January 26, 2018 Edition

Legislature Continues Action on Remaining Two-Year Bills

With few days remaining before the January 31 deadline for two-year bills to be advanced from their house of origin, the Legislature this week continued consideration and action on a handful of measures. Busy floor sessions in both the Senate and Assembly early next week are likely to result in a number of bills that will survive a series of deadlines for two-year bills.

Below, we highlight several bills of interest to CHEAC Members. This week’s full CHEAC Bill Chart is available here.

Environmental Health

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

AB 626 by Assembly Member Eduardo Garcia would create a new type of food facility termed “microenterprise home kitchens” in the California Retail Food Code. These new entities would be allowed to operate in private home kitchens and prepare and sell potentially-hazardous and time/temperature control foods, including meats, seafood, and produce. Local health departments would be required to permit and inspect these entities.

Recall, CHEAC and our county partners, including HOAC, CSAC, UCC, and RCRC, jointly oppose this measure with concerns around a substantial risk of foodborne illness and increased regulatory and enforcement functions beyond the scope and ability of local health departments.

The latest amendments made to AB 626 do not address our fundamental concerns and instead provide liability protections to third party platforms involved in microenterprise home kitchens. AB 626 is scheduled to be considered on the Assembly Floor on Monday, January 29.

Health Coverage/Health Reform

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

AB 11 by Assembly Member Kevin McCarty 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. CHEAC took a support position on the measure this week given our interest in enhanced developmental screening tools and activities, particularly among this vulnerable population. AB 11 is scheduled for consideration on the Assembly Floor on Monday, January 29.

Tobacco Control

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

AB 1097 by Assembly Member Marc Levine would ban smoking on state beaches and parks. The measure allows the director of the Department of Parks and Recreation to post signs within state beaches and units of the state park system designating the areas as exempt from the ban and imposes a $50 violation fine. The measure will be considered on the Assembly Floor on Monday, January 29.

Governor Brown Delivers Final State of the State Address

On Thursday, Governor Jerry Brown delivered his sixteenth and final State of the State Address at the State Capitol in Sacramento. Brown’s address was largely optimistic and highlighted the state’s unprecedented economic growth, cap-and-trade program, pension overhaul reforms, and bipartisan solutions to transportation and infrastructure funding. By nearly all measures, Brown declared that California is prospering and detailed a path for the state to continue its progress.

However, Brown issued a stern warning about persistent threats to the state on a global scale by declaring, “Our world, our way of life, our system of governance – all are at immediate and genuine risk.” Brown cautioned against new weapons systems, antagonism among countries, partisan divisiveness, and climate change and called “for courage, for imagination, and for generous dialogue” in addressing these threats.

Related to health, Brown briefly included in his address a mention of the Affordable Care Act (ACA) and the expansion of health-related programs. Declaring that California has “boldly embraced” the ACA, Brown highlighted the 5 million increase in enrollment in Medi-Cal and the 1.3 million increase in enrollment in the Covered California exchanges that has occurred since the rollout of ACA.

Brown stressed the dependency of the state’s health care system on “tens of billions of federal dollars” and Congress’ continued threats to repeal and replace current law. By name, Brown thanked U.S. Senators John McCain (R-Arizona), Lisa Murkowski (R-Alaska), and Susan Collins (R-Maine) for voting against the ACA repeal measure and protecting healthcare for millions of Americans last year. Brown did not address ongoing conversations related to health coverage and access, including the recent push for universal, single-payer health coverage in California.

A significant amount of Brown’s address was dedicated to environmental- and climate change-related issues, including the state’s cap-and-trade program, energy efficiency standards, zero-emissions vehicles, and disproportionate environmental impacts on disadvantaged communities. He also defended transportation-related projects, including the high-speed train between San Francisco and Los Angeles.

Brown emphatically thanked first responders and firefighters in their response activities related to the Northern and Southern California wildfires and recent mud and debris slides in Southern California. He discussed at length the state’s firefighting and emergency communications capabilities and the need to reassess and prepare for future natural disasters. In his final year in office, Brown will be assembling a task force of scientists and forest management experts to determine strategies to reduce the risk of wildfires in the state.

