January 11, 2019 Edition

Newsom Inaugurated, Issues Series of Executive Orders Related to Health, Emergency Preparedness

On Monday, Gavin Newsom was sworn in as California’s 40th governor. On the steps of the State Capitol in Sacramento, Newsom in his expansive inaugural address underscored his commitment to Californians stating, “Our government will be progressive, principled, and always on the side of the people.” Newsom highlighted the need for a range of investments and action to strengthen California’s safety net and address persistent challenges, including affordability, housing, and homelessness. He discussed plans to improve lives of California families through an expansion of paid family leave, earned income tax credits, and early childhood development and care initiatives.

In a nod to the Brown Administration, Newsom stressed the importance of being “prudent stewards of taxpayer dollars” and planning for a potential future economic downturn. Newsom credited former Governor Jerry Brown for much of California’s progress and promised to serve as a uniting force to establish a “California for all.”

Following his inauguration, Newsom issued a series of executive orders related to health coverage, prescription drugs, and emergency preparedness and response. Below, we highlight these executive orders:

California Surgeon General

Governor Newsom issued Executive Order N-02-19 establishing a California Surgeon General to lead Californians in addressing root causes of serious health conditions, including adverse childhood experiences (ACEs) and the social determinants of health. Newsom pointed to a growing body of scientific evidence showing how upstream factors such as toxic stress eventually leads to chronic and acute health conditions amongst Californians. The executive order tasks the surgeon general with marshaling “the insights and energy of medical professionals, public health experts, public servants, and everyday Californians to solve our most pressing health challenges with surgical focus.”

The surgeon general is required to be a physician licensed to practice in California and a recognized thought-leader in addressing root causes of health disparities, among other qualifications. The position is required to be appointed by February 1, 2019.

Prescription Drug Purchasing

Governor Newsom issued Executive Order N-01-19 to address rising prices of prescription drugs. The executive order tasks the Department of Health Care Services (DHCS) and other departments with transitioning all pharmacy services for Medi-Cal managed care to a fee-for-service benefit by January 2021, reviewing purchasing initiatives through the California Pharmaceutical Collaborative, and taking steps to expand bulk pharmaceutical product purchasing. Newsom charts the path for private and public purchasers to negotiate prescription drug prices with pharmaceutical companies through this executive order.

Additional details related to Newsom’s pharmaceutical drug proposals are covered in his budget proposal released this week.

Letter to Federal Government Leaders

Governor Newsom sent a letter to President Donald Trump and Congressional leaders calling on the federal government to remove barriers that currently prevent states from designing and implementing solutions for affordable health care and expanded coverage. Newsom discusses in his letter opportunities around cost and coverage waivers, expanded tax subsidies, and cost containment efforts. The letter urges the federal government to lift current limitations that could allow California to develop a single-payer health system and establish universal coverage for all residents.

Natural Disaster Preparedness and Response

Governor Newsom issued Executive Order N-05-19 that tasks state agencies with a series of actions related to wildfire and natural disaster preparedness and response. The California Department of Fire and Forestry (Cal Fire), among other state agencies, is required to recommend to the governor administrative, regulatory, and policy changes necessary to prevent and mitigate wildfires with an emphasis on public health and safety. A report is required to be provided to the governor within 45 days that details personnel and resource deployment, resource procurement, and community assessment efforts. Assessment activities are required to detail high-hazard areas, socioeconomic factors, and vulnerable populations particularly at risk in natural disaster events.

Procurement Processes for Preparedness and Response Resources

Governor Newsome issued Executive Order N-04-19 that lays out streamlined and flexible procurement processes for emergency preparedness and response resources. State agencies are tasked with developing a new iterative procurement approaches, starting with innovative solutions to the state’s wildfire risks and forest health.

Newsom Releases $209 Billion Budget, Prioritizes Education, Health and Human Services

On Thursday, Governor Gavin Newsom released his proposed FY 2019-20 State Budget, proposing significant expenditures in the state’s fiscal health and new initiatives. The proposed budget totals $209 billion ($144 billion General Fund) and projects a $21.4 billion surplus. The total budget represents a four percent increase from last year’s budget.

In a nearly two-hour presentation on Thursday, Newsom walked through the details of his proposal, some of which includes $4.8 billion to reduce unfunded pension liabilities, $4 billion to pay off long-standing debt, and $4.8 billion to strengthen the state’s budgetary reserves. $700 million is slated to be set aside for the Safety Net Reserve to be used for Medi-Cal and CalWORKs in the event of an economic downturn.

Nearly 81 percent of Newsom’s proposed General Fund expenditures would be dedicated to education and health and human services. During his press conference, Newsom discussed proposed investments in emergency preparedness and response, early childhood initiatives, health coverage issues, housing and homelessness efforts, and affordability matters.

Following the release of the proposed budget, CHEAC produced a summary of the Governor’s 2019-20 Budget Proposal; that memo is available here. Additional budget resources will be posted on our CHEAC Budget Page throughout the year.

The California Department of Public Health’s (CDPH) budget overview is available here and the California Department of Health Care Services’ (DHCS) budget overview is available here.

Over the coming weeks, the Legislature will begin hearing proposed budget items and stakeholder proposals. The Senate is scheduled to convene a budget overview hearing on January 17, and the Assembly will convene a similar hearing on January 29.

Figueroa, Others Announced to Newsom Administration Posts

On Wednesday, Governor Gavin Newsom named a handful of individuals to key administration positions within the Governor’s Office. Among those appointments was Richard Figueroa as Deputy Cabinet Secretary. Figueroa joins the administration from The California Endowment where he served as Director of Prevention. Figueroa previously served as Deputy Cabinet Secretary for Governor Arnold Schwarzenegger and Deputy Legislative Secretary for Governor Gray Davis, among other administrative and legislative roles. The full announcement from the Newsom Administration is available here.

Despite Shutdown, USDA Authorizes SNAP Funding through February

Despite the ongoing partial government shutdown, the U.S. Department of Agriculture (USDA) on Tuesday announced that Supplemental Nutrition Assistance Program (SNAP) benefits would be funded through February. Agriculture Secretary Sonny Perdue indicated that USDA will be working with states to issue February benefits earlier than usual. States have until January 20 to request and receive these early SNAP benefits; a provision of the recently-expired funding bill allows certain programs, including SNAP, to request additional funding within 30 days of the bill’s expiration.

Recall, USDA’s funding expired on December 21, 2018, when Congress failed to reauthorize its spending authority. SNAP benefits for January, however, were already fully funded. USDA also indicated this week that funding for other major nutrition assistance programs have sufficient funding to continue operations into February. Child nutrition programs, including the school meals and after-school programs, have funding to continue operations through March, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has prior year funding to ensure benefits through February.

While the USDA assured uninterrupted nutrition benefits into February, it remains to be seen what actions the Trump Administration may take to continue benefits as the partial federal government shutdown enters its fourth week tomorrow. In an analysis released this week, the Center on Budget and Policy Priorities (CBPP) projected dire impacts to state SNAP operations and low-income households if the shutdown continues into February.

HHS Seeks Comments on Healthy People 2030 Objectives

The U.S. Department of Health and Human Services (HHS) is currently soliciting written comments on proposed objectives for Healthy People 2030. Healthy People focuses on health promotion and disease prevention topics and sets forth critical public health priorities by addressing leading causes of morbidity and mortality.

Healthy People 2030 has three types of objectives: Core, Developmental, and Research. Public comment is welcome on each of the objective areas and additional feedback is sought around other new potential objective areas. Public comment is due on Thursday, January 17, 2019. Additional information is available here.