January 28, 2022 Edition
The California State Senate and Assembly on Monday, January 31 will reach the deadline for two-year bills to be advanced from their house of origin. Lawmakers have been busy this week working to secure amendments and votes on any remaining two-year bills prior Monday’s deadline. Several notable measures, including AB 1400 (Kalra) that would create a universal health care system in California, remain outstanding and await action on their respective floors.
Of note this week, Governor Newsom, Senate President pro Tempore Toni Atkins, and Assembly Speaker Anthony Rendon on Tuesday announced they have reached an agreement on a framework to ensure employees have access to COVID-19 supplemental paid sick leave through September 30, 2022. The move is anticipated to be part of a series of early budget action items, including funding proposed to bolster COVID-19 response efforts amid the continued pandemic. Additional details on the supplemental paid sick leave agreement are expected over the coming weeks.
Below, we highlight several bills of interest this week. For a full update, the latest edition of the CHEAC Weekly Update is available here.
Environmental Health
AB 257 (Holden) as amended January 27, 2022 – OPPOSE UNLESS AMENDED
Assembly Member Chris Holden’s AB 257, a two-year bill, must be passed off the Assembly Floor on Monday to remain in play for the remainder of the legislative session. The measure would establish the Fast-Food Sector Council to set sector-wide minimum standards on wages, working hours, and working conditions to ensure and maintain health, safety, and welfare of fast food restaurant workers. Earlier in the week, CHEAC joined CCDEH, HOAC, and CSAC in an oppose unless amended position as oversight and regulation of wages and employment conditions falls outside of the jurisdiction of local environmental health programs.
Health Coverage/Health Care Reform
AB 1355 (Levine) as amended January 13, 2022 – WATCH
AB 1355, authored by Assembly Member Marc Levine, would require Department of Health Care Services (DHCS) to establish an Independent Medical Review (IMR) system within the Medi-Cal program for purposes of allowing Medi-Cal beneficiaries to seek a reversal of denied services. This measure would commence in January 2023. AB 1355 requires DHCS to contract with an IMR organization to conduct reviews and specifies requirements of that organization, including relative provisions to conflict of interest and quality assurance mechanisms. The measure was advanced from the Assembly Floor to the Senate on a 68-0 vote with 8 members not voting on Thursday.
On Wednesday, the Assembly Budget Committee convened an overview hearing on the Governor’s 2022-23 Budget Proposal. The Assembly’s hearing followed an identical hearing convened by the Senate Budget & Fiscal Review Committee last week and similarly featured presentations from the Department of Finance (DOF) and the Legislative Analyst’s Office (LAO).
Assembly Budget Committee Chair Phil Ting opened the committee’s first hearing of the year by discussing many important priorities included in the Governor’s proposal and Assembly blueprint, including resources to support the continued response to the COVID-19 pandemic, health care access, housing affordability and homelessness, education funding, and economic development, among other areas.
DOF Deputy Director Erika Li provided the committee a high-level overview of significant investments included in the Governor’s January Budget Proposal. Legislative Analyst Gabriel Petek additionally presented to the committee, detailing the budget condition, Newsom Administration’s budget structure, and considerations of note for lawmakers as they begin assessing proposed investments. Petek discussed the State Appropriations Limit (SAL) and his recommendation that the Legislature develop a plan for meeting the current year SAL requirement.
Of note, Assembly Member Joaquin Arambula applauded the Newsom Administration for including proposed funding for the continued COVID-19 pandemic response, as well as full-scope Medi-Cal coverage for all income-eligible residents regardless of citizenship status. Assembly Member Jim Wood queried DOF about the recently announced deal for supplemental paid sick leave that was struck between the Administration and legislative leaders.
Budget subcommittees will begin their work in earnest over the coming weeks. Stay tuned for continued budget updates, including investments related to public health infrastructure and workforce, among other notable items.
The full agenda from the hearing is available here. A video recording of the hearing is available here.