During his address, Brown also took a moment to request that the Legislature take time to more deeply consider and understand the criminal justice system, including the need for more health and drug rehabilitation services, before enacting new laws based on individual crimes and media coverage.

As he ended his final State of the State Address to a standing ovation, Brown reiterated his commitment to ensuring California continues on its progressive path during his final year of office.

Assembly Budget Committee Convenes Overview Hearing on Governor’s Proposed State Budget

The Assembly Budget Committee held a hearing on Tuesday to provide an overview of Governor Brown’s proposed 2018-19 State Budget. In like fashion of last week’s Senate Budget and Fiscal Review Committee overview hearing, Amy Costa from the Department of Finance walked members through major components of the Governor’s proposal and Mac Taylor from the Legislative Analyst’s Office (LAO) highlighted particular areas of the budget where the Legislature could take different action than what Governor Brown proposed.

During the hearing, members focused much of their attention on the higher education and the proposed new statewide online community college, transportation infrastructure spending, and courts and criminal justice. Disaster response and preparedness activities garnered much attention as well, with discussion focused around firefighting capabilities, emergency communications, forest management, and recovery efforts related to the recent wildfires throughout the state and Southern California mud and debris slides.

Assembly Member Jim Wood inquired about the impact that the federal Children’s Health Insurance Program (CHIP) reauthorization would have on the state budget. The Department of Finance indicated savings to the state would be realized as a result of the six-year federal reauthorization, and more detail will be provided in the Governor’s May Revise. Health-related topics were largely not addressed during the hearing and will be further explored during upcoming meetings of the Assembly Budget Subcommittee No. 1 on Health and Human Services.

Assembly Budget Committee Chairman Philip Ting adjourned the hearing, indicating that the overview hearing was the first of many hearings in the months to come; last year, the Committee held 98 hearings in total on all budget-related proposals. Subcommittee hearings will being in March.

CHIP Reauthorized, Negotiations Continue over Government Funding After Brief Shutdown

After a stalemate in negotiations over government funding and immigration, the U.S. Government entered partial federal government shutdown beginning at midnight last Friday. Senate Republicans and Democrats spent a fair amount of the weekend directing blame toward one another over the shutdown after not enough votes were secured to pass a four week continuing resolution to keep the federal government open.

Urgent negotiations among a small bipartisan group of U.S. Senators took place in the later part of the weekend to attempt to determine a path forward, and on Monday, a compromise was struck to fund the government through Thursday, February 8. Enough Democratic Senators agreed to vote for the continuing resolution on the pledge from Senate Majority Leader Mitch McConnell (R-Kentucky) that he intends to take up immigration legislation on the Senate Floor either in the next spending bill or thereafter. Specific details of McConnell’s pledge to Democrats were unclear.

Recall, Senate Democrats previously refused to vote for last week’s continuing resolution over Republicans’ refusal to address the Deferred Action for Childhood Arrivals (DACA) program that provides protection from deportation to over 700,000 immigrants brought to the country illegally as children. President Donald Trump last year decided to rescind the Obama Administration-era program, and protection provided to DACA recipients will begin expiring in March.

Monday’s continuing resolution to fund the government through February 8 passed the Senate on an 81-18 vote, with both of California’s Senators Dianne Feinstein and Kamala Harris voting against the measure over the lack of a solution to DACA and immigration reforms. The House passed the measure on a 266-150 vote shortly after the Senate. President Trump signed the continuing resolution into law on Monday evening, returning the federal government to normal operations.

Included in the 17-day continuing resolution was a six-year reauthorization of the Children’s Health Insurance Program (CHIP). Notably, the reauthorization:

  • Provides federal funding for CHIP for six years (FY 2018 – FY 2023)
  • Continues the 23 percent enhanced federal match rate (for a total of 88 percent) for FY 2018 and FY 2019; the enhanced match rate decreases 11.5 percent (for a total of 76.5 percent) in FY 2020 and then returns to the standard CHIP match rate (65 percent) for FY 2021 through FY 2023
  • Extends the requirement for states to maintain coverage from 2019 through 2023; after October 2019, states are required to maintain coverage for children in families with incomes at or below 300 percent of the federal poverty level (FPL)

Additional background and information on the reauthorization is available from the Kaiser Family Foundation (KFF) here.

