A bill introduced in the California State Assembly would tax prescription opioid medications and use the tax revenues to fund drug addiction treatment and rehabilitation programs.
Assembly Bill 1512, authored by assembly member Kevin McCarty (D-Sacramento), would assess a 1-cent-per-milligram tax on prescription opioid drugs and use the funds to support county programs to treat and prevent drug addiction.
The surcharge "would be placed on opioid prescription wholesalers" and not on consumers, McCarty said.
"California's opioid epidemic has cost state taxpayers millions and the lives of too many of our sons and daughters," he said.
"We must do more to help these individuals find hope and sobriety. This plan will provide counties with critical resources needed to curb the deadly cycle of opioid and heroin addiction in California."
McCarty cited statistics from the California Department of Public Health (CDPH) that estimate 2,024 state residents died from prescription opioid overdoses in 2014. State legislators in Minnesota, Connecticut, and Pennsylvania have considered similar bills to tax opioid medications in the past, he said.
Will Zasadny, a spokesperson for the California Life Sciences Association, which represents pharmaceutical firms in California, said the group is monitoring AB 1512 but has not taken a formal position on the bill.
In the past, pharmaceutical manufacturers have usually opposed bills that tax prescription drugs or affect pricing in any way.
In the state Senate, Sen. Anthony J. Portantino (D-Flintridge) introduced a bill that would place new limits on prescriptions for oxycodone.
Senate Bill 419 would prohibit oxycodone prescriptions in California to be written for anyone under the age of 21.
"The abuse of this drug is a national epidemic and we need to protect our children from being prescribed this highly addictive substance," said Portantino.
"Lawmakers, regulators, and medical professionals have been wrestling with how best to control this synthetic heroin and … while we're looking for solutions, let's make sure we keep it away from our most vulnerable population."
The California Life Sciences Association said it opposes SB 419 and contends that it takes a "blunt instrument" approach to a complex problem.
"We are concerned about the impact of such a blunt instrument being applied to an issue as complex as how clinicians address pain in pediatric patients," said Zasadny.
The two bills are part of a slate of four measures introduced this year that target the pharmaceutical industry.
In February, assembly member Jim Wood (D-Healdsburg) introduced Assembly Bill 265, which would prohibit prescription drug manufacturers from distributing discount coupons for brand-name drugs when there is a less expensive, generic alternative available.
The coupons are a "marketing tool to drive patients to higher priced drugs," said Wood.
Another bill introduced this year would require drug manufacturers to explain prescription drug price hikes.
Senate Bill 17, authored by Ed Hernandez (D-West Covina), would require manufacturers to provide state regulators and consumers with "information about the justification, if any, for the prices of newly emerging medications and price increases for existing medications."
Hernandez introduced a similar bill in 2016 but pulled it from consideration after it was amended in the state Assembly.
Overall cancer rates in California declined during the recession of 2008–2012 and the decline was due, at least in part, to higher unemployment and more people losing their health insurance, a recent study found.
The research, published in the February 2017 edition of Cancer Causes & Control, found that cancer rates among men in California declined 3.3% from 2008 to 2012 and declined 1.4% among women.
That compared to a decline of 0.7% among men and 0.5% among women during a pre-recession study period from 1997 to 2007.
The results suggest the decline in cancer rates was due to a similar decline in physician visits that resulted in fewer cancer diagnoses, said study lead author Scarlett Lin Gomez.
The study was conducted by researchers at the Cancer Prevention Institute of California.
"We speculate that, during periods of high unemployment, more people forgo wellness health visits for economic reasons due to changes in health insurance, such as losing insurance or going with a high-deductible plan," said Gomez. "This could decrease the number of cancer cases diagnosed, especially those that are early stage and non-symptomatic."
Researchers said the decline in cancer rates was surprising, given the aging population in California.
The study found that "lower case counts, especially for prostate and liver cancer among males; and breast cancer, melanoma, and ovarian cancer among females, were associated with higher unemployment rates."