The California Department of Public Health (CDPH) this week amended three existing State Public Health Officer Orders requiring COVID-19 boosters for specified health care workers. The amended orders extend the deadline for covered health care workers to receive their booster from February 1, 2022, to March 1, 2022.
According to CDPH, the change was necessary because of challenges caused by the Omicron surge that made it difficult for some individuals to receive their booster doses by the initial deadline. The updated orders apply to health care workers, correctional health care workers, and adult care facilities and direct care workers.
The California Health Care Foundation (CHCF) this week released its 2022 California Health Policy Survey, its annual poll examining Californians’ views on health care affordability, housing and homelessness, experiences with health care, health care equity, and the COVID-19 pandemic. CHCF partnered with the National Opinion Research Council (NORC) at the University of Chicago to assess opinions among a random representative sample of nearly 1,700 Californians 18 and older. The survey was conducted between September 27 through November 17, 2021.
Of particular note, topping the list of Californians’ health care priorities is ensuring state and local health departments have the resources they need to respond to emergencies (51 percent indicating this is “extremely important” and 34 percent said “very important”). Although the survey was conducted prior to the Omicron surge, the survey found that COVID-19 remains a major concern amongst state residents with 56 percent indicating their health has been negatively impacted by the stress and anxiety caused by the pandemic. One in 10 residents say the pandemic has worsened their chronic health conditions.
Californians additionally expressed worry about the rising costs of health care services, with one in four residents indicating they have struggled to pay for at least one medical bill in the past 12 months (up from 20 percent last year) and 49 percent indicating that they have postponed care due to cost. More than 8 in 10 Californians say it is “extremely” or “very” important for the Governor and Legislature to work on “making health care more affordable” in the coming year, rising above other high-profile issues, including improving public education and combating climate change.
Other key findings from the survey include:
- While rising costs are a concern for all Californians, they have become particularly serious for lower-income households: 43 percent of Californians with lower incomes report having problems paying for at least one medical bill. More than 6 in 10 Californians overall worry about unexpected medical bills (63 percent) and out-of-pocket health care costs (60 percent).
- One in five Californians (19 percent) say they or someone close to them has experienced a period of homelessness in the past five years. The same proportion (19 percent) are “very” or “somewhat” worried about experiencing homelessness. Californians see a connection between affordable housing and health status, with 80 percent of residents saying lack of affordable housing impacts the physical or mental health of people with low incomes “a lot” or “some.”
- Nearly 6 in 10 residents (59 percent) believe that the health care system treats people unfairly based on their race or ethnic background: one quarter (26 percent) “regularly” and a third (33 percent) “occasionally.” 83 percent of Black residents expressed this belief, a significantly higher percentage than any other race or ethnic group. Black and Latino residents were more likely than White or Asian Californians to report negative experiences by a doctor or other health care provider.
The full CHCF 2022 California Health Policy Survey is available here.
The “Yes to Protect Kids” Coalition on Thursday launched its statewide campaign to keep children safe and healthy by ending the sale of candy-flavored tobacco and nicotine products. Numerous California officials, including U.S. Senator Alex Padilla, Lieutenant Governor Eleni Kounalakis, and Board of Equalization Chair Malia Cohen, spoke during the campaign launch, highlighting the dangers of flavored tobacco products and importance of protecting young people from such products.
Recall, SB 793 (Chapter 34, Statutes of 2020) by then-Senator Jerry Hill would ban the sale of flavored tobacco products throughout California. The law, which was signed into statute in August 2020, was set to take effect at the beginning of last year. However, a referendum sponsored by a coalition of retailers and tobacco industry representatives, including tobacco giant R.J. Reynolds and Philip Morris USA, successfully gathered enough signatures to place the law on hold until voters statewide have an opportunity to weigh in during the November 2022 General Election.
The “Yes to Protect Kids” seeks a “yes” vote on the referendum to uphold the flavored tobacco ban enacted through SB 793. CHEAC was a proud supporter of SB 793 and is a supporting member of the “Yes to Protect Kids” Coalition.
Additional information is available here.
