October 27, 2017 Edition
Alameda County announced the hiring of Colleen Chawla as the Alameda County Health Care Services Agency Director. Colleen is currently the Deputy Director of the San Francisco Department of Public Health and will begin her new role in Alameda County on December 18, 2017.
Mendocino County recently hired Barbara Howe as the Director of Public Health. Howe began her new role last week and returned to California after serving as the Deputy Director of Public Health with the New Mexico Department of Health. Previously, Howe was the Public Health Administrator in Humboldt County.
Riverside County recently announced that former Director of Public Health Sarah Mack has been promoted to Riverside County Assistant Chief Executive Officer for Human Services. Riverside County recently named Kim Saruwatari as the new Director of Public Health. Saruwatari was most recently the Director of Emergency Management for Riverside County and began her new role last week.
Please join us in welcoming Colleen Chawla, Barbara Howe, and Kim Saruwatari to their new roles!
Registration for CHEAC’s Health Realignment Training will close on Friday, November 3. The one-day training will be held on Wednesday, December 6, 2017, from 10:00 am to 3:15 pm at The California Endowment in Sacramento (1414 K Street, First Floor – Adelante Room). The training will include the following sessions:
- Realignment Historical Overview
- Realignment Basics
- Significant Policy Changes Impacting 1991 Realignment
- CHEAC Realignment Tracking
- County Realignment Budgeting and Projecting
The cost to attend is $100 and includes all session materials, light breakfast/coffee, and lunch. Seating is very limited.
More information and registration may be accessed here. For any questions, please contact CHEAC Staff at admin@cheac.org or 916-327-7540.
Despite a series of failed negotiations and legislative attempts throughout the year, Congress continues to propose measures to attempt to stabilize federal health insurance marketplaces. We highlight the latest proposals below, as well as detail recent developments around health insurance premiums in light of President Trump’s decision to end cost-sharing reduction (CSR) payments.
Legislative Proposals
Alexander-Murray Proposal
Last week, Senators Lamar Alexander (R-Tennessee) and Patty Murray (D-Washington) reached an agreement to stabilize health insurance marketplaces and reduce health insurance premiums. The proposed measure is the result of months of ongoing bipartisan meetings and negotiations between Alexander and Murray that initially began after the Senate’s failed attempt to repeal and replace the ACA in July. Notably, the latest bipartisan deal would:
- Restore cost-sharing reductions (CSRs) to insurance companies through 2019
- Reinvest in outreach and enrollment assistance activities through 2019
- Maintain ACA core protections around affordability, coverage, and comprehensiveness (including restrictions on lifetime coverage limits and coverage of essential health benefits and pre-existing conditions)
- Streamline state waiver processes to permit additional state flexibility
The measure would also expand eligibility for catastrophic health plans to individuals over age 30 and also require the Administration to issue regulations around interstate health compacts.
The Congressional Budget Office (CBO) released an analysis of the Alexander-Murray proposal this week. The report estimated that, if the measure were to be signed into law, the federal deficit would be reduced by approximately $4 billion over the next decade and would not substantially impact the number of Americans with health insurance.
A bipartisan coalition of 24 U.S. Senators—12 Republicans and 12 Democrats—signed off on the Alexander-Murray proposal, and the bill is expected to have enough support to pass the Senate. President Trump, however, has not indicated his support for the measure and has been pushing for more conservative changes to the measure that Democrats are not likely to support. Senate Majority Leader Mitch McConnell (R-Kentucky) announced he will not bring the bill to the Senate Floor for a vote until President Trump gives his approval.