The study estimates that "the associations for melanoma translated with up to a 3.6% decrease in [diagnosed] cases with each 1% increase in unemployment."
Overall, the study found that "the large recent absolute declines in case counts of some cancers may be attributable to the large declines in employment in the recessionary period."
The study results also suggest that researchers may see cancer rights climb in 2013 and beyond as people regained insurance and began making more regular visits to physicians, Gomez said.
"The fact that cancer diagnoses declined so dramatically during the recession suggests that we could be seeing more late-stage cancer diagnoses in the coming years," she said.
A related study published in the British medical journal The Lancet in 2016 estimated that the global recession produced an additional 260,000 cancer deaths in 34 countries that do not have universal healthcare.
The study attributed the spike in cancer deaths to people losing their employment-based health coverage during the recession and concluded that "increased unemployment is linked with increased cancer mortality."
A bill introduced in the California Assembly would create a tougher review process for physicians accused of actions that cause harm to patients, but advocacy groups say the legislation doesn't go far enough to protect patients.
Assembly Bill 505, authored by assembly member Anna Caballero (D-Salinas), would prohibit the Medical Board of California from entering into settlement agreements involving probation with physicians if they're accused of felony-level transgressions.
As written, the bill would "prohibit the board from entering into any stipulation for disciplinary action, including placing a licensee on probation, if the operative accusation includes specified acts."
Those acts include a felony conviction involving harm to a patient, drug or alcohol use that results in harm to a patient, or sexual abuse or exploitation of a patient.
The bill is supported by the California Medical Association (CMA), which says AB 505 will allow due process for physicians, but won't allow doctors accused of the worst crimes to settle a case with probation.
"AB 505 takes settlement for probation off the table for serious offenses that put patients at risk," said Joanne Adams, associate director of communications for the CMA. "Instead, these allegations will go through a full hearing process so that the Medical Board has a finding of fact based on evidence before deciding upon disciplinary actions."
No Patient Notification
However, advocacy group Consumer Watchdog says AB 505 sidesteps the related issue of whether patients should be notified when a physician is on probation.
Under current law, physicians are not required to notify patients if they are on probation, even if the allegations against them involve sexual abuse. Consumer Watchdog has petitioned the Medical Board and state legislators to change the law and make patient notification a requirement.
"This bill is attempting to head off legislation that would require doctors to disclose their probationary status to patients," said Carmen Balber, executive director for Consumer Watchdog.
Lisa McGiffert, director of the Safe Patient Project for advocacy group Consumers Union, described the bill as a "diversion" and suggested the wording of AB 505 makes some of its provisions difficult to enforce.
"The bill states that the review process will be required in cases where drugs or alcohol are 'directly' involved in patient harm," said McGiffert. "Unless someone actually sees a doctor ingesting drugs before an incident, direct harm is very difficult to prove."
The Medical Board of California, which has not yet taken a position on AB 505, requires doctors placed on probation to inform the hospitals with which they're affiliated about their probationary status. The physicians must also notify insurance carriers, but are not required to inform patients.
The Medical Board website provides information about doctors' probationary status, but Consumer Watchdog argues that patients should not be required to search the Internet to determine if their physician is on probation.
Michele Altawil, a legislative aide for Assemblywoman Caballero, said that "at this time, AB 505 does not include a requirement for physicians to disclose whether they have been on probation or not to patients."
In 2016, state Sen. Jerry Hill (D-San Mateo) introduced Senate Bill 1033, which would have required physicians to tell patients if they are on probation. SB 1033 was defeated in a 15-13 vote in the state Senate in June 2016.
Legislation introduced in the California Senate last month would create stricter protocols for hospitals to follow if they plan to shut down their emergency departments.
Senate Bill 687, authored by state Sen. Nancy Skinner (D-Berkeley), would require not-for-profit hospitals to receive approval from the State Attorney General before closing a hospital emergency department.
The bill would also require hospitals to hold at least one public hearing on the impact of the ED closure and notify the California Department of Public Health at least 90 days in advance of a planned closure.
