March 23, 2018 Edition
After weeks of negotiations, Congressional leaders this week emerged with a $1.3 trillion omnibus budget bill that will fund the federal government through the remainder of the 2018 fiscal year, with funding expiring on September 30. The expansive 2,232 page bill featured significant increases in both defense spending, which was widely supported by President Trump and Congressional Republicans, and increases in domestic spending, which was urged by Congressional Democrats.
On Thursday, the House passed the measure on a 256-167 vote, and the Senate passed the measure on a 65-32 vote early this morning, effectively avoiding a federal shutdown that was slated to occur beginning midnight tonight, Friday, March 23. President Donald Trump, though he tweeted an early morning threat to veto the bill, signed the measure into law today.
Recall, in early February, Congress passed a short-term continuing resolution funding the government through today and agreed to a two-year budget framework that increased federal spending on defense and nondefense programs by over $300 billion over the next two years and increased the debt ceiling for one year.
Since the passage of the short-term funding measure and budgetary framework in February, Congressional leaders have been locked in negotiations to determine the amount of funds and where they would be spent. While the spending plan funds virtually all federal government departments and agencies, there are a number of health-related funding provisions included in the measure. These include:
- $78 billion in overall funding to the U.S. Department of Health and Human Services ($10.1 billion increase from FY 2017)
- $8.3 billion in funding to the U.S. Centers for Disease Control and Prevention (CDC) ($1.1 billion increase from FY 2017)
- $3.6 billion in additional funds to address the national opioid crisis via prevention, treatment, and law enforcement activities
- $135 million in additional funds to community health centers
- $37 billion in funding to the National Institutes of Health (NIH) to support further research into opioid addiction, a universal flu vaccine, brain initiatives, Alzheimer’s Disease and dementia, and other health conditions ($3 billion increase from FY 2017)
Notably, the spending measure did not include language or funding to help stabilize Affordable Care Act (ACA) marketplaces and lower premiums for low- and middle-income Americans. Recall, Senators Susan Collins (R-Maine) agreed to support the GOP’s tax cut measure last year on the promise that provisions would be included in the budget measure to stabilize marketplaces by reinstating cost-sharing reduction payments (CSRs) provided to health insurance companies to lower enrollee copayments and deductibles. Senator Lamar Alexander (R-Tennessee) has also been pushing for such stabilization provisions, though Congressional leaders were unable to come to consensus on a proposal.
The funding measure also includes provisions known as the Fix NICS Act, which addresses loopholes in the National Instant Criminal Background Check System that is used when individuals attempt to purchase firearms. The spending measure includes language explicitly specifying that the CDC can, in fact, conduct research into gun violence. The measure did not, however, address the Dickey Amendment, which prohibits the CDC from using funds that “may be used to advocate or promote gun control.”
Related to immigration, the measure includes $1.6 billion for protections along the U.S.-Mexico border, but with significant limitations around how the funding may be used. Increased funding is also provided to customs and immigration enforcement. The spending measure notably does not address the Deferred Action for Childhood Arrivals Program (DACA) which provides protections from deportation to over 700,000 immigrants brought to the country without documentation as children.
With federal government funding secured through the remainder of the fiscal year upon President Trump’s signature, reports suggest that this funding measure will be the last major legislative achievement ahead of the 2018 midterm elections that will be held in November.
Yesterday, the Senate Budget Subcommittee No. 3 on Health and Human Services convened hearing items related to four state agencies, the California Emergency Medical Services Authority, Department of Managed Health Care, Department of Health Care Services and the Department of Public Health. Two key items of interest to CHEAC, our request for Oral Health Rollover and the Governor’s proposal to eliminate the use of 340B in the Medi-Cal Program, were included in the hearing.
Oral Health Rollover. CHEAC worked within a coalition of organizations – California Dental Association (CDA), California Health+ Advocates, California Pan-Ethnic Health Network, Children Now, The Children’s Partnership, and the University of the Pacific Dugoni School of Dentistry Pacific Center for Special Care – to advocate for state authority to rollover local oral health program funding for three years as modeled in the tobacco control program. Dr. Kumar, the State Dental Director, provided the subcommittee with an overview of the Local Oral Health Program and the status of contracts with local jurisdictions. Michelle Gibbons (CHEAC) and Brianna Pittman (CDA), followed Dr. Kumar’s presentation and highlighted compressed timelines local jurisdictions faced during this first year and the concerns around the inability to carry-over funding from year-to-year.
Dr. Kumar then provided new information related to an “ administrative fix” that they believe will resolve the issue. The Department of Finance provided remarks reiterating that the administrative fix should resolve the concerns. While this is the first we have heard of this fix, we will continue to work with the Administration to better understand the details. Dr. Pan, chair of the subcommittee encouraged continued conversation between the department and our organizations and alluded to the Legislature taking additional measures if needed.
The item was held open. The discussion can be viewed using this link and begins at the 6 hour and 19 minute mark.
The request for Oral Health Rollover will be heard by the Assembly Budget Subcommittee No. 1 on HHS on April 30.
