections that it did not address immigration or include a solution to the Deferred Action for Childhood Arrivals (DACA) Program that expires early next month.

However, House Democrats declined to stall the government funding measure over immigration concerns. The House passed the measure on a 240-186 vote just before sunrise this morning; 73 Democrats voted for the bill and 67 Republicans voted against it. President Donald Trump signed in the measure into law early this morning, effectively reopening the government.

The spending measure will extend current government funding levels until March 23, 2018, which will allow Congressional leaders to finalize an omnibus spending bill for the remainder of the current fiscal year and remove the need for continued short-term funding measures. A framework for the omnibus spending measure was agreed to by both the House and Senate and President Trump with its passage this morning.

The continuing resolution and omnibus framework includes provisions to increase federal spending on defense and nondefense programs by $300 billion over the next two years and increase the debt ceiling for one year. A number of public health- and safety-related items were included in the CR and framework; for example, the measure:

  • Extends funding for the Children’s Health Insurance Program (CHIP) for an additional four years beyond its recent six-year reauthorization; CHIP is now authorized for 10 years through 2027
  • Reauthorizes funding for community health centers and related programs for two years using over $7 billion
  • Provides $6 billion dedicated to opioid treatment and mental health services
  • Increases funding to the National Institutes of Health by $2 billion
  • Extends the Maternal, Infant and Early Childhood Home Visiting Program for five years
  • Provides nearly $90 billion in emergency disaster relief for states and areas impacted by recent wildfires and hurricanes
  • Dissolves the Independent Payment Advisory Board (IPAB) which was created by the Affordable Care Act (ACA) to control rising costs of Medicare; the Congressional Budget Office (CBO) estimated eliminating the board would increase federal spending by $17.5 billion over the next decade
  • Delays cuts to Medicaid Disproportionate Share Hospital (DSH) payments by two years

In order to partially offset the cost of these health-related spending items, Congress will be making further cuts to the Prevention and Public Health Fund (PPHF) in the net amount of $1.35 billion over the next 10 years. The offset includes increases in the PPHF between FY 2019 and 2021, but deeper cuts over the decade. At this time, it is unclear what impact the cuts will have on the U.S. Centers for Disease Control and Prevention (CDC); the PPHF provides the CDC with 12 percent of its overall budget.

With a resolution to significant and persistent issues—that being a budget deal and an increase to the debt ceiling—Congress now moves on to other significant issue items, including immigration. Senate Majority Leader Mitch McConnell has already begun process in the Senate to begin floor debate next week on immigration and the DACA Program.  House Speaker Paul Ryan has also indicated his intention to address immigration in his chamber in the coming weeks.

For now, however, the repeated threat of federal government shutdowns appears to have been eliminated with the enactment of today’s continuing resolution and two-year budget framework.

Bill Introduction Deadline Quickly Approaching

Only one week remains for the Legislature to introduce bills for consideration this Legislative year as Friday, February 16 marks the bill introduction deadline. The CHEAC Legislative Committee will be reviewing new bills on February 23 and March 9, and CHEAC will provide an updated bill chart identifying active bills following those meetings.

In the meantime, our current bill chart has been updated to reflect two-year bills that are proceeding through the legislative process. Our CHEAC Weekly Bill Chart is available here.

Assembly Business and Professions Committee Explore Ways to Address the Opioid Epidemic

The Assembly Business and Professions Committee, chaired by Assembly Member Evan Low (Santa Clara), held an informational hearing this week titled ‘Advancing Technology to Combat the Opioid Crisis’.  The hearing had a robust discussion and consisted of four panels: 1) Overview of the Opioid Crisis; 2) CURES Program Overview and Future; 3) Balancing Patient Privacy and the Lewis Decision; and 4) Practice Perspectives.

Dr. Karen Smith, Director of the California Department of Public Health (CDPH), and Kelly Pfeifer of the California Health Care Foundation (CHCF) provided committee members with an overview of the current opioid challenges in California. They discussed the work being led by CDPH in partnership with CHCF, including the opioid safety coalitions, the Drug Medi-Cal Organized Delivery System and the hub-and-spoke model for medication assisted treatment. They noted that while California’s overdose rate is less than the national average, there is still much work to be done. In addition they highlighted wide variation in overdose rates county to county. Dr. Smith also noted that while opioid overdoses are declining in our state, illicit drug overdoses – such as fentanyl and heroine – are increasing.

Members of the committee raised questions around racial disparities, disproportionate impacts to rural communities, and stigma on treatment and harm reduction strategies – with Assembly Member Eggman referencing her bill to create safe-injection sites that failed last year.

Other panels walked through the evolution and limitation of the CURES system, who has access, how data is extracted, and what opportunities lie ahead. The American Civil Liberties Union highlighted concerns around law enforcement’s access to the CURES system without a warrant in light of medical information being shared with non-medical personnel. Pharmacists and physicians provided examples of how the CURES systems have successfully been used in their fields and others spoke to expanding opportunities for other medical practices that could reduce chronic pain. Lastly, one panelist raised concerns that prescribing opioids is becoming increasingly stigmatized and that there are circumstances that do warrant continued access to opioids for pain management such as traumatic injuries and end-of-life care.

Additional information is provided in the agenda and background paper.

Hearings Conclude on Universal Coverage

This week, the Assembly Select Committee on Health Care Delivery Systems and Universal convened their last two hearings exploring Universal Coverage. Monday’s hearing focused on implementation considerations for universal coverage and explored the financing challenges of a new model. The Legislative Analyst’s Office released Financing Considerations for Potential State Healthcare Policy Changes and provided the Select Committee with an overview. The discussions highlighted the challenges in moving forward, which included securing under a seemingly unsupportive Federal Administration in addition to Constitutional challenges related to state revenue sources.