Current state law requires a hospital to provide 90 days notice to the California Department of Public Health before shutting down operations.
"Closing hospitals and emergency rooms worsens health outcomes and increases deaths," said Skinner. "There are longer waiting times for services, longer ambulance travel times, and overcrowding at facilities."
Skinner cited statistics from the American College of Emergency Care that show California has only 6.7 emergency departments per 1 million residents, the lowest ED-to-resident ratio of any state in the nation.
"California is already the state with the fewest emergency departments per capita," said Skinner. "Further emergency department closures put all Californians at risk."
SB 687 would "require any nonprofit corporation that operates or controls a health facility … that provides emergency services at a licensed emergency center, to provide written notice to—and obtain the written consent of—the [State] Attorney General prior to a reduction in the level of emergency medical services provided, or their elimination."
Lost Emergency Services
In recent years, some hospital closures in California have raised more concerns about the elimination of emergency services than the actual loss of inpatient care.
The 2015 shuttering of Saddleback Memorial Medical Center in San Clemente, which left the city of San Clemente and surrounding communities without an ED, was a notable example.
In an attempt to address the closure of Saddleback Memorial, state Sen. Patricia Bates and Assembly Member Bill Brough drafted companion bills that would have allowed the city of San Clemente to operate a stand-alone ED without an acute care hospital to support it.
Both bills failed, prompting Bates and Brough to draft a joint statement contending the failure of the bills was "the clearest indication yet that Sacramento has no plan to deal with the closing of emergency rooms in California."
The California Hospital Association is still evaluating SB 687 and has not yet taken a position on the bill, said CHA vice president of external affairs Jan Emerson-Shea.
Santa Clara County (CA) officials have filed a lawsuit against the federal government over its proposal to reduce federal funding to "sanctuary" cities and regions, suggesting the plan would potentially cut millions of dollars in funding for healthcare and other services.
The suit, filed in federal district court last month, seeks a preliminary injunction against an executive order signed by President Donald Trump in January that would withhold federal funding from cities and counties that "willfully violate federal law" by shielding undocumented immigrants from deportation.
The lawsuit states that the executive order "throws plaintiff county of Santa Clara’s budgetary process into chaos" and poses a risk to the health, safety, and welfare of thousands of county residents.
"The President’s order is an unconstitutional attempt to coerce state and local governments into assisting with mass deportation," said Santa Clara County Counsel James R. Williams.
"We will resist any effort to illegally withhold funding for critical county services that support the health, safety, and well-being of our residents."
Disruption at Safety Net Hospital
The proposal to reduce federal funding to sanctuary regions by 35% would disrupt services at Santa Clara Valley Medical Center, a safety net hospital where the majority of patients are insured through Medi-Cal or Medicare, county officials said.
They estimated the hospital and related facilities receive nearly $1 billion per year in federal funding, primarily for Medicaid and Medicare patients.
Santa Clara County is one of 15 sanctuary counties in California on a list that includes Los Angeles, San Diego, Sacramento, and San Francisco counties. State legislators in February introduced Senate Bill 54, which would make California a "sanctuary state."
The bill is awaiting a hearing in the Senate Appropriations Committee.
In a related matter, Los Angeles County supervisors last month approved a motion to direct county administrators to "develop options on how health insurance coverage could be maintained and/or extended within the County and the State given proposed federal legislation concerning the Affordable Care Act."
"Should a repeal or any significant diminution occur, LA [County] needs to be at the forefront of helping to craft a way to protect those we serve," said Los Angeles County Supervisor Sheila Kuehl.
More than 1.2 million Los Angeles County residents have gained coverage under the ACA, with 900,000 acquiring coverage through Medicaid expansion and 300,000 receiving subsidies, according to data from the UCLA Center for Health Policy Research.
Recent court decisions that blocked proposed mergers between Anthem Blue Cross and Cigna and Aetna and Humana aren't likely to dampen the enthusiasm for future mergers in California or the nation as a whole.