This week, the U.S. Government Accountability Office (GAO) issued a comprehensive report as part of its series of reports examining the federal government’s response to the ongoing COVID-19 pandemic. In its latest report, GAO sets forth five recommendations relative to pandemic funding managed by the U.S. Department of Health and Human Services (HHS), tax relief for businesses, and rental and nutrition assistance programs.
Notably, the GAO has designated HHS’ leadership and coordination of public health emergencies as a “high risk” issue. GAO has reported on HHS’ execution of its role in preparing for and responding to a range of public health emergencies and has found persistent deficiencies in its ability to perform its role. These deficiencies, according to the GAO, have hindered the nation’s response to the current COVID-19 pandemic and a variety of past threats, including the H1N1 influenza pandemic, Zika, Ebola, and extreme weather events.
The GAO notes that HHS has taken some actions to address the 115 recommendations GAO has offered related to its leadership and coordination of public health emergencies since 2007. However, 72 recommendations remain open and not acted upon, including a 2020 recommendation that HHS work with the Federal Emergency Management Agency (FEMA) to develop plans to mitigate supply chain shortages for the remainder of the pandemic. GAO additionally recommended in January 2021 that HHS develop a comprehensive and publicly available testing strategy which has not happened, according to the report.
GAO’s previous efforts have identified deficiencies in HHS’ preparedness and response efforts in numerous areas, including: 1) establishing clear roles and responsibilities for the wide range of key federal, state, local, tribal, territorial, and nongovernmental partners; 2) collecting and analyzing complete and consistent data to inform decision making as well as future preparedness; 3) providing clear and consistent communication to key partners and the public; 4) establishing transparency and accountability to ensure program integrity and build public trust; and 5) understanding key partners’ capabilities and limitations.
With GAO designating HHS’ leadership and preparedness as a high-risk issue, it aims to help ensure the executive and legislative branches pay sustained attention in order to make additional progress in implementing GAO’s outstanding recommendations and strengthen HHS’ leadership and coordination role for future public health emergencies.
Additional information, including the full report, is available here.
The Centers for Medicare & Medicaid Services (CMS) recently announced it has committed $49.4 million to fund organizations to connect more eligible children, parents, and pregnant individuals to health care coverage through Medicaid and the Children’s Health Insurance Program (CHIP). Awardees, including state and local governments, tribal organizations, federal health safety net organizations, non-profits, schools, and others, will receive up to $1.5 million for a three-year period to reduce the number of uninsured children by advancing Medicaid and CHIP enrollment and retention.
The move by CMS supports the Biden-Harris Administration’s Executive Order on Strengthening Medicaid and the Affordable Care Act. Funded organizations will provide enrollment and renewal assistance to children and their families, as well as pregnant people which is a new optional target population in this year’s award announcement.
Applicants are encouraged to consider a range of activities, including engaging schools and other programs serving young people, bridging racial and demographic health coverage disparities, establishing and developing application assistance resources, and using parent mentors and community health workers to assist families with enrolling in Medicaid and CHIP, retaining coverage, and addressing social determinants of health.
The Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017 (HEALTHY KIDS Act) provided continued funding for outreach and enrollment aimed at reducing the number of children eligible for but not enrolled in Medicaid and CHIP.
Applications will be accepted through March 28, 2022. Additional information is available here.
The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making available more than $2 billion in Provider Relief Fund (PRF) Phase 4 General Distribution payments to more than 7,600 providers nationwide this week. These payments follow the nearly $9 billion issued by HHS in December 2021.
Provider Relief Fund payments, according to HHS, have been critical in helping health providers prevent, prepare for, and respond to the COVID-19 pandemic. Providers have used funds to remain in operation and to continue supporting patient care by covering a variety of costs, including personnel, recruitment and retention initiatives, medical supplies, information technology, and other activities.
Phase 4 payments have an increased focus on equity, including reimbursing a higher percentage of losses for smaller providers and incorporating “bonus” payments for providers serving Medicaid, Children’s Health Insurance Program (CHIP), and Medicare beneficiaries.
Additional information from HHS is available here.