October 23, 2020 Edition

Senate Convenes Informational Hearing on Threats to the Affordable Care Act

This week, the Senate Health Committee convened an informational hearing entitled “The Affordable Care Act in Jeopardy: What does it mean for California?” bringing together several experts and consumers to discuss what would happen in California if the Affordable Care Act (ACA) is struck down by the US Supreme Court. The hearing featured several panels providing perspectives on the ACA including an overview, the law’s legal status and potential impacts on California if the law is repealed, a consumer panel, a health provider panel, and a panel representing consumer advocates and business representatives.

The first panel included health expert Deborah Reidy Kelch, former Executive Director of the Insure the Uninsured Project (ITUP) and legislative staffer and Melanie Fontes Rainer, representing California Attorney General Xavier Becerra. Ms. Kelch provided a broad overview of the ACA noting that the rate of uninsured Californians declined from 29 percent when the ACA first passed in 2013 to 11 percent by 2017. She also commented that according to the UC Berkeley Labor Center, California could stand to lose $27 billion in federal funding if the ACA is repealed or struck down. Ms. Fontes Rainer explained the pending lawsuit at the Supreme Court, California v. Texas. She outlined the three arguments California’s Solicitor General, Michael Mongan, will be arguing before the Supreme Court next month:

  • No plaintiffs in the case have standing to file suit
  • Despite congressional changes to the individual mandate tax penalty, what remains of the individual mandate is constitutional
  • Even if the court decides the zero-dollar individual mandate tax penalty is unconstitutional, the penalty is severable from the rest of the ACA

Following the opening panel, the second group focused on how the ACA currently operates in California and what could happen if the ACA is struck down. Panelists included Peter Lee, Executive Director of Covered California, Jacey Cooper, Chief Deputy of Health Care Programs, Department of Health Care Services (DHCS) and Medicaid Director, and Ben Johnson, Principal Fiscal and Policy Analyst, Legislative Analyst’s Office (LAO). Mr. Lee commented that with Covered California’s open enrollment period about to commence, there are 1.5 million Californians renewing their enrollment in the health exchange next year – an all-time high. He also noted that California receives $7 billion in federal premium subsidies, which makes healthcare more affordable for many Californians. Ms. Cooper discussed how the Medicaid expansion has significantly helped millions of low-income Californians and is particularly invaluable during a pandemic. She noted that 3.8 million adults are now on Medi-Cal as part of the ACA’s expansion to low-income childless adults and with the ACA’s simplified eligibility rules, 5.2 million children are now covered by Medi-Cal. In addition, if the law is eliminated, California’s counties and safety net hospitals will be significantly impacted as well as mental health, substance use disorder, IHSS, family planning, and 340B programs among others. Ben Johnson from the LAO provided an overview of the fiscal impacts, including a loss of $25 billion annual fiscal loss to California with significant impacts on California’s $400 billion health care system with the most severe impacts on California’ healthcare safety net providers in addition to millions of healthcare consumers. Mr. Johnson also noted that disruptions to the coverage provided by Covered California, where 1.2 million receive $7 billion in premium support, would cause subscribers to bear a much more significant amount of their healthcare costs with many likely to drop their coverage. California would also lose federal funding from the ACA’s Prevention and Public Health fund that supports immunizations, epidemiological and lab capacity, chronic disease prevention programs, and tobacco prevention and cessation programs.

The third panel included three Californians who discussed their experiences with the healthcare system and serious health conditions for themselves or their children, and what the elimination of the ACA would mean for them and their families in the future. Representing California’s healthcare system, three panelists representing a public hospital, a rural health clinic, and a safety net system physician discussed what the loss of the ACA will mean to their health systems, patients and communities. The fifth and final panel, representing consumer healthcare advocates and business representatives, including the California Chamber of Commerce, talked about the difficulties in obtaining care prior to the ACA given preexisting conditions, the disproportionate impacts of the coronavirus on communities of color, and potential disruptions to employer-based coverage as well as all Californians regardless of where they receive their health insurance.

During committee member questions, Senator Rubio asked the state panelists, assuming the ACA is struck down, what would California have to do? Jacey Cooper responded that DHCS is holding some contingency planning discussions; however, she said it will depend on extensive discussions/decisions with and from the Centers for Medicare and Medicaid Services (CMS), but would also include difficult state budget discussions. She noted the federal government would have to provide for a transition period. Peter Lee commented contingency planning is like adding lifeboats to the Titanic, and he said Covered California is focused on enrollment for next year and assuring California consumers they will have coverage for the foreseeable future. Dr. Pan asked the LAO about the ongoing cuts by the federal government to the Public Health and Prevention Fund. Ben Johnson concurred that cuts have significantly reduced the reach of funding from the Prevention Fund, but he also noted the loss of current Prevention Fund allocations would impact epidemiology and lab capacity as well as other prevention programs statewide. Dr. Pan closed with impassioned comments about how the ACA has provided freedom from fear for many Californians and the freedom to make different career choices, and will the Supreme Court take away that freedom.

The agenda from the hearing is available here. A background paper is available here. A video recording of the hearing is available here.

