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April 5, 2019

Bills Introduced to Bolster the ACA

This week, the House Energy and Commerce Committee advanced to the floor six measures to bolster the Affordable Care Act (ACA).  All bills passed the committee in votes along party lines:  HR 1385 would provide $200 million annually for state-based Affordable Care Act marketplaces; HR 1386 would provide $100 million to the federal navigator program; and HR 1425, is a reinsurance bill intended to lower ACA premiums.  The goal of the three other bills is to push back on some of the Trump Administration policies that may weaken the ACA:  HR 1010 would reverse the Administration's expansion of short-term health plans;  HR 986 would require the administration to rescind guidance that made it easier for plans in general to soften protections for pre-existing conditions; and HR 987, the MORE Health Education Act, would restore ACA outreach and enrollment funding that had been cut, while restricting the funds from going to any marketing for short-term plans.

March 29, 2019

RAND Report on Seismic Safety Mandate

On Thursday, a new RAND Corporation report was released that examined the cost to hospitals to meet 2030 seismic safety mandate standards to remain operational after an earthquake.  The report titled, “Seismic Safety Upgrades May Cost California Hospitals Billions, Increase Number of Hospitals in Financial Distress” was commissioned by the California Hospital Association (CHA), but the findings were reached independently by RAND.  According the report, California hospitals would have to spend between $35 billion and $143 billion to meet 2030 state seismic safety standards.  After the 1994 Northridge Earthquake, the state adopted SB 1953 that required hospitals to reduce their buildings’ risk of collapse by 2020 and ensure the structures can remain operational by 2030.

Since the passage of SB 1953, hospitals have been implementing upgrades to comply with the standards. The study does not look at the money hospitals have already spent to meet the 2020 standards — researchers say no reliable estimate is available — but instead evaluates the potential cost to meet 2030 standards. 

Most, if not all, of the state's more than 400 acute-care hospitals have already completed or will meet the 2020 deadline. However, the researchers note that meeting the 2030 guidelines will present a burden for hospitals given that hospitals must fund the entire cost of the upgrades. These potential costs of SB 1953 have raised significant concerns regarding both the financial burden on hospital systems and the opportunity costs associated with hospitals investing large pools of capital in implementing seismic upgrades.  The very detailed report offers direct estimates of the costs of retrofitting or rebuilding noncompliant buildings, and the authors assess the affordability of compliance based on recent hospital financial data.

Their main conclusion is: Diverse stakeholders agree that the intent of SB 1953 continues to have merit, but it is appropriate to reassess whether SB 1953 remains the best policy to ensure resilience and to consider potential alternatives.

The full report and its key findings can be found at:

CHA will hold a legislative advocacy day to educate lawmakers on these seismic issues and in support of the hospital-sponsored bill SB 758 (Portantino) next Tuesday, April 2.

March 23, 2019

Senate Budget Subcommittee Hearing

Senate Budget Subcommittee HearingOn Thursday, the Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services reviewed issues impacting the Department of Managed Care, California Health Benefit Exchange and the Department of Health Care Services, including review of Medi-Cal eligibility, benefits and issues related the Affordable Care Act (ACA).

Individual Mandate. One of the issues discussed was Governor Newsom’s proposal for a state individual mandate that would require residents without health coverage to pay a penalty of $695 per adult per year and $348 per child modeled after the ACA penalty. According the Department of Finance (DOF), the maximum fine would be $2,085 per year, or 2.5 percent of annual household income – whichever is higher. It would maintain religious, veteran and other exemptions previously in place under the Affordable Care Act.  Revenue from penalties (estimated $500 million per year) would go to the general fund and pay for expanded financial assistance for people who purchase plans through Covered California. The proposal would boost subsidies for those already eligible for financial assistance under the ACA, as well as help those who currently earn too much to qualify.

If approved, households earning between 400 and 600 percent of the federal poverty level would be eligible for financial help, which would make California the first state in the nation to offer assistance beyond the maximum income level under the ACA. In total, the governor's "ACA Plus" program would expand premium assistance available to people earning 250 to 600 percent of federal poverty, equivalent to $62,750 to $150,000 per year for a family of four. Subsidy levels would change annually depending on the budget and how much penalty revenue comes in, creating significant fiscal uncertainty year to year. The subsidy program would sunset after three years, though the mandate and penalty would remain in place.

Senator Richard Pan (D-Sacramento), Senate budget subcommittee chair, said the subsidies should be larger. He also expressed concern about making financial assistance dependent on penalty revenue. He suggested the state renew the Managed Care Organization (MCO) tax to help offset state costs for expanded subsidies. The MCO tax generates $1.5 billion per year for the general fund and is set to expire July 1.  Senator expressed concern about people being priced out of coverage as the level of assistance drops.

