August 14, 2017

President Trump Declares Opioid Crisis a National Emergency

“We’re going to spend a lot of time, a lot of effort, and a lot of money on the opioid crisis,” said President Trump on Thursday, accepting the recommendation of the White House Commission on Combating Drug Addiction and the Opioid Crisis by declaring a national emergency. The president’s surprise announcement came two days after Secretary of Health and Human Services Tom Price and presidential adviser Kellyanne Conway discussed the Commission’s interim report in a press conference, vowing to devote resources to combat the epidemic, but stopped short of an emergency declaration.  Declaring the crisis an emergency is expected to improve prevention, treatment, and recovery outcomes by directing and mobilizing additional resources to address addiction; however, the specifics are not yet clear.

The bipartisan Commission, led by New Jersey Governor Chris Christie, provided additional recommendations which include increasing treatment capacity for those living with addiction and better educating prescribers about the potential for abuse. There are currently six states that have already declared the opioid crisis an emergency, responding by directing funding to medication-assisted treatment programs, tightening prescribing rules, and allowing broader access to naloxone, an overdose-reversal drug. A national declaration may result in similar actions being taken at the federal level.  

Resources for Meeting with Representatives Over Congressional Recess

NACCHO’s most recent Action Alert provided an advocacy toolkit and asked for leadership in sharing information with representatives, as the fiscal year ends on September 30 and congress will need to make decisions about funding priorities impacting community health. Members of Congress will be adjourned until September 5. During the recess, members are more likely to be in their districts, giving you more opportunities to meet with your representative. Here are some additional NACCHO resources for public health advocacy:

State Lawmakers Return to Sacramento Next Week

California’s Senators and Assemblymembers have been on recess since July 21 and will return to Sacramento next Monday. Once lawmakers arrive, they will be met with a series of quickly approaching bill deadlines until September 15, when the first-year of the two-year legislative session comes to an end. 

August 7, 2017

Assembly Speaker Rendon Faces Recall Effort After Tabling Single-Payer Healthcare Bill

Assembly Speaker Anthony Rendon is now facing recall efforts following his decision to table SB 562 (Lara and Atkins), which would have made California the “single-payer” for healthcare services in the state. SB 562 was passed by the Senate, despite having an unclear path to fund its estimated $400 billion cost – an amount larger than our state’s budget. At the time, many progressive senators were conflicted, as they acknowledged the bill’s infeasibility while defending their conceptual support for single-payer healthcare. The majority of senators voted in support of SB 562 as a gesture to continue the single-payer conversation, thereby leaving members of the Assembly to develop a funding solution to a bill that is essentially seen by both Democrats and Republicans as being fiscally unworkable.

Importantly, single-payer healthcare has become something of a litmus test for California Democrats, who fear the optics of voting against providing everyone with health coverage. With no solution for funding, Speaker Rendon decided to table the enormously expensive proposal, shielding members of the Assembly from publicly voicing their concerns to the popular, yet impractical, SB 562. He alone now faces the consequences of saying “no.”

It is still uncertain how serious of a threat the recall challenge will turn out to be. Organizers will need to collect more than 20,000 signatures to hold a recall. Speaker Rendon has more than $1 million in campaign accounts and claimed landslide victories in his last three elections.

White House Opioid Commission Recommends State of Emergency

President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis, established in late March and led by New Jersey Governor Chris Christie, provided an interim report last week examining and recommending solutions to combat the nation’s opioid epidemic. The interim report urges the president to declare a national emergency either under the Public Health Service Act or the Stafford Act and shares many startling facts about the severity of the epidemic, most notably acknowledging the number of Americans dying every day from accidental overdose is “equal to September 11th every three weeks.” The Commission argues the president’s declaration would empower his administration with the resources to handle the crisis, noting that “if this scourge has not found you or your family yet, without bold action by everyone, it soon will.” President Trump is still considering the Commission’s recommendations.

Communicate with Members of Congress Back Home 

(From NACCHO’s News from Washington) The House and Senate are on recess until Labor Day. This is your opportunity to meet with policymakers back home and communicate with them about public health issues in your community. NACCHO has provided an advocacy toolkit that gives you guidance about how to communicate with policy makers and offers talking points, sample meeting request letters and sample factsheets.

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.

June 26, 2017

HOAC Sponsored AB 511 (Arambula) Stalls in Senate Health

I don’t think I’ve ever written an opinion piece in one of our weekly updates, but I’m eager to share some thoughts after what unfolded at last week’s AB 511 (Arambula) hearing. Our sponsored TB control legislation was a hotly debated item in the Senate Health Committee last Wednesday. The committee spent over an hour hearing testimony on AB 511, but before I go further in updating you on its outcome, I want to first express HOAC’s gratitude for Dr. Louise McNitt, who served as an expert witness in support of the bill. Throughout the hearing, she was a fearless defender of evidence-based public health policy. It takes a lot to go before a committee and field tough questions in a highly contentious environment, like the one we encountered last week. HOAC cannot be thankful enough for her expertise and leadership in Wednesday’s hearing.

