March 3, 2017 Edition

Senate Subcommittee No. 3 on HHS hears CCI/IHSS

This week, the Senate Subcommittee No. 3 on Health and Human Services convened a hearing focused on Department of Social Services issues, including In-Home Supportive Services (IHSS) and the Coordinated Care Initiative (CCI).

During the hearing, the Legislative Analyst’s Office provided members of the subcommittee with a succinct overview of the structure of 1991 Realignment and highlighted the impacts of shifting upwards of $623 million in costs from the State to counties. Subcommittee members were also provided the county perspective through a panel consisting of CSAC, CWDA, CBHDA, labor and a public health nurse from Los Angeles County.

Senator Pan, Chair of the Subcommittee, quickly honed in on the downstream implications to various county programs including health, mental health and social services and questioned the Administration’s rationale for shifting these costs to counties. Members asked the Department of Finance for their analysis of the impacts to counties, which is in progress, but not yet available.

CHEAC also provided comments highlighting how resources dedicated to both public health services and indigent care services would be adversely impacted and noted threats at the federal level underscoring the need to protect resources dedicated to these services.

The Subcommittee held this item open.

The Assembly will hear this item on Wednesday, March 8. CHEAC’s letters of opposition can be found here.

Legislative Update

Policy committees have started to hear legislative bills this week.  Of interest to CHEAC members, AB 6 (Lackey) was heard in the Assembly Public Safety Committee.  AB 6 creates a drugged driving task force within the CA Highway Patrol to develop recommendations for best practices, protocols, proposed legislation, and other policies that will address the issue of driving under the influence of drugs including cannabis.  After emotional testimony from a witness whose husband was killed by a drugged driver, the committee unanimously approved the bill.  It now moves to the Assembly Appropriations Committee.

The first CHEAC Legislative Bill Chart for 2017 can be found here, and it reflects the bills reviewed by CHEAC’s Legislative Committee last week.  Next Friday, CHEAC’s Legislative Committee will reconvene here in Sacramento to review the remaining bills introduced this year of interest to the organization.

President Trump Addresses Congress

Tuesday night, President Trump delivered his first address to a joint session of Congress. During his speech, he called on Congress to make investments in infrastructure, increases to defense spending and to repeal and replace the Affordable Care Act (ACA) among other things.

In regards to the ACA, President Trump called on Congress to replace the ACA with reforms that “expand choice, increase access, lower costs, and at the same time, provide better Healthcare.” He outlined key principles that should be included in the replacement, however offered no detail regarding how to accomplish the following:

  • Ensuring Americans with pre-existing conditions have access to coverage;
  • Ensuring a stable transition for those enrolled in exchanges;
  • Helping Americans purchase coverage with the use of tax credits and Health Savings Accounts;
  • Giving States flexibility with Medicaid;
  • Implement reforms to prevent costs that increase insurance premiums and bring down the cost of high-price drugs; and
  • Allow the purchase of insurance plans across state lines.

President Trump noted his intent to increase defense spending, but did not specify what the increase would be during his speech. Prior to the speech, White House officials noted the President’s intent to increase defense spending  by $54 billion on the cuts of other federal programs.  While details are limited, the Administration has signaled that the cuts would not impact Medicare, Social Security, veterans benefits, or law enforcement. Programs under the Centers for Disease Control would be at risk.

Repeal and Replace Bill Next Week?

Last week, a draft of the House Republican reconciliation bill to repeal and replace the Affordable Care Act was leaked. Key components of the leaked draft include the:

  • Elimination of the Prevention and Public Health Fund in FY 2018.
  • Repeal of the Medicaid Expansion.
  • Repeal of the individual and employer mandate.
  • Creation of per capita caps for Medicaid spending for states in FY 2019.
  • Deferring to states to define in essential health benefits in 2019.
  • Utilization of tax credits and health savings accounts as a means for making insurance affordable.
  • Elimination of Medicaid funding for planned parenthood for one year and bans federal subsidies for plans that cover abortions.

Politico compiled a helpful infographic outlining key aspects of the leaked bill.

Additionally, reports from Capitol Hill this week suggest that a House bill may be introduced as early as next week and few significant deviations from the leaked bill are expected.

Nomination of Seema Verma moves to the Senate Floor

The nomination of Seema Verma for Administrator of the Centers for Medicare and Medicaid Services was approved in the Senate Finance Committee with a party line vote of 13 to 12; Democrats voting no. Verma, a health care policy consultant was instrumental in designing the Healthy Indiana Plan for Indiana’s Medicaid program. Her nomination now moves to the Senate Floor for a final vote.

Trump Administration chooses Brian Neale as Director of Center for Medicaid and CHIP Services

According to recent reports, the Trump Administration has chosen Brian Neale to lead the Center for Medicaid and CHIP Services. Neale would report to Seema Verma, who awaits confirmation by the full Senate. Neale has served as health care policy director under then Governor Mike Pence, where he worked with Verma on Indiana’s Healthy Indiana Plan. He is currently the Executive Director of the United States Congress Joint Economic Committee.

County Health Rankings

On Wednesday, March 29, the eighth County Health Rankings report will be released.  A few important dates to keep in mind:

  • March 20: The embargoed state toolkit will be available.
  • March 21: The embargoed beta website will be available.
  • March 22: State Team Webinar to go over important details about this year’s release, review the communication toolkit and walk you through the embargoed website.  Register here:
  • March 29 at 12:01am ET: Release of the 2016 County Health Rankings

We will forward information on how to access your embargoed information later this month.