September 15, 2017 Edition

Last Day of 2017 Legislative Session, CHEAC Report to Follow

The California Legislature is set to end the first year of the 2017-18 Legislative Session late this evening. This week has been extremely busy for both the Senate and Assembly as both houses worked their way through remaining legislative proposals, including those on major topics such as housing, immigration, and climate change.

CHEAC continues to monitor final actions on the Senate and Assembly Floors and will issue our 2017 End of Session Memo, including our weekly bill chart, once both houses have concluded their business.

Divergent Health Care Proposals Emerge at the Federal Level

This week, two very different proposals related to the Affordable Care Act (ACA) and federal health insurance marketplaces were introduced by members of Congress. Washington continues to debate and discuss potential options to health care reforms, and we highlight some of this week’s activities below.

Graham-Cassidy Proposal

Led by Senators Lindsey Graham (R-South Carolina) and Bill Cassidy (R-Louisiana), and cosponsored by Senator Dean Heller (R-Nevada), Senate Republicans have proposed to use $1.2 trillion in funds spent under the ACA’s tax credits, Medicaid expansion, and cost-sharing payments to instead provide states with large block grants. H.R. 1628 would also repeal the ACA’s individual and employer mandates, as well as the medical device tax.

Senate Republicans have until the end of September before key procedural powers expire that permit the passage of measures with only a simple majority. Typically major legislation requires 60 votes to gain passage in the Senate. With limited time remaining before this procedural power expires, the Graham-Cassidy proposal faces a difficult road to passage ahead. Several Senate Republicans have already expressed concerns about such measure, and Senators face an already-busy agenda for the remainder of September. Additionally, it is unclear if the Congressional Budget Office (CBO) would have enough time to issue an analysis on the measure before the end of the month.

Due to significant concerns over any attempts to reduce or cap Medicaid funding, CHEAC, along with California State Association of Counties (CSAC) and other California county organization colleagues, have signed onto a letter opposing H.R. 1628 by Senators Graham and Cassidy.


On the other end of the spectrum, Senator Bernie Sanders (D-Vermont) and 16 other U.S. Senators, including California’s own Kamala Harris (D-California), introduced a “Medicare-for-All” measure this week aimed at providing universal, single-payer health coverage to all Americans. The proposal would expand Medicare eligibility over time and provide for a greater range of benefits, including dental, vision, and hearing services. At this time it remains unclear how such a measure might be funded. Sanders did release a list of potential financing options, including increasing tax rates and imposing fees on financial institutions, upon introducing his proposal this week.

This measure certainly will not pass given the current Congressional makeup. However, when Sanders introduced a similar measure in 2013, he was unable to secure even one co-sponsor. With 16 high-profile co-sponsors this go-around, the concept of universal, single-payer health coverage is clearly gaining momentum among Democrats and signaling a continued political shift in Washington.

Bipartisan Efforts

A bipartisan approach to health care reform remains in the works by Senate Committee on Health, Education, Labor, and Pensions (HELP) Chair Senator Lamar Alexander (R-Tennessee) and Vice-Chair Senator Patty Murray (D-Washington). The Senate HELP Committee recently held a series of bipartisan hearings on how to tweak the ACA to stabilize insurance marketplaces. However, with another quickly-approaching deadline for insurance companies to commit to selling plans on ACA marketplaces and set final health plan prices at the end of the month, it is likely to be a heavy lift for the Republican and Democrat pair to have a proposal ready for Congressional consideration.

It remains to be seen what action, if any, Congress will take related to the ACA and federal health insurance marketplaces.

Senate Finance Committee Announces Agreement on 5-Year CHIP Reauthorization

This week, Senate Finance Committee Chair Orrin Hatch (R-Utah) and Vice Chair Ron Wyden (D-Oregon) announced agreement on a $35 billion five-year funding extension of the Children’s Health Insurance Program (CHIP). Such long-term extension is expected to provide stability to the CHIP program and its beneficiaries, as well as increased flexibility for states to administer the program. The proposed legislation would continue the 23 percent increase in the federal matching rate afforded by the Affordable Care Act’s (ACA) through 2019, decrease the rate to 11.5 percent in 2020, and eliminate the enhanced rate in 2021. A brief overview of the proposal from the Senate Finance Committee is available here and full legislative text is expected within the coming days.

The House Energy and Commerce Committee, however, has yet to announce or unveil legislation related to the CHIP reauthorization. Recently, California Health and Human Services Agency Secretary Diana Dooley submitted a letter to the leadership of both the Senate Finance Committee and House Energy and Commerce Committee urging the reauthorization of CHIP and highlighting the importance of such program to more than two million children and pregnant women in California. Secretary Dooley’s letter is available here.

Experts Concerned Recent Vaccine Study May be Misleading to Pregnant Women

A recent article published in the academic journal Vaccine may be misleading to pregnant women, according to experts. The article provides puzzling data suggesting an association—not a causal link—between miscarriage and previous receipt of back-to-back annual pH1N1 influenza vaccines. This study is the first of its kind to explore such connection between influenza vaccines and risks during pregnancy, but it is important to note that, at this time, no published data have confirmed an association between miscarriage and influenza vaccines.

The U.S. Centers for Disease Control and Prevention (CDC), the U.S. Advisory Committee on Immunization Practices (ACIP), the American College of Obstetricians and Gynecologists (ACOG), and the study authors continue to strongly recommend universal influenza vaccines for everyone six months and older, including women during any trimester of their pregnancy. Experts have determined the research featured in the recent article to be too weak and preliminary to change the advice established over a multitude of previous rigorous studies that pregnant women should receive an influenza vaccine. Influenza during pregnancy, experts note, can result in a deadly outcome that may cause serious birth defects and miscarriage. The CDC has issued a fact sheet and guidance on the recent article. A commentary article has been issued in Vaccine disputing the original article’s suggested association between vaccines and miscarriage, and ACOG has also issued a statement that it is safe for pregnant women to receive an influenza vaccine.