March 11, 2022 Edition
Today, the CHEAC Legislative Committee convened for its second virtual daylong bill review meeting to assess legislative measures of interest to CHEAC Members and California local health departments. The Legislative Committee reviewed over 90 new bills introduced in the second year of the 2021-22 Legislative Session.
As policy and fiscal committees continue to set measures for hearings over the coming weeks and months, CHEAC will keep Members apprised of the latest and most relevant legislative developments. The latest edition of the CHEAC Weekly Bill Chart is available here.
On Monday, March 14, Assembly Budget Subcommittee No. 1 on Health and Human Services will be hearing the Governor’s health care workforce budget proposals under issue 7. While the focus is on the health care workforce, CHEAC has been invited to join the panel discussion to highlight the challenges the public health workforce is experiencing, including but not limited to significant workforce recruitment and retention challenges, many of which existed prior to the pandemic, but have only been exacerbated by burnout, harassment of public health officials, and increased competition with other sectors.
The Assembly Budget Subcommittee No. 1 on Health and Human Services hearing agenda can be found here. More detail on this panel and the health care workforce proposals can be found on page 31.
This week, the U.S. Congress passed a $1.5 trillion omnibus appropriations bill to fund the federal government through Federal Fiscal Year 2022, which ends in September.
The final bill includes funding increases to public health agencies and programs under the U.S. Department of Health and Human Services (HHS), including a $582 million increase for the U.S. Centers for Disease Control and Prevention (CDC). However, funding for some public health programs was lower than expected based on the levels that had been included in the versions of FY 2022 appropriations bills drafted in Senate and House subcommittees.
According to the National Association of County and City Health Officials (NACCHO), the omnibus bill establishes a new funding line for public health infrastructure and allocates $200 million for FY 2022, which was lower than anticipated. Other highlights from the omnibus measure include:
- $715 million for the Public Health Emergency Preparedness Cooperative Agreement, a slight increase over the FY 2021 funding but less than the $1 billion requested by NACCHO
- $100 million for the Data Modernization Initiative at CDC
- $1 billion to establish the Advanced Research Project Agency for Health (ARPA-H) which is yet to be authorized by Congress under the National Institutes of Health (NIH)
- $550 million to expand broadband internet access in underserved areas, including rural areas.
In addition to setting FY 2022 funding levels, the omnibus measure also includes several policy changes:
- Provides U.S. Food and Drug Administration (FDA) authority to regulate synthetic nicotine products
- An extension of Schedule I classification of fentanyl-like substances
- The bill does not extend a policy that allowed schools to serve universal free meals during the pandemic, reverting to the Obama Administration-era nutrition standards that force schools to collect eligibility paperwork that was waived during the COVID-19 pandemic
Of particular note, the FY 2022 omnibus measure initially included $15.6 billion to support the nation’s continued COVID-19 pandemic response. According to NACCHO, Congressional Republicans have voiced skepticism of new COVID-19 funds and pushed for any new funds to be offset. To address this concern, Congressional Democratic leaders included a provision to claw back certain unused COVID-19 funding from state governments. In turn, Democratic members of many of those states objected, causing the entire slate of COVID-19 funding to be stripped from the FY 2022 omnibus measure.
The House will vote next week on a standalone COVID-19 supplemental funding measure, with its passage expected. The standalone COVID-19 measure faces an uncertain future in the Senate, however, given that bipartisan support of the measure will be required for passage.
The $15.6 billion proposed in the FY 2022 omnibus measure was short of the $30 billion the Biden-Harris Administration has said it needs to sustain its COVID-19 response and prepare for future COVID-19 variants.
The full $1.5 trillion omnibus measure is available here. CHEAC will continue analyzing funding included in the FY 2022 omnibus measure, as well as the forthcoming standalone COVID-19 funding measure. We will keep Members apprised of any developments of interest and relevance to California local health departments.
On Tuesday evening, Governor Gavin Newsom delivered his State of the State address to an in-person audience of the California State Legislature. Governor Newsom, in his relatively brief address, touted the many successes of the state across a wide range of subjects, including climate change mitigation, economic growth and development, innovation, and social safety net policies.
The Governor briefly touched on the subject of COVID-19, highlighting his Administration’s continued COVID-19 vaccination efforts and its recently released SMARTER Plan. Governor Newsom additionally pointed to the successes of nonpharmaceutical interventions, including stay-at-home orders and masks, in protecting residents, decreasing cases, and saving lives.
The full text of the Governor’s State of the State address is available here.