As we’ve shared in past updates, AB 511 is facing strong opposition from the California Nurses Association. However, there was a shift in the tone of CNA’s opposition from previous hearings – they likely think Senate Health is their best chance to kill AB 511 and have taken their opposition to new highs (or lows?). You can view the AB 511 hearing at Digital Democracy. CNA’s often disrespectful testimony showed little regard for intellectual honesty or professional courtesy, referring to the bill’s author, a physician specialized in emergency medicine, as “Mr. Arambula” before beginning a slanderous attack on the integrity of public health officers. CNA misleadingly characterized TB risk-assessment as a veiled attempt for our members to “shift emphasis” from public health to cost-savings. They implied that HOAC was aiming to “segregate” populations based on TB risk, an offensive remark on many levels. However, they dodged many questions requiring TB expertise with a phrase like “ask them, they’re the experts.”

Ultimately, AB 511 was not taken up for a vote last week. Opponents created a lot of confusion around the bill and it became clear committee members needed more time to understand the issue at-hand. Rather than risk not having the votes, which would kill the bill right then and there, the decision was made to postpone the vote for a week or two. This gives us time to respond in more detail to the specific and complex questions asked by committee members. With that said, the confusion around this bill has created an opportunity for your expertise to be of incredible value to members of the Senate Health Committee. By suggesting in committee that we postpone the vote, these senators have indicated their need and sincere willingness to learn from you.

Senate Republicans Reveal ACA Replacement

Republican leaders in the Senate revealed the Better Care Reconciliation Act (BCRA), their attempt at a more palatable version of the Affordable Health Care Act narrowly passed by the House in early-May. Senate Republicans are hopeful they can vote on the bill before the July 4th recess. Here is some of the key information:

  • Cumulatively cuts billions in funding to the Public Health and Prevention Fund
  • Converts Medicaid to a per capita cap model
  • Eliminates individual and employer mandates
  • Eliminates Essential Health Benefit provisions
  • Defunds Planned Parenthood
  • Allows states to enact work requirements to receive Medicaid benefits, exempting disabled, elderly, and pregnant women
  • Authorizes $2 billion to support substance use treatment and recovery
  • Congressional Budget Office estimates number of uninsured will increase by 15 million, while reducing the federal deficit by $321 billion by 2026.
  • Provides $10 billion in safety net funding for non-expansion states
  • Results in 16 percent drop in Medicaid enrollment

BCRA can be passed by a simple majority. The Senate’s 100 members are comprised of 52 Republicans, 46 Democrats, and 2 Independents who caucus with Democrats. No Democrats are expected to vote for the bill and 5 Republicans have already expressed their opposition. However, there is still time for Senate Republicans to iron out the issues keeping at least 2 of their colleagues from supporting their proposed ACA replacement. With the count being so close, there is a chance Vice President Pence would get to cast the tie-breaking vote.

California Single-Payer Health Proposal Gets Shelved in the Assembly

Assembly Speaker Anthony Rendon made the call to shelve SB 562 (Lara and Atkins), a bill to establish a single-payer healthcare system in California. SB 562 passed the Senate, but did not advance to a policy committee in the Assembly, with Speaker Rendon calling the bill “woefully incomplete.” Many senators who voted for the bill did so while also acknowledging the difficult challenges – most notably its price tag – that would need to be resolved in the Assembly. Senators Ricardo Lara and Toni Atkins, the bill’s authors, issued a joint statement expressing disappointment that the “robust debate about healthcare for all… won’t continue in the Assembly.” The authors insist “this issue is not going away.” We are in the first-year of a two-year legislative session, so SB 562 may be acted on in 2018.

June 19, 2017

Call to Action: Senate Health Will Hear HOAC Sponsored TB Control Legislation

Members of the Senate Health Committee will hear HOAC’s sponsored AB 511 (Arambula) on Wednesday. Our bill would build on previous legislative accomplishments to replace mandated TB testing of certain low-risk populations with risk assessment screening and targeted testing, as recommended by the CDC, CDPH, and other expert public health bodies. AB 511 passed the Assembly despite facing strong opposition, which has since grown. HOAC calls on your leadership to challenge this opposition by educating Senators about the best TB control practices, which do not include universally testing low-risk populations.

If you can take a moment to share your knowledge with a lawmaker or their staff, members of the Senate Health Committee would benefit from your input. Contact information for members of this committee is listed below and I would be happy to provide talking points, a fact sheet, or any other materials that would be helpful in guiding your discussions.

