January 13, 2017 Edition

Announcements

Los Angeles County Public Health Director

Dr. Barbara Ferrer was recently appointed by the Los Angeles County Board of Supervisors as the Director of the Los Angeles County Department of Public Health, effective February 7, 2017. Dr. Ferrer worked as the Chief Strategy Officer of the W.K. Kellogg Foundation. She served as the Executive Director of the Boston Public Health Commission, where she led a range of public health programs and built innovative partnerships to promote health and education, improve family economic security and address racial health disparities. Please join us in welcoming Dr. Ferrer to her new role.

Tulare County Health and Human Services Director

The Tulare County Board of Supervisors appointed Jason Britt as the Director of the Tulare County Health and Human Services Agency, effective December 24, 2016. Jason has been with Tulare County since 1994 and has held a variety of senior management positions including: Director of Public Health, Director of Human Services, and Associate Health and Human Services Agency Director. Please join us in congratulating Jason on his new role.


Budget Update

Governor Brown’s Budget Release

The Governor released his  2017-18 budget proposal this past Tuesday. Unlike in recent years, the Governor projects a $1.6 billion deficit in the forthcoming fiscal year. While the Governor remarked on the looming federal changes ahead, his proposal continues to assume current federal policies and funding levels. CHEAC prepared a summary of the Governor’s proposed budget, which can be found here.

The California Department of Public Health and Department of Health Care Services also released budget highlight documents which are linked below:

California Department of Public Health

California Department of Health Care Services

Legislative Analyst’s Office Summary

The LAO published their initial response to the Governor’s 2017-18 budget proposal, which can be found here.

California Budget and Policy Center Webinar

The California Budget and Policy Center, an independent entity that provides fact-based, nonpartisan analyses of state fiscal and tax policies, released its budget brief, summarizing key provisions of the Governor’s proposed budget. They will host a webinar on Wednesday, January 18 at 1:00 pm. To sign up for this webinar, click here.


Federal Update

Early Thursday morning, Senate Republicans began the process of repealing the ACA by opening up the debate on a budget resolution (which provides direction to key committees for the budget reconciliation process, including drafting specific legislative language). During the debate, Senators proposed non-binding amendments to the resolution to be voted upon, which social media tagged as #votarama. Some of the failed amendments included ensuring the Medicaid expansion stays in place, protecting people with pre-existing health conditions, allowing young adults to stay on their parent’s health plans, and protecting children on Medicaid or CHIP. The resolution passed on a 51-48 party-line vote.

Today, House Republicans passed the same resolution, with a 227-198 vote, all Democrats and nine Republicans voting no. These resolutions, do not require presidential signature.

Moving forward, house and senate committees with jurisdiction over the ACA will begin to draft elements of the budget reconciliation bill (which can pass with a 51-vote majority in the Senate). Through this process, how much of the ACA Congress intends to repeal will become clearer and may also include some replacement ideas. However, uncertainty on an ACA replacement remains rampant on Capitol Hill. Complicating matters, the President-Elect stated in his news conference earlier this week that his administration would submit a repeal and replace plan as soon as his Health & Human Services Secretary, Tom Price, was confirmed (his confirmation hearing is slated for Wednesday, January 18). He also noted repeal and replace would happen “simultaneously.”

The California Senate sent a letter to Congressman Kevin McCarthy warning of the harm to California residents should the ACA be repealed, absent a substantive replacement. The letter highlighted the declines in California’s uninsured rate and offered suggestions on improving coverage rather than focusing on a repeal.

Early Thursday morning, Senate Republicans began the process of repealing the ACA by opening up the debate on a budget resolution (which provides direction to key committees for the budget reconciliation process, including drafting specific legislative language). During the debate, Senators proposed non-binding amendments to the resolution to be voted upon, which social media tagged as #votarama. Some of the failed amendments included ensuring the Medicaid expansion stays in place, protecting people with pre-existing health conditions, allowing young adults to stay on their parent’s health plans, and protecting children on Medicaid or CHIP. The resolution passed on a 51-48 party-line vote.