On Wednesday, the Senate Health Committee and Special Committee on Pandemic Response convened a joint informational hearing entitled, “The Long Haul: Preparing for the Impacts of Long COVID.” The hearing featured four panels of medical and public health experts, patients, and consumers to discuss the overview of long COVID, the experience of living with long COVID, statewide planning and preparation, and long-term impacts of the condition.
Representatives from the University of California, San Francisco (UCSF), Children’s Hospital Los Angeles, the University of California, Los Angeles (UCLA), and the Mayo Clinic to discuss the condition of long COVID infection and symptoms, impacts on the health care delivery system, and potential health-related needs as the result of long COVID.
State Epidemiologist Dr. Erica Pan from the California Department of Public Health (CDPH), as well as Dr. Jennifer Chevinsky from the Riverside County Department of Public Health, discussed various local, state, and federal efforts in responding to long COVID, addressing disparities in long COVID conditions, promoting awareness, and delivering various supports to individuals impacted by long COVID.
The hearing agenda is available here. A background paper from the hearing is available here. Other presentation materials can be accessed here. A video recording of the hearing is available here.
Following its recent update to the National COVID-19 Preparedness Plan, the Biden-Harris Administration announced additional details on its nationwide Test-to-Treat Initiative. Through the program, individuals who test positive for COVID-19 will be able to visit local pharmacy-based clinics and federally qualified health centers (FQHCs), and long-term care facility residents in one stop, be assessed by a qualified health care provider who can prescribe antiviral pills.
The Administration issued a fact sheet on the Test-to-Treat Initiative outlining the overall program and addressing frequently asked questions. The information is available here.
On Thursday, the Transportation Security Administration (TSA), at the recommendation of the U.S. Centers for Disease Control and Prevention (CDC), extended its security directive requiring the use of a mask on public transportation and transportation hubs for one month, through April 18, 2022.
According to the CDC, during that time, the agency will work with its partner governmental agencies to help inform a revised policy framework for when, and under what circumstances, masks should be required in the public transportation sector. The revised framework will be based on the CDC COVID-19 Community Levels, risk of new variants, national data, and the latest science.
Additional information is available here.
U.S. Surgeon General Vivek Murthy has announced a request for information (RFI) on the impact and prevalence of health misinformation in the digital information environment during the COVID-19 pandemic. Surgeon General Murthy seeks to understand the impact of COVID-19 misinformation on public health and the health care infrastructure during the pandemic, including quality of care, health decisions and outcomes, direct and indirect costs, trust in the health care system and providers, and health care worker morale and safety.
The overarching goal of the RFI is to understand how the exposure to misinformation played a role in the societal response to the COVID-19 pandemic and any implications for future public health emergencies. The RFI seeks to understand how the public can access trusted and credible health information during a public health emergency, and how that could impact an individual’s decision to receive a vaccination or other life-saving health decisions.
Additional information is available here. Comments may be submitted through the Federal eRulemaking Portal, available here.
The Bipartisan Policy Center (BPC) will host a webinar on Thursday, March 17 entitled “Transitioning Out of the COVID-19 Emergency Phase.” The BPC will host CDC Director Dr. Rochelle Walensky to discuss her COVID-19 forecast for 2022.
Other leading public health experts will participate in a discussion of the implications of the eventual end of the public health emergency for the coverage and delivery of public health and health care services. Discussion topics will include care delivery in and financing of hospitals and nursing homes, the new normal of telehealth, and whether low-income individuals will find it harder to stay on Medicaid.
The webinar will be hosted from 6:30 am to 7:30 am PT. Additional information, including registration, is available here.
The California Health and Human Services (CalHHS) Agency, in partnership with its Departments of Health Care Services, Managed Health Care, Public Health, Health Care Access and Information, and the Office of the California Surgeon General, will host a webinar on March 15, 2022, from 10:00 am to 12:00 pm to provide an overview of the Children and Youth Behavioral Health Initiative (CYBHI).
The CYBHI was created to enhance, expand, and redesign the California behavioral health systems for all children, youth, and families by delivering equitable, appropriate, timely, and accessible behavioral health services and supports. The CYBHI will be designed and implemented in partnership with CalHHS departments, sister state agencies, and other stakeholders.
Additional information, including registration is available here.
The U.S. Department of Health and Human Services (HHS) this week announced a series of funding opportunities totaling nearly $35 million to strengthen and expand suicide prevention programs and strengthen community mental health services for the country’s children and young adults. Funding for the programs, in part, was provided through the American Rescue Plan Act (ARPA).
Seven grant program opportunities exist through the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of Minority Health (OMH). Additional information on the opportunities is available here.
