January 19, 2018 Edition

Hours Remain Until Federal Government Shutdown

With hours remaining until the federal government enters a partial shutdown beginning at midnight, a government funding deal has yet to be struck among Congressional leaders and the White House. In what is reported to be a highly volatile situation, Congressional Republicans are beginning to place blame on Senate Democrats for forcing the political standoff and deadlocked negotiations.

Late Thursday, the U.S. House of Representatives passed another short-term continuing resolution (CR), extending current government funding levels through February 16. The short-term CR would reauthorize the Children’s Health Insurance Program (CHIP) for six years and delay certain Affordable Care Act (ACA) taxes, but it does not address community health center funding or other critical health-related program funding. Thursday’s short-term funding measure passed in the House on a vote of 230-197 with six Democrats voting with Republicans. The House passage of the short-term CR placed the government funding onus on the Senate, where tense negotiations have been occurring throughout the week.

Senate Democrats are insisting that the government funding measure include long-term increases in military and domestic spending, as well as a solution to the Deferred Action for Childhood Arrivals (DACA) program. DACA provides legal protections for nearly 700,000 immigrants who were brought to the country illegally as children. The program was established under the Obama Administration, and last year, the Trump Administration announced it would rescind the program. As such, deportation protection provided to DACA recipients will begin expiring in March.

Congressional Republicans have opposed including provisions related to DACA as part of any government funding measure, instead preferring to address the matter in a separate measure at a later date. In calling for Congressional Democrats to support a short-term government funding measure, Senate Majority Leader Mitch McConnell (R-Kentucky) indicated more than a month remains to strike a deal on an immigration-related package before DACA expires.

It is unclear how the Senate plans to move forward on government funding, as well as a number of other high-profile issues including immigration. Reports suggest a three-to-five-day funding measure may be in the works to prevent a shutdown and finalize negotiations, though members of both parties have expressed little appetite for such action. Further, many members have also expressed opposition to another 30-day continuing resolution, citing the lack of productive negotiations.

In a last-minute attempt to secure a deal on a funding measure today, President Donald Trump invited Senate Minority Leader Chuck Schumer (D-New York) to the White House for additional negotiations. While those negotiations did not produce any meaningful outcomes, it was indicated discussions would continue among Congressional leaders and the White House.

For the House’s short-term funding measure to be advanced in the Senate, 60 votes are needed. Reports suggest Senate Republicans will need to secure upwards of one dozen Democratic votes for the measure to proceed given ‘no’ votes and absences among Republicans. With hours remaining until a shutdown, it is uncertain what the outcome of the highly volatile situation in Washington will be.

Should a federal government shutdown occur, widespread and long-lasting ramifications for public health at the national level are likely. Each federal agency and department would be required to develop a contingency plan and determine “essential” and “non-essential” services. “Non-essential” personnel would be furloughed, and certain government operations and services would cease.

The U.S. Department of Health and Human Services (HHS) released a FY 2018 contingency plan that details plans for staffing and activities in the event of a shutdown. The guidance for the U.S. Centers for Disease Control and Prevention (CDC) states that, “CDC will continue minimal support to protect the health and well-being of U.S. citizens…” It is unclear at this time what impact a federal government shutdown will have on the state or local level.

Fiscal Committees Act on Two Year Bills, AB 626 Advanced to Assembly Floor

This week, fiscal committees in both houses acted on a number of two year bills hoping to continue through the legislative process. Today is the deadline for bills introduced in 2017 to be heard and reported to the floor. Two year bills that were advanced to the floor of their house of origin must be acted upon by January 31 to remain in play.

Our weekly CHEAC Bill Chart is available here. Outcomes on bills of key interest to CHEAC are noted below.

Environmental Health

AB 626 (E. Garcia) as amended on 05/02/2017 – Oppose

AB 626 by Assembly Member Eduardo Garcia would create a new type of food facility under the California Retail Food code for “microenterprise home kitchens.” These entities would be allowed to operate in private home kitchens with a limitation on the number of meals that can be prepared per day and per week, along with a gross annual sales limitation of $50,000. Local health departments would be required to permit and inspect these entities.

CHEAC and our county partners including HOAC, CSAC, UCC, and RCRC jointly oppose this bill with specific concerns around the increased potential for foodborne illness and the proposed regulatory role going beyond the scope and ability of local health departments.

AB 626 passed unanimously out of the Assembly Appropriations Committee this week and is scheduled for consideration on the Assembly Floor next week. As a two year bill, the measure must be acted upon by January 31.

Tobacco Control

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

AB 1097 by Assembly Member Marc Levine seeks to ban smoking on state beaches and parks. Recall the measure is identical to last year’s AB 725 which passed the Legislature and was vetoed by the Governor. The measure allows the director of the Department of Parks and Recreation to post signs within the state beach and units of the state park system designating the areas as exempt from the smoking ban and imposes a fine of $50 for violations.

The Assembly Appropriations Committee passed the measure with Republicans voting no. The bill now moves to the Assembly Floor for consideration.

Senate Budget and Fiscal Review Committee Convenes First Hearing of Year

Yesterday, the Senate Budget and Fiscal Review Committee convened a hearing to provide an overview of the Governor’s proposed 2018-19 Budget. Senator Holly Mitchell, chair of the Committee, remarked on how she was encouraged to see continued investments in critical public services, such as early childhood education, K-12 and higher education, Medi-Cal (via provider rates) and courts, among others. She also suggested more could be done to serve Californians as vital public services, including health care, the social safety net and flood infrastructure, remain underfunded.