Proposition 55 Funds. Dr. Pan also asked both the DOF and the Legislative Analysts’ Office (LAO) about the lack of Proposition 55 funds for the Medi-Cal budget.  As you recall, in good budget years, the state should expect additional revenues to flow into the Medi-Cal program, and for the second year in a row the DOF has used a flawed formula which ensures no additional funding goes for health care.  Dr. Pan expressed a great deal of frustration and concern that because the DOF was “playing games” with the funding formula that voter confidence will be undermined.  Our estimates indicate that this year, with using a more appropriate formula, Medi-Cal should expect a $700 million infusion.  Dr. Pan mentioned that to the Medi-Cal program.  He asked the LAO to estimate exactly how good the budget would have to be for funding to ever get deposited in the Medi-Cal account.  We are pleased to see Dr. Pan and the Senate take up this issue.  The hospital community is working with the Assembly to have them raise the same concerns.

March 15, 2019

Budget Hearings: Subcommittees on Health

Next Thursday, March 21, the Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services will hold a hearing reviewing issues impacting the Department of Managed Care, California Health Benefit Exchange and the Department of Health Care Services, that will include review of Medi-Cal eligibility, benefits and issues related the Affordable Care Act.

On the following Monday, March 25, there will be a joint informational hearing of the Assembly Budget Subcommittee No. 1 on Health and Human Services and the Budget Subcommittee No. 2 on Education Finance on “Meeting the Demand for Health: Report of the California Future Health Workforce Commission,”  As we reported previously, co-chaired by Dignity Health’s Lloyd Dean, the goal of the commission was to address the looming health care workforce crisis and to create a comprehensive action plan for building the health workforce California will need by 2030. The three overall strategies include: 1) Increase opportunity for all Californians to advance in the health professions; 2) Align and expand education and training to prepare health workers to meet California’s health needs; and 3) Strengthen the capacity, effectiveness, well-being, and retention of the health workforce.

March 15, 2019

Budget Outlines Proposes Health Care Cuts

On Monday, President Trump released his FY 2020 $4.75 trillion budget blueprint entitled, “A Budget for a Better America,” that includes $1.9 trillion in cuts to health care programs such as Medicaid and Medicare. As reported by the Catholic Health Association of the U.S., the budget outline also proposes steep cuts of $1.1 trillion to discretionary spending programs over the next ten years. However, the proposal already has met stiff resistance from House leadership and even from some of the Administration's congressional allies, making it unlikely that much if any of its provisions will make it into FY 2020 appropriations bills. Further complicating the budget process, mandatory across-the-board spending caps are scheduled to go into effect later this year. House Democrats are beginning work on their own budget outline that also would avoid the mandatory caps, but it is not likely to result in a House vote on the overall budget. Instead, the individual committees will begin work on their appropriations bills with budget allocations provided by the leadership.

March 9, 2019

New Select Committee on Social Determinants of Children’s Well-Being

Last month, the Senate created a new Select Committee focused on the social determinants of health – the conditions in which people are born, grow, live, work and age.  Science is increasingly showing that children’s well-being, in particular, is linked to their social determinants.  As an example, nearly a quarter of young children in California live in poverty – a fact that has profound educational, health, and economic repercussions now and in the long term in that they create inequities that could be mitigated.  The Committee is looking at people from birth through age 26.

The bipartisan Select Committee members will hold a series of informational hearings that focus on the specific social determinants of health that drive negative outcomes, such as housing and homelessness, access to health care, immigration status, poverty and the safety net, land use, and education.  The Committee seeks to understand challenges in the current systems with the various determinants and consider ways to improve outcomes for children.

Interestingly, the Select Committee has decided to have a geographic focus which includes areas of high poverty rates in the state:  Los Angeles, the San Joaquin Valley, the Inland Empire, the Central Coast, and Northern Border/Tribal Lands. They are clear, though, that this geographic focus is not exclusive of their work.

The Committee is set to be active throughout the two-year session and all recommendations will be posted on their website.  They held a rally to kick off the Select Committee this week, featuring a special address by labor rights leader Dolores Huerta, and with a focus on the communities in the San Joaquin Valley.

The members of the Committee are Senators:  Chair, Holly Mitchell (D-Los Angeles); Patricia Bates (R-Laguna Niguel); Melissa Hurtado (D-Sanger); Bill Monning (D-Carmel); Richard Pan (D-Sacramento); and Susan Rubio (D-West Covina).