Hatch-Brady Proposal
This week, Senator Orrin Hatch (R-Utah) and Representative Kevin Brady (R-Texas) countered the bipartisan Alexander-Murray Proposal with a proposed measure that includes top priorities of Congressional Republicans and the Trump Administration. The Hatch-Brady Proposal would:
- Fund cost-sharing reductions (CSRs) through 2019
- Temporarily eliminate the ACA individual mandate until 2021
- Forgive penalties assessed for ACA employer mandate non-compliance between 2015-2017
- Expand health saving accounts (HSAs)
The Hatch-Brady proposal, however, has not received a warm reception among Congressional Republicans and appears to have party members split. Several Republicans do not believe the measure is expansive enough, while other Republicans seem inclined to support a more bipartisan approach to healthcare. The full legislative text of the Hatch-Brady measure is expected to be released in the coming days
Uncertainty Continues as Judge Rules on CSR Request, Premiums Expected to Rise
A federal judge in California this week denied an emergency motion that would have required the Trump Administration to immediately restore cost-sharing reduction payments to insurance companies while a lawsuit makes its way through the courts. Recall, shortly after President Trump indicated he would no longer make cost sharing reduction (CSR) payments, 18 states, including California, and the District of Columbia filed a federal lawsuit, arguing that withholding CSRs is unlawful and violates mandate provisions of the ACA.
U.S. District Court Judge Vince Chhabria was not convinced that ending CSR payments would cause immediate harm to residents of the state. Citing action by several states in anticipation of a Trump Administration decision to eliminate CSR payments, Judge Chhabria, in his 29-page ruling, determined that the majority of people who purchase insurance on health insurance exchanges would be unharmed. Despite being denied their emergency request, the 19 state attorneys generals have indicated they will continue to push for a permanent resolution during the remainder of their lawsuit.
Also this week, Avalere Health released an independent analysis revealing that premiums for the most popular ACA health plans are rising by an average of 34 percent in 2018 among states using the federal health insurance marketplace exchange. Avalere Health indicated the premium increases are primarily being driven by overall marketplace instability.
With open enrollment set to begin next week, it remains to be seen what impact the looming uncertainty will have on marketplaces and enrollment numbers.
Next week, the U.S. House of Representatives will hold a vote on extending funding for the Children’s Health Insurance Program (CHIP). Recall earlier this month, the House Energy and Commerce Committee advanced a bill on a partisan vote that would extend CHIP funding for five years. Democrats voted against the measure citing concerns with some of the bill’s offsets, such as utilizing the Prevention and Public Health Fund (PPHF) to fund CHIP and increasing Medicare premiums for individuals with specified incomes.
House Energy and Commerce Committee Chair Greg Walden (R-Oregon) delayed sending the approved bill to the House Floor to facilitate negotiations around funding mechanisms between House Republicans and Democrats. However, after weeks of negotiations, House Majority Leader Kevin McCarthy (R-California) declared those negotiations unsuccessful and will be moving forward with a floor vote on the measure advanced by the Energy and Commerce Committee.
Today, CSAC and CHEAC submitted a letter to all California members of the U.S. House of Representatives over opposition to using PPHF dollars to fund CHIP reauthorization. While we firmly support the reauthorization of CHIP, using PPHF would undermine the ability of counties to protect and promote the health of our communities.
The Senate Finance Committee also advanced a bipartisan five-year CHIP extension earlier this month, but funding sources have yet to be identified and a floor vote has not been set.
Though the CHIP Program expired at the end of September, a number of states had enough funding to continue the program for a short time. Several states could potentially run out of funding as early as November.
The Assembly Select Committee on Health Care Delivery Systems and Universal Coverage held two informational hearings this week to examine current health care systems in California and other countries. The hearings featured detailed presentations about public programs, the individual market, employer-based coverage, safety net programs, and universal systems being utilized in countries throughout the world. Presenters included Deborah Kelch and Elia Gallardo with the Insure the Uninsured Project (ITUP), Edwin Park with the Center on Budget and Policy Priorities, Ken Jacobs and Laurel Lucia of the UC Berkley Center for Labor Research & Education, and Robin Osborn and Sara Collins with The Commonwealth Fund.
