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.