Wednesday’s hearing continued to explore options for universal coverage and included a presentation by the California Nurses Association focused on single payer. While single payer took up a considerable portion of the morning discussion, the Committee was provided additional presentations from key health experts including Health Access.

During the hearing, Assembly Member Wood announced the Committee would release a report in the Spring based on the findings from the five hearings conducted, which may include actionable items and indicated Wednesday’s hearings concluded the select committee convenings.

Hearing agendas and materials can be found here.

CDPH Local Oral Health Program Webinar to be Held Next Week

The California Department of Public Health (CDPH) Oral Health Program will be hosting a webinar for local health departments on getting started with the Local Oral Health Program (LOHP). The webinar will provide information on Year 1 deliverables, available resources to conducting a needs assessment, and the role of the University of California, San Francisco (UCSF) Technical Assistance Center.

The webinar will be held on Tuesday, February 13, 2018, from 10:30 am to 12:00 pm. Registration for the webinar is available here.

Updated UCSF Evaluation of the Community Paramedicine Pilot Program Now Available

Earlier this week, the University of California, San Francisco (UCSF) released an update of the required evaluation report of the OSHPD Health Workforce Pilot Project focused on community paramedicine.  There are currently fourteen pilot programs operating throughout California testing seven community paramedicine concepts, including post-discharge – short-term follow-up, frequent EMS users, DOT for TB patients, hospice, alternate destination – mental health, alternate destination – urgent care centers, and alternate destination – sobering centers.  The project began in 2014, and this updated evaluation report analyzes data collected from the pilot programs through September 2017.  The updated evaluation report is available here.

Upcoming Workshops for Urban Greening Grant Program Announced

The Urban Greening Program announced a series of upcoming technical assistance grant workshops throughout the state, with the first two being held next week in Sacramento and Lynwood. The Sacramento workshop will be held on Wednesday, February 14 and the Lynwood workshop will be held on Thursday, February 15. Additional information on the upcoming grant workshops is available here.

The Urban Greening Program, part of California Climate Investments, is a statewide grant program that utilizes billions of cap-and-trade dollars to reduce greenhouse gas emissions, strengthen the economy, and improve public health and the environment—particularly in disadvantaged neighborhoods. California Climate Investment projects include those related to affordable housing, public transportation, environmental restoration, and more. At least 35 percent of these investments are made in disadvantaged and low-income communities. More information on California Climate Investments is available here.

CDC Launches Expanded Flu Vaccination Campaign Materials

The U.S. Centers for Disease Control and Prevention (CDC) this week released expanded seasonal flu vaccination campaign materials to assist health departments and partners in communicating the importance of receiving the flu vaccination.

The digital messaging toolkit includes print-ready materials, graphics and flyers, fact sheets, sample social media and newsletter content, and web assets, among other resources. Materials are targeted toward various audiences and are downloadable, shareable, and customizable. The 2017-2018 Flu Season Digital Campaign Toolkit is available here.

CDC Vital Signs Features Asthma in Children

This month’s U.S. Centers for Disease Control and Prevention (CDC) Vital Signs publication highlights asthma in children, showing a decrease in asthma attacks, missed school days, and hospital visits. More children with asthma are improving their ability to control their asthma condition with an asthma action plan.

However, more than half of children with asthma had at least one attack in 2016. Every year, 1 in 6 children with asthma visit the emergency department and about 1 in 20 children require hospitalization. The CDC highlights actions and interventions for public health practitioners, health care providers, health insurance plans, and parents and children. This month’s full Vital Signs report, including a child asthma fact sheet, is available here.

NACCHO Publishes Cannabis Policy Statement

Late last year, NACCHO’s Board of Directors adopted a policy statement on medical and recreational cannabis and cannabinoids.  In brief, NACCHO recommends that the federal government remove administrative and regulatory barriers to allow for increased scientific and epidemiological research on both the positive and negative impacts of cannabis/cannabinoid consumption.  Furthermore, they also encourage state and local health departments get involved in the law and policy-making processes surrounding the regulation of both medical and adult use cannabis.  They also delineate several issues for consideration as states and local health departments contemplate regulation of cannabis including:

  • Funding for localized cannabis research, evidence-based health services, and core public health functions using state and local taxes on cannabis/cannabinoids
  • Allocation of adequate resources to establish youth cannabis prevention and education activities
  • Provision of accurate and effective educational materials to the public and medical cannabis patients and providers
  • Involvement of LHDs in guiding laws and policies focused on the regulation of cannabis production and sales (eg: pesticide use, packaging, labeling, age restrictions)
  • Incorporation of inhaled cannabis/cannabinoid products and delivery systems into exiting clean indoor and workplace air-quality laws
  • Coordination of law enforcement and public safety related activities with the public health community
  • Coordination of public health and behavioral health activities across public health cannabis related initiatives
  • Prevention and treatment of health disparities related to adverse health impacts of cannabis availability and use by adults and youth

The full NACCHO policy statement is available here.

Applications Now Open for Human Impact Partners Leadership Institute Opportunity

Human Impact Partners is now accepting applications for Health Equity Awakened: A Leadership Institute. The year-long Institute is focused on advancing health equity and identifying and systemically addressing root causes of disparate health outcomes, including oppression and racism.

Applicants must be currently employed full-time at a local health department and the deadline to apply is Wednesday, February 28. Additional information and the application are available here.