White House Releases Plan for Mandatory Sequester Cuts
On Friday, September 14, the Office of Management and Budget released their report that details how sequestration cuts will be implemented. Part of the Budget Control Act (BCA) passed in August 2011, the sequester is a package of automatic spending cuts that were scheduled for January 1, 2013 after the failure of the bi-partisan Super Committee to develop an alternative budget.
The plan includes approximately $54 billion in cuts to both defense and non-defense spending every year for the next 9 years for a total of $948 billion in direct cuts. Some examples of cuts that would affect the nation’s health include:
- 2% cut in Medicaid
- 8% cut to the Environmental Protection Agency's water quality oversight
- 8% cut to the Federal Drug Administration’s food inspection program
- 8% cut to the National Institute of Health’s research budget
- 8% cuts to certain housing and food assistance programs for low-income families.
Most federal government employees will receive pay cuts as well. It unlikely that any alternatives to the sequester will be proposed until after the November election. For more information, contact CHC Policy Analyst Rad Cunningham.
Healthy Families Transition to Medi-Cal
The state’s legislative session officially ended on August 31 and with it died two proposals (SB 301 and AB 826) to extend the managed care tax worth $200 million in exchange for a partial transition of children from the Healthy Families program to Medi-Cal. State agencies must still obtain approval from CMS for State Plan Amendments and Section 1115 Waiver approvals prior to implementing the transition.
Healthy Families Clean-Up Legislation. AB 1468, which the Governor signed on September 22, makes technical statutory revisions affecting health programs necessary to implement the FY 2012-2013 budget. Some of the Healthy Families to Medi-Cal transition provisions include the following:
- Sets premiums at $13 per child per month with a maximum of $39 per family per month for families with incomes between 151%-200% FPL (up to 250% FPL with income disregard)
- States that families who pay three months of required premiums in advance will receive the fourth consecutive month of coverage with no premium required. Family contributions paid into Healthy Families for children who move to Medi-Cal will be credited to their Medi-Cal premiums balance
- Maintains that families who elect to pay premiums through an approved electronic funds transfer (EFT) will continue receiving a 25% discount on their premiums. If MRMIB and DHCS determine it is feasible, DHCS will treat an EFT authorization under Healthy Families as an EFT authorization under the Medi-Cal program
- Exempts DHCS from competitive bidding rules for the purposes of contracting with the Healthy Families Program administrative vendor for implementing and maintaining the necessary systems and activities for providing healthcare coverage to children
- Permits DHCS to enter into a contract with the Health Care Options Broker of the Department for purposes of managed care enrollment activities
- Requires state agencies to submit a report on the transition to the fiscal and policy committees of the legislature twelve months after the transition is complete.
Draft Strategic Plan for the Transition. On October 2, the California Health & Human Services Agency submitted their strategic plan to transition Healthy Families children to the Medi-Cal program. The plan was presented to the fiscal and policy legislative committees on October 2nd and includes plans for beneficiary communication, assessing and reporting on the provider network adequacy, obtaining federal approval and monitoring the entire process. CHC continues to provide comment on the transition and participate on various committees to ensure that children are not harmed and there is no loss in coverage or delay in care.
Details about the transition are posted on the DHCS and MRMIB websites. For more information on these issues, contact CHC Policy Analyst Fatima Morales.
ACA Implementation: CA Health Benefits Exchange
The Exchange Board took action on a variety of issues this summer. Highlights include:
Outreach & Education Grant Program. Exchange staff presented a preliminary plan for a two-year grant program that would allocate $40 million to organizations capable of reaching local communities with information about healthcare coverage options. Although details are still being finalized, the plan proposes that (1) grants be awarded geographically and for special priorities; (2) award sizes range between $25,000-$250,000 with $500,000 awards for regional/multi-county grants; (3) flexibility in approaches under broad guidelines and minimum deliverables be allowed; and (4) any public/private entity be eligible as long as there is no conflict of interest.
Funding will be distributed in two phases only if phase I applications do not yield the right mix of grants (geographic/populations). Phase I applications are expected to be released November 16, 2012 for submission by January 4, 2013 with announcements made by February 15, 2013. The draft grant application process will be presented and voted on at the October Board Meeting.
Qualified Health Plan Design & Policies. Insurers hoping to sell products in the Exchange will be required to adhere to Board policies regarding network design, strategies, and standards for assuring quality and affordability, health and wellness programs, and supplemental health benefits (vision and dental). In a move supported by health advocates, the Board voted to broaden the federal definition of Essential Community Providers to include private practice physicians, physician groups, Medicaid Disproportionate Share Hospitals and other clinics that have historically served uninsured, low-income and medically-underserved populations.