The proposed Aetna-Humana merger was rejected in January and a merger between Anthem and Cigna was blocked in February by federal court judges.
In both cases, courts sided with anti-trust lawsuits filed by the U.S Department of Justice (DOJ) that contend the mergers would lead to increased premiums and fewer choices for customers.
Although Anthem and Cigna have appealed their ruling, Aetna and Humana announced in early February that they will not pursue an appeal.
The court decisions were a major setback for insurance industry consolidation, but aren't likely to prevent future merger proposals. Every merger agreement is different, said Gerald Kominski, director of the UCLA Center for Health Policy Research.
"Mergers are always judged, in my experience, on the merits of the specific case and I don't think it's possible to generalize about whether mergers are more or less likely as a result of these behemoths being blocked from merging," said Kominski.
"I think, in general, that when giants want to merge, regulators get skeptical about the benefits of reducing competition."
Not all insurer mergers are destined for failure, as evidenced by federal and state regulators' approval in 2015 of the $6.3 billion merger between Centene Corp. and Health Net. That merger was nowhere near the scale of the Anthem-Cigna merger ($48 billion) or the Aetna-Humana deal ($34 billion).
"These are four of the biggest health insurers in the country, so I don't draw any conclusions other than the government doesn't want to reduce competition in the employer-sponsored market and Medicare Advantage market by allowing mergers of companies that already have considerable market share," said Kominski.
Anthem and Cigna have decided to appeal the February 8 ruling from U.S. District Court Judge Amy Berman Jackson that blocked the merger.
In her ruling, Jackson said the merger would reduce competition in dozens of major insurance markets, including California, where Anthem and Cigna have more than 8.2 million policyholders combined.
On February 22, the U.S. Court of Appeals for the District of Columbia granted Anthem's motion for speedy appeal and scheduled oral arguments to begin on March 23.
Aetna and Humana opted not to appeal a January ruling from U.S. District Court Judge John Bates that rejected their proposed merger.
In a statement, Aetna CEO Mark Bardolino said that "while we continue to believe that a combined company would create greater value for healthcare consumers through improved affordability and quality, the current environment makes it too challenging to continue pursuing this transaction."
The failed merger carried a high price for Aetna, which must pay Humana a $1 billion break-up fee as part of their original merger agreement. If an appeals court upholds the ruling that blocked the Anthem-Cigna merger, Anthem will be on the hook for a $1.85 billion break-up fee payment to Cigna.
As federal lawmakers push to repeal the Affordable Care Act (ACA), a state senator has introduced legislation to establish a single-payer healthcare system in California.
Sen. Ricardo Lara (D-Bell Gardens) introduced Senate Bill 562, which would establish a "universal, single-payer healthcare program" that would replace private insurance with a public plan run by the government.
Lara introduced the bill as debate continued in Congress on proposals to repeal and replace the ACA.
"The health of Californians is really at stake here, and is at risk by what's being threatened in Congress," said Lara. "We don't have the luxury to wait and see what they are going to do and what the plan is."
Senate Bill 562 is sponsored by the California Nurses Association, which said the bill will "set a standard for America and be a catalyst for the nation."
Details of the bill will be worked out during the 2017 legislative session, Lara said.
SB 562 does not identify a source of funding for a single-payer system but states that the intent of the bill is to "establish a comprehensive, universal, single-payer healthcare coverage program and a healthcare cost control system for the benefit of all residents of the state."
Lara introduced his bill a few days before federal lawmakers in the House of Representatives unveiled an ACA replacement plan that would allocate a set amount of Medicaid funding for each state under a block grant system and reduce the federal contribution toward Medicaid expansion from 90% to 50%.
The ACA replacement proposal would result in California losing about $8 billion of the $16 billion it currently receives from the federal government to fund Medicaid expansion, according to consumer advocacy group Health Access California.
