June 18, 2021 Edition
On Monday, the California State Senate and Assembly passed AB 128 (Ting),representing the Legislature’s joint $267.1 billion budget package which includes significant investments in public health and health care, individual financial supports, education, and aging, and more. Legislators faced a June 15 constitutionally required deadline to pass a state budget for the upcoming fiscal year or risk forfeiting a portion of their salaries. While the Legislature met the state’s constitutional deadline by passing a budget framework, the Legislature’s budget will not be the final state budget for the upcoming fiscal year that begins on July 1.
Budget negotiations between legislative leaders and the Newsom Administration reportedly continue as involved parties work to land on a unified spending plan for the state. Governor Newsom on Monday released a statement on the Legislature’s budget package, expressing confidence that his administration and legislative leaders will soon reach agreement on a state budget. As negotiations continue, budget activities are anticipated to stretch over the coming months as funding and implementation details will need to be finalized.
For a high-level summary of investments included in the Legislature’s budget framework that was passed on Monday, visit a previous CHEAC Weekly Update article here.
Legislature Continues with Policy Committee Hearings, CHEAC Measure Advances
This week, the California State Senate and Assembly continued with policy committee hearings, reviewing, amending, and advancing measures from the opposite house. The next several weeks are anticipated to be quite busy as the Legislature works through numerous policy committee hearings ahead of its scheduled month-long summer recess, set to begin upon the Legislature’s adjournment on July 16. Between now and then, legislators will be working to advance their measures along the legislative process, facing a July 14 deadline for policy committees to meet and report bills.
Of note, Senate President pro Tempore Toni Atkins and Assembly Speaker Anthony Rendon this week announced expanded public access to the Capitol as the state moves Beyond the Blueprint, retiring most of the state’s COVID-19 pandemic-related restrictions. This week, capacity was limited to 500 members of the public at any given time, and Rules Committees of the Senate and Assembly continue to assess increasing capacity to a total of 1,000 members of the public as soon as next week.
Below, we highlight several actions of interest to CHEAC Members. Of note, CHEAC’s sponsored measure to assess local health department infrastructure was advanced by the Senate Health Committee. For a full update, the latest edition of the CHEAC Weekly Bill Chart is available here.
Public Health Infrastructure
AB 240 (Rodriguez) as Amended June 10, 2021 – SPONSOR
AB 240 by Assembly Member Freddie Rodriguez was heard in the Senate Health Committee this week. This bill would require the California Department of Public Health (CDPH) to contract with a qualified and appropriate entity to conduct an evaluation of the adequacy of the local health department infrastructure and to make recommendations for future staffing, workforce, and resources needs. This bill is sponsored by CHEAC, HOAC, and SEIU California, UCC, RCRC, and Public Health Advocates. AB 240 advanced out of Senate Health Committee on a 10-0 vote with one member not voting and now moves on to the Senate Appropriations Committee.
AB 263 (Arambula) as amended April 15, 2021 – SUPPORT
Assembly Member Rob Bonta’s AB 263 was heard in the Senate Public Safety Committee on Tuesday. This measure would require a private detention facility operator to comply with and adhere to all local and state public health orders and occupational safety and health regulations. AB 263 is sponsored by the Immigrant Defense Advocates, NextGen, Physicians for Human Rights, and the California Collaborative for Immigrants Justice. CHEAC is joined by HOAC in supporting the measure which was passed by the Senate Public Safety Committee to the Senate Judiciary Committee on consent.
Health Coverage/Health Care Reform
AB 4 (Arambula) as Introduced December 7, 2020 – SUPPORT
Assembly Member Joaquin Arambula’s AB 4 was heard this week in the Senate Health Committee. This measure would expand Medi-Cal coverage to all undocumented adults with income at or below 138 percent of the Federal Poverty Level (FPL), contingent upon an appropriation by the Legislature. AB 4 was passed out of the Senate Health Committee to the Senate Appropriations Committee on an 8-2 vote with one member not voting.
AB 541 (Berman) as amended May 24, 2021 – SUPPORT
AB 541 by Assembly Member Marc Berman was heard in the Senate Health Committee this week. This measure would require alcoholism and substance use disorder recovery and treatment facilities licensed by the Department of Health Care Services (DHCS) to assess each patient or client for tobacco use at the time of initial intake. If tobacco use disorder is identified, a facility or program is required to provide specific information, including an offer for treatment or referral for tobacco use disorder treatment. AB 541 was passed out of Senate Health Committee to the Senate Appropriations Committee on a 9-0 vote with two members not voting.