Newsom Names Scientific Safety Workgroup to Review COVID-19 Vaccines

On Monday, Governor Gavin Newsom announced the formation of the COVID-19 Scientific Safety Review Workgroup, comprised of nationally acclaimed California physician scientists with expertise in immunization and public health. The workgroup will be tasked with independently reviewing the safety and efficacy of any COVID-19 vaccine that receives approval for distribution from the U.S. Food and Drug Administration (FDA). According to the Newsom Administration, workgroup members will be guided by the principles of safety, equity, and transparency in reviewing and verifying the safety of any vaccine before it is made available to any Californians.

The COVID-19 Scientific Safety Review Workgroup is a key component of the state’s initial COVID-19 vaccine distribution plan that was recently submitted to the U.S. Centers for Disease Control and Prevention (CDC). As part of the plan, Governor Newsom indicated the first doses of any approved vaccine will be provided to health care workers, first responders, and individuals who are especially vulnerable to COVID-19.

Members of the Scientific Safety Review Workgroup are:

  • Chairman Dr. Arthur Reingold, Epidemiology and Biostatistics Division Head at the University of California, Berkeley School of Public Health
  • Dr. Tómas Aragón, Health Officer of the County & City of San Francisco and Director of the Population Health Division of the San Francisco Department of Public Health
  • Dr. Matt Zahn, Medical Director of the Division of Epidemiology and Assessment for the Orange County Health Care Agency
  • Dr. Rob Schechter, Immunization Branch Chief at the California Department of Public Health (CDPH)
  • Ambassador Eric Goosby, Distinguished Professor of Medicine and Director of the Center for Global Health Deliverty, Diplomacy, and Economics at the University of California, San Francisco
  • Dr. Rodney Hood, President and Founder of the Multicultural Health Foundation
  • Dr. Nicola Klein, Senior Research Scientist at Kaiser Permanente Northern California Division of Research and Director of the Kaiser Permanente Vaccine Study Center
  • Dr. Grace Lee, Professor of Pediatrics at the Lucile Salter Packard Children’s Hospital at Stanford
  • Dr. Yvonne (Bonnie) Maldonado, Professor and Chief of the Division of Infectious Diseases at the Stanford Medicine Department of Pediatrics
  • Dr. Mark Sawyer, Infectious Disease Specialist at Rady Children’s Hospital and Professor of Clinical Pediatrics at University of California, San Diego
  • Dr. Peter Szilagyi, Pediatric Health Services and Clinical Researcher at UCLA

The Newsom Administration notes that many members of the workgroup are current and prior members of the Advisory Committee on Immunization Practices (ACIP) for the CDC. A Drafting Guidelines Workgroup will also be formed to develop California-specific guidance for the prioritization and allocation of vaccines when supplies are limited; this workgroup will be comprised of immunization, public health, ethicists, and health care and academic experts. A Community Advisory Vaccine Committee will additionally provide input and feedback on the state’s planning efforts and solve barriers of equitable vaccine implementation and decision-making.

The full announcement from the Newsom Administration is available here.

State Allocates Additional $400m for Homekey, Childcare, and Food and Diaper Banks

The Newsom Administration and legislative leaders this week reached an agreement to allocate an additional $400 million in Coronavirus Relief Funds (CRF) to support Homekey, as well as other social supports including childcare, food banks, and diaper banks.

Recall, late last month, the Newsom Administration requested from the Joint Legislative Budget Committee (JLBC) an additional $200 million CRF to support the state’s Homekey initiative to purchase and rehabilitate housing – including hotels, motels, vacant apartment buildings, and other properties – to convert them into permanent, long-term housing for people experiencing or at-risk of experiencing homelessness. According to the Administration, the additional funds were needed to initiate approximately 20 Homekey projects that were waitlisted pending additional funds.

The JLBC approved the Newsom Administration’s request to use an additional $200 million CRF for Homekey. As part of the authorization, however, JLBC Chair Senator Holly Mitchell advocated for additional funding to support other programs that have realized an increased need during the COVID-19 pandemic. Legislative leaders and the Newsom Administration brokered a deal to provide an additional $110 million CRF for subsidized childcare during the pandemic, $75 million CRF to support emergency food assistance, and $15 million to provide diaper supplies. 

Senate President pro Tempore Toni Atkins and JLBC Chair Senator Mitchell praised the collaborative solution reached between the Newsom Administration and the JLBC to address urgent pandemic-related needs of Californians including shelter, food, supplies, and safety.

CDC Estimates 300,000 Excess Deaths in 2020, Largely Driven by COVID-19

This week, the U.S. Centers for Disease Control and Prevention (CDC) released a report indicating that from late January to early October 2020, the United States experienced nearly 300,000 more deaths than the typical number during the same period in previous years. Notably, at least two-thirds of the 300,000 excess deaths were related to COVID-19. According to the CDC, several racial and ethnic subgroups experienced disproportionate increases in deaths. Specifically, the largest percentage increases in excess deaths occurred among Hispanic or Latino, Asian, American Indian, and Black individuals, as well as all adults aged 25-44.

The full CDC report is available here.

FDA Approves Remdesivir, Becomes First COVID-19 Treatment

On Thursday, the U.S. Food and Drug Administration (FDA) approved the antiviral drug Remdesivir for use in adult and pediatric patients 12 years of age and older for the treatment of COVID-19 requiring hospitalization. The drug becomes the first FDA-approved treatment for COVID-19 and should only be administered in a hospital or healthcare setting.

A full FDA news release on the Remdesivir approval is available here.