March 24, 2017 Edition

Los Angeles and San Francisco Public Health Departments Awarded Accreditation Status

We are excited to announce that the Los Angeles County Department of Public Health and the San Francisco Department of Public Health were awarded national public health accreditation status by the Public Health Accreditation Board (PHAB) last week. To date, nine of California’s local health departments have achieved accreditation status, in addition to the California Department of Public Health.

Please join us in congratulating the hard work and success of our colleagues in Los Angeles and San Francisco! Information on PHAB and the press release can be found here.

House Republicans Pull American Health Care Act

This has been an action-packed week for the American Health Care Act (AHCA), which was met with increased resistance. Several amendments were introduced to appease the concerns of the Freedom Caucus, that the AHCA does not do enough to repeal the Affordable Care Act (ACA). The Congressional Budget Office released their updated budget score of the AHCA, in light of recently introduced amendments.

Conservative members of the House GOP sought to eliminate the essential health benefits and provisions prohibiting insurers from denying coverage for pre-existing conditions, among others. Yet those demands left moderate members of the House GOP fainting from support of the bill. As a result, Republicans were unsuccessful in securing enough votes for the passage of the American Health Care Act, which was pulled this afternoon.

For now, the ACA will continue on, however, today’s events do not end the ongoing threats to the ACA. We will continue to provide updates as things progress.

California Counties Oppose the American Health Care Act

CHEAC has signed onto a joint letter in collaboration with CSAC, CAPH, CBHDA, CMSP and CWDA in opposition to the House Republican repeal and replacement proposal, better known as the American Health Care Act (ACHA). The letter highlights our concern around eliminating the Prevention and Public Health Fund, eliminating the enhanced federal match, and placing a per capita limit on Medicaid spending, among other key aspects of the bill. To view the full letter, please click here.

California Department of Health Care Services Preliminary Analysis of the AHCA

The California Department of Health Care Services (DHCS), released a preliminary fiscal analysis of the Medicaid provisions included in the House Republican repeal and replacement bill, the American Health Care Act (AHCA). According to the department, the federal proposal would result in nearly $6 billion ($4.3 B GF) in costs to California in 2020, increasing to $24.3 billion ($18.6 B GF) by 2027.

The department further highlights concern around additional cost pressures to California as the proposal moves away from the historical payment structure between the states and the federal government, into per capita spending limits. They estimate California would be responsible for $680 million in 2020, growing to $5.3 billion by 2027.  Additionally, the proposed construct of the enhanced match no longer being available to new Medi-Cal enrollees or those who have a break in coverage, would result in nearly all expansion enrollees being subject to the 50/50 cost share instead of the current enhanced match 90/10 cost sharing structure under the Affordable Care Act. They estimate the costs to be roughly $4.8 billion ($3.3 B GF) in 2020 increasing to over $18.5 billion ($13 B GF) in 2027.

In short, the department concludes that the AHCA represents a massive shift in costs to states, which will also increase the burden on the state safety net providers and potentially increase uncompensated care costs in the hundreds of millions and potentially billions each year.

California Senate and Assembly Health Hearings on the AHCA

The California Senate and Assembly Health Committees convened informational hearings on the American Health Care Act in Fresno and San Diego, respectively. The hearings, to the hearing held in Kern County earlier this year, included an overview about health care delivery in California, followed by presentations focused on the impact of the AHCA in California. Both hearings included a wealth of public comments underscoring the value of the Affordable Care Act to California. Links to materials and web streams are provided below:

Senate Health Committee



Assembly Health Committee



Policy Committees build momentum

Policy committees continue to build momentum as they heard a number of bills this week. Looking ahead, fiscal bills must be heard in the policy committee of their house of origin by April 28, while the deadline for non-fiscal bills is May 12. The legislature will leave for Spring Recess on April 6 and returning to Sacramento on April 17.

Legislative actions on bills of particular interest this week are noted below. Other pertinent bill updates are included in our bill chart.

Tobacco Control

AB 725 (Levine) as introduced on 2/15/17 – Support

AB 725 by Assembly Member Levine was heard in the Assembly Water, Parks, and Wildlife Committee this week. The measure would ban smoking on a state coastal beaches and state parks, in addition to banning the disposal of cigar or cigarette waste on those premises as well. There was considerable discussion surrounding whether the measure was too much of an imposition on individual freedoms at places intended for recreation. Additionally, members questioned whether cigars should be included in the measure, given that the litter is predominately caused by cigarettes. The measure did pass with 8 ‘aye’ votes, 4 ‘no’ votes and 3 abstentions. AB 725 now moves to the Assembly Appropriations Committee.

Health Care Coverage

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

The Assembly Health Committee heard AB 340 by Assembly Member Arambula, which would require screenings provided under Early and Periodic Screening, Diagnosis and Treatment (EPSDT) to screen for trauma. The measure received support by several organizations including CWDA and HOAC and was unanimously passed by the Committee. AB 340 now moves to the Assembly Appropriations Committee.

Dental Health Services

 AB 15 (Maienschein) as amended 3/23/17 – Support

AB 15 by Assembly Member Maienschein would, in FY 2017-18, require the Department of Health Care Services to double Denti-Cal provider reimbursement rates for the 15 most common prevention, treatment, and oral evaluation services. The measure was heard in Assembly Health Committee this week and was unanimously passed with bipartisan support. The measure now moves to the Assembly Appropriations Committee.