On Tuesday, the State of California retired the majority of its COVID-19 restrictions, including the Blueprint for a Safer Economy, more fully reopening the state’s economy and ending a series of pandemic requirements such as masking for vaccinated individuals, physical distancing, and capacity restrictions in virtually all settings.
With the retirement of most restrictions, only a handful of COVID-19-related precautions remain in place for certain populations and settings. Recall, Governor Gavin Newsom and California Department of Public Health (CDPH) Director and State Public Health Officer Dr. Tomás Aragón last week issued an updated executive order and public health order setting forth Beyond the Blueprint guidelines for the state, which are limited to:
- Face Coverings – Updated CDPH guidance specifies that masks are not required for fully vaccinated persons except in certain situations where masks are required for everyone regardless of vaccination status (e.g., public transit, indoor K-12 or childcare settings, health care settings, correctional facilities, shelter settings).
- Mega Events – CDPH specifies limited COVID-19 precautions for mega events, defined as events with large crowds over 5,000 persons indoors and over 10,000 persons outdoors. Under the state public health officer order, CDPH will reassess the necessity of mega event guidance no later than September 1, 2021.
- K-12 Schools – COVID-19 guidance remains in place for K-12 schools in California, as well as for childcare programs and providers. Updates to K-12 school guidance from the U.S. Centers for Disease Control and Prevention (CDC) is anticipated to be released over the coming weeks.
CDPH will continue to offer public health recommendations and guidance related to COVID-19.
To commemorate the state’s retirement of the Blueprint for a Safer Economy, Governor Gavin Newsom on Tuesday convened a press event at Universal Studios in Los Angeles County. During the event, the Governor reflected on the state’s experience in responding to COVID-19, expressed grief for the more than 62,000 state residents who died of COVID-19, and remarked on the state’s vaccination progress to date.
Governor Newsom additionally conducted the grand prize drawing as part of the state’s $116.5 million “Vax for the Win” incentive program. 10 vaccinated individuals were randomly selected to win $1.5 million each, and winners were from the following counties: Los Angeles, Marin, Riverside, Santa Barbara, Sacramento, Stanislaus, and Ventura. CDPH has begun notifying grand prize winners of the drawing. All winners have the option to accept their cash prize while remaining anonymous or declining it altogether.
According to the Governor’s Office, California was one of the only states in the country to achieve a week-over-week increase in vaccination rates after announcing the “Vax for the Win” program. The state most recently realized a 22 percent increase in vaccinations, and more than three million vaccine doses have been reported since the state launched the incentive program.
To further encourage more residents to receive the COVID-19 vaccine, Governor Newsom this week announced additional incentives and prizes available to state residents. To highlight the state’s travel and tourism economy, the Governor announced the state will conduct a random drawing among vaccinated residents for one of six different vacation packages to “California’s gateway destination cities.” Winners will be selected on July 1, will receive an all-expenses paid trip, and $2,000 to offset travel expenses. Trip packages include:
- Discover the Best of Anaheim Package for four
- Greater Palm Springs Luxury Package for two
- Premium Los Angeles Experience for four
- San Diego Beach Dream Vacation for four
- San Diego Downtown Dream Vacation for four
- San Francisco “Our Gate is Open” Welcome Package for four
Additionally, in partnership with Six Flags, the state will be providing 50,000 free tickets to Six Flags to residents ages 12 and older who receive their first COVID-19 vaccine dose at select clinic locations in the state.
More information on the state’s COVID-19 vaccine incentive program is available here.
Today, the California Department of Public Health (CDPH) and the California Department of Technology (CDT) announced the launch of a new digital COVID-19 vaccine verification tool, offering state residents who received a COVID-19 vaccination to conveniently access their vaccine record from the state’s immunization registry systems. California’s Digital COVID-19 Vaccine Record, available on myvaccinerecord.cdph.ca.gov, follows national standards for security and privacy, is built and maintained by the state, and provides residents a way to view and save their vaccine record.
The digital record system displays the same information as the paper CDC vaccine card and includes a QR code that makes vaccine details readable by a QR scanner. The state developed the digital record system using the SMART Health Card Framework, which is dedicated to improving privacy and security of patient information, making medical records portable, and reducing health care fraud. Businesses that incorporate QR scanning into their own systems must adhere to the SMART Health Card Framework developed by the VCI coalition.
The state’s Digital COVID-19 Vaccine Record is now live and can be accessed here.