340B. The Governor’s proposed 2018-19 budget included a proposal to eliminate 340B drug purchasing within the Medi-Cal program. CHEAC signed onto a coalition letter requesting the Senate and Assembly Budget Subcommittees on Health and Human Services to reject the Administration’s proposal.
Yesterday’s hearing included an overview of the proposal by DHCS, who reiterated their goal of eliminating duplicate claiming in the program and interim solutions being implemented. Others expressed deep concerns regarding the downstream implications of such a massive change and encouraged the Legislature and Administration to work with stakeholders to identify other solutions as a more immediate step.
Senator Stone questioned the need to move directly to eliminating the 340B program within Medi-Cal and referenced the 2016 OIG report that indicated other states had found solutions to ensure no “double-dipping” of the federal dollars. The Legislative Analyst’s Office focused on the concept of potential savings from the proposal and how the legislature could direct the savings. However, Senator Pan stressed the potential net loss of federal dollars and encouraged the department to examine not only the savings, but the impacts to our healthcare systems. This item was held open.
Senate Budget Subcommittee No. 3 Agenda
CHEAC Letters and Budget Resources
Atkins Sworn in as Senate President Pro Tempore, Legislature Breaks for Spring Recess
The California Legislature maintained a busy schedule this week with a number of hearings, amended bills, and a Senate leadership change prior to adjourning for its 10-day Spring Recess.
On Thursday, Senator Toni Atkins was sworn in as the Senate President Pro Tempore, replacing outgoing Senator Kevin de León. Atkins is the first-ever female Senate leader, first openly gay leader, and first member of the Legislature to serve as both the Assembly Speaker and Senate President pro Tempore. Atkins takes the Senate helm at a particularly interesting time as sexual harassment and assault, immigration, health care, climate change, and other hot-button issues continue to garner significant attention in Sacramento and throughout the state.
The Legislature is due back in Sacramento on Monday, April 2, where the month of April is expected to be a very busy month dominated with policy and budget committee hearings.
Below, we highlight significant actions this week in the Legislature. Our full CHEAC Weekly Bill Chart is available here.
AB 1766 (Maienschein) as revised on March 6, 2018 – Support
Assembly Member Brian Maienschein’s AB 1766 was unanimously advanced from the Assembly Health Committee to the Assembly Appropriations Committee this week. The measure would require public swimming pools to provide a readily-available AED unit during pool operations and would also require the California Department of Education (CDE) to work in consultation with the California Department of Public Health (CDPH) to issue best practice guidelines for pool safety at K-12 schools.
AB 1798 (Chu) as amended on March 14, 2018 – Support
AB 1798 by Assembly Member Steven Chu would require all school buses in the state of California to be equipped with a passenger restraint system by July 2035. The measure was recently amended to extend the date of compliance a number of years due to cost concerns.
CHEAC supports this measure to prevent injury and death among California’s children. AB 1798 was passed out of the Assembly Transportation Committee and to the Assembly Education Committee.
Chronic Disease Prevention & Wellness Promotion
AB 3043 (Berman) as amended on March 13, 2018 – Support
Assembly Member Marc Berman’s AB 3043 was advanced from the Assembly Education Committee to the Assembly Appropriations Committee this week. AB 3043 would authorize any school that participates in the federal School Breakfast Program to provide a universal school breakfast service in which a nutritionally-adequate breakfast is provided to every pupil at no charge. The measure also increases CDE grant awards upon budgetary appropriation from $15,000 to $30,000 per school site to initiate or expand a school breakfast program or federal summer meals program. CHEAC supports this measure to ensure California’s children have access to nutritious meals.
AB 1787 (Salas) as introduced on January 8, 2018 – Watch
AB 1788 (Salas) as introduced on January 8, 2018 – Watch
AB 1880 (Fong) as amended on March 1, 2018 – Watch
AB 1881 (Fong) as amended on March 14, 2018 – Watch
Assembly Members Salas and Fong, along with several other members joining as coauthors, have introduced a series of bills to address Valley Fever. The four bills above were scheduled to be heard in the Assembly Health Committee earlier this week. Both AB 1880 and AB 1881 were pulled from the hearing (and will not move forward); however, some elements of AB 1880 were incorporated into AB 1787. For AB 1787, which requires CDPH to establish a March 1 deadline for local health officers to report cases of Valley Fever to CDPH, the author accepted amendments to move that deadline from March 1 to March 31. An additional amendment, taken from AB 1880, would require CDPH to collect and aggregate all Valley Fever data by April 15 of each year. AB 1788, which allows CDPH to use laboratory results to confirm a case of Valley Fever with or without clinical criteria, was amended to add additional co-authors to the bill. Both AB 1787 and AB 1788 were presented to the Committee by Assembly Members Salas and Fong and passed out unanimously with amendments. The bills now move to the Assembly Appropriations Committee.