Individual Exchange Premium Aggregation. Consumers will be required to pay their premiums directly to health insurers rather than the Exchange. Health advocates noted that this robs the Exchange of an opportunity to market and brand itself as a trusted source of coverage with the population it serves. Although Exchange staff acknowledged concerns by advocates, staff maintained that having consumers pay insurers directly will alleviate the Exchange of an additional administrative responsibility during its early years in operation.
Stakeholder Advisory Groups. The Exchange has decided to continue existing stakeholder engagement activities through 2012 and then create three advisory groups beginning in 2013. These advisory groups include: (1) Plan Management and Delivery System Reform; (2) Marketing, Outreach and Enrollment Assistance; and (3) Small Employer Health Options Program. Nominations are currently being accepted through November 2.
Next Board Meeting. The Exchange Board will next meet on October 30. Please also note that the previously scheduled meeting in November has been changed to the 14th and will now take place in Sacramento. The Exchange Board will host its January 2013 meeting in Los Angeles. For more information or details on these policies, visit the Exchange website or contact CHC Policy Analyst Fatima Morales.
National Childhood Obesity Awareness Month
President Obama designated September 2012 National Childhood Obesity Awareness Month. The proclamation cites a number of national childhood obesity reduction initiatives, from new school-meals regulations per the Healthy, Hunger-Free Kids Act of 2010 to updated standards in the federal government’s Dietary Guidelines for Americans. It also notes that over “4,000 schools have established rigorous nutrition and physical activity standards through the HealthierUS School Challenge, and more than a million Americans have earned the Presidential Active Lifestyle Award by committing to healthy eating and regular exercise.” For more information, contact Breanna Morrison, CHC Policy Analyst.
Oil Concerns Remain Unaddressed
Even after over 400 Los Angeles residents filled the Culver City Council Chambers back in June to express their concerns about unregulated fracking in the Baldwin Hills/ Inglewood Oil Field, Sacramento lawmakers failed to pass three pieces of legislation aimed at protecting community health and safety.
AB 972, authored by Assemblymember Betsy Butler, would have placed a conditional moratorium on fracking activities in the state until new fracking regulations were in place. The measure, supported by Community Health Councils and environmental advocates, was a precautionary approach to halt potentially hazardous fracking activities until regulators took time to study the impacts associated with the practice. AB 591, a bill authored by Assemblymember Bob Wieckowski, would have mandated oil companies to disclose information related to fracking such as the amount and type of chemicals used in fracking fluids. Earlier, SB 1054, a bill by Senator Fran Pavley, which would have required notification to residents of any nearby fracking activity, failed on the Senate floor.
During this time, CHC and community partners stressed the importance of taking a comprehensive approach to the regulation of fracking and implementing a moratorium while regulations were drafted. Community Health Councils and partners continue to be involved with the Baldwin Hills/ Inglewood Oil Field Community Advisory Panel (CAP) and activities mandated by the July 2011 Settlement Agreement. The Los Angeles County Department of Regional Planning recently awarded funding for an Air Quality Monitoring Study that will quantify air toxic emissions from the Oil Field operations and assess the health risk of both acute and chronic exposure to air toxic emissions. The study will last one year and provide important baseline information to be considered jointly with other oil field studies. In July, the Los Angeles County Department of Public Health released findings from its Community Health Survey, indicating that the community has significant health and safety concerns about oil field operations. Finally, Plains Exploration & Petroleum (PXP) will release findings of the 2011-2012 Fracking Study at its annual community meeting on Monday, October 15, 6:30pm at Knox Presbyterian Church (5840 La Tijera Blvd, Los Angeles, 90056).
The Community Advisory Panel meets monthly on the 4th Thursday at Kenneth Hahn State Recreation Park Community Center from 7-9pm. More information can be found at the Department of Regional Planning or by contacting Mark Glassock, CHC Policy Analyst.
South LA Trees & the Shuttle Endeavour
The California Science Center announced plans in July to transport the space shuttle Endeavour by removing 393 trees along a route through the cities of Los Angeles and Inglewood, replacing them on a 2-to-1 basis. Together with a consortium of neighborhood councils that included the Empowerment Congress West Area Neighborhood Council, Park Mesa Heights Neighborhood Council, Empowerment Congress Central Area Neighborhood Council, and Empowerment Congress North Area Neighborhood Council), CHC raised concerns about the community impact from the removal of trees in Council Districts 8 and 10—areas with the lowest tree canopy cover in Los Angeles.
