May 28, 2021 Edition
Budget activities remained in full swing this week as the Legislature approaches the June 15 constitutional deadline to pass a budget for the upcoming 2021-22 fiscal year. On Monday, the Senate Budget & Fiscal Review Subcommittee No. 3 on Health and Human Services (HHS) convened a hearing to review remaining proposed investments, including items within the California Department of Public Health (CDPH).
Among the items reviewed by the Subcommittee was the Newsom Administration’s proposal to invest $3 million for a pandemic response review, allowing CDPH to conduct a review of essential public health infrastructure needs and the root causes of disparities and inequities experienced by those disproportionately impacted by COVID-19. According to the Administration, the review would also assess lessons learned and identify programmatic gaps to inform and develop a budget proposal for the FY 2022-23 budget.
During the hearing, CDPH Director and State Public Health Officer Dr. Tomás Aragón presented the Administration’s proposal to review the pandemic response and discussed how long-term underfunding and the COVID-19 pandemic have exposed significant gaps in the ability of state and local public health agencies to respond to the needs of state residents. However, Dr. Aragón reassured the subcommittee of ongoing work in assessing the state of the state’s public health infrastructure and indicated a more robust funding proposal would be offered next year.
Subcommittee member Senator Richard Pan pushed back on the Newsom Administration, raising significant concerns with the lack of investments proposed for public health workforce and infrastructure. At one point, Dr. Pan, urging a long-term public health investment, expressed, “Let’s not pretend we don’t know there are problems. We already know there are problems,” ranging from information technology (IT) limitations to staff recruitment and retention challenges, among other significant areas.
Members of the California Can’t Wait Coalition, including CHEAC, provided public comment during the subcommittee hearing urging the Legislature to invest in $200 million ongoing for local health department infrastructure and workforce.
On Wednesday, the Senate Budget & Fiscal Review Subcommittee No. 3 and the Assembly Budget Subcommittee No. 1 met to close out the majority of investment proposals related to health and human services. Notably, action on the Newsom Administration’s $3 million pandemic response review proposal was not taken by either subcommittee but instead deferred to the full budget committees.
With the conclusion of budget subcommittees’ work this week, full budget committees are set to meet next week to begin finalizing the 2021-22 budget. The full Senate Budget & Fiscal Review Committee will meet on Tuesday morning and the Assembly Budget Committee will meet on Wednesday afternoon. The Legislature is not anticipated to convene a Budget Conference Committee this year given COVID-19 restrictions and timing limitations in negotiating budget items with the Newsom Administration. As such, both budget committees will aim to find agreement on as many investment items as possible before hammering out remaining proposals between legislative leaders and the Governor.
Numerous high-level investments will be left up to full budget committees, including funding for public health infrastructure and workforce, the California Advancing and Innovating Medi-Cal (CalAIM), homelessness services, behavioral health, and other notable items. Over the next several weeks as legislators race to finalize their budget package, additional details on budget investments are anticipated to emerge. Further, with considerable resources to allocate and the complexity and size of several proposals, more granular budget deliberations and trailer bill development is likely to continue beyond the June 15 deadline.
Voting results from the Senate Budget & Fiscal Review Subcommittee No. 3 are available here. Voting results from the Assembly Budget Subcommittee No. 1 are available here.
The California Legislature held a steady pace of actions on the Senate and Assembly Floors this week as legislators face a June 4 deadline to pass to the next house bills introduced in their house of origin. Next week will feature floor sessions only with committees unable to meet for any purpose until June 7.
Of particular note, CHEAC’s sponsored bill, AB 240 (Rodriguez), on Thursday was unanimously advanced from the Assembly Floor to the Senate on a 71-0 vote. Recall, AB 240 would require the California Department of Public Health (CDPH) to contract with an appropriate and qualified entity to conduct an evaluation of the local health department infrastructure in California and make recommendations for future staffing, workforce, and resource needs. CHEAC is joined by HOAC, SEIU California, UCC, RCRC, and Public Health Advocates in sponsoring the measure.
Today, the California State Assembly administered the oath of office to Assembly Member Isaac Bryan, representing Assembly District 54 in Los Angeles County. Recall, the seat was vacated by now-Senator Sydney Kamlager earlier this spring. Assembly Member Bryan is an educator and community organizer, and he previously served as a senior adviser to Senator Kamlager and the founding director of the UCLA Black Policy Project.
With a looming June 15 deadline to pass a budget for the upcoming fiscal year, the next several weeks are anticipated to be very busy in Sacramento. CHEAC will continue to keep its Members apprised of relevant legislative and budget updates over the coming weeks.
