June 30, 2017 Edition

CHEAC Closed on Independence Day

CHEAC will be closed next Tuesday, July 4 in observance of Independence Day. We will be open on Monday and will return on Wednesday. Have a safe and enjoyable holiday!

A Flurry of Activities this Week around the Senate’s ‘Better Care Reconciliation Act’

Senate Republicans Postpone Vote on ‘Better Care Reconciliation Act’

After releasing the ‘Better Care Reconciliation Act’ (BCRA) late last week, Senate Republicans faced stiff opposition, both from the public and within their party, forcing Senate Majority Leader Mitch McConnell to postpone the vote until after the July 4 Recess. On Monday, the Congressional Budget Office (CBO) released a cost estimate of the BCRA, estimating that the bill would increase the number of people who are uninsured by 22 million in 2026, for a total of 49 million Americans without insurance. With the sobering CBO score and increasing GOP turmoil, the Senate’s proposal to repeal the ACA quickly began to unravel.

McConnell spent the remainder of the week meeting with Republican Senators in an attempt to bridge the gap between moderate and conservative members of his party by offering changes to the legislation. Potential changes have reportedly included increasing opioid prevention spending to $45 billion, allowing pre-tax health savings accounts to pay for insurance premiums, and removing tax breaks for high-income people, yet no legislative language has been released. On Thursday, the CBO issued another analysis of the BCRA detailing the longer-term effects of the proposed legislation, estimating Medicaid spending would be 35 percent lower in 2036.

Despite the attempts to sweeten the deal for some Republican Senators, both factions of the party appeared to be at an impasse as Senators returned to their states on Thursday evening. Latest reports suggest Republican Senators will spend the Independence Day Recess writing new legislation for a vote upon their return to Washington after next week’s recess. President Trump, on the other hand, began advocating Friday that the Senate repeal the ACA immediately and replace it at a later date.

In its released form, the BCRA proposes to eliminate the Public Health and Prevention Fund, roll back Medicaid Expansion, implement Medicaid per capita caps, and eliminate Essential Health Benefits, among other drastic changes. CHEAC included a brief overview of the Senate’s proposal in last week’s update available here and continues to closely follow the ongoing effort to repeal the ACA.

DHCS Releases Analysis on Senate’s Better Care Reconciliation Act (BCRA)

The California Department of Health Care Services (DHCS) released a preliminary fiscal analysis of the BCRA this week, revealing that California could face more than $30 billion annually in additional health care costs by 2027. BCRA would drastically shift costs from the federal government to the State of California, resulting in cumulative costs of $114.6 billion, $92.4 billion of which would be costs to the General Fund, between 2020 and 2027.

Further, the BCRA would quintuple the State’s costs for the more than 3.8 million Californians in the ACA expansion population currently covered by Medi-Cal, resulting in an estimated $74.1 billion in costs between 2021 and 2027. This proposal dramatically reshapes the federal-state partnership of Medicaid and threatens to force California to consider reducing or even ending vital health care services to the state’s most vulnerable individuals, according to the analysis.

DHCS’s analysis and fiscal estimates for the BCRA are available here.

CHEAC Activity

CHEAC signed onto a letter organized by the Trust For America’s Health (TFAH) to Senate leadership opposing the repeal of the Affordable Care Act’s Prevention and Public Health Fund. The Prevention and Public Health Fund supports essential core public health services, including immunization programs, epidemiology and laboratory services, cancer screenings, and chronic disease prevention efforts. The letter, featuring more than 580 signees, is available here.

CHEAC also signed onto a letter this week with a coalition of California county organizations. The letter was delivered to U.S. Senators and is available here.

Members are can find additional ACA-related resources on our website.

Governor Brown Signs $183B Budget

On Tuesday this week, Governor Jerry Brown signed into law a $183 billion ($125 billion General Fund) state budget without issuing any vetoes. The newly-signed budget goes into effect starting July 1, and notably increases spending on Medi-Cal, education, child care, and transportation infrastructure. The budget also provides $1.8 billion to the rainy day fund and despite signing in the largest budget in state history, Governor Brown continued to stress the importance of maintaining fiscal prudence ahead of uncertain financial times.

The new budget provides $60.2 billion for the Health and Human Services Agency and features $711.2 million for new growth in Medi-Cal expenditures and $546 million for supplemental Medi-Cal provider payments in Proposition 56 funding. The budget also includes county mitigation for the IHSS program associated with the end of the Coordinated Care Initiative, restores Medi-Cal optical and dental benefits, and establishes a unified state regulatory system for medicinal and adult-use cannabis. CHEAC’s detailed summary of the cannabis trailer bill can be found here.

A handful of budget trailer bills have been passed by both houses and are now awaiting the Governor’s signature. The Governor’s full budget summary is available here. CHEAC recently included a brief of the budget passed by the Legislature in our weekly update available here.

Policy Committee Hearings in Full Swing

Policy committees in both houses continue ahead of the looming July Legislative deadlines. With just two weeks to pass fiscal bills and three weeks to pass non-fiscal bills, policy committees are scheduled to meet on Monday, will break on Tuesday for the Independence Day holiday, and reconvene on Wednesday.

This week’s full bill chart is available here. Below, we highlight several legislative actions of interest to CHEAC Members from this week.