On Thursday, the California Division of Occupational Safety and Health (Cal/OSHA) Occupational Safety and Health Standards Board (OSHSB) adopted revisions to the state’s COVID-19 prevention emergency temporary standards (ETS) that govern most workplaces throughout the state. OSHSB’s updates to the ETS follow several weeks of back-and-forth actions by the regulatory board as a result of updates to other federal and state COVID-19 regulations and public health guidelines.
The new ETS adopted on Thursday align with the latest public health guidance on the use of face coverings for vaccinated persons and reflect rising vaccination rates statewide. The revisions to the ETS now allow fully vaccinated employees to go maskless in indoor work settings if employers document the status of fully vaccinated employees. Physical distancing requirements have been eliminated except where an employer determines there is a hazard, and employees who are not fully vaccinated may request respirators for voluntary use from their employer at no cost and without fear of retaliation from employers. Also of note, employees are explicitly allowed to wear a face covering without fear of retaliation from employers.
The revised ETS, adopted on a 5-1 vote with one member absent, would normally go to the Office of Administrative Law (OAL) for review and approval before taking effect statewide. Governor Gavin Newsom, however, following OSHSB’s vote on the ETS, issued Executive Order N-09-21 enabling the revised regulations to take effect immediately without the 10-day review period by OAL.
Additional information from Cal/OSHA is available here. Information on the Governor’s executive order is available here.
For the third time on Thursday, the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act (ACA), leaving in place the landmark law’s broad provisions on health care access and coverage originally enacted by Congress in 2010. The case, California v. Texas, was initiated by a coalition of 18 states and two individuals, led by Texas, and sought the entire elimination of the ACA on the grounds that the ACA could not stand on its own after Congress removed the individual mandate tax penalty in 2017. The Texas coalition case was consolidated with another case brought by 17 states, led by then-California Attorney General Xavier Becerra, seeking to protect the sweeping health reform law.
Leading up to the Supreme Court, the challenge against the ACA by Texas and other states was largely successful in lower courts, as evidenced by a Texas federal judge’s ruling in 2018 that the entire law was invalid and agreement by appellate justices in New Orleans in 2019 that the individual mandate was unconstitutional.
Thursday’s ruling by the Supreme Court did not align with rulings by lower courts and largely did not address most of the arguments advanced by the Texas coalition. Instead, the majority opinion of the court, drafted by Justice Stephen Breyer, found that the challenging states had no legal standing to bring the case to court because they had not shown a past or future injury as a result of the ACA’s individual mandate. Justice Breyer was joined in the opinion by Chief Justice John Roberts and Justices Clarence Thomas, Sonia Sotomayor, Elena Kagan, Brett Kavanaugh, and Amy Coney Barrett. Justices Samuel Alito and Neil Gorsuch dissented, arguing the law’s mandate was now unconstitutional without the penalty and could not be severed from the rest of the law.
Thursday’s ruling represents the third time the U.S. Supreme Court has upheld the ACA. Of note, each ruling over the years has gained support upholding the sweeping health care reform law. In 2012, the Supreme Court upheld the constitutionality of the ACA’s individual mandate and optional state Medicaid expansion on a 5-4 vote. In 2015, the Supreme Court ruled in a 6-3 vote that federal subsidies could be used in states that did not set up their own insurance exchanges. And on Thursday, the Supreme Court ruled in a 7-2 vote that the plaintiffs had no standing to challenge the ACA in court.
Dramatic, nationwide changes to health coverage and patient protections were expected if the Supreme Court ruled in favor of plaintiffs in the California v. Texas case. However, with the court’s Thursday ruling, health experts largely anticipate the ACA to be secure for the foreseeable future. In a statement on the ruling by President Joseph R. Biden, Jr., the president declared, “The Affordable Care Act remains law of the land. … Today’s decision affirms that the Affordable Care Act is stronger than ever, delivers for the American people, and gets us closer to fulfilling our moral obligation that, here in America, health care is a right and not a privilege.” Similarly, U.S. Health and Human Services Secretary Xavier Becerra issued a statement applauding the Supreme Court’s ruling and recommitting the Biden-Harris Administration to protecting the ACA.
The Supreme Court’s full ruling on the California v. Texas case is available here.
This week, the Biden-Harris Administration announced it is investing more than $3 billion in American Rescue Plan Act (ARPA) funds to accelerate the discovery, development, and manufacturing of antiviral medicines to develop the next generation of COVID-19 treatments. The U.S. Department of Health and Human Services (HHS), including the National Institutes of Health (NIH) and the Biomedical Advanced Research and Development Authority (BARDA), will launch the Antiviral Program for Pandemics to respond to the urgent need for antivirals to treat COVID-19 and build sustainable platforms for discovery and development of antivirals for other viruses with pandemic potential.