"While they promised not to pull the rug out from under anyone, their plan would cut $8 billion from Medi-Cal, imperiling the coverage of the over 4 million Californians who got coverage under Medicaid expansion," said Anthony Wright, executive director of Health Access California.
'Single-Payer Systems Don't Work'
Although single-payer systems sound good in concept, they are much harder to implement, policy experts said. "Single-payer systems don't work, period," said Micah Weinberg, president of the Bay Area Council Economic Institute.
"To make it a reality, you need everyone to take the money they spend on premiums and put that into a single payer system, and that doesn't work in an economy where the majority of people have employer-sponsored health coverage."
Weinberg points to a failed effort in 2014 to enact a single-payer system in Vermont, where state officials dropped the plan when they could not figure out a way to fund it.
"If you can't do it in a state that is essentially a socialist state, with fewer than 1 million people, how is it going to work in California?" said Weinberg.
"A single-payer program in California would be on a much larger scale, and scale always makes things more difficult."
Countries with single-payer style systems make it work by paying healthcare workers much lower wages than those paid in the United States, Weinberg added. "In order to make it work, you would need employees to take major salary cuts," said Weinberg.
"That alone would make any single-payer health system bill a tough sell."
A state review of provider directories and compliance reports supplied by insurers found most insurers had conflicting information on the number of physicians in their provider networks.
The California Department of Managed Health Care (DMHC) issued a report that found that 36 out of 40 Timely Access Compliance Reports submitted by insurers for 2015 contained "significant data inaccuracies" to the degree that they were not usable.
"Ninety percent of the 2015 Timely Access Compliance Reports submitted to the DMHC contained one or more significant data inaccuracies, making it virtually impossible for the DMHC to measure individual health plan compliance and compare plans across the industry," the report stated.
As part of its review, the DMHC compared the identity of primary care physicians (PCP) in each insurer's Compliance Reports and Provider Rosters, with one providing a list of physicians available to members during the year and the other a year-end summary of providers.
The reports listed a significant percentage of PCPs who were not actually part of the health plan's own network of providers, based on the information provided by the plan through its Provider Roster, according to the review.
Care 1st Health Plan had the highest percentage of physicians listed in the compliance report but not listed in the plan's provider roster, at 56%, the DMHC report stated. UnitedHealthcare of California had a rate of 45% , and 43% of physicians listed on Health Net's compliance report were not on the plan's provider roster.
Blue Shield of California had the lowest percentage at 22%. Others with low percentages including Cigna (36%), Anthem Blue Cross (36%), and Aetna (29%).
"Health plans that failed to follow the mandatory DMHC methodology or submitted inaccurate or erroneous data … violated California's health plan law, known as the Knox-Keene Act," and could face fines, the report stated.
"The DMHC's Office of Enforcement will be investigating these plans for possible disciplinary action."
The report attributed some errors to "a failure by health plans to follow mandatory DMHC methodology;" other errors were attributed to one source.
A single vendor hired by numerous health plans to gather data and prepare compliance reports may have caused significant errors, the report stated. Twenty-two health plans that used this vendor submitted deficient compliance reports.
Insurers declined to comment on the reports and referred inquiries to the California Association of Health Plans (CAHP).
Timely access to care is difficult to measure, but some health plans "have work to do" in providing better data, CAHP CEO Charles Bacchi said.
"Health plans are committed to providing timely access to healthcare and we believe that we provide that successfully," said Bacchi. "Unfortunately, timely access to care is difficult to measure in every doctor's office across the state.
"Clearly, this report demonstrates that we have work to do to improve our survey responses."
New reports estimate that 21 public hospitals in California stand to lose more than $2 billion in combined annual revenue if the Affordable Care Act (ACA) is repealed.
The studies from the California Association of Public Hospitals and Health Systems (CAPH) examined the impact of an ACA repeal on the 21 public health systems it represents in the state.
"The estimates are based on an increase in uncompensated care costs for hospitals in the event that people who gained coverage under the ACA become uninsured," said Erica Murray, president and CEO of the CAPH.