Local Health Department Administration

AB 1250 (Jones-Sawyer) as amended on 6/21/17 – Oppose

CHEAC continues to oppose AB 1250, introduced by Assembly Member Reginald Jones-Sawyer, Sr., which would place onerous requirements on county contracting, including many of the contracts into which local health departments enter for vital public health services. The bill is scheduled to be heard in the Senate Governance and Finance Committee next Wednesday, July 5 at 9:30 am.

CHEAC has joined a growing coalition of organizations led by the California State Association of Counties (CSAC), including nearly 100 partners and 40 counties, in opposing this measure. Our opposition letter may be viewed here. CHEAC Members are encouraged to contact members of the Senate Governance and Finance Committee that represent your jurisdiction to express your opposition and/or educate the legislator on the potential adverse impacts to local health departments and the services we provide.

Health Coverage

SB 562 (Lara) as amended on 5/26/17 – Special Interest Bill

Late last week, Assembly Speaker Anthony Rendon released a statement indicating SB 562 will not be acted upon this year. SB 562, authored by Senator Ricardo Lara, would establish the Healthy California Act to provide universal, single-payer health coverage for every Californian. Speaker Rendon noted he is supportive of single-payer health reform and was encouraged by the discussion around SB 562; however, Rendon called the Senate bill ‘woefully incomplete,’ citing its lack of details around financing, delivery of care, and cost controls.

Given that this is the first year of the two-year legislative session, the bill may return next year if Senators add financing and delivery details. For now, however, SB 562 will remain in the Assembly Rules Committee until further notice.

AB 340 (Arambula) as introduced on 2/7/17 – Support

Assembly Member Joaquin Arambula’s AB 340 was advanced from the Senate Health Committee to the Senate Appropriations Committee. The measure would require that any Early and Periodic Screening, Diagnosis and Treatment (EPSDT) screen include screening for trauma and proposes statewide guidance to practitioners to look for trauma when children are screened. CHEAC supports the measure, along with the Health Officers Association of California (HOAC), the County Welfare Directors Association (CWDA), and the County Behavioral Health Directors Association (CBHDA).

Tobacco

AB 725 (Levine) as introduced on 2/14/17 – Support

SB 386 (Glazer) as amended on 6/28/17 – Support

AB 725 by Assembly Member Marc Levine and SB 386 by Senator Steven Glazer were heard in the Senate Natural Resources & Water Committee and the Assembly Water, Parks & Wildlife Committees, respectively, this week. The measures are identical and would ban smoking (including e-cigarettes) and disposal of cigar and cigarette waste at state coastal beaches, parks, public campgrounds, monument sites, landmark sites, and sites of historical interests.

Upon recommendation by the Assembly Water, Parks & Wildlife Committee, amendments were made to SB 386 to limit the scope of the bill by allowing the Director of Parks and Recreation to exempt certain areas of state parks from the smoking ban to address a previous veto message by Governor Brown. Both measures were advanced from their committees to the Assembly and Senate Appropriations Committees.

Maternal and Child Health

SB 426 (Pan) as amended on 5/26/17 – Watch

SB 426, introduced by Senator Richard Pan, was heard in the Assembly Human Services Committee this week. The measure establishes a community-based home visitation pilot program in three counties to provide child abuse and neglect prevention and intervention services through a family resource center in each county contingent on an appropriation. During the hearing, some concern was expressed about the training and professional skillset for those providing home visiting services, the need to make the program voluntary, and the potential duplication of existing home visiting programs. Senator Pan accepted the committee’s amendments to extend the sunset date by three years and add technical requirements of the pilot programs. The measure was advanced to the Assembly Appropriations Committee.

Cannabis

AB 175 (Chau) as amended on 5/30/17 – Support

Assembly Member Ed Chau’s AB 175 was advanced from the Senate Business, Professions & Economic Development Committee to the Senate Health Committee this week. The measure requires adult use cannabis manufacturers, prior to releasing cannabis-infused edible products, to receive approval from the California Department of Public Health (CDPH) including submitting their packaging and labeling to CDPH for review. CHEAC supports AB 175, which attempts to prevent the accidental ingestion of cannabis products.

SB 663 (Nielsen) as introduced on 2/17/17 – Support

SB 663, introduced by Senator Jim Nielsen, was passed from the Assembly Health Committee to the Assembly Business and Professions Committee this week. The measure deems the packaging or labeling of cannabis products as appealing to children if: 1) it includes transparent packaging, 2) if the product resembles any existing candy, snack food, baked good, or beverage, 3) if the product includes any statement, artwork, or design that is misleading to a person under 21, 4) if it includes any cartoon, logo, colors, image, or design feature making it attractive to children, or 5) if it includes a name or slogan appealing to those under 21.

Health Equity

AB 210 (Santiago) as amended on 5/2/17 – Support

Assembly Member Miguel Santiago’s AB 210, which would allow counties to establish multidisciplinary teams to facilitate the expedited identification, assessment, and linkage of homeless individuals to housing and supportive services, was advanced from the Senate Human Services Committee to the Senate Judiciary Committee this week.

Chronic Disease Prevention and Wellness Promotion

AB 841 (Weber) as amended on 5/17/17 – Support

AB 841 by Assembly Member Shirley Weber was passed from the Senate Education Committee to the Senate Floor this week. The measure prohibits schools from advertising food or beverages or corporate brands unless all products are sold or served during the school day and prohibits participation in corporate incentive programs that reward students with food or beverages when they achieve academic goals. Several advertisements are exempted, and certain items, such as scoreboards and sports uniforms, are grandfathered in. CHEAC supports this measure as a way to encourage healthy food and beverage consumption among children.