Below, we highlight a couple bills of interest to CHEAC Members. For a full update, the latest edition of the CHEAC Weekly Bill Chart is available here.
Communicable Disease Control
AB 1344 (Arambula) as amended April 8, 2021 – WATCH
Assembly Member Joaquin Arambula’s AB 1344 was advanced from the Assembly Floor to the Senate this week on a 49-20 vote with nine members not voting. AB 1344 would exempt needle and syringe exchange services application submissions, authorizations, and operations from review under the California Environmental Quality Act (CEQA) and would declare bill provisions to be declaratory of existing law.
COVID-19
AB 650 (Muratsuchi) as amended May 24, 2021 – OPPOSE
AB 650 by Assembly Member Al Muratsuchi would require health care employers that employ 100 or more employees to provide hazard pay retention bonuses to employees providing direct patient care and services supporting patient care. Employees eligible include but are not limited to pharmacists, clinicians, nurses, aides, technicians, janitorial and housekeeping staff, security, food services, laundry, and administrative staff. Employers would be required to issue quarterly hazard pay bonuses in 2022, with total amounts ranging from $4,000 to $10,000 depending on employee status. Employers would be authorized to reduce bonus amounts if any qualifying monetary bonus was provided to employees during the COVID-19 pandemic. CHEAC joins a coalition of organizations, including the California Association of Public Hospitals and Health Systems (CAPH), in opposition to the measure due to significant anticipated costs.
On Thursday, Governor Gavin Newsom announced the launch of “Vax for the Win,” a multifaceted vaccinate incentive program aimed at motivating residents to receive the COVID-19 vaccine as the state approaches the June 15 retirement of the Blueprint for a Safer Economy.
Under the program, the following prizes will be available:
- $16.5 Million in Cash Winnings – On June 15, the state will conduct a random drawing of 10 vaccinated residents for prizes of $1.5 million each, totaling $15 million in total grand cash prizes. Cash prizes of $50,000 each for 30 vaccinated residents will also be awarded on Friday, June 4, and Friday, June 11.
- $100 Million in Prepaid Cards – Beginning May 27, the next two million residents who begin and complete their COVID-19 vaccination will automatically be eligible for a $50 virtual prepaid card or a $50 grocery gift card, totaling $100 million in prizes.
According to the Newsom Administration, the “Vax for the Win” program will provide an extra nudge to individuals who still need to receive a COVID-19 vaccine, especially in hard-to-reach communities. The funding for the prizes is initially coming from the state’s General Fund, using the state’s disaster response account. However, the funding is anticipated to be backfilled by federal funds under the American Rescue Plan Act (ARPA).
All residents ages 12 and older who are at least partially vaccinated are automatically eligible for cash prize drawings occurring in June. Winners must complete their full vaccination series to claim their prize, and if someone under the age of 18 wins, the cash will be placed into a savings account until the winner is 18 years old.
Additional information from the Governor’s Office is available here. A one-pager on the incentive program is available here.
Today, the California Division of Occupational Safety and Health (Cal/OSHA) made available its updated proposed emergency temporary standard (ETS) relative to COVID-19 precautions in workplace settings. Recall, Cal/OSHA last week announced it was delaying proposed action on its ETS proposal that would have allowed individuals to return to workplaces without physical distancing or face coverings if all individuals in the workplace are vaccinated. The delay came after updated guidance for fully vaccinated persons from the U.S. Centers for Disease Control and Prevention (CDC) and an announcement from the California Department of Public Health (CDPH) that guidance for the use of face coverings would be relaxed in nonworkplace settings on June 15.
Under the newly issued ETS, Cal/OSHA aligns its guidance with the latest available guidelines from the CDC and CDPH. The Occupational Safety and Health Standards Board (OSHSB) will meet next Thursday, June 3 to consider the newly proposed standard. If adopted by OSHSB at that time, it is anticipated the standard would become effective on June 15.
Additional information on the newly proposed standard, as well as next week’s meeting materials, are available here.
This week, the National Association of County and City Health Officials (NACCHO) and the Network for Public Health Law (NPHL) issued a report entitled, “Proposed Limits on Public Health Authority: Dangerous for Public Health.” The report details state-level efforts in the U.S. to roll back or severely limit the authority of public health agencies which will ultimately impact their ability to protect the public from serious illness, injury, and death both during and long after the COVID-19 pandemic.
In recent months, at least 15 state legislatures have passed or are considering measures to limit the legal authority of public health agencies, and other states may consider such legislation in the future, hindering the ability to health departments to do their jobs and putting the public at risk.