The studies estimate the 21 public health systems and related facilities serve as the primary care provider for more than 560,000 California residents who gained coverage under the ACA since 2014, people who would likely lose coverage if the ACA is repealed without a replacement plan.
"A repeal of Medi-Cal expansion could result in California's public healthcare systems losing $2.2 billion in revenue every year," the report states.
It estimates a repeal would more than double California's current uninsured rate of 7.6% to more than 17% and result in the loss of $16 billion in federal funding the state currently receives for Medicaid expansion along with $5 billion in lost funding in federal subsidies.
A study of Arrowhead Regional Medical Center (ARMC) in San Bernardino County estimates the 465-bed hospital would lose $120 million in revenue each year with a repeal of the ACA.
The report estimates that 211,000 county residents would lose their health coverage and that "a dramatic increase in the number of uninsured, coupled with a loss of funding, could destabilize San Bernardino County's health delivery system."
An ACA repeal would result in $125 million in lost revenue per year, with 133,000 San Francisco residents losing health coverage, according to a San Francisco Health Network study.
Natividad Medical Center in Monterey County would lose about $36 million in revenue as more than 50,000 county residents lose health coverage and San Joaquin General Hospital would lose an estimated $50 million in annual revenue with an ACA repeal.
A repeal of the ACA would have repercussions beyond higher uncompensated care cost for hospitals.
The study noted that since Medicaid expansion was introduced in 2013, "public healthcare systems have given around 700,000 patients newly assigned primary care teams and have added more than 1 million patients to disease management registries."
The study noted that since the advent of federal healthcare reform, "public healthcare systems have decreased the rate of diabetes patients being hospitalized for short-term complications by more than 20% and the rate of patients with uncontrolled diabetes has dropped from 1% to 0.18%.
"There are a lot of programs like this that are related to, but distinct from, Medicaid expansion that would be impacted by a repeal," said Murray.
"If people lose their insurance, they'll also lose access to these preventive care and coordinated care programs that make care more cost-effective and keep costs down."
A new bill introduced in the state legislature last week would require California beverage manufacturers to place warning labels on sugary beverages sold in the state.
State Senator Bill Monning (D-Carmel) introduced Senate Bill 300, which would require manufacturers to post health warning labels on all sugar-sweetened beverages with more than 75 calories per 12-ounce serving.
The warning labels would read: "Drinking beverages with added sugar contributes to obesity, type 2 diabetes, and tooth decay."
"I am doing this so that consumers will be given more information to help them make more healthful choices," said Monning. "Strong and compelling scientific evidence clearly shows drinking sodas, sport drinks, and other sugary drinks heightens your risk of preventable, chronic disease."
Warning labels could help reduce the prevalence of health problems like type 2 diabetes and fatty liver disease that begin at an early age, said Robert Lustig, MD, a professor of pediatrics at the UC San Francisco Division of Endocrinology.
"We have warning labels on alcohol," said Lustig. "We need them on sugar for the same reason."
The American Beverage Association (ABA) is opposed to SB 300 and said the bill would require manufacturers to include "misleading warnings" on its products.
"American beverage companies already provide fact-based, easy-to-use calorie labels on the front of every bottle, can, and pack we produce, and we are placing calorie awareness messages on 3 million vending machines, self-serve fountain dispensers, and retail coolers nationwide," the ABA stated.
"Misleading warnings about common beverages will do nothing for real public health challenges like obesity and diabetes."
SB 300 will probably face an uphill battle, given the past performance of similar bills in California. In 2016, Monning introduced a similar bill—Senate Bill 203—that failed to advance out of the Senate Health Committee. Similar bills introduced in 2014 and 2015 also failed to advance.
Other efforts to curb sales of sugary beverages in the state have had mixed results. In 2014, voters in Berkeley approved a soda tax measure that charges retailers 1 cent for every ounce of sugary drinks sold within the city limits.
In 2012, voters in the cities of Richmond and El Monte rejected ballot measures calling for a similar tax on sugary drinks.