The California Department of Cannabis Control recently announced updated proposed cannabis regulations. These include:
Readoption of Emergency Regulations. The Department of Cannabis Control (DCC) is proposing to readopt its emergency regulations to consolidate the commercial cannabis regulations. The readoption process will allow the emergency regulations to remain in place while DCC completes the regular rulemaking process, which began on March 4.
Initial notice and proposal – March 10, 2022
Consolidated Cannabis Regulations. The DCC has released their comprehensive proposal to make changes to streamline and simplify the cannabis regulations. The proposed regulations include the changes that are in as emergency regulations and additional changes to streamline and strengthen the regulatory framework. The proposed regulations would take effect in Fall 2022 if approved.
Initial notice and proposal – March 4, 2022
Public comment can be submitted in the following ways:
CHEAC will be reviewing the proposed regulations in the coming weeks and will determine whether to weigh in with public comment. We welcome input from local health departments as departments complete their review. Should your local health department submit public comment, we ask that you please provide a copy or key points to CHEAC.
The U.S. Centers for Disease Control and Prevention (CDC) released the results of the 2021 National Youth Tobacco Survey (NYTS) this week, finding that approximately 2.55 million U.S. middle and high school students report current (past 30-day) use of a tobacco product in 2021.
The NYTS was conducted among U.S. middle and high school students during the COVID-19 pandemic in an online format, allowing eligible students to complete the survey at home, school, or other location. The CDC notes, because of the change in settings, the 2021 NYTS survey results cannot be compared with results from previous NYTS surveys that were primarily conducted on school campuses.
According to the data, electronic cigarettes were the most common tobacco product currently used among middle and high school students (2.06 million) in 2021. This was followed by cigarettes (410,000), cigars (380,000), smokeless tobacco (240,000), hookahs (220,000), nicotine pouches (200,000), heated tobacco products (170,000), and pipe tobacco (80,000).
The CDC notes disparities in tobacco use persist among subgroups of youth. These include:
- Among middle and high school students combined, current use of any tobacco product was higher among students who identified as lesbian, gay, or bisexual (14.2 percent) than those who identified as heterosexual (7.9 percent) and those who were “not sure” about their sexual identify (5.5 percent); and higher among students who identified as transgender (18.9 percent) compared to those not transgender (8.2 percent)
- Current use of any tobacco product was higher among students who had severe (14.2 percent), moderate (11.2 percent), or mild (9.6 percent) of symptoms of psychological distress compared to those with no psychological distress (5.5 percent)
- Among all race and ethnicity groups, non-Hispanic Black students report the highest prevalence of current combustible tobacco product use (5.2 percent) and specifically cigar use (3.1 percent)
Further, the CDC notes that among the approximately 2.55 million middle and high school students who currently used any tobacco product, most (about 8 in 10 or 1.95 million) reported using flavored tobacco products in the past 30 days. Approximately 76 percent of students in 2021 reported exposure to tobacco product marketing through traditional media (e.g., newspapers or magazines) and approximately 74 percent of students who used social media had ever seen e-cigarette-related posts or content.
Of the 2.55 million students who currently used any tobacco product, 65.3 percent reported they were seriously thinking about quitting all tobacco products. Further, 60.2 percent of students who currently used tobacco products reported that they stopped using all tobacco products for one or more days in the past 12 months because they were trying to quit.
The full 2021 NYTS survey results are available here.
The National Academies of Sciences, Engineering, and Medicine recently released a report, “Premium Cigars: Patterns of Use, Marketing, and Health Effects.” The report found that overall cigar consumption has increased every year since the late 1990s, with a total increase of 145 percent from 1998 to 2020. The report details 13 findings, 24 conclusions, and nine priority research recommendations. Further, the report assesses the state of evidence on premium cigar characteristics, current patterns of use, marketing and perceptions of products, and short-and long-term health effects.
NASEM’s recommendations for federal agencies include:
- Development of formal categories and definitions of all cigar types to be used for research to ensure consistency among studies
- Implementation of a strategic plan to regularly monitor patterns of use, product characteristics, consumer knowledge, collection of sales and marketing data
- Improvement of survey data collection
- Research to assess specific aspects of premium cigars for characteristics, health effects, addiction potential, marketing practices, and consumer perceptions and knowledge
The full NASEM report is available here.
The Trust for America’s Health (TFAH) this week released its annual report entitled, “Ready or Not 2022: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism,” evaluating states’ performance on 10 key emergency preparedness indicators and identifying gaps in states’ readiness to respond to emergencies. The report calls for urgent investment to create a public health system to protect all Americans’ health during emergencies.