Senate Committee on Health
State LegislatorPartyPhone NumberCounties Served
Connie LeyvaD916-651-4020Los Angeles, San Bernardino
Ed Hernandez (Chair)D916-651-4022Los Angeles
Holly MitchellD916-651-4030Los Angeles
Janet Nguyen (Vice-Chair)R916-651-4034Orange
Jim NielsenR916-651-4004Butte, Colusa, Glenn, Placer, Sacramento, Sutter, Tehama, Yuba
Josh NewmanD916-651-4029Los Angeles, Orange, San Bernardino
Richard RothD916-651-4031Riverside
Toni AtkinsD916-651-4039San Diego

LegislatorPartyPhoneCounties Served
Connie LeyvaD916-651-4020Los Angeles, San Bernardino
Ed Hernandez (Chair)D916-651-4022Los Angeles
Holly MitchellD916-651-4030Los Angeles
Janet Nguyen (Vice-Chair)R916-651-4034Orange
Jim NielsenR916-651-4004Butte, Colusa, Glenn, Placer, Sacramento, Sutter, Tehama, Yuba
Josh NewmanD916-651-4029Los Angeles, Orange, San Bernardino
Richard RothD916-651-4031Riverside
Toni AtkinsD916-651-4039San Diego
William MonningD916-651-4017Monterey, San Luis Obispo, Santa Cruz

California Lawmakers Approve Budget

The budget was passed on Thursday, marking the seventh straight year California’s lawmakers have approved a budget before the deadline. At more than $183 billion, the state’s largest to date, this year’s budget is filled with what Governor Brown has called “progressive priorities,” which include funds for after-school programs, students attending CSUs and UCs, and low-income people through the Earned Income Tax Credit, among other priorities you can read a bit more about here. Though the budget was passed on time, it was not done so without the usual heated negotiations between legislators and the governor’s administration. Much of this year’s contention focused on the allocation of Prop. 56 (tobacco tax) revenues, which generated $1.3 billion. Under the budget, many of these dollars will go toward increasing reimbursement rates for healthcare providers treating Medi-Cal patients.

US Senate to Vote on AHCA

After a failed attempt to whip the votes earlier this year, the House narrowly passed the Affordable Health Care Act (AHCA) last month. The version of AHCA passed by the House has proven controversial for many reasons, not the least of which is a provision that would allow insurers to deny coverage for pre-existing conditions. Interestingly, the New York Times reports a poll showing the AHCA does not enjoy a plurality of support from voters in a single state. In fact, when polled, the AHCA is the least popular piece of legislation considered by Congress in decades – even less popular than the Troubled Asset Relief Program, which is pejoratively called “the bailout.”
Importantly, the version of AHCA passed by the House was done so with an expectation that it would be revamped in the Senate. However, to avoid intense public scrutiny over the bill’s contents, Republican Senators officially tasked with rewriting AHCA – none of whom are women – have shared little about the bill’s contents, leading Democratic Senators to call on their Republican colleagues to hold public hearings. Though the public is largely unaware of its contents, architects of AHCA are hoping they will have enough support to pass the bill by July 4, before lawmakers adjourn for the summer.

As part of the 2017 federal budget process, the AHCA can pass the Senate with a simple majority of votes, which would repeal parts of the Affordable Care Act that are within the scope of the budget. This would include eliminating individual and employer mandates, as well as various taxes.

June 12, 2017

Senate Health Schedules Hearing for HOAC Sponsored TB Control Legislation
Members of the Senate Health Committee will hear HOAC’s sponsored AB 511 (Arambula) on June 21. Our bill would build on previous legislative accomplishments to replace mandated TB testing of certain low-risk populations with risk assessment screening and targeted testing, as recommended by the CDC, CDPH, and other expert public health bodies. AB 511 passed the Assembly, despite facing strong opposition from the California Nurses Association. We must now call on your help to overcome this opposition by educating Senators about the best TB control practices, which do not include universally testing low-risk populations.

If you can share this knowledge with a lawmaker or their staff, members of the Senate Health Committee would benefit from your input. Contact information for members of this committee is listed below and I would be happy to provide talking points, a fact sheet, or any other information on AB 511 to those interested.

LegislatorPartyPhoneCounties Served
Connie LeyvaD916-651-4020Los Angeles, San Bernardino
Ed Hernandez (Chair)D916-651-4022Los Angeles
Holly MitchellD916-651-4030Los Angeles
Janet Nguyen (Vice-Chair)R916-651-4034Orange
Jim NielsenR916-651-4004Butte, Colusa, Glenn, Placer, Sacramento, Sutter, Tehama, Yuba
Josh NewmanD916-651-4029Los Angeles, Orange, San Bernardino
Richard RothD916-651-4031Riverside
Toni AtkinsD916-651-4039San Diego
William MonningD916-651-4017Monterey, San Luis Obispo, Santa Cruz

Partial California Budget Deal Reached Thursday Night: Tobacco Tax Allocation Remains Outstanding Issue

The Democratic majority in the legislature and Governor Brown have reached a partial deal for the 2017/18 FY State Budget, increasing funds for after-school programs, providing money for in-state students attending CSUs and UCs, preserving the Middle-Class Scholarship, restoring adult dental and optical services under Med-Cal, expanding the Earned Income Tax Credit for low-income people, and funding dam safety and emergency flood projects. However, no agreement was reached on allocating Proposition 56 (tobacco tax) revenues. The additional $2 per pack of cigarette tax hike approved by voters in 2016 generated $1.3 billion. Governor Brown has proposed using the money to increase spending on the Medi-Cal program, while many legislators – along with the medical and dental lobbies – contend these revenues should fund increases in reimbursement rates for physicians and dentists who treat Medi-Cal patients.

Legislators will have until midnight on June 15 to finalize their negotiations with the governor and pass a budget.