On Wednesday, the Trump Administration named HIV researcher Robert Redfield, M.D. as the next director of the U.S. Centers and Disease Control and Prevention (CDC). According to a statement from Health and Human Services Secretary Alex Azar, Redfield served as the founding director of the U.S. Military’s HIV Research Program Department of Retroviral Research and retired after 20 years of service with the U.S. Army Medical Corps. Redfield also cofounded the University of Maryland’s Institute of Human Virology and served as the Chief of Infectious Diseases and Vice Chair of Medicine as the University of Maryland School of Medicine.
Despite concerns, including those regarding his lack of experience in leading a government public health agency, among a number of policymakers and key stakeholders, many praised Redfield’s selection. His appointment does not require confirmation from the U.S. Senate and he is expected to begin in his new role in the coming days. Dr. Anne Schuchat, who has been serving as the acting director, is expected to return to her existing role as CDC Principal Deputy Director.
On Monday, President Donald Trump unveiled his Administration’s wide-ranging plan to address the nation’s opioid epidemic, vowing to “liberate” the country from the crisis. Recall, President Trump convened an opioid commission last year to identify recommended interventions, declared the opioid epidemic a public health emergency five months ago, and hosted an opioid epidemic summit at the White House last month. As a result of these actions, President Trump detailed a three-pronged method focused on reducing access to prescription opioid drugs, increasing treatment and recovery support services, and taking a tougher law enforcement approach to the issue.
Monday’s address to a large crowd in New Hampshire—one of the states that has been impacted most significantly by the epidemic—largely focused on how to crack down on the opioid epidemic yet provided few concrete details around how the Administration plans to address the increasing number of opioid overdoses and deaths throughout the country. Trump’s strategy did include increasing access to treatment and recovery services, ensuring prescribers are following best practices for prescribing opioids, and expanded research into less-addictive pain-reducing drugs. Overall, the plan seeks to reduce the number of opioid prescriptions filled by one-third within three years. Trump also highlighted the need for increased access to naloxone in schools and for first responders.
However during the address, Trump continued to stress a tougher law enforcement approach to the issue as a hallmark of his Administration’s strategy. He pitched utilizing mandatory minimum sentences and the death penalty for individuals who traffic illicit opioid drugs such as heroin and fentanyl. Attorney General Jeff Sessions was in the audience on Monday and echoed President Trump’s sentiments, indicating in a statement that the Department of Justice intends to “aggressively prosecute drug traffickers” and “seek the death penalty wherever appropriate.”
Experts in the opioid epidemic, including professionals and practitioners in addiction and public health, expressed concerns with Trump’s law enforcement-heavy approach to the opioid crisis. Experts and scholars noted that while law enforcement is a necessary element of addressing the issue, a focus on prevention and treatment services is needed. There are many outstanding questions amongst experts around the cost and funding of the Trump Administration’s strategy to address the epidemic and specifically how the Administration plans to implement these interventions. With the latest data indicating 64,000 drug overdose deaths in the U.S. in 2016 alone, experts continue urge an immediate, comprehensive, and evidence-based approach to the opioid epidemic to decrease the number of overdoses and related deaths.
An overview of the Trump Administration’s opioid epidemic strategy is available from the White House here.
The CHEAC-CCLHO California Chronic Disease Prevention Leadership Project will be hosting a regional convening workshop titled, Innovative Approaches to Creating an Integrated Chronic Disease Prevention Agenda. The workshop will be held on Wednesday, June 13 from 9:00 am to 3:00 pm at The California Endowment – Oakland Regional Office in Oakland, California.
Local health department leadership, health officers, senior staff, and other local health department leads from the Bay Area and Sacramento regions are encouraged to attend. Registration will be coming soon, and professional continuing medical education credits will be offered. View the save the date event flyer here.
Recently, the Brookings Institution released the report Housing as a Hub for Health, Community Services, and Upward Mobility, which explores ways in which housing can impact the overall health, lives, and success of individuals and details how the effect varies for differing segments of the U.S. population. The report determines that, in many instances, a number of systems and policy issues obstruct the capacity of housing to serve as a source for good health, educational attainment, and upward mobility.
An increasing number of housing experts, public health practitioners, and policymakers have recognized housing as a “hub” for wellbeing and have begun examining how housing-based initiatives can foster improved health, economic opportunities, and social mobility. A set of recommendations is identified in the report to strengthen the role of housing as a social determinant for health and success; these recommendations consist of:
- Improving data collection, sharing, and evaluation
- Improving budgetary coordination and funding experimentation
- Experimenting with different models to organize and manage housing-based services
- Strengthening housing-health partnerships
The report is intended to be used as a guide for intersectoral partnerships among governmental and community-based organizations and entities. The full report is available here.
The U.S. Centers for Disease Control and Prevention (CDC) has declared April 2018 as STD Awareness Month. This year’s theme is “Treat Me Right” which is intended to encourage health care providers to foster a trusting patient-provider relationship and ensure patients are correctly diagnosed. The theme is also intended to encourage patients to know what they can do to stay safe and healthy and how to ask their health care provider for necessary care.
The CDC provides a variety of public health practitioner, provider, and patient resources related to STDs on its website. More information on CDC’s April STD Awareness Month is available here.