This six-year reauthorization did not include any additional cuts to the Prevention and Public Health Fund (PPHF), as did the short-term CHIP funding patch that was passed in December 2017. Recall, CHIP funding initially expired on September 30, 2017. States throughout the country had been faced with funding shortfalls and decisions over coverage eliminations. In California alone, CHIP provides health care coverage to nearly two million low income children and pregnant women.

A funding reauthorization for community health centers and other related health programs was not included in this week’s continuing resolution measure. Funding also initially expired for community health centers on September 30, 2017, and, like CHIP, centers were provided a short-term funding patch in December 2017. Community health centers are expected to only have enough funding to remain operational until the end of March without further Congressional action.

With the government funding deadline now less than two weeks away, we find ourselves in a familiar place. While negotiations continue over another government funding measure and other significant issues, including immigration, national security and defense, and domestic spending, it remains to be seen what deals will be struck among Congressional leaders and the White House.

Azar Confirmed as HHS Secretary on a 55-43 Vote

On Wednesday, Alex Azar was confirmed as the next U.S. Department of Health and Human Services (HHS) Secretary. Azar was confirmed on a 55-43 vote with all but one Republican, six Democrats, and one Independent senator voting in support of the appointee. HHS has been without a permanent leader for nearly four months after then-Secretary Tom Price resigned over failed attempts to repeal the Affordable Care Act (ACA) and scrutiny of his use of private and military jets for travel.

Azar spent nearly a decade at pharmaceutical company Eli Lilly, where he most recently served as president of U.S. operations before leaving in 2017. Prior to this time at Eli Lilly, Azar served as the HHS General Counsel from 2001 to 2005 and the Deputy Secretary from 2005 to 2007 during the George W. Bush Administration.

As Azar’s confirmation was being considered by the U.S. Senate, several senators expressed concerns over Azar’s role in the Trump Administration’s continued threats to the ACA and Azar’s involvement in the pharmaceutical industry, particularly around rising prescription drug prices. Despite these concerns, Azar is generally regarded as a detail-oriented bureaucrat who has a deep understanding of the in-and-outs of administrative and regulatory systems.

In his new role, Azar has committed to reining in drug prices and making health care more affordable. However, reports suggest much of his focus will likely be on rebuilding internal morale within HHS, launching a listening tour within Capitol Hill to solicit policy ideas, and strengthening lines of communication with and between the various HHS entities. Acting Secretary Eric Hargan is expected to return to his role as HHS Deputy Secretary.

Public Health Emergency Declaration on Opioid Crisis Renewed

This week, the Trump Administration renewed its public health emergency declaration related to the national opioid epidemic. The U.S. Department of Health and Human Services (HHS) posted a notice signed by HHS Acting Secretary Eric Hargan renewing the declaration for another 90 days. The initial emergency declaration was declared by Hargan on October 26, 2017, and was set to expire on Tuesday of this week.

CBPP Determines Link Between SNAP and Improved Nutritional Outcomes, Lower Health Care Costs

In a study recently published by the Center for Budget and Policy Priorities (CBPP), the Supplemental Nutrition Assistance Program (SNAP) is linked to improved health outcomes and lower health care costs. In a typical month in 2017, SNAP provided food assistance to nearly 42 million low-income Americans. Emerging research has shown:

  • Food insecurity increases the risk of adverse health outcomes, complicates the ability to manage illness, and is linked to higher health care costs
  • SNAP improves food security, offers benefits that enable families to purchase healthier foods, and frees up resources that can be used for health-promoting activities and health care
  • SNAP is associated with improved current and long-term health, as well reduced health care costs

The CBPP report also discusses that changes in policies to improve access to SNAP benefits could provide short- and long-term relief to state Medicaid budgets. The full report is available here.