July 31, 2017

Lawmaker Education Week and Fall CME Activity

This October’s Continuing Medical Education activity will focus on public health law and policy. Among other things, the fall conference will prepare health officers to build relationships with elected leaders and become stronger public health advocates for their communities. HOAC staff will be organizing a Lawmaker Education Week for health officers to engage and share information with their community’s elected representatives. Planning will take place throughout the fall, and the week itself will begin Monday, October 23.

US Climate and Health Alliance Launches State Policy Initiative

The US Climate and Health Alliance has launched the State Policy Initiative, which provides many tools to help public health leaders become more influential advocates for state and local climate policy. The site includes reference materials and other information that may be helpful in discussing the health aspects of climate change with policymakers. 

Senate Republicans Fail to Repeal Affordable Care Act

After failing to pass “repeal and replace” and “repeal only,” the US Senate rejected a scaled-down plan to repeal parts of the Affordable Care Act (ACA) in the early hours of Friday Morning. The Health Care Freedom Act, also called a “skinny repeal,” would have repealed the ACA’s individual and employer mandates, among other provisions, and was estimated by the nonpartisan Congressional Budget Office to increase the number of people who are uninsured by 15 million. With Senate Democrats being joined by three Republican senators in voting against the skinny repeal, Republican efforts to dismantle one of President Obama’s crown achievements appear to be derailed. For the foreseeable future, ACA is here to stay, as it is unclear how House and Senate Republicans can move forward, though the president has declared his intent to “let Obamacare fail.”

Legislature Adjourned

State lawmakers are adjourned for the summer and will reconvene the legislative session on August 21.

July 24, 2017

U.S. Senate May Vote on Healthcare as Early as Tomorrow

After months of debating and planning, the Senate majority leader is expected to take up the House-approved bill to repeal and replace the Affordable Care Act as early as tomorrow. Though the House bill is not likely to pass the Senate, if Senator Mitch McConnell can reach the 50 votes needed to begin debate on the House bill, he can move to repeal ACA without a replacement – an amendment that would be unlikely to pass, though being suggested by a handful of Republican lawmakers. If the amendment fails, Senator McConnell could move to replace the House-approved bill with the version developed by a group 13 Republican senators – all men – tasked with making the GOP’s plan to repeal ACA more palatable, not just to the public, but to their colleagues. The repeal effort would be considered as a budgetary item, which limits debate, prohibits a filibuster, and will allow its passage with a simple majority vote. As of now, the Senate appears to be short of the votes. With 52 of the Senate’s 100 members being Republicans, Senator McConnell can only afford to lose two votes – one if Senator John McCain, who announced last week that he was diagnosed with brain cancer, is absent.

California Budget & Policy Center Begins Series Examining the Feasibility of Single-Payer Healthcare  

In the first post of a new series, the California Budget & Policy Center provided an excellent analysis of a prospective single-payer healthcare system in California. In light of SB 562 (Lara and Atkins), the single-payer bill that was approved by the Senate and stalled in the Assembly, their analysis also provides a thoughtful overview of the challenges that resulted in the bill’s demise.

STEM Trained Candidates Seeking Public Office in Age of Trump

With the help of a new nonprofit political action committee called 314 Action, many scientists are considering a run for public office. As the Trump administration and Republican-led congress propose numerous cuts to science programs across the country, the “lab coat liberals,” as they’ve been called, are seeking to fight back by running for local, state, and federal offices. Going from scientist to politician, groups of STEM trained candidates are running with a commitment to protect research funding and pledge to aggressively advocate for evidence-based policy in areas where scientific evidence is disputed. Read more about the movement here.

California Legislature Adjourns for Summer Recess

State lawmakers officially adjourned for the summer on Friday. They will reconvene on August 21, when they will begin the final stretch of this legislative-year, which ends on September 15. 

July 17, 2017

U.S. Senate Postpones Action on Healthcare

Senate Republicans released their revised version of the Better Care Reconciliation Act (BRCA), their Affordable Care Act (ACA) replacement, on Thursday. The draft was met with continued concern or opposition from nine Republican senators, most serving states that expanded Medicaid under ACA and saw a reduction in the uninsured population, who worry about the impact cuts to Medicaid, among other provisions, will have on vulnerable constituents.

The Congressional Budget Office (CBO) previously estimated that the $772 billion in cuts would result in 22 million fewer people would having Medicaid coverage. Expecting a new CBO analysis on the revised bill to be released today, Republican leadership was looking to move BRCA forward as early as tomorrow. However, Senate Majority Leader Mitch McConnell indicated that the Senate will postpone action on their healthcare reform bill, giving time for Senator John McCain to recover from a medical procedure. The delay also gives more time for opposition to organize.

Currently, two Republican senators – Susan Collins and Rand Paul – are expected to join their 48 Democratic colleagues in voting against the bill. Proponents of BRCA will need the 50 remaining Senate Republicans in support. A 50-50 count in the Senate would allow Vice President Mike Pence to cast the deciding vote.

California Legislative Deadlines

State lawmakers on Friday had to meet a legislative deadline requiring most bills to be acted on by a policy committee. The two HOAC supported bills listed below were not heard by Friday’s deadline. They are inactive for the year and can move forward again in 2018.