NACCHO and NPHL highlight numerous examples of proposed legislation in various states that would prohibit requiring face coverings in any situation, ban the use of quarantine, block the closure of businesses necessary to prevent the spread of the disease, and strip local governments of the ability to respond to local emergency conditions, among other actions.
The report raises significant concerns with limitations on legal authorities of public health agencies and details the four conclusions:
- Legislation to block reasonable public health measures like mask wearing, social distancing, and quarantine poses an immediate threat to life and health.
- Legislation to stop expert public health agencies from leading the response to health emergencies creates unforeseen, serious risks to life and health.
- Legislation that strips authority from public health agencies and the executive branch infringes on the constitutional separation of powers and undermines effective government response.
- These laws could make it harder to advance health equity during a pandemic that has disproportionately sickened and killed Black, Hispanic and Latino, and Indigenous Americans.
The full NACCHO-NPHL report is available here.
On Thursday, the National Association of County and City Health Officials (NACCHO) announced its 2021 Innovative Practice Award Winners. The award recognizes programs developed in response to the COVID-19 pandemic demonstrating effective community partnerships and collaboration, adaptability and program resilience, and innovation. 33 local health departments received this recognition with eight Gold Awardees, five Silver Awardees, and 20 Bronze Awardees. An additional 15 programs received Honorable Mentions.
Below, we highlight awardees from California:
2021 Innovative Practice Awards – Gold
- County of San Diego Health & Human Services Agency, San Diego COIVD-19 Response – Academic Detailing by Zip Code
2021 Innovative Practice Awards – Silver
- County of San Diego Health & Human Services Agency, Operationalizing the Live Well San Diego Framework: A Population Health Approach to the COVID-19 Pandemic
2021 Innovative Practice Awards – Bronze
- County of San Diego Health & Human Services Agency, Operationalizing the Live Well San Diego Framework: COVID-19 Prevention Hygiene Kit Distribution Program
- County of San Diego Health & Human Services Agency, Cross-Border (San Diego-Tijuana) COVID-19 Collaboration
2021 Innovative Practice Awards – Honorable Mention
- County of San Diego Health & Human Services Agency, Community Health Worker Communication and Outreach Services
Please join us in congratulating the County of San Diego Health & Human Services Agency! Additional information on the NACCHO Innovative Practices Award is available here.
On Wednesday, President Joseph R. Biden, Jr. directed the U.S. Intelligence Community to “redouble” their efforts to collect and analyze information on the origins of the COVID-19 virus. President Biden indicated the Intelligence Community earlier this month provided him with a preliminary report in which the Intelligence Community coalesced around two likely scenarios of how COVID-19 spread. However, in the preliminary report, the Intelligence Community concluded they did not have sufficient information to draw a conclusion.
President Biden has directed Intelligence Agencies to report back to him within 90 days and has asked that the report detail areas of further inquiry that may be required, including specific questions for China. President Biden has also directed national laboratories and other governmental agencies to augment the Intelligence Community’s efforts.
A statement from President Biden on the investigation of COVID-19 is available here.
This week, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the issuance of $4.8 billion from the American Rescue Plan Act (ARPA) to support the HRSA COVID-19 Uninsured Program. The funding will allow the program to continue reimbursing health providers for testing uninsured individuals for COVID-19. As of May 19, 2021, the program has already issued nearly $4 billion in testing reimbursements to providers.
According to HHS, there are approximately 29 million uninsured individuals living in the U.S. By ensuring programs like the HRSA COVID-19 Uninsured Program remains adequately funded, HHS indicates cost impediments will be removed so anyone exposed to COVID-19 may seek appropriate testing and care.
Additional information on the HRSA COVID-19 Uninsured Program is available here.
Earlier this week, the U.S. Senate confirmed Chiquita Brooks-LaSure as Administrator of the U.S. Centers for Medicare & Medicaid Services on a bipartisan 55-44 vote. Ms. Brooks-LaSure was then sworn into her new role by U.S. Health and Human Services (HHS) Secretary Xavier Becerra on Thursday.
Brooks-LaSure becomes the first Black woman to lead the federal agency where she previous served as the deputy director for policy at the CMS Center for Consumer Information and Insurance Oversight. Earlier, she served within HHS as the director of coverage policy and led efforts on the passage and implementation of the Affordable Care Act (ACA).
Additional information on the swearing in of Ms. Brooks-LaSure as the CMS Administrator is available here.