March 9, 2019

Governor Newsom Appoints New Secretary of Health and Human Services Agency

On Thursday, Governor Gavin Newsom appointed practicing pediatrician and current Director of Health and Social Impact for Los Angeles County, Mark Ghaly, as his Secretary for the California Health and Human Services Agency (CHHS). As both a physician and an expert in public health, Newsom states that Dr. Ghaly brings a deep knowledge and understanding of how individual and community health outcomes intersect with policy and law on issues like whole-person care, mental health and stage of life care. He will help lead the Administration’s efforts to advance the Governor’s health care agenda, including proposals to lower prescription drug costs, provide coverage to young undocumented adults through Medi-Cal, and help put California on a path toward single-payer health care.

Dr. Ghaly has served as Director of Health and Social Impact for Los Angeles County since 2018. He was deputy director of the Los Angeles County Department of Health Services overseeing community health and integrated programs from 2011 to 2018 and medical director for the Southeast Health Center, a San Francisco Department of Public Health clinic, from 2006 to 2011. Ghaly earned a Doctor of Medicine degree from Harvard Medical School and a Master of Public Health degree in health policy from the Harvard School of Public Health.

The Governor also announced the reappointment of Michelle Baass as undersecretary of the California Health and Human Services Agency, where she has served as undersecretary since 2018 and was deputy secretary of the Office of Program and Fiscal Affairs from 2017 to 2018. Many in the health community have worked with Baass in her role as Deputy Director for the California State Senate Committee on Budget and Fiscal Review from 2016 to 2017, where she was Principal Consultant from 2012 to 2016. Previously, she was deputy director for the California State Senate Office of Research from 2011 to 2012, where she was Principal Consultant from 2008 to 2011. She was a senior fiscal and policy analyst at the California Legislative Analyst’s Office from 2004 to 2008 and a manager and consultant for Accenture from 1996 to 2004.

The California Health and Human Services Agency oversees 12 departments and four offices that provide a range of health care services, social services, mental health services, alcohol and drug services, income assistance, and public health services to Californians. More than 33,000 people work for departments in CHHS at state headquarters in Sacramento, regional offices throughout the state, state institutions and residential facilities serving the mentally ill and people with developmental disabilities.

February 28, 2019

New Task Force Outlines the Way Forward for California’s Health Care Workforce

The California Future Health Workforce Commission was created in 2017 by a group of the state’s leading health philanthropies to address the looming health care workforce crisis – and to create a comprehensive action plan for building the health workforce California will need by 2030.

The Taskforce acknowledged that California’s health system is facing a crisis, which at its core is the simple fact that California does not have enough of the right types of health workers in the right places to meet the needs of its growing, aging, and increasingly diverse population.  The Commission focused on the need to increase the diversity of the state’s health workforce, enable the workforce to better address health disparities, and incorporate new and emerging technologies.

The Commission was co-chaired by Lloyd Dean, president and CEO of Dignity Health, and was noted as one of the state’s largest health systems and health employers; and Janet Napolitano, president of the University of California (UC), which operates the largest health sciences education and training system in the nation and is a major health provider.  The 24 commissioners included prominent health, policy, workforce development, and education leaders in the state.  They developed three key strategies, with more than two dozen specific recommendations.  The report provides a real roadmap for Legislators and other decisionmakers, by including timelines associated with each recommendation and a preliminary assessment of the cost to implement each item.

The three overall strategies include: 1) Increase opportunity for all Californians to advance in the health professions; 2) Align and expand education and training to prepare health workers to meet California’s health needs; and 3) Strengthen the capacity, effectiveness, well-being, and retention of the health workforce.

The Task Force hopes that Strategy 1 will result in an expanded, more qualified, and diverse pool of candidates from California communities with greater motivation, support, incentives, and opportunity to successfully pursue careers in primary care, behavioral health, and care for older adults and service in underserved communities.  Strategy 2 is expected to ensure that health professions training programs in California provide access to and graduate enough qualified, diverse candidates with the skills and experience to meet health and workforce needs in all communities.  Strategy 3 is aimed at providing incentives, training, tools, and innovations to increase the capacity and optimize the roles of the current and future health workforce within emerging health models.

Specific recommendations include: expanding the scope of nurse practitioners to “help fill in the gaps in primary care;” develop a psychiatric nurse practitioner program; work to eliminate provider burnout; expand medical school enrollment at public institutions; increase mental health training for primary care providers; and expand the number of residency position in the state.

You can access the full report here.
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