Led by Assembly Member Co-Chairs Jim Wood and Joaquin Arambula, the committee used the informational hearings to begin exploring how to increase coverage and access to health care in California. Several members discussed during the hearing the need to focus on preventive services and public health as part of the broader health systems delivery reforms. Notably, however, the hearings were only attended by Democratic Assembly Members. Materials from the two hearings are available here. The committee is expected to hold additional hearings on similar topics in the coming weeks and months.
Nearly three months after signaling his intention to do so, President Donald Trump this week officially directed the acting director of the Department of Health and Human Services to declare the opioid crisis a public health emergency. The declaration will permit public health agencies to redirect existing resources to address the crisis, eliminate or reduce “bureaucratic delays” in hiring personnel, and expand access to telemedicine, including remote prescribing of medication assisted treatment (MAT).
The declaration by the Trump Administration is narrower in scope than what his own opioid commission recommended and does not include any funding to combat the crisis. Currently, the amount in the HHS public health emergency fund is around $57,000. Senior Administration officials indicated there have been ongoing discussions with Congress around the appropriate level of funding to address the emergency and that Trump may ask Congress for additional opioid funds later this year. Senate Democrats this week introduced a bill that would appropriate $45 billion toward the epidemic, and several Republicans also support additional funds to address the crisis.
Notably, the declaration does not include several of the top priority needs of state and local officials, such as access to naloxone. The declaration of a public health emergency lasts 90 days and can be renewed until the emergency no longer exists.
The California Health Care Foundation (CHCF) will be holding a briefing on California’s response to the opioid epidemic on Monday, November 27 from 12:00 pm to 1:30 pm at the DHCS Auditorium in Sacramento (1500 Capitol Avenue, Sacramento, CA 95814). The briefing will examine the role of state agencies and other collaborative approaches being utilized throughout the state to address the epidemic, including promoting safer prescribing practices, expanding access to medication-assisted treatment (MAT), and improving communications between prescribers and providers. Speakers will include:
- Jennifer Kent, Director, California Department of Health Care Services (DHCS)
- Lance Lang, MD, Chief Medical Officer, Covered California
- Melanie Fontes Rainer, JD, Special Assistant Attorney General, California Department of Justice
- Karen Smith, MD, Director, California Department of Public Health (CDPH)
The event will also be available via telephone and webcast. For more information and to register, visit here.
The National Academies of Sciences, Engineering, and Medicine (NASEM) Roundtable on the Promotion of Health Equity will be holding a one-day workshop in Oakland entitled Immigration as a Social Determinant of Health on Tuesday, November 28. The workshop will feature invited speaker presentations and discussions that examine the history of immigration laws and policies and how these laws and policies affect immigrant health and broader population health. For more information and to register, visit here.
Dialogue 4 Health is conducting a webinar on Tuesday, November 14, from 10:30 am until 12:00 pm, PST, entitled “Marijuana and Our Health: What We Do and Don’t Know.” This is the first of series of forums to explore the impacts of cannabis on human health, communities, and public health. Information on how to register for the November 14 webinar can be found here.
The U.S. Centers for Disease Control and Prevention (CDC) and ChangeLab Solutions have partnered to launch the Public Health Law Academy, a free online, on-demand training resource for public health professionals. The Public Health Law Academy offers three types of courses:
- Introduction to Public Health Law
- Hot Topics in Public Health Law
- Legal Epidemiology Overview
Each course type consists of several comprehensive public health legal topics, and additional courses are expected to be added over the coming months.
Last month, Capitol Weekly and the UCS Sol Price School of Public Policy held a conference entitled Health Care in Crisis in Sacramento. The conference examined the state of health care in California in light of federal attempts to repeal and replace the Affordable Care Act. Topics covered during the event included how to improve the state’s current health system, universal coverage proposals, and the status of the opioid epidemic. The California Channel filmed the event panel and keynote addresses, and the videos are now available online.