BILL ANALYSIS                                                                                                                                                                                                    






                                 SENATE HEALTH
                               COMMITTEE ANALYSIS
                        Senator Elaine K. Alquist, Chair


          BILL NO:       SB 769                                       
          S
          AUTHOR:        Alquist                                      
          B
          AMENDED:       April 2, 2009                               
          HEARING DATE:  April 22, 2009                               
          7
          CONSULTANT:                                                 
          6
          Moreno/                                                     
          9              
                                        
                                     SUBJECT
                                         
               Federal funding:  economic stimulus:  local health  
                                 administration

                                     SUMMARY  

          Requires federal funding received pursuant to the American  
          Recovery and Reinvestment Act of 2009 (Recovery Act), for  
          purposes of chronic disease prevention and wellness, to be  
          subject to appropriation by the Legislature commencing with  
          the 2009-10 fiscal year.

                             CHANGES TO EXISTING LAW  

          Existing federal law:
          Under the Recovery Act, makes supplemental appropriations  
          for job preservation and creation, infrastructure  
          investment, energy efficiency and science, assistance to  
          the unemployed, and state and local fiscal stabilization,  
          for the fiscal year ending September 30, 2009.
          
          Existing state law:
          Establishes local health departments to protect and  
          preserve the public health.   Provides for the allocation  
          of state aid to local health departments according to a  
          specified formula for prescribed purposes, including  
          communicable disease control activities and community and  
          public health surveillance activities.
                                                         Continued---



          STAFF ANALYSIS OF SENATE BILL  SB 769 (Alquist)Page 2


          

          
          This bill:
          Requires federal funding received pursuant to the Recovery  
          Act, for purposes of chronic disease prevention and  
          wellness, to be subject to appropriation by the Legislature  
          commencing with the 2009-10 fiscal year.
           
          Provides that its provisions apply when federal funding is  
          allocated and expended for disease control and prevention  
          activities by local health jurisdictions and specifies that  
          funds appropriated for those purposes cannot be used to  
          supplant funding for existing levels of service.
           
          Requires allocations to be made by the Department of Public  
          Health (DPH) to the administrative bodies of qualifying  
          local health jurisdictions and requires funds to be used  
          for activities to improve and enhance evidence-based  
          clinical and community-based prevention and wellness  
          strategies authorized by the federal Public Health Services  
          Act that deliver specific measurable health outcomes that  
          address chronic disease rates.  

                                  FISCAL IMPACT 

          Unknown.

                            BACKGROUND AND DISCUSSION  

          According to the author, this bill will provide guidelines  
          for the distribution of federal stimulus funds to be used  
          for chronic disease control and prevention activities at  
          the local level.  The federal stimulus bill states that  
          $650 million "shall be [used] to carry out evidence-based  
          clinical and community-based prevention and wellness  
          strategies? that deliver specific, measurable health  
          outcomes that address chronic disease rates."
          This bill is to ensure that a maximum amount of the funds  
          allocated by the Recovery Act to California for this  
          purpose are passed along to the local health officers, who  
          are at the front line of these activities.  

          Recovery Act of 2009
          The Recovery Act includes spending increases and tax  
          relief, intended to spur an economic recovery and create  
          jobs.  The final bill includes $507 billion in spending  
          programs and $282 billion in tax relief.   According to a  




          STAFF ANALYSIS OF SENATE BILL  SB 769 (Alquist)Page 3


          

          summary of the House Committee on Appropriations, the money  
          allocated for healthcare-related activities is distributed  
          as follows:
          o Health Information Technology: $19 billion to jumpstart  
            efforts to computerize health records.
          o Prevention and Wellness Fund: $1 billion to fight  
            preventable chronic diseases and infectious diseases. Of  
            this amount, $300 million goes towards immunization  
            programs and $650 million goes towards clinical and  
            community-based prevention and wellness strategies.
          o Healthcare Effectiveness Research: $1.1 billion for  
            Healthcare Research and Quality programs to compare the  
            effectiveness of different medical treatments. 
          o Community Health Centers: $2 billion for the provision of  
            services to the uninsured, renovate clinics, and make  
            health information technology improvements.
          o Training Primary Care Providers: $500 million to address  
            workforce shortages and future demand.  
          o Indian Health Service: $500 million to modernize aging  
            hospitals and health clinics and make healthcare  
            technology upgrades to improve healthcare for underserved  
            rural populations.

          Arguments in support
          According to the Health Officers Association of California  
          (HOAC), hiring public health nurses and other professionals  
          will immediately stimulate the economy by providing an  
          infusion of money to local health departments that have  
          been forced to slash their workforce as a result of the  
          economic downturn.  HOAC writes that this bill will make  
          sure that public health funding provided by the federal  
          government will be used where it can do the most good, both  
          for the economy and for public health.

                                     COMMENTS
           
          1.Work in progress.  The author has introduced this bill to  
            provide a vehicle for the prevention and wellness funding  
            that will be going to the states under the Recovery Act.   
            At this point, it is not clear how much prevention and  
            wellness funding will be allocated to public health  
            entities at the federal level and how much will be  
            allocated to states.  Once guidance is received from the  
            federal government this bill is likely to be amended.
                                        
                                    POSITIONS  




          STAFF ANALYSIS OF SENATE BILL  SB 769 (Alquist)Page 4


          



          Support:  Health Officers Association of California  
          (sponsor)
          
          Oppose:   None received


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