The Senate Budget and Fiscal Review Committee kicked off with an overview of the Governor’s budget proposal provided by Amy Costa from the Department of Finance. Mac Taylor, from the Legislative Analyst’s Office followed by drawing attention to particular areas within the Governor’s proposed budget that Legislature could act differently, similar to those laid out in the LAO’s Budget Overview released earlier in the week. Areas highlighted include setting their own targeted level of reserves and exploring the Administration’s Proposition 55 allocation methodology. He also noted that lawmakers would need to carefully consider how to handle surplus revenues as formulas adopted in Prop. 98, Prop. 2, and Prop 55 add another layer of complexity.

During the course of the hearing, Senator Pan stressed the need to focus on investments that help to decrease future costs and urged the Department of Finance to score cost savings versus only showing the cost of investments. He highlighted the need to invest in public health readiness and mentioned flu season and the wildfires and floods. He later urged the Legislature to consider these investments during good budget times given that when the state is in a recession, policy makers are less likely to do so. The LAO characterized costs as certain, they are right away and returns come much later; he further noted that this is a hurdle we must get over.

Senator Mitchell noted upcoming budget activities, consisting of full committee oversight hearings beginning in February and deeper dives into proposals and issues beginning in the spring. Budget subcommittee hearings will begin in March.

LAO Publishes Overview of Governor’s Proposed Budget

The California Legislative Analyst’s Office (LAO) recently published its overview of Governor Brown’s proposed FY 2018-19 State Budget. The overview details major proposals of the budget, including funding the rainy day reserve fund, boosting spending on schools and community colleges, and supporting new infrastructure projects.

The LAO projects that based on their current assessments, revenues in FY 2017-18 and FY 2018-19 are likely to be higher than the Administration’s estimates; however similar to the Administration, the LAO notes a level of uncertainty around the recent passage of federal tax reform and federal health related proposals.

In evaluating the Governor’s January proposal, the LAO encourages the Legislature to:

  • Consider their optimal level of targeted reserves, despite the Governor’s fiscally prudent approach of fully funding the state’s rainy day fund.
  • Delve deeper into the Administration’s calculation of Proposition 55, given this first year can be precedent setting and can determine the likelihood of a supplemental appropriation to Medi-Cal in future years.
  • Adopt a similar mix of one-time and ongoing spending proposals similar to that in the Governor’s January proposal to avoid over committing spending in tougher economic times.

The complete LAO overview is available here.

In the coming weeks, the LAO will analyze the proposed budget more thoroughly and release a series of additional budget analysis publications.

Assembly Select Committee on Universal Coverage Holds Third Hearing

On Wednesday, the Assembly Select Committee on Health Care Delivery Systems and Universal Coverage convened an informational hearing on achieving better access and greater value in California. The hearing featured a range of speakers exploring Medi-Cal enrollees’ access to care and physicians, stark differences in provider payments, costs of healthcare, and coverage in California.

One speaker, Larry Levitt, Senior Vice President of the Kaiser Family Foundation, noted that designing health care systems is particularly difficult, especially when looking to secure waivers. He encouraged committee members to think about where they would like the system to go and incremental steps that could be taken to get there.

Committee Co-Chair Assembly Member Joaquin Arambula shared the saying, “an ounce of prevention equals a pound of cure”, as he offered his thoughts around the fragmentation of the health care system.  As done in previous hearings, he continued to stress the importance of investing in prevention strategies.

At the conclusion of the hearing, Co-Chair Assembly Member Jim Wood announced the next committee hearing will be held on February 7 and will include a panel discussion on SB 562, the universal, single-payer measure introduced by Senator Ricaro Lara and passed by the California Senate last year.

Hearing materials from Wednesday’s hearing are available here.

HHS Announces New Conscience and Religious Freedom Division

On Thursday, the U.S. Department of Health and Human Services (HHS) announced the formation of the new Conscience and Religious Freedom Division in the HHS Office of Civil Rights (OCR). The new division was created to protect doctors, nurses, and other health care professionals who refuse to take part in certain medical procedures, such as abortion services, or treat certain individuals on the grounds of moral or religious objections.

The creation of the division is a reversal of an Obama-era policy that banned health care professionals from refusing treatment to transgender individuals or people who have had or are seeking abortion services. Legal action challenging the creation of the HHS division is expected to be filed in the coming weeks and months.

CHEAC Opposes Cuts to Prevention and Public Health Fund

This week, CHEAC signed onto a Trust for America’s Health (TFAH) letter to Congressional leaders expressing disappointment in and opposition to the recent $750 million cut to the federal Prevention and Public Health Fund (PPHF). Recall, the cut was made as part of the December short-term government funding measure and was used to offset temporary funding authorizations for the Children’s Health Insurance Program (CHIP) and community health centers. The $750 million cuts will occur between FY 2019 and FY 2022. It is unclear what impact the PPHF cuts will have on the U.S. Centers for Disease Control and Prevention (CDC). PPHF provides approximately 12 percent of the CDC’s annual budget.

CHEAC recognizes the importance of the reauthorization of CHIP and community health centers, which provide affordable health care coverage and comprehensive health services to millions of Californians. However, using the PPHF as a funding source without a clear plan for replacement seriously undermines the ability of counties to protect and promote the health of our communities.

TFAH Releases Report on Racial Healing and Health Equity

The Trust for America’s Health (TFAH) released this week Racial Healing and Achieving Health Equity in the United States, a report that highlights health inequities, the factors that influence them, and policy recommendations to achieve health equity. The report was produced in conjunction with the W.K. Kellogg Foundation Truth, Racial Healing & Transformation (TRHT) initiative.

TFAH showcases several examples of programs addressing health equity, including work being conducted throughout the state by The California Endowment. More information on the project is available here; the full report is available here.