  • AB 62 (Wood), a bill to prohibit the use of tobacco products in public housing units. 
  • SB 210 (Leyva), which would require schools to take steps to ensure pupils have access to safe drinking water that is free of contamination from lead and other sources. 

The State Senate and Assembly will adjourn for Summer Recess on Friday, reconvening on August 21.

July 10, 2017

AB 511 (Arambula) Now a Two-Year Bill

HOAC’s sponsored bill to update TB screening requirements, AB 511 (Arambula), will be held in the Senate Health Committee for the rest of the year. AB 511 will now be a two-year bill, eligible to move forward again in January of 2018. In the meantime, HOAC will be asking health officers to include support of AB 511 in their county legislative platforms. We will be reaching out to other potential supporters, and may work on amending the bill.

HOAC would like to thank all the health officers, TB controllers, and others who have worked hard to craft language, testify, and meet with elected officials. Your voice has been essential in moving the bill this far. Regardless of what happens moving forward, we can be proud that we got AB 511 out of the Assembly without any “no” votes, in spite of vocal opposition led by the California Nurses Association. 

Academic Consortium Studying SB 277

Health officers will soon receive an interview request from an academic consortium studying the outcomes of 2015’s SB 277, the bill to remove the personal belief exemption to vaccines. The study is being conducted by a team representing Emory University, the University of Pennsylvania, Johns Hopkins University, and Northern California Kaiser Permanente in collaboration with HOAC. They will be asking about how your county has worked with schools and any challenges you’ve faced. Please expect to see an e-mail from HOAC staff.

July 3, 2017

Update on Opposed/Opposed Unless Amended Legislation

Since the start of the 2017/18 Legislative Session, HOAC has taken oppose or oppose until amended positions on seven bills. So far, we have achieved our desired outcome on all but one of these bills – SB 384 (Wiener), which would allow localities to extend the hours of sale for alcohol by two hours, and is scheduled to be heard by the Assembly Committee on Governmental Organization this Wednesday.

HOAC’s legislative program has taken great strides this year in forming an internal Legislative Committee, which has allowed health officers to more expediently share expertise with our lawmakers. The committee has also allowed health officers to evaluate even more legislative items, resulting in HOAC taking about twice as many positions on legislative items than we did at this time in the 2016/17 Legislative Session.

President Trump Nominates Indiana Health Officer as U.S. Surgeon General

The White House announced on Thursday that President Trump has nominated Jerome Adams, MD, MPH to serve as Surgeon General of the Untates. Adams has served as Indiana’s health commissioner – a position equivalent to California’s health officer – since 2019 and is an Assistant Professor of Anesthesiology at the Indiana University School of Medicine. As Indiana’s top-doc, Adams worked under then-governor Mike Pence in 2015 to implement a needle-exchange program in response to an HIV outbreak among needle-sharing oxymorphone users in Scott County, a rural area in Southeast Indiana.

The 2015 outbreak, which left nearly 200 people HIV-positive, was unprecedented in Indiana and is considered a defining moment of Pence’s tenure as governor. In 2013, Scott County’s Planned Parenthood – the only HIV testing center available to the county’s 24,000 residents – was closed during Pence’s first year as governor. Opioid addiction and IV drug use has long been a critical challenge to Scott County, where about 20 percent of residents live below the poverty line, and the clinic’s closure greatly hindered the rural community’s access to HIV testing and prevention services. The lack of accessible resources coupled with the high rates of needle-sharing among drug users aided a community-wide HIV outbreak that, at its height, resulted in 20 new infections each week.

Health officials identified an HIV outbreak in Southeast Indiana by January 2015. At the time, both Adams and Pence, a steadfast evangelical conservative, shared moral concerns over initiating a needle-exchange program (in Indiana, it is illegal to possess a syringe without a prescription). However, by March 2015, the number of infections continued to rise, and Adams became a leading voice in encouraging Pence to authorize the exchange. In light of new information and mounting political pressure, Pence reversed his position and issued an executive order that allowed for the distribution of thousands of syringes. The exchange program, along with aggressive outreach, was successful in slowing HIV infection rates to a trickle.

As an anesthesiologist and academic, Adams has research interests in pain management and opioid addiction. Adams once revealed in his testimony during a House committee hearing that his brother is living with addiction, and has been an outspoken advocate for increasing the accessibility of naloxone, a lifesaving overdose reversal medication. If confirmed, Adams would replace Vivek Murthy, MD, MBA, who was asked by President Trump to resign his post as Surgeon General in April.

Better Care Reconciliation Act Would Eliminate Prevention and Public Health Fund in 2018

The Better Care Reconciliation Act (BCRA), the Senate Republican healthcare proposal to repeal and replace the Affordable Care Act, proposes eliminating the Prevention and Public Health Fund next year. The Fund makes up 12 percent ($900 million) of the CDC’s budget. Additionally, local and state health departments receive more than $620 million annually through the Fund for various programs.
Senate Republican leaders were hopeful they could pass BCRA before adjourning for Independence Day, however a handful of the Senate’s Republicans have indicated their opposition to the bill – interestingly, some think the proposal goes too far, and others think it doesn’t go far enough. Appearing to have fallen short of the 50 votes needed, Senate Republican leaders agreed to act on BCRA after the July 4 holiday.