According to a poll conducted during the COVID-19 pandemic by the Robert Wood Johnson Foundation (RWJF) and the Harvard T.H. Chan School of Public Health, a large majority of the public favors substantially increasing federal spending on improving the nation’s public health programs. A similar majority believes the activities of public health agencies in the U.S. are extremely or very important to the health of the United States.
The poll, “The Public’s Perspective on the United States Public Health System,” reported that when it comes to trust, the public is more trusting of health workers than U.S public health institutions and agencies. Public trust was highest in nurses (71 percent), health workers they know (70 percent), and doctors (67 percent). The lowest levels of trust came from the U.S. Centers for Disease Control and Prevention (CDC) (52 percent), state health departments (41 percent), and local health departments (41 percent), the National Institute of Health (37 percent), and the Food and Drug Administration (FDA) (37 percent).
Additionally, the poll’s survey responses found only about one-third of adults (34 percent) gave positive ratings on the nation’s system from protecting the public from health threats and preventing illnesses. However, the research found that the public’s trust in the nation’s medical system increased during the Covid-19 pandemic, with half of the adults giving it a positive rating in 2020.
Co-Director of the survey Richard L. Menschel, Professor at Harvard T.H. Chan School of Public Health, highlighted the critical importance of increasing public trust in public health institution and agencies during this time. Menschel also noted that it is a moment for public health to commit to addressing the systemic challenges to improve health and well-being, which includes structural racism and discrimination.
The full public health poll can be accessed here.
The Big Cities Health Coalition (BCHC) and the Prevention Institute recently issued a reported entitled, “Community Safety Realized: Public Health Pathways to Preventing Violence.” The report is designed to support health departments and other organizations in work to prevent and address violence in communities. According to BCHC and the Prevention Institute, risk factors for violence, such as economic instability and social isolation, increased during the COVID-19 pandemic, resulting in increases in violent incidents nationwide.
Community Safety Realized is intended to move the conversation about reimagining community safety from aspiration to concrete strategies and action steps. The report is based on interviews with dozens of health directors, government leaders, epidemiologists, and violence prevention advocates and practitioners. The framework includes best practices of strategies and partnerships that, when put into place, can effectively create community safety using a public health methodology.
The four defining features of the report include:
- Truth, racial healing, and transformation: Racial injustice embedded in policies at all levels of government has resulted in inequities in rates of violence. A shared understanding that violence is rooted in structural racism can build public will for public health strategies for community safety.
- Community leadership and power: The people who are most impacted by violence and injustice have a democratic right to drive public policy agendas, influence institutional decision-making, and set budget priorities that will improve their lives and neighborhoods.
- Data and evidence-driven: Community safety strategies should be informed by a careful and thorough assessment of violence in a community, including who is most affected, and factors and circumstances that are either contributing to violence or helping to create safety, using a variety of data sources.
- Collaborative action: A public health approach to community safety depends on collaborative action because the policies and conditions that lead to either safety or violence are shaped by multiple sectors and systems.
The BCHC and Prevention Institute will convene a webinar on June 8 to further detail the Community Safety Realized framework and provide interested parties an opportunity to hear directly from health department leaders who have contributed to the development of the framework.
The full report is available here. Information on the upcoming webinar, including registration, is available here.
The Office of the California Surgeon General and California Department of Health Care Services (DHCS) will host a webinar on Wednesday, June 2, at 12:00 pm to 2:00 pm to share information about the Science of Adverse Childhood Experiences and Toxic Stress. The webinar will feature how ACEs and toxic stress can impact our biology, explain ACEs screening, and the importance of joining a trauma-informed network of care.
Additional information and registration are available here.
The Essentials for Childhood (EfC) Initiative, a joint effort between the California Department of Public Health (CDPH), Injury and Violence Prevention Branch (IVPB) and the California Department of Social Services (CDSS), Office of Child Abuse Prevention (OCAP) recently released a new resource entitled, “Creating Safe, Stable, and Nurturing Relationships and Environments for Children.”
The resource is intended to elevate primary prevention strategies that support creating safe and nurturing settings for children and highlight 2019 data from the U.S. Centers for Disease Control and Prevention’s (CDC) Awareness, Commitment, and Norms survey.
The resource and additional information are accessible here.
The Healthy Aging Initiative of the California Department of Public Health (CDPH) is hosting a virtual event on Thursday, June 24 from 9:00 am to 12:00 pm. The convening will feature keynote speaker Dr. Reginald Tucker-Seeley, ScD, Assistant Professor of Gerontology at the USC Leonard Davis School of Gerontology, to discuss an organizational framework for defining social determinants of health to support implementation of health equity activities.
Additional information, including registration, is available here.