5 Things California: May Revise, Access to care, Federal health agenda

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With help from Emily Boerger

1. Health proposals in the May Revise

Governor Newsom announced last week his $267 billion May Revise proposal – a $40 billion increase compared to his January proposal. Among the many health-related proposals in the budget is a $12 billion homelessness package, over $3 billion for the Children and Youth Behavioral Health Initiative, and $35 million in General Funds over 5 years for a Universal Basic Income pilot program.

The May Revision estimates $27.6 billion in General Fund expenditures for Medi-Cal for 2021-22 (a $6.1 billion increase compared to 2020-21). “The May Revision assumes that caseload will increase by approximately 7.1 percent from 2019-20 to 2020-21 and increase by 6.6 percent from 2020-21 to 2021-22. Medi-Cal is projected to cover approximately 14.5 million Californians in 2021-22, over one-third of the state’s population.”


2. Did Newsom “miss the mark” on health equity?

Following the release of Newsom’s budget proposal, State of Reform Reporter Sydney Kurle reached out to stakeholders for their takes on the May Revision. While the overall reception of the budget was favorable, some stakeholders commented that the proposal doesn’t go far enough to address racial equity in health care and public health.

“At a time when we have such a huge surplus and also such a strong stream of funding from the federal government from the American Rescue Plan, we feel like Governor Newsom certainly missed the mark,” said Ronald Coleman of the California Pan-Ethnic Health Network. During a California Can’t Wait Coalition press conference on Wednesday, health committee leaders Sen. Richard Pan and Asm. Jim Wood called for a budget that prioritizes public health and adequately funds public health infrastructure and workforce. The coalition is calling for $200 million in annual state funding to support local health jurisdictions.

3. Report: Impact of COVID on access to care

The significant declines in health care employment seen at the start of the COVID-19 pandemic have recovered unevenly across provider type, according to a recent Legislative Analyst’s Office (LAO) publication titled the “Impact of COVID-19 on Health Care Access.” For example, employment at California skilled nursing facilities decreased by about 10% by summer 2020 and has not recovered since.

The report also details trends in utilization data – which has also recovered unevenly based on type of health care service – and notes that overall health plan enrollment has actually grown during the pandemic. The report includes policy options for the Legislature to consider to improve health care access in California including: funding outreach to encourage coverage enrollment, making efforts to address the deficit in children’s preventive services among Medi-Cal enrollees during the pandemic, and improving the timeliness of data collection related to health access.


4. Uncertainty in the 2021 federal health agenda

President Biden’s health policy agenda got off to a quick start but may slow in the coming months. In his latest piece, State of Reform columnist Jim Capretta outlines the high-profile health reforms that Democrats are discussing for possible inclusion in the infrastructure or family support bills that Biden has teed up.

Among the list of reforms up for discussion are efforts to lower the Medicare eligibility age to 60, include dental and vision coverage under Medicare, give HHS the authority to negotiate pricing for Medicare-covered drugs directly with the pharmaceutical industry, and create a public option. Capretta highlights the outlook, challenges, and opposition for each of these proposals.

5. Ten industries saw a 30% increase in deaths

Workers in 10 California industries experienced an over 30% increase in deaths during the first 10 months of the pandemic, according to a UC Merced Community and Labor Center analysis of state public health data. The 10 industries considered “high risk” include: warehousing, agriculture, bars, food processing, wholesale trade, restaurants/food services, nursing care, landscaping, grocery, and building services.

Warehouse workers led the way with a 57% increase in pandemic-era deaths followed by agriculture workers who saw a 47% increase. The report notes that many of the top ten high risk industries have traditionally had high rates of migrant workers. The latest data from the California Department of Public Health indicates Latino residents account for 55.8% of the state’s COVID cases and 46.5% of the COVID-related deaths, despite accounting for 38.9% of the state population.