The report tiers states and the District of Columbia into three performance levels: high, middle, and low, placing 17 states in the high-performance tier, 20 states in the middle-performance tier, and 13 states in the low-performance tier based on their 2021 performance. Notably, California was ranked in the middle-performance tier.
Other key findings of the report include:
- A majority of states had plans in place to expand health care and public health laboratory capabilities in an emergency
- Most states are accredited in the areas of public health, emergency management, or both
- A large majority of Americans who receive their household water through a community water system had access to safe water
- Only about half of the U.S. population is served by a comprehensive local public health system
- Seasonal flu vaccination rates have risen significantly in recent years but are still lower than the goal set by Healthy People 2030
- Just over half of workers used some kind of paid time off in a one-month sample; the need for paid time off has become particularly apparent during the pandemic, as many workers became ill or needed to care for a sick family member
- Only 28 percent of hospitals, on average, earned a top-quality patient safety grade during the year, down from 31 percent the year prior.
TFAH, in its report, notes that while critical progress was made in fighting COVID-19 during 2021, the pandemic continued to illuminate the ways in which health inequities put communities of color and low-income communities at heightened risk for worse health outcomes during an emergency.
TFAH sets forth the following policy recommendations:
- Congress and states should provide stable, flexible, and sufficient funding for public health, including infrastructure, data systems, and the public health workforce
- Congress should create a COVID-19 Commission to review and address gaps in the pandemic response, and leaders at all levels of government should reject attempts to weaken public health authorities
- Policymakers should take steps to prevent disease outbreaks by investing in vaccination infrastructure, antibiotic resistance programs, and by providing paid leave for all workers
- Congress should create programs to help build resilient communities by investing in health equity and the social determinants of health, including anti-poverty programs and programs that build financial security for families
- Congress should invest in the development and distribution of medical countermeasures to enable rapid development and effective deployment of life-saving products during emergencies and federal and state policymakers and health systems should work together to prioritize effective coordination and communication during emergencies
- The White House, Congress, and states should develop plans and provide funding to maximize the health impacts of climate change and do so in ways that address health equity
The full TFAH report is available here.
The California Department of Public Health (CDPH) is currently soliciting nominations for the 2021 and 2022 Beverlee A. Myers Award for Excellence in Public Health. This award recognizes the contributions of public health and health care services professionals in improving the health status of everyone who calls California home and the millions who visit the state every year.
The Beverlee A. Myers award is presented annually to an individual not currently working at CDPH who has exhibited outstanding leadership and accomplishments in public health in California. Nominations are due to CPDH by Thursday, March 31 at 5:00 pm. The award recipients for 2020, 2021, and 2022 will be recognized at the Public Health Week Virtual Awards Ceremony on Thursday, April 21, 2022.
Additional information on the award and the nomination process is available here.
The University of California, Los Angeles and the University of California, San Francisco (UCLA-UCSF) ACEs Aware Family Resilience Network (UCAAN) recently announced a grant funding opportunity entitled, “Preventing and Responding to Adverse Childhood Experience (ACE)-Associated Health Conditions and Toxic Stress in Clinics through Community Engagement (PRACTICE).”
The statewide grant seeks to strengthen partnerships to screen for ACEs and respond to toxic stress, develop sustainable, evidence-informed clinical services that target ACE-associated health conditions, and build a sustainable workforce to support ACE screening and respond to the impact of toxic stress and adversity. PRACTICE seeks to support clinical teams mobilizing a health system’s response to addressing toxic stress within California communities.
The PRACTICE Grant will provide funding support, technical assistance, and peer-to-peer learning to clinical teams participating in the statewide learning collaborative. Findings from PRACTICE Grantees will inform the next phase of the ACEs Aware initiative and ongoing work throughout the state to develop partnerships, evidence, and care practices that interrupt the impact of ACE-associated health conditions and toxic stress.
Additional information is anticipated to be released in early April 2022. A request for information (RFI) has been issued ahead of the forthcoming request for proposals (RFP) and is available here. More information about the opportunity is available here.
The Insure the Uninsured Project (ITUP) will host the first ITUP Policy Forum of 2022 on March 30 from 9:30 am to 12:00 pm. The Policy Forum will convene experts for state-level discussions related to health policy in California and will feature constructive dialogue, problem-solving, and identification of creative policy solutions to today’s pressing health policy-related issues.
The March 30 Policy Forum will discuss health coverage expansion policies, including the Governor’s recently proposed investment to expand full-scope Medi-Cal to all income-eligible adults regardless of immigration status.
Additional information, including registration, is available here.