While CHC regrets the loss of many majestic trees that have aided the South LA community for decades, agreements were reached with the Science Center and the Mayor’s Office to ensure the future of a greener South LA. CHC and neighborhood groups successfully preserved the Canary Pine trees planted along Martin Luther King Blvd in memorial to the civil rights leader and similar trees along Crenshaw Blvd. In total, 119 trees in Districts 8 and 10 were preserved in the final plan. Highlights from the agreement include 4-to-1 tree replacement, 50% local hire for maintenance 5 years past date of replacement planting, student scholarships and professional development programs for South LA teachers, a $400,000 fund for tree trimming, a South LA Park Master Plan, and a South LA Tree Master Plan.
For more information on the Settlement or CHC’s vision for a green, healthy South Los Angeles, please contact Mark Glassock, CHC Policy Analyst.
Vacant Lots Not Empty of Opportunity
Across the nation, cities like Detroit, Philadelphia, and Cleveland are pioneering innovative partnerships and policies to address growing epidemics of vacant lots that impact local economic development, community health, public safety, and the environment. Much like these large urban cities, South Los Angeles continues to grapple with the effects of decades of lost investment, capital flight, and economic downturn that serve as the driver for the creation and stagnation of public and private vacant property. Vacant lots interrupt residential neighborhoods and are situated along major transit and business corridors, reducing the safety and walkability of communities. Left undeveloped, this land presents a hazard and potential impediment to active transit and a lost opportunity for economic development.
Residents of South Los Angeles are well aware of the impact that vacant lots have on communities: decreasing property values, increasing amounts of blight, crime, and vandalism, and significant impacts to public health have been reported in study after study. Within the City of Los Angeles, significant inequities exist in physical activity and open space resources, particularly in South Los Angeles. Disturbingly, residents in South Los Angeles on average have only 0.8 acres per 1,000 population; children in their districts have only 2.9 acres per 1,000, the lowest in the city. Most residents in South Los Angeles find themselves more than a 10 minute walk from a local park and far away from healthy food retailers, according a recent survey conducted by UCLA. All these factors contribute to the current health crisis: This generation of children is the first that will not live longer than their parents due to obesity, diabetes, and preventable chronic disease.
Given the critical need for new community resources including parks, open space, and community gardens and the city’s limited ability to develop these resources on its own, the Coalition for an Active South LA (CASLA) and partner organizations are spearheading an effort to create a new partnership model to take advantage of the opportunities that exist in vacant land throughout South Los Angeles. The Coalition believes that a solution can be found to promote healthy parks and community gardens that were once vacant lots, and that such a solution can help solve a number of community issues such as economic development, job training, access to food, and access to quality physical activity resources.
The Coalition for an Active South LA is leading the charge to understand and quantify the extent of vacant land in South Los Angeles. If you are interested in learning more about vacant lots in South Los Angeles and building a strong winning coalition, please contact Mark Glassock, CHC Policy Analyst.
New Report: Dialogues with South Los Angeles Safety Net Users on Health Reform
Community Health Councils released its newest report Dialogues with South Los Angeles Safety Net Users on Health Reform in late August. The report analyzes data on safety net users’ knowledge of health reform, what they are worried about when it comes to healthcare, and their likelihood to change providers in 2014. Data was gathered through three distinct efforts: the California Healthcare Experience Survey, Dialogues with Dr. Katz (Director of the LA Department of Health Services), and Health Reform Focus Groups with safety net users.
The report analyzes the results of the qualitative and quantitative approaches to gather information from consumers about their experiences and opinions of the safety net healthcare system in South Los Angeles and highlights common themes expressed by patients across the three assessment areas. The surveys and focus groups also examined where safety net users are getting information on health reform.
Among the findings:
- Fewer than 20% of respondents know what a medical home is, a centerpiece of the new policy, and those who do know have difficulty describing it.
- Less than half of respondents (48%) indicate having heard or learned about health reform.
- Among those who have heard about health reform, only 6% heard about it through their doctor’s office.
- Latinos in our focus groups felt there had been no significant outreach to them.
- A stark increase in focus group approval for health reform occurred after a brief educational presentation and discussion.
The perspectives and needs of consumers must be understood and addressed if the landmark overhaul of the safety net system through the Patient Protection and Affordable Care Act (ACA) is to result in meaningful change. Health reform will transform the healthcare landscape in South LA, and the transparent, timely, and accountable implementation of the ACA is critical to the health of current and future generations. For more information, contact CHC Policy Analyst Rad Cunningham.