Today, House Republicans passed the same resolution, with a 227-198 vote, all Democrats and nine Republicans voting no. These resolutions, do not require presidential signature.

Moving forward, house and senate committees with jurisdiction over the ACA will begin to draft elements of the budget reconciliation bill (which can pass with a 51-vote majority in the Senate). Through this process, how much of the ACA Congress intends to repeal will become clearer and may also include some replacement ideas. However, uncertainty on an ACA replacement remains rampant on Capitol Hill. Complicating matters, the President-Elect stated in his news conference earlier this week that his administration would submit a repeal and replace plan as soon as his Health & Human Services Secretary, Tom Price, was confirmed (his confirmation hearing is slated for Wednesday, January 18). He also noted repeal and replace would happen “simultaneously.”

The California Senate sent a letter to Congressman Kevin McCarthy warning of the harm to California residents should the ACA be repealed, absent a substantive replacement. The letter highlighted the declines in California’s uninsured rate and offered suggestions on improving coverage rather than focusing on a repeal.


Whole Person Care – Second Round News

The Department of Health Care Services (DHCS) released their second-round applications for Whole Person Care pilots (WPC). The department posted both an application for new pilots and instructions for first-round “legacy” pilots seeking to expand, on the WPC website  The department also posted revised budget instructions. DHCS will also host a webinar on Friday, January 27 from 9:30 – 11:00 am for new entities interested in participating in the second round. DHCS will send out a webinar invitation next week.


Report on the Health Impacts of Cannabis Released

Yesterday, the National Academies of Sciences, Engineering and Medicine released their report on the health impacts of cannabis and cannabinoids. Please recall that the California Department of Public Health was one of the sponsors of the study that assessed over 10,000 studies exploring the various impacts cannabis has on a variety of issues including human health, cancer, prenatal, perinatal, and neonatal exposure, and mental health. Some of their findings are outlined below:

  • In adults with chemotherapy-induced nausea and vomiting, oral cannabinoids are effective antiemetics.
  • In adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms.
  • Evidence suggest that smoking cannabis does not increase the risk for certain cancers (lung, head, and neck) in adults.
  • Smoking cannabis on a regular basis is associated with chronic cough and phlegm production.
  • It is unclear whether cannabis use is associated with COPD, asthma, or worsened lung function.
  • Smoking cannabis during pregnancy is linked to lower birth weight in the offspring.
  • The relationship between smoking cannabis during pregnancy and other pregnancy and childhood outcomes is unclear.
  • Initiating cannabis use at a younger age increases the likelihood of developing problem cannabis use.
  • Cannabis use prior to driving increases the risk of being involved in a motor vehicle accident.
  • In states where cannabis use is legal, there is increased risk of unintentional cannabis overdose injuries among children.
  • Recent cannabis use impairs the performance in cognitive domains of learning, memory, and attention.
  • Cannabis use during adolescence is related to impairments in subsequent academic achievement and education, employment and income, and social relationships and social roles.
  • Cannabis use is likely to increase the risk of developing schizophrenia and other psychoses; the higher the use the greater the risk.

A couple of other items to note from the study included a paucity of research on the connection between drugged driving and accidents, prohibitive federal rules have made research exceedingly difficult, and finally, that testing the health effects of cannabis products available to consumers is illegal (including barring researchers from testing edible cannabis products for contaminants).


The California Endowment Equity Awards

The California Endowment (TCE) is soliciting applications from local health departments for their second round of Health Equity Awards. Advancing Health Equity Awards 2017: Highlighting Health Equity Practice in California Public Health Departments is intended to recognize and support the innovative work that local public health departments do to achieve health equity.

Applications are due by 5pm on Tuesday, February 21, 2017. Awardees will be announced in Spring 2017, and will attend a recognition event on May 24, 2017 in Los Angeles. For more information, please visit: https://sites.google.com/calendow.org/hea2017/home

A recording of the webinar TCE hosted last week regarding the award process can be found here.