The program will support research to identify and accelerate availability of breakthrough treatment options to ensure the public has access to viable medicines that can save lives and prevent overwhelming surges in hospitalizations. Under the program, more than $300 million will be dedicated for research and laboratory support, nearly $1 billion for preclinical and clinical evaluation, and nearly $700 million for development and manufacturing through the National Institutes of Allergy and Infectious Diseases (NIAID) and BARDA. An additional $1.2 billion is allocated to support the creation of collaborative drug discovery groups called Antiviral Drug Discovery (AViDD) Centers for Pathogens of Pandemic Concern.
Additional information on HHS’ investments is available here.
The U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) this week announced the establishment of an $80 million Public Health Informatics & Technology Workforce Development Program (PHIT Workforce Program) to strengthen U.S. public health informatics and data science. The initiative will work closely with colleges and universities, particularly those serving underserved and populations of color, to develop curriculum, recruit and train participants, secure paid internship opportunities, and assist in career placement at public health agencies, public health non-profit organizations, or public health-focused private sector or clinical settings.
The PHIT Workforce Program aims to train more than 4,000 individuals over a four-year period through an interdisciplinary approach in public health informatics and technology. ONC will award up to $75 million to cooperative agreement recipients and use the remaining $5 million for overall federal program administration. Award recipients will need to ensure their training, certificate, degree, and placement programs are sustainable to create a continuous pipeline of diverse public health information technology professionals.
Additional information, including information on the application process, is available here.
During a visit to Kern County on Wednesday, Governor Gavin Newsom announced the formation of the Governor’s Advisory Council on Physical Fitness and Mental Well-Being, a new advisory council that will be tasked with exploring strategies for promoting physical and mental health, particularly among children and youth. The council will be led and convened by First Partner Jennifer Siebel Newsom, and up to 15 representatives from health and wellness organizations, youth sports programs, education, and the entertainment and fitness industry are anticipated to be named to the council at a later date.
The Advisory Council will be tasked with the following activities:
- Advising on the development of physical activity and wellness goals for Californians of all ages.
- Advising on methods to increase awareness among all age groups, especially among children and youth, about how physical activity, sport, nutrition, and mental wellness contribute to healthy and productive lives.
- Encouraging intergenerational physical fitness activities, including the use of physical activity and sport to strengthen families.
- Facilitating collaboration among federal, state, and local agencies, education, business and industry, the private sector, and others in the promotion of physical activity and mental well-being.
Additional information from the Governor’s Office is available here.
In light of an extreme heat wave impacting many areas of the state, Governor Gavin Newsom on Friday issued an emergency proclamation to free up energy capacity and resources. The proclamation suspends certain permitting requirements, allows the use of back-up power generation, and frees up additional energy resources to help alleviate heat-induced demands on the state’s energy grid.
The Governor’s proclamation is available here.
The California Department of Health Care Services (DHCS) will host a webinar on Medi-Cal managed care and upcoming policy changes associated with the California Advancing and Innovating Medi-Cal (CalAIM) initiative on Tuesday, June 29 from 2:00 pm-3:00 pm. The webinar is intended for counties and providers and will feature an opportunity to learn the latest on Enhanced Care Management (ECM) and In Lieu of Services (ILOS) components of CalAIM. The June 29 webinar will be the first of a two-part webinar series.
Additional information, including registration, is available here.
The Center for Innovation in Academic Detailing on Opioids, a center within the San Francisco Department of Public Health (SFDPH), will hold a webinar on Wednesday, June 23 from 12:00 pm-1:00 pm entitled, “What Do I Do with Inherited Patients on Opioids? A Webinar for Providers.” The webinar will share information and clinical tools about inheriting patients on opioid therapy, ensuring continuity of care, and utilizing buprenorphine.
Registration and additional information is available here.
The de Beaumont Foundation is now offering a 15–20-hour online business certificate program designed specifically for public health professionals. This course, entitled BEAM – Building Expertise in Administration and Management, will focus on the following areas: strategic problem definition, budgeting, procurement, contracts, contract management, and financial health. BEAM was created to fill a gap identified by state and local public health professionals who say they need supplemental training in budgeting and financial management. Individual participant fees are $500 with discounts offered for groups of six or more. Information on the course can be found here